Comparison of Clinical Results between 2.2 mm and 2.8 mm Incision Cataract Surgery Using Ellips Ultrasound

PURPOSE: Introduction of phacoemulsification and development of foldable artificial lens has facilitated smaller incisions, even micro-coaxial incisions. However, there have been several studies showing that micro-coaxial incision has no benefit compared with the conventional small incision method. Cases where Ellips ultrasound was used have not yet been reported. Therefore, we compared the postoperative results between 2.2-mm and 2.8-mm incision groups using Ellips ultrasound. METHODS: Among 49 eyes receiving cataract surgery from March, 2012 to August, 2012, 27 eyes in the 2.2-mm group and 22 eyes in the 2.8-mm group were examined to obtain cumulated dissipated energy (CDE), use of balanced salt solution (BSS), best-corrected visual acuity (BCVA), corneal endothelial cell count (ECC), corneal thickness at center and incision site, and keratometric astigmatism before and after surgery. RESULTS: There were no statistically significant differences between the 2.2-mm and 2.8-mm groups in CDE (2.5 +/- 2.0 vs. 2.5 +/- 2.3) and use of BSS (188 +/- 127 vs. 138 +/- 43 mL) during the surgery, BCVA (-0.45 +/- 0.62 vs. -0.55 +/- 0.79 log MAR), ECC (-178 +/- 210 vs. -99 +/- 114 cells/mm2), corneal thickness at center (23 +/- 23 vs. 27 +/- 23 microm) and incision site (24 +/- 19 vs. 27 +/- 19 microm) and keratometric astigmatism before and after the surgery. CONCLUSIONS: A 2.2-mm micro-coaxial incision using Ellips ultrasound showed no statistically significant differences in BCVA, ECC, corneal thickness at center and incision site, and keratometric astigmatism compared with 2.8-mm small incision.

A Case of Alternaria Species Infection after Corneal Tattooing

PURPOSE: To report a case of successful treatment of Alternaria species infection after corneal tattooing using penetrating keratoplasty corneal perforation. CASE SUMMARY: A 65-year-old male underwent corneal tattooing for corneal opacity of the left eye. One month later, epithelial defect and necrosis of the left eye were observed, thus a smear and culture were performed and Alternaria species were cultured. He was treated with 0.3% amphotericin B-fortified eyedrops and Itraconazole oral medication; however, 3 weeks later, corneal perforation of the left eye was observed and penetrating keratoplasty was performed. Postoperatively, due to persistent increased intraocular pressure, trabeculectomy was performed. Two months later, donor cornea was well-grafted and recurrent keratitis was not observed. CONCLUSIONS: Corneal tattooing can cause damage to the corneal epithelium and anterior stroma and increase the risk of infection when using steroids. In the case of infection, detecting and differentiating the type of microorganisms are more difficult. Therefore, proper care and close monitoring for the signs of infection are important during and after the surgery.

Quantitative Measurement of the Sella Turcica in Pseudotumor Cerebri

PURPOSE: In this study we evaluated the hypothesis that sella turcica enlarged in size due to increased intracranial hypertension by measuring the sella turcica area using magnetic resonance imaging (MRI) in patients with increased intracranial hypertension and compared to normal controls. METHODS: Brain magnetic resonance (MR) midsagittal images of patients diagnosed with pseudotumor cerebri from 2005 to 2012 at Dankook University Hospital and 10 normal controls who had no overt signs or symptoms of neurological disease and had normal gadolinium-enhanced MR examination of brain were compared. The area of the sella turcica was measured by the double-blind method using Dicomworks v 1.3.5b (Philippe Puech and Loic Boussel, Freeware, France). Statistical analysis was conducted using GraphPad Prism (GraphPad Software, Inc., USA) and Mann-Whitney U-test. RESULTS: The sella turcica areas of 2 pseudotumor cerebri patients were 93 mm2 and 123 mm2 and were significantly larger than in the controls (p = 0.03). CONCLUSIONS: Empty sella which commonly occurs in pseudotumor cerebri can be caused by pituitary gland atrophy but, conversely, can result from the enlargement of the bony sella in response to an abnormal cerebrospinal fluid pressure gradient.

A Case of Posner-Schlossman Syndrome with Retinal Arterial Tortuosity in a Young Male

PURPOSE: To report a case of Posner-Schlossman syndrome with retinal arterial tortuosity in a young male. CASE SUMMARY: A 15-year-old male presented to our department with a halo in his left vision. Best corrected visual acuity was 0.6 and intraocular pressure was 59 mm Hg in the left eye. Slit lamp examination revealed corneal edema, keratic precipitate, deep anterior chamber, anterior chamber cell (1+) and open angle. Fundus examination revealed increased cup/disc (C/D) ratio and retinal arterial tortuosity. After treatment with anti-glaucomatic eyedrops, steroid eyedrops, and nonsteroidal anti-inflammatory drug (NSAID) eyedrops, intraocular pressure decreased to 15 mm Hg and C/D ratio decreased. CONCLUSIONS: Posner-Schlossman syndrome can occur even at an early age and must be included in the differential diagnosis of glaucoma in pediatric patients. Additional studies should be conducted regarding the association between retinal arterial tortuosity and Posner-Schlossman syndrome.

Ischemic Retinopathy Due to Suspicious Gentamicin Retinal Toxicity after Primary Repair of Scleral Laceration

PURPOSE: To report a case of ischemic retinopathy due to suspicious gentamicin retinal toxicity after primary repair of a scleral laceration. CASE SUMMARY: A 45-year-old man presented to our department with decreasing vision in his right eye after ocular trauma. Best corrected visual acuity (BCVA) was 0.02 in the right eye and slit lamp examination revealed scleral laceration. Both intravenous and topical antibiotics (10% cefazolin and 2% gentamicin) were immediately administered. On intraoperative examination, a scleral laceration located 5 mm to 11 mm from nasal limbus, prolapsed vitreous body and partial division of medial rectus muscle were observed. After irrigation with gentamincin 0.2% around the wound, primary repair was performed. On postoperative day 3, fundus examination revealed a retinal break, barrier laser was performed. On postoperative day 4, diffuse retinal edema with intraretinal hemorrhage was observed as well as, superonasal ghost vessels. Subsequently, fluorescein angiography showed diffuse leakage of retinal vessels and a nonperfusion area at the periphery, especially on the nasal side. As vitreous opacity became worse, the patient underwent pars plana vitrectomy with endolaser. One month later, vitreous cavity was clearer and best visual acuity was 0.2. CONCLUSIONS: Large doses of intraocular gentamicin ccan cause retinal toxicity. Increased gentamicin application through a scleral laceration may lead to toxic antibiotic levels. When a scleral laceration wound irrigation is performed, precautions are necessary to prevent retinal ischemia associated with gentamicin toxicity.