Sae Heun Rho

Prediction of enophthalmos by computer-based volume measurement of orbital fractures in a Korean population.

Purpose: To estimate posttraumatic enophthalmos using computer-based volume measurement of the orbital fracture to provide information on surgical guidelines. Methods: The fracture volume of orbital wall fractures in 35 patients who did not undergo surgery was measured using a Rapidia work station system. Hertel ophthalmometry, diplopia, and ocular motility were investigated. The fracture volume measurements relative to the intact contralateral orbit were correlated with enophthalmos, diplopia, and ocular motility. Patients were examined at the initial visit, then at 1 week, 1 month, and 3 months. Results: There was a correlation between the fracture volume and enophthalmos. Late enophthalmos increased in size in proportion to the volume of the fractured site. The predicted orbital fracture volume with an enophthalmos measurement of 2 mm or more was 2.30 ml. Conclusions: Computer-based measurements of orbital fracture volume can be used to predict overall enophthalmos and provide useful information to surgeons.

Cytoplasmic and Nuclear Anti-Apoptotic Roles of αB-Crystallin in Retinal Pigment Epithelial Cells

In addition to its well-characterized role in the lens, αB-crystallin performs other functions. Methylglyoxal (MGO) can alter the function of the basement membrane of retinal pigment epithelial (RPE) cells. Thus, if MGO is not efficiently detoxified, it can induce adverse reactions in RPE cells. In this study, we examined the mechanisms underlying the anti-apoptotic activity of αB-crystallin in the human retinal pigment epithelial cell line ARPE-19 following MGO treatment using various assays, including nuclear staining, flow cytometry, DNA electrophoresis, pulse field gel electrophoresis, western blot analysis, confocal microscopy and co-immunoprecipitation assays. To directly assess the role of phosphorylation of αB-crystallin, we used site-directed mutagenesis to convert relevant serine residues to alanine residues. Using these techniques, we demonstrated that MGO induces apoptosis in ARPE-19 cells. Silencing αB-crystallin sensitized ARPE-19 cells to MGO-induced apoptosis, indicating that αB-crystallin protects ARPE-19 cells from MGO-induced apoptosis. Furthermore, we found that αB-crystallin interacts with the caspase subtypes, caspase-2L, -2S, -3, -4, -7, -8, -9 and -12 in untreated control ARPE-19 cells and that MGO treatment caused the dissociation of these caspase subtypes from αB-crystallin; transfection of S19A, S45A or S59A mutants caused the depletion of αB-crystallin from the nuclei of untreated control RPE cells leading to the release of caspase subtypes. Additionally, transfection of these mutants enhanced MGO-induced apoptosis in ARPE-19 cells, indicating that phosphorylation of nuclear αB-crystallin on serine residues 19, 45 and 59 plays a pivotal role in preventing apoptosis in ARPE-19 cells. Taken together, these results suggest that αB-crystallin prevents caspase activation by physically interacting with caspase subtypes in the cytoplasm and nucleus, thereby protecting RPE cells from MGO-induced apoptosis.

Synthetic bile acid derivatives induce nonapoptotic death of human retinal pigment epithelial cells

Purpose. To study whether the synthetic ursodeoxycholic acid (UDCA) and chenodeoxycholic acid (CDCA) derivatives, which we have synthesized and have reported their apoptosis-inducing effect, have the effect on the proliferation of retinal pigment epithelial cells. Methods. UDCA, CDCA, and their synthetic derivatives were administered in culture to the human retinal pigment cell line, ARPE-19. The effect on cell viability and growth was assessed by trypan blue dye exclusion. In order to evaluate the type of cell death, mitochondrial membrane potential assay, DNA electrophoresis, TUNEL assay, nuclear staining and Western blotting for caspase-3 and poly(ADP-ribose) polymerase (PARP) activities were conducted. Results. Unlike UDCA and CDCA, which did not exhibit a significant effect on viability, their synthetic derivatives decreased the viability of ARPE-19 cells in a concentration-dependent manner. The cells treated with the synthetic derivatives did not demonstrate the characteristic findings of apoptosis, such as DNA ladder, DNA fragmentation, nuclear condensation or fragmentation, and caspase-3 and PARP activation. The reduction of mitochondrial membrane potential was shown. In electron microscopical study nuclear condensation was not shown. Conclusions. The synthetic UDCA and CDCA derivatives induced nonapoptotic death of ARPE-19 cells.

Canaliculitis with a papilloma-like mass caused by a temporary punctal plug.

Absorbable plugs are used before attempting permanent occlusion to observe whether the patient will be amenable to treatment for dry eye. Little is known about the complications of absorbable plugs. The authors present a case of canaliculitis with a papilloma-like mass caused by long-standing unabsorbed collagen plug that had been placed 3 years earlier. This is an uncommon clinical presentation that may be encountered in patients who have canaliculitis symptoms and a history of intracanalicular temporary plug placement.

Potential benefit of intraocular pressure reduction in normal-tension glaucoma in South Korea.

PURPOSE The aim of this study was to evaluate the potential benefit of intraocular pressure (IOP) reduction in normal tension glaucoma (NTG) Asian adult patients in South Korea. METHODS This was a retrospective, multicenter analysis of 166 NTG Asian adult patients in South Korea. The patient population consisted of Korean patients with NTG with at least 5 years of records available for evaluation. Patients all had typical glaucomatous optic-disc and/or visual-field changes but had never had a recorded IOP >21 mmHg. RESULTS Overall, 48 (29%) patients were progressed and 116 (71%) were stable over the follow-up period. Of patients with IOPs <or=14 mmHg (21/93), 23% progressed and >or=15 mmHg (27/73) 37% progressed (P = 0.041). The mean IOP for the stable group was 14.0 +/- 1.8 mmHg, whereas with the progressed group the average mean IOP was 14.4 +/- 1.6 mmHg (P = 0.20). The mean peak IOP was 17.4 +/- 2.2 mmHg in the stable group and 17.8 +/- 2.0 mmHg in the progressed group (P = 0.26). Multivariate linear regression analysis did not any identify independent risk factors for progression, including age, gender, or mean and peak IOP. CONCLUSIONS This study provides initial evidence that Korean patients with normal-tension glaucoma, treated to lower IOPs, may have a decreased incidence of progression over 5 years than those patients with higher IOPs. More research is required to confirm this finding.

Sensitization of RPE Cells by αB-Crystallin siRNA to SAHA-Induced Stage 1 Apoptosis through Abolishing the Association of αB-Crystallin with HDAC1 in SC35 Speckles

PURPOSE To better understand the mechanism underlying the anti-apoptotic activity of alphaB-crystallin in RPE cells. METHODS Cells of the human retinal pigment epithelial line ARPE-19 were treated with a histone deacetylase inhibitor (HDACI), suberoylanilide hydroxamic acid (SAHA), with or without alphaB-crystallin siRNA. To examine the mechanism underlying the cell death induced in ARPE-19 cells, nuclear staining, flow cytometry, DNA electrophoresis, pulse field gel electrophoresis, Western blot analysis, confocal microscopy, and coimmunoprecipitation assay were undertaken. RESULTS The present study demonstrated that an HDACI, SAHA, at the usual doses or the silencing of alphaB-crystallin by siRNA alone did not effectively induce apoptosis in ARPE-19 cells. Silencing of alphaB-crystallin likely abolishes the anti-apoptotic activity of alphaB-crystallin. The data indicated that silencing of alphaB-crystallin sensitizes ARPE19 cells to SAHA-induced apoptosis and leads them to stage 1 apoptosis. alphaB-Crystallin associates with HDAC1 on SC35 speckles, and silencing of alphaB-crystallin abolishes this association, resulting in the induction of apoptosis. The data indicated that the association between alphaB-crystallin and HDAC1 on SC35 speckles plays a pivotal role in anti-apoptotic activity. CONCLUSIONS Knockout of alphaB-crystallin may be a promising new approach to enhance therapeutic potency for proliferative vitreoretinopathy without compromising efficacy.

Epiblepharon Related to High Body Mass Index in Korean Children

PURPOSE To evaluate the clinical manifestations of epiblepharon in Korean children and the relationship between this condition and body mass index. METHODS In a retrospective case-control study, 223 children 6 to 15 years of age treated surgically for epiblepharon were studied and compared with an age-matched control group of 264 children. Data on age, sex, weight, height, and recurrence were recorded. RESULTS Mean age of the patients was 8.63 ± 4.43 years. Lower eyelids were commonly involved bilaterally. Chief complaints included ocular discomfort, eye rubbing, visual disturbances, photophobia, and epiphora. Minimal resection of orbicularis oculi with full-thickness eyelid rotatory suture for epiblepharon was performed on 223 patients. The body mass index in girls 12 to 15 years old with epiblepharon was significantly higher than that in children without epiblepharon (P < .05). There was a statistically significant correlation between the incidence of epiblepharon and obesity with aging in girls (P < .05). Reoperation was performed on 12 patients (4.4%) because of recurrence of corneal irritation with inverted eyelashes. Clinical factors such as sex, age, and body mass index did not affect the rate of recurrence. CONCLUSION Epiblepharon is one of the most common eyelid abnormalities among Asian children. Obese Korean girls aged 12 to 15 years demonstrated symptomatic epiblepharon at a statistically significant level.

Application of Newly Developed Amniotic Membrane Ointment for Photorefractive Keratectomy in Rabbits

We developed amniotic membrane ointment (AMO), and the effect of instilling the AMO after photorefractive keratectomy (PRK) was investigated with respect to inflammatory cell infiltration into the corneal stroma, apoptosis of keratocytes, and suppression of lipid peroxidation of cellular walls. The PRK procedure was performed on both eyes of 10 white rabbits. One eye of each rabbit (the experimental eye) was instilled with the AMO and the other eye of the rabbit (the control eye) with a base ointment 0, 8 and 16 h after the PRK procedure. Corneal specimens were collected 24 h after the PRK procedure. Hematoxylin-eosin stain and TUNEL assay were conducted to demonstrate polymorphonuclear and apoptotic cells, respectively. To assess lipid peroxidation, immunohistochemical staining with an antibody to malondialdehyde was undertaken. Compared to the control, the cornea instilled with the AMO had significantly less polymorphonuclear cells infiltrating into the corneal stroma as well as keratocytes subjected to apoptosis. These corneas also showed a significantly less extent of lipid peroxidation than the control. These data support that instillation of the AMO effectively reduced the recruitment of polymorphonuclear cells, the induction of apoptosis in keratocytes, and lipid peroxidation induced by PRK. Thus, this study could provide basic data on the clinical application of the AMO in the days ahead.

The effect of a temperature-sensitive poloxamer-alginate-CaCl2 mixture after strabismus surgery in a rabbit model

PURPOSE To determine the efficacy of a temperature-sensitive poloxamer-alginate mixture in reducing adhesions after strabismus surgery in a rabbit model. METHODS The superior rectus muscle was recessed in each of 36 eyes from 18 rabbits. One randomly assigned eye in each rabbit was treated with a poloxamer-alginate mixture (PA group); the other eye was treated with a subconjunctival injection of saline (control group). The adhesions between the superior rectus muscle, sclera, and conjunctiva were clinically evaluated by a masked observer at 1 day, 1 week, and 4 weeks after surgery. Inflammation was analyzed by hematoxylin and eosin staining and anti-CD11b staining. Late fibrosis was assessed by the Masson trichrome and α-smooth muscle actin staining. Adhesion, inflammation, and fibrosis were graded on a scale of 0-4. RESULTS There was no significant between-group difference in the degree of adhesion at 1 day and 4 weeks after surgery. However, the degree of adhesion in the PA group was lower than that in the control group at postoperative week 1 (P < 0.05). Acute inflammation was similar between the groups (P > 0.05). At postoperative week 4, inflammatory cell infiltration was reduced in the PA group (P = 0.046). A significant between-group difference in late fibrosis at postoperative week 4 was observed through the Masson trichrome (P = 0.024) and α-smooth muscle actin staining (P = 0.025). CONCLUSIONS The poloxamer-alginate mixture significantly decreased adhesion after strabismus surgery in a rabbit model. Additional studies are warranted to evaluate the use of this mixture in preventing postoperative adhesions.

Co-treatment of suberoylanilide hydroxamic acid and mitomycin-C induces the apoptosis of rabbit tenon's capsule fibroblast and improves the outcome of glaucoma filtration surgery.

Purpose: This study was undertaken to develop a new treatment modality that would be able to minimize fibrosis and provide better outcome with glaucoma filtration surgery (GFS). Methods: We examined whether co-treatment with mitomycin-C (MMC) and histone deacetylase inhibitor (HDACi) suberoylanilide hydroxamic acid (SAHA) efficiently induces apoptosis on rabbit Tenons capsule fibroblasts (TCF) in vitro. We further examined the effect of co-treatment with SAHA and MMC on the alteration of IOP and the bleb survival in rabbits following GFS. Results: Co-treatment of MMC and SAHA efficiently induces apoptosis in TCFs via the up-regulation of p53 and increased phosphorylation of p53 on serine 15 and 392. Also, co-treatment of SAHA and low-dose MMC decreases IOP, prolongs bleb survival, and induces apoptosis of cells under the bleb area following GFS. Conclusion: This study shows that a co-treatment of SAHA and MMC could improve the outcome of GFS.