This is a report of an atypical case of progressive outer retinal necrosis (PORN) and the effect of highly active antiretroviral therapy (HAART) on the clinical course of viral retinitis in an acquired immunodeficiency syndrome (AIDS) patient. A 22-year-old male patient infected with human immunodeficiency virus (HIV) presented with unilaterally reduced visual acuity and a dense cataract. After cataract extraction, retinal lesions involving the peripheral and macular areas were found with perivascular sparing and the mud-cracked, characteristic appearance of PORN. He was diagnosed as having PORN based on clinical features and was given combined antiviral treatment. With concurrent HAART, the retinal lesions regressed, with the regression being accelerated by further treatment with intravenous acyclovir and ganciclovir. This case suggests that HAART may change the clinical course of PORN in AIDS patients by improving host immunity. PORN should be included in the differential diagnosis of acute unilateral cataract in AIDS patients.
AIDS-Related Opportunistic Infections/complications/*drug therapy ; Acyclovir/therapeutic use ; Adult ; *Antiretroviral Therapy, Highly Active ; Antiviral Agents/*therapeutic use ; Cataract/complications ; Disease Progression ; Drug Therapy, Combination ; Fluorescein Angiography ; Ganciclovir/therapeutic use ; Herpes Zoster Ophthalmicus/*drug therapy/etiology ; Humans ; Male ; Phacoemulsification ; Retinal Necrosis Syndrome, Acute/*drug therapy/etiology ; Visual Acuity

PURPOSE: To evaluate the inhibitory effect of chlorogenic acid on laser-induced choroidal neovascularization (CNV) in a rat model. METHODS: Intraperitoneal injection of chlorogenic acid (10 mg/kg) was inititated one day prior to laser photocoagulation and continued for eight days. Eyes were removed 14 days after laser photocoagulation. Fluorescein angiography was employed at seven and 14 days to assess the CNV lesions, and histological examination was performed. Quantification of CNV size and leakage were performed both in histological sections and fluorescein angiography in order to compare the inhibitory effects of chlorogenic acid on CNV with the results of the control. RESULTS: Histological analysis showed no significant difference in CNV size between the treated and control groups. However, CNV leakage on fluorescein angiography had significantly decreased in the chlorogenic acid-treated group at 14 days after laser photocoagulation compared with that of the control group. In addition, CNV size on fluorescein angiography had significantly decreased in the treated group at seven and 14 days. CONCLUSIONS: These results suggest that chlorogenic acid has anti-angiogenic effects on CNV and may be useful as an inhibitor in the treatment or prevention of neovascular age-related macular degeneration.
Angiogenesis Inhibitors/*administration & dosage ; Animals ; Capillary Permeability/drug effects ; Chlorogenic Acid/*administration & dosage ; Choroid/pathology ; Choroidal Neovascularization/diagnosis/etiology/*physiopathology ; Fluorescein Angiography ; Injections, Intraperitoneal ; Laser Coagulation ; Radiation Injuries ; Rats ; Rats, Inbred BN

PURPOSE: To investigate the correlation between the severity of diabetic retinopathy and the responses of multifocal electroretinogram (mERG). METHODS: The amplitude and peak time of mERG was evaluated in a group of 88 diabetics and 20 control subjects. The severity of diabetic retinopathy was determined according to the ETDRS scale using color fundus photographs and fluorescein angiograms. RESULTS: The amplitudes of the summed mERG and the central seven hexagons were significantly lower in diabetic patients compared with control subjects, and the more severe the diabetic retinopathy was , the less the amplitude was (P<0.05). The peak times of the summed mERG and the central seven hexagons were significantly delayed in diabetic patients, and the peak time was increased in parallel with the severity of retinopathy (P<0.05). These significant correlations between mERG responses and the severity of diabetic retinopathy was maintained even after the exclusion of patients with diabetic macular edema. CONCLUSIONS: The macular function in diabetic patients is correlated with the grade of diabetic retinopathy, and mERG may have a clinical application in evaluating macular function in these patients.
Diabetic Retinopathy* ; Fluorescein ; Humans ; Macular Edema

The authors investigated macular circulation in a group of 27 patients(54 eyes) with diabetes melitus to evaluate the change of macular blood flow according to the grade of retinopathy, the status of glucose control and the duration of diabetes. Blood volume, flow and velocity on macular area were measured by Heidelberg Retinal Flowmeter(HRF, Heidelberg Engineering). Paticents with moderate or severe diabetic retinopathy showed a significant increase in macular blood flow than patients with less degree of diabetic retinopathy(502.45+/-223.58 AU vs, 355.19+/-123.84 AU, p=0.003). Both blood volume and velocity were also significantly increased in the patients with more advanced diabetic retinopathy. Macular blood flow was increased in the patients with higher fasting blood glucose, although the statistical significance was in borderline(473.12+/-238.57 AU vs, 362.14+/-103.22 AU, p=0.066). These results show that macular blood flow increases in the diabetic patients with more advanced diabetic retinopathy, suggesting that the increase in the macular blood flow may play a role in the development of diabetic macular microangiopathy.
Blood Glucose ; Blood Volume ; Diabetic Retinopathy ; Fasting ; Glucose ; Humans ; Retinaldehyde

PURPOSE: To assess the clinical outcomes of cyclosporine treatment for noninfectious uveitis. METHODS: A retrospective review of medical records was completed for 182 noninfectious uveitis patients who were treated with cyclosporine between January 2001 and August 2010. Data was obtained relevant to demographic characteristics, anatomic classification, and laterality of uveitis, associated systemic disorder, dosage of cyclosporine and prednisolone, usage of other immunosuppressive drugs, visual acuity (VA), control of uveitic activity, and adverse effects during the cyclosporine use. RESULTS: Uveitic activity was controlled to a level of minimal inflammation in 89.0% and completely in 78.6% of patients by the median duration of 49 and 98 days, respectively. Prednisolone-sparing (dose < or =10 mg) control of inflammation equal to or less than the minimal activity was achieved in 75.3% of patients. VA was aggravated more than 0.2 logarithm of the minimum angle of resolution in 17.3% of eyes in spite of cyclosporine treatment for the mean follow-up of 698.4 days. Dose reduction and cessation of cyclosporine was required only in 3.3% and 9.3%, respectively, due to the intolerable toxicity, although 44.0% of patients experienced mild to moderate adverse effects. CONCLUSIONS: Cyclosporine combined with corticosteroids or other immunosuppressive drugs as needed is an effective treatment for noninfectious uveitis, thus minimizing the adverse effects of corticosteroids and other toxic drugs. However, careful monitoring for the toxicity of cyclosporine is needed, because a small group of patients cannot tolerate its toxicity.
Adolescent ; Adult ; Aged ; Cyclosporine/administration & dosage/*therapeutic use ; Female ; Humans ; Immunosuppressive Agents/administration & dosage/*therapeutic use ; Kaplan-Meier Estimate ; Male ; Middle Aged ; Prednisolone/administration & dosage/therapeutic use ; Republic of Korea ; Retrospective Studies ; Treatment Outcome ; Uveitis/*drug therapy ; Visual Acuity

To determine prognostic factors of vitrectomy for posterior complications, secondary to uveitis, various perioperative factors and surgical results were anaylized in 30 eyes of 30 uveitis patients who were followed up for 6 months or more after vitrectomy. Surgical indications were vitreous opacity, vitreous hemorrhage, and retinal detachment. Postoperatively, retina was reattached in 15 eyes(83.3%) among 18 eyes. Postoperatively, visual acuity was maintained or improved in 25 eyes(83.3%) among 30 eyes. Cystoid macular edema was the leading cause of poor visual outcome. Preoperative electroretinographic findings and the duration of postoperative inflammation had statistical significance on the final visual outcome. These results suggest that chronic uveitis patients with vitreoretinal complications can be managed by vitreous surgery with good anatomic and functional results.
Humans ; Inflammation ; Macular Edema ; Retina ; Retinal Detachment ; Uveitis* ; Visual Acuity ; Vitrectomy* ; Vitreous Hemorrhage

PURPOSE: This study aimed to find out the difference in between the anatomic properties children with intermittent exotropia and children with orthophoria. METHODS: The intermittent exotropia group consisted of 35 patients who had an angle of deviation of more than 15 prisms. The control group consisted of 35 orthophoric children with comparable age and sex ratio. From the view of skull AP, we compared the diameter, interlateral wall distance, and intermedial wall distance of the orbital rim. Also we compared the intercanthal distance, interlateral canthal distance of eyelids, and interpupillary distance. RESULTS: The average values of interpupillary distance, intercanthal distance, and interlateral canthal distance of exotropic group were 54.23+/-1.85 mm, 34.75+/-1.66 mm, and 78.25+/-4.21 mm, respectively. Compared to those of control group, which were 53.59+/-1.21 mm, 33.56+/-1.54 mm, and 76.68+/-3.23 mm, respectively, there was no significant difference (P>0.05). The average values of the diameter, interlateral wall distance and the intermedial wall distance of the orbital rim were not significantly different between two groups (p>0.05). CONCLUSIONS: Our results showed that the anatomic properties including orbital rim size and orbital exodeviation did not seen to influence the development of intermittent exotropia.
Child ; Exotropia* ; Eyelids ; Humans ; Orbit ; Sex Ratio ; Skull

To determine surgical results and predictive factors of final visual acuity, a total of 30 eyes in 30 uveitis patients who underwent vitreous surgery including pars plana vitrectomy were followed for at least 6 months and various preoperative factors and postoperative results were analyzed. Our surgical indications were vitreous opacity, traction retinal detachment, combined rhegmatogenous-traction detachment. Preoperatively detached retina was finally reattached in 15 (83.3%) of 18 eyes. Final visual acuity improved in 19 (63.3%) of 30 eyes, but decreased in 3 eyes compared with the initial acuity. Cystoid macular edema was the main cause of poor visual acuity after surgery. Eyes with good final visual acuity showed relatively normal electroretinograms before surgery, but the relationship between them was not statistically significant. Duration of postoperative inflammation affected final visual acuity significantly. These results suggest that chronic uveitis patients with vitreoretinal complications can be managed by vitreous surgery with good anatomic and functional results.
Adolescent ; Adult ; Child ; Chronic Disease ; Eye Diseases/etiology/surgery ; Female ; Humans ; Male ; Middle Aged ; Prognosis ; Retinal Diseases/etiology/*surgery ; Uveitis/*complications ; Visual Acuity ; *Vitrectomy ; Vitreous Body/*surgery

To determine surgical results and predictive factors of final visual acuity, a total of 30 eyes in 30 uveitis patients who underwent vitreous surgery including pars plana vitrectomy were followed for at least 6 months and various preoperative factors and postoperative results were analyzed. Our surgical indications were vitreous opacity, traction retinal detachment, combined rhegmatogenous-traction detachment. Preoperatively detached retina was finally reattached in 15 (83.3%) of 18 eyes. Final visual acuity improved in 19 (63.3%) of 30 eyes, but decreased in 3 eyes compared with the initial acuity. Cystoid macular edema was the main cause of poor visual acuity after surgery. Eyes with good final visual acuity showed relatively normal electroretinograms before surgery, but the relationship between them was not statistically significant. Duration of postoperative inflammation affected final visual acuity significantly. These results suggest that chronic uveitis patients with vitreoretinal complications can be managed by vitreous surgery with good anatomic and functional results.
Adolescent ; Adult ; Child ; Chronic Disease ; Eye Diseases/etiology/surgery ; Female ; Humans ; Male ; Middle Aged ; Prognosis ; Retinal Diseases/etiology/*surgery ; Uveitis/*complications ; Visual Acuity ; *Vitrectomy ; Vitreous Body/*surgery

Experimental melanin-induced uveitis[EMIU]was induced in Lewis rats to investigate the mechanisms of the tissue destruction and spontaneous turning off of the endogenous uveitis. The eyes were enucleated serially, and immunohistochemistry, TUNEL stains, and flow cytometry were performed. The major infiltrating inflammatory cells were CD4 T cells in the uveal tissue of EMIU. Apoptosis of these cells has occurred and progressed throughout the inflammatory period in EMIU eyes. Most TUNEL positive cells revealed CD4 positive. These results suggest that apoptotic cell death occurred primarily in the infiltrating inflammatory cells not in the tissue cells of the eye and the apoptosis of CD4 T cells may play a key role in the spontaneous turning off mechanism of intraocular inflammation in EMIU.
Animals ; Apoptosis* ; Cell Death ; Coloring Agents ; Flow Cytometry ; Immunohistochemistry ; In Situ Nick-End Labeling ; Inflammation ; Rats ; T-Lymphocytes ; Uveitis*