Tzu-Hsun Tsai

Comparison of fluoroquinolones: cytotoxicity on human corneal epithelial cells

PurposeTo compare the cytotoxicity of different fluoroquinolones (FQs) towards human corneal epithelial cells (HCECs).MethodsHCECs were incubated with FQs (norfloxacin, ciprofloxacin, ofloxacin, levofloxacin, moxifloxacin, and gatifloxacin), both as commercial ophthalmic formulations and as unpreserved solutions. Cells incubated in different formulations of gentamicin, cefazolin, and benzalkonium chloride (BAC) were also compared. A cell viability assay, using 3-(4,5-dimethylthiazol-2-yl)-5-(3-carboxymethoxyphenyl)-2-(4-sulfophenyl)-2H-tetrazolium (MTS) assay, was used to evaluate the drug effects on cell viability after five incubation times (30 min, 1 h, 4 h, 8 h, and 24 h). Transepithelial electrical resistance (TEER) was measured with a voltohmmeter to help understand changes in paracellular permeability at five time points (4 h, 8 h, 12 h, 24 h, and 48 h). Cell morphology was observed with an inverted fluorescence microscope, with multiple stage position and in time-lapse mode.ResultsThe preserving solutions and BAC at concentrations above 0.005% significantly decreased cell viability, when assayed by MTS. Increased paracellular permeability and decreased membrane integrity were also observed by TEER measurements and inverted fluorescence microscopy. Ofloxacin and levofloxacin were both free of preservatives and showed the least cytotoxicity towards HCECs in commercial FQ eye drops.ConclusionsThe cytotoxicity observed with FQ eye drops seems to be caused mainly by the preservative, which induced a significant decrease in membrane integrity and increased paracellular permeability. We found the new generation of FQs (moxifloxacin and gatifloxacin) no less cytotoxic towards HCECs than the old generation ones.

Recurrent Corneal Erosions Treated with Anterior Stromal Puncture by Neodymium: Yttrium-Aluminum-Garnet Laser

PURPOSE To evaluate the clinical outcomes in patients with recurrent corneal erosions who received anterior stromal puncture by use of neodymium:yttrium-aluminum-garnet (Nd:YAG) laser. DESIGN Retrospective, nonrandomized, consecutive case series. PARTICIPANTS From 2000 to 2005, 33 eyes of 33 patients with unilaterally recurrent macroform corneal erosions showing poor response to conservative management who were treated with Nd:YAG laser were studied. INTERVENTION Anterior corneal stromal puncture with Nd:YAG laser was performed in the loosened epithelium or epithelial defect area. The causes and frequency of corneal erosions and the spot numbers and total energy of the Nd:YAG laser were recorded. Slit-lamp biomicroscopic examination, refraction, corneal topography, and times of laser were reviewed. A questionnaire regarding the preoperative and postoperative difference in the intensity of pain and frequency of corneal erosion was provided. MAIN OUTCOME MEASURES Rate of recurrence and pain assessment by numerical rating scale. RESULTS Sixteen eyes were completely symptom free and 12 eyes had mild pain but no evidence of recurrent corneal erosion after operation. Five eyes had repeated episodes of recurrent corneal erosion. Eyes with a traumatic cause responded better to Nd:YAG laser therapy than those without. The frequency of corneal erosions and the severity of pain significantly improved in eyes with macroform and symptom-only recurrence. There was no significant change in refraction, but corneal surface regularity slightly improved after surgery. No adverse reaction was observed during follow-up. CONCLUSIONS Anterior stromal puncture by Nd:YAG laser is an effective and simple procedure to treat recurrent corneal erosion. It can ameliorate the frequency of attacks and the intensity of pain.

Reticular Dystrophy of the Retinal Pigment Epithelium

A laser flare-cell meter was used to examine blood-aqueous barrier function in a 57-year-old male patient who had typical reticular dystrophy of the retinal pigment epithelium with a bilateral hyperpigmented reticular pattern at the posterior pole in both eyes. Fluorescein angiography showed hypofluorescent reticular net resembling a fishing net with knots associated with a central diffuse hyperfluorescence. Dark adaptation test revealed that the final rod threshold was elevated. Laser photometry showed an increase in the aqueous flare intensity in both eyes, as compared to the results in normal subjects. Quantitative measurement of the aqueous flare intensity by a laser flare-cell meter might indicate abnormalities in the blood-aqueous barrier in patients with reticular dystrophy of the retinal pigment epithelium.

Nonaneurysmal Cranial Nerve Compression as Cause of Neuropathic Strabismus: Evidence From High-Resolution Magnetic Resonance Imaging

PURPOSE To seek evidence of neurovascular compression of motor cranial nerves (CNs) in otherwise idiopathic neuropathic strabismus using high-resolution magnetic resonance imaging (MRI). DESIGN Prospective, observational case series. METHODS High-resolution, surface coil orbital MRI was performed in 10 strabismic patients with idiopathic oculomotor (CN III) or abducens (CN VI) palsy. Relationships between CNs and intracranial arteries were demonstrated by 0.8-mm thick, 162-μm resolution, heavily T2-weighted MRI in fast imaging using steady-state acquisition sequences. Images were analyzed digitally to evaluate cross-sectional areas of extraocular muscles. RESULTS In one patient with CN III palsy, an ectatic posterior communicating artery markedly flattened and thinned the ipsilateral subarachnoid CN III. Cross-sections of the affected medial, superior, and inferior rectus muscles 10 mm posterior to the globe-optic nerve junction were 17.2 ± 2.5 mm(2), 15.5 ± 1.3 mm(2), and 9.9 ± 0.8 mm(2), significantly smaller than the values of 23.6 ± 1.9 mm(2), 30.4 ± 4.1 mm(2), and 28.8 ± 4.6 mm(2), respectively, of the unaffected side (P < .001). In 2 patients with otherwise unexplained CN VI palsy, ectatic basilar arteries contacted CN VI. Mean cross-sections of affected lateral rectus muscles were 24.0 ± 2.3 mm(2) and 29.8 ± 3.1 mm(2), significantly smaller than the values of 33.5 ± 4.1 mm(2) and 36.9 ± 1.6 mm(2), respectively, in unaffected contralateral eyes (P < .05). CONCLUSIONS Nonaneurysmal motor CN compression should be considered as a cause of CN III and CN VI paresis with neurogenic muscle atrophy when MRI demonstrates vascular distortion of the involved CN. Demonstration of a benign vascular cause can terminate continuing diagnostic investigations and can expedite rational management of the strabismus.

Blood-aqueous Barrier Function in a Patient with Choroideremia

The purpose was to determine whether there was a breakdown of the blood-aqueous barrier in a patient with choroideremia. A 27-year-old man with typical choroideremia underwent standardized ophthalmo-logical evaluation, including quantitative measurement of aqueous flare intensity, by a laser flare-cell meter. The results showed areas of atrophy of the choriocapillaries and retinal pigment epithelium in the mid-periphery and posterior pole, although not in the macula. Fluorescein angiography showed areas of loss of the choriocapillaries and retinal pigment epithelium. The fovea was spared with a surrounding zone of hy-perfluorescence. Electroretinography showed a subnormal photopic amplitude and extinguished scotopic response. Electrooculography revealed that the light peak/dark trough ratio was reduced. Goldmann perimetry showed constricted peripheral fields. Laser photometry showed an increase in the aqueous flare intensity in both eyes, as compared with normal subjects. We conclude that the function of the blood-aqueous barrier might be affected in patients with choroideremia.

ENDOGENOUS ENDOPHTHALMITIS WITH SUBRETINAL ABSCESS AFTER DENTAL PROCEDURES

Endogenous endophthalmitis with subretinal abscess is an extremely uncommon complication following dental procedures. An unsuspected source of infection or misdiagnosis of the condition as iridocyclitis may result in inadequate or delayed treatment leading to severe visual impairment. A high index of suspicion is required for accurate diagnosis and prompt treatment. A 49-year-old man was found to have endophthalmitis in his right eye after treatment of gingival abscess. Ophthalmoscopic examination revealed multiple septic emboli and a 4-disc diameter sized subretinal abscess in his retina. No other infectious origin could be found on systemic work-up. Cultures from blood, urine, aqueous and vitreous were all negative. Pars plana vitrectomy was performed 8 days after the initial presentation because of deterioration of visual acuity to finger counting despite intravitreal and systemic antibiotics administration. Visual acuity recovered to 20/25 one month postoperatively and the retina remained attached during follow-up for 1 year. Ophthalmologists should be aware of the possibility of transient septicemia-induced endophthalmitis and subretinal abscess after dental procedures. Prompt intervention with systemic and intravitreal antibiotics combined with pars plana vitrectomy can achieve successful visual and anatomic outcome.

Dematiaceous fungal keratitis presented as a foreign body-like isolated pigmented corneal plaque: a case report

Dematiaceous fungal keratitis presented as a foreign body-like isolated pigmented corneal plaque: a case report

Transpupillary thermotherapy for the treatment of choroidal neovascularization in age-related macular degeneration in Taiwan

PurposeTo evaluate the therapeutic outcome and the recurrence of choroidal neovascularization (CNV) secondary to age-related macular degeneration (AMD) after transpupillary thermotherapy (TTT) in light-brown retinas.MethodsA retrospective, non-randomized study of 58 eyes in 55 patients with subfoveal CNV treated with TTT was conducted. Power settings were set about half the value for Caucasian eyes. The outcome was assessed with best-corrected visual acuity, fluorescein angiography, indocyanine green angiography, and fundoscopic examination.ResultsForty-four membranes were occult, six classic, and eight mixed. Mean follow-up was 16.6±10.7 months (range: 6–48 months). Membranes closed in 46 eyes. Iatrogenic complications included three subretinal haemorrhage, two retinal pigment epithelium tears, and two macular area cystic changes. In eyes with occult CNV, visual acuity improved in six (13.6%), 14 (31.8%) remained unchanged, and 24 (54.6%) deteriorated. For various CNV, average logMAR changes from baseline at last follow-up were 0.30 in occult, −0.08 in classic, and 0.59 in mixed (P<0.01). Thirty eyes experienced recurrence within 9.2±6.2 months (range: 2–22 months). Cumulative recurrence rate was 45% at 12 months and 71% at 22 months, with no significant difference between occult and non-occult type CNV.ConclusionsTranspupillary thermotherapy does not cure CNV secondary to AMD. High recurrence was found independent of CNV type. Most improved vision was found mostly in classic CNV. Complications associated with high energy level should be considered in light-brown retinas.

Retinal Detachment in a Patient with Microphthalmos and Choroidal Coloboma

We report a rare case of retinal detachment with microphthalmos and choroidal coloboma. A 28-year-old man who had suffered from poor vision since early childhood was examined because of progressive deterioration of vision in his right eye. Examination of the anterior segment showed microphthalmos with microcornea and coloboma of the iris. Fundus examination revealed an inferior choroidal coloboma extending to the optic disc. The patient also had total bullous retinal detachment. Pars plana vitrectomy with silicone oil tamponade was performed, and the retina was reattached. Although rare, retinal detachment may develop in patients with microphthalmos and choroidal coloboma. Pars plana vitrectomy with additional scleral encircling buckle may be performed to treat this condition.

Outcomes of pediatric cataract surgery with triamcinolone-assisted vitrectomy

BACKGROUND/PURPOSE To evaluate outcomes in pediatric patients undergoing lensectomy, posterior capsulotomy, and triamcinolone-assisted vitrectomy for congenital cataract. METHODS This retrospective study included 34 patients younger than 72 months who underwent lensectomy, posterior capsulotomy, and triamcinolone-assisted vitrectomy with or without intraocular lens (IOL) implantation for cataract at the National Taiwan University Hospital from July 2006 to December 2012. RESULTS Fifty-one eyes from 34 patients with cataract (unilateral in 17 patients, bilateral in 17 patients) were included. The mean age at surgery was 26.74 months (range: 2-72 months). The mean postoperative follow-up was 27.8 months (range: 6-72 months). Primary IOL implantation was performed in 25 eyes, 21 of which had the IOL implanted in the capsular bag. Fifty eyes had a central round pupil. The median logarithm of the minimum angle of resolution visual acuity was 0.3 in patients with unilateral cataract and 0.1 in those with bilateral cataract. Three eyes (5.9%) developed visual axis opacification (VAO) and required further surgery. Univariate analysis using Fishers exact test indicated that surgery in the first 12 months of life was significantly associated with development of VAO (p=0.047). The incidence of postoperative VAO was approximately 15.8% in this age group. CONCLUSION Triamcinolone-assisted vitrectomy can be used in pediatric cataract surgery without serious long-term adverse effects. While the incidence of VAO is low, it appears unavoidable in approximately one-sixth of patients who undergo surgery before 12 months of age.