Acute onset of deep calcareous degeneration treated with keratoplasty procedures: Two cases report.

There are two types of corneal calcium deposition, one is calcific band keratopathy and another is calcareous degeneration. We report two cases of acute onset of calcareous degeneration after using topical eye drops for their corneal wounds. The calcification in both the cases developed within 1 month. Due to the deeper stromal opacity, calcareous degeneration was impressed. In our cases, the deposits were too deep that they required keratoplasty procedures as better treatment options. One of the cases was treated with penetrating keratoplasty and another case was treated with deep anterior lamellar keratoplasty. Both of our cases had stable corneal grafts, and there were no ocular inflammation and no recurrence of calcification at least for 6 months.

Anterior high-resolution OCT in the diagnosis and management of corneal squamous hyperplasia mimicking a malignancy: a case report.

BACKGROUND: Anterior high-resolution optical coherence tomography (HR-OCT) is a novel non-invasive in vivo imaging modality that can assist in the diagnosis and management of various ophthalmic pathologies. The implementation of diagnosing ocular surface lesions has been explored in previous studies, successfully revealing specific signs in some ocular lesions. This case report aims to exhibit a case of corneal squamous hyperplasia diagnosed via anterior HR-OCT, prior to surgical intervention. CASE PRESENTATION: A 69 year-old male had blurred vision and foreign body sensation OD for several weeks. A rapidly-grown corneal mass was presented, showing an appearance of a grayish flesh-colored mass with elastic texture. Large vessels supplying the mass were also found. Anterior HR-OCT was performed, and the results suggested the lesion be benign hyperplasia. Superficial keratectomy was done, and the pathologic report showed mild-appearing epithelial squamous hyperplasia, which confirmed the analysis via anterior HR-OCT. CONCLUSION: In the categorization by Nanji, et al. of corneal surface diseases using anterior OCT, the comparative epithelial thickness (normal range: 47-68 µm); inferior border obscuration of epithelium (normal or benign inferior border: no shadowing); reflectivity of epithelial layer (normal: not hyper-reflective); abrupt transition (normal: no horizontally abrupt transition); and sub-epithelium analysis vary between benign and malignant lesions (normal: demarcated anterior to Bowman's layer), and the differences are systemically sorted. We applied all these characteristics to our patient as guidance, and the measurement results indicated the lesion be a benign lesion, which is consistent with the tissue pathology. Anterior HR-OCT is overall a non-invasive and timely method capable of assisting the diagnosis of ocular surface disease, predicting the qualities of a lesion, and determining the follow-up treatment plan.

Thermo-responsive hydrogel as an anti-VEGF drug delivery system to inhibit retinal angiogenesis in Rex rabbits.

BACKGROUND: Wet age-related macular degeneration (Wet AMD) has been treated clinically by intravitreal injection of bevacizumab, which is a kind of the anti-VEGF antibody drug. Nevertheless, because of the short half-life and frequent injections, the use of this treatment is limited. OBJECTIVE: To confirm whether mPEG-PLGA-BOX can be considered as a VEGF drug delivery system to inhibit retinal angiogenesis. METHODS: A thermo-responsive hydrogel of methoxy-poly (ethylene glycol)-block-poly (lactic-co-glycolic acid) (mPEG-PLGA-BOX) was synthesized. The thermo-responsive hydrogel mPEG-PLGA-BOX was able to have sol-gel phase transition upon stimulation by the body temperature with improved biocompatibility and biodegradation. The bevacizumab released from mPEG-PLGA-BOX inhibited RF/6A cells according to a JC-1 assay, which indicated that the released bevacizumab was active to be able to suppress the growth of new blood vessels. In an animal study, retinal laser photocoagulation was performed to induce angiogenesis in the eyes of Rex rabbits using an 810-mm laser. RESULTS: The retina was penetrated when the laser power was more than 500 mW and the exposure time was more than 500 ms. New blood vessels were created at the 28th day after retinal laser photocoagulation. At this time, intravitreal 0.05-mL injections of mPEG-PLGA-BOX (bevacizumab) solution were administered. The bevacizumab released from mPEG-PLGA-BOX (bevacizumab) solution suppressed the angiogenesis. In an in vivo study, the histomorphology of the rabbit retina also indicated that mPEG-PLGA-BOX after intravitreal injection is not toxic to the rabbit retina. CONCLUSIONS: Bevacizumab released from mPEG-PLGA-BOX (bevacizumab) solution suppressed angiogenesis, and mPEG-PLGA-BOX can be considered as a novel thermo-responsive hydrogel with potential as a gelling carrier for extended bevacizumab drug release to treat intraocular neovascular diseases.

Irritant contact keratitis caused by the bodily fluids of a brown marmorated stink bug.

PURPOSE: The brown marmorated stink bug is native to Asia (China, Taiwan, Japan, and the Korean peninsula). Its bodily fluids are toxic and irritating to the human skin and eyes. Human case reports are rare. Only one report of irritant contact dermatitis has been published. We report a case of irritant contact keratitis resulting from the chemical components of the bodily fluids of the bug. MATERIALS AND METHODS: A case report. RESULTS: A 74-year-old male presented to our emergency department with pain and redness in his right eye, which had been exposed to the bodily fluids of a brown marmorated stink bug. A patch of central corneal epithelial defect with conjunctival congestion and chemosis was found in his right eye. His best-corrected visual acuity (BCVA) (OD) was 6/20. We prescribed topical antibiotic and lubricant medications. The corneal epithelial defect recovered gradually over the course of several days. BCVA worsened to 2/60 but recovered gradually to 6/8.6 after the epithelial defect healed and after use of topical steroid for suppression of the local inflammation. DISCUSSION: The adult brown marmorated stink bug is characterized by its shield shape and its dark, mottled, brown color. The stink bug ranges in length from 14 to 17 mm. A startled stink bug will react by biting or spraying a foul-smelling liquid from its thorax. When disturbed or crushed, the stink bug excretes a highly potent, odorous smell. The major component of the bodily fluids is trans-2-decenal and trans-2-octenal, chemicals that belong to the aldehyde group. Hydrogen ions (H+) produced by reduction and oxidation of aldehyde can induce chemical burn injuries to the ocular surface. Irritant contact keratitis may occur through this mechanism. CONCLUSION: Stink bugs excrete odorous bodily fluids as a defensive mechanism when threatened. If the toxic fluid gets into the human eye, it can cause unexpected chemical burns or injury. Patients whose eyes come into contact with these bodily fluids should rinse their eyes thoroughly and immediately seek medical attention.

Neovascular age-related macular degeneration is not associated with coronary heart disease in a Chinese Population: a population-based study.

PURPOSE: This case-control study aimed to explore the association between prior coronary heart disease (CHD) and neovascular age-related macular degeneration (AMD) using a population-based data set in Taiwan. METHODS: We analysed data sourced from the Taiwan Longitudinal Health Insurance Database 2005. The study consisted of 1970 patients with neovascular AMD as cases and 5910 age- and sex-matched controls. We performed a conditional logistic regression to examine the odds ratio (OR) and its corresponding 95% confidence interval (CI) for previously diagnosed CHD between cases and controls. RESULTS: Of the 7880 sampled patients, 24.5% had a prior history of CHD; CHD was found in 25.7% of cases and in 22.7% of controls (p = 0.008). The conditional logistic regression analysis indicated that the OR for prior CHD for cases was 1.17 [95% confidence interval (CI): 1.04-1.32] compared to the controls. However, after adjusting for patient's monthly income, geographic location, urbanization level, age, hyperlipidaemia, diabetes and hypertension, we failed to observe an association between prior CHD and AMD (OR = 1.03, 95% CI = 0.91-1.17). Additionally, the medical comorbidities of hyperlipidaemia (adjusted OR = 1.29, 95% CI = 1.15-1.45), hypertension (adjusted OR = 1.20, 95% CI = 1.05-1.37) and diabetes (adjusted OR = 1.47, 95% CI = 1.32-1.65) were significantly associated with AMD. CONCLUSIONS: This study presented no significant difference in the odds of prior CHD between patients with AMD and those without AMD after adjusting for comorbidities and sociodemographic characteristics in a Chinese population.

Easy-to-prepare autologous platelet-rich plasma in the treatment of refractory corneal ulcers.

As platelets are rich in growth factors for tissue regeneration, autologous platelet-rich plasma (PRP) has been used to treat some refractory corneal defects. Although PRP is effective, the cost of its preparation is very high. This article presents three cases of refractory corneal ulcer under the prescription of autologous PRP. The autologous PRP used in these cases was easily prepared in the blood bank laboratory. In this paper, we collected three patients with refractory corneal ulcer who were unresponsive to conventional treatment. The patients presented with neurotrophic ulcer, exposure corneal ulcer, and limbal deciency with corneal ulcer after hepatitic keratitis. Although we easily prepared autologous PRP eye drops using simple laboratory centrifugation, this preparation still had a clinical effect on corneal defect. The mean intervention time was 24 ± 6.9 days. The case with exposure corneal ulcer had significant wound healing and the other two cases felt subjective symptom relief. There were some clinical improvements of refractory corneal ulcers in our three cases. We present the clinical results of three cases and report an easy procedure for the preparation of autologous PRP. Autologous PRP prepared simply in the laboratory, it may be an alternative option for treating refractory corneal ulcer.

Controlled release bevacizumab in thermoresponsive hydrogel found to inhibit angiogenesis.

Age-related macular degeneration (ARMD) and intraocular neovascular diseases have been treated clinically by anti-VEGF antibody drug bevacizumab. However, the use of bevacizumab in the treatment of retinal neovascular diseases has been limited due to the short half-life and frequent injections. In this research, novel amphiphilic hydrophilic-hydrophobic block copolymers of methoxy-poly (ethylene glycol)-block-poly (lactic-co-glycolic acid) were synthesized with ring-opening polymerization, and cross-linked with 2,2-bis (2-oxazoline) (BOX). The aqueous solution of the block copolymers can reverse the sol-gel-sol phase transition. After 1 month of intravitreal injection, the histomorphology of a rabbit's retina was preserved, which indicated the mPEG-PLGA-BOX hydrogel had no cytotoxicity in vivo. Released bevacizumab from the mPEG-PLGA-BOX hydrogel inhibited the RF/6A (Maraca mulatta retina epithelial cell) and HUVEC cell growth, and anti-angiogenesis in 3-D cultures, which showed the bioactivity of the anti-VEGF agent, were maintained in the hydrogel within the release process. In conclusion, the mPEG-PLGA-BOX hydrogel had a sol-gel behavior phase transition, and its intraocular biocompatibility and the characteristics of biodegradability and bioactivity appear to be a promising intravitreal injection carrier for bevacizumab delivery.

Increased risk of Parkinson disease following a diagnosis of neovascular age-related macular degeneration: a retrospective cohort study.

PURPOSE: To investigate the risk for Parkinson disease during a 3-year follow-up period after a diagnosis of neovascular age-related macular degeneration (AMD) using a nationwide population-based dataset in Taiwan. DESIGN: A retrospective matched-cohort study. METHODS: We identified 877subjects with neovascular AMD as the study cohort and randomly selected 8770 subjects for a comparison cohort. Each subject was individually followed for a 3-year period to identify those who subsequently developed Parkinson disease. Stratified Cox proportional hazard regressions were performed as a means of comparing the 3-year risk of subsequent Parkinson disease between the study and comparison cohorts. RESULTS: The incidence rate of Parkinson disease was 5.32 (95% confidence interval [CI]: 3.03-8.72) per 1000 person-years in patients with neovascular AMD and 2.09 (95% CI: 1.59-2.70) per 1000 person-years in comparison patients. The log-rank test indicated that subjects with neovascular AMD had a significantly lower 3-year Parkinson disease-free survival rate than comparison subjects (P < .001). After censoring cases in which patients died during the follow-up period and adjusting for monthly income, geographic region, hypertension, diabetes, hyperlipidemia, and coronary heart disease, the hazard ratio of Parkinson disease during the 3-year follow-up period for subjects with neovascular AMD was 2.57 (95% CI: 1.42-4.64) that of comparison subjects. CONCLUSION: In this study, subjects with neovascular AMD were found to be at a significant risk of Parkinson disease during a 3-year follow-up period after their diagnosis among Taiwanese Chinese. Further study is needed to confirm our findings and explore the underlying pathomechanism.

Obstructive sleep apnea and increased risk of glaucoma: a population-based matched-cohort study.

PURPOSE: Previous studies had reported an increased prevalence of glaucoma in patients with obstructive sleep apnea (OSA). However, the risk of open-angle glaucoma (OAG) among patients with OSA remains unclear. Using a nationwide, population-based dataset in Taiwan, this study aimed to examine the prevalence and risk of OAG among patients with OSA during a 5-year follow-up period after a diagnosis of OSA. DESIGN: A retrospective, matched-cohort study. PARTICIPANTS AND CONTROLS: This study used data sourced from the Longitudinal Health Insurance Database 2000. We included 1012 subjects with OSA in the study cohort and randomly selected 6072 subjects in the comparison group. METHODS: Each subject in this study was individually traced for a 5-year period to identify those subjects who subsequently received a diagnosis of OAG. Cox proportional hazards regression was performed to calculate the 5-year risk of OAG between the study and comparison cohorts. MAIN OUTCOME MEASURES: The incidence and risk of OAG between the study and comparison groups. RESULTS: During the 5-year follow-up period, the incidence rate per 1000 person-years was 11.26 (95% confidence interval [CI], 8.61-14.49) and 6.76 (95% CI, 5.80-7.83) for subjects with and without OSA, respectively. After adjusting for monthly income, geographic region, diabetes, hypertension, coronary heart disease, obesity, hyperlipidemia, renal disease, hypothyroidism, and the number of outpatient visits for ophthalmologic care during the follow-up period, stratified Cox proportional hazards regression revealed that the hazard ratio for OAG within the 5-year period for subjects with OSA was 1.67 (95% CI, 1.30-2.17; P<0.001) that of comparison subjects. CONCLUSIONS: Our results suggest that OSA is associated with an increased risk of subsequent OAG diagnosis during a 5-year follow-up period. FINANCIAL DISCLOSURES(S): The authors have no proprietary or commercial interest in any of the materials discussed in this article.

Correlation of microRNA-145 levels and clinical severity of pterygia.

PURPOSE: MicroRNA-145 (miR-145) has known anti-tumor properties and has been reported to be involved in regulating corneal epithelium differentiation. The exact role of miR-145 in ocular tissue remains unclear. In this study, we evaluate the effect of miR-145 expression levels on pterygium properties. SETTING: Ophthalmology department of a tertiary medical center. DESIGN: : Case series study. METHODS: Information regarding patient age, pterygium recurrence and pterygium severity (extension [E], vascularity [V] and thickness [T]) were gathered from records. Expression levels of miR-145 were obtained through examination of excised pterygium tissue. Correlations between age, pterygium classification, and miR-145 levels were evaluated. RESULTS: This study evaluated 253 patients (mean age 54.1±10.8 years). As pterygium severity increased, miR-145 levels decreased. Negative correlations were also found between miR-145 expression levels and pterygium extension (E) and vascularity (V). Thickness (T) had a weak negative correlation. There was only a mild negative correlation between patient age and miR-145 levels, which was only seen in patients with primary pterygium (not recurrent ones). Additionally, miR-145 expression was significantly higher in primary samples than in recurrent ones. CONCLUSIONS: We demonstrated an association between miR-145 and pterygium characteristics, consistent with its known tumor suppression effect. Because the management of pterygium is often difficult, we suggest that miR-145 should be further studied as a potential treatment.

A one-year follow-up study on the incidence and risk of endophthalmitis after pyogenic liver abscess.

PURPOSE: Although endophthalmitis secondary to pyogenic liver abscess (PLA) is becoming a globally emerging infectious disease, population-based investigations evaluating the relationship between PLA and endogenous endophthalmitis remain scarce. This study aimed to investigate the incidence and risk of endogenous endophthalmitis in patients with PLA compared with unaffected individuals by using a nationwide, population-based dataset. DESIGN: Retrospective, cohort study. PARTICIPANTS AND CONTROLS: This study used data sourced from Taiwan's National Health Insurance Research Database. In total, 12 727 patients with PLA were included in the study group and 63 635 matched subjects were randomly extracted as a comparison group. METHODS: Stratified Cox proportional hazards regressions were performed to assess the effect of PLA on the hazard of developing endogenous endophthalmitis. MAIN OUTCOME MEASURES: The incidence and risk of endogenous endophthalmitis between the study group and comparison group. RESULTS: Of the total sample, 148 subjects (0.10%) were diagnosed with endophthalmitis during the 1-year follow-up period. Endophthalmitis was found in 106 patients (0.84%) with PLA and 42 comparison patients (0.07%). After adjusting for patient monthly income, geographic location, and urbanization level, those suffering from PLA were found to have a greater likelihood of developing endophthalmitis during the 1-year follow-up period than comparison patients (hazard ratio [HR], 12.83; 95% confidence interval, 8.94-18.41). Stratification did not reveal any large differences in the adjusted HRs for endophthalmitis between PLA patients suffering from diabetes and those in whom diabetes was absent. We further analyzed the etiology of cases with endogenous endophthalmitis in this investigation and found Klebsiella pneumonia to be the causative organism among 75.5% of the cases but only 33.4% of the comparison group. CONCLUSIONS: We found that the incidence and risk of developing endophthalmitis was significantly higher among patients with PLA compared with matched controls irrespective of diabetes status.

Increased risk of co-morbid eye disease in patients with chronic renal failure: a population-based study.

PURPOSE: A large-scale population-based study on ophthalmic disorders among patients suffering from chronic renal failure (CRF) is lacking in the literature. This study examined the prevalence and risk of selected ocular co-morbidities (including retinal disorders, uveitis, glaucoma, cataract, and dry eye) in patients with CRF. METHODS: Data were sourced from the Taiwan Longitudinal Health Insurance Database. 9,149 patients with CRF were included in the study group, and 27,447 matched patients in the comparison group (age 40-98 years). We calculated the prevalence of retinal disorders, uveitis, glaucoma, cataract, and dry eye for patients with and without CRF. Conditional logistic regression analyses were also performed to compare the risk of ophthalmic disorders for patients with and without CRF, after taking into consideration sex, age group, diabetes, hypertension, monthly income, geographic region, and level of urbanization of the patient's community. RESULTS: In this study, patients with CRF had significantly higher prevalence of retinal disorders (16.62% vs. 9.70%), uveitis (1.38% vs. 0.95%), glaucoma (7.56% vs. 5.70%), and cataract (33.08% vs. 28.90%) than patients without CRF (all p < 0.001). However, no significant difference was observed in the prevalence of dry eye between these two groups. After adjusting for potential confounders, patients with CRF had higher odds of retinal disorder (odds ratio, OR, 1.84, 95% confidence interval, CI, 1.72-1.98), uveitis (OR 1.33, 95% CI 1.07-1.66), glaucoma (OR 1.35, 95% CI 1.23-1.48), and cataract (OR 1.24, 95% CI 1.18-1.31) than patients without CRF. CONCLUSION: We conclude that patients with CRF had a significantly higher prevalence of retinal disorders, uveitis, glaucoma, and cataract compared with patients without CRF.

Increased risk of anterior uveitis following herpes zoster: a nationwide population-based study.

OBJECTIVE: To investigate the relationship between herpes zoster (HZ) and the subsequent risk of anterior uveitis during the year following an HZ diagnosis, using a nationwide population-based data set. METHODS: This study used the Taiwan National Health Insurance Research Database. The study cohort consisted of 314,405 patients who received a diagnosis of HZ. The comparison cohort comprised 943,215 randomly selected patients. We tracked each patient for a 1-year period from their index ambulatory care visit to identify those who subsequently received a diagnosis of anterior uveitis. Stratified Cox proportional hazard regressions were performed to compute the adjusted 1-year uveitis-free survival rate, after adjusting for patient's age, sex, and geographic region and the presence of rheumatoid arthritis, psoriasis, mumps, systemic lupus erythematosus, tuberculosis, ankylosing spondylitis, and human immunodeficiency syndrome/AIDS. RESULTS: During the 1-year follow-up period, 2515 (0.2%) of 1,257,620 sampled patients were diagnosed with anterior uveitis: 908 from the study cohort (0.3% of the patients with HZ) and 1607 from the comparison cohort (0.2% of patients without HZ). After adjusting for potential confounders, the hazard ratio of anterior uveitis during the 1-year follow-up period was 1.67 for patients with HZ (P < .001) compared with the comparison cohort. In addition, the hazard ratio of anterior uveitis for patients with HZ ophthalmicus was 13.06 (P < .001) when compared with patients without HZ. CONCLUSIONS: The risk of anterior uveitis increased in the year following a diagnosis of HZ. We suggest that patient eye condition be evaluated following diagnosis with HZ.

MicroRNAs and cataracts: correlation among let-7 expression, age and the severity of lens opacity.

BACKGROUND: Let-7 microRNA is an important regulator of cellular ageing and tissue senescence. The objective of this study is to evaluate the expression of let-7a/let-7b/let-7c microRNAs in human age-related cataracts. AIM: To evaluate the correlation among the severity of lens opacity, the level of let-7a/let-7b/let-7c microRNA expression and patient age in the context of age-related cataracts. METHODS: The authors evaluated the mRNA level of let-7a/let-7b/let-7c microRNA in lens epithelia obtained from 174 eyes with age-related cataracts. The authors also recorded the patient age and the severity of lens opacity as classified according to the modified version of the Lens Opacities Classification System version III. RESULTS: Let-7b microRNA expression was demonstrated to be positively associated with patient age (R=0.472; p<0.001). A positive correlation was also observed between higher N, C and P cataract scores and higher expression of let-7b microRNA in patients with age-related cataracts (p<0.001). However, no significant correlation was observed between the let-7a and let-7c microRNA expression levels and either the severity of lens opacity or the patient age. CONCLUSION: These findings suggest that microRNAs play a role in age-related cataracts. A local let-7b microRNA increase may represent a risk factor in the formation of age-related cataracts.

Comorbidities of dry eye disease: a nationwide population-based study.

PURPOSE: To investigate the comorbidities of dry eye disease in a nationwide population-based data in Taiwan. METHODS: This study features a study group and a comparison group. The study group comprised 12 007 patients who sought ambulatory care for treatment of dry eye in 2005 and 2006. In total, 36 021 randomly selected patients were in the comparison group. Conditional logistic regression analyses conditioned on gender, age, monthly income and level of urbanization of the community in which the patient resided were conducted to calculate the odds ratio (OR) for each of 33 comorbidities among patients with and without dry eye disease. RESULTS: The regression analyses revealed that compared to patients without dry eye disease, patients with dry eye disease were more likely to have comorbidities of ischaemic heart disease (OR = 1.36), hyperlipidaemia (OR = 1.68), cardiac arrhythmias (OR = 1.55), peripheral vascular disorders (OR = 1.57), stroke (OR = 1.31), migraines (OR = 1.76), myasthenia gravis (OR = 2.85), RA (OR = 2.86), systemic lupus erythematosus (OR = 3.98), asthma (OR = 1.25), pulmonary circulation disorders (OR = 1.37), diabetes with complications (OR = 1.31), hypothyroidism (OR = 1.94), liver diseases (OR = 1.71), peptic ulcers (OR = 1.76), hepatitis B (OR = 1.64), deficiency anaemias (OR = 1.31), depression (OR = 2.11), psychoses (OR = 1.87) and solid tumours without metastasis (OR = 1.41). CONCLUSIONS: This study demonstrates significantly higher prevalence of medical comorbidities in patients with dry eye disease in Taiwan.

Open-angle glaucoma and the risk of erectile dysfunction: a population-based case-control study.

PURPOSE: Open-angle glaucoma (OAG) is associated with systemic metabolic and cardiovascular disorders, and both share common risk factors with erectile dysfunction (ED). However, few studies have investigated the association of ED with OAG. This study aimed to estimate the association of ED with prior OAG by using a nationwide, population-based data with a retrospective case-control cohort design in Taiwan. DESIGN: Age-matched case-control study. PARTICIPANTS AND CONTROLS: We identified 4605 patients with ED as the cases and randomly selected 23 025 subjects as the controls (5 controls to 1 case). METHODS: We used conditional logistic regression analysis to estimate the odds ratio and 95% confidence interval of having previously been diagnosed with OAG according to the presence/absence of ED after adjusting for patient's monthly income, geographical location, hypertension, diabetes, coronary heart disease, hyperlipidemia, obesity, and alcohol abuse. MAIN OUTCOME MEASURES: We identified OAG cases not only based on an International Classification of Diseases, Ninth Revision, Clinical Modification code, but also by the prescription of topical antiglaucoma medication. RESULTS: In total, prior OAG was found among 137 subjects (0.5 %); 53 individuals (1.1% of the ED patients) from the cases and 84 individuals (0.4% of patients without ED) from the controls. Conditional logistic regression analysis demonstrated that, after adjusting for potential confounders, patients with ED were more likely to have prior OAG than controls (odds ratio, 2.85; 95% confidence interval, 2.10-4.07). CONCLUSIONS: This study identifies a novel association between ED and prior OAG.

Seasonality of retinal detachment incidence and its associations with climate: an 11-year nationwide population-based study.

This study aimed to examine the seasonal variability of retinal detachment (RD) in Taiwan by using an 11-yr nationwide population database. This study also investigated the association of weather conditions, i.e., ambient temperature, relative humidity, rainfall, monthly hours of sunshine, and atmospheric pressure, with RD. Data were retrospectively collected from the Taiwan National Health Insurance Research Database. The study sample included 23 718 RD hospitalizations between January 1999 and December 2009. The incidence rate of RD/100 000 people over the 132 months was computed according to sex and age groupings of <20, 20-39, 40-59, and ≥60 yrs. Then, the association between climatic factors and the monthly RD incidence rate was examined. The ARIMA (autoregressive integrated moving average) method was also employed to test the seasonality of RD incidence rates and their association with climatic factors. The annual RD incidence rates were between 7.8 and 10.8 cases/100 000 people during the study period. A fairly similar seasonal pattern of monthly RD incidence rates was apparent for males and females and males and females combined. Rates were highest August through October, decreasing in November, and lowest in February. After adjusting for time, trend, and month, the ARIMA regression models for the male, female, and males and females combined consistently revealed the monthly RD incidence rate was significantly and positively associated with ambient temperature, but negatively associated with atmospheric pressure. The authors conclude that the monthly RD incidence rates were significantly associated with seasonality. The monthly RD incidence rates were positively associated with ambient temperature and negatively associated with atmospheric pressure.

Role of pirenoxine in the effects of catalin on in vitro ultraviolet-induced lens protein turbidity and selenite-induced cataractogenesis in vivo.

PURPOSE: In this study, we investigated the biochemical pharmacology of pirenoxine (PRX) and catalin under in vitro selenite/calcium- and ultraviolet (UV)-induced lens protein turbidity challenges. The systemic effects of catalin were determined using a selenite-induced cataractogenesis rat model. METHODS: In vitro cataractogenesis assay systems (including UVB/C photo-oxidation of lens crystallins, calpain-induced proteolysis, and selenite/calcium-induced turbidity of lens crystallin solutions) were used to screen the activity of PRX and catalin eye drop solutions. Turbidity was identified as the optical density measured using spectroscopy at 405 nm. We also determined the in vivo effects of catalin on cataract severity in a selenite-induced cataract rat model. Sodium dodecyl sulfate polyacrylamide gel electrophoresis (SDS-PAGE) was applied to analyze the integrity of crystallin samples. RESULTS: PRX at 1,000 µM significantly delayed UVC-induced turbidity formation compared to controls after 4 h of UVC exposure (p<0.05), but not in groups incubated with PRX concentrations of <1,000 µM. Results were further confirmed by SDS-PAGE. The absolute γ-crystallin turbidity induced by 4 h of UVC exposure was ameliorated in the presence of catalin equivalent to 1~100 µM PRX in a concentration-dependent manner. Samples with catalin-formulated vehicle only (CataV) and those containing PRX equivalent to 100 µM had a similar protective effect after 4 h of UVC exposure compared to the controls (p<0.05). PRX at 0.03, 0.1, and 0.3 µM significantly delayed 10 mM selenite- and calcium-induced turbidity formation compared to controls on days 0~4 (p<0.05). Catalin (equivalent to 32, 80, and 100 µM PRX) had an initial protective effect against selenite-induced lens protein turbidity on day 1 (p<0.05). Subcutaneous pretreatment with catalin (5 mg/kg) also statistically decreased the mean cataract scores in selenite-induced cataract rats on post-induction day 3 compared to the controls (1.3±0.2 versus 2.4±0.4; p<0.05). However, catalin (equivalent to up to 100 µM PRX) did not inhibit calpain-induced proteolysis activated by calcium, and neither did 100 µM PRX. CONCLUSIONS: PRX at micromolar levels ameliorated selenite- and calcium-induced lens protein turbidity but required millimolar levels to protect against UVC irradiation. The observed inhibition of UVC-induced turbidity of lens crystallins by catalin at micromolar concentrations may have been a result of the catalin-formulated vehicle. Transient protection by catalin against selenite-induced turbidity of crystallin solutions in vitro was supported by the ameliorated cataract scores in the early stage of cataractogenesis in vivo by subcutaneously administered catalin. PRX could not inhibit calpain-induced proteolysis activated by calcium or catalin itself, and may be detrimental to crystallins under UVB exposure. Further studies on formulation modifications of catalin and recommended doses of PRX to optimize clinical efficacy by cataract type are warranted.

One-year outcomes of intravitreal bevacizumab (avastin) therapy for polypoidal choroidal vasculopathy.

PURPOSE: To report on 1-year visual, anatomical, and angiographic responses with intravitreal bevacizumab for the treatment of polypoidal choroidal vasculopathy. METHODS: Patients with macula-involved, symptomatic polypoidal choroidal vasculopathy with initial best-corrected visual acuity of 20/400 or better and a minimal follow-up period of 12 months were retrospectively enrolled. Eyes were treated with intravitreal bevacizumab (2.5 mg) at baseline and monitored monthly for best-corrected visual acuity and central retinal thickness (by optical coherence tomography). Indocyanine green angiography was evaluated on a 6-month basis. Eyes were retreated on an "as-needed" basis according to visual and anatomical changes. RESULTS: A total of 35 eyes of 33 patients were treated with a mean of 3.3 (range, 1-8) times of injection. Best-corrected visual acuity significantly improved from a mean logarithm of the minimum angle of resolution of 0.79 ± 0.42 at baseline (Snellen equivalent, 20/123) to 0.69 ± 0.47 (20/94), 0.66 ± 0.45 (20/87), 0.67 ± 0.44 (20/87), 0.67 ± 0.48 (20/87), and 0.67 ± 0.51 (20/87) at 1, 3, 6, 9, and 12 months, respectively (P = 0.002, 0.0003, 0.0008, 0.017, and 0.02, respectively; paired Student's t-test). Central retinal thickness also significantly improved from a mean of 297 ± 94 µm at baseline to 215 ± 58 µm, 214 ± 59 µm, 218 ± 79 µm, 213 ± 75 µm, and 221 ± 61 µm at 1, 3, 6, 9, and 12 months, respectively (all P < 0.0001, paired Student's t-test). Indocyanine green angiography showed 3 of 32 eyes (9.4%) and 5 of 31 eyes (16.1%) with completely resolved polyps and 11 of 32 eyes (34.4%) and 10 of 31 eyes (32.3%) with reduced polyps at 6 and 12 months, respectively. No systemic complication or severe local complication, such as endophthalmitis, was found. CONCLUSION: Intravitreal bevacizumab therapy has a favorable outcome in improving visual acuity and macular exudative changes in patients with polypoidal choroidal vasculopathy. It can also moderately reduce polypoidal lesions on indocyanine green angiography.