Latanoprostene Bunod 0.024% w/v Treatment of Open-anlge Glaucoma: Short-term Effects, Safety, and Changes in Ocular Blood

Purpose@#To study the short-term intraocular pressure (IOP)-lowering effect and optic nerve head (ONH) blood flow improvement after switching from latanoprost 0.005% w/v to latanoprostene bunod 0.024% w/v. @*Methods@#This prospective study ran from May 2022 to December 2022 and included 40 patients with open-angle glaucoma who switched from latanoprost 0.005% w/v to latanoprostene bunod 0.024% w/v. The IOP, ONH blood flow, and conjunctival hyperemia, corneal erosion, and eyelid pigmentation status were measured 3 months after switching. We recorded all possible side effects. @*Results@#The baseline IOP significantly dropped from 17.53 ± 6.49 to 16.00 ± 8.06 mmHg at 3 months (p = 0.032). The best-corrected visual acuity did not significantly change (0.24 ± 0.19 to 0.23 ± 0.16); neither did eyelid pigmentation (1.16 ± 0.78 to 1.16 ± 0.82) nor the corneal erosion score (0.58 ± 0.85 to 0.39 ± 0.76). Conjunctival hyperemia significantly decreased from 2.00 ± 0.69 to 1.67 ± 0.63 (p = 0.010). Neither the whole-image vessel density nor the peripapillary vessel density significantly changed. However, pruritus became significantly worse after the change (p = 0.008). @*Conclusions@#In the short term, latanoprostene bunod 0.024% w/v lowered the IOP more effectively than did latanoprost 0.005% w/v. However, there was no significant change in ONH blood flow after the switch.

Effect of Mask Mandates on the Intraocular Pressure Measured via Goldmann Applanation Tonometry

Purpose@#The corona virus disease-19 (COVID-19) pandemic has resulted in mandatory masking of patients and physicians during outpatient visits. This study evaluated the changes in intraocular pressure (IOP) according to mask use. @*Methods@#This prospective study enrolled 30 healthy volunteers (60 eyes). IOP was measured via Goldmann applanation tonometry (GAT) for the subjects wearing one of four commonly used masks: dental, bi-folding Korean Filter (KF)94, tri-folding KF94, and dust masks. Subjects with IOP measurement errors of more than 5 mmHg were rechecked with another GAT type. @*Results@#The mean IOP measured via GAT before mask wearing was 13.7 ± 1.7 mmHg. It was 13.5 ± 2.1, 14.0 ± 2.3, 14.3 ± 2.5, and 13.8 ± 1.6 mmHg with the dental, bi-folding KF94, tri-folding KF94, and dust masks, respectively. There were no significant differences in IOP according to mask type (p = 0.635). IOP errors above 5 mmHg were detected in three subjects who had contact between the GAT feeler arm and tri-folding KF94 mask during IOP measurement. @*Conclusions@#The IOP as measured via GAT is artificially elevated by mechanical interference from the tri-fold KF94 mask. To minimize such mask-induced artifacts in GAT measurements, compress the patient’s mask or change the mask type to prevent any contact during measurement.

Adherence Improvement in Glaucoma Patients: Effects of Educational Intervention Using an Eye Drop Chart

Purpose@#To evaluate the effects of an educational intervention using an eye drop chart and supplementary education on glaucoma patients’ adherence. @*Methods@#In this multicenter prospective study, medically treated glaucoma patients were educated on the administration of eye drops using an eye drop chart. At the time of recruitment, all of the patients completed a questionnaire on demographic characteristics and adherence. Three months after the initial educational intervention, the patients were randomly divided into two groups: an education group and a control group. The education group received supplementary education. Immediately thereafter and at 6 months, all of the patients completed the questionnaire on adherence again. Changes in instillation behavior, the relationship between the adherence score and demographic characteristics, and factors contributing to an improvement in adherence and intraocular pressure were then analyzed. @*Results@#The adherence scores were significantly higher in patients with fewer medications, a higher annual income and higher educational level, and an urban residence (p = 0.038, p = 0.033, p = 0.041 and p = 0.047, respectively). Education on the administration of eye drops and use of the eye drop chart improved adherence scores from 23.05 ± 3.52 to 21.30 ± 3.95 (p = 0.021) and significantly reduced the average intraocular pressure from 14.3 ± 2.9 to 12.4 ± 3.1 mmHg (p < 0.001). Working indoors (odds ratio [OR] = 5.47, p = 0.032) and supplementary education at 3 months (OR = 4.53, p = 0.030) were also correlated with improved adherence. @*Conclusions@#An eye drop chart is an effective tool for improving adherence and intraocular pressure control in glaucoma patients. Improvement in adherence was especially notable in patients whose work predominantly involved indoor activity. The effectiveness of the eye drop chart was improved by supplementary education.

Effect and Safety of Travoprost 0.003% in Open Angle Glaucoma

Purpose@#To determine whether travoprost 0.003% has a similar intraocular pressure (IOP) reduction effect to that of travoprost 0.004% while reducing side effects. @*Methods@#This was a prospective study from January 2018 to December 2018 that included 102 patients diagnosed with open angle glaucoma who switched from travoprost 0.004% to travoprost 0.003%. We investigated the changes in IOP, conjunctival hyperemia, corneal erosion, and eyelid pigmentation before and at 3 months after switching to travoprost 0.003%. Additionally, a questionnaire survey of these patients was conducted to determine possible side effects, including hyperemia, stinging, pruritus, irritation, blurred vision, dryness, and foreign body sensation. @*Results@#IOP readings before and after switching to travoprost 0.003% were 12.95 ± 4.25 and 12.94 ± 3.89 mmHg, respectively, showing no significant change (p = 0.974). No changes were observed in corneal erosion or eyelid pigmentation; however, conjunctival hyperemia was reduced significantly from 1.60 ± 0.88 to 1.36 ± 0.84 (p = 0.001). No significant changes in hyperemia, stinging, pruritus, irritation, or foreign body sensation were reported; however, a significant improvement was noted for blurred vision and dryness (p = 0.008, p = 0.007, respectively). @*Conclusions@#We were able to show the effectiveness and safety of travoprost 0.003% as being as effective as travoprost 0.004% in reducing IOP and injections while improving blurred vision and dryness.

Effect and Safety of Travoprost 0.003% in Open Angle Glaucoma

Purpose@#To determine whether travoprost 0.003% has a similar intraocular pressure (IOP) reduction effect to that of travoprost 0.004% while reducing side effects. @*Methods@#This was a prospective study from January 2018 to December 2018 that included 102 patients diagnosed with open angle glaucoma who switched from travoprost 0.004% to travoprost 0.003%. We investigated the changes in IOP, conjunctival hyperemia, corneal erosion, and eyelid pigmentation before and at 3 months after switching to travoprost 0.003%. Additionally, a questionnaire survey of these patients was conducted to determine possible side effects, including hyperemia, stinging, pruritus, irritation, blurred vision, dryness, and foreign body sensation. @*Results@#IOP readings before and after switching to travoprost 0.003% were 12.95 ± 4.25 and 12.94 ± 3.89 mmHg, respectively, showing no significant change (p = 0.974). No changes were observed in corneal erosion or eyelid pigmentation; however, conjunctival hyperemia was reduced significantly from 1.60 ± 0.88 to 1.36 ± 0.84 (p = 0.001). No significant changes in hyperemia, stinging, pruritus, irritation, or foreign body sensation were reported; however, a significant improvement was noted for blurred vision and dryness (p = 0.008, p = 0.007, respectively). @*Conclusions@#We were able to show the effectiveness and safety of travoprost 0.003% as being as effective as travoprost 0.004% in reducing IOP and injections while improving blurred vision and dryness.

Clinical Features of Delayed Diagnosed Acute Angle Closure Glaucoma in an Emergency Room

Purpose@#To analyze the clinical features of delayed diagnosed acute angle-closure glaucoma (AACG) patients who were misdiagnosed with neurologic disease in an emergency room (ER). @*Methods@#This study was conducted with a total of 77 patients (77 eyes) who had been diagnosed with AACG in the ER. Age, gender, laterality, best-corrected visual acuity (BCVA) of the affected eye at the time of the ER visit and at an outpatient clinic follow-up examination, bilateral intraocular pressure (IOP) at time of visit, previous eye-disease history, previous history of ophthalmic surgery, underlying systemic disease including metabolic syndrome, previous neurologic disease history, referral source, chief complaint, past history of migraine, residence, and specialty of the initial doctor in charge of the ER were statistically analyzed. @*Results@#Among the 77 patients, 34 received a delayed diagnosis and 43 were diagnosed in a timely manner. Higher cases of delayed diagnosis were observed in patients who had lower BCVA at the time of the ER visit (p = 0.001), nonophthalmologic referral source visiting the ER (p < 0.001), a chief complaint of extra-ocular symptoms (p < 0.001), and a non-ophthalmologist as the initial doctor in charge of the ER (p < 0.001). None of the other factors, including IOP, previous eye-disease history, previous ophthalmic surgery, underlying systemic disease including metabolic syndrome, previous neurologic disease history, past history of migraine, or residence showed any statistically significant intergroup difference. @*Conclusions@#Among the AACG patients visiting the ER, many were delayed in their diagnosis and thus required much attention afterwards. Careful examination and a detailed recording of a patient’s medical history by an ophthalmologist is important for accurate and timely diagnosis in the ER.

Clinical Features of Delayed Diagnosed Acute Angle Closure Glaucoma in an Emergency Room

Purpose@#To analyze the clinical features of delayed diagnosed acute angle-closure glaucoma (AACG) patients who were misdiagnosed with neurologic disease in an emergency room (ER). @*Methods@#This study was conducted with a total of 77 patients (77 eyes) who had been diagnosed with AACG in the ER. Age, gender, laterality, best-corrected visual acuity (BCVA) of the affected eye at the time of the ER visit and at an outpatient clinic follow-up examination, bilateral intraocular pressure (IOP) at time of visit, previous eye-disease history, previous history of ophthalmic surgery, underlying systemic disease including metabolic syndrome, previous neurologic disease history, referral source, chief complaint, past history of migraine, residence, and specialty of the initial doctor in charge of the ER were statistically analyzed. @*Results@#Among the 77 patients, 34 received a delayed diagnosis and 43 were diagnosed in a timely manner. Higher cases of delayed diagnosis were observed in patients who had lower BCVA at the time of the ER visit (p = 0.001), nonophthalmologic referral source visiting the ER (p < 0.001), a chief complaint of extra-ocular symptoms (p < 0.001), and a non-ophthalmologist as the initial doctor in charge of the ER (p < 0.001). None of the other factors, including IOP, previous eye-disease history, previous ophthalmic surgery, underlying systemic disease including metabolic syndrome, previous neurologic disease history, past history of migraine, or residence showed any statistically significant intergroup difference. @*Conclusions@#Among the AACG patients visiting the ER, many were delayed in their diagnosis and thus required much attention afterwards. Careful examination and a detailed recording of a patient’s medical history by an ophthalmologist is important for accurate and timely diagnosis in the ER.

Clinical Features of Primary Rhegmatogenous Retinal Detachment According to Initial Intraocular Pressure

PURPOSE: To determine the correlations of intraocular pressure (IOP) with risk factors in rhegmatogenous retinal detachment (RRD) patients. METHODS: A total of 113 eyes in 113 consecutive patients with RRD were enrolled in this study. IOP was measured using applanation tonometry at the initial visit. Based on the difference in IOP between the affected and unaffected eyes, the subjects were divided into two groups: group 1 (IOP difference ≤ 2 mmHg) and group 2 (IOP difference > 2 mmHg). Correlations between the IOP and RRD morphology, visual acuity (VA), best-corrected VA (BCVA), retinal break size and location, range of retinal detachment, macular involvement, and proliferative vitreoretinopathy were analyzed. RESULTS: The IOP at the initial visit was 12.88 ± 3.2 mmHg in the affected eyes and 14.27 ± 2.5 mmHg in the unaffected eyes. The IOP difference between the affected and unaffected eyes was −1.40 ± 2.82 mmHg. The BCVA and range of retinal detachment showed statistically significant differences between groups 1 and 2. CONCLUSIONS: In patients with RRD, the IOP difference compared to the unaffected eye was correlated with the extent of area of retinal detachment and decreased BCVA.

Eye Drop Chart for Improvement of Topical Eye Drops Administration and Adherence

PURPOSE: To evaluate the efficacy of an eye drop chart and to determine the factors contributing to adherence enhancement using the eye drop chart. METHODS: In this prospective study, enrolled glaucoma patients were educated on the administration of eye drops and use of the eye drop chart. They were required to complete a questionnaire on demographic characteristics and adherence. After 3 months, they completed a second questionnaire on adherence and satisfaction with the use of the eye drop chart. Changes in instillation behavior, relationships between performance scores and demographic characteristics, as well as factors contributing to the improvement of performance scores were analyzed. RESULTS: Forty-seven patients were enrolled in this study. The performance scores were significantly better for those who administered the eye drops by themselves (p = 0.002), those with an annual income > 60 million won (p = 0.036), and patients with at least a college degree (p = 0.002). After using the eye drop chart for 3 months, the average intraocular pressure was significantly reduced (p = 0.041) and the performance score was improved (p = 0.019). The working area (p = 0.009) and eye drop applicator (p = 0.001) were correlated with performance score enhancement. CONCLUSIONS: The eye drop chart was a cost-effective tool for improving the adherence and instillation practices of glaucoma patients. Adherence was improved among patients with more indoor activity, and those who practiced self-instillation. It is expected that the respective conditions of such patients would be more efficiently improved in a clinical setting.

Bilateral Acute Angle-Closure Glaucoma after Macular Hole Surgery

No abstract available.

Predictors of Success of Selective Laser Trabeculoplasty Adjusted for Intraocular Pressure Variations

PURPOSE: To investigate the efficacy, and identify predictors of success of selective laser trabeculoplasty (SLT) in open-angle glaucoma (OAG) patients after adjusting for intraocular pressure (IOP) changes in the untreated fellow eye. METHODS: This retrospective chart review included 52 eyes of 52 OAG patients who underwent SLT in one eye and were followed-up for at least 1 year after the procedure. The IOP was measured before the treatment, at 1, 2, and 3 months posttreatment, and every 3 months thereafter. To account for the possible influence of IOP fluctuations on laser outcomes, post-laser IOP values of the treated eye of each patient were also analyzed, after adjusting for IOP changes in the untreated fellow eye. Success was defined as an IOP decrease ≥20% of the pretreatment IOP. The success rate was determined based on Kaplan-Meier survival analysis and factors predictive of success were analyzed using the Cox proportional hazard model. RESULTS: The mean pretreatment IOP was 23.17 ± 6.96 mmHg. The mean IOP reduction was 5.59 ± 4.78 mmHg (29.7%) and the success rate was 65.4% at 1 year. The adjusted mean IOP reduction was 4.70 ± 4.67 mmHg (23.9%) and the adjusted success rate was 53.9%. Pretreatment IOP was associated with SLT success; the higher the pretreatment IOP, the greater the post-laser IOP reduction (p = 0.025). Age and mean deviation index did not show a significant association with SLT success (p = 0.066 and p = 0.464, respectively). CONCLUSIONS: SLT is a safe and effective alternative method of IOP reduction in OAG patients. Herein, pretreatment IOP was the only factor significantly associated with SLT success. IOP fluctuations of the untreated eye should be considered for a better understanding of the impact of treatment.

Refractive Error Induced by Combined Phacotrabeculectomy

PURPOSE: We evaluated the postoperative accuracy of intraocular lens power prediction for patients undergoing phacotrabeculectomy and identified preoperative factors associated with refractive outcome in those with primary open-angle glaucoma (POAG). METHODS: We retrospectively reviewed the medical records of 27 patients who underwent phacotrabeculectomy to treat POAG. We recorded all discrepancies between predicted and actual postoperative refractions. We compared the data to those of an age- and sex-matched control group that underwent uncomplicated cataract surgery during the same time period. Preoperative factors associated with the mean absolute error (MAE) were identified via multivariate regression analyses. RESULTS: The mean refractive error of the 27 eyes that underwent phacotrabeculectomy was comparable to that of the 27 eyes treated via phacoemulsification (+0.02 vs. −0.01 D, p = 0.802). The phacotrabeculectomy group exhibited a significantly higher MAE (0.65 vs. 0.35 D, p = 0.035) and more postoperative astigmatism (−1.07 vs. −0.66 D, p = 0.020) than the phacoemulsification group. The preoperative anterior chamber depth (ACD) and the changes in the postoperative intraocular pressure (IOP) were significantly associated with a greater MAE after phacotrabeculectomy. CONCLUSIONS: POAG treatment via combined phacoemulsification/trabeculectomy was associated with greater error in terms of final refraction prediction, and more postoperative astigmatism. As both a shallow preoperative ACD and a greater postoperative change in IOP appear to increase the predictive error, these two factors should be considered when planning phacotrabeculectomy.

Serous Retinal Detachment Following Laser Peripheral Iridotomy for the Angle Closure Secondary to Posterior Scleritis / 계명의대학술지

This study was aimed to report a case of serous retinal detachment following laser peripheral iridotomy (LPI) for the treatment of angle closure secondary to posterior scleritis. A 55-year-old man with bilateral ocular pain, redness, and headache was referred to Keimyung University Dongsan Medical Center. At the initial examination, his visual acuity was 1.0 in the both eyes. The intraocular pressure (IOP) was 25 mmHg in the right eye and 28 mmHg in the left eye. Slit lamp examination showed a shallow anterior chamber, which was found to be Shaffer grade I by gonioscopy. There were no specific findings in the fundus, except a slightly edematous disc margin in both eyes. LPI was performed on both eyes. Fourth day after LPI, the patient complained of a central scotoma and visual disturbance of the left eye, in which the visual acuity had decreased to 0.06. The optical coherence tomography showed serous retinal detachment at the posterior pole. Fluorescein angiography revealed a focal leakage in the superotemporal area, as well as multiple hyperfluorescence lesions. Posterior scleritis of the left eye was diagnosed. Systemic steroid therapy was initiated and the area with the leakage was treated by focal laser photocoagulation. Two weeks later, the serous retinal detachment of the left eye resolved and visual acuity improved to 0.63. Laser peripheral iridotomy can exacerbate serous retinal detachment in patients with posterior scleritis that presented as acute angle closure.

Acute Angle Closure Glaucoma in a Patient with Pseudoxanthoma Elasticum

No abstract available.

Utility of the Swept Source Optical Coherence Tomography for Measurements of Central Corneal Thickness

PURPOSE: To evaluate the efficacy of swept source optical coherence tomography (SS-OCT) by comparing the measurement of central corneal thickness (CCT) to the measurement obtained using Orbscan II, anterior segment optical coherence tomography (AS-OCT) and ultrasound pachymetry. METHODS: One examiner measured the CCT in 65 eyes of 65 healthy subjects using Orbscan II, AS-OCT, SS-OCT and ultrasound pachymetry. The mean values and correlations were analyzed. RESULTS: The average CCT measurements obtained using Orbscan II, AS-OCT, SS-OCT and ultrasound pachymetry were 534.83 ± 38.46, 517.80 ± 32.48, 528.22 ± 33.71 and 528.02 ± 34.90 µm, respectively. A significant linear correlation was observed among Orbscan II, AS-OCT, SS-OCT and ultrasound pachymetry (r > 0.894, p < 0.001). There was no significant difference between the SS-OCT and ultrasound pachymetry (p = 0.782). CONCLUSIONS: The results of the 4 methods were significantly correlated and the SS-OCT reached a high level of agreement when CCT was determined using ultrasound pachymetry. The CCT measurements using SS-OCT is a better alternative for ultrasound pachymetry than Orbscan II and AS-OCT.

The Factors Influencing the Visual Acuity and Streoacuity Outcome in Refractive Accommodative Esotropia

PURPOSE: To evaluate the factors affecting the visual acuity and stereoacuity of patients with refractive accommodative esotropia who have successful optical alignment obtained by refractive error management. METHODS: The charts of 60 patients, including medical history, age of onset, chief complaint at first visit, age at which glasses were first worn, refractive error, visual acuities with and without glasses, angle of deviation, and stereoacuity were retrospectively reviewed. RESULTS: The mean follow-up period was 59.20 +/- 40.26 months, and the mean hypermetropia at the initial visit was 4.90 +/- 1.75 diopters (D). Fifty-three patients had decreased hypermetropia, with a mean of 0.94 +/- 0.91 D, while seven patients had increased hypermetropia, with a mean of 0.38 +/- 0.17 D. The mean deviation at the initial visit was 28.40 +/- 9.05 prism diopters (PD) at near without glasses and decreased to 3.20 +/- 3.50 PD with glasses at the final visit. Children who had anisometropia at the initial visit had a higher prevalence for amblyopia at the final visit (p = 0.000). However, the degree of hypermetropia, age at onset, deviation before glasses correction, interval from onset to glasses correction, and amblyopia at diagnosis were not significant risk factors for amblyopia or anomalous streoacuity at the final visit. CONCLUSIONS: The degree of hypermetropia, age at onset, deviation before glasses correction, interval from onset to glasses correction, and amblyopia at diagnosis were not significant risk factors for amblyopia. However, anisometropia was a significant risk factor for the development of amblyopia in patients with refractive accommodative esotropia, and these children should receive careful and long-term follow-up management.

Factors Influencing the Prevalence of Amblyopia in Children with Anisometropia

PURPOSE: To evaluate factors that can influence the prevalence of amblyopia in children with anisometropia. METHODS: We retrospectively reviewed the records of 63 children 2 to 13 years of age who had anisometropic amblyopia with a difference in the refractive errors between the eyes of at least two diopters (D). The type of anisometropia (myopia, hyperopia, and astigmatism), degree of anisometropia (4 D), best corrected visual acuity (BCVA) of the amblyopic eye at the time of initial examination, BCVA differences between sound and amblyopic eyes, whether or not occlusion therapy was performed, compliance with occlusion therapy, and the patient's age when eyeglasses were first worn were investigated. RESULTS: There was an increase in the risk of amblyopia with increased magnitude of anisometropia (p=0.021). The prevalence of amblyopia was higher in the BCVA 4 lines between sound and amblyopic eyes (p=0.008 and p=0.045, respectively). There was no statistical relationship between the prevalence of amblyopia and the type of anisometropia or the age when eyeglasses were first worn. Poor compliance with occlusion therapy was less likely to achieve successful outcome (p=0.015). CONCLUSIONS: Eyes with poor initial visual acuities of 4 line difference in the BCVA between sound and amblyopic eyes at the initial visit may require active treatment.

Opacification of the Optic of an Akreos Adapt Intraocular Lens

A 60-year-old diabetic patient transferred to our retina clinic for a regular follow-up for diabetic retinopathy. He had uneventful cataract surgery at the time of pars plana vitrectomy in the right eye due to diabetic retinopathy at a private ophthalmologic hospital. Six months after the surgery, neovascular glaucoma with hyphema developed in the right eye and an Ahmed valve was implanted at our hospital. Ten months after cataract surgery, we found opacification of the intraocular lens (IOL) which was causing significant visual disturbance. At the time, the best corrected visual acuity (BCVA) in the right eye was hand motion. The IOL was explanted 45 months after the operation. Five months after explantation, the BCVA was 0.06. Unfortunately, pathologic analysis was not performed. Patient-related factors such as an anterior chamber reaction caused by hyphema might have been responsible for the opacification. To our knowledge, there are no previous reports of opacification of the Akreos Adapt IOL.

Cellular Viability of Cryopreserved Porcine Valve According to Warm Ischemic Time / 대한흉부외과학회지

BACKGROUND: Valve replacement using cryopreserved valved homograft is increasing because of resistance of infection and excellent hemodynamics. The viability of fibroblast which is related with warm ischemic time affects the durability of implanted cryopreserved valved homograft. We evaluated how long the warm schemic time is acceptable by examining the viability of cells depending upon warm ischemic time. MATERIAL AND METHOD: 1. Retrieval of tissues; Thirty-two slaughted porcine heart and lung enblocs were stored at refrigerator(4~8 degreesC) for various time period(Warm Ischemic Time), and the heart was dissected and stored in Hartman solution at 4 degreesCfor 24 hours(Cold Ischemic Time) as the simulation of retrieval and dissection of human heart. The hearts were assigned to groups A(2 hours), B(12 hours), C(24 hours), D(36 hours) depending on warm ischemic time. 2. Sterilization; The valved homografts were sterilized in the RPMI 1640 solution with antibiotics. 3. Freezing and Storage; The homografts were freezed by computerized freezer, stored 7 days at liquid nitrogen tank, and thawed. 4. Evaluation of the viability; The viability was evaluated by Triphan blue test after warm ischemic time, after cold ischemic time and after thawing. 5. Analysis; The viability of fibroblast was analysed by pearson correlation test of SAS program. RESULT: 1. The viability between after cold ischemic time and after thawing was not different(p=0.619) for the adequacy of sterilization, freezing and thawing. 2. The viability which was evaluated after warm ischemic time, cold ischemic time and thawing, and the various warm ischemic times are strongly correlated as R is -0.857, -0.673 and -0.549 respectively. The viability of tricuspid valve is well related with the viability of aortic valve. CONCLUSION: 1. The longer the warm ischemic time, the lesser the viability of fibroblast. The viability of fibroblast after cryopreservation was decreased less 60% if the warm ischemic time was over 12 hours. 2. The method of cryopreservation is acceptable for maintaining the viability of fibroblast, and the viability of tricuspid valve may be the indicator of the viability of aortic valve. 3. However, the study for the optimal viability which is necessary to the durabiltiy of implanted valved homograft is needed.