Long-Term Results of LASIK for Presbyopia Correction in Myopic Patients Using Aspheric Micro-Monovision

PURPOSE: To evaluate the efficacy, safety, and satisfaction of patients who underwent LASIK for presbyopia correction in myopic patients using aspheric micro-monovision. METHODS: LASIK for presbyopic correction using aspheric micro-monovision was performed in 18 patients between December 2010 and December 2011. Distance, intermediate, and near visual acuity, refractive change, and patient's satisfaction were evaluated for at least 12 months after the surgery. RESULTS: Among dominant eyes, 100% achieved uncorrected distance and intermediate visual acuity of 0.8 or better and 100% of the eyes achieved 0.8 or better binocularly. In the non-dominant eyes, 83% achieved uncorrected near visual acuity of J3 or better, and 94% of the eyes achieved J3 or better binocularly. Postoperatively, the mean manifest refraction spherical equivalent (MRSE) of the dominant eyes were -0.09 +/- 0.35D, -0.17 +/- 0.42D, and -0.17 +/- 0.47D at 1, 6 and 12 months, respectively. The MRSE of the non-dominant eyes were -0.94 +/- 0.53D, -1.03 +/- 0.56D, and -1.02 +/- 0.50D at postoperative 1, 6, and 12 months, respectively, without significant regression. After surgery, the patient's overall satisfaction score was good (4.2 out of 5). CONCLUSIONS: The aspheric micro-monovision protocol showed good distance, intermediate, and near visual outcomes, and was a well-tolerated, stable, and effective procedure for treating patients with myopic presbyopia.

A Case of Chrysosporium Parvum Endophthalmitis

PURPOSE: To report a case of Chrysosporium parvum endophthalmitis after trauma. METHODS: A 42-year-old healthy woman visited our hospital complaining of ocular pain after trauma sustained with a wire used to tie grapes. She showed corneal laceration and iris prolapse of the right eye on slit lamp examination. She underwent primary suture of the corneal laceration. Two days later, she presented with hypopyon of the anterior chamber. She was treated with topical antibiotics and a topical steroid. On follow-up examination, she again presented with hypopyon of the anterior chamber. She was admitted for microbiologic examination and was again treated with topical antibiotics and a topical steroid. Unfortunately, no organisms were identified by culture. Later, she reported a recurrent history of the inflammation. After 9 months, she presented with increased hypopyon of the anterior chamber and was treated with anterior chamber irrigation and intracameral antibiotics injection on two different occasions. But, still no organisams were identified. After one year, the patient visited our clinic with ocular pain and decreased visual acuity. Her intraocular pressure was 72 mmHg and there was whitish infiltration and hypopyon around 360 degrees of the anterior chamber and angle. At the same time, the intraocular pressure and inflammation were uncontrolled. Ultimately, microscopic examination of specimens obtained directly from tissue after enucleation identified the organism as Chrysosporium parvum. CONCLUSIONS: We experienced a case of Chrysosporium parvum endophthalmitis after trauma. To our knowledge, this was the first report of a case of Chrysosporium parvum endophthalmitis in the world.

Epidemiologic Studies of Keratoplasty in Korea

PURPOSE: To report an epidemiologic study of keratoplasty in which we analyze basic data of corneal transplants and corneal donations in Korea. METHODS: From June 2004 through October 2004, questionnaires were distributed to 25 hospitals. The questionnaires were about the characteristics of patients registered in eye banks for keratoplasty from May 2001 to April 2003, and about the results of keratoplasties performed from May 2002 to April 2003. RESULTS: The leading corneal diseases in patients registered for keratoplasty were infectious keratitis (22.0%), trauma (21.0%), and pseudophakic and aphakic bullous keratopathy (13.8%), in that order. The leading indications in corneal recipients were: trauma (15.5%), pseudophakic and aphakic bullous keratopathy (13.7%), and infectious keratitis (10.7%), in that order. In 233 cases of keratoplasties, penetrating keratoplasty was performed in 229 cases (98.3%) and lamellar keratoplasty was performed in 4 cases (1.7%). The most common combined surgery was cataract extraction. Common causes of graft failure were rejection of donor cornea and infection. Imported donor corneas were used in sixty-one cases (26.2%) among the 233 total keratoplasties. CONCLUSIONS: We constructed an epidemiologic data base of patients registered for keratoplasty, corneal donation, and the results of keratoplasties throughout Korea.

Epidemiologic Studies of Keratoplasty in Korea

PURPOSE: To report an epidemiologic study of keratoplasty in which we analyze basic data of corneal transplants and corneal donations in Korea. METHODS: From June 2004 through October 2004, questionnaires were distributed to 25 hospitals. The questionnaires were about the characteristics of patients registered in eye banks for keratoplasty from May 2001 to April 2003, and about the results of keratoplasties performed from May 2002 to April 2003. RESULTS: The leading corneal diseases in patients registered for keratoplasty were infectious keratitis (22.0%), trauma (21.0%), and pseudophakic and aphakic bullous keratopathy (13.8%), in that order. The leading indications in corneal recipients were: trauma (15.5%), pseudophakic and aphakic bullous keratopathy (13.7%), and infectious keratitis (10.7%), in that order. In 233 cases of keratoplasties, penetrating keratoplasty was performed in 229 cases (98.3%) and lamellar keratoplasty was performed in 4 cases (1.7%). The most common combined surgery was cataract extraction. Common causes of graft failure were rejection of donor cornea and infection. Imported donor corneas were used in sixty-one cases (26.2%) among the 233 total keratoplasties. CONCLUSIONS: We constructed an epidemiologic data base of patients registered for keratoplasty, corneal donation, and the results of keratoplasties throughout Korea.

Influence of Central Corneal Thickness Change on Intraocular Pressure Measurement after LASIK and LASEK

PURPOSE: To evaluate the influence of central corneal thickness change after LASIK and LASEK to intraocular pressure (IOP) measured by Goldmann applanation tonometer and noncontact tonometer. METHODS: The pre-and post-operative IOP, central corneal thickness were measured in the 94 eyes of 47 patients who underwent refractive surgeries (LASIK and LASEK) from November 2000 to November 2001. Central corneal thickness was measured by ultrasonic pachymeter. IOP was measured by Goldmann applanation and noncontact tonometer. RESULTS: Post-operative IOP after LASIK and LASEK was significantly lower than pre-operative IOP. IOP measured with the noncontact tonometer was higher than that with Goldmann applanation tonometer in the group with thick cornea (>500micro meter in thickness) and lower in the group with thin cornea (< 500micro meter in thickness). Positive relationship between corneal thickness and measured IOP was greater in noncontact tonometer than Goldmann applanation tonometer. In noncontact tonometer, the amount of decreased IOP of LASIK group was greater than that of LASEK group. CONCLUSIONS: There was a close relationship between central corneal thickness and IOP. Measured IOP may be influenced by surgical method and type of tonometer. These findings suggest that we should be cautious when evaluating the IOP of eyes which underwent excimer laser refractive surgery because the measured IOP can be lower than actual IOP.

Laser in Situ Keratomileusis Versus Laser Epithelial Keratomileusis for Low to Moderate Myopia

PURPOSE: To compare the efficacy, predictability, safety, and stability of Laser epithelial keratomileusis (LASEK) with conventional Laser in situ keratomileusis (LASIK) for correction of low to moderate myopia. METHODS: In this study, LASIK-treated 31 eyes of 17 patients and LASEK-treated 33 eyes of 17 patients were followed for 6 months. Uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), manifest refraction, IOP, topography, keratometry, pachymetry and specular examination were performed. RESULTS: Postoperative mean UCVA was logMAR 0.02+/-0.09 in LASIK group and logMAR 0.01+/-0.09 in LASEK group. Postoperative mean refraction was 0.04+/-0.36D in LASIK group and 0.07+/-0.28D in LASEK group and there was no significant difference between 2 groups (P>0.05). 71.0%(22 of 31) of LASIK eyes and 81.8%(27 of 33) of LASEK eyes had an uncorrected visual acuity of 20/20 or better at 6 months after surgery. 87.1%(27 of 31) of LASIK eyes and 97.0%(32 of 33) of LASEK eyes achieved predictability within +/-0.5D at 6 months follow up. There was no decrease in best-corrected visual acuity of two Snellen lines or more in both groups. CONCLUSIONS: In this study, there was no difference in postoperative mean UCVA and mean refraction in LASIK and LASEK group. However, LASEK group had better results in UCVA of more than 20/20 and predictability but there was no significant difference between 2 groups.

Sutureless Small Incision ECCE with Phaco Prechopper

PURPOSE: The study was done to introduce the new small incision sutureless extracapsular cataract extraction (ECCE) surgical technique and its safety using phaco prechopper. METHODS: After 4.5 mm scleral frown incision from 2 mm surgical limbus, continuous curvilinear capsulorhexis and complete hydrodissection, nucleus was divided into 2 fragments with phaco prechopper which is special forceps for nuclear divider in the bag. One piece of lens was drawn into anterior chamber from capsular bag using Sinskey hook and removed it with Wilder lens loop (size:4 x15 mm) from anterior chamber. The other piece of lens was removed with the same method. To evaluate the safety of new method compared to phacoemulsification (P.E), analysis of the serial changes of the corneal endothelial cell density, hexagonal pattern and mean cell sizes before and 3months after the operation in 40eyes (ECCE group : 20eyes, P.E group : 20eyes) was made. RESULTS: There were no significant complications such as posterior capsular rupture, vitreous loss, capsulorhexis tear but transient corneal edema was found. The mean percentage of corneal endothelial cell loss was 9.05+/-6.5% in ECCE group and 9.80+/-6.7% in the P.E group. CONCLUSIONS: This new method is safe, easy and does not require expensive instrumentation. It can be of great help for the phaco beginners to practice capsulorhexis, hydrodissection and the use of phaco system. We think it is an alternative method for phacoemulsification in cataract surgery.

A Case of Corneal Transplantation for Type III Lattice Corneal Dystrophy with Aphakia

Lattice corneal dystrophy is a genetic disorder which deposits linear amyloid in corneal stroma and because of this deposition, patient, s visual acuity is decreased and recurrent corneal erosion occurs.There are three types of lattice corneal dystrophy, and among these types, especially type III has extremely low prevalence rate and quite different clinical findings compared with type I and II, and never has been reported in Korea.We report one case of type III lattice corneal dystrophy with aphakia who had been managed by penetrating keratoplasty with secondary PCL implantation.

A Case of Isolated Posterior Capsule Rupture Caused by Blunt Ocular Trauma

Isolated rupture of the posterior capsule caused by blunt ocular trauma is rarely reported and is usually detected incidentally during surgery for the associated cataract. We report a case of isolated posterior capsule rupture detected during cataract surgery in a 33-year-old man who had traumatic cataract. In this case, the ruptured posterior capsule had relatively large defect in size(5x5 mm)with thickened and fibrosed edge and vitreous opacity existed. The surgical management of this case consisted of phacoemulsification with PC-IOL implantation and pars plana vitrectomy. During surgery, although the posterior capsule rupture was large, further rupture of the capsule was prevented by the fibrosed edge which tightened the margin ofthe ruptured capsule, and so PC-IOL implantation could be possible securely.

The Comparison of Clinical Results of Medial Clear Corneal Incision with Lateral Clear Corneal Incision in Cataract Surgery

In temporal clear corneal incision cataract surgery, it is essential to change the equipment and personnel between right eye and left eye. To obtain an advantages of clear corneal incision without going through the hassles and same effect of postoperative astigmatism and visual acuity, we sat at 10 o`clock orientation on patient`s head(right handed surgeon)and performed lateral clear corneal incision on the right eye and medial clear corneal incision on the left eye. Temporal clear corneal incision in right eye(Group 1)and medial clear corneal incision in left eye(Group 2)were performed in randomly selected 20 eyes in each group by one surgeon between June 1997 and October 1997 at Dongguk University Medical Center. Preoperative corneal astigmatism , surgically induced corneal astigmatism and changes of visual acuity were analyzed at 1 week, 2 weeks, 4 weeks, 2 months, 3 and 6 months postoperatively using corneal videokeratography(EYESYS Technology)and visual acuity chart projector(Topcon ACP-7). Postoperative uncorrected visual acuities were 20/40 or better in 75%(15 eyes)in group 1 and 70%(14 eyes)in group 2. In preoperative corneal astigmatism, there was no statistical significance between the two groups (P>0.05)(Group 1: 0.58+/-0.28D, Group 2: 0.59 +/-0.17D). In surgically induced corneal astigmatism, we found there was statistically significant difference between the two groups(P0.05)(Group 1: 0.87+/-0.59D, Group 2: 1. 14+/-0.58D). In conclusion, medial clear corneal incision did not need to change the personnel and equipment from case to case and the nose didn`t get in the way in medial approach. We consider that medial clear corneal incision is recommendable procedure because there were no significant differences in postoperative visual acuity and surgically induced astigmatism at 6 months postoperatively between the two groups.

A Clinical and Mycological Study of 14 Cases with Mycotic Keratitis / 대한의진균학회지

BACKGROUND: Clinical concern and incidence of mycotic keratitis in ophthalmic practice has been increasing. OBJECTIVE: The purpose of this study was to investigate clinical and mycological feature of mycotic keratitis. METHODS: We evaluated the clinical and mycological aspect of mycotic keratitis in 14 patients from October 1993 to March 1997 in Dongguk Unversity Hospital. RESULTS AND CONCLUSION: Mycotic keratitis showed high incidence in fifth (42.9%), sixth (35.7%), and fourth decade (14.3%). The ratio of male to female patient was 1:3.6. The seasonal prevalence was highest in autumn. A scratch or abrasion from vegetation was the most common type of the eye trauma in mycotic keratitis. The positive rate of KOH examination and culture was 92.9%, respectively. The common causative organisms of mycotic keratitis were Fusarium sp. (38.5%) and Alternaria sp. (38.5%), followed by Curvularia sp. (7.7%), Aspergillus flavus (7.7%) and Acremonium sp. (7.7%).

Ultrastructural Changes of the Rabbit Lens Fiber Cells in Cataract

This study was carried out to investigate the ultrastructural changes of lens fiber cells, length of gap junctions, and distribution of proteoplycans in cataractous lens. The cataract was induced by stabbing the posterior surface of the lens with 25 gauge needle. The lens were obseved by electron microscopy with estimation of the gap junction. Alcian blue stain was performed for examination of proteoglyscas. The results were as follows. Characteristic changes of the cataractous lens fiber cells were swelling and condensation of the cytoplasm, alterations of cytoplasmic granules including changes of density and size of cytoplasmic granules, and formation of microfibrills, high electron-dense amorphous substance, electron-dense particles, variably sized globular bodies, and multilamellar bodies. The lengths of gap junctions were 2.51+/-1.09um in control and 1.06+/-0.33um in cataractous lens fiber cells(P<0.001). Proteoglycans showing high electron-dense amophorous substance were distributed in the intercellular spaces along the cytoplasmic membrane in control group, but disapperaed in cataractous lens fiber cells. According to these results, it is conceivalble that the changes of the gap junctions and proteoglycans were closely related to the pathogenesis of cataract.

Rabltit Model of Acenitine Myelo-optic Neuropathy

A single sublethal dose of aconitine, a principal constituent of aconite, was administered intraperitoneally to evaluate its toxic effects on the visual pathway, spinal cord and peripheral nerve of the rabbit. Histopathological findings indicate that moderate aconitine poisoning in the rabbit consists primarily of myelopathy. Aconitine is chemically acetyl-benzoyl-ester of aconin, a base derived from quinonline. This fact may explain the similarity of pathologic pictures between subacute myelo-optic neuropathy(SMON) caused by halogenated hydroxyquinoline and acomtine poisoning.

A Case of Pigmented Paravenous Retino-Choroidal Atrophy and Retinitis Pigmentosa

Pigmented paravenous retinochoroidal atrophy(PPRCA) is an uncommon disease that was first reported in 1937 by T.H.Brown. The diagnosis was based on the distinctive fundus appearance of bone corpuscular pigment accumulation, exclusively along the distribution of the retinal vein. Depending on the degree of severity, there may be peripapillary changes, as well as areas of chrioretinal atrophy adjacent to the perivenular pigmentary changes. Although the fundus abnormalities can be mild or severe, retinal function tests indicated that this is geographic and not a generalized disorder. We experienced a case of PPRCA in the left eye a 40 year-old male, which was associated with retinitis pigmentosa in his right eye.