Hsu Wm

Exophthalmos of patients with Graves' disease in Chinese of Taiwan

PurposeTo determine the exophthalmos measurements in patients with Graves disease (GD) and to compare with those of normal subjects among the Chinese of Taiwan.MethodsHertels exophthalmometry were performed in 163 consecutive adult GD patients and 419 normal subjects. The values of exophthalmos, asymmetry, and the distance between lateral orbital rims (base) were evaluated.ResultsThere was a significant difference between GD and normal adults for exophthalmos and asymmetry, with GD patients demonstrating a mean exophthalmos of 18.32u2009mm and asymmetry of 0.93u2009mm as compared with 13.91 and 0.55u2009mm for normal subjects (P<0.001). The mean value of base for GD adults (106.52u2009mm) is slightly greater than normal subjects (105.82u2009mm). There was no gender difference in exophthalmometric value or asymmetry in each group. A total of 79 (48.5%) GD patients had exophthalmos greater than the upper limit of normal Chinese in Taiwan (18.6u2009mm). Asymmetry over 2u2009mm was observed in 11 (6.7%) patients with GD but in none of the normal subjects.ConclusionsGD patients have significant exophthalmos and asymmetry compared to normal subjects. In comparison with previous studies, exophthalmos values for Chinese in Taiwan tend to be lower than those of Caucasians and black-American people, but are close to those of Korean, Japanese, Iranian, Indian, and Asian-American people. Adequate adjustment of normal and abnormal values of exophthalmos according to individual differences is important for the diagnosis of orbital morbidity and management of thyroid associated orbitopathy.

Increased oxidative DNA damage, 8-hydroxydeoxy- guanosine, in human pterygium.

PurposeChronic exposure to ultraviolet (UV) light is a widely accepted aetiological factor in the development of pterygium. UV radiation may induce production of reactive oxygen species via photosensitized oxidation, thus causing oxidative damage. This study was conducted to test the hypothesis that oxidative damage to DNA is increased in pterygium.MethodsImmunohistochemical analysis employing a monoclonal antibody specific for 8-hydroxy-2′-deoxyguanosine (8-OHdG), a ubiquitous maker of oxidative stress, was performed in three patients with primary pterygium. The levels of 8-OHdG in DNA isolated from the other 29 pterygium specimens and their adjacent normal conjunctival tissues were determined using enzyme-linked immunosorbent assay (ELISA).ResultsImmunohistochemistry of 8-OHdG showed a distinct pattern of more extensive and intense staining in the nuclei of pterygium tissue compared with that in their adjacent normal conjunctiva. ELISA also revealed that the average level of 8-OHdG in the pterygium tissues was 4.7-fold higher than that of the corresponding normal conjunctiva (P<0.001).ConclusionsThe increased levels of 8-OHdG in the pterygium tissues indicate that oxidative stress could play a role in the development of pterygium. These findings provide new information to better understand the pathogenesis of pterygium and are useful in the prevention and treatment of this disease.

Increased oxidative DNA damage, lipid peroxidation, and reactive oxygen species in cultured orbital fibroblasts from patients with Graves' ophthalmopathy: evidence that oxidative stress has a role in this disorder.

PurposeWe investigated the oxidative stress in orbital fibroadipose tissues and cultured orbital fibroblasts from patients with Graves’ ophthalmopathy (GO).MethodsThe content of 8-hydroxy 2′-deoxyguanosine (8-OHdG), an important biomarker of oxidative DNA damage, was measured in orbital fibroadipose tissues and cultured orbital fibroblasts from patients with GO and compared with age-matched normal controls. A product of lipid peroxidation, malondialdehyde (MDA), and intracellular reactive oxygen species (ROS) in cultured orbital fibroblasts was also determined.ResultsThere was no significant difference in the 8-OHdG content of orbital fibroadipose tissues between patients with GO and age-matched normal controls (P=0.074). However, the levels of 8-OHdG and MDA in GO orbital fibroblasts were significantly higher than those of normal controls (P=0.0026 and P<0.001, respectively). In addition, GO orbital fibroblasts had higher contents of superoxide anions and hydrogen peroxide compared with those of normal controls (P=0.0133 and 0.0025, respectively).ConclusionsOrbital fibroblasts represent the most abundant cell type among orbital connective tissues and exhibit great differences in their phenotypes. Increased oxidative DNA damage and lipid peroxidation, as well as higher intracellular ROS levels in GO orbital fibroblasts may have a role in the pathogenesis of GO.

Efficacy of probing the nasolacrimal duct with adjunctive Mitomycin-C for epiphora in adults.

PURPOSEnTo investigate the efficacy and safety of adjunctive low-dose mitomycin-C during lacrimal probing for adults with blocked nasolacrimal ducts.nnnDESIGNnProspective, noncomparative, interventional case series.nnnPARTICIPANTSnFrom January 1998 to December 2000, a total of 32 adult patients (36 eyes) seen with epiphora caused by primary nasolacrimal duct obstruction was treated and evaluated.nnnINTERVENTIONnLacrimal probing with adjunctive mitomycin-C (0.2 mg/ml).nnnMAIN OUTCOME MEASURESnObjective evaluation of patency with irrigation, as well as patients subjective assessment of improvement.nnnRESULTSnFor 32 of the treated eyes (89%), the nasolacrimal duct remained open 9 months after treatment. Repeat procedure was successful for two of the remaining four eyes with recurrent obstruction during follow-up, yielding an overall patency rate of 94%. Patient satisfaction was assessed after 9 months and indicated that the epiphora was at least mildly improved for 30 (83%) of the treated eyes. Watering was completely absent for nine eyes (25%), rated as moderately improved for 17 (47%), and mildly improved for 4 (11%). No complications were encountered over the 9-month follow-up period.nnnCONCLUSIONSnOur experience suggests good long-term results for probing with adjunctive, topical Mitomycin-C for cases of adult epiphora caused by obstruction of the nasolacrimal duct followed by repeat procedure if necessary. It can be recommended as a simple, effective, and minimally invasive technique, with no significant complications resulting from low-dose use in our study.

Genetic polymorphism of hOGG1 and risk of pterygium in Chinese

AbstractPurpose Ultraviolet irradiation is known to cause oxidative DNA damage and is thought to be a major factor implicated in the pathogenesis of pterygium. The highly mutagenic 8-hydroxy-2′-deoxyguanosine, a marker for the evaluation of photo-oxidative DNA damage, can be repaired by human 8-oxoguanine glycosylase I (hOGG1). A transition of C to G at nucleotide position 1245 in exon 7 of the hOGG1 gene is associated with the substitution of cysteine for serine at codon 326. In this study, we investigated the association of the hOGG1 Ser326Cys polymorphism with pterygium in a Chinese population.Methods In all, 70 patients and 86 controls were enrolled in this study. The Ser326Cys polymorphism was determined by the polymerase chain reaction-restriction fragment-length polymorphism analysis. The association between this genetic polymorphism and risk of pterygium was examined by χ2-test and logistic regression.Results The allelic frequencies for the Ser and Cys variants of hOGG1 gene were not significantly different between the two groups. However, when compared with Ser/Ser and Ser/Cys genotypes combined, we found that the homozygous Cys/Cys genotype was more prevalent in pterygium patients than controls (P=0.024) with the odds ratio being 2.2 (95% CI: 1.1–4.5). In the pterygium group, the mean age of patients with the Cys/Cys genotype was younger than those with the other two genotypes (P=0.025).Conclusions Our findings suggest that the 1245C → G transition in exon 7 of the hOGG1 gene, which results in Ser326Cys substitution of the enzyme, might play a role in the susceptibility of humans to pterygium.

Corneal ulcer of the side port after phacoemulsification induced by Acinetobacter baumannii

A 75-year-old man had clear corneal phacoemulsification using a temporal approach in the left eye. Two months after surgery, a focal corneal epithelial defect developed with infiltration near the lower limbus on the site of the side-port incision. The culture of corneal scrapping grew Acinetobacter baumannii, which is resistant to most ordinary antibiotics in sensitivity tests. After appropriate antibiotic treatment, the ulcer healed gradually with vessel ingrowth. Acinetobacter baumannii is usually found in nosocomial infection of immune-compromised patients in the intensive care unit. It is a rare pathogen of infectious keratitis. Our case, with its unusual infection site, may point to potential risk factors for this pathogen.

Lymphoepithelial carcinoma of the lacrimal sac

This case illustrates two non-infectious forms of endophthalmitis associated with IVTA in the same eye. First, a rapid sterile endophthalmitis resulted from an acute reaction to either triamcinolone or its vehicle components. This inflammatory reaction may be similar to that of toxic anterior shock syndrome (TASS). Our patient with chronic uveitis developed this when the IVTA was combined with a cataract surgery. Previous intraocular surgery and uveitis have been reported to be risk factors for sterile endophthalmitis. Subsequently, he developed pseudoendophthalmitis, which results from the anterior migration of triamcinolone crystals. In our patient, loose zonules may have contributed to the anterior migration. The patient’s findings were not typical of infectious endophthalmitis, given the rapidity of the hypopyon and lack of pain. However, the dramatic rise in IOP is uncommon in non-infectious endophthalmitis. Given the atypical presentation, aspirates were taken for culture. To the best of our knowledge, this is the first report of sterile endophthalmitis and pseudoendophthalmitis in the same eye.

Pulsatile ocular blood flow change after treatment with systemic steroid in patients with Graves' ophthalmopathy

PurposeOur previous study has demonstrated an impairment of pulsatile ocular blood flow (POBF) in patients with Gravesophthalmopathy (GO). Here we further evaluate the haemodynamic change in GO patients after systemic steroid.MethodsIn a prospective, interventional, consecutive clinical case series, all patients with active and moderately severe GO who underwent systemic steroid treatment were evaluated. The change of POBF and the clinical activity and severity of the disease were assessed.ResultsIn total, 11 patients underwent intravenous methylprednisolone pulse therapy followed by 2-month oral prednisolone therapy. POBF improved from a mean value of 476.5 to 614.7u2009μl/min (P<0.001) after treatment. Likewise, the mean clinical activity score reduced from 4.8 to 1.6. However, systemic steroid had less effect on the severity of GO. It also revealed that there is a greater improvement of POBF in those with more clinical activity score (>4) at the onset.ConclusionsFollowing treatment with systemic steroid we have demonstrated a significant improvement in POBF in patients with GO.

Metastatic prostatic adenocarcinoma to the orbit diagnosed by prostate-specific antigen staining

Metastatic prostatic adenocarcinoma to the orbit diagnosed by prostate-specific antigen staining