A Case of Pigmentary Glaucoma after Posterior Chamber Phakic Intraocular Lens Implantation

PURPOSE: To report a case of secondary pigmentary glaucoma after implantable contact lens (ICL) implantation successfully treated with trabeculectomy without ICL removal. CASE SUMMARY: A 29-year-old woman presented with refractory intraocular pressure (IOP) increase in both eyes. IOP was 22 mm Hg in the right eye and 39 mm Hg in the left eye. The patient received posterior chamber phakic intraocular lens implantation in both eyes 22 months prior. Slit lamp examination revealed patent iridotomy sites in both eyes. Gonioscopy revealed open angles with 4-degree pigment deposits on the trabecular meshwork in both eyes. Ultrasound biomicroscopy examination confirmed contact between ICL and the posterior surface of the iris. In spite of well tolerated medical therapy and selective laser trabeculoplasty, IOP was 46 mm Hg in her left eye. Trabeculectomy was performed in her left eye without ICL removal. At 6 months postoperative, IOP measured 6 mm Hg without any anti-glaucoma medication and bleb was maintained in good condition in the left eye. CONCLUSIONS: The results from this case study indicate that ICL implantation can lead to secondary pigmentary glaucoma and trabeculectomy without ICL removal may help to decrease the IOP.

Gene Microarray Related with Apoptosis in Diabetic OLETF Keratocytes

PURPOSE: This study was to identified differentiated genes concerned with apoptosis that are up-regulated or down-regulated in OLETF corneal keratocytes stimulated with interleukin-1alpha. METHODS: Otsuka Long Evans Tokushima Fatty (OLETF) corneal keratocytes were primarily cultured and treated with 20 ng/ml of IL-1a for 6 hours. Hybridization was carried out using Oligonucleotide microarray. A sample of normal keratocytes was labeled with Cy 3, and a diabetic keratocytes sample was labeled with Cy 5. RESULTS Diabetes showed 20 down-regulated genes and 24 up-regulated genes compared with normal keratocytes. Also, IL-1alpha-treated diabetic keratocytes expressed 31 down-regulated and 33 up-regulated genes. Compared with diabetic keratocytes, the newly expressed genes in OLETF treated with IL-1alpha were Bcl, Lam, Timp, Mmp, Socs, Bmp, Ccl, Lcn, C7, etc. CONCLUSIONS: There were some genes related with apoptosis that expressed differently between normal and diabetic keratocytes of OLETF. Also, IL-1alpha may stimulate differing effects of apoptosis on diabetic corneal keratocytes. Studies analyzing the apoptotic significance of these differences identified in diabetic keratocytes are needed.

Gene Microarray Related with Apoptosis in Diabetic OLETF Keratocytes

PURPOSE: This study was to identified differentiated genes concerned with apoptosis that are up-regulated or down-regulated in OLETF corneal keratocytes stimulated with interleukin-1alpha. METHODS: Otsuka Long Evans Tokushima Fatty (OLETF) corneal keratocytes were primarily cultured and treated with 20 ng/ml of IL-1a for 6 hours. Hybridization was carried out using Oligonucleotide microarray. A sample of normal keratocytes was labeled with Cy 3, and a diabetic keratocytes sample was labeled with Cy 5. RESULTS Diabetes showed 20 down-regulated genes and 24 up-regulated genes compared with normal keratocytes. Also, IL-1alpha-treated diabetic keratocytes expressed 31 down-regulated and 33 up-regulated genes. Compared with diabetic keratocytes, the newly expressed genes in OLETF treated with IL-1alpha were Bcl, Lam, Timp, Mmp, Socs, Bmp, Ccl, Lcn, C7, etc. CONCLUSIONS: There were some genes related with apoptosis that expressed differently between normal and diabetic keratocytes of OLETF. Also, IL-1alpha may stimulate differing effects of apoptosis on diabetic corneal keratocytes. Studies analyzing the apoptotic significance of these differences identified in diabetic keratocytes are needed.

Effects of Air in Cases that Leak from Scleral Incision of Temporal Incision Sutureless Cataract Surgery

PURPOSE: The study was done to evaluate the sealing effect of air on wound leakage, on the cornea and on the postoperative changes of corneal astigmatism in cases that leak from scleral incision due to incompletion of internal corneal lip. METHODS: 30 eyes of 29 patients among 6.0 mm temporal incision and sutureless cataract surgery from December 1997 to October 1998 were examined for the study. RESULTS: The mean preoperative and postoperative 1 day intraocular pressures were 13.45 and 13.19 mmHg. In postoperative 2 months, the corneal endothelial cell loss was about 15%. The mean uncorrected visual acuity of postoperative 1, 2 weeks and 1, 2, 3 months was 0.53, 0.56, 0.56, 0.68 and 0.58, respectively. And the mean best corrected visual acuity of those periods was 0.76, 0.84, 0.80, 0.87 and 0.93, respectively. There was decreasing postoperative corneal astigmatism of the same period such as 0.90, 0.63, 0.68, 0.51 and 0.41 diopter with the rule change. CONCLUSIONS: We suggest that when the leakage occurs due to incompletion of internal corneal lip, but the anterior chamber somewhat remains for 6.0 mm incision sutureless cataract surgery to reduce previous astigmatism, injection of air rather than the use of sutures provides the advantage of sutureless cataract surgery as well as the sealing effect upon wound leakage.

Comparison of Corneal Astigmatism According to the Distance between Limbus and Internal Lip after Temporal Incision Cataract Surgery

This study was carried out to evaluate corneal astigmatism according to distance between the limbus and internal lip after temporal incision cataract surgery. Twenty-five eyes of patients undergoing routine phacoemulsification with one plate haptic silicone IOL(STAAR)posterior chamber lens implantation with 3.0 mm temporal scleral pocket incision and sutureless method by one surgeon were randomly selected. Corneal astigmatism was evaluated at postoperative first day, first week, second week, first month, second month and analyzed by the Cravy s vector method. Internal lip length 1.0 mm group showed 0.11 diopter aganist-the-rule change of corneal astigmatism at the first week and 0.11 diopter with-therule change at the third month and internal lip length 1.5 mm group showed 0.16 diopter aganist-the-rule change of corneal astigmatism at first week and 0.04 diopter agaist-the-rule change at the third month but these differences were not statistically significant(students t-test:p>0.05). In this study we found that if a distance between the limbus and internal lip has longer than 1.0 mm, it was not an important factor on influencing the surgically induced astigmatism and could get wound stability after sutureless cataract sugery using a watertight scleral tunnel incision.

The Surgical Outcome of Clear Lens Extraction for Correction of Severe High Myopia

The authors performed clear lens extraction on 22 eye to treat severe high myopia more than 12 diopters(D). The changes in spherical equivalent (S. E.), visual acuity improvement, and the complications were evaluated during 6 months postoperatively. A scleral pocket incision and continuous curvilinear capsulorhexis was made and lens extraction was performed via phacoemulsification and low power poserior chamber intraocular lens was implanted. The postoperative refractive error target were form -1.5D to-2.0D. More than 85% of eyes were within +/-1D of targeted refractive error. The posoperative uncorrected visual acuities were increased more than 20/200 in all eyes and 20% of eyes were increased more than 20/40 at postoperative two months. The postoperative corrected visual acuities were increased two or more limes in more than 80% of eyes. Intraoperatively, hyphema in one eye, wound leaking in two eyes and radial tear during contimuous curvilinear capsulorhexis in one eye were developed. Poltoperatively, retinal detachment in two eyes, subretinal neovascularization in one eye and posterior capsular opacification in three eyes were developed. In conclusion, the clear lens extraction was a effective method for correction of severe high myopia but longer follow-up of large number of cases is needed to fully assess the safety.

Effect of Electrocauterization on Corneal Astigmatism in Temporal Incision Cataract Surgery

This study was carried out to evaluate the effect of electrocauterization on corneal astigmatism after cataract operation with temporal incision. Forty-two eyes of patients undergoing routine phacoemulsification with one piece type polymethymethacrylate(PMMA) posterior chamber lens implantation with 6.0mm temporal scleral pocket incision and sutureless method by one surgeon were randomly selected Corneal astigmatism was evaluated for postoperative 3 months and analyzed by Cravy`s vector method. Both groups(electrocauterization group and no electrocauterization group) showed slight with-the-rule change of corneal astigmatism till postoperative 3 months and electrocauterization group showed +0.31D at postoperative 3 months but these differences were not statistically significant(student`s t-test: p=1.10). This results demonstrate that the scleral electrocauterization at temporal incision site induced more with-the-rule change than no cauterization group.

A Case of Conchal Mucocele with Exophthalmos / 대한이비인후과학회지

An enlarged pneumatized middle turbinate, termed "concha bullosa" is a relatively common anatomical variant. It may be the site of inflammatory disease ranging from simple mucosal thickening to a mucocele. But a conchal mucocele is a rare disease such as mucoceles of the posterior ethmoid and sphenoid sinus. The mucociliary transport within a concha bullosa is usually toward the conchal ostium located on the anterosuperior aspect of the middle turbinate and in most cases it opens into the frontal recess. Chronic obstruction of a conchal ostium can lead to a mucocele. Chronic pressure within the mucocele can cause the walls of the middle turbinate to expand, further destructing bulla, other ethmoid cells, and lamina papyracea. Authors have experienced one case of a conchal mucocele with anterior ethmoid and frontal recess extension which presented with exophthalmos. We performed functional endoscopic sinus surgery. Postoperatively, exophthalmos was spontaneously corrected.

Histopathologic Study of Allergic Rhinitis Treated with Contact ND: YAG Laser Surgery / 대한이비인후과학회지

BACKGROUND: Many kinds of method have been tried for the management of allergic rhinitis. However, there is no completely satisfactory modality of treatment. Recent studys are reporting that laser vaporization on the inferior turbinate for the treatment of allergic rhinitis may be a valuable surgical method with safety, less morbidity and good efficasy. But, long term effects are unkown as yet. OBJECTIVES: We aimed to observe histopathologic changes of nasal mucosal membrane about 2 years after laser surgery and to investigate relationships between improvement in subjective symptoms, frequency of surgery, and histopathologic findings. MATERIALS AND METHODS: The inferior turbinates of 24 patients with perennial allergic rhinitis were vaporized by Contact ND: YAG laser. About 2 years after surgery, specimens obtained from the inferior turbinate were examined under the light microscopy. RESULTS: 1. Common findings of histopathologic change in all cases: 1) Fibrous proliferation and scar formation in the superficial layer of the submucosa. 2) Decreased number and atrophy of goblet cells, glands and vessels. 3) Complete regeneration of ciliated pseudostratified columnar epithelium. 2. Generally, grade of fibrosis in the submucosal superficial layer tend to increase as the frequency of surgery increase. but there is no relation, statistically. The higher grade of fibrosis do not induce the better subjective improvement. 3. Significant subjective improvement(Good and excellent results) was 75%. CONCLUSION: These results suggest that allergic symptoms may be inhibited by fibrous scar formation of the submucosal superficial layer and by decreased number and atrophy of overproliferation of cells leading to allergic reaction. In addition laser surgery may be a safe and effective method with good regeneration of ciliated epithelium and high rate of improvement for treatment of allergic rhinitis. However, further study is necessary to proper explanation for result that grade of fibrosis have not a relation with subjective improvement and for long term effect of the laser surgery.

Analysis of Coins in the Esophagus / 대한이비인후과학회지

Esophageal foreign bodies caused by accidents and carelessness are very common problems in otorhinolaryngology field. They are closely related to regional life style, culture, and economical status. The lodgement of coins in the esophagus is one of the most common foreign body problems. It occurs usually under the age of 10 years. From March, 1981 through September, 1996, one hundred and forty-nine patients were analysed. Most common coin type was one hundred won-coin(51.2mm flat circumference). One half of the cases were under 3.5 years old. Ninety percent of the cases were under 7.6 years of age. Over half the ten won-coins(48.8mm flat circumference) were found under 3.3 years old, and 90 percent of the cases in which those coins were lodged were found to be less than 4.5 years of age. None could seen under one years old or above ten. This result suggests that there are relative correlation between coin size and patient age.

Early Result of Corneal Astigmatism in Sutureless Cataract Surgery

Since surgically induced corneal astigmatism was one of important complications after cataract extraction the authors analyzed corneal astigmatism for 3 months after sutureless cataract surgery. Among the patients who were treated with phacoemulsification and PCL implantation by one surgeon (L. E. H.), 40 patients had sutureless cataract surgery by 5mm incision and 51 patients had 10-0 nylon shoelace suture by 7mm incision. Corneal astigmatism was analyzed by algebraic and vector method. Visual acuity was analyzed in patients who were below 60 years age and without posterior segment disorders, whose predictive refractive errors were -0.75D according to SRK/T formula. 0.19D with-the-rule astigmatism induced at 1 day after 5mm sutureless cataract surgery was nearly unchanged until 3 months postoperatively and induced with-the-rule astigmat ism at 1 day after operation was not changed into against-the-rule astigmatism, visual rehabilitation was faster and corrected visual acuity was better.

Apparent Accommodation in Posterior Chamber IOL Implanted Eyes

In order to evaluate the cause of apparent accommodation in pseudophakia, we performed ECCE and implanted biconvex, monofocal I0L in the bag in 24 patients(32 eyes) and followed up for more than 2 months. We measured apparent accommodation, corneal astigmatism and near visual acuity. And we also measured apparent accommodation and the changes of anterior chamber depth according to the movement of I0L and apparent accommodation according to the changes of pupil diameter in normal state before drug instillation and after instillation of either 10% phenylephrine or 2% pilocarpine. The results were as follows: 1. The mean apparent accommodation was 1.36 +/- 0.52 diopters. 2. There was negative correlation between corneal astigmatism and apparent accommodation and between cornel astigmatism and near visual acuity. 3. There was negative correlation between anterior chamber depth and apparent accommodation measured in normal state before drug instillation. And also there was negative correlation between the changes of anterior chamber depth and the changes of apparent accommodation measured after instillation of either 10% phenylephrine or 2% pilocarpine. 4. There was positive correlation between reciprocal changes of pupil diameter and apparent accommodation. So we conclude that the apparent accommodation is seemed! to be a resultant changes according to the changes of the pupil diameter.

Apparent Accommodation in Posterior Chamber IOL Implanted Eyes

In order to evaluate the cause of apparent accommodation in pseudophakia, we performed ECCE and implanted biconvex, monofocal I0L in the bag in 24 patients(32 eyes) and followed up for more than 2 months. We measured apparent accommodation, corneal astigmatism and near visual acuity. And we also measured apparent accommodation and the changes of anterior chamber depth according to the movement of I0L and apparent accommodation according to the changes of pupil diameter in normal state before drug instillation and after instillation of either 10% phenylephrine or 2% pilocarpine. The results were as follows: 1. The mean apparent accommodation was 1.36 +/- 0.52 diopters. 2. There was negative correlation between corneal astigmatism and apparent accommodation and between cornel astigmatism and near visual acuity. 3. There was negative correlation between anterior chamber depth and apparent accommodation measured in normal state before drug instillation. And also there was negative correlation between the changes of anterior chamber depth and the changes of apparent accommodation measured after instillation of either 10% phenylephrine or 2% pilocarpine. 4. There was positive correlation between reciprocal changes of pupil diameter and apparent accommodation. So we conclude that the apparent accommodation is seemed! to be a resultant changes according to the changes of the pupil diameter.

Correction of High Myopia by Worst-Fechner Biconcave Lens

For the purpose of correction of high myopia, we had implanted Worst-Fechner Biconcave Lens (Ophtec B.V., Groningen, Holland) in the 10 phakic eyes which were more myopic than -8.0 D. We examined postoperative visual acuity and complications. Postoperative uncorrected visual acuity was from 0.3 to 1.0. Cataract, glaucoma, chronic iridocyclitis and macular edema or retinal detachment did not occur and during the iris fluorescein angiography of 4 eyes there was no leakage of dye at the fixation site of iris by haptic of the lens. But all patients complained of glare. In the 3 eyes which were followed up for 12 months, corneal endothelial cell loss occurred continuously and the endothelial cell loss was 17.2% at the central cornea and 19.5% at the paracentral cornea. Therefore, long term follow up is necessary.