Pigmented Mass in the Anterior Chamber Suspected of Granuloma Caused by a Metallic Foreign Body

PURPOSE: To report on a patient with a brown pigmented mass in the anterior chamber suspected of a granuloma caused by a metallic foreign body and to review the relevant literature. CASE SUMMARY: A 63-year-old man presented with blurring in his right eye, which had initially began several years prior. Concentric corneoscleral brown pigmentation about 2 mm in diameter was found in the superonasal limbal area. A rectangular parallelepiped mass was observed in the superonasal anterior chamber, which was an even brown color with a small white portion, smooth-surfaced, and non-vascularized. The pupil was oval and dragged superonasally, possibly due to mild compression of the iris caused by the mass. In pre-enhanced orbital computed tomography, a round high signal intensity with a diameter of 3.0 mm was found in the superonasal anterior segment. Though excisional biopsy using the lamellar scleral flap was considered for exact diagnosis, this was not performed considering the clinical features are more indicative of granuloma than iris melanoma. Neither changes in the size of the mass nor the shape of the pupil were observed during the follow up period until 19 months after the first visit. CONCLUSIONS: When a pigmented mass in the anterior chamber is detected, benign and malignant iris tumors and granulomas should be considered for a differential diagnosis. The patient's exact past medical history and clinical features differentiating malignant and benign masses are important for proper diagnosis due to the difficulty in obtaining tissue diagnoses in some cases.

A Case of Choroidal Metastasis from Renal Cell Carcinoma

PURPOSE: To report a rare case of choroidal metastasis from renal cell carcinoma. CASE SUMMARY: A 61-year-old man visited our clinic with the chief complaint of decreased vision in the right eye. Three years earlier, he underwent right nephrectomy due to renal cell carcinoma. Best corrected visual acuity was 0.2 in the right eye and 1.0 in the left eye. Fundoscopic examination of the right eye revealed a yellowish, dome-shaped elevated choroidal mass with serous retinal detachment, measuring 5.0 x 4.0 disc diameter and located lateral to the macular area. Systemic evaluations showed multiple lung and brain metastases. A diagnosis of choroidal metastasis from renal cell carcinoma was made for the right eye, and the patient received local treatments with oral sorafenib therapy, composed of subtenon triamcinolone injection and intravitreal ranibizumab injection. Tumor progression continued, and visual acuity declined to hand motion. Enucleation was recommended, but the patient refused and is on a regular follow-up after transpupillary thermotherapy. CONCLUSIONS: Ocular manifestation may be the initial presenting sign of a recurrent tumor, and an extensive systemic evaluation for metastatic malignancy should be performed. The present example showed a rare case of choroidal metastasis from renal cell carcinoma.

Treatment of Compressive Optic Neuropathy by Recurred Maxillary Cancer Using Stereotactic Radiosurgery: A Case Report

PURPOSE: To report a case of a female patient treated with stereotactic radiosurgery for compressive optic neuropathy by recurred maxillary cancer. CASE SUMMARY: A 51-year-old woman with a history of maxillary cancer presented with decreased visual acuity and visual field and color vision defects in the right eye. The CT scan revealed a wide spread mass along the ethmoid sinus, orbit, optic canal, and skull base. Under the impression of compressive optic neuropathy, stereotactic radiosurgery was performed. A cumulative dose of 39 Gy in 3 daily fractions of 13 Gy was administered to the mass. After 10 days, visual acuity, color vision, and visual field improved and were maintained after a 2 month follow-up. CONCLUSIONS: Stereotactic radiosurgery could be another treatment option for patients with compressive optic neuropathy caused by a malignant tumor.

Cavernous Sinus Metastasis of Non-Small Cell Lung Cancer / 결핵및호흡기질환

Progressive ptosis and headache developed in a 50-year-old woman with non-small cell lung cancer. Although brain magnetic resonance imaging showed improved cerebellar metastasis after prior radiotherapy without any other abnormality, the follow-up examination taken 6 months later revealed metastasis to the cavernous sinus. The diagnosis of metastasis to the cavernous sinus is often difficult because it is a very rare manifestation of lung cancer, and symptoms can occur prior to developing a radiologically detectable lesion. Therefore, when a strong clinical suspicion of cavernous sinus metastasis exists, thorough neurologic examination and serial brain imaging should be followed up to avoid overlooking the lesion.

Long Term Follow-up Results of External Beam Radiotherapy as Primary Treatment for Retinoblastoma

The authors reviewed their experiences of external beam radiotherapy (EBR) as an initial treatment in retinoblastoma patients to determine its long-term effect on subsequent tumor control and complications. A total of 32 eyes in 25 patients that underwent EBR for retinoblastoma were reviewed retrospectively. The patients consisted of 21 boys and 4 girls of median age at treatment of 7.1 months. Radiation doses ranged from 35 to 59.4 Gy. The 10-yr ocular and patient survivals were 75.4% and 92.3%, respectively. Nine of the 32 eyes progressed; 7 of these were enucleated and 2 were salvaged by focal treatment. According to the Reese-Ellsworth classification, 4 of 5 eyes of Group II, 13 of 16 Group III eyes, 2 of 4 Group IV eyes, and 5 of 7 Group V eyes were retained, and of the 32 eyes, 13 had visual acuity better than 20/200. Eleven patients experienced a radiation-induced complication. No patient developed a second malignancy during follow-up. Despite the limited number of patients enrolled, EBR may provide a mean of preserving eyeball and vision for some advanced lesions.

Bilateral retinoblastoma: Long-term follow-up results from a single institution / 소아과

PURPOSE: The authors aimed to analyze the long-term effects of treatments, especially external beam radiotherapy (EBRT), in bilateral retinoblastoma patients. METHODS: This retrospective study analyzed the medical records of 22 bilateral retinoblastoma patients who were registered between October, 1987 and October, 1998 and followed-up for more than 10 years. They were treated by enucleation, EBRT, and systemic chemotherapy. Age at diagnosis, sex, delay prior to treatment, Reese-Ellsworth (RE) classification, and the local treatment modalities were analyzed in relation to recurrence-free survival (RFS) and complications. RESULTS: Median age at diagnosis was 7.0 months (range 1.7-31.6 months). Leukocoria was the most common presenting feature. Two patients had a familial history. The RE classifications of the 44 eyes were group II in 4, III in 14, IV in 4, and V in 22. At the end of a median follow-up period of 141 months (range 55-218 months), 20 patients were alive. The 10-year ocular survival rate of the 44 eyes was 56.8+/-7.5%. The 10-year RFS and ocular survival rate of the 29 eyes treated by combined EBRT and chemotherapy were 75.9% and 86.2%, respectively. Treatment delay (>3 months) was found to be related to higher risk of recurrence. Complications after EBRT were cataract, retinal detachment, phthisis bulbi, and facial asymmetry. No patient developed a second malignancy during the follow-up period. CONCLUSION: Early detection and prompt treatment can increase ocular survival rates. In addition, careful attention should be paid to possible long-term sequelae in these patients.

The Discriminatiuon between Congenital and Acquired Color Vision Defects by Computerized Color Vision Test

PURPOSE: To investigate the characteristics of congenital and acquired color vision defects with Seohan computerized hue test and SNU (Seoul National University) computerized color test and to help to discriminate between congenital and acquired color vision defect METHODS: from June 2003 to January 2004, patient with congenital and acquired color vision defect and visual acuities more than 20/30 underwent Seohan computerized hue and SNU computerized color tests. Their results were compared with each other. Quadrant analysis and RQ calculation were done. RESULTS: On Seohan computerized hue and SNU computerized color tests, congenital color vision defects showed mainly red-green color vision defects (p<0.01, paired t-test) while acquired color vision defects showed blue-yellow color vision defect(p<0.01, paired t-test). RQ had 95% sensitivity and 98% specificity with a standard of 1.5 by Seohan computerized hue test, and 96% sensitivity and 98% specificity with standard of 1.0 by SNU computerized color test, for the discrimination of congenital and acquired color vision defects (ROC curve, confidence interval 95%). CONCLUSIONS: Seohan computerized hue and SNU computerized color tests were effective to classify types of color vision defects and discriminate between the congenital and acquired color vision defects.

Color Vision Defect in Diabetic Retinopathy by Computerized Color Test

PURPOSE: To investigate the color vision defect in diabetic patients using the SNU computerized color test (SCCT). METHODS: From May to September 2003, diabetic patients with visual acuity 0.6 or better underwent various examinations including biomicroscopy, fundus photography, Ishihara color test, Hardy?Rand?Rittler (HRR) test, Seohan computerized hue test (SCHT), and SNU computerized color test. The SCCT was developed by using the Matlab 6.0 program. RESULTS: A total of 160 eyes of 82 diabetic patients were included. Thirty-two patients had no diabetic retinopathy, 19 had mild nonproliferative diabetic retinopathy (NPDR), 12 had moderate NPDR, 12 had severe NPDR, and 7 had proliferative diabetic retinopathy (PDR). In the all diabetic patients, the average total error score (TES) of SCHT was 189 and that of SCCT was 8.5; in patients without diabetic retinopathy, the scores were 125 and 3.64; in patients with mild NPDR, 185 and 8.16; in patients with moderate NPDR, 209 and 11.1; in patients with severe NPDR, 288 and 15.6 ; and in patients with PDR, 324 and 17.6 respectively. On the HRR test, patients without diabetic retinopathy had 1 tritan defect; those with mild NPDR 2 tritan, 2 protan, and 2 deutan defects: those with moderate NPDR, no color defects ; and those with severe NPDR, 2 tritan, and 2 protan defects, and 1 deutan defect. CONCLUSIONS: In diabetic patients, TES of SCHT and SCCT was higher according to the severity of diabetic retinopathy. SCHT and SCCT were more useful than HRR test.

The Classification of Congenital Color Vision Deficiency by SNU Computerized Color Test

PURPOSE: This study was designed to investigate the characteristics and classification of congenital color vision deficiency (CVD) by the SNU computerized color test (SCCT) that was developed to sufficiently utilize the advantages of a computer. METHODS: Hardy-Rand-Rittler test (HRR test), Nagel anomaloscope and SCCT were performed on 60 eyes of 30 CVD patients and 30 normal subjects and the results were compared. RESULTS: In normal subjects, the error scores were all zero at all colors by SCCT. By SCCT protan color defectives showed a peak at hue 0 red in 7 eyes (29.2%), at hue 150 green in 3 eyes (12.5%), at hue 180 green in 18 eyes (75%), and at hue 330 red in 2 eyes (8.3%). By SCCT, deutan color defectives showed a peak at hue 0 red in 2 eyes (5.6%), at hue 150 green in 24 eyes (66.7%), at hue 180 green in 2 eyes (5.6%), and at hue 330 red in 23 eyes (63.9%). CONCLUSIONS: SCCT showed specific axes in CVD patients, with accuracy and high sensitivity to diagnosis. SCCT appears to be useful clinically as a color vision test to diagnose and classify CVD patients.

Biological Safety Test of Seoultype Keratoprosthesis

PURPOSE: To perform biological safety test of the Seoul-type keratoprosthesis (SKpro) according to the international standards. METHODS: Mouse fibroblasts were used to assess the cellular toxicity, and albino rabbits were used for the irritation test, intradermal test, ocular toxicity test, pyrogenic test and transplantation test. Albino guinea pigs were used for the sensitization test, and rats were used for the acute toxicity test and chronic toxicity test. All tests were performed using the SKpro extracts, which was extracted under 121degrees C for 1 hour using a 0.9% normal saline as the solvent. RESULTS: For the cellular toxicity test, all the rat fibroblasts showed cell proliferation inhibition of less than 29%, which proved to be non-cellular toxic. For the irritation test and the intradermal reaction test, none of the albino rabbits showed skin rash, crust or edema. On the ocular irritation test, there were no conjunctival, corneal or iris abnormalities among the albino rabbits. On the sensitization test, none of the guinea pigs showed skin rash, crust or edema. On the acute systemic toxicity test, there were no signs of lethargy or coma among rats. On the pyrogenic test, no temperature increase was observed in the albino rabbits. On the transplantation test, there was no evidence of graft reaction around the cornea. On the chronic toxicity test, complete blood analysis, urinalysis and histological findings 6 month after exposure showed no signs of abnormalities. CONCLUSIONS: The result of this study shows that SKpro is non-toxic and biologically safe.

Clinical Manifestation of Asteroid Hyalosis

We investigated fifteen men and twenty one women, who were diagnosed to have asteroid hyalosis between June, 1997 and November, 1997 at Seoul National University Hospital. After obtaining their medical history a complete eye examination was performed. Specimen was examined by light microscope in one case. Funduscopic examination revealed bilateral involvement in 5 cases. Twenty six patients were diabetic and 12 were hypertensive. There was a significant association with diabetes. Light microscopic exam showed variable sized spherical structures with brown rim. Further decrease in visual acuity due to asteroid hyalosis was not observed in 35 cases in which follow-up exams were possible. In conclusion, asteroid hyalosis rarely caused visual loss and were likely to be monocular and to occur in old age.

Treatment and Clinical Results of Coats` Disease

To evaluate the clinical courses and the results of treatment of Coats`disease, we retrospectively investigated the medical records of 30 patients (27males,3 females). The age at diagnosis, bilaterality, chief complaints, associated abnormalities, retinal distributions of vascular change and exudate, and methods and results of treatment were reviewed. The average age at diagnosis was 4.6 years (range:1.0~8.2 years) and all cases were unilateral. Exotropia was the most common presenting signs. Following treatment, 60.0%of eyes were clinically worsened in subretinal fluid drainage/vitrectomy group, 6.7% in laser/cryotherapy group,and 28.6%in no treatment group. These results suggest that laser/cryotherapy may treat effectively the early change in Coats`disease, and making a diagnosis and treatment before the development of bullous retinal detachment may be advisable.

The Change of Corneal Astigmatism Following Varying Incision Locations and Methods for Cataract Surgery in Case of Against-the-Rule Astigmatism

Phacoemulsification and foldable PCL implantation was done on 51 eyes with preoperative against-the-rule corneal astigmatism. Different locations and incisions were employed: 18 cases of supeiror scleral pocket incision(Group 1), 16 cases of temporal scleral pocket incison(Group 2), and 17 cases of temporal clear corneal incison(Group 3). Changes in corneal astigmatism were analyzed by vector method following operation. In group 1, the amount of against-the-rule surgically-induced-astigmatism was 0.72 D at potoperative 2 months. Minimal corneal astigmatic chagne was observed in group 2. Change of 0.83 D in the with-the rule direction was in with-the rule direction. In cases of against-the rule corneal astigmatism patients, it is better to use temporal approach considering surgically induced astigmatism, and, at postoperative 2 months, we observed that clear corneal incision induces with-the-rule surgically-induced astigmatism, and reduced total amount of corneal astigmatism.

Comparison of the Effect of Topical Steroid with Nonsteroidal Anti-inflammatory Drugs (NSAIDs) on Corneal Haze and Myopic Regression after Excimer Laser Photorefractive Keratectomy

We wanted to evaluate the effects of topical nonsteroidal antiinflammatory drugs (NSAIDs) on refractive outcome and corneal haze after PRK(photorefractive keratectomy) according to the degree of myopia, and compare their effect with those of topical steroids. We divided our patients into moderate myopes ( OR = -6.0D), and each patient was randomly allocated to one of three drugs for initial management: 0.1% fluorometholone, 0.03% flurbiprofen, 0.1% diclofenac for 4 months after PRK. In moderate myopes, steroid group and NSAIDs group showed no difference in refraction after 6 months, and the subjective haze grading was consistently lower in steroid group after 3 weeks. In high myopes, steroid group and NSAIDs group showed no difference in both refraction and corneal haze after 6 months. Steroid group showed severe myopic regression or corneal haze less frequently than NSAID groups in high myopes. Topical NSAIDs are assumed to be less effective than topical steroids in reducing myopic regression and haze especially in high myopes after PRK.

Renal Damage induced by Doxorubicin-Lipiodol Emulsion infused into Rabbit Renal Artery: Comparison with CT andHistologic Findings

PURPOSE: The purpose of this study was to evaluate the utility of renal CT scanning and to histologicallycorrelate renal damage induced by renal arterial infusion of 0.2 ml/kg of doxorubicin-lipiodol emulsion. MATERIALS AND METHODS: Renal CT scans of 20 rabbit kidneys were obtained 15 days after transcatheter arterialchemoembolization and were classified into four grades, as follows : Grade 0 - no fleck, Grade 1 - one to threenodular flecks ; Grade 2 - four or more nodular flecks, or one semilunar fleck ; and Grade 3 - two or moresemilunar flecks. The percentage of histological section occupied by lesion was determined using squared paper,and compared with the grades determined on the basis of CT. RESULTS: The histologic findings were interstitialinflammatory cell infiltration, intratubular lipiodol droplets, dystrophic calcification, and cellular necrosis.The mean sizes of grade 0, 1, 2 and 3 histological lesions were 2.2%(n=5), 4.5%(n=4), 21.9%(n=7), and 24%(n=4),respectively. Grades 0 and 1 accounted for nine cases(3.2%), while grades 2 and 3 accounted for 11(22.6%) ; thisdifference was statistically significant(p<0.01). CONCLUSION: CT findings showing nodular or semilunar flecks 15days after infusion into the renal artery of doxorubicin-lipiodol emulsion correlate with the size of the damagedkidney, as seen on histological specimens.