Analysis of Choroidal Thickness Measured Using RTVue and Associated Factors in Open-Angle Glaucoma

PURPOSE: To compare the macular choroidal thickness, ganglion cell complex thickness, peripapillary choroidal thickness and retinal nerve fiber layer thickness among normal, primary open angle glaucoma (POAG) and normal tension glaucoma (NTG) patients using RTVue (Fourier-domain optical coherence tomography; Optovue, Fremont, CA, USA). METHODS: A retrospective analysis of 32 normal controls, 32 POAG and 52 NTG patients was performed. Choroidal thickness, ganglion cell complex thickness and retinal nerve fiber layer thickness were compared among normal controls, POAG and NTG subjects. Additionally, the factors influencing choroidal thickness (age, axial length, spherical equivalent, central corneal thickness, mean deviation, nocturnal dip, blood pressure variability) were analyzed. RESULTS: A total of 32 normal controls, 32 POAG and 52 NTG patients were enrolled in this study. Macular and peripapillary choroidal thicknesses were significantly thinner in the NTG patients. In NTG subjects, the significant influencing factors associated with macular and peripapillary choroidal thicknesses were age, axial length, nocturnal dip (diastolic blood pressure), diastolic blood pressure variability and ganglion cell complex thickness. In POAG patients, significant influencing factors associated with macular and peripapillary choroidal thicknesses were age and axial length. CONCLUSIONS: Choroidal thickness was significantly thinner in NTG patients compared with normal controls and POAG patients. Factors influencing choroidal thickness in NTG patients were age, axial length, nocturnal dip (diastolic blood pressure), diastolic blood pressure variability and ganglion cell complex thickness. In POAG patients, significant factors influencing choroidal thickness were age and axial length.

Analysis of Choroidal Thickness Measured Using RTVue and Associated Factors in Open-Angle Glaucoma

PURPOSE: To compare the macular choroidal thickness, ganglion cell complex thickness, peripapillary choroidal thickness and retinal nerve fiber layer thickness among normal, primary open angle glaucoma (POAG) and normal tension glaucoma (NTG) patients using RTVue (Fourier-domain optical coherence tomography; Optovue, Fremont, CA, USA). METHODS: A retrospective analysis of 32 normal controls, 32 POAG and 52 NTG patients was performed. Choroidal thickness, ganglion cell complex thickness and retinal nerve fiber layer thickness were compared among normal controls, POAG and NTG subjects. Additionally, the factors influencing choroidal thickness (age, axial length, spherical equivalent, central corneal thickness, mean deviation, nocturnal dip, blood pressure variability) were analyzed. RESULTS: A total of 32 normal controls, 32 POAG and 52 NTG patients were enrolled in this study. Macular and peripapillary choroidal thicknesses were significantly thinner in the NTG patients. In NTG subjects, the significant influencing factors associated with macular and peripapillary choroidal thicknesses were age, axial length, nocturnal dip (diastolic blood pressure), diastolic blood pressure variability and ganglion cell complex thickness. In POAG patients, significant influencing factors associated with macular and peripapillary choroidal thicknesses were age and axial length. CONCLUSIONS: Choroidal thickness was significantly thinner in NTG patients compared with normal controls and POAG patients. Factors influencing choroidal thickness in NTG patients were age, axial length, nocturnal dip (diastolic blood pressure), diastolic blood pressure variability and ganglion cell complex thickness. In POAG patients, significant factors influencing choroidal thickness were age and axial length.

The Relationships among Delayed Recovery in Finger Temperature, Nocturnal Dip, and Glaucoma Progression

PURPOSE: To investigate the effects of a delay in finger temperature recovery rate on the hand cold provocation test (HCPT) and a nocturnal dip greater than 10% (dipper) on the progression of glaucomatous visual field (VF) defects in open-angle glaucoma patients when the intraocular pressure (IOP) was well controlled lower than the target pressure. METHODS: 30 patients (58 eyes) with normal tension glaucoma (NTG) and 13 patients (24 eyes) with primary open angle glaucoma, and 12 normal controls (24 eyes) were retrospectively enrolled in this study. We performed HCPT, 24 hour ambulatory blood pressure monitoring (24-hr ABPM), Goldmann applanation tonometer measurements, and VF tests on all subjects. The delay in finger temperature recovery rate was defined as a delay longer than 15% of the mean finger temperature of normal controls over 2 intervals among 5, 10, 15, and 20 minutes after the immersion of cold water. We examined the relationships among the delay in finger temperature recovery rate, dipper, and the progression of glaucomatous VF defects. RESULTS: The finger temperature recovery rate in NTG patients was significantly delayed more than that of normal controls at 5, 10, and 15 minutes after the immersion. The delay in finger temperature recovery rate significantly correlated with dipper in NTG patients. Glaucomatous VF defects were significantly progressed in the presence of dipper in NTG patients. Delay in finger temperature recovery rate was significantly related to the progression of glaucomatous VF defects in NTG patients. In the binary logistic regression test, delay in finger temperature recovery rate was the only factor that was strongly related to the progression of glaucomatous visual field in NTG patients. CONCLUSIONS: When glaucomatous VF defects progressed despite the IOP being well controlled, 24-hr ABPM and HCPT for detecting vascular dysregulation might be helpful for diagnosis and treatment of glaucoma.

Relationship among Water-Shed Zone, Nocturnal Dip and Visual Field Progression in Open Angle Glaucoma

PURPOSE: To investigate the influence of water-shed zone (WSZ) and nocturnal dip (ND) on the progression of the glaucomatous visual field (V/F) defects in open-angle glaucoma (OAG) patients when the intraocular pressure (IOP) was maintained under the target pressure. METHODS: We performed fluorescence angiography (FAG), 24-hour ambulatory blood pressure monitoring (24-hr ABPM), and V/F tests. We examined the relationships among WSZ in early-FAG, ND over 10% (dip), and the progression of the glaucomatous V/F defects using chi-square, Fisher's exact, and multivariate logistic regression tests. A p-value < 0.05 was considered statistically significant. RESULTS: When considering the correlation between WSZ and dip, statistical significance was found in OAG (p = 0.024, odds ratio (OR) = 3.308) and normal tension glaucoma (NTG) (p = 0.029, OR = 4.364) patients. In patients with dip, glaucomatous V/F defects significantly progressed (OAG: p = 0.003, OR = 5.938, NTG: p = 0.005, OR = 13.929). In patients with WSZ, the glaucomatous V/F defects progressed in all groups (OAG: p = 0.002, OR = 5.156, NTG: p = 0.024, OR = 4.750, primary open angle glaucoma (POAG): p = 0.021, OR = 8.750). In the patients with WSZ involving optic nerve head, the glaucomatous V/F defects had progressed in OAG (p = 0.004, OR = 5.958) and NTG (p = 0.009, OR = 8.333) groups. Based on binary logistic regression analysis, dip (p = 0.010, OR = 6.227) significantly affected V/F progression only in OAG patients. CONCLUSIONS: In the OAG and NTG groups, ND over 10% influenced the progression of the glaucomatous V/F defects. The patients with WSZ tended to have ND over 10% in OAG and NTG groups and glaucomatous V/F defects progressed in all patients. Therefore, performing early FAG and 24-hr ambulatory blood pressure monitoring may be helpful for glaucoma patients with progressing glaucomatous V/F defects even when the IOP was maintained under the target pressure.

Relationship Between Nocturnal Dip, Carotid Artery Blood Flow, Brain Ischemic Change in Open Angle Glaucoma

PURPOSE: To investigate the effect of nocturnal dip, carotid artery blood flow, and brain ischemic change on the progression of glaucomatous visual field defect in open-angle glaucoma (OAG) when IOP is less than the target pressure. METHODS: We classified OAG patients (74 patients, 148 eyes) who maintained IOP less than the target pressure as normal tension glaucoma (NTG; 52 patients, 104 eyes) or primary OAG (POAG; 22 patients, 44 eyes). Additionally, we performed 24-hr ambulatory blood pressure monitoring (24-hr ABPM), carotid artery color Doppler U/S (CAD), brain MRI, and visual field (V/F) tests on the patients. Nocturnal dips less than 10% were classified as non-dippers, and dips greater than 10% as dippers. The relationships among nocturnal dip, carotid artery blood flow, brain ischemic change, and progression of glaucomatous V/F defect were examined. RESULTS: In the case of dippers, glaucomatous V/F defects were aggravated, with a relative risk of approximately 1.74 (NTG) and 2.91 (POAG) times that of non-dippers. In NTG, decreased carotid artery blood flow and brain ischemic change furthered glaucomatous V/F defects, with a relative risk of approximately 2.40 and 2.54 times that of normal carotid artery blood flow and brain MRI findings, respectively. However, in POAG, decreased carotid artery blood flow and brain ischemic change were not influenced by the progression of glaucomatous V/F defects. CONCLUSIONS: In dippers, decreased carotid artery blood flow and brain ischemic change caused a progression of glaucomatous V/F defects in NTG and POAG patients. Thus, performing 24-hr ABPM, CAD, and brain MRI should be helpful for glaucoma patients with progression of glaucomatous V/F defects even when the IOP is less than the target pressure. In addition, this analysis provides useful information regarding glaucoma diagnosis and treatment.

Age-Related Differences of Spectral-Domain Optical Coherence Tomography Data in Koreans

PURPOSE: We evaluated the thickness of RNFL and optic nerve head parameters with age in normal eyes using Spectral-Domain Optical Coherence Tomography (SD-OCT). METHODS: A total of 128 normal Korean volunteers in different age groups were recruited (age range, 20-70 years). RESULTS: A significant negative correlation in average RNFL thickness with increasing age was found. The inferior areas (130.31 +/- 3.33 micrometer) were significantly thicker than other areas (superior area 119.05 +/- 2.12 micrometer, nasal area 71.80 +/- 0.57 micrometer, temporal area 77.72 +/- 0.16 micrometer). The average C/D ratios (mean 0.38 +/- 0.14) and vertical C/D ratios (mean 0.35 +/- 0.11) both showed significant increases with age, and the vertical C/D ratio correlation coefficient was higher (average C/D ratio r = 0.249, vertical C/D ratio r = 0.537). However, rim area, disc area, and cup volume were not correlated with age. CONCLUSIONS: From these findings, we conclude that, in normal Koreans, the mean RNFL thickness decreases and the C/D ratio increases with age, with the increase in the vertical C/D ratio being greater.

A Comparison of 2-Octyl Cyanoacrylate Adhesives versus Conventional Suture Materials for Eyelid Wound Closure in Rabbits

PURPOSE: To evaluate the clinical efficacy and histopathological tolerance of 2-octyl cyanoacrylate versus conventional suture materials for eyelid wound closure in rabbits. METHODS: We performed an experimental study on 16 eyes of eight New Zealand albino rabbits. Eyelid incisions of 15 mm were done 4mm from the upper eyelid margin in both eyes. The eyes of the rabbits were divided into two groups: eyelid incisions of the right eye were closed by a 2-octyl cyanoacrylate adhesive (group A) and eyelid incisions of the left eye were closed by 7-0 nylon sutures (group B). At 1, 2, 4, and 8 weeks after surgery, the rabbits were macroscopically examined and then sacrificed. The specimens of their eyelid tissues were stained by a hematoxylin and eosin stain and Masson-trichrome stain, and were observed under microscope. RESULTS: Both eyelid surgical closure methods were found to be equally efficacious in fixing the eyelids of groups A and B, and their clinical efficacy was similar. Histopathological findings of the hematoxylin and eosin stain of group A showed less inflammatory infiltration than group B at 2 weeks. There were no significant histopathological differences between the two groups at 1, 4, and 8 weeks. The degree of fibrosis of the Masson-trichrome stain was similar between the two groups at 8 weeks. CONCLUSIONS: The 2-octyl cyanoacrylate adhesive proved to be an effective eyelid closure method and was very well tolerated by the skin surface. 2-Octyl cyanoacrylate could be used as an alternative tissue adhesive for eyelid wound closure along with conventional suture materials.

The Changes in Tear Film and Corneal Sensation after Refractive LASIK Surgery for Presbyopia

PURPOSE: To evaluate the changes in break-up time (BUT) and corneal sensitivity following LASIK surgery for refractive error correction with presbyopia in patients older than 45 years. METHODS: The authors of the present study measured the BUT and corneal sensitivity of 92 eyes that received LASIK surgery for correcting refractive error with presbyopia. The eyes were divided into groups according to gender and preoperative refractive error before surgery and 1, 3, 6 and 12 months after LASIK. RESULTS: The mean age of patients was 52.01 +/- 5.51 years, and the male to female eye distribution was 31:61. The value of BUT before surgery and 1, 3, 6, and 12 months postoperative was 5.31 +/- 2.03 sec, 4.47 +/- 1.67 sec, 4.04 +/- 1.58 sec, 4.53 +/- 1.51 sec, and 4.87 +/- 1.46 sec, respectively; corneal sensitivity was 56.35 +/- 5.94 mm, 40.07 +/- 14.21 mm, 46.42 +/- 10.41 mm, 50.75 +/- 8.04 mm, and 52.92 +/- 7.51 mm, respectively. BUT was not significantly different relative to refractive error and was significantly shorter in the female group than the male group at 1 month postoperative. Corneal sensation of myopia at 12 months postoperative was statistically higher than at other time points; however, there was no difference between genders. BUT and corneal sensitivity at 12 months postoperative recovered to 91.6% and 93.9% of the preoperative value, respectively. CONCLUSIONS: BUT and corneal sensitivity after LASIK for presbyopia were decreased until 12 months postoperative and recovered slowly, but did not return to preoperative levels.

Correlation Between Nocturnal Dip and Progression of Glaucoma

PURPOSE: To investigate the effect of nocturnal dip influence on the progression of glaucomatous visual field defect. METHODS: We performed 24hr ABPM and V/F tests on patients diagnosed with NTG (140 patients, 280 eyes) and POAG (84 patients, 168 eyes). Nocturnal dips below 10% were classified as non-dippers, and those above 10% were noted as dippers. The correlations among nocturnal dip, progression of glaucomatous visual field defect, and hypertension treatment were examined. RESULTS: In NTG, dippers in both systolic and diastolic blood pressure furthered glaucomatous visual field defects, with a relative risk of approximately three times that of non-dippers. Hypertension treatment was not influenced by the progression of glaucomatous visual field defect but was influenced by dips in the systolic and diastolic pressures in NTG and in diastolic pressure in POAG. Nocturnal dips were more frequent in the group with progression of the visual field compared to those in the group with non-progression of the visual field in NTG. CONCLUSIONS: Dipper caused a progression of glaucomatous visual field defects in NTG and was influenced by hypertension treatment in NTG and POAG. Performing 24hr ABPM should be helpful for glaucoma patients with progression of a glaucomatous visual field defect even when the IOP is less than the target pressure. In addition, hypertension treatment should be considered an important factor in the treatment of glaucoma.

Comparison of Dynamic Contour Tonometry and Goldmann Applanation Tonometry

PURPOSE: To compare dynamic contour tonometry (DCT) and Goldmann applanation tonometry (GAT) and investigate the influence of central corneal thickness (CCT) onintraocular pressure. METHODS: In a prospective study of 165 eyes with glaucoma (135 eyes), glaucoma suspect (14 eyes), and ocular hypertension (16 eyes), intraocularpressure was measured with DCT and GAT, and followed by measurement of the CCT with ultrasound pachymetry. Statistical analysis were performed with simple linear regression analysis and t-test using SPSS (Statistical software, ver. 10; SPSS Inc., Chicago, IL). RESULTS: A clear correlation between DCT and GAT was found (r=0.733, p<0.001). The average intraocular pressure was 14.92+/-2.28 mmHg with DCT and 13.97+/-3.12 mmHg with GAT, and the intraocular pressure with DCT was 0.95+/-2.49 mmHg higher than with GAT. A meaningful correlation was shown between GAT and CCT (r2=0.145, p<0.001), but was not demonstrated between DCT and CCT (r2=0.012, p=0.081). In addition, the difference of intraocular pressure between GAT and DCT (GAT-DCT) showed a significant correlation with CCT (r2=0.145, p<0.001). CONCLUSIONS: DCT appears to be a reliable method for intraocular pressure measurement, which is not influenced by CCT, unlike GAT.

Comparision of Anterior Segment Parameters in Angle-Closure Glaucoma Using Scheimpflug Camera

PURPOSE: To compare anterior segment parameters in angle-closure glaucoma (ACG), primary open angle glaucoma (POAG), and normal subjects (N) using a Schiempflug camera. METHODS: Central corneal thickness (CCT), lens thickness (LT), axial length (AL), anterior chamber angle (ACA), anterior chamber depth (ACD), and anterior chamber volume (ACV) were measured in ACG (93 eyes of 92 patients), POAG (90 eyes of 87 patients), and normal (91 eyes of 88 subjects) with Pentacam(R) and A-scan. All of the results and measurements were then compared. RESULTS: Compared to normal and POAG patients, ACG patients presented with significantly different measurements of CCT, LT, AL, and ACA, ACD, and ACV (p<0.05). Further, correlations were high between three measurements (ACA, ACD, ACV) in ACG, and the best correlations were found in acute angle-closure glaucoma (P<0.05). CONCLUSIONS: By using a Schiempflug camera it was possible to assess the correlation between anterior segment parameters (ACA, ACD, ACV) in glaucoma patients. The best correlations were found in acute angle-closure glaucoma, and thus anterior segment parameters can offer reciprocally complementary information.

The Comparison of The Matrix Perimetry and Humphrey Standard Perimetry in Various Patients Group

PURPOSE: To study the correlation between the Humphrey standard automated perimetry (SAP) and the Humphrey Matrix Frequency Doubling Technology (FDT) perimetry and diagnostic usefulness of the Humphrey Matrix FDT perimetry. METHODS: This study included 170 eyes of 170 patients. The 170 eyes were classified into 50 normal eyes, 20 ocular hypertensive eyes, 50 glaucoma-suspect eyes and 50 glaucomatous eyes. All subjects were examined with the Humphrey Matrix perimetry and the Humphrey standard automated perimetry. We studied the correlations between mean deviation (MD) and pattern standard deviation(PSD) of the Humphrey SAP and those of the Humphrey Matrix perimetry, respectively, in each of the classified group. RESULTS: Overall, MD and PSD of the Humphrey SAP were significantly correlated with MD and PSD of the Humphrey Matrix perimetry, respectively. However, MD and PSD of the Humphrey Matrix perimetry were not showed a significant correlation in normal subjects (P>0.05). CONCLUSIONS: In this study, there were significant correlations between the MD and PSD of the SAP and those of the Humphrey Matrix perimetry in glaucoma, glaucoma-suspect and ocular hypertension. These finding suggests the Humphrey Matrix perimetry has performance characteristics similar to SAP and diagnostic value.

Age-Related Differences of Optical Coherence Tomography Data in Koreans

PURPOSE: Optical coherence tomography (OCT) is a new imaging technique that can provide cross-sectional images of the retina. This study was designed to evaluate the thickness of the retinal nerve fiber layer (RNFL) and optic nerve head shape in normal eyes using OCT. METHODS: A total of 134 normal Korean volunteers in different age groups (age range, 10-50 years) were recruited for this study. Fifty-nine males and 75 females were enrolled. The mean age of the subjects was 24.0+/-12.91 years. RESULTS: At optic disc scan, the horizontal and vertical C/D ratios were 0.55 and 0.48, respectively, which were statistically significant (p<0.05). A significant positive correlation with increasing age was identified in the C/D area ratio and horizontal C/D ratio. According to the RNFL scan, the inferior and superior areas were significantly thicker than the nasal and superior areas. These areas were thinner with age. In addition, RNFL thickness in the superonasal, inferotemporal and superotemporal areas differed between subjects under 20 years old and those over 21 years old. CONCLUSIONS: We determined that RNFL thickness and optic nerve head shape in normal Koreans had age-related differences. These results could provide correctness with OCT scan in glaucoma patients.

Long-term Results of Hydroxyapatite and Medpor(R) Orbital Implant

PURPOSE: This study was conducted to determine long-term results of Hydroxyapatite and Medpor(R) ocular implants. METHODS: This study was done on 108 eyes inserted with hydroxyapatite ocular implant and 82 eyes inserted with Medpor(R) ocular implant that were treated at the present hospital from January 1992 to December 2002. We compared the types, frequencies, and onset and treatment of complications according to the types of surgery. RESULTS: The clinical outcome for 14 months to 10 years (average: 57.6 months) was examined in the hydroxyapatite implantation group. The complications were implant exposure in 14 eyes (13%), soft tissue complication in 27 (25%), eyelid complication in 30 (27.8%), and complication due to Peg insertion in 21 (27.3%). The clinical outcome for 5 months to 4 years (average: 18.6 months) was examined in the Medpor(R) implant group. The complications involved were implant exposure in 5 eyes (6.1%), soft tissue complication in 14 (17.1%), eyelid complication in 25 (30.5%), and complication due to MCP insertion in 3 (16.7%). CONCLUSIONS: Active treatment for early complications and long-term follow-up for late complications are needed with hydroxyapatite and Medpor(R) implantations.

The Effects of Oral Ginkgo Biloba Extract on Visual Field Change in Patients with NTG

PURPOSE: To assess the effect of oral Ginkgo biloba extract (EGB 761) on visual field in patients with normal tension glaucoma (NTG) based on the vascular theory among the machanisms of glaucomatous optic nerve damage. METHODS: A retrospective automated visual field data were obtained from Ginkgo group (20 patients, 38 eyes) and control group (20 patients, 40 eyes). Both groups underwent five Humphrey C24-2 field program over at least 4 years, and had glaucomatous optic nerve damage and visual field change, whose IOP were maintained under 21mmHg during all follow-up periods. Linear regression was performed with respect to mean deviation (MD), corrected pattern standard deviation (CPSD), and mean thresholds of Glaucoma Hemifield test (GHT). Subjects were classified as progressive, improvement, stationary based on the slope and statistical significance. RESULTS: There were 6 eyes (15.8%) with improvements with regard to MD in Ginkgo group. There were 5 eyes (13.2%) with improvements in Ginkgo group and 3 eyes (7.5%) with improvements in control group with regard to CPSD. With GHT cluster analysis, there were 13 eyes (34.2%) with improvements in Ginkgo group and 5 eyes (12.5%) with improvements in control group. CONCLUSIONS: The visual field in patient with NTG was improved in GBE group through MD, CPSD, and GHT cluster mean threshold, which was relatively compatible with known NTG visual field defect.

Clinical Observation of Combined Trabeculotomy and Trabeculectomy on Congenital Glaucoma

PURPOSE: To investigate the result of combined trabeculotomy and trabeculectomy as an initial operative treatment of congenital glaucoma. METHODS: We retrospectively reviewed the medical records of 8 patients (14 eyes) who were operated with combined trabeculotomy and trabeculectomy as an initial operative treatment of congenital glaucoma from October 13, 1998 to February 20, 2001. The mean age of patients was 1.2 years (ranging from 0.75 to 2 years) and the mean follow-up period was 12.4 months (12.3+/-8.18). We assessed the mean age at surgery, preoperative corneal diameter, preoperative and postoperative intraocular pressure, preoperative and postoperative C/D ratio, postoperative complications. RESULTS: The mean age at first surgery was 4.4 months (4.3+/-2.45), the mean postoperative intraocular pressure (IOP) at the end of follow-up period was 13.2+/-2.01mmHg, significantly lower than the mean preoperative IOP which was 25+/-5.23mmHg (P<0.05), the mean postoperative C/D ratio at the end of follow-up period was 0.38+/-0.14, significantly lower than the mean preoperative C/D ratio which was 0.55+/-0.15 (P<0.05), C/D ratio of 3 eyes among them was decreased by more than 0.2. The overall success rate was 71.4% (10 eyes) after single procedure. All the 4 failed eyes underwent trabeculectomy again and the IOP was well controled. The complications included hyphema(5 eyes), corneal edema (3 eyes), vitreous prolapse (3 eyes), posterior synechiae (2 eyes), and they were all resolved spontaneously. CONCLUSIONS: The combined surgery of trabeculotomy and trabeculectomy as an initial single procedure of congenital glaucoma lowered the IOP without serious complications.

The Effect of Ginkgo Biloba to Retinal Microcirculation

PURPOSE: We evaluated the microcircular changes of optic disc, peripapillary and macular area in healthysubjects who had taken Gingko biloba extract. METHODS: 10 healthy subjects (20 eyes) took Gingko biloba extract 40mg three times daily. Confocal scanning laser flowmetry (Heidelberg Retina Flowmetry, Heidelberg Engineering, Heidelberg, Germany) was used to measure the changes of microcirculation at before and after 2, 4 hours, 1 day, 1, 2, 3, 4 weeks. RESULTS: After administration of Gingko biloba extract, blood velocity, blood flow and blood volume in optic disc, peripapillary and macular area increased in all periods but statistically significant in 1 day, 1, 2, 3, 4 weeks except blood volume of macular area in 1 day. No side effects related to Gingko biloba extract were found. CONCLUSIONS: Gingko biloba extract increased microcircular blood velocity, flow, and volume in healthysubjects.

Amniotic membrane transplantation for repair of late bleb leaking

PURPOSE: To evaluate the effect of amniotic membrane transplantation which has anti-inflammatory functions and facilitates epithelialization on leaking blebs. METHODS: Patients who had bleb leakage after trabeculectomy were included, 2 eyes of 2 patients with primary open-angle glaucoma and 1 eye of 1 pa-tient with primary angle-closure glaucoma. After amniotic membrane was transplanted in the conjunctiva and cornea at the center of bleb leakage, the state of bleb leakage was observed retrospectively. RESULTS: In the first patient, there was no bleb leakage at postoperative day 1 and showed epithelialization at postoperative day 10. At two days after surgery, bleb leakage was controlled in the second patient and it showed epithelialization at four days after surgery. From the first day after surgery, there was no bleb leakage in the third patient. The patients were put on T-lens because of foreign body sensation, which was improved two days after surgery, and were epithelialized in 1 week. Out of all three eyes, there was no avascular bleb with leakage. CONCLUSION: Amniotic membrane can be a useful therapy of bleb leakage , which may cause the complications after trabeculectomy in glaucoma patients.

The Effects of the Application of Human Amniotic Membrane Ointment in Filtering Surgery on Rabbits

PURPOSE: We investigated the anti-inflammatory and anti-fibrotic effects of amniotic membrane(AM) ointment in filtering surgery of rabbits. METHODS: After filtering surgery was performed on both eyes of 10 rabbits, the AM ointment was applied over and under the scleral flap on one eye whereas base ointment excluding AM element was applied to the other as a control. The shapes of blebs were observed under slit-lamp biomicroscopy at postoperative 3 days, 1 week, 2 weeks and 4 weeks, and the tissues were excised for histologic studies. RESULTS: Serial changes of intraocular pressures had no significant difference. Slit-lamp biomicroscopy demonstrated that conjunctival blebs of AM ointment group were more elevated and cystic at 1 and 2 weeks. The heights of conjunctival blebs were significantly higher at 1, 2 and 4 weeks, and the width of scleral tracks was significantly wider at 1 and 2 weeks in AM ointment group. The number of inflammatory cells in the scleral track was significantly less at 3 days and 1 week, the number of fibroblasts in scleral track was significantly less at 2 and 3 weeks in AM ointment group. Masson s trichrome stain was less positive in AM ointment and the stain area of alpha-smooth muscle actin-positive fibroblasts was insignificant with image analysis system. Collagen type 3 appeared in scleral track from postoperative 1 week in control group, however, in AM ointment group, from 4 weeks. CONCLUSIONS: AM ointment is beneficial to suppress fibroblast differentiation, proliferation and inflam-matory reaction in filtering surgery and might be safe and effective adjunctive for enhancement of success in filtering surgery.

The Effects of Amniotic Membrane Ointment Application on Photore fractive Keratectomized Cornea in Rabbits

The authors investigated the effects of amniotic membrane ointment on inflammatory cell infiltration into corneal stroma, early keratocyte and inflammatory cell apoptosis and lipid peroxidation of cell membrane after photorefractive keratectomy (PRK) in rabbits. PRK was performed on both eye of 10 white rabbits, then we applied amniotic membrane ointment on one eye and ointment base on the other eye, three times a day, respectively. All corneas were harvested after 24 hours. Hematoxylineosin (H&E) stains for polymorphonuclear cells (PMNs) infiltration, terminal deozyribonucleotidyl transferase mediated dUTP-digoxigenin nick end labeling (TUNEL) stains for keratocyte apoptosis and malondialdehyde (MDA) immunohistochemical stains for lipid peroxidation were performed. In amniotic membrane ointment applicated group, PMNs in corneal stroma, TUNEL stain positive cells and degree of lipid peroxidation were significantly less than those of base ointment applicated group (P<0.05). Therefore, those findings may be able to utilize as basic data for clinical use of amniotic membrane ointment.