The Effect of Bevacizumab on Corneal Neovascularization in Rabbits

PURPOSE: To determine the efficacy of topical application and subconjunctival injection of bevacizumab in the treatment of corneal neovascularization. METHODS: Corneal neovascularization was induced with a silk suture of the corneal stroma in 12 rabbits (24 eyes). One week after suturing, four rabbits were treated with topical bevacizumab at 5 mg/mL (group A) and another four rabbits were treated with topical bevacizumab 10 mg/mL (group B) in the right eyes twice a day for two weeks. A subconjunctival injection of bevacizumab 1.25 mg/mL was done in the right eyes of four rabbits (group C). All of the left eyes (12 eyes) were used as controls. The area of corneal neovascularization was measured after one and two weeks, and the concentration of vascular endothelial growth factor (VEGF) in corneal tissue was measured after two weeks. RESULTS: The neovascularized area was smaller in all treated groups than in the control group (p<0.001). Upon analysis of the neovascularized area, there was no significant difference between groups A and B. However, the mean neovascularized area of group B was significantly smaller than that of group C after two weeks of treatment (p=0.043). The histologic examination revealed fewer new corneal vessels in all treated groups than the control group. The concentration of VEGF was significantly lower in all treated groups compared to the control group (p<0.01), but no difference was shown between treated groups. CONCLUSIONS: Topical and subconjunctival bevacizumab application may be useful in the treatment of corneal neovascularization and further study is necessary.

Two Cases of Acute Retinal Necrosis Treated With Systemic Antiviral Drugs and Intravitreal Antiviral Injections

PURPOSE:To report the use of intravitreal antiviral injections as adjunctive therapy in the managementof two immunocompetent patients with acute retinal necrosis. CASE SUMMARY: We performed two or three intravitreal injections of gancyclovir (2,000 microg/0.05 ml) on two patients (two eyes) with acute retinal necrosis resistant to intravenous acyclovir therapy (1,500 mg/m2/day). Both patients received intravitreal antiviral injections for the treatment of retinitis that progressed despite standard intravenous acyclovir therapy. The retinitis resolved, and visual acuity improved after 18 months of follow-up in both cases. CONCLUSIONS: Intravitreal antiviral injections may be a safe and efficacious adjunctive therapy in the management of patients with acute retinal necrosis resistant to intravenous acyclovir therapy.

The Intraocular Pressure Rise Secondary to Subtenon's Injection of Triamcinolone After Intravitreal Injection

PURPOSE: To evaluate the safety of posterior subtenon's injection of triamcinolone acetonide (PSTA) after intravitreal triamcinolone acetonide injection (IVTA). METHODS: We reviewed the charts of 34 patients who had previously treated with IVTA. Patients were categorized as steroid responder or non-responder. Responders were defined as having a relative intraocular pressure increase of 5 mmHg and absolute intraocular pressure greater than 24 mmHg. Relative risk of intraocular pressure was prospectively evaluated after PSTA. RESULT: Eighteen eyes were categorized as steroid responders after IVTA injection and sixteen eyes were categorized as non-responders. For the actual amount of increase in the intraocular pressures, the steroid responder group (39%) was shown to be statistically higher than the non-responder group (6%) (P=0.044). However, the mean pressure values did not show a significant difference (P>0.05). Only one eye required the use of glaucoma medications and the intraocular pressure remained normal after treatment. CONCLUSIONS: PSTA is a relatively safe treatment method after IVTA injection regardless of steroid responsiveness.

Herpes Zoster Ophthalmicus Complicated by Hyphema, Glaucoma and External Ophthalmoplegia

PURPOSE: To report a patient with herpes zoster ophthalmicus in whom hyphema, glaucoma and external ophthalmoplegia occurred. CASE SUMMARY: A 59-year-old male patient developed severe ocular pain and decreased visual acuity in his left eye 10 days ago. He had been diagnosed as herpes zoster ophthalmicus 14 days before and given antiviral agent. He could not percept light. His left eye showed hyphema, severe exudative iritis and elevated IOP. Lid drooping and complete external ophthalmoplegia were present in the left eye. Systemic corticosteroid with concomitant antiviral agents and antiglaucomatous agents was administered. RESULTS: Light perception did not recover and phthisis bulbi developed in his left eye at 2 months after the onset of the skin lesion. The patient showed gradual improvement in movement of the lid and external ocular muscle.

Current Trends in the Recognition and Treatment of Dry Eye: A Survey of Ophthalmologists

PURPOSE: Based on the questionnaires for dry eyes in 2006, we have investigated the current status and new trends in the recognition and management of the dry eye. METHODS: We ask the 15 questionnaires to 197 ophthalmologists. After reorganizing the data based on each questions, we compared the result with the most current studies in Korea and other countries as well. Then, we report the current trends in the diagnosis and treatment of dry eye. RESULTS: Dry eye patients account for take up about 20-30% of total outpatients and it is currently accepted etiology that dry eye inflammation is related to the function of the immune system. Patient's symptoms and slit lamp examination are important for diagnosis. An anti-inflammatory therapy is needed for patients with moderate to severe dry eye. CONCLUSIONS: Increasingly, there are positive attitudes toward accepting that persistent dry eye is an inflammatory disease; therefore, there are increases in use of an anti-inflammatory agent for treatment.

Corneal Epithelial Separation and Corneal Wound Healing Effect between Alcohol and Mechanical Device for Epithelial Flap

PURPOSE: Laser epithelial keratomileusis (LASEK) is a refractive surgery technique in which the cornea is covered with the epithelial flap after keratectomy. However, there have been reports of tissue damage by the alcohol utilized in this procedure while preparing the epithelial flap, which has led to novel methods. One of these is the mechanical designing of the epithelial flap named epipolis laser assisted in situ keratomileusis (Epi-LASIK). This study evaluates the histologic features and wound healing process of the corneal flap using Epi-Tome, which is the epithelial cutter of the newly introduced Epi-Lasik. METHODS: Twenty-four eyes of 12 dogs were devided into two groups. In one group (n=12), 20% alcohol was used and, in the other group (n=12), Epi-Tome (Gebauer, Germany) was used to make a corneal flap. The size change of a fluorescein-stained epithelial defect was followed postoperatively at 6, 12, 24, and 36 hours. RESULTS: The maximum decrease in defect size were observed at 0 to 6 hours in the Epi-Tome group, and from 6 to 12 hours in the alcohol group; the value were 10.01+/-5.32 mm2 and 9.23+/-4.75 mm2 respectively. Histologic review revealed that there was less tissue damage and smoother cut edge in the Epi-Tome group compared to the alcohol group, and the adhesion between stroma and epithelium was faster in the Epi-Tome group. CONCLUSIONS: Mechanically detached corneal flaps had favorable chances of survival such that re-epithelialization occurred early in the postoperative phase. A few epithelial fragments at a corneal section plane prevent corneal opacification and minimize inflammatory reaction, thus reducing postoperative pain.

Efficacy of Screening with Topical Steroids before Intravitreal Triamcinolone Injection

PURPOSE: To evaluate the efficacy of screening of high risk groups with topical steroids due to increased ocular pressure by intravitreal triamocinolone injection (IVTA). METHODS: We selected 96 eyes that had undergone IVTA between January 2003 and December 2004. The screening method used was as follows; We administered 4 drops daily of prednisolone (1%) eye drops for 3weeks and included patients with an intraocular pressure increase of less than 5 mmHg for the procedure. Two groups consisting of the post-screening IVTA group (group A) and non-screening group (group B) were classified, and intraocular pressure was measured using a Goldman applanation tonometer at 1 week, 1 month, 2 months, 3 months and 6 months after the procedure. RESULTS: One patient in group A (3.1%) required glaucoma medication compared with 10 patients in group B (17.9%), and one of these group B patients required surgical intervention. Chi-square analysis showed a statistically significant reduction in glaucoma medication use in group A compared with group B (P<0.05). Group B had a higher percentage of patients with an increase of intraocular pressure over 5 mmHg compared with values before the procedure, particularly in the second and third months after the procedure. CONCLUSIONS: IVTA after screening resulted in less use of glaucoma medication and a reduced rate of increase in intraocular pressure. Complications due to increased intraocular pressure by IVTA can be minimized by screening high risk groups.