Asymptomatic Unexplained Visual Field Loss Diagnosed as Early Retinitis Pigmentosa without Pigmentation: A Case Report

PURPOSE: We report a case of asymptomatic unexplained visual field loss diagnosed as early retinitis pigmentosa (RP) without pigmentation. CASE SUMMARY: A 33-year-old woman was referred to us with a constricted visual field (C24-2) before laser-assisted in-situ keratomileusis surgery. The visual field test (C30-2) revealed significantly decreased sensitivity between 15 to 25 degrees in both eyes. Close fundus examination revealed a subtle greyish retinal atrophic lesion along the vascular arcade and fluorescein angiography revealed a window defect in accordance with a retinal atrophic lesion in both eyes. Optical coherence tomography showed decreased retinal thickness around the macula. Electroretinogram revealed decreased b waves in rod response. Based on these findings, we diagnosed the patient with early RP without pigmentation. CONCLUSIONS: The possibility of early RP without pigmentation presenting as slight atrophy around the macula without significant pigmental degeneration should also be considered if a patient presents with peripheral visual field constriction without other symptoms. The ophthalmologist should ensure that the location of the visual field defect matches the location of the lesion. In addition, a detailed fundus examination with macular optical coherence tomography can be helpful to diagnose such a lesion.

Streptococcus Gordonii Endophthalmitis after Pneumaic Retinopexy

PURPOSE: To report a case of streptoococcus gordonii endophthalmitis after pneumaic retinopexy in a patient with rhegmatogenous retinal detachment. CASE SUMMARY: A 40-year-old man presented with a right eye macula-on retinal detachment extending from 9 to 1 o'clock with one-clock-hour hole at 11 o'clock. After sterilizing with a Betadine solution, 0.6 cc 100% SF6 gas was injected into the vitreous through the pars plana at 11 o'clock. Two days after the injection, eyeball pain, cell and flare, and pupillary membrane developed. Under the diagnosis of endophthalmitis, vitreous tap and intravitreous vancomycin (1.0 mg/0.1 cc) and ceftazime (2.0 mg/0.1 cc) were administered. However the symptoms and signs worsened, so vitrectomy was performed, and intravitrous injections of silicone, vancomycin and ceftazime were administered. Streptococcus gordonii was identified from the excised vitreous. Visual acuity was light perception due to severe retinal necrosis. CONCLUSIONS: In cases of endophthalmitis after pneumatic retinopexy even with meticulous sterilization, a prompt operation is necessary to prevent extensive retinal damage and visual loss due to the possibility of pathogen growth other than conjunctival normal flora.

Therapeutic Effect of Photodynamic Therapy with Indocyanine Green Dye in the Treatment of Choroidal Neovascularization

PURPOSE: To determine experimentally the effectiveness of photodynamic therapy (PDT) with indocyanine green (ICG) dye in the treatment of choroidal neovascularization. METHODS: Following the creation of choroidal neovascularization in the retina of 18 pigmented rats (36 eyes), and ICG dye injection (10 mg/kg) in 18 of the eyes, the authors performed PDT, at intensity of 60 mW, spot size of 2.0 mm, and duration of 20 seconds within 2 minutes after ICG dye injection. 0ne, 4, 6, and 8 weeks after PDT, the authors examined the retina for any signs of regression through angiogram and light microscope. RESULTS: When authors conducted PDT after injecting ICG dye into pigmented rats, there was no significant damage to retina when the intensity was set at 60mW with duration of 10 or 20 seconds. Choroidal neovascularization was found in 18 eyes after argon laser photocoagulation, and regression of neovascularization was confirmed through angiogram and pathologic examination after PDT was performed with ICG dye. Pathologic views revealed significant fibrosis and fibrinoid necrosis. The control group consisting of 18 eyes in which no diode laser photocoagulation was performed, showed no regression of choroidal neovascularization. CONCLUSIONS: PDT with ICG dye was found to be quite effective in the treatment of choroidal neovascularization.

RBC Sorbitol Analysis in Diabetes Mellitus / 대한임상병리학회지

BACKGROUND: Red blood cell (RBC) sorbitol has been implicated in the pathogenesis of organic complications of diabetes mellitus. W8 investigated RBC sorbitol level as an indicator of glucose control or diabetic complications, and also evaluated whether RBC sorbitol/plasma glucose ratio is an indicator of diabetic complications. METHODS: RBC sorbitol levels were measured in 43 healthy persons and 133 diabetes mellitus (DM) patients by enzymatic method. We also tested linearity, inter- and intra- assay precisions. Plasma glucose and Hb Alc were measured by hexokinase method and HPLC, respectively. Hospital records were reviewed. RESULTS: The intra- and inter-assay coefficients of variation of RBC sorbitol test are 8.7% and 28.5%, respectively. Linearity is good. The RBC sorbitol level(3.60+/-1.00 ug/mL) and RBC sorbitol/plasma glucose ratio (2.37+/-0.98%) in diabetic patients are significantly higher than those in normal control (1.69+/-0.43 ug/mL, 1.85+/-0.49 per mill), respectively(p<0.0001). We can't observe correlation between RBC sorbitol and Hb Alc in BM patients, but observe that in non-treatment DM patients. We also observed correlation between Hb Alc and glucose and reverse correlation between RBC sorbitol ratio and Hb Alc. We can't find significant relation between diabetic complications and RBC sorbitol or RBC sorbitol/plasma glucose. CONCLUSIONS: We suggest that the reference range of normal RBC sorbitol level and RBC sorbitol/plasma glucose ratio by enzymatic method are 1.69+/-0.86 ug/mL and 1.85+/- 0.98%,. These Ire significantly different from DM patients and may be useful in diagnosis of DM.

RBC Sorbitol Analysis in Diabetes Mellitus / 대한임상병리학회지

BACKGROUND: Red blood cell (RBC) sorbitol has been implicated in the pathogenesis of organic complications of diabetes mellitus. W8 investigated RBC sorbitol level as an indicator of glucose control or diabetic complications, and also evaluated whether RBC sorbitol/plasma glucose ratio is an indicator of diabetic complications. METHODS: RBC sorbitol levels were measured in 43 healthy persons and 133 diabetes mellitus (DM) patients by enzymatic method. We also tested linearity, inter- and intra- assay precisions. Plasma glucose and Hb Alc were measured by hexokinase method and HPLC, respectively. Hospital records were reviewed. RESULTS: The intra- and inter-assay coefficients of variation of RBC sorbitol test are 8.7% and 28.5%, respectively. Linearity is good. The RBC sorbitol level(3.60+/-1.00 ug/mL) and RBC sorbitol/plasma glucose ratio (2.37+/-0.98%) in diabetic patients are significantly higher than those in normal control (1.69+/-0.43 ug/mL, 1.85+/-0.49 per mill), respectively(p<0.0001). We can't observe correlation between RBC sorbitol and Hb Alc in BM patients, but observe that in non-treatment DM patients. We also observed correlation between Hb Alc and glucose and reverse correlation between RBC sorbitol ratio and Hb Alc. We can't find significant relation between diabetic complications and RBC sorbitol or RBC sorbitol/plasma glucose. CONCLUSIONS: We suggest that the reference range of normal RBC sorbitol level and RBC sorbitol/plasma glucose ratio by enzymatic method are 1.69+/-0.86 ug/mL and 1.85+/- 0.98%,. These Ire significantly different from DM patients and may be useful in diagnosis of DM.