PURPOSE: To present a case of a unilateral diffuse retinal hemorrhage in a 15-year-old girl, who underwent bilateral trabeculectomy for steroid induced glaucoma. METHODS: Despite the maximally tolerable medical treatment, IOP in the right eye remained above 50 mmHg for four months, and was simultaneously elevated in the left eye. So we performed bilateral trabeculectomy. RESULTS: On the first postoperative day, diffuse retinal hemorrhages were observed in the right eye; however, no retinal hemorrhage was found in the left eye. The hemorrhages resolved completely without consequences two months later. CONCLUSIONS: In the case of high IOP for a long period, sudden lowering of IOP may acutely increase the blood flow and consequently rupture multiple retinal capillaries because of altered autoregulatory function. Special care is therefore needed to prevent an abrupt fall in IOP before, during, and after surgery, especially when IOP has been highly elevated for an extended period.
Administration, Topical ; Adolescent ; Female ; Fluorescein Angiography ; Fundus Oculi ; Glaucoma/chemically induced/*surgery ; Humans ; Retinal Hemorrhage/diagnosis/*etiology/pathology ; Steroids/administration & dosage/adverse effects/therapeutic use ; Trabeculectomy/*adverse effects ; Uveitis/drug therapy

We evaluated the effect of cataract extraction on the intraocular pressure(IOP)in patients with cataract and angle closure glaucoma. We divided the patients into two groups, one of which underwent trabeculectomy(group 1), and the other control(group 2). Also, we assessed the effect of peripheral anterior synechiolysis performed during the cataract extraction on IOP. There was a significant difference between the preoperative IOP of two groups, but no difference was noted until 6 months after the operation. However the difference became significant afterwards. IOP reduction was more significant after the synechiolysis in group 2, but no difference was found in group 1. It is thought that the IOP decrease can be achieved by cataract extraction only in chronic angle closure glaucoma. but the effect may not be maintained. Synechiolysis may be helpful to further decrease in IOP after cataract extraction only.
Cataract Extraction* ; Cataract* ; Glaucoma, Angle-Closure* ; Humans ; Intraocular Pressure* ; Trabeculectomy

PURPOSE: To compare the measured values of anterior chamber depth and angle in glaucoma patients using Ultrasound Biomicroscopy (UBM) and Orbscan(TM) IIz Topography. METHODS: We measured the anterior chamber depth and angles of four directions in 26 eyes of 13 primary open angle glaucoma (POAG) patients, 26 eyes of 13 normal tension glaucoma (NTG) patients, and 20 eyes of 10 angle closure glaucoma (ACG) patients, with UBM and Orbscan. RESULTS: The values of anterior chamber depth did not show any difference between UBM and Orbscan. The values for anterior chamber angle in POAG and NTG eyes were not different between UBM and Orbscan, but the values for all anterior chamber angles except the superior angle, measured with UBM were significantly larger than those for ACG measured by Orbscan. CONCLUSIONS: Both UBM and Orbscan showed similar results in the measurement of anterior chamber depth and angle in POAG and NTG patients, but showed different results in the anterior chamber angle for ACG patients. UBM will be more useful in evaluating the anterior chamber angle in ACG patients because it can assess the structures of the anterior chamber angle objectively.
Anterior Chamber* ; Glaucoma ; Glaucoma, Angle-Closure ; Glaucoma, Open-Angle ; Humans ; Low Tension Glaucoma ; Microscopy, Acoustic* ; Ultrasonography*

PURPOSE: To assess the effect of intravitreal and posterior subtenon injections of triamcinolone acetonide (TA) on intraocular pressure (IOP). METHODS: we reviewed 42 consecutive eyes after intravitreal TA injection (IVTA) and 43 eyes following posterior subtenon TA injection (PSTA). All cases had a minimum follow-up time of three months. After injection, the value and time of the maximal IOP, the amount of IOP elevation and the needs of the medication were assessed. RESULTS: The IOP increased significantly (p<0.001) from 16.3+/-2.5 mmHg preoperatively to a mean maximum of 21.7+/-5.3 mmHg in the IVTA group, and from 15.3+/-4.5 mmHg to 20.6+/-3.0 mmHg in the PSTA group. An elevation in the IOP of more than 5 mmHg from the baseline IOP was seen in 52.4% of the IVTA group at a mean time of 3.1 weeks postoperatively, and 44.2% of the PSTA group displayed an IOP elevation at 5.9 weeks. CONCLUSIONS: Both developed significant elevations of IOP, but this appeared at a later date in the PSTA group. Careful follow-up after local injection of steroids is necessary.
Vitreous Body ; Uveitis, Posterior/*drug therapy/pathology ; Triamcinolone Acetonide/administration & dosage/*adverse effects ; Time Factors ; Retrospective Studies ; Orbit ; Ocular Hypertension/*chemically induced/physiopathology ; Middle Aged ; Male ; Macular Edema, Cystoid/*drug therapy/pathology ; Intraocular Pressure/*drug effects ; Injections ; Humans ; Glucocorticoids/administration & dosage/*adverse effects ; Follow-Up Studies ; Female ; Aged, 80 and over ; Aged ; Adult

PURPOSE: We evaluated the change of the intraocular pressure (IOP) after phacoemulsification and IOL implantation in patients with cataract and open angle glaucoma. METHODS: We divided the patients into two groups; group 1 (non trabeculectomy group: IOP was well controlled medically, and had not undergone trabeculectomy) and group 2 (trabeculectomy group: trabeculectomy was performed). Phacoemulsification was performed in both groups, and preoperative and postoperative IOP was compared. RESULTS: IOP decreased after phacoemulsification in both groups. Early transient postoperative IOP elevation was observed in 3 patients of group 1, but postoperative IOP was lower than preoperative IOP throughout the follow up period, and there was no difference between the two groups. The average number of antiglaucomatous agent decreased to 0.29 postoperatively from 1.23 preoperatively and there was no significant difference between two groups. CONCLUSIONS: IOP reduction was observed in open angle glaucoma patients combined with cataract after phacoemulsification, even in the patients who had undergone trabeculectomy previously (group 2). The difference between preoperative and postoperative IOP was larger in group 1, and mean postoperative IOP was lower in group 2.
Cataract ; Follow-Up Studies ; Glaucoma, Open-Angle* ; Humans ; Intraocular Pressure* ; Phacoemulsification* ; Trabeculectomy

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*

To report three cases in which reorganization of the photoreceptor layer on optical coherence tomography (OCT) was concurrent with long-term visual recovery after macular hole surgery. Serial OCT scans of three eyes in which visual acuity continued to improve for 1 or more years after successful macular hole surgery were reviewed. Case 1. At postoperative four weeks, visual acuity was 20/100 with disorganized photoreceptor layer on OCT. The photoreceptor layer had been reorganized and visual acuity had improved to 20/25 by 1 year. Case 2. Two weeks after the operation, visual acuity was 20/125 and disorganization of the photoreceptor layer was noted. Visual acuity improved to 20/50 by four months. The photoreceptor layer had been partly reorganized and had appearance of a broken line. Visual acuity had improved to 20/40 and the photoreceptor layer had been reorganized further with a residual defect on OCT by 15 months. Case 3. Visual acuity at two weeks was 20/100. OCT revealed disorganization of the photoreceptor layer. Six months after the operation, the partly reorganized photoreceptor layer appeared as a broken line and visual acuity had reached 20/80. Visual acuity had improved further to 20/40 by 1 year, concurrent with improved organization of the photoreceptor layer. The reorganization of the photoreceptor layer plays a part in long-term improvement of visual acuity after macular hole surgery.
Adult ; Aged ; Basement Membrane/surgery ; Female ; Humans ; Middle Aged ; Photoreceptor Cells, Vertebrate/*physiology ; Regeneration/*physiology ; Retinal Perforations/*surgery ; Tomography, Optical Coherence ; Visual Acuity/*physiology ; Vitrectomy

PURPOSE: To analyze localized RNFL defect cases that were identified in retinal nerve fiber layer (RNFL) fundus photographs but not in optical coherence tomography (OCT). METHODS: Analysis of OCT scans and images was performed for 14 eyes (17 locations) that showed localized RNFL defects in RNFL fundus photographs but not in RNFL thickness average analysis. RESULTS: With respect to the range of RNFL defects, 41.2% were less than 10degrees, 47.0% were 11 to 20degrees, and 11.8% were 21 to 30degrees. In 71.4% of the RNFL cases the defects were less than 10degrees and the decrease of RNFL thickness was not readily observable on the OCT scan images. In all cases of RNFL defects in the 11 to 30degrees range the decrease in RNFL thickness could be assessed on the OCT scan images. Nonetheless, the decrease of RNFL thickness could not be seen on the OCT analysis images in which the results of the RNFL thickness made through an automated computer algorithm were displayed. CONCLUSIONS: The range of localized RNFL defects that were difficult to detect with OCT consisted of those cases that were almost less than 20degrees. The limitations of the OCT scan itself in patients with RNFL with an angular width defect less than 10degrees and the problems of RNFL thickness analysis processing in patients with an angular width of 11 to 30degrees may decrease the sensitivity of OCT in diagnosing RNFL defects.
Eye ; Humans ; Nerve Fibers ; Retinaldehyde ; Tomography, Optical Coherence

PURPOSE: This study was aimed to evaluate changes in the stromal keratocyte after ablation of 50 micrometer and 100 micrometer with use of photorefractive keratectomy(PRK). METHODS: At 4 hours, 24 hours, 72 hours, 7 days and 1 month after PRK, each group of rabbits including normal control group was treated with terminal deoxyribonucleotidyl transferase-mediated dUTP-digoxigenin nick-end labeling(TUNEL) staining using ApopTag(R) kit in vivo, then apoptotic keratocytes were evaluated with light microscope. RESULTS: There was no response with TUNEL staining of the epithelial cells, stromal keratocyte, and endothelium in normal cornea. In the ablation group, however, regardless of the depth of photorefractive ablation, the TUNEL signal was maximal after 4 hours, and it decreased with time. The signal was more intense in 100 micrometer ablation group than 50 micrometer ablation group, although the signal was not observed at the endothelial cells in both groups. The number of apoptotic stromal keratocytes at each time point of 4 hr, 24 hr, 72 hr, and 1 week was 57+/-8.9, 49+/-7.5, 36+/-5.1, and 12+/-1.3 cells/field in 100 micrometer ablation group, and 31+/-4.4, 28+/-4.6, 21+/-3.9, and 5+/-1.1 cells/field in 50 micrometer ablation group, and the difference between the two groups was statistically significant(P<0.05). CONCLUSION: The more the amount of ablation with photorefractive keratectomy, the stronger the apoptotic response. The postoperative apoptotic response was observed especially within 1 week. These findings suggest that early suppression of postoperative apoptosis within 1 week will influence on the prognosis of visual quality after photorefractive keratectomy, and more studies will be needed in the future.
Apoptosis* ; Cornea ; Endothelial Cells ; Endothelium ; Epithelial Cells ; In Situ Nick-End Labeling ; Photorefractive Keratectomy* ; Prognosis ; Rabbits