Effect of Lacrimal Sac Incision Using Keratome in Endonasal Dacryocystorhinostomy

PURPOSE: To evaluate the effectiveness of using Keratome in endonasal Dacryocystorhinostomy (DCR). METHODS: The authors used 3.0mm keratome, designed for cataract surgery, to incise medial wall of the lacrimal sac during endoscopic endonasal DCR in 11 patients with nasolacrimal duct obstruction. RESULTS: Surgical success rate was 90% with fast recovery time of nasal mucosa without specific complication. CONCLUSIONS: Lacrimal sac incision using keratome was more effective and non-invasive than using nasal forceps, with advantages such as shorter operation time and less nasal mucosa injury with rapid recovery time.

Study on Fibrovascular Ingrowth into the Intraocular Implant, Medpor(R)

PURPOSE: We investigated the effects of bFGF/Sucralfate/Hydron suspension and hyperbaric oxygen on fibrovascular ingrowth into porous implants materials. METHODS: Eight rabbits underwent bilateral abdominal incision through which porous orbital disc-shaped implants were inserted between abdominal muscles. These implants were either uncoated or coated with suspension of bFGF/Sucralfate/Hydron. Hyperbaric oxygen therapy was performed on 4 selected rabbits for 5 days or 10 days. Implants were harvested after 3 days, 1 week, 2 weeks and 4 weeks. RESULTS: Enhanced fibrovascular ingrowth was shown in bFGF/Sucralfate/Hydron or hyperbaric oxygen treated implants. bFGF/Sucralfate/Hydron treated implants demonstrated more fibrovascularization than hyperbaric oxygen treated implants. CONCLUSIONS: Simultaneous therapy of bFGF/Sucralfate/Hydron and hyperbaric oxygen showed more fibrovascularization than separately treated implants.

The Factors Related to Surgical Success Rate of Endonasal Dacryocystorhinostomy

Endonasal DCR has been reported for the advantages of lack of a cutaneous scar and short operating time but that the surgical success rates were lower than conventional method. We have performed endonasal DCR and had follow-up of at least 6 months in 107 patients who had been diagnosed with lacrimal pathway obstruction, and also surveyed the age, sex, sac size and nasal cavity abnormality to evaluate the factors related to success rate. Primary success rates were 82.2%(88eyes) and higher success rates were noted in younger age, man and large sac but not significant. But. the cases associated with nasal cavity abnormality as septal deviation, middle turbinate hypertrophy, ethmoiditis and polyp showed poor surgical results due to membranous ostium closure, formation of granuloma within the ostium, and formation of cicatrix with the middle turbinate.(P<0.05) Improvement of success rate may be owing to appropriate preoperative evaluation, proper management of nasal cavity abnormality preoperatively and intraoperatively, and show consider the conventional method in cases of that lower success rate are predict.

Clinical Study of Vacularization of Hydroxyapatite Ocular Implants by 99mTc-MDP Bone Scan

Hydorxyapatite ocular implants, which are used to replace the volume of the orbit following enucleation and evisceration, allow the artificial eye to move. For this advantage, drilling is required to integrate peg into implant for transfer of motion. The earlier drilling, the earlier good results in cosmesis, but it should be done in the conditon of complete vascularization to reduce infection and exposure. To evaluate the proper timing for drilling and the difference of vascularization rate between standard eevisceration(group A) and modified evisceration(group B), we attempted to evaluate implant vascularization by using 99mTc-MDP bone scan prospectively at various intervals from 10 to 23 weeks(6 patients at 10-12 weeks, 29 patients at 13-16 weeks, 31 patients at 1720 weeks, and 7 patients as 21-23 weeks) after implantation. In 7 out of 73 patients postcontrast MRI was performed on the same day of 99mTc-MDP bone scan, we compared the degree of enhancement with that of uptake in each patients. In group A the ratio of complete graft vascularization was seen in 0% at 1012 weeks, 33% at 13-16 weeks, 50% at 17-20 weeks, and 67% at 21-23 weeks. On the other hadnd in group B it was seen in 50% at 10-12 weeks, 55% at 13-16 weeks, 55% at 17-20 weeks, and 75% at 21-23 weeks. It was increased with time. The time of complete vascularization was not different between group A and B. In 7 patients studied with both 99mTc-MDP bone scan and MRI, the degrees of vascularization were very similar on the two examinations in each patients. We would like to suggest that it is proper to perform 99mTc-MDP bone scan at 21 weeks after implantation regardless of surgical methods. 99mTc-MDP bone scan is more economic than postcontrast MRI for evaluation of complete vascularization in hydroxyaptite implant.

Plasmacytoma on the upper cyclid

Plasmacytoma is one of the plasma cell dyscrasia. It occurs commonly on nasopharynx and paranasal sinus, but rare on the eyelid. If it involves the orbit, variable symptoms are presented, such as painless growing mass, proptosis, diplopia, decrease of vision, eyeball deviation etc. Irradiation is generally accepted as the treatment of choice for extramedullary plasmacytoma. Although the patient treated with irradiation safisfactory, wer must carefully follow up the patient about progression of multiple myeloma. We experienced a 15-years-old female who had a progressive growing palpable and non-tender mass on the right upper eyelid. The mass was confirmed as plasmacytoma by pathologic examination. We treated the mass with radiation. So, We present a case of plasmacytoma on the upper eyelid.

A Clinical Study of Cause of Unilateral Exophthalmos

We reviewed the charts of 39 patients had a exophthalmos of 2mm or more than the sound eye by Hertel's exophthalmometer during the last 5 years retrospectively. We attempted to analyze the causes of exophthalmos and the correlation between its causes and degree of exophthalmos, visual acuity, extraocular muscle motion limitation and fundus changes. The most common cause of unilateral exophthalmos was orbital tumor(14/39, 36%), the degree of exophthalmos in orbital tumor showed a tendency to be greater than that of other causes. In orbital tumor patients, extraocular muscle motion limitation and fundus changes also shows a higher tendency than the others. Among unilateral exophthalmos patients, if the degree of exophthalmos, fundus changes and extraocular muscle motion limitation shows moderate or over, it may strongly suggest that the cause is orbital tumor. And also, it is important to cooperate with other departments, especially otorhinolaryngology, in diagnosis and treatment of unilateral exophthalmos patients.

A Case of VADS Induced by Immunosuppessants Therapy in Uveitis Patient

VAHS is characterized by viral-like prodromal symptoms, high fever' malaise, hepatosp lenomegaly, pancytopenia. The dignosis is based on a bone marrow biopsy specimen that demonstrates histiocytic hyperplasia with prominent hemophagocytosis of red blood cells, platelets, and nucleated hematopoietic cells Recently, the use of immunosuppressants tends to increase due to increase of autoimmune disease and organ transplantation patients. A large portion of leukemia and organ transplant patients developed VAHS as a secondary viral infection after anticancer drug and immunosuppressants therapy was administered In the field of ophthalmology, VAHS can occur by administration of immunosuppressants in corneal transplantation and autoimmune uveitis patients. Recently we experienced a case of fatal VAHS in a young uveitis patient who had been treated with immunosuppressants. We report this specfic case with literature review bec,lUse of the need for careful observation of general findings occurring during treatment of immunosuppressants such as corticosteroid.

Treatment of Retinal Detachment with Macular Hole: Paracentesis, Subretinal Fluid Drainage and Intravitreal Gas Injection

Six patients with macular hole and retinal detachment and no visible vitreoretinal connection examined by slitlamp and 3-mirror contact lens were treated by two methods. In two patients with relatively localized retinal detachment in central fundus, 0.7ml or more of pure SF6 gas was injected into vitreous cavity by 27 gauge needle after paracentesis was done because of keeping the large space of gas injection as preventmg the increase of lOP. In the remained 4 patients, 1.2ml or more of pure SF6 gas was injected into vitreous cavity after the subretinal fluid was released externally, and then paracentesis was done because of preventing the increase of lOP. After operation, all patients were placed in prone position for 6 hours or more in a day. In 5 of 6 patients, the retina remained attached duing more than 6 months. Even if 2 with posterior staphyloma in 6 patients were treated with two or more operations, 1 patient was failed. Although visual improvement at 6 months after operation was limited due to macular degeneration, the visual acuity were above 0.05 in 3 patients. This operation is simple and safe and not damaged en macula. This procedure is good surgical method in patients with retinal detachment wirh macular hole but without other breaks or visible vitreous adhesion or posterior staphyloma.

Treatment of Retinal Detachment with Macular Hole: Paracentesis, Subretinal Fluid Drainage and Intravitreal Gas Injection

Six patients with macular hole and retinal detachment and no visible vitreoretinal connection examined by slitlamp and 3-mirror contact lens were treated by two methods. In two patients with relatively localized retinal detachment in central fundus, 0.7ml or more of pure SF6 gas was injected into vitreous cavity by 27 gauge needle after paracentesis was done because of keeping the large space of gas injection as preventmg the increase of lOP. In the remained 4 patients, 1.2ml or more of pure SF6 gas was injected into vitreous cavity after the subretinal fluid was released externally, and then paracentesis was done because of preventing the increase of lOP. After operation, all patients were placed in prone position for 6 hours or more in a day. In 5 of 6 patients, the retina remained attached duing more than 6 months. Even if 2 with posterior staphyloma in 6 patients were treated with two or more operations, 1 patient was failed. Although visual improvement at 6 months after operation was limited due to macular degeneration, the visual acuity were above 0.05 in 3 patients. This operation is simple and safe and not damaged en macula. This procedure is good surgical method in patients with retinal detachment wirh macular hole but without other breaks or visible vitreous adhesion or posterior staphyloma.

Hypotensive Effect of 2% Mikelan(R) and 1% Bentos(R) and Combined Therapy of 2% Mikelan(R), 1% Bentos(R) in Normal Volunteers

Thirty normal volunteers(60 eyes) of the third decade were evaluated. Thirty normal volunteers were divided into three groups, -2% Mikelan group, 1% Bentos group and combined group of 2% Mikelan and 1% Bentos-. Double masked single dose study was done by instillation each eye solution into the one eye selected randomly. The intraoculat pressure, pupil size, visual acuity, blood pressure and pulse rate were measured before the instillation of eye solution and 30 minutes, 1, 2, 3, 4, 5, 6 hours after instillation and the statistical significance was estimated using the paired t-test. The following results were obtained: 1. In group of 2% Mikelan(R), the IP reduction was noted since thirty minutes after instillation and maximum reduction ratio of IOP was 45.5% at 4 hours after instillation than IOP measured before instillation. 2. In both groups of 1% Bentos(R) and combined group of 2% Mikelan(R) and 1% Bentos(R), the IOP reduction was noted since 1 hour after instillation and each maximum reduction ratio of IOP was 32.8%, 34.9% at 4 hours after instillation than IOP measured before instillation. 3. Statistically significant IOP reduction was also noted in the contralateral eyes in each group. 4. Statistically significant IOP reduction was noted in 2% Mikelan(R) group than 1% Bentos(R) group on 30 minutes, 1, 2, 4, 6 hours after instillation. 5. Statistically significant IOP reduction was noted in 2% Mikelan(R) group than combined group of 2% Mikelan(R) and 1% Bentos(R) on 30 minutes, 1, 4, 6 hours after instillation. 6. Synergistic effect of IOP reduction in combined therpy of 2% Mikelan(R) and 1% Bentos(R) was not noted. 7. The pupil size, visual acuity, blood pressure and pulse rate were not changed significantly after the instillation of 2% Mikelan(R), 1% Bentos(R).

A Clinical Analysis on 456 Cases of Glaucoma Among Outpatients During 5 Years

Glaucoma cases undoubtedly represent one of the biggest ophthalmic problems in the field of public health. We analysed statistically 456 cases of the glaucoma patients among 35150 outpatients who visited to our eye department from Jan. 1982 to Dec. 1986. Diagnosis was performed by intraocular pressure, visual acuity, visual field, fundus and gonioscopic examination. The prevalence of the galucoma was 1.3% which was similar as other reports. The following results were obtained. 1. Among the 456 cases including 218 male and 238 female patients, there was no significant sexual difference statistically. 2. The age group over 40 years old occupied 65.9%. 3. The age group 4th and 6th decade in male and 6th and 7th decade in female occupied higher prevalence rate. 4. Open angle glaucoma has the highest prevalence rate. 5. Visual acuity was not significantly correlated to the latency. 6. Intraocular pressure appeared not to have significant correlation to the latency. 7. There was no significant difference in left and right eye. 8. There was significant correlation between the visual acuity and the intraocular pressure.

A Case of Anterior Ischemic Optic Neuropathy

Anterior ischemic optic neuropathy is the general term of disease causing visual disturbance by stenosis or obstruction of nutritional vessels of optic nerve with or without organic lesion. Patient was a 64 year old man who visited our hospital because of further evaluation of sudden visual loss and loss of lower visual field of left eye. In this case, it is observed that visual acuity of left eye was decreased suddenly and visual field of left eye was constricted on inferior area on 4 month after initial visit, visual acuity and visual field of right eye were affected. On the visual evoked potential, bilateral optic pathway disturbance finding is seen, faulty perfusion of the disc capillary and absence or decrease of the choroidal filling are seen by fluorescein angiography. Thus, anterior ischemic optic neuropathy is suspected by history, visual field, visual evoked potential and fluorescein angiography. This case was presented and a brief review of literatures has been described.