Learning Curve in Phaco Chop Cataract Surgery Using an Illuminated Chopper

Purpose@#To confirm that the phaco chop method using an illuminated chopper (iChopper; Oculight, Seongnam, Korea) can reduce cataract surgery complications, and that even beginners can safely and effectively perform phaco chop. @*Methods@#We retrospectively analyzed the medical records of the first 30 phaco chop cases using illuminated chopper of four cataract surgeons. Four ophthalmologists had a variety of empirical backgrounds, from those who have experienced more than 10,000 cataract surgery, to beginners who have experienced 20 cataract surgery. @*Results@#Of the total 120 eyes, two eyes (1.67%) had posterior capsule rupture. The chopping method was changed from phaco chop to stop and chop in three eyes (2.5%) including one eye with brown cataract with pseudoexofoliation syndrome and two eyes with nuclear opacity grade ≥5. @*Conclusions@#The rates of posterior capsule rupture of phaco chop using an illuminated chopper were very low in four surgeons with various experiences and who became proficient shortly in phaco chop.

Illuminated Chop Using an Illuminated Chopper in Cataract Surgery: on the Way to Minimal-energy Phacoemulsification

Purpose@#To minimize ultrasound power use and surgical phaco time in illuminated chop cataract surgery. @*Methods@#The charts of patients who underwent senile cataract surgery by a single surgeon were reviewed retrospectively. A conventional intracameral endoilluminator was used in a Stop & Chop group (n = 45), while an illuminated chopper was used in an illuminated chop (I-Chop) group (n = 71). EFX, a unitless value that roughly correlates with ultrasound energy during phacoemulsification, surgical phaco time, and changes in endothelial cell count were compared between the two groups and the ratio of zero phacoemulsification in the I-Chop group was evaluated. @*Results@#EFX of the Stop & Chop and I-Chop groups was 18.08 ± 16.15 and 0.82 ± 3.53, respectively (p = 0.001), while the surgical phaco time was 185.08 ± 41.42 and 162.04 ± 49.65 seconds (p = 0.01). However, the endothelial loss did not differ in the two groups (7.03 ± 7.89 vs. 7.13 ± 9.47%, p = 0.76). In the I-Chop group, 56 (86%) eyes had zero phaco energy and patients with EFX >1 (n = 6) had more severe nuclear sclerosis grading (2.90 ± 0.71 vs. 4.5 ± 1.0; p = 0.001). @*Conclusions@#The I-Chop group had lower EFX and shorter surgical phaco time than the Stop & Chop group. Illuminated chop using an illuminated chopper is one way to attain minimal phacoemulsification.

Relationship between Bone Mineral Density and Spinal Muscle Area in Magnetic Resonance Imaging

BACKGROUND: Bone mineral density (BMD) is known to have a positive correlation with lean body mass. Several studies have also reported the positive correlation between muscle power and BMD. From this point of view, we hypothesized BMD of lumbar spine to have a positive correlation with muscle mass. METHODS: Seventy-nine female patients aged between 60 and 75 years old and who underwent magnetic resonance imaging (MRI) and BMD studies were included. Muscle mass in spine MRI was defined by the sum of the average muscle area of three axial images for each disc level. Lumbosacral muscle is the sum of paraspinal muscle and psoas muscle. RESULTS: In correlation analysis, paraspinal muscle mass showed positive correlation with BMD of lumbar spine. Lumbosacral muscle mass showed positive correlation with BMD of trochanteric area of the femur. However, BMD of other area showed no significant correlation with muscle mass. CONCLUSIONS: Therefore, postmenopausal women older than 60 years with a well developed spine muscle mass, have a high BMD.

Case of Macular Hole after Surgery in Macular Detachment with Optic Disc Pit in a Child

PURPOSE: To report a case of macular hole after surgery in macular serous detachment associated with optic disc pit in a child, which was treated with silicone oil as an intraocular substitute. CASE SUMMARY: A 12-year-old boy was referred for examination due to visual disturbance in his left eye for the last 1 week. Corrected visual acuity at presentation was 0.08 in the left eye. The anterior part of the left eye was normal on slit lamp examination. Funduscopic examination revealed optic disc pit associated with macular detachment. The patient was treated with vitrectomy, internal limiting membrane (ILM) peeling and gas tamponade. One week after treatment, the patient presented with central visual disturbance and showed a full thickness macular hole in the left eye. Extensive ILM peeling and silicone oil instillation were performed and after 2 months, silicone oil removal was performed. The macular hole appeared to be closed and visual acuity improved to 0.2. Recurrence was not observed until 20 months after treatment. CONCLUSIONS: After surgical treatment due to macular detachment associated with optic disc pit in a child, occurrence of a macular hole is possible. Regarding macular hole treatment, silicone oil instillation and fast removal could be a beneficial option.

A Case of Episcleritis as a Manifestation of Neurosyphilis

PURPOSE: To report a rare case of episcleritis as the only manifestation of neurosyphilis. CASE SUMMARY: A 40-year-old female was referred to the outpatient clinic because of right episcleritis that was unchanged during the month of treatment. Her headache persisted, and slit lamp examination showed tortuous congestion of engorged episcleral vessels with swelling in the superior-temporal region of the right eye, but fundus and radiological studies showed normal findings. Serological tests were reactive for venereal disease research laboratory test, treponema pallidum hemagglutination assay test, and fluorescent treponemal antibody absorption test. Under the suspicion of persistent syphilis infection, cerebrospinal fluid examination was performed, and the diagnosis of neurosyphilis with episcleritis was diagnosed. Treatment consisted of intravenous injections of 5 million IU penicillin G potassium every 4 hours for 14 days. The ocular inflammation resolved within the first week of treatment and did not recur. CONCLUSIONS: We report a case of intractable episcleritis that required examination for syphilitic infection using serological and CSF tests, and the appropriate antimicrobial therapy for syphilis with follow-up examinations.

Comparison of Postoperative Visual Field and Nerve Fiber Layer Change in Rhegmatogenous Retinal Detachment

PURPOSE: To compare the visual field and retinal nerve fiber layer of scleral buckling (SB) and primary pars plana vitrectomy (PPV) for treatment of simple rhegmatogenous retinal detachment (RRD). METHODS: We studied 20 eyes with RRD that were underwent successful surgical reattachment. Visual field test and retinal nerve fiber layer (RNFL) thickness measurements were performed in patients, and outcomes were compared not only between the operated eye and fellow eye, but also between SB and PPV 3 months postoperatively. RESULTS: After the operation, PSD and MD were higher in the operated eye than in the fellow eye (p = 0.002, p < 0.001, respectively). RNFL thickness was lower in the operated eye than in the fellow eye (p < 0.001). No significant differences in BCVA were detected between SB and PPV. However, the respective differences between the operated eye and fellow eye regarding pattern standard deviation (4.0 +/- 4.0, 0.7 +/- 1.5), mean deviation (6.5 +/- 4.6, 1.9 +/- 1.9), and RNFL (8.2 +/- 10.3 microm, 1.8 +/- 2.7 microm) were significantly higher in PPV than in SB. CONCLUSIONS: Both visual field defect and retinal nerve fiber damage are significantly larger in PPV than in SB.

Effect of 23-gauge Sutureless Vitrectomy & Preoperative Bevacizumab on Results of Diabetic Vitrectomy

PURPOSE: To investigate the results of 23-gauge sutureless vitrectomy and preoperative bevacizumab in diabetic retinopathy cases. METHODS: A total of 212 eyes received pars plana vitrectomy by a single surgeon for proliferative diabetic retinopathy and were followed up for at least 6 months. The change of visual acuity and operative complications among the 20-gauge vitrectomy (group I, 86 eyes), 23-gauge vitrectomy (group II, 30 eyes), and 23-gauge vitrectomy with preoperative intravitreal bevacizumab (IVB) injection (group III, 96 eyes) were retrospectively analyzed. RESULTS: One month postoperatively, visual improvement was better in groups II and III than in group I. Three months postoperatively, visual improvement was better in group III than in groups I and II. Six months postoperatively, visual improvement in group III was better than in group I, but there was no significant difference between group II and III. Intraoperative retinal breaks and postoperative vitreous hemorrhage were less common in group III than in groups I and II. CONCLUSIONS: In patients with proliferative diabetic retinopathy, 23-gauge sutureless vitrectomy showed faster visual recovery compared with 20-gauge vitrectomy, and vitrectomy with preoperative bevacizumab had less intraoperative and postoperative complications than vitrectomy without preoperative bevacizumab.

Leber's Idiopathic Stellate Neuroretinitis with Peripapillary Serous Retinal Detachment

PURPOSE: To report a patient with Leber's idiopathic stellate neuroretinitis accompanying peripapillary sensory retinal detachment detected with optical coherence tomography. CASE SUMMARY: A 26-year-old woman complained of visual disturbance in her right eye for several months. Her best corrected visual acuity was 0.5 in the right eye and 0.9 in the left eye. A relative afferent papillary defect was present in the right eye. Severe disc swelling with retinal hemorrhage and stellate macular exudates were observed in the right eye. Fluorescein angiography revealed optic disc leakage. There appeared to be no leakage from the other retinal vessels or from the retinal pigment epithelium. OCT revealed outer nuclear-plexiform layer fluid accumulation in the papillomacular region. Eight weeks after steroid treatment, the best corrected visual acuity in the right eye had improved to 0.7, and the optic disc edema had improved. The OCT showed that the fluid in the outer nuclear-plexiform layer space had largely been absorbed.

Choroidal Ischemia and Serous Macular Detachment Associated with Severe Postoperative Pain

To report the association of a unilateral serous macular detachment with severe postoperative pain. A 71-year-old woman presented with a sudden decrease in vision in the right eye, seven days after a total knee replacement arthroplasty. The patient's history was unremarkable except for a severe pain greater than the visual analog scale of 8 points for about 2 days after surgery. Retinal examination showed a well differentiated serous detachment that was about 3.5 disc diameter in size and located in the macular area. Fluorecein angiography and indocyanine green angiography showed delayed perfusion of the choriocapillaris without leakage points in the early phase and persistent hypofluorescence with pooling of dye in the subretinal space in the late phase. There was a spontaneous resolution of the serous detachment and the choroidal changes with residual pigment epithelial changes. Severe postoperative pain may influence the sympathetic activity and introduce an ischemic injury with a focal, choroidal vascular compromise and secondary dysfunction of overlying RPE cells in select patients.

The Effect of Intravitreal Triamcinolone Injection According to the OCT Patterns of Diabetic Macular Edema

PURPOSE: To determine the preoperative factors of different types of diabetic macular edema (DME) classified using Optical Coherence Tomography (OCT) and to evaluate the short-term therapeutic effects and pattern changes of intravitreal triamcinolone acetonide injection (IVTA). METHODS: Seventy-seven eyes of 60 patients, who had been previously diagnosed with DME through fundoscopy and fluorescein angiography, were enrolled, and each patient was classified as one of three DME types according to his/her OCT features: Type 1, diffuse retinal thickening; Type 2, cystoid macular edema; and Type 3, serous macular detachment. We compared age, sex, the duration of diabetes mellitus (DM), and decreased visual acuity (VA). We analyzed VA, intraocular pressure (IOP), foveal thickness (FT), total macular volume (TMV), and pattern changes that occurred between pre-operation and 1 month post-operation. RESULTS: The duration of DM was short in Type 3 DME patients. There were no differences in age or the duration of decreased VA. Pre-operative VA was higher in Type 1 than in Type 2 or 3 patients. FT and TMV increased in thickness from Type 1 through Type 3. VA after IVTA improved in Types 2 and 3. FT and TMV after IVTA decreased in each type. However, the extent of the changes in Types 2 and 3 was greater than that in Type 1. Seventy-four percent of Type 2 and 83% of Type 3 changed to Type 1 after IVTA. CONCLUSIONS: This study found that there were differences in the therapeutic effect of IVTA among patients with different DME patterns. According to our results, the effectiveness of IVTA can be predicted, which we believe will help to objectively determine DME treatment.

Intravitreal Injection of Triamcinolone Acetonide for Macular Edema : Long-term Safety and Efficacy after Two Years

PURPOSE: To evaluate the 2 year safety and efficacy of intravitreal injection of triamcinolone acetonide in macular edema associated with diabetic retinopathy and retinal vein occlusion. METHODS: Medical records of patients who underwent an intravitreal injection of 4 milligrams of triamcinolone acetonide for macular edema due to diabetic retinopathy and retinal vein occlusion from September 2002 to March 2004 were reviewed retrospectively. Out of 108 eyes, 50 eyes, which allowed for continuous follow-up, were chosen. The measured results included visual acuity (ETDRS), macular thickness (OCT), intraocular pressure, formation or progression of cataract, and additional intervention. RESULTS: Out of 50 eyes, 17 eyes (34%) showed steady improvement of visual acuity and macular thickness in during the follow up period. Out of 17 eyes, 15 eyes underwent additional laser photocoagulation before or after injection. Significant elevation of IOP developed in 5 eyes (10%). Cataract progressed in 7 phakic eyes (14%) required operation. CONCLUSIONS: Additional treatments such as laser photocoagualtion appear to enhance the duration of efficacy in intrvitreal triamcinolone for macular edema.

Lens Particle Glaucoma with Intraocular Foreign Body

PURPOSE: To report a case of acute lens particle glaucoma with an intraocular foreign body that persisted for a long duration. CASE SUMMARY: A 47-year-old man visited our clinic due to severe pain in his right eye. His uncorrected visual acuity was hand movement, and intraocular pressure (IOP) measured by a Goldmann applanation tonometer was 76 mmHg in the right eye. Severe corneal edema and floating lens materials in the anterior chamber were revealed by slit-lamp examination. An ultrasonography scan showed that the lens had dislocated into the vitreous cavity and revealed vitreous opacities. To remove lens materials and control IOP, anterior chamber irrigation and trans pars plana vitrectomy with lensectomy were performed under local anesthesia. During the operation, an intraocular foreign body was removed from the anterior chamber. Dislocated lens particles were removed by vitrectomy. After the operation, his best corrected visual acuity was 1.0, and intraocular pressure was 12 mmHg in the right eye. CONCLUSIONS: Close observation is needed in cases with lens particle glaucoma, because a long-persisting intraocular foreign body can be accompanied by lens particle glaucoma.

Result of PCL Substitution Type Total Knee Arthroplasty with Scorpio(R) System (minimum 3-year follow up) / 대한정형외과학회잡지

PURPOSE: To evaluate the clinical and radiologic result of total knee arthroplasty using Scorpio. total knee system retrospectively. MATERIALS AND METHODS: Between January 1999 and December 2001, 71 knees in 51 patients who had been followed up mean 3.6 years (minimum 3.0 years) after total knee arthroplasty with Scorpio(R) system (posterior substitution type) were evaluated retrospectively for clinical result, active range of motion, flexion contracture and radiologic result. RESULTS: The average active range of motion increased from 108degrees (75-144degrees) preoperatively to 120degrees(90-144degrees) at last follow up. The average flexion contracture improved from 12degrees(0-30degrees) preoperatively to 2degrees(0-13degrees) at last follow up. The average HSS knee score was measured 54 preoperatively and was measured 88 postoperatively. There was no difference in clinical result, active range of motion and flexion contracture between resurfaced patella group and nonresurfaced patella group. Radiologic evaluation revealed radiolucency rate of 11% in Tibia anteroposterior view and 10% in femur. Complications were periprostheitc fracture in one case, deep infection in one case and peroneal nerve palsy in one case. In one case, femoral and tibial component migration due to aseptic loosening was noted. Revision of tibial and femoral component was done. CONCLUSION: The 3.6 years follow up results of Scorpio(R) system (posterior substitution type) were excellent in range of motion and function. There was no difference between resurfaced patella group and nonresurfaced patella group in clinical result.

The Optical Coherence Tomography Analysis of Hyperfluorescence by Scanning Laser Ophthalmoscope in Central Serous Chorioretinopathy

PURPOSE: To analyze the optical coherence tomography (OCT) result at the area of hyperfluorescence by scanning laser ophthalmoscopy (SLO) in central serous chorioretinopathy. METHODS: We investigated sensory detachment, pigment epithelial detachment (PED), choroidal neovascularization (CNV), and retinal pigment epithelial atrophy using OCT in the area of hyperfluorescein by scanning laser ophthalmoscopy (SLO) in 29 eyes of 29 patients with CSC. RESULTS: Of 29 eyes, no specific finding was noted in 19 eyes. Small PED corresponding to the leaking point was noted in 3 eyes, large serous PED with leaking point in 2 eyes, hemorrhagic PED in 1 eye, subretinal precipitate and PED in 1 eye, and retinal pigment epithelial atrophy in 2 eyes. CONCLUSIONS: OCT provided intuitive and objective information on the pathophysiologic state of the retinal pigment epithelial layer at the area of hyperfluorescence by SLO in CSC.

Quantitative Analysis of Macular Thickness with OCT Map

PURPOSE: To analyse the macular thickness in normal and diabetic patient using OCT mapping protocol. METHODS: OCT using macular thickness map protocol was performed in 46 eyes of 25 healthy volunteers and 121 eyes of 85 diabetic patients with clinical diagnosis of no diabetic retinopathy (25 eyes), nonproliferative diabetic retinopathy (NPDR) without clinically significant macular edema (CSME; 35 eyes), proliferative diabetic retinopathy (PDR) without CSME (27 eyes), and diabetic retinopathy with CSME (34 eyes). RESULTS: The mean +/- standard deviation foveal thickness was 146 +/- 21 micrometer in normal eyes, 147 +/- 20 micrometer in diabetic eyes without retinopathy, 173 +/- 24 micrometer in NPDR without CSME, 174 +/- 27 micrometer in PDR without CSME, and 322 +/- 146 micrometer in diabetic retinopathy with CSME. There was significant difference in foveal and outer temporal retinal thickness between the normal eyes and the diabetic retinopathy without CSME group (p<0.01). Diabetic eyes with CSME had a statistically significant greater thickness in each of the areas compared with the other group and showed perifoveal focal macular edema in 5 eyes. CONCLUSIONS: OCT mapping protocol provide intuitive and objective information on focal diabetic macular edema.

Intramedullary Nailing for the Fracture of Proximal Humerus

PURPOSE: To evaluate the clinical and radiological result of the treatment for the fracture of proximal humerus using intramedullary nail. MATERIALS AND METHODS: Nine cases with fractures around the shoulder joint treated with Polarus IM nail from February 1999 to June 2002 was selected. There were 1 case with segmental fracture, 2 cases with nonunion after conservative treatment, 3 cases with nonunion after IM nail, 1 case with nonunion after pinning, 1 case with metal failure after plate fixation, and 1 case with fracture combined with shoulder dislocation. Bone union was evaluated with simple radiographic findings, and functional evaluation was done using Kona evaluation method. RESULTS: The average follow up period after the operation was 16 months and the average duration of immobilization was 2 weeks. All cases showed radiographic union and the average duration until union was 3.1 months. On the functional evaluation using Kona evaluation method, 3 cases excellent, 3 cases good, 2 cases fair, and 1 case showed poor result. The cases with poor result had combined elbow, forearm, and hand fractures at the initial injury. The complication of periprosthetic fracture caused by repeated trauma was reported in 1 case. CONCLUSION: Polarus IM nailing can result in good clinical and functional results for the treatment of nonunion, plate failure, segmental fracture and fracture of proximal humerus with shoulder dislocation.

A Case of Sarcoidosis Misdiagnosed as Tuberculosis in the Early Phase

PURPOSE: Sarcoidosis is a multsystem granulomatous disorder of an unknown etiology. In the early phase, sarcoidosis is clinically similar to the tuberculosis. In the Korea, few case have been reported. We experienced a case of sarcoidosis that was diagnosed with an ocular examination and corresponded with a systemic investigation. We report a case of sarcoidosis. METHODS: The authors experienced a case of sarcoidosis in a 33-year-old female who was given an incorrect diagnosis of tuberculosis in the early phase. The ocular examination revealed an anterior chamber cell and flare, posterior synechia, periphlebitis, and discitis. A systemic investigation yielded an increase in ACE (angiotensin converting enzyme) and an abnormal 67-Gallium-scintigraphy. RESULTS: The antituberculosis agents were stopped and the patient was started on systemic steroid, prednisolon 60mg once daily for 4weeks, which was slowly tapered off over subsequent 8 weeks. Good results were obtained.

A Case of Traumatic Globe Luxation

PURPOSE: The globe luxation is a rare phenomenon in which there is a forward displacement of the eye ball so that the eye lids spasmodically close behind it. In Korea, no case has been reported. The authors experienced a case of globe luxation by laceration of the conjunctiva with trauma. METHODS: The authors experienced a case of globe luxation in 64-year-old male who had crushed with infantile marry-go-round handle and complained proptosis and ocular pain. Ocular examination revealed best corrected visual acuity of right eye 0.1, IOP 44mmHg, conjunctival hyperemia and laceration, extraocular muscle limitation in all direction. Exophthalmometer shows right eye 23mm, left eye 19mm. Orbital CT yielded proptosis and globe luxation without avulsion of internal and external rectus muscle and optic nerve. RESULTS: After the lateral canthotomy, we successfully treated with the corticosteroid therapy without visual impairment or eyeball movement disorder. we report a case of globe luxation with the review of literature.

Clinical Experiences of Venous Stent for Deep Vein Thrombosis in the Lower Extremity

PURPOSE: To evaluate the efficacy of venous stenting in the treatment of venous obstruction or stenosis of symptomatic deep vein thrombosis (DVT). METHOD: Eight consecutive patients with lower extremity DVT underwent venous stenting. The duration of symptoms were 20 days or less in 6 cases (acute) and above than 20 days in 2 cases (chronic). The cause of DVT was venous thrombophlebitis in 7 cases and extrinsic compression in 1 case. The indication of venous stenting is venous obstruction or stenosis after aspiration thrombectomy and direct catheter thrombolysis. The exclusion criteria were successful treatment of DVT with aspiration thrombectomy, direct catheter thrombolysis and percutaneous angioplasty. The follow-up examination was performed 1 week, 2~3 month interval by Doppler ultrasound, which was evaluated thrombi formation and patency of venous stenting. If the lesion detect in Doppler, second intervention was performed. RESULT: The venous stenting was successfully performed in all cases. Initial aspiration thrombectomy was performed in all cases. The urokinase was performed in 4 cases which was 500,000~750,000 IU (mean, 675,000) during from 2 to 8 hours (mean, 4). After that, the venous stenting was performed at the site of the venous occlusion and stenosis. The direct venography after stenting showed good reconstruction of vein and adequate restoration of venous flow. Seven patients relieved from lower extremity swelling without recurrence. One patient had re-thrombosis after venous stenting, which was successfully treated with percutaneous angioplasty. The follow-up duration was from 3 to 14 months (mean, 8 months). There were no thrombi in follow-up Doppler and normal regular life was resumed without lower extremity swelling. CONCLUSION: Venous stenting in the treatment of deep vein thrombosis is an effective and safe treatment method in the venous obstructive or stenotic remnant lesion despite following aspiration thrombectomy, direct catheter thrombolysis and percutaneous angioplasty.

Expression Pattern and Prognostic Correlation of BAG - 1 Protein in Breast Cancer / 대한암학회지

PURPOSE: The objective of this study was to understand the expression of BAG-1 in the human breast cancer. MATERIALS AND METHODS: We studied its expression in one hundred and thirteen patients diagnosed with breast cancer in Dong-A university hospital between 1992 and 1996 by performing immunohistochemical staining with BAG-1 monoclonal antibody. RESULTS: Of the 113 breast carcinoma examined, 62.0% were positive for BAG-1 cyto- plasmic expression, 28.0% were positive for nuclear BAG-1 expression and 9.7% were positive for both BAG-1 cytoplasmic and nuclear expression. The higher histologic grade was correlated with the higher cytoplasmic expression (p<0.05). Except for histologic grade, no correlation was observed between BAG-1 expression and conventional prognostic factors such as age, menopausal status, metastatic status of the axillary lymh nodes, cathepsin-D, p53, C-erbB-2, DNA ploidy, S-phase fraction, PCNA (proliferating cell nuclear antigen). CONCLUSION: The high histologic grade was found to correlate with positive BAG-1 cyto- plasmic staining which did not correlate with conventional prognostic factors. Our data indicate that furthermore investigation is warranted to define the role of BAG-1 as an meaningful prognostic factor in patients with newly diagnosed breast cancer.