Use of the Bispectral Index to Predict Eye Position of Children during General Anesthesia

PURPOSE: To assess the relationship between eye position and anesthesia depth using the bispectral index (BIS) value, a parameter derived from electroencephalography data. METHODS: We investigated the relationship between BIS value and eye position in 32 children who underwent surgery for epiblepharon under general anesthesia. BIS values were recorded continuously throughout the procedure (from induction to awakening). Eye positions were video-recorded and analyzed after surgery. The vertical position of each eye was scored according to its height in relation to the medial canthus. An eye position in which the upper eyelid covered one-third of the cornea was defined as a significant ocular elevation. RESULTS: The BIS value correlated inversely with the end-tidal concentration of each anesthetic agent, whereas it correlated positively with the eye elevation score (eye position = 0.014 × BIS + 0.699, p = 0.011). The mean eye position score was significantly greater in patients whose BIS values were over 65. Eleven patients (34.4%) had significant ocular elevation; their mean concurrent BIS value was 61.6. Two of these patients had elevation during surgery and 9 had elevation during emergence from anesthesia. CONCLUSIONS: We found that high BIS values were correlated with low levels of anesthetic concentration and high eye position, suggesting that BIS monitoring may be useful for predicting eye position during anesthesia. Particular attention must be given to eye position during ophthalmic surgery. Anesthesia depth can be maintained by assuring that the BIS value remains below 65.

Identification and Functional Characterization of ST3GAL5 and ST8SIA1 Variants in Patients with Thyroid-Associated Ophthalmopathy

PURPOSE: This study was conducted to identify and to functionally characterize genetic variants in ST3GAL5 and ST8SIA1 in Korean patients with thyroid-associated ophthalmopathy (TAO). MATERIALS AND METHODS: Genetic analyses were conducted using DNA samples from TAO patients (n=50) and healthy subjects (n=48) to identify TAO-specific genetic variants of ST3GAL5 or ST8SIA1. The effect of each genetic variant on the transcription or expression of these genes was examined. Additionally, correlations between functional haplotypes of ST3GAL5 or ST8SIA1 and clinical characteristics of the patients were investigated. RESULTS: Six promoter variants and one nonsynonymous variant of ST3GAL5 were identified, and four major promoter haplotypes were assembled. Additionally, three promoter variants and two major haplotypes of ST8SIA1 were identified. All ST3GAL5 and ST8SIA1 variants identified in TAO patients were also found in healthy controls. Promoter activity was significantly decreased in three promoter haplotypes of ST3GAL5 and increased in one promoter haplotype of ST8SIA1. Transcription factors activating protein-1, NKX3.1, and specificity protein 1 were revealed as having roles in transcriptional regulation of these haplotypes. The nonsynonymous variant of ST3GAL5, H104R, did not alter the expression of ST3GAL5. While no differences in clinical characteristics were detected in patients possessing the functional promoter haplotypes of ST3GAL5, exophthalmic values were significantly lower in patients with the ST8SIA1 haplotype, which showed a significant increase in promoter activity. CONCLUSION: These results from genotype-phenotype analysis might suggest a possible link between the ST8SIA1 functional promoter haplotype and the clinical severity of TAO. However, further studies with larger sample sizes are warranted.

Benzylideneacetophenone derivatives attenuate IFN-gamma-induced IP-10/CXCL10 production in orbital fibroblasts of patients with thyroid-associated ophthalmopathy through STAT-1 inhibition

The aim of the present study was to identify a new candidate anti-inflammatory compound for use in the active stage of thyroid-associated ophthalmopathy (TAO). Benzylideneacetophenone compound JC3 [(2E)-3-(4-hydroxy-3-methoxyphenyl)phenylpro-2-en-l-one] was synthesized based on a structural modification of yakuchinone B, a constituent of the seeds of Alpinia oxyphylla, which belongs to the ginger family (Zingiberaceae), has been widely used in folk medicine as an anti-inflammatory phytochemical. Orbital fibroblasts were primarily cultured from patients with TAO, and the potential of JC3 to suppress the interferon (IFN)-gamma-induced protein (IP)-10/CXCL10 production in these cells was determined. IFN-gamma strongly increased the level of IP-10/CXCL10 in orbital fibroblasts from patients with TAO. JC3 exerted a significant inhibitory effect on the IFN-gamma-induced increase in IP-10/CXCL10 in a dose-dependent manner; its potency was greater than that of an identical concentration of yakuchinone B with no toxicity to cells at the concentration range used. Moreover, the constructed dimer and trimer polystructures of JC3, showed greater potency than JC3 in suppressing the IFN-gamma-induced production of IP-10/CXCL10. JC3 significantly attenuated the IP-10/CXCL10 mRNA expression induced by IFN-gamma, and a gel-shift assay showed that JC3 suppressed IFN-gamma-induced DNA binding of signal transducer and activator of transcription-1 (STAT-1) in TAO orbital fibroblasts. Our results provide initial evidence that the JC3 compound reduces the levels of IP-10/CXCL10 protein and mRNA induced by IFN-gamma in orbital fibroblasts of TAO patients. Therefore, JC3 might be considered as a future candidate for therapeutic application in TAO that exerts its effects by modulating the pathogenic mechanisms in orbital fibroblasts.

Comparison of Wettability for Ocular Prosthesis Depending on Different Kinds of Artificial Tear Eye Drops

PURPOSE: In this study we compared the surface wettability of ocular prosthesis and depositions depending on different types of artificial tear eye drops. METHODS: The artificial tear eye drops contain sodium hyaluronate (HA) 0.1%, 0.18%, 0.3%, carboxylmethylcellulose sodium (CMC), hydroxymethylcelluose + dextran (HMC), propylene glycol + polyethylene glycol (PG), polysorbate 80 (PS) povidone (Pov) were evaluated. Flat rectangular parallelepiped blocks consisting of polymethylmethacrylate (PMMA) or silicone materials were made. One artificial tear eye drop was applied on the surface of two different blocks of artificial eyes using a 23-gauge needle. Then, the static method contact angle was measured by using a contact angle goniometer. To measure the deposits, a petri dish was covered with 3 mL of artificial tear eye drops and dried for 48 hours at room temperature. Then, the light transmittance at the center of the petri dish was measured to investigate the amount of the residue. RESULTS: The contact angles of HA 0.1%, 0.18%, 0.3%, CMC, HMC, PG, PS and Pov on PMMA were 78.69degrees, 84.29degrees, 75.46degrees, 80.93degrees, 66.29degrees, 71.26degrees, 58.40degrees and 70.24degrees, respectively. The contact angles on silicone were 53.68degrees, 60.87degrees, 64.46degrees, 62.78degrees, 38.89degrees, 63.58degrees, 30.68degrees and 51.41degrees, respectively. The largest decrease in transparency was observed in the artificial tear eye drops containing HMC. CONCLUSIONS: The wettability and deposits on the surface of ocular prosthesis can vary based on the components and concentration of artificial tear eye drops. The results from this study should be considered when choosing the right artificial tear eye drops for improving dry eye symptoms in patients wearing ocular prostheses.

Comparison of Wettability for Ocular Prosthesis Depending on Different Kinds of Artificial Tear Eye Drops

PURPOSE: In this study we compared the surface wettability of ocular prosthesis and depositions depending on different types of artificial tear eye drops. METHODS: The artificial tear eye drops contain sodium hyaluronate (HA) 0.1%, 0.18%, 0.3%, carboxylmethylcellulose sodium (CMC), hydroxymethylcelluose + dextran (HMC), propylene glycol + polyethylene glycol (PG), polysorbate 80 (PS) povidone (Pov) were evaluated. Flat rectangular parallelepiped blocks consisting of polymethylmethacrylate (PMMA) or silicone materials were made. One artificial tear eye drop was applied on the surface of two different blocks of artificial eyes using a 23-gauge needle. Then, the static method contact angle was measured by using a contact angle goniometer. To measure the deposits, a petri dish was covered with 3 mL of artificial tear eye drops and dried for 48 hours at room temperature. Then, the light transmittance at the center of the petri dish was measured to investigate the amount of the residue. RESULTS: The contact angles of HA 0.1%, 0.18%, 0.3%, CMC, HMC, PG, PS and Pov on PMMA were 78.69degrees, 84.29degrees, 75.46degrees, 80.93degrees, 66.29degrees, 71.26degrees, 58.40degrees and 70.24degrees, respectively. The contact angles on silicone were 53.68degrees, 60.87degrees, 64.46degrees, 62.78degrees, 38.89degrees, 63.58degrees, 30.68degrees and 51.41degrees, respectively. The largest decrease in transparency was observed in the artificial tear eye drops containing HMC. CONCLUSIONS: The wettability and deposits on the surface of ocular prosthesis can vary based on the components and concentration of artificial tear eye drops. The results from this study should be considered when choosing the right artificial tear eye drops for improving dry eye symptoms in patients wearing ocular prostheses.

Repair of Inferomedial Orbital Wall Fractures with Bony Strut Loss by Overlapping Absorbable Copolymer

PURPOSE: To report the results of surgical repairing of inferomedial orbital wall fractures accompanied with loss of bony strut by an overlapping method using Resorb X(R) plates (poly(D,L)-lactic acid). METHODS: To repair inferomedial orbital wall fractures with loss of bony strut, we bent the medial aspect of the plate for floor fracture according to the anatomical structure and then inserted the floor implant, which was supported by anterior, posterior and lateral margins of the floor fracture. Then, the medial implant, which was supported by the bent medial edge of the floor implant, was inserted. Postoperatively, we analyzed the outcomes of 21 patients regarding postoperative enophthalmos, limitation of eye movement (LOM) and diplopia. The diagonal lengths of the orbit in the operated side were compared with the non-traumatized side based on the coronal view of the postoperative CT scans to determine the success or failure of the reconstruction. RESULTS: The average postoperative enophthalmic value was 0.5 mm, and no significant differences between the orbital diagonal lengths of the operated and non-operated eyes were observed. The LOM shown in 7 out of 8 patients was completely resolved during the postoperative follow-up period. All patients with diplopia, including one patient who showed partial remission of LOM, experienced complete symptom resolution. No other complications related to the implant were recorded. CONCLUSIONS: Inferomedial orbital wall fractures with the loss of bony strut can be successfully repaired by the overlapping method using Resorb X(R) implants.

The Influence of a Silicone Tube on Tear Drainage in Patients with Healed Rhinostomy after Dacryocystorhinostomy

PURPOSE: To evaluate the influence of a silicone tube on tear drainage in patients with a healed rhinostomy site after dacryocystorhinostomy. METHODS: The subjects of the present study included the patients for whom the removal of a silicone tube was performed after dacryocystorhinostomy for acquired nasolacrimal duct obstruction. The silicone tube was removed after the rhinostomy site was completely healed. The tear drainage function was evaluated using the fluorescein dye disappearance test at the following 3 time points: immediately before, immediately after, and 1 month after silicone tube removal. In addition, a Schirmer test was performed and tear break-up time was measured at each time point. To study the correlation between the measured values and subjective tearing symptoms, self-report questionnaires were given to each patient at his/her last visit. RESULTS: The 3 measured values showed no statistical difference between the 3 time points, immediately before, immediately after, and 1 month after silicone tube removal. When the patients were divided into groups according to their subjective symptomatic changes after silicone tube removal, no group showed statistically significant difference in the 3 measured values before, between, and after silicone tube removal. CONCLUSIONS: In patients with a healed rhinostomy site after dacryocystorhinostomy, the removal of the silicone tube did not induce a change of tear drainage function. Therefore, based on the results from the present study, a silicone tube may not have influence on tear drainage functions.

Effect of Gangliosides Mixture on Differentiation of Orbital Fibroblasts into Adipocytes

PURPOSE: To investigate the role of gangliosides in the differentiation of orbital fibroblasts into adipocytes, a component in the pathogenesis of Graves' ophthalmopathy. METHODS: Orbital tissues were obtained during orbital surgery for subjects without Graves' ophthalmopathy or other inflammatory orbital disease, and orbital fibroblasts were primarily cultured from each obtained tissue. Morphological examination of orbital fibroblasts was performed after treatment with commercially available gangliosides mixture (Gmix) comprised of several subtypes. To determine the effect of Gmix on the differentiation of orbital fibroblasts into adipocytes and the differentiation-related genes, Oil Red-O staining and RT-PCR were performed. RESULTS: The treatment with Gmix induced the morphological changes, which at least in part were explained with the differentiation of orbital fibroblasts into adipocytes in accordance with the increase of mRNA level of genes known to be related to adipogenesis, whereas dermal fibroblasts and preadipocytes were irresponsive to the same treatment. CONCLUSIONS: The results from the present study suggest gangliosides may have a role in pathologic mechanisms of Graves' ophthalmopathy by the induction of differentiation of orbital fibroblasts into adipocytes.

Recurrence Rates of Conjunctival Autograft Transplantation With Aminiotic Membrane Transplantation in Primary Pterygium Surgery

PURPOSE: To compare postoperative recurrence rates between conjunctival autograft transplantation alone and conjunctival autograft transplantation with amniotic membrane transplantation in primary pterygium surgery. METHODS: The authors conducted a retrospective analysis of 66 eyes from 62 patients who underwent primary pterygium surgery from January 2001 to May 2009. Twenty three eyes underwent conjunctival autograft transplantation alone, 43 eyes underwent conjunctival autograft transplantation with amniotic membrane transplantation. RESULTS: Recurrence of pterygium was observed in 5 of 23 eyes that received conjunctival autograft transplantation alone. There were 2 cases of recurrence of 43 eyes that received conjunctival autograft transplantation and amniotic membrane transplantation. No major complications such as necrotizing scleritis, sclera ulcer, or corneal perforation were observed in either group after surgery. CONCLUSIONS: The present study showed that receiving both conjunctival autograft transplantation and amniotic membrane transplantation in pterygium surgery has a lower recurrence rate than conjunctival autograft transplantation alone.

Results of Reconstruction of Orbital Wall Fracture With Bioresorbable Plate

PURPOSE: To investigate the long-term results and complications of orbital wall fracture reconstruction using the bioabsorbable orbital implant, Macropore(R) orbital floor liner. METHODS: This retrospective study included patients who underwent the reconstruction of an orbital wall fracture using Macropore(R) orbital floor liner and completed a postoperative follow-up longer than 6 months. The enophthalmic values as well as the data of ocular movement and diplopia was collected from the medical records of each patient and analyzed. RESULTS: A total of 35 patients were evaluated with an average follow-up period of 14.0 months. The average enophthalmic value of 29 patients, whose reconstruction was primarily indicated from enophthalmic tissue, was 0.90 mm at the last follow-up. No significant progression of enophthalmos was observed at postoperative 12, 18 and 24 months when compared with the enophthalmic value at postoperative 6 months. All 15 patients who have had the limitation of ocular movement or diplopia preoperatively resolved completely or improved to the degree that no clinically significant limitation or diplopia further existed. No complications such as dislocation of implant, infection, and aggravation of ocular limitation were observed during the follow-up period. CONCLUSIONS: Macropore(R) orbital floor liner may be regarded as a useful implant in reconstruction of orbital wall fracture with no significant implant-related complications during its absorption.

Congenital Ptosis Repair by Preserved Fascia Lata with Direct Tarsal and Frontalis Fixation

PURPOSE: To investigate the outcome of frontalis suspension surgery congenital blepharoptosis with poor levator palpebral muscle function using preserved fascia lata with direct tarsal and frontalis fixation method. METHODS: Twelve congenital ptosis patients (fourteen eyes) who underwent frontalis suspension using preserved fascia lata with direct tarsal and frontalis fixation method between July 1999 and June 2002 with the mean follow-up time of 54.8 months (31 months~78 months) included. And the postoperative results were obtained from medical records retrospectively. RESULTS: The desired lid height was achieved in eight out of twelve patients (71.4%) after surgery. In four patients (4 eyes) (28.6%), adjustment was required due to under-correction within one month postoperatively. At a mean follow-up period of 54.8 months, all twelve patients had good final results with no postoperative complications. CONCLUSIONS: Frontalis suspension using preserved fascia lata with direct tarsal and frontalis fixation method provided cosmetically pleasing results with a low rate of ptosis recurrence and complication related to procedures. This method using preserved facia lata could be considered as alternative to the use of autogenous facia lata for the repair of ptosis.

Congenital Ptosis Repair by Preserved Fascia Lata with Direct Tarsal and Frontalis Fixation

PURPOSE: To investigate the outcome of frontalis suspension surgery congenital blepharoptosis with poor levator palpebral muscle function using preserved fascia lata with direct tarsal and frontalis fixation method. METHODS: Twelve congenital ptosis patients (fourteen eyes) who underwent frontalis suspension using preserved fascia lata with direct tarsal and frontalis fixation method between July 1999 and June 2002 with the mean follow-up time of 54.8 months (31 months~78 months) included. And the postoperative results were obtained from medical records retrospectively. RESULTS: The desired lid height was achieved in eight out of twelve patients (71.4%) after surgery. In four patients (4 eyes) (28.6%), adjustment was required due to under-correction within one month postoperatively. At a mean follow-up period of 54.8 months, all twelve patients had good final results with no postoperative complications. CONCLUSIONS: Frontalis suspension using preserved fascia lata with direct tarsal and frontalis fixation method provided cosmetically pleasing results with a low rate of ptosis recurrence and complication related to procedures. This method using preserved facia lata could be considered as alternative to the use of autogenous facia lata for the repair of ptosis.

A Study for Manufacturing Light Artificial Eye

PURPOSE: To manufacture a light artificial eye that is lighter in weight than a conventional artificial eye and to correct the problems resulting from the long-term use of artificial eyes in anophthalmic patients. METHODS: The light artificial eyes were manufactured by substituting their posterior portions with a lightweight material, polystyrene. The conventional artificial eyes manufactured with polymethylmethacrylate (PMMA) and sold by the American Optical Corporation were used as the control. The control was grouped according to 3, 4, and 5 grams in weight with 8 sets in each group. The light artificial eyes that have the same volume and shape as the conventional ones was compared in terms of the reduction rates of weight with each group. RESULTS: The reduction rates of weight in the light artificial eyes were 22.6%, 40.2%, and 46.7% in the 3-, 4-, and 5-gram groups, respectively. In addition, the light artificial eyes showed significant statistical differences from the conventional ones. CONCLUSIONS: The light artificial eye, the posterior portion of which was substituted with a lightweight material, showed a significant reduction in weight, and the rate of weight reduction was higher with the heavier groups. Therefore, the lightweight artificial eye, which has fewer side effects to the orbit and adnexa, could contribute to the rehabilitation of the anophthalmic patients.

Comparison between the Exposure Rates of Tutoplast(R) and Vicryl Mesh Used as Wrapping Materials for Hydroxyapatite Orbital Implant

PURPOSE: To compare the exposure rates of two wrapping materials for hydroxyapatite (HA) ocular implants (Tutoplast(R) vs. vicryl mesh). METHODS: We reviewed the medical records of 137 eyes of 137 patients who had received intraorbital HA implantation from March 1997 to March 2001. RESULTS: We used Tutoplast(R) in 72 patients and vicryl mesh in 65 patients. The mean follow-up period was 22.1 months. Implant exposure developed in four cases of eyes using vicryl mesh. No case of exposure occurred in eyes using Tutoplast(R). The mean period from operation and implant exposure was 3.5 weeks (1.5~5 weeks). CONCLUSIONS: When vicryl mesh was used as the wrapping material for HA intraorbital implant it is advisable to pay more attention to the possible postoperative implant exposure than when Tutoplast(R) was used.

Exophthalmometric values of Korean using Hertel and Naugle exophthalmometers

PURPOSE: The purpose of this study was to propose the mean exophthalmometric values of Korean using both Hertel and Naugle exophthalmometers. METHODS: We measured 176 eyes in 88 (Male 45, Female 43) normal subjects without any orbital disease using both Hertel and Naugle exophthalmometers. RESULTS: The analysis of Hertel measurements showed a mean reading of 17.2+/-1.5 mm in the male group, and of 16.1+/-1.4 mm in the female group, respectively. And the analysis of Naugle measurements showed a mean reading of 19.5+/-1.1 mm in the male group, and of 18.3+/-1.3mm in the female group, respectively. There was no difference among different age groups in male and female groups, respectively. The exophthalmometric value of Naugle measurement was significantly higher than that of Hertel measurement in both male and female groups by 2.3 mm and 2.2 mm respectively (p<0.05). CONCLUSIONS: In Korean, the exophthalmometric value of Naugle instrument is larger than Hertel in both male and female. And there is significant difference between male and female, but no difference among different age groups. These data can be useful for mean exophthalmometric value of Korean.

Clinical Results of Hydroxyapatite Orbital Implantations using Autologous Sclera as a Wrapping Material

PURPOSE: To evaluate the clinical result of hydroxyapatite implantation using autologous sclera as wrapping material. METHODS: From December 2001 to February 2003, we performed 20 cases of hydroxyapatite implantation with autologous sclera as wrapping material. Eyes were enucleated for severe phthisis because evisceration could not provide adequate space for hydroxyapatite implantation or secondary hydroxyapatite implantation after prior evisceration. Postoperative complications were evaluated at postoperative 1 week, 2 weeks, 3 weeks - 1 month, 2 months, 3 months, and every 2 or 3 months thereafter. RESULTS: The mean follow up period was 12.1 +/- 4.52 months (4~18 months). During the follow up period, conjunctival erosions developed in 2 cases, which were controlled by conservative management only. No such postoperative complications as implant exposure, orbital infection, extrusion, inflammatory reaction occured. CONCLUSIONS: Autologous sclera is the suitable wrapping material of hydroxyapatite implant when enucleation is needed in primary surgery for severe phthisis, or for secondary hydroxyapatite implantation after prior evisceration surgery.

Corneal Flap Thickness according to Suction Time of Microkeratome in Porcine Eye

PURPOSE: The purpose of this study is to investigate the effect of the suction time in forming the corneal flap with microkeratome on the corneal flap thickness. METHODS: Thirty porcine eyes were randomly assigned into 3 groups according to suction duration: group 1(10 sec), group 2(35 sec) and group 3(60 sec). The Hansatome microkeratome with 160 plate and a suction ring with 8.5mm diameter were used to create corneal flap. The thickness of central cornea was measured with automated ultrasound pachymeter before the procedure. And after making the flap, the remained corneal thickness was measured with the same method. Then, the difference between the two values was thought to be the corneal flap thickness. RESULTS: The mean corneal flap thickness in group1, 2, and 3 were 91.0+/-24.1 micromiter, 110.1+/-8.9 mu m and 127.2+/-6.1 mu m, respectively. The difference was significant among the three groups(p=0.010), and the longer suction duration made the flap thicker. CONCLUSIONS: These results suggest that in forming the corneal flap with microkeratome, the suction duration has an effect on the corneal flap thickness and an increase of suction duration makes the flap thicker in porcine eyes.

Intraocular Pressure following Cataract Surgery using Sutureless Clear Corneal Incision

PURPOSE: The purpose of this study is to investigate the effect on intraocular pressure (IOP) of sutureless clear corneal phacoemulsification with foldable posterior intraocular lens implantation. METHODS: We measured the IOP using both a non-contact pneumotonometer and a Goldmann applanation tonometer preoperatively and postoperatively (1, 3, 10, 30, 60 and 90 days). In operation, the incision site was determined depending on the axis of preoperative corneal astigmatism and divided into two groups: Temporal (Group 1) and Superior clear corneal incision (Group 2). It is postulated that if there is more damage to the surrounding tissue in superior incision group due to poorer surgical accessibility than temporal group, it may affect on postoperative IOP. RESULTS: The mean preoperative IOP of Group 1 (59 eyes) and Group 2 (41 eyes) were 14.6 mmHg and 14.3 mmHg respectively. At postoperative 1 day, the IOP decreased in both groups by 14.2 mmHg and 14.0 mmHg respectively (p>0.05), and at 3 days, 13.1 mmHg and 13.2 mmHg respectively (p<0.05). And from then on, there was no statistically significant change to 3 months. The mean IOP of postoperative 3 months was 12.9 mmHg in both groups; decreased to 1.7 mmHg and 1.4 mmHg respectively compared to preoperative value (p<0.05). In all periods of this study, there was no significant difference between two groups and between two methods of measurement. CONCLUSIONS: These results suggest that in case of uncomplicated senile cataract, sutureless clear corneal phacoemulsification with foldable posterior intraocular lens implantation reduces the IOP in short term follow up period.