Clinical Analysis of Vitrectomy Efficiency for Non-diabetic Vitreous Hemorrhage

PURPOSE: To investigate postoperative visual acuities of patients who underwent vitrectomy for their dense nondiabetic vitreous hemorrhage, and in addition to assess postoperative visual results of the group who underwent early vitrectomy. METHODS: Included in the study were 52 patients (52 eyes) who had undergone vitrectomy and been followed up for longer than 4 months after surgeries. Authors investigated the underlying diseases of vitreous hemorrhage, surgical outcomes, and the rate of complications. In addition, we evaluated the results of the group who had undergone vitrectomy between 4 weeks and 6 weeks after development of hemorrhage. RESULTS: The most common cause of vitreous hemorrhage was branch retinal vein occlusion followed by macular hole, ocular trauma, central retinal vein occlusion, age related macular degeneration, Terson`s syndrome, and unknown cases. Visual acuity before operation is less than light perception to 0.3 and improved in 44 eyes (84.6%) after operation. The rate of more than 5 lines' improvement is 63.4% (33 eyes) and 51.9% (27 eyes) obtained their visual acuity of 0.5 or better. In the group which had been operated 4 to 6 weeks after the development, visual acuity improved in 100% (16 eyes). Thirteen eyes (81.2%) showed more than 5 lines' improvement of their visual acuity and 12 eyes had 0.5 or better (75.5%). The most common complication after surgeries is cataract in 5 eyes (10.8%), others were macular hole in 3 eyes (5.7%), retinal detachment in 2 eyes (3.8%), macular hole in 1 eye (6.2%). CONCLUSIONS: Pars plana vitrectomy is a good procedure to improve visual acuity for the patients who have suffered persistent visual disturbances due to non-diabetic vitreous hemorrhage. Also, early vitrectomy should be considered for early visual rehabilitation.

The Ocular Disorders Observed in Patients with Vitiligo / 대한피부과학회지

BACKGROUND: Vitiligo is a common disorder caused by a loss of epidermal pigment cells. The pigment cells in the skin and uveal tract are similar in their physiology and morphology and share a common embryologic origin. OBJECT: The purpose of our study was to determine the nature of the relationship between vitiligo and ocular disease. METHODS: Fifty-two patients with vitiligo were examined for ocular abnormalities. RESULTS: There were 17ocular abnormalities our study; 5 fundal focal hypopigmented spots (9.6%), 6 iris pigment clumps(11.5%), and 6 lens opacity(11.5%). CONCLUSION: We believe that vitiligo may affect pigment cells in the eye. Therefore, all patients with vitiligo should have ocular examinations.

A Case of Total Descemet's Nembrane Detachment Treated by Non-expansible SF6 Gas Iinfusion

PURPOSE: We intend to report that a case of total Descemet's membrane detachment, occured after cataract operation which was reattached with non-expansible SF6 gas infusion. METHODS: 77-year-old woman who was undertaken cataract surgey 7days ago showed corneal edema, decreased visual acuity and rolled detached Descemet's membrane which was attached inferior cornea. Nine days after cataract surgery, 0.25 ml of non-expansible SF6 gas 20% was infused into anterior chamber. RESULTS: Three days after intracameral injection of non-expansible SF6 gas 20%, Descemet's membrane was begin to reattach and corneal edema was improved progressively. CONCLUSIONS: When total Descemet's membrane detachment occurs after intraocular surgery, intracameral injection of non-expansible SF6 gas is to be a effective treatment.

The Effect on Early Visual Outcome of Corneal Cap Attachment with Brushing after LASIK

PURPOSE: This study was to investigate the effect on early visual outcome of corneal cap attachment with brushing after LASIK. METHOD: We studied 40 eyes of 20 patients who received LASIK from April, 1998 to March, 1999. Early visual acuity was measured in the first, second and third day after LASIK between the group that received brushing procedure and the group that didn't. RESULT: The consecutive group that received brushing procedure showed considerable increase in recovery rate of visual acuity compared to the control group that did not receive brushing procedure on the first day (P0.05) after LASIK. CONCLUSION: We think that corneal cap attatchment with brushing helps early visual recovery and further investigation in this study is needed.

Surgical Correction of Convergent Strabismus Fixus: A Case Report

PURPOSE: Strabismus fixus is a rare form of strabismus which is known for its difficulty to correct surgically, because it tends to go back to its previous state after the surgery. We report the case because we had successfully corrected the case of convergent strabismus fixus. SUBJECTS AND METHODS: A 38-year-old female patient who had both medial rectus muscle tenotomy 10 years before was operated with both lateral rectus muscle resection, superior and inferior rectus muscle recession and temporary traction suture for 5 days, but it was dissatisfactory, so making a hole in the lateral orbital rim was performed by microdrill, with fixation of insertion site of the lateral rectus muscle to the lateral orbital rim by permanent traction suture. RESULTS: At three months after the surgery, patient appeared to be almost orthophoric at primary position. Eye movement was impossible but we had satisfactory result cosmetically. CONCLUSION: It is suggested that eyeball fixation to lateral orbital rim is an effective surgical procedure for the case of convergent strabismus fixus which was not corrected by previous surgical techniques.

Effectiveness of Washing Nasolacrimal Duct as an Additional Therapy after Dacryocystorhinostomy

The surgical methods for the obstruction of nasolacrimal duct include conventional dacryocystorhinostomy and nasal endoscopic dacryocystorhinostomy.The authors followed 52 eyes of 54 patients who had undergone conventional or endoscopic dacryocystorhinostomy to compare the surgical success rate, between the group whose nasolacrimal duct was washed with normal saline and the control group without irrigation. Nasal cavity of all patients were examined for the abnormalities such asnasal septal deviation, hypertropy of middle concha, ethmoid sinusitis and nasal polyp.The patients with those abnormalities were excluded. There was significant difference between the two groups, showing better outcome in the group with nasal irrigation. These results suggest that washing NLD after the dacryocystorhinostomy may be effective as an additional therapy to enhance the success rate of operation.

Scanning Electron Microscopic Findings of Human Bruch's Membrane

Anatomical examinations on Bruch's membrane have almost been by light microscopy or transmission electron microscopy. Scanning electron microscopy allowed us to evaluate surface features topographically. Each layer of Bruch's membrane was exposed sequentially to mechanical or enzymatic treatment of the retinal pigment epithelium choroid complex from human cadavar eye. The authors examined the surface features of the membrane by dry-cracking scanning electron microscopy. The basement membrane of retinal pigment epithelium appeared like a smooth thin plastic membrane which was framed by collagen fibers. The inner collagenous layer was composed of many collagen fiber bundles which were placed in order and the ground substance between them was not visible. Elastic layer of Burch's membrane appeared to be coarse and fine fibers matted together by some amorphous substance. This layer had many openings on its solid sheet and the outer collagenous zone was visible though these openings.

The Effectiveness of Canaliculoplasty Using Mini-Monoka(r) or Bicanalicular Stent for Repair of Upper and Lower Canalicular Laceration

A retrospective study was designed to compare postoperative effect in 45 cases of patients of bicanaliculoplasty with lower canaliculoplasty. The 30 of 45 cases received bicanalicular stent and the 15 cases had lower canaliculoplasty using Mini-Monoka(r) (lower canaliculoplasty).The age ranged from 5 to 67 years (mean: 37.1 years).Thirty-two patients were men and 6 patients were women.After follow-up period of 6 to 12 month (mean 8.6 month), 27 cases (90%)of bicanaliculoplasty and 9 cases (60%)of lower canaliculoplasty became recanalized well. Postoperative complications included granuloma of the punctum in both cases (6 cases of bicanaliculoplasty, 3 case of lower canaliculoplasty)and loss of tube (3 case of bicanaliculoplasty, 6 case of lower canaliculoplasty). When both upper and lower canalicula were injuried, better result was seen in the method of lower canaliculoplasty using Mini-Monoka(r) than that of bicanaliculoplasty using bicanalicular stent. Both bicanalicular stent and Mini-Monoka(r) were good for canaliculoplasty.

Comparison of Clinical Results between LASIK and PRK in Moderate Myopia with VISX STAR(r)

To compare the clinical results of LASIK with that of PRK in moderate myopia, we reviewed clinical outcome of LASIK and PRK for postoperative six months.In the LASIK, the manual microkeratome produced by SCMD and the VISX STAR model laser were used.In the PRK, the same model laser by the same company was used.The number of patients receiving the LASIK was 41 (75 eyes)and that of the PRK was 36 (68 eyes).In a week following the surgery the mean uncorrected visual acuity was 0.8 or better 36 eyes (52%)in the PRK and 54 eyes (70%)in the LASIK respectively (p<0.05).At postoperative three months and six month, the uncorrected visual acuity become stable showing 61 eyes (89%)and 65 eyes (94%)in the PRK and 66 eyes (88%)and 70 eyes (93%)in the LASIK respectively.At postoperative 1 month, the average corneal haziness was grade 1.7 and at postoperative six month, it reduced considerably to 0.6 in average in PRK group but no haziness was detected in the LASIK group.In both groups, the uncorrected visual acuity improved, however the best corrective visual acuity were reduced in four eyes of the PRK group and nine eyes of the LASIK group.From the above results, it is concluded that there is no significant difference between the outcome of PRK and LASIK in moderate myopia.

The Macular Circulation State on BRVO According to Occlusion Site

We did clinical analysis on the macular circulatory state in 34 patients(34 eyes)who were diagnosed to have branch retinal vein occlusion and followed for over 6 months. After dividing them into two groups according to their occlusion sites, we evaluated the differences of foveal capillary ring state and size of macular ischemic area between the ones who had vein occlusion in their first retinal branches and the others in their second and the rest retinal branches. We were unable to find any differences between them. However, we could find statistical correlation between their visual acuities in acute stage of the disease and macular circulatory states even though we could not find any differences between their final visual acuities or degree of their visual improvement and circulatory states during follow up period.

Usefulness of Two-dimensioanl CT & Three-dimensional CT in Blow-out Fracture

The purpose of this study is to compare the diagnostic accuracy and usefulness of three-dimensional CT, two-dimensional CT in case of blow-out fracture. Two-dimensional CT, three-dimensional CT images of twenty-four blow-out fracture and soft tissue incarceration. Two dimensional CT was superior to three-dimensional CT in evaluating orbital bone fracture and soft tissue incarceration. But, three-dimensional CT was more useful to identify of orbital bone fracture than two-dimensional CT in associated facial bone fracture. Coexamination with two-dimensional axial & three-dimensonal CT was useful not only in the detection of fracture but in the evaluation of soft tissue incarcerated blow-out fracture.

Endoscopic Intranasal Reconstruction of Medial Orbital Wall Fracture with Muco-periosteal Flap

Surgical method for blow out fracture of medial orbital wall is performed by medial canthotomy and subciliary incision or transconjunctival incision. However, these approaches can leave cosmetic problem due to skin incision and have a risk of infection and absorption of prosthetic implant for a large medial wall fracture. The authors performed endoscopic intranasal reconstruction of the isolated medial wall fracture in a case with significant functional impairment of extraocular muscle. After the incision of the middle turbinate, medial wall fracture was reconstructed with muco-periosteal flap under endoscopic control. We had a good result without intraoperative or postoperative complications caused by prosthetic implant. There was no disadvantage seen with the traditional approaches by medial canthotomy. Endoscopic intranasal reconstruction with muco-periosteal flap appears to be a new safe method for especially large defect.

A Case of Fungal Sphenoidal Sinusitis Involving Optic Nerve

Few have reported fungal sinusitis confined in only sphenoidal sinus which caused orbital complication. Reportedly, early surgical treatment can lead to visual recovery especially in its involvement of optic nerve. We report a patients who was hospitalized due to sudden decrease in visual acuity and headache, and was histopathologically diagnosed as having aspergillosis confined in sphenoid sinus, but failed to show restoration of visual acuity after the operation using nasal endoscope.

Removal of Orbital Osteoma Using Bicoronal Approach

Osteomas are benign tumors, which occur in various bones of the body, and it is mostly located in skull and facial bones. Osteoma of orbital area may produce ophthalmologic symptoms and cosmetic problem, for which cases surgical removal is recommended. We report two cases of orbital osteomas occurred in young women, which were removed by bicoronal approach for the purpose of cosmetic effect.

Removal of Orbital Osteoma Using Bicoronal Approach

Osteomas are benign tumors, which occur in various bones of the body, and it is mostly located in skull and facial bones. Osteoma of orbital area may produce ophthalmologic symptoms and cosmetic problem, for which cases surgical removal is recommended. We report two cases of orbital osteomas occurred in young women, which were removed by bicoronal approach for the purpose of cosmetic effect.

Hydroxyapatite Implantation using Autogenous Temporalis Muscle Fascia

Hydroxyapatite is generally used as an orbital implant which is biocompatible. It is considered esthetically and functionally better than traditional measure. We performed hydroxyapatite implantation using autogenous temporalis muscle fascia for 4 eyes of 4 phthisis patients by truma. Hydroxyapatite implants wrapped with autogenous temporalis muscle fascia were inserted into all eyes after enucleation. Follow-up for 12-15 months [mean:13.4 months] showed less inflammatory reaction. There were has no wound dehiscence, implant protrusion and migration. MRI showed a goodfibrovascular proliferation at 4-5 months postoperatively, so we performed drilling. Temporalis muscle fascia is easily obtained and there is no esthetic problem because scar at scalp is covered by hair.

A Clinical Study on the Endonasal Microdrill-assisted Dacryocystorhinostomy

As noe of causes of epipora, anatomic abnormality of nasolacrimal duct, has been treated with dacryocystorhinostomy. Recently, the development of nasal endoscopy has made it easy to observe the intranasal sturcture. Thus, authors investigated the effect of nasal endoscopic dacryocystorhinostomy used in combination with microdrill and nasal endoscopy in those patients, with nasolcrimal obsturction at the time of dacryocystorhinography. From 1995 to April 1997, twenty-four patients have been treated by the intranasal dacryocystorhinostomy using the microdrill with follow up more than six months. All patients had been tested by preoperative intranasal exam and was measured radiologically preoperative`s size of lacrimal sac. The nasal endoscopy using microdrill had shown success rate of 83.3 percent and the surgerywas more successful as the size of preoperative lacrimal sac was larer without any complication. The formation of accurate bone foramen did not remarkably differ from the skin incisio at the time of operation. Therefore, dacryocystorhinostomy using microdrill can be useful for the treatment of lacrimal canal obstruction, especially with the proper operating equipment.

Posterior Triple Surgery in Ocular Trauma Patients

Cataract extraction, intraocular lens implantation, and pars plana vitrectomy combined in a one-stage procedure(posterior segment triple surgery) are effective operation method for complications of diabetic retinopathy and uveitis. We performed posterior segment triple surgeries in 12 eyes(12 patients) with traumatic eye injuries. After a follow up of at least 3 months, eleven eyes(92%) had a visual acuity f 20/200 or more: seven eyes(58%), 20/40 or morel. The result suggest that posterior segment triple surgery is effective in traumatic eye injuries for the fast visual rehabilitation.

A Clinical Study on Cataract Surgery in High Myopia: Pseudophakia and Aphakia

Anthors have evaluated postoperative visual outcome and complications on 60 high myopic patients who had underwent extracapsular cataract extraction (ECCE) with or without posterior chamber intraocular lens (PC IOL) implantation, retrospectively. The average axial length of eyeballs of patients underwent only ECCE and ECCE with PC IOL were 30.7 mm and 27.04 mm, respectively. Corrected visual acuity was improved in 56 eyes (91.5%) after cataract sugery. 19 eyes (63.6%) out of 30 aphakia and 11 eyes(36.2%) out of 30 pseudophakia showed better than 20/40 and this difference was statistically significant (p< 0.05). Posterior capsular opacity and cystoid macular edema (CME) were founf in 7 eyes (23.3%) and in 2 eyes (6.6%) of 30 aphakia, while those were in 2 eyes (6.6%) and 1 eye (3.3.%) of 30 pseudophakia, respectively. However, these complications did not decrease a visual acuity and there was no retinal detachment in both aphakia and pseudophakia, with these resuls, it was founf that the clinical results of ECCE with PC IOL was more effective in visual improvement and prevention of posterior capsular opacity than only ECCE for high myopic patients.

A Clinical Observation on the Argon Laser Effect of the Pterygium

Pterygium is a common disease recurred frequently. Although several methods have been suggested for prevention of recurrences there was no royal road for that. In this study, we applied argon laser on each pterygium of 55 eyes and evaluated the effect of the argon laser treatment by observing the recurrence rate. The stage of pterygium was evaluated by the degree of corneal involvement and the number of blood vessels frorn the base to apex of the pterygium was also counted. We applied argon laser to the pterygium before or after surgical removal. The recurrence rate of pterygium was high in the persons under 50 years old and having many number of fibrovascular blood vessels in the pterygoid mass. This difference was statistically significant(p<0.05). However, sex of patients and size of pterygium did not influence the recurrence rate. Conclusively, argon laser treatment for pterygium would be recommendable to the aged patients having a few number of blood vessels in pterygoid mass.