Prolonged hypotony and related complications can occur after trabeculectomy, especially with adjunctive mitomycin C. Prolonged hypotony can produce a permanent reduction in vision. A 22-year-old woman with primary open-angle glaucoma underwent uncomplicated trabeculectomy. A sponge soaked with a 0.5mg/ml solution of mitomycin C was placed between the conjunctiva and the scleral flap for 5 minutes. Two weeks after surgery, visual acuity was reduced to 20/400 and intraocular pressure was 3mmHg. There were disc edema, vascular tortuosity, and radiating chorioretinal folds in the macular area. The bleb was pale, highly elevated, and extended for 270 degrees of the limbus. The anterior chamber was formed, and no bleb leak, cyclodialysis cleft, choroidal detachment were seen. Her intraocular pressure was 2-7mmHg during the 12 weeks after surgery. At the last examination, visual acuity improved at the preoperative level of 20/30 and intraocular pressure was 10mmHg. Fortunately, hypotony maculopathy had improved without any specific management.
Anterior Chamber ; Blister ; Choroid ; Conjunctiva ; Edema ; Female ; Glaucoma, Open-Angle ; Humans ; Intraocular Pressure ; Mitomycin* ; Porifera ; Trabeculectomy* ; Visual Acuity ; Young Adult

OBJECTIVES: We compared the characteristics of the pain threshold and pain experience between demented group and non-demented group. METHODS: This study was part of Gangwon projects for early detection of dementia in 2010. We recruited 8302 local resident ages over 65 years old. Of theses, 1259 people who scored low MMSE were selected and 365 of them completed CERAD-K(Consortium to Establish a Registry for Alzheimer's disease). Finally, 90 in non-demented group and 57 in demented group(mild to moderate Alzheimer's disease) were analyzed. Pain threshold was experimentally measured by pressure algometer and we investigated the pain experience, by Brief pain inventory (BPI), a self-report test. RESULTS: In the demographic characteristics, there are more female, higher ages, lower education in the demented group. There was no significant difference between the two groups in the pain threshold. On the BPI results, 'shoulder pain', 'the number of pain' and 'interference of working' were significantly more prevalent in non-demented group. However, there are no significant differences between the groups in the 'pain severity', 'prevalence of pain' and 'pain treatment'. CONCLUSIONS: Demented group report less pain experience but, still perceived pain. It support previous studies that patient with dementia have increased pain tolerance but preserved pain threshold. Thus, active pain assessment and treatment for patients with dementia is needed.
Aged* ; Dementia* ; Education ; Female ; Gangwon-do ; Humans ; Pain Measurement ; Pain Threshold*

PURPOSE: To identify the risk factors associated with false negative findings of optical coherence tomography (Stratus OCT) in patients with photographic localized retinal nerve fiber layer (RNFL) defects. METHODS: Twenty-four patients with preperimetric glaucoma and 173 patients with perimetric glaucoma, all with localized RNFL defects were included in the present study. The patients were divided into 2 groups according to the presence or absence of detection of photographic defects by OCT. Gender, age, refractive error, diabetes, hypertension, central corneal thickness, type of glaucoma, mean deviation, pattern standard deviation, average RNFL thickness, disc area, and photographic RNFL defect related variables (location, number, and angular width) were compared between the 2 groups. Each variable was initially evaluated by univariate analysis and significant variables (p < 0.1) were included in the logistic regression analysis. RESULTS: Photographic RNFL defects were not detected by OCT in 51 (25.9%) of the 197 eyes. The angular locations and widths of RNFL defects by OCT were significantly correlated with those of RNFL defects by red-free RNFL photographs (Pearson correlation coefficient R = 0.98 and 0.64, respectively). Logistic regression analysis revealed the risk factors for false negative findings of OCT included average RNFL thickness (odds ratio = 1.106, 95% confidence interval [CI] = 1.057-1.156, p < 0.001) and angular width of defect (odds ratio = 0.929, 95% CI = 0.884-0.977, p = 0.004). CONCLUSIONS: This present study suggests that false negative findings of OCT in patients with photographic localized RNFL defects were associated with thicker RNFL thickness and smaller angular width of RNFL defect.
Eye ; Glaucoma ; Humans ; Hypertension ; Logistic Models ; Nerve Fibers ; Refractive Errors ; Retinaldehyde ; Risk Factors ; Tomography, Optical Coherence

The purpose of this study is to compare the efficacy and safety of 0.25 and 0.5mg/ml of mitomycin C(MMC) on the outcome of glaucoma filtration surgery in eyes undergoing primary trabeculectomy. Twenty-eight eyes of 20 patients with primary open-angle glaucoma or primary angle-closure glaucoma, who underwent primary trabeculectomy with 0.25mg/ml MMC for 3 minutes were compared with a demographically similar group of 31 eyes of 22 patients with primary open-angle glaucoma or primary angle-closure glaucoma, who had undergone primary trabeculectomy with 0.5mg/ml MMC for 3 minutes. MMC was applied between the sclera and Tenon's capsule during trabeculectomy, and scleral flap was closed with tight releasable sutures. The mean preoperative intraocular pressure was 35.2 +/- 9.3mmHg in the 0.25mg group and 32.1 +/- 9.2mmHg in the 0.5mg group(p=0.21, Student's unpaired t-test). The mean number of preoperative medications was 2.7 +/- 0.9 and 2.7 +/- 0.8(p=0.92, Mann Whitney U test), respectively. No statistically significant differences were found in mean intraocular pressures between the two groups at the three. six, and nine months postoperative periods. The mean follow-up was 9.2 months in the 0.25mg group and 9.0 months in the 0.5mg group(p=0.82, Student's unpaired t-test). At the last postoperative visit. 89%(25 eyes) in the 0.25mg group and 97%(30 eyes) in the 0.5mg group had an intraocular pressure less than 21mmHg with or without glaucoma medication(p=0.50, Fisher exact test). The mean intraocular pressures were 16.0 +/- 6.9mmHg and 13.6 +/- 3.6mmHg, respectively (p=0.10, Student's unpaired t-test). The 0.25mg group received an average of 0.5 medications for IOP control, and the 0.5mg group received an average of 0.2 medications(p=0.32, Mann Whitney U test). The postoperative visual outcome of the two groups did not differ significantly(p=0.27, Fisher exact test). There was no significant difference in complications between the two groups. Hypotony developed in one eye in the 0.5mg group. These results suggest that using 0.25 and 0.5mg/ml MMC for 3 minutes in primary trabeculectomy yields similar results in terms of efficacy and safety.
Filtering Surgery ; Follow-Up Studies ; Glaucoma* ; Glaucoma, Angle-Closure ; Glaucoma, Open-Angle ; Humans ; Intraocular Pressure ; Mitomycin* ; Postoperative Period ; Sclera ; Sutures ; Tenon Capsule ; Trabeculectomy*

No abstract available.
Infant, Newborn ; Meconium Aspiration Syndrome

Several studies have reported that the extent of cupping reversal after reduction of intraocular pressure may decrease with the progression of glaucomatous optic nerve damage. Three cases of reversal of glaucomatous cupping occurred after mitomycin C trabeculectomy in 20 and 22-year-old patients with advanced open angle glaucoma. The magnitude of intraocular pressure reduction was 35 to 38mmHg(average 36.7mmHg), a 79.1% drop from initial pressures. An improvement in the visual field occurred in one eye after re versa 1 of cupping. The most likely mechanism to explain reversal of cupping is a reduction in the posterior bowing of the lamina cribrosa. Even in the advan ced stage of glaucoma, reversal of cupping may be possible in young adults, as seen in our cases.
Adult* ; Glaucoma* ; Glaucoma, Open-Angle ; Humans ; Intraocular Pressure ; Mitomycin ; Optic Nerve ; Trabeculectomy ; Visual Fields ; Young Adult

PURPOSE: To compare the glaucomatous optic nerve damage in primary angle-closure glaucoma (PACG) with acute attack (acute PACG; AACG) and PACG without acute attack (chronic PACG; CACG). METHODS: The study subjects were 84 normal individuals, 130 AACG patients, and 86 CACG patients. Color optic disc photographs were evaluated for the presence or absence of 10 qualitative signs to differentiate between normal and glaucomatous optic discs. RESULTS: Abnormally shaped rim width (alteration of ISN'T rule), bared circumlinear vessel, vessel bayonetting, rim width narrower than the temporal sector, and zone beta (nasal and superotemporal sectors) were detected more frequently in the CACG group than in the AACG group (P< 0.05). The most accurate qualitative sign was abnormally shaped rim width in both groups. The specificity and sensitivity of abnormally shaped rim width were 71.4% and 60.8% for AACG, and 71.4% and 81.4% for CACG, respectively. CONCLUSIONS: The optic disc damage is greater in CACG than in AACG.
Optic Nerve/*pathology ; Middle Aged ; Male ; Intraocular Pressure ; Humans ; Glaucoma, Angle-Closure/*pathology/physiopathology ; Female ; Chronic Disease ; Aged ; Acute Disease

No abstract available.
Transplantation*

PURPOSE: To determine if korean normative database improve diagnostic ability of Stratus OCT for detection of glaucoma. METHODS: Peripapillary retinal nerve fiber layer (RNFL) and optic nerve head regions were measured using a Stratus OCT. The normative data were collected from 129 normal individuals. We obtained values at the 5% and 1% levels according to the disc area stratified into equal thirds to minimize the error by the individual variation of optic disc size and these levels were considered abnormal. One eye of each 94 normal-tension glaucoma patients with early visual field defects (mean deviaton = -3.84+/-1.40dB) and 87 another normal subjects were enrolled. Glaucoma was defined by visual field defects. RESULTS: The use of Korean normative database had higher sensitivity and no significant difference of specificity than that of a Stratus OCT except for a few parameters. The criteria that show the highest diagnostic ability were 1 > or = quadrants RNFL thickness abnormal at the < 5% when using a Korean normative database (sensitivity = 81.9%, specificity = 81.6%) and 1 > or = clock hours abnormal at the < 5% when using a Stratus OCT normative database (sensitivity = 71.3%, specificity = 87.4%) (p=0.004, p=0.180, respectively, McNemar test). CONCLUSIONS: The criterion using a Korean normative database had higher sensitivity and no difference of specificity compared with criterion using a Stratus OCT normative database. The best criterion using a Korean normative database may be helpful for early detection of normal-tension glaucoma.
Eye ; Glaucoma ; Humans ; Nerve Fibers ; Optic Disk ; Optic Nerve ; Retinaldehyde ; Sensitivity and Specificity ; Tomography, Optical Coherence ; Visual Fields

No abstract available.
Plasma* ; Prostate* ; Prostatic Neoplasms* ; Stomach Neoplasms*