A Case of the Bilateral Metastatic Endophthalmitis

Metastatic endophthalmitis (also called endogenous endophthalmitis) is ther infection of intraocular tissues resulting from hematogenous spread of pathogenic microorganisms to the eye. We experienced a case of bilateral Klebsiella pneumonia endophthalmitis in treated diabetic patient. Blood culture was negative and identification of a remote focus of infection was failed. In spite of vitrectomy, lensectomy and aggressive antibiotic therapy, both eyes progressed to phthisis state. We reviewed the available literatures regarding this uncommon disease.

Endothelial F-actin changes in the alkali burned rabbit cornea

The healing mechanism of corneal endothelium after alkali burn was not completely understood. Rabbit cornea was burned with 1N sodium hydxoside for 1 minute. Endothelial F-actin was stained with NBD-phallacidin in regular sequence to find out the details of endothelial healing after alkali burn. F-actin was completely destroyed leaving a sharp margin against the unaffected area 1 hour after the burn. In the 3, 5 and 7 day specimens, highly active F-actin reactions were noted at the wound margin. New multiple F-actin layers, arising from the intact endothelium near the wound margin, were noted in the 9 day specimen. In the 8 1/2 month specimen, the endothelial defected area was covered by large primitive cells, each of which showed F-actin fiber bundles in the cytoplasm with a large nuclear shadow. Nearly all of the large primitive cells showed F-actin fibers arranged in shapes of cell junctions. Twelve months after the burn, endothelial defects were not found. Nearly all of the endothelial cells were normal in size and shape except for some mushroom-like projections toward the anterior chamber in some areas. Nineteen months after the burn, the endothelial cells were normal. Endothelial wound healing process can be continued even 1 year after the alkali burn in rabbit cornea.

Cytomegalovirus Retinopathy in Aequired Immunodeficieney Syndrome

Cytomegalovirus retinopathy(CMV)is a necrotizing retinitis which can occur as a late manifestation of the Acquired immunodeficiency syndromde(AIDS), which rapidly increases in number after original description of the disease in 1981 by Gottliebet al. We experienced a patient, who complained of decreased visual acuity of the left eye only we initially diagnosed the patient as CMV retinitis, and during the course of treatment, finally diagnosed the patient as CMV retinitis with AIDS, and the patient was subdivided into Group IV, Subgroup C by center for disease control classification system To our knowledge, for about 10% of the patient of the CMV retinopathy, AIDS was diagnosed like same manner as we did, but we couldn't find any report in korea, so we report this case with a review of literatures.

Clinical Study of Traumatic Hyphema

We reviewed 114 patients who were admitted and treated at the Chonju Presbyterian Medical Center between 1986 and 1990 for nonperforating traumatic hyphema. Of these 114 cases, 103 (90.4%) were male and 11 (9.6%) were female. Mostly, they were under 20 years of age. Grade I hyphema (bleeding less than one third of anterior chamber) was 72 cases (63.2%). The causes of injuries were blows to the eye (56 cases, 49%) and projectile objects (45 cases, 39.5%). Associated injuries to the eye and periocualr structures occurred in 78 patients (68.4%), which were angle recession (23.7%), eyelid laceration (20.2%), increased intraocular pressure (16.7%), traumatic cataract (14.0%). Secondary hemorrhage occurred in 15 patients (13.2%) and was significantly more frequent among patients whose initial hyphema filled more than one therd of the anterior chamber. The final visual acuity were worse in eye with associated ocular injuries such as vitreo-retinal disorders, traumatic cataracts, etc.

Clinical Study of Traumatic Hyphema

We reviewed 114 patients who were admitted and treated at the Chonju Presbyterian Medical Center between 1986 and 1990 for nonperforating traumatic hyphema. Of these 114 cases, 103 (90.4%) were male and 11 (9.6%) were female. Mostly, they were under 20 years of age. Grade I hyphema (bleeding less than one third of anterior chamber) was 72 cases (63.2%). The causes of injuries were blows to the eye (56 cases, 49%) and projectile objects (45 cases, 39.5%). Associated injuries to the eye and periocualr structures occurred in 78 patients (68.4%), which were angle recession (23.7%), eyelid laceration (20.2%), increased intraocular pressure (16.7%), traumatic cataract (14.0%). Secondary hemorrhage occurred in 15 patients (13.2%) and was significantly more frequent among patients whose initial hyphema filled more than one therd of the anterior chamber. The final visual acuity were worse in eye with associated ocular injuries such as vitreo-retinal disorders, traumatic cataracts, etc.

A Case of Optic Disc Pit

Optic disc pits are an uncommon congenital anomaly of the optic nerve head. Serous detachment of the macula is a well known complication in patients with an optic disc pit Although spontaneous reattachment has been reported, most eye with macular detachment associated with optic disc pit have a poor visual prognosis inspite of treatments. We have experienced a case of optic disc pit associated with serous macular detachment, that has been treated with argon pure green laser photocoagulation, reporting it with a review of literature.

A Case of Homocystinuria with Ectopia Lentis

Homocystinuria is an inborn error on the pathway of the methionine metabolism. It is mainly caused by a cystathionine B-synthase deficiency in the brain or liver. Homocystinuria is biochemically characterized by: 1) an increase of the homocystine and methionine concentration in the plasma; and 2) a decrease of the cystine with an increased excretion of homocystine in the urine. The clinical manifestations of this autosomal recessive disorder include: ectopoia lentis, skeletal abnormalities, high incidence of thromboembolism and high frequency of mental retardation. We have been experiencing a case of a 10 year old female patient who has suffered from homocystinuria. She has undergone mental retardation, poor vision caused by ocular complications and Marfanoid feautures.

Retinal Pigment Epithelial Detachment in Posterior Scleritis

Posterior scleritis must be one of the most underdiagnosed treatable conditions in ophthalmology, partly because its manifestations are so protean and partly because the diagnosis is rarely considered. Although ultrasonography and computer tomogram are ancilliary tests, a careful examination of the posterior segment of the eye including the area of the ora serrata, macula and disc is essential to discover the presence of a posterior scleritis. We experienced prolonged retinal pigment epithelial detachments which had appered at early phase of posterior scleritis.

A Case of Anterior Ischemic Optic Neuropethy

Anterior ischemic optic neuropathy is due to acute ischemia of the anterior part of the optic nerve, whose main source of blood supply is from the posterior ciliary circulation, either by direct branches or through the peripapillary choroid, with minor and differing contributions from other sources. The clinical features are charaterized by sudden visual impairment, optic nerve related visual field defect and optic disc edema. For pathogenetic as well as therapeutic reasons, these patient can be subdivided into two major subgroups: a nonarteritic group, an arteritic group. The authors experienced a case of AION, which occurred in a young male, probably arteritic. So, the literature of the AION was briefly reviewed and the purpose of this review is to increase awareness of this not uncommon condition.

Serologic Evaluations and The Effect of Dantrium(R) for Preventing Malignant Hyperthermia in Strabismus Children

Malignant hyperthermia is of particular interest to ophthalmologist because of higher incidence in children and its' potential for occurrence in strabismus and blepharoptosis patients. We analyzed the serologic data including serum CPK and the effectiveness of dantrolene sodium in strabismus children for screening carriers of malignant hyperthermia. The results were as follows; 1. Comprehensive studies including family history, laboratory test, underlying muscular disorder, muscle biopsy for susceptible individuals can help to make the diagnosis accurately. 2. No significant difference on serum CPK, LDH, GOT levels between the strabismus patients and control groups. 3. Dantrolene Sodium is effective agent for preventing malignant hyperthermia. 4. General anesthesia or stress associated with surgery and sex were the factors influencing serum CPK levels(i.e., values were significantly higher in postoperative periods and males).

Serologic Evaluations and The Effect of Dantrium(R) for Preventing Malignant Hyperthermia in Strabismus Children

Malignant hyperthermia is of particular interest to ophthalmologist because of higher incidence in children and its' potential for occurrence in strabismus and blepharoptosis patients. We analyzed the serologic data including serum CPK and the effectiveness of dantrolene sodium in strabismus children for screening carriers of malignant hyperthermia. The results were as follows; 1. Comprehensive studies including family history, laboratory test, underlying muscular disorder, muscle biopsy for susceptible individuals can help to make the diagnosis accurately. 2. No significant difference on serum CPK, LDH, GOT levels between the strabismus patients and control groups. 3. Dantrolene Sodium is effective agent for preventing malignant hyperthermia. 4. General anesthesia or stress associated with surgery and sex were the factors influencing serum CPK levels(i.e., values were significantly higher in postoperative periods and males).

Clinical evaluation of severe penetrating injury involving vitreous gel treated with pars plana vitrectomy

The author experienced 96 cases of eyeball perforation from January 1980 to May 1982. Of those evaluated 24 cases of severe penetrating injuries involving vitreous gel were treated with pars plana vitrectomy. The conclusions were as follows: 1. Visual improvement was achieved in 45.B%, of the 24 patients with ocular penetrating injury treated by pars plana vitrectomy. 2. The prognosis was poorer in cases with scleral or corneoscleral injury than corneal penetrating injury. 3. The final visual prognosis was poorer in the 8 cases with large scleral laceration (more than 8mm) than in the other 16 cases. The visual acuity was limited to hand motion or less in 12 cases. 4. Those patients who were operated on between 2 weeks and 6 weeks after the injury had a better prognosis than others.

Two Cases of Monochromatic Green Argon Laser Photocoagulation for Choroidal Neovascular Membrane in High Myopes

High myopia, often called malignant, pathologic or degenerative myopia, involves a progressive elongation of globe, accompanied by degenerative changes of the retina and choroid. Continued stretching and degeneration of the choroid causes eyes with severe myopia to develop breaks in Bruch's membrane which, called lacquer cracks, and permits neovascular proliferation from the choriocapillaris into the subretinal pigment epithelial space. Neovascularization associated with severe myopia deteriorates central visual acuity due to exudation and/or hemorrhage. Laser photocoagulation therapy is useful in treating neovascular membrane outside the foveal avascular zone or extending to the edge of the perifoveal capillary network. We have evaluated three patients with macular hemorrhage which associated with high myopic choroidal degeneration. Subretinal neovascular membrane was detected by fluorecein angiography and was treated with monochromatic Argon green laser photocoagulation in two patients indicated. The visual acuities were improved. But one patient who had macular hemorrhage involving both foveas could not be treated with laser photocoagulation. Then his visual acuity severly decreased. We give our experiences with the review of other papers in this report.

Total Hyphema Treated with Ocutome

Author have experienced 3 cases of intractable total traumatic hyphema on conservative medical treatment and have good results after surgical management by using Model 800(A) Ocutome vitrectomy instrument. For evacuation of blood clot in anterior chamber. The conclusion were as follow; 1. We experienced no significant intraoperative complication. 2. All 3 cases achieved intraocular presure controls in early post operative state and these controls were sustained till now without any antiglaucomatous agent. 3. Good final visual acuity was obtained in pure total hyphema in which there was no other associated intraocular injury at the time of trauma.

A Case of Traumatic Endophthalmitis Managed with Pars Plans Vitrectomy

Although we managed a patient with traumatic endophthalmitis with potent antibiotics for 7 days topically and systemically, her clinical symtoms and signs did not improved and her visual activity decreased from hand motion to light perception. So, we performed pars plana vitrectomy and lensectomy using the Ocutome(R) and Frognatome(TM) and achieved a successful result with final visual acuity of 50 cm finger count or better without evidence of phthisis bulbi in this case.

Clinical Aspect of Lens Extraction by Pragmatome(TM) and Ocutome(R): A preliminary report

Phacofragmentation is one of the method of extracapsular lens extraction using ultrasonic frequency. We have used this method, sometimes inconjunction with anterior vitrectomy since April, 1980 for 10 eyes of 10 cataract or early adult cataract. Our machines for this purpose is one of the Girard type phacofragmetor, Berkeley Model 820 Fragmatome(TM), in conjunction with Berkeley Model 800A Ocutome(R). We have had quite good results after operation and we are sure this method was preferable operation at least in above mentioned cases. This is an our preliminary report and it will be necessary to perform operation to many cataract patients and to determine longterm effects of the operation.

Clinical Evaluation for 28 Cases of Vitreous Surgery: A preliminary report

Vitreous surgery has become a widly practiced procedure for use in the variety of pathological conditions in the anterior and posterior semgment of the eye. The goal of the vitreous 'surgery is to clear the optic pathway and restore the anatomy and function of the eye. Vitreous surgery was performed in 28 eyes using the O'malley ocutome from April, 1980 to October, 1980. Among the 28 eyes, 14 eyes received anterior segment surgery and the other 14 eyes received posterior segment surgery. The follow up period after surgery ranged from 3 weeks to 7 months and the average period was 4 months. The conditions requiring surgery were as follows: 9 eyes had Reconstruction of anterior segment after trauma; 4, removal of pupillary membrane due to chronic uveitis and after cataract; and 1, anterior vitrectomy with removal of subluxated lens. As for the causes of posterior segment surgery, 5 eyes had trauma of eyeballs; 3, hypertensive retinopathies; 2, vitreous opacity with retinal detachment; 1, diabetic retinopathy; 1, central retinal vein occlusion; 1, nonmagnetic intraocular foreignbody; and 1, lost lens nucleus into the vitreous. The improvement of visual acuity after surgery was seen in 14 eyes (50%), 9 eyes in anterior segment surgery and 5 eyes in posterior segment surgery. The complications during operation were vitreous hemorrhage (1 eye; 3.5%), retinal detachment (2 eye; 7%), and traumatic cataract (1 eye; 3.5%). Postoperative complications were phthisis bulbi (1 eye; 3.5%), and cataract (1 ; 3.5%). We found that vitreous surgery is not only useful to removal of the various pathologic conditions of vitreous through the pars plana approach but in anterior segment as an emergency procedure at the time of trauma and vitreous loss during anterior segment surgery.

Clinical Evaluation of the Strabismus Patient

The authors studied 410 cases of strabismus patients who visited our clinic from 1973 to 1978 Among them, 170 cases of esotropia, 234 cases of exotropia and 6 cases of hypertropia were observed. The average age at the time of onset was 3.4 years in esotropia and 5.2 years in exotropia. Visul acuity in exotropia was relatively good. 0.7 or more visual acuity was 53 % in exotropia and 34.7 % in exotropia. Refractive status, hypertropia above 1.5D was 64. 2 % in esotropia, but, no specific correlation was found between exotropia and refractive status. The incidence of amblyopia was 33.1 % in esotropia and 19.7 % in exotropia. In accomodative esotropia, the patients with high AC/A ratio were treated with bifocal segment glasses. and the results were good.

A Clinical Evaluations of Trabeculectomy

During the last two years, 43 cases of various types of glaucomatous eyes recieved trabeculectomy ab externo under the surgical microscope. To increase filtration, edges of the scleral incision were cauterized after suture of the lamellar scleral flap. And successful trabeculectomy was achieved in 10 of 11 eyes (90%) with primary open angle glaucoma and in 15 of 17 eyes (88%) with chronic angle closure glaucoma. But the results of trabeculectomy in patients with congenital glaucoma. aphakic glaucoma and absolute glaucoma were poor. In one of the congenital glaucoma case, trabeculotomy was performed simultaneously with trabeculectomy and a good result was achieved.

Clinical Evaluations After Cataract Operation

It is hard to advice for fitting contact lens in the case of monocular lens extraction in rural area because of exposure to dust laden air and elderly people in most cases. Questionares for comfortability, Side effects and the method of visual correction were obtained in 200 cases of cataract operation in rural area. Most of the advanced age group replyed that the unsatisfactory and difficulty for fitting contact lens, therefore it is desirable method to obtain good adaptation and binocualr vision with P-A (Phakic and Aphakic) spectacles by intensive training.