A Case of Delayed Infective Endophthalmitis Associated with Exposure of Scleral Fixation Knot

PURPOSE: To report a case of delayed infective endophthalmitis associated with exposure of scleral fixation knot. CASE SUMMARY: A 35-year-old female was transferred from a local clinic with sudden onset right eye pain under suspicion of uveitis. The patient received vitrectomy, scleral encircling and lensectomy for rhegmatogenous retinal detachment before 16 years. In addition, she underwent secondary scleral fixation of intraocular lens (IOL) 1 year previously. Best-corrected visual acuity was hand motion and intraocular pressure was 28 mmHg. Slit lamp examination revealed diffuse keratic precipitates and anterior chamber reaction was 4 positive. Exposed scleral fixation knot outside conjunctiva at 2 o' clock combined with suppurative discharge was observed. On fundus examination, red reflex was decreased due to vitreous haze. She was diagnosed as infective endophthalmitis associated with exposure of scleral fixation knot. The patient received vitrectomy and intravitreal injection of antibiotics and vitreous culture. After 2 days, IOL removal, silicone oil tamponade and intravitreal injection of antibiotics were performed due to uncontrolled inflammation with accompanying hypopyon. Hemophilus influenza was isolated in the vitreous sample. Removal of silicone oil was performed at 1 month. There was no recurrent inflammation at 1 year and she received scleral fixation of IOL for the second time. At 1 year and 3 months, corrected visual acuity was 0.4 without signs of inflammation. CONCLUSIONS: In cases of exposed scleral fixation knot after IOL insertion, a risk of endophthalmitis exists. Meticulous care is required when fixation knot is exposed due to thinning of overlying conjunctiva.

Verification of a computer-aided replica technique for evaluating prosthesis adaptation using statistical agreement analysis

PURPOSE: The purpose of this study was to evaluate the reliability of computer-aided replica technique (CART) by calculating its agreement with the replica technique (RT), using statistical agreement analysis. MATERIALS AND METHODS: A prepared metal die and a metal crown were fabricated. The gap between the restoration and abutment was replicated using silicone indicator paste (n = 25). Gap measurements differed in the control (RT) and experimental (CART) groups. In the RT group, the silicone replica was manually sectioned, and the marginal and occlusal gaps were measured using a microscope. In the CART group, the gap was digitized using optical scanning and image superimposition, and the gaps were measured using a software program. The agreement between the measurement techniques was evaluated by using the 95% Bland-Altman limits of agreement and concordance correlation coefficients (CCC). The least acceptable CCC was 0.90. RESULTS: The RT and CART groups showed linear association, with a strong positive correlation in gap measurements, but without significant differences. The 95% limits of agreement between the paired gap measurements were 3.84% and 7.08% of the mean. The lower 95% confidence limits of CCC were 0.9676 and 0.9188 for the marginal and occlusal gap measurements, respectively, and the values were greater than the allowed limit. CONCLUSION: The CART is a reliable digital approach for evaluating the fit accuracy of fixed dental prostheses.

Comparison of Therapeutic Effects of 3% Diquafosol Tetrasodium with Aging in Dry Eye

PURPOSE: The aim of this study was to evaluate the clinical effect of 3% diquafosol in dry eye patients aged around 60 years. METHODS: In total, 68 patients with dry eye syndrome were divided by age into 2 groups, Group I (29 patients, 29 eyes) under the age of 60 years and Group II (39 patients, 39 eyes) over the age of 60 years. To evaluate the effectiveness of 3% diquafosol, we measured the tear film break-up time (tBUT), performed the Schirmer I test, and used the corneal staining score as an objective indicator and the ocular surface disease index (OSDI) score as a subjective indicator at initial visit, 1 month, 2 months, and 4 months. RESULTS: Significant improvements in the tear film break-up time, Schirmer I test, and OSDI were observed at 1,2, and 4 months after treatment with 3% diquafosol tetrasodium in both dry eye groups, but significant difference in the corenal staining score were not observed (p > 0.05). There were statistically significant improvement between the 2 age groups in the tBUT at 1 month (p = 0.012), 2 months (p = 0.005), and 4 months (p = 0.005), and improvements in the Schirmer I test between the 2 age groups at 1 month (p = 0.015), 2 months (p = 0.005), and 4 months (p = 0.005) were also observed. But, there was no significant difference in the corneal staining score and OSDI score between the 2 groups at 1, 2, and 4 months (p > 0.05). CONCLUSIONS: Topical 3% diquafosol tetrasodium administration was shown to be an effective treatment to improve clinical symptoms and objective indicators in dry eye patients regardless of age, showing significant improvements in tBUT and the Schirmer I test under the age of 60.

Clinical Feature of Unilateral Ptosis with Positive Result in Phenylephrine Test

PURPOSE: To investigate the clinical features and therapeutic effects of unilateral ptosis in patients who respond to the phenylephrine (PE) test. METHODS: Patients who presented with unilateral ptosis from January 2010 to December 2014 and underwent a PE test were included in the analysis. A 2.5% ophthalmic solution of phenylephrine hydrochloride was instilled at the superior conjunctival fornix in the ptotic eye. After 10 minutes of instillation, the patients' eyelid heights were evaluated. Underlying systemic diseases were examined based on previous medical history, a blood test, neurologic examination, and radiologic imaging findings. RESULTS: Twenty-six of 44 patients who underwent a PE test showed positive results. Fourteen (53.8%) patients with positive PE test had systemic disease, and 2 (11.2%) patients had systemic disease with negative PE test. In the positive PE test group, the associated systemic disease frequency was remarkably high (p = 0.004). Myasthenia gravis (MG) was found more frequently in the positive PE test group than in the negative PE test group (p = 0.031). After 6 months, the interpalpebral fissure height increased by 2.20 mm in the positive PE test group and 2.38 mm in the negative PE test group. Patients receiving medication treatment experienced an increase in interpalpebral fissure height of 2.00 mm in the positive PE test group and 2.50 mm in the negative PE test group. In patients undergoing observation alone, the interpalpebral fissure height increased by 1.50 mm in the positive PE test group and 0.80 mm in the negative PE test group. There was no significant difference in treatment methods (respectively, p = 0.147, p = 0.228 and p = 0.112). CONCLUSIONS: The PE test can be considered to help with differential diagnosis when examining patients with mild to moderate ptosis. If the PE test is positive, underlying comorbidity including MG should be considered.

Prognostic Factors of Anatomical Success in Microincisional Vitrectomy for Rhegmatogenous Retinal Detachment

PURPOSE: To determine the prognostic factors of primary anatomical success after microincisional vitrectomy for rhegmatogenous retinal detachment (RRD). METHODS: The medical records of 206 eyes treated with microincisional vitrectomy for RRD from 2009 to 2014 were retrospectively reviewed. The preoperative factors (best corrected visual acuity, break sites, number of breaks, break size, extent of retinal detachment, high myopia, lens status) and intraoperative factors (combined cataract surgery, vitrectomy machine, tamponade, sclerotomy size) were investigated to determine correlations with primary anatomical success. RESULTS: Of the 206 eyes, 198 eyes (96.1%) were reattached after primary vitrectomy; 46 eyes of 48 eyes with inferior breaks (95.8%, p = 1.000), 42 eyes of 44 pseudophakic eyes (95.5%, p = 1.000), 84 eyes of 89 eyes with multiple breaks (95.4%, p = 0.296). All 39 eyes using air tamponade (100%, p = 0.224) were reattached and there was no significant correlation with primary anatomical success. Conversely, 44 eyes of 49 eyes with high myopia (89.8%) were reattached after primary surgery, which was lower than non-high myopic eyes (98.1%, p = 0.028). Multivariate logistic regression showed that high myopia was an independent factor for primary reattachment failure (odds ratio = 5.795, 95% confidence interval = 1.332–25.208, p = 0.019). CONCLUSIONS: Microincisional vitrectomy for RRD showed a high reattachment rate regardless of break site and number, lens status, or tamponade type. However, primary reattachment failure was relatively common in high myopia patients, thus, meticulous care is required.

Clinical Effects of Intranasal Steroid Application after Silicone Tube Intubation in Nasolacrimal Duct Obstruction

PURPOSE: To investigate the effects of intranasal steroid spray after silicone tube intubation in nasolacrimal duct obstruction. METHODS: We included 73 patients (73 eyes) who had undergone silicone tube intubation with partial nasolacrimal duct obstruction and who had been followed-up for more than 6 months. We divided them into two groups: Group 1 (37 patients, 37 eyes), who used intranasal steroid spray twice a day for 4 weeks after silicone tube intubation, and Group 2 (36 patients, 36 eyes), who did not use intranasal steroid spray. A retrospective medical record review was performed to analyze the clinical features of epiphora improvement and complications in the two groups. RESULTS: No significant difference was found in epiphora improvement after surgery between the two groups (33 eyes [89.2%] in Group 1, 31 eyes [86.1%] in Group 2) (p = 0.736). In addition, the difference in success rate between the two groups was also not statistically significant (33 eyes [89.2%] in Group 1, 28 eyes [77.8%] in Group 2) (p = 0.221). Group 1 (5/37 [13.5%] eyes) and Group 2 (12/36 [33.3%] eyes) complained of ocular discomfort during the period of silicone tube intubation (p = 0.045). The complication rate of Group 1 (5/37 [13.5%] eyes) was significantly lower than that of Group 2 (13/36 [36.1%] eyes) (p = 0.024). CONCLUSIONS: Silicone tube intubation is an effective treatment option for adults diagnosed with partial nasolacrimal duct obstruction, and postoperative intranasal steroid application may contribute to improvement of ocular symptoms after the surgery. There may be a merit of using intranasal steroid spray for adjuvant therapy to prevent postoperative complications, but it needs further study considering various factors.

Role of the "Mini" Caldwell-Luc Operation for Treatment of Chronic Maxillary Sinusitis

BACKGROUND AND OBJECTIVES: The aims of the study were to reintroduce a surgical technique for a "mini" Caldwell-Luc operation and to determine its efficacy. MATERIALS AND METHODS: A prospective study was performed in 23 patients undergoing the "mini" Caldwell-Luc operation. Improvements in clinical symptoms and endoscopic and computed tomographic (CT) findings were evaluated postoperatively over a follow-up period ranging from 6 to 21 months. All patients were surveyed for nasal symptoms (nasal obstruction, rhinorrhea, posterior nasal drip, headache, and anosmia), complications (tooth or gum pain, numbness, persistent facial pain, and facial hypo-paresthesia), and recurrence. Preoperative nasal polyps were classified by the Gaskins method, and preoperative paranasal sinusitis was graded according to the Kennedy CT staging system. RESULTS: Symptom scores were all significantly reduced postoperatively (paired t-test, p<0.05). There were no major complications specific to this technique. Among 29 maxillary sinuses that received the "mini" Caldwell-Luc operation, seven showed recurrence (24%). CONCLUSION: The "mini" Caldwell-Luc operation provides an alternative method of obtaining access to the maxillary antrum and is associated with minimal morbidity.

Comparison of Analgesic Efficacy between Single Interscalene Block Combined with a Continuous Intra-bursal Infusion of Ropivacaine and Continuous Interscalene Block after Arthroscopic Rotator Cuff Repair

BACKGROUND: This study evaluated the effectiveness of a continuous interscalene block (CISB) by comparing it with that of a single interscalene block combined with a continuous intra-bursal infusion of ropivacaine (ISB-IB) after arthroscopic rotator cuff repair. METHODS: Patients who had undergone CISB (CISB group; n = 25) were compared with those who had undergone ISB-IB (ISB-IB group; n = 25) for more than 48 hours after surgery. The visual analog scale (VAS) for pain, motor and/or sensory deficit, supplementary analgesics and adverse effects were recorded. RESULTS: There were no significant differences between the postoperative VAS of the CISB and ISB-IB groups, except at 1 hour after surgery. Their supplementary analgesics of the two groups were similar. Transient motor weakness (52%) and sensory disturbance (40%) of the affected arm were observed in patients in the CISB group. The catheters came out accidentally in 22% of the CISB group but in only 4% of the ISB-IB group. CONCLUSIONS: ISB-IB provides similar analgesia to CISB. However, the ISB-IB group had a lower incidence of neurological deficits and better catheter retention.

Study on HBV Gene Replication and Expression of Experimental Hepatitis B Model Using Baculovirus Gene Delivery System

PURPOSE: The lack of reliable in vitro infection systems or convenient animal models has hindered the progress of hepatitis B virus (HBV) research and the development of new treatment options. We established an in vitro model of hepatitis B, using recombinant HBV encoding baculovirus, which provided HBV replication and antigens expression in HepG2 cells. The objectives of this study were to characterize the magnitude of HBV expression and the level of replication obtainable in HepG2 cells, to establish the optimum infection and culture conditions of HBV expression and replication. METHODS: Replication of a competent HBV genome encoding the baculovirus, RC-HBV-Bac, was generated for delivering the HBV genome to HepG2 cells. HBV replication and antigens expression were determined in relation to the infection and culture conditions. RESULTS: In RC-HBV-Bac infected HepG2 cells, HBsAg, HBeAg and HBcAg were expressed in the cytoplasm and nuclei, and secreted into the medium. HBV replication was evidenced by the presence of a replication complex and covalently closed circular (ccc) DNA in the cytoplasmic fraction of infected cells. The level of HBV expression was directly proportional to the multiplication of RC-HBV-Bac infection. Polyethylene glycol was able to enhance the infection efficiency of the baculovirus to HepG2 cells. High levels of HBV replication were achieved under culture conditions supplemented with dimethyl sulfoxide and a low serum concentration. CONCLUSION: This in vitro model of hepatitis B, generated by baculovirus gene delivery, represents a simple and flexible system for the study of HBV replication and drug testing.

A comparative study on post-operative analgesic effect for patient-controlled and intramuscular analgesia in mandibular fracture patients

0.05). 4. In patient group with surgery of open reduction using rigid internal fixation at single fractured site, there was no significant difference of postoperative analgesic effect during the first and second postoperative day when compared between experimental group and control group(p>0.05). 5. In patient group with surgery at two fractured sites, there was significant difference of postoperative analgesic effect during the first postoperative day when compared between experimental group and control group(p<0.05). As mentioned above, it suggest that patient-controlled analgesia is more effective for postoperative pain relief than intramuscular injection in patients with rigid internal fixation by open reduction after mandibular fracture occurred. Especially, it is considered that in patient with more than 90 minutes surgery time or in cases with multiple fractured sites had more effective results with PCA therapy than conventional intramuscular analgesics.

Gamma-Knife Radiosurgery of Upper Cervical Spinal Cord Tumor

OBJECTIVE: The lower limit of gamma knife radiosurgery is considered as foramen magnum. The head is long and narrow in western people, however, the head is short and wide in oriental people. In microcephalic oriental person, gamma knife radiosurgery is tried for the upper cervical cord tumor. METHODS: We have treated seven patients of upper cervical cord tumor with Gamma-plan during the last 8 years. The seven patients consisted of one man and six women, and ages ranging from 25 to 67 years. The histologic diagnoses were cervicomedullary hemangioblastoma in two, meningioma in two, brain stem glioma extending to C2 in one, hemangioma in one, glomus jugulare tumor in one. Preradiosurgical surgical intervention was performed in three patients. Mean marginal dose was 10.8Gy. RESULTS: The median follow-up period was 40 months (12-51 months). Four tumor had markedly decreased in size on follow-up magnetic resonance image. The remaining four cases were stationary in size. There was no complication. CONCLUSION: In microcehalic or normocephalic oriental person, the lower limit of gamma knife radiosurgery is level of second cervical spine.