Clinical Outcomes of ATOS-mediated SmartSight Lenticule Extraction

Purpose@#To evaluate the clinical outcomes of a new refractive corneal lenticule extraction method (SmartSight) using a Schwind ATOS femtosecond laser (Schwind Eye-Tech-Solutions, Kleinostheim, Germany). @*Methods@#The medical records of 338 eyes of 170 patients who underwent SmartSight treatment from April to September 2022 and were followed-up for at least 3 months were retrospectively analyzed. The patients were followed-up at 1 day, 1 week, and 1 and 3 months after operation. Refraction, visual acuity, and intraocular pressure were measured at each visit. @*Results@#Preoperatively, the uncorrected distant visual acuity was 1.26 ± 0.33 logarithm of minimum angle or resolution (logMAR) and the spherical equivalent was -4.52 ± 1.77 diopters. The 3-month, postoperative, uncorrected distant visual acuity was 0.01 ± 0.03 logMAR and the spherical equivalent was -0.12 ± 0.22 diopters. The 3-month data were as follows: efficacy of refractive surgery, 0.99 ± 0.11; safety, 1.00 ± 0.05; predictabilities at ±0.5 and ± 1.0 diopters, 97% and 100%, respectively. @*Conclusions@#Myopic astigmatism correction using the SmartSight method was effective, safe, and predictable in terms of visual outcomes.

Intraocular Pressure Measurement with the Noncontact Tonometer and Rebound Tonometer through Plano Soft Contact Lenses

PURPOSE: To investigate the accuracy of intraocular pressure (IOP) measurement through a plano soft contact lens (SCL) in situ by a noncontact tonometer (NCT) and a rebound tonometer (RBT). METHODS: The IOP of 66 eyes of 33 subjects with no ocular pathology was measured by NCT (tonometer CT-80, TOPCON, Japan) and RBT (iCare rebound tonometry(TM), Tiolat Oy, Finland). IOP measurement was repeated through plano SCL (ACUVUE OASYS(R), Johnson & Johnson Vision Care Inc., USA) in situ. Statistical analysis was performed using the paired t-test. RESULTS: Mean IOP measured by NCT was 13.10 +/- 2.52 mmHg without SCL and 12.95 +/- 2.56 mmHg with SCL. Mean IOP measured by RBT was 14.13 +/- 2.94 mmHg without SCL and 13.84 +/- 2.75 mmHg with SCL. No significant statistical differences were found between IOP measured with and without SCL (p=0.47, p=0.11 respectively). CONCLUSIONS: Reliable measurement of IOP by NCT and RBT can be achieved through plano SCL.

Ophthalmic Artery Obstruction and Cerebral Infarction Following Periocular Injection of Autologous Fat

We report a case of ophthalmic artery obstruction combined with brain infarction following periocular autologous fat injection. The patient, a 44-year-old woman, visited our hospital for decreased visual acuity in her left eye and dysarthria one hour after receiving an autologous fat injection in the periocular area. Her best corrected visual acuity for the concerned eye was no light perception. Also, a relative afferent pupillary defect was detected in this eye. The left fundus exhibited widespread retinal whitening with visible emboli in several retinal arterioles. Diffusion-weighted magnetic resonance imaging of the brain showed a hyperintense lesion at the left insular cortex. Therefore, we diagnosed ophthalmic artery obstruction and left middle cerebral artery infarction due to fat emboli. The patient was managed with immediate ocular massage, carbon dioxide, and oxygen therapy. Following treatment, dysarthria improved considerably but there was no improvement in visual acuity.

Comparison of Laparoscopic with Open Resections in Colorectal Cancer: Analysis of Short-term Results

PURPOSE: This study aimed to compare the results of laparoscopic resection with those of open resection for consecutive colorectal cancer patients who underwent surgery at a single center. METHODS: During the thirty-month period between January 2003 and August 2005, patients with a colorectal adenocarcinoma admitted to our hospital were assessed. Cancers related with FAP or HNPCC, cancers treated with endoscopy or local excision, and recurrent cancers were excluded from the study. Three hundred two laparoscopic resection patients were matched to 302 open resection patients. RESULTS: The mean age of the laparoscopic resection group was 59.5 years while that of the open resection group was 59.4 years. Patients in two groups were similar in terms of gender distribution, level of CEA and ASA, and location and size of tumor. The modified Dukes' stages showed 51 patients in stage A, 33 in stage B1, 62 in stage B2, 17 in stage C1, and 139 in stage C2 for the laparoscopic resection group and 33 in stage A, 52 in stage B1, 82 in stage B2, 18 in stage C1, and 117 in stage C2 for the open resection group (P=0.024). The operative time averaged 9.6 minutes longer in the laparoscopic group (188.9 vs. 179.3 min, P<0.0001). The rate of stoma formation for protection of anastomosis in the laparoscopic group was 4.9% (5.8% in open group). There were significant differences in blood loss (556.2 vs. 952.8 ml, P<0.0001), the amount of intraoperative blood transfusion (1.6 vs. 2.3 unit, P=0.004), the number of harvested lymph nodes (21.1 vs. 16.9, P<0.0001), and the rate of high ligation of IMA (91.7 vs. 75.5%, P<0.0001). The length of the distal resection margins from cancer was longer in the open group (2.9 vs. 3.5 cm, P=0.037). Patients in the laparoscopic group had a faster recovery of bowel function (P<0.0001) and a significant reduction in the mean length of hospital stay (11.5 vs. 16.8 days, P<0.0001). There was no mortality in either group. Early and late complications were comparable. The conversion rate was 1.6 percent. CONSLUSIONS: The benefits of a laparoscopic resection for colorectal cancers are less blood loss and transfusion, faster postoperative bowel motion, a shorter hospital stay, low morbidity, and a large number of harvested lymph nodes. In conclusion, a laparoscopic resection for colorectal cancers can be done safely and effectively and is an acceptable alternative to a conventional open resection.

Clinicopathologic Characteristics of Colorectal Mucinous Carcinoma

PURPOSE: The aim of this study was to assess the clinicopathological characteristics and prognosis of colorectal mucinous carcinomas. METHODS: 1, 809 patients who underwent curative resection, between January 1989 and December 1999, for colorectal carcinomas, were enrolled in this study. Of these, 128 patients had more than 50% mucin secreting acini that could be classified as the mucinous type. These mucinous carcinoma patients were compared with 1, 681 non-mucinous carcinoma patients, in order to evaluate differences in their clinicopathological characteristics, recurrence pattern and prognosis. RESULTS: The incidence of mucinous carcinomas was 7.1%. The mean age of the mucinous carcinoma patients was younger than the non-mucinous carcinoma patients (P=0.001). The mucinous carcinomas occurred in the right colon more frequently than non-mucinous carcinoma, and the size of the tumor was larger (P<0.001). There were no significant differences in the loco-regional and systemic recurrence rates, but the systemic recurrence pattern of the mucinous carcinomas was different from those of the non-mucinous carcinomas. With a mucinous carcinoma, the most common site for systemic recurrence was the peritoneal metastasis, whereas in a non-mucinous carcinoma, was the liver. There was no significant difference in the 5-year survival rate between the two groups. CONCLUSION: In a mucinous carcinoma, the most common pattern of treatment failure was a peritoneal recurrence. The hepatic recurrence rate of the mucinous carcinomas was less than that of the non-mucinous carcinoma. Therefore, more aggressive diagnostic and therapeutic approaches, under the consideration of peritoneal recurrence in mucinous carcinomas, will be required.

The Impact of Acute Rejection on Long-Term Graft Outcome in Renal Allograft Recipient / 대한이식학회지

Acute rejection after renal transplantation is still the most common cause of graft failure during the early post-transplant period. To determine whether an acute rejection episode adversely affects long-term graft survival, we retrospectively analyzed our single center patients population of 1266 consecutive living donor kidney transplantations performed between April 1984 and October 1995. Five hundred twenty three recipients(41.3%) experienced 711 acute rejection episodes. Among these 711 episodes, 92.6% were respond to anti-rejection therapy and treatment failure rate was 7.6%. Late onset acute rejection, which developed 1 year after transplantation, showed poor treatment response(79.7%). There was statistically significant difference of graft survival rate between acute rejection free group and acute rejection group. Furthermore, the frequency of acute rejection, response rate the steroid pulse therapy and the degree of remission affected the graft survival rate. Donor source impacted on the development of acute rejection-33.1% in living related donor, 39.9% in living unrelated donor and 57.1% in cadaveric donor transplantation. In living related donor kidney transplantations, HLA identical pairs(11%) showed less acute rejection episodes than HLA haplo-identical pairs(38.7%). In living unrelated donor kidney transplantations, HLA antigen match adversely affected the acute rejection rate-43.9%, 35.8% and 30.6% in 1~2, 3 and 4~5 Ag match group, respectively. ABO blood group compatibility, recipient's age and compatibility of HLA DR Ag did not influenced to the development of acute rejection. These results suggest that the acute rejection could be a major determinant of long-term graft outcome.

The Impact of Acute Rejection on Long-Term Graft Outcome in Renal Allograft Recipient / 대한이식학회지

Acute rejection after renal transplantation is still the most common cause of graft failure during the early post-transplant period. To determine whether an acute rejection episode adversely affects long-term graft survival, we retrospectively analyzed our single center patients population of 1266 consecutive living donor kidney transplantations performed between April 1984 and October 1995. Five hundred twenty three recipients(41.3%) experienced 711 acute rejection episodes. Among these 711 episodes, 92.6% were respond to anti-rejection therapy and treatment failure rate was 7.6%. Late onset acute rejection, which developed 1 year after transplantation, showed poor treatment response(79.7%). There was statistically significant difference of graft survival rate between acute rejection free group and acute rejection group. Furthermore, the frequency of acute rejection, response rate the steroid pulse therapy and the degree of remission affected the graft survival rate. Donor source impacted on the development of acute rejection-33.1% in living related donor, 39.9% in living unrelated donor and 57.1% in cadaveric donor transplantation. In living related donor kidney transplantations, HLA identical pairs(11%) showed less acute rejection episodes than HLA haplo-identical pairs(38.7%). In living unrelated donor kidney transplantations, HLA antigen match adversely affected the acute rejection rate-43.9%, 35.8% and 30.6% in 1~2, 3 and 4~5 Ag match group, respectively. ABO blood group compatibility, recipient's age and compatibility of HLA DR Ag did not influenced to the development of acute rejection. These results suggest that the acute rejection could be a major determinant of long-term graft outcome.

The Effect of the Degree of Tumor Necrosis on Survival in Patients with Hepatocellular carcinoma Treated with Curative Resection Following Preoperative Transcatheter Arterial Therapy / 대한암학회지

PURPOSE: To investigate the effect of patient and tumor factors on the degree of tumor necrosis and the effect of the degree of the tumor necrosis on the survival in patients treated with curative resection following transcatheter arterial therapy. MATERIALS AND METHODS: 90 patients diagnosed as having hepatocellular carcinoma and treated with curative resection following transcatheter arterial therapy at Yonsei Medical Center between January 1986 and December 1995. The subjects were classified into four groups: 100% necrosis group (Group I, n=29), over 95% necrosis group (Group II, n=28), 50-95% necrosis group (Group III, n=13) and below 50% necrosis group (Group IV, n=20). The factors which affect on the necrosis of the tumor were compared. The overall and disease-free survival rates according to the degree of tumor necrosis were illustrated. RESULTS: There was no statistical difference in the degree of the tumor necrosis according to age, sex, HBsAg, g-FP, liver cirrhosis, tumor size and morphological classification. In the comparison between the preoperative transcatheter arterial therapies, however, transcatheter arterial chemo-oily embolization (TACOE), which used the injection of the mixture of 3 10 cc Lipiodol and 30-50 mg Adriamycin followed by Gelfoam em- bolization, showed the higher number of 100% necrosis and over 95% necrosis cases. The 1, 3 year overall survival rates were greater for Group I, although not statistically significant. The 1, 5 year disease-free survival rates were greater for Group I, although not statistically significant. CONCLUSION: In the preoperative transcatheter arterial embolization, TACOE was most effective to get total necrosis of tumor. However overall survival and disease free survival were not affected by the amount of tumor necrosis.