Visual Field Changes after Internal Limiting Membrane Peeling in Glaucoma Patients with Epiretinal Membrane

PURPOSE: To report visual field changes after internal limiting membrane (ILM) peeling for macular epiretinal membrane (ERM) according to the severity of glaucoma. METHODS: A retrospective review of 37 eyes from 37 patients who underwent ILM peeling to treat ERM. Standard automated perimetry (Humphrey visual field 24-2 program) was performed preoperatively and postoperatively. Based on the Advanced Glaucoma Intervention Study (AGIS) scoring system of preoperative visual field, patients were classified into the early glaucoma (AGIS ≤ 1) group or the advanced glaucoma (AGIS ≥ 2) group. Postoperative visual field sensitivity at each point was compared with the preoperative value. RESULTS: Out of 37 eyes, 15 eyes had early glaucoma and 22 had advanced glaucoma. Eyes from both groups had poor postoperative visual field parameters. For eyes with advanced glaucoma, the visual field index was significantly reduced and the visual field damage was larger and wider compared to those with early glaucoma. In both groups, visual field impairment was greater on the nasal side than on the temporal side, and visual acuity was not significantly different. Postoperatively, the macular ganglion cell-inner plexiform layer thickness was decreased, especially on the temporal side of advanced glaucoma. CONCLUSIONS: Visual field impairment was greater and wider in eyes with advanced glaucoma than in those with early glaucoma after ILM peeling in patients with ERM.

Transscleral Cyclopexy Using Partial-Thickness Scleral Flap for Repairing Cyclodialysis Cleft: a Case Report

PURPOSE: To report a case of a cyclodialysis cleft that was successfully managed with gonioscopically guided transscleral cyclopexy using partial-thickness scleral flap. CASE SUMMARY: A 44-year-old man complaining of blurred vision in the left eye after blunt trauma was referred to our hospital. The intraocular pressure (IOP) was 4 mmHg and the visual acuity was counting finger. Gonioscopy examination revealed cyclodialysis cleft from 3 to 6 o'clock and fundus examination revealed macular folds. After the failure of conservative medical therapy and laser photocoagulation, gonioscopically guided transscleral cyclopexy using partial-thickness scleral flap was performed. Four months later, the IOP was 18 mmHg, the visual acuity was 0.8, and fundus examination showed the disappearance of the macular folds. CONCLUSIONS: Transscleral cyclopexy using partial-thickness scleral flap is a safe and effective method to treat hypotony maculopathy due to cyclodialysis and to minimize pupil distortion.

The Effect of Fixed Combination of Brinzolamide 1% and Timolol 0.5% in Normal-Tension Glaucoma

PURPOSE: We conducted a study to evaluate the effects of brinzolamide/timolol fixed combination (BTFC) in normal-tension glaucoma (NTG) patients. METHODS: We reviewed the records of 33 normal-tension glaucoma patients treated with BTFC in the unilateral eye. We measured intraocular pressure (IOP) every 2 and 1/2 hours between 09:00 am and 04:30 pm. After using BTFC at 8:00 am and 8:00 pm for 6 months, we measured the IOP at the same time period. We analyzed and compared the IOP of eyes treated with BTFC and contralateral eyes. RESULTS: The mean reduction in IOP was -2.85 +/- 1.43 mm Hg (-18.36 +/- 8.58%) in the eyes treated with BTFC and -2.21 +/- 1.73 mm Hg (-13.90 +/- 10.66%) in the contralateral eyes. The IOP lowering effect was greater in the eyes treated with BTFC than in the contralateral eyes. After 6 months of BTFC instillation, the changes in IOP measurements were the lowest at 11:30 am and increased at each time point afterwards. The greatest reduction in IOP was observed at 1 month; however, significant IOP reduction was observed at 3 and 6 months in both BTFC and contralateral eyes. There was no serious adverse event causing ocular damage. CONCLUSIONS: BTFC provided a significant IOP reduction in both BTFC and contralateral eyes in NTG patients.

A Case of Oxaliplatin-Related Ocular Toxicity

PURPOSE: To report a case of oxaliplatin (Eloxatin(R))-related ocular toxicity in a patient with advanced stomach cancer. CASE SUMMARY: A 43-year-old female with advanced stomach cancer experienced visual symptoms during the treatment with oxaliplatin on a XELOX schedule (a combination of oxaliplatin and capecitabine). After 1 cycle of chemotherapy, she complained of blurred vision and visual field defects in both eyes. Visual field tests showed a bilateral concentric field defect and the electroretinogram revealed a marked reduction of responses in both eyes. On the second cycle of chemotherapy, oxaliplatin was discontinued due to suspicious ocular toxicity. Her visual symptoms improved and visual field test showed normal results 1 month after oxaliplatin discontinuation. However, 3 months after oxaliplatin discontinuation, electroretinogram remained abnormal despite the progressive improvement. CONCLUSIONS: Platinum-based antineoplastic agents such as oxaliplatin should be administered with caution because oxaliplatin can cause damage to the retinal photoreceptors and the optic nerve. Early detection of ocular toxicity and discontinuation of oxaliplatin therapy could prevent severe and irreversible visual loss.

Single pretreatment of remifentanil may reduce pain after propofol and rocuronium injection in rapid sequence induction / 대한마취과학회지

BACKGROUND: We designed this double-blind, placebo-controlled study to compare the efficacy of remifentanil in reducing the pain of both propofol and rocuronium injection during rapid-sequence induction. METHODS: Ninety-five patients, scheduled for elective surgery under general anesthesia, were divided into 3 groups: saline (Group S, n = 31), remifentanil 1 microg/kg (Group R, n = 32), and lidocaine 1.5 mg/kg (Group L, n = 32) were administered after tourniquet application. The occlusion was released after 1 min and 5 ml of 1% propofol was injected over 10 s. Pain on propofol injection was evaluated by a 10-point verbal numeric rating scale (VNRS). The rest of the induction dose of propofol and 1 mg/kg of rocuronium, were injected. Pain on rocuronium injection was evaluated by a four-point score (FPS). RESULTS: The VNRS of propofol injection was as follows: R (0.78) = L (1.34) < S (4.26). The incidence of withdrawal response due to rocuronium was as follows: R (6.3%) < L (53.1%) < S (83.9%). The FPS of rocuronium injection was as follows: R (0.81) < L (1.78) < S (2.93). CONCLUSIONS: Pretreatment with a bolus of remifentanil was effective in simultaneously reducing injection pain of propofol and rocuronium. In addition, remifentanil pretreatment was more effective in suppression of withdrawal response by rocuronium than lidocaine.

Peripheral Analgesic and Anti-inflammatory Effects of Diclofenac, SC-560 and NS-398 on Acute Arthritic Model in Rats / 대한마취과학회지

BACKGROUND: Non-steroidal anti-inflammatory drugs (NSAIDs) are generally attributed to suppression cyclooxygenase enzymes, leading to decreased products of the arachidonic acid cascade. Since the discovery of two isoenzymes of cyclooxygenase, inhibition of cyclooxygenase-2 has been suggested to be responsible for therapeutic effects of NSAIDs without side effects. In the present study, to investigate the extent to peripheral nociception and inflammation of cyclooxygenase-1 and cyclooxygenase-2, diclofenac (non-selective inhibitor), SC-560 (selective cyclooxygenase-1 inhibitor) and NS-398 (selective cyclooxygenase-2 inhibitor) are injected intra-articularly on acute arthritic model in rats. METHODS: Arthritis was induced with 2% lamda-carrageenan (suspended in 50microliter normal saline) into the right knee joint cavity under enflurane anesthesia (2-4%). Before and after the injection, rats were allowed to walk freely through a pathway constructed to record weight load by means of 8 weight sensors (strain gauge type) attached to 8 plates which function independently. The weight load, diameter of both knee joints and weight of rat were measured at each test. At 4 hours and 30 minutes, diclofenac, SC-560 and NS-398 dissolved in 10% dimethyl sulfoxide were injected intra-articularly (50microgram/50microliter). RESULTS: The weight loads increased in diclofenac group at 6 and 9 hours and in NS-398 group at 24 and 48 hours after induction of arthritis. The diameter ratio decreased in diclofenac group at 12 hours after induction of arthritis. CONCLUSIONS: These results suggest that peripheral nociception and inflammation in acute model of arthritis in rats are likely related with both cyclooxygenase-1 and cyclooxygenase-2 pathways.

Submandibular Gland Enlargement Which Appeared Immediately after Insertion of Intubating LMA: Two case reports / 대한마취과학회지

Submandibular gland enlargement in assoication with general anesthesia is an unusual complication and easy to be unnoticeable. This report describes a case of bilateral enlargement of submandibular gland that developed just after failure of inserting Intubating LMA (ILMA) during stormy induction. The submandibular gland enlargement was benign, rubbery in consistency, without crepitus and not massive to inhibit ventilation. The patient's airway could be maintained with LMA. The mechanism of the occurrence remains unknown, but several factors that are most closely associated with this event are parasympathetic hyperactivity, physical obstruction by ILMA. This enlagement was gradually decreased in size within 1 hour and massaged gently and could not be palpated 3 hours later.

Characterization of the Multinucleated Giant Cell Glycoconjugates in the Tubercle of Human Pulmonary Tuberculosis / 체질인류학회지

Multinucleated giant cells (MGCs) are a prominent characteristic of granulomatous inflammation including tuberculosis. The present study was performed to investigate the characteristics and distribution pattern of intracellular and cell surface glycoconjugates of the MGCs in human pulmonary tubercles using lectin histochemistry. The cytoplasmic staining patterns could be divided into three groups. First, VVL, LCA and SBA showed intense reactivity in the great majority of the MGCs. Second, BS -I, DBA, WGA, PNA, ECL, PHA -L and PHA -E also showed positive staining in the cytoplasm of many MGCs, but the reaction patterns were not uniform. Third, the other group (BS -I - B4 and UEA -I) exhibited very weak or no staining in the cytoplasm. With regard to the membranous staining, the lectin binding patterns could be divided into two groups. First, WGA, ECL, PHA -L & PHA -E showed intense membranous staining. Second, the other lectins (BS -I, BS -I -B4, DBA, VVL, LCA, PNA, SBA and UEA -I) did not show any membranous staining. There was no significant difference in lectin binding patterns between the two types of MGCs. Our results demonstrated the characterization of glycoconjugates expressed in the MGCs in human pulmonary tubercles.