Intravitreal Bevacizumab Injection for Macular Edema Secondary to Branch Retinal Vein Occlusion: Long-Term Results

PURPOSE: To evaluate the long-term results of intravitreal bevacizumab injection for macular edema secondary to branch retinal vein occlusion (BRVO). METHODS: Fifty-six eyes with macular edema secondary to BRVO were treated with intravitreal bevacizumab injection. They were classified into two groups, one group that received three initial intravitreal bevacizumab loadings at monthly intervals and a second group that received only one initial injection. In the two groups, additive injection was performed at recurrence. The best corrected visual acuity (BCVA), central macular thickness (CMT) and retinal ischemic change was analyzed for more than 12 months postoperatively. RESULTS: After 12 months of follow-up, mean BCVA improved and mean CMT reduced significantly in both groups (p < 0.05). However, the range of BCVA improvement and CMT reduction was wider in the three-injection group than in the single-injection group. Fluorescein angiography revealed posterior retinal ischemic changes; bevacizumab didn't seem to aggravate the ischemic change. No drug-related ocular or systemic side effects were observed in the follow-up period after intravitreal bevacizumab treatment except subconjunctival hemorrhage and a mild increase of intraocular pressure. CONCLUSIONS: In patients with macular edema secondary to BRVO, intravitreal bevacizumab injection was a safe and effective treatment, and a more significant visual improvement and reduction of macular edema was achieved after three initial loadings rather than after a single injection.

A Case of Coexisting Neuromyelitis Optica in Systemic Lupus Erythematosus

PURPOSE: We present a case of a patient with coexisting neuromyelitis optica and systemic lupus erythematosus (SLE). CASE SUMMARY: A 26-year-old female was hospitalized in our medical center due to decreased visual acuity in her left eye; she had a history of gastric ulcers and herpes zoster infection. Steroid treatment was started under suspicion of optic neuritis, and she was diagnosed with SLE. After treatment, her vision improved, but eleven months later she was hospitalized with paresthesia on the abdomen and left flank progressing to the lower extremities. Spinal MRI showed transverse myelitis, suggesting multiple sclerosis. Fifteen months later, the patient was hospitalized due to decreased visual acuity and ocular pain in the right eye. Her vision was improved by steroid therapy. However, optic neuritis recurred in the right eye after five weeks, thus azathioprine was added to the treatment. Anti-aquaporin-4 Ab test was conducted based on the suspicion of neuromyelitis optica, and the serum was positive for anti-aquaporin-4 Ab (NMO-IgG). The patient was hospitalized again due to paraplegia after three months. Coexistence of neuromyelitis optica was verified because spinal MRI showed longitudinally extensive transverse myelitis. The symptoms were improved by high doses of steroids, a series of plasmaphereses, and rituximab. Optic neuritis was repeated in the right eye and the symptoms were improved with high doses of steroids. Myelitis recurred later and the symptoms improved with high doses of steroids and a series of plasmaphereses. CONCLUSIONS: Coexisting neuromyelitis optica should be considered in cases with relapsing events which have transverse myelitis without cranial lesions in autoimmune diseases such as SLE.

Cataract Extraction and Intraocular Lens Implantation in Megalocornea

PURPOSE: To report a case that underwent successful centration of intraocular lens (IOL) and visual acuity improvement after cataract extraction in a megalocornic eye in our medical center. CASE SUMMARY: A 27-year-old man with bilateral megalocorneas came to our medical center. The patient had progressive loss of vision and floaters in both eyes for 3 months. His horizontal corneal diameter was approximately 14 mm in both eyes. The initial best corrected visual acuity was 0.02 in the right eye and 0.5 in the left eye. There was a white cataract and nuclear sclerotic cataract without lens luxation, respectively. The cataract was extracted from the patient's right eye after anterior continuous curvilinear capsulorrhexis (CCC), the preloaded custom IOL was inserted in the bag, and pars plana vitrectomy was performed. Two months later, after the cataract was extracted from the left eye, optic capture through a posterior capsule was attempted but converted to anterior capsule (reverse optic capture) because of the posterior CCC's radial tear, and pars plana vitrectomy performed. The IOL had a 6 mm optic and an overall length of 12.5 mm. The IOL in the right eye was decentrated inferiorly in the bag due to a large capsule diameter, but the IOL captured through the anterior capsule in the left eye had good centration. The best corrected visual acuity of both eyes improved to 0.8 without other complications.

Clinical Application of Polyether Ester Urethane in Endonasal Dacryocystorhinostomy

PURPOSE: To evaluate the clinical effect of intraoperative application of polyether ester urethane (Nasopore(R)) in endonasal dacryocystorhinostomy. METHODS: Endonasal dacryocystorhinostomy was performed on 77 eyes diagnosed with nasolacrimal duct obstruction between January 2010 and February 2011. Nasopore(R) was applied to the newly-formed internal lacrimal opening in the experimental group (41 eyes), and vaseline gauze was applied in the control group (36 eyes). For the evaluation of clinical effects regarding postoperative adhesion and stenosis of the internal lacrimal opening, subjective symptom improvement, lacrimal irrigation tests, and endoscopic examinations were performed at 1 week, 2 weeks, 1 month, 3 months, and 6 months, postoperatively. RESULTS: In subjective symptom improvement and lacrimal irrigation tests, differences between the 2 groups were not statistically significant. In endoscopic findings, the Nasopore(R) group showed significantly lower severity of adhesion and stenosis of the internal lacrimal opening at 1 week, 2 weeks, and 1 month after operation (p < 0.05). CONCLUSIONS: Application of the Nasopore(R) may effectively reduce initial postoperative adhesion or stenosis of the internal lacrimal opening after endonasal dacryocystorhinostomy and has usefulness as an auxiliary method.

Expression of OD314 during ameloblast differentiation and maturation / 대한치과보존학회지

Ameloblasts are responsible for the formation and maintenance of enamel which is an epithelially derived protective covering for teeth. Ameloblast differentiation is controlled by sequential epithelial-mesenchymal interactions. However, little is known about the differentiation and maturation mechanisms. OD314 was firstly identified from odontoblasts by subtraction between odontoblast/pulp cells and osteoblast/dental papilla cells, even though OD314 protein was also expressed in ameloblast during tooth formation. In this study, to better understand the biological function of OD314 during amelogenesis, we examined expression of the OD314 mRNA and protein in various stages of ameloblast differentiation using in-situ hybridization and immunohistochemistry. The results were as follows : 1. The ameloblast showed 4 main morphological and functional stages referred to as the presecretory, secretory, smooth-ended, and ruffle-ended. 2. OD314 mRNA was expressed in secretory ameloblast and increased according to the maturation of the cells. 3. OD314 protein was not expressed in presecretory ameloblast but expressed in secretory ameloblast and maturative ameloblast. OD314 protein was distributed in entire cytoplasm of secretory ameloblast. However, OD314 was localized at the proxiamal and distal portion of the cytoplasm of smooth-ended and ruffle-ended ameloblast. These results suggest that OD314 may play important roles in the ameloblast differentiation and maturation.