Resveratrol prevents hypoxia-induced retinal ganglion cell death related with ErbB2.

AIM: To confirm the changes in proteins related with hypoxia-induced retinal cell death and to assess the effects of resveratrol (Res). METHODS: The therapeutic effect of Res was verified using an ischemic/reperfusion (I/R) model in vivo and a hypoxia modelin retinal ganglion cells (RGCs) in vitro. Death of RGCs were confirmed by TUNEL assay. Protein expression was confirmed by Western blotting and immunohistochemistry. In addition, flow cytometric analysis was used to confirm the response in the cell unit to obtain more accurate data. RESULTS: ErbB2 expression and apoptosis in the ganglion cell layer (GCL) increased after I/R injury. Treatment of Res rescued I/R-induced ganglion cell death, downregulated apoptosis and ErbB2 protein expression in the retina. In subsequent in vitro models, Res affects apoptosis by regulating the phosphorylation and expression of mouse double minute 2 homolog (MDM2), along with those of ErbB2. These results suggest that Res reverses GCL-specific apoptosis via downregulation of ErbB2 in ischemic injury. CONCLUSION: In light of Res favorable properties, it should be evaluated in the treatment of RGC death and related retinal disease characterized by ErbB2 and MDM2 expression. Therefore, Res is appropriate therapeutic agent for treating ischemic injury-related eye diseases by targeting the expression of ErbB2 and MDM2.

Clinical characteristics and prognostic factors in hypertensive anterior uveitis diagnosed with polymerase chain reaction.

Aim of the study is to report the clinical characteristics and prognostic factors in hypertensive anterior uveitis (AU) diagnosed with multiplex polymerase chain reaction (PCR). Eighty-eight eyes of 88 patients with hypertensive AU were enrolled from 2015 to 2019 in a tertiary center in South Korea. All patients underwent multiplex PCR that was performed using aqueous humor samples collected at first visit to detect the DNA of six herpesviruses. Twenty-eight (31.8%) eyes were PCR positive. Herpes simplex virus was found in 6 (6.8%) eyes, varicella-zoster virus in 7 (8.0%) eyes, cytomegalovirus in 14 (15.9%) eyes, and Epstein-Barr virus in 1 (1.1%) eye. On multivariate regression analysis, PCR positivity was significantly associated with coin-shaped keratic precipitates (odds ratio (OR) = 6.01, P = 0.044). Recurrence and final visual acuity were significantly associated with a presumed diagnosis of viral endotheliitis (OR = 21.69, P = 0.04 and OR = 6.3, P = 0.004, respectively). This study showed the importance of PCR positivity, suggesting that identification of the virus through active PCR testing could affect the course, treatment, and prognosis of hypertensive AU.

The effect of initial intravitreal tissue plasminogen activator and gas injection on vision improvement in patients with submacular haemorrhage associated with age-related macular degeneration.

PURPOSE: To compare visual improvements between initial intravitreal t-PA with gas injection before anti-vascular endothelial growth factor (VEGF) and anti-VEGF injection monotherapy for submacular haemorrhage (SMH) associated with age-related macular degeneration (AMD). METHODS: We retrospectively reviewed medical records of naive patients treated with intravitreal t-PA with gas injection before anti-VEGF (Group 1) or only with intravitreal anti-VEGF injection (Group 2) for SMH [disc area (DA) ≥ 2] associated with AMD from two institutions. Both groups received 3 monthly loads of anti-VEGF injections followed by injections as needed for AMD treatment. Changes in best-corrected visual acuity (BCVA, logMAR) between the initial visit and after 6 months of treatment were compared between two groups. RESULTS: A total of 82 patients were enroled. Of these, 32 patients and 50 patients were grouped in Groups 1 and 2, respectively. The mean change in BCVA over 6 months for Group 1 was -0.52 ± 0.88, which was significantly larger (p = 0.044) than the mean change for Group 2 (-0.15 ± 0.58). We compared visual improvements between the two groups based on the following SMH size categories: ≤5, >5, and ≤15, and >15 DA. When the SMH size was ≤5, or >5 and ≤15 DA, the mean change in BCVA was larger for Group 1 than for Group 2, but this difference was not significant. When SMH size was >15 DA, Group 1 patients exhibited a mean visual improvement of -0.79 ± 0.80, which was significantly greater (p = 0.029) than that of Group 2 (-0.06 ± 0.67). CONCLUSIONS: Patients that were primarily treated for SMH associated with AMD using t-PA and gas injection (followed by anti-VEGF injection) exhibited better visual improvement than those treated with anti-VEGF monotherapy, especially in patients exhibiting larger SMH sizes (>15 DA) at the initial visit.

Risk factors for breakthrough vitreous hemorrhage after intravitreal tissue plasminogen activator and gas injection for submacular hemorrhage associated with age related macular degeneration.

PURPOSE: We investigated risk factors for breakthrough vitreous hemorrhage (VH) after an intravitreal tissue plasminogen activator (tPA) and gas injection in patients with submacular hemorrhage (SMH) associated with age-related macular degeneration (AMD). METHODS: The medical records of patients diagnosed with SMH associated with AMD who received an intravitreal tPA (50 µg/0.05 mL) and perfluoropropane gas (0.3 mL) injection were reviewed retrospectively. We analyzed the associations of breakthrough VH with age, sex, best-corrected visual acuity, intraocular pressure, AMD subtype, accompanying sub-retinal pigment epithelium (RPE) hemorrhage, history of cataract surgery, history of hypertension and diabetes mellitus, history of drinking and smoking, and history of antiplatelet or anticoagulant medication. We also examined the relationships between various parameters, including the area ratio of the SMH to the optic disc (AHD) and the height of the SMH obtained from optical coherence tomography. RESULTS: In total, 52 eyes from 52 patients were enrolled in this study; 16 eyes (30%) showed breakthrough VH. The proportions of patients with a current smoking history were 75.0% in the VH group and 22.2% in the non-VH group (p = 0.010). Other factors did not differ significantly between the two groups. The proportion of cases with accompanying sub-RPE hemorrhage was 50.0% and 58.3% in the VH and non-VH groups, respectively (p = 0.763). The AHD (p = 0.001) and SMH height (p < 0.001) were significantly greater in the VH group. In a receiver operating characteristic curve analysis, the cut-off values of AHD and SMH height were 20.1 and 1208 µm, respectively. According to logistic regression analysis, when the AHD and SMH height were greater than the individual cut-off values, the odds ratio of VH increased by 10.286 fold (95% confidence interval [CI], 2.452-43.148; p = 0.001) and 75.400 fold (95% CI, 7.991-711.441; p < 0.001), respectively, with respect to their respective reference groups (less than the cut-off value). Among the significant factors associated with VH occurrence, including current smoking, AHD, and SMH height, only current smoking and SMH height were found to be significant in multiple regression analysis (p = 0.040, 0.016). CONCLUSIONS: The incidence of breakthrough VH was significantly higher in those with current smoking status and for SMH with a larger AHD and greater height. The height of the SMH was more predictable of the possibility of VH than AHD.

Full thickness macular hole formation and spontaneous closure associated with branch retinal vein occlusion in a vitrectomized eye: A case report.

RATIONALE: Macular hole (MH) formation after vitrectomy is rare and it may be due to several mechanisms associated with change of foveolar anatomy by vitrectomy. If a MH develops after vitrectomy, surgical treatments including internal limiting membrane peeling and intravitreal gas injection are usually needed for repair of hole. Spontaneous closure of MH is much rarer. PATIENT CONCERNS: A 66-year-old patient had a vitrectomy for rhegmatogenous retinal detachment not involving the macula of the right eye. Eight months after the vitrectomy, the visual acuity decreased and full-thickness defect of macula, epiretinal membrane progression, intraretinal cysts, and flame shape hemorrhage along with superior temporal vascular arcade were observed on fundus examination and optical coherence tomography. DIAGNOSES: MH and branch retinal vein occlusion (BRVO) accompanying cystoid macular edema (CME) were both present on her right eye. Thus, we planned a surgery for MH repair. INTERVENTIONS: The status of MH was observed while waiting the surgery schedule. At 2 weeks after detection of the MH, optical coherence tomography showed that intraretinal cysts had decreased in extent and the inner wall of the MH had contracted; 4 weeks later, the MH was closed with a subtle subretinal space. OUTCOMES: The fovea was well-maintained with a complete closure for 9 months. LESSONS: MH formation and spontaneous closure occurred in association with BRVO accompanying CME in a patient who had a vitrectomy. In vitrectomized eyes, physicians should consider the possibility of MH development in association with BRVO, and possible spontaneous closure of the MH in accordance with CME resolution.

Phosphorylation of STAT3 and ERBB2 mediates hypoxia­induced VEGF release in ARPE­19 cells.

Neovascularization in the retina can cause loss of vision. Vascular endothelial growth factor (VEGF) serves an important role in the pathogenesis of retinal vascular diseases. Hypoxia is a notable cause of VEGF release and both STAT3 and ERBB2 are known to be associated with VEGF. In addition, STAT3 and ERBB2 interact with each other. In the present study, it was hypothesized that signal transducer and activator of transcription 3 (STAT3) and erbB­2 receptor tyrosine kinase 2 (ERBB2) may be involved in the regulation of hypoxia­induced VEGF in the retina. Cells of the retinal pigment epithelium (RPE) are an important source of VEGF. Therefore, the RPE­derived human cell line ARPE­19 was exposed to hypoxia. Hypoxia­induced phosphorylation of STAT3 and ERBB2 in ARPE­19 cells was decreased by AG490, an inhibitor of Janus kinase 2, as were hypoxia­induced VEGF release and tube formation in human umbilical vein endothelial cells. Thus, phosphorylation of ERBB2 and STAT3 regulates hypoxia­induced VEGF release in ARPE­19 cells. The results of the present study suggested that inhibition of ERBB2 and STAT3­mediated pathways under hypoxia may represent a new strategy for treating retinal vascular disease.

Corneal topography and angle parameters after laser iridotomy combined with iridoplasty assessed by dual Scheimpflug analyzer.

PURPOSE: To investigate the changes in corneal topography including parameters such as corneal curvature and corneal aberrations, along with anterior chamber angle (ACA) after laser iridotomy (LI) combined with peripheral iridoplasty (PI) using dual Scheimpflug analyzer. METHODS: In this prospective observational study, dual Scheimpflug analyzer images were acquired before and 1 week after LI plus PI. Corneal curvature of both axial and instantaneous maps from anterior and posterior surface, respectively, and total corneal power (TCP) were acquired. These corneal parameters from three zones (central, middle, and peripheral) and total corneal wavefront aberration, trefoil, and coma were obtained. The ACA from four quadrants, anterior chamber depth (ACD), anterior chamber volume (ACV), and intraocular pressure (IOP) were also inspected. RESULTS: ACD increased significantly from 2.15 ± 0.25 to 2.18 ± 0.24 mm (P = 0.002). ACV and ACA from all four quadrants increased significantly after the laser treatment (all P < 0.05). IOP decreased significantly from 16.9 ± 3.1 to 14.7 ± 2.9 mmHg following LI plus PI (P = 0.000). No significant changes were detected in corneal axial and instantaneous curvature from three zones on the anterior and posterior corneal surface after LI plus PI (all P > 0.05). The TCP, total corneal wavefront aberration, trefoil, and coma also revealed no significant changes after the laser procedure (all P > 0.05). CONCLUSIONS: Treatment with LI combined with PI did not affect the corneal topographic parameters from both anterior and posterior surfaces. However, LI plus PI improved ACA parameters significantly and effectively.

Ocular complications of Garcinia cambogia extract diet pills: Case report.

BACKGROUND: Garcinia cambogia contains hydroxycitric acid. Hydroxycitric acid is a potent competitive inhibitor of adenosine triphosphate citrate lyase which is a key enzyme in the synthesis of fatty acids. Hydroxycitric acid also regulates the level of serotonin. In these regards, hydroxycitric acid has been reported to exhibit weight loss activity. Adverse reactions of G. cambogia from numerous clinical studies demonstrated relatively mild reactions. However, there are some complications of G. cambogia reported in the past: acute liver injury, acute hepatitis, and hepatic failure. However, ocular complications of G. cambogia have not been reported yet. CASE PRESENTATION: A 35-year-old female visited our clinic with decreased vision in the left eye and ocular pain in both eyes for the last 6 days. She also complained of headache, dizziness, and nausea. She had taken G. cambogia extract more than the recommended dose. There was myopic shift with anterior chamber shallowing in both eyes, especially in the left eye. Moreover, swelling and retinal folds of peripapillary retinal nerve fiber layer and macula were observed in both eyes. These ocular complications of G. cambogia extract resolved after discontinuation of the extract and topical and oral steroid treatment. Herein, we report the first case of ocular complications of G. cambogia extract diet pill assessed with optical coherence tomography of optic disk and macula along with dual Scheimpflug analyzer. CONCLUSION: It is necessary that physicians dealing with obesity advice patients about possible visual disturbance of this extract when taken in overdose so that they can see an ophthalmologist immediately.

Effects of Emotional Stability on Insomnia through Anxiety in Patients with Cataracts.

This study investigated the effect of emotional stability (ES) on insomnia through anxiety in preoperative patients with cataracts. Fifty-four subjects completed a self-questionnaire that included the Insomnia Severity Index (ISI), the International Personality Item Pool (IPIP) for ES, and the Hospital Anxiety and Depression scale (HADS). Pathway analysis was performed to analyze the mediating effects of ES, the anxiety subscale scores of the HADS, and the ISI scores. The low-ES group exhibited an insomnia severity that was significantly higher than that of the high-ES group (p=0.048). According to the pathway analysis, the significant indirect effect of ES on the ISI scores was mediated by the scores on the anxiety subscale of the HADS. Cataract patients with low ES waiting to undergo surgery have a high risk of experiencing insomnia due to anxiety. Before surgery, it is essential to identify patients' personality characteristics and provide appropriate intervention.

Effect of Nd:YAG Laser Capsulotomy on Anterior Segment Parameters in Patients with Posterior Capsular Opacification after Phacovitrectomy.

PURPOSE: To compare changes in anterior segment parameters after Nd:YAG laser capsulotomy in eyes that underwent either combined phacovitrectomy or cataract surgery. METHODS: This retrospective study enrolled 37 eyes of 35 patients with posterior capsular opacification treated with combined phacovitrectomy (group A), and 35 eyes of 32 patients with posterior capsular opacification treated with cataract surgery (group B). Anterior segment parameters, including anterior chamber depth (ACD), anterior chamber angle, and anterior chamber volume, were measured by a Pentacam before Nd:YAG laser capsulotomy and 1 hour, 1 day, 1 week, 1 month, and 3 months after this treatment. RESULTS: In the cataract surgery group, the ACD was significantly lower 1 day (3.75 ± 0.74 mm), 1 week (3.73 ± 0.24 mm), and 3 months (3.74 ± 0.33 mm) after Nd:YAG laser capsulotomy compared with the pretreatment value (4.20 ± 0.62 mm, p = 0.002). By contrast, the ACD did not change significantly over time in the combined phacovitrectomy group. The ACD differed significantly between the two groups at 1 week, 1 month, and 3 months after capsulotomy. There were no significant changes in the anterior chamber volume, anterior chamber angle, central corneal thickness, or pupil size from before to after capsulotomy in either group. A non-significant trend toward myopic shift was observed in group A (p = 0.072) and B (p = 0.055). CONCLUSIONS: The results of the present study may help determine the power of the intraocular lens in patients who underwent combined surgery or cataract surgery and who will receive Nd:YAG laser capsulotomy.

Extensive Submacular Hemorrhage After Trabeculectomy With Mitomycin C.

PURPOSE: We report the occurrence of an extensive submacular hemorrhage after trabeculectomy with mitomycin C in a patient with an occult choroidal neovascular membrane (CNVM). PATIENTS AND METHODS: A 66-year-old man had a 3-year history of primary open-angle glaucoma in the left eye, which had been treated with topical antiglaucoma medication. The patient had age-related macular degeneration with an occult CNVM, for which he had received 5 intravitreal injections of ranibizumab and 5 intravitreal injections of bevacizumab in the left eye over a 3-year period. As intraocular pressure was not under control in the left eye over a 2-month period, trabeculectomy with mitomycin C was performed. RESULTS: On the first postoperative day, intraocular pressure was 8 mm Hg with a well-formed bleb in the left eye. However, extensive subretinal hemorrhage was observed, and the patient underwent pneumatic displacement and pars plana vitrectomy to remove the hemorrhage. After 7 months, extensive subretinal fibrosis was observed and visual acuity was low (hand movement only). CONCLUSIONS: To our knowledge, this is the first report of an extensive submacular hemorrhage after trabeculectomy with mitomycin C in a patient with an occult CNVM.

Distinguishing Uveitis Secondary to Sarcoidosis From Idiopathic Disease: Cardiac Implications.

Importance: Idiopathic disease is the most frequent diagnosis in a uveitis clinic. The need to distinguish sarcoidosis from idiopathic uveitis is controversial. However, cardiac involvement in sarcoidosis can be life-threatening. Objective: To report a series of patients with uveitis and cardiac sarcoidosis to illustrate the importance of categorizing the causes of uveitis. Design, Setting, and Participants: This retrospective observational case series reviewed the medical records of 249 patients with uveitis who were referred to the Casey Eye Institute between July 1, 2008, and February 28, 2017. Main Outcomes and Measures: We describe patients who initially received a diagnosis of idiopathic uveitis but subsequently received a diagnosis of sarcoidosis. Clinical data, including ophthalmologic findings, were collected. We summarized the number of patients who initially presented with idiopathic uveitis, the number of patients who recived a classification of idiopathic uveitis after evaluation, the number of patients who underwent chest computed tomography or an electrocardiogram, and the number of patients with ocular sarcoidosis. Results: Of 33 patients with sarcoidosis, 21 (63.6%) were women and the mean (SD) age was 53.5 (13.8) years. Of 249 patients, the referring diagnosis was idiopathic uveitis for 179 (72%). After history, examination, and laboratory testing, 127 (51%) were still considered to have idiopathic disease. Fifty-three of the 179 patients (30%) with idiopathic disease underwent chest computed tomography scanning. A diagnosis of presumed sarcoidosis, usually on the basis of a chest computed tomography scan, was made in 19 patients (36.2%). As 14 patients (5.6%) were previously known to have sarcoidosis, 33 patients (13.3%) were evaluated with definite or presumed ocular sarcoidosis. We obtained electrocardiograms as a screen for cardiac sarcoidosis on 14 (42.4%) of these patients. Nine patients with abnormal electrocardiogram results were referred to cardiologists. Four of the 19 patients (21.1%) who were referred for idiopathic uveitis but subsequently received a diagnosis of presumed sarcoidosis were found to have episodes of ventricular tachycardia that required implantable cardiac defibrillators. Distinguishing ocular sarcoidosis from idiopathic uveitis had potentially life-saving implications for these patients. Conclusions and Relevance: The present case series shows the potential utility of distinguishing sarcoidosis-associated uveitis from idiopathic uveitis. We suggest that patients older than 40 years with a history of idiopathic uveitis be evaluated with chest computed tomography and an electrocardiogram if sarcoidosis is suggested on ophthalmic examination.

Tristetraprolin regulates the decay of the hypoxia-induced vascular endothelial growth factor mRNA in ARPE-19 cells.

The aim of the present study was to investigate the effects of tristetraprolin (TTP) on the vascular endothelial growth factor (VEGF) mRNA and protein expression levels in retinal pigment epithelial cells under hypoxic conditions, and to consider the possibility of using TTP as a novel treatment tool for neovascular age­related macular degeneration (AMD). Overexpression of TTP reduced the expression and secretion levels of VEGF in ARPE­19 cells under hypoxic conditions. TTP destabilized the VEGF mRNA by binding to adenosine and uridine­rich elements regions in its 3'­untranslated region. Furthermore, conditioned medium (CM) from TTP­overexpressing ARPE­19 cells suppressed the tube formation in human umbilical vein endothelial cells compared with hypoxic CM. These findings indicate that regulation of TTP expression may be a promising therapeutic tool for neovascular AMD, however, further research is required.

Comparison of the most common isolates of postoperative endophthalmitis in South Korea; Enterococcus species vs coagulase-negative staphylococci.

BACKGROUND: To compare the related factors or manifestations of the two most common isolates of post-operative endophthalmitis, which were Enterococcus spp. and coagulase-negative staphylococci (CNS) in South Korea. METHODS: Medical records were reviewed for cases of post-operative endophthalmitis caused by Enterococcus spp. and CNS at eight institutions between January 2004 and July 2010. Various factors including age, sex, residence, systemic diseases, smoking and drinking history, and best corrected visual acuity, and length of time between causative intraocular surgery and symptom development were compared between the two groups. RESULTS: The total number of post-operative endophthalmitis cases was 128 and in 116 cases, microbiological culture tests from the aqueous humor or vitreous were performed. Among these cases, 67 (57.8%) were culture proven. Among these 67 cases, 19 (28.4%) were caused by Enterococcus spp., 14 (20.9%) were caused by Staphylococcus epidermidis endophthalmitis, and 5 (7.5%) were caused by other CNS spp. Age, sex, causative procedure, past medical history, social history, and laterality were not different in the two groups. Mean initial and final visual acuity were significantly worse in the Enterococcus spp. endophthalmitis group than in the CNS group (p = 0.049, 0.042, respectively). Length of time between the causative procedure and symptom development was significantly shorter in cases of Enterococcus spp. endophthalmitis (p = 0.004). CONCLUSIONS: Enterococcus spp. induce more severe and rapid-onset postoperative endophthalmitis than CNS. Infectious endophthalmitis developed within 2 days after cataract operation could be caused by Enterococcus spp. and have chance to be poor prognosis in South Korea.

Resveratrol suppresses vascular endothelial growth factor secretion via inhibition of CXC-chemokine receptor 4 expression in ARPE-19 cells.

The present study characterizes the effects of resveratrol (Res) on vascular endothelial growth factor (VEGF) secretion in retinal pigment epithelial (RPE) cells. ARPE-19 cells were treated with CoCl2, a hypoxia mimetic agent. CoCl2 treatment increased protein levels of hypoxia inducible factor-1α (HIF-1α) and CXC-chemokine receptor 4 (CXCR4), and secretion of VEGF. To confirm the effects of Res on VEGF secretion, the human umbilical vein endothelial cell tube formation assay was performed with conditioned medium from Res-treated ARPE-19 cells. The well-known antioxidant Res effectively blocked these effects and reduced phosphorylation of nuclear factor (NF)-κB, an upstream activator of CXCR4. Furthermore, Res also suppressed VEGF secretion induced by SDF-1, a ligand of CXCR4. Conditioned medium from Res-treated ARPE-19 cells clearly suppressed tube formation compared with hypoxia-treated conditioned medium. The results demonstrated that Res inhibited the hypoxia mimetic CoCl2-induced expression of VEGF in ARPE-19 cells. Res suppressed CXCR4 expression through decreased phosphorylation of NF-κB, resulting in downregulation of VEGF secretion.

Suppression of laser-induced choroidal neovascularization by intravitreal injection of tristetraprolin.

AIM: To examine the effect of intravitreal adenoviral vector-mediated tristetraprolin (Ad-TTP) on VEGF mRNA expression in a rat model of laser-induced choroidal neovascularization. METHODS: Ad-TTP was prepared using a commercial kit. Retinal laser-induced photocoagulation (10 spots per eye) was performed on rats in this experimental choroidal neovascularization (CNV) model. Rats were divided into four groups: control (single intravitreal injection of balanced salt solution, n=10), laser-induced CNV (photocoagulation only, n=20), laser-induced CNV plus Ad-TTP injection (photocoagulation plus a single intravitreal Ad-TTP injection, n=20) and Ad-TTP injection only (n=10). Changes in choroidal morphology were evaluated in ten rats in the laser only and the laser plus Ad-TTP groups. Two weeks after laser injury, the size of CNV was calculated by perfusion with high-molecular-weight fluorescein isothiocyanate (FITC)-dextran. VEGF mRNA expression in retina-choroid tissue from ten rats in each group was measured by reverse transcription polymerase chain reaction (RT-PCR). RESULTS: Two weeks after treatment, the area of laser-induced CNV was reduced by approximately 60% in the rats given the Ad-TTP injection compared with that in the laser-only group. There was a tendency toward decreased VEGF mRNA expression in the Ad-TTP injection groups. CONCLUSION: A single intravitreal injection of Ad-TTP significantly suppressed CNV size in this experimental laser-induced CNV model. Ad-TTP injection also decreased VEGF mRNA expression compared with that in the laser-induced CNV group. The present study is meaningful as the first study to investigate the effect of tristetraprolin delivered via intravitreal injection.

The effect of 0.02% mitomycin C injection into the hair follicle with radiofrequency ablation in trichiasis patients.

PURPOSE: To investigate the inhibitory effect of 0.02% mitomycin C on eyelash regrowth when injected to the eyelash hair follicle immediately after radiofrequency ablation. METHODS: We prospectively included 21 trichiasis patients from June 2011 to October 2012. Twenty eyes of 14 patients were treated with 0.02% mitomycin C to the hair follicle immediately after radiofrequency ablation in group 1, while radiofrequency ablation only was conducted in ten eyes of seven patients in group 2. Recurrences and complications were evaluated until six months after treatment. RESULTS: One hundred sixteen eyelashes of 20 eyes in group 1 underwent treatment, and 19 (16.4%) eyelashes recurred. Eighty-four eyelashes of ten eyes in group 2 underwent treatment, and 51 (60.7%) eyelashes recurred. No patients developed any complications related to mitomycin C. CONCLUSIONS: Application of 0.02% mitomycin C in conjunction with radiofrequency ablation may help to improve the success rate of radiofrequency ablation treatment in trichiasis patients.

Effect of Dorzolamide/Timolol or Brinzolamide/Timolol prophylaxis on intravitreal anti-VEGF injection-induced intraocular hypertension.

PURPOSE: To evaluate prospectively whether anti-glaucomatic drugs administered prior to intravitreal anti-vascular endothelial growth factor (VEGF) injection bevacizumab (Avastin,® Roche) or ranibizumab (Lucentis,® Novartis) prevents intraocular hypertension after the injection. SUBJECTS AND METHODS: In total, 166 patients (175 eyes) scheduled for intravitreal anti-VEGF injection treatment were prophylactically treated 1 hour before the procedure with Dorzolamide/Timolol (Cosopt,® MSD) (Group 1, 53 eyes) or Brinzolamide/Timolol (Elazop,® Alcon) (Group 2, 84 eyes) or left untreated (Group 3, 29 eyes). Intraocular pressure was analyzed 5 minutes prior to the injection, every 5 minutes for 30 minutes after the procedure, and 1 hour, 1 day, 7 days, and 1 month after the procedure. RESULTS: The intraocular pressures 5 minutes before the procedure (baseline) for Groups 1, 2, and 3 were 12.06 ± 1.85, 13.98 ± 2.68, and 13.81 ± 2.24 mmHg, respectively. Five and 30 minutes after the procedure, the intraocular pressures of the three groups were 14.12 ± 4.18, 14.87 ± 3.35, and 28.21 ± 3.16 mmHg, respectively, and 10.87 ± 1.58, 14.25 ± 2.43, and 17.48 ± 2.34 mmHg, respectively. For all three groups, the changes relative to baseline 5 and 30 minutes after injection were significant. When the three groups were divided according to whether they received bevacizumab or ranibizumab and the changes in intraocular pressure relative to baseline were analyzed, all six subgroups exhibited significant changes in intraocular pressure 5 and 30 minutes after the procedure. CONCLUSION: The prophylactic administration of anti-glaucomatic drugs prior to intravitreal anti-VEGF injection effectively reduced the early intraocular pressure elevation. This approach was also safe and could be performed accurately.

A Case of Invasive Aspergillosis Presenting as Acute Angle Closure Glaucoma.

Purpose: To report a case of invasive aspergillosis presenting as acute angle closure glaucoma. Case: A 72-year-old male patient visited our clinic with decreased visual acuity and ocular pain on the right eye lasting for 3 d. His intraocular pressure was 42 mmHg in the right eye and 18 mmHg in the left eye. And, there was about 2 mm of exophthalmos, slight ptosis with decreased motility in all directions, conjunctival injection, moderate mydriasis with a relative afferent pupillary defect, and angle closure in the right eye. Orbital computed tomography and magenetic resonance imaging showed isotense mass involving right orbit and ethmoid sinus. Based on the biopsy, invasive aspergillosis was definitely diagnosed. Despite perfoming peripheral laser iridotomy and administrating antifungal agent and antiglaucoma medication, the patient was blinded in his right eye. During the follow-up period, visual acuity in the left eye suddenly decreased due to the invasive aspergillosis in the left paranasal sinus and optic nerve, and eventually the patient lost his left vision as well. Conclusion: This report is regarding a case of an invasive aspergillosis resulting in blindness in both eyes with the clinical manifestations of acute angle closure caused by invasive aspergillosis.