A Case of Orbital Abscess Secondary to Dacryocystitis

PURPOSE: We report a case of orbital abscess secondary to acute dacryocystitis in which the patient had been cared for chronic dacryocystitis. METHODS: A 59-year-old woman presented to our clinic with a history of chronic sinusitis from childhood and right chronic dacryocystitis treated for 6 years. She had sufferred from influenza 2 weeks previously and complained of painful lid swelling, limitation of ocular movement, exophthalmos, chemosis, and decreased vision of the right eye for 2 weeks. An orbital CT scan was taken and bacterial culture and sensitivity tests were done from the discharge. RESULTS: CT scan showed inflammation and abscess formation around the right nasolacrimal duct orifice which was swollen and widened. Some of the inflammation tissues extended into the retrobulbar portion. Streptococcus pyogenous was cultured. Lid swelling, pain, exophthalmos, and visual acuity improved after external dacryocystorhinostomy, and surgical drainage. CONCLUSIONS: We should be careful in a case of acute dacryocystitis underlying chronic dacryocystitis as it easily causes complications, and in such a case early surgical management as well as antibiotics therapy is more effective.

Ballooning Canaliculoplasty and Silicone Tube Intubation after Lacrimal Trephination

PURPOSE: The purpose of this study was to assess the satety and effectiveness of lacrimal trephination and balloon dilatation in treatment of obstruction of the lacrimal canaliculus. METHODS: Lacrimal trephination and subsequent balloon dilation was performed in 7 eyes of 7 consecutive patients with epiphora due to lacrimal canalicular obstruction and common canalicular obstruction. RESULTS: The average age of patients was 50.3 years old and the average follow-up period was 17.7 months. Anatomical success was 7 of 7 eyes (100%) and functional success , resolution of epiphora was 5 of 7 eyes (71%) CONCLUSIONS: Lacrimal trephination and subsequent ballooning canaliculoplasty in treatment of obstruction of the lacrimal canaliculus seems to be safe and valuable as an primary procedure before Jones tube bypass surgery.

A Case of Nasal Endoscopic Treatment for Paranasal Mucocele

PURPOSE: We report a case of sphenoid and ethmoid mucocele causing orbital apex syndrome, which was successfully treated with drainage under nasal endoscopy. METHODS: A 82-year-old female visited the hospital complaining of decreased visual acuity in her left eye for 15days. Visual acuity of the left eye was hand motion . She also complained of left ocular pain and headache. In ophthalmologic examination, exophthalmos, mild ptosis, extraocular muscle movement limitation and RAPD (relative afferent pupillary defect) of the left eye were found. Orbital CT showed a 3.3 X 2.9 X 4.1 cm sized well-demarcated cystic lesion involving the left sphenoid sinus, left ethmoid sinus, and posterior portion of the right ethmoid sinus. The ethmoid air cell was remodeled by this cystic mass. The medial wall of the left orbit was protruded outward. So, the medial rectus muscle and optic nerve in the left orbit were compressed. We found a bulging yellowish cystic mass supero-posterior to the middle turbinate under nasal endoscopy. We performed incision and drainage under nasal endoscopy. RESULTS: At post-operative 2days, orbit CT showed the removed large mucocele in the sphenoid and ethmoid sinuses. At post-operative 2weeks, corrected visual acuity of the left eye was 0.6. There was no exophthalmos, ptosis, or extraocular muscle movement limitation. CONCLUSIONS: Endoscopic surgery in the treatment of paranasal mucocele can be performed during a short time under local anesthesia and anatomical change of the paranasal sinus can be minimized. We therefore suggest that drainage through nasal endoscopy is effective method in the treatment of paranasal sinus mucocele.

Result of Partial Nasolacrimal Duct Obstruction After Silicone Tube Intubation

PURPOSE: In a preliminary series of 36 eyes with partial nasolacrimal duct obstruction, the types of dacryoscintigraphy result were classified and the results of silicone tube intubation were analysed. METHODS: The results of dacryoscintigraphy, performed in 36 eyes of 29 patients with partial nasolacrimal duct obstruction, were classified into the following 3 types: pre-lacrimal sac type, proximal nasolacrimal duct type and distal nasolacrimal duct type. Punctoplasty accompanied by silicone tube intubation was conducted selectively. RESULTS: In dacryoscintigraphy, symptoms improved in 6 eyes among 6 in distal nasolacrimal duct type (100%), 14 eyes among 18 in proximal nasolacrimal duct type (77.8%) and 8 eyes among 12 in pre-lacrimal sac type (66.7%). CONCLUSIONS: We conclude that dacryoscintigraphy predicts the results of silicone tube intubation. Furthermore, silicone tube intubation was effective in proximal nasolacrimal duct type and distal nasolacrimal duct type, but less effective in pre-lacrimal sac type of partial nasolacrimal duct obstruction.

Result of Surgery for Epiretinal Membrane and Their Recurrence

We retrospectively reviewed the medical records of 25 cases of removal of macular epiretinal membrane who had been treated by vitrectomy. Indication for vitrectomy was decreased central vision less than 20/60, metamorphopsia or progressive decreased vision (more than 2 lines on Snellen chart) during 6 months.Preoperative and postoperative examination include best corrected visual acuity, biomicroscopic fundus examination with contact and other routine ocular examination.A standard three port pars plana vitrectomy with removal of membrane was performed in all cases, and the lens was removed when necessary.The average follow up period was 12.9 +/-8 . 4 months.Nineteen of 25 eyes (76%)showed a postoperative visual improvement of two lines or more on Snellen chart.Postoperative visual acuity was improved more than 20/40 in 10 of 25 eyes (40%).Postoperative complications were recurrence of uveitis in 3 eyes, progressive cataract in 6 of 14 phakic eyes and recurrent epiretinal membrane in 1 eye.This study demonstrates that vitrectomy for macular epiretimnal membrane results in the overall favorable visual prognosis without serious complication.

Regression and its Mechanism after Laser In Situ Keratomileusis

We evaluated the degree and mechanism of regression after laser in situ keratomileusis[LASIK]on moderate to highly myopic eyes during the first postopserative 6 months. Betwwen January 1997 and October 1998, 61 eyes operated on with LASIK for myopia, with 2 diopter or more myopic regres-sion occuring during than first 6 months were included in this study. And 79 eyes in control group with less than 1 diopter were included. The attemped correction for refractive error was determined by cycloplegic refraction. We evaluated the changes of refractive error, uncorrected visual acuity, best corrected visual acuity, corneal topography, corneal thickness and keratometry before operation, one day, one week, two months and six months after operation. In regression group, corneal thickness was significantly incresed from 0.425 +/-0.048millimeter at postoperative 1 week to 0.444 +/-0.050millimeter postoperative 6 month[p=0.003]and central corneal power was significantly increased from 36.45 +/-2.03 dopter at 1 week to 37.45 +/-5.52 diopter.[p<0.01]The larger sperical equivalent and cylinder were, the more amount myopic regression was in contrast with control group. Early regression of refractive effect after LASIK appears to be a consequence of an increase in corneal thickness associated with central corneal steepening.

The rapeutic Effects of Low Dose Triple Agents Steroid, Cyclosporine and Azathiprineon Refractory Uveitis

Immunosuppressive agent has been used as a therapeutic agent for Endogeneous posterior uveitis[EPU]. But serious side effect of steriod or cyclosporine and frequent recurrence of ocular inflammation warrant the addition of other immunosuppressive agents. In this study, we evaluated the therapeutic effectiveness of low dose triple therapy using steroid, cyclosporine and azathioprine when combination therapy with steroid and cyclosporine had failed. We reviewed the records of 10 Behcet's patients[18 eyes]and 2 sympathetic ophthalmia patients[2 eyes]who had been resistant to steroid and cyclosporine combination therapy. The median follow up duration of triple therapy was 16.3 months. Recurrence, severity of inflammation, systemic manifestations associated with Behcet's disease, and side effect of therapeutic agents were evaluated. There was a significantly decrease in the frequency[0.37/month during pretriple therapy and 0.14/month after triple therapy]and severity of ocular inflammation[p<0.01]. The frequency and severity of systemic manifestations also decreased. Visual acuity remained stable in 7 eyes[35%]and improved in 13 eyes[65%]. No serious side effects or newly developed side effect were developed during triple therapy except reversible mild anemia in 1 patient. The results of our study suggest that triple agent immunosuppressive therapy is well tolerated and appears to be effective for the severe uveitis which is refraction to steroid and cyclosporine combination therapy.

Glaucomatous Optic Nerve Head Progression and its Risk Factor in Glaucoma:Longitudinal Study of Heidelberg Retina Tomograph

This study evaluated the risk factor of glaucoma progression despite of adequate intraocular pressure[IOP]and that of glaucomatous optic nerve head progression before visual field progression with minimum treatment regimen. Inclusion criteria included subjects with elevated intraocular pressure and glaucomatous optic nerve head in fundus examination. Patients were main-tained their IOP by medication or filtering surgery. Baseline assessment included routine ocular examination, Heidelberg Retina Tomograph[HRT]and visual field. All patients were reexamined 6 months after the first examina-tion. We review the results of 61 patients[118 eyes]. In multiple logistic regression analysis, the risk factors of glaucoma progression were age[p=0.027] and the intraocular pressure at the first HRT examination[p=0.0216]. Glaucomatous visual field progression correlated significantly with HRT progres-sion[p=0.0216]. If the early glaucoma progression is detected with HRT, progression of glaucoma can be prevented. In the groups with the risk factors, the target pressure should be lower to prevent further loss or blindness with agressive treatment. In groups without risk factor, the quality of patient's life can be improved with minimum treatment. We may be able to prevent the progression of glaucomatous field defect, if we can recognize the early change of their optic nerve head morphology. Their findings may help us to differentiate non-risk group from risk group. We hope that we would improve our patient's life quality by minimizing glaucoma treatment especially in the non-risk group.

Effect of Laser in Situ Keratomieusis on Astigmatic Correction

We studied the effect of LASIK(laser in situ keratomileusis) on the correction of astigmatism for patients with simple myopia & compound myopic astigmatism. LASIK was performed on 147 eyes of 108 patients using VISX STAR. All the cases were divided into two groups by the amount of underlying astigmatism: 64 eyes for simple myopic group(equal or less than 0.5D) and 83 eyes for compound myopic astigmatism group(more than 0.75D). The attemped correction for refractive error was determind by cycloplegic refraction. We evaluated the changes of refractive error, uncorrected visual acuity, best corrected visual acuity, corneal topography, corneal thickness and keratometry before operation, one day, one week,two months and six months after operation. Uncorrected visual acuity improved from 0.062+/-0.056 before operation to 0.821+/-0.215 at six months after operation in simple myopic group and from 0.069+/-0.068 to 0.735+/-0.224 in compound myopic group. Spherical equivalent was reduced from -8.135+/-2.096D before operation to -0.765+/-1.186D at six months after operation in simple myopic group and from -9.498+/-3.181D to -1.022+/-1.504D in compound myopic astigmatic group. Mean astigmatism increased from -0.300+/-0.205D before operation to -0.703+/-0.553D at six months after operation in simple myopic group and was reduced from -1.640+/-1.047D to -1.075+/-0.811D in compound myopic astigmatic group. Decentration of ablation from the pupil center was ranged between 0.00 and 1.42mm(mean 0.449+/-0.341mm) in all the patients by corneal topography. It was 0.446+/-0.333mm in simple myopic group and 0.452+/-0.353mm in compound myopic astigmatic group respectively. The patients with a decentration more than 1.00mm showed a statistically significant astigmatism than those with a decentration equal or less than 1.00mm.With these results it is suggested that LASIK with VISX STAR would be effective in correction of astigmatism equal or more than 0.75D. In contrast, it is not effective in correction of astigmatism equal or less than 0.5D.

Microbial Contamination of Contact Lens Storage Cases in Contact Lens-induced Keratitis Patients

In order to evaluate the microbial contamination of contact lens cases in patients with contact lens-induced keratitis, 27 contact lens storage cases were collected and their solutions were cultured. Of 27 contact lens cases, 25%(93%) showed microbial contamination, Four contact lens cases(15%) were contaminated by single species., 14 contact lens cases(52%) by two species. and 9 contact lens cases(33%) by more than three species. Of total 36 identified microorganisms, the most commonly cultured microorganism was Pseudomonas sp.. Other G(-) bacteria such as Serratia, Enterobacter and Acanthamoeba were also cultured. Based on data from this study, most contact lens cases of patients with contact lens=induced keraititis were contaminated with multiple microorganisms. When considering the high contamination rate of contact lens cases and its causative factor in development of keratitis, proper disinfection of contact lens cases can not be overemphasized. Therefore, ophthalmologists should continue patient education for proper care of contact lens, especially disinfection of contact lens cases.