Effects of smoking on tear film and ocular surface.

This study was performed to evaluate the changes of tear film and ocular surface caused by smoking. Symptom scoring, tear film break-up time (BUT), basal tear secretion test, corneal sensitivity test, keratoepitheliopathy scoring, and conjunctival impression cytology were performed in 29 smokers (58 eyes) and 26 non-smokers (52 eyes). Tear film BUT, basal tear secretion, corneal sensitivity, and squamous metaplasia were 7.71+/-2.66 sec, 6.29+/-2.85 mm, 53.69+/-5.69 mm, and 2.45+/-1.26 in smokers and 9.62+/-3.14 sec, 10.04+/-3.87 mm, 56.46+/-4.79 mm, and 1.12+/-0.83 in non-smokers, respectively (p<0.05). Symptom score, keratoepitheliopathy score, and goblet cell density were not significantly different between the two groups. Tear film BUT was shorter, basal tear secretion and corneal sensitivity were lower, and squamous metaplasia was higher in heavy smokers than in light smokers. In conclusion, smoking deteriorates the tear film and ocular surface with decreased quantity and quality of tear film, decreased corneal sensitivity, and squamous metaplasia, and this deterioration is related to the amount of smoking.

Vibrio vulnificus endophthalmitis occurring after ingestion of raw seafood.

Ocular Vibrio vulnificus infections are quite rare, and all previously reported cases have been associated with exposure to seafood and seawater. Here, we report a case of endogenous endophthalmitis caused by V. vulnificus, occurring after the ingestion of raw seafood. This case was not associated with any cutaneous or other severe systemic manifestations.

Eyelid sparganosis.

PURPOSE: To report a case of sparganosis in the muscle layer of the eyelid. DESIGN: Observational case report. METHODS: A 67-year-old man with migratory painful swelling on the eyelid that was unresponsive to medications was evaluated and treated surgically. RESULTS: Computed tomography showed a 1.5 x 1.5-cm sized, thick-walled lesion and ultrasound biomicroscopy showed hypoechoic tubular and cystic lesions. During surgery, a white, thread-like plerocercoid, 7 cm in length was detected in the orbicularis muscle of the lower eyelid. Histopathologic examination demonstrated the characteristic feature of the sparganum larva and foreign body granulomatous reaction. Serodiagnosis by enzyme-linked immunosorbent assay was positive. Three months postoperatively, the lesion resolved completely. CONCLUSION: Although rare, sparganosis should be suspected in a moving eyelid mass unresponsive to the medical treatment.

Subhyaloid hemorrhage treated with SF6 gas injection.

A 72-year old woman with a premacular subhyaloid hemorrhage could not be treated by laser photodisruption due to a thick posterior cortical vitreous. Pure sulfur hexafluoride (SF6, 0.3 mL) gas was injected intravitreally without recombinant tissue plasminogen activator, and facedown positioning was recommended for 5 days. Posterior vitreous detachment was induced and the hemorrhage dispersed into the vitreous cavity. Eight weeks later, her visual acuity had recovered from hand motions to 20/40. Fluorescein angiography revealed an arterial macroaneurysm in the inferotemporal retina. Intravitreal SF6 gas injection without recombinant tissue plasminogen activator may be an alternative method for treating a relatively new subhyaloid hemorrhage.

Changes of tear film and ocular surface in diabetes mellitus.

This study was performed to investigate the changes of tear film and ocular surface in diabetic patients, as well as the ocular and systemic factors related to these changes. We assessed the scoring of keratoepitheliopathy, corneal sensitivity test, tear film break-up time (BUT), Schirmer test, and conjunctival impression cytology in 94 eyes of 47 patients with noninsulin-dependent diabetes mellitus and in 60 eyes of 30 normal subjects. The degree of keratoepitheliopathy was severe, and the corneal sensitivity, BUT, and tear secretion were significantly reduced in the diabetic patients. Conjunctival impression cytology showed a higher grade of conjunctival squamous metaplasia and lower goblet cell density in the diabetic patients. All parameters were related to the status of metabolic control, diabetic neuropathy, and stage of diabetic retinopathy. We think that diabetic patients with poor metabolic control, neuropathy, and advanced stage of retinopathy should be examined for tear film and ocular surface changes.

Orbital trapdoor fracture in children.

This study was performed to evaluate the clinical symptom, fracture finding, and surgical outcome in children with orbital trapdoor fracture. Forty-four patients with pure orbital trapdoor fracture, under 18 yr of age, were included. Time interval between injury and surgery, length of time for improvement, resolution of ocular motility restriction, and other factors were analyzed in 36 patients who underwent surgery. The median improvement time was 3.5 days for patients (n=8) receiving surgery within 5 days, 18.0 for those (n=19) receiving surgery between 6 and 14 days, and 50.0 for those (n=9) receiving surgery after 15 days (p=0.03). One month after operation, the mean change in supraduction limitation was 3.50 +/- 0.53 for patients receiving surgery within 5 days, 2.11 +/- 1.24 for those receiving surgery between 6 and 14 days, and 1.67 +/- 0.82 for those receiving surgery after 15 days (p=0.04). Three months after operation, the mean change in supraduction limitation was 3.88 +/- 0.35, 2.94 +/- 1.55, and 2.50 +/- 1.38, respectively (p=0.14). In conclusion, trapdoor fracture of the orbit in children must be diagnosed by careful CT evaluation and clinical evidence of entrapment. For patients with severe limitation of ocular motility, early surgery within 5 days of injury leads to more rapid and better postoperative improvement.

Macular hole after peeling of the internal limiting membrane in diabetic macular edema.

A 61-year-old man had peeling of the internal limiting membrane using indocyanine green in combination with pars plana vitrectomy for the treatment of diffuse diabetic macular edema in the right eye. As the macular edema began to improve, a small macular hole was noticed, which progressed rapidly. After fluid-gas exchange with 10% perfluoropropane, the macular hole was closed. Caution may be needed to reduce the mechanical stress on the fovea when the internal limiting membrane is peeled in diffuse diabetic macular edema.

The kinase inhibitor PKC412 suppresses epiretinal membrane formation and retinal detachment in mice with proliferative retinopathies.

PURPOSE: Platelet-derived growth factor (PDGF) is an important stimulatory factor for proliferative retinopathies. Expression of PDGF-B in the retinas of transgenic mice (hemizygous rho/PDGF-B mice) results in rapid-onset retinal detachment caused by proliferation of glial cells, endothelial cells, and pericytes, whereas expression of PDGF-AA (homozygous rho/PDGF-A or PDGF-AA mice) causes slowly progressive retinal detachment from proliferation of glial cells. In this study, we investigated the effect in rho/PDGF-B and rho/PDGF-AA mice of several different receptor kinase inhibitors. METHODS: Hemizygous rhoPDGF-B or homozygous rho/PDGF-A mice were treated orally with PKC412 (an inhibitor of PDGF, VEGF, and c-kit receptor kinases and several isoforms of PKC), PTK787 (an inhibitor of PDGF, VEGF, and c-kit receptor kinases), SU1498 (an inhibitor of VEGF receptor kinases), imatinib mesylate (an inhibitor of PDGF, c-kit, and v-abl receptor kinases), or vehicle, and at appropriate time points epiretinal membrane (ERM) formation and retinal detachment were quantified. RESULTS: In either rho/PDGF-B or rho/PDGF-A mice, oral administration of PKC412 or PTK787, but not SU1498 or imatinib mesylate, significantly reduced ERM formation. PKC412 reduced the incidence of severe retinal detachments in both models and PTK787 did so in homozygous rho/PDGF-A mice. CONCLUSIONS: These data indicate that PKC412 (and possibly PTK787) has appropriate activity and sufficient intraocular bioavailability after oral administration to prevent retinal detachment in models of proliferative retinopathy. PKC412 should be considered for treatment of vascular and nonvascular proliferative retinopathies in humans.

Mechanical treatment of phthiriasis palpebrarum.

Phthiriasis palpebrarum is a rare disease in which crab lice infest the eyelashes. It can cause pruritic lid margins or unusual blepharoconjunctivitis and is difficult to diagnose and treat. We diagnosed and managed a case of phthiriasis palpebrarum in both upper eyelids, accompanied by nits, on the scalp of a 6 year-old female child. We removed the eyelashes, including lice and nits, by pulling with fine forceps without sedation. On the second month after treatment, all lice and nits were eradicated without recurrence and the eyelashes grew back. In conclusion, phthiriasis palpebrarum can be diagnosed by close examination of the eyelashes and eyelid margins with slit lamp and can be managed mechanically.

Photoreceptor-specific overexpression of platelet-derived growth factor induces proliferation of endothelial cells, pericytes, and glial cells and aberrant vascular development: an ultrastructural and immunocytochemical study.

Platelet-derived growth factor (PDGF) is necessary for the normal development of the retinal vasculature and its overexpression is likely to contribute to proliferative retinal disorders, such as proliferative vitreoretinopathy. Transgenic mice that overexpress PDGF-B in the photoreceptors (rho/PDGF-B mice) develop traction retinal detachment. In the present study, a detailed histopathological analysis was performed in rho/PDGF-B mice. In these transgenic mice, endothelial cells, pericytes, and glial cells begin to proliferate at postnatal day 7 (P7). All three cell types increase in numbers, forming a highly vascularized cell mass, which reaches a maximum thickness at P14. Cords of endothelial cells and glia invade the retina and exert traction, generating retinal folds; however, the deep capillary bed never forms. Griffonia simplicifolia isolectin B4 (GSA)-positive endothelial cells form tubes and penetrate the retina to the level of the outer plexiform layer, but they never interconnect to form the deep capillary bed. The vessels within the cell mass are patent, but have a very immature morphology. They often are thin-walled with fenestrations. Pericytes and glial cells are usually found in clusters and are not associated with the abnormal vessels. The lack of this association may account for the failure to form a mature vasculature.

Phacofragmentation for the treatment of a completely posterior dislocation of the total crystalline lens.

In order to evaluate the effectiveness and safety of intravitreal phacofragmentation, we analyzed cases of pars plana vitrectomy (PPV) with intravitreal phacofragmentation and scleral fixation of an intraocular lens (IOL) performed in patients with a crystalline lens completely dislocated into the vitreous cavity without any damage to the lens capsule. Of the 23 eyes examined, the dislocated lens was related with a hypermature cataract in 4 eyes and Marfan syndrome in 2 eyes, developed after argon and Nd:YAG laser iridotomy in 2 eyes, and was due to ocular trauma in 15 eyes. The dislocated lens was present for more than a year in 6 eyes and less than 4 weeks in 13 eyes. PPV, intravitreal phacofragmentation and scleral fixation of IOL were performed in all 23 eyes. Additionally, trabeculectomy was performed in 4 eyes, iridoplasty in 1 eye and cryopexy with intravitreal injection of sulfur hexafluoride in 2 eyes. Perfluorocarbon liquid was used in 9 eyes. The mean follow-up period was 11.7 months. On final examination, the visual acuity was better than 20/40 in 17 eyes (73.9%) and counting fingers in 1 eye due to traumatic optic neuropathy. There was no postoperative retinal detachment. These results demonstrated that PPV with intravitreal phacofragmentation and other combined procedures is a safe and effective surgical method for treating a completely dislocated crystalline lens.

Neovascular glaucoma associated with cilioretinal artery occlusion combined with perfused central retinal vein occlusion.

BACKGROUND: Cilioretinal artery occlusion rarely results in neovascular glaucoma, especially in cases of extensive cilioretinal infarction and combined retinal vascular occlusion. CASE: A 62-year-old man with diabetes mellitus and essential hypertension showed a visual acuity of counting fingers, retinal whitening temporal to the optic disc with mild dilation and tortuosity of the retinal veins, and retinal hemorrhages in four quadrants of his right eye. Fluorescein angiography demonstrated a delayed filling of the central retinal vein and cilioretinal artery. OBSERVATIONS: Two months later, neovascular glaucoma developed and retinal ablation was performed using an argon laser. Trabeculectomy was also performed due to the intractability of the glaucoma, and central artery occlusion was found. On magnetic resonance angiography, the right distal common carotid artery was irregularly narrowed and the right ophthalmic artery was almost entirely occluded. CONCLUSIONS: In cases of cilioretinal artery occlusion and perfused central retinal vein occlusion with multiple risk factors, close follow-up is advised.