Effects of Mitomycin C on Scleral Collagen Fibrils According to Atomic Force Microscopy

PURPOSE: To investigate the effects of mitomycin C on the scleral collagen surfaces using atomic force microscopy (AFM). METHODS: Two non-contact mode AFM machines were used to observe changes in the morphological characteristics of human scleral surfaces before and after one, three, and five minutes of 0.02% mitomycin C application. Based on AFM topography and deflection images of the collagen fibril, the morphological characteristics of scleral fibrils including the fibril diameter and D-period were measured using the line profile. RESULTS: The sclera collagen fibril treated with 0.02% mitomycin C for one minute did not show any significant increases in mean fibril diameter (155.04 +/- 17.46 nm) or mean D-periodicity (70.02 +/- 3.33 nm), compared to those of the control group. However, the scleral collagen fibrils treated with 0.02% mitomycin C for three and five minutes showed significant increases in mean fibril diameter (182.33 +/- 16.33 nm, 199.20 +/- 12.40 nm, respectively) and mean D-periodicity (70.27 +/- 13.66 nm, 72.75 +/- 19.32 nm, respectively), compared to those of the control group. CONCLUSIONS: The present study examined the structural changes in the scleral collagen fibrils before and after mitomycin C application according to atomic force microscopy. The results indirectly suggest that three or more minutes of 0.02% mitomycin C application affects the morphology of scleral collagen.

A Case of Rubinstein-Taybi Syndrome with Optic Disc Coloboma and Chorioretinal Coloboma

PURPOSE: The authors report a case of Rubinstein-Taybi syndrome with optic disc coloboma and chorioretinal coloboma. CASE SUMMARY: A 17-month-old female infant was brought to our clinic presenting exodeviation in the right eye. On cycloplegic refraction, her refractive power was -5.50 D sph -2.50 D cyl axis 180degrees in the right eye and +0.50 D sph in the left eye. On ophthalmologic examination, exotropia of 60 prism diopters with no limitation of ocular movement was observed. Fundus examination showed optic disc coloboma and chorioretinal coloboma in the right eye. The patient's physical characteristics were downward slanted palpebral fissures, long eyelashes, low set ears, and the thumb and the big toe were disproportionately broad. The patient also demonstrated delayed gait abilities. The clinical diagnosis of Rubinstein-Taybi syndrome was given. CONCLUSIONS: The authors report a child with Rubinstein-Taybi syndrome with optic disc coloboma and chorioretinal coloboma, the first to be reported in Korea.

A Case of Conjunctival Lymphangioma With Clinical Manifestations of Superior Limbic Keratoconjunctivitis After Upper Lid Blepharoplasty

PURPOSE: To report a case of conjunctival lymphangioma with clinical manifestations of superior limbic keratoconjunctivitis after upper lid blepharoplasty. CASE SUMMARY: A 55-year-old woman who had upper lid blepharoplasty performed 1 year before complained of pain, injection, and blurred vision in her right eye, which lasted for 2 days. The slit lamp examination revealed a poorly demarcated hypertrophic lesion with central erosion on the superior bulbar conjunctiva and a diffuse corneal erosion and edema in the area of the superior limbus. Tenderness of the superior bulbar conjunctiva and corneal erosion were treated with artificial tears, antibiotic eye drops, and a therapeutic contact lens. Slight anterior chamber reaction was found and treated by steroid eye drops; however, there was no improvement. After eversion of the right upper eyelid with a Desmarres retractor, a hypertrophic lesion with central dimpling was found. However, no exposed sutures were observed. Resection and biopsy of the superior bulbar conjunctiva and a subtarsal triamcinolone injection were performed for diagnosis and treatment. A conjunctival biopsy specimen showed conjunctival lymphangioma. CONCLUSIONS: Conjunctival lymphangioma can occur due to pressure and friction of an eyelid lesion after upper lid blepharoplasty.

The Relationship between Axial Length, Refractive Power and Foveal Thickness Measured by OCT in Koreans

PURPOSE: To evaluate the relationship between foveal thickness and axial length and refractive power in healthy Koreans. METHODS: Ninety-eight healthy eyes were studied. The axial length was measured using A-scan (Paradigm mode p45, Kent, U.K.) and refractive power using automatic refractor Automatic refractor(HARK-599, Carl Zeiss, USA). The subjects were divided into 2 groups based on axial length (>or=25 mm and -6.0D). The foveal thickness was measured using OCT 3000 (Optical Coherence Tomography, Carl Zeiss, USA) and the statistical relationship between the 2 groups was analyzed by independent t-test. RESULTS: There was no statistically significant difference found in foveal thickness according to axial length between the two groups (p>0.05) nor according to refractive power (p>0.05). CONCLUSIONS: When eyes with pathologic myopia were excluded, The axial length and refractive power of the eyes had no relation to foveal thickness measured by OCT.

The Effect of Intravitreal Triamcinolone Acetonide Second Injection for Diabetic Macular Edema

PURPOSE: To evaluate the outcome of a second intravitreal injection of triamcinolone acetonide for the treatment of diabetic macular edema. METHODS: This clinical series study was carried out on 12 eyes with diabetic macular edema. All patients had shown VA (visual acuity) improvement after the first intravitreal injection of triamcinolone acetonide (4 mg). Following the exhibition of decreased VA and increased foveal thickness, the eyes received a second intravitreal injection. We analyzed the visual acuity and foveal thickness at post-treatment 1, 3, and 6 months by ETDRS (LogMar) and optical coherence tomography (OCT). RESULTS: The mean improvement of visual acuity was 0.24, 0.11, and 0.00 at the 1-, 3-, and 6-month follow-up after the first injection, and was 0.09, 0.00, and -0.20 at the 1-, 3-, 6-month follow-up after the second injection. The mean decrease of foveal thickness was 400, 243, and 109 micrometer at the 1-, 3-, 6-month follow-up after the first injection and 298, 78, and -53 micrometer at the 1-, 3-, and 6-month follow-up after the second injection. The differences of change in foveal thickness after the first and second injections were significant (P=0.02, 0.04, 0.02) but the differences of change in visual acuity were not significant (P=0.14, 0.41, 0.28). CONCLUSIONS: Intravitreal injection of 4 mg of triamcinolone acetonide may increase the visual acuity and may decrease the foveal thickness in the short term, postoperative period, but the second intravitreal injection was less effective than the first injection.

Comparison of Corneal Haze according to the Success of Corneal Epithelial Flap after Laser Subepithelial Keratomileusis

PURPOSE: This present study aims at comparing the degree of corneal opacity after LASEK according to the status of corneal epithelial flap in myopia of low, moderate and high myopic patients. METHODS: In this study, 75 eyes of 39 patients treated with LASEK were examined during three months. We subdivided into three groups which were high myopia(>or=-6 diopter), moderate myopia(>or=-3 diopter, <-6 diopter), and low myopia(<-3 diopter) group. The corneal epithelial flap was classified into good, moderate, and poor flap according to the state after repositioning epithelium, also the corneal opacity was described by Fantes classification and measured at post-LASEK one, three day, one week, one month, and three months. RESULTS: The 10 eyes of 12 eyes with poor corneal flap had corneal opacity of grade 1 and over at 1 month. The corneal opacity of four eyes among them improved less than trace at 3 months. The degree of corneal opacity by corneal epithelial flap had a significant difference in low and moderate myopic groups at first month after the surgery. The more the myopic degree was, the more the degree of corneal opacity was. CONCLUSIONS: The degree of corneal opacity was affected by the status of corneal epithelial flap. Therefore, careful managements of epithelial flap were needed during LASEK.

Laparoscopic Adrenalectomy: A Comparison with Open Adrenalectomy / 대한내분비외과학회지

PURPOSE: The advent of laparoscopic abdominal surgery made it possible to perform a laparoscopic adrenalectomy (LA). We have successfully performed 10 such operations since November 21, 1995. We retrospectively compared the effectiveness and the safety of a laparoscopic adrenalectomy with the effectiveness and the safety of an open adrenalectomy (OA). METHODS: The 45 patients with adrenal diseases who underwent an adrenalectomy from March 1990 to January 1998 were included in this study. Ten (10) laparoscopic cases comprised the study group, and 17 of the 32 open adrenalectomy cases, performed by anterior approach, comprised the control group. RESULTS: No one died from an adrenalectomy. Nine cases (45%) from the OA group needed transfusions (average: 661 ml), but one patient from the LA group, who had required a conversion to a celiotomy, required a transfusion (400 ml). The operating times were, on average, 191 minutes in the OA group and 230 minutes in the LA group (p=0.0384). The average size of the masses was 6.5 cm. The first days of walking after the operation was 3.4 days for the OA group and 1.3 days for the LA group (p=0.0002). The patients' former regular diets were started on days 6.9 and 3.2 for the OA and LA groups, respectively (p=0.0001). Postoperative in-hospital days were 17.5 for the OA group and 7.9 for the LA group (p=0.0001). CONCLUSION: In comparison with an open adrenalectomy, a laparoscopic adrenalectomy showed better convalescent features: that is, less chance of transfusion, earlier recovery, faster resumption of the former diet, shorter postoperative hospital stays, and cosmesis. We think and suggest that a laparoscopic adrenalectomy is a safe and effective procedure, and hopefully it will become the standard choice of operation for various adrenal diseases.

Laparoscopic Adrenalectomy: A Comparison with Open Adrenalectomy / 대한내분비외과학회지

PURPOSE: The advent of laparoscopic abdominal surgery made it possible to perform a laparoscopic adrenalectomy (LA). We have successfully performed 10 such operations since November 21, 1995. We retrospectively compared the effectiveness and the safety of a laparoscopic adrenalectomy with the effectiveness and the safety of an open adrenalectomy (OA). METHODS: The 45 patients with adrenal diseases who underwent an adrenalectomy from March 1990 to January 1998 were included in this study. Ten (10) laparoscopic cases comprised the study group, and 17 of the 32 open adrenalectomy cases, performed by anterior approach, comprised the control group. RESULTS: No one died from an adrenalectomy. Nine cases (45%) from the OA group needed transfusions (average: 661 ml), but one patient from the LA group, who had required a conversion to a celiotomy, required a transfusion (400 ml). The operating times were, on average, 191 minutes in the OA group and 230 minutes in the LA group (p=0.0384). The average size of the masses was 6.5 cm. The first days of walking after the operation was 3.4 days for the OA group and 1.3 days for the LA group (p=0.0002). The patients' former regular diets were started on days 6.9 and 3.2 for the OA and LA groups, respectively (p=0.0001). Postoperative in-hospital days were 17.5 for the OA group and 7.9 for the LA group (p=0.0001). CONCLUSION: In comparison with an open adrenalectomy, a laparoscopic adrenalectomy showed better convalescent features: that is, less chance of transfusion, earlier recovery, faster resumption of the former diet, shorter postoperative hospital stays, and cosmesis. We think and suggest that a laparoscopic adrenalectomy is a safe and effective procedure, and hopefully it will become the standard choice of operation for various adrenal diseases.

High Tibial Osteotomy With Fibular Shaft Osteotomy

The purpose of this paper was to report clinical results and complications of high tibial osteotomy with fibular shaft osteotomy for medial unicompartmental osteoarthritis with varus deformity of the knee. Especially, the complications related to fibular shaft osteotomy were surveyed and analysed. Among one hundred and thirty-one cases which underwent high tibial osteotomy from Nov 1993 to May 1999, twenty-five cases underwent it combined with fibular shaft osteotomy and followed up at least more than 2 years. Average follow-up period were 47 months. Hospital for special surgery(HSS) knee score and femorotibial angle from weight bearing anteroposterior roentgenography of the knee were evaluated and measured. HSS knee score was improved from average 69 points preoperatively to 93 points in average at the final follow-up. Femorotibial angle was varus 2.9 degrees in average preoperatively and improved to valgus 8.1 degrees in average postoperatively and valgus 6.6 degrees at the final follow-up. Complications were tender- ness near to fibular shaft osteotomy in 9 cases, superficial peroneal nerve injury in 8 cases, non-union of fibu- lar osteotomy in 7 cases, non-union or delayed union of tibia osteotomy in 3 cases. High tibial osteotomy with fibular shaft osteotomy was a effective procedure in improving clinical results of osteoarthritis of the knee. However care must be taken to avoid complications rel#ated to fibular osteotomy

Laparoscopic Adrenalectomy A comparison with open adrenalectomy

BACKGROUNDS: The advent of laparoscopic abdominal surgery made it possible to perform a laparoscopic adrenalectomy (LA). We have successfully performed 10 such operations since November 21, 1995. We retrospectively compared the effectiveness and the safety of a laparoscopic adrenalectomy with the effectiveness and the safety of an open adrenalectomy (OA). METHODS: The 45 patients with adrenal diseases who underwent an adrenalectomy from March 1990 to January 1998 were included in this study. Ten (10) laparoscopic cases comprised the study group, and 17 of the 32 open adrenalectomy cases, performed by anterior approach, comprised the control group. RESULTS: No one died from an adrenalectomy. Nine cases (45%) from the OA group needed transfusions (average:661 ml), but one patient from the LA group, who had required a conversion to a celiotomy, required a transfusion (400 ml). The operating times were, on average, 191 minutes in the OA group and 230 minutes in the LA group (p = 0.0384). The average size of the masses was 6.5 cm. The first days of walking after the operation was 3.4 days for the OA group and 1.3 days for the LA group (p = 0.0002). The patients' former regular diets were started on days 6.9 and 3.2 for the OA and LA groups, respectively (p = 0.0001). Postoperative in-hospital days were 17.5 for the OA group and 7.9 for the LA group (p = 0.0001). CONCLUSIONS: In comparison with an open adrenalectomy, a laparoscopic adrenalectomy showed better convalescent features:that is, less chance of transfusion, earlier recovery, faster resumption of the former diet, shorter postoperative hospital stays, and cosmesis. We think and suggest that a laparoscopic adrenalectomy is a safe and effective procedure, and hopefully it will become the standard choice of operation for various adrenal diseases.