Changes in Intraocular Pressure During Hemodialysis: A Meta-analysis.

PRCIS: Acetate dialysate causes elevation of intradialytic intraocular pressure (IOP) and contributed to the rise of IOP in the early years of hemodialysis (HD). Glaucoma, narrow-angle, or impaired aqueous outflow is another moderator causing a rise of intradialytic IOP. PURPOSE: Severe IOP elevation during HD has been described in many case reports. However, the results of primary studies are conflicting. This meta-analysis examined the impact of HD on IOP and explored the potential moderators. METHODS: Medline, PubMed, Embase, Web of Science, and Cochrane were systematically searched. Before-after studies reporting the change of IOP during HD were included. Intradialytic IOP changes were calculated based on 4 different definitions: highest-baseline, lowest-baseline, max-baseline, and end-baseline IOP difference. Standardized mean difference (SMD) was pooled using the random-effects model. RESULTS: Fifty-three studies involving 1903 participants and 2845 eyes were included. Overall data pooling showed no significant rise in intradialytic IOP. However, subgroup analysis showed an intradialytic IOP rise before 1986 (SMD: 0.593; 95% confidence interval: 0.169-1.018; max-baseline IOP difference as representative; most studies using acetate dialysate), no change between 1986 and 2005 (using both acetate and bicarbonate), and a decline after 2005 (SMD: -0.222; 95% confidence interval: -0.382 to -0.063; entirely using bicarbonate). Multivariable meta-regression showed only the type of dialysate, but not publication year or other potential factors, as a significant moderator. Glaucoma was found to be another significant moderator independent of the dialysate effect in bivariate meta-regression. CONCLUSIONS: IOP elevation in the early years of HD with the use of acetate dialysate is less of a clinical problem following its substitution with bicarbonate dialysate. However, physicians should still be cautious of potential IOP changes in the HD population with glaucoma.

Correlation of Visual Field With Peripapillary Vessel Density Through Optical Coherence Tomography Angiography in Normal-Tension Glaucoma.

Purpose: To investigate the retinal vessel density (VD) in healthy and normal-tension glaucoma (NTG) eyes through optical coherence tomography angiography (OCTA) and to determine the correlation between VD and the retinal nerve fiber layer (RNFL) thickness and functional visual field (VF) defects for different locations. Methods: A total of 74 NTG eyes and 24 healthy eyes were included. OCTA VD at 4.5 × 4.5 mm peripapillary region and 3.0 × 3.0 mm macula area, RNFL thickness, and VF pattern deviation results were individually analyzed on the basis of the Garway-Heath sectorization. Correlations between VD and VF/RNFL and VF were compared. Results: In the NTG group, peripapillary VD, superficial macula VD, RNFL thickness, and ganglion cell complex thickness were significantly lower. In the whole peripapillary area and inferotemporal sector, anatomic correlations between VD and VF pattern deviation values were significantly higher than those between the RNFL thickness and VF values. In the subgroup analysis, VD was anatomically correlated with VF in early-, moderate-, and severe-stage NTG eyes, whereas the RNFL thickness was correlated with VF in moderate- and severe-stage NTG eyes. Conclusions: We observed VD reduction in the peripapillary retina and superficial macula area in NTG eyes. The microvascular dropout of VD in the peripapillary retina, especially in the inferotemporal sector, provided a more accurate anatomic correlation with functional VF defects than that of the RNFL thickness, especially in early-stage NTG eyes. Translational Relevance: In patients who cannot comply VF exam, VD is a good tool for disease detection.

Optic disc hemorrhage in nonglaucomatous eyes: A cross-sectional study with average 8-year follow-up.

PURPOSE: To characterize changes in the retinal nerve fiber layer (RNFL) and peripapillary vessel density (VD) at the site of disc hemorrhage (DH) in nonglaucomatous eyes. MATERIALS AND METHODS: This retrospective cross-sectional study included nonglaucomatous eyes diagnosed with unilateral DH. The change of DH was recorded using disc photography. Both anatomical data and functional visual field (VF) data were collected using optical coherence tomography angiography and Humphrey VF examination. RESULTS: Sixteen patients were included with average follow-up duration of 95 months. Almost half of DH episodes was initially presented at the inferotemporal area of the optic disc. Pigment formation at the previous DH site after resolution was noted in 12.5% of eyes. Sectoral radial peripapillary VD at the DH site was significantly lower in DH eyes than in the control group; however, the sectoral RNFL thickness at the DH site was not significantly decreased. Progression of the VF defect corresponding to the DH site was found in 81.3% of eyes despite regular use of antiglaucoma agents. The mean change in the VF mean deviation was -0.64 dB/year in DH eyes. CONCLUSION: During long follow-up periods, decreased peripapillary VD at the DH site and progression of the VF defect corresponding to the DH site were detected in nonglaucomatous eyes. Retinal pigmentation with an RNFL defect is a clue for DH, although RNFL showed no significant change. Antiglaucoma treatment may not prevent the deterioration of visual function.

Early versus Delayed Phacoemulsification and Intraocular Lens Implantation for Acute Primary Angle-Closure.

PURPOSE: To compare the effects of early phacoemulsification and intraocular lens implantation (phaco/IOL), delayed phaco/IOL after initial laser peripheral iridotomy (LPI), and conventional LPI alone in patients with acute primary angle-closure (PAC). METHODS: Patients with acute PAC were included in the study, and those with secondary glaucoma, prior ocular trauma, or other ocular diseases and those who had undergone ocular surgeries previously were excluded. Patients were categorized into three groups: Group A, which underwent primary phaco/IOL after acute PAC; Group B, which underwent LPI initially after acute PAC, followed by phaco/IOL within 6 months; and Group C, which underwent LPI alone. The IOP control success at 12 months as well as changes in ocular characteristics and the number of antiglaucoma medications used after the treatment among the groups were evaluated. RESULTS: Eighty-one eyes were included in the study: 24 eyes in Group A, 23 eyes in Group B, and 34 eyes in Group C. The linear mixed model analysis demonstrated considerable IOP control in Groups A and B. Visual acuity, anterior chamber depth (ACD), and angle width improved significantly in Groups A and B, but not in Group C. The number of antiglaucoma medications used was significantly higher in Group C than in Groups A and B. CONCLUSIONS: Patients who underwent phaco/IOL had better IOP control, improved vision, deeper ACD, and wider angle and required less antiglaucoma medications than those who underwent LPI alone. Performing phaco/IOL weeks to months after the initial LPI did not appear to adversely affect outcomes compared with those of early phaco/IOL.

Contact dermatitis on the lower eyelid related to tick infestation: A case report in Taiwan.

Tick bite on the lower eyelid is a rare condition. We reported a case of contact dermatitis on the lower eyelid related to the tick infestation. Ticks are vectors for disease transmission. Symptoms and treatments for tick-borne diseases were reviewed.

Neovascular glaucoma after central retinal vein occlusion in pre-existing glaucoma.

BACKGROUND: To determine the outcome of central retinal vein occlusion (CRVO) in pre-existing glaucoma and the predisposing factors of developing neovascular glaucoma (NVG). METHODS: We retrospectively assessed a pre-existing glaucoma CRVO group and a non-glaucoma CRVO group to elucidate the demographics, clinical course and ocular parameters of these two cohorts. Among the pre-existing glaucoma cases, the predisposing factors for the development of NVG were monitored, including the retinal capillary non-perfusion status, intraocular pressure (IOP) and best-corrected visual acuity (BCVA) at presentation. RESULTS: Of 642 CRVO patients reviewed in this 10-year cohort study, 60 (9.3%) had pre-existing glaucoma at a mean follow-up of 30.8 months, including 28 (4.4%) primary open angle glaucoma (POAG), 27 (4.2%) primary angle closure glaucoma (PACG), and 5 (0.8%) normal tension glaucoma (NTG) cases. Although the presence of glaucoma in the CRVO eyes was not significantly associated with the risk of developing NVG, the incidence of developing NVG in pre-existing glaucoma eyes was significantly higher in the group with IOP greater than 20 mmHg at CRVO presentation (P = 0.02, Chi-square test) as well as in the ischemic CRVO group compared to the non-ischemic patients (P = 0.005, Fisher's exact test). Overall, 20% of pre-existing glaucoma patients needed glaucoma surgery after a CRVO event, including 11.7% of patients who developed iris neovascularisation (INV) and 8.3% of patients who developed a high IOP without INV. CONCLUSIONS: Both the retinal non-perfusion status and uncontrolled IOP contribute to NVG in patients with pre-existing glaucoma after CRVO. Following CRVO, glaucoma surgery is necessary for pre-existing glaucoma cases with intractable elevated IOP with or without INV.

Axial length and proliferative diabetic retinopathy.

PURPOSE: To determine the correlation between axial length and diabetic retinopathy (DR) in patients with diabetes mellitus for 10 years or more. METHODS: This study was a prospective, observational, cross-sectional study. Patients with diabetes for 10 years or more were included. We excluded eyes with any other significant ocular disease or any prior intraocular surgery, except uncomplicated cataract surgery. Only one eye of each patient was included as the study eye. The severity of DR was graded as no DR, non-proliferative DR (NPDR), or proliferative DR (PDR). Axial length was measured by A-scan ultrasound (10 MHz Transducer, AL-2000 Biometer/Pachymeter; Tomey, Phoenix, AZ). Univariate logistic regression models were used to evaluate the relationship between the dependent variables (any DR, PDR) and all potential risk factors. Axial length and other factors with p value <0.1 were included in multivariate logistic regression models. Backward selection based on the likelihood ratio statistic was used to select the final models. RESULTS: We included 166 eyes from 166 patients (93 female and 73 male; mean age, 68.8 years). The mean diabetes duration was 15.4 years. Fifty-four (32.5%) eyes had no DR, 72 (43.4%) eyes had NPDR, and 40 (24.1%) eyes had PDR. In univariate analysis, hypertension (p = 0.009), renal impairment (p = 0.079), and insulin use (p = 0.009) were associated with developing any DR. Hypertension (p = 0.042), renal impairment (p = 0.014), insulin use (p = 0.040), pseudophakia (p = 0.019), and axial length (p = 0.076) were associated with developing PDR. In multivariate analysis, hypertension (p = 0.005) and insulin use (p = 0.010) were associated with developing any DR. Hypertension (p = 0.020), renal impairment (p = 0.025), pseudophakia (p = 0.006), and axial length (p = 0.024) were associated with developing PDR. CONCLUSIONS: This observational study suggests an inverse relationship between axial length and the development of PDR in patients with diabetes for 10 years or more. No relationship was found between axial length and the development of any DR.

Cyclosporine a eye drop-induced elongated eyelashes: a case report.

PURPOSE: The most common ocular adverse event following the use of cyclosporine A (CsA) 0.05% ophthalmic emulsion is ocular burning (17%). Other adverse effects that have been reported include conjunctival hyperemia (1-5%), discharge, epiphora, eye pain, foreign body sensation, pruritus, stinging and blurred vision. Here, we report a specific side effect of CsA, namely eye drop-induced eyelash elongation in a patient with refractory giant papillary conjunctivitis. DESIGN: Observational case report. METHODS: Case report and review of the literature. RESULTS: A 32-year-old female with giant papillary conjunctivitis on the left eye, who had undergone papillectomy 3 years previously and was refractory to topical steroid therapy, was treated with CsA 0.05% ophthalmic emulsion (Restasis) 4 times a day, preservative-frees artificial tears and gentamicin ophthalmic solution in the left eye. After 5 months of topical CsA treatment, elongated eyelashes of her left eye were observed without other adverse effects. CONCLUSION: Although hypertrichosis and trichomegaly have been documented in the literature as side effects of systemic CsA, topical CsA 0.05% eye drop-induced elongated eyelashes have not been reported, and we believe ophthalmologists should be mindful and inform patients about this specific side effect.

Secondary ocular hypertension after intravitreal injection with 2 mg or 4 mg of triamcinolone in retinal vein occlusion.

PURPOSE: To evaluate secondary ocular hypertension after intravitreal injection of triamcinolone acetonide (IVTA) with 2 mg/0.05 mL or 4 mg/0.1 mL for macular edema associated with retinal vein occlusion (RVO). METHODS: A retrospective chart review was performed. Patients with RVO, including central RVO and branch RVO, were divided into 2 groups. Group 1 was patients who received 2 mg IVTA and group 2 received 4 mg IVTA. The dose of IVTA was dependent on individual surgeon's decision. Secondary ocular hypertension was defined as intraocular pressure (IOP) >21 mmHg. Long-term antiglaucoma medication referred to eyes that required antiglaucoma agents for >6 months. RESULTS: Thirty-six eyes in group 1 and 32 eyes in group 2 were included in the analyses. The mean age of all the patients was 58.6 years, and 52.9% of patients were men. The mean follow-up period was 12.4 months. A wide range (from day 7 to month 8) of time until the onset of the IOP spike was recorded after the injection. The incidence of secondary ocular hypertension was not significantly different between group 2 and group 1 (38.9% vs. 50%, P = 0.36). However, group 2 had a higher proportion of long-term antiglaucoma medication usage than group 1 (5.6% vs. 40.6%; Pearson chi-square, P < 0.001). Ultimately, 2.9% of patients underwent filtration surgery. Macular edema diminished and best-corrected visual acuity improved at 3 months later in both groups. CONCLUSIONS: With a similar effect on vision recovery and alleviating macular edema associated with RVO, 2 mg IVTA required a shorter duration of medical control for secondary ocular hypertension than 4 mg IVTA.

Associations between chronic glycosylated haemoglobin (HbA1c) level and macular volume in diabetes patients without macular oedema.

PURPOSE: This study aimed to examine the correlation between glycosylated haemoglobin (HbA1c) level and macular volume in diabetes patients without diabetic macular oedema (DMO). METHODS: We carried out an observational, cross-sectional study. Patients who had diabetes mellitus (DM) of ≥ 10 years duration without DMO were included. Only one eye of each patient was selected for analysis. Eyes with proliferative diabetic retinopathy were excluded. Central subfield thickness (CST), central subfield volume (CSV) and total macular volume (TMV) were measured by optical coherence tomography (OCT). Chronic HbA1c level was defined as the mean HbA1c value in the year prior to enrolment. RESULTS: We included 97 eyes from 97 patients (47 women, 50 men; mean age 62.2 years). They included eight type 1 and 89 type 2 DM patients. The mean duration of DM was 15.5 years. Forty-two (43%) eyes had no diabetic retinopathy and 55 (57%) eyes had non-proliferative diabetic retinopathy. In statistical analysis, CST (mean 188.80 ± 27.64 µm; r = 0.220, p = 0.030), CSV (mean 0.149 ± 0.021 mm(3) ; r = 0.213, p = 0.036) and TMV (mean 6.497 ± 0.715 mm(3) ; r = 0.299, p = 0.003) positively correlated with chronic HbA1c level (7.95 ± 1.29%). The linear regression model showed that chronic HbA1c level (standardized coefficient 0.253; p = 0.013) and age (standardized coefficient - 0.206; p = 0.040) were factors significantly related to TMV. CONCLUSIONS: Chronic HbA1c level positively correlates with macular thickness and volume in patients with DM of ≥ 10 years duration without DMO. Our results suggest that subclinical macular volume and thickness changes may occur before DMO becomes clinically evident. Early tight glycaemic control prior to the onset of DMO may play an important role in preventing the deterioration of macular function by altering macular haemodynamics.

Spontaneous orbital subcutaneous emphysema after sneezing.

Orbital subcutaneous emphysema develops when air enters the surrounding soft tissue. This occurs as a result facial bone trauma, iatrogenic dental and otolaryngeal procedures, and gas-producing infectious microorganisms. Case reports regarding this phenomenon after sneezing are very uncommon. Although orbital subcutaneous emphysema is not a true emergency, it can be distressful to patients. This case serves to bring awareness to emergency department physicians regarding the possibility of a nontraumatic orbital subcutaneous emphysema and its related complications.

Association between severity of vitreous haemorrhage and visual outcome in primary rhegmatogenous retinal detachment.

PURPOSE: To elucidate the relationship between the severity of vitreous haemorrhage (VH) and visual outcome in primary rhegmatogenous retinal detachment (RRD) without previous vitreoretinal surgery. METHODS: We carried out a retrospective review of patients presenting with RRD and VH between January 1993 and December 2002. Diabetic retinopathy, retinal vessel occlusion and open-globe injury patients were excluded. Study patients were separated into group 1 (eyes with mild to moderate VH) and group 2 (eyes with severe VH). RESULTS: Our sample included 71 eyes of 71 patients (mean age 48.0 years, range 7-78 years) (median follow-up period 19 months, range 12-140 months), of which 21 had mild, 17 had moderate and 33 had severe VH. The mean visual acuity (VA) in logMAR (logarithm of minimum angle of resolution) of the 38 eyes in group 1 improved from 1.90 (Snellen equivalent [SE] 20/1589) to 0.68 (SE 20/96). In the 33 eyes in group 2, mean logMAR VA improved from 2.42 (SE 20/5261) to 1.63 (SE 20/853). Group 2 patients were significantly older (p = 0.002), had longer duration of preoperative haemorrhage (p = 0.004), lower presenting VA (p < 0.001), worse final VA (p < 0.001), and a higher incidence of severe (grade C) proliferative vitreoretinopathy (PVR) (p = 0.002). More eyes in group 2 required silicone oil tamponade, although this was not statistically significant (p = 0.133). The overall recurrence rate of retinal detachment after primary surgery was around 21% in both groups. CONCLUSIONS: Rhegmatogenous retinal detachment with severe VH is associated with longer duration of preoperative haemorrhage, a higher incidence of severe PVR and worse visual outcome. Close follow-up and aggressive surgical interventions are suggested in these patients.

Alport syndrome with recurrent herpes simplex virus keratitis.

PURPOSE: To report a case of Alport syndrome with recurrent herpes simplex virus (HSV) keratitis. METHODS: Case report and review of the literature. RESULTS: A 29-year-old man with Alport syndrome suffered from 4 consecutive episodes of HSV keratitis within 2 years. A type IV collagen defect in basement membranes plays an important role in the pathogenesis of Alport syndrome. The relationship between HSV keratitis and Alport syndrome is discussed. After remission from HSV keratitis, the patient underwent bilateral phacoemulsification and posterior-chamber intraocular lens implantation for anterior lenticonus and an anterior polar cataract. After surgery, the uncorrected visual acuity was 20/20 in both eyes. CONCLUSIONS: We assume that the underlying basement membrane defects in Alport syndrome may account for the recurrent episodes of HSV keratitis in this patient. In addition, phacoemulsification and posterior-chamber intraocular lens implantation, rather than correction of refractive errors, provide a safe and efficient therapeutic choice for the management of anterior lenticonus, with or without associated cataract in patients with Alport syndrome.

Safety and efficacy of topical anesthesia combined with a lower concentration of intracameral lidocaine in phacoemulsification: paired human eye study.

PURPOSE: To assess the safety and efficacy of phacoemulsification under a topical anesthesia combined with intracameral lidocaine 0.5%. SETTING: Department of Ophthalmology, Chang Gung Memorial Hospital, Taoyuan, Taiwan, China. METHODS: A prospective randomized double-blind study was designed in which patients had phacoemulsification performed under topical anesthesia (4 drops of nonpreserved lidocaine 2%) with 0.15 mL intracameral placebo (balanced salt solution) in 1 eye (Group 1) and topical anesthesia with intracameral nonpreserved lidocaine 0.5% in the other eye (Group 2). Endothelial changes, including cell density, coefficient variation of cell size, and percentage of hexagonal cells, were measured by noncontact specular microscopy. Preoperative and postoperative best corrected visual acuity was also documented. The degree of pain throughout surgery was ranked on a 10-point visual analog pain scale. RESULTS: Thirty-three patients were recruited. There was no significant difference in preoperative and postoperative mean endothelial parameters between the 2 groups. Furthermore, mean endothelial cell loss was similar. Mild or no pain (score 0 to 1) was reported by 48.5% in Group 1 and 90.9% in Group 2. Patients reported less pain with combined topical and intracameral lidocaine anesthesia (P = .001, Mann-Whitney test). Vision was significantly improved in both groups. However, 1 patient in Group A developed vitreous loss as a result of involuntary eye movement. CONCLUSION: Combining topical anesthesia with intracameral lidocaine 0.5% [corrected] anesthesia was safe and effective in phacoemulsification with intraocular lens implantation.

Interleukin-1 receptor antagonist (IL-1RA) prevents apoptosis in ex vivo expansion of human limbal epithelial cells cultivated on human amniotic membrane.

Stem cells of the corneal epithelium have been found to be located exclusively at the anatomical junction between the cornea and the conjunctiva, the limbus. Ex vivo expanded limbal epithelial cells on amniotic membrane (AM) are capable of restoring the corneal surface with limbal stem cell deficiency. Recent studies indicate that intact AM preserves the limbal epithelial phenotype and that distinct epithelial morphology is noted among various culture matrix. However, the factors in response to the interaction between limbal epithelial cells and AM were not well understood. Using Annexin V-fluorescein isothiocyanate staining, we found that human limbal epithelial cells expanded on intact human AM demonstrated fewer apoptotic cells as compared with those on plastic dishes. To identify the anti-apoptotic factors, we performed cDNA microarray analysis and showed that interleukin-1 receptor antagonist (IL-1RA) was overexpressed in cultures on intact AM, which was confirmed by reverse transcription-polymerase chain reaction (RT-PCR), real-time quantitative PCR (Q-PCR) and enzyme-linked immunosorbent assay. In addition, we also noted that the phenomenon of apoptosis detected in cultures on plastic dishes could be reversed by adding recombinant IL-1RA protein into the media, whereas apoptosis of limbal epithelial cells cultivated on intact AM could be induced by exogenous neutralizing IL-1RA neutralizing antibody. These results demonstrated that intact human AM may prevent cultured human limbal epithelial cells from undergoing apoptosis. IL-1RA might be a candidate mediator to exert as an anti-apoptotic molecule during the interaction between human limbal epithelial cells and intact human AM.

Choroidal detachment after filtering surgery.

BACKGROUND: The purpose of this study is to report the treatment and outcome of eight cases of choroidal detachment, which occurred several days to many years after trabeculectomy. METHODS: This is a retrospective study of eight cases of choroidal detachment after trabeculectomy with or without cataract extraction reviewed at CGMH, Keelung, from 2002 to 2004. One eye with idiopathic scleromalacia with chronic uveitis and secondary glaucoma, five eyes with primary open angle glaucoma and two eyes with chronic angle closure glaucoma after trabeculectomy were reported. Six of the eight cases developed acute onset choroidal detachment within two weeks after surgery. The other two cases suffered from choroidal detachment many years after trabeculectomy for different reasons. Regarding the types of operation, combined glaucoma and cataract surgery was performed in five cases and intraoperative application of adjunctive mitomycin C was used in two cases. Decrease in vision acuity and varying degrees of eye pain with a flat or shallow chamber were noted in all cases. Associated hypotony was found in six of the eight cases. The treatment included topical cycloplegic corticosteroid and oral corticosteroid. RESULTS: Choroidal detachments were improved or complete resolution obtained after medical treatment for about three weeks to one month in all cases. But persistent poor control of intraocular pressure was found in two cases. Ultrasonography was used as a reliable tool to confirm the diagnosis and resolution of choroidal etachment in cases of blurred fundus examination and synechiae miotic pupil. CONCLUSIONS: Choroidal detachment is one of the complications after trabeculectomy. The diagnosis of choroidal detachment can be confirmed most reliably by ultrasonography. Medical therapy is effective for resolution.

Role of matrix metalloproteinase-9 in ex vivo expansion of human limbal epithelial cells cultured on human amniotic membrane.

PURPOSE: To investigate the expression and pivotal role of matrix metalloproteinase (MMP)-9 in the ex vivo expansion of human limbal explants with or without amniotic membrane (AM). METHODS: Corneoscleral buttons were cultured on intact, denuded AM or plastic dishes for 3 weeks. To determine the role of MMP-9 in cell migration, either the MMP inhibitor GM6001 or an MMP-9 antibody was used. Expression of MMP-9 was determined by gelatin zymography, reverse transcription-polymerase chain reaction, and immunohistochemical staining. RESULTS: The expression of MMP-9 in all culture conditions increased in a time-dependent manner. However, the active form of MMP-9 emerged only in cultures on both intact and denuded AM from the second week. The averaged corrected ratio of MMP-9 expression in cultures on intact AM versus those on denuded AM or plastic dishes was 2.76 +/- 0.69- or 4.25 +/- 0.30-fold, respectively, when total RNA was used as an internal control. MMP-9 transcripts were upregulated in cultures on intact AM compared with the other two culture conditions. Immunohistochemical staining demonstrated that the MMP-9 protein was located on the limbal epithelial cells. Upregulation of MMP-9 associated with cell migration was significantly attenuated by both GM6001 and MMP-9 antibody, consistent with the inhibition of MMP-9 activity, as determined by gelatin zymography. In contrast, the sizes of limbal outgrowth were not different between the control and MMP-9 antibody-treated plastic dishes. CONCLUSIONS: These results demonstrated that MMP-9 not only was upregulated, it was also involved in the outgrowth of limbal epithelial cells. These results suggest that cell-cell matrix interaction is involved in the expansion of limbal epithelial cells on intact AM, and MMP-9 may be a key element.

Efficacy and safety of phacoemulsification with intraocular lens implantation under topical anesthesia.

BACKGROUND: To eliminate complications of peribulbar and retrobulbar anesthesia and to achieve efficacy and safety for topical anesthesia with cataract surgery. METHODS: We performed clear corneal phacoemulsification with foldable intraocular lens (IOL) implantation under topical anesthesia using preservative-free 2% lidocaine drops, without intracameral anesthetic supplementation. The exclusion criteria were anxiety, small pupil, baseline endothelial count 1500 cells/mm2, uncontrolled glaucoma, other ocular entities affecting corneal endothelium, and allergy to the relevant medications. We used a specular microscope to evaluate the effect on the endothelium and employed a 10-point visual analog pain scale to assess the discomfort experienced during the operation. RESULTS: Totally, 29 eyes of 29 patients were enrolled in this series. The mean age was 71.5 +/- 8.5 years. Twenty-three of 29 (79.3%) cases achieved a best-corrected visual acuity (BCVA) equal to 20/40 or better at an interval of 3 months postoperatively. Most patients (86.5%) felt mild or no pain during surgery. Pre- and postoperative endothelial counts were 2072.6 +/- 104 and 1927.4 +/- 196 cell/mm2, respectively. One in 29 cases developed vitreous loss due to involuntary eye movements intraoperatively. CONCLUSIONS: Topical anesthesia with preservative-free 2% lidocaine drops is an effective and safe modality for clear corneal phacoemulsification with IOL implantation. On the other hand, for patients with small pupil or those who are anxious, the procedure may be time-consuming, and it is challenging for physicians to perform cataract surgery merely using topical anesthesia.

Progression of diabetic retinopathy after phacoemulsification in diabetic patients: a three-year analysis.

BACKGROUND: This retrospective study was conducted to analyze the progression rates of diabetic retinopathy (DR) after phacoemulsification in diabetic patients and to determine whether phacoemulsification causes the progression of DR. METHODS: The medical charts of diabetic patients who had undergone cataract surgery using phacoemulsification techniques during a 3-year period and had completed 3 years of follow-up were retrospectively reviewed. Data were collected to evaluate the visual outcomes and progression of DR postoperatively. The retinopathy progression rates of operated and nonoperated eyes were compared. RESULTS: Thirty-seven diabetic patients were enrolled. Binocular cataract surgeries were performed in 14 patients. Monocular cataract surgeries were performed in the remaining 23 patients whose nonoperated fellow eyes served as the control group. The postoperative retinopathy progression rates of eyes with preoperative mild to moderate nonproliferative diabetic retinopathy (NPDR) were significantly greater than eyes without preoperative retinopathy whether at postoperative 1 year or postoperative 3 years. No statistical significance was found for the rate of retinopathy progression between operated and nonoperated eyes at 1 year and 3 years postoperatively. Of 51 operated eyes, 33 (64.7%) achieved an uncorrected visual acuity of 20/40 at 1 year postoperatively, and 47 (92.1%) had improvement of visual acuity of more than two lines. CONCLUSION: Uncomplicated phocoemulsificaton had no significant influence on the postoperative progression of DR. Patients with preoperative NPDR had greater chances to show postoperative retinopathy progression. The majority of diabetic patients who had no DR or had mild to moderate NPDR achieved visual improvement after phacoemulsification.

Surgical management of scleral perforation after pterygium excision.

OBJECTIVE: Scleral perforation is a rare complication occurring after pterygium excision often leading to scleral ulceration and loss of vision. Our purpose is to evaluate the long-term effectiveness and safety of tenonplasty and amniotic membrane transplantation in the management of scleral perforation after pterygium excision. PATIENTS AND METHODS: We performed a retrospective study on patients with scleral perforation after pterygium excision that underwent tenonplasty and amniotic membrane transplantation at Chang Gung Memorial Hospital from 1997 to 1999 and followed up for at least 12 months postoperatively. RESULTS: There were 6 patients, 1 male and 5 females ranging in ages from 46 to 71 years (mean, 63.3). The interval between pterygium excisions to scleral perforation ranged from 3 to 20 years. There were no recurrences during the follow-up period of 12 to 24 months (average, 18.3 months). CONCLUSIONS: Tenonplasty and amniotic membrane transplantation appears to be a relatively simple, safe, and effective method for treating scleral perforation after pterygium excision.