Prevalence and Risk Factors of Dry Eye Syndrome in the Incheon Area

PURPOSE: To investigate the prevalence, clinical manifestations, and risk factors of dry eye syndrome (DES) among people over 50 years old in the Incheon area. METHODS: A cross-sectional prevalence study was performed on 462 people over 50 years old in Dong-gu, Incheon. DES was defined as the constant or frequent presence of symptoms of both dryness and irritation. Symptoms and past medical history were assessed by a survey. Eye examination included slit lamp examination, Schirmer test, and tear break-up time (T-BUT). Age, sex, living habits, systemic and eye diseases were also analyzed to determine the risk factors of DES. RESULTS: The prevalence of DES was 26.2%. The major symptoms were as follows in descending order: dryness (77.9%), tearing (75.2%), and sandiness (72.7%). An average of 12.1 +/- 6.0 mm in the Schirmer test and 6.7 +/- 2.4 seconds in the T-BUT were significantly different in the DES group from the normal group (p < 0.001). Variables such as age, sex, living habits, and eye diseases were not related to the diagnosis of DES, whereas diabetes was the only risk factor of DES with statistical significance (p = 0.03). CONCLUSIONS: In the present study, the prevalence of DES among people over 50 years old in the Incheon area was 26.2%. Schirmer test and T-BUT were considered to be helpful tools for the diagnosis of DES, and diabetes was a significant risk factor of DES.

Effect of Hormone Replacement Therapy on Dry Eye Syndrome in Postmenopausal Women: A Prospective Study

PURPOSE: To evaluate the effects of conjugated hormone replacement therapy (HRT) on dry eye syndrome in postmenopausal women. METHODS: Thirty-six healthy postmenopausal women (72 eyes) were included in this three-month prospective study. Schirmer test, tear film break-up time (BUT), fluorescein staining score and symptom score were performed on all patients at the time of enrollment, one month and three months after initiation of HRT. All patients received HRT consisting of conjugated estrogen and progesterone taken orally in a continuous combined regimen. RESULTS: Symptom score significantly decreased from 2.10+/-0.79 before HRT to 1.32+/-0.84 after one month and to 0.88+/-0.67 after three months (p<0.001). In addition, tear film BUT measurements significantly increased from 6.04+/-2.54 seconds to 7.99+/-2.43 seconds after one month and to 8.93+/-2.20 after three months (p<0.001). The fluorescein staining score was 0.94+/-0.71 before HRT and decreased to 0.42+/-0.60 after one month and to 0.22+/-0.42 after three months (p<0.001). CONCLUSIONS: Hormone replacement therapy consisting of conjugated estrogen and progesterone significantly improved the symptoms and signs of dry eye syndrome in postmenopausal women.

Augmented Asymmetric Lateral Rectus Recession in Intermittent Exotropia With Fixing Eye

PURPOSE: To document and compare the clinical results of symmetrical rectus muscle recession and asymmetrical rectus muscle recession in intermittent exotropia. METHODS: The medical records of 27 patients who had symmetric bilateral rectus recession and 24 patients who had asymmetric bilateral rectus recession for intermittent exotropia with at least six months of postoperative follow-up from March 2004 to March 2007 were reviewed retrospectively. The authors performed a recession of 2 mm or greater in the deviating eye than in the fixing eye. RESULTS: The mean age was 7.14+/-4.23 (range 3 to 15) years for symmetric bilateral rectus recession and 7.33+/-4.01 (range 3 to 14) years for asymmetric bilateral rectus recession. The mean follow-up was 11.83+/-5.74 (range 6 to 26) months in the symmetric bilateral rectus recession group and 11.14+/-5.05 (range 6 to 30) months in the asymmetric bilateral rectus recession group. The mean preoperative angle deviations were 27.5+/-4.8 prism diopter (PD) (range 30 to 40PD) and 27.3+/-4.6PD (range 20 to 40PD) in each group. The outcome of final follow-up (postoperative 24 months) was favorable in both groups, and slightly more successful in the asymmetric bilateral recession group but not a statistically significant amount (75.5% in the symmetric bilateral recession group and 81.2% in the asymmetric bilateral recession group). CONCLUSIONS: The present study suggests that there are no significant differences at postoperative 24 months between symmetric bilateral recession and asymmetric bilateral recession in intermittent exotropia having a fixing and a deviating eye.

2007 Survey for KSCRS Members: Current Trends in Cataract Surgery in Korea

PURPOSE: This study investigated the current situation and future trends in the field of cataract surgery in Korea. METHODS: Since 1995, the members of the Korean Society of Cataract and Refractive Surgery (KSCRS) have conducted annual surveys regarding cataract and refractive surgery. The 2007 annual survey, consisting of 85 multiple-choice questions, was mailed in February 2008 to 301 KSCRS members. Sixty-two (20.6%) members answered the questions. Current data were compared with data from previous annual surveys and with surveys in the United States and Europe. RESULTS: Fifty-four percent of the respondents were over 50 years of age. The duration of hospital stay has decreased annually and the use of topical anesthesia (57%) has slightly increased. Self-sealing wound construction was the main wound closure technique in phacoemulsification (60%). The implantation of phakic intraocular lenses (IOL) was performed in 56% of the respondents and the most preferred IOL for small incision cataract surgery were acrylic (88%). Interest in the additional value of IOL has increased annually. CONCLUSIONS: This survey summarized current trends and changes in cataract surgery in Korea.

The Post-operative Changes of Stereopsis in Adult Strabismus

PURPOSE: To evaluate the postoperative changes of stereopsis after surgical correction of adult strabismus. METHODS: We retrospectively evaluated strabismus patients older than 16 years at the time of operation at our hospital between April of 1999 and December of 2006. We retrospectively examined the medical records of 53 exotropia and 11 esotropia patients. We divided the pre-operative stereopsis into three groups:above 3000 arc of sec, between 3,000 to 100 arc of sec, and below 100 arc of sec. We analyzed the correlation between the post-operative status of stereopsis and the pre-op type of strabismus, the onset and duration of strabismus, and the presence or absence of amblyopia. RESULTS: In patients who had pre-op stereopsis above 3,000 arc of sec, 31.6% showed improvement, whereas 77.8% of patients who had pre-operative stereopsis between 3,000~100 showed improvement; this value was 89.5% for patients with pre-operative stereopsis below 3000. 94.5% of patients in the intermittent exotropia group who had a good pre-operative stereopsis condition showed postoperative improvement and maintenance. For those patients with poor stereopsis at pre-operative, 32.2% of patients with exotropia and 18.1% of patients with esotropia showed improvement. Stereopsis decreased when consecutive esotropia occurred. CONCLUSIONS: This study showed deterioration of stereopsis in patients with consecutive esotropia. Post-operative stereopsis was correlated with the pre-operative stereopsis status and with the type of strabismus. No other factors that we examined were correlated with stereopsis. Post-operative stereopsis in exotropiaand intermittent exotropia were better than esotropia and constant exotropia.

A Case of Atypical Miller Fisher Sndrome

PURPOSE: To report one case of atypical Miller Fisher syndrome with spontaneous recovery. METHODS: A 44-year-old woman was visited our clinic complaining of diplopia for 2 days. She has irregular medication history for thyroid dysfunction, and there was no antecedent respiratory or gastrointestinal infection. The best corrected visual acuity of both eyes was 20/20. She showed bilateral proptosis and limitation of abduction and supraduction, mild blepharoptosis of left eye and esotropia of 30 prism diopter (PD). RESULTS: Thyroid fuction test, orbital CT and electromyography were normal. Cerebrospinal fluid (CSF) analysis revealed albuminocytologic dissociation. Steroid pulse therapy was started promptly, but there was no improvement. Extraocular movement and diplopia gradually improved after 4 weeks of onset. and spontaneously recovered completely after 2 months. CONCLUSIONS: We reported a case of atypical Miller Fisher syndrome that completely and spontaneously recovered within 2 months., and represented normal findings by every examination such as orbital CT, thyroid function test, electromyography and CSF analysis.

A Case of Leiomyosarcoma of the Conjunctiva

PURPOSE: We describe a very rare the leiomyosarcoma that developed in the conjunctiva. METHODS: A 59-year-old man was treated at another hospital two months before presenting to our institution. He had not gotten any better and so was admitted to our hospital. He had normal visual acuity and intraocular pressure. However, we found a geographic, highly vascularized mass involving the corneal limbus in the medial bulbar conjunctiva, from which a pterygium had been removed a year previously. An excision of the mass was carried out to detect a suspected conjunctival intraepithelial neoplasm. RESULTS: Tissue obtained from operation had cells with thin nuclei, spindle cells with pleomorphic cigar-shaped nuclei and eosinophilic cytoplasm, atypical cells, and from four to five mitotic figures under ten high power field. In immunohistochemical staining, Vimentin, Smooth muscle actin (SMA), Desmin, CD68 stained positively and cytokeratin, Cam5.2, S-100, HMB-45, CD 34 stained negatively. We found no clues of other origins from the general physical examination. Considering these factors, we conclude that this was a Stage I, G2T1aN0M0 leiomyosarcoma with moderate differentiation. CONCLUSIONS: Analysis by immunohistochemical staining is necessary to detect leiomyosarcoma in the conjunctiva, as it is very rare and hard to diagnose by the histologic method alone. We report a leiomyosarcoma of the conjunctiva after pterygium excision, and suggest that it be considered a differential diagnosis of conjunctival masses, even though it is very rare.