`95 Survey of Korean Society of Cataract and Refractive Surgery Members

A questionnaire on a variety of ophthalmic topics was made up and sent to 150 members of the Korean Society of Cataract and Refractive Surgery-[KSCRS] in May, 1996. Forty percent [60/150] responded within the deadline in June, 1996. As the contents of the questionnaire were almost identical to the ones prepared in the USA [1994, 1995] and in Japan [1994], the answer to the questionnaire could be compared with those gathered from the USA and Japan. Over half of the respondents [57%] were in their forties. The average number of operations done per month was 26. Cataract operation accounted for over 60% of the total operations in 34% of KSCRS members. And more than 76% of the cataract operation were done using phacoemulsification technique in 31% of the respondents. There were no difference in the preferred method of local anesthesia for the cataract surgery in Korea compare to the USA or Japan. And there was less likelihood of using peribulbar anesthesia and no suture technique in Korea compared to the USA. Sixty-one percent of the Korean ophthalmic surgeon implanted the intraocular lenses even before the patients were younger than 20 years old whereas, 82% of ophthalmic surgeon in Japan did only when the patients were older than 20 years of age. For radial keratotomy as a means of correcting myopia, 91% of the Korean respondents were not performing the procedure any more, while 45% of the American respondents abandoned it. Fifty four percent of the Korean respondents and 46% of the American respondents have been doing excimer laser photorefractive keratectomy. There was no statistical difference between the two. From the answers to the qustionnaire, we found that our results did not differ significantly from those of the USA or Japan and we believe that these results reflect the present trends of cataract and refractive surgeries in Korea.

The Role of Proteinase in Acanthamoeba keratitis and the Effect of Amniotic Membrane as a Proteinase Inhibitor

This study was performed to investigate the biochemical properties of Acanthamoeba proteinase, its role in the pathogenesis of Acanthamoeba keratitis and the therapeutic effect of the homogenate of amniotic membrane as a proteinase inhibitors. Acanthamoeba castellanii isolated from the keratitis patient was cultured in PYG medium, in which the excretory and secretory products were analysed. The secretory proteinases of A. castellanii wre identified using in vitro azocasein assay, activity-PAGE, and various protein substrate degradation assays, and one of them was purified and characterized. The pruified secretory proteinase was a kind of serine proteinase. Its molecular weight was 105 kDa and optimal pH was 8.5. It was able to degrade the various protein substrates such as fibronectin, IgA, IgG, fibrinogen. The various proteinase ingibitors and the amniotic membrane homogenates were tested in vitro against the purified seirne proteinase. The amniotic membrane homegenates markedly showed the inhibitory effect against the enzyme activity and this inhibitory effect was also revealed in animal study. In vivo study, this purified proteinase was infected into 14 pigmented rabbit corneas, pretreated with steroids. The corneal lesions induced by both of the purified proteinase and A. castellanii, showed similar clinical findings each other, in which the stromal infiltration and opacity with epithelial defect was revealed. These corneal lesions were significantly inhibited without any side effects of the amniotic membrane homogenates. Conclusively, Acanthamoeba proteinase was closely associated with the pathogenesis of Acanthamoeba keratitis. This study provides a successful animal model of Acanthamoeba keratitis using pigmented rabbit. And the fact that Acanthamoeba-induced corneal lesions were inhibited by the amniotic membrane homogenate, suggested that the amniotic membrane homogenate have the ability of the serine protinase inhibition further investigative studies are also necessary.

Conjunctivochalasis as a Cause of Epiphora and its Histopathological Findings

When examining in the patients with epiphora, it is common to evaluate only the insufficiency or obstruction of lacrimal pathway by irrigation or dacryocystography and to over look the conjunctival conditions near the punctum in most cases. Authors found marked redundancy of conjunctival tissue around the punctal area in 8 patients(12 eyes) who complained of epiphora. They have neither lacrimal pathway insufficiency and obstruction, nor facial palsy or lid laxity that can impass the lacrimal pump action, and also no anatomical anomaly of the puncta. In fluorescein dye dissappearence test of these patients, the clearance of dye was markedly delayed on the lesion site(Grade 3 to 4). Epiphora was dramatically improved after simple resection of redundant conjunctiva under surgical microscope. The Hematoxylin-Eosin and Toluidine-Blue staining of resected conjunctiva revealed infiltration of many inflammatory cells and increase of metachromatic cells in the conjunctival stroma.

Effects of Botulinum Toxin Combined with Diltiazem on Blepharospasm and Hemifacial Spasm

We investigated whether symptom-free period(mean response time) could be prolonged when diltiazem, one of the calcium-channel blocker, as a adjuvant was administered with botulinum toxin in blepharospasm and hemifacial spasm. The patients were 10 blepharospasms and 20 hemifacial spasms who had been treating with botulinum toxin injection in our hospital. When they received only botulinum toxin for treatment of blepharospasm and hemifacial spasm, their mean response times were 126.94 +/- 42.74 and 167.32 +/- 52.90 days, respectively. After start combination therapy of diltiazembotulinum toxin, mean response times were prolonged to 163.83 +/- 53.07 (p=0.0446) in patients with blepharospasm, on the other hand, 154.21 +/- 43.36(p=0.2156) days in patients with hemifacial spasm. This study suggests that a combination treatment of diltiazem and toxin may be effective especially when the mean response time is decreased due to antibody production and the local complications are possibly expected in some patients. Present study is meaningful in that it provides a new treatment modality for blepharospasm and hemifacial spasm.