The Effect of Subconjunctival Injection of Bevacizumab After Resection of Muscle in Rabbit Models

PURPOSE: To study the effects of subconjunctival injection on the conjunctiva and muscles after muscle resection in a rabbit model. METHODS: Resection surgery of 5 mm was performed on both the superior rectus muscle (SR) and the inferior rectus muscle (IR) in five white rabbits. As such, 2.5 mg bevacizumab was subconjunctivally injected around the right SR and IR in the experimental group. The left eyes were not injected and were instead used as the control group. The degrees of injection and edema of conjunctiva were classified on a scale from 0 to 4 via gross examination by five examiners at two and four weeks after surgery. The strength of the muscle attachment was assessed, and the degrees of conjunctival inflammation and inflammation and fibrosis of the muscle were classified on a scale from 0 to 4 at four weeks after surgery via histologic examination. RESULTS: The results of gross examination at two and four weeks after surgery showed positive correlation among the five examiners (k=0.52, k=0.4), although there was no statistically significant difference between the experimental and control groups (p=0.285, p=0.364). There was also no significant difference between the two groups with regard to tensile strength of the attachment (p=0.414), inflammation of the conjunctiva and muscle, or fibrosis of the muscle in histologic examination (p=0.698, p=0.702, p=0.232, respectively). CONCLUSIONS: There were no significant effects on the inflammation and fibrosis of the conjunctiva or muscles due to subconjunctival injection of 2.5 mg of bevacizumab after muscle resection in a rabbit model.

The Clinical Features With Recurrence of Amblyopia After Cessation of Amblyopic Treatment

PURPOSE: To identify the clinical features with recurrence of amblyopia after cessation of amblyopic treatment. METHODS: Amblyopic children followed up at least 1 year after successful treatment were evaluated. A recurrence of amblyopia was defined as a reduction of more than 2 levels in visual acuity (VA) of the amblyopic eye after cessation of treatment. The age and VA of the amblyopic eye at the start and during follow-up, type of amblyopia, type and duration of treatment, weaning and stereopsis on cessation of treatment were analyzed. RESULTS: Amblyopia recurred in 5 out of 82 patients with successful treatment, and the period of recurrence varied from 7 to 31 months after cessation of treatment. Two out of 5 recurred patients had only patching therapy and the other 3 patients had atropine penalization after patching therapy. The weaning was performed in the 5 recurred patients at cessation of treatment. There was no remarkable clinical factor associated with recurrence of amblyopia. CONCLUSIONS: The recurrence rate was 6% after cessation of amblyopic treatment and there was no factor associated with recurrence of amblyopia. Therefore, regular follow-up may be required after successful treatment for amblyopia.

Clinical Course of Strabismus Developed in Siblings

PURPOSE: To determine the clinical characteristics of strabismus and the clinical course after treatment, such as surgery or glasses, in siblings with strabismus. METHODS: Siblings diagnosed with strabismus were investigated according to sex, age and type of strabismus. The initial angle of deviation and the change of angle after treatments in the same type were evaluated and analyzed. The analysis showed that therapeutic results corresponded in cases of siblings at the last visit. RESULTS: Fifteen out of 58 sibling couples (average age: 6.2 years old) were enrolled in this study on the same initial visit date. In the cases where sibling couples had their initial examination on different dates, siblings were on average 5.3 and 6.4 years old, irrespectively (p0.05). The concordance of the final result after treatment was 68.4%, and was statistically significant. CONCLUSIONS: There were many cases in which siblings demonstrated the same type of strabismus. In these cases, the clinical courses and final results were similar. Therefore, if one sibling was treated, the other sibling's course and result after treatment could be predicted accurately.

Clinical Course of Patients With Delayed Consecutive Esotropia After Exotropia Surgery

PURPOSE: To report the characteristics and therapeutic results of patients with delayed consecutive esotropia after undergoing surgery for exotropia. METHODS: Ten patients with delayed consecutive esotropia of more than 10 prism diopters (PD) after orthotropia was obtained postoperatively were included in this study. The authors investigated the clinical characteristics, the deviated angle at postoperative day one, the duration between surgery and orthotropia, the duration between surgery and delayed esotropia, the angle of esotropia, and the result of treatment in delayed consecutive esotropia. RESULTS: The average of the preoperative angle of exodeviation was 30PD at distance and 31PD at near. The patients underwent surgery for exotropia at a mean age of 5.3 years, and one day postoperatively, the angle of esodeviation was 12PD at distance and 10PD at near. All 10 patients demonstrated orthotropia at 0.9 months after surgery. However, esotropia of 21PD occurred 4 months after surgery for all patients. Six of the 10 patients demonstrated orthotropia or 10PD or less at the last visit after patching therapy or fitting for Fresnel prism glasses. The remaining four patients did not improve or showed aggravated esotropia with a doubled-angle of esotropia. CONCLUSIONS: In patients with orthotropia after exotropia surgery, delayed consecutive esotropia can occur, and the prognosis of non-surgical treatment is relatively poor.

Effect of Needle Revision of Failed Filtering Blebs with Different Concentrations of Mitomycin C

PURPOSE: To investigate the efficacy and the risk factors for failure and complications of mitomycin C (MMC)-augmented needle revision (NR) of failed filtering blebs. METHODS: Thirty eyes whose intraocular pressure (IOP) did not decrease after the cutting of scleral flap sutures were recruited. NR was performed with a 26-gauge needle under a slit-lamp. Immediately following NR, all eyes received a subconjunctival injection of 0.1 ml of 0.02 mg/ml (group A) or 0.1 mg/ml (group B) MMC at the adjacent conjunctiva. The mean follow-up period after the last needle revision was 13.2+/-4.2 months. RESULTS: The mean IOP decreased from 25.7+/-10.6 mmHg before surgery to 13.7+/-2.5 mmHg at the last follow-up in group A and from 24.1+/-6.8 mmHg to 17.7+/-8.6 mmHg in group B (group A: p=0.001, group B: p=0.065). Subconjunctival hemorrhage, hyphema, and a shallow anterior chamber appeared in most cases. However, choridal detachment and avascular changes of the conjunctiva were observed in group B. CONCLUSIONS: IOP decreased in both groups A and B, but severe complications appeared only in group B. NR followed by a subconjunctival injection of 0.02 rather than 0.1 mg/ml is a safe and effective method.

Papilledema Associated with Anemia in a Patient with Paroxysmal Nocturnal Hemoglobinuria

PURPOSE: To report a case of bilateral optic disc edema associated with hemolytic anemia and paroxysmal nocturnal hemoglobinuria (PNH). METHODS: A 51-year-old woman visited our ophthalmologic clinic complaining of metamorphopsia. Twenty eight years ago, she had been diagnosed with PNH and hemolytic anemia and had received blood transfusion on an irregular basis. The best corrected visual acuity was initially 0.5 in the right eye and 1.0 in the left eye. Light reflex was intact and no afferent pupillary defect was found. Fundus examination revealed severe optic disc swellings with indistinct margins in both eyes. Papillary and peripapillary retinal hemorrhages were also present. RESULTS: A visual field test revealed the enlarged physiologic scotoma in both eyes. Fluorescein angiograms showed hyperfluorescence of the optic disc and blocked fluorescence due to the papillary hemorrhages. Optical coherence tomograms of the optic disc showed the loss of physiologic disc cupping and severe elevation. There was no evidence of an intracranial lesion upon brain magnetic resonance imaging. These findings were compatible with optic disc edema associated with anemia and the management was oriented towards the anemia. At the 2-months follow-up, the best corrected visual acuity of both eyes had improved to 1.0 and optic disc edema markedly decreased. However, the patient's overall physical condition deteriorated and she expired due to dyspnea and hepatic coma.