The functioning filtering bleb constructed after trabeculectomy in glaucomatous patient might be fail after cataract operation probably due to transient collapse during cataract extraction and inflammatiry reaction of the filtering bleb which result in unsuccessful intraocular pressure control. To compare if the results were identical in cases with the use of encircling band to enlarge the aqueous absorbing scar tissue to trabeculectomy, intraocular pressure was followed for more than 6 months after cataract extraction and posterior chamber lens implantation in 7 eyes that previously underwent silicone tube insertion with the use of encircling band. There were no cases with increased intraocular pressure needed to control postoperatively. Therefore it could be possible to concluded that inflammatory reaction of the filtering bleb or transient collapse during cataract extraction has no negative influences on intraocular pressure in silicone tube implanted eye using encircling band.

PURPOSE: To report a case of a endogenous Aspergillus endophthalmitis associated with mycotic cerebral aneurysmal rupture. CASE SUMMARY: A 51-year-old woman was referred to our retina clinic for decreased visual acuity in the left eye. The patient had previously undergone a liver transplant for liver cirrhosis and hepatocellular carcinoma. On fundus examination, vitreous opacities with a yellowish-white subretinal abscess were observed. There were no abnormal findings except the positive sign in the laboratory serum Aspergillus antigen test performed on admission. Based on the suspicion of endogenous endophthalmitis, pars plana vitrectomy was performed with intravitreal antibiotics injection to treat fungal and bacterial infections. There was no growth in either the vitreous or anterior chamber culture. After vitrectomy, visual acuity improved and the inflammation subsided. However, by the three-week follow-up, acute-onset left hemiplegia with a right hemisphere cerebral hemorrhage had occurred. Cerebral magnetic resonance angiography showed multiple mycotic aneurysms characterized by a large and fusiform appearance. The patient was treated with neuro-embolization and was stabilized with minimal sequalae. CONCLUSIONS: Although the immunocompromised endophthalmitis patient can be treated using proper management, brain lesions such as mycotic aneurysm may exist and should be carefully considered.
Abscess ; Aneurysm ; Aneurysm, Infected ; Anterior Chamber ; Anti-Bacterial Agents ; Aspergillus ; Bacterial Infections ; Brain ; Carcinoma, Hepatocellular ; Cerebral Hemorrhage ; Endophthalmitis ; Eye ; Female ; Follow-Up Studies ; Hemiplegia ; Humans ; Inflammation ; Intracranial Aneurysm ; Liver ; Liver Cirrhosis ; Magnetic Resonance Angiography ; Middle Aged ; Retina ; Transplants ; Visual Acuity ; Vitrectomy

PURPOSE: To determine the risk factors of retinal pigment epithelial (RPE) tears developed after treatment of exudative age-related macular degeneration (AMD) and to report its clinical manifestations. METHODS: A retrospective, consecutive chart review was performed for all patients with exudative AMD treated with intravitreal anti-vascular endothelial growth factor (VEGF) antibody or photodynamic therapy (PDT) between March 2010 and January 2013. The main outcome measures were the time from first injection to development of the RPE tear and pre- and post-RPE tear visual acuity. The visual acuity conservational interval was defined between the time the RPE tear occurred and the time visual acuity decreased 5 letters or more from pre-RPE tear visual acuity. RESULTS: A total of 219 eyes were treated with intravitreal bevacizumab, ranibizumab or PDT. Ten eyes from 10 patients developed a RPE tear (4.6%); 7 were occult choroidal neovasculization (CNV) and 3 were polypoidal choroidal vasculopathy (PCV). The average age of the RPE tear patients was 75.4 years which is statistically greater than the others (65.7) (p = 0.001). Ninety percent (9/10) of the RPE tears occurred within the first 12 weeks after treatment started. Five patients conserved their visual acuity for approximately 4 months after the RPE tear occurred. However, all 10 patients had poor visual acuity within 1 year of the follow-up period. CONCLUSIONS: RPE tears occur after intravitreal anti-VEGF antibody or PDT treatments for exudative AMD in elderly patients. Visual acuity could be conserved in the early period after a RPE tear occurred but decreased within the next year.
Aged ; Antibodies, Monoclonal, Humanized ; Choroid ; Endothelial Growth Factors ; Eye ; Follow-Up Studies ; Humans ; Macular Degeneration* ; Outcome Assessment (Health Care) ; Photochemotherapy ; Retinaldehyde* ; Retrospective Studies ; Risk Factors ; Triazenes ; Visual Acuity ; Bevacizumab ; Ranibizumab

PURPOSE: To report a case of vitreous inflammation (vitreous web) after intravitreal bevacizumab injection accompanying pars plana vitrectomy (PPV) for the treatment of proliferative diabetic retinopathy with vitreous hemorrhage. CASE SUMMARY: A 41-year-old female who underwent panretinal photocoagulation for diabetes mellitus (DM) retinopathy presented with decreased visual acuity in her right eye which was caused by vitreous hemorrhage. The patient underwent PPV with intravitreal bevacizumab injection. One day after surgery, the vitreous hemorrhage cleared and there was no inflammation in the anterior segment; however, multiple inflammatory white strands (vitreous web) were found in the vitreous cavity. She was diagnosed with non-infectious endophthalmitis and treated with topical steroid and additional oral steroids, resulting in clearance of the vitreous web on postoperative day 4. One month later, vitreous hemorrhage occurred in the other eye. PPV without bevacizumab injection cleared the vitreous hemorrhage with no evidence of vitreous web. CONCLUSIONS: Vitreous web-like inflammation can occur after intravitreal bevacizumab injection accompanying PPV for the treatment of DM vitreous hemorrhage. After eliminating infectious endophthalmitis based on lack of pain, conjunctival injection, anterior chamber hypopyon, and inflammatory cells, the web can be cleared without invasive intravitreal antibiotics injections.
Adult ; Anterior Chamber ; Anti-Bacterial Agents ; Diabetes Mellitus ; Diabetic Retinopathy ; Endophthalmitis ; Female ; Humans ; Inflammation ; Light Coagulation ; Steroids ; Visual Acuity ; Vitrectomy* ; Vitreous Hemorrhage ; Bevacizumab

PURPOSE: To report a case of multiple serous chorioretinopathy after facial herpes zoster. CASE SUMMARY: A 48-year-old male visited our clinic due to visual disturbance in the left eye which occurred 3 days after left facial pain and vesicles. Chemosis and multiple serous retinal detachments were found. The patient was diagnosed with multiple serous chorioretinopathy due to herpes zoster virus and was started on intravenous acyclovir at a dose of 10 mg/kg every 8 hours for 9 days and herpes eye ointment 5 times daily. After the initial treatment, oral prednisolone 60 mg was given daily for 6 days. Skin lesions were cleared, and abnormal fundus and visual acuity improved after treatment. CONCLUSIONS: Ophthalmopathy including multiple serous chorioretinopathy should be considered in managing herpes zoster ophthalmicus patients.
Acyclovir ; Facial Pain ; Herpes Zoster Ophthalmicus ; Herpes Zoster* ; Herpesvirus 3, Human ; Humans ; Male ; Middle Aged ; Prednisolone ; Retinal Detachment ; Skin ; Visual Acuity

PURPOSE: To introduce a case of complicated ophthalmopathy in herpes zoster ophthalmicus including vitreous opacity, retinal hemorrhage and optic neuropathy having components of anterior ischemic optic neuropathy and optic neuritis. CASE SUMMARY: A 59-year-old man visited our clinic because of visual disturbance in the right eye which occurred after right facial pain and vesicles. There were inflammatory cells in the anterior chamber, retinal hemorrhage in the retina and vitreous opacity was found. Track-like high signal intensity along the right optic nerve was found on T1 MRI. Partial filling defect of optic disc was observed on fluorescein angiography (FAG). The patient was diagnosed with herpes zoster ophthalmicus complicated by anterior uveitis and optic neuropathy having components of anterior ischemic optic neuropathy and optic neuritis. The patient was started on intravenous acyclovir at a dose of 10 mg/kg every 8 hours for 5 days and Herpesid eye ointment 5 times daily. After the initial treatment, oral acyclovir 400 mg was given 3 times daily for 14 days. Skin symptoms and fundus findings improved but the visual acuity did not improve because of optic atrophy. CONCLUSIONS: Ophthalmopathy including anterior uveitis, vitreous opacity, retinal hemorrhage and optic neuropathy having components of anterior ischemic optic neuropathy and optic neuritis should be considered in herpes zoster ophthalmicus patients.
Acyclovir ; Anterior Chamber ; Eye ; Facial Pain ; Fluorescein Angiography ; Herpes Zoster ; Herpes Zoster Ophthalmicus ; Humans ; Optic Nerve ; Optic Nerve Diseases ; Optic Neuritis ; Optic Neuropathy, Ischemic ; Retina ; Retinal Hemorrhage ; Retinaldehyde ; Skin ; Uveitis, Anterior ; Visual Acuity

PURPOSE: We report two cases of phototherapeutic keratectomy(PTK) treatment of Avellino corneal dystrophy with topical intraoperative application of 0.02% mitomycin C(MMC). METHODS: In the first case, a 27-year-old woman who had recurrent Avellino corneal dystrophy after uncomplicated bilateral LASIK underwent PTK, and then intraoperative 0.02% MMC applied topically with a soaked microsponge at the posterior corneal flap surface and the stromal bed and vigorous irrigation. In the second case, a 30-year-old man who had recurrent Avellino corneal dystrophy despite seven PTKs, underwent PTK with intraoperative 0.02% MMC at the corneal surface. RESULTS: In the first case, the preoperative best corrected visual acuity(BCVA) was 20/200. And 9 months after the operation, uncorrected visual acuity was 20/25. In the second case, the preoperative BCVA was 20/200. And 6 months of follow-up, BCVA was 20/25 and there was no evidence of recurrence. CONCLUSIONS: The intraoperative use of topical 0.02% MMC in conjunction with PTK may prevent or delay the recurrence of Avellino corneal dystrophy.
Adult ; Female ; Follow-Up Studies ; Humans ; Keratomileusis, Laser In Situ ; Mitomycin* ; Recurrence ; Visual Acuity

Extracorporeal shock wave lithotripsy(ESWL) for urinary calculi is usually performed under general anesthesia, regional anesthesia or intravenous anesthesia. We evaluated the sedativeanalgesic effeet and untoward effects of diazepam-fentanyl for ESWL. 60 patients were belonged to physical status 1 or 11 of ASA classification who injected diazepam(5~10 mg) and fentanyl(1.5 ug/kg) at 2 minutes were as follows The results were as follows; 1) Mean arterial pressure(MAP) was significantly decreased in 3-10 minutes after injection compared to baseline value. 2) Heart rate(HR) was statistically nonsignificant but slightly decreased from 2 minutes after injection. 3) Respiratory rate(RR) and arterial oxygen saturation(SaO2) were significantly decreased until 15 miuntes after injection but SaO was not decreased below 92.7% and RR was not decreased below 13 rates/minute. 4) Pain and movement during ESWL developed in 18 cases but repositioning and discon- tinuation of EWSL were not necessary. Episodes of desaturation(SaO2<90%) developed in 2 cases. 5) Postoperative dizziness developed in 24 cases. nausea and vomiting developed in a few cases. We concluded that intravenous administration of diazepam-fentanyl is more convenient and simpler than other anesthetic technique for ESWL.
Administration, Intravenous ; Analgesia ; Anesthesia, Conduction ; Anesthesia, General ; Anesthesia, Intravenous ; Classification ; Diazepam* ; Dizziness ; Fentanyl* ; Heart ; Humans ; Lithotripsy* ; Nausea ; Oxygen ; Shock* ; Urinary Calculi ; Vomiting

PURPOSE: To investigate the outcome of surgery for a metallic intraocular foreign body and prognostic factors for visual acuity. METHODS: A retrospective chart review was performed on 47 eyes of 47 patients who underwent surgical removal of a metallic intraocular foreign body (IOFB) after eyeball laceration between 2000 and 2010. We investigated the location and size of eyeball lacerations, the location of IOFB, the clinical findings at initial examination, surgical methods and best corrected visual acuity. We analyzed the prognostic factors for final visual acuity. RESULTS: The mean age was 45 years, and the most common cause of IOFB was lawnmower use. Cornea (77%) was the most frequently involved structure, and hyphema (72%) was the most common finding at initial slit lamp examination. Retina was the most common site of IOFB. The average visual acuity was 0.17 +/- 0.49 before surgery, and the final visual acuity was 0.23 +/- 0.39. Good visual prognosis was observed when the initial visual acuity was good or when the IOFB was located in the anterior segment, but the prognosis was poor when there was a vitreous opacity compromised with endophthalmitis at initial examination. CONCLUSIONS: An IOFB should be removed as soon as possible. Good initial visual acuity and anterior segment IOFB are good prognostic factors of visual outcome.
Cornea ; Endophthalmitis ; Eye ; Foreign Bodies ; Humans ; Hyphema ; Lacerations ; Prognosis ; Retina ; Retrospective Studies ; Visual Acuity

PURPOSE: The purpose of this study was to determine if ceramide, which is known as secondary messenger of programmed cell death (apoptosis), can cause apoptosis in lens epithelial cell (LEC) and if so, to identify the pathway by which apoptosis occurs. METHODS: After LECs were exposed to various concentrations of ceramide and phytoceramide, we evaluated the resulting apoptosis response using the Hoechst-EthD stain and Annexin stain. To search for the apoptosis pathway, LECs were preincubated in various concentrations of CPP32-like protease inhibitor, specific caspase-8 inhibitor, and specific caspase-9 inhibitor, then treated with ceramide and phytoceramide. We performed LDH assay 12 hours later. Cytochrome c immunostaining was done after exposure to the ceramide and phytoceramide. RESULTS: All kinds of ceramide induced time and concentration dependent apoptosis in LEC. Caspase 8 inhibitor and caspase 9 inhibitor reduced the apoptosis in ceramide VI, phytoceramide II, and phytoceramide VI. In all ceramides, cytochrome c staining was positive. CONCLUSIONS: Ceramide and phytoceramide can cause apoptosis in LEC. Ceramide and phytoceramide may be used to prevent the posterior capsular opacity after cataract surgery.
Apoptosis* ; Caspase 8 ; Caspase 9 ; Cataract ; Cell Death ; Ceramides ; Cytochromes c ; Epithelial Cells* ; Protease Inhibitors