Chang-Ping Lin

Clinical experiences of infectious scleral ulceration: a complication of pterygium operation

AIMS To report the special clinical manifestations and determine the appropriate management of infectious scleral ulceration. METHODS A retrospective study was performed on 30 eyes with infectious scleral ulceration. Information was recorded on patients’ age, onset and course of disease, pathogenic organism, clinical presentations, methods of diagnosis, treatment, and outcome. RESULTS 10 cases (33.3%) were accompanied by corneal involvement. Subconjunctival abscess was noted in 16 cases (53.3%). 17 cases (56.7%) gave positive results of pathogen culture and all were Pseudomonas aeruginosa. Two cases had combined bacterial infections and one case was complicated by fungal infection. A total of 26 cases had surgical debridement in this series. Extensive involvement of the sclera with the presence of a ‘tunnel lesion’ or a ‘satellite subconjunctival abscess’ were found during debridement. All of the eyeballs involved were salvaged except one. CONCLUSION The results of this study were contrary to the poor prognosis presented in previous reports. Early and repetitive surgical debridement is believed to be mandatory in the intractable cases to shorten the admission period and to save these eyes.

Combined Use of an Amniotic Membrane and Tissue Adhesive in Treating Corneal Perforation: A Case Report

We report a new method combining the use of an amniotic membrane and cyanocrylate tissue adhesive to seal a corneal perforation. A 47-year-old male suffered from an alkali injury complicated with corneal melting and perforation in the left eye. We placed an amniotic membrane of optimal size in the anterior chamber directly under the corneal perforation lesion. The cyanocrylate tissue adhesive was then applied over the perforation site and sealed successfully. Three weeks later, the tissue adhesive had dislodged. The amniotic membrane had sealed the perforated lesion and was well adhered to the surrounding corneal tissue with complete epithelial covering. Vision was 20/25 six months after the operation. The combined use of an amniotic membrane and tissue adhesive is a promising method in the treatment of corneal perforation.

Effect of fortified antibiotic solutions on corneal epithelial wound healing.

Purpose. To evaluate the influence of fortified antibiotic eyedrops on corneal epithelial wound healing. Methods. We developed an in vitro epithelial wound-healing model to evaluate the toxicity of antibiotics. An excimer laser was used to create an epithelial defect 1.5 mm in diameter, 70 &mgr;m in depth on the central area of porcine cornea. The intact animal globes were maintained in the incubator by a perfusion system. Fortified antibiotics: 10% piperacillin, 5% cefazolin, 0.5% chloramphenicol, 5% vancomycin, 1% amikacin, 2% gentamicin, and 0.1% amphotericin B were applied to the wound in three applications. The wounds were evaluated 24 h after setup with fluorescein stain and a scoring system. Results. The 0.1% amphotericin B and 2% gentamicin disturbed the corneal epithelial healing rate significantly. The remaining antibiotics did not interfere with the epithelial healing rate in our study design. Conclusion. Fortified antibiotic eyedrops demonstrated varied degrees of influence on corneal epithelial wound healing. When antibiotic eyedrops are used, both the efficacy and toxicity of the antibiotics should be the major concern. If efficacy is equivalent, less-toxic agents should be given preference.

Photodynamic Therapy With or Without Intravitreal Bevacizumab for Polypoidal Choroidal Vasculopathy: Two Years of Follow-Up

PURPOSE To compare the long-term results of the efficacy of photodynamic therapy (PDT) with or without intravitreal bevacizumab (IVB) injections for polypoidal choroidal vasculopathy. DESIGN Retrospective, comparative, interventional case series. METHODS We included 69 eyes of 69 patients with macula-involved polypoidal choroidal vasculopathy. All patients were followed up for more than 2 years. We compared the treatment outcomes between groups and investigated the factors influencing visual improvement at 24 months of follow-up. RESULTS Thirty-six patients received PDT combined with IVB and 33 patients received PDT monotherapy. At 3 months, the mean logarithm of minimal angle of resolution (logMAR) best-corrected visual acuity (BCVA) improved from 0.73 to 0.53 in the combined therapy group (P < .001) and from 0.79 to 0.72 in the PDT monotherapy group (P = .02), with a significant difference in treatment efficacy between the 2 groups (P < .001). However, the improvements in BCVA were not statistically significant after 21 months in the combined therapy group and 15 months in the monotherapy group. The difference in treatment efficacy between the 2 groups was not significant after 6 months. Initial BCVA (P = .005), lesion size (P = .011), patient age (P = .018), and location of polyps (P = .006) significantly predicted the final visual outcome rather than treatment modality (P = .243). CONCLUSIONS PDT combined with IVB for symptomatic PCV was temporarily superior to PDT monotherapy, and the treatment efficacy decreased with time. Initial BCVA, lesion size, and location were more significant than treatment modality as the factors influencing final visual improvement.

Suture fixation technique for posterior chamber intraocular lenses

&NA; We describe a modified method for scleral fixation of posterior chamber intraocular lenses (IOLs). A double‐armed, 10‐0 polypropylene (Prolene®) suture on a curved long needle is passed through a groove in the sclera and retrieved within the barrel of a bent 25‐gauge needle through the opposite groove. Double transscleral passages enable 4‐point fixation and provide better stability and centration. Knots are buried completely in the scleral groove. In a series of 10 cases, the IOLs were well centered, no sutures protruded from the scleral groove, and the vision in all eyes improved. In 1 case, a ciliary hemorrhage occurred during insertion of the 25‐gauge needle, but the bleeding stopped after ocular pressure reform. This technique is easy to perform, improves centration and stability of the IOL, and avoids suture exposure.

Characteristics of primary rhegmatogenous retinal detachment in Taiwan

PurposeTo investigate the epidemiological characteristics and related risk factors for primary rhegmatogenous retinal detachment (RRD) in Taiwan.MethodsThe case–control study was based on retrospective chart review of hospital patients treated for primary RRD from 1995 to 2001, inclusively. The preoperative fundus findings and refractive status were collected for each patient. Controls were selected from a nationwide survey of visual impairment in the adult population during the same period. Risk factors for RRD were analysed by logistic regression. A total of 1032 RRD cases and 3537 controls were enrolled for the study.ResultsA pronounced bipeak pattern was evident in the age distribution for primary RRD in the third and sixth decades of life. Atrophic hole with lattice degeneration was preferential to younger (20–30 years) and highly myopic individuals (−7.4±5 D), whereas the flap tear tended to occur in middle-aged individuals (50–60 years) and those with moderate myopia (−4.1±5 D). The odds ratio for primary RRD with myopia, male gender, and older age (>40 years) were 1.33/D, 2.15, and 1.69, respectively.ConclusionsMyopia is an important RRD risk factor for young Taiwanese. The increasing prevalence of myopia has predisposed the young population to RRD.

Immunologic and clinical manifestations of infectious scleritis after pterygium excision

Purpose: To present the immunologic status and clinical manifestations of patients who had infectious scleritis after pterygium excision. Methods: This prospective noncomparative study of immunologic status and clinical manifestations involved 18 eyes of 18 patients with infectious scleritis (16 bacterial and 2 fungal infections) with a history of pterygium excision from 1999 to 2001. Results: The period between pterygium excision and scleritis ranged from 1 to 36 years. None of the 18 patients had any history of systemic autoimmune disease. Elevated erythrocyte sedimentation rates were found in 9 (50%) of 18 patients. Elevated serum C-reactive protein levels were found in 9 (75%) of 12 patients. Other serologic tests were all negative. The most common pathogen of infectious scleritis, Pseudomonas aeruginosa, was present in 13 patients (72.2%), significantly higher than any others (P < 0.05). All of the eyeballs were salvaged, and 9 (50%) of 18 patients had final vision better than 2/20. Conclusion: There was no underlying autoimmune disease associated with infectious scleritis in this study. Early diagnosis and aggressive medical and surgical treatment might have saved the eyes.

Repair of a giant scleral ulcer with preserved sclera and tissue adhesive.

BACKGROUND AND OBJECTIVE Infectious scleral ulcer is a rare but severe late complication of pterygium surgery. Scleral grafts may be required in scleral ectasia with uveal exposure, corneal distortion, and severe anterior chamber reaction that are induced by scleral ulcer. The authors report a method for scleral grafting with preserved sclera and tissue adhesive. PATIENTS AND METHODS Six cases of infectious scleral ulcers were repaired with this method. Preserved sclera was attached to the thinning sclera with tissue adhesive without sutures. The free or rotation conjunctival flap was placed over the graft area and sutured with 10-0 nylon. RESULTS The six cases repaired by this method showed good results during the follow-up, except for one loss. The only complication was protrusion of the adhesive postoperatively. This protrusion can be easily removed with forceps on an outpatient basis. CONCLUSION Tissue adhesive with preserved sclera is a useful method for repair of scleral thinning.

Clinical Outcomes in Cytomegalovirus-Positive Posner-Schlossman Syndrome Patients Treated With Topical Ganciclovir Therapy

PURPOSE To evaluate the clinical characteristics and therapeutic outcomes of cytomegalovirus (CMV)-positive Posner-Schlossman syndrome patients undergoing topical ganciclovir treatment. DESIGN Retrospective, comparative, and interventional case series. METHODS One eye of each of 126 consecutive Posner-Schlossman syndrome patients was investigated using aqueous polymerase chain reaction (PCR) between January 2006 and June 2013. The initial presentations and follow-up data of the CMV-positive patients (68 eyes) and CMV-negative patients (58 eyes) were compared. RESULTS Severe endothelial cell loss (P < .001) and a higher number of eyes requiring glaucoma filtering surgery (P = .017) were observed in CMV-positive Posner-Schlossman syndrome patients. All CMV-infected eyes treated with continual topical 2% ganciclovir exhibited an undetectable CMV level at the following taps. During follow-up, the average number of antiglaucomatous agents decreased, and a similar frequency of intraocular pressure (IOP) spikes was observed in both groups (P = .358). Patients with CMV-positive eyes with a disease duration over 5 years were likely to require glaucoma surgery (P = .024, log-rank test). All patients receiving surgery exhibited CMV-negative PCR during the IOP attack, but experienced severe peripheral anterior synechiae and pigment clogging. Both groups exhibited a similar endothelial cell decrease (P = .243) and probability of progressive endothelial cell loss (P = .219, log-rank test). CONCLUSION Ganciclovir treatment was effective for clearing the viral load, assisting the IOP control, and preserving the corneal endothelium of CMV-positive Posner-Schlossman syndrome patients. Early diagnosis and proper treatment could decrease the risk of advanced glaucoma and avoid glaucoma surgery in long-lasting cases.

Cytotoxicity of Intracameral Injection Drugs to Corneal Endothelium as Evaluated by Corneal Endothelial Cell Culture

The cell culture method was used to quantitatively evaluate the cytotoxicity to porcine corneal endothelial cells by drugs in the usual concentrations of intracameral injections (ICI). Time-dependent cytotoxicity of drugs was evaluated quantitatively; dye exclusion assay by trypan blue was used as a viability assay; and cytotoxicity to corneal endothelium was tested using amphotericin-B, amikacin, colistin, sulbenicillin, and cephradine in their original, 10-fold, and 100-fold ICI concentrations. Original and 10-fold ICI concentrations of betamethasone also were used. In original and 10-fold ICI concentrations, only amphotericin-B had significant cytotoxicity. In 100-fold ICI concentrations, amphotericin-B, colistin, and sulbenicillin had significant cytotoxicity. Betamethasone had neither a cytotoxic nor a proliferative effect in its original and 10-fold ICI concentrations. A 0.1-fold ICI concentration of amphotericin-B also showed 42.75% cytotoxicity after a 32-min exposure. Evaluating drug cytotoxicity to corneal endothelium by monolayer cultured cells and the time-dependent cytotoxicity of drugs as a quantitative method is efficient and objective.