Early changes in retinal structure and BMP2 expression in the retina and crystalline lens of streptozotocin-induced diabetic pigs / 한국실험동물학회지

PURPOSE: This study aims to evaluate early changes in retinal structure and BMP2 expression in the retina and crystalline lens by comparing streptozotocin-induced diabetic pigs and normal control group pigs. METHODS: Five eye samples from five diabetic Micro-pigs (Medikinetics, Pyeongtaek, Korea) and five eye samples from five control pigs bred in a specific pathogen-free area were used. Diabetes was developed through intravenous injection of nicotinamide and streptozotocin, and the average fasting glucose level was maintained at 250 mg/dL or higher for 16 weeks. To evaluate BMP2 expression in the retina and crystalline lens, Western blotting was performed. RESULTS: In Hematoxylin and Eosin staining, most diabetic pigs showed structural abnormalities in the inner plexiform layer. The number of nuclei in the ganglion cell layer within the range of 10⁴µm² was 3.78±0.60 for diabetic pigs and 5.57±1.07 for control group pigs, showing a statistically significant difference. In immunohistochemical staining, diabetic retinas showed an overall increase in BMP2 expression. In Western blotting, the average BMP2/actin level of diabetic retinas was 1.19±0.05, showing a significant increase compared to the 1.06±0.03 of the control group retinas (P=0.016). The BMP2/actin level of diabetic crystalline lenses was similar to the control group crystalline lenses (P=0.730). CONCLUSIONS: Compared to control group pigs, the number of nuclei in the inner nuclear layer of retinas from streptozotocin-induced diabetic pigs decreased, while an increase in BMP2 expression was observed in the retina of diabetic pigs.

Effects of Vitreomacular Traction on Ranibizumab Treatment Response in Eyes with Neovascular Age-related Macular Degeneration

PURPOSE: To investigate the effects of vitreomacular traction (VMT) on ranibizumab treatment response for neovascular age-related macular degeneration (AMD). METHODS: A retrospective review of 85 eyes of 85 patients newly diagnosed with neovascular AMD was conducted. Patients were eligible if they had received more than three consecutive monthly ranibizumab (0.50 mg) treatments and ophthalmic evaluations. Patients were classified into a VMT (+) group or VMT (-) group according to optical coherence tomography imaging. Best corrected visual acuity and central retinal thickness (CRT) measurements were obtained at three and six months after initial injection. RESULTS: One month after the third injection, mean visual acuity (VA) increases of 6.36 and 9.87 letters were observed in the VMT (+) and VMT (-) groups, respectively. The corresponding mean CRT values decreased by 70.29 microm and 121.68 microm, respectively. A total 41 eyes were identified as eligible for a subsequent fourth injection; 71.1% of patients (27 eyes) in the VMT (+) group but only 29.8% of patients in the VMT (-) group needed a subsequent fourth injection. Follow-up was extended to six months for 42 of the 85 enrolled patients (49.4%). The trends in VA and optical coherence tomography were found to be maintained at six-month follow-up. CONCLUSIONS: VA and CRT appeared to be more improved after ranibizumab treatment in the VMT (-) group compared to the VMT (+) group. VMT might antagonize the effect of ranibizumab treatment in a subpopulation of AMD patients.

Difference of GCIPL Thickness of Diabetes and Normal Eyes in Spectral Domain OCT

PURPOSE: To analyze the difference of the ganglion cell-inner plexiform layer (GCIPL) thickness in diabetic and normal eyes of patients using spectral domain optical coherence tomography (OCT) (Carl Zeiss Meditec, Dublin, CA, USA). METHODS: The authors compared and analyzed the difference of the GCIPL thickness measured with spectral domain optical coherence tomography (OCT) in 42 diabetic and 92 normal subjects. RESULTS: The study subjects were divided into 3 groups: 92 normal subjects, 22 diabetic patients without diabetic retinopathy, and 26 diabetic patients with diabetic retinopathy. Presence of diabetes mellitus (DM) or diabetic retinopathy did not influence the retinal nerve fiber layer (RNFL) thickness. The GCIPL thickness tended to be thinner especially in the superior sector GCIPL. The GCIPL thickness of normal subjects, diabetes patients without diabetic retinopathy, and diabetic retinopathy patients was 82.24 +/- 7.21 microm, 81.86 +/- 9.53 microm, and 76.77 +/- 14.13 microm, respectively, especially in the superior sector GCIPL (p = 0.029). CONCLUSIONS: Retinal ganglion cell layer thinning was induced by diabetes and diabetic retinopathy, and originated specifically from the superior part of the retina.

Influence of Patent Ductus Arteriosus and Its Treatment on Retinopathy of Prematurity

PURPOSE: This study investigated the influence of patent ductus arteriosus (PDA) and its treatment on incidence and progression of retinopathy of prematurity (ROP). METHODS: The authors retrospectively reviewed the medical records of 408 infants who underwent screening examinations for ROP at the Neonatal Intensive Care Unit of our hospital. RESULTS: The total incidence of ROP was 23.5% (96 out of 408) and the patients that needed treatment were 7.4% (30 out of 408). The mean birth weight and gestational age was 1406.1 grams and 30.67 weeks in patients without ROP, and 979.8 grams and 27.46 weeks in patients with ROP, respectively. In both total and very low birth weight (VLBW) patients, the incidence of ROP was higher in the PDA group than the non-PDA group, but the PDA group was an independent risk factor only in the VLBW group (p = 0.033). The incidence of threshold disease was not significantly different between the PDA and control groups (p = 0.757). There was no significant difference of incidence of ROP and threshold disease among the 3 treatment groups for PDA. CONCLUSIONS: In VLBW patients, the presence of PDA increased the risk of ROP and its progression, thus more attention is needed for PDA patients. However, there was no significant difference in ROP incidence and progression according to different PDA treatment methods.

Depression and Anxiety in Korean Patients with Age-Related Macular Degeneration

PURPOSE: To examine the degree of depression and anxiety in Korean patients with age-related macular degeneration (AMD) and to evaluate the influence of mood disturbance on patient's treatment satisfaction and compliance. METHODS: Forty-four patients with AMD and thirty-three controls comprised the study populations. Patients and controls rated themselves on the Korean Beck Depression Inventory (BDI) and Beck Anxiety Inventory (BAI). The effect of mood disturbance on the patient's satisfaction and compliance was evaluated. RESULTS: The depression and anxiety scores were significantly higher in patients with AMD. The mood disturbance was negatively correlated with the patient's satisfaction and compliance. 14 patients (31.8%) were lost to follow-up 1 year later. The depression and anxiety scores of these patients were higher than those of remaining thirty patients. CONCLUSIONS: Depression and anxiety of patients with AMD affect on patient's satisfaction and compliance. So recognition and management of mood disturbance may help improving visual function and maintaining quality of life in patients.

Prognostic Factors after Intravitreal Triamcinolone Injection for Macular Edema due to Branch Retinal Vein Occlusion

PURPOSE: To evaluate prognostic factors for improvement of visual acuity after intravitreal triamcinolone acetonide injection (IVTA) for treatment of macular edema (ME) secondary to branch retinal vein occlusion (BRVO). METHODS: Sixty-eight eyes of 68 consecutive patients treated with IVTA for ME due to BRVO were retrospectively reviewed. Patients were categorized into 2 groups according to the final visual acuity. The 'gainer group' consisted of eyes with a gain of 2 or more Snellen chart lines and the 'non-gainer group' consisted of eyes with less than 2 lines improvement or which had worsened at the last follow-up visit. Comparative clinical characteristics and ophthalmoscopic examinations were analyzed between the 2 groups. RESULTS: Out of the 68 eyes, 38 (56%) showed improved vision and were categorized as the gainer group; 30 eyes (44%) were categorized as the non-gainer group. The duration of symptoms in the non-gainer group was longer than the gainer group. Additionally, patients with a better baseline vision were expected to show greater improvement. The number of early visual acuity gainers who showed visual improvement at 1 month after IVTA was significantly higher in the gainer group. The number of eyes with angiographically documented macular ischemia was significantly higher in the non-gainer group. Existence of subretinal fluid has been identified as a positive factor for visual improvement. CONCLUSIONS: The cases with early treatment, good baseline visual acuity, case of favorable response to the initial IVTA, absence of macular ischemia, and baseline subretinal fluid are favorable prognostic factors for the outcome of visual acuity after IVTA for ME due to BRVO.

Three Various Cases of Retinal Hemorrhages Caused by Plasmodium vivax Malaria

PURPOSE: To report three various cases of retinal hemorrhages caused by Plasmodium vivax malaria. CASE SUMMARY: Two 55-year-old male patients and a 52-year-old male patient with cyclic high fever were admitted to the department of internal medicine. Three of the patients were diagnosed with malaria caused by P. vivax based on a peripheral blood smear. The patients were treated with hydroxychloroquine and premaquine but complained of decreased visual acuity. The patients were examined with funduscopy, fluorescein angiography, and optical coherence tomography. The first case showed 2 areas of retinal hemorrhages on the macular in the right eye and 1 area of retinal hemorrhage in the left eye. The second case showed many cotton-wool spots along with a number of small retinal hemorrhages and tortuous blood vessels in both eyes. The third case showed 1 area of retinal hemorrhage in the right eye and many cotton-wool spots in both eyes. CONCLUSIONS: P. vivax malaria rarely causes retinal hemorrhage. Manifestations of retinal hemorrhage and degree of visual acuity loss may vary among patients. P. vivax malaria should be considered when patients with unexplained high fever present with retinal hemorrhage, even without a history of overseas travel.

Intravitreal Bevacizumab Alone versus Combined with Macular Photocoagulation in Diabetic Macular Edema

PURPOSE: To compare the efficacy between intravitreal bevacizumab and combination treatment (bevacizumab and macular photocoagulation) for the treatment of diabetic macular edema (DME). In addtion, changes of DME type were researched using optical coherence tomography. METHODS: The present study included 90 eyes with bevacizumab injection and 38 eyes with combination treatment. Using chart records, patients were reviewed until 6 months after treatment. The present study compared changes of visual acuity (VA) and macular thickness at each follow up. DME was classified into 4 types and the morphologic pattern was compared. RESULTS: In patients with the bevacizumab injection only, VA improved from 0.29 +/- 0.18 to 0.48 +/- 0.26 at 1 month and returned to 0.32 +/- 0.20 at 6 months after treatment. In the combination treatment, VA improved from 0.32 +/- 0.22 to 0.52 +/- 0.26 at 1 month and returned to 0.36 +/- 0.18 at 6 months after treatment. There was no significant improvement of VA at the final follow-up with either treatment. There was significant decrease of macular thickness except in the mixed DME type. CONCLUSIONS: The combination treatment did not yield better VA or macular thickness reduction at 6 months than bevacizumab injection alone. By classifying and observing the change of DME type, determining the treatment objectively and predicting the effectiveness of treatment can be helpful.

Intravitreal Bevacizumab Alone versus Combined with Macular Photocoagulation in Diabetic Macular Edema

PURPOSE: To compare the efficacy between intravitreal bevacizumab and combination treatment (bevacizumab and macular photocoagulation) for the treatment of diabetic macular edema (DME). In addtion, changes of DME type were researched using optical coherence tomography. METHODS: The present study included 90 eyes with bevacizumab injection and 38 eyes with combination treatment. Using chart records, patients were reviewed until 6 months after treatment. The present study compared changes of visual acuity (VA) and macular thickness at each follow up. DME was classified into 4 types and the morphologic pattern was compared. RESULTS: In patients with the bevacizumab injection only, VA improved from 0.29 +/- 0.18 to 0.48 +/- 0.26 at 1 month and returned to 0.32 +/- 0.20 at 6 months after treatment. In the combination treatment, VA improved from 0.32 +/- 0.22 to 0.52 +/- 0.26 at 1 month and returned to 0.36 +/- 0.18 at 6 months after treatment. There was no significant improvement of VA at the final follow-up with either treatment. There was significant decrease of macular thickness except in the mixed DME type. CONCLUSIONS: The combination treatment did not yield better VA or macular thickness reduction at 6 months than bevacizumab injection alone. By classifying and observing the change of DME type, determining the treatment objectively and predicting the effectiveness of treatment can be helpful.

The Results of Nation-Wide Registry of Age-related Macular Degeneration in Korea

PURPOSE: To evaluate the incidence and clinical features of age-related macular degeneration (AMD) in Korea. METHODS: Web-based (www.armd-nova.or.kr) registration was conducted for AMD patients aged 50 or more who were newly diagnosed by retinal specialists in Korea from August 20, 2005 to August 20, 2006. Patient data including ophthalmologic examination, fundus photography, fluorescein angiogram and/or indocyanin green angiogram (ICG), past medical history, behavioral habit, combined systemic diseases were up-loaded. RESULTS: Among finally enrolled 1,141 newly diagnosed AMD patients, 690 patients (60.5%) were male and 451 patients (39.5%) were female. The average age of AMD patients was 69.7+/-8.0. Early AMD was observed in 190 patients and 951 patients had late AMD. Classic choroidal neovascular membrane (CNVM) was observed in 18.6% of exudative AMD patients and 63.4 % had occult CNVM. Subfoveal CNVM was observed in 80.4% of the patients with CNVM. Among the 580 exudative AMD eyes that performed indocyanin green angiography (ICG), 184 eyes (31.7%) had polypoidal choroidal vasculopathy (PCV) and 36 eyes (6.2%) showed retinal angiomatous proliferation (RAP). Age, male gender, smoking, diabetes and hypertension significantly increased the risk of the AMD among Koreans. CONCLUSIONS: Because of the low rate of participation by retinal specialists, definite incidence of AMD was not obtainable. However, the estimated 1-year AMD incidence in the Pusan area of Korea is at least 0.4%. In contrast to Western people, 31.7% of exudative AMD cases were revealed to be PCV and 6.2% were revealed to be RAP. This discrepancy between ethnic groups should be considered in the diagnosis and treatment modality selection of Korean AMD patients.

A Case of Valganciclovir Treatment for Cytomegalovirus Retinitis

PURPOSE: To report a case of a patient with cytomegalovirus (CMV) retinitis who was treated with oral valganciclovir. CASE SUMMARY: A 34-year-old man who had undergone anti-cancer chemotherapy for Non-Hodgkin lymphoma was referred to the ophthalmologic oncology clinic because of decreased vision in both eyes. Fundus examination showed white, opaque, and granular retinal lesions in both eyes, and a serologic test showed a positive response to CMV antibody IgG and a negative response to CMV antibody IgM. The patient received induction therapy with intravenous ganciclovir and maintenance therapy with oral valganciclovir 900 mg once daily. CMV retinitis reactivated 4 weeks after maintenance therapy was discontinued. At that point, the patient received induction therapy with oral valganciclovir 900 mg twice daily for 3 weeks and maintenance therapy with 900 mg once daily for 5 weeks. The retinal lesion disappeared and did not recur after oral administration of valganciclovir. The patient discontinued valganciclovir after 5 weeks of maintenance therapy, and CMV retinitis did not reactivate during 6 months of follow-up. CONCLUSIONS: Oral valganciclovir was clinically effective in the treatment of CMV retinitis in a patient who was treated with anti-cancer chemotherapy for non-Hodgkin lymphoma.

Relations between Age, Weight, Refractive Error and Eye Shape by Computerized Tomography in Children

PURPOSE: To investigate relationships between age, weight, refractive error, and morphologic changes in children's eyes by computerized tomography (CT). METHODS: Of the 772 eyes of 386 patients under the age of 20 years, who visited our Department of Ophthalmology between January 2005 to August 2006 and underwent CT of the orbit, 406 eyes of 354 patients with clear CT images and normal eyeball contour were enrolled in the present retrospective study. The axial lengths, widths, horizontal and vertical lengths, refractive errors, and body weight of eyes were measured, and relationship between these parameters were investigated. RESULTS: Axial length was found to correlate significantly with eye width (r=0.914), and in emmetropic eyes and myopic eyes, axial lengths and widths were found to increase as age and body weight increased. Axial lengths increased rapidly until age 10, and then increased slowly. In emmetropic eyes, widths / axial lengths increased with age, but in myopic eyes these decreased as age or severity of myopia increased. Moreover, as age increased, the myopic population and severity also increased. CONCLUSIONS: The axial length was longer in case of myopia compared to emmetropia in all age groups and there was almost no difference in the increase rate of axial length by the age of myopia and emmetropia. However, the width was wider in case of myopia compared to emmetropia in all age groups and the increase rate of width in myopia by age was smaller than that of emmetropia. Myopia showed decreasing rate of width/axial length with increase of age, from 1.004 in 5 years to 0.971 in 20 years. However, emmetropia showed increasing rate of width/axial length with increase of age, from 0.990 in 5 years to 1.006 in 20 years.

Effectiveness of ILM Peeling on Vitrectomy Patients with Diabetic Macular Edema

PURPOSE: To evaluate the effectiveness of a combined procedure of peeling the internal limiting membrane with vitrectomy in diabetic macular edema. METHODS: This study comprised 16 eyes of 16 patients hospitalized during a 1-year period. They were randomized to either a vitrectomy group (10 eyes in 10 patients) or to a combined procedure group (6 eyes in 6 patients). Preoperative and postoperative macular center thickness, best corrected visual acuity and postoperative complications 4 months postoperative were investigated. RESULTS: There were no statistically significant differences in the mean values of preoperative and postoperative best corrected visual acuity (logMAR) between the two groups. The mean values of preoperative and postoperative macular center thickness in the vitrectomy group were respectively 509.50+/-36.77 and 332.60+/-91.73; while in the combined procedure group, they were 516.17+/-55.43 and 333.83+/-51.64. Again, there were no statistically significant differences between the two groups. At the 4-month follow-up, decreased visual acuity was found in 3 eyes of the vitrectomy group and in 2 eyes of the combined procedure group. Vitreous hemorrhage (3 eyes) and tractional retinal detachment (1 eye) were found in the vitrectomy group and vitreous hemorrhage (2 eyes) was diagnosed in the combined group. CONCLUSIONS: In our study, vitrectomy with peeling of the internal limiting membrane was not more effective than vitrectomy alone in decreasing macular edema or in improving best corrected visual acuity. Additional studies of the combined procedure are needed to verify this result.

Factors Affecting the Visual Outcome after Scleral Buckle in Rhegmatogenous Retinal Detachment Involving Macula

PURPOSE: To investigate the factors affecting the visual outcome after a scleral buckle in a rhegmatogenous retinal detachment involving the macula. METHODS: A retrospective survey of 70 eyes was carried out. The preoperative factors examined in this study included the preoperative visual acuity, the patient's age, the duration of macular detachment, the extent of the detached retina, the location of the retinal hole, and the surgical procedure. The correlation between these factors and the postoperative visual outcome were investigated. RESULTS: The factors related to a favorable visual outcome were the preoperative visual acuity, age, the duration of macular detachment, surgical procedure, and the location of the retinal hole. A preoperative visual acuity of 0.1 or more, an age of 30 years or less, a detached retina of 2 quadrants or less, and duration of macular detachment of 7 days or less were factors that indicated a favorable visual outcome. The surgical procedure and the location of the retinal hole were not associated with the visual outcome. CONCLUSIONS: The factors related to a favorable visual outcome were a preoperative visual acuity of 0.2 or higher, an age of 30 or less, a detached retina of 2 quadrants or less, and duration of the macular detachment of 7 days or less. The location of the retinal hole, however, did not affect the visual outcome.

Incidence, Treatment and Prognosis of Terson's Syndrome

PURPOSE: To investigate the incidence of Terson's syndrome, to find the proper time for its treatment, and to give a prognosis of visual acuity. METHODS: In order to investigate the incidence of Terson's syndrome, 228 patients were taken as the subjects of this study from among the total 275 patients who had been hospitalized in the neurosurgical department for a year. Forty-seven patients were excluded who developed vitreous hemorrhage due to any cause other than intracranial hemorrhage and could not be followed up for three months. In the fundus examination of study subjects, the incidence of Terson's syndrome based on preceding diseases and the patient age, and prognosis of visual acuity with surgical treatment were analyzed according to the Snellen chart, along with nine eyes of seven patients who showed vitreous hemorrhage. RESULTS The average incidence of Terson's syndrome between groups was 3.1%; it was 3.7% for patients with subarachnoid hemorrhage and 2.6% for the other patients (subdural hemorrhage, epidural hemorrhage). The 29% of the subjects were due to binocular involved. Patients in their 40's and 50's accounted for 6.0%, which was higher the percentage of any other age group. The decision as to whether or not to surgically treat Terson's syndrome was made based on the extent of visual acuity improvement during the three months after vitreous hemorrhage development. Thus, we observed comparatively good long-term prognoses for visual acuity and a low frequency of complications occurring. CONCLUSIONS: We expect a relatively good prognosis of visual acuity and a low occurrence of complications. More research similar to this case-control study is needed to confirm the usefulness of such therapy.

Incidence, Treatment and Prognosis of Terson's Syndrome

PURPOSE: To investigate the incidence of Terson's syndrome, to find the proper time for its treatment, and to give a prognosis of visual acuity. METHODS: In order to investigate the incidence of Terson's syndrome, 228 patients were taken as the subjects of this study from among the total 275 patients who had been hospitalized in the neurosurgical department for a year. Forty-seven patients were excluded who developed vitreous hemorrhage due to any cause other than intracranial hemorrhage and could not be followed up for three months. In the fundus examination of study subjects, the incidence of Terson's syndrome based on preceding diseases and the patient age, and prognosis of visual acuity with surgical treatment were analyzed according to the Snellen chart, along with nine eyes of seven patients who showed vitreous hemorrhage. RESULTS The average incidence of Terson's syndrome between groups was 3.1%; it was 3.7% for patients with subarachnoid hemorrhage and 2.6% for the other patients (subdural hemorrhage, epidural hemorrhage). The 29% of the subjects were due to binocular involved. Patients in their 40's and 50's accounted for 6.0%, which was higher the percentage of any other age group. The decision as to whether or not to surgically treat Terson's syndrome was made based on the extent of visual acuity improvement during the three months after vitreous hemorrhage development. Thus, we observed comparatively good long-term prognoses for visual acuity and a low frequency of complications occurring. CONCLUSIONS: We expect a relatively good prognosis of visual acuity and a low occurrence of complications. More research similar to this case-control study is needed to confirm the usefulness of such therapy.

Comparision of Results of Electroretinogram, Fluorescein Angiogram and Color Vision Tests in Acute Central Serous Chorioretinopathy

PURPOSE: This paper investigates the correlation of the electroretinogram (ERG) with fluorescein angiography (FAG) and the color vision test among those who have acute central serous chorioretinopathy (CSCR). METHODS: The study was performed with 30 patients who had one CSCR-affected eye but the other unaffected. RESULTS: ERG showed that the b-wave amplitudes in the affected eyes decreased significantly compared to those in the unaffected eyes (P<0.05) and that there were no significant changes in a-wave or implicit time. FAG revealed that the b-wave amplitude decreased significantly when the leaking point was within a distance of 1/4 disk diameter from the fovea center, compared to when it was more distant (P<0.05). The amplitude also reduced significantly when the size of retinal detachment was more than 1 disk diameter compared to when it was less (P<0.05). The affected eyes which showed abnormality in color vision test decreased significantly a- and b-waves compared to the unaffected eyes in the test (P<0.05). CONCLUSIONS: In acute CSCR patients, the correlation of ERG with FAG showing size of retinal detachment, the location of leaking point and the color vision test was statistically significant. Therefore, ERG could be used to assess the affecting degree of the disease.

Change of Residual Period and Clearance Rate of Intravitreal Triamcinolone According to Initial Injection Dosage

PURPOSE: We sought to determine how the initial concentration of triamcinolone acetonide injected intravitreally might influence the clearance and residual period of the intravitreal triamcinolone acetonide. METHODS: Sixty-four eyes of 32 rabbits were divided into 4 groups. Each group was injected with 5, 10, 15, or 20 mg/0.1 ml of triamcinolone acetonide intravitreally. At 1, 7, 14, and 28 days after intravitreal injection, four eyes were obtained from each group by sacrificing two rabbits. The vitreous bodies were obtained and prepared for HPLC analysis. The concentrations of triamcinolone acetonide were quantitated by HPLC with fluorescence detector. We compared the data using the logarithmic regression coefficients of each line. RESULTS: The elimination half-lives of the intravitreal triamcinolone acetonide were 3.23 days, 3.73 days, 4.11 days, and 4.98 days at the initial injection doses of 5, 10, 15, and 20 mg per 0.1 ml, respectively. Compared to the 5 mg initial dose, the clearance rate of the intravitreal triamcinolone acetonide was decreased 1.15 times, 1.27 times and 1.55 times at 10 mg, 15 mg, and 20 mg of the initial dose, respectively. CONCLUSIONS: The residual duration of intravitreal triamcinolone acetonide was prolonged as the initial concentration of intravitreal injection increased. Furthermore, the clearance rate decreased as the injection dose is increased. This shows that higher injection doses of triamcinolone acetonide induce not only an increased intravitreal concentration, but also prolonged the duration of effectiveness.

Transthoracic Echocardiography and Carotid Doppler Ultrasound for Detection of Cardiac and Carotid Artery Disease in Patients with Acute Retinal Artery Obstruction

We reviewed the medical records of patients with acute retinal artery obstruction (RAO) and evaluated the importance of transthoracic echocardiography (TTE) and carotid Doppler ultrasound in determining causes of cardiac and carotid artery origin in RAO. A retrospective case study conducted in the Department of Ophthalmology, Inha University Hospital, Korea comprised 26 patients presenting with acute RAO who underwent systemic evaluation, TTE and carotid Doppler ultrasound between June 1, 1997 and December 31, 2003. Among these 26 patients, abnormal cardiac findings were detected in 12 (46%) and abnormal carotid findings in 4 (15%). Furthermore, other risk factors for RAO were found in 2 (8%) and stroke broke out within 7 months after experiencing RAO in 4 (15%) of the 26 patients. In patients with acute RAO, TTE and carotid Doppler ultrasound play an important role in pinpointing the origins of retinal emboli. It is thought that TTE and carotid Doppler ultrasound may be essential examinations for determining the underlying cause, planning treatment strategies, and preventing stroke and death.

The Alteration of Accommodative Power after Scleral Buckling and Pars Plana Vitrectomy

PURPOSE: To evaluate the effect of scleral buckling and pars plana vitrectomy on accommodative power. METHODS: The study groups consisted of 30 eyes after buckling and 30 eyes after pars plana vitrectomy. Each control group comprised 30 eyes. Accommodative power, pupil diameter and anterior chamber depth were measured and the correlation coefficient to accommodative power was calculated. RESULTS: There was no statistical significance in the buckling group. In the pars plana vitrectomy and control groups, the accommodative powers were 4.03 +/- 2.30D and 2.26 +/- 2.70D (p0.8 or r<-0.8). CONCLUSIONS: After pars plana vitrectomy, the accommodative power was increased, which suggested that the anatomical and structural change of the vitreous after pars plana vitrectomy influences the accommodative power.