Po-Kang Lin

Intraocular Gene Transfer of Ciliary Neurotrophic Factor Rescues Photoreceptor Degeneration in RCS Rats

Ciliary neurotrophic factor (CNTF) is known as an important factor in the regulation of retinal cell growth. We used both recombinant CNTF and an adenovirus carrying the CNTF gene to regulate retinal photoreceptor expression in a retinal degenerative animal, Royal College of Surgeons (RCS) rats. Cells in the outer nuclear layer of the retinae from recombinant-CNTF-treated, adenoviral-CNTF-treated, saline-operated, and contralateral untreated preparations were examined for those exhibiting CNTF photoreceptor protective effects. Cell apoptosis in the outer nuclear layer of the retinae was also detected. It was found that CNTF had a potent effect on delaying the photoreceptor degeneration process in RCS rats. Furthermore, adenovirus CNTF gene transfer was proven to be better at rescuing photoreceptors than that when using recombinant CNTF, since adenoviral CNTF prolonged the photoreceptor protection effect. The function of the photoreceptors was also examined by taking electroretinograms of different animals. Adenoviral-CNTF-treated eyes showed better retinal function than did the contralateral control eyes. This study indicates that adenoviral CNTF effectively rescues degenerating photoreceptors in RCS rats.

Hyperhomocysteinemia in Patients with Polypoidal Choroidal Vasculopathy: A Case Control Study

Purpose To determine whether elevated plasma homocysteine and serum high sensitivity C-reactive protein (hsCRP) levels, two established risk factors of vascular diseases, are associated with polypoidal choroidal vasculopathy (PCV). Design Retrospective case-control study. Methods One hundred and nineteen consecutive patients with PCV and 119 matched controls were enrolled in a tertiary hospital from September 2008 to June 2013. Plasma homocysteine and serum hsCRP levels were measured. Associations among plasma homocysteine, serum hsCRP levels and PCV were further evaluated using multivariable logistic regression analysis. Results The median plasma homocysteine level was significantly higher in patients with PCV than in the controls (12.20 µmol/L vs. 9.80 µmol/L, p<0.001). The median serum hsCRP level was slightly higher in the PCV group (0.16 mg/dl vs. 0.11 mg/dl in control group, p = 0.07). After multivariable logistic regression analysis, each 1 µmol/L increase of plasma homocysteine was associated with a 1.5-fold increase in likelihood of having PCV (OR, 1.54; 95% confidence interval (CI), 1.33–1.79, p<0.001). Conclusions Hyperhomocysteinemia was associated with PCV and might play a role in the pathogenesis of PCV.

EFFICACY OF INTRAVITREAL INJECTION OF ANTI-VASCULAR ENDOTHELIAL GROWTH FACTOR AGENTS FOR STAGE 4 RETINOPATHY OF PREMATURITY

Purpose: To investigate the efficacy of intravitreal injection of anti-vascular endothelial growth factor agents for Stage 4 retinopathy of prematurity. Methods: Retrospective case series study. The medical records of patients receiving intravitreal injection of anti-vascular endothelial growth factor agents for Stage 4 retinopathy of prematurity from January 2007 to May 2012 in Taipei Veterans General Hospital were reviewed. Results: A total of 13 eyes of 7 patients (3 boys and 4 girls) with Stage 4 retinopathy of prematurity were included. The mean gestational age and birth weight were 27.6 ± 2.6 weeks (range, 24.5–30.5 weeks) and 893.1 ± 293.2 g (range, 550–1422 g), respectively. The mean age at the time of injection was 38.2 ± 1.9 weeks (range, 36.0–41.5 weeks) postmenstrual age, and the mean follow-up period was 37.8 ± 19.5 months (range, 11.0–67.5 months). The active neovascularization regressed rapidly, and the anatomical outcomes were favorable in all patients. One eye developed recurrent retinal hemorrhage with localized retinal detachment 21 weeks after initial treatment, which resolved after a second injection. There were no ocular or systemic complications in these patients. Conclusion: Intravitreal injection of anti-vascular endothelial growth factor agents may be effective as monotherapy or as supplement to failed laser treatment for patients with Stage 4 retinopathy of prematurity without additional surgical intervention. Further randomized controlled trials are necessary to compare the clinical efficacy and safety with other conventional interventions.

Optic neuropathy in a patient with chronic inflammatory demyelinating polyneuropathy.

Optic neuropathy in a patient with chronic inflammatory demyelinating polyneuropathy Chronic inflammatory demyelinating polyneuropathy (CIDP) is a widespread, often patchy, demyelination of the peripheral nervous system (PNS) . Optic neuropathy is a rare manifestation of CIDP. Some sporadic reports have mentioned central nervous system involvement in CIDP.l-4 But the course and prognosis of optic neuropathy related to CIDP are not well documented in the literature. We illustrate the abnormal findings, relapsing course and treatment of optic neuropathy in a patient with CIDP.

Corneal crystalline deposits as the initial manifestation of IgA-kappa multiple myeloma.

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Cerebral venous thrombosis presenting as acute visual loss

Editor,—The common features associated with cerebral venous thrombosis (CVT) are headache, papilloedema, motor or sensory deficits, seizures, and conscious disturbance.1Ophthalmological manifestations including diplopia, subnormal visual acuity, or visual field defect are primarily the consequence of increased intracranial pressure (IICP).2 Visual disorientation, psychic gaze paralysis, and inferior altitudinal hemianopsia may develop if cerebral infarction is complicated in the parieto-occipital (P-O) region.3 We describe an unusual oriental case of CVT presenting uncommon transient visual loss to stress the diversity of the manifestations of CVT. ### CASE REPORT A 54 year old woman suffered from sudden onset of severe headache and progressive visual loss in both eyes within 1 day. Her past history was unremarkable but her family history was significant for thrombophilia, pulmonary embolism (her father), and deep vein thrombosis (her son). She had just undergone hormone replacement therapy with oral conjugated oestrogen and medroxyprogesterone for 1 month. On admission, she was conscious. Blood pressure was 156/84 mm Hg. Physical and neurological examinations were normal. Ophthalmic examinations disclosed corrected visual acuity of 1/60 in the right eye and counting fingers in the left eye. Both eyes exhibited …

Long-Term Outcome of Vitreous Surgery for Proliferative Diabetic Retinopathy

Background. Proliferative diabetic retinopathy (PDR) is one of the most prevalent causes of blindness in developed countries. This retrospective study evaluated the long-term visual outcomes and complications of vitrectomy resulting from various PDR complications. Methods. A review of 436 eyes (367 patients) treated with pars plana vitrectomy for complications of PDR was conducted for the period of 1992 to 1997 at the Veterans General Hospital-Taipei. Results. Indications for surgery were: (1) vitreous hemorrhage, 263 eyes (60.3%); (2) vitreous hemorrhage and tractional retinal detachment, 86 eyes (19.7%); (3) tractional retinal detachment, 80 eyes (18.3%); (4) combined tractional and rhegmatogenous retinal detachment, 2 eyes (0.5%); (5) progresssive fibrovascular proliferation, 5 eyes (1.1%). Best postoperative visual acuity was improved for 274 eyes (63%), unchanged for 27 eyes (6%), and worse for 135 eyes (31%). Postoperative results yielded 203 eyes (46.6%) that had final vision of 3/60 or better, and 102 eyes (23.4%) that had 6/30 or better. The most common intraoperative complication was iatrogenic retinal tear (11.1%) while the most common postoperative complication was recurrent vitreous hemorrhage (23.4%). Conclusions. More than half of the cases with complications of proliferative diabetic retinopathy could be effectively treated with vitreous surgery.