Therapeutic Effect of 0.03% Tacrolimus Ointment for Ocular Graft versus Host Disease and Vernal Keratoconjunctivitis

PURPOSE: To determine whether topical tacrolimus might prove effective in the treatment of refractory anterior segment inflammatory diseases, and to evaluate its efficacy in eyes with ocular graft versus host disease (GVHD), and vernal keratoconjunctivitis (VKC). METHODS: Twenty-eight eyes of 14 patients with anterior segment inflammation refractory to steroid treatment were treated with 0.03% tacrolimus ointment at the Samsung Medical Center, Seoul, Korea from March 2008 through August 2009. Seven patients had ocular GVHD and seven had VKC. We evaluated the conjunctival and corneal inflammatory change at one, two, four, and eight weeks after treatment with a scoring system. Time to initial response of treatment and therapeutic effect between GVHD and VKC was also analyzed. After the eight-week treatment period, patients were divided into two groups (maintenance group and discontinuance group). Eight patients maintained the treatment for an additional four months, and six patients discontinued the treatments. Therapeutic effect was also compared between the groups at eight weeks and six months after treatment. RESULTS: The mean conjunctival and corneal inflammation score was reduced significantly at eight weeks after treatment (p 0.05). Six months after treatment, we noted no therapeutic differences between the maintenance group and discontinuance group (p > 0.05). CONCLUSIONS: 0.03% tacrolimus ointment was safe and effective for use in anterior segment inflammatory disease refractory to steroid.

Comparison of 180degrees and 360degrees Selective Laser Trabeculoplasty

PURPOSE: To compare the effect and safety of two regimens of Selective Laser Trabeculoplasty (SLT), SLT on 180degrees of trabecular meshwork and SLT with 100 laser spots on 360degrees of trabecular meshwork in patients with primary open-angle glaucoma and ocular hypertension. METHODS: In a retrospective clinical study, the authors compared the pressure-lowering effects of SLT in two groups of patients; group 1 (83 patients) received SLT on 180degrees, group 2 (30 patients) on 360degrees of trabecular meshwork. The clinical outcome indicators included intraocular pressure (IOP) at one day, one week, one month, two months, three months and six months after SLT, and the anterior chamber reaction at post-laser one day. RESULTS: There was no statistically significant difference in the IOP reduction between these two regimens after six months. The anterior chamber reactions in the two groups were significantly different (group 1; 0.61 +/- 0.64, group 2; 1.25 +/- 0.83, p = 0.001). The success rate of group 2 (43.3%) was not different from that of group 1 (31.3%; p = 0.23). CONCLUSIONS: SLT on 180degrees of trabecular meshwork had a similar effect compared to that of SLT on 360degrees of trabecular meshwork in terms of IOP reduction. The authors of the present study suggest that 180degrees SLT is the safest procedure with regard to success rate and complications.

Effect of Intravitreal Injection as a Primary Treatment in Cystoid Macular Edema after Cataract Surgery

PURPOSE: To report the clinical manifestations of intravitreal triamcinolone injection as a primary treatment method for patients with cystoid macular edema after cataract surgery. METHODS: The present retrospective study was comprised of patients diagnosed with cystoid macular edema after cataract surgery performed between March 2006 and March 2008. To treat the edema, intravitreal triamcinolone injection was administered. Best corrected visual acuity (BCVA) and central macular thickness were measured, and complications as well as efficacy of the treatment were evaluated. RESULTS: Twelve eyes were selected for the present study with a mean patient age of 67.3 years. The average period between cataract surgery and diagnosis of cystoid macular edema was 7.6 weeks. All 12 eyes received an intravitreal triamcinolone injection, and the patients were followed up for an average of 6.7 months. BCVA (log MAR) was changed from 0.29 +/- 0.12 to 0.11 +/- 0.09, showing statistically significant improvement (p = 0.000). The OCT showed that the average CMT was statistically decreased from 390.58 +/- 94.98 microm to 165.17 +/- 39.95 microm (p = 0.001). No complications were reported after the procedure, and vision and edema improved after one month in all 12 eyes. CONCLUSIONS: After performing intravitreal triamcinolone injection as a primary treatment method for cystoid macular edema which developed after cataract surgery, rapid recovery and improvement of vision and macular thickness were confirmed in all 12 eyes.

Diagnostic Outcomes of Patients Suspicious for Glaucoma Referred from The Company Health Screening

PURPOSE: To evaluate the diagnostic outcomes of patients suspicious for glaucoma referred from the company health screening. METHODS: In this prospective study, 147 (87 male, 60 female) patients for glaucoma suspicious referred from the company health screening were enrolled. They underwent slit-lamp examination, Goldmann applanation tonometry, gonioscopy, optic disc examination, visual field examination and peripapillary retinal nerve fiber layer (RNFL) thickness measurement using optical coherence tomography (StratusOCT) and scanning laser polarimetry (GDx VCC). We analyzed their diagnostic outcomes. RESULTS: The mean age of patients was 43.8 9.6 years. Reasons for glaucoma suspicion and the number of referred patients were 111 (75.5%) high cup/disc ratio, 23 (15.6%) high intraocular pressure and 13 (8.8%) both of these. The diagnostic outcome was as follows: glaucoma, 26 (17.7%); glaucoma suspect, 4 (2.7%); ocular hypertension (OHT), 14 (9.5%); no glaucoma and no ocular hypertension, 89 (60.5%); and normal, 18 (12.2%). CONCLUSIONS: Glaucoma, glaucoma suspect and ocular hypertension were confirmed in 27.2% of patients suspicious for glaucoma referred from the company health screening. Thus, the company health screening appears to be relatively sensitive to detecting glaucoma patients.

The Effect of Nasal Cavity Abnormality Related to Surgical Success Rate of Endonasal Dacryocystorhinostomy

PURPOSE: To investigate the effect of a nasal cavity abnormality on the success rate of endonasal dacryocystorhinostomy (DCR). METHODS: Two hundred seventy eyes of 230 patients who had undergone endonasal DCR from February 2003 to July 2004 were retrospectively analyzed. The patients were classified into three groups after all were preoperatively examined by an otolaryngologist. Group A consisted of patients who had no nasal cavity abnormality; Group B, patients who had a nasal cavity abnormality and who received treatment; and Group C, patients with a nasal cavity abnormality but who received no treatment. RESULTS: The success rate of endonasal DCR were 83.9% in Group A, 87.5% in Group B, and 79.2% in Group C, with no statistical significance among the three groups (p>0.05). CONCLUSIONS: The presence of a nasal cavity abnormality did not affect the success rate of endonasal DCR.

The Comparison of Intraocular Pressure Elevation after Intravitreal Injection of Different Concentration of Triamcinolone Acetonide

PURPOSE: The purpose of this study was to compare the effects of intravitreal injections of 4 mg or 8 mg triamcinolone acetonide(TA) on intraocular pressure (IOP) in macular edema. METHODS: This was a retrospective study conducted by reviewing follow-up records for the eyes of 60 patients with macular edema 6 months receiving a intravitreal TA injection. Two groups, A and B, who had received TA injections of either 4 or 8 mg, respectively, were compared. RESULTS: The average pre-injection IOP for group A was 12.8+/-2.6 mmHg, and the average post-injection IOP at 1 day, 1 week, 1 month, 3 months, and 6 months was 15.0+/-2.7, 14.6+/-3.2, 15.3+/-3.5, 15.8+/-4.0, and 14.4+/-2.8 mmHg, respectively. The average pre-injection IOP for group B was 12.5+/-2.4 mmHg, and the average post-injection IOP at 1 day, 1 week, 1 month, 3 months, and 6 months was 14.9+/-2.9, 14.3+/-3.0, 14.7+/-3.2, 15.2+/-4.4, and 14.5+/-4.5 mmHg, respectively. The difference in IOP elevation between the two groups was not statistically significant (p>0.05). CONCLUSIONS: There was no statistically significant difference between a 4 mg or 8 mg intravitreal TA injection with respect to IOP elevation.