Prevalence of Zidovudine Resistant Human Immunodeficiency Virus Type 1 in Zidovudine-naive Patients / 감염

BACKGROUD: Drug resistant virus has been seen with all effective antiretroviral drugs in current practice. The isolation of resistant virus from subjects is associated with more rapid clinical outcome. The presence of resistance-conferring mutations in a patient in whom therapy is failing indicates that other antiretroviral drugs should be considered. So, the identification of drug resistant Human Immunodeficiency Virus (HIV-1) mutations is of increasing importance. Zidovudine monotherapy for HIV-1 infection has been widely used in Korea since 1990. So, the prevalence of zidovudine resistant virus has been expected to be high. The purpose of the present study is to determine the prevalence of zidovudine resistant HIV-1 among zidovudine-naive Korean patients. METHODS: We tested drug susceptibility of HIV-1 isolated from 19 zidovudine-naive Korean patients. We amplified a portion of gene reverse transcriptase of HIV-1 by RT nested PCR method. The susceptibility of HIV-1 to zidovudine was determined by sequencing the DNA base pairs of gene reverse transciptase. RESULTS: Two (10.5%) of 19 HIV-1 isolates from zidovudine naive patients showed resistance conferring mutations to zidovudine. Two (2.1%) of 95 codons analysed from zidovudine naive patients showed mutations conferring resistance to zidovudine. CONCLUSION: The prevalence of zidovudine resistant HIV-1 was 10.5% among zidovudine-naive Korean patients.

Facial Palsy as a Presenting Symptom of Wegener's Granulomatosis / 대한류마티스학회지

Wegener's granulomatosis is a serious multi-systemic disease pathologically characterized by necrotizing vasculitis and granuloma. Although nervous system is one of major target organs in Wegener's granulomatosis, the involvement of facial nerve was rarely reported as an initial symptom. We experienced a female patient with Wegener's granulomatosis presenting otitis media, sinusitis and right facial palsy. Nasal mucosal biopsy revealed necrotizing vasculitis with granuloma formation, which was consistent with Wegener's granulomatosis. During steroid and cyclophosphamide therapy, she developed paralysis of abducens nerve. Methyprednisolone pulse therapy was administrated with symptomatic improvement. We describe a case of Wegener's granulomatosis presenting facial nerve palsy.

The Effects of Mitomycin C and Ascorbic Acid on the Holmium Laser Sclerostomy in Rabbits

Several methods of mitomycin administration or subconjunctival injection of ascorbic acid was combined with holmium laser scleorstomy for the evaluation of their effects in the sclerostomy. Thirty rabbits(60 eyes) were divided into 6 groups. Group 1 received topical application of 0.04% mitomycin for 2 weeks ostoperatively. Group 2 received subconjunctival injection of 0.04% mitomycin 3 hours before sclerostomy combined with postoperative topical use of mitomycin. Group 3 received subconjunctival injection of 0.04% mitomycin just before operation. Suconjunctival injection of 0.004% mitomycin was underwent 3 hours before surgery in group 4 and just before scierostomy in group 5. After subconjuctival injection of 25mg ascorbic acid, sclerotomy was performed on group 6. We evaluated duration of success and complication, mean duration of success was 7.4 days, in group 1, 35 days in group 2, 11.9 days in group 3, 7.2 day in group 4, 10.1 days in group 5, and 10.7 days in group 6. All methods were less effective than Subconjunctival mitomycin injection 3 hours before surgery. Corneal erosion, corneal, opacity, hyphema, and early hypotony were found in mitomycin use. Ascorbic acid injection did not develop complications. In these results, the subconjunctival injection of 0.04% mitomycin C 3 hours before the holmium laser sclerostomy was regarded as the most effective to holmium laser sclerostomy without complications. Subconjunctival injection of ascorbic acid was helpful for sclerostomy but less effective than mitomycin use.

Measurement of The Depth and Angle of The Peripheral Anterior Chamber and Iris Thickness by Ultrasonographic Biomicroscopy

Measurement of the depth and angle of the anterior chamber can provide valuable information for the diagnosis, treatment and prognosis of angle closure glaucoma. We measured the depth and angle of the peripheral anterior chamber in the normal and the angle closure glaucoma eyes by utilizing ultrasonographic biomicroscopy. We also measured the 4 directions of the depth and angle of the peripheral anterior chamber and iris thickness before and after dilation in the normal eyes. The mean depth and angle of the peripheral anterior chamber were 421 +/- 73 micro meter, 30.46 +/- 6.49 degree in the normal eyes and 294 +/- 25 micro meter, 29.12 +/- 3.75 degree in the angle closure glaucoma eyes respectively. The differences of the depth and angle of the peripheral anterior chamber between the two groups were statistically significant(P<0.05, respectively). The depth and angle of the peripheral anterior chamber significantly increased after dilation in the normal eyes(P<0.05, respectively). The thickness of the iris was 421 +/- 54 micro meter at the iris root site, 509 +/- 57 micro meter in at the middle site and 582 +/- 74 micro meter at the pupillary margin site.

The Anterior Chamber Depth According to Age in Normal Urban Adult

The anterior chamber depth is important in diagnosis and treatment of glaucoma, thus the research of the anterior chamber depth would help the understanding of angle closure glaucoma. Then the estimation of anterior chamber depth might help the diagnosis of certain cases of glaucoma. It has been reported by other authors in Korea, but there were not enough subjects to see the correlation between age and the anterior chamber depth. The purpose of this study was to measure the variation of the anterior chamber depth in relation to the normal aging process. The anterior chamber depth was measured in 2,524 eyes of normal subjects aged 20 years or older who visited our hospital to receive a health examination. Measurements of the anterior chamber depth were carried out conviniently with the Haag-Streit pachometer. Intraocular pressures were measured with the Pulsair non-contact tonometer, and the refractive errors of each subject were divided into hyperopia, emmetropia, and myopia. These data were analyzed statistically by Student's t-test. Female subjects had a smaller measurement for anterior chamber depth than male. The average anterior chamber depth of the emmetropes was smaller than that of the my opes and larger than that of the hyperopes. It was found that the anterior chamber depth decreased with age(0.015mm/year). The anterior chamber depth seemed not to be correlated with the intraocular pressure.

Trabeculectomy with Mitomycin C(MMC)

Mitomycin C has an inhibitory effect on the proliferation of fibroblasts and it is used as an adjunct to trabeculectomy. To clarify the effects of mitomycin C on trabeculectomy, we ana lysed 95 eyes that received trabeculectomy with mitomycin C and 90 eyes that received trabeculectomy without mitomycin C. There were no significant differences in sex, age, type of glaucoma and preoperative intraocular pressure (IOP) between two groups (p>0.05 respectively). The mean rops at 6 months after surgery and the success rate were not significantly different between two groups (p>0.05). But considering the mean IOP of successful cases, the mitomycin C used group showed the lower postoperative IOP(p<0.05). The rate of complete seccess which had no antiglaucoma medications and 5-fluorouracil administration during the postoperative period was higher in the mitomycin C used group (p<0.05). Postoperative complications, espicially hypotony, were more common in the mitomycin C used patients. Hypotony was more frequent in the patients who received brief exposure of mitomycin C. Most of the hypotony patients had primary open angle glaucoma and lower preoperative IOP. According to the results of our study, mitomycin C should be used in the high risk group patients who are young and have secondary glaucoma or history of failure of filtering procedures, and also in the patients with difficulty of postoperative medical treatment and requiring lower IOP.

The Prevalence of Glaucoma in Korean Careermen

The Epidemiological study of glaucoma in Korean is essential because the prevalence and distribution of glaucoma can be different among race and country. We surveyed the prevalence and distribution of glaucoma in Korean careerrnen aged 20 years or older who visited Yongdong Severance Hospital to undergo a regular physical examination during the year of 1992 and the total number of subjects examined was 4959 adults. A mainstay of the screening consisted of applanation tonometry and direct ophthalmoscopy, followed by automatic perimetry as a recall examination. Patients with suspected abnormalities in either the IOP >or=22mmHg or the optic disc findings such as high cup/disc ratio (>or=0.7) were referred for recall examination as the second stage of the visual field test. Overall prevalence of glaucoma obtained was 2.04% (101 patients) and the most common type of glaucoma was low tension glaucoma, 1.71% (85 patients). The prevalence of glaucoma increase with aging especially in low tension glaucoma.

Sudden Wipeout Phenomenon Following Fitering Surgery in Patients with Advanced Glaucoma

It was previously reported that sudden loss of central vision and small residual fields in advanced glaucomatous eyes after filtering surgery. This study was undertaken to assess the risk of sudden wipe-out phenomenon on 57 eyes of advanced glaucomatous patients who could be followed up at least 8 weeks after filterlng surgery. The eyes were classified into three categones according to the seventy of visual field loss, evaluated with Humphrey computerized visual field analyzer and Goldmann perimetry using target with I-4-e. Sudden wipe-out phenomenon was divided into absolute and relative. The former was sudden complete loss of central vision immediately after filtering surgery. The latter was visual acuity decreasing 2 or more lines in Snellen visual acuity chart compared with before surgery or obvious progress1on of visual field defect at the t1me of 8 to 1O weeks after surgery However there were no absolute and relative sudden wipe-out phenomenon in our study. In the light of our experiences, it is concluded that filtering surgery can be performed with caution in advanced glaucomatous eye whenever it is indicated.

Reliability Indexes of Automated Perimetric Tests

The "reliability" of a subject's automated perimetric result is generally assessed by three measures: fixation loss, false positive and false negative rates. These reliability indicies were examined for 237 glaucomatous and ocular hypertensive eyes who for the first time underwent visual field testing (central 30-2 test on Humphrey visual field analyzer. Allergan Humphrey). Of the examination results, 11% of subjects were considered unreliable with the use of the manufacturer's reliability criteria. 71% of the unreliable results were due to failure to meet the criterion for fixation loss. The rest 29% were due to high false negative rates. After given reinstruction and more attention to fixation loss throughout the test by the technician, second visual field test was performed. On second examination, 82% of fixation loss and 71% of false negative rate was reduced.

The Prevalence of Glanucoma in Korean Adults

Early detection of glaucoma by mass screening is the most practical approach for prevention of blindness. An epidemIOlogical study gives the most essential information on prevalence an distribution of the disease in relation to diverse background factors. But, before now, an epidemiological study for glaucoma has not been carried out in Korea. Our glaucoma survey was conducted in the health examination center of Yongdong Severance hospital during 1990 and 1991. The total numbers of subjects examined was 4424 persons aged 30 years or older. A mainstay of the screening consisted of applanation tonometry and fundus photography with a non-mydriatic camera, followed by automated perimetry as a recall examination. Overall prevalences of glaucoma obtained were primary open angle glaucoma 0.23% (10 patients), low tension glaucoma 2.04% (108 patients), and ocular hypertension 0.23% (10 patients). The mean lOP obtained with applanation tonometry was 14.04 +/- 2.99 mmHg for men and 14,07 +/- 2.67 mmHg for women. In additon, our data have pointed out that the lOP in different ages tends to be constant, whereas prevalences of glaucoma and low tension glaucoma increase with aging.

The Factors Affect on the Success Rate of the Trabeculectomy

To find the factors that affect on the success rate of the trabeculectomy, we investigated 208 eyes of 158 patients with various types of glaucoma which had undergone trabeculectomy. The patients were followed up at least 3 month postoperatively. The criteria of success was maintenance of postoperative IOP below 21 mmHg. The total success rate was 89.4%. In young patients, the success rate was lower than that of older ones. The success rate of open angle glaucoma, acute angle closure glaucoma and chronic angle closure glaucoma were higher than that of congenital glaucoma and secondary glaucoma. Recently performed operation demonstrated higher success rate. The type of conjunctival flap, scleral flap and use of 5-fluorouracil were independent factors that affect on the success rate.

Long Term Fluctuation of Visual Field in Glaucoma Patients

Visual field measurements are useful tool for diagnosis and management of glaucoma, and for evaluation of prognosis. But it has intratest and intertest variability, which interfere the precise interpretation of visual field changes. To examine the long term fluctuation, we conducted visual field measurements on three separate sessions in 44 glaucomatous eyes using Humphrey visual field analyzer. Each visual field results were compared with that of the following results. The long term fluctuation of visual field measurem-ent was between 1.85 and 8.81dB and in average 4.36 +/- 1.56dB. If one retinal location shows variaton greater than 8.81dB, automated visual fields must be interpreted cautiously and require confirmation and assessment of other clinical factors.

Long Term Fluctuation of Visual Field in Glaucoma Patients

Visual field measurements are useful tool for diagnosis and management of glaucoma, and for evaluation of prognosis. But it has intratest and intertest variability, which interfere the precise interpretation of visual field changes. To examine the long term fluctuation, we conducted visual field measurements on three separate sessions in 44 glaucomatous eyes using Humphrey visual field analyzer. Each visual field results were compared with that of the following results. The long term fluctuation of visual field measurem-ent was between 1.85 and 8.81dB and in average 4.36 +/- 1.56dB. If one retinal location shows variaton greater than 8.81dB, automated visual fields must be interpreted cautiously and require confirmation and assessment of other clinical factors.

Radial Retinotomy in the Macula

Retinotomy, cutting of the retina, can be helpful in hte management of giant retinal tears, subretinal strands, and retinal incarceration. Relaxing retinotomies are used in the presence of retinal shortening or fibrous proliferation and contraction, and usually performed in the peripheral or equatorial retina. To fascilitate retinal attachment, the authors used intraocular scissors to perform radial retinotomy in the macula of two patients during vitrectomy surgery. We obtained a successful result using retinotomy in the macula as an adjunct to repair of retinal detachment with macular hole formation.

UV Protection Effect of Commonly Used Sunglasses and Guideline for Selecting Sunglasses

Although it is well known that ultraviolet and short wavelength visible rays are harmful to the human lens and the retina, consumers still tend to select sunglasses on the basis of fashion rather than protective quality. In order to provide guidelines for selecting appropriate sunglasses, we studied the mechanism of phototoxic damage and UV protective quality of commonly used sunglasses. Commonly used sunglasses were chosen by random sampling, and their UV transmittance was examined by spectrophotometer using neutral density filter method. UV transmittance was shown to be 3.0% to 40.8% and there was no significant relationship between UV transmittance and the tint or darkness of the sunglasses.