Surgical Management of Edentulous Atrophic Mandible Fractures in the Elderly / 대한악안면성형재건외과학회지

Fractures of the mandible occur with a greater frequency in the elderly. This study reports three cases of edentulous atrophic mandible fracture in elderly patients treated with open reduction technique. Three patients who presented with edentulous atrophic mandible fractures underwent surgical management using open reduction and internal fixation. After treatment, clinical evaluations and postoperative complications were examined with postoperative x-ray. Patients were followed with clinical and radiographic examinations. In the postoperative clinical evaluation, two male patients healed well, but one female patient complained of pain and swelling. In radiographic examinations, no union delay or lack of fusion was observed in the edentulous area. Open reduction technique is a viable treatment option for the edentulous atrophic mandible fractures in geriatric patients.

The Clinical Results of 6-mm Iris-Fixated Phakic IOL

PURPOSE: To evaluate the clinical results of 6 mm iris-fixated phakic intraocular lens (Artisan(R) lens) implantation in myopic patients. METHODS: Forty eyes of 23 myopic patients underwent 6-mm Artisan(R) phakic IOL implantation and were followed-up for over 6 months. We prospectively analyzed the efficacy, stability, predictability, change of astigmatism, endothelial cell count, pupil diameter, degree of decentration, subjective satisfaction and complications. RESULTS: The preoperative mean spherical equivalent was -9.46 D, and postoperative spherical equivalent was -0.70D at 1 month, -0.55D at 3 months, -0.54D at 6 months, -0.78D at 12 months and remained stable during the follow-up period. The preoperative mean astigmatism was -1.88D and postoperative astigmatism was -0.87D at 6 months. Postoperative uncorrected visual acuity (UCVA) was more than 0.8 in 85% of the eyes at 1 month, 91% at 3 months, 95% at 6 months, and 89% at 12 months. The spherical equivalent refraction after surgery was within 1.0D of emmetropia in 78% of eyes at 1 month, 80% at 3 months, 88% at 6 months, and 64% at 12 months. There was no significant decrease in the endothelial cell count during the follow-up period. Preoperative scotopic pupil diameters were significantly decreased at 1 month and the mean decentration of the lens was 0.38 mm. Patient satisfaction was generally high. Complications included the transient elevation of intraocular pressure in 1 eye, corneal edema in 4 eyes, iritis in 1 eye, traumatic dislocation in 1 eye and iris atrophy in 2 eyes. CONCLUSIONS: The 6-mm Artisan(R)phakic IOL implantation may be an effective surgical procedure for myopic patients who cannot undergo corneal refractive surgery, as it provided good visual results, predictability, patient satisfaction, and short-term safety.

A Study on the Clinical Usefullness of Digitalized Random-dot Stereoacuity Test

Existing methods of stereoacuity testing need specific glasses or optical device for use. We have designed a new stereoacuity test for the digitalized, random-dot stereogram and researched its clinical usefulness. A digitalized, random-dot, stereoacuity test card was created with a computer program that used a preferred symbol and the designed system was tested along with the Randot preschool stereoacuity, Titmus-fly and Lang tests to compare their sensitivity and specificity. The mean success rate of the digitalized, random-dot test was 98.2%, while the rates of the Randot preschool stereoacuity, Titmus-fly and Lang tests were 89.3%, 74.2% and 86.1%, respectively. Sensitivity and specificity of the new test were 100% and 95.3%, respectively, which were not that different from those of the Randot preschool stereoacuity, Titmus-fly and Lang tests. We found that the digitalized, random-dot, stereoacuity test has a high success rate and can be appropriately used in medical examinations and follow-up tests for strabismus patients.

Measurement of Angle Deviation Using Digital Photographs

PURPOSE: The prism-cover test has been known to be the most accurate method in measuring ocular angle deviation, but the Hirschberg test is used in poorly cooperative patients. To enhance the accuracy of Hirschberg test, we designed a geometric model using digital photographs. METHODS: Fifty normal volunteers were included in this study, who had no ocular disorders. Digital photographs were obtained in the subjects seated 2 m in front of the fixation targets and the camera was set 1 m in front of subjects. In each photograph, the apparent width of the cornea and the distance from the corneal light reflex to the limbus were measured using computer program for calculation of angle deviation. Then we compared the calculated angle deviation with the actual one. RESULTS: Calculated angle deviations with digital image photographs were corresponded to the actual ones from esodeviation 40delta to 10delta (p>0.05), whereas in esodeviation 60delta, 70delta and exodeviation, the larger the deviation angle, the larger the calculated angle composed with the actual one. CONCLUSIONS: Angle deviation measurement using digital photographs appears to be relatively precise and its clinical application will be available in measuring angle deviation of esodeviation.

Surgical results of Vitrectomy for Diabetic Macular Heterotopia

PURPOSE: This study aimed to investigate visual prognosis and postoperative complications of vitrectomies for macular heterotopia, and compare it with that of tractional macular detachment. METHODS: Medical records of 10 eyes which had undergone pars plana vitrectomy for diabetic macular heterotopia and 21 eyes which for diabetic tractional macular detachment in the 202 patients who had been diagnosed as proliferative diabetic retinopathy at Pusan Paik hospital from January, 1995 to december, 1998 were reviewed to study their clinical features, complications, visual outcome. RESULTS: Final postoperative improved visual acuity was documented in 70% of patients with macular heterotopia and 38% of patients with tractional macular detachment (P>0.05). Postoperative vitreous hemorrhage and cataract developed in 20% and 10% of patients with macular heterotopia and 19% and 10% of patients with tractinal macular detachment. Patients with macular heterotopia experienced retinal detachment and macular hole. Patients with tractional macular detachment experienced increased IOP, neovascular glaucoma and phthisis. CONCLUSIONS: Although we could not revealed statistical significance, the surgical results of vitrectomy for diabetic macular heterotopia was better than that of diabetic tractional macular detachment and in the view of vision and complications, diabetic macular heterotopia was more favorable.

Angle Kappa Measurement with Slit Lamp Biomicroscope

PURPOSE: There has been a difficulty in measuring angle kappa because special instrument was required. To measure the angle kappa conveniently, we designed a new method using slit lamp biomicroscope. METHODS: We measured the angle kappa in 124 eyes of 62 patients with newly designed method and compared the measurement by new method with those by T-shape ruler or the major amblyoscope. RESULTS: We found the average angle kappa was +3.12 degrees by slit lamp, +2.85 degrees by major amblyoscope and +3.04 degrees by T shape ruler method. There was no significant difference between slit lamp and either major amblyoscope method (p=0.48) or T shape ruler (p=0.18). CONCLUSIONS: The new method of measuring angle kappa using slit lamp biomicroscope seemed to be a convenient and relatively accurate method for measuring of angle kappa and appeared to be beneficial in measurement of ocular deviation.

The Clinical Analysis of Surgical Methods in Intermittent Exotropia

PURPOSE: The outcome after operations for intermittent exotropia were frequently unsatisfactory because of high incidence of postoperative undercorrection, overcorrection or recurrence. The author studied surgical outcome of each operation method in intermittent exotropia. METHODS: The results of surgical treatment in 90 patients with intermittent exotropia were reviewed. The operative procedure were devided into 3 groups-bilateral rectus muscle recessions, unilateral lateral rectus muscle recession and medial rectus muscle resection and medial rectus muscle resection of dominant eye and lateral rectus muscle recession of non-dominant eye. The success of operation was defined as a final alignment of orthotropia, esotropia less than 5 prism diopter or exotropia less than 10 prism diopter in primary position at postoperative 6 months. RESULTS: The method of of operation in medial rectus muscle resection of dominant eye and lateral rectus muscle recession of non-dominant eye lead to higher success rate than other surgical method (96.7%) and the difference with statistically significant (p=0.03). The success rate of bilateral rectus muscle recessions group was 76.6%, and that of unilateral lateral rectus muscle recession and medial rectus muscle resection group was 80.0%. CONCLUSIONS: This result suggested that medial rectus muscle resection of dominant eye and lateral rectus muscle recession of non-dominant eye might be a most effective surgical method for intermittent exotropia.

Macular Ischemia in Temporal Branch Retinal Vein Occlusion: Fluorescein angiographic classification and Visual prognosis

There have been various report about visual prognosis in branch retinal vein occlusion according to location and size of occluded vessel, status of perifoveal capillary ring, presence of retinal ischemia and hypertension. We therefore sought to determine prognostic indicators of BRVO by observing retrospectively the natural course of the BRVO with macular ischemia. To do that, we devide 63 eyes with BRVO into groups according to the macular perfusion status on high-quality fluorescein angiography. The patients without broken capillary ring exhibited better initial, final visual acuity and visual improvement. The patients with the extent of macular ischemia under 90degree exhibited better initial and final visual acuity but same visual improvement. There were no statistically significant difference in visual prognosis according to the status of perifoveal capillary ring, extent of macular ischemia and presence of hypertension.

Effect of Intravitreal Gas Injection in Retinal Detachment Assiciated with Macular Hole: Long Term Follow-up

In 11(64.7%) of 17 eyes treated by intravitreal gas injection, the retinas were successfully attached during follow-up period that ranged from 12 to 39 months. Group I(detachment limited to the perimaculararea) patients need more frequent gas injection than group II(detachment extending to equator), but success rate of group I(83.3%) is higher than group II(66.7%). Group III(detachment with peripheral retinal break) patients are not successful by gas injection only. In the succesful eyes, macular holes are not visible, but "window defects" are present on FAG. The relative scotomas improve. Recurrent detachment cases(31.3%) are associated with posterior staphyloma, peripheral retinal break and trauma. Time of late recurrences ranged from 4 to 13 months postoperatively(mean: 7 months).