Sphingosine-1-phosphate expression in human epiretinal membranes.

The abnormal posterior vitreous detachment (PVD) is speculated as an important mechanism of the development of the epiretinal membrane (ERM). However, there is only limited information about the molecular mechanism. Sphingosine-1-phosphate (S1P) is a mediator of the mechanosensitive response in several cell types that may have a role in the pathogenesis of ERM during abnormal PVD. Therefore, we evaluated the expression of S1P in the human ERM and the role of S1P in cultured human Muller glial cells. Among 24 ERM specimens, seven specimens (29.2%) exhibited S1P expression. Patients with secondary ERM or ellipsoid zone defects, which suggest abnormal PVD presented a significantly higher S1P+ cell density (secondary ERM: 128.20 ± 135.61 and 9.68 ± 36.01 cells, p = 0.002; EZ defects: 87.56 ± 117.79 vs 2.80 ± 8.85, p = 0.036). The addition of S1P increased the migrative ability and expression of N-cadherin and α-SMA in human Muller glial cells, suggesting S1P is a potential causative molecule for the development of ERM during abnormal PVD.

Clinical Patterns of Uveitis in Tertiary Ophthalmology Centers in Seoul, South Korea.

PURPOSE: To identify the characteristics and causes of uveitis in Seoul, South Korea. METHODS: We performed a retrospective medical record review of 602 patients diagnosed with uveitis at seven tertiary ophthalmology centers between January and December 2013. RESULTS: The most common type of uveitis was anterior uveitis (n = 281), followed by posterior uveitis (n = 152), panuveitis (n = 126), and intermediate uveitis (n = 43). Among patients with an identified cause (n = 252), 149 and 103 had non-infectious and infectious uveitis, respectively, and ankylosing spondylitis (n = 53), Behcet disease (n = 43), and endophthalmitis (n = 25) were common identified causes of uveitis. CONCLUSIONS: Anterior uveitis was the most common type of uveitis, and the incidence of infectious uveitis was relatively high in Seoul. Ankylosing spondylitis and Behcet disease were the most common systemic diseases causing uveitis in this sample.

Cytomegalovirus as a cause of hypertensive anterior uveitis in immunocompetent patients.

BACKGROUND: The aims of this study are to investigate the clinical characteristics of patients with anterior hypertensive uveitis and to compare the characteristics between patients in cytomegalovirus (CMV)-positive and CMV-negative groups in their aqueous humor samples. Immunocompetent patients (n = 42) with a history of chronic and/or recurrent hypertensive anterior uveitis underwent ophthalmic examination and serological tests. Among the 42 patients with hypertensive anterior uveitis, aqueous humor sampling was performed in 21, and they were analyzed for viral deoxyribonucleic acids using the polymerase chain reaction (PCR). RESULTS: The average age of the 42 patients with hypertensive anterior uveitis was 57.6 years, and 29 (69.0 %) of the subjects were males. Of the patients, 22 (52.4 %) underwent glaucoma surgery, and the average corneal endothelial cell counts were 1908 cells/mm(2). Among the 21 patients who underwent an aqueous sampling, 6 were positive for CMV-DNA, while 15 were negative. The frequency of glaucoma surgery was similar between groups (CMV positive vs. CMV negative, 66.0 vs. 66.0 %, P = 0.701). However, 66.7 % of the CMV-positive group underwent glaucoma tube shunt surgery, whereas 80 % of the CMV-negative group underwent trabeculectomy or received an ExPRESS glaucoma filtration device (Alcon, Fort Worth, TX) for glaucoma surgery (P = 0.095). The corneal endothelial cell counts were significantly lower in the CMV-positive group (CMV positive vs. CMV negative, 1245 ± 560 vs. 1981 ± 387 cells/mm(2); P = 0.009). CONCLUSIONS: CMV was found to be an etiological factor in patients with hypertensive anterior uveitis in Korea. Special caution is needed for patients with CMV-induced hypertensive anterior uveitis, considering its adverse effect on the corneal endothelium.

Clinical Features of Ocular Toxocariasis in Adult Korean Patients.

PURPOSE: To investigate the clinical characteristics and treatment results of adult patients with ocular toxocariasis. METHODS: A total of 54 consecutive patients who were clinically and serologically diagnosed with ocular toxocariasis were retrospectively reviewed. RESULTS: Among patients, 66.7 and 77.3% showed increases in eosinophil cationic protein (ECP) and total Ig E in serum, respectively. Four eyes (7.2%) initially presented as neuroretinitis with subsequent motile retinal lesion. The recurrence rates in the combination treatment group with albendazole and corticosteroids were significantly lower than those in the steroid-alone group during the mean follow-up of 27.6 months (p = 0.001). CONCLUSIONS: The adjunctive test of serum total IgE level may be helpful for the diagnosis of ocular toxocariasis. Ocular toxocariasis should be considered in the differential diagnosis of unilateral neuroretinitis with subsequent motile retinal lesion. Combined treatment with albendazole and corticosteroids appeared to be effective for reducing the recurrence of intraocular inflammation.

Ocular manifestations of idiopathic aplastic anemia: retrospective study and literature review.

Aplastic anemia (AA) is a rare disease with few reports on its ophthalmic manifestations. The ocular findings are described in a retrospective consecutive series of 719 AA Korean patients followed at the Hematology Clinic of The Catholic University of Korea. Out of a total of 719 patients, 269 patients had eye examinations, 156 patients had retinal evaluation, and 37 (23.7%) had retinal findings. These 37 patients had unilateral retinal hemorrhage in seven and bilateral retinal hemorrhage in 30 with mean hemoglobin of 6.6 g/dL (range 2.7-12.6 g/dL) and platelet counts of 18.8×10(9)/L (range 4-157×10(9)/L); central retinal vein occlusion-like picture occurred in nine patients and these had similar rheology to the rest of the subjects; optic disc edema, cotton-wool spots, macular edema, and dry eyes occurred in two, three, five, and three patients, respectively. In this Korean series of 141 subjects with AA, systemic bleeding occurred in 24.8% of subjects, retinal hemorrhage in 37% of subjects, and any bleeding site (eye or elsewhere) occurred in 47.5% of subjects with AA. A literature review (1958-2010) of 200 AA cases revealed retinal hemorrhages in 56%, subhyaloid or vitreous hemorrhage in 9%, peripheral retinal vasculopathy in 5.5%, and cotton-wool spots, Sjögren's syndrome, or optic disc edema in 4% each. The prevalence of retinopathy among series of AA patients varied from 20% to 28.3%, which is consistent with the Korean series of 24.8%. Management of AA patients needs to involve multiple specialties, including hematologists, ophthalmologists, and infectious disease specialists.

Half-dose photodynamic therapy targeting the leakage point on the fluorescein angiography in acute central serous chorioretinopathy: a pilot study.

PURPOSE: To evaluate the efficacy of half-dose photodynamic therapy (PDT) targeting only the focal leakage point on fluorescein angiography for acute central serous chorioretinopathy. DESIGN: Nonrandomized, retrospective, comparative, interventional case series. METHODS: Ten consecutive eyes with acute central serous chorioretinopathy underwent PDT, and later, 11 eyes were observed without treatment. Main outcome measures included achievement of complete resolution of subretinal fluid, change in best-corrected visual acuity, and central retinal sensitivity. RESULTS: Complete resolution of subretinal fluid was achieved in 80.0% and 18.2% of eyes in the PDT group and the observation group at 1 month (P = .009), 100% and 27.3% at 3 months (P = .001), and 90% and 63.6% at 12 months (P = .311), respectively. At 12 months, 3 eyes (27%) in the observation group had a persistent lesion, whereas no such lesions were observed in the eyes in the PDT group. One eye in each group showed recurrence during the 12-month follow-up period. Visual acuity improved significantly in both groups at each time point, and the differences between groups were not significant. The mean central retinal sensitivity at 3 months was significantly higher in the PDT group compared with the observation group. CONCLUSIONS: Fluorescein angiography-guided half-dose PDT seems to facilitate faster resolution of subretinal fluid in acute central serous chorioretinopathy without, however, convincing long-term anatomic and functional benefits. This protocol may enhance the safety of PDT further.

Acute endophthalmitis after intravitreal injection and preventive effect of preoperative topical antibiotics.

PURPOSE: To evaluate the incidence, causative organism, clinical features, and visual outcome of acute endophthalmitis following intravitreal injection and to report the clinical outcome of patients receiving preinjection antibiotics for the prevention of endophthalmitis. METHODS: For all intravitreal triamcinolone acetonide, bevacizumab, ranibizumab, and C3F8 gas injections performed in our outpatient clinic between June 2008 and November 2012, the number of injections, indications, types of administered drugs, and methods of injection were investigated. A retrospective chart review was performed comparing patients with self-administration of antibiotic eye drops for 3 days before injection (n=8649 injections), and patients those who received no pretreatment with antibiotics (n=8683 injections). Cases of suspected endophthalmitis after intravitreal injection during this period were identified and reviewed retrospectively. RESULTS: The total number of intravitreal injections was 17,332. The incidence of acute endophthalmitis for all intravitreal injections was 0.000% (0/849) for triamcinolone acetonide, 0.022% (2/9,125) for bevacizumab, 0.000% (0/7,061) for ranibizumab, and 0.337% (1/297) for C3F8 gas injections. The overall rate of intravitreal injection-related endophthalmitis with the use of topical antibiotics given 3 days before injection was no less statistically significant compared with that of no antibiotics. Staphylococcus species was confirmed in the bacterial culture of one eye with acute endophthalmitis. After early vitrectomy and intravitreal antibiotic injection, one eye maintained vision, but the other eye developed phthisis. CONCLUSIONS: All 3 endophthalmitis patients had not taken prophylactic preinjection topical antibiotics, but the difference in the rates of endophthalmitis between those who received a multiday course of preinjection antibiotics and those who did not was not statistically significant. The rate of endophthalmitis after intravitreal injection using aseptic techniques in the clinical practice setting is similar with or without the use of preinjection antibiotics. Preinjection antibiotic use confers no additional benefit in the treatment of endophthalmitis compared to without preinjection antibiotics.

Diversity of killer cell immunoglobulin-like receptor genes in uveitis associated with autoimmune diseases: ankylosing spondylitis and Behçet disease.

PURPOSE: To determine whether the frequencies of specific killer cell immunoglobulin-like receptors (KIR) genotypes are associated with the incidence of uveitis in ankylosing spondylitis (AS) and Behçet disease (BD). METHODS: The authors analyzed the frequency of 16 KIR genes in Koreans with either AS (110 patients, all HLA-B27-positive) or BD (86 patients), using polymerase chain reaction sequence-specific oligonucleotide probing. RESULTS: The frequency of the inhibitory receptor KIR3DL1 was lower in AS patients affected by uveitis than that in the general population (p < 0.05). The frequency of the KIR3DL1(-)/2DS3(-) was significantly higher in AS patients with uveitis (odds ratio = 9.306, p = 0.007). CONCLUSIONS: The study suggests that KIR3DL1 might associate with the resistance to AS-associated uveitis by influencing natural killer cell activity.

[A case of angiographic embolization of aortoenteric fistula caused by endovascular stent grafting for an abdominal aortic aneurysm].

Aortoenteric fistula (AEF) developed after treatment for an abdominal aortic aneurysm (AAA) is a rare but usually fatal complication. We report a rare case of AEF bleeding after endovascular stent grafting for AAA which was managed angiographically. An 81-year-old man presented with hematochezia and acute abdominal pain for 1 day ago. Four years ago, an aortic stent was implanted in the infrarenal aorta for AAA. Endoscopies were performed to evaluate the hematochezia. Evidence of gastrointestinal bleeding was observed, but a clear bleeding point was not detected on upper endoscopy and colonoscopy. Contrast-enhanced computed tomography performed subsequently showed that the bleeding point was located in the fourth portion of the duodenum as an AEF caused by an inflammatory process in the stent-graft. Intra-arterial angiography showed a massive contrast leakage into the bowel via a small fistula from around the aortic stent graft site. Embolization was successfully performed by injecting a mixture of glue and lipiodol into the AEF tract. The patient was discharged with no evidence of gastrointestinal bleeding after the embolization.

Adjusted retreatment of polypoidal choroidal vasculopathy after combination therapy: results at 3 years.

PURPOSE: The purpose of this study was to evaluate the 3-year outcome of adjusted retreatment with photodynamic therapy (PDT), thermal laser, and intravitreal bevacizumab (IVB) after their initial PDT/IVB combination therapy for polypoidal choroidal vasculopathy. METHODS: Data on 40 treatment-naive eyes of 38 patients with polypoidal choroidal vasculopathy were reviewed, all initially subjected to whole-lesion PDT/IVB. When retreating persistent or recurrent exudation, the aim was to reduce PDT frequency and spot size, avoiding whole-lesion PDT when feasible. Distinct polyps were thus selectively targeted using PDT and/or laser, routinely combined with IVB. If polyps were absent or questionable, IVB monotherapy was given. RESULTS: At Year 3, the mean logarithm of minimal angle of resolution best-corrected visual acuity improved from 0.67 (Snellen equivalent of 20/93) to 0.55 (Snellen equivalent of 20/70), but the improvement was not statistically significant (P = 0.076). Best-corrected visual acuity remained stable or improved in 33 eyes (82.5%). The mean number of combination treatments and total IVB courses were 1.66 (range, 1-4) and 5.92 (range, 1-18), respectively. Five eyes (12.5%) required focal laser treatment for extrafoveal polypoidal lesions during follow-up. CONCLUSION: Compared with reported 3-year outcomes of PDT as monotherapy for polypoidal choroidal vasculopathy, this approach proved favorable in improving or stabilizing visual acuity and reducing cumulative PDT exposure.

Is endoscopic mucosal resection a sufficient treatment for low-grade gastric epithelial dysplasia?

BACKGROUND/AIMS: The rate of diagnosis of gastric adenoma has increased because esophagogastroduodenoscopy is being performed at an increasingly greater frequency. However, there are no treatment guidelines for low-grade dysplasia (LGD). To determine the appropriate treatment for LGD, we evaluated the risk factors associated with the categorical upgrade from LGD to high grade dysplasia (HGD)/early gastric cancer (EGC) and the risk factors for recurrence after endoscopic treatment. METHODS: We compared the complication rates, recurrence rates, and remnant lesions in 196 and 56 patients treated with endoscopic submucosal dissection (ESD) and endoscopic mucosal resection (EMR), respectively, by histologically confi rming low-grade gastric epithelial dysplasia. RESULTS: The en bloc resection rate was significantly lower in the EMR group (31.1%) compared with the ESD group (75.0%) (p<0.001). However, no significant difference was observed in the prevalence of remnant lesions or recurrence rate (p=0.911) of gastric adenoma. The progression of LGD to HGD or EGC caused an increase in the incidence of tumor lesions >1 cm with surface redness and depressions. CONCLUSIONS: For the treatment of LGD, EMR resulted in a higher incidence of uncertain resection margins and a lower en bloc resection rate than ESD. However, there was no signifi cant difference in recurrence rate.

Responses to photodynamic therapy in patients with polypoidal choroidal vasculopathy consisting of polyps resembling grape clusters.

PURPOSE: To investigate the responses to photodynamic therapy (PDT) in patients with polypoidal choroidal vasculopathy (PCV) that show large aneurysmal dilation with internal angio-architecture consisting of diverse patterns of curvilinear vessels and polyps resembling grape clusters. DESIGN: Retrospective, interventional case series. METHODS: Twenty-two eyes of 22 patients were included. All patients initially received PDT monotreatment. The main outcome measures were the rates of complete polyp regression on indocyanine green angiography and initial favorable responses observed clinically. Also, the rates of recurrent exudative changes were evaluated at the 2-year follow-up. We focused on changes in the vascular features and their clinical association. RESULTS: Complete regression of polypoidal lesions was observed in 21 eyes (95%) after a mean of 1.7 PDTs. However, favorable clinical responses were achieved in only 9 eyes (41%), and 6 of them had recurrent exudation. Main vessels, previously consisting of the polypoidal lesion frame, persisted. Additionally, aberrant vessels with a thin radiating or tortuous configuration were observed in the area where large aneurysmal dilation was present. Leakage from this vascular complex or an expanded vascular complex was observed in a total of 14 eyes (64%) during the 2-year follow-up, contributing to persistent (8 eyes) or recurrent (6 eyes) exudation. This seemed to represent secondary choroidal neovascularization (CNV). In another 4 eyes (18%), fibrous changes developed immediately after PDT. Polyps recurred in 8 eyes (38%). CONCLUSIONS: This PCV pattern frequently evolved into typical CNV after PDT, resulting in persistent or recurrent exudation despite the disappearance of polypoidal structures.

Vitrectomy and internal limiting membrane peeling with and without gas tamponade for myopic foveoschisis.

PURPOSE: To compare clinical outcomes after vitrectomy and internal limiting membrane (ILM) peeling, with and without gas tamponade, for the treatment of myopic foveoschisis. DESIGN: Retrospective, comparative, interventional case series. METHODS: In this retrospective clinical study, 17 eyes of 17 consecutive patients underwent vitrectomy and ILM peeling for treatment of myopic foveoschisis. Eyes were divided into 2 groups, those with gas tamponade (n = 9) and those without (n = 8). Gas tamponade was chosen according to the period and surgeon's discretion. The changes of foveal anatomy on preoperative optical coherence tomography (OCT) were not considered in the decision. Main outcome measures were the rate of resolution of myopic foveoschisis measured by OCT, the time interval until resolution of myopic foveoschisis, central foveal thickness, and best-corrected visual acuity (BCVA). RESULTS: After surgery, OCT showed a resolution of myopic foveoschisis in 8 eyes (88.9%) in the gas-treated group and in 6 eyes (75.0%) in the no-gas group. This difference between the groups was statistically insignificant (P = .576). The mean period until the resolution of myopic foveoschisis was 2.25 months in the gas-treated group and 4.50 months in the no-gas group (P = .011). The mean BCVA improved significantly in both the gas-treated and no-gas groups (P = .011 and P = .017, respectively). CONCLUSIONS: Vitrectomy and ILM peeling without gas tamponade appears to be as effective in the treatment of myopic foveoschisis as vitrectomy with gas tamponade. However, eyes treated with gas tamponade showed more rapid resolution of myopic foveoschisis.

Indocyanine green toxicity after macular hole surgery in both eyes.

PURPOSE: To report on a patient with bilateral macular holes who developed circular retinal pigment epithelial atrophy at the fovea after macular hole surgery using indocyanine green in both eyes. METHOD: Interventional case report. RESULTS: A 68-year-old woman presented with a Stage 3 macular hole in each eye. Complete pars plana vitrectomy with indocyanine green-assisted internal membrane peeling was performed. The procedures were uneventful. The concentration and the exposure time to intravitreal indocyanine green were tolerable. One month after surgery, the macular hole was closed, but underlying circular retinal pigment epithelial atrophy was observed in both eyes. CONCLUSION: In clinical practice, if indocyanine green-related ocular toxicity develops in one eye after macular hole surgery, care should be taken regarding indocyanine green use during surgery of the other eye.