Effective Delivery of Exogenous Compounds to the Optic Nerve by Intravitreal Injection of Liposome

PURPOSE: To improve the treatment efficiency of optic nerve diseases by delivering therapeutic materials to the optic nerve directly. METHODS: We tried to optimize liposomal composition to deliver a payload to the optic nerve efficiently when it is injected intravitreally. After loading dexamethasone into this liposome, we tested the therapeutic effect of liposomes in this treatment using a murine model of ischemic optic neuropathy. RESULTS: Our optimized liposome can deliver its payload to the optic nerve more efficiently than other tested compositions. Moreover, dexamethasone-loaded liposomes had a significant therapeutic effect in a murine model of ischemic optic neuropathy. CONCLUSIONS: Here, we demonstrate the optimal composition of liposomes that could efficiently deliver intravitreally injected exogenous compounds to the optic nerve. We expect that the intravitreal injection of liposomes with the suggested composition would improve the delivery efficacy of therapeutic compounds to the optic nerve.

Bilateral Arteritic Anterior Ischemic Optic Neuropathy Associated with Giant Cell Arteritis in Korea

No abstract available.

Prevalence and Factors Associated with the Use of Eye Care Services in South Korea: Korea National Health and Nutrition Examination Survey 2010–2012

PURPOSE: To estimate the factors and prevalence of eye care service utilization in the South Korean population. METHODS: This cross-sectional, population-based study included data from 22,550 Koreans aged ≥5 years who participated in the Korea National Health and Nutrition Examination Survey from 2010 to 2012. For people aged 5 to 11 years (young children), information was based on self-reports of contact with eye care service in the past year; for people aged ≥12 years (older population), the information was based on the self-reported lifetime contact with eye care service. Univariate and multivariate logistic regression analyses of the complex sample survey data were performed. RESULTS: The prevalence of eye care service use in young children during the past year was 61.1% (95% confidence interval, 58.1%–64.1%), while that in the older population during their lifetime was 73.5%. Subjects aged 7 to 11 years were more likely to have had an eye examination in the past year than subjects aged 5 to 6 years (odds ratio, 3.83; 95% confidence interval, 2.37–6.19). Multivariate logistic regression analysis indicated that higher monthly household income, being a National Health Insurance holder, and having private health insurance were related to more frequent use of eye care services in young children. For the older population and women, those living in an urban area and those with a best-corrected visual acuity less than 20 / 40 in the worse-seeing eye were more likely to have had an eye examination during their lifetime. Low education level was associated with low lifetime use of eye care services in the older population. CONCLUSIONS: There are sociodemographic disparities with use of eye care services in South Korea. This population-based study provides information that is useful for determining different intervention programs based on sociodemographic disparities to promote eye care service utilization in South Korea.

Clinical Usefulness of Spectral-Domain Optical Coherence Tomography in Glaucoma and NAION / 전남의대학술지

The development of optical coherence tomography (OCT) has changed the clinical management of ophthalmic diseases by furthering the understanding of pathogenesis, as well as improving the monitoring of their progression and assisting in quantifying the response to treatment modalities in ophthalmic diseases. Initially, the two-dimensional configuration of the optic nerve head (ONH) and the thickness of the retinal nerve fiber layer (RNFL) were the main OCT structural parameters used in clinical management of optic nerve diseases. Now, with higher resolution power and faster acquisition times, the details of ONH and the retina including the macular area can be measured using spectral domain OCT (SD-OCT) with high reproducibility and increased diagnostic ability. OCT can provide structural information to improve the understanding and management of optic nerve diseases. In this review, we will briefly summarize the clinical applications of SD-OCT in glaucoma and nonarteritic anterior ischemic optic neuropathy, which are two representative optic nerve diseases.

Clinical Usefulness of Spectral-Domain Optical Coherence Tomography in Glaucoma and NAION / 전남의대학술지

The development of optical coherence tomography (OCT) has changed the clinical management of ophthalmic diseases by furthering the understanding of pathogenesis, as well as improving the monitoring of their progression and assisting in quantifying the response to treatment modalities in ophthalmic diseases. Initially, the two-dimensional configuration of the optic nerve head (ONH) and the thickness of the retinal nerve fiber layer (RNFL) were the main OCT structural parameters used in clinical management of optic nerve diseases. Now, with higher resolution power and faster acquisition times, the details of ONH and the retina including the macular area can be measured using spectral domain OCT (SD-OCT) with high reproducibility and increased diagnostic ability. OCT can provide structural information to improve the understanding and management of optic nerve diseases. In this review, we will briefly summarize the clinical applications of SD-OCT in glaucoma and nonarteritic anterior ischemic optic neuropathy, which are two representative optic nerve diseases.

Arteritic Anterior Ischemic Optic Neuropathy Associated with Giant Cell Arteritis in an Elderly Korean Man

No abstract available.

Effect of Laser Photocoagulation and Intravitreal Bevacizumab Injection on Zone I Retinopathy of Prematurity

PURPOSE: To evaluate the efficacy and safety of laser photocoagulation and intravitreal injection of bevacizumab in zone I ROP (retinopathy of prematurity) accompanied with plus signs. METHODS: We performed a retrospective analysis of the records of 12 eyes of 7 premature infants with zone I ROP accompanied with plus signs, treated with diode laser photocoagulation and intravitreal injection of bevacizumab that were followed-up for at least 12 months. RESULTS: Mean gestational age was 30 + 2 weeks, mean birth weight was 1437 +/- 478 g, mean follow-up period was 14.7 +/- 2.0 months and mean age of diagnosis was 36 + 3 weeks. Plus signs were disappeared after an average of 10.1 +/- 2.4 postoperative days in all 12 eyes. The outcome was favorable in 11 (91.7%) of 12 treated eyes after a minimum of 12 months of follow-up. No local or systemic complications were observed. CONCLUSIONS: Laser photocoagulation and intravitreal injection of bevacizumab are effective and safe for treatment of zone I ROP accompanied with plus signs and require long-term follow-up.

Comparison of Functional Equator-Considering and Parks Methods in Bilateral Medial Rectus Recession for Esotropia

PURPOSE: To compare the surgical outcomes of functional equator-considering and Parks' methods in infantile esotropia and partially accommodative esotropia. METHODS: The medical records of 96 patients with infantile esotropia and partially accommodative esotropia who underwent bilateral medial rectus muscle recession by functional equator-considering and Parks' methods were reviewed retrospectively. The surgery success rate at 1 month, 3 months, 6 months and 12 months was compared by the deviation angle measurement. RESULTS: Overall success rates were not statistically different between the 2 groups. Additionally, there were no differences in surgical success rate of functional equator-considering and Parks' methods in infantile esotropia and partially accommodative esotropia. When the patients were divided into 2 groups based on 40 PD, no significant difference in success rate between the 2 groups was observed. When patients were divided into 2 groups based on 22 mm of axial length, there was no statistical difference observed. Postoperative overcorrection was 2 (4%) in the functional equator group and 3 (6.5%) in Parks' method group and postoperative undercorrection was 9 (18%, 19.6%) in each group. The incidence of undercorrection in the Parks' method group was significantly higher in the greater than 22 mm axial length group (7, 35.0%) than in the less than 22 mm group (2, 7.7%) (p = 0.029). CONCLUSIONS: There was no statistically significant difference in surgical success rate between the functional equator and Parks' methods in infantile esotropia and partially accommodative esotropia.

The Changes in the Clinical Features of Pediatric Ocular Trauma

PURPOSE: To review the recent changes in the clinical features of ocular trauma in pediatric patients younger than 15 years of age. METHODS: We performed a retrospective study using clinical records of 147 patients from 1993 to 1998, and those of 175 pediatric patients younger than 15 years old from 2003 to 2007. RESULTS: The most common cause of pediatric ocular trauma in the 2000's was fist blow (66 patients, 37.7%), while that in the 1990's was trauma by stick or branch (20 patients, 13.6%) (p < 0.001). The number of patients with perforating ocular trauma decreased to 25 patients (14.3%) in the 2000's, from 55 patients (37.4%) in the 1990's (p < 0.001). The number of patients who received surgery due to ocular trauma was 87 (59.2%) in the 1990's, decreasing to 53 (30.3%) in the 2000's (p < 0.001). The number of orbital wall reconstructions increased from 6 patients (6.9%) in the 1990's to 20 patients (37.7%) in the 2000's, a statistically significant increase (p < 0.001). CONCLUSIONS: Perforating ocular trauma decreased in children in the studied age range, but non-perforating injuries caused by fist blow were increased in the years studied. These results indicate that management or establishment of preventive for pediatric violence will be helpful to lower the frequency of pediatric ocular traumas.

The Relationship Between Bagolini Test and Other Sensory Tests and Surgical Outcome of Intermittent Exotropia

PURPOSE: To determine the surgical outcome of intermittent exotropia according to preoperative retinal correspondence with the Bagolini striated glasses test and the relationships between the Worth-4-dot test or stereoacuity with the B-VAT test. METHODS: We analyzed retrospectively preoperative fusion statuses with the Worth-4-dot test, stereoacuity with the B-VAT test and retinal correspondence with the Bagolini striated glasses test to determine any possible relationships with surgical outcome. The surgical outcome and binocular function were further investigated six months postoperatively in 114 patients who had undergone surgery for intermittent exotropia. RESULTS: The surgical outcome according to preoperative fusion status and stereoacuity was not statistically significant(p=0.38, p=0.59). whereas, preoperative retinal correspondence with the Bagolini striated glasses test was statistically significant(p<0.01). More over there was a relationship between retinal correspondence and fusion status or stereoacuity(p<0.01, p<0.01). CONCLUSIONS: The preoperative Bagolini striated glasses test was the factor predicting a favorable surgical outcome and there was a relationship between the preoperative Worth-4-dot test and the B-VAT test.

The Changes of Corneal Astigmatism and Refraction After Horizontal Rectus Muscle Surgery in Intermittent Exotropia

PURPOSE: To investigate changes in corneal astigmatism and refractive power in intermittent exotropia after lateral rectus recession with or without medial rectus resection. METHODS: We compared visual acuity, spherical equivalent, refractive power, astigmatism from cycloplegic refraction, and Orbscan corneal topography in two groups consisting of 40 eyes from 20 patients who underwent bilateral lateral rectus recession (Group 1) and 33 eyes from 33 patients who underwent monocular medial rectus resection with lateral rectus recession (Group 2) immediately preoperatively and at 1 and 4 weeks postoperatively. RESULTS: In Group 1, the refractive power changed +0.12 D on average in the horizontal median and -0.08 D on average in the vertical median at 1 week postoperatively. The refractive power changed +0.07 D on average in the horizontal median and -0.04 D on average in the vertical median at 4 weeks postoperatively. No significant change in the corneal astigmatic axis was detected. In Group 2, the refractive power changed +0.4 D on average in the horizontal median and -0.19D on average in the vertical median, and the corneal astigmatic axis significantly shifted by +0.51 D in the 'with-the-rule astigmatism' direction at 1 week postoperatively (p=0.02). However, the refractive power changed +0.2 D on average in the horizontal median and -0.09 D on average in the vertical median, and the corneal astigmatic axis changed +0.2 D at 4 weeks postoperatively, although these values were not statistically significant. CONCLUSIONS: Postoperative refractive power and corneal astigmatism did not change significantly, as compared to preoperative values, at 4 weeks postoperatively in the lateral rectus recession-only or medial-and-lateral rectus recession group.

A Case of Rectus Muscle Transposition With Silicone Band in Strabismus Fixus With High Myopia

PURPOSE: To present a surgical result of rectus muscle transposition with silicone band without suture on the sclera in strabismus fixus with high myopia. CASE SUMMARY: A 73-year-old female patient with a 20-year history of bilateral esotropia and hypotropia visited our clinic. The patient`s right eye was aphakic because crystalline lens removal was performed 17 years earlier and the left eye was phthisical after retinal detachment, due to high myopia. Ocular movements in both eyes were severely restricted in all directions with the cornea barely visible. Ultrasound examination revealed posterior staphyloma of the retina. The axial length measurement was 32 mm in the right eye, and could not be measured in the left eye. Posterior tenon fixation of the medial rectus and inferior rectus muscle tendon was performed, in addition, fixation of the lateral half of the superior rectus and superior half of the lateral rectus muscle on the silicone band 10 mm posterior to each muscle's scleral insertion as a transposition procedure was performed. At 6 months postoperatively, there was no residual esotropia or hypotropia. The right eye maintained a gaze limitation but improved abduction and supraduction. CONCLUSIONS: In strabismus fixus with high myopia, posterior tenon fixation and muscle transposition with silicone band is an effective method without complication.

Comparison of Frequency Doubling Technology Perimeter and RNFL Photography for Early Diagnosis of Glaucoma

PURPOSE: To compare the frequency doubling technology perimeter (FDT) with retinal nerve fiber layer (RNFL) photography as a tool for the early detection of glaucoma. METHODS: Ninety-eight eyes of 98 patients were evaluated over a period of 3 months. According to the results of RNFL photography and FDT, Patients were divided into four groups based on the results of RNFL photography and optical coherence tomography (OCT). A comparison of the RNFL thickness of each group was performed using the OCT results. RESULTS: RNFL thickness in the group with abnormal FDT and normal RNFL were significantly decreased from those in the group with normal FDT and RNFL photography at the 6, 7 and, 10 o'clock area (p<0.05). CONCLUSIONS: There were statistically significant differences in the RNFL thickness between the group with abnormal FDT and normal RNFL photography, and the group with normal FDT and RNFL photography within the limited areas. These results imply that FDT is more useful for the early detection of glaucoma than RNFL photography.

Anomalous Scleral Insertion of Superior Oblique in Axenfeld-Rieger Syndrome

Axenfeld-Rieger syndrome (ARS) is associated with ocular and systemic anomalies. PITX2 is known to be a major controlling gene in the pathogenesis of ARS and is associated with differentiation in both the neural crest and mesoderm during eye development. A 4-year-old girl with bilateral ARS had 20 prism diopters (PD) of exotropia with 30PD of A- pattern deviation, more than 20PD of dissociated vertical deviation (DVD), and severe superior oblique overaction (SOOA). During surgery we observed that the SO inserted more posteriorly than normal. We believe this finding is one of the abnormal manifestations of the development of the extraocular muscles in ARS.

The Efficacy of Imaging Diagnosis in Oculomotor Abnormalities

PURPOSE: To evaluate the usefulness of imaging diagnosis in patients with atypical oculomotor abnormalities and paralytic strabismus. METHODS: The magnetic resonance imaging (MRI) or computed tomography (CT) of 3 patients with atypical Y pattern vertical incomitance and medial rectus (MR) paresis after MR impingement reduction and A pattern vertical incomitance were analyzed. High-resolution, surface coil MRI was used to obtain sets of contiguous, 2-mm thick quasi-coronal images in 9-cardinal gaze directions. Digital image analysis was used to evaluate the results. RESULTS: MRI revealed lateral displacement of the superior rectus (SR) and inferior displacement of the lateral rectus (LR) during upper temporal gaze and inferior displacement of the LR during lateral gaze in patients with Y pattern vertical incomitance. In patients with MR paresis, the maximal surface area of MR cross section is in the image plane 10 mm posterior from the orbital center at primary gaze. The maximal surface area of MR cross section is in the image plane 22 mm posterior from the orbital center during medial gaze. Quasi-coronal images show that contraction tends to cause the plane of maximum cross-section to move posteriorly. Surgical treatment was avoided and observational treatment maintained. There is incyclotorsion of both extraocular muscles in patients with A pattern vertical incomitance and upslanted palpebral fissure. CONCLUSIONS: Imaging diagnosis of pulley position and rectus muscle contractility is helpful for determining accurate diagnosis and treatment methods at atypical oculomotor abnormalities and paralytic strabismus.

Chinese Cabbage Clubroot Pathogen, Plasmodiophora brassicae, Is Genetically Stable

Single spore isolates of Plasmodiophora brassicae e4 and e9 obtained from diseased Chinese cabbage were identified as race 4 and race 9, respectively, by the Williams' differential variety set. To confirm the possibility of variation in same generation and progeny of a single spore isolate of P. brassicae, random amplified polymorphic DNA (RAPD) analysis was conducted using the URP 3, 6 and OPA 7 primers. There was no difference in band type at each part of the gall of Chinese cabbage obtained by inoculation of e4 and e9 and amplification using the URP 3 and 6 primers when the same generation was analyzed. In addition, the progeny analysis, which was expanded to the third generation and conducted using the URP 3 and OPA 7 primers, revealed no differences in the band type of the e4 isolate. Based on these results, the single spore isolate of P. brassicae was genetically stable.

Comparison of Long-Term Results between One-piece and Three-piece Acrylate Intraocular Lens

PURPOSE: To compare the long-term clinical results of one-piece Acrysof(R) (SA60AT) hydrophobic acrylic intraocular lens (IOL) implantation compared with implantation of three-piece Acrysof(R) (MA60BM) hydrophobic acrylic IOL. METHODS: We retrospectively analyzed each 50 eyes of 50 patients underwent MA60BM or SA60AT IOL implantation and followed for at least 6 months. RESULTS: Final visual acuity of 0.5 or better was 38 eyes (76%) and 0.8 or better was 20 eyes (40%) in the SA60AT group. In the MA60BM group, it was 41 eyes (82%) and 23 eyes (46%) respectively. There were no significantly differences in predictability, intraocular pressure, endothelial cell density, astigmatism, and incidence of posterior capsule opacification between the two groups. Spherical equivalent at postoperative 1 week was -0.50+/-0.95D in SA60AT group and was -0.31+/-0.88D in MA60BM group (P=0.04). However, there was no significant difference between the two groups during follow up period. In MA60BM group, anterior chamber depth (P=0.02) and distance between iris and IOL (P=0.04) reduced significantly during the first postoperative month. CONCLUSIONS: Early postoperative axial displacement and changes in spherical equivalent can be occurred in MA60BM group. However there was no difference in long-term clinical results between SA60AT and MA60BM groups.

The Effect of Inferior Oblique Muscle Surgery in Congenital Superior Oblique Palsy

PURPOSE: To compare the postoperative results of inferior oblique muscle operation in congenital superior oblique palsy (CSOP) according to the preoperative vertical deviation. METHODS: This study reviewed medical records of 26 patients who were diagnosed as CSOP with the largest vertical deviation at adducted position and incomitant vertical strabismus from May 2003 to April 2004 at hospital. The patients were divided into two groups, the group 1 (18 patients) shows less than 20 prism diopter (PD) vertical deviation at the primary position, the group 2 (10 patients) shows no less than 20 PD vertical deviation at the primary position preoperatively. We performed operation of the inferior oblique muscle (IOM) for both group. We evaluated the surgical effect at the primary position and both lateral gaze after 3 months. and performed reoperation as needed. RESULTS: Mean correction amount of vertical deviation at primary position of two groups were 11.6+/-2.7 PD in the group 1 and 7.4+/-3.5 PD in the group 2. Postoperative vertical deviation was decreased compared to preoperative value and it was statistically significant. But there were statistically significant differences in the corrected amount after inferior oblique muscle operation between two groups at all gazes. Surgical result of group 1 was successful (100%), but in group 2, all failed (100%) and needed reoperation. CONCLUSIONS: This study showed that corrected amount with IOM operation was smaller in CSOP with no less than 20 PD vertical deviation at primary position and incomitant vertical strabismus. It may be taken into consideration when operation for rectus and oblique musle were performed simultaneously in CSOP.

Therapeutic Effect of Topical Testosterone Gel in Patients with Dry Eye Syndrome

PURPOSE: To evaluate the therapeutic effect of topical testosterone gel application to periocular area in dry eye. METHODS: Thirty-four eyes of 17 patients with refractory dry eye were included. Five patients had Sjogren's syndrome and 12 were non-Sjogren's syndrome patients. Testosterone gel was applied on the periocular area three times a day. Symptom score corneal sensitivity test (CST), tear film break-up time (BUT), basal tear secretion test (BST), fluorescein staining, tear clearance test (TCR), and conjunctival impression cytology were checked and evaluated before, one month after and two months after treatment. RESULTS: The mean symptom score before topical testosterone gel application was 3.44+/-0.70; it was 2.88+/-0.84 at 1 month after application and 2.03+/-1.09 at 2 months after application. The improvement of tear film parameters including BUT, tear clearance rate, fluorescein staining score, conjunctival metaplasia and goblet cell density was statistically significant (P<0.05) at one and two months after treatment but neither BST nor CST was improved with statistically significance. There was no difference in the therapeutic effect of topical testosterone gel between Sjogren's syndrome and non-Sjogren's dry eye patients. CONCLUSIONS: The function of tear film and the integrity of ocular surface improved after topical application of testosterone gel in dry eye patients. Topical testosterone gel application may be an effective adjuvant therapy for the treatment of dry eye.

The Use of Fibrin Glue for Conjunctival Autotransplantation in Pterygium

PURPOSE: To investigate the efficacy of fibrin glue for conjunctival autotransplantation in pterygium. METHODS: Forty eyes of 32 patients who underwent conjunctival autotransplantation for primary pterygium with a minimum follow-up period of 6 months were included. Postopertive pain, foreign body sensation, tearing, subconjunctival hemorrhage, surgery time, complication, and recurrence were evaluated prospectively in 20 eyes of 15 patients undergoing surgery with fibrin glue, and in 20 eyes of 17 patients undergoing surgery with sutures. RESULTS: One day postoperative, the scores of pain (P<0.01), foreign body sensation (P<0.01), tearing (P<0.01), and subconjunctival hemorrhage (P=0.01) were significantly lower in the fibrin glue group than in the suture group. One week postoperative, the scores of foreign body sensation (P=0.01) and tearing (P=0.01) were significantly lower in the fibrin glue group than in the suture group. Mean surgery time in the fibrin glue group (18 8 minutes) was significantly shorter than in the sutures group (32 11 minutes) (P<0.01). There was no significant difference in the recurrence rates of the two groups. CONCLUSIONS: Use of fibrin glue for conjunctival autotransplantation in pterygium can reduce postoperative discomfort and required surgical time.