Bilateral optic neuritis as first manifestation of systemic lupus erythematosus

A 21-year-old woman presented with bilateral optic neuritis, combined with central retinal vein occlusion. General physical examination and neurologic consultation revealed no other findings. Laboratory investigation yielded an elevated erythrocyte sedimentation rate, positive LE preparation, elevated ANA titer, and elevated blood urea nitrogen and creatinine levels. Diagnosis of systemic lupus erythematosus (SLE) was made. Renal failure developed quickly and she was treated with hemodialysis, transfusion and subsequently systemic corticosteroid. Anti-phospholipid antibody was positive to lupus anti-coagulant and the titer was normalized after 2-month steroid therapy at which time the visual outcome differed between the eyes. The right eye showed improvement in visual acuity and visual field, but the left eye was not improved and retained a central scotoma. SLE needs to be considered in young women with optic neuritis when other causes of optic neuritis have been excluded, and serologic tests including anti-phospholipid antibody should be conducted.

A Case of Valsalva-induced Subhyaloid Hemorrhage Nasal to the Optic Disc

PURPOSE: To report a case of valsalva hemorrhagic retinopathy. METHODS: A 14 year-old healthy man who presented with subhyaloidal and subretinal hemorrhages after blowing his nose over 30 times. RESULTS: Initial visual acuity was 20/20 and right fundal examination revealed peripapillary subhyaloidal and subretinal hemorrhages as well as vitreous hemorrhage. Fluorescein angiography demonstrated blocked fluorescences due to the hemorrhage and no leakage from the retinal vessels. At 4 week follow up, corrected visual acuity remained as 20/20 and subhyaloidal and vitreous hemorrhages were completely absorbed. Subretinal hemorrhage decreased significantly.

A Comparison of Frequency Doubling Technology N-30 and Humphrey Field Analyzer Central 30-2

To evaluate the validity of FDT as a field analyzer by comparing to Humphrey perimetry with global indeces.FDT is known as a easy to use and convenient device, and there is restriction in pupil size and refractive error within 7 diopters. Forty-two glaucoma patients[79 eyes]were included in this study. All subjects performed FDT N-30 and HFA C30-2 apart 15 minutes on same day.Mean age of subjects were 48.18 +/-16.46years[from sixteen to seventy four years].Twenty-five men and seventeen women were included in this study. Test duration was 4.92 +/-1.08 minutes with FDT N-30 and 13.79 +/-3.32 minutes with HFA C30-2.In global index mean deviation was 14.63 +/-9.52 decibel with HFA C30-2 and 10.33 +/-6 .8 3 decibel with FDT.There was a significant correlation with coefficient correlation 0.940 between two tests[p<0.01]. Pattern standard deviation was 7.89 +/-3 .8 5 decibel in HFA C30-2 and 7.80 +/-3.13 in FDT.There was a significant correlation with coefficient correlation 0.702 between FDT PSD and HFA C30-2 PSD, and 0.691 between FDT PSD and HFA C30-2 CPSD, too[P<0.01].In diagnosing glaucoma, sensitivity and specificity of FDT was 86% and 70% respectively. FDT is thought to be convenient and effective screening tool in glaucoma patients for with a high correlation with HFA C30-2.

The Effect of Genistein on the Glaucoma Filtering Surgery in Rabbit

No Abstract Available.

Comparison of the Intraocular Pressure Reducing E ffect of Latanoprost with Timolol

We compared the intraocular pressure reducing effect and side effects of 0.005%Latanoprost administered once daily with 0.5%Timolol administered twice daily in patients with open-angle glaucoma or ocular hypertension. This was an open randomized study with two parallel groups and a treatment period of 12 weeks. A total of 76 patients were included:38 in the Latanoprost group and 38 in the Timolol group. Intraocular pressure was reduced from 25.92 mms of mercury to 17.12 mms of mercury[33.91%]with Latanoprost and from 22.53 mms of mercury to 18.38 mms of mercury[18.42%]with Timolol. The efficacy of Latanoprost was statistically superior to timolol[p<0.001]. Latanoprost induced a slight conjunctival hyperemia and ocular discomfort but both drugs were generally well tolerated. Iris hyperpigmentation reported as a significant side effect of Latanoprost was not observed during 12 weeks of follow-up. It is concluded that Latanoprost administered once daily in the evening reduced intraocular pressure as well as and probably more than Timolol administered twice daily.

Comparison of Trabeculectomy and Medication Effects on Visual Field

To access the effects of trabeculectomy or medical treatment on automated visual field progression in glaucoma, a retrospective automated visual field data were obtained for those who underwent six Humphrey C30-2 field tests over at least 4 years. The first field data was excluded. Linear regression was performed with respect to mean deviation[MD], corrected pattern standard deviation[CPSD], and mean thresholds of Glaucoma Hemifield test[GHT]. Subjects were classified as progressive or stable based on the slope and statistical significance. There were 19 persons[25eyes]in surgery group and 16 persons [27eyes]in medication group. The levels of IOP in all subjects were maintained under 21 mms of mercury during all follow-up periods. There was no difference in mean postoperative IOP between both groups[p>0.05]. There were no significant dif-ferences in numbers of aggravation respect to MD, CPSD, and GHT between two groups of surgery and medication[p>0.01]. There was no differnce in the visual field outcome between two groups of surgery and medication with same level of IOP.

The Effects of Genistein on the Proliferation of Subconjunctival Fibroblasts in Rabbit

Failure of glaucoma filtering surgery most commonly results from excessive fibrosis and occlusion of the filtration site. Many drugs have been investigated to improve surgical results, but drugs that effectively suppress fibroblast activity with less side effects have not been found yet. Genistein, an isoflavonoid phytoestrogen found in soya bean and other legumes, has been reported as a potent inhibitor of tyrosine kinase and suppresses the receptor activation of many growth factors. In this study, the effect of genistein on the proliferation of subconjunctival fibroblast in rabbits were investigated. Cell proliferation was assayed after bFGF (10ng/ml), TGF-beta1 (10ng/ml), EGF (5ng /ml), PDGF (20ng/ml) in cultured rabbit fibroblasts and the effects of genistein on them were analyzed. Each growth factors stimulated fibroblast proliferation effectively. bFGF, TGF-beta1, EGF and PDGF stimulated cell growth by 183%, 163%, 134%, and 182% after 24 hours, respect- ively, and cell growths were increased up to 72 hours. Genistein 50 micrometer suppressed stimulated fibroblast growth by 36%, 46%, 65% and 43%in bFGF, TGF-beta1, EGF and PDGF stimulated samples 24 hours later respectively. Therefore, we speculate that genistein suppresses the proliferating activity of growth factor-induced fibroblasts in rabbit.

Surgical Result in Glaucoma Associated with Iridocorneal Endothelial Syndrome

Iridocorneal endothelial(ICE) syndrome is charaterized by unilateral glaucoma, abnormal corneal endothelium with proliferation, and iris stromal abnormalities. Uncontrolled glaucoma in ICE syndrome has been treated with filtering surgery, but the late failures occurred frequently. The medical records of nine patients with ICE syndrome that underwent glaucoma surgery were retrospectively reviewed. 6 eyes were progressive iris atrophy, and 3 eyes were Cogan-Reese syndrome. The success rates of primary trabeculectomy at 1 and 2 years were 57.1% and 33.3%, respectively. Ahmed glaucoma valve implant oeprations were performed on 6 eyes with failed previous filtering operation. 4 of 6 eyes resulted in controlled IOP until last follow up visit(mean ; 18.8 months). Overall, 1.9 times operations were needed to control IOP. Operations were performed only one time in 4 patients and two times in 3 patients to control IOP.

Central Corneal Thickness and Intraocular Pressure in Diabetes

To determine whether intraocular pressure is overestimated in diabetes with increased corneal thickness. Fifty-four patients with proliferative retinopathy and thirty-six control subjects were included in this study. Corneal thickness was measured by ultrasound pachymetry and intraocular with Goldmann tonometer in all subjects. There were no significant differences in age distribution between control and diabetes mellitus group (59.5 +/-10.4 years versus 60.6 +/-9.5 years). The corneal thickness was greater in patients with diabetes mellitus than in controls (566.8 +/-30.4 micrometerversus 549.9 +/-28.7 micrometer, p<0.05). The intraocular pressure was increased in diabetes mellitus than in controls, too (14.8 +/-2 .6 mmHgversus 13.1 +/-2.7 mmHg,p<0.05). The corneal thickness was correlated with the intraocular pressure (p<0.05). The increased intraocular pressure in diabetes mellitus is associated with increased corneal thickness.

The Acute Effect of Betaxolol and Difivefrin on Optic Nerve Head and Retinal Blood Flow in Normal Tension Glaucoma

The effect of betaxolol and dipivefrin on microcirculation of peripapil lary reina and optic disc in normal tension glaucoma was assessed. Betaxolol, selective beta-1 blocker, was known to improve the blood flow of retrobulbar arteries, and dipivefrin was known to decrease the flow of ciliary body. Total subjects were 29 normal tension glaucoma patients; 18 subjects with no previous IOP reducing eye drops during 4 weeks were assigned for betaxolol group, and 11 subjects with using timolol for dipivefrin group. The intraocular pressure was significantly reduced after instillation in betaxolol group(p<0.01), and in dipivefrin group(p<0.05). But systemic blood pressure and pulse rate were not changed after instillations in both groups. Blood flow, volume, velocity of optic disc and peripapillary retina of betaxolol group and dipivafrin group were not significantly changed. From the above results, we concluded that betaxolol and dipiverin with timolol did not influenced the microcirculation of peripapillary retina and opit disc.

Postoperative Ptosis after Cataract and Glaucoma Surgery

A retrospective study was done on 189 eyes of 156 patients who underwent cataract and/or glaucoma surgery to evaluate the effect of surgical technique, operation time, age of patients, mitomycin C use and superior rectus muscle injury on the incidence of postoperative ptosis. Interpalpebral fissure and levator funtion were measured preand postoperatively. All patients had topical and pin-point anesthesia. For the cataract patients, wire speculum was used and traction suture on superior rectus muscle was performed with 4-0 black silk. For the glaucoma patients, plate speculum was used and traction suture on superior rectus muscle was performed with 6-0 black silk. Decrease of the interpalpebral fissure over 2mm were observed in 7 of 115 eyes (6.0%) in cataract surgery, 5 of 51 eyes (9.8%) in glaucoma surgery and 3 of 23 eyes (13.0%) in triple surgery for cataract and glaucoma at postoperative 6 months. The variables significantly infuencing the incidence of ptosis were as follows; age of the patients (more than 50 years old. relative risk=1.7), operation time (more than 40 minutes, R.R=2.3) and mitomycin C use (R.R.=1.9). Development of superior rectus hematoma during the traction suture did not affect the incidence of postoperative ptosis.

The Influence of Age on Retinal and Optic Nerve Microcirculation in Normal Subjects

Perfusion disorder of the optic nerve head has been thought to be one of the risk factors glaucoma and studies on optic nerve perfusion have been performed recently. Heidelberg Retina Flowmeter(HRF: Heidelberg Engineering GbmH, heidelberg, Germany) is known to be useful in the evaluation of retinal and optic nerve head microcirculation. The objective of this study is to present the changes of retinal and optic nerve head blood flow with regard to the age in normal subjects, thus providing the reference values of retinal and optic nerve head microcirculation. Twenty subjects of each decade from third to eighth, total 120 were included in this study. Microcirculations were measured by HRF at nasal and temporal juxtapapillary retina, nasal and temporal neuroretinal rim, and optic cup area. The mean flow was measured to be 385.14 at temporal neuroretinal rim, 432.62 at nasal neuroretinal rim, and 157.12 at optic cup area. Student`s t-test revealed that there was o significant difference in flow between nasal and temporal neuroretinal rim(0.45), and between nasal and temporal juxtapapillary retina(p=0.36). Pearson`s correlation analysis revealed significant linear inverse relationship between the age and flow at neuroretinal rim(NRR) and juxtapapillary retina(JPR)(correlation coefficient r=-0.83, p=0.034 for NRR and r=-0.87, p=0.012 for JPR), but not at optic cup(r=-0.62, p=0.13).

Results of Surgical Management of Congenital Glaucoma

Congenital glaucoma is the disease that requires operation and its prognosis is not good. In our study, we estimated the operative results of congenital glaucoma. We retrospectively reviewed the medical records of 39 patients(65 eyes) who were diagnosed with and operated for congenital glaucoma since 1986 and followed at least 6 months thereafter. Operation included goniotomy, trabeculotomy, trabeculectomy, Holmium laser sclerostomy, and Seton operation. Twenty five patients were male and fourteen were female, and the mean age at diagnosis was 18.7 months. Mean operation number ws 2.5. Success rate after only one operation without further medication was 20.0%. Sucess rate after only one operation with or without medical treatment was 32.3%. Success rate after more than two operations was 50.8%, and overall success rate was 83.1%. First operation before 3 years of age and preoperative intraocular pressure below 25mmHg had the higher success rate. And initial cup to disc ratio has no influence on the success rate. In congenital glaucoma, they need mean 2.5 operations on the average for success.

Combined Phacoemulsification, Posterior Chamber Lens Implantation and Trabeculectomy in Advanced Glaucoma Patients

The treatment of the patients with coexisting cataract and glaucoma is various. It is possible that small conjuntival and scleral incisions, minimal conjunctival dissection, and less ocular inflammation could decrease wound healing stimuli.So, we studied the results of combined phacoemulsification, posteior chamber lesn implantation and trabeculectomy with or without mitomycin C (MMC) in advanced glaucoma patients with coexisting cataract. The preoperative, postoperative 1months and last follow-up intraocular pressures (mean+/-standard deviation) were 23.4+/-8.29, 12.8+/-2.95 and 14.1+3.37mmHg, respectively. Mitomycin C was applied to 13 eyes in high risk group offiltering bleb failure during the combined operation. The amount of postoperative intraocular pressure decrease was not significantly different between two groups. The preoperative and postoperative last follow-up visual acuities (mean) wer 20/200 and 20/30 in bot group, respectively. The complications were corneal epithelial defect, hyphema and posterior subcapsular opacity. But there wer no hypotony with symptomatic maculopathy and bleb leakage. Therefore combined phacoemulsification, posterior chamber lens implantation and trabeculectomy with or without mitomycin C appears to be a safe and effective surgical technique for treating advanced glaucoma patients with coexisting cataract.

Clinical Evaluation of Solitary Macular Hemorrhages

Authors reviewed the clinical datas of 22 patients who were visited to Kyung Hee Medical Center from 1991 to 1994 for solitary macular hemorrhages. Solitary macular hemorrhge was defined as unilateral, solitary hemorrhge located in macular area with no associated retinal or choroidal diseases. Of these 22 patients, seven (31%) were male, 15(69%) were female. Seven had hemorrahges on their right eyes and 15 had it on their left eyes. Authors classified the solitary macular hemorrhages according to the location of hemorrhages and the size of hemorrhages. In the follow-up period, patients with preretinal and intraretinal hemorrhages had revealed a better final visual acuity than patients with subretinal hemorrhges. Also visual prognosis was more better in patients with small sized hemorrhges than the patients with the large sized homorrhages.

Reproducibility of Optic Nerve Head Topographic Measurements with the Heidelberg Retina Tomograph

Laser scanning tomography is an accurate method for the three-dimentional assessment of the optic nerve head. But its topographic measurement should be highly reproducible for early diagnosis and follow-up of patients with glaucoma. The authors evaluated the reproducibility of optic nerve head topographic measurements by the Heidelberg retina tomograph(HRT). The mean standard deviation of height measurements and the mean coefficient of variation of each parameters were calculated on the 10 independent measurements in five normal eyes. The results showed that the mean standard deviation of height measurements was 29.19 microgram. The mean coefficient of variation of the cup area, rim area, rim volume, mean cup depth and the mean retinal nerve fiber layer thickness was under 10%. Optic nerve head topographic measurement by the HRT is highly reprooucible, which may help follow-up of glaucoma patients.

Effects of Antimetabolites on Proliferation of Rabbit Retinal Pigment Epithelial Cells

Inspite of technical advances, the need for pharmacologic treatment of proliferative vitreoretinopathy was increased. In order to evaluate the antiproliferative effect of various antimetabolites to the rabbit retinal pigment epithelial cell, we treated cultured rabbit retinal pigment epithelial cell with different concentration of drugs to perform dose inhibition studies. We found that the antimetabolites inhibited the proliferation of rabbit retinal pigment epithelial cell in a dose dependent and a time dependent manner. The drug concentration required for 50% inhibition of cell growth (ID50) were found to be as follows (BCNU; 6.51 mg/L, 5-FU ; 8.94 mg/L, Daunorubicin; 0.03mg/L, Mitomycin-C; 0.26mg/L).

Collagen Matrix Contraction by Cell of Proliferative Vitreoretinopathy

Epiretinal membrane by retinal detachment and proliferative vitreoretinopathy is mainly thought to be composed by choroidal fibroblast and retinal pigment epithelium. We, therefore evaluated the relative contractibility of cell-types thought to be involved in epiretinal membrane formation. Rabbit dermal fibroblast(RDF), were suspended in floating type I collagen matrix. The cells were used at a concentration of 200,000 cells per 1 ml of collagen matrix. The concentration of the collagen was adjusted to 3 mg/ml. Morphologic study of matrix contraction were performed by scanning and transmission electron microscopy. The contraction was found to be proportional to the serum concentration. Without the serum concentration, the contraction did not occur. Fibroblast contracted the matrix to 46% of its original area in 3 days and RPE contracted the matrix below 20% in 3 days. The cell free collagen matrix consisted of a mesh interweaving collagen fiber measuring 0.2 - 0.5 microgram in diameter, but the collagen fiber with fibroblast and RPE were aggregated to form a bundle to 2 micrometer in diameter. RPE and fibroblast reorganize the collagen matrix through celluar locomotion and attachment to collagen fiber. Fibroblast presented more potent contraction than RPE.

A Statistical Observation of Industrial Eye Injuries

The 362 industrial eye injuries among the 14374 out-patient who visited to Dept. of Ophthalmology, Wonju Christian Hospital, Yonsei University, College of Medicine from Jan. 1975 to Dec. 1980 were statistically evaluated. 1. Industrial eye injuries occupied 2.52% of all eye injuries. 2. The majority of industrial eye injuries was due to flying particles including dust and stones(28.04%), explosives(24.66%) which resulted in corneal foreign bodies(10.27%). 3. The final visual acuity of 82 eyes(21.98%) was 20/400 or less. And 36 eyes(9.65%) were absolutIy blinded. 4. The trade-distribution of industrial eye injuries was as follows; Stope mm(36.82%), Assistant(11.15%), Miscellaneous service (7.09%), 38.53% of industrial eye injuries of Stope men was injured by explosives.