A case of acute retinal toxicity caused by an intraocular foreign body composed of cobalt alloy.

CONTEXT: We describe a case of acute retinal toxicity caused by an intraocular foreign body composed of a cobalt alloy. CASE PRESENTATION: A 36-year-old man presented to an outside clinic with a traumatic cataract and corneal laceration of his left eye, which had occurred while grinding a shelf. The lacerated cornea was closed primarily and the traumatic cataract was phacoemulsified. He was transferred to our hospital due to identification of a metallic intraocular foreign body in the vitreous. On arrival at our institution, the intraocular foreign body was removed as soon as possible after vitrectomy. On the first postoperative day, vasculitis and serous retinal detachment were observed on the retina at the previous site of the foreign body. Two months after surgery, atrophy of nearly half of the inferior retina was noted on funduscopy, and visual acuity was such that the patient could only count fingers at 30 cm. Analysis of the foreign body revealed that it was composed of 84.99% tungsten carbide, 15% cobalt and had traces of titanium and alumina. DISCUSSION: Cobalt containing metallic foreign bodies should be immediately removed, as they have the potential to cause permanent visual disturbance.

The effect of intravitreal bevacizumab injection before Ahmed valve implantation in patients with neovascular glaucoma.

To evaluate the effect of intravitreal bevacizumab (IVB) before Ahmed valve implantation for treatment of neovascular glaucoma (NVG). This study is a retrospective, comparative, consecutive case series. The study group consisted of 27 eyes of 26 patients with NVG who underwent an Ahmed valve implantation. Thirteen eyes were treated with Ahmed valve implantation alone (control group), and 14 eyes were treated with a combination of preoperative IVB injection and Ahmed valve implantation (IVB group). Visual acuity, intraocular pressure (IOP), number of anti-glaucoma medications, surgical complications, and success rate were compared between the two groups. There were no significant differences in preoperative characteristics between the two groups. Visual acuity at 1, 2 weeks, and 1 month after surgery were significantly better in the IVB group (p = 0.038, 0.034, and 0.032, respectively). Hyphema associated with Ahmed valve implantation occurred significantly less in the IVB group (p = 0.016). On the other hand, the mean IOP and number of anti-glaucoma medications at all follow-up periods were similar between the two groups. Kaplan-Meier survival analysis showed the probability of success 6 months after surgery as 71.4 % in the IVB group and 84.6 % in the control group. No significant difference in success rate was found between the groups (p = 0.422). IVB before Ahmed valve implantation for treatment of NVG reduced the incidence of hyphema. In this retrospective study, IVB provided better visual outcome in the early postoperative periods but did not significantly improve mean IOP, number of anti-glaucoma medications, or success rate.

Changes in Opacification of Hydrophobic Acrylic Intraocular Lenses According to Temperature and Hydration.

PURPOSE: To investigate optic opacification of hydrophobic acrylic intraocular lens (IOL) depending on hydration and temperature conditions. METHODS: IOL (Acrysof® MA60BM Alcon, Fort Worth, Texas, USA) extracted from a 55-year-old male who underwent binocular cataract 11 years ago were used for the analysis. On slit lamp examination, the binocular IOL optics showed homogenous opacification. After extraction of the IOLs, the IOL opacification disappeared during dry storage at 4°C. To investigate the changes in IOL opacification according to temperature and hydration, an extracted IOL was stored in either dry conditions or normal saline at 4°C, room temperature, or 37°C for 24 hours, and then the degree of haziness was examined. To investigate the impact of an opaque optic on visual function, light transmission was performed using an ultraviolet-visible spectrophotometer (U-3000, Hitachi High-Technologies Corp., Tokyo, Japan). RESULTS: The extracted IOL optics at 4°C, room temperature, and 37°C were transparent at dry conditions. When the dried IOL was immersed in normal saline at room temperature and 37°C, opacification appeared. However, when the dried IOL was immersed in normal saline at 4°C, opacification of the IOL did not appear. When compared with the control, light transmission of the extracted IOLs from the right and left eyes stored in 37°C normal saline decreased by 4.7% at 453 nm and by 5.1% at 482 nm, respectively. CONCLUSION: In acrylic hydrophobic IOLs, optic opacification can occur depending on temperature and hydration conditions.

Fluoroquinolone resistance of Staphylococcus epidermidis isolated from healthy conjunctiva and analysis of their mutations in quinolone-resistance determining region.

BACKGROUND: Staphylococcus epidermidis is the most common pathogen in postoperative endophthalmitis and causes various infectious eye diseases. However, there is very little information on fluoroquinolone antibiotic resistance to S. epidermidis identified in conjunctival microbe and analysis of related genes. Here, the authors investigated the rate of resistance to fluoroquinolones of Staphylococcus epidermidis isolated from normal conjunctival microbes and mutations in the quinolone-resistance determining region (QRDR). METHODS: 377 eye samples from 187 patients who underwent intravitreal injection and cataract surgery were included. Specimens were taken from the bilateral lower conjunctival sacs using a cotton swab and cultured. The cultures were identified using MALDI-TOP MS and gyrA, gyrB, parC, and parE gene mutations of QRDR were confirmed by DNA extraction from resistant strains of S. epidermidis with a micro-dilution method using ciprofloxacin, levofloxacin, and moxifloxacin. RESULTS: The culture positive rate was 61.8% (231) for 374 eye samples. Of the 303 total strains cultured, S. epidermidis was the most common with 33.7% (102). Ten types of gene mutations were observed in the resistant S. epidermidis of 21 strains. One-point mutation was observed mainly in gyrA and parC, and a small number of mutations were observed in parE in the form of a double point mutations. When there were multiple point mutations in both gyrA and parC, the highest minimum inhibitory concentration was observed. CONCLUSIONS: The quinolone resistance rate of S. epidermidis increased in comparison with previous studies, and resistant S. epidermidis showed mostly QRDR mutations, which were mainly found in gyrA and parC, and showed strong resistance when mutated in both genes.

Topical cell-free conditioned media harvested from adipose tissue-derived stem cells promote recovery from corneal epithelial defects caused by chemical burns.

Corneal chemical burns can lead to blindness following serious complications. As most of these complications are caused by failure of reepithelization during the acute phase, treatment at this stage is critical. Although there have been some studies on corneal injury recovery using adipose tissue-derived stem cells (ADSCs), none has reported the effect of topical cell-free conditioned culture media (CM) derived from ADSCs on corneal epithelial regeneration. Here, the best conditions for CM were selected and used for in vitro and in vivo experiments. Corneal burn in rats was induced using 100% alcohol. The chosen CM was administered to corneal burn rats (CM-treated [CT] group) four times a day for three days and this group was compared with the normal control and corneal burn (CB) groups. Biomicroscopic fluorescence images and the actual physical corneas were taken over time and used for analysis. mRNA levels of hepatocyte growth factor and epidermal growth factor (EGF) were significantly increased, whereas those of vascular endothelial growth factor, interleukin (IL)-1ß, IL-6, IL-10, and matrix metalloproteinase-9 were significantly decreased in the CT group compared with those in the CB group. The numbers of proliferating cell nuclear antigen- and zonular occludens-1-positive cells in the CT group were significantly higher than those in the CB group. The macrophage-infiltrating corneas in the CT group expressed significantly more of the M2 marker arginase than corneas in the CB group. Optimal CM (× 0.5 concentration) treatment significantly accelerated the migration of corneal epithelial cells and induced upregulation of the expression of IL-6, EGF, and C-X-C chemokine receptor type 4 mRNAs. Overall, in this study, topical administration of cell-free CM promoted regeneration of the corneal epithelium after induction of chemical burns.

Time Series Changes in Cataract Surgery in Korea.

PURPOSE: We analyzed time series changes in cataract surgeries in Korea, and provide basic data to enhance the efficiency of medical services for cataract surgery. METHODS: Among cataract surgery statistics registered in the Korean National Health Insurance Cooperation from 2006 to 2012, we used data regarding the number of patients and operations and the number of patients and operations per 100,000 people. We analyzed various time series changes, including differences by sex and age. RESULTS: The total numbers of patients from 2006 to 2012 by year were 207,370; 228,170; 250,289; 268,548; 289,867; 308,111; and 302,182, respectively. The total numbers of operations from 2006 to 2012 by year were 272,920; 305,807; 338,332; 365,874; 398,338; 428,158; and 420,905, respectively. The number of patients and operations per 100,000 people were highest in men 80 to 84 years old and women 75 to 79 years old. Comparing the number of operations in 2006 and after, the patient age group with the highest increase rate changed from over 85 years old to 75-79 years old since 2010 in men and from over 85 years old to 50-54 years old since 2009 in women. For each year investigated, the number of operations performed was higher than the number of patients who received operations. CONCLUSIONS: Over the study period, the number of cataract surgeries increased, while the age of cataract patients decreased. Additionally, the number of cataract-related surgeries increased in relation to the number of patients.