Analysis of Referred 113 Patients with Endophthalmitis after Cataract Surgery and Associated Prognostic Factors

PURPOSE: To evaluate factors affecting final visual acuity by analyzing patients referred with infectious endophthalmitis after cataract surgery. METHODS: A retrospective investigation of clinical notes of 113 patients referred with endophthalmitis following cataract surgery was conducted from January 2008 to December 2013. To evaluate factors affecting final visual acuity, initial visual acuity, onset of endophthalmitis after the cataract surgery, types of treatment, presence of hypopyon and culture results were investigated. RESULTS: Of the 113 patients, visual acuities at presentation were hand motions or less in 75 patients (66.3%) and final visual acuities after treatments were 0.5 or better in 73 patients (64.6%). Cases with initial visual acuity of hand motions or better achieved favorable outcomes whereas cases with gram-negative infection or endophthalmitis occurring within 2 days postoperatively showed poor prognosis. Statistically, vitrectomy versus intraocular antibiotic injection as primary means of treatment showed no differences in final visual acuity in patients with initial visual acuity of hand motion or better. CONCLUSIONS: Visual acuities at presentation, type of cultured organism and onset of endophthalmitis after cataract surgery are significantly related to visual prognosis. Advantages of initial vitrectomy versus intraocular antibiotic injections were unclear and further investigations are necessary to clarify these issues.

Clinical Characteristics of Retinal Detachment Associated with Atopic Dermatitis

PURPOSE: To evaluate the clinical characteristics and surgical outcomes of retinal detachment associated with atopic dermatitis. METHODS: A retrospective investigation of clinical notes of 37 patients with retinal detachment associated with atopic dermatitis was conducted from January 2009 to December 2015. Initial visual acuity, medical history, type of retinal detachment, number of tears, types of treatment, success rate of treatment, and presence of cataract were investigated. To evaluate the relationship with cataract, the patients were classified into three groups according to lens status: group A (eyes with clear lens), group B (eyes with cataract), and group C (pseudophakic eyes). RESULTS: Of the 37 patients, 29 were male and 8 were female; 10 patients had bilateral retinal detachment (27.0%). The retinal breaks were often located temporally (89.4%), with only 5 cases (10.6%) involving nasal-side retinal breaks. No significant differences were noted in the ratio of males to females, age distribution, visual acuity before and after treatments, axial length, and location of retina breaks among the three groups. After primary surgery, retinal detachment recurred in 12 patients (14 eyes), 5 of whom were initially diagnosed with bilateral retinal detachment. In addition, 12 of 14 eyes underwent a second operation, in which detachment recurred in 3 eyes. CONCLUSIONS: Incidence of bilateral retinal detachment was high in patients with atopic dermatitis, and the retinal breaks were often found on the temporal side. Retinal re-detachment was statistically high in patients with cataract or pseudophakic eyes compared to patients with clear lens (p = 0.024).

Outcomes of Relaxing Retinectomy in Patients with Proliferative Vitreoretinopathy

PURPOSE: To report the outcomes of relaxing retinectomy for retinal detachment in patients with proliferative vitreoretinopathy (PVR). METHODS: Sixty-four cases of relaxing retinectomy for PVR with a minimum follow-up of 6 months were retrospectively reviewed. The outcomes included achievement of complete retinal reattachment, PVR recurrence, the mean number of additional operations, visual acuity and incidence of postoperative complications. We analyzed the influence of intraoperative factors including lens status, retinectomy extent, additional scleral buckling, and tamponade agent on primary retinal reattachment. RESULTS: Complete retinal reattachment was achieved in 47 eyes (74.3%) without an additional surgery. PVR recurred in 19 eyes (29.7%) and an additional operation was performed in 17 eyes (26.6%). Fifty-seven (89.1%) eyes showed complete retinal reattachment and 40 eyes (62.5%) had visual acuity of 0.02 or more at the final follow-up visit. Hypotony was the major complication and developed in 10 eyes (15.6%). Eyes undergoing smaller ( or = 180degrees) retinectomy or gas tamponade (p = 0.043 and 0.013, respectively). CONCLUSIONS: Relaxing retinectomy is a useful technique for retinal detachment with PVR, but risk of recurrent proliferation or hypotony should be considered.

Surgical outcomes of 2 3-gauge vitrectomy for the management of lens fragments dropped into the vitreous cavity during cataract surgery

To assess the clinical features and surgical outcomes of 23-Gauge [G] vitrectomy for lens fragments dropped into the vitreous during cataract surgery. A retrospective, non-comparative, interventional case series at a single medical center. The medical records of 45 eyes from 45 consecutive patients who were referred to our hospital for surgical retrieval of phacoemulsification dropped lens fragments and who underwent 23-G vitrectomy were retrospectively reviewed. Data pertaining to patient demographics, pre- and post-operative Snellen visual acuity, and postoperative complications were recorded. Factors associated with dropped lens fragments were also examined. Mean patient age was 68.18 +/- 11.47 years. The preoperative and postoperative mean logarithm of minimum angle of resolution [logMAR] visual acuity was 1.91 +/- 0.59 [Snellen equivalent 0.06 +/- 0.15] and 0.42 +/- 0.51 [Snellen equivalent 0.54 +/- 0.31], respectively. Forty-two eyes [93.3%] had dislocated lens fragments <50% of the total lens size. Two eyes [4.4%] had a large and hard lens nucleus, which necessitated the use of a 20-G fragmatome to efficiently and completely remove the lens material. At the final examination, 30 eyes [66.6%] had a visual acuity better than 20/40. Post-vitrectomy complications included elevated IOP for at least 3 months [n = 5 eyes, 11.1%], intraocular lens dislocation [n = 2 eyes, 4.4%], and cystoid macular edema [n = 1 eye, 2.2%]. No cases of postoperative endophthalmitis or retinal detachment were observed. A 23-G vitrectomy is safe and efficient for the surgical management of dropped lens fragments following cataract surgery

Comparison of Therapeutic Effect Between Half-Energy Photodynamic Therapy and Intravitreal Bevacizumab Injection in Chronic Central Serous Chorioretinopathy for 12 Months

PURPOSE: In this study we compared the effectiveness between half energy photodynamic therapy (PDT) and intravitreal bevacizumab (IVB) injection for chronic central serous chorioretinopathy (CSC). METHODS: Forty-five eyes of 42 patients diagnosed as chronic CSC from March 2008 to April 2011 were treated with half energy PDT or IVB injection. The subjects were chosen for a retrospective study and analysis was performed on changes in best corrected visual acuity and existence of subretinal fluid, recurrence rate and changes in central macular thickness. RESULTS: Similar improvement of visual acuity was observed in both treatment groups 1 month after treatment and no meaningful difference was found in each stage for both groups (p = 0.001, p = 0.0012, respectively). However, 6 to 12 months after the treatment, the half energy PDT group showed more improvement in visual acuity compared to the IVB injection group (p = 0.019, p = 0.043, respectively). Nineteen out of 21 cases showed full recovery of subretinal fluid in the half energy PDT group with an average treatment period of 1.3 +/- 0.8 months and 7 out of 24 cases showed full recovery in the IVB injection group with an average treatment period of 3.2 +/- 2.8 months. There was a single case of recurrence in the half energy PDT group and 4 in the IVB injection group. The half energy PDT group showed a meaningful decline in central macular thickness at 1, 3, and 6 months after treatment (p = 0.001, p = 0.005, p = 0.007, respectively) compared to the IVB injection group and showed numerous cases with decline in central macular thickness below the 2 standard deviation from normal values (p = 0.002). CONCLUSIONS: Both half energy PDT and IVB injection were effective for the treatment of chronic central serous chorioretinopathy. However, the half energy PDT group comparatively showed better anatomical and functional outcomes. The thinning of central macular thickness below normal value was also observed, thus careful choice of treatment is necessary for patients with chronic central serous chorioretinopathy.

The Short-term Effect of Intravitreal Bevacizumab for Treatment of Central Serous Chorioretinopathy

PURPOSE: To determine whether intravitreal bevacizumab is effective for the treatment of central serous chorioretinopathy. METHODS: We retrospectively examined 42 eyes after intravitreal bevacizumab (1.25 mg) injection for central serous chorioretinopathy. After 1 month, improvement of vision and change in sensory retinal detachment were evaluated with a fundus examination and optical coherence tomography. RESULTS: The mean duration of symptoms was 3.9+/-2.31 months. After intravitreal bevacizumab injection, mean best corrected visual acuity improved from 0.53+/-0.31 to 0.72+/-0.29 at 1 month. In addition, neurosensory retinal detachment disappeared in 32 patients (76.2%). Five patients among ten who did not show improvement of neurosensory retinal detachment underwent reinjection of bevaczumab, and three of those reinjected showed the resolution of neurosensory retinal detachment at another 1 month. No improvement was seen among the patients who did not undergo reinjection. CONCLUSIONS: Intravitreal bevacizumab injection appears to have a short-term benefit for the treatment of central serous chorioretinopathy.

Irreducible Posterolateral Dislocation of the Knee Joint with Lateral Dislocation of the Patella: A Report of Two Cases

Reduction of the knee is impossible if the medial femoral condyle is caught in the medial soft tissue while posterolateral dislocation of the knee happens. Irreducible posterolateral dislocation with buttonholing of the medial femoral condyle through the torn vastus medialis muscle has rarely been reported. Furthermore, such a case associated with patella lateral dislocation has very seldom been reported. We report here on 2 such cases that were treated with open reduction.

Ocular Findings in Cri Du Chat Syndrome: A Case Report

PURPOSE: To report the ophthalmologic examination of an infant who has cri du chat syndome with exotropia and facial abnormalities. CASE SUMMARY: A 7 - month - old infant was confirmed as having cri du chat syndrome by a chromosomal study. He showed mild developmental retardation and eyeball deviation. This male infant underwent ophthalmic evaluations, including an extraocular examination, measurement of deviation, ocular movement test, interepicanthal distance, and fundus examination. As a result, facial abnormalities were found, including telecanthus and epicanthal folds. The infant had intermittent exotropia of 40 prism diopters according to the Hirschberg test and optic atrophy according to the fundus examination. CONCLUSIONS: Cri du chat syndrome manifests with many different ocular symptoms, including hypertelorism, telecanthus, epicanthal folds, and exotropia.

Consecutive Esotropia in Intermittent Exotropia Patients with Immediate Postoperative Overcorrection More Than 17 Prism Diopters

PURPOSE: To report the incidence and the factors of consecutive esotropia (ET) in patients with immediate postoperative overcorrection of at least 17 prism diopters (PD) after surgery for intermittent exotropia (X(T)). METHODS: Four-hundred-five patients under the age of 18 were included in this study. They underwent bilateral lateral rectus recession (LROU-rec) or unilateral recession-resection (R&R) for X(T). On postoperative day one, the patients with at least 17 PD overcorrection were classified as group 1 and those with less than 17 PD as group 2. Age, refractive error, type of surgery, lateral incomitancy, and the incidence of consecutive ET were analyzed for each group. RESULTS: Group 1 consisted of 116 patients (28.6%) and group 2 consisted of 289 (71.4%). At the six-month follow-up visit, consecutive ET had developed in 16 patients (13.8%) in group 1, and in five patients (1.7%) in group 2 (p<0.001). The occurrence of consecutive ET was not related to age at the time of surgery (p=0.46 in group 1 ; p=0.54 in group 2), refractive error (p=0.18 in group 1 ; p=0.08 in group 2), or the type of surgery (p=0.69 in group 1 ; p=1.00 in group 2). The incidence in group 1 was 23.8% in patients with lateral incomitancy and 8.1% in patients without lateral incomitancy (p<0.05). In group 2, the incidence was 4.4% in patients with lateral incomitancy and 0.5% in patients without lateral incomitancy (p=0.04). CONCLUSIONS: Consecutive ET developed in 13.8% of patients with immediate overcorrection of at least 17 PD. Lateral incomitancy was the most important risk factor.

Comparison of Corneal Thickness Measured by Specular, US Pachymetry, and Orbscan in Post-PKP Eyes

PURPOSE: To compare the accuracy and reproducibility of central corneal thickness measured by non-contact specular microscopy, ultrasound pachymetry, and Orbscan in the post-penetrating keratoplasty eyes. METHODS: Central corneal thickness was prospectively measured in eyes that had recieved penetrating keratoplasty at least 1 month before. One experienced technician measured all eyes using three methods; non-contact specular microscopy (Topcon SP-2000P; Topcon Corporation, Tokyo, Japan), Orbscan IIz (Orbtek; Bausch & Lomb, Rochester, USA), and ultrasound pachymetry (AL-2000; Tomey, Erlangen, Germany). Three consecutive measurements were performed using each method and the mean values and coefficient of variation were compared. RESULTS: The mean values of central corneal thickness were 550.7+/-63.3 micrometer with specular microscopy, 548.2+/-72.5 micrometer with ultrasound pachymetry, and 472.5+/-151.7 micrometer with Orbscan. There was no significant difference between the measurements obtained by specular microscopy and ultrasound pachymetry (p=0.53), and both methods showed high reproducibility. The corneal thickness measured by Orbscan was remarkably variable and in some patients, Orbscan was unable to measure corneal thickness. CONCLUSIONS: Non-contact specular microscopy appears to be an effective technique, potentially replacing ultrasound pachymetry for measuring central corneal thickness in the post-penetrating keratoplasty eyes.

Gamma Knife Radiosurgery for Pediatric Arteriovenous Malformations

OBJECTIVE: Stereotactic radiosurgery for arteriovenous malformation(AVM) is an accepted treatment option, however, few reports have been published on the results of this treatment in pediatrics. In this study, the authors describe a series of pediatric patients. METHODS: Between March 1992 and December 2000, 27 children with AVMs were treated with gamma knife radiosurgery. Follow-up information was available in 18 of these patients. The mean age at the time of initial treatment was 11.2 years(range, 7-16 years). Twelve children(66.7%) presented with hemorrhage and 6 children(33.3%) had non-hemorrhagic symptoms(seizure in 2 cases, headache in 4 cases). Eight AVMs were located in deep-seated area and 10 AVMs in cerebral hemisphere(7 cases in eloquent area, 3 cases in non-eloquent area). The mean marginal dose was 22.9Gy(range, 15-30Gy). The mean follow-up period was 52 months(range, 24-90 months). RESULTS: Complete obliteration was noted in 13 cases(72.3%), subtotal obliteration in 3 cases(16.5%) and partial obliteration in 2 cases(11.2%). One case(5.6%) suffered from rebleeding at 45 months after gamma knife radiosurgery and 2 cases(11.1%) experienced symptomatic adverse radiation effect at 1 and 10 months after gamma knife radiosugery. CONCLUSION: Gamma knife radiosurgery may be an effective treatment option for pediatric AVMs as adult AVMs. To establish the precise efficacy of radiosurgery for pediatric AVMs, wide experience and long-term follow up is mandatory.

Expression of Inducible Nitric Oxide Synthase (iNOS, NOS2) in Osteosarcoma Correlates with Prognosis / 대한정형외과학회잡지

PURPOSE: This study was performed to investigate the expression pattern of inducible nitric oxide synthase (iNOS) in osteosarcoma and to determine whether its expression correlates with metastatic potential and prognosis. MATERIALS AND METHODS: Pathologic tissues obtained from 48 patients with primary osteosarcoma were examined immunohistochemically.Stained tissues were categorized into three groups (negative, mild, strong), according to expression intensity, and matched with clinical data. Results were analysed statistically. RESULTS: iNOS was expressed in 18 of 48 samples (38%). Among the iNOS positive cases, mild expression was observed in 9 patients (18%). There was statistically significant correlation between mild iNOS expression and metastasis (p=0.019). By multivariate analysis mild iNOS expression turned out to be a significant prognostic factor for reduced survival (Risk ratio 4.399, 95% CI 1.694-11.421: p=0.02). CONCLUSION: Mild expression of iNOS was significantly related to metastasis in osteosarcoma and can be considered a significant prognostic factor.

A Study on the Relationship between the Risk Factors of Stroke and Cognitive-Perceptual Function

OBJECTIVE: To investigate the correlation of main risk factors and cognitive-perceptual functions of stroke patients assessed with Mini-mental status examination (MMSE) and Motor-free visual perception test (MVPT) scores. METHOD: Subjects were 41 stroke patients from 35 to 70 years of age. Data collection was done through chart review on risk factors of stroke including hypertension, diabetes mellitus, heart disease, hypercholesterolemia, and cigarette smoking. Three months after the onset of stroke, MMSE and MVPT were performed. RESULTS: The subjects with diabetes had significantly lower scores in MMSE (p<0.05) and MVPT (p<0.05) compared to those with nondiabetics. The subjects with left hemispheric lesion scored higher in MMSE than those with right hemispheric lesion (p<0.05). CONCLUSION: Among the several risk factors, diabetes mellitus has significant relationship to cognitive and visual perceptual function in the stroke patients.