Intrastromal Corneal Ring Segments (KeraRing(R)) Implantation for the Correction of Keratoconus

PURPOSE: To report the outcomes after the implantation of intrastromal corneal ring segments (KeraRing(R)) by manual tunnel creation for the correction of keratoconus. METHODS: The present retrospective case series was comprised of 12 eyes of 11 consecutive keratoconic patients. Intrastromal corneal ring segments (KeraRing(R)) were implanted for keratoconus correction after manual tunnel creation. Uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), refractive outcome, and complete ophthalmologic examinations were performed before and after surgery at 1 day, 1 week, 3 months, and 6 months. Corneal topography was measured before surgery, 6 months after surgery and during any necessary follow-up visits. RESULTS: Intrastromal corneal ring segments (KeraRing(R)) implantation significantly increased BCVA from logMAR 0.47 +/- 0.19 to logMAR 0.28 +/- 0.17 (P < 0.05) and decreased the spherical equivalent from -6.03 +/- 3.24 D to -2.24 +/- 1.96 D. The simulated keratometric value in the Orbscan IIz significantly decreased in K maximum from 50.7 +/- 2.93D to 47.65 +/- 3.15 D and in K minimum from 47.65 +/- 3.15 D to 44.92 +/- 2.80 D. CONCLUSIONS: Intrastromal corneal ring segments implantation (KeraRing(R)) by manual tunnel creation appears to be effective in improving BCVA and reducing corneal astigmatism and keratometric value in keratoconic patients. KeraRing(R) may delay or prevent the need for a corneal graft, and reduce the contact lens intolerance.

A Case of Granular Cell Tumor in Form of Ciliary Body Tumor

PURPOSE:To report a case of a granular cell tumor in the form of cilliary body tumor. CASE SUMMARY: A 42-year-old women visited our clinic with blurred vision of the right eye, which began was 1 month earlier ago. Her medical history was unremarkable. Slit-lamp examination revealed a ciliary body tumor and complicated cataract due to a mass lesion. For treatment, an excisional biopsy of the ciliary body tumor and phacoemulsification were performed. The pathologic finding confirmed the diagnosis of a granular cell tumor. There was no evidence of a recurrent lesion of the tumor at the 6-month postoperative follow-up. CONCLUSIONS: We confirmed a granular cell tumor in the form of a cilliary body tumor based on pathologic findings.

Factors Affecting the Ocular Response Analyzer Parameters in Normal Korean

PURPOSE: To identify the normal range of factors which can be measured with Ocular Response Analyzer (ORA, Reichert Inc., Depew, NY, USA) in normal Korean, and to analyze factors affecting ORA by measuring intraocular pressure (IOP) of noncontact tonometer (NCT) and central corneal thickness (CCT). METHODS: Three hundred and one normal Korean subjects who did not have specific ophthalmological diseases and surgeries in the past were recruited for this study. Corneal hysteresis (CH), corneal response factor (CRF), corneal-compensated IOP (IOPcc), and Goldmann correlated IOP (IOPg) were measured using ORA. In addition, IOP of NCT and CCT were measured and the results and factors analyzed. RESULTS: The mean CH measured among normal Korean subjects in this study was 10.70 mmHg. The mean CRF was 10.40 mmHg. CH and CRF were significantly higher in the juvenile group. IOPcc and IOPg as measures of IOP using the ORA had significant correlation with IOP of NCT. In particular, IOPcc appeared to be independent of CCT. CONCLUSIONS: CH and CRF were different according to age, indicating a difference in biomechanical properties of the cornea. In particular, IOPcc is more important as it is independent of corneal thickness and should be compensated in general measurements of IOP reflecting biomechanical properties.

A Case of Melanocytoma of the Ciliary Body

PURPOSE: To report a patient with melanocytoma of the ciliary body. METHODS: A 52-year-old woman, who transferred from a private ophthalmic clinic to our hospital after a cataract operation due to a mass behind the iris, was evaluated. The patient had a dark brown mass with a smooth surface confirmed by ultrasonogram, CT, and MRI. The mass was removed by en bloc resection. RESULTS: The tumor had a gross finding of a dark brown, soft, and smooth surface 0.5x0.5x0.5 cm in size. Histopathologic examination revealed a melanocytoma originating in the ciliary body. There was no evidence of metastasis. CONCLUSIONS: A very rare ciliary body melanocytoma was discovered with a good surgical result obtained by its removal.

Two Cases of Topiramate-induced Acute Myopia

PURPOSE: We describe 2 cases of bilateral acute myopia associated with topiramate, a drug that has recently been prescribed for epilepsy or weight reduction. CASE SUMMARY: A 24-year-old woman and a 25-year-old woman, both previously devoid of ocular problems, visited our hospital with blurry vision after taking topiramate for weight reduction. A thorough medical history review and ocular examinations, including a slit lamp examination, were performed. CONCLUSIONS: Slit-lamp examinations revealed forward displacement of the lens-iris diaphragm, which resulted in myopia and anterior chamber shallowing. Discontinuation of topiramate and the administration of cycloplegic agents successfully resolved the symptoms.

Clinical Outcomes of Implantable Contact Lens and Iris-Fixed Intraocular Lens for Correction of Myopia

PURPOSE: We compared the results of implanting an implantable contact lens (ICL) and an iris claw lens (Artisan(R) lens) in patients' wtih myopia and sought to determine a basis for choosing between the two lenses. METHODS: ICLs were implanted in 32 eyes of 18 patients, and Artisan(R) lenses were implanted in 40 eyes of 23 patients. Uncorrected visual acuity, refraction, endothelial cell density, intraocular pressure, and slit lamp measurements were taken for 12 months. RESULTS: All the patients had improved UCVA from the day after the operation until the 12th month. The mean spherical equivalent refraction at postoperative month 12 was -0.78+/-0.54D in the ICL group and -0.78+/-0.59D in the Artisan(R) lens group. In the same period, endothelial cell density loss was 5.34% in the ICL group but was not significant in the Artisan(R) lens group. There were no significant complications in either group. CONCLUSIONS: Both ICL and Artisan(R) lens implantation resulted in immediate visual improvement and stability of vision during the follow-up period. There was no significant difference in post-operative results. Further study will be needed to decide which lens is the better choice for delicate conditions in myopic patients.

Clinical Evaluation of Monovision After Cataract Surgery

PURPOSE: To evaluate the clinical results of monovision treatment applied to cataract patients who planned to undergo phacoemulsification and posterior chamber intraocular lens (PC IOL) implantation. METHODS: Phacoemulsificaiton and implantation of a monofocal PC IOL were performed in 40 patients between January 2005 and January 2006. Surgeries were performed on the dominant eye with the postoperative goals of emmetropia and on the nondominant eye with the postoperative goals of mild myopia. Patients' satisfaction, refractive change, and visual acuity were evaluated for at least 3 months after the surgery. RESULTS: The mean postoperative uncorrected near visual acuity (UCNVA) of binocular eyes was 0.56+/-0.52, which was a statistically significant improvement compared with the mean preoperative UCNVA (P<0.001). The mean postoperative uncorrected far visual acuity(UCFVA) of binocular eyes was 0.70+/-0.34, which was a statistically significant improvement compared with the mean preoperative UCFVA (P<0.001). In all, 77.5% (31 of 40) of patients were satisfied with the results. CONCLUSIONS: Monovision induced by phacoemulsification and implantation of a monofocal PC IOL is suggested to be a good option in patients with presbyopia and cataract.

Two-year Endothalial Changes after Iris Fixed Phakic Intraocular Lens Implantation in Korean

PURPOSE: To investigate quantitative and morphometric endothelial changes in phakic eyes implanted with an iris-fixed phakic intraocular lens in Korean patients. METHODS: We prospectively examined the endothelial cell density (ECD), ECD loss (ECL), coefficient variations (CV), and frequency of Hexagons (6A) in 46 phakic eyes implanted with an iris-fixed phakic intraocular lens. The effect of anterior chamber depth (ACD) and diopter of iris-fixed phakic intraocular lens on ECD was statistically analyzed. RESULTS: Preoperative mean ECD was 2923+/-257 cells/mm2. ECL at postoperative 1, 3, 6, 12, and 24 monthswas 0.71%, 0.88%, 0.70%, 0.64%, and 2.34%. It was significant only in the month 24 results. The mean CV value at the same time was 0.343, 0.342, 0.334, 0.329, 0.326, and 0.338. The change was significant at the 12th month. The mean 6A value at the same time was 58.2%, 57.8%, 59.7%, 59.6%, 60.1%, and 58.8%. There was no significant change in 6A value. Preoperative ACD and diopter of iris-fixed phakic intraocular lens didn't affect the ECD change. CONCLUSIONS: This two-year follow-up study of changes in endothelial cells after implantation iris-fixated phakic intraocular lens showed statistically significant decreases in the cells, which is not very significant considering the physiologic reduction rate of the cells. Thses decreases showed a tendency to be stabilized with recovery of morphological changes. Further long-term follow-up is needed to determine its long-lasting effect.

Acute Choleystitis due to Torsion of the Gallbladder

Torsion of the gallbladder is a uncommon disease. Since Wendel reported the first case of torsion of the gallbladder in 1898, approximately 400 or more cases have been reported on. A mobile gallbladder with abnormal anatomical fixation to the liver is required for this torsion. Twisting of the mobile gallbladder on its pedicle creates occlusion of the blood supply or bile flow to the organ, and gangrene and necrosis finally occurs. Prompt surgery is required for this condition. Unless cholecystectomy is performed, this condition could cause severe postoperative complications or death to the patient. Torsion of the gallbladder has been known to occur frequently in thin, elderly females. Because of its medical rarity, diagnosis of torsion prior to operative exploration is extremely difficult and the diagnosis is generally maded by laparotomy. We report here on a case of torsion of the gallbladder. The patient was an 82 years old female who complained of severe epigastric pain, nausea, and vomiting. Ultrasonography and computed tomography were performed and these modalities demonstrated a distended gallbladder with wall thickening; the gallbladder didn't contain stones. Explorative laparotomy and cholecystectomy was then performed. We found that the necrotized gallbladder was twisted around its pedicle. We report here on a case of gallbladder torsion and we discuss the clinical features and diagnostic methods for this malady.

Clinical Effects of Various Antiinflammatory Therapies in Dry Eye Syndrome

PURPOSE: To evaluate the therapeutic effect of cyclosporin A, corticosteroid, autologous serum in patients with severe dry eye syndrome. METHODS: Patients (72 eyes) with severe dry eye syndrome were classified into four groups were treated for 3 months. Each group was treated with 0.05% cyclosporin A, 1% rimexolone, 20% autologous serum, and artificial tears. Before and after treatment (2, 4, 8, 12 weeks), Ocular Surface Disease Index (OSDI), tear film break-up time (BUT), Schirmer test, corneal sensitivity, and lissamine green staining score were measured. RESULTS: After treatment, OSDI, tear film BUT, Schirmer test, corneal sensitivity, and the lissamine green staining score were improved in groups using cyclosporin A, autologous serum and corticosteroid(p0.05). CONCLUSIONS: Antiinflammatory theraphy is more effective than the conventional symptomatic theraphy in patients with severe dry eye syndrome.

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.

The Effects of the Cyanoacrylate Tissue Adhesive Mono-therapy for Corneal Perforation

PURPOSE: To report cases of corneal perforation among corneas treated with cyanoacrylate tissue adhesive. METHODS: We performed cyanoacrylate tissue adhesive application on 1 case of corneal perforation due to fungal keratitis, one case of corneal perforation due to neurotrophic keratitis, one case of corneal fistula due to foreign body and one case of corneal perforation due to corneal stromal dystrophy. After cyanoacrylate tissue adhesive removal, amniotic membrane transplantation was conducted in two cases, and keratoplaty was performed in another two cases. RESULTS: Postoperative follow-up period was 12 months on average. In all four cases, ocular integrity was successfully restored. There was no sign of recurrence, infection or inflammation. CONCLUSIONS: Cyanoacrylate tissue adhesive monotherpy can restore ocular integrity successfully in various type of corneal perforation and After cyanoacrylate tissue adhesive removal, amniotic membrane transplantation and keratoplaty can be performed additionally.

Clinical Effects of Phototherapeutic Keratectomy on Terminal Bullous Keratopathy

PURPOSE: Although the treatment of choice for bullous keratopathy is typically penetrating keratoplasty (PKP), not all patients are suited for this treatment. Thus, we evaluated the clinical effects of phototherapeutic keratectomy (PTK) on pain relief and on the improvement of photophobia and visual acuity in patients suffering from bullous keratopathy. METHODS: Twenty-three patients with bullous keratopathy who were awaiting PKP and suffering from ocular pain, photophobia, and cosmetic problems, were assessed. Twelve eyes were treated with PTK using the excimer laser (VISX STAR S3, Irvine, CA, U.S.A). Another 11 eyes were treated with eye drops or other conservative modalities. Statistically significant differences in pain relief, photophobia improvement, and cosmetic improvement between two groups were assessed by Fisher's exact test. RESULTS: Twelve eyes with bullous keratopathy underwent PTK. At post-operative 1 month, 83% of patients showed relief of pain, 75% of patients showed improvements in photophobia, and 58% of patients had increased visual acuity of one or more line. The overall satisfaction rate of PTK was 91%, but 67% of patients showed recurrence of corneal opacity and bullae formation at 6 months after the procedure. CONCLUSIONS: Phototherapeutic keratectomy (PTK) reduced pain and improved visual acuity slightly in patients with bullous keratopathy. This procedure could be considered a valuable alternative treatment modality while awaitng PKP.

A Study of Mesopic Vision and Glare in Normal Subjects and Post-LASIK Patients Using Mesoptometer

PURPOSE: To evaluate of the mesopic vision and glare in normal subjects and post-LASIK patients by using mesoptometer. METHODS: One hundred sixty eyes of eighty subjects with normal vision and no ocular disease were divided into four groups. Each twenty subjects were followed up for more than 3 months and the authors tested the mesopic vision and glare disability with Mesotest II. The authors also measured eighty eyes of forty patients by same means depending on pupil size and high order root mean square (RMS) values before LASIK surgery in 1st and 3rd months postoperatively and compared with data of normal subjects. RESULTS: The mesopic vision and glare disability at 1: 5 contrast level were extremly reduced in the group over 60 age old but there was no statistical significance. In post-LASIK patients, mesopic vision and glare disability were significantly reduced in 1st month after surgery. However the values returned nearly to preoperative figures in 3rd month. Patients with large pupil and high order RMS values reduced more in mesopic vision and glare disability but there was not statistical significance. CONCLUSIONS: The mesopic vision and glare disability were reduced in older age group and they were reduced in the patients with large pupils and high order RMS values in the early postoperative period after LASIK.

Clinical Analysis of Rhegmatougenous Retinal Detachment after Laser Refractive Surgery

PURPOSE: To evaluate the clinical presentation, surgical outcome of rhegmatogenous retinal detachment(RRD) after laser refractive surgery and the relationship between RRD and laser refractive surgery. METHODS: We examined age distribution, refractive error, time interval of RRD onset after refractive surgery, shape and location of retinal break, extent of RD, refractive change and postoperative complications in fifteen patients who experienced RRD after LASIK(9 eyes), or PRK(6 eyes) from March 1993 to August 2001. RESULTS: 66% of patents were in twenties, 47% of patients developed RD within 1 year after refractive surgery, 80% of patients had horse shoe type retinal tear and refractive changes after RD surgery were within 2 diopters. Patients who had undergone LASIK had shorter time interval in developing RRD, more refractive change, and more complications than those with PRK. CONCLUSIONS: These results suggest that laser refractive surgery can be one of the cause of RD. LASIK had more association with RD than PRK. Thorough retinal exam will be needed in patients undergoing LASIK.

Efficacy of Intracameral Lidocaine During Phacoemulsification in Vitrectomized Eye

PURPOSE: This study was designed to evaluate the efficacy of intracameral lidocaine injection on patient' s pain relief during phacoemulsification in vitrectomized eyes and the influence on the corneal endothelial cells. METHODS: A prospective, double blind clinical trial was performed on 60 eyes of 60 patients who had undergone phacoemulsification from October 2000 to February 2001 at Busan PAIK Hospital. Thirty eyes had prior vitrectomy. Before surgery specular microscopic examination was performed. The patients were divided into vitrectomized and nonvitrectomized groups, and the lidocaine or placebo (BSS) was injected into the anterior chamber of 15 eyes each in two subgroups within each group. Pain was assessed using a visual analogue scale before, during and after operation. Endothelial cells were examinined at one week, one month, and three months after operation with a specular microscope. RESULTS: In vitrectomized patients, intracameral lidocaine injection resulted in significantly lower intraoperative pain score. There were no significant differences in morphological changes of endothelium between lidocaine and placebo groups. CONCLUSIONS: Intracameral lidocaine injection with topical anesthesia had significant effect in intraoperative pain relief during phacoemulsification in vitrectomized eyes. There was no significant effects on corneal endothelium. We conclude that intracameral anesthesia is safe and reduces intraoperative pain in vitrectomized eyes.