E-cadherin promoter hypermethylation may contribute to protein inactivation in pterygia.

PURPOSE: Our recent reports indicated that the molecular changes of pterygia are similar to tumor cells. We believe that pterygia may have a similar mechanism in oncogenesis. Many studies have revealed that E-cadherin associated protein expression decreases in many tumors and pterygia. E-cadherin may be a marker for both tumor metastasis and prognosis. However, no studies have examined the reason for E-cadherin protein inactivation in pterygia. Therefore, this study aimed to analyze the association of E-cadherin promoter hypermethylation with protein inactivation in pterygial tissues. METHODS: E-cadherin methylation-status and the expression of E-cadherin and beta-catenin protein were studied using methylation-specific PCR and immunohistochemistry, respectively, on 120 pterygial specimens and 30 normal conjunctivas. RESULTS: Hypermethylation of E-cadherin gene promoter was detected in 32 (26.7%) of the 120 pterygial specimens. A total of 79 (65.8%) pterygial specimens tested positive for E-cadherin protein expression and 41 (34.2%) specimens tested negative. The E-cadherin staining was limited to the membrane of the epithelial layer. There was a reverse correlation between E-cadherin gene promoter hypermethylation and E-cadherin protein expression (p<0.0001). Aberrant localization of beta-catenin was higher in the E-cadherin negative group than in E-cadherin positive group. CONCLUSIONS: Our study demonstrates E-cadherin gene promoter hypermethylation were associated with low or absent expression of E-cadherin. Moreover, loss of E-cadherin protein may contribute to aberrant localization of beta-catenin. These data provide evidence that methylation exists in pterygia and may play a role in their development.

Early treatment of severe cystoid macular edema in central retinal vein occlusion with posterior sub-tenon triamcinolone acetonide.

PURPOSE: To evaluate the clinical outcomes of posterior sub-Tenon (PST) injection of triamcinolone acetonide (TA) in the early treatment of severe cystoid macular edema (CME) in central retinal vein occlusion (CRVO). METHODS: In a noncomparative, prospective study, 18 eyes of 18 patients with severe CME (central macular thickness, CMT >450 microm) secondary to recent-onset CRVO (the onset of symptoms < or =4 weeks) and a decrease in visual acuity (< or =80 letters of Early Treatment Diabetic Retinopathy Study [ETDRS] scores, 20/50) were included. PST injection of 40 mg of TA was given under topic anesthesia. All patients received three biweekly injections and were evaluated at baseline and at 1 day, 1, 2, 4, 6, and 8 weeks, and 3, 6, and 9 months after injection. The main outcome measures were ETDRS scores, CMT, intraocular pressure (IOP), cataract progression, and frequency of complications. RESULTS: The mean age of the 18 patients was 61.17 years (range, 24-81 years) and the mean duration of symptoms was 15.28 days (range, 9-28 days). Eight eyes were diagnosed with ischemic CRVO and 10 eyes with nonischemic CRVO. Mean baseline ETDRS visual acuity (VA) score was 36.89 +/- 18.22 in all affected eye. There was a significant improvement in VA at 1, 3, 6, and 9 months of follow-up. The mean VA at these time points were 46.61 +/- 20.21, 58.11 +/- 22.19, 59.39 +/- 22.98, and 58.67 +/- 23.27 (all P < 0.001), respectively. Both nonischemic and ischemic eyes benefited with a statistically significant VA improvement at each time point. A comparison of the gain in VA between two subgroups was not significant at 1 and 3 months (P > 0.05), but was statistically significant at 6 and 9 months (P = 0.009 and 0.008, respectively). VA gain of 10 or more letters was found in all nonischemic eyes (10/10) and 3 ischemic eyes (3/8) at the 9-month follow-up. Two ischemic eyes were found to have no gain of letters in VA at the 9-month follow-up. The mean baseline CMT for all eyes was 566 +/- 42 microm. There was a 29% reduction with a mean CMT of 404 +/- 49 microm (P < 0.001) at 1 month, 51% reduction with a mean CMT of 278 +/- 40 microm (P < 0.001) at 3 months, 61% reduction with a mean CMT of 222 +/- 56 microm (P < 0.001) at 6 months, and 63% reduction with a mean CMT of 210 +/- 30 microm (P < 0.001) at 9 months. Both nonischemic and ischemic eyes demonstrated a statistically significant reduction in CMT (all P < 0.001). A comparison of the reduction in CMT between these two subgroups was not significant at each visit (all P > 0.05). For both subgroups, there was no statistically significant difference in IOP change at baseline, 1 week, 1, 3, 6, and 9 months of follow-up. Only two patients required topic antiglaucoma drops for elevated IOP. Three patients developed a recurrence of CME accompanied with visual decrease. No cataract progression or other complications were observed. CONCLUSIONS: PST injection of TA is effective in reversing CME and improving visual acuity in recent-onset CRVO in the first 9 months. Patients with nonischemic CRVO may respond more favorably than patients with ischemic CRVO. Early treatment may be better for visual improvement before longstanding macular edema results in irreversible photoreceptor damage. Further study with longer follow-up period is necessary.

Stratus optical coherence tomography for evaluating optic disc pits associated with maculopathy before and after vitrectomy: two case reports.

Optic disc pit (ODP) can be either congenital or acquired. Congenital ODP is typically unilateral, and the visual acuity and visual field are normal unless associated with macular serous detachment, which occurs in about 25-75% of cases. Acquired ODP is known as an important risk factor for progressive visual field loss in glaucoma. The fundus finding of congenital ODP includes oval depression involving the optic disc, with or without macular serous detachment. We used third-generation Stratus optical coherence tomography (Straus OCT) to investigate the possible pathogenesis of ODP associated with maculopathy and to monitor the anatomic changes before and after treatment.

Noninfectious hypopion after intravitreal triamcinolone acetonide injection for central retinal vein occlusion: a case report.

Although it is rare, infectious endophthalmitis is a severe ocular complication resulting from intravitreal injection of triamcinolone acetonide (TA). Therefore, care must be taken by ophthalmologists to differentiate between what is infectious and noninfectious endophthalmitis. We report on a 62-year-old woman who received an intravitreal injection of TA for treatment of central retinal vein occlusion. One day after the injection, a hypopion (a white-yellowish deposit) was noted in the inferior anterior chamber. The patient complained that her vision had deteriorated, but there was no pain, eyelid edema, increased conjunctival injection or corneal edema. The hypopion gradually diminished and by the fifth postoperative day, resolved completely without the administration of intravitreal or systemic antibiotic therapy.

Deep dissection plane for endoscopic-assisted comminuted malar fracture repair.

Endoscopic technique has been used in the management of comminuted malar fractures. However, the reported dissection plane is close to the frontal branch of the facial nerve, and paralysis of the frontal muscle is sometimes noted postoperatively. From January 1998 to November 2001, 42 patients underwent endoscopic-assisted zygomatic bone repair at Kaohsiung Medical University Hospital and Kaohsiung Municipal Hsiao Kang Hospital. The zygomatic arch was approached via a dissection plane beneath the deep temporal fascia, and the plate was fixed on the upper border of the arch. The advantages of this method are 1) one temporal incision is sufficient for dealing with the zygomatic arch fracture; 2) the learning curve for endoscopic technique is shortened; 3) there is less risk of injury to the frontal branch of the facial nerve; and 4) the periosteum at the anterior and inferior border of the zygomatic arch is preserved. The deep method is a safe alternative for endoscopic-assisted comminuted malar fracture repair.