Predictive Accuracy of Refraction after Transscleral Fixation of Intraocular Lenses in Trabeculectomized Eyes with Glaucoma

Purpose@#To investigate the predictive accuracy of refraction and any change in intraocular pressure (IOP) after transscleral fixation of intraocular lenses (IOLs) in trabeculectomized eyes with glaucoma. @*Methods@#We retrospectively reviewed the medical records of glaucoma patients who underwent trabeculectomy, followed by transscleral fixation of dislocated IOLs combined with vitrectomy. The refraction predicted by the SRK/T formula and the postoperative refraction were converted into spherical equivalents. Predictive refraction accuracies were analyzed when the differences between the two values were within ± 0.5 diopters (D) and ± 1.0 D. The IOP was measured before and after surgery. @*Results@#Eleven eyes of 11 men (mean age, 67.27 ± 10.55 years) were included. The mean axial length was 23.64 ± 1.26 mm; the mean predicted and postoperative refractions were -0.02 ± 0.46 D and -0.80 ± 0.98 D, respectively (p = 0.029). The refractive outcome was more myopic (by -0.78 ± 1.11 D) than predicted. The predictive accuracies were 36.4% and 72.7% when the differences were ± 0.5 and ± 1.0 D, respectively. The IOP did not change during follow-up (13.18 ± 4.56, 12.82 ± 5.88, and 12.73 ± 4.58 mmHg at baseline, 1 week, and 3 months, respectively). @*Conclusions@#In trabeculectomized eyes, transscleral IOL fixation did not affect the IOP, but the refractive outcome was more myopic than predicted. This difference should be considered when choosing IOL target power.

Spontaneous Improvement of Visual Function in Suprasellar Meningioma

Purpose@#To report a case of spontaneously improved visual acuity in a patient with suprasellar meningioma.Case summary: A 55-year-old female presented with decreased visual acuity for 1 week. She had chronic headache and ocular pain. Her visual acuity of the right eye was 0.1 and temporal and inferior visual field defects were found. Relative afferent pupillary defect was observed in the right eye. On orbital magnetic resonance image, a homogenous enhancing mass with a broad dural base at the jugum sphenoidale was found. This was likely to represent a meningioma and was referred to neurosurgery. The patient refused the surgery and did not receive any treatment. After 1 month, the visual acuity of the right eye improved to 0.5. The improved vision remained until 6 months later. @*Conclusions@#Visual loss associated with meningioma can spontaneously improve and this should be considered when making diagnostic and treatment decisions for meningioma.

Spontaneous Improvement of Visual Function in Suprasellar Meningioma

Purpose@#To report a case of spontaneously improved visual acuity in a patient with suprasellar meningioma.Case summary: A 55-year-old female presented with decreased visual acuity for 1 week. She had chronic headache and ocular pain. Her visual acuity of the right eye was 0.1 and temporal and inferior visual field defects were found. Relative afferent pupillary defect was observed in the right eye. On orbital magnetic resonance image, a homogenous enhancing mass with a broad dural base at the jugum sphenoidale was found. This was likely to represent a meningioma and was referred to neurosurgery. The patient refused the surgery and did not receive any treatment. After 1 month, the visual acuity of the right eye improved to 0.5. The improved vision remained until 6 months later. @*Conclusions@#Visual loss associated with meningioma can spontaneously improve and this should be considered when making diagnostic and treatment decisions for meningioma.

Streptococcus infantarius Endophthalmitis after XEN Gel Stent Implantation

Purpose@#To report a case of Streptococcus infantarius endophthalmitis related to the use of a XEN® Gel Stent.Case summary: A 75-year-old male was referred to our practice with a diagnosis of endophthalmitis 55 days after XEN® Gel Stent implantation. He had primary open-angle glaucoma. Visual acuity was 20/50. Slit-lamp examination revealed conjunctival injection and anterior chamber inflammation with hypopyon. Fundus examination showed inflammatory cells with exudative materials in the vitreous. The aqueous sampling for culture of causative micro-organisms was followed by removal of the XEN® Gel Stent, along with anterior chamber irrigation and intracameral and intravitreal injection of antibiotics. Streptococcus infantarius was isolated after 5 days. Vitrectomy, anterior chamber lavage, and intravitreal injection of antibiotics were additionally performed to control the intraocular inflammation. Sixteen days after vitrectomy, the intraocular inflammation disappeared. The choroidal detachment was resolved 34 days after vitrectomy. Visual improvement was limited to 20/100 at 6 months. @*Conclusions@#XEN® Gel Stent-related bacterial endophthalmitis was successfully treated by implant removal, vitrectomy, and proper intraocular antibiotic treatment.

Internal Fixation Using Clavicle Hook Plates for Distal Clavicle Fractures

BACKGROUND: To report the radiological and clinical outcomes of internal fixation using distal clavicle hook plates for distal clavicle fractures. METHODS: From April 2008 to December 2012, 32 patients with distal clavicle fractures underwent surgery using an AO hook plate. The reduction was qualified and evaluated according to the radiological findings. The evaluation of the clinical outcomes was performed with the University of California at Los Angeles (UCLA) score, the Korean Shoulder score, and the visual analogue scale (VAS) pain score. RESULTS: By radiological evaluation, we found that 31 of 32 patients showed anatomical reduction and solid bone union. Although we obtained satisfactory UCLA scores, Korean Shoulder Scale scores, and VAS pain scores, 12 cases of complications were present. We found 4 cases of osteolysis of the acromion, 1 case of nonunion, 3 cases of periprosthetic fractures, 3 cases of subacromial pain, and 1 case of skin irritation. We performed re-operations in 2 patients. CONCLUSIONS: To avoid complications associated with clavicle hook plates, choosing the appropriate hook size and bending of the hook according to the slope of the acromion undersurface is critical. Also, we believe that early removal of clavicle plates may help reduce complications.

Internal Fixation Using Clavicle Hook Plates for Distal Clavicle Fractures

BACKGROUND: To report the radiological and clinical outcomes of internal fixation using distal clavicle hook plates for distal clavicle fractures. METHODS: From April 2008 to December 2012, 32 patients with distal clavicle fractures underwent surgery using an AO hook plate. The reduction was qualified and evaluated according to the radiological findings. The evaluation of the clinical outcomes was performed with the University of California at Los Angeles (UCLA) score, the Korean Shoulder score, and the visual analogue scale (VAS) pain score. RESULTS: By radiological evaluation, we found that 31 of 32 patients showed anatomical reduction and solid bone union. Although we obtained satisfactory UCLA scores, Korean Shoulder Scale scores, and VAS pain scores, 12 cases of complications were present. We found 4 cases of osteolysis of the acromion, 1 case of nonunion, 3 cases of periprosthetic fractures, 3 cases of subacromial pain, and 1 case of skin irritation. We performed re-operations in 2 patients. CONCLUSIONS: To avoid complications associated with clavicle hook plates, choosing the appropriate hook size and bending of the hook according to the slope of the acromion undersurface is critical. Also, we believe that early removal of clavicle plates may help reduce complications.

Peroneus Tendon Dislocation Associated with Fracture of Lateral Process of Talus: A Case Report

Traumatic peroneal tendon dislocation in association with fracture of the lateral process of the talus is a rare injury, which is difficult to diagnose. As a result, early detection is often delayed, which in turn leads to ankle pain and dysfunction. We treated a patient by open reduction and screw fixation in fracture of the lateral process of talus and primary repair of the superior peroneal retinaculum. We report this case with a brief review of the literature.

A standardized bamboo leaf extract inhibits monocyte adhesion to endothelial cells by modulating vascular cell adhesion protein-1

Bamboo leaves (Phyllostachys pubescens Mazel ex J. Houz (Poacea)) have a long history of food and medical applications in Asia, including Japan and Korea. They have been used as a traditional medicine for centuries. We investigated the mechanism of anti-inflammatory activity of a bamboo leaf extract (BLE) on tumor necrosis factor-alpha (TNF-alpha)-induced monocyte adhesion in human umbilical vein endothelial cells (HUVECs). Exposure of HUVECs to BLE did not inhibit cell viability or cause morphological changes at concentrations ranging from 1 microg/ml to 1 mg/ml. Treatment with 0.1 mg/ml BLE caused 63% inhibition of monocyte adhesion in TNF-alpha-activated HUVECs, which was associated with 38.4% suppression of vascular cell adhesion molecule-1 expression. Furthermore, TNF-alpha-induced reactive oxygen species generation was decreased to 47.9% in BLE treated TNF-alpha-activated HUVECs. BLE (0.05 mg/ml) also caused about 50% inhibition of interleukin-6 secretion from lipopolysaccharide-stimulated monocyte. The results indicate that BLE may be clinically useful as an anti-inflammatory or anti-oxidant for human cardiovascular disease including atherosclerosis.

Reversible MRI Findings in Metronidazole-induced Cerebellar Dysfunction

Metronidazole is widely used for the treatment of trichomoniasis, giardiasis, amebiasis, and anaerobic infections. It pro-duces a number of neurological side effects including peripheral neuropathy, encephalopathy, cerebellar dysfunction, and seizures. A 66-year-old male patient was admitted to our department because of a tingling sensation in both toes as well as ataxia with dizziness which had developed five prior to admission. He had had been diagnosed with hepatoma and had an operation in 1993. One month before admission, he felt a febrile sensation and was diagnosed as having abdominal abscess by an ultrasonography, and took about 30g of metronidazole until visiting our emergency room. A nerve conduc-tion test revealed sensorimotor polyneuropathy in the four extremities. A brain MRI showed symmetrically increased signal intensities without enhancement in the supratentorial white matter and the dentate nucleus of the cerebellum. After stopping metronidazole, his neurological symptoms began to improve and on the following MRI taken seven weeks later, the symmetrically increased signal intensities in the dentate nucleus of the cerebellum were nearly disappeared.

Reversible MRI Findings in Metronidazole-induced Cerebellar Dysfunction

Metronidazole is widely used for the treatment of trichomoniasis, giardiasis, amebiasis, and anaerobic infections. It pro-duces a number of neurological side effects including peripheral neuropathy, encephalopathy, cerebellar dysfunction, and seizures. A 66-year-old male patient was admitted to our department because of a tingling sensation in both toes as well as ataxia with dizziness which had developed five prior to admission. He had had been diagnosed with hepatoma and had an operation in 1993. One month before admission, he felt a febrile sensation and was diagnosed as having abdominal abscess by an ultrasonography, and took about 30g of metronidazole until visiting our emergency room. A nerve conduc-tion test revealed sensorimotor polyneuropathy in the four extremities. A brain MRI showed symmetrically increased signal intensities without enhancement in the supratentorial white matter and the dentate nucleus of the cerebellum. After stopping metronidazole, his neurological symptoms began to improve and on the following MRI taken seven weeks later, the symmetrically increased signal intensities in the dentate nucleus of the cerebellum were nearly disappeared.

A Case of Lateral Sinus Thrombosis Presenting with Cranial Nerve Syndrome

Cerebral venous thrombosis (CVT) is a disease sometimes associated with a wide variety of clinical signs and symp-toms. Single or multiple cranial nerve palsies without evidence of any other signs and symptoms have not, so far, been considered as a relevant syndrome of CVT. A 49-year-old woman was admitted to our hospital because of diplopia, vertigo with tinnitus and ataxia which had begun approximately three weeks before. Neurological examination revealed a right 6th nerve palsy by a red glass test and an impaired tandem walking test. Laboratory tests including CSF exami-nation and brain MRI were normal but MR venography and following 4-vessel angiography showed thrombosis in the left transverse and sigmoid sinuses and suspicious thrombosis in the right lateral sinus. She was treated with heparin and proceeded to get well.

The prognostic factors of seizure recurrence in newly diagnosed epilepsy

BACKGROUND: To evaluate the prognostic factors of seizure recurrence in newly diagnosed epilepsy at 1 year follow up. METHODS: From the IUED (Inje University Epilepsy Database) we retrieved the epilepsy patients who had never before taken any antiepileptics (AED) and were followed up for 1 year. We retrospectively reviewed the medical records with special attention to : a) age of onset, b) history of antecedents, c) seizure frequency before starting AED, d) abnormal neurological examination, e) MRI findings, f) EEG findings, g) epileptic syndrome classification. We defined seizure recurrence as any seizure occurring during the 1 year evaluation follow up except during the AED titra-tion period, having only an aura and being in poor compliance. We analyzed the prognostic factors that could reliably predict the seizure recurrence at 1 year follow up. RESULTS: We found 104 patients (64 male, 40 female) who met the inclusion criteria. The mean age of onset was 23.7 years. Of 104 patients 19 had generalized epilepsy, 82 had partial epilepsy and 3 had unclassified epilepsy. Thirteen percent (13/104) developed seizure recurrence at the 1 year follow up. Significant univariate associations were noted between seizure recurrence and these factors: presence of antecedents [odds ratio (OR) 4.8; 95% confidence interval (CI) 1.2-18.5 ], post-encephalitic epilepsy (OR 7.7; 95% CI 2.1 ~ 28), and abnormal neurological examination(OR 14.6; 95% CI 3.9-55). With multivariate logistic regression, the independent predictor of seizure recurrence was the abnormal neurological examination (OR 9.7; 95% CI 2.4 ~ 39.4). CONCLUSIONS: The chance of developing a seizure recurrence at the 1 year follow up was 13 percent and the prognostic factors were the presence of antecedents, post-encephalitic epilepsy and an abnormal neurological examination.

Cerebral infarctions associated with intravenous use of methamphetamine

Methamphetamine is one of the most popular abuse drug in the South Korea. Intracranial hemorrhage or ischemic stroke have been well known as one of the complications with methamphetamine abuse. We experienced two cases with cerebral vasculopathy which had developed after intravenous use of methamphetamine. The first patient was a previously healthy 20-year-old woman, who was admitted because of drowsy mentality with left hemiparesis and dysarthria. The second patient was a 24-year-old man who was admitted because of seizure and left extremity weakness. They reported several intravenous administration of methamphetamine during previous months. In both case, brain CT showed cerebral infarction compatible with vascular territories. And also, carotid angiographys demonstrated that multiple intracranial vessels were involved with narrowing and stenotic nature, consisting with vasculitis in the both cases.

A case of cerebral infarction caused by occlusive vasculopathy after previous gamma knife radiosurgery for pituitary adenoma

The radiation-induced occlusive vasculopathy has been known as the one of the side effects of radiation therary The gamma knife for stereotactic radiosurgery has been used popularly as a valuable adjunctive therapeutic option in some patients with pituitary tumors for its accuracy and effectiveness. But the long term complication of gamma knife have not been revealed until now. In spite of the remarkable improvement in radiologic technology, the side effect of radiation induced vasculaopathy remains an unsolved issue. We experienced the occlusion of intracranial portion of the internal carotid artery in one patient with pituitary adenoma, who had been treated with gamma knife radiosurgery previously.

A case of cerebral infarction caused by occlusive vasculopathy after previous gamma knife radiosurgery for pituitary adenoma

The radiation-induced occlusive vasculopathy has been known as the one of the side effects of radiation therary The gamma knife for stereotactic radiosurgery has been used popularly as a valuable adjunctive therapeutic option in some patients with pituitary tumors for its accuracy and effectiveness. But the long term complication of gamma knife have not been revealed until now. In spite of the remarkable improvement in radiologic technology, the side effect of radiation induced vasculaopathy remains an unsolved issue. We experienced the occlusion of intracranial portion of the internal carotid artery in one patient with pituitary adenoma, who had been treated with gamma knife radiosurgery previously.