Long Term Corneal Endothelial Cell Density Loss after Iris-fixed Phakic Intraocular Lens Implantation

PURPOSE: To report three cases of severe endothelial cell density loss after iris claw phakic intraocular lens (Artisan® lens) implantation. CASE SUMMARY: A 32-year-old woman underwent iris claw intraocular lens implantation in both eyes. Preoperative corneal endothelial cell count was 2,556 cells/mm² in the right eye and 2,674 cells/mm² in the left eye. After 4 years, the corneal endothelial cell count was 1,968 cells/mm² in the right eye and 1,997 cells/mm² in the left eye. A 27-year-old woman underwent iris claw intraocular lens implantation in both eyes. Preoperative corneal endothelial cell count was 3,222 cells/mm² in the right eye and 3,122 cells/mm² in the left eye. After 4 years 8 months, the corneal endothelial cell count was 2,729 cells/mm² in the right eye and 2,488 cells/mm² in the left eye. A 39-year-old woman underwent phakic intraocular lens implantation in other clinic, and the lens of left eye was removed the same day because of elevated intraocular pressure. She underwent iris claw intraocular lens implantation in the left eye. Preoperative corneal endothelial cell count was 2,500 cells/mm² in the left eye, which decreased to 1,873 cells/mm² after 8 years. Six months after intraocular lens removal and cataract surgery, her cornea endothelial cell count was 1,412 cells/mm². CONCLUSIONS: Although iris-fixed intraocular lens implantation is safe and effective for correcting myopia, at least 4 years of long-term observation for evaluating corneal endothelial cell density maybe necessary.

Clinical Outcomes of an Optimized Prolate Ablation Procedure for Correcting Residual Refractive Errors Following Laser Surgery

PURPOSE: The purpose of this study was to investigate the clinical efficacy of an optimized prolate ablation procedure for correcting residual refractive errors following laser surgery. METHODS: We analyzed 24 eyes of 15 patients who underwent an optimized prolate ablation procedure for the correction of residual refractive errors following laser in situ keratomileusis, laser-assisted subepithelial keratectomy, or photorefractive keratectomy surgeries. Preoperative ophthalmic examinations were performed, and uncorrected distance visual acuity, corrected distance visual acuity, manifest refraction values (sphere, cylinder, and spherical equivalent), point spread function, modulation transfer function, corneal asphericity (Q value), ocular aberrations, and corneal haze measurements were obtained postoperatively at 1, 3, and 6 months. RESULTS: Uncorrected distance visual acuity improved and refractive errors decreased significantly at 1, 3, and 6 months postoperatively. Total coma aberration increased at 3 and 6 months postoperatively, while changes in all other aberrations were not statistically significant. Similarly, no significant changes in point spread function were detected, but modulation transfer function increased significantly at the postoperative time points measured. CONCLUSIONS: The optimized prolate ablation procedure was effective in terms of improving visual acuity and objective visual performance for the correction of persistent refractive errors following laser surgery.

Clinical Outcomes of Advanced Surface Ablation with Smoothing in High Myopia

PURPOSE: To investigate the results of Advanced Surface Ablation (ASA) coupled with "smoothing" to smooth the ablation surface after covering masking fluid. METHODS: ASA was performed in 61 eyes with ablation depth of more than 75 microm. The mean refractive error was -5.88 +/- 1.27 D and mean ablation depth was 102.93 +/- 12.06 microm. Smoothing was performed in all patients (mean depth 16.79 +/- 2.43 microm, mean diameter 8.77 +/- 0.16 mm). Customized Aspheric Transition zone (CATz) was used in the laser algorithm. RESULTS: The mean refractive error was -0.29 +/- 0.41 D at postoperative 6 months and 97% of patients had an UCVA of 1.0 or better at postoperative 6 months. There was no statistically significant difference in magnitude of high-order aberrations at postoperative 6 months. The magnitude of total spherical aberrations increase was 0.084 microm at postoperative 6 months (p<0.05, paired t-test). The cornea was maintained clear in the majority of eyes. CONCLUSIONS: Excellent results were obtained by ASA coupled with "smoothing" in high myopia patients with an ablation depth greater than 75 microm.

Two-year Endothalial Changes after Iris Fixed Phakic Intraocular Lens Implantation in Korean

PURPOSE: To investigate quantitative and morphometric endothelial changes in phakic eyes implanted with an iris-fixed phakic intraocular lens in Korean patients. METHODS: We prospectively examined the endothelial cell density (ECD), ECD loss (ECL), coefficient variations (CV), and frequency of Hexagons (6A) in 46 phakic eyes implanted with an iris-fixed phakic intraocular lens. The effect of anterior chamber depth (ACD) and diopter of iris-fixed phakic intraocular lens on ECD was statistically analyzed. RESULTS: Preoperative mean ECD was 2923+/-257 cells/mm2. ECL at postoperative 1, 3, 6, 12, and 24 monthswas 0.71%, 0.88%, 0.70%, 0.64%, and 2.34%. It was significant only in the month 24 results. The mean CV value at the same time was 0.343, 0.342, 0.334, 0.329, 0.326, and 0.338. The change was significant at the 12th month. The mean 6A value at the same time was 58.2%, 57.8%, 59.7%, 59.6%, 60.1%, and 58.8%. There was no significant change in 6A value. Preoperative ACD and diopter of iris-fixed phakic intraocular lens didn't affect the ECD change. CONCLUSIONS: This two-year follow-up study of changes in endothelial cells after implantation iris-fixated phakic intraocular lens showed statistically significant decreases in the cells, which is not very significant considering the physiologic reduction rate of the cells. Thses decreases showed a tendency to be stabilized with recovery of morphological changes. Further long-term follow-up is needed to determine its long-lasting effect.

The Clinical Results of 6-mm Iris-Fixated Phakic IOL

PURPOSE: To evaluate the clinical results of 6 mm iris-fixated phakic intraocular lens (Artisan(R) lens) implantation in myopic patients. METHODS: Forty eyes of 23 myopic patients underwent 6-mm Artisan(R) phakic IOL implantation and were followed-up for over 6 months. We prospectively analyzed the efficacy, stability, predictability, change of astigmatism, endothelial cell count, pupil diameter, degree of decentration, subjective satisfaction and complications. RESULTS: The preoperative mean spherical equivalent was -9.46 D, and postoperative spherical equivalent was -0.70D at 1 month, -0.55D at 3 months, -0.54D at 6 months, -0.78D at 12 months and remained stable during the follow-up period. The preoperative mean astigmatism was -1.88D and postoperative astigmatism was -0.87D at 6 months. Postoperative uncorrected visual acuity (UCVA) was more than 0.8 in 85% of the eyes at 1 month, 91% at 3 months, 95% at 6 months, and 89% at 12 months. The spherical equivalent refraction after surgery was within 1.0D of emmetropia in 78% of eyes at 1 month, 80% at 3 months, 88% at 6 months, and 64% at 12 months. There was no significant decrease in the endothelial cell count during the follow-up period. Preoperative scotopic pupil diameters were significantly decreased at 1 month and the mean decentration of the lens was 0.38 mm. Patient satisfaction was generally high. Complications included the transient elevation of intraocular pressure in 1 eye, corneal edema in 4 eyes, iritis in 1 eye, traumatic dislocation in 1 eye and iris atrophy in 2 eyes. CONCLUSIONS: The 6-mm Artisan(R)phakic IOL implantation may be an effective surgical procedure for myopic patients who cannot undergo corneal refractive surgery, as it provided good visual results, predictability, patient satisfaction, and short-term safety.

A Case of Steroid Treatment on Haze after LASIK Retreatment in eye with previous PRK

PURPOSE: A corneal haze after LASIK retreatment in eye with previous PRK has not been reported in Korea. We experienced a case of myopic regression and haze after LASIK retreatment and treated it with fortified steroid eye solution. Herein we will present it. METHODS: A 38-year-old woman underwent the PRK for the correction of myopia in 1994 and the bilateral LASIK retreatment of myopic regression in January 2000. One year later, the left eye showed myopic regression and severe corneal haze but right eye was nearly emmetropia. PredForte(R) was dropped 4 times daily for 3 months, tapered, substituted with Flumetholon(R) for the next 3 months. We observed for 6 months. RESULTS: Three months later, refraction became nearly emmetropic and uncorrected visual acuity was 0.6. Corneal haze, central keratometric and pachymetric value were much decreased. It remained stable for 6 months.

An Association between Apolipoprotein E Genotype and Colonic Adenomas in Korean / 대한소화기내시경학회지

BACKGROUND/AIMS: Apolipoprotein E polymorphism plays an important role in the metabolism of cholesterol and bile acids, which may be related to the development of colorectal adenomas. An association between apolipoprotein E genotype and colonic adenomas has been reported in a western country. This study was designed to determine whether the apolipoprotein E was genotype would be associated with proximal or distal colonic adenomas in Koreans. METHODS: On the colonoscopy, colonic adenomas were found in 132 patients. Proximal colonic adenoma was found in 35 patients and distal colonic adenoma was found in 97 patients. Serum levels of total cholesterol, LDL-cholesterol, HDL-cholesterol and triglyceride were measured. Apolipoprotein E genotype was determined by PCR and allele specific oligonucleotide hybridization. 279 control subjects without an adenoma on the screening sigmoidoscopy were selected randomly. RESULTS: The serum levels of total cholesterol, LDL-cholesterol, HDL-cholesterol and triglyceride did not significantly differ between each adenoma group and control group. The individual frequencies of epsilon2, epsilon3 and epsilon4 alleles in patients with colonic adenomas did not differ from those in control subjects. The frequency of either heterozygote or homozygote for epsilon4 allele in patients with proximal adenoma was lower than that in control subjects (0.029 vs 0.168, p<0.05). CONCLUSIONS: The data suggest that epsilon4 allele may be associated with a lower risk for the development of proximal colonic adenoma in Korean men.

Prevalence and risk factors of gallbladder polyps in health screening subjects / 대한내과학회지

BACKGROUND: Gallbladder (GB) polyps are now increasingly detected by ultrasonography. We investigated the prevalence and risk factors of GB polyps in health screening population. METHODS: An ultrasonographic study of GB polyps were conducted in 35,012 subjects who received a paid health screening examination at Samsung Medical Center. Controls, twice the subjects with GB polyp, were randomly selected from the cases with normal GB. The demographic characteristics and biochemical parameters were recorded. RESULTS: The overall prevalence of GB polyps was 2.94% (1,330/15,573). Among them, 3.63% were men, 2.09% were women. In both males and females, the prevalence was highest in their 40s. The diameter of GB polyps ranged from 2 mm to 20 mm (mean 4.5 mm). Most polyps (98.3%) were less than 10 mm in diameter. Of 1,030 subjects, 64% had a single polyp and 36% had multiple polyps. Multiple logistic regression, with reference group of body mass index (BMI, <22.5 kg/m2), showed odds ratio of 1.074 and 1.864 for BMI groups of 22.5-24.9 and 25 or more respectively. In contrast, other demographic characteristics and biochemical parameters, such as age, smoking, alcohol use, glucose, liver function tests, lipid profiles and HBsAg carriage were lack of any relation to GB polyps. CONCLUSIONS: GB polyps are not likely to be rare in Korean adults despite their low prevalence compared to other reports. The body mass index may be a risk factor for GB polyps.

Postoperative Capsular Bag Distension in Cataract Surgery

We have experienced six cases of postoperative capsular bag distension following continuous curvilinear capsulorhexis(CCC) and phacoemulisification with posterior chamber intraocular lens. Successful CCC, phacoemulsification and in the bag fixation of intraocular lens(IOL) were accomplished, and the optics of the IOL were made of silicone material in 6 cases. We have observed various degree of anterior chamber shallowing, anterior displacement of IOL, bulging of posterior capsule, and myopic shift of refractive error, and these findings improved by YAG laser anterior or posterior capsulotomy. Mean refractive change was +2.6D(diopter) at post-laser 1 day.

A Case of Giant Retinal Tear in Atopic Dermatitis

Retinal detachments occuring in atopic dermatitis patients are usually associated with tears of peripheral retina or nonpigmented epithelium of the ciliary body or retinal dialysis. It has been considered relatively rare, however, its clinical reports have been increasing recently. We experienced a case of atopic dermatitis with retinal detachment of right eye caused by giant retinal tear and retinal tear of left eye in 23-year-old male, we could obtain successful result by treating his right eye with scleral buckling procedure and intravitreal gas injeciton.

Postoperative Changes of Continuous Curvilinear Capsulorhexis

As a growing number of surgeons are perforining cataract extraction by phacoernulsification and the continuous curvilinear capsulorhexis [CCC] has rapidly increased in popularity as the anterior capsulotomy technique, its advantages have been reported recently. But its complications induced by capsular contraction after ccc have been noted, and so we have studied the change in anterior capsular opening area and refractive error after ccc. One surgeon performed cataract extraction using ccc and phacoernulsification, and implanted posterior chamber IOL [optic size 5. 5mm, Pharmacia 812A] in the bag in 48 eyes, and we measured the area of anterior capsular opening and refractive error [spherical equivalent] at I week and 3 months after operation. The average percentage of anterior capsular shrinkage rate at 3 months was 14.8% and showed statistically significant difference [P<0.05], but. had not correlation with initial ccc size. The average refractive change at 3 months was 0. 2D hyperopic shift but did not show statistically significant difference.

Differentiations of Retinal Detachment and Vitreous Membrane Using Color Doppler Imaging

In eyes with media opacity and equivocal ultrasonographic findings, we can differenciate retinal detachment from vitreous membrane using color doppler imaging(CDI), which allows the display of blood flow characteristics on conventional ultrasonography. The authors performed high resolution Bscan ultrasonography and color doppler imaging simultaneously in 31 eyes with opacity of ocular media, and their intraoperative characteristics and post operative results were evaluated. In 30 eyes with retinal detachment or vitreous membrane, 7 eyes(23%) had equivocal ultrasonographic findings and needed color doppler imaging. Nine eyes(75%) had positive color signal in 12 eyes with retinal detachment, whereas 3 eyes negative. 17 eyes(94%) had negative color signal in 18 eyes with vitreous membrane, 1 eye with proliferative diabetic retinopathy had positive. In conclusion, color doppler imaging is a useful diagnostic method in differentiating retinal detachment from vitreous membrane.