Epidemiologic and Genetic Studies of Keratoconus Patients in Korea

PURPOSE: To report the characteristics and genetic epidemiology of keratoconus patients in the Korean population based on questionnaires, ophthalmologic findings, and genetic studies. METHODS: From September 2007 through August 2009, an epidemiologic investigation was performed through questionnaires and ocular examination of 190 keratoconus patients. To investigate the genetic cause, blood samples were taken from the keratoconus patients. Genetic analysis of keratoconus was performed through the analysis of sensitive candidate genes. RESULTS: The mean age of the study subjects was 29.6 years. Seventy-seven percent of the subjects rubbed their eyes with 17 percent suffering from atopy, allergy, and asthma. Thirty-two percent of subjects demonstrated Vogt's striae as the most frequent biomicroscopic keratoconus finding. No family history was found. Genetic analysis showed sensitive genetic variations of VSX1, LUM, and IL1B. CONCLUSIONS: Epidemiology of Korean keratoconus patients was investigated through research and genetic study resulting in discovery of sensitive genes.

Early Corneal-Thickness Changes after Penetrating Keratoplasty

The functional restoration of the corneal endothelium is vital to the success of penetrating keratoplasty and essential in maintaining corneal clarity. The corneal thickness is the important prognostic factors for penetrating keratoplasty and evaluated with pachymetry. We studied the serial corneal thickness change after penetrating keratoplasty to evaluate the integrity of the corneal endotehlium and to determine the prognostic value. We found the Pearsons coorelation coefficient and evaluate the effect of following parameters with such as donor age, donror cornea status, enucleation time, corneal storage time, preoperative diagnosis, operation methods, lens status and post operative course on the changes of corneal thickness. The central corneal thickness was measured in 41 eye and averaged 0.716 mm. in the post operative 1 day. Average central corneal thickness progressively decreased following penetrating keratoplasty and reached the stabilization of corneal thikckness at the postoperative 30 days with 0.537mm. Factors influencing on the corneal thickness are lens status, combined procedure with keratoplasty, longer enucleation time, complications during the follow-up course.

Result of Unilateral Medial Rectus Recession in Moderate Angle Esotropia

We analysed the results of residual esotropia with deviation of 15 to 35 prism diopters after a full correction with bimedial rectus recession and unilateral medial rectus recession. The remained mean deviation at postoperative 2 months was 6.17 prism diopters in unilateral MR recession group and 4.23 prism diopters in BMR recession group. The success rates were 75% in unilateral MR recession group and 87% in BMR recession group at postoperative 2 months, 56% in unilateral MR recession group and 89% in BMR recession group at postoperative 6 months. The difference of success rates in two groups at 2 months is not significant statistically but the success rate of BMR recession group at 6 months was higher than that of unilateral MR recession group significantly. There were no significant differences in success rate and residual deviation between the groups of nonaccomodative, partially accomodative esotropia, and all esotropias under 20 prism diopters. In conclusion, unilateral MR recession is considered as very useful surgical procedure in all kinds of esotropia under 20 prism diopters. But further study in the moderate degree esotropia over 20 prism diopters is need.

Postoperative Binocularity and Binocular Visual Field in Long-standing Strabismus

We compared preoperative binocularity and binocular visual field with postoperative ones in heterotropic patients without any treatment during the critical period for the development of binocular visual function. Nineteen patients were enrolled: seven of them had esotropia and twelve patients had exotropia. All of them showed suppression of deviating eye. The mean preoperative extent of binocular visual field measured by Goldmann perimeter was 112.1 degrees(+/-20.3) in esotropia, 114.4 degrees(+/-9.5) in exotropia. In postoperative Bagolini test, six of esotropic patients (85.7%) and twelve exotropic patients (100%) showed fusion. In Titmus test, one case of esotropic patient (14.3%) showed stereopsis of 100 arc of second while seven cases of exotropic patients(58.3%) showed stereopsis of 100 arc of second or more. Mean postoperative extent of binocular visual field was 113degree(+/-13.5) in esotropia and 112.9degree(+/-7.4) in exotropia. There was no significant difference between pre- and post operative extent of binocular visual field. Conclusively, we suggest the binocularity could be improved by the surgical alignment in adults with long-standing strabismus. We could not observe, however, any significant difference between pre- and postoperative extent of binocular visual field.

A Case of Multiple Skeletal Tuberculosis with Spina Ventosa: A Case Report / 대한정형외과학회잡지

A case of multiple skeletal tuberculosis with spina ventosa proved by radiological and pathologicaI methods in 3 year old Korean male child is reported. It was treated with antituberculous chemotherapy (triple method of PAS, INAH, streptomycin). At follow up check within 2 years, we obtained good healing process without other complication.

A Case of Atraumatic Aseptic Necrosis of Both Talus: A Case Report / 대한정형외과학회잡지

We report one case of aseptic necrosis of both talus which has developed without any evidence of previous trauma. Aseptic necrosis of the talus is known to occur after any trauma which result in iterruption the blood supply to talus. Atraumatic aseptic necrosis of talus is extremely rarre condition. Some cases of atraumatic aseptic necrosis of talus were repoted by some authers, in whom Garcia described the first case in 1928. Most of the reported atraumatic aseptic necrosis were due to long term steroid therapy for unrelated medical problems and others were related to Alcoholism, Sepsis and Tuber culosis. ln this case we think for it may be caused or contributed by steroid therapy.

Familial Absence of the Patella: A Report of three Members is a Family / 대한정형외과학회잡지

Bilateral absence of the patella as an isolated congenital abnormality is an extremly rare condition. Three members in a family were found to be afflicted with the condition. Clinical examination failed to reveal any stigmata of hereditary osteo-onychodysplasia.

The Conservative Treatment of Congenital Torticollis / 대한정형외과학회잡지

The analysis of 48 infants of congenital torticollis and the result of their conservative treatment are reported. The abnormalities of their neck were noticed by mothers within three months of infant life but mostly at three to four weeks. The ratio of male to female was 9:7 and incidence of right and left was 30 to 18. The mass located mostly(50%) at middle third of the sternocleidomastoid muscle belly. The prominence of incidence were noticed on the abnormality of fetal position in the uterus, mode of delivery and also on the baby of elderly primipara. About 67% of cases were breech(46%) and transverse(21%) position prenatally and 67% were delivered by forceps(41.7%), vacum and induction(12.5%each). The age of mother at delivery has close relationship between congenital torticollis with about two third of them are born of 29–34 year old mother and primipara infants were 61%. For the treatment, daily stretch exercises of affected sternocleidomastoid muscle was done by physical therapist for 20–30 times in two separate session. The effect can be noticed by the gradual correction of rotation deformity first and then the mass become soften and smaller. The next change is the correction of deviation deformity but the mass remain last. However, the mass remaining one fourth of original size was absorbed spontaneously without further treatment. The result of complete cure in ten weeks of treatment were 43(90%) out of 48 patients and the remianing five cases required for 15 weeks of treatment. In conclusion the congenital torticollis can be treated effectively by stretch exercises when it began within three months of age of the patient. A hundred per cent effect of cure may be obtained in ten weeks of treatment in case of initial treatment is begin within four weeks of age and required for 15 weeks of treatment on 4–12 weeks old infants.

A Case of Desmoid Tumor / 대한정형외과학회잡지

A case report of desmoid tumor(musculo-aponeurotic fibromatosis) arising from sternum and upper part of anterior sheath of rectus abdominis muscle in a one and half years old male child is reported. The patient's parent noticed a protruding hard mass on the lower end of sternal portion two weeks previous to surgery. The mass had dense, grayish white and glistering character invading the upper part of rectus abdominis muscle and cartilagenous portion of sternum including xyphoid process. Wide excision of mass including myo-fascial tissue of the rectus abdominal apponeurosis was performed. The excised mass was 4×4×2cm in size and the microscopic findings were typical desmoid tumor. The operative wound had partial skin necrosis due to poor circulation of skin because of the mass extended up to subcutaneous tissue and biopsy scar but eventually healed. There is no any signs of recurrence of tumor on 7 months postoperative follow up but may need more observation to define it.