Comparison of Methicillin-Sensitive Staphylococcus Epidermidis (MSSE) Keratits and Methicillin-Resistant Staphylococcus Epidermidis (MRSE) Keratitis

PURPOSE: To investigate the clinical features and treatment outcomes between methicillin-sensitive Staphylococcus epidermidis (MSSE) and methicillin-resistant Staphylococcus epidermidis (MRSE) keratitis groups. METHODS: A retrospective analysis of case series was conducted of all patients with keratitis caused only by Staphylococcus epidermidis from January 1997 through December 2008. Sex, age, history of trauma, systemic disease, previous ocular history, antibiotic sensitivity test results, and treatment outcomes were evaluated. Patients were categorized into two groups as MSSE and MRSE according to methicillin-sensitivity result, and a comparative analysis was performed. RESULTS: There were no significant differences in clinical features, such as risk factors or size or location of keratitis between the two groups. All MSSE and MRSE isolates were sensitive to vancomycin, moxifloxacin, and levofloxacin. All MSSE and 17%, 50%, 52%, and 57% of MRSE isolates were sensitive to cephalothin, norfloxacin, ciprofloxacin, and erythromycin, respectively (p < 0.05). There was no significant difference in visual acuity between the two groups. CONCLUSIONS: All MSSE and MRSE isolates were sensitive to vancomycin and to third- or fourth-generation fluoroquinolones In addition, approximately 50% of MRSE isolates were sensitive to norfloxacin and ciprofloxacin. There were no significant differences in clinical features of keratitis caused by MSSE versus those of MRSE isolates. Both keratitis groups had relatively good visual prognoses.

Clinical Results of Corneal Triple Procedure and Risk Factors for Graft Failure

PURPOSE: To evaluate the clinical results of corneal triple procedure, as well as the causes and the risk factors for graft failure. METHODS: Indications, survival period of graft, causes of graft failure, and risk factors for failure in 29 patients (29 eyes) who had undergone penetrating keratoplasty combined with cataract surgery and intraocular lens (IOL) implantation were retrospectively analyzed. RESULTS: The most common primary indication of corneal triple procedure was bacterial keratitis (24%), followed by corneal trauma, herpes simplex keratitis, and graft failure. The average survival period of corneal graft in corneal triple procedure was 29.2+/-23.2 months. The most common cause of graft failure was allograft rejection (56.3%). The risk factors of graft failure by an univariate analysis were preoperative unfavorable diagnosis (bullous keratopathy, corneal ulcer, and trauma), corneal neovasculization, intraoperative additional procedure (anterior vitrectomy, synechiolysis, and anterior chamber irrigation), immune rejection, and postoperative glaucoma, but were unrelated to methods of cataract surgery, graft size, or IOL position. In a multivariate analysis, graft rejection and corneal neovascularization were identified as risk factors for graft failure in patients undergoing triple procedure. CONCLUSIONS: Corneal graft in corneal triple procedure had various success rates according to the many factors. Risk factors for graft failure included graft rejection and corneal neovascularization.

Clinical Analysis of Sensory Strabismus

PURPOSE: This study was carried out for the clinical analysis of deviation axis of sensory strabismus METHODS: We retrospectively reviewed the medical records of 100 patients who had been diagnosed with sensory strabismus and undergone surgery. Etiology, age at onset of vision loss, duration of vision loss, refraction in sound eye, angle of deviation according to sensory esotropia and exotropia were analyzed. RESULTS: The most common etiology was corneal opacity which occurred in 17 patients (17.0%). Fifteen patients had esotropia and 85 patients exotropia. Esotropia was commonly developed in congenital origin (9 patients, 60%) and under the age of 5 years (12 patients, 80%). Exotropia was commonly developed in acquired origin (68 patients, 80%) and over the age of 6 years (53 patients, 62.4%) (P=0.003). When the refraction in sound eye was hyperopia, esotropia developed in 3 patients (18.8%) and exotropia in 13 patients (81.2%). When the refraction in sound eye was myopia, esotroia developed in 12 patients (14.3%) and exotropia in 72 patients (85.7%). But there was no statistical significance (P=0.445). CONCLUSIONS: Type of horizontal strabismus in sensory strabismus was significantly related to the age at onset of vision loss, but not to the refraction in sound eye.

Anatomical Study of Lacrimal Passage using Computed Tomography

OBJECTIVE: We could measure diameters of lacrimal sac and surrounding bone thickness of normal Korean with accurate data by using orbital CT. METHODS: We measured the lacrimal sac, surrounding bone thickness, and frequency of Haller cell with thin-section computed tomography examinations in 115 normal Korean orbits with no signs of pathology related to the lacrimal drainage system for 1999 to 2001. RESULTS: The mean length of lacrimal sac was 10.45+/-1.96 mm, A-P width was 5.96+/-1.26 mm, L-R width was 3.72+/-0.92 mm. The surrounding bone thickness of upper portion of lacrimal sac was 6.46+/-1.40 mm, middle portion was 3.24+/-1.11 mm, lower portion was 0.78+/-0.23 mm. The frequency of Haller cell was 13.9%. The diameters of lacrimal sac and surrounding bone thickness were larger in males than females, and increasing tendency with aging. CONCLUSION: In this study, Korean lacrimal sac size was slightly smaller than the caucasian and Korean male's surrounding bone thickness was thicker than female. These data will be very helpful in making appropriate osteotomy by using the drill during dacryocystorhinostomy and avoiding unnecessary manipulation.