Effect of Disintegrin in Retina after Laser Photocoagulation

PURPOSE: To investigate weather an administrated inhibitor (disintegrin) of angiogenic factors inhibits the development of laser-induced experimental choroidal neovascularization (CNV) in rat model. METHODS: Experimental CNV was induced by red argon laser photocoagulation in the eyes of 10 Brown Norway rats. The rats were divided into two groups, the disintegrin (flavoridin)-treated group and control group. Fundus photography and fluorescein angiography were performed to identify late leakage after two weeks of laser photocoagulation. Three days after fluorescein angiography, the expression of vascular endothelial growth factor (VEGF) was identified by immunohistochemical stain. RESULTS: CNV-related fluorescein leakage appeared in forty-four (18 in the flavoridin-treated group, 26 in the control group) of 64 laser spots delivered to the 10 eyes that were tested at two weeks post-treatment. Expression of VEGF on laser-induced CNV lesions was reduced in the flavoridin-treated group. CONCLUSIONS: The results of this study suggest that disintegrin is an inhibitor of ocular angiogenesis; disintegrin reduced CNV in laser-induced experimental model. We expect that disintegrin may have a potent effect in age-related macular degeneration.

A Case of Atypical Valsalva Retinopathy after Strenuous Exercise

PURPOSE: To report a case of recurrent bilateral preretinal hemorrhages in a healthy male with no previous history of systemic or ocular diseases and to review the relevant literature. METHODS: History taking, measurement of visual acuity and intraocular pressure, slit-lamp examination, fundoscopy, and fluorescein angiography were performed in a 15-year-old male who had experienced a sudden decrease in visual acuity in both eyes after a couple of strenuous exercises in school. RESULTS: Best-corrected visual acuity (BCVA) was 0.9 in the right eye and 0.2 in the left, and bilateral premacular hemorrhages were observed. Most of the preretinal hemorrhages were completely resolved by the sixth week and visual acuity in the left eye improved to 0.6. Nine months after the initial event, preretinal hemorrhages recurred bilaterally, worse in the left eye, and BCVA decreased to 0.3 in the right eye and 0.02 in the left eye. We performed Nd: YAG laser disruption of the internal limiting membrane in the left eye. Four weeks after the procedure, most of the preretinal hemorrhages were resolved and visual acuity in the left eye improved to 0.2. CONCLUSIONS: Clinical improvement was achieved after Nd: YAG laser disruption of the internal limiting membrane in a case of recurrent bilateral preretinal hemorrhages.

Evaluation of Clinical Usability and Effects of Photochromic Lenses

PURPOSE: To evaluate stability and effects of photochromic lenses in light-sensitive patients. METHODS: Analyzing 65 patients, this research employed a standardized survey, fundus examination, and slit-lamp biomicroscopy to evaluate the changes in photophobia, tears, asthenopia, and the deterioration of outdoor visual acuity after wearing photochromic lenses for one month. Measurement of visual acuity was performed outdoors at noon on a bright day using Dr. Hahn's standard test chart for 3 m. RESULTS: Photochromic lenses, considerably decreased photophobia, tears, and asthenopia. The "normal" visual acuity of 38 patients was established without photochromic lenses. Re-examination after the lenses had been worn for a specified period of time showed that 29 subjects could discern at least one line higher than their "normal" acuity. CONCLUSIONS: Photochromic lenses reduced photophobia and the disabling effect of bright light such that comfort was increased. Not only did the lenses improve vision, they also enhanced the overall quality of vision.

ReVersible Change of Vision in Patients Receiving Deferoxamine

PURPOSE: To report 2 cases of acute visual neurotoxicity in patients with paraquat poisoning receiving deferoxamine. METHODS: A 48-year-old woman and a 37-year-old man received intravenous infusion of deferoxamine at 3g/day for 7 days for treatment of paraquat poisoning. They presented with severely impaired visual acuity, generalized constriction of visual field, and decreased amplitude of visual evoked potential. They improved clinically upon drug-withdrawal. CONCLUSIONS: Deferoxamine is an effective agent for treatment of paraquat poisoning, but can cause visual neurotoxicity. We recommend careful regulation of the deferoxamine dosage and serial visual monitoring in patients receiving the drug.

Comparison of Optic Disc Appearance in Anterior ischemic optic neuropathy and Optic neuritis

PURPOSE: Optic disc edema in anterior ischemic optic neuropathy (AION) and optic neuritis (ON) have overlapping features. To determine whether characteristics of optic nerve swelling help to differentiate ON from AION. METHODS: A medical records were reviewed retrospectively for the patients who had been diagnosed as AION or ON in which photographs for acute phase were available. Color of optic disc, distribution of edema, presence of hemorrhage and caliber of artery and vein was analyzed in each fundus photograph. RESULTS: AION was diagnosed clinically in 67% of the cases with altitudinal edema, in 77% of the cases with disc hemorrhage, in 87.5% of the cases with pallid optic disc and in 77% of the cases with vascular abnormality. A pale optic disc with hemorrhage, regardless of the type of edema, always represented AION (100%). Normal-colored optic disc without hemorrhage always also represented optic neuritis (100%). CONCLUSIONS: Analysis of disc characteristics may enhance diagnostic accuracy and help to differentiate AION from ON.

Effect of Intravitreal Ciprofloxacin in the Treatment of Experimental Bacillus Endophthalmitis

PURPOSE: Bacillus cereus is an important cause of post-traumatic endophthalmitis. Several different anti-biotics have been used to prevent permanent visual loss. The authors compared the efficacy of intravitreal vancomycin and ciprofloxacin in the treatment of experimental Bacillus cereus endophthalmitis. METHODS: Forty eyes of 20 white rabbits were inoculated with B. cereus organisms. Ten eyes were randomized to receive intravitreal vancomycin (group 1) and 10 eyes ciprofloxacin (group 2) after 12 or 24 hours. Fellow eyes were injected with normal saline as control group. After 48 hours, the eyes were examined and graded for clinical signs of infection and enucleated for histologic examination. RESULTS: There was a statistically significant difference in clinical features between treated groups and control group (p<0.05). There was no significant difference between vancomycin-treated group and ciprofloxacin-treated group. Compared to eyes treated 12 hours after inoculation, eyes treated 24 hours after inoculation showed worse clinical gradings (p<0.05). Histologic examination showed vancomycin or ciprofloxacin-treated groups had significant less inflammation and tissue destruction than control group (p<0.05). There was a statistically significant difference in vitreous and retinal structure between ciprofloxacin-treated after 12 hours inoculation and 24 hours inoculation group (p<0.05). CONCLUSIONS: Ciprofloxacin appeared to be limiting inflammation and tissue destruction in experimental Bacillus endophthalmitis and might effective in substitute vancomycin when necessary.

A Case of Agrobacterium Radiobacter Endophthalmitis following Cataract Surgery

PURPOSE: We report a case of Agrobacterium radiobacter endophthalmitis following cataract surgery and treated with pars plana vitrectomy and intravitreal antibiotics injection. METHODS: A 63 year-old male patient was transferred for the endophthalmitis following cataract surgery on his left eye. His initial visual acuity was hand motion. Slit lamp examination showed marked inflammatory cells in anterior chamber and vitreous opacity was seen in fundus examination with indirect ophthalmoscopy. We performed the removal of implanted IOL, pars plana vitrectomy and intravitreal antibiotics injection(Vancomycin 1.0 mg/0.1 ml, Ceftazidime 2.0 mg/0.1 ml). RESULTS: Gram stain results revealed the gram negative rods and bacterial culture identification revealed the Agrobacterium radiobacter using the RapID NF plus system. After 8 weeks, his corrected visual acuity is 0.3 and fundus examination shows the localized atrophic change and preretinal membrane in inferotemporal retina.

Intraocular Candidiasis in Babies with Candida Sepsis

Systemic candidiasis is a life-threatening disease in premature infants and may result in several complications. Early recognition is essential, but it is delayed and treatment is difficult. Candida endophthalmitis develop with systemic infection and intraocular involvement is detected by fundus examination with an indirect ophthalmoscope. Improvement of intraocular lesion and therapeutic effect of systemic candidiasis are detected with careful retinal examination. Twenty five premature infants received indirect ophthalmoscopic examination and we investigated the prevalence of intraocular involvements and related factors for eye involvement. The ocular findings were classified chorioretinitis, endophthalmitis and nonspecific lesion, except premature vitreous haziness. Chorioretinitis in 4 infants and nonspecific lesion in 3 infants were detected but endophthalmitis was not found. There was slight difference in each group for gestational age, birth weight and ventilator etc, but no signifficant statistical difference was noted. Systemic candidiasis was treated with systemic antifungal agent, and the chorioretinitis is resolved with systemic antifungal agents. We propose that retinal examination be performed on all infants suspected of having systemic candidiasis for the diagnosis and early treatment. Funduscopy may be a helpful as an early diagnostic tool, and to monitor appropriate therapy of systemic candidiasis.

Bilateral Acute Idiopathic Maculopathy

Unilateral acute idiopathic maculopathy is a rare, self limiting disorder that affects healthy young adults with sudden, severe loss of central vision. We diagnosed bilateral acute idiopathic maculopathy in a 17-year-old man who experienced sudden, rapidly progressive central visual loss following a flu-like illness and report this case with a review of the literatures.

Photodisruption of Premacular Hemorrhage with Nd: YAG Laser

Premacular hemorrhage (preretinal,subhyaloid, or sub-internal limiting membrane hemorrhage)impairs central vision abruptly and occurs in various underlying diseases. In cases of persistent hemorrhage, permanent impairment of vision may occur. Proposed therapeutic options for premacular hemorrhage consist of conservative treatment, laser photodisruption and early vitrectomy. Laser photodisruption may be performed in cases of persistent or slow-clearing hemorrhage, in patients with occupational need for prompt restoration of binocular vision or in patients with poor vision in their fellow eyes. The authors report 4 patients with premacular hemorrhage who were treated with Nd: YAG laser photodisruption with the review of the literatures.

Conversion of Nonischemic Central Retinal Vein Occlusion to Ischemic Occlusion

Most nonischemic CRVOs present relatively good prognosis in visual acuity and spontaneous resolution is relatively common after a certain period of time, but a small portion convert to ischemic CRVOs. The point of conversion from nonischemia to ischemia ranges from few weeks to several years. But because more than half of these conversions occur within the first four months, it requires careful follow-up during this period. The authors retrospectively reviewed 44 patients(47 eyes)who initially showed definite signs of nonischemic CRVO on fundus examination and nonperfusion area less than 10 disc areas proven by fluorescein angiogra-phy. The conversion rate, point of conversion, incidence of anterior segment neovascularization and neovascular glaucoma, predictive factors related to conversion were identified. The average age of the patients was 46. 1 years and 26 patients(59. 0%) were male. 25 patients(56. 8%)had underlying systemic and ocular disorders such as hypertension, chronic renal failure, diabetes mellitus, primary open-angle glaucoma. Final visual acuity was 0.5 or above in 24 eyes(51. 0%)and 0.1 or below in 14 eyes(29. 8%). 7 eyes(14. 9%)converted to ischemic occlusion. The average age of this group of patients was 40.8 years and 4 eyes had underlying systemic disorders. Initial visual acuity showed wide range from 0.15 to 0.7 but final visual acuity was 0.1 or below in all of the cases. The point of the conversion was less than 4 months(average: 9.3 weeks)in all eyes and 5 eyes(71.4%)developed anterior segment neovascularization. All of the eyes that showed definite evidence of anterior segment neovascularization were treated with panretinal photocoagulation but in 2 eyes(28. 6%), regression of neovascularization did not occur and further developed neovascular glaucoma.

Case Report on Primary Extramedullary Plasmacytoma Originating in the Lacrimal Gland

Most plasmacytomas originate from the bone marrow and only 3% of these tumors are from the soft tissues outside the bone marrow. Mean survival rate and clinical manifestations including metastasis and response to therapy are quite different from each other. Although both groups share plasma cell as their stem cell, these two groups are presumed to be different disease entities. The authors report a rare case of extramedullary plasmacytoma of lacrimal gland origin in a 42-year-old man who presented with painless proptosis.

Clinical Analysis of Retinal Detachment Following Extracapsular Cataract Extraction

The authors reviewed retrospectively preoperative ocular clinical characteristics, operative methods, postoperative anatomical results and visual rehabilitation for the 24 eyes, retinal detachments following extracapsular cataract extraction (ECCE). The most, common preoperative visual symptom was decreased vision, 19 eyes (79%) and the significant preoperative ocular findings were vitreous opacity 14 eyes (58%) and posterior capsular rupture 14 eyes (58%). The horseshoe tear 11 eyes (46%), atrophic hole 9 eyes (38%) were more comnnonly encountered, and the retinal breaks were principally located in the superotemporal quadrant in 18 eyes (75%), the superonasal quadrant. in 12 eyes (42%). Also, macular detachment 19 eyes (79%) was found most frequently with retinal detachment eyes. The overall anatomic success rate of surgical treatment of retinal detachment after ECCE was 21 eyes (88%). Especially, the visual acuity improved two line or more in II eyes (85%) with posterior chamber intraocular lens (PC-IOL) implantation group. We suggest that the early detection of retinal detachment. after ECCE with complications and proper operations are important to inaprove the postoperative anatomic success rate and the postoperative visual prognosis.

Four Cases of Ocular Injury caused by Gramoxone

Parquat, more commonly used in its commercial name, Gramoxone, is a widely used herbicide for it is inexpensive and effective. It is lethal when ingested accidentally or for the purpose of committing suicide. Having experienced four patients who were injured accidentally in the eye by Gramoxone (herbicide containing paraquat and diquat), we report these cases with the review of the literatures.

The Pupillary Dilatation Effect of Phenylephrine 2.5% Versus 10% in Patients with Diabetes

We assessed the degree of mydriasis induced by 1% tropicamide and 2.5% phenylephrine compared with that induced by 1% tropicamide and 10% phenylephrine in 100 patients with diabetes. Additionally we studied the difference of pupillary dilatation according to duration of dibetes, severity of retinopathy, and performance of photocoagulation. Maximum dilated pupillary diameter was 7.25+/-1.27mm in 2.5% phenylephrine group and 7.32+/-1.36mm in 10% phenylephrine group, respectively the difference in pupillary dilatation between two groups was not statistically significant. We advise the use of the 2.5% phenylephrine in patients with diabetes, who already exhibit a higher prevalence of vascular disease and autonomic nerve system dysfunction because 2.5% phenylephrine may produce a lower incidence of side effects than 10% concentration and have the same effect of pupil dilatation as 10% phenylephrine.

Effect of Ocular Hypotensives and Honan Intraocular Pressure Reducer on Ocular Tension after Retrobulbar Anesthesia

The retrobulbar injection of anesthetic widely used in intraocular surgery will produce anterior displacement of eyeball and a rise in intraocular pressure that may be sufficient to compromise ocular perfusion. We investigated whether ocular hypotensive agent and Honan intraocular pressure reducer which reduced ocular tension before retrobulbar injection effected on lessening the risk of vascular compromise after retrobulbar injection. In the 1st group(15 eyes), no ocular pressure reducing procedure was applied, a mean intraocular pressure immediately after retrobulbar injection was 22.0+/-9.7mmHg. In the 2nd group (14 eyes), using ocular hypotonic agent before retrobulbar injection, a mean intraocular pressure was 13.8+/-4.4mmHg. In the 3rd group (20 eyes), using Honan intraocular pressure reducer, a mean intraocular pressure was 14.2+/-5.2mmHg. The difference in the rise of pressure attributable to retrobulbar injection of group 1 was statistically significant. An it was in only 2 eyes of gorup 1 that hypertension (IOP >35mmHg) which put the eye at risk for vascular occlusion after retrobulbar injection developed. The digital massage for 5 minute following retrobulbar injection produced no statistical difference in intraocular pressure before cataract surgery among all 3 groups. Using ocular hypotensive agents or Honan intraocular pressure reducer before retrobulbar injection may lessen the risk of vascular compromise immediately following retrobulbar injection. And preoperative digital massage for 5 minute may adequately decrease the intraocular pressure for intraocular surgery.

Clinical Evaluation of Visual Prognosis of Traumatic Cataract Patients

We have evaluated our clinical results of the traumatic cataract operations in 109 patients, 112 eyes. Group 1 (72eyes) was defined that the best corrected vision was 0.1 or better at the final follow up visit, group 2 (40 eyes) less than 0.1 vision. And we have analyzed the predictors of the visual outcome. Average age of patients was 33 years old and male were 89 patients, female 20. The most significant predictors of good visual prognosis were left eye among both eyes, good initial visual acuity, presence of anterior capsular rupture, but absence of hyphema, iris prolapse into the wound, vitreous prolapse into the anterior chamber, lens subluxation or dislocation. It was not statistically significant with final corrected visual acuity that were type and location of injury, location and extent of corneal laceration, method of cataract extraction and timing of intraocular lens implantation.

Clinical Feature and Factors of Operative Result on Infantile Esotropia

We present the retrospective study to identify the clinical characteristics and the results of surgical correction for 50 patients with diagnosis of infantile esotropia at Soonchunhyang Chunan University Hospital from January 1990 to August 1994. The following results were obtained. Of 50 patients, 29(58%) patients were male and 21(42%)patients were female. Initial visit was most common between age of 2 and 3 years. 14% of patients were seen at age of 2 years or less. Average initial visit was 5.16 years. Esotropia was noted most commonly 2 to 4 month after birth in 23 patients(46%). Preoperative deviation angle was over 30PD in 88% of patients, and preoperative cycloplegic refraction showed +2.0D-O in 62%. The prevalence of associated findings such as amblyopia, dissociated vertical deviation(DVD), inferior oblique muscle overaction, and nystagmus were 32%, 14%, 38%, 4% by sequence. Surgical correction was performed before age of 2 year if noted at initial visit. The average age of surgical correction was 5.42 years. Bilateral medial rectus muscle recessions were performed in 30%, Unilateral resection and recession were performed in 35 patients(70%), Orthophoria(within +10 prism diopters) was achieved in 58% of the patients postoperatively. In 16% of patients residual esotropia of more than 20PD remained, which required further operation. These patients had average preoparative esotropia of 51PD and amblopia and inferior oblique overaction were seen in 87.5% preoperatively. We found that the two variables of amblyopia and inferior oblique muscle overaction lead to less satisfactory outcomes(P<0.01). Since amblyopia and inferior oblique muscle overaciton were seen more commonly in those patients that required reoperation. The average follow up time was 9.4 months.

Morning Glory Syndrome

Recently we have experienced two cases of the morning glory syndrome which is an uncommon congenital anomaly of optic nerve head. Visual evoked potentials and fluorescein angiographic findings are described. The visual evoked potentials elicited with bright flashes and patterns revealed delayed latencies and subnormal amplitudes. The amplitude of the traces probably depends on the severity of the involvement of the optic nerve. Also, the possible macular abnormalities and the strabismic or anisometropic amblyopia developing in morning glory syndrome may contribute to the abnormal finding of visual evoked potentials.

A Clinical Study of Retinopathy of Prematurity

Thirty infants(22.4%) of clinically diagnosed as retinopathy of prematurity by indirect ophthalmoscope as screening among 134 premature infants who were admitted in nursery room of Soonchunhyang University Hospital from May 1988 to August 1990, and 5 premature infants previously diagnosed as retinopathy of prematurity, transferred from other hospital were analysed the clinical records and the risk factors of retinopathy. The results were as follows: 1. The high incidence of retinopathy of prematurity was associated with lower birth weight(or=200 hours, p1.96). 3. The first examination was performed at 3.4 +/- 2.3 weeks of life. The retinopathy of prematurity was diagnosed at 6.0 +/- 2.7 weeks, and the maximal stage occured at 8.9 +/- 3.1 weeks. 4. Eighteen(51%) of the 35 premature infants with stage 3 plus retinopathy of prematurity were treated with cryotherapy. Thirteen(72%) of the 18 treated infants showed regression of neovascularization.