Long-term efficacy and safety of ExPress implantation for treatment of open angle glaucoma.

AIM: To compare the long-term efficacy and safety of ExPress implantation and standard trabeculectomy in patients with primary open angle glaucoma (POAG). METHODS: In this retrospective study, we compared 17 eyes treated by ExPress implantation with 23 eyes treated by trabeculectomy. Efficacy was assessed according to the relevant intraocular pressure (IOP) values and success rates during the first year of follow-up. Postoperative corneal endothelial cell loss was also compared. RESULTS: The number of antiglaucoma medications and the IOP reduction were similar between the 2 groups during the follow-up period. Although the mean IOP was similar, the IOP-fluctuation rate during the early postoperative period was significantly lower in the ExPress group than in the trabeculectomy group (P=0.038). A Kaplan-Meier survival curve analysis showed no significant success-rate difference between the groups (P=0.810). The corneal endothelial cell loss rate, moreover, was significantly lower in the ExPress group (P=0.05). CONCLUSION: ExPress implantation compared with trabeculectomy showed similar IOP-reduction and success rates along with lower IOP fluctuation and endothelial cell loss rates. For this reason, it can be considered to be the treatment of choice for patients with advanced glaucoma or low corneal endothelial cell density.

Ganglion cell-inner plexiform layer and retinal nerve fiber layer thickness according to myopia and optic disc area: a quantitative and three-dimensional analysis.

BACKGROUND: To determine the influences of myopia and optic disc size on ganglion cell-inner plexiform layer (GCIPL) and peripapillary retinal nerve fiber layer (RNFL) thickness profiles obtained by spectral domain optical coherence tomography (OCT). METHODS: One hundred and sixty-eight eyes of 168 young myopic subjects were recruited and assigned to one of three groups according to their spherical equivalent (SE) values and optic disc area. All underwent Cirrus HD-OCT imaging. The influences of myopia and optic disc size on the GCIPL and RNFL thickness profiles were evaluated by multiple comparisons and linear regression analysis. Three-dimensional surface plots of GCIPL and RNFL thickness corresponding to different combinations of myopia and optic disc size were constructed. RESULTS: Each of the quadrant RNFL thicknesses and their overall average were significantly thinner in high myopia compared to low myopia, except for the temporal quadrant (all Ps ≤0.003). The average and all-sectors GCIPL were significantly thinner in high myopia than in moderate- and/or low-myopia (all Ps ≤0.002). The average OCT RNFL thickness was correlated significantly with SE (0.81 µm/diopter, P < 0.001), axial length (-1.44 µm/mm, P < 0.001), and optic disc area (5.35 µm/mm2, P < 0.001) by linear regression analysis. As for the OCT GCIPL parameters, average GCIPL thickness showed a significant correlation with SE (0.84 µm/diopter, P < 0.001) and axial length (-1.65 µm/mm, P < 0.001). There was no significant correlation of average GCIPL thickness with optic disc area. Three-dimensional curves showed that larger optic discs were associated with increased average RNFL thickness and that more-myopic eyes were associated with decreased average GCIPL and RNFL thickness. CONCLUSION: Myopia can significantly affect GCIPL and RNFL thickness profiles, and optic disc size has a significant influence on RNFL thickness. The current OCT maps employed in the evaluation of glaucoma should be analyzed in consideration of refractive status and optic disc size.

Factors affecting refractive outcome after cataract surgery in primary angle-closure glaucoma.

BACKGROUND: To evaluate the biometric factors associated with the accuracy of intraocular lens power predictions for cataract surgery in primary angle-closure (PAC) or primary angle-closure glaucoma (PACG) eyes. DESIGN: Cross-sectional study PARTICIPANTS: This study included 103 PAC or PACG patients who had undergone cataract surgery. METHODS: All participants underwent anterior-segment optical coherence tomography preoperatively. Two novel biometric factors - the relative lens vault (the ratio of lens vault to anterior vault) and the anterior vault (the sum of lens vault and anterior chamber depth) - were measured using customized software. The powers of the implanted intraocular lens and the actual postoperative refractive errors were compared. The mean refractive error and the median absolute error were calculated and compared using repeated measures ANOVA and Wilcoxon matched-pairs signed-rank test. The biometric factors associated with the postoperative refractive error were investigated by multivariate regression analysis. MAIN OUTCOME MEASURES: Preoperative anterior-segment biometric factors, difference between predicted and actual postoperative refraction. RESULTS: The Haigis, Hoffer Q and SRK/T formulas all showed a slight tendency toward resultant hyperopia, respectively (P < 0.001, P = 0.05, P = 0.003). The Hoffer Q formula had the least prediction error (P < 0.001). In the multivariate regression analysis, the relative lens vault was the only independent factor predicting postoperative refractive error (ß = 0.392, P = 0.011). CONCLUSION: Intraocular lens power predictions for cataract surgery in PAC or PACG patients can be inaccurate. Such results might be associated with anterior-segment biometric factors. Preoperative relative lens vault appears to be a significant factor predicting refractive outcome after cataract surgery in patients with PAC or PACG.

Quantitative analysis of localized retinal nerve fiber layer defects using spectral domain optical coherence tomography.

PURPOSE: To compare the topographic features of localized retinal nerve fiber layer (RNFL) defects presented in red-free RNFL photography and spectral domain optical coherence tomography (SD-OCT), and to evaluate the correlation with structural and functional parameters. METHODS: Sixty eyes with localized RNFL defects in red-free RNFL photographs were included. RNFL thickness map and significance map were obtained by SD-OCT. The angular location, angular width, and area of localized RNFL defects were measured and compared among RNFL thickness map, significance map (red, <1% level; yellow, <5% level), and RNFL photograph. The RNFL defect areas were analyzed by their correlations with structural and functional parameters. RESULTS: The RNFL defect area of RNFL thickness map was significantly greater than those of red significance map, and smaller than those of RNFL photograph and yellow significance map (all P<0.001). RNFL thickness map showed a significantly narrower angular width than RNFL photograph and yellow significance map (all P<0.001). The area, angular width, and angular location of localized RNFL defects in RNFL photographs strongly correlated with those of RNFL thickness maps and significance maps (all r≥0.741, P<0.001). The relationship between RNFL defect area and structural-functional parameters was also significant. CONCLUSIONS: The high topographic correlations in RNFL defects between RNFL photography and SD-OCT RNFL maps suggest the validity of SD-OCT RNFL imaging for detecting localized glaucomatous RNFL damage. In addition, structural and functional parameters are closely related to RNFL defect areas. Quantitative measurements of RNFL defects might be valuable for glaucoma diagnosis.

Prevalence and risk factors of superior segmental optic hypoplasia in a Korean population: the Korea National Health and Nutrition Examination Survey.

BACKGROUND: This study investigated the prevalence and risk factors for superior segmental optic hypoplasia (SSOH) in a Korean population based on the data from the nationwide Korea National Health and Nutrition Examination Survey (KNHANES). METHODS: We performed a retrospective review of the KNHANES dataset covering January 2012 to December 2012. The study population comprised 5,612 subjects (≥19 years of age) who had participated in a medical interview covering demographic and systemic information, been issued a questionnaire regarding associated SSOH risk factors including gender, age, systemic disease, and family history, and had undergone an ophthalmologic examination. Two masked readers evaluated fundus photography, paying special attention to the presence of SSOH. Associations of risk factors (identified in the medical interview portion) with SSOH prevalence were investigated using multivariate logistic regression analysis. RESULTS: SSOH was detected in 16 eyes of 14 subjects, or 0.24% of the 5,612 subjects. All 16 eyes showed a corresponding visual-field defect. In multivariate logistic regression analyses, maternal history of diabetes (Odds ratio (OR), 7.666; 95% Confidence interval (CI), 2.601 ~ 22.593, p < 0.001) and paternal history of ischemic heart disease (IHD) (OR, 11.105; CI, 3.361 ~ 36.686, p < 0.001) were associated with increased risk of SSOH. CONCLUSIONS: This study provides the first representative population-based data on SSOH prevalence in Korea. Additionally, multivariate analyses revealed that a history of maternal diabetes and paternal IHD was the most important factor influencing the prevalence of SSOH.

A global gene expression analysis of the peripheral blood mononuclear cells reveals the gene expression signature in psoriasis.

BACKGROUND: Psoriasis is a chronic inflammatory skin disease that affects approximately 1~3% of the general population. OBJECTIVE: We performed cDNA microarray analysis with using the dendrimer labelling method to investigate the gene expression profile in the peripheral blood mononuclear cells (PBMCs) of psoriatic patients. METHODS: The peripheral blood mononuclear cells of 5 patients with psoriasis and 8 control subjects were used in the gene expression analyses of psoriasis. RESULTS: We identified 212 differentially expressed genes that showed at least a two-fold induction and/or reduction in psoriatic patients. Among those, 63 genes, including CD44, CD56 and IL7R, were induced, while 139 genes, including the sphingosine kinase 1 and p16-INK genes, were reduced in the psoriatic patients. CONCLUSION: We can speculate that these genes may have a role for the pathogenesis of psoriasis via their affecting different cellular functions. Our results suggest a possible mechanism by which activated immune cells migrate from the blood to the skin in psoriatic patients, and we provide novel putative targets for developing drugs to treat psoriasis.

IFN-gamma regulates the expression of B7-H1 in dermal fibroblast cells.

BACKGROUND: Programmed cell death ligand 1 (B7-H1) was recently cloned in antigen presenting cells (APCs) and represents a third member of the B7 family. Thus, B7-H1 may be a novel target for clinical intervention in human inflammatory disease. OBJECTIVE: The aim of this study is to investigate the signal transduction mechanism and transcriptional regulation of B7-H1 expression in human dermal fibroblasts. METHODS: We performed reverse transcription PCR (RT-PCR) for the detection of mRNA expression, luciferase reporter assays with B7-H1 promoter constructs, and Western blot analysis. RESULTS: From RT-PCR analysis, IFN-gamma can induce the expression of B7-H1 mRNA in dermal fibroblast. This expression is similar to the results of luciferase reporter assay with B7-H1 promoter. Western blot analysis and EMSA revealed that NF-kappaB transcription factors mediate the induction of B7-H1 expression via the transient phosphorylation of ERK1/2 and PI3K when cells are stimulated by IFN-gamma. Also, Specific destruction of the NF-kappaB binding site abolished the induction of the promoter activity by IFN-gamma. CONCLUSION: Our data not only provides the first evidence to demonstrate that dermal fibroblast express the B7-H1 mRNA in the process of skin inflammation, but also suggests the involvement of NF-kappaB and MAPK and PI3K, that may play some important roles in inflammation process in human skin diseases.

Direct adaptive controller for nonaffine nonlinear systems using self-structuring neural networks.

A direct adaptive state-feedback controller is proposed for highly nonlinear systems. We consider uncertain or ill-defined nonaffine nonlinear systems and employ a neural network (NN) with flexible structure, i.e., an online variation of the number of neurons. The NN approximates and adaptively cancels an unknown plant nonlinearity. A control law and adaptive laws for the weights in the hidden layer and output layer of the NN are established so that the whole closed-loop system is stable in the sense of Lyapunov. Moreover, the tracking error is guaranteed to be uniformly asymptotically stable (UAS) rather than uniformly ultimately bounded (UUB) with the aid of an additional robustifying control term. The proposed control algorithm is relatively simple and requires no restrictive conditions on the design constants for the stability. The efficiency of the proposed scheme is shown through the simulation of a simple nonaffine nonlinear system.