Nasolacrimal Duct Obstruction after Radioactive Iodine Therapy for Thyroid Cancer

PURPOSE: To investigate the clinical manifestation of nasolacrimal duct obstruction after radioactive iodine therapy for thyroid cancer. METHODS: The authors examined 622 patients who were treated with radioactive iodine therapy after the operation for thyroid cancer from January 2009 to December 2011. Fourteen patients (18 eyes) were diagnosed nasolacrimal duct obstruction based on the lacrimal irrigation test, lacrimal probing test and dacryocystography in our oculoplastic clinic. We analyzed the dose of radioactive iodine therapy, number of treatments, clinical manifestation and treatment type by retrospectively reviewing the patients' medical records. RESULTS: The mean radioactive iodine dose (215.7 +/- 23.1 mCi, p = 0.01) and the mean number of treatments (1.36 +/- 0.50, p< 0.001) were significantly greater in 14 patients who had nasolacrimal duct obstruction than in patients who did not. The average onset of tearing symptoms occurred 10.2 months after radioactive iodine therapy. The mean time between correct diagnosis and therapy was 18.4 months. Three patients (3 eyes) had occlusion at the common cannaliculus and 11 patients (15 eyes) had occlusion at the nasolacrimal duct. Ten patients (13 eyes) underwent endonasal dacryocystorhinostomy for complete obstruction and 4 patients (5 eyes) underwent silicone tube intubation for partial obstruction. CONCLUSIONS: Nasolacrimal duct obstruction is a rare complication associated with radioactive iodine therapy for thyroid cancer, thus, clinicians should be aware of this complication and refer patients with symptoms of epiphora to the oculoplastic department for specialized evaluation and treatment.

The Effect of Breath-Hold Diving on Intraocular Pressure, Optic Nerve, Visual Field in Korean Haenyeo (Female Divers)

PURPOSE: To examine how breath-hold diving activities of Korean haenyeo female divers affect intraocular pressure (IOP), optic nerve and visual field (VF). METHODS: Basic ophthalmologic tests were performed for a group of breath-hold female divers (26 eyes) and a control group of non-divers (26 eyes) and the results compared between the 2 groups. For the breath-hold female diver group, a questionnaire survey was conducted on the patterns of breath-hold diving and the correlation with abnormalities in IOP, optic nerve and VF analyzed. RESULTS: IOP was significantly higher in the diver group (diver group: 15.00 +/- 3.76 mm Hg, control group: 13.93 +/- 2.36 mm Hg, p < 0.05). Between the 2 groups, the cup area (diver group: 1.21 +/- 0.60 mm2, control group: 0.83 +/- 0.46 mm2, p < 0.05), the cup-to-disc (C/D) ratio (diver group: 0.44 +/- 0.21, control group: 0.31 +/- 0.14, p < 0.05), and the vertical C/D ratio (diver group: 0.70 +/- 0.17, control group: 0.51 +/- 0.12, p < 0.05) were also significantly different. A significant correlation between working hours per day and IOP (r = 0.44, p < 0.05), between diving depth and RNFL defect, and cup area, and vertical C/D ratio (r = 0.43, r = 0.41, r = 0.39, p < 0.05) was observed. CONCLUSIONS: Subjects who breath-hold dive for a long period, such as Korean Haenyeo, need to have a glaucoma test regularly.

Change in Intraocular Pressure According to Sleeping Posture in Normal People

PURPOSE: The present study examined how intraocular pressure is affected by changes in sleeping posture (22-2400 hours) from the sitting position to the supine, prone, and lateral positions in normal subjects. METHODS: Ophthalmological examination was performed on 140 eyes of 70 healthy adult men, and changes in the intraocular pressure were measured according to posture during sleep. The subject was initially relaxed and the base intraocular pressure was measured in the sitting position. In order to reduce the influence of intraocular pressure among the positions, namely, the supine, the prone, and the lateral recumbent positions, the subject was seated for ten minutes before assuming each position. Intraocular pressure was measured twice at 0 and 10 minutes in each position, and the mean of the two values was used for comparison. RESULTS: Compared to the intraocular pressure in the sitting position, intraocular pressure increased significantly in the supine, prone, and lateral positions (p< 0.05). Compared to the base intraocular pressure, the intraocular pressure measured in the prone position showed the largest difference, increasing 6.34 mm Hg in the right eye and 6.43 mm Hg in the left eye. The intraocular pressure measured in the lateral position was 3.62 mm Hg higher in the right eye and 3.63 mm Hg higher in the left eye, and that in the supine position was 2.42 mm Hg and 2.28 mm Hg higher in the right and left eyes, respectively. CONCLUSIONS: The change in posture during sleeping from the sitting position to the supine, prone, and lateral positions caused increases in intraocular pressure in normal subjects. The results show that the change in sleeping posture induced by sleeping habits may raise intraocular pressure.

A Case of Ahmed Glaucoma Valve Implantation without Removal of the Anterior Chamber Lens

PURPOSE: To report the results of performing an Ahmed glaucoma valve implantation without removing the anterior chamber lens to treat secondary glaucoma. CASE SUMMARY: A 72-year-old male visited the hospital for imminent visual field loss in the left eye. At the time of the visit, he had a mild headache, and the intraocular pressure of the left eye was 38 mm Hg. The left eye had received anterior chamber lens insertion with iridectomy and the posterior capsule was ruptured. The vitreous protruded at the two o'clock site and adhered to the backside of the anterior chamber lens tilting it toward the temporal cornea. At the time of the visit, the maximum corrected vision of the left eye was 0.32. The patient was diagnosed with secondary glaucoma caused by the anterior chamber lens. Because the patient did not want to have the anterior chamber lens removed and the supporting area of the anterior chamber lens blocked the trabeculectomy and peripheral iridectomy sites, the authors performed an Ahmed glaucoma valve implantation instead. The outcome of Ahmed glaucoma valve implantation was evaluated through a preoperative and postoperative vision test and periodical corneal endothelial cell analysis. During the six months of postoperative follow-up, the vision was improved, intraocular pressure was stabilized, and corneal endothelial cells were maintained. CONCLUSIONS: When a patient requires glaucoma surgery for secondary glaucoma caused by an anterior chamber lens, an Ahmed implantation without lens removal may be an option which may carefully be considered. However, because of the possibility of subsequent complications, a longer follow-up period is necessary.

A Case of Recurrent Posterior Scleritis With Hyperthyroidism in Both Eyes

PURPOSE: Posterior scleritis is known to be a rare disease. The authors of the present study herein report a case of posterior scleritis, which occurred in a patient's eye, accompanied by hyperthyroidism and recurring in the other eye one year later. CASE SUMMARY: A 39-year-old female patient visited the hospital for ocular pain in the left eye and a headache. The patient was diagnosed with posterior scleritis through fundus examination, ultrasonography, CT and MRI, and an effective outcome of treatment was obtained by oral administration of methylprednisolone. Four months after discharge, the patient received left subtotal thyroidectomy for thyroid papillary cancer. Seven months after surgery she visited again, due to ocular pain that started 1 week earlier in the left eye, as well as a headache, and was diagnosed with posterior scleritis upon fundus examination, ultrasonography and MRI. Methylprednisolone was administered orally and an effective treatment result was obtained. After discharge, the patient was followed up for 5 months and did not show any signs of recurrence. CONCLUSIONS: When a hyperthyroidism patient has ocular pain or a headache, the possibility of posterior scleritis accompaniment should be considered, as well as the possibility that posterior scleritis, which already occurred in one eye, may recur in the other eye.

The Facial Tissue Expansion to Achieve the Natural Cervicomental Angle

PURPOSE: Wide scars occurring on the lower face and neck cause both functional and esthetic problems. Consequently, we can use skin grafts, pedicled flaps, free flaps, and tissue expansion for the reconstruction of this area. Compared with other reconstruction techniques, tissue expansion is advantageous in that it enables the maintenance of a color and texture similar to that of the adjacent tissue. However, the conventional method of tissue expansion has been reported to lead to an unnatural cervicomental angle and to the deformity of adjacent structures. We have therefore made efforts to prevent these problems through the use of several operative procedures. METHODS: Forty-one patients with lower facial and cervical scars underwent tissue expansion. The tissue expansion was performed using a rectangular-shaped Nagosil(R) tissue expansion device. On insertion of the tissue expander, the intermediate area of superficial fat layer was dissected and then the tissue expander was inserted to make a flap that was as thin as possible. In advancement of the flap, a capsule formed by the tissue expander was used for the interrupted fixed suture of the flap to the fascia of the platysma muscle of the neck. This procedure was performed multiple times and also performed between the flap and the periosteum of the mandible, such that the tension was removed during the suture of the flap margin. Finally, the patients were fitted with a Jobst(R) facial garment in order to stabilize the operation site at least twelve months. RESULTS: The most prevalent location of the scar was the cheek(15 cases), followed by the chin in 14 cases and the neck in 12 cases. The mean size of scar was 55.7+/- 39.4cm2. CONCLUSION: Using our procedures, we have experienced no significant deformities and have also achieved a more natural cervicomental angle in the patients.

The Effect of Positional Changes during Heavy Weight Lifting on Intraocular Pressure

PURPOSE: To measure intraocular pressure (IOP) as a function of positional changes of the head during heavy weight lifting. METHODS: The subjects of this study were 30 healthy adult males in their twenties to forties. This study investigated their ophthalmic examinations, BMI (body mass index), and 1RM (one repetition maximum) according to the three bench press positions. RESULTS: Before exercising, the IOP was higher in the lowered head position in the decline bench press (18.20+/-2.89 mmHg) than in the incline bench press (14.38+/-2.32 mmHg) (p<0.001). The IOP increased significantly during the bench press exercise, relative to during the pre-exercise (p<0.001). Upon lift down, IOP increased by 3.72+/-1.85 mmHg greater than upon lift up, and mean IOP increased by 2.61+/-1.63 mmHg (p<0.001). In our experiments, IOP increased to a maximum of 22.10+/-2.79 mmHg, measured during lift down in the decline bench press configuration. The BMI and the IOP before exercise showed significant correlation (p<0.05). CONCLUSIONS: IOP increased more during exercise involving a lower head position. Further study is needed to know the extent to which this result is relevant for glaucoma patients and which activities and head positions during exercise may worsen glaucoma. In the meantime, patients with severe glaucoma may need to avoid lifting heavy objects with a lowered head position.

Clinical studies on the elderly primiparas / 대한산부인과학회잡지

No abstract available.

A case of primary squamous cell carcinoma of vagina / 대한산부인과학회잡지

No abstract available.

Clinical survey on total abdominal hysterectomy / 대한산부인과학회잡지

No abstract available.

A Morphological Study of the Parotid Gland and the Peripheral Branches of the Facial Nerve in Koreans

In this study, 45 parotid glands and 111 facial nerves were examined in adult Korean cadavers to determine the morphological relationship of the parotid gland and the peripheral facial nerve. The results are summarized below; (1) The average length of the parotid gland was 54.7mm and the width averaged 32.9mm, and the gland was slightly larger in males. (2) The shape of the parotid gland was classified into four types and the series contained 66.7% type A, 15.5% type B, 8.9% type C and 8.9% type D. Type A was the most common type. (3) The patterns of tributory ducts into Stenson's duct were divided into 5 types and the series showed 42.2% type a, 26.7% type b 4.4% type c, 4.4% type d, 22.3% type e. The frequency of occurrence of accessory glands was 22%. (4) The average distance from the external angle of the mandible to the bifurcation of the facial nerve trunk was 28.8mm. (5) A pattern of trifurcation of the main facial nerve trunk was discovered in 4.4% of the cases. (6) The pattern of anastomosis of the peripheral branches of the facial nerve was classified into six types, and the rate of occurrence of each type was type I 6.3%, type II 13.5 %, type III 33.4%, type IV 23.4%, type V 6.3%, type VI 17.1%.