Antibiotics Susceptibility in Bacterial Keratitis and Proper Initial Treatment

PURPOSE: The present study aims to determine the common pathogens involved in the etiology of bacterial keratitis and to analyze not only the antibiotic susceptibility of bacterial isolates from patients with bacterial keratitis but also the propriety of initial treatment. METHODS: A retrospective study of 161 eyes in 161 patients with bacterial keratitis, who were diagnosed by cultures from 2000 to 2011, was performed. Causative bacteria and antibiotic susceptibility were evaluated in consecutive 6-year periods. RESULTS: The most common bacteria was the pseudomonas species in the 2 time periods tested and cefazolin with tobramycin was the most commonly used antibiotic (125 cases, 77.6%) for initial treatment of bacterial keratitis. In vitro testing showed gram-negative susceptibility to tobramycin and ciprofloxacin was over 70%, gram-positive susceptibility to cephalothin and vancomycin was 100% and there was no significant difference between the 2 time periods tested. Eight cases had resistance to the initial treatment, but only 1 case showed treatment failure. CONCLUSIONS: Antibiotics used for initial treatment of bacterial keratitis were able to obtain a proper effect but several cases showed bacterial resistance to antibiotics. Thus, continued testing is essential to monitor for antibiotic resistance.

Unilateral Ptosis Due to Isolated Levator Myositis

PURPOSE: To present a rare case of idiopathic orbital myositis involving levator palpebrae superioris. CASE SUMMARY: A 27-year-old male presented with a 1-week history of redness, discomfort, swelling, and drooping of his left upper eyelid. A computed tomography scan showed isolated enlargement of the right superior rectus/levator muscle complex. On examination, there was a left blepharoptosis, although eye movements were normal. The authors treated the patient with 3rd-generation cephalosporin; however, after 3 days, the symptoms did not improve. Subsequently, the patient was diagnosed with idiopathic orbital myositis and treated with oral corticosteroids for 1 month; the symptoms gradually resolved. CONCLUSIONS: Idiopathic orbital myositis is a subtype of nonspecific orbital inflammation primarily involving the extraocular muscles. Although the exact cause of orbital myositis is unknown, an immune-mediated pathophysiologic mechanism appears to be one of the causes. Medial rectus myositis is the most common, and isolated levator muscle myositis is very rare. The authors of the present study reported a case of orbital myositis involving the levator palpebrae superioris which should be considered a differential diagnosis of blepharoptosis with eyelid swelling.

A Case of Alveolar Rhabdomyosarcoma of the Ethmoid Sinus Invading the Orbit in an Adult

PURPOSE: A case study and literature review of alveolar rhabdomyosarcoma (RMS) in an adult. METHODS: A 48-year-old male patient presented at our clinic complaining of proptosis that had persisted for 2 weeks in his left eye. A computed tomography (CT) scan revealed a destructive soft-tissue mass in the left ethmoid sinus with invasion of the left orbit and compression of the medial rectus muscle. Endoscopic intranasal biopsy revealed alveolar RMS. Conservative debulking and orbital wall decompression were performed. RESULTS: Immunohistochemical testing was positive for desmin, S-100, and smooth muscle actin (SMA), supporting the diagnosis of RMS. Since ipsilateral cervical and spinal metastasis was detected, systemic treatment was administered simultaneously. CONCLUSIONS: Although rarely found in adults, RMS should be considered in the differential diagnosis of orbital tumors. Immunohistochemical analysis plays an important role in the definitive diagnosis of RMS.

Comparison of Anesthetic Efficacy and Intraocular Pressure by Volume of Sub-Tenon's Anesthetic in Vitreoretinal Surgery

PURPOSE: To compare the effects of different volumes of sub-Tenon's anesthetic on intraocular pressure (IOP) and to evaluate the treatment efficacy of vitreoretinal surgery. METHODS: A prospective, clinical trial was conducted on patients undergoing sub-Tenon's anesthesea for vitreoretinal surgery. Patients were randomized to receive either 3 mL, 5 mL or 7 mL of anesthetic solution. IOPs were measured immediately prior to, immediately after, and at 2, 5 and 10 min after the injection. Pain scores were assigned using a numerical visual analogue scale immediately following surgery and again on postoperative day one. RESULTS: A total of 108 patients (119 eyes) were studied, including 35 eyes in the 3 mL group, 48 eyes in the 5 mL group, and 36 eyes in the 7 mL group. There was significant elevation in mean IOP following injection in all groups and a trend toward a larger increase in the group receiving the larger volume (p<0.01). Mean IOPs were elevated immediately after the injections and reduced at all subsequent time intervals. But reduction to the pre-injection level was only achieved in the 3 mL group. There was no significant difference in patient-reported pain scores among the groups when assessed immediately after surgery or on postoperative day one. The incidence of chemosis and high IOP elevation (40 mmHg < or =) was more frequent in the 7 mL group than the other groups (p<0.05). CONCLUSIONS: Sub-Tenon's anesthesia is effective in vitreoretinal surgery. It would appear that a 3-5 mL volume of anesthetic is safe even when complications are considered.

Visual Improvement in High Myopic Amblyopic Adult Eyes following Phakic Anterior Chamber Intraocular Lens Implantation

PURPOSE: To evaluate the efficacy and safety of angle-supported phakic anterior chamber intraocular lenses in amblyopic adult eyes with very high myopia. METHODS: We evaluated 12 eyes in nine patients with very high myopic amblyopia who received angle-supported phakic intraocular lenses (Phakic 6H(R)) and followed them for more than six months. Uncorrected visual acuity (UCVA), best-corrected visual acuity (BCVA), and complications were evaluated. A satisfaction score was rated by patients using a 5-point (1~5) numeric scale. RESULTS: The mean age of patients was 37.3+/-9.4 years, ranging from 29 to 59 years old. The preoperative mean refraction (spherical equivalent, SE) was -20.10+/-5.41 diopters (D). The postoperative mean refraction (SE) was -1.75+/-0.76 D at six months. The postoperative BCVA improved an average 3.92+/-1.24 lines over preoperative values, and mean endothelial cell loss was 8.9% at six months. Development of cataracts, glaucoma, and pupil abnormalities were not demonstrated in any case during the study. The patients were all very satisfied, as the average satisfaction score was 4.3. CONCLUSIONS: This study indicates that angle-supported phakic anterior chamber intraocular lens implantation may be an effective surgical alternative for the correction of amblyopic adult eyes with very high myopia. However, long-term evaluation is necessary to assess possible complications and long-term safety.

Treatment of Hypotony Retinopathy with Cyclodialysis Cleft by Intravitreal Gas Injection

PURPOSE: We report a case of post-traumatic hypotony retinopathy with cyclodialysis cleft treated by intravitreal gas injection. METHODS: A 38-year-old man presented with decreased visual acuity after blunt trauma to the left eye. Visual acuity of the left eye was 0.06 and intraocular pressure was 1 mmHg. No external wound was found. The anterior chamber showed a microscopic hyphema and, upon funduscopic examination, mild macular edema and striae were seen. The cyclodialysis was identified using gonioscopy. We treated the patient with intravitreal gas (perfluoropropane, C3F8) injection under topical anesthesia and tracked the outcome of this treatment. RESULTS: On the first postoperative day, intraocular pressure fell to the normal range. After 7 days the visual acuity improved to 1.0. During a follow-up period of 10 months, intraocular pressure and visual acuity remained in their normal range. CONCLUSIONS: Intravitreal gas injection offers a safe and effective method of treating hypotony retinopathy with cyclodialysis cleft.

The Frontalis Sling Operation Using Preserved Fascia Lata: Modified Crawford Technique

PURPOSE: For the correction of ptosis with very poor levator function, frontalis sling operation with various materials has been used. The purpose of this study was to evaluate the effect of the modified Crawford technique using preserved fascia lata. METHODS: The photographs and charts of 46 patients who underwent frontalis sling operation using preserved fascia lata from June 2001 to February 2004 at our hospital were retrospectively reviewed. The eyelid crease approach was used with the suturing of the sling material directly to the tarsus. RESULTS: The patients were 27 males and 19 females. There were 20 (44%) unilateral cases and 26 (56%) bilateral cases. The age of the patients ranged from 1 to 65 years at the time of surgery, with an average age of 8.3 years. The success rate was 93% (43/46 patients) for a mean postoperative follow-up of 9 months (range 4~26 months). The complications consisted of one case of overcorrection and 2 cases of undercorrection. Knot exposure occurred in 2 cases. CONCLUSIONS: The modified Crawford technique using preserved fascia lata appears to be an effective treatment for severe ptosis. The lid crease formation provides good cosmetic results and the direct suturing of the preserved fascia lata to the tarsus prevents its migration.

2003 Survey for KSCRS Members: Current Trends in Cataract and Refractive Surgery in Korea

PURPOSE: This study investigates the current situation and future trends in the field of cataract and refractive surgery in Korea. METHODS: Since 1995, the members of the Korean Society of Cataract and Refractive Surgery (KSCRS) have been annually surveyed on cataract and refractive surgery. The 2004 annual survey, consisting of 128 multiple-choice questions, was mailed in February 2004 to 396 KSCRS members. Eighty-eight(22.2%) members answered. Current data were compared with those of previous annual survey and with those of the USA. RESULTS: The duration of hospitalization has decreased annually and the use of topical anesthesia (41%) was stationary. Self sealing wound construction was the main wound closure technique in phacoemulsification (51%). The most preferred intraocular lenses for small incision cataract surgery are acrylic (60%). Excimer laser keratomileusis was performed for refractive surgery by 63% of the repondents. Most respondents preferred LASIK regardless of diopter range. More respondents had experienced legal problems associated with PRK or LASIK than in the last year survey. The implantation of phakic IOL was performed by 29% of the respondents and 96% of the respondents were interested in it. CONCLUSIONS: This survey summarized current trends and changes in cataract and refractive surgery in Korea.