Effectiveness of Topical Ganciclovir 2% Monotherapy Versus Combined Steroid Therapy in Cytomegalovirus Endotheliitis.

We aimed to report the clinical manifestations of cytomegalovirus (CMV) corneal endotheliitis and the results of long-term treatment with topical ganciclovir 2% with and without steroids. This retrospective, interventional study included 15 eyes of 13 patients diagnosed with CMV corneal endotheliitis by positive CMV DNA and treated with long-term topical ganciclovir 2% eye drops at a tertiary referral center and the median follow-up period was 17 months. Ocular manifestations included keratic precipitates (KPs) (100%), elevated IOP (93.3%), iritis (60%), corneal edema (60%), and moth-eaten iris atrophy (60%). After long-term treatment, corneal edema, iritis, and KPs significantly decreased (effect size: 72%, 76% and 70%, respectively; p = 0.024, p = 0.006 and p < 0.001, respectively). Both the logMAR acuity and IOP significantly improved (median logMAR was 0.52 before treatment and 0.22 after treatment; median IOP was 42 mmHg before treatment and 12 mmHg after treatment; p = 0.001 and p < 0.001, respectively). The ECD was maintained (effect size: 80%), and the percentage of hexagonal cell ratio of endothelial cells significantly improved after treatment (effect size: 82%; p = 0.035). Fewer anti-glaucoma medications were used in the non-steroid group (effect size: 79%; p = 0.034). Long-term maintenance treatment with topical ganciclovir 2% monotherapy not only provides effective therapy and reduces recurrence, but also decreases the high IOP related to the combination of steroids used.

The relationship between optic nerve head deformation and visual field defects in myopic eyes with primary open-angle glaucoma.

PURPOSE: To investigate the relationship between the morphologic features of myopic optic nerve head (ONH) and visual field (VF) defects in myopic subjects with primary open-angle glaucoma (POAG) by intraindividual comparison. METHODS: Myopic POAG subjects with unilateral glaucomatous VF defect were recruited. The morphologic features of myopic ONH, including optic disc tilt, optic disc rotation, and ß-zone parapapillary atrophy (PPA) were measured from color fundus photographs. The comparisons were performed between the eyes with VF defects and the contralateral eyes without VF defects. Logistic regression analysis was performed to investigate the relationship between various ocular parameters and the presence of VF defects. RESULTS: We retrospectively included 100 eyes of 50 myopic POAG subjects. (Mean age: 50.1 ± 10.0 years). The tilt ratio was similar between the paired eyes. The degree of optic disc rotation (12.96 ± 7.21°) in eyes with VF defects were statistically greater than the contralateral eyes (6.86 ± 4.30°; P < 0.001) without VF defect. The ß-zone PPA-to-disc area ratio was significantly greater in eyes with VF defects than the contralateral eyes (P = 0.024) without VF defect. In multivariate logistic regression analysis, the greater degree of optic disc rotation was significantly associated with the presence of VF defects (P < 0.001). However, tilt ratio, ß-zone PPA-to-disc area ratio, refractive error, and axial length were not associated with the presence of VF defects. CONCLUSIONS: Among the morphologic features of myopic ONH, only the greater degree of the optic disc rotation was associated with the presence of VF defects in myopic subjects with POAG.

Late-onset Hypotony Maculopathy After Trabeculectomy in a Highly Myopic Patient With Juvenile Open-angle Glaucoma.

Hypotony maculopathy is a sight-threatening complication after trabeculectomy. We report on a 34-year-old man with juvenile open-angle glaucoma and high myopia, who developed hypotony maculopathy 14 years after trabeculectomy without bleb leak. This represents the longest known period from trabeculectomy to the development of hypotony maculopathy without bleb leak. The possible mechanisms for the development of late-onset hypotony maculopathy in the highly myopic patient are progressive scleral thinning, reduced scleral rigidity, and scleral morphologic change with aging. These changes might weaken the biomechanical properties of sclera and then contribute to the collapse of the scleral wall during hypotony. This case serves as a reminder that hypotony maculopathy can happen up to 14 years after tabeculectomy even without bleb leak and hypotony should be avoided after trabeculectomy in highly myopic patients with juvenile open-angle glaucoma.

Orbital infarction syndrome after multiple percutaneous sclerotherapy sessions for facial low-flow vascular malformation: A case report and literature review.

Vision loss following sclerotherapy for facial vascular malformations (VMs) is a rare but detrimental complication. Here, we report a case of an 11-year-old boy with acute onset blepharoptosis, ophthalmoplegia, and blindness in his right eye after the 14 th sclerotherapy session (percutaneous intralesional injection of sodium tetradecyl sulfate) for a right facial low-flow VM without orbital involvement. Computed tomography angiography revealed no contrast enhancement in the right ophthalmic artery, superior ophthalmic vein, or extraocular muscles. He presented with the hallmarks of orbital infarction syndrome: Clear signs of anterior and posterior segment ischemia and disrupted arterial flow to the extraocular muscles. His blepharoptosis and eye movement improved 4 months later; however, he remained blind, and phthisis bulbi developed eventually. Thus, sclerotherapy for facial VM-even without orbital involvement--may result in severe ocular and orbital complications.

Phenotypes of trypsin- and collagenase-prepared bovine corneal endothelial cells in the presence of a selective Rho kinase inhibitor, Y-27632.

PURPOSE: To optimize isolation of viable bovine corneal endothelial cells (BCECs), we evaluated the effectiveness of various preparation protocols. This entailed comparing the effects of collagenase A and trypsin in the presence and absence of a Rho kinase inhibitor, Y-27632, on proliferation and tight junctional and cytoskeletal integrity during their expansion. METHODS: 5-bromo-2'-deoxyuridine (BrdU) incorporation evaluated cell proliferation. Western blot analysis evaluated F-actin, zonule occludin, and ZO-1 associated nucleic acid binding protein (ZONAB) and RhoA expression. Rho A pulldown assay evaluated Rho A activity. RESULTS: In the trypsin (TrypLE)-prepared BCECs, BrdU incorporation decreased whereas nuclear ZONAB expression increased and became stable from day 3 to 7. In contrast, in the collagenase-A-prepared BCECs, we observed preserved ZO-1 integrity, invariant nuclear ZONAB expression, and dense cortical F-actin expression, and BrdU incorporation was invariant from days 1 to 7. Y-27632 did not increase BrdU incorporation and nuclear ZONAB expression in the TrypLE-prepared and the collagenase-A-prepared BCECs. Moreover, Y-27632 increased irregular cellular morphology and downregulated the expression of ZO-1 in the collagenase-A-prepared BCECs from days 1 to 7. Y-27632 inhibited RhoA activation irrespective of whether the cells were isolated with trypsin or collagenase A. CONCLUSIONS: It is preferable to isolate BCECs with collagenase A and expand them without Y-27632. With this protocol, proliferative activity and tight junctional and cytoskeletal integrity are better preserved than if trypsin is used in the presence or absence of Y-27632.

Diabetic polyneuropathy and the risk of developing diabetic retinopathy: a nationwide, population-based study.

PURPOSE: To assess the relationship between diabetic polyneuropathy (DPN) and the risk of diabetic retinopathy (DR). METHODS: From 1997 to 2010, we identified 5031 newly diagnosed DPN patients and 20 124 controls matched for sex, age, and index year. Cox proportional hazards regression analyses were used to estimate the adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) of DR between the DPN patients and the non-DPN group. The adjusted hazard ratio was calculated and adjusted for age, sex, duration of diabetes and comorbidities of hypertension, cardiovascular disease and diabetic nephropathy. RESULTS: The incidence rate of DR was 5.87-fold higher in the DPN patients than in the non-DPN group (44.0 vs. 7.22 per 1000 person-years), with an adjusted HR of 5.41(95% CI = 4.92-5.94). The DPN-to-non-DPN DR incidence rate ratio decreased with age (adjusted HR = 6.63 for subgroup younger than 65 years and adjusted HR = 3.91 for subgroup aged 65 years or older). Compared with the non-DPN group, the DPN patients had a 5.63-fold risk of non-proliferative DR (adjusted HR = 5.63, 95% CI = 5.11-6.21) and a 3.67-fold risk of proliferative DR (adjusted HR = 3.67, 95% CI = 2.57-5.23). CONCLUSION: The patients with DPN had an increased risk of developing DR and advanced DR compared with the non-DPN group, particularly among the subgroup aged younger than 65 years.

Hypoxia-induced retinal neovascularization in zebrafish embryos: a potential model of retinopathy of prematurity.

Retinopathy of prematurity, formerly known as a retrolental fibroplasia, is a leading cause of infantile blindness worldwide. Retinopathy of prematurity is caused by the failure of central retinal vessels to reach the retinal periphery, creating a nonperfused peripheral retina, resulting in retinal hypoxia, neovascularization, vitreous hemorrhage, vitreoretinal fibrosis, and loss of vision. We established a potential retinopathy of prematurity model by using a green fluorescent vascular endothelium zebrafish transgenic line treated with cobalt chloride (a hypoxia-inducing agent), followed by GS4012 (a vascular endothelial growth factor inducer) at 24 hours postfertilization, and observed that the number of vascular branches and sprouts significantly increased in the central retinal vascular trunks 2-4 days after treatment. We created an angiography method by using tetramethylrhodamine dextran, which exhibited severe vascular leakage through the vessel wall into the surrounding retinal tissues. The quantification of mRNA extracted from the heads of the larvae by using real-time quantitative polymerase chain reaction revealed a twofold increase in vegfaa and vegfr2 expression compared with the control group, indicating increased vascular endothelial growth factor signaling in the hypoxic condition. In addition, we demonstrated that the hypoxic insult could be effectively rescued by several antivascular endothelial growth factor agents such as SU5416, bevacizumab, and ranibizumab. In conclusion, we provide a simple, highly reproducible, and clinically relevant retinopathy of prematurity model based on zebrafish embryos; this model may serve as a useful platform for clarifying the mechanisms of human retinopathy of prematurity and its progression.

Bilateral optic neuritis related to chronic inflammatory demyelinating polyneuropathy.

Chronic inflammatory demyelinating polyneuropathy (CIDP) is a condition that mainly affects the peripheral nervous system; however, the central nervous system has also been involved in rare cases. Herein, we describe the case of a 33-year-old man with CIDP who presented with progressively blurred vision and pain with eye movement in both eyes for 1 month. Ocular examination revealed reduced visual acuities of 0.15 (oculus unitas or OU) and unremarkable fundi (OU). Furthermore, bitemporal visual field defects and prolonged visually evoked potentials were evident. Brain magnetic resonance imaging revealed nothing remarkable along the optic nerve and chiasm. These findings were compatible with the diagnosis of bilateral optic neuritis. The patient's symptoms and visual acuity improved after 5 days of intravenous (IV) corticosteroid pulse therapy, which was subsequently replaced by oral prednisolone therapy with a tapering schedule. The patient's visual acuity returned to 1.0 (OU) 6 months after treatment. However, bilateral optic neuritis recurred in 7 months while the patient was on oral prednisolone and azathioprine. IV corticosteroid pulse therapy was subsequently reinitiated and the patient's visual acuity returned gradually to 1.0 (OU). Bilateral optic neuritis is a rare manifestation of CIDP. It responded well to IV corticosteroid therapy in our case.

Autologous serum therapy in recalcitrant laser-assisted in situ keratomileusis-induced neurotrophic epitheliopathy.

BACKGROUND/PURPOSE: To evaluate the efficacy of autologous serum eye drops for patients with recalcitrant laser-assisted in situ keratomileusis (LASIK)-induced neurotrophic epitheliopathy (LINE) unresponsive to conventional treatment, and to determine the possible predisposing risk factors of these patients. METHODS: We enrolled 10 consecutive patients (20 eyes) undergoing femtosecond-assisted myopic LASIK surgery presenting with recalcitrant LINE for > 1 year. Another 340 patients (713 eyes) receiving femtosecond-assisted myopic LASIK without recalcitrant LINE were set as controls. Possible risk factors associated with recalcitrant LINE were investigated. Twenty percent autologous serum treatment was prescribed to 20 eyes. The efficacy of autologous serum was assessed with ocular surface conditions, tear function, and the change of best-corrected visual acuity. RESULTS: Age older than 30 years [odds ratio (OR) = 7.74; 95% confidence interval (CI), 1.74-34.50], flap thickness < 110 µm (OR = 3.47; 95% CI, 1.22-9.73), and a flap diameter < 8.5 mm (OR = 5.38; 95% CI, 1.95-14.85) pose higher risks in femtosecond laser-assisted myopic LASIK. All eyes (100%) achieved remission after autologous serum treatment. The visual acuity before treatment was 0.49 ± 0.41 in LogMAR, and the visual acuity after treatment was 0.14 ± 0.22 in LogMAR. Time to achieve remission was 8.26 ± 11.87 weeks. Mean relapse-free survival after discontinuing autologous serum was 47 weeks. CONCLUSION: Risk factors of recalcitrant LINE in femtosecond laser-assisted myopic LASIK were identified as older age, a thinner flap (<110 µm), and a small flap diameter (<8.5 mm). Autologous serum eye drops can effectively improve corneal surface conditions and postoperative visual acuity.

Correlation between central corneal thickness and myopia in Taiwan.

The aim of the study was to explore the correlation between central corneal thickness (CCT) and the degree of myopia in Taiwanese adults. A total of 528 individuals were enrolled to undergo myopic laser refractive surgery from January 2004 to December 2006. Preoperative CCT was measured using the Orbscan corneal topography system and refractive status was determined by cycloplegic spherical equivalent. The relationship between CCT and refractive error was investigated by interindividual and intraindividual analyses. Participants had a mean age of 34.8 ± 7.3 years, and 79.9% were female. The mean refractive error was -7.27 ± 2.96 diopters and the mean CCT measurement was 560 ± 35 µm. CCT revealed that there was no association with age. However, CCT was significantly (p = 0.012) less in females than in males. The CCT also showed no significant association with refractive error (p = 0.49). Among the 67 participants with myopic anisometropia, the mean difference between both eyes was 3.09 ± 1.06 diopters. There was no association between the intereye CCT difference and refractive error (p = 0.57). The results remained the same after adjusting for age and sex. In conclusion, there was no correlation between CCT and the degree of myopia among adults in Taiwan. These data might contribute to the ongoing discussion about the role of CCT in the higher incidence of development and progression of glaucoma in myopic individuals.

Effect of supplemental L-arginine on the function of T lymphocytes and the formation of advanced glycosylated end products in rats with streptozotocin-induced diabetes.

OBJECTIVE: We investigated the effect of supplemental L-arginine on lymphocyte function in diabetes and its association with suppressed formation of advanced glycosylated end products (AGEs). METHODS: For the in vivo study, rats with streptozotocin-induced (65 mg/kg of body weight, intravenously) diabetes were treated with or without 2% L-arginine or glycine (as a positive control) in drinking water for 8 wk. We then measured serum fructosamine concentrations and concanavalin A-induced proliferative ability of lymphocytes from these animals. For the in vitro study, AGEs derived from albumin were prepared by incubating D-glucose (200 mmol/L) and bovine serum albumin (100 mg/mL) at 37 degrees C for 2 wk in the presence or absence of L-arginine (0.1-10 mmol/L). These preparations were quantified for their bovine serum albumin--derived AGE content, and their effect on concanavalin A-induced proliferative activity of T lymphocyte from normal rats was measured. RESULTS: Serum fructosamine concentrations were significantly higher in the diabetic rats than in the control rats (P<0.05) but were significantly lowered with L-arginine supplementation (P<0.05). The lower lymphocyte proliferation rate found in the diabetic rats was reversed by supplemental L-arginine (P<0.05). During the course of incubation of bovine serum albumin with D-glucose, the presence of L-arginine prevented the formation of bovine serum albumin-derived AGEs and attenuated their inhibitory effect on the rate of lymphocyte proliferation in a dose-dependent manner. CONCLUSION: Supplemental L-arginine improved the function of T lymphocytes in diabetic rats in association with decreased formation of AGEs.