The Change of Anterior Chamber Parameters with Pentacam(R) after Intravitreal Injection

PURPOSE: To evaluate the changes of anterior chamber parameters and intraocular pressure (IOP) with Pentacam(R) after intravitreal injection. METHODS: A total of 76 eyes of 76 patients received an intravitreal injection of either triamcinolone acetonide (TA) or bevacizumab. Twelve patients were treated with an intravitreal injection of TA 0.1 ml, 16 patients were treated with an intravitreal injection of TA 0.05 ml, while the remaining 48 patients received a bevacizumab 0.05 ml injection. All patients underwent anterior chamber depth, anterior chamber angle, and anterior chamber volume evaluation with Pentacam(R) before and 5 minutes after injection. Additionally, IOP measurements were taken 5 minutes before and 5 minutes, 30 minutes, 1 hour and 1 day after injection. RESULTS: Anterior chamber depth, anterior chamber angle, anterior chamber volume, and IOP changes in patients receiving TA 0.1 ml were 0.4 +/- 0.11 mm, 10.2 +/- 4.1degrees, 33.7 +/- 5.9 mm3 and 18.8 +/- 12.1 mm Hg, respectively. Anterior chamber depth, anterior chamber angle, anterior chamber volume, and IOP changes in patients receiving TA 0.05 ml were -0.01 +/- 0.05 mm, 2.4 +/- 3.2degrees, 5.8 +/- 9.5 mm3 and 4.8 +/- 7.4 mm Hg, respectively. Anterior chamber depth, anterior chamber angle, anterior chamber volume, and IOP changes in patients receiving bevacizumab were 0.28 +/- 0.99 mm, 0.8 +/- 4.0degrees, 7.1 +/- 9.6 mm3 and 5.4 +/- 6.3 mm Hg, respectively. There was a significant difference between TA 0.1 ml and 0.05 ml. However, there was no significant difference between TA 0.05 ml and bevacizumab 0.05 ml. CONCLUSIONS: Because of similar anterior chamber parameters changes after 0.05 ml intravitreal injection with TA or bevacizumab, early period IOP increases due to intravitreal volume expansion. Intravitreal 0.05 ml injections do not require any other procedures for controlling IOP 30 minutes after injection.

Gene Expression Changes in a Rat Model of Oxygen-Induced Retinopathy

PURPOSE: To identify altered patterns of retinal mRNA expression in a rat model of oxygen-induced retinopathy (OIR). METHODS: Sprague-Dawley rats from P2 to P14 were exposed to hyperoxia (80% oxygen) to induce OIR and then returned to normoxic conditions. Control rats were sustained in room air. Retinal gene expression between the rats of OIR and the controls was compared using cDNA microarray analysis. Reverse transcriptase polymerase chain reaction (RT-PCR) was used to verify the microarray results. RESULTS: Among a total of 12,731 cDNAs analyzed by mircroarray, 13 genes were strongly up- or down-regulated (>2-fold change over controls) in the OIR rats. We found a significant increase in expression of 10 genes (CaM-kinase II inhibitor; acidic nuclear phosphoprotein 32 family, member A; vascular endothelial growth factor; interferon alpha-inducible protein 27-like; similar to enthoprotin, epsin 4, clathrin interacting protein; nidogen [entactin]; tubulin, beta5; fibrillin-1; spectrin beta2; and stearoyl-coenzyme A desaturase 2) and a significant decrease in expression of 3 genes (myelin-associated oligodendrocytic basic protein, heat shock protein, and decorin) in OIR rats compared to controls. CONCLUSIONS: We confirmed changes in expressions of various retinal genes in a rat model of OIR by microarray and RT-PCR. This study should contribute to the understanding of genetic indicators associeated with OIR.

A Case of Fungal Keratitis Caused by Drechslera Species

PURPOSE: To report a case of fungal keratitis caused by Drechslera species. CASE SUMMARY: A 77-year-old man visited our clinic complaining of left ocular pain and decrease of visual acuity for 1 week On slit-lamp examination, epithelial defect and stromal infiltration on the corneal center with numerous inflammatory cells in the anterior chamber were found. There was no improvement after routine antibiotic treatment. A corneal biopsy and culture were performed on the corneal lesion. The KOH smear study reported hyphae, thus the patient was treated with 0.25% amphotericin B, 0.2% fluconazole and 5% natamycin eye drops. A clinical improvement was observed on the corneal lesion and Drechslera species was identified by the culture study. CONCLUSIONS: The authors report an experience of fungal keratitis caused by Drechslera species.

A Case of Chorioretinal Coloboma in a Patient with Achondroplasia

Achondroplasia is a congenital disorder resulting from a specific disturbance in endochondral bone formation. The ophthalmic features reportedly associated with achondroplasia are telecanthus, exotropia, inferior oblique overaction, angle anomalies and cone-rod dystrophy. This is first report of chorioretinal coloboma in achondroplasia. An 8-year-old female was diagnosed with a developmental delay, known as achondroplasia, seven months after birth. Upon her initial visit, visual acuity was 0.3 in both eyes. The patient had telecanthus but normal ocular motility. Findings were normal upon anterior segment examination. Fundus examination of both eyes revealed about 1,500 microm sized chorioretinal coloboma inferior to the optic nerve head. Upon fluorescent angiography, there was chorioretinal coloboma without any other lesions. Afterward, there was no change in the fundus lesion, and best corrected visual acuity was 0.6 in both eyes. Chorioretinal coloboma is associated with choroidal and retinal detachment. As chorioretinal coloboma and achondroplasia are developmental disorders in the embryonic stage, early detection and regular ophthalmologic examination would be essential in patients with achondroplasia.

A Case of Low Grade Malignant Fibrous Histiocytoma in Lateral Canthus

PURPOSE: To report a case of malignant fibrous histiocytoma of the lateral canthal area that was diagnosed clinically as a benign epidermal inclusion cyst. CASE SUMMARY: A 49 year-old man presented with a cutaneous mass involving the lateral canthal area. A 0.7-cm cystic lesion was freely movable and non-inflamed. After excisional biopsy, the results of immunohistochemical staining led to a final diagnosis of low-grade malignant fibrous histiocytoma. The specimen from excisional biopsy had margins positive for malignancy; the patient underwent a second procedure for complete resection, and that specimen had tumor-free margins. CONCLUSIONS: Fibrous histiocytoma is a rare disease but may occur in the eyelid. Therefore, when an eyelid tumor progresses rapidly, malignant fibrous histiocytoma should be considered as a diagnosis.

Spontaneous Anterior Lens Capsular Dehiscence Causing Lens Particle Glaucoma

To report acute onset lens particle glaucoma associated with a spontaneous anterior capsular dehiscence. A 66-year-old man presented with spontaneous anterior lens capsule dehiscence with an acute onset of right eye pain that was associated with white particles in the anterior chamber angle and intraocular pressure (IOP) of 55 mmHg. No trauma or other inflammatory antecedents were reported. A hypermature cataract was observed at slit lamp exam. After medical treatment without IOP control, we performed extracapsular cataract extraction and anterior vitrectomy. Anterior chamber aspirate confirmed the presence of macrophages. The postoperative IOP at one month was 16 mmHg OD without medication. Spontaneous dehiscence of the anterior lens capsule in a patient with a hypermature cataract may release lens cortical material, resulting in lens particle glaucoma. Prompt surgical removal of the lens material usually controls the high IOP, and the need for additional glaucoma surgery is not common.

Alterations of Tyrosine Hydroxylase and Choline Acetyltransferase in the Retina of the Diabetic Rat / 대한해부학회지

To investigate the effect of hyperglycemia on the visual system, we investigated the retinal dopaminergic and cholinergic systems using tyrosine hydroxylase (TH) and choline acetyltransferase (ChAT) in the rat retinas of streptozotocin (STZ)-induced diabetes. Diabetes was induced by a single intraperitoneal injection of STZ (50 mg/kg) to Sprague-Dawley rats (250~300 g). We first analyzed morphologic thickness changes in the several retinal layers of 6-week-old control and STZ-diabetic rats after H & E staining. To confirm whether TH and ChAT protein expressions changed, we carried out immunohistochemistry analysis and Western blotting. After induction of diabetes, significant changes were not shown in the retinal thickness at 6 weeks. TH and ChAT immunoreactivities were clearly detected in amacrine cells and sublaminas in the inner retina of both control and diabetic rats, showing continuously reduced positive amacrine cells in the retinas during diabetes. In addition, the decline in TH and ChAT protein expression was already present to a significant extent in the retina at 6 weeks in early diabetes. Our present study demonstrates the possibility that the observed alterations in TH and ChAT in the diabetic retina may cause the visual system changes in the retinal pathophysiology associated with diabetes mellitus.

Two Cases of Orbital Apex Syndrome

PURPOSE: To report two cases of orbital apex syndrome: one induced by penetrating orbital injury and the other by severe optic nerve swelling associated with bacterial meningitis. METHODS: We have experienced a 40-year-old male after penetrating orbital injury who complained of loss of vision, ocular pain, ptosis, hypesthesia of forehead, and total ophthalmoplegia. The CT image of this patient showed a severe retrobulbar hemorrhage and marked enlargements of extraocular muscles. In a 62-year-old male who had a same symptom after headache and decreased mentality, a bacterial meningitis was diagnosed from CSF study and we saw a very severe swelling of the unilateral entire optic nerve and optic nerve sheath in CT. We managed these two patients with a large amount of systemic RESULTS: In 40-year-old man, there were improvements of ptosis and visual acuity from negative light perception to positive, but ophthalmoplegia was not improved. In 62-year-old man, ptosis and ophthalmo-plegia were improved after early antibiotics administration and papilledema disappeared two months after development, but visual acuity was not improved from negative light perception.

The Effect of Early Amniotic Membrane Transplantation in the Rabbits' Corneal Ulcer by Staphylococcus Epidermidis

PURPOSE: Untill now, AMT at the early stage of corneal ulcer has been prohibited by the reasons that measurement of progression of ulcer by active pathogens was difficult through the transplanted amniotic membrane and anxiety about worsening by decreased permeability of antibiotics. This study has investigated the effect of early AMT in the bacterial corneal ulcer. METHODS: We made experimental bacterial corneal ulcer in 10 rabbits with Staphylococcus epidermidis, which typically has a more indolent clinical course. After certification of infection, fresh amniotic membranes, soaked by fortified antibiotics was transplanted to 5 eyes to which we dropped fortified antibiotics. And to another 5 eyes we applied only fortified antibiotics. After observing the progression of corneal ulcer for 4 weeks, we compared the degree of corneal opacity and histopathologic changes between the two groups to measure the effect of early AMP in the bacterial corneal ulcer. RESULTS: Corneal ulcer was healed in the all 5 cases of early AMT-performed group, And compared with the group without AMT, successful decrement of corneal opacity was observed in the 4 cases of early AMT-performed group. Histopathologic observation has revealed only mild inflammation and the maintenance of parallel architecture of stromal collagens. CONCLUSIONS: In the experimental corneal ulcer with Staphylococcus Epidermidis, we observed healing of the ulcer with decrement of corneal opacity, result from early transplantation of amniotic membrane, soaked in fortified antibiotics followed by dropping of fortified antibiotics at an early stage of ulcer.

A Case of Optic Nerve Evulsion

PURPOSE: The authors report a case of optic nerve evulsion with literature review. METHOD: 15-year-old boy, who had optic nerve evulsion by tear of inferior rectus and medial rectus muscles, and hypotony by retinal and choroidal detachment RESULTS: we could preserve the eyeball with normal pressure by pars plana vitrectomy, endolaser photocoagulation and silicone oil injection

Secondary Intraocular Lens Implantation in Pediatric Aphakia

A retrospective study was done on secondary intraocular lens implantation in 19 children(22 eyes)who were not satisfied with aphakic glasses and were not tolerant with contact lenses.In all cases,postoperative visual acuity improved or remained at the preoperative level.In 10 cases,postoperative visual acuity was better than 20/40. After at least 12 months of follow-up,average difference of refractive power between the two eyes in the same patient is 0.79 diopter. Early postoperative complications related to secondary intraocular lens implantation were vitreous hemorrhage(1 eye)and IOL decentration. Vitreous hemorrhage was resorbed in three weeks.In case of IOL decentration,we repositioned the IOL.Late complcations during the follow-up period included development of dense capsular opacification in four eyes.They are all treated by Nd:YAG capsulotomy. After capsulotomy there were some improvement in visual acuity. From these results,secondary intraocular lens implantation appears to be a safe, effective method for correction of aphakic children who are not satisfied with aphakic glasses and/or intolerant of use of contact lenses.

The Effect of Cataract Operation on Ocular Hypotony after Trabeculectomy with Mitomycin C

Cataract operation was carried out in 7 glaucomatous eyes with prolonged ocular hypotony after trageculectomy with intraoperative mitomycin C. In all cases, The postoperative intraocular pressure(IOP) rose and the postopeative average IOP was 6.0+/-2.0mmHg higher than their preoperative average IOP. The preexisting bleb was reduced in size eyes that underwent phacoemulsification and posterior chamber intraocular lens(PC-IOL) implantation. But. It was not changed in extracapsular cataract extraction and IOL implantation. In our study, cataract operation in eyes that had lens opacity with prolonged hypotony induced IOP rise and was beneficial to hypotony.

Toxicity of Ciprofloxacin in Vitreous Infusion Fluid on Rabbit Retina

To investigate the retinal toxicity of ciprofloxacin on retina, 23 New Zealand white rabbits received vitrectomy with intravitreal infusion that contain of 1 g/ml, 2 g/ml, 5 g/ml, 10 g/ml, and 25 g/ml of ciprofloxacin(20 eyes) or balanced salt solution(BSS) only(3 eyes). In transmission elctron microscope, no disintegration of all retinal layers and slightly irregular pattern of disc of outer segment of rod were observed in 1, 2 and 5 g/ml of ciprofloxacin groups at 14 days postinfusion. In concentration of 10 g/ml or greater, retina showed destroyed inner and outer segment of the photoreceptor cells, pyknotic nuclei in the outer nuclear layer, lucent vacoules and pigment granules in apical cytoplasm of the retinal pigment epithelium(RPE), loss of photoreceptor outer segment-RPE integration. This study suggest that infusion with 5 g/ml or less of ciprofloxacin may be safe when used in the treatment of bacterial endophthalmitis.