A Case of Scleromalacia Perforance That Developing after Surgery for Excision of the Pterygium in a Patient with Rheumatoid Arthritis / 대한류마티스학회지

The ocular manifestations of rheumatoid arthritis (RA) are common and they can vary from patient to patient. However, necrotizing anterior scleritis without inflammation (scleromalacia perforans) is a rare and serious opthalmic complication, and it is typically associated with long-standing RA. Although the etiology and pathogenesis of scleromalacia perforans are diverse and they are not completely understood, ophthalmic surgery is one of the well known causes of scleromalacia perforans. Patients with systemic autoimmune disease such as RA have an especially higher risk of scleromalacia perforans after opthalmic surgery. Because scleromalacia perforans is a potential threat not just to eyesight, but to life as well, early diagnosis and prompt treatment are required for its successful management. We experienced a case of scleromalacia perforans that developed after scleral excision of pterygium in a 58 year old woman who had a 7 year history of RA, and this was well treated with an early screral graft. We report here on this case along with a review of the relevant literature.

Population based Study of Risk Factors and Environmental Factors Contributing to Cataractogenesis

To evaluate the prevalence and related risk factors of the senile cataract, we performed epidemiologic study in two different geographic area with population based study in the group of 40 years or more old subjects. The results of this study are as follow. The prevalence rate of senile cataract was 32.8% in mountainous area (Chung Won) and 43.3% in rural area (Mun Kyung). The prevalence rate in both area had strong tendency to increase according to age, especially after 7th decade. But there was no clear relationship between male and female. In geographic characterisitic, annual sunshine time was longer, but cloud cover was lesser in Mun Kyung. Also related risk factors of senile cataract were smoking, low education level and poor health status. The cataract was more common in patients with diabetes, hypertension and arthritis. And long term use of steroids, antihypertensive drugs and analgesics for arthritis were risk factors for the cataractogenesis. But alchol consumption and number of pregnacny were not contributing to cataractogenesis. As a result, the senile cataract has mulifactorial factors and its process is complex phenomenon which is still partially known.

An Epidemiological Study of the Risk Factors Contributing to the Senile Cataractogenesis by the Korean Cooperative Cataract Epidemiology Study Group (KCCESG)

To evaluate the related risk factors of the senile cataract, we performed an epidemiological study in 215 cataract patients and 64 non cataract patients who visited to the Department of Ophthalmology of 6 general hospitals in Korea from August to December, 1990. The study revealed that sun-light exposure, smoking, ocular contusion and pregnancy were related to the cataract formation. And also the cataract was more common in patients with diabetes, hypertension and arthritis. And long term use of steroids and herb drugs were a risk factor for the cataractogenesis. The cataract patients preferred grains and fishes comparing with the non-cataract patiens.

Surgical Treatment of Congenital Nystagmus

Congenital nystagmus is an involuntary, rhythmic oscillation of the eyes noted during the first months of life. The nystagmus may diminish in a particular pasition of gaze referred to as the null point or neutral zone. If the null point is located in the primary position, there is no need for a compensatory head posture, But, if a patient has an eccentric null point, torticollis occurs in which the head is rotated so that the eyes have a minimal nystagmus. This abnormal head posture can be very marked, cosmetically disturbing and disadvantageous both to the body posture and psyche. Attempts at surgical management were reported by Kestenbaum and Anderson in early 1950's. We obtained following results in 4 cases operated on utilizing similar procedures of Park's method and Dyer's principles of strabismus operations that recession of a medial rectus and lateral rectus muscle must not exceed 4.5mm - 5.5mm and 6.5mm - 7.5mm, respectively. One week after the operation, the head turn disappeared in 3 of 4 cases, and one revealed mild residual turn. Two months after the operation, 2 of 4 cases kept their head straight, and the other two showed a return of head turn in about one half amount of the preoperative condition.

Posterior Capsular Rupture in Planned ECCE for Posterior Chamber Intraocular Lens Implantation

The incidence of inadvertent posterior capsular rupture at each stage of planned ECCE and posterior chamber intraocular lens implantation was studied. From June 1985 to Dec. 1986, 133 cases of planned ECCE for posterior chamber intraocular lens implantation were performed. Posterior capsular rupture with or without vitreous loss was developed in 11 cases(8.2%) out of 133. The rupture occurred during nuclear expression in 2 cases(1.5%), during cortical clean-up in 6 cases(4.5%), during remval removal of anterior capsular flaps in 2 cases(1.5%), during posterior chamber intraocular lens implantation in 1 case(0.7%), but during posterior capsule polishing in nocase(0%). Vitreous loss was combined with posterior capsular rupture in 6 cases(4.5%), but the other 5 cases were not associated with vitreous loss(3.7%). After management of vitreous loss by automated anterior vitrectomy in 10 cases, anterior chamber intraocular lens was implanted. But in the other 1 cases with mid posterior capsular rupture without vitreous loss, anterior chamber intraocular lens was implanted without anterior vitrectomy. A final visual acuity of 0.5 or better by 2 months postoperatively was observed in 10 cases out of 11(91%).

Surgical Treatment of Congenital Nystagmus

Congenital nystagmus is an involuntary, rhythmic oscillation of the eyes noted during the first months of life. The nystagmus may diminish in a particular position of gaze referred to as the null point or neutral zone. If the null point is located in the primary position, there is no need for a compensatory head posture. But, if a patient has an eccentric null point, torticollis occurs in which the head is rotated so that the eyes have a minimal nystagmus. This abnormal head posture can be very marked, cosmetically disturbing and disadvantageous both to the body posture and psyche. Attempts at surgical management were reported by Kestenbaum and Anderson in early 1950's. We obtained following results in 4 cases operated on utilizing similar procedures of Park's method and Dyer's principles of strabismus operations that recession of a medial rectus and lateral rectus muscle must not exceed 4.5mm-5.5mm and 6.5mm-7.5mm, respectively. One week after the operation, the head turn disappeared in 3 of 4 cases, and one revealed mild residual turn. Two months after the operation, 2 of 4 cases kept their head straight, and the other two showed a return of head turn in about one half amount of the preoperative condition.

Surgical Treatment of Congenital Nystagmus

Congenital nystagmus is an involuntary, rhythmic oscillation of the eyes noted during the first months of life. The nystagmus may diminish in a particular position of gaze referred to as the null point or neutral zone. If the null point is located in the primary position, there is no need for a compensatory head posture. But, if a patient has an eccentric null point, torticollis occurs in which the head is rotated so that the eyes have a minimal nystagmus. This abnormal head posture can be very marked, cosmetically disturbing and disadvantageous both to the body posture and psyche. Attempts at surgical management were reported by Kestenbaum and Anderson in early 1950's. We obtained following results in 4 cases operated on utilizing similar procedures of Park's method and Dyer's principles of strabismus operations that recession of a medial rectus and lateral rectus muscle must not exceed 4.5mm-5.5mm and 6.5mm-7.5mm, respectively. One week after the operation, the head turn disappeared in 3 of 4 cases, and one revealed mild residual turn. Two months after the operation, 2 of 4 cases kept their head straight, and the other two showed a return of head turn in about one half amount of the preoperative condition.

Meibomian Gland Adenocarcinoma of the Orbit

Meibomian gland adenocarcinoma is a rare neoplasm which may be overlooked until it spreads into the orbit. We have experienced a case of meibomian gland adenocarcinoma which spread into the orbit, and performed orbital exenteration. Two months later, the patient had a recurrence at the superolateral margin of the orbit that surgically excised. The radiation therapy with total dose of 5000 rads over a period of one month was performed and the tumor mass was regressed. There was no evidence of recurrence at 12 months after radiation therapy.