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Nan-Kai Wang,
Chi-Chun Lai,
Chai Lin Chou,
Yen-Po Chen,
Lan-Hsin Chuang,
An-Ning Chao,
Hsiao-Jung Tseng,
Chee-Jen Chang,
Wei-Chi Wu, Kuan-Jen Chen,
Stephen H Tsang
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ABSTRACT: Validation of choroidal thickness and other biometrics measured by spectral domain optical coherence tomography (SD-OCT) in predicting lacquer cracks formation in highly myopic eyes.
Patients with a refractive error worse than -8 diopters and moderate myopic maculopathy were recruited into two groups based on the presence or absence of lacquer cracks (36 eyes without and 33 eyes with lacquer cracks). Choroidal thickness, refractive error, and axial length were measured and subjected to receiver operating characteristic curve analysis to identify the optimal cutoff values at predicting lacquer crack formation. The width of the retinal pigment epithelium (RPE), RPE to the inner segment/outer segment line, RPE to the external limiting membrane were also measured and compared to the subfoveal choroidal thickness to assess their relationships as potential markers of lacquer crack formation.
Lacquer crack is associated with decreased choroidal thickness, lower best-corrected visual acuity, longer axial length and higher refractive errors. Choroidal thickness has the strongest association with lacquer crack formation versus axial length and refractive error. In eyes with lacquer cracks, stellate lacquer cracks are associated with thinner choroidal thickness compared to eyes with linear lacquer cracks. Subfoveal choroidal thickness less than the width of the retinal pigment epithelium to the inner segment/outer segment line is also associated with lacquer crack formation (sensitivity 78.8%, specificity 88.3%, and accuracy 81.2%).
This study suggests that choroidal thickness and other SD-OCT measurements could be employed clinically to predict the development and severity of lacquer cracks in patients with high myopia.
PLoS ONE 01/2013; 8(1):e53660. · 4.09 Impact Factor
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ABSTRACT: PURPOSE:: The purpose of this study was to evaluate the best-corrected visual acuity and occurrence of neovascular glaucoma with vitrectomy (VT) and panretinal photocoagulation or without VT in central retinal vein occlusion (CRVO) associated with vitreous hemorrhage (VH). METHODS:: The charts from patients diagnosed as having CRVO with VH at Chang Gung Memorial Hospital (Taiwan) were reviewed. They were grouped based on whether they also underwent VT. The main outcome measurements were the best-corrected visual acuity and incidence of neovascular glaucoma. RESULTS:: There were 83 eyes that had CRVO with VH from 83 patients (VT group, 56 eyes; non-VT group, 27 eyes). There was no significant difference between the VT and non-VT groups in terms of age, gender, diabetes, hypertension, lens status, and follow-up period. The non-VT group had a better best-corrected visual acuity (P = 0.018) and less VH (P = 0.025) than the VT group at baseline; however, the VT group had a better best-corrected visual acuity at the end of the follow-up than the non-VT group (P < 0.001). Most importantly, there was a higher neovascular glaucoma development (37%) in the non-VT group compared with that (14.3%) in the VT group (P = 0.025). CONCLUSION:: The visual outcomes of CRVO with VH are unfavorable whether VT was performed. However, VT and panretinal photocoagulation improved visual acuity and reduced the incidence of neovascular glaucoma in CRVO with VH.
Retina (Philadelphia, Pa.) 10/2012; · 2.93 Impact Factor
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Archives of ophthalmology 09/2012; 130(9):1126. · 3.86 Impact Factor
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American journal of ophthalmology 07/2012; 154(1):213-4; author reply 214. · 3.83 Impact Factor
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Nan-Kai Wang,
Lan-Hsin Chuang,
Chi-Chun Lai,
Chai Lin Chou,
Hsueh-Yen Chu,
Ling Yeung,
Yen-Po Chen, Kuan-Jen Chen,
Wei-Chi Wu,
Tun-Lu Chen,
An-Ning Chao,
Yih-Shiou Hwang
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ABSTRACT: The aim of this study was to describe multimodal retinal imaging of fundus albipunctatus (FA) with the newly identified compound heterozygous RDH5 mutation and to review the relevant literature. Five family members were examined, and the RDH5 gene was analyzed by direct sequencing. The clinical features and genetic study of FA are reviewed. The proband had a compound heterozygotic missense mutation of Cys59Ser (TGC → AGC) and a nonsense mutation of Trp95ter (TGG → TGA) in the RDH5 gene. Fundus examination revealed diffuse yellow flecks with foveal sparing. Infrared reflectance (IR) imaging showed multiple discrete round lesions, and fundus autofluorescence (FAF) imaging showed decreased autofluorescence. In spectral domain optical coherence tomography (SD-OCT), the lesions spanned across the retinal pigment epithelium complex and the photoreceptor inner segment ellipsoid band. The outer nuclear layer thickness is decreased compared to normal control. Electroretinography (ERG) showed improved dark-adapted responses after a prolonged 2.5-h dark adaptation. The fundi of the patient's son and daughter both appeared unremarkable. The clinical findings, differential diagnosis, and genetic studies of these features are reviewed. This is the first time that IR imaging of this disease has been reported; IR imaging showed more detail than did FAF imaging. Although retinal imaging (fundus photographs, FAF, IR, SD-OCT) of FA showed characteristic findings, ERG and genetic study remain the most reliable tests for making the diagnosis.
Documenta Ophthalmologica 06/2012; 125(1):51-62. · 2.11 Impact Factor
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Wei-Chi Wu,
Rey-In Lin,
Chia-Pang Shih,
Nan-Kai Wang,
Yen-Po Chen,
An-Ning Chao, Kuan-Jen Chen,
Tun-Lu Chen,
Yih-Shiou Hwang,
Chi-Chun Lai,
Chung-Ying Huang,
Shawn Tsai
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ABSTRACT: To examine the optical components and spectral-domain optical coherence tomography (OCT) findings in children with a history of retinopathy of prematurity (ROP) and to identify any associations between the OCT findings and the visual acuities of the patients.
Prospective, case-controlled study.
Children who were between 6 and 14 years of age were divided into the following 4 groups: Patients with a history of threshold ROP who had been treated using laser therapy or cryotherapy (group 1), patients with regressed ROP who had not received any treatment (group 2), patients who were born prematurely but who had no history of ROP (group 3), and normal full-term children (group 4). The posterior poles of the eyes of all of the patients seemed to be normal.
Visual acuities, optical components, and macular thicknesses were measured in 4 groups of patients, and comparisons between the groups were made. Macular thicknesses were measured using OCT.
Visual acuity (VA), optical components, and OCT findings.
We enrolled 133 patients in the study. Patients in group 1 had significantly thicker foveas than the other patients, as demonstrated by OCT, and this finding was negatively correlated with gestational age. The incidence of abnormal foveal contours among patients in group 1 was significantly higher than among the rest of the patients. Retention of the inner retinal layers was noted in group 1 patients; however, the structure of the outer retina remained intact. Greater degrees of myopic shift and astigmatism, steeper corneal curvatures, shallower anterior chamber depths, and thicker lenses were noted in previously treated ROP patients. These findings corresponded with poor VA and high refractive errors in group 1 patients.
Patients with a history of threshold ROP are more likely to show abnormal foveal development and have a poorer visual prognosis than other patient groups despite a fundus with no macular dragging, disc dragging, or retinal detachment. A steeper corneal curvature, shallower anterior chamber, and greater lens thickness are the main changes in the optical components in these patients.
Ophthalmology 05/2012; 119(9):1907-16. · 5.45 Impact Factor
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American journal of ophthalmology 04/2012; 153(4):778-9; author reply 779-80. · 3.83 Impact Factor
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Annals of emergency medicine 02/2012; 59(2):e3-4. · 4.23 Impact Factor
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Annals of emergency medicine 01/2012; 59(1):18, 26. · 4.23 Impact Factor
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ABSTRACT: To compare the macular choroidal thickness in 2 types of early dry-type myopic maculopathy.
Prospective, observational, comparative study.
Patients with a refractive error of less than -8 diopters were included and were classified into 2 groups. Group 1 consisted of 24 eyes with a tessellated fundus, and group 2 consisted of 33 eyes with diffuse chorioretinal atrophy, but not to the extent of patchy chorioretinal atrophy. These 2 groups were compared with regard to their clinical characteristics, refractive error, axial length, macular choroidal thickness, and best-corrected visual acuity (BCVA). Linear regression was used to evaluate the explanatory variables in terms of macular choroidal thickness and BCVA.
Patients in group 1 were significantly younger and had better BCVA, less myopia, shorter axial length, and less staphyloma than those in group 2. Refractive error, axial length, and BCVA correlated significantly with macular choroidal thickness in group 2. However, no such significant correlations were observed in group 1. Multiple linear regression analysis showed that age and macular choroidal thickness were the variables that associated most strongly with BCVA, whereas neither refractive error nor axial length was a significant predictor of BCVA. In group 2, eyes with lacquer cracks showed worse BCVA and thinner macular choroidal thickness than eyes without lacquer cracks.
Macular choroidal thickness is an important factor in myopic maculopathy and can be a better indicator of its severity. These findings suggest that BCVA reduction in eyes with dry-type myopic maculopathy can be related to a thinner macular choroidal thickness and to the development of lacquer cracks.
American journal of ophthalmology 11/2011; 153(4):669-77, 677.e1-2. · 3.83 Impact Factor
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ABSTRACT: To investigate the effects of pyrrolidine dithiocarbamate (PDTC), a nuclear factor κ-light-chain-enhancer of activated B cells (NF-κB) inhibitor, on the expression of matrix metalloproteinases (MMP) and MMP-mediated apoptosis in retinal ganglion cells (RGCs) following the transection of the optic nerve (ON) in rats.
The ON of adult male Sprague-Dawley rats was transected. The expression of MMP-2, MMP-9, and NF-κB was measured by Western blot analysis and immunohistochemical analysis following transection. In situ zymography was also performed to localize gelatinolytic activity in the retinas. PDTC was injected intravitreally immediately following transection of the ON to evaluate the effect on the expression of NF-κB and MMP as well as its anti-apoptotic effect and neuroprotective effect on RGCs.
Significant up-regulation of MMP-9, and NF-κB was observed 7 days post-transection; however, this was not observed for MMP-2. PDTC at concentrations of 0.5 mM suppressed the up-regulation of MMP-9 and NF-κB, inhibiting gelatinolytic activity in the RGC layer. Meanwhile, far fewer apoptotic RGCs were detected and more surviving RGCs were preserved in PDTC-treated retinas 7 days post-transection compared to retinas in the control group. However, this kind of neuroprotective effect was not significant at 14 days post-transection.
This study demonstrated that PDTC, mediated in part through the down-regulation of MMP-9, could contribute to delaying the death of RGCs following transection of the ON.
Current eye research 11/2011; 36(11):1053-63. · 1.51 Impact Factor
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ABSTRACT: To evaluate the outcome of a novel, modified 23-gauge vitrectomy system in the treatment of stage 4 retinal detachment in retinopathy of prematurity.
Consecutive patients with stage 4 retinopathy of prematurity treated with modified 23-gauge vitrectomy were included in this medical record review. Major novel modifications included the use of a small infusion cannula, a 20-gauge blade for the creation of sclerotomies in the pars plicata, and a 23-gauge endoilluminator and vitreous cutter. Conjunctival dissection and suturing of sclerotomies were performed using this modified 3-port, 23-gauge vitrectomy technique. Anatomic success and surgical complications were analyzed.
Twenty-six eyes of 17 patients were included and analyzed. The mean (SD) gestational age was 28.0 (2.5) weeks, and the mean birth weight was 1199 (449) g. Mean postmenstrual age at the time of vitrectomy was 40.5 (3.0) weeks. Overall, 20 eyes (77%) achieved retinal attachment in a single operation, and 23 eyes (88%) achieved retinal attachment after multiple procedures. Postoperative complications included disc dragging (5 eyes [19%]), cataracts (4 [15%]), glaucoma (2 [8%]), persistent vitreous hemorrhage (1 [4%]), and posterior synechia (1 [4%]).
This 23-gauge vitrectomy system seems to be a safe and effective approach for treatment of stage 4 retinopathy of prematurity. This modified system combines the benefits of 20- and 23-gauge vitrectomy and offers safer insertion of infusion cannulas in smaller eyes, more working space in pediatric eyes, a cutting port that is closer to the retina, and a faster cutting speed with less vitreous traction during the operation.
Archives of ophthalmology 10/2011; 129(10):1326-31. · 3.86 Impact Factor
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ABSTRACT: 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.
Observational case report.
Case report and review of the literature.
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.
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.
Case reports in ophthalmology. 09/2011; 2(3):398-400.
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ABSTRACT: To evaluate the efficacy and safety of using diluted autologous blood clumps to assist in vitrectomy and internal limiting membrane (ILM) peeling for macular hole (MH) repair.
Twenty-six patients with MHs who underwent ILM peeling were enrolled. The blood clump solution was prepared by mixing autologous whole blood with 5% glucose water. This solution was introduced to identify the posterior vitreous and was then used to coat the surface of the ILM in the macular area. The blood clump-coated ILM was removed with forceps in a circular fashion. The MH closure rate, the pre- and postoperative best-corrected visual acuity change, and retinal changes were evaluated.
The blood clump-assisted procedure effectively labeled the posterior vitreous and coated the ILM, enhancing the visibility of ILM and, thus, facilitating MH repair. The MHs were closed by a single surgery in 24 eyes (92%), and the other 2 holes were closed after a second gas-fluid exchange. The pre- and postoperative mean best-corrected visual acuities were 0.96 ± 0.3 and 0.38 ± 0.3 (logarithm of the minimum angle of resolution visual acuity ± SD, P < 0.001), respectively. No toxic fundus changes were observed during the follow-up period.
This novel blood clump-assisted procedure effectively labeled the posterior vitreous and coated the ILM, enhancing the visibility of ILM and thereby facilitating MH repair.
Retina (Philadelphia, Pa.) 06/2011; 31(10):2014-20. · 2.93 Impact Factor
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American journal of ophthalmology 06/2011; 151(6):1105-6; author reply 1106-7. · 3.83 Impact Factor
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ABSTRACT: To evaluate enteric-coated mycophenolate sodium (EC-MPS) as a corticosteroid-sparing agent in the treatment of autoimmune scleritis.
A retrospective, interventional, noncomparative review of EC-MPS use in patients with autoimmune scleritis.
Seven eyes of 5 patients (all female; median age: 47 years, range: 20-55 years) with inflammatory scleral disease were treated with EC-MPS. The mean follow-up duration was 16.4 months (range, 12-20 months). EC-MPS was started at 360 mg twice daily. The mean time to treatment success was 1.6 months (range, 1-3 months). The mean prednisolone dosage at the onset of EC-MPS was 24 mg daily (range, 15-30 mg), and this was reduced to 6.5 mg daily (range, 0-10 mg) as inflammation control was achieved. No severe adverse events except for 1 patient with transient knee pain were reported; the incidence of adverse events after using EC-MPS was 1/6.83 person-years. There was no recurrence of scleral inflammation during the follow-up period.
EC-MPS can be used as a corticosteroid-sparing agent to safely suppress inflammatory autoimmune scleritis.
Cornea 03/2011; 30(3):260-4. · 1.73 Impact Factor
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ABSTRACT: To compare the long-term anatomical and visual outcomes of patients with idiopathic epiretinal membrane (ERM) removed by vitrectomy and membrane peeling with or without the use of intravitreal injection of triamcinolone acetonide (IVTA).
A retrospective chart review was performed. Subjects who underwent vitrectomy and who were followed over 12 months were included. The study included two groups of patients. In group 1 (71 eyes), the patients underwent vitrectomy and membrane peeling without the use of IVTA. In group 2 (27 eyes), 2 mg of IVTA was given at the end of the surgery. The main outcome measures were best-corrected visual acuity (BCVA), central foveal thickness (CFT) determined by optical coherence tomography (OCT), the number of cataract surgeries, and the use of anti-glaucomatous drugs during the follow-up period.
This study included 98 eyes with ERM from 98 patients. There was no significant difference between the two groups with respect to age, gender, pre- and postoperative lens status, BCVA, CFT, or length of the follow-up period. The mean age for all of the patients was 62.45 ± 10.01 (mean ± SD) years, and the mean follow-up length was 20.58 ± 9.64 (mean ± SD) months. In all cases, the mean best-corrected logarithm of minimum angle of resolution (logMAR) acuity improved from a preoperative value of 0.91 ± 0.32 [Snellen equivalent (SE), 0.16 ± 0.14] to a postoperative value of 0.46 ± 0.36 (SE, 0.46 ± 0.29) (P < 0.0001). The CFT was reduced from a preoperative value of 473.46 ± 96.91 μm to a postoperative value of 302.44 ± 69.80 μm (P < 0.0001). Six patients (22.2%) in group 2 required anti-glaucomatous drugs to control intraocular pressure (IOP) during the follow-up period, and three patients (4.2%) in group 1 required drugs to control IOP (P = 0.012).
The postoperative visual outcomes for patients with idiopathic ERM were favorable, but CFT did not return to a normal level, even in eyes in which 2 mg IVTA was used. The IVTA use after ERM removal produced no significant benefits during long-term follow-up, but IVTA did increase the risk of increased IOP.
Cutaneous and Ocular Toxicology 03/2011; 30(4):292-7. · 0.91 Impact Factor
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American journal of ophthalmology 01/2011; 151(1):185-6; author reply 186. · 3.83 Impact Factor
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ABSTRACT: Anterior segment cytomegalovirus (CMV) infection, which can be presented as anterior uveitis and corneal endotheliitis, has recently been reported in immunocompetent patients. We would like to access the validity of two presumed characteristic clinical profiles: profile 1, non-herpes simplex virus (HSV)/varicella zoster virus (VZV) corticosteroid-recalcitrant inflammatory ocular hypertensive syndrome (IOHS), and profile 2, corneal endotheliitis with specific coin-shaped keratic precipitates (KPs), that could be helpful in identifying CMV anterior segment intraocular infection.
Patients with either profile 1 or profile 2 or both were enrolled consecutively from the uveitis service in Chang Gung Memorial Hospital, Taoyuan, between January 1, 2006 and May 31, 2010. Diagnostic anterior chamber tapping was performed and followed by real-time quantitative polymerase chain reaction (PCR) to detect herpesviridae DNA including HSV I and II, VZV, CMV, and Epstein-Barr virus.
Thirty-one eyes of 30 patients (21 males and nine females) were enrolled in this study. CMV DNA PCR was positive in 29 eyes of 28 patients (20 males and eight females). Nineteen of 20 eyes (19 patients) in profile 1 had positive CMV PCR. Ten of 11 eyes (11 patients) in profile 2 had positive CMV PCR. The positive predictive value of profile 1 and profile 2 was 94.7% and 90.9%, respectively. The positive predictive value of combining the two profiles was 93.3%.
Non-HSV/ZVZ corticosteroid-recalcitrant IOHS and corneal endotheliitis with specific coin-shaped KPs could be used as the screening tool for CMV anterior segment intraocular infection.
Albrecht von Graæes Archiv für Ophthalmologie 01/2011; 249(1):103-10. · 2.17 Impact Factor
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ABSTRACT: To compare the serum concentration of bevacizumab after intravitreal injection of bevacizumab (IVB) in an experimental model of branch retinal vein occlusion (BRVO) with control injections in albino rats.
BRVO was created in one eye of each of the 24 albino rats. Another 24 rats served as controls. The BRVO was generated by argon laser photothrombosis after intravenous injection with Rose Bengal. Three days later, IVB (5 μl) was administered to both BRVO and control eyes. The serum concentration of bevacizumab was examined at baseline, 6 h, 1 day, 3 days, 7 days, 14 days, and 28 days after IVB.
At baseline, no serum bevacizumab was detected in either group. The serum concentration of bevacizumab reached a peak concentration at 1 day with 5,020 ± 1,602 ng/ml in the BRVO group and 4,103 ± 1,790 ng/ml in the control group (p < 0.001). The concentration decreased subsequently on days 3, 7, 14 and 28. The serum concentration of bevacizumab was significantly higher in BRVO rats up to 28 days after IVB.
The serum concentration of bevacizumab after IVB reached its peak on day 1 in both BRVO and control eyes. This value was significantly higher in BRVO rats than in control rats up to 28 days after intravitreal injection.
Ophthalmic Research 01/2011; 45(1):31-5. · 1.56 Impact Factor
