Serial study of Apoptosis and Morphologic Change of Retina in Experimental Model of Chronic Retinal Ischemia in Rats

PURPOSE: We investigated the serial developement of programmed cell death or apoptosis as a mechanism of cell death by inducing chronic retinal ischemia in experimental permanent common carotid artery ligation in rats. We also hope this model to be applied in study of normal tension glaucoma or ischemic ocular disease. METHODS: After ligation of both common carotid arteries of rats under anesthesia, they were sacrificed on the 1st, 3rd, 5th, 7th, 14th, 28th, and 63rd day and then enucleation was done. After separating retina, we did TdT-dUTP nick-end labeling (TUNEL)stain and Bax immunochemistry stain to study apoptotic change and we also did hematoxylin eosin stain to evaluate retinal morphologic changes. RESULTS: Apoptotic cells were showed in ganglion cell layer cheifly on TUNEL stain and Bax immunochemistry stain on the first day after ligation of common carotid artery, as time as gone, apoptotic cell increased and then developed in all layers on the 28th day. Cell density decreased in ganlion cell layer, inner nuclear layer, and outer nuclear later on hematoxylin eosin stain on the third day; as time as gone, cell density further decreased and thickness of inner plexiform layer and nuclear layer decreased also. CONCLUSIONS: This result shows that apoptosis has the important role in the cell death at the ischemic retina. The results of this study will also provide baseline information for the further study on normal tension glaucoma or ocular ischemic diseases compared to transient retinal ischemia model induced by elevation of intraocular pressure.

A Case of Medial Rectus Muscle Injury after Functional Endoscopic Sinus Polypectomy and Ethmoidectomy

PURPOSE: To report appropriate treatment of medial rectus muscle injury after functional endoscopic sinus polypectomy and ethmoidectomy METHODS: The author experienced the right medial rectus muscle injury after functional endoscopic polypectomy and ethmoidectomy in a 42-year-old man who complained of decreased visual acuity, ocular pain, binocular diplopia, and exophthalmos in the right eye at the first postoperative day. His best corrected visual acuity of right eye was 0.3, Intraocular pressure was 26 mmHg, and pupillary light reflex was decreased. On exophthalmometry, the right eye was more exophthalmic by 3 mm than the left eye. After steroid therapy and befunolol eyedrops instillation, the visual acuity was improved to 0.8 and intraocular pressure was decreased to 18 mmHg. There was severe limitation of medial gaze and about 65 prism diopters of right exodeviation in red filter test. In computerized tomography, bony defect in the right orbital medial wall and defect in the right medial rectus muscle were confirmed. On the third postoperative day, silastic sheet was applied in dehiscent medial wall under endoscopic examination in otorhinolaryngologic outpatient department. Because exodeviation and diplopia had not improved, on the 61th postoperative day, right lateral rectus muscle recession 12 mm was carried out, and then, on the 88th postoperative day, Hummelsheim operation on right eye was done. RESULTS: Right exodeviation was decreased by about 40 prism diopters after right lateral rectus muscle recession 12 mm. and then, after Hummelsheim operation, he had right exodeviation 20 prism diopters of and less binocular diplopia. We prescribed 10 prism diopters of prism lens in each eye, but he complained of decreased visual acuity and cosmetic problem. So, we prescribed 5 prism diopters of prism lens in each eye. At the last follow-up he is satisfied with his visual acuity and cosmetic aspect.

Normal Intraocular Pressure of Neonates Measured with Tono-pen

PURPOSE: It is difficult to estimate definite intraocular pressure of neonates. We intended to evaluate neonatal normal intraocular pressure using Tono-pen, and compared mean intraocular pressures between groups divided by sex, birth weight, and gestational age. METHOD: We measured the intraocular pressure with Tono-pen in 504 eyes of 252 newborn, who admitted in our hospital from June 2000 to January 2001 at their the second day of life. One observer measured the intraocular pressure with Tono-pen five to ten times after proparacain HCL 0.5% instillation on regular time. Only 5% of Tono-pen's coefficient of variance was considered valuable. Neonates suspected having congenital glaucoma or retinopathy were excluded. Conclusively, 462 eyes of 231 newborns were included. Mean gestational age was 38 weeks and 6 days. Mean birth weight was 3.23 kg. We achieved average intraocular pressures of neonates having gestational age between 38 weeks and 42 weeks, and birth weight between 3.0 kg and 3.5 kg. We achieved also average intraocular pressure of neonates divided by sex, gestational age, and birth weight, compared them with average intraocular pressure of normal neonates by 3-way ANOVA. RESULT: Average of intraocular pressure of normal neonates was 13.61+/-2.02 mmHg. Intraocular pressure of normal neonates is not statistically significant in the classification by sex, gestational age, and birth weight.(p-value>0.05) CONCLUSION: These value will aid the ophthalmologists in the diagnosis and screening of congenital glaucoma.

Primary Cutaneous Adenoid Cystic Carcinoma on Lower Lid

PURPOSE: Primary cutaneous adenoid cystic carcinoma(PCACC) is a very rare malignant tumor originating from the eccrine glands of skin and 39 cases have been reported in the world literature. We report PCACC on the lower lid with metastasis to the lung and brain. METHOD: 56 years old man visited because of hard mass on left lower lid which developed 18 months ago. On punch biopsy the mass showed malignant nature and it was removed by wedge resection method with clear margin. RESULT: Adenoid cystic carcinoma was diagnosed by histologic exam of removed mass and it was diagnosed PCACC because salivary gland region is normal and systemic exam shows no abnormality. After 2 years 10 months recurrent tumor developed on medial lower lid and zygomatic area. We tried to remove mass totally but it failed. Metastases to lung and brain developed.

Change of Visual Acuity and Astigmatism after Operation in Epiblepharon Children

To study the relationship between the corneal erosion by inverted eyelash and the degree of astigmatism and visual acuity, we reviewed the surgical recorders of epiblepharon children. We classified 106 eyes of 53 children as 3 groups according to the area of corneal erosion(grade I:confined below pupil, grade II:involving pupil partially, grade III:involving pupil totally). We examined uncorrected visual acuity(UCVA), best corrected visual acuity(BCVA)and noncycloplegic auto-refraction test before and 1 month after surgery. Mean UCVA was increased from 0.61 before surgery to 0.71 after surgery and mean BCVA was increased from 0.82 to 0.89 and the differences were stastically significant(p0.05). The degree of visual improvement and astigmatic decrease was similar in 3 groups. In conclusion in epiblepharon children the visual acuity was poor more likely due to corneal erosion itself than due to refractive error like astigmatism. In epiblepharon children with-the-rule astigmatism was more prevalent than in normal children before and after the surgery.

Glaucomatous Optic Nerve Head Progression and its Risk Factor in Glaucoma:Longitudinal Study of Heidelberg Retina Tomograph

This study evaluated the risk factor of glaucoma progression despite of adequate intraocular pressure[IOP]and that of glaucomatous optic nerve head progression before visual field progression with minimum treatment regimen. Inclusion criteria included subjects with elevated intraocular pressure and glaucomatous optic nerve head in fundus examination. Patients were main-tained their IOP by medication or filtering surgery. Baseline assessment included routine ocular examination, Heidelberg Retina Tomograph[HRT]and visual field. All patients were reexamined 6 months after the first examina-tion. We review the results of 61 patients[118 eyes]. In multiple logistic regression analysis, the risk factors of glaucoma progression were age[p=0.027] and the intraocular pressure at the first HRT examination[p=0.0216]. Glaucomatous visual field progression correlated significantly with HRT progres-sion[p=0.0216]. If the early glaucoma progression is detected with HRT, progression of glaucoma can be prevented. In the groups with the risk factors, the target pressure should be lower to prevent further loss or blindness with agressive treatment. In groups without risk factor, the quality of patient's life can be improved with minimum treatment. We may be able to prevent the progression of glaucomatous field defect, if we can recognize the early change of their optic nerve head morphology. Their findings may help us to differentiate non-risk group from risk group. We hope that we would improve our patient's life quality by minimizing glaucoma treatment especially in the non-risk group.

The Study of Intraocular Vascular Endothelial Growth Factor Concentration in Diabetic Retinopathy after Panretinal Photocoagulation

Vascular endothelial growth factor[VEGF] might play important roles in angiogenesis of diabetic retinopathy. Aim of this study is to determine the effect of panretinal photocoagulation[PRP] on the level of VEGF in intraocular fluid of proliferative diabetic retinopathy[PDR]. Aqueous humor was obtained during cataract surgery from 35 eyes of 35 patients with PDR and VEGF concentration was measured using enzyme-linked immunosorbent assay[ELISA]. Patients were classified into 4 groups according to total amount of panretinal photocoagulation[PRP][group A:no PRP, group B: less than 1000 spots, group C: 1000~1500 spots, group D: more than 1500 spots] and VEGF level was analyzed in each group using Spearman's correlation coefficient by rank. Mean concentration of VEGF is 615pg/mlin group A, 307pg/mlin group B, 234 pg/mlin group C, and 136pg/mlin group D. The level of VEGF was significantly lower as total amount of PRP increased[p<0.05]. These findings suggest that therapeutic effect of PRP on PDR can be explained by the reduction of VEGF concentration in intraocular fluid.

Comparison of the Change of Intraocular Pressure after Operation between LASIK and PRK

The authors compared the intraocular pressure(IOP) after excimer laser photorefractive keratectomy(PRK) and laser-assisted in situ keratomileusis(LASIK) and examined the factors that affected the intraocular pressure following the surgery. One hundred twenty-three patients(184 eyes) park of the cornea with microkeratome(SCMD, USA) and STAR laser(VISX, USA)and 55 patients*76 eyues) who underwent PRK with the sam laser were examied retrospectively. The IOP was meaured in the central part of the cornea with non contact tommeter(NCT, Topcon CT-20, Japan) at 7 day, 2, 6, and 12 months after PRK and LSSIK. the patiehts were divided into two groups: PRK group and LASIK group. There was no difference bvwtween the proparative IOPs in the two groups(0.11). Each IOP measure 7 days, 2, 6, and 12 months after PRK and LASIK was significantly lower than that measured before operation(P<0.05). The IOP measured 7 days after PRK or LASIK was significantly lower tham that measured 2.6. and 12 months after PRK or LASIK and , respectively (P<0.05). There were no difference among the IOPs measured 2,6, and 12 month after PRK or LASIK, respectively(P<0.05). The postoperative Change of IOP between PRK and LASIK was significant at 2, 6, and 12 months(P<0.05) except 7 days after surgery(p=0.066). The difference between the properative IOP and the IOP at 6 months after the surgery had the low correlation with the changes of the spherical equivalents and keratomertry readings and total ablation depth in both groups. In conclusion, the decrease of IOP after LASIK was severer than that after PRK and so the IOP measurement is ought to be interpreted carefully after LASIK.

Clinical Experience with the Ahmed Glaucoma Valve Implant

This study was performed to determine effectiveness and safety of Ahmed glaucoma valve implantation for control of intraocular pressure in patients that had not responded to medical treatment and previous glaucoma surgery. Thirty eyes of 30 patients who had undergone Ahmed glaucoma valve implant surgery between April 1996 and October 1997 were reviewed retrospectively. Intraocular pressure(IOP) was reduced from a mean of 35.3+/-13.0mmHg to 14.3+/-5.9 mmHg at follow-up intervals of 6 to 28 months(mean 13.2+/-4.9 months). In 26 eyes(86.7%) IOP could be controlled between 6mmHg and 21mmHg. When surgical success was defined as IOP less than 22mmHg and greater than 5mmHg with or without medications, 9 and 12-months life table success rate(621mmHg) in two eyes(6.7%), hyphema in two eyes(6.7%), blocked tube in two eyes(6.7%) and anterior chamber inflammation in one eye(3.3%). The result of this study suggests that the Ahmed glaucoma valve implantation is effective in lowering the IOP in patients with intractable glaucoma. However, this drainage device does not climinate early postoperative hypotony with its attendant complication.

Clinical Experience with the Ahmed Glaucoma Valve Implant

This study was performed to determine effectiveness and safety of Ahmed glaucoma valve implantation for control of intraocular pressure in patients that had not responded to medical treatment and previous glaucoma surgery. Thirty eyes of 30 patients who had undergone Ahmed glaucoma valve implant surgery between April 1996 and October 1997 were reviewed retrospectively. Intraocular pressure(IOP) was reduced from a mean of 35.3+/-13.0mmHg to 14.3+/-5.9 mmHg at follow-up intervals of 6 to 28 months(mean 13.2+/-4.9 months). In 26 eyes(86.7%) IOP could be controlled between 6mmHg and 21mmHg. When surgical success was defined as IOP less than 22mmHg and greater than 5mmHg with or without medications, 9 and 12-months life table success rate(621mmHg) in two eyes(6.7%), hyphema in two eyes(6.7%), blocked tube in two eyes(6.7%) and anterior chamber inflammation in one eye(3.3%). The result of this study suggests that the Ahmed glaucoma valve implantation is effective in lowering the IOP in patients with intractable glaucoma. However, this drainage device does not climinate early postoperative hypotony with its attendant complication.

Introduction of a New Therapeutic Modality for the Chronic Behcets Disease Patients: Synchronization of Plasmapheresis with Immune Modulation Therapy-

The Behcets disease patients with uveitis are oftern suffering from chronic recurrent inflammation resulting in the blindness. Etiology, prognosis, treatment modalities of this disease are various, and the factors, affecting the chronic long term prognosis are not clearly identified. Current treatment for Behcets disease is combination therapy : steroid with colchicine, cyclophosphamide, or cyclosporin. But these kinds of treatment was insufficient to change the disease process and often produced severe complications. Authors treated 4 cases of Behcets patients who had chronic progressive steroid resistent uveitis, with synchronizatin of plasmapheresis and immune modulation therapy. All of them showed marked improvement in uveal inflammatory reaction and visual acuity.

Pterygium Surgery Using Dermabrader

The aim of this study was to evaluate safety and effectiveness of dermabrader to smooth the wound bed in pterygium surgery. A total dof 69 eyes of 62 patients were divided into two groups according to surgical method. 33 eyes of 29 patients who underwent pterygium surgery with bare-sclera technique and smoothing of the wound bed using dermabrader were included in group 1 and 36 eyes of 33 patients with bare aclera technique only were included in group 2. Postoperatively, the eyes were medically treated with topical mitomycin C(0.02%) two times per day for 5 days in both groups. The mean follow up visit was 12.1+/-2.89 months(range: 9-15months). Recurrence developed in 3(9.1%) of 33 eyes in group 1, while in 12(33.3%) of 36 eyes in group 2. This difference was statistically significant(p<0.05). This result suggests that the excision of pterygium using the bare-sclera technique, smoothing of the wound bed using dermabrader and low dose topical mitomycin C(0.02%) eye drops is a safe and effective method with a low recurrence rate.

Congenital Hypertrophy of the Retinal Pigment Epithelium in Familial Colonic Polyposis

Congenital hypertrophy of the retinal pigment epithlium(CHRPE)is a well-circumscribed, flat, pigmented fundus lesion that is presented solitary or grouped. It is the most common extracolonic manifestation of familial adenomatous polyposis(FAP). Unfortunately, there is no phenotypic biochemical abnormality or serological marker which indicates whether or not a family member will be affected FAP. However, most of patients with polyposis have CHRPE which is usually multiple and bilateral, The presence of CHRPE in a family member should therefore arouse suspicion of increased risk of polyposis. We experienced one case of familial adenomatous polyposis that showed no extracolonic manifestation except multiple, bilateral fundus lesions. A prophylactic total colectomy was performed. So we report it with the review of literature of clinical value of CHRPE as a predictive congenital marker of FAP.

Lyophilized Dura Mater Patch Graft in Glaucoma Valve Implantation

This study was performed to know effectiveness and safety of cadaveric lyophilized dura mater grafts(Lyodura, B.Braun Melsungen, Germany) to cover glaucoma implant tube. Tewnty-seven eyes of 25 patients who underwent glaucoma implant surgery between April 1996 and September 1997 received a lyophilized dura mater patch graft to cover the subconjunctival portion of the tube and then followed up for clinical signs. The mean follow up visit was 10.3 months (range: 5-18 months). All eyes tolerated the lyophilized dura mater grafts well without clinical signs of graft related conjunctival, scleral, of intraocular inflammation. And no conjunctival erosion or melting of the graft was observed. The result of this study suggests that preserved dura mater is maybe a reasonable alternative to eye bank sclera for use in glaucoma implant surgery.

A Case of Dural Carotid-Cavernous Sinus Fistula Associated with Ophthalmic Manifestations

Dural carotid-cavernous sinus fistula is an abnormal communication between meningeal branches of the carotid artery and cavernous sinus. It usually occurs spontaneously, and 25 to 50% of fistula close spontaneously. Most cases are unilateral and rarely, contralateral or bilateral symptoms occur. Most of the patients are postmenopausal women, and show dilated conjunctival and episcleral vessels, exophthalmos, limited ocular movement and elevation of intraocular pressure. We report a case of dural carotid-cavernous sinus fistula in a 53 year old woman with typical ophthalmic manifestations.

Clinical Effects of Punctal Occlusion Using Chromic Catgut

The treatment of dry eye patients is based on the management of the main causes of the disease. When the process of disease continues regardless of various conventional treatments, punctal occlusion can be employed. We used collagen implant. 1-0 and 2-0 chromic catgut in 33 eyes of dry eye patients to evalute the efficacy of punctal occlusion using chromic catgut. Symptoms(grade 0 to 3) were improved from the first week and persistently decreased in symptom grade during four weeks' follow-up period. The superficial corneal punctate erosion(grade 0 to 3) was improved after 2 weeks of the procedure in the whole 33 eyes(p<0.05). There was no superiority between collagen implant and chromic catgut. There was no improvement by score of the Schirmer test and the BUT in each group(p<0.05). We concluded that chromic catgut was easily applicable, very effective, inexpensive and showed less complication compared with collagen implant. We suggested that it could be used more widely in punctal occlusion in dry eye patients.

Case Report of Blindness After Intranasal Ethmoidectomy

Surgical extirpation and drainage of the paranasal sinus is frequently used by the otolaryngologist in the management of allergic, infectious, and neoplastic sinus diseases. Several surgical approaches to the ethmoid and maxillary sinuses, including ethmoidectomy and Caldwell-Luc's operation, may be used. In the intranasal approach to ethmoidectomy, the lamina papyracea, the thin partition separating the periorbita from the ethmoid sinus. cannot be directly visualized during this procedure and may be perforated inadvertently. Endoscopic nasal sinus surgery has only recently been introduced into Korea. This rather novel technique, especially when used by less-experienced surgens, has major complications similar to what has been reported with the traditional intranasal sphenoethmoidectomy. Even then, major complications may occur in the hands of very experienced surgeons. The ophthalmolgist may be consulted in the management of patients with orbital complications of sinus surgery. We present one patient with ophthalmic complications of sinus surgery encountered by the authors. The purpose of this report is to present to the ophthalmologist examples of orbital complications that may arise from sinus surgery, and treatment options.

Effect of Plasma Coagulation Factor XIII Deficiency on the Healing Following Trabeculectomy in Rabbits

Conjunctival fibroblastic proliferation with contracting scar formation has been implicated as a possible cause of glaucoma filtering surgery failure. The inhibitory effect of plasma coagulation factor XIII deficiency on the healing following trabeculectomy of the eyes in rabbits was studied. The plasma coagulation factor XIII deficiency was induced by two successive intravenous injections of anti-rabbit plasma coagulation factor XIII-goat immunoglobulin. Grossly, artificially prepared filtering bleb was well preserved on plasma coagulation factor XIII ddicient groups compared with control groups. Histologically. wound healing following trabeculectomy was delayed and the size of the scar was reduced on plasma coagulation factor XIII deficient groups compared with control groups. The above findings suggest that plasma coagulation factor XIII deficiency inhibit the healing precess following traheculectomy.

Incidence of Demodex Folliculorum in Chronic Blepharitis

Demodex is a common ectoparasite in human eyelash. However the occurrence rate and pathogencity are still controversial. The purpose of this study were to investigate the occurrence rate and classification of Demodex from eyelashes and its relationship with blepharitis. We selected 28 blepharitis patients and 132 patients without blepharitis(control group) who vistied St. Family's Hostital from March 1992 to July 1992. The following results were obtained. Demodex was observed in 17 out of 28 blepharitis patients(60.7%) and in 32 out of 132 control group(24.2%). This difference was stastically significant(p<0.05). In blepharitis patients. Demodex index was 19.6 and lash index was 12.2. In control group. Democlex index 7.4 and lash index 5.3.

Normal Conjunctival Goblet Cell Density in Korean Measured by Impression Cytology

Conjunctival goblet cells are thought to be the main source of tear mucin, and it is believed that this mucin plays an important role on increasing the tear film stability and the wettability of the ocular surface. The measurement of the conjunctival goblet cell density is useful for the differential diagnosis among the various ocular surface diseases, and for the evaluation of the efficacy of the treatment. This method can be checked simply and rapidly, but the normal conjunctival goblet cell density in Korean has not been reported. We examined the goblet cell density in the 68 eyes (57 patients) of normal subjects using an impression cytological technique on the palpebral and bulbar conjunctiva. The results were as follows: 1. Normal goblet cell density was 1316.9 +/- 491.7 cells/mm2 in the inferior palpebral conjunctiva, 57.9 +/- 67.9 cells/mm2 in the superor bulbar conjunctiva. 2. There was no significant difference in goblet cell density according to sex and age ( p>0.05, t-test). 3. The goblet cell density was increased as a rise of break-up time(BUT), but was not correlated with BUT(r=0.24, 0.05). Also there was no correlation between the goblet cell density and Schirmer test value (r=-0.10, 0.09), (r=regression coefficient). It is suggested that the above findings would aid in the diagnosis of the dry eye syndrome and allow differential diagnosis among the various ocular surface diseases.