The Effect of Nasal Cavity Abnormality Related to Surgical Success Rate of Endonasal Dacryocystorhinostomy

PURPOSE: To investigate the effect of a nasal cavity abnormality on the success rate of endonasal dacryocystorhinostomy (DCR). METHODS: Two hundred seventy eyes of 230 patients who had undergone endonasal DCR from February 2003 to July 2004 were retrospectively analyzed. The patients were classified into three groups after all were preoperatively examined by an otolaryngologist. Group A consisted of patients who had no nasal cavity abnormality; Group B, patients who had a nasal cavity abnormality and who received treatment; and Group C, patients with a nasal cavity abnormality but who received no treatment. RESULTS: The success rate of endonasal DCR were 83.9% in Group A, 87.5% in Group B, and 79.2% in Group C, with no statistical significance among the three groups (p>0.05). CONCLUSIONS: The presence of a nasal cavity abnormality did not affect the success rate of endonasal DCR.

A Case of Visual Field Defect from Intracranial Optic Nerve Compression by Normal Caliber Internal Carotid Artery

PURPOSE: Compression of the optic nerve by a dolichoectatic internal carotid artery is known to cause of visual field defects. We experienced a case of optic nerve compression by a normal-appearing internal carotid artery. METHODS: A 22-year-old man presented with left eye visual field defect without obvious cause and magnetic resonance imaging revealed compression of the left optic nerve by ipsilateral internal carotid artery. RESULTS: At eight-month follow-up, there was no improvement in visual field defect or optic disc change. CONCLUSIONS: In an unexplained optic neuropathy, T1-weighted MRI is needed to evaluate the relationship between the optic nerve and internal carotid artery.

The Histopathologic and Clinical Features of Idiopathic Macular Hole

PURPOSE: The purpose of this study was to assess surgical results of internal limiting membrane maculorrhexis and to better understand the ultrastructural features of excised tissue during surgery for idiopathic macular holes. METHODS: We studied 10 patients (10 eyes) with idiopathic macular hole, who had undergone trans-pars planar vitrectomy, peeling of internal limiting membrane with maculorrhexis maneuver, air-fluid exchange, and intravitreal gas tamponade. During the vitrectomy surgery for idiopathic macular hole, we excised specimens. These surgical specimens were evaluated with transmission electron microscopy for their histopathologic features. RESULTS: We achieved complete hole closure in all 10 eyes, postoperatively. Sixty percent of the patients achieved visual improvement of 2 or more lines on Snellen E visual acuity chart. In the ultrasutuctural findings, internal limiting membranes were noted. Some of them showed cellular components enmeshed in a collagenous matrix. In many cases, we could find that the internal limiting membranes were covered on its inner surface by a layer of cells. The most frequent cell type was myofibroblasts, followed by fibrocytes and fibrous astrocytes. CONCLUSIONS: Our study supports the hypothesis that idiopathic macular holes occur because of histopathologic changes of the prefoveal internal limiting membranes. And we postulate that intentional removal of internal limiting membrane with maculorrhexis is a logically reasonable surgical treatment for idiopathic macular holes.

Wernicke's Syndrome Induced by Hyperemesis Gravidarum

PURPOSE: Wernicke's syndrome, which is characterized by nystagmus, abducent and conjugate gaze palsies, ataxia, mental confusion, and amnesia, is caused by a deficiency in levels of thiamine and is observed mainly in persons who abuse alcohol. Recognized predisposing conditions other than alcoholism include chronic dietary deprivation(imbalanced diet, prolonged intravenous feeding.) and impaired absorption or intake of dietary nutrients. METHODS: We have experienced a 31-year-old female presented 15 weeks into pregnancy who complained of icteric skin color, diplopia, and gait disturbance after prolonged vomiting for 2 months. Neurologic examination demonstrated obtunded sensations, nystagmus and ataxia of gait. EEG showed a mild degree of slowly diffuse activity. The neurological signs pointed to a diagnosis of Wernicke's encephalopathy. RESULTS: We report a case of Wernicke's syndrome induced by hyperemesis gravidarum with the review of literature.

Choroidal Tuberculoma with Membranous Glomerulonephritis

We report treatment of a 24-year-old man with membranous glomerulonephritis (MGN) who developed a solitary choroidal tuberculoma in association with miliary tuberculosis during steroid therapy. In June 1995, the patient had developed nephrotic syndrome. He had refused renal biopsy at that time. So we treated him with corticosteroids having assumed a diagnosis of minimal change nephrotic syndrome. After initial corticosteroids and diuretics therapy for 5 months, his generalized edema resolved but proteinuria (3 positive) continued, suggesting the presence of other forms of glomerulonephritis. Renal biopsy performed in January 1996. The patient was diagnosed as having MGN. The patient was closely observed over a period of 34 months and remained stable without steroid therapy. However at 34 months, generalized edema was again noted and steroid therapy at high dosage was initiated. After 5 months of steroid therapy, he developed miliary tuberculosis and a solitary choroidal mass. An antituberculosis chemotherapeutic regimen was started and after a further 5 months, all clinical symptoms and signs of the pulmonary lesion were resolved and a measurable shrinking of the choroidal mass was recorded.

Effects of Dimethyl Sulfoxide (DMSO) on the Contraction of the Rat Iris Muscle

PURPOSE: To evaluate the effects of DMSO on the iris muscle contractility and to compare DMSO with other detergents(ethanol and triton-x 100). METHODS: After anesthesizing rats with an intraperitoneal injection of pentobarbital sodium, each animal was fixed under microscope. The pupil response to the drugs was examined by CCD camera and the video edge motion detector was used for measurement of alteration of the pupil size. The pupil response to the drugs was recorded by MacLab chart(version 3.6/s). RESULTS: Miosis induced by DMSO was initiated after 5 minutes, peaked at around 30 minutes and maintained until 3 hours after instillation. Miotic effect of DMSO was in a dose dependent manner ranging 0.01%-10% and was not reversed after washout. All detergents used in the present experiment induced miosis, however, DMSO elicited the strongest miotic response. After pretreatment with atropine, DMSO-induced miotic response was not affected, showing similar changes with control group. CONCLUSIONS: Taken together, it is concluded that DMSO induces miosis by inducing relaxation of iris dilator muscle.