Effects of Glaucoma Medication on Dry Eye Syndrome and Quality of Life in Patients with Glaucoma

Purpose@#To investigate ocular surface diseases and changes in the quality of life of patients using glaucoma medications. @*Methods@#Participants were divided into the normal (31 individuals, 62 eyes) and glaucoma medication (30 patients, 60 eyes) groups. Changes in tear break-up time, lipid layer thickness (LLT), corneal and conjunctival staining scores, ocular surface disease index (OSDI), and Visual Function Questionnaire 25 (VFQ-25) score were assessed for 1 year. @*Results@#The change in mean LLT was lower in glaucomatous eyes than in control eyes (p = 0.019) after 1 year. The results of OSDI deteriorated (p’ = 0.008), but conjunctival staining and Schirmer test results showed improvement in glaucomatous eyes compared to those in control eyes (p’ =0.035 and 0.009, respectively). The average LLT decreased at 6 and 12 months, but there was no change at 24 months. In pairwise analysis, the decrease in LLT over the first 6 months was statistically significant (p < 0.001) and remained unchanged until 24 months. Among the VFQ items, scores for near activity and social function deteriorated over 1 year in the medication group (p’ = 0.033 and 0.015, respectively). However, there was no difference in the total VFQ score. @*Conclusions@#Significant reduction in LLT and deterioration of OSDI were observed in the medication group compared to the control group. However, this deterioration was observed only in the first 6 months. There was no significant difference in the VFQ total score. Nonetheless, there were significant differences in near activity and social function between the control and medication groups. Therefore, the results of this study showed that although glaucoma medication worsened eye dryness, the change was limited and did not worsen the quality of life. Glaucoma medication should be used with the consideration that they can limit near activity and social functioning.

Clinical Predictors of the Region of First Structural Progression in Early Normal-tension Glaucoma

Purpose@#This study aimed to compare the clinical characteristics of patients who showed structural progression in the peri-papillary retinal nerve fiber layer (RNFL) first against those who showed progression in the macular ganglion cell-inner plexi-form layer (GCIPL) first and to investigate clinical parameters that help determine whether a patient exhibits RNFL or GCIPL damage first. @*Methods@#A retrospective review of medical records of patients diagnosed with early-stage normal-tension glaucoma was performed. All eyes underwent intraocular pressure measurement with Goldmann applanation tonometer, standard auto-mated perimetry, and Cirrus optical coherence tomography at 6-month intervals. Structural progression was determined using the Guided Progression Analysis software. Blood pressure was measured at each visit. @*Results@#Forty-one eyes of 41 patients (mean age, 52.6 ± 16.7 years) were included in the study. In 21 eyes, structural pro-gression was first detected in the RNFL at 54.2 ± 14.8 months, while structural progression was first observed at the macular GCIPL at 40.5 ± 11.0 months in 20 eyes. The mean intraocular pressure following treatment was 13.1 ± 1.8 mmHg for the RNFL progression first group and 13.4 ± 1.8 mmHg for the GCIPL progression first group (p = 0.514). The GCIPL progression first group was older (p = 0.008) and had thinner RNFL at baseline (p = 0.001). The logistic regression analyses indicated that both age and follow-up duration until first progression predicted the region of structural progression (odds ratio, 1.051; 95% confidence interval, 1.001–1.105;p= 0.046 for age; odds ratio, 0.912; 95% confidence interval, 0.840–0.991; p = 0.029 for time until progression). @*Conclusions@#Age of glaucoma patients and time until progression are associated with the region of the first structural pro-gression in normal-tension glaucoma. Further studies exploring the association between glaucomatous progression and the location of damage are needed.

Hierarchical Cluster Analysis of Peripapillary Retinal Nerve Fiber Layer Damage and Macular Ganglion Cell Loss in Open Angle Glaucoma

Asymmetry of Peak Thicknesses between the Superior and Inferior Retinal Nerve Fiber Layers for Early Glaucoma Detection: A Simple Screening Method

PURPOSE: To assess whether the asymmetry in the peripapillary retinal nerve fiber layer (pRNFL) thickness between superior and inferior hemispheres on optical coherence tomography (OCT) is useful for early detection of glaucoma. MATERIALS AND METHODS: The patient population consisted of Training set (a total of 60 subjects with early glaucoma and 59 normal subjects) and Validation set (30 subjects with early glaucoma and 30 normal subjects). Two kinds of ratios were employed to measure the asymmetry between the superior and inferior pRNFL thickness using OCT. One was the ratio of the superior to inferior peak thicknesses (peak pRNFL thickness ratio; PTR), and the other was the ratio of the superior to inferior average thickness (average pRNFL thickness ratio; ATR). The diagnostic abilities of the PTR and ATR were compared to the color code classification in OCT. Using the optimal cut-off values of the PTR and ATR obtained from the Training set, the two ratios were independently validated for diagnostic capability. RESULTS: For the Training set, the sensitivities/specificities of the PTR, ATR, quadrants color code classification, and clock-hour color code classification were 81.7%/93.2%, 71.7%/74.6%, 75.0%/93.2%, and 75.0%/79.7%, respectively. The PTR showed a better diagnostic performance for early glaucoma detection than the ATR and the clock-hour color code classification in terms of areas under the receiver operating characteristic curves (AUCs) (0.898, 0.765, and 0.773, respectively). For the Validation set, the PTR also showed the best sensitivity and AUC. CONCLUSION: The PTR is a simple method with considerable diagnostic ability for early glaucoma detection. It can, therefore, be widely used as a new screening method for early glaucoma.

Diagnostic Ability of Swept-Source and Spectral-Domain Optical Coherence Tomography for Glaucoma

PURPOSE: To compare the diagnostic abilities of swept-source optical coherence tomography (OCT) [Deep Range Imaging OCT-1 (DRI-OCT)] and spectral-domain OCT (Cirrus HD-OCT) for glaucoma in Korean adults. MATERIALS AND METHODS: This retrospective study involved measuring peripapillary retinal nerve fiber layer (PP-RNFL) thickness, full macular thickness, and ganglion cell-inner plexiform layer (GC-IPL) thickness on two different OCT systems. We used three-dimensional optic disc scanning of DRI-OCT and included 12 clock-hour sectors for measurement of the PP-RNFL. Areas under receiver operating characteristic curves (AUCs) were calculated and compared to determine how well each system could distinguish control and glaucomatous patients. RESULTS: Ninety-one healthy and 58 glaucomatous eyes were included. Both systems could clearly distinguish between control eyes and eyes with moderate to severe glaucoma. Among all sectors, the AUC values of areas associated with glaucoma were >0.7 for both OCTs. The PP-RNFL sector of highest AUC value on both OCTs was the inferior sector of the clock-hour map (0.968 and 0.959 in DRI-OCT and Cirrus HD-OCT, respectively). Among macular thickness sectors, AUC values were highest on both OCTs for the outer inferior sector (0.859 and 0.853 in DRI-OCT and Cirrus HD-OCT, respectively). The GC-IPL also provided high diagnostic values (DRI-OCT and Cirrus HD-OCT were the best in the average and inferior sectors, respectively). CONCLUSION: Although the two OCT systems provided different thickness measurements, DRI-OCT exhibited as good, if not better, diagnostic ability for glaucoma as Cirrus HD-OCT in Korean adults.

Mislocation of Boundary of Localized Retinal Nerve Fiber Layer Defect in Red-free Photography of Three Glaucoma Patients

No abstract available.

Effect of Anti-vascular Endothelial Growth Factor Antibody on the Survival of Cultured Retinal Ganglion Cells

PURPOSE: To investigate the effects of anti-vascular endothelial growth factor (VEGF) antibody on the survival of retinal ganglion cell (RGC)-5 cells differentiated with staurosporine under oxidative stress. METHODS: We used real-time polymerase chain reaction and Western blot to confirm the expression of VEGF, VEGF receptor (VEGFR)-1 and VEGFR-2 in RGC-5 cells differentiated with staurosporine for 6 hours. The differentiated RGC-5 cells were treated with 800 µM hydrogen peroxide (H₂O₂) for 24 hours to induce oxidative stress. Then, the survival rate of RGC-5 was confirmed by lactate dehydrogenase assay at each concentration (0, 0.01, 0.1, and 1 mg) using bevacizumab as the anti-VEGF antibody. The expression of VEGF, VEGFR-1, and VEGFR-2 was confirmed using real-time polymerase chain reaction. RESULTS: VEGF, VEGFR-1, and VEGFR-2 were all expressed in differentiated RGC-5 cells. When RGC-5 cells were simultaneously treated with bevacizumab and 800 µM H₂O₂, survival of RGC-5 decreased with bevacizumab concentration. VEGF expression in RGC-5 cells increased with increasing concentration of bevacizumab. Similar patterns were observed for VEGFR-1 and VEGFR-2, but the degree of increase was smaller than that for VEGF. CONCLUSIONS: When bevacizumab was administered to differentiated RGC-5 cells, the cell damage caused by oxidative stress increased. Therefore, given these in vitro study results, caution should be exercised with bevacizumab treatment.

Correlations between Preoperative Angle Parameters and Postoperative Unpredicted Refractive Errors after Cataract Surgery in Open Angle Glaucoma (AOD 500)

PURPOSE: To assess the accuracy of intraocular lens (IOL) power prediction for cataract surgery with open angle glaucoma (OAG) and to identify preoperative angle parameters correlated with postoperative unpredicted refractive errors. MATERIALS AND METHODS: This study comprised 45 eyes from 45 OAG subjects and 63 eyes from 63 non-glaucomatous cataract subjects (controls). We investigated differences in preoperative predicted refractive errors and postoperative refractive errors for each group. Preoperative predicted refractive errors were obtained by biometry (IOL-master) and compared to postoperative refractive errors measured by auto-refractometer 2 months postoperatively. Anterior angle parameters were determined using swept source optical coherence tomography. We investigated correlations between preoperative angle parameters [angle open distance (AOD); trabecular iris surface area (TISA); angle recess area (ARA); trabecular iris angle (TIA)] and postoperative unpredicted refractive errors. RESULTS: In patients with OAG, significant differences were noted between preoperative predicted and postoperative real refractive errors, with more myopia than predicted. No significant differences were recorded in controls. Angle parameters (AOD, ARA, TISA, and TIA) at the superior and inferior quadrant were significantly correlated with differences between predicted and postoperative refractive errors in OAG patients (-0.321 to -0.408, p<0.05). Superior quadrant AOD 500 was significantly correlated with postoperative refractive differences in multivariate linear regression analysis (β=-2.925, R²=0.404). CONCLUSION: Clinically unpredicted refractive errors after cataract surgery were more common in OAG than in controls. Certain preoperative angle parameters, especially AOD 500 at the superior quadrant, were significantly correlated with these unpredicted errors.

Uremic Optic Neuropathy in Chronic Renal Failure

PURPOSE: To report a case of uremic optic neuropathy occurring in a patient with chronic renal failure. CASE SUMMARY: A 40-year-old male who was diagnosed with chronic renal failure and treated with peritoneal dialysis and hemodialysis for 17 years presented with blurred vision and a moving pain in his left eye for 2 days. The best corrected visual acuity (BCVA) was 0.2 in his left eye, and an inferior altitudinal visual field defect was noted on Humphrey perimetry. Fundus examination and optical coherence tomography showed optic disc swelling in his left eye; the right eye was unremarkable. These findings were compatible with a diagnosis of uremic optic neuropathy or anterior ischemic optic neuropathy of his left eye. After treatment of hemodialysis and intravenous high dose steroid pulse therapy, the BCVA in his left eye was 0.8. However, since he refused oral steroid maintenance therapy, his BCVA later decreased to 0.4. After treatment with subtenon triamcinolone injection, the BCVA in his left eye was 1.0 and showed a stable disease course. CONCLUSIONS: When patient with chronic renal failure presents with acute decrease in visual acuity and visual field defect, optic neuropathies including uremic optic neuropathy should be considered and prompt hemodialysis and systemic steroid treatment should be done.

Effect of a Preservative-free Dorzolamide/Timolol Fixed Combination on Elevated Intraocular Pressure after Vitrectomy

PURPOSE: To verify the effect of preservative-free Dorzolamide/Timolol fixed combination (PFDTC) on intraocular pressure (IOP) elevation after vitrectomy. METHODS: We retrospectively reviewed medical records of 33 patients who used PFDTC after pars plana vitrectomy. All patients' visual acuity and IOP was measured and symptoms of conjunctival irritation were investigated through survey and slit lamp examination. RESULTS: Before vitrectomy, the mean IOP was 13.6 ± 4.4 mm Hg which was elevated to 31.7 ± 5.4 mm Hg after vitrectomy (p < 0.001) and applying eyedrop lowered the mean IOP to 17.2 ± 7.0 mm Hg (p < 0.001). Regardless of tamponade material type, all elevated IOP decreased (p < 0.001) and the IOP of all 33 eyes did not rise to over 30 mm Hg again. No additional surgery for IOP control was needed during two-month follow-up period. Of the 33 patients using PFDTC, patients who felt discomfort were five (15.2%) and no patients showed side effects severe enough to stop use of eyedrop. CONCLUSIONS: PFDTC is an anti-glaucomatic agent which can reduce the IOP by inhibiting aqueous humor production. Without need for additional surgery, the eyedrop can effectively lower elevated post-vitrectomy IOP, with expectation of good patient compliance due to low risk of conjunctival irritation.

Surgical Results of Trabeculectomy and Ahmed Valve Implantation Following a Previous Failed Trabeculectomy in Primary Congenital Glaucoma Patients

PURPOSE: To compare the surgical results of trabeculectomy and Ahmed glaucoma valve implantation after a previous failed trabeculectomy. METHODS: A retrospective comparative case series review was performed on 31 eye surgeries in 20 patients with primary congenital glaucoma who underwent trabeculectomy or Ahmed glaucoma valve implantation after a previous failed trabeculectomy with mitomycin C. RESULTS: The preoperative mean intraocular pressure was 25.5 mmHg in the trabeculectomy group and 26.9 mmHg in the Ahmed glaucoma valve implantation group (p = 0.73). The 48-month postoperative mean intraocular pressure was 19.6 mmHg in the trabeculectomy group and 20.2 mmHg in the Ahmed glaucoma valve implantation group (p = 0.95). The 12-month trabeculectomy success rate was 69%, compared with 64% for Ahmed glaucoma valve implantation, and the 48-month success rates were 42% and 36% for trabeculectomy and valve implantation, respectively. The success rates following the entire follow-up period were not significantly different between the two groups (p > 0.05 by log rank test). Postoperative complications occurred in 25% of the trabeculectomy-operated eyes and 9% of the Ahmed-implanted eyes (p = 0.38). CONCLUSIONS: There was no significant difference in surgical outcome between the trabeculectomy and Ahmed glaucoma valve implantation groups, neither of which had favorable results. However, the trabeculectomy group demonstrated a higher prevalence of adverse complications such as post-operative endophthalmitis.

Treatment Outcome of Triple Procedure in Open-Angle Glaucoma and Angle-Closure Glaucoma

PURPOSE: To compare the surgical outcomes of triple procedure in patients with open-angle glaucoma and angle-closure glaucoma. METHODS: The patients who underwent triple procedures for open-angle glaucoma and angle-closure glaucoma and were followed up for more than 1 year postoperatively were retrospectively reviewed. Preoperative and postoperative visual acuity, intraocular pressure (IOP), visual field mean deviation, refractive error, number of medications, and complications were analyzed. The effect of surgery on IOP reduction and refractive error correction was compared. RESULTS: The IOP at 1 year postoperatively was 13.39 +/- 2.25 mm Hg, 13.41 +/- 2.79 mm Hg (p = 0.981) and IOP reduction was 4.51 +/- 6.35 mm Hg, 9.11 +/- 8.27 mm Hg (p = 0.042) in the open angle glaucoma group and angle closure glaucoma group, respectively. No patient in either group required reoperation due to uncontrolled IOP. The percentage of patients showing postoperative IOP reduction of at least 10% and 20% from baseline IOP was statistically higher in the angle-closure glaucoma group than in the open-angle glaucoma group. Prediction errors were -0.84 +/- 0.88 D and -0.13 +/- 0.65 D in the open-angle glaucoma group and angle-closure glaucoma group, respectively. CONCLUSIONS: Triple procedure was effective in reducing IOP in both open-angle glaucoma and angle-closure glaucoma patients. The patients with angle-closure glaucoma showed better results in IOP control and refractive error correction compared with patients with angle-closure glaucoma.

Incidence of Steroid-Induced Ocular Hypertension Following Myopic Refractive Surgery

PURPOSE: To determine the incidence of steroid-induced ocular hypertension following myopic vision correction. METHODS: This study retrospectively reviewed the medical records of 6,087 patients (12,164 eyes) who underwent myopic refractive surgery (laser-assisted in-situ keratomileusis [LASIK]/photorefractive keratectomy [PRK]/phakic intraocular lens [IOL] implantation) at Eyereum Eye Clinic between July 2011 and February 2013. Ocular hypertension was defined when post-operative intraocular pressure (IOP) was increased more than 30% compared to predicted IOP adjusted according to corneal thickness. All preoperative IOPs were measured using Goldmann applanation tonometer (GAT). Postoperative IOPs were measured using non-contact tonometer first and with GAT when the IOP was suspiciously increased. RESULTS: Steroid-induced ocular hypertension after a myopic refractive surgery occurred in 680 eyes (5.58%) of 404 patients (6.64%). The incidence based on surgery was LASIK (0.06%, 2/3, 514 eyes) followed by PRK (7.63%, 575/7,533 eyes) and phakic IOL implantation (9.2%, 103/1,117 eyes). The average increased IOP level in patients with steroid-induced ocular hypertension was 5.62 +/- 3.73 mm Hg after PRK and 9.35 +/- 4.95 mm Hg after phakic IOL implantation. A statistically significantly higher change in IOP was observed in the phakic IOL group (p < 0.001). However, the PRK group had a longer treatment period for ocular hypertension and used more antiglaucoma medications than the phakic IOL group (p < 0.05). Most patients with ocular hypertension were successfully treated with cessation of topical steroid or use of antiglaucoma medications. Only 2 eyes required glaucoma surgery because IOP was not controlled. CONCLUSIONS: IOP measurements should be initiated no later than 1 week after surgery because steroid-induced ocular hypertension following myopic refractive surgery can occur in approximately 5.58% of patients and most cases of ocular hypertension can be controlled with careful follow-up and use of antiglaucoma medications.

Treatment Outcome of Triple Procedure in Open-Angle Glaucoma and Angle-Closure Glaucoma

PURPOSE: To compare the surgical outcomes of triple procedure in patients with open-angle glaucoma and angle-closure glaucoma. METHODS: The patients who underwent triple procedures for open-angle glaucoma and angle-closure glaucoma and were followed up for more than 1 year postoperatively were retrospectively reviewed. Preoperative and postoperative visual acuity, intraocular pressure (IOP), visual field mean deviation, refractive error, number of medications, and complications were analyzed. The effect of surgery on IOP reduction and refractive error correction was compared. RESULTS: The IOP at 1 year postoperatively was 13.39 +/- 2.25 mm Hg, 13.41 +/- 2.79 mm Hg (p = 0.981) and IOP reduction was 4.51 +/- 6.35 mm Hg, 9.11 +/- 8.27 mm Hg (p = 0.042) in the open angle glaucoma group and angle closure glaucoma group, respectively. No patient in either group required reoperation due to uncontrolled IOP. The percentage of patients showing postoperative IOP reduction of at least 10% and 20% from baseline IOP was statistically higher in the angle-closure glaucoma group than in the open-angle glaucoma group. Prediction errors were -0.84 +/- 0.88 D and -0.13 +/- 0.65 D in the open-angle glaucoma group and angle-closure glaucoma group, respectively. CONCLUSIONS: Triple procedure was effective in reducing IOP in both open-angle glaucoma and angle-closure glaucoma patients. The patients with angle-closure glaucoma showed better results in IOP control and refractive error correction compared with patients with angle-closure glaucoma.

Incidence of Steroid-Induced Ocular Hypertension Following Myopic Refractive Surgery

PURPOSE: To determine the incidence of steroid-induced ocular hypertension following myopic vision correction. METHODS: This study retrospectively reviewed the medical records of 6,087 patients (12,164 eyes) who underwent myopic refractive surgery (laser-assisted in-situ keratomileusis [LASIK]/photorefractive keratectomy [PRK]/phakic intraocular lens [IOL] implantation) at Eyereum Eye Clinic between July 2011 and February 2013. Ocular hypertension was defined when post-operative intraocular pressure (IOP) was increased more than 30% compared to predicted IOP adjusted according to corneal thickness. All preoperative IOPs were measured using Goldmann applanation tonometer (GAT). Postoperative IOPs were measured using non-contact tonometer first and with GAT when the IOP was suspiciously increased. RESULTS: Steroid-induced ocular hypertension after a myopic refractive surgery occurred in 680 eyes (5.58%) of 404 patients (6.64%). The incidence based on surgery was LASIK (0.06%, 2/3, 514 eyes) followed by PRK (7.63%, 575/7,533 eyes) and phakic IOL implantation (9.2%, 103/1,117 eyes). The average increased IOP level in patients with steroid-induced ocular hypertension was 5.62 +/- 3.73 mm Hg after PRK and 9.35 +/- 4.95 mm Hg after phakic IOL implantation. A statistically significantly higher change in IOP was observed in the phakic IOL group (p < 0.001). However, the PRK group had a longer treatment period for ocular hypertension and used more antiglaucoma medications than the phakic IOL group (p < 0.05). Most patients with ocular hypertension were successfully treated with cessation of topical steroid or use of antiglaucoma medications. Only 2 eyes required glaucoma surgery because IOP was not controlled. CONCLUSIONS: IOP measurements should be initiated no later than 1 week after surgery because steroid-induced ocular hypertension following myopic refractive surgery can occur in approximately 5.58% of patients and most cases of ocular hypertension can be controlled with careful follow-up and use of antiglaucoma medications.

Relationship between Peripapillary Retinal Nerve Fiber Layer Thickness Measured by Optical Coherence Tomography and Visual Field Severity Indices

PURPOSE: Though there are many reports regarding the structure-function relationship in glaucoma, they are too complicated to apply to the routine clinical setting. The aim of this study was to investigate the direct relationship between peripapillary retinal nerve fiber layer (RNFL) thickness measured by optical coherence tomography (OCT) and visual field (VF) severity indices computed by standard automated perimetry. METHODS: This cross-sectional comparative study included 104 glaucomatous patients and 59 healthy subjects. Peripapillary RNFL thickness was measured by spectral domain (SD) and time domain (TD) OCTs. Four glaucoma VF severity indices, including mean deviation (MD), pattern standard deviation (PSD), Collaborative Initial Glaucoma Treatment Study (CIGTS) VF score, and Advanced Glaucoma Intervention Study (AGIS) VF score, were calculated using standard automated perimetry. The Pearson's correlation coefficients (r) between the average and quadrants of peripapillary RNFL thicknesses and the four VF severity indices were calculated. RESULTS: In glaucomatous eyes, the r value between the average RNFL thickness measured by SD OCT and each VF severity index were 0.562, -0.514, -0.577, and -0.567 for the MD, PSD, CIGTS VF score, and AGIS VF score, respectively (all p < 0.001). Among each quadrant, the inferior RNFL thickness showed the largest r value; 0.587, -0.552, -0.613, and -0.598 for the MD, PSD, CIGTS VF score, and AGIS VF score, respectively (all p < 0.001). Measurements by TD OCT showed similar strengths of association with SD OCT. CONCLUSIONS: Moderate correlation was identified between peripapillary RNFL thicknesses measured by SD/TD OCT and glaucoma VF severity indices. Among each quadrant, the inferior RNFL thickness showed the greatest association with glaucoma VF severity indices. There was no significant difference according to the type of VF severity index or the type of OCTs.

The Neuroprotective Effect of Maltol against Oxidative Stress on Rat Retinal Neuronal Cells

PURPOSE: Maltol (3-hydroxy-2-methyl-4-pyrone), formed by the thermal degradation of starch, is found in coffee, caramelized foods, and Korean ginseng root. This study investigated whether maltol could rescue neuroretinal cells from oxidative injury in vitro. METHODS: R28 cells, which are rat embryonic precursor neuroretinal cells, were exposed to hydrogen peroxide (H2O2, 0.0 to 1.5 mM) as an oxidative stress with or without maltol (0.0 to 1.0 mM). Cell viability was monitored with the lactate dehydrogenase assay and apoptosis was examined by the terminal deoxynucleotide transferase-mediated terminal uridine deoxynucleotidyl transferase nick end-labeling (TUNEL) method. To investigate the neuroprotective mechanism of maltol, the expression and phosphorylation of nuclear factor-kappa B (NF-kappaB), extracellular signal-regulated kinase (ERK), c-Jun N-terminal kinase (JNK), and p38 were evaluated by Western immunoblot analysis. RESULTS: R28 cells exposed to H2O2 were found to have decreased viability in a dose- and time-dependent manner. However, H2O2-induced cytotoxicity was decreased with the addition of maltol. When R28 cells were exposed to 1.0 mM H2O2 for 24 hours, the cytotoxicity was 60.69 ± 5.71%. However, the cytotoxicity was reduced in the presence of 1.0 mM maltol. This H2O2-induced cytotoxicity caused apoptosis of R28 cells, characterized by DNA fragmentation. Apoptosis of oxidatively-stressed R28 cells with 1.0 mM H2O2 was decreased with 1.0 mM maltol, as determined by the TUNEL method. Western blot analysis showed that treatment with maltol reduced phosphorylation of NF-kappaB, ERK, and JNK, but not p38. The neuroprotective effects of maltol seemed to be related to attenuated expression of NF-kappaB, ERK, and JNK. CONCLUSIONS: Maltol not only increased cell viability but also attenuated DNA fragmentation. The results obtained here show that maltol has neuroprotective effects against hypoxia-induced neuroretinal cell damage in R28 cells, and its effects may act through the NF-kappaB and mitogen-activated protein kinase signaling pathways.

Thickness in Ganglion Cell-Inner Plexiform Layer on Spectral-Domain Optical Coherence Tomography after Cataract Surgery

PURPOSE: To assess changes in ganglion cell-inner plexiform layer (GCIPL) thickness after cataract surgery using spectral-domain optical coherence tomography (OCT). METHODS: Forty-three eyes of 33 patients, who underwent cataract surgery were imaged with spectral-domain OCT before and after surgery to measure peripapillary retinal nerve fiber layer (RNFL) and GCIPL thickness, signal strength (SS), quadrant, 12 clock-hour RNFL thickness and sectoral GCIPL thickness. RESULTS: The postoperative SS, RNFL and GCIPL thickness were higher than before surgery (p < 0.05). Multivariate analysis showed that endothelial cell count and preoperative SS were significantly correlated with SS changes in RNFL parameters and preoperative SS was significantly correlated with SS changes in GCIPL parameters. Univariate analysis indicated that age was significantly correlated with RNFL thickness changes in RNFL parameters and no factor was correlated with GCIPL thickness in GCIPL parameters (p < 0.05). CONCLUSIONS: Cataracts may decrease peripapillary RNFL and GCIPL thickness measurements and SS on OCT scans. Peripapillary RNFL and GCIPL thickness measurements should be interpreted with caution in eyes with significant cataracts.

Intravitreal Bevacizumab for the Treatment of Optic Disc Edema in a Patient with POEMS Syndrome

No abstract available.

Cytotoxicities and Anti-Fibrotic Effects of Pirfenidone and Mitomycin C on Human Fibroblasts

PURPOSE: The cytotoxicities and anti-fibrotic effects of mitomycin C and pirfenidone on human dermal fibroblast were evaluated. METHODS: Initially, 24-hour cell cultures were exposed to transforming growth factor (TGF)-beta1, different concentrations of mitomycin C, and pirfenidone solutions in order to evaluate cytotoxicity. Expressions of fibronectin, collagen type 1, alpha smooth muscle, and beta-actin were evaluated by real-time reverse transcription-polymerase chain reaction (RT-PCR) and western blot in mitomycin C solutions at concentrations of 4 microg/mL and 20 microg/mL, and in pirfenidone solutions at 250 microg/mL and 500 microg/mL. RESULTS: In comparison to cell cultures exposed to TGF-beta1 solutions, cytotoxicities were increased in solutions of mitomycin C at 4 microg/mL, 20 microg/mL, 40 microg/mL and pirfenidone at 500 microg/mL, 750 microg/mL, 1,000 microg/mL (p < 0.05, Mann Whitney U-test). The results of real-time RT-PCR show that expressions of fibronectin, collagen type 1, and alpha smooth muscle were significantly more decreased in all concentrations of mitomycin C and pirfenidone compared to those in TGF-beta1 solution. In western blot analysis, expressions of fibronectin and alpha smooth muscle were decreased in all concentrations of mitomycin C and pirfenidone compared to TGF-beta1 solution. CONCLUSIONS: Both drugs have cytotoxicities and anti-fibrotic effects, but pirfenidone was found to have less cytotoxicity and mitomycin C was found to have more anti-fibrotic effects when compared to each other.