Effect of Focal and Grid Pattern PASCAL Photocoagulation Treatment in Diabetic Macular Edema

PURPOSE: To investigate the effect of focal and grid pattern PASCAL photocoagulation treatment in diabetic macular edema patients. METHODS: A total of 72 patients (75 eyes) who were diagnosed as diabetic macular edema were retrospectively analyzed. The patients were divided into 3 groups as follows: group 1 (31 patients, 31 eyes) received an intravitreal bevacizumab injection, group 2 (17 patients, 20 eyes) underwent focal and grid pattern PASCAL photocoagulation treatment, and group 3 (24 patients, 24 eyes) underwent focal and grid pattern argon photocoagulation treatment. Macular thickness and visual acuity (logMAR) of 75 eyes were compared among groups before and after treatments. RESULTS: Visual acuity improved in 13 eyes (65.0%) in group 1, 16 eyes (51.6%) in group 2, and in 10 eyes (41.6%) in group 3; however, there was no statistical significance. Macular thickness reduction occurred in 24 eyes (77.4%) in group 1 and 13 eyes (65.0%) in group 2 which were statistically significant decreases at only 1 month after treatment (p < 0.05). CONCLUSIONS: Focal and grid pattern PASCAL photocoagulation is a good therapeutic option for diabetic macular edema. Focal and grid pattern PASCAL photocoagulation is as effective as intravitreal bevacizumab injection or focal and grid pattern argon photocoagulation treatment.

A Comparison of 2-Octyl Cyanoacrylate Adhesives versus Conventional Suture Materials for Eyelid Wound Closure in Rabbits

PURPOSE: To evaluate the clinical efficacy and histopathological tolerance of 2-octyl cyanoacrylate versus conventional suture materials for eyelid wound closure in rabbits. METHODS: We performed an experimental study on 16 eyes of eight New Zealand albino rabbits. Eyelid incisions of 15 mm were done 4mm from the upper eyelid margin in both eyes. The eyes of the rabbits were divided into two groups: eyelid incisions of the right eye were closed by a 2-octyl cyanoacrylate adhesive (group A) and eyelid incisions of the left eye were closed by 7-0 nylon sutures (group B). At 1, 2, 4, and 8 weeks after surgery, the rabbits were macroscopically examined and then sacrificed. The specimens of their eyelid tissues were stained by a hematoxylin and eosin stain and Masson-trichrome stain, and were observed under microscope. RESULTS: Both eyelid surgical closure methods were found to be equally efficacious in fixing the eyelids of groups A and B, and their clinical efficacy was similar. Histopathological findings of the hematoxylin and eosin stain of group A showed less inflammatory infiltration than group B at 2 weeks. There were no significant histopathological differences between the two groups at 1, 4, and 8 weeks. The degree of fibrosis of the Masson-trichrome stain was similar between the two groups at 8 weeks. CONCLUSIONS: The 2-octyl cyanoacrylate adhesive proved to be an effective eyelid closure method and was very well tolerated by the skin surface. 2-Octyl cyanoacrylate could be used as an alternative tissue adhesive for eyelid wound closure along with conventional suture materials.

Analysis of Age-related Changes in the Lower Lid and Soft Tissue Using Computed Tomography

PURPOSE: The anatomic relationships of the lower lid and soft tissue between younger and older groups were compared using CT scans for confirming the negative vector relationship in the Korean population. METHODS: The study sample was composed of 100 patients with no history of previous surgery and no ocular disease. Two groups of 100 patients, younger (less than 30 years of age) versus older (above 50 years of age), were studied using CT scans. The distances from the anterior cornea to the lower lid fat, inferior orbital rim and anterior cheek mass were measured at the midpupillary plane. RESULTS: The mean age of the younger group was 22.0 years (ages 14 through 29), compared with 60.6 years (ages 53 thru 73) for the older group. Comparison of mean linear measurements revealed an anterior movement of the lower lid fat between younger and older groups (-5.09 mm vs. -3.50 mm, respectively, P < 0.01). A regression of the inferior orbital rim (-6.93 mm vs. -8.98 mm, P < 0.01) and anterior cheek mass (3.07 mm vs. 0.43 mm, P < 0.01) was observed with age in the sagittal cross section view. CONCLUSIONS: The present study demonstrates the orbital remodeling according to age in the Korean population. Because the negative vector is more common in the elderly and portends a greater risk for lower lid complications after surgery, surgeons need to consider the orbital remodeling according to age before surgery.

Comparision of Anterior Segment Parameters in Angle-Closure Glaucoma Using Scheimpflug Camera

PURPOSE: To compare anterior segment parameters in angle-closure glaucoma (ACG), primary open angle glaucoma (POAG), and normal subjects (N) using a Schiempflug camera. METHODS: Central corneal thickness (CCT), lens thickness (LT), axial length (AL), anterior chamber angle (ACA), anterior chamber depth (ACD), and anterior chamber volume (ACV) were measured in ACG (93 eyes of 92 patients), POAG (90 eyes of 87 patients), and normal (91 eyes of 88 subjects) with Pentacam(R) and A-scan. All of the results and measurements were then compared. RESULTS: Compared to normal and POAG patients, ACG patients presented with significantly different measurements of CCT, LT, AL, and ACA, ACD, and ACV (p<0.05). Further, correlations were high between three measurements (ACA, ACD, ACV) in ACG, and the best correlations were found in acute angle-closure glaucoma (P<0.05). CONCLUSIONS: By using a Schiempflug camera it was possible to assess the correlation between anterior segment parameters (ACA, ACD, ACV) in glaucoma patients. The best correlations were found in acute angle-closure glaucoma, and thus anterior segment parameters can offer reciprocally complementary information.

Changes of Contralateral Eyelid Position after Unilateral Blepharoptosis Repair

PURPOSE: To evaluate the effect of unilateral blepharoptosis repair on contralateral eyelid position. METHODS: The medical records of 39 patients who had undergone unilateral blepharoptosis repair were reviewed for preoperative and postoperative margin reflex distance (MRD). RESULTS: Of the 39 patients, 28 (71.8%) had congenital ptosis and 11 (28.2%) revealed acquired ptosis. Twenty-two (56.4%) patients were male and 17 (43.6%) were female. Ages ranged from 3 to 55 years (mean 15.3+/-20.1 years). After unilateral blepharoptosis repair, the postoperative mean (+/-SD) change in MRD of nonoperated eye was -0.3+/-0.7 mm at week one, -0.3+/-0.6 mm at three months, and -0.2+/-0.7 mm at six months. CONCLUSIONS: After unilateral blepharoptosis repair, 35.9% of patients had a decrease in contralateral eyelid height at postoperative 3 months and amount of decrease was 0.2+/-0.7 mm.

Power Vector and Aberrations Using Corneal Topographer and Wavefront Aberrometer Before and After Pterygium Surgery

PURPOSE: To determine the power vector and aberrations before and after surgery for pterygium using a corneal topographer and a wavefront aberrometer. METHODS: The study group consisted of 34 eyes of 31 patients with pterygium, and were divided into two groups by pterygium size ( or = 3 mm, group II). Power vector and wavefront aberrations were evaluated using a corneal topographer (Oculus inc., Germany) and a wavefront aberrometer (LADARWAVE(R), Hartmann shack aberrometer, Alcon inc., US) at pre- and postoperative 1 week, 1 month, and 3 months. RESULTS: The preoperative blurring strength (B) and high order aberrations significantly decreased at postoperative 3 months in all groups (P or = 3 mm). To reduce aberrations and astigmatism effectively, we suggested surgical intervention in eyes with pterygia sized < 3.0 mm.

Clinical Effects of Conjunctiva-Muller Muscle Resection in Anophthalmic Ptosis

PURPOSE: To evaluate the clinical effects of conjunctiva-Muller muscle resection through conjunctival incision in anophthalmic patients with mild ptosis. METHODS: Conjunctiva-Muller muscle resection was performed by one surgeon in 8 patients (8 eyes) who had received evisceration or enucleation and responded to 10% phenylephrine solution to correct ptosis. The average age of the patients was 35.87+/-13.4 years. Ptosis was seen from 1 to 34 months after evisceration or enucleation. The preoperative MRD 1 was -2 to 0.5 mm (average: -0.25+/-1.10 mm) and the difference of MRD 1 between before and after 10% phenylephrine use was 2.56+/-0.98 mm. The Muller muscle was resected 7.5 to 9 mm through conjunctival incision during surgery to match the MRD 1 of sound eye. Mean follow-up period after the operation was 2 to 16 months (average: 8.1 months). RESULTS: Postoperatively, the MRD 1 increased by 1.81+/-0.88 mm on the average, corresponding to the improvement in lid elevation after the use of 10% phenylephrine performed before resection. Surgery was successful in most patients, and postoperative difference in MRD 1 was less than 1 mm from the sound eye. No special postoperative complication was observed. CONCLUSIONS: Conjunctiva-Muller muscle resection is one of the effective methods of correcting mild ptosis in anophthalmic patients.

Clinical Effects of Conjunctiva-Muller Muscle Resection in Anophthalmic Ptosis

PURPOSE: To evaluate the clinical effects of conjunctiva-Muller muscle resection through conjunctival incision in anophthalmic patients with mild ptosis. METHODS: Conjunctiva-Muller muscle resection was performed by one surgeon in 8 patients (8 eyes) who had received evisceration or enucleation and responded to 10% phenylephrine solution to correct ptosis. The average age of the patients was 35.87+/-13.4 years. Ptosis was seen from 1 to 34 months after evisceration or enucleation. The preoperative MRD 1 was -2 to 0.5 mm (average: -0.25+/-1.10 mm) and the difference of MRD 1 between before and after 10% phenylephrine use was 2.56+/-0.98 mm. The Muller muscle was resected 7.5 to 9 mm through conjunctival incision during surgery to match the MRD 1 of sound eye. Mean follow-up period after the operation was 2 to 16 months (average: 8.1 months). RESULTS: Postoperatively, the MRD 1 increased by 1.81+/-0.88 mm on the average, corresponding to the improvement in lid elevation after the use of 10% phenylephrine performed before resection. Surgery was successful in most patients, and postoperative difference in MRD 1 was less than 1 mm from the sound eye. No special postoperative complication was observed. CONCLUSIONS: Conjunctiva-Muller muscle resection is one of the effective methods of correcting mild ptosis in anophthalmic patients.

The Comparison of The Matrix Perimetry and Humphrey Standard Perimetry in Various Patients Group

PURPOSE: To study the correlation between the Humphrey standard automated perimetry (SAP) and the Humphrey Matrix Frequency Doubling Technology (FDT) perimetry and diagnostic usefulness of the Humphrey Matrix FDT perimetry. METHODS: This study included 170 eyes of 170 patients. The 170 eyes were classified into 50 normal eyes, 20 ocular hypertensive eyes, 50 glaucoma-suspect eyes and 50 glaucomatous eyes. All subjects were examined with the Humphrey Matrix perimetry and the Humphrey standard automated perimetry. We studied the correlations between mean deviation (MD) and pattern standard deviation(PSD) of the Humphrey SAP and those of the Humphrey Matrix perimetry, respectively, in each of the classified group. RESULTS: Overall, MD and PSD of the Humphrey SAP were significantly correlated with MD and PSD of the Humphrey Matrix perimetry, respectively. However, MD and PSD of the Humphrey Matrix perimetry were not showed a significant correlation in normal subjects (P>0.05). CONCLUSIONS: In this study, there were significant correlations between the MD and PSD of the SAP and those of the Humphrey Matrix perimetry in glaucoma, glaucoma-suspect and ocular hypertension. These finding suggests the Humphrey Matrix perimetry has performance characteristics similar to SAP and diagnostic value.

The Effect of 4 Rectus Muscle Anterior Displacement in Porous Polyethylene Orbital Implant Exposure

PURPOSE: To investigate the effects of anterior displacement of four rectus muscles in exposure of porous polyethylene orbital implant (Medpor(R)). CASE SUMMARY: This retrospective study reviewed 4 eyes with exposed orbital implant who underwent evisceration with porous polyethylene orbital implant (Medpor(R)). The technique involves dissection of conjunctiva and tenon's capsule and isolation of four rectus muscles from sclera. Unsure if each muscle was sutured to each other or if a group of muscles were sutured to another group (i.e. superior and inferior to medial and lateral). Posterior tenon's capsule was closed interruptedly and conjunctiva was closed continuously. Orbital implant exposure was occurred at 2~36 months later after evisceration and implant insertion. One eye was noted wound dehiscence 1 week after operation, then re-suture was done. Re-exposure was notified in 1 eye at postoperative 3 months, but it was small, then we just observed. In other 3 cases, exposure was not identified till last follow up. CONCLUSIONS: Four rectus muscle anterior displacement procedure may be simple and useful method in exposure of orbital implant.

Conjunctival Epithelial Cells Auto-Cultivated In Vivo on Human Amniotic Membrane in Rabbits

PURPOSE: The purpose of this study was to investigate the phenotype of conjunctival epithelial cells auto-cultivated in vivo on human amniotic membrane (CIVAMs) in rabbits for ocular surface reconstruction. METHODS: A fornix based-conjunctival flap 8 mm in diameter was made in 12 eyes of rabbits. Amniotic membrane was implanted into the conjunctival defects. Rabbit conjunctival epithelial cells were cultivated in vivo on amniotic membrane for a week. A frozen section was made of the excised specimen. To investigate the phenotype of CIVAMs, Hematoxylin-eosin staining, immunohistochemical staining to anti-MUC5AC (monoclonal antibody to conjunctival goblet cell mucin), and transmission electron microscopy were performed. RESULTS In 11 of 12 eyes, conjunctival epithelial cells grew successfully on amniotic membrane. Light microscopy demonstrated two to three layers of cuboidal epithelial cells and two to three layers of stratified epithelial cells in CIVAMs. CIVAMs exhibited non-goblet epithelial differentiation as determined by immunohistochemistry to anti-MUC5AC. Transmission electron microscopy of CIVAMs showed fine structure similar to that of normal conjunctival epithelial cells. CONCLUSIONS: CIVAMs showed morphological findings similar to normal conjunctival epithelial cells and are expected to accomplish more rapid reconjunctivalization than simple amniotic membrane transplantation. We expect that CIVAMs will be adopted in treating conjunctival burn, symblepharon, conjunctiva-scleral ulcer, and filtering bleb leakage with conjunctival defects.

Conjunctival Epithelial Cells Auto-Cultivated In Vivo on Human Amniotic Membrane in Rabbits

PURPOSE: The purpose of this study was to investigate the phenotype of conjunctival epithelial cells auto-cultivated in vivo on human amniotic membrane (CIVAMs) in rabbits for ocular surface reconstruction. METHODS: A fornix based-conjunctival flap 8 mm in diameter was made in 12 eyes of rabbits. Amniotic membrane was implanted into the conjunctival defects. Rabbit conjunctival epithelial cells were cultivated in vivo on amniotic membrane for a week. A frozen section was made of the excised specimen. To investigate the phenotype of CIVAMs, Hematoxylin-eosin staining, immunohistochemical staining to anti-MUC5AC (monoclonal antibody to conjunctival goblet cell mucin), and transmission electron microscopy were performed. RESULTS In 11 of 12 eyes, conjunctival epithelial cells grew successfully on amniotic membrane. Light microscopy demonstrated two to three layers of cuboidal epithelial cells and two to three layers of stratified epithelial cells in CIVAMs. CIVAMs exhibited non-goblet epithelial differentiation as determined by immunohistochemistry to anti-MUC5AC. Transmission electron microscopy of CIVAMs showed fine structure similar to that of normal conjunctival epithelial cells. CONCLUSIONS: CIVAMs showed morphological findings similar to normal conjunctival epithelial cells and are expected to accomplish more rapid reconjunctivalization than simple amniotic membrane transplantation. We expect that CIVAMs will be adopted in treating conjunctival burn, symblepharon, conjunctiva-scleral ulcer, and filtering bleb leakage with conjunctival defects.

The Characteristics of Limbal Epithelial Cells Auto-Cultivated In Vivo on Amniotic Membrane in Rabbits

PURPOSE: To investigate the characteristics of the limbal epithelial cells auto-cultivated in vivo on amniotic membrane (LIVAMs) designed for the treatment of limbal stem cell deficiency. METHODS: We removed the epithelium of AM with a No.15 blade after it was blotted with 20% ethanol and made a 360 degrees stromal flap along the epithelial defect. We then mounted over-sized AM (1 mm larger in diameter than the defect) over the defect with the border of AM inserted under the flap, and performed interrupted suture with 10-0 nylon. A therapeutic contact lens was fitted over the AM and a temporary tarsorrhaphy was performed. To examine whether the limbal epithelial cells grew well onto AM, we observed the cornea after fluorescein dye staining using a slit lamp. To explore the characteristics of LIVAMs, we performed hematoxylin-eosin (H&E) staining, immunochemical staining with AK-2, AE-5, AM-3 monoclonal antibodies, and transmission electron microscopy. RESULTS: Three of four rabbits had successful epithelial growth on the amniotic membrane. The epithelial growth on the amniotic membrane was stained using immunohistochemical staining (AK-2, AE-5). Electron microscopy showed a structure similar to that of a normal corneal epithelium. CONCLUSIONS: The technique of auto-cultivation of limbal epithelial cells in vivo on amniotic membrane can be an efficient and convenient method and preserves the characteristics of limbal epithelial cells for the treatment of limbal stem cell deficiency.

The Effects of Amniotic Membrane for Prevention of Adhesion in Strabismus Surgery in Rabbits

PURPOSE: The formation of adhesion following strabismus surgery resulted in restrictive ocular motility dysfunction, recurrence, and failure of adjustable strabismus surgery. From these results, authors used amniotic membrane and evaluated its effect for prevention of adhesion in strabismus surgery in rabbit eyes. METHODS: Recession of superior rectus muscle was performed in 48 eyes of 32 rabbits. In 16 rabbits, both eyes were operated. Sixteen left eyes of 16 rabbits, control group, received no treatment after operation. In 16 right eyes of 16 rabbits, a sponge soaked in mitomycin C was applied after recession of superior rectus muscle. In 16 right eyes of other 16 rabbits, amniotic membrane transplantation was performed after procedure. After operation, 4 rabbits were sacrified in 24 hours, 2 weeks, 4 weeks, 3 months and evaluated the change of inflammation & fibrosis. The degree of inflammatory cell infiltration was evaluated on H & E stain and Masson-trichrome stain was performed to evaluate the degree of fibrosis. An immunohistochemical stain for alpha-smooth muscle actin was done for detection of myofibroblasts. RESULTS: On post-operation 24 hours and 2 weeks, the amniotic membrane-used group and the mitomycin C-used group showed less inflammatory cell infiltration than control group. On post-operation 2 weeks, 4weeks, and 3 months, amniotic membrane-used group and the mitomycin C-used group showed less fibrosis and fibroblast proliferation than control group (P<0.05). CONCLUSIONS: From these findings, authors conclude that the use of amniotic membrane transplantation after strabismus surgery is an effective method for prevention of postoperative adhesion.

Use of Temporalis Fascia for Frontalis Sling

PURPOSE: A wide variety of surgical materials have been used for blepharoptosis such as catgut, silicone, 4-0 nylon polyfilament cable-type ophthalmic suture (Supramid(R)), autogenous tendon (palmaris longus),banked sclera, dura mater, fascia lata, and temporalis fascia. The aim of this study was to evaluate the effect of frontalis suspensory surgery with temporalis fascia. METHODS: The authors studied 91 frontalis slings (71 patients) performed from 1993 to 1999 at our hospital for repair of blepharoptosis. Results with temporalis fascia (group A) as the suspensory material were compared to those with autogenous (group B) and preserved (group C) fascia lata. RESULTS: The success rates of group A (31 lids 21 patients), group B (28 lids 24 patients), group C (32lids 26 patients) were 80.6%, 75%, 78.1% respectively. But there was no statistically significant difference in each groups (P>0.05). CONCLUSIONS: We concluded that temporalis fascia for frontalis sling could be used as suspensory material successfully. Moreover, long term and further evaluations must be considered.

Change of Surface Carbohyd rate during Trans differentiation of Retinal Pigment Epithelial Cell

This study was conducted to study the changes of cell surface carbohydrates during transdifferentiation of retinal pigment epithelial(RPE)cells. RPE cells were cultured from adult pig eyes. Surface carbohydrates of RPE cells from 1st, 3rd, 5th, 7th and 9th passages were assayed by lectin histochemistry and enzyme immunoassay. Changes in binding affinities to the lectins employed were demonsrated during trasdifferentiation of RPE cell. Whereas binding affinities of ConA, ECL, PNA, WGA, and UEA-I decreased graudally as the number of culture passage increased, binding properties to LCA, STL and DBA fluctuated depending on the number of passages. The results demonstrate changes of surface carbohydrates of RPE cell during trasdifferentiation. We suggest that changes of surface carbohydrates of RPE cell during trasdifferentiation may be close relations with the functional changes during transdifferentiation.

The Efficacy of Topical 1%Brinzolamide (AzoptTM) as Combined Therapy of beta-blocker for Primary Open Angle Glaucoma and Ocular Hypertension

We investigated the effects of 1%brinzolamide on intraocular pressure (IOP)and peripapillary and optic nerve head (ONH)microcirculation with Heidelberg Retina Flowmeter (HRT)in primary open-angle glaucoma (POAG) and ocular hypertension. Primary open-angle glaucoma and ocular hypertension patients (60 eyes 60 person)were divided into 2 groups named A and B.In group A, patients had 1%brinzolamide and beta-blocker (30 eyes 30 person).In group B, patients had beta-blocker only (30 eyes 30 person).IOP and peripapillary and ONH microcirculation were measured before, 1 week, 2 weeks, 1 month, and 3 months after instillation and adverse effects were monitored. In group A, the rate of IOP decrease was 15.5%at 8:00 AM after 1 week of instillation, 17.6%at 4:00 PM after 1 week of instillation, 20.8%at 8:00 AM after 3 months of instillation, 20.8%at 4:00PM after 3 months of instillation, which were statistically significant.The adverse effects were rare including bitter tasting (3 eyes), transient visual disturbance (2 eyes), foreign body sensation (1 eye), etc.But there was no stastically significant change of microcirculation in both groups (P>0.05). We concluded that 1%brinzolamide had good effect for IOP decrease as an adjuvant medication to the beta-blocker.Moreover, long term and further evaluations are considered to be necessary.

Topographic Measurement of the Optic Nerve Head with Heidelberg Retina Tomograph (HRT) in Normal Korean

We analyzed the optic nerve head of 180 normal eyes (male 107 eyes,female 73 eyes) of Korean with Heidelberg Retina Tomograph (HRT), and obtained the mean value of each parameters and the difference between men and women with use of HRT. We also studied the distribution of the values of each parameter and influence of age on optic disc parameters in normal Korean. In addition, for the parameters of Rim/Disc area ratio, we measured the mean value in 6 divisions of optic nerve head. The range of each values was distributed widely and there were many variations in optic nerve head parameters. Height variation contour was statistically different between men and women. Cup volume and Maximal cup depth increased statistically with age. Further evaluation will be needed to analyze more accurate and highly reproducible analysis.