Comparison of Surgical Outcomes after Phacoemulsification between Trabeculectomized Eyes and Ahmed Valve-implanted Eyes

Purpose@#We compared the outcomes of cataract surgery in patients who underwent trabeculectomy and Ahmed glaucoma valve implantation. @*Methods@#Twenty-nine trabeculectomized eyes of 29 patients (group 1) and 20 Ahmed glaucoma valve-implanted eyes of 20 patients (group 2) were enrolled consecutively. All subjects underwent thorough ophthalmic examinations, including slit-lamp microscopy and Goldmann applanation tonometry preoperatively, on postoperative days 1 and 7, and at postoperative months 1, 3, and 6. The surgical outcomes including intraocular pressure (IOP) and the required number of IOP-lowering medications were compared between the two groups. @*Results@#The mean preoperative IOP in groups 1 and 2 was 15.34 ± 4.34 and 16.35 ± 3.44 mmHg, respectively (p = 0.265). In group 1, the IOP on postoperative day 1 increased significantly (by 3.86 ± 9.69 mmHg, p = 0.038), and the number of IOP-lowering medications rose at both 3 months (0.28 ± 0.70, p = 0.046) and 6 months (0.34 ± 0.94, p = 0.047) postoperatively. Group 2 exhibited no change in the IOP postoperatively or the number of IOP-lowering medications required in the postoperative period. Subconjunctival 5-fluorouracil injections for IOP control were required by two group 1 patients within 1 month postoperatively. @*Conclusions@#In patients with a trabeculectomized eye, the IOP increased immediately after cataract surgery; additional IOP-lowering procedures were required by some patients. The number of IOP-lowering medications increased after 3 months postoperatively. As cataract surgery may compromise filtering bleb function to a greater extent in trabeculectomized than in Ahmed glaucoma valve-implanted eyes, the former eyes require closer observation during the early postoperative period.

Comparison of Surgical Outcomes after Phacoemulsification between Trabeculectomized Eyes and Ahmed Valve-implanted Eyes

Purpose@#We compared the outcomes of cataract surgery in patients who underwent trabeculectomy and Ahmed glaucoma valve implantation. @*Methods@#Twenty-nine trabeculectomized eyes of 29 patients (group 1) and 20 Ahmed glaucoma valve-implanted eyes of 20 patients (group 2) were enrolled consecutively. All subjects underwent thorough ophthalmic examinations, including slit-lamp microscopy and Goldmann applanation tonometry preoperatively, on postoperative days 1 and 7, and at postoperative months 1, 3, and 6. The surgical outcomes including intraocular pressure (IOP) and the required number of IOP-lowering medications were compared between the two groups. @*Results@#The mean preoperative IOP in groups 1 and 2 was 15.34 ± 4.34 and 16.35 ± 3.44 mmHg, respectively (p = 0.265). In group 1, the IOP on postoperative day 1 increased significantly (by 3.86 ± 9.69 mmHg, p = 0.038), and the number of IOP-lowering medications rose at both 3 months (0.28 ± 0.70, p = 0.046) and 6 months (0.34 ± 0.94, p = 0.047) postoperatively. Group 2 exhibited no change in the IOP postoperatively or the number of IOP-lowering medications required in the postoperative period. Subconjunctival 5-fluorouracil injections for IOP control were required by two group 1 patients within 1 month postoperatively. @*Conclusions@#In patients with a trabeculectomized eye, the IOP increased immediately after cataract surgery; additional IOP-lowering procedures were required by some patients. The number of IOP-lowering medications increased after 3 months postoperatively. As cataract surgery may compromise filtering bleb function to a greater extent in trabeculectomized than in Ahmed glaucoma valve-implanted eyes, the former eyes require closer observation during the early postoperative period.

Safety of Active Phacoemulsification Fluidics with Bevel-down Phaco-tip on Corneal Endothelial Cells

Purpose@#To evaluate the safety of active phacoemulsification fluidics with a bevel-down phaco-tip on corneal endothelial cells in patients with various corneal endothelial cell densities (ECDs). @*Methods@#One hundred and seventy-three eyes of 111 patients who underwent cataract surgery using active phacoemulsification fluidics with a bevel-down phaco-tip technique were consecutively enrolled. We analyzed the postoperative changes in corneal parameters including ECD and clinical factors associated with percent change in ECD. @*Results@#Preoperative mean ECD was 2,511.02 ± 463.14 cells/mm2 (range, 540-3,390 cells/mm2). There was a significant change in postoperative ECD (-50.70 cells/mm2, p < 0.017), and no significant change in hexagonality or coefficients of variation. A higher preoperative mean ECD (B = -0.010, p < 0.001), a higher grade of nucleus sclerosis (B = -3.002, p < 0.001), and a younger age (B = 0.167, p = 0.040) were associated with a larger percent change in ECD. @*Conclusions@#There was very low ECD loss after active phacoemulsification fluidics with a bevel-down phaco-tip. The lower preoperative ECD was not a risk factor for postoperative ECD loss. Therefore, we suggest that active phacoemulsification fluidics with a bevel-down phaco-tip technique can be performed safely in patients with low ECD when nuclear sclerosis is not severe.

Secondary Open-angle Glaucoma and Vitreous Opacity as Presenting Manifestations of Familial Amyloid Polyneuropathy

Purpose@#We report a case of familial amyloid polyneuropathy in a patient presenting with open-angle glaucoma and progressive vitreous opacity.Case summary: A 62-year-old female patient presented with uncontrolled intraocular pressure (IOP) in the left eye that did not respond to medical treatment. She had no history of systemic diseases other than hypertension. Trabeculectomy was performed in the left eye. Thirteen months later, as IOP in the right eye suddenly increased to 50 mmHg and was not controlled, trabeculectomy was also performed in the right eye. Anterior chamber angle was wide and open in both eyes and there were no abnormalities. Vitreous opacity increased gradually in both eyes. Neurological examination was conducted as the patient complained of numbness in the feet, and a diagnosis of familial amyloid polyneuropathy was confirmed. @*Conclusions@#Although rare, familial amyloid polyneuropathy and secondary glaucoma should be considered as differential diagnoses in open-angle glaucoma patients showing high intraocular pressure accompanied by progressive vitreous opacity.

Safety of Active Phacoemulsification Fluidics with Bevel-down Phaco-tip on Corneal Endothelial Cells

Purpose@#To evaluate the safety of active phacoemulsification fluidics with a bevel-down phaco-tip on corneal endothelial cells in patients with various corneal endothelial cell densities (ECDs). @*Methods@#One hundred and seventy-three eyes of 111 patients who underwent cataract surgery using active phacoemulsification fluidics with a bevel-down phaco-tip technique were consecutively enrolled. We analyzed the postoperative changes in corneal parameters including ECD and clinical factors associated with percent change in ECD. @*Results@#Preoperative mean ECD was 2,511.02 ± 463.14 cells/mm2 (range, 540-3,390 cells/mm2). There was a significant change in postoperative ECD (-50.70 cells/mm2, p < 0.017), and no significant change in hexagonality or coefficients of variation. A higher preoperative mean ECD (B = -0.010, p < 0.001), a higher grade of nucleus sclerosis (B = -3.002, p < 0.001), and a younger age (B = 0.167, p = 0.040) were associated with a larger percent change in ECD. @*Conclusions@#There was very low ECD loss after active phacoemulsification fluidics with a bevel-down phaco-tip. The lower preoperative ECD was not a risk factor for postoperative ECD loss. Therefore, we suggest that active phacoemulsification fluidics with a bevel-down phaco-tip technique can be performed safely in patients with low ECD when nuclear sclerosis is not severe.

Secondary Open-angle Glaucoma and Vitreous Opacity as Presenting Manifestations of Familial Amyloid Polyneuropathy

Purpose@#We report a case of familial amyloid polyneuropathy in a patient presenting with open-angle glaucoma and progressive vitreous opacity.Case summary: A 62-year-old female patient presented with uncontrolled intraocular pressure (IOP) in the left eye that did not respond to medical treatment. She had no history of systemic diseases other than hypertension. Trabeculectomy was performed in the left eye. Thirteen months later, as IOP in the right eye suddenly increased to 50 mmHg and was not controlled, trabeculectomy was also performed in the right eye. Anterior chamber angle was wide and open in both eyes and there were no abnormalities. Vitreous opacity increased gradually in both eyes. Neurological examination was conducted as the patient complained of numbness in the feet, and a diagnosis of familial amyloid polyneuropathy was confirmed. @*Conclusions@#Although rare, familial amyloid polyneuropathy and secondary glaucoma should be considered as differential diagnoses in open-angle glaucoma patients showing high intraocular pressure accompanied by progressive vitreous opacity.

Learning Curve for Endoscopic Endonasal Dacryocystorhinostomy

PURPOSE: To elucidate the learning curve for endoscopic endonasal dacryocystorhinostomy (EE-DCR) based on the results of EE-DCR performed by three surgeons at three different tertiary hospitals. METHODS: A retrospective review of the medical records of 386 eyes of 337 patients who had undergone EE-DCR by three surgeons at three tertiary hospitals and who were available for a >6-month postoperative observation period was conducted. The success of a given surgery was determined based on the results of a test performed during the patient's last outpatient visit to the hospital. The learning curve was identified by dividing the patients into four groups (20, 30, 40, and 50 eyes in each respective group) and comparing their success rates. RESULTS: The overall success rate of the entire study population was 86.3%. The success rates for each of three surgeons was 83.3%, 85.6%, and 88.1%, respectively. After dividing the patients into groups of 30 eyes each, all three surgeons showed a significant increase in surgery success rates after their first group of 30 eyes (p 90% (A, 94.4%; B, 90.8%; C, 95.4%). CONCLUSIONS: A surgeon should be required to perform at least 30 EE-DCR procedures to obtain stable surgical skill for this procedure.

Change in Visual Acuity Following Trans-Scleral Diode Laser Cyclophotocoagulation in Refractory Glaucoma

PURPOSE: To evaluate the effects of trans-scleral diode laser cyclophotocoagulation (TSDLC) on best corrected visual acuity (BCVA) in patients with refractory glaucoma. METHODS: The medical records of 148 eyes of 148 patients with refractory glaucoma who were followed-up for over 6 months after TSDLC were analyzed retrospectively. Among them, 49 eyes of 49 subjects who had BCVA greater than no light perception (NLP) before TSDLC were classified as Group 1 and the other 99 eyes of 99 patients who had NLP vision were classified as Group 2. The outcomes of TSDLC including change in BCVA following surgery were analyzed for all patients and 49 subjects. RESULTS: The mean follow-up period in Group 1 was 19.1 +/- 13.5 months and 16.7 +/- 12.7 months in Group 2. The intraocular pressure (IOP) and the number of IOP lowering medications decreased in both groups (both p or = 0.2 log MAR was found in 31 eyes (63.3%) and light perception was lost in 15 eyes (30.6%). After treatment, corneal edema developed in 5 eyes (3.4%), phthisis bulbi and chronic hypotony occurred in 3 eyes each (2%) and iridocydlitis occurred in 2 eyes (1.4%). CONCLUSIONS: TSDLC in patients with refractory glaucoma showed an efficient reduction in IOP and the number of IOP-lowering medications. However, there was a significant loss in BCVA in many patients and therefore, careful monitoring regarding potential visual loss is necessary when considering TSDLC in glaucoma patients with useful vision.

Efficacy of Tenofovir-based Rescue Therapy for Patients with Drug-resistant Chronic Hepatitis B / 대한소화기학회지

BACKGROUND/AIMS: Tenofovir disoproxil fumarate (TDF) plays a pivotal role in the management of drug-resistant chronic hepatitis B. However, it remains unclear whether TDF-nucleoside analogue combination therapy provides better outcomes than TDF monotherapy. This study aimed to compare the efficacy of TDF monotherapy with that of TDF-nucleoside analogue combination therapy in patients with drug-resistant chronic hepatitis B. METHODS: This retrospective cohort study included 76 patients receiving TDF-based rescue therapy for more than 12 months. Suboptimal response was defined as serum HBV-DNA level of >60 IU/mL during prior rescue therapy. Multi-drug resistance was defined as the presence of two or more drug resistance-related mutations confirmed by mutation detection assay. The relationship between baseline characteristics and virologic response (HBV DNA <20 IU/mL) at 12 months were evaluated using logistic regression analysis. RESULTS: Fifty-five patients (72.4%) were suboptimal responders to prior rescue therapy, and 26 (34.2%) had multi-drug resistance. Forty-two patients (55.3%) received combination therapy with nucleoside analogues. Virologic response at 12 months was not significantly different between the TDF monotherapy group and TDF-nucleoside analogue combination therapy group (p=0.098). The serum HBV DNA level was reduced to -4.49+/-1.67 log10 IU/mL in the TDF monotherapy group and to -3.97+/-1.69 log10 IU/mL in the TDF-nucleoside analogue combination therapy group at 12 months (p=0.18). In multivariate analysis, female sex (p=0.032), low baseline HBV-DNA level (p=0.013), and TDF monotherapy (p=0.046) were predictive factors for virologic response at 12 months. CONCLUSIONS: TDF monotherapy showed similar efficacy to that of TDF-nucleoside analogue combination therapy in patients with drug-resistant chronic hepatitis B.

Widening of Palpebral Fissure Due to Lateral Rectus Muscle Recession

PURPOSE: To evaluate the incidence and course of widening of palpebral fissure after unilateral lateral rectus muscle recession. METHODS: The palpebral fissure width (PFW) was measured in 20 patients with intermittent exotropia before unilateral rectus muscle recession and 1 week, 1 month and 6 months after the surgery. RESULTS: The amount of recession was from 7.5 to 9.0 (mean 8.37 +/- 0.51) mm. More than 0.6 mm of change in PFW after surgery was defined as the significant change. The significant change was observed in 10 patients (50%) after 1 week, 7 patients (35%) after 1 month and 7 patients (35%) after 6 months after the surgery. The amount of recession was significantly greater in the group with significant change (8.60 +/- 0.39 mm) than the group without significant change (8.15 +/- 0.53 mm) (p < 0.05). CONCLUSIONS: Thirty five percent of the patients showed palpebral fissure widening lasts at least 6 months after unilateral lateral rectus muscle recession. We think it is necessary to notice patients about the possible change in palpebral fissure width before strabismus surgery. And we believe that more cosmetically satisfactory outcome would be resulted if surgeons consider eyelid condition when they are planning strabismus surgery.

Endoscopic Removal of a Proximally Migrated Metal Stent during Balloon Sweeping after Stent Trimming

Placement of a self-expanding metal stent (SEMS) is an effective method for palliation of a malignant biliary obstruction. However, metal stents can cause various complications, including stent migration. Distally migrated metal stents, particularly covered SEMS, can be removed successfully in most cases. Stent trimming using argon plasma coagulation may be helpful in difficult cases despite conventional methods. However, no serious complications related to the trimming or remnant stent removal method have been reported due to the limited number of cases. In particular, proximal migration of a remnant fragmented metal stent after stent trimming followed by balloon sweeping has not been reported. We report an unusual case of proximal migration of a remnant metal stent during balloon sweeping following stent trimming by argon plasma coagulation. The remnant metal stent was successfully removed with rotation technique using a basket and revised endoscopically.

A Case of Q Fever that may Mimic Systemic Lupus Erythematosus

Q fever is a zoonosis caused by a Coxiella burnetii. Q fever is clinically variable, presenting as asymptomatic infection, pneumonia, hepatitis and endocarditis. Treatment of acute Q fever with doxycycline is usually successful. Autoantibodies, such as anti-mitochondrial antibodies, smooth muscle antibodies (SMA), anti-cardiolipin and lupus anticoagulant, often rise in acute Q fever infection. Some cases may occasionally meet the criteria for autoimmune disease like systemic lupus erythematosus. We report a first case of Q fever that may mimic systemic lupus erythematosus in Korea.

A Case of Q Fever that may Mimic Systemic Lupus Erythematosus

Q fever is a zoonosis caused by a Coxiella burnetii. Q fever is clinically variable, presenting as asymptomatic infection, pneumonia, hepatitis and endocarditis. Treatment of acute Q fever with doxycycline is usually successful. Autoantibodies, such as anti-mitochondrial antibodies, smooth muscle antibodies (SMA), anti-cardiolipin and lupus anticoagulant, often rise in acute Q fever infection. Some cases may occasionally meet the criteria for autoimmune disease like systemic lupus erythematosus. We report a first case of Q fever that may mimic systemic lupus erythematosus in Korea.

A Case of Activated Charcoal Aspiration Treated by Early and Repeated Bronchoalveolar Lavage / 결핵및호흡기질환

Activated charcoal is an inert substance and it is used in standard therapy in patients with acute intoxication. Charcoal has some side effects such as pulmonary aspiration, gastrointestinal complications, and electrolyte abnormalities. Although aspiration of charcoal is a rare complication, it can cause fatal sequelae. We report a 69-year old man who developed acute respiratory failure associated with charcoal aspiration after management of glyphosate poisoning. The patient was drowsy and suffered severe vomiting during transport to our hospital. On arrival, acute respiratory failure was observed due to charcoal aspiration, but the clinical state was improved with repeated bronchoscopy with a bronchoalveolar lavage (BAL). We presumed that the aspirated charcoal was an important factor in evoking a lung injury. Early bronchoscopy with a BAL might be an effective method for eliminating charcoal from the lung, especially in the case of a large amount of aspiration, and be helpful in decreasing respiratory failure due to charcoal aspiration.

A Case Report of Lipoma with Chondro-Osteoblastic Metaplasia

Lipomas, which are benign adipose tissue tumors, are the most common tumors of mesenchymal origin in humans. Some variants of lipoma have been described according to the type of tissue present. A rare variant consists of a lipoma with osseous or cartilaginous metaplasia. We present the case of a lipoma with chondro-osteoblastic metaplasia of right buttock in a 57-year-old male. He was referred for a painless mass on the right lateral margin of the buttock, and present for about 1 month. Magnetic resonance images revealed a 12x8x4 cm sized mass with secondary degeneration focally, involving deep portion of the right gluteus maximus muscle, and protruded to adductor magnus muscle. T1 weighted images showed signal enhancement within the mass. He underwent complete resection of the tumor. No recurrence was observed after five years follow-up. Lipoma with chondro-osteoblastic metaplasia is extremely rare disease. Here, we report it along with the corresponding literature.

A Case of Klinefelter's Syndrome Associated with Rheumatoid Arthritis

Klinefelter's syndrome (KFS) is a gonosomal aberration disease that occurs in males, and is characterized by 47, XXY karyotype, hypogonadism and a lack of secondary sexual characteristics. A potential link between this hormonally deficient syndrome and autoimmune disease, particularly systemic lupus erythematosus (SLE), has been reported. On the other hand, KFS is rarely reported to be accompanied by rheumatoid arthritis (RA), and there are no Korean cases reported. We report the first Korean case of a KFS patient with sero-positive RA and discuss the role of the pathogenesis of RA with KFS.

Long QT Syndrome and Torsade de Pointes Associated with Takotsubo Cardiomyopathy

Prolongation of QTc interval associated with Takotsubo cardiomyopathy (TC) has previously been reported in published case series. We report an unusual case of a patient who presented with TC associated with long-QT syndrome and developed cardiac arrest secondary to torsade de pointes. Since QT prolongation and bradycardia persisted after the resolution of TC, the patient received permanent pacemaker. Since then additional event did not occur. QT prolongation and bradycardia could be persistent even after recovery of TC, and permanent pacemaker insertion may be a treatment option of long QT syndrome related with TC.

An Analysis of the Outcome of Transforaminal Epidural Steroid Injections in Patients with Spinal Stenosis or Herniated Intervertebral Discs / 대한통증학회지

BACKGROUND: Spinal stenosis and herniated intervertebral discs are the principal causes of lumbosacral radiculopathy. This study was conducted to compare the therapeutic value and duration of pain relief of fluoroscopic guided transforaminal epidural steroid injections (TFESIs) in patients with refractory radicular leg pain. METHODS: Between August 2006 and March 2007, 87 patients (H group: patients with herniated intervertebral disc, S group: patients with spinal stenosis) who met the inclusion criteria were treated with fluoroscopic guided TFESIs. Prior to treatment, the VAS and ODI scores were determine to evaluate the degree of pain and level of disability. The degree of pain relief was then assessed 1 month after treatment with the TFESIs and graded as excellent (no residual pain), good (improvement of pain symptoms by more than 50%), fair (improvement of pain symptoms by less than 50%) and Poor (no improvement of pain). In addition, the duration of pain relief was evaluated by regular outpatient visits for 6 months, and by telephone interviews after 6 months. RESULTS: The H and S group both had excellet results at 1 month after treatment with TFESIs showing improvements of 44.1% and 20.8% respectively. However this difference was not significant between groups. In addition, a duration of pain relief greater than 6 months was achieved in 32.4% of the patients in the H group and 37.7% of those in the S group. CONCLUSIONS: TFESIs had a similar degree of therapeutic effectiveness and duration of pain relief in patients with spinal stenosis and herniated intervertebral discs.

Tension Carbon Dioxide Pneumothorax Developed during Laparoscopic Partial Hepatectomy: A case report / 대한마취과학회지

Pneumothorax is a rare and potentially serious complication that can be occurred during laparoscopic surgery. This is a case report of a 34-year-old man who underwent elective laparoscopic partial hepatectomy under general anesthesia. About 45 min after carbon dioxide pneumoperitoneum, hypotension, tachycardia, decreased oxygen saturation, increased peak inspiratory pressure, increased end-tidal CO2 tension, hypercapnia, and hypoxemia were suddenly developed. Altering for the worse vital sign was owing to tension pneumothorax by accidental CO2 influx through inadvertently perforated diaphragm. Repairing diaphragm under open laparotomy, positive manual bagging was effectively applied enough not to require surgical drainage. Therefore, closed observation and careful monitoring is essential to prevent tension pneumothorax during laparoscopic surgery.

The Effect of ACE Inhibitors on the Gene Expression of Various Cytokines in Peripheral Blood Mononuclear Cells from Patients with Glomerular Diseases: TGF-beta, IL-6, IL-10 and TNF-alpha / 대한신장학회잡지

Angiotensin II(ANG II) has been known to induce systemic and glomerular hypertension, which leads to renal tissue injury and progressive fibrosis of kidney. Some effects of ANG II may be mediated by its effect on the cytokine synthesis. In the present study, we investigated the effect of ANG II inhibition on the expression of various cytokines implicated in the pathogenesis and progression of the kidney disease. Blood samples of 11 patients with glomerulonephritis were obtained before the ACE inhibitor therapy and then while they were taking ACE inhibitors. Using peripheral blood mononuclear cells(PBMC) harvested from the samples, RT-PCR was performed to evaluate the changes in mRNA expression of TGF-beta1, IL-6, TNF-alpha and IL-10. The ratios of target cytokines and beta-actin were calculated. TGF-beta1 mRNA expression was decreased in five pat ients after ANG II inhibition with ACE inhibitors, while it was increased in the remaining six patients. ACE inhibitors consistently decreased IL-6 mRNA expression in all 11 patients. IL-10 expression was decreased in 4 patients, and increased in 3 patients after ANG II inhibition. It was not expressed in 4 patients. TNF-alpha expression was increased in 8 patients, and decreased in only 1 patient. In two patients, it was not changed while on ACE inhibitors. Conclusion: ACE inhibitors attenuate IL-6 expression consistently in all 11 patients. This is the first-time demonstration of the in vivo inhibitory effect of ACE inhibitors on IL-6 mRNA expression in humans. The lack of significant suppression of TGF-beta1 in PBMC suggests that the in vivo attenuating effect of ACE inhibitors on TGF-beta1 may be derived from renal hemodynamic changes. The tendency of heightened expression of TNF-alpha confirms the previous investigations in which IL-6 was shown to down regulate TNF-alpha expression