The Anti-angiogenic Effect of Chlorogenic Acid on Choroidal Neovascularization

PURPOSE: To evaluate the inhibitory effect of chlorogenic acid on laser-induced choroidal neovascularization (CNV) in a rat model. METHODS: Intraperitoneal injection of chlorogenic acid (10 mg/kg) was inititated one day prior to laser photocoagulation and continued for eight days. Eyes were removed 14 days after laser photocoagulation. Fluorescein angiography was employed at seven and 14 days to assess the CNV lesions, and histological examination was performed. Quantification of CNV size and leakage were performed both in histological sections and fluorescein angiography in order to compare the inhibitory effects of chlorogenic acid on CNV with the results of the control. RESULTS: Histological analysis showed no significant difference in CNV size between the treated and control groups. However, CNV leakage on fluorescein angiography had significantly decreased in the chlorogenic acid-treated group at 14 days after laser photocoagulation compared with that of the control group. In addition, CNV size on fluorescein angiography had significantly decreased in the treated group at seven and 14 days. CONCLUSIONS: These results suggest that chlorogenic acid has anti-angiogenic effects on CNV and may be useful as an inhibitor in the treatment or prevention of neovascular age-related macular degeneration.

Serous Retinal Detachment in Patients with Choroidal Neovascularization Following Photodynamic Therapy

PURPOSE: To quantify the development and resolution of serous retinal detachment in patients with choroidal neovascularization (CNV) following photodynamic therapy (PDT). METHODS: Six eyes of five patients who developed serous retinal detachment two days after PDT were included in this study. Retinal thickness was measured by optical coherence tomography (OCT) before PDT, and at two days, seven days, and three weeks after PDT. The number of PDT and the greatest linear dimension (GLD) of the CNV lesion were recorded. RESULTS: Serous retinal detachment was demonstrated on OCT at two days after PDT. Retinal elevation increased significantly from 313.2 micrometer before PDT to 640.7 micrometer two days after PDT (P<0.01); elevation and decreased to 303.2 micrometer seven days after PDT, and decreased to 223.4 micrometer three weeks after PDT. The mean number of PDT treatments 2.0 (range: 1~3), and the mean GLD before PDT was 3122.8+/-1275.9 micrometer. CONCLUSIONS: This study suggest that serous retinal detachment in patients with CNV may develop following PDT but may also resolve spontaneously seven days after PDT.

Factors Affecting the Visual Outcome of Cataract Surgery in the Very Elderly

PURPOSE: To analyze the outcome of cataract surgery and to determine factors influencing the postoperative visual acuity in patients aged 85 years and older. METHODS: The best corrected visual acuity before and 3 months after cataract surgery in patients aged 85 years and older was measured. Age, sex, diabetes mellitus, hypertension, astigmatism, corneal endothelial cell count, ocular comorbidity, and intraoperative complication were analyzed to determine which factors influence the postoperative visual acuity. RESULTS: The postoperative visual acuity improved in 87% of patients, and a visual acuity of 20/40 or better was achieved in 56% of patients. Posterior capsular rupture and zonular dialysis were found as intraoperative complications in 16% of patients. Multiple regression analysis was used to determine which factors influence the postoperative visual acuity; age(p=0.009), ocular comorbidity (p=0.009), and intraoperative complication (p=0.010) were significantly associated with postoperative visual acuity. CONCLUSIONS: The postoperative visual acuity following cataract surgery in patients aged 85 years and older improved in 87% of patients, and old age, ocular comorbidity, and intraoperative complication were predictors of a poorer visual outcome.

Cosmetic Repair of Band Keratopathy Using Stained Amniotic Membrane

PURPOSE: To evaluate the efficacy of stained amniotic membrane transplantation (AMT) for cosmetic repair of band keratopathy. METHODS: Eight eyes from 8 patients with band keratopathy without the possibility of visual improvement were treated with corneal tattooing and stained AMT. Calcific plaques were removed with EDTA and a blade prior to the tattooing. Tattooing by the injection of tissue marking dye into the corneal stroma was performed in corneal opacities. The remaining opacity, which could not be treated with corneal tattooing, was treated with black dye-stained AMT. RESULTS: The most common cause of band keratopathy was trauma (50%) and the mean time to epithelial healing was 11.3 days. All patients showed satisfactory results with cosmetic staining. Recurring cases and significant complications were not observed during the mean follow-up period of 7.4 months. CONCLUSIONS: Cosmetic repair by corneal tattooing and stained AMT is an effective treatment for band keratopathy and is not associated with any significant complications.

Visual Field Changes in Pediatric and Adolescent Patients Treated with Vigabatrin

PURPOSE: To investigate perimetric changes in pediatric and adolescent patients treated with vigabatrin and to assess the relationship between the visual field defect and the cumulative dose, the duration of treatment, or the age when vigabatrin was first taken. METHODS: Pediatric and adolescent patients treated with vigabatrin for seizure for at least 6 months were examined with Goldmann perimetry. The cumulative dose, the duration of treatment, the age when vigabatrin was first taken, and whether a combination of anticonvulsants and vigabatrin was taken were recorded. Mean radial degree (MRD) determination from the right eye was used to compare the amount of constriction. RESULTS: Visual field constriction developed in 19 (27.1%) out of 70 patients and MRD decreased by 22.7% a mean duration of 86.7+/-27.4 months of treatment. The visual field significantly decreased in the superior, nasal, and inferior field with temporal and central sparing (p<0.001). There was a statistically significant correlation between the average MRD and the cumulative dose (r2=0.1772, p<0.001), and the duration of treatment (r2=0.1713, p<0.001), but no correlation between the average MRD and either the age when vigabatrin was first taken, or the combination of anticonvulsants with vigabatrin. CONCLUSIONS: Visual field constriction developed in one quarter of pediatric and adolescent patients treated with vigabatrin, which significantly correlated with the cumulative dose and the duration of treatment. Therefore, a regular examination of the visual field is warranted for pediatric and adolescent patients treated with vigabatrin.

The Effect of Topical Pilocarpine on Basic Tear Secretion

PURPOSE: To evaluate the effect of topical pilocarpine on basic tear secretion, using the Schirmer test. METHODS: The Schirmer test was performed in 22 eyes of 11 healthy volunteers before instillation and at 10, 20, and 30 minutes after instillation of 1% pilocarpine and in 22 eyes of 12 healthy volunteers before instillation and at 10, 20, and 30 minutes after instillation of 2% pilocarpine. As for control group, the Schirmer test was performed in 22 eyes of 11 healthy volunteers by the same method except with normal saline. RESULTS: The ratio of tear secretion was calculated by dividing the wet length of a Schirmer strip after instillation by the wet length before instillation for comparative analysis. In the control group, the mean ratio decreased with time to 0.78 at 10 minutes, 0.64 at 20 minutes, and 0.63 at 30 minutes after instillation of normal saline. In the 1% pilocarpine group, the mean ratio decreased with time, but there was no significant difference in comparison to the ratio of the control group. In the 2% pilocarpine group, the ratio increased significantly to 1.28 (p<0.001) at 10 minutes, 1.07 (p=0.002) at 20 minutes, and decreased to 0.63 (p=0.041) at 30 minutes after instillation. CONCLUSIONS: The basic tear secretion did not change significantly after instillation of 1% pilocarpine but increased significantly at 10 minutes after instillation of 2% pilocarpine to the highest level observed, which was followed by a decrease in basic tear secretion.

Treatment of Hypotony Maculopathy Caused by Traumatic Cyclodialysis with Vitrectomy, Gas Tamponade, and Cryotherapy

PURPOSE: To report a case of hypotony maculopathy caused by traumatic cyclodialysis and treated by vitrectomy combined with gas tamponade and cryotherapy. METHODS: A 35-year-old man with hypotony maculopathy caused by traumatic cyclodialysis was unsuccessfully treated with conservative medical therapy, laser photocoagulation, and direct cyclopexy. The intraocular pressure (IOP) was 2 mm Hg and the vision was counting finger with chorioretinal folds. Vitrectomy combined with gas tamponade and cryotherapy was performed without lens surgery 5 months after trauma. RESULTS: After vitrectomy, fundus photograph and optical coherence tomography revealed complete loss of preoperative chorioretinal folds. The visual acuity improved to 0.3 and IOP was maintained within a normal range during the 24 month follow-up. CONCLUSIONS: This case shows that vitrectomy combined with gas tamponade and cryotherapy is effective for the treatment of traumatic cyclodialysis with persistent hypotony, probably without lens surgery.

Cosmetic Repair of Corneal Opacity by Tattooing

PURPOSE: To evaluate the efficacy of tattooing with tissue marking dye for cosmetic repair of corneal opacity. METHODS: Tattooing by the injection of tissue marking dye into the corneal stroma was performed in 67 eyes of 67 patients in whom there were no changes in visual acuity or size of corneal opacity for at least 5 years. Conjunctivalized corneal opacities and calcium deposits were removed before tattooing. All patients were followed up for a period of at least 3 months. RESULTS: The most common causes of corneal opacity were trauma (56.6%) and infectious disease (19.4%). Combined ocular diseases included sensory exotropia (43.3%) and band keratopathy (31.3%). In this study, 98.5% of patients showed satisfactory results with cosmetic staining. Remaining opacity was observed in 1 eye (1.5%). Intraoperative complications occurred in 6 eyes (9.0%) and were resolved completely during surgery. Foreign body sensations (38.8%) and conjunctival injection (32.8%) disappeared within 2 months after surgery. CONCLUSIONS: Cosmetic repair by tattooing using tissue marking dye is an effective treatment for corneal opacity and is not associated with any significant complications.