PURPOSE: To determine the efficacy of 4-haptic bitoric intraocular lens (IOL) implantation in Asian patients with cataract and astigmatism. METHODS: A total of 19 eyes with ≤25.0 mm axial length and ≥0.75 diopters (D) corneal astigmatism were included in this prospective non-comparative study. All subjects underwent phacoemulsification with implantation of an AT Torbi 709M IOL. Visual and refractive outcomes as well as toric IOL axis were evaluated during a 3-month follow-up. Errors in predicted residual spherical equivalent were calculated by subtracting predicted residual spherical equivalent from postoperative refraction. RESULTS: Uncorrected and corrected distance visual acuity improved significantly 3 months after surgery, from 0.43 to 0.05 and from 0.24 to −0.05, respectively. Mean refractive cylinders also decreased significantly, from −1.91 preoperatively to −0.54 D 3 months after surgery. Mean J0 and J45 decreased 3 months postoperatively, from 0.26 to 0.03 D and from 0.24 to −0.06 D, respectively. After 3 months, mean absolute IOL rotation was 1.81°. Errors in predicted residual spherical equivalent showed a hyperopic shift of 0.35 D. CONCLUSIONS: Implantation of 4-haptic bitoric IOL proved to be effective for correcting astigmatism in Asian eyes during cataract surgery.
Asian Continental Ancestry Group ; Astigmatism ; Cataract ; Follow-Up Studies ; Humans ; Lens Implantation, Intraocular ; Lenses, Intraocular ; Phacoemulsification ; Prospective Studies ; Visual Acuity

Recently xenotransplantation has been thought as a final solution for the controi of donor organ shortage in allograft. In order to be a ciinicai entity, xenotransplantation has many obstacles such as hyperacute rejection and delayed xenogratt rejection as a potent immunologic reaction, zoonosis and ethical problems. We already reported the eariy immunoiogic events occuring soon after xenograft in animal model, in which natural antibody and complement have a crucial roie in rejection response. As a further step for the prolongation of graft survival, we used anticomplement agent (cobra venom factor, CVF) in the same model. Graft survival in discordant (guinea pig-to-rat) xenogratt was extended from 30.6 minutes to 2 days following singie injection of CVF, which showed similar pattern of rejection with the concordant xenogratt in terms of time of rejection response after grafting. In this setting antibody response in the blood did not show any difference between that of pre CVF and post CVF, even though IgM response was more pronounced than IgG. The complement activity in the blood showed marked suppression following CVF injection. Intragraft complement gene (C3 mRNA) expression in CVF injected discordant showed delayed response in a similar pattern like that of concordant xenograft. Interestingly enough intragraft anticomplement gene expression showed the simiiar pattern of response with the complement. From these results we can conclude that anticomplement agent (CVF) extended the graft survival in discordant xenograft upto the level of concordant xenograft by shifting the complement activation response from that of discordant to concordant xenograft.
Rats ; Animals

PURPOSE: To evaluate the effect of Nd: YAG laser capsulotomy for posterior capsular opacification (PCO) after posterior chamber intraocular lens (PC-IOL) implantation in children. METHODS: Thirty eyes of 23 children underwent Nd: YAG laser capsulotomy for PCO after PC-IOL implantation. The frequency of laser capsulotomy, elapsed time between cataract surgery and capsulotomy, laser parameters, pre and postoperative visual acuity, complications and recurrence were reviewed. RESULTS: From 108 eyes with intact posterior capsule after lensectomy, 30 (27.8%) were treated with Nd: YAG laser capsulotomy. The mean age at Nd: YAG laser capsulotomy was 7 years, the mean follow-up was 27 months, and the time interval between cataract operation and Nd: YAG laser capsulotomy was 13 months. Visual acuities of 20/40 or better were attained in 73% of eyes and visual acuities of 20/60 or less in 10% of eyes. PCO recurred in 12 eyes (40%), 10 of which were treated by performing a second laser capsulotomy, but the other two required a third laser capsulotomy. There was no relationship between the recurrence and the delay to initial laser capsulotomy, the amount of energy used for laser capsulotomy, or the patient age. One eye (3%) had corneal erosion, a bleeding from the pupillary margin and increased IOP; however, all responded well to medical treatment. CONCLUSIONS: Nd: YAG laser capsulotomy for PCO after PCL implantation in children offers a noninvasive and safe capability to create a clear visual axis. Although considered effective, there is a high likelihood that Nd: YAG laser capsulotomy will require revision.
Axis, Cervical Vertebra ; Cataract ; Child* ; Follow-Up Studies ; Hemorrhage ; Humans ; Lasers, Solid-State* ; Lenses, Intraocular ; Recurrence ; Visual Acuity

PURPOSE: To investigate the clinical outcomes of primary pediatric keratoplasty. METHODS: Records of patients who underwent penetrating keratoplasty at the age of 5 years or younger were retrospectively reviewed. The survival rates of corneal grafts, postoperative complications, and causes of graft failure were evaluated. RESULTS: A total of 31 penetrating keratoplasties were performed in 29 patients, two of which were bilateral. The mean follow-up period was 78.72 +/- 8.94 months. The overall graft survival rate was 51.61%. The graft survival rate was 77.4% at 6 months, 61.3% at 12 months, 57.5% at 2 years, and 49.5% at 5 years after the surgery (the median survival time, 39.2 months). The main surgical indications included sclerocornea (35.5%), followed by Peter's anomaly (25.8%) and congenital glaucoma (9.7%). There were significant differences in graft survival time among the surgical indications, of which sclerocornea was the worst (p = 0.003). The main cause of graft failure was rejection (46.7%), followed by infection (26.7%) and primary endothelial decompensation (20%). When patients were sub-grouped according to age (under 12 months, between 12 to 48 months, and over 48 months), there was significant difference in graft survival time (p = 0.037) but not in overall graft survival rate (p = 0.154). Graft rejection occurred more frequently in patients between 12 to 48 months of age compared to other age groups (p = 0.016). Three out of 13 graft infections occurred in patients under 12 months of age. CONCLUSIONS: The type of disease causing corneal opacity was a significant factor affecting the clinical outcomes of penetrating keratoplasty in children.
Child ; Cornea ; Corneal Diseases ; Corneal Opacity ; Follow-Up Studies ; Glaucoma ; Graft Rejection ; Graft Survival ; Humans ; Keratoplasty, Penetrating ; Postoperative Complications ; Rejection (Psychology) ; Retrospective Studies ; Survival Rate ; Transplants

PURPOSE: Transglutaminase type 2 (TG2) is an extracellular matrix crosslinking enzyme with a pivotal role in kidney fibrosis. We tested whether quantification of urinary TG2 may represent a noninvasive method to estimate the severity of kidney allograft fibrosis. METHODS: We prospectively collected urine specimens from 18 deceased donor kidney transplant recipients at 1-day, 7-day, 1-month, 3-month, and 6-month posttransplant. In addition, kidney allograft tissue specimens at 0-day and 6-month posttransplant were sampled to analyze the correlation of urinary TG2 and kidney allograft fibrosis. RESULTS: Thirteen recipients had increased interstitial fibrosis and tubular atrophy (IFTA) scores at the 6-month protocol biopsy (IFTA group). The mean level of urinary TG2 in the IFTA group was higher compared to that of 5 other recipients without IFTA (no IFTA group). Conversely, the mean level of urinary syndecan-4 in the IFTA group was lower than levels in patients without IFTA. In the IFTA group, double immunofluorescent staining revealed that TG2 intensity was significantly upregulated and colocalizations of TG2/heparin sulfate proteoglycan and nuclear syndecan-4 were prominent, usually around tubular structures. CONCLUSION: Urinary TG2 in early posttransplant periods is a potent biomarker for kidney allograft inflammation or fibrosis.
Allografts ; Atrophy ; Biomarkers ; Biopsy ; Extracellular Matrix ; Fibrosis ; Humans ; Inflammation ; Kidney Transplantation ; Kidney ; Methods ; Prospective Studies ; Proteoglycans ; Syndecan-4 ; Tissue Donors ; Transplant Recipients

PURPOSE: The alpha-melanocyte-stimulating hormone (alpha-MSH) has been shown to interact with various cells of the immune and inflammatory system and down-regulate either the production or the action of the pro-inflammatory cytokines. In this study, we investigated the potential of alpha-MSH on preventing pancreatic islet cell from death and dysfunction by inflammatory cytokines released from peripheral blood mononuclear cells (PBMCs) in rat. METHODS: Rat pancreatic islets were co-cultured with PBMCs, stimulated by phorbol myrstic acid and ionomycin. alpha-MSH was treated to PBMCs for 2 hours before co-culture. Viability and apoptosis of islets were observed by MTT and FACS. Inflammatory cytokines and nitric oxide (NO) were measured. Insulin release from islet co-cultured with mononuclear cells was checked for the islet function. RESULTS: In comparison to control group, viability of islets with alpha-MSH treated mononuclear cells was increased and apoptosis was reduced significantly. Inflammatory cytokines such as TNF-alpha and IL-1beta were reduced in alpha-MSH-treated group. NO production in alpha-MSH-treated group was decreased. Insulin secretory function of islet was recovered in condition of alpha-MSH treatment. CONCLUSION: This study demonstrates that alpha-MSH protects cell death and preserves the secretory function of pancreatic islet cells from the pro-inflammatory reaction of mononuclear cells, and may have the potential to improve the graft survival in clinical islet transplantation.
alpha-MSH ; Animals ; Apoptosis ; Cell Death ; Coculture Techniques ; Cytokines ; Graft Survival ; Insulin ; Ionomycin ; Islets of Langerhans Transplantation ; Islets of Langerhans* ; Nitric Oxide ; Rats ; Tumor Necrosis Factor-alpha

PURPOSE: To investigate the color vision defect in diabetic patients using the SNU computerized color test (SCCT). METHODS: From May to September 2003, diabetic patients with visual acuity 0.6 or better underwent various examinations including biomicroscopy, fundus photography, Ishihara color test, Hardy?Rand?Rittler (HRR) test, Seohan computerized hue test (SCHT), and SNU computerized color test. The SCCT was developed by using the Matlab 6.0 program. RESULTS: A total of 160 eyes of 82 diabetic patients were included. Thirty-two patients had no diabetic retinopathy, 19 had mild nonproliferative diabetic retinopathy (NPDR), 12 had moderate NPDR, 12 had severe NPDR, and 7 had proliferative diabetic retinopathy (PDR). In the all diabetic patients, the average total error score (TES) of SCHT was 189 and that of SCCT was 8.5; in patients without diabetic retinopathy, the scores were 125 and 3.64; in patients with mild NPDR, 185 and 8.16; in patients with moderate NPDR, 209 and 11.1; in patients with severe NPDR, 288 and 15.6 ; and in patients with PDR, 324 and 17.6 respectively. On the HRR test, patients without diabetic retinopathy had 1 tritan defect; those with mild NPDR 2 tritan, 2 protan, and 2 deutan defects: those with moderate NPDR, no color defects ; and those with severe NPDR, 2 tritan, and 2 protan defects, and 1 deutan defect. CONCLUSIONS: In diabetic patients, TES of SCHT and SCCT was higher according to the severity of diabetic retinopathy. SCHT and SCCT were more useful than HRR test.
Color Vision Defects* ; Color Vision* ; Diabetic Retinopathy* ; Humans ; Photography ; Visual Acuity

PURPOSE: This study was designed to investigate the characteristics and classification of congenital color vision deficiency (CVD) by the SNU computerized color test (SCCT) that was developed to sufficiently utilize the advantages of a computer. METHODS: Hardy-Rand-Rittler test (HRR test), Nagel anomaloscope and SCCT were performed on 60 eyes of 30 CVD patients and 30 normal subjects and the results were compared. RESULTS: In normal subjects, the error scores were all zero at all colors by SCCT. By SCCT protan color defectives showed a peak at hue 0 red in 7 eyes (29.2%), at hue 150 green in 3 eyes (12.5%), at hue 180 green in 18 eyes (75%), and at hue 330 red in 2 eyes (8.3%). By SCCT, deutan color defectives showed a peak at hue 0 red in 2 eyes (5.6%), at hue 150 green in 24 eyes (66.7%), at hue 180 green in 2 eyes (5.6%), and at hue 330 red in 23 eyes (63.9%). CONCLUSIONS: SCCT showed specific axes in CVD patients, with accuracy and high sensitivity to diagnosis. SCCT appears to be useful clinically as a color vision test to diagnose and classify CVD patients.
Classification* ; Color Vision Defects* ; Color Vision* ; Diagnosis ; Humans

PURPOSE: Transplantation of microencapsulated islets is proposed as an ideal therapy for the treatment of type 1 diabetes mellitus without immunosuppression. This is based on the principle that foreign cells are protected from the host immune system by an artificial membrane. The aim of this study is to establish an ideal condition of microencapsulation by using an air-driven droplet generator and alginate in vitro. METHODS: Islets were prepared from Sprague Dawley rat and semi SPF-micro pig. Alginate concentrations were changed from 1.5% to 3.0%, and inflow rate of alginate was varied from 10 mL/hr to 40 mL/hr. CO2 flow rate was regulated from 2.0 L/min to 4.0 L/min. Viability was checked by dithizone and FDA/PI staining. Secretory function was tested with glucose challenge and insulin stimulation index was investigated. RESULTS: The optimal conditions for islet encapsulation were revealed with alginate inflow rate of 10 mL/hr, CO2 flow rate of 2.0 L/min in concentration of 2% alginate. In concentration of 2.5% alginate, alginate inflow rate of 20 mL/hr, CO2 flow rate 3.0 L/min was ideal, and alginate inflow rate of 40 mL/hr, CO2 flow rate of 4.0 L/min showed good conditions of microcapsules in concentration of 3% alginate. Viability of encapsulated islets was higher than 90% in both rat and porcine. In terms of insulin secretion, encapsulated islets secreted insulin in response to glucose in static culture medium. However there was no normal response to low and high glucose challenge with stimulation index of less than 2.0. CONCLUSION: Microencapsulation of islets in rat and pig was successful with air-driven droplet generator and alginate in vitro. Further studies about biocompatibility and glucose control in vivo should be followed to be a useful tool for treatment of diabetes mellitus patients in clinical setting.
Animals ; Capsules ; Diabetes Mellitus ; Diabetes Mellitus, Type 1 ; Dithizone ; Drug Compounding ; Glucose ; Humans ; Immune System ; Immunosuppression ; Insulin ; Islets of Langerhans* ; Membranes, Artificial ; Rats