[Show abstract][Hide abstract] ABSTRACT: Fungal keratitis is one of the major causes of infectious keratitis in tropical countries. Symptoms of fungal keratitis consist of blurred vision, redness, tearing, photophobia, pain and foreign body sensation. If not treated effectively, it could lead to blindness. Common causes include Candida spp., Fusarium spp. and Aspergillus spp.. With the limited choices of topical antifungal agents, we were faced with Cladosporium keratitis, a rare cause of fungal keratitis.
A 62-year-old Asian male construction worker came to us with intense ocular pain, injection of the conjunctiva, blurred vision, and foreign body sensation in his left eye. His visual acuity was 20/40 OD and 20/400 OS. Slit-lamp exam revealed a corneal ulcer with feathery margin and Descemet's membrane folding. The culture yielded Cladosporium species.. The patient did not show improvements after applying topical natamycin (5 %), topical amphotericin B (1mg/ml), topical fluconazole (2mg/ml) and oral ketoconazole (200mg). After shifting the medical regimen to voriconazole via topical and systemic routes (1mg/ml and 200mg respectively), the keratitis was controlled.
Fungal keratitis remains a challenge for ophthalmologists as there is no evidence suggesting any particular drug or combination of drugs is more effective than another. A review of common topical antifungal agents was done. Voriconazole could be a good choice for treating corneal infection by Cladosporium species.
Full-text · Article · Dec 2015 · BMC Ophthalmology
[Show abstract][Hide abstract] ABSTRACT: Purpose: To compare axial length (AL) and subfoveal choroidal thickness (SFCT) between individuals with age-related macular degeneration (AMD) and controls with no lesions. Methods: This was a case-control study. In total, 853 eyes of 484 patients (>65 years), including 397 eyes at various AMD stages and 456 eyes with no fundus lesions (controls) were recruited. Using color fundus photography, eyes were grouped according to AMD degree. AL was automatically measured using IOL Master and SFCT was manually measured by two independent observers. The associations among age, AL, SFCT, and each AMD grade were analyzed. Results: Out of 853 eyes, 456 had no lesions, 217 contained drusen only, 134 had early AMD, and 46 had late AMD. The eyes with late AMD were older (p = 0.007) and had longer AL (p < 0.001) and thinner SFCT (p < 0.001) compared with groups of no fundus lesions, drusen only, and early AMD. SFCT in eyes with late AMD decreased by 19.20 μm (p = 0.049), 24.78 μm (p = 0.029), and 15.56 μm (p = 0.162) compared with groups of no fundus lesions, drusen only, and early AMD, respectively. SFCT decreased by 14.18 μm/mm increase in AL (p < 0.001). The odds ratio (OR) for late AMD by longer AL (≥25 mm) and thinner SFCT (<240 μm) was 4.54 (χ2 = 9.36; p = 0.002) and 4.86 (χ2 = 17.62; p < 0.001), respectively, and was 9.57 (χ2 = 18.07; p < 0.001) when both AL ≥ 25 mm and SFCT < 240 μm. Conclusion: Eyes with late AMD have distinct reduced SFCT and elongated AL. Eyes with thinner SFCT and longer AL showed high ORs for late AMD and even higher ORs when both factors were simultaneously present. These findings illustrate the crucial pathophysiological role of these two important ocular factors and arouse our attention to patients with both characteristics, especially in Asian countries where the prevalence of myopia are disturbingly high.
No preview · Article · Nov 2015 · Taiwan Journal of Ophthalmology
[Show abstract][Hide abstract] ABSTRACT: Cytomegalovirus (CMV) retinitis is a late complication of organ and hematopoietic stem cell transplant, the risk of which depends on the degree of immunosuppression. With the institution of preemptive ganciclovir therapy early after transplant, most patients survive episodes of life-threatening CMV infection during the early months (usually the first 3 months) after transplant and hence late onset of CMV disease, such as CMV retinitis, is being recognized more frequently. Direct involvement of the macula or optic head remains the leading cause of visual loss in patients with CMV retinitis, but there are few studies investigating the management of this condition.Herein, we present the case of 28-year-old man who had acute myeloid leukemia and developed CMV retinitis with bilateral cystoid macular edema and optic swelling in the right eye 6 months after bone marrow transplant. He received treatment with intravitreal methotrexate in the right eye in combination with oral valganciclovir. Visual acuity improved 1 month after four weekly injections of intravitreal methotrexate 400 μg/0.1 mL. Resolved disc swelling and regression of macular edema were also observed. By comparing binocular outcome, we present our findings and discuss the possible efficacy and safety of this treatment with respect to regression of anatomical damage and improvement in visual acuity.
No preview · Article · Oct 2015 · Taiwan Journal of Ophthalmology
[Show abstract][Hide abstract] ABSTRACT: In March 2014, a 56-year-old woman without previous underlying disease underwent encircling scleral buckling, 20-gauge pars plana vitrectomy, cryotherapy around a retinal tear, and gas-fluid exchange with 15% perfluoropropane flush for upper rhegmatogenous retinal detachment of the left eye. However, she developed progressive left leg swelling, pain, warmth, and redness, associated with difficulty in elevating her left leg after continuously maintaining a prone head position when either lying down or sitting for 2 days. When she arrived at the emergency room, she had an elevated d-dimer level. After undergoing Doppler ultrasound imaging, she was diagnosed as having deep vein thrombosis of the left leg. She received anticoagulation therapy with enoxaparin and warfarin overlapping for 7 days. The edema, pain, and paresthesia of her left leg were relieved. However, because of the risk of bleeding with anticoagulation drug usage, the patient needed to be monitored for 6 months. Prone positioning for gas tamponade is important for anatomic and functional success in retinal detachment surgery; however, timely walking and rest between periods of continuous prone positioning should be encouraged to prevent deep vein thrombosis and other impaired circulation-related complications.
No preview · Article · Aug 2015 · Taiwan Journal of Ophthalmology
[Show abstract][Hide abstract] ABSTRACT: Chien-Neng Kuo 1,2,3,4, Chung-Yi Chen 5, San-Ni Chen 6,7, Lin-Cheng Yang 8, Li-Ju Lai 1,2,3, Chien-Hsiung Lai 1,2,3, Miao-Fen Chen 2,3,9, Chia-Hui Hung 2,3,10 and Ching-Hsein Chen 11,* 1 Department of Ophthalmology, Chang Gung Memorial Hospital, No.6, W. Sec., Jiapu Rd., Puzi City, Chiayi County 61363, Taiwan; E-Mails: firstname.lastname@example.org (C.-N.K.); email@example.com (L.-J.L.); firstname.lastname@example.org (C.-H.L.) 2 Chang Gung University College of Medicine, No.259, Wenhua 1st Rd., Guishan Township, Taoyuan County 33302, Taiwan; E-Mails: email@example.com (M.-F.C.); firstname.lastname@example.org (C.-H.H.) 3 Chang Gung University of Science and Technology, No.2, W. Sec., Jiapu Rd., Puzi City, Chiayi County 61363, Taiwan 4 Department of Ophthalmology, Changhua Christian Hospital, Yun Lin Branch, No.375, Shichang S. Rd., Xiluo Township, Yunlin County 64866, Taiwan 5 School of Medical and Health Sciences, Fooyin University, No.151, Jinxue Rd., Daliao Dist., Kaohsiung City 83102, Taiwan; E-Mail: email@example.com 6 Department of Ophthalmology, Changhua Christian Hospital. No.135, Nanxiao St., Changhua City, Changhua County 50006, Taiwan; E-Mail: firstname.lastname@example.org 7 School of Medicine, Chung-Shan Medical University, Taichung City 50000, Taiwan 8 Gene Therapy Laboratory, E-DA Hospital, I-Shou University, No.1, Sec. 1, Syuecheng Rd., Dashu District, Kaohsiung City 84001, Taiwan; E-Mail: email@example.com 9 Department of Radiation Oncology, Chang Gung Memorial Hospital, No.6, W. Sec., Jiapu Rd., Puzi City, Chiayi County 61363, Taiwan 10 Department of Dermatology, Chang Gung Memorial Hospital, No.6, W. Sec., Jiapu Rd., Puzi City, Chiayi County 61363, Taiwan 11 Department of Microbiology, Immunology and Biopharmaceuticals, College of Life Sciences, National Chiayi University, Chiayi City 60004, Taiwan * Author to whom correspondence should be addressed; E-Mail: firstname.lastname@example.org; Tel.: +886-5-362-1000 (ext. 2580); Fax: +886-5-362-3002.
Full-text · Article · Apr 2013 · International Journal of Molecular Sciences
[Show abstract][Hide abstract] ABSTRACT: Two elderly patients with histories of myelodysplastic syndrome and idiopathic thrombocytopenic purpura both suffered from blurred vision for a long time and asked for cataract surgery. Due to their extremely low platelet counts, 5000/μL and 6000/μL, respectively, we administrated 12-unit platelet transfusions each, 2 hours to the surgery. The operations were carried out smoothly, and there were no bleeding-associated complications during these operative procedures. Both patients were satisfied with their visual improvement at post-operative 1-week follow up with visual acuity of 0.8 and 1.0, respectively, and there was no adverse event reported. From these two cases, we suggested that in patients with thrombocytopenia, phacoemulsification cataract surgery can be performed with pre-operative platelet transfusion, producing favorable results without any bleeding-associated complications.
No preview · Article · Jan 2013 · Taiwan Journal of Ophthalmology
[Show abstract][Hide abstract] ABSTRACT: Bevacizumab, a recombinant humanized monoclonal antibody, binds vascular endothelial growth factor (VEGF) and inhibits its interaction with receptors found on endothelial cells. Bevacizumab has been increasingly used as an off-label treatment for exudative age-related macular degeneration (AMD). Whether or not bevacizumab is capable of arresting the growth of human retinal pigment epithelial cells remains to be clarified. In this study, flow cytometry was used to evaluate whether bevacizumab markedly induced the G1/S phase arrest. The G1/S phase cycle-related protein analysis demonstrated that the expression of cyclin-dependent kinase (CDK)2, 4 and 6 and of cyclin D and E, as well as the phosphorylation of retinoblastoma tumor suppressor protein (ppRB) production were found to be markedly reduced by bevacizumab. By contrast, the protein levels of p53, p16, p21 and p27 were increased in bevacizumab-treated ARPE-19 cells (a human retinal pigment epithelial cell line). These events of G1/S arrest induced by bevacizumab in ARPE-19 cells suggest that a preventive effect of bevacizumab exists in AMD.
Full-text · Article · Jul 2012 · Molecular Medicine Reports
[Show abstract][Hide abstract] ABSTRACT: This review describes the morphological, phytochemical and pharmacological properties of Cinnamomum subavenium (Lauraceae). The plant grows wild in southern Mainland China, Burma, Cambodia, Taiwan, Malaysia and Indonesia. This plant is recorded as having long been used to treat carcinomatous swelling, stomach ache, chest pain, abdominal pain, hernia, diarrhoea, rheumatism, nausea and vomiting. This article enumerates an overview of phytochemical and pharmacological aspects that is useful to researchers for further exploration for the necessary development of this potential herb.
Full-text · Article · Jun 2012 · Natural product research
[Show abstract][Hide abstract] ABSTRACT: To identify optical coherence tomography (OCT) patterns in diabetic macular edema (DME) that were predictive of visual outcomes after intravitreal bevacizumab (IVB) injection.
This was a retrospective study. We examined 31 eyes (24 patients) with clinically significant macular edema that received IVB injections along with macular OCT data. The eyes were categorized into 4 groups by using OCT features: diffuse retinal thickening (DRT), cystoid macular edema (CME), serous retinal detachment (SRD), and vitreomacular interface abnormalities (VMIAs). Changes in retinal thickness, retinal volume, and visual acuity (VA) after IVB injection were compared on the basis of OCT patterns.
After IVB injections, changes in VA logarithm of the minimum angle of resolution were -0.06±0.36, -0.26±0.26, 0.09±0.13, and -0.08±0.15, respectively, for DRT, CME, SRD, and VMIA patterns. Central macular thickness decreased by 70.5±105.5, 110.67±97.28, 181±125.87, and 24.25±77.12 μm for the DRT, CME, SRD, and VMIA patterns, respectively. The CME group was associated with a greater reduction in retinal thickness (P=0.009) and volume (P=0.027) with superior VA improvement (P=0.012) as compared with the DRT, SRD, and VMIA groups.
Patients with CME gained greater improvement in visual acuity and macular thickness and volume after IVB injection had been administered as the primary treatment for DME, as compared with other patients. The OCT patterns of DME may indicate the appropriate treatment; we consider these patterns to be prognostic of the response to IVB injection for macular edema.
No preview · Article · Feb 2012 · Journal of ocular pharmacology and therapeutics: the official journal of the Association for Ocular Pharmacology and Therapeutics
[Show abstract][Hide abstract] ABSTRACT: Propyl gallate (PG) is a synthetic antioxidant that has been used in processed food and medicinal preparations. The anti-cancer effect of PG in leukemia is unclear. In the present study, we demonstrate that PG reduced cell viability in THP-1, Jurkat, and HL-60 leukemia cells and induced apoptosis in THP-1 cells. PG activated caspases 3, 8, and 9 and increased the levels of p53, Bax, Fas, and Fas ligand. PG activated mitogen-activated protein kinases (MAPKs), inhibited nuclear translocation of the nuclear factor erythroid 2-related factor 2 (Nrf-2) and induced intracellular glutathione (GSH) depletion. In addition, PG increased superoxide dismutase-1 expression and decreased intracellular levels of reactive oxygen species. Our data show for the first time that an early event of PG-induced apoptosis is MAPKs/Nrf-2-mediated GSH depletion and that PG induced apoptosis via multiple pathways in human leukemia. PG might serve as a potential chemotherapeutic agent or food supplement for human leukemia patients.
Preview · Article · Feb 2011 · Food and chemical toxicology: an international journal published for the British Industrial Biological Research Association
[Show abstract][Hide abstract] ABSTRACT: The use of Synthetic Amphiphile INTeraction-18 (SAINT-18) carrying plasmid pigment epithelium-derived factor (p-PEDF) as an anti-angiogenesis strategy to treat corneal neovascularization in a rat model was evaluated. Four partially dried forms (Group A: 0 μg, B: 0.1 μg, C: 1 μg, D: 10 μg) of a p-PEDF–SAINT-18 were prepared and implanted into the rat subconjunctival substantia propria 1.5 mm from the limbus at the temporal side. The 1 μg of plasmid-basic fibroblast growth factor–-SAINT-18 (p-bFGF–SAINT-18) (1 μg) was prepared and implanted into the rat corneal stroma 1.5 mm from the limbus on the same side. Inhibition of neovascularization was observed and quantified from day 1 to day 60. PEDF (50-kDa) and bFGF (18-kDa) protein expression were analyzed by biomicroscopic examination, Western blot analysis, and immunohistochemistry. Gene expression in corneal and conjunctival tissue was observed as early as 3 days after gene transfer and stably lasted for over 3 months with minimal immune reaction. Subconjunctival injection of a highly efficient p-PEDF–SAINT-18 successfully inhibited corneal neovascularization. Successful gene expression of bFGF, PEDF and a mild immune response of HLA-DR were shown by immunohistochemistry staining. We concluded that SAINT-18 was capable of directly delivering genes to the ocular surface by way of subconjunctival injection, and delivered sustained, high levels of gene expression in vivo to inhibit angiogenesis.
Full-text · Article · Nov 2009 · Experimental Eye Research
[Show abstract][Hide abstract] ABSTRACT: To evaluate the effect of pterygium surgery on refractive spherocylinder power and corneal topography.
Twenty-four patients (27 eyes) undergoing pterygium surgery from January to December 2006 were retrospectively identified. Visual acuity, refractive spherocylinder power, and corneal topography were measured preoperatively and postoperatively.
Improvement of visual acuity, decreases of refractive spherocylinder power, and significant differences of 3-mm topographic irregularity and 3-mm topographic astigmatism postoperatively were found. Differences of refractive spherocylinder power preoperatively and postoperatively correlated significantly with differences of 3-mm topographic irregularity (spherical, r = 0.828, P = .000; cylinder, r = -0.805, P= .000) and of 3-mm topographic astigmatism (spherical, r = 0.673, P= .000; cylinder, r = -0.811, P = .000) preoperatively and postoperatively.
Pterygium surgery produces improvements in visual acuity, decreases of refractive spherocylinder power, topographic irregularity, and topographic astigmatism. Three-millimeter topographic irregularity and astigmatism have a close correlation with refractive spherocylinder power.
No preview · Article · Jan 2009 · Ophthalmic Surgery Lasers and Imaging
[Show abstract][Hide abstract] ABSTRACT: We describe a novel vector system of nonviral gene transfer into the cornea using a partially dried form of a plasmid expressing 18-kDa basic fibroblast growth factor (p-bFGF)-synthetic amphiphile INTeraction-18 (SAINT-18) complex.
Corneal neovascularization (NV) was evaluated in 48 eyes of Sprague-Dawley rats after implantation of SAINT-18 containing 2 micro g of plasmid-expressing green fluorescent protein (p-GFP; control group), 0.2 micro g, 2 micro g, or 20 micro g of p-bFGF from day 0 to day 60. bFGF protein expression was analyzed by Western blotting and immunohistochemistry.
The p-bFGF-SAINT-18 complex induced dose-dependent corneal neovascularization, which reached a maximum on days 15-21 in the 20-micro g p-bFGF group, days 12-18 in the 2-micro g p-bFGF group, and on days 9-15 in the 0.2-micro g p-bFGF group, and then regressed progressively. No NV was observed in the p-GFP group.
This noninflammatory corneal transfection model using partially dried p-bFGF-SAINT-18 complex allows precise localization of tranfection reagents for producing corneal neovascularization.
Full-text · Article · Nov 2008 · Current eye research
[Show abstract][Hide abstract] ABSTRACT: To investigate the long-term effect of insulin on vascular endothelial growth factor (VEGF) of streptozotocin (STZ)-induced diabetic rats.
Male Sprague-Dawley rats received intraperitoneal injections of STZ (60 mg/kg) to induce diabetes. The diabetic rats were divided into two groups: the poorly controlled diabetic group (4 U of Ultratard week) and the insulin-controlled group (2-8 U of Ultratard per day according to blood glucose level). The animals were sacrificed 4 months after diabetes induction. The intraocular fluids of four eyes from two rats were pooled together as one sample. VEGF was checked using an enzyme-linked immunosorbent assay (ELISA) kit.
There were eight rats in the poorly controlled diabetic group, 13 in the insulin-controlled group and 10 in the healthy group. The concentration of VEGF ranged from 70.72-164.89 pg/ml (mean, 99.60 +/- 31.37 pg/ml) in the poorly controlled diabetic group, 65.17-124.33 pg/ml (mean, 79.05 +/- 21.50 pg/ml) in the insulin-controlled group and 50.6-67.6 pg/ml (mean, 58.07 +/- 6.49 pg/ml) in the healthy group. There were statistical differences between groups (ANOVA, p < 0.001). The mean difference between the poorly controlled diabetic group and the insulin-controlled group was 20.55 +/- 9.61 pg/ml (p = 0.041).
The concentrations of VEGF in the two diabetic rat groups were higher than that in the healthy rat group. Insulin control reduced the rise of VEGF.
Preview · Article · Nov 2006 · Chang Gung medical journal
[Show abstract][Hide abstract] ABSTRACT: We describe a novel vector system of nonviral gene transfer into the cornea using a dehydrated form of a plasmid expressing basic fibroblast growth factor-polyethylenimine (p-bFGF-PEI) complex to induce angiogenesis.
Corneal neovascularization was evaluated in 48 eyes of Sprague-Dawley rats after implantation of a dehydrated form of PEI containing 1 microg green fluorescent protein (p-GFP-PEI; control group), or 10 microg, 1 microg, or 0.1 microg of p-bFGF-PEI introduced by spin vacuum at ambient temperature. Neovascularization was observed and quantified from day 1 to day 45. Eighteen kDa bFGF protein expression was analyzed by Western blot and immunohistochemistry.
Limbal vessels began to sprout on day 3 in the p-bFGF-PEI groups. The dehydrated form of the p-bFGF-PEI complex induced dose-dependent corneal neovascularization, which reached a maximum on days 24-30 in the 10 microg bFGF group, days 18-24 in the 1 microg bFGF group, and days 15-21 in 0.1 microg bFGF group, and then regressed progressively. No neovascularization was observed in the GFP group.
The dehydrated form of the p-bFGF-PEI complex is a novel and precise method for controlling the dose, localizing the reagents, and avoiding loss of liquid form during transfection into corneal tissue.
No preview · Article · Dec 2005 · Current Eye Research
[Show abstract][Hide abstract] ABSTRACT: A preference for the primary use of standard gas tamponade or a vitrectomy combined with other adjuvant measures to treat myopic eyes with macular holes (MHs) and retinal detachment (RD) has not been established. This article evaluates postoperative outcomes of both surgeries, and recommends a surgical method based on the findings.
We reviewed the records of 61 patients (62 eyes) with high myopia (> -6.0 diopter, > 26 mm of axial length, or visible posterior staphyloma) and MHs with secondary RD (no peripheral retinal break) who were treated between April 1986 and September 2002 in southern Taiwan. Descriptive statistics of baseline examinations and results of the operations were retrospectively analyzed.
Baseline clinical data of the primary gas tamponade and vitrectomy groups did not significantly differ, except for the mean preoperative log (minimum angle of resolution) visual acuity (VA) (p = 0.016) and extent of RD (p = 0.001, located in the posterior staphyloma only). None of the results (including success rate, cause of failure, number of operations until stability was achieved, and mean duration of postoperative follow-up) of the operations in the 2 groups significantly differed, except for the improved VA at the final status (p = 0.03).
Among highly myopic eyes with MHs, we suggest a vitrectomy for those with poorer VA and a greater extent of RD. However, gas tamponade is strongly recommended for those with RD with posterior staphyloma (PS) only because this procedure is safer and requires no sophisticated instruments.
Full-text · Article · Aug 2003 · Chang Gung medical journal