Seven patients with aortic valve vegetation were examined by M-mode and two dimensional echocardiography. Underlying cardiac abnormalities were found in 6 patients, four had rheumatic heart disease, one had congenital bicuspid aortic valve, one had coexistence of asymmetrical septal hypertrophy and aortic regurgitation. Aortic regurgitation were found in all patients. One of seven patients had cerebral embolization and all patients had overt congestive heart failure. Of 5 patients medically treated, three became moribund, one died and one improved clinically. One patient underwent cardiac surgery, the aortic cusps were congenital bicuspid with vegetation, aortic valve replacement was successful. Echocardiogram of 7 patients with aortic valve vegetation showed characteristic shaggy, irregular mass of echoes produced by vegetation in the aortic valve during systole and diastole. Two of seven patients had abnormal mass of echoes in the left ventricular outflow tract. During systole, two had vegetation on the right coronary cusp and one had vegetation on the noncoronary cusp by M-mode echocardiography. In other patients we could not localize invoving aortic cusps by M-mode echocardiogram. All patients had left ventricular volume overload. For of seven patients had fluttering of anterior mitral valve. Two had fluttering of interventricular seputm. Five had premature mitral valve closure before QRS complex.
Aortic Valve Insufficiency ; Aortic Valve* ; Bicuspid ; Diastole ; Echocardiography* ; Heart Failure ; Humans ; Hypertrophy ; Mitral Valve ; Rheumatic Heart Disease ; Systole ; Thoracic Surgery

PURPOSE: To investigate the effects of varying the time of Mitomycin-C (MMC) subconjunctival injection before, during and after operation. METHOD: We divided rabbits into 3 groups according to injection time. Subconjunctival injections of 0.01% MMC 0.05 ml were given to the preoperative group at 6, 12 and 24 hours before operation, and to the postoperative group at 6, 12 and 24 hours after operation. The control group was given the injections during operation. Bleb formation and histologic analyses were studied for 4 weeks after operation. RESULTS For gross findings, the blebs of the preoperative and control groups were seen on the fourth day and completely formed at one week after operation, and were larger than those of the postoperative group. On the other hand, the blebs of the postoperative group were seen to have poor formation, displaying hypervascularity on the fourth day and disappearing one week after operation. For histologic findings, the proliferation of collagen fibers and the undifferentiation of fibroblasts observed in the preoperative and control groups were almost identical. But, the proliferation of collagen fibers and well-differentiated fibroblasts were seen to increase in the postoperative group, so aqueous flow was obstructed at week 3. CONCLUSIONS: Subconjunctival injections within 24 hours before or during glaucoma filtration surgery were better for bleb formation and preservation than those administerd after surgery.
Blister ; Collagen ; Fibroblasts ; Filtering Surgery* ; Filtration* ; Glaucoma* ; Hand ; Mitomycin* ; Rabbits*

PURPOSE: To investigate the effects of varying the time of Mitomycin-C (MMC) subconjunctival injection before, during and after operation. METHOD: We divided rabbits into 3 groups according to injection time. Subconjunctival injections of 0.01% MMC 0.05 ml were given to the preoperative group at 6, 12 and 24 hours before operation, and to the postoperative group at 6, 12 and 24 hours after operation. The control group was given the injections during operation. Bleb formation and histologic analyses were studied for 4 weeks after operation. RESULTS For gross findings, the blebs of the preoperative and control groups were seen on the fourth day and completely formed at one week after operation, and were larger than those of the postoperative group. On the other hand, the blebs of the postoperative group were seen to have poor formation, displaying hypervascularity on the fourth day and disappearing one week after operation. For histologic findings, the proliferation of collagen fibers and the undifferentiation of fibroblasts observed in the preoperative and control groups were almost identical. But, the proliferation of collagen fibers and well-differentiated fibroblasts were seen to increase in the postoperative group, so aqueous flow was obstructed at week 3. CONCLUSIONS: Subconjunctival injections within 24 hours before or during glaucoma filtration surgery were better for bleb formation and preservation than those administerd after surgery.
Blister ; Collagen ; Fibroblasts ; Filtering Surgery* ; Filtration* ; Glaucoma* ; Hand ; Mitomycin* ; Rabbits*

Purpose: To determine the incidence and characteristics of iatrogenic retinal breaks in patients who underwent 25-gauge vitreous surgery for macular hole and idiopathic epiretinal membrane, with a comparison and analyses of surgical records and preoperative data, including wide-angle fundus imaging and indirect ophthalmoscopic examination findings. Methods: The medical records were analyzed retrospectively for 82 macular hole eyes and 285 epiretinal membranes that underwent vitrectomy at our hospital from January 2016 to December 2019. The number and location of retinal breaks observed in preoperative fundus examination and wide-angle fundus imaging were compared with those indicated in the surgical records. The presence of retinal breaks and retinal lattice degeneration was investigated, and the relationship of each factor with respect to posterior vitreous detachment (PVD) was examined. Results: Of the 367 eyes that underwent vitrectomy, six eyes (1.6%) developed iatrogenic retinal breaks. Thirty-four eyes (9.3%) had retinal breaks before surgery. Retinal break was found in 15 (4.1%) eyes, retinal lattice degeneration was indicated in 32 eyes (8.7%), and PVD occurred in 261 eyes (71.1%). The association of iatrogenic retinal break and PVD was not confirmed. An additional 14 preoperative breaks, not seen in indirect ophthalmoscopic examination, were identified in wide-angle fundus images. Conclusions It was found that 25-gauge vitrectomy-related iatrogenic retinal breaks occurred at a lower frequency than previously reported for 20-gauge vitrectomy procedures. Wide-angle fundus imaging was able to identify retinal breaks more accurately than conventional research methods.

Purpose: To report a case of preretinal pigmentary proliferation on the fovea after scleral buckling for rhegmatogenous retinaldetachment.Case summary: A 49-year-old female visited out clinic complaining of a visual field defect in the right eye for 5 days. Thebest-corrected visual acuity (BCVA) was 0.8 in her right eye. Fundus examination of the right eye revealed an upper rhegmatogenousretinal detachment without macular involvement and retinal breaks were found at 11 o’clock and 11’ 30” direction. She underwentscleral buckling, subretinal fluid drainage, and cryoretinopexy under general anesthesia. At postoperative day 4, thesubretinal fluid was reduced, but the BCVA decreased to 0.2. The fovea was covered with a brownish pigmentary clump and preretinalhyperreflective proliferative tissue was observed on the fovea by optical coherence tomography. Oral steroid was administeredand a decrease of pigmentary proliferation was observed at 2 weeks after surgery. At 3 months postoperatively, thepigmentary proliferation had almost disappeared and the BCVA recovered to 0.8. Conclusions Pigmentary proliferation on the fovea may be observed in patients treated with scleral buckling for rhegmatogenousretinal detachment, so careful observation is needed to differentiate this process from other proliferative diseases.

Purpose: To determine the incidence and characteristics of iatrogenic retinal breaks in patients who underwent 25-gauge vitreous surgery for macular hole and idiopathic epiretinal membrane, with a comparison and analyses of surgical records and preoperative data, including wide-angle fundus imaging and indirect ophthalmoscopic examination findings. Methods: The medical records were analyzed retrospectively for 82 macular hole eyes and 285 epiretinal membranes that underwent vitrectomy at our hospital from January 2016 to December 2019. The number and location of retinal breaks observed in preoperative fundus examination and wide-angle fundus imaging were compared with those indicated in the surgical records. The presence of retinal breaks and retinal lattice degeneration was investigated, and the relationship of each factor with respect to posterior vitreous detachment (PVD) was examined. Results: Of the 367 eyes that underwent vitrectomy, six eyes (1.6%) developed iatrogenic retinal breaks. Thirty-four eyes (9.3%) had retinal breaks before surgery. Retinal break was found in 15 (4.1%) eyes, retinal lattice degeneration was indicated in 32 eyes (8.7%), and PVD occurred in 261 eyes (71.1%). The association of iatrogenic retinal break and PVD was not confirmed. An additional 14 preoperative breaks, not seen in indirect ophthalmoscopic examination, were identified in wide-angle fundus images. Conclusions It was found that 25-gauge vitrectomy-related iatrogenic retinal breaks occurred at a lower frequency than previously reported for 20-gauge vitrectomy procedures. Wide-angle fundus imaging was able to identify retinal breaks more accurately than conventional research methods.

Purpose: Here, we report a case of acute noninfectious endophthalmitis after removal of silicone oil (SO) and posterior capsulectomy in a patient with proliferative diabetic retinopathy.Case summary: SO removal and posterior capsulectomy were performed in a 61-year-old man who had undergone vitrectomy with combined cataract surgery, membrane peeling, laser photocoagulation, and SO injection to treat vitreous hemorrhage and tractional retinal detachment three months previously. The patient’s best-corrected visual acuity on the day after surgery was 20/50; it decreased to hand motion at five days after SO removal. Exudative membrane with hypopyon, anterior chamber cell (trace), and mild conjunctival injection were observed. The patient did not complain of ocular pain. Topical steroid was applied following a diagnosis of postoperative noninfectious endophthalmitis. The exudative membrane and hypopyon decreased after three days of treatment and had resolved completely after one month of treatment. The patient’s visual acuity improved to 20/50. Conclusions Noninfectious endophthalmitis can develop after removal of SO and posterior capsulectomy. Topical steroid treatment is effective in such cases.

Purpose: We report bilateral, diffuse, uveal melanocytic proliferation caused by a stomach adenocarcinoma.Case summary: A 78-year-old male complained of visual impairment 3 months in duration. He had diabetes and had undergone cataract surgery on both eyes 4 years prior. His best-corrected visual acuity was counting fingers in the right eye and 20/160 in the left eye. Both intraocular pressures were normal. The anterior segments yielded no specific findings. The maculae exhibited multiple, round, patchy, pigmented or depigmented lesions with exudative retinal detachment. Fluorescein angiography revealed multiple hyperfluorescent lesions. Optical coherence tomography revealed that the hyper-reflective exudates lay between the neurosensory retina and the retinal pigment epithelium. We diagnosed bilateral, diffuse, uveal melanocytic proliferation and performed a systemic evaluation. Computed tomography revealed several mass lesions in the lung, stomach, and lymph nodes; these appeared to be malignant. An esophagogastroduodenoscopic biopsy confirmed that the lesions were adenocarcinomas. Conclusions A bilateral, diffuse, uveal melanocytic proliferation induced by a primary malignant tumor exhibited multiple, pigmented subretinal exudates associated with exudative macular retinal detachment. In patients with such findings, it is necessary to evaluate the malignant tumor status of remote organs.

Purpose: To investigate the changes in intraocular cytokines after ranibizumab treatment in patients with polypoidal choroidal vasculopathy (PCV). Methods: This multicenter, prospective study enrolled patients with PCV treated with three monthly ranibizumab followed by a pro re nata regimen for 24 weeks. Best corrected visual acuity, slit lamp examination, fundus photography, and optical coherence tomography were performed every 4 weeks. Aqueous humor was collected to measure intraocular cytokines at baseline, week 8, and the time of recurrence or week 20. The association of changes in intraocular cytokines with visual acuity, central macular thickness, central choroidal thickness, area of abnormal vessels, and polyp closure was assessed. Results: This study included 25 eyes. The mean patient age was 70.3 ± 6.1 years. The vascular endothelial growth factor (VEGF) concentration decreased at week 8, but only interferon (IFN)-γ, tissue inhibitors of matrix metalloproteinases (TIMP)-2, and monocyte chemoattractant protein (MCP)-2 decreased at the time of recurrence. The recurrence interval was positively associated with the baseline epithelial-neutrophil activating peptide (ENA)-78, interleukin (IL)-17, leptin, and transforming growth factor-β1, and baseline central macular thickness was positively correlated with the baseline fibroblast growth factor-4 and IL-10. Thick central choroidal thickness was associated with a low basic fibroblast growth factor and high IFN-γ at baseline. The MCP-3 and Tie-2 levels decreased in two eyes with polyp closure. Conclusions Ranibizumab significantly reduced intraocular VEGF concentrations and consequently improved PCV. However, the cytokines IFN-γ, TIMP-2, and MCP-2, rather than VEGF, were associated with PCV recurrence. Further studies of intraocular cytokines involved in neovascularization in PCV are needed.

Purpose: To describe the development of multiple retinal hemorrhages after uncomplicated macular hole (MH) surgery, and to determine the associated factors. Methods: The medical records of 163 patients (167 eyes) diagnosed with idiopathic MHs and who underwent surgery at Pusan National University Hospital between March 2016 and July 2018 were retrospectively reviewed. The development of retinal hemorrhages was evaluated using ultra-widefield fundus photographs. Multiple retinal hemorrhages were defined as three or more dot or blot hemorrhages that had not been observed before and during the surgery. The patients were divided into two groups according to the presence of multiple retinal hemorrhages. The variable parameters were compared between the two groups to find the risk factors. The associated factors were evaluated further for the independent factor using multiple logistic regression analysis. Results: Multiple retinal hemorrhages were observed in 31 eyes (18.6%) after MH surgery. The associated factors were the surgical induction of posterior vitreous detachment (PVD) (p = 0.003), use of the internal limiting membrane flap technique (p = 0.028), and staining with Brilliant Blue G (BBG) (p = 0.003). Retinal hemorrhages were exclusively observed in eyes in which BBG was used. Surgical PVD induction was the only independent risk factor (odds ratio, 13.099; p = 0.013). No statistically significant differences were observed between the two groups in the postoperative visual outcomes and MH closure rate. Additionally, patients who underwent surgery for idiopathic epiretinal membrane during the study period were reviewed to validate the above findings. Multiple retinal hemorrhages were noted in only one case (0.4%) in which BBG was used after surgical induction of PVD. Conclusions Multiple retinal hemorrhages after MH surgery appear to be related to the intravitreal use of BBG in eyes that sustained mechanical damage because of surgical induction of PVD; however, they did not affect surgical outcomes.