Preliminary Effects of Oral Uridine on the Ocular Surface in Dry Eye Patients

We designed a randomized, double blinded, 3-months controlled prospective clinical study to investigate effects of oral uridine on the ocular surface in dry eye patients. Twenty-seven patients who diagnosed as dry eye with lower than 5 mm of wetting in the Schirmer strip, with corneal epithelial erosion and who completely followed-up till 3 months were enrolled. Corneal-conjunctival fluorescein staining, non-anesthetic Schirmer test, impression cytology, and Ocular Surface Disease Index (OSDI) were evaluated in the experimental and placebo groups at the baseline, 1 and 3 months after start of medication in a double blinded manner. Fluorescein stain score of the cornea was markedly decreased in oral uridine group compared to the placebo group at 3 months after medication (P=0.032, Mann-Whitney U test). The Schirmer wetting score for the oral uridine group was significantly increased (P=0.001, Wilcoxon signed rank test) at 3 months and its difference between two groups was statistically significant (P=0.030, Mann-Whitney U test). OSDI scores were significantly decreased at 1 and 3 months in treatment group. Oral uridine is effective in treatment of dry eyes.

Limbal Transplantation: A Midterm Clinical Outcome with Continuous Systemic Immune Suppression

PURPOSE: To investigate the midterm outcome of limbal transplantation combined with continuous systemic immune suppression. METHODS: The medical records of 15 eyes in 14 patients who underwent limbal transplantation were reviewed retrospectively. All had been followed up for 6 months or more. Limbal transplantation was performed with 360 degrees of 0.19 mm partial corneal trephined tissues, accompanied with transient amniotic membrane transplantation. The procedure was accomplished with systemic cyclosporine or mycophenolate. We defined complete success as neither rejection nor epithelial defect; partial success as partial conjunctival ingrowth and neovascularization without epithelial defect; and graft failure as persistent epithelial defect or total conunctivalization with neovascularization. RESULTS: Mean age at surgery was 45.1 years. 9 eyes yielded complete success, 2 had partial success, and graft failure occurred in 4 on an average of 23.4 months postoperatively. Success including complete and partial success showed 67% incidence (4 of 6) of chemical burn, 33% (1 of 3) with Stevens-Johnson syndrome, and 100% (6 of 6) experienced another intractable ocular surface disease. Of 10 eyes (67%), which experienced graft rejection in an average of 2.7 months; 4 demonstrated full recovery with oral corticosteroid and enhanced immunosuppression, 2 presented with chronic graft rejection, and the other 4 ended in graft failure. CONCLUSIONS: Total success rate was revealed as 73.3% for on average 23.4 months in limbal transplantation with continuous systemic immune suppression, utilized for chronic intractable ocular surface disease.

Limbal Transplantation: A Midterm Clinical Outcome with Continuous Systemic Immune Suppression

PURPOSE: To investigate the midterm outcome of limbal transplantation combined with continuous systemic immune suppression. METHODS: The medical records of 15 eyes in 14 patients who underwent limbal transplantation were reviewed retrospectively. All had been followed up for 6 months or more. Limbal transplantation was performed with 360 degrees of 0.19 mm partial corneal trephined tissues, accompanied with transient amniotic membrane transplantation. The procedure was accomplished with systemic cyclosporine or mycophenolate. We defined complete success as neither rejection nor epithelial defect; partial success as partial conjunctival ingrowth and neovascularization without epithelial defect; and graft failure as persistent epithelial defect or total conunctivalization with neovascularization. RESULTS: Mean age at surgery was 45.1 years. 9 eyes yielded complete success, 2 had partial success, and graft failure occurred in 4 on an average of 23.4 months postoperatively. Success including complete and partial success showed 67% incidence (4 of 6) of chemical burn, 33% (1 of 3) with Stevens-Johnson syndrome, and 100% (6 of 6) experienced another intractable ocular surface disease. Of 10 eyes (67%), which experienced graft rejection in an average of 2.7 months; 4 demonstrated full recovery with oral corticosteroid and enhanced immunosuppression, 2 presented with chronic graft rejection, and the other 4 ended in graft failure. CONCLUSIONS: Total success rate was revealed as 73.3% for on average 23.4 months in limbal transplantation with continuous systemic immune suppression, utilized for chronic intractable ocular surface disease.

The Effect of Intravitreal Triamcinolone Acetonide on Intraocular Pressure

PURPOSE: To evaluate the effect of a single intravitreal injection of 4.0 mg/0.1ml triamcinolone acetonide on intraocular pressure (IOP). METHODS: Retrospective studies were conducted by reviewing the charts of 26 eyes of 24 patients that were followed up for 16 weeks after intravitreal triamcinolone injection. The IOPs before and after triamcinolone injection were measured with Goldmann applanation tonometer. RESULTS: Within 16 weeks after intravitreal triamcinolone acetonide injection, 23 of 26 eyes (88.5%) demonstrated an increment in IOP of 5 mmHg or greater, and 6 of 26 (23.1%) had an increment of 10 mmHg or greater. The mean duration of the increase in IOP of 5 mmHg or greater was 5.5 weeks (standard deviation=4.4), and the mean time to reach maximum IOP was 6.6 weeks (standard deviation=4.4). The difference between the mean pre-injection IOP (14.12 mmHg, n=26) and the maximum post-injection IOP (24.65 mmHg, n=26) was statistically significant (P<0.001). All eyes that needed treatment responded to topical glaucoma medication. CONCLUSIONS: An increment in IOP is a common complication after a single intravitreal injection of 4.0 mg/0.1ml triamcinolone acetonide and despite this serious increment in IOP, it was controlled by topical glaucoma medication.

A Case of Bilateral Oculomotor Nuclear Palsy

To the best of our knowledge, isolated bilateral oculomotor nuclear palsy has not yet been reported in the literature, while bilateral oculomotor nuclear palsy with more widespread rostral brainstem infarction has often been reported. We present a patient having top of the basilar syndrome with midbrain infarction selectively involving the bilateral oculomotor nucleus. A 61-year-old woman with two episodes of vertebrobasilar infarction presented with sudden onset of bilateral ptosis. Examination revealed pronounced bilateral ptosis. In the primary position, fixation of either eye produced an approximately 50 prism diopter exotropia. Adduction of the right eye was restricted to the midline. There was moderately decreased adduction of the left eye, severe limitation of depression, and moderately decreased elevation of both eyes. Abduction of both eyes was normal. The pupils were equal, round, and reactive to light. Bilateral ptosis is suggestive of oculomotor nuclear palsy. On the basis of clinical findings alone, we could not establish whether the precise location of the lesion was all the subdivisions of the oculomotor nucleus except the Edinger-Westphal nucleus or the central caudal nucleus and bilateral fascicles. However, because axial MRI showed a small midbrain infarct in the oculomotor nucleus region, we concluded that she had an isolated, pupil-sparing, bilateral oculomotor nuclear palsy caused by midbrain infarct.