A Case of Premacular Hemorrhage Treated by Q-switched Nd:YAG Laser Puncture

Preretinal hemorrhage, which is located between the retina and vitreous face and is commonly developed on the macula, causes impaired central vision and if it persists, it may cause complications, such as epimacular membrane. A 49-year-old male who had dry type of age-related macular degeneration in both eyes and had an oval shaped premacular hemorrhage of unknown etiology in his left eye. We applied Q-switched Nd:YAG laser on membrane anterior to preretinal hemorrhage and ruptured it. Preretinal hemorrage was drained to inferior vitreous cavity and his central vision was rapidly improved.

Ultrastructural Study on the Development of Ciliary Body in Human Fetuses

Morphological development of the ciliary body was studied by electron microscope in human fetuses from 50 to 260 mm crown-rump length(11-30 weeks of gestational age). At a 50 mm(11 weeks) fetus, the anlage of ciliary body was not appeared. At a 70 mm(13 weeks) fetus, the anlage of ciliary epithelium was appeared as the folds were formed by invaginating vessels in the basal surface of pigmented epithelium at the rim of optic cup. At the time, the anlage of ciliary muscle was formed as the mesenchymal cells, which located between the rim of optic cup and the scleral condensation, different-iate into the myoblasts, and the unmyelinated nerve fibers and the axon terminals were found in the interstitial tissue of mesenchyme. At 100-260 mm(15-30 weeks) fetuses, the myoblasts of ciliary body continued to develop into typical smooth muscle cells. At 200-260 mm(20-30 weeks) fetuses, the well-developed infoldings in the basal lamina and the well-developed interdigitations in the lateral sur-face were observed at both pigmented and nonpigmented epithelia. At the time, ganglion cells, Schwan cells and axon terminals were observed in the interstitial tissue of ciliary muscle.

A Case of Frosted Branch Angiitis

Frosted branch angiitis menifests with acute visual loss in an otherwise young healthy patient. The fundus findings are dramatic and characterized by severe white sheathing of the retinal vessels. A variable amount of anterior chamber and vitreous inflammation also occur. Fluorescein angiography demonstrates leakage of dye from the retinal vessels with no evidence of vascular stasis or occlusion. The clinical findings respond dramatically to systemic corticosteroids. The authors experienced a case of frosted branch angiitis which occured in 5year-old female whose fundus findings were marked white sheathing and macular thicking.

Contact Transscleral Continuous-wave Nd:YAG Laser Retinopexy: Comparison with Cryoretinopexy

We studied clinical applicability of the contact transscleral retinopexy using the continuous-wave Nd:YAG (CW-YAG) laser. CW-YAG laser photocoagulation was done over sclera through contact probe in the pigmented rabbit eyes. Cryoretinopexy was also done and their morphologic findings were compared. Acute lesions produced with the laser photocoagulation were noted to have the characteristic white-colored distinct depigmentation. Its microscopic findings were oharacterized by choroidal necrosis, disruption of Bruch's membrane, dispersion of retinal pigment epithelial cells, and disorganization of sensory retina. Acute lesions after the cryoretinopexy were much more broader in its area and showed slight tanslucent retinal edema. Its microscopic findings showed relatively well-preserved choroid including Bruch's membrane. These data demonstrated that the contact transscleral CW-YAG laser retinopexy is capable of inducing more localized, stronger chorioretinal adhesion than the cryoretinopexy.

A Clinical Study on Rhegmatogenous Retinal Detachment

A retrospective study was performed in 180 eyes (173 patients) with rhegmatogenous retinal detachment which underwent primary scleral buckling operations. One hundred and sixteen patients (67.1 %) were men. The most common age group was the seventh decade (34 patients, 19.6%). Moderate- to high- degree myopia were the most numerous (65 eyes, 38.0%) as the associated ocular findings and the peripheral retinal degenerations were next (44 eyes. 257%). One hundred and fifty eyes had retinal breaks preoperatively, 129 eyes (76.8%) had breaks distributed in the superior and/or inferior temporal quadrants, 84 eyes (56.0%) had breaks located in the equator and 82 eyes (54.7%) had atrophic holes. Among 180 eyes studied, 141 eyes (78.3%) achieved retinal reattachment by primary scleral buckling operations. Preoperative and/or postoperative proliferative vitreoretinopathy as causes of failure were presented in 18 eyes. Ten eyes had intraocular hemorrhage as intraoperative complications and the other 10 eyes developed cataract as postoperative ones. Fourty-seven eyes (33.3%) had corrected visual acuity below 0.1 in spite of successful retinal reattachment and 23 eyes had macular degenerations as the most common causes of poor vision.

A Clinical Study on Strabismus in Children

Retrospective studies were performed in 338 cases among 633 cases under the age of 12 who visited the ophthalmologic department of Chonnam National University hospital from Jan. 1982 to Dec 1989. With this sample group, we have assessed information such as detected time of strabismus, type of deviation, sex distribution, refractory power, visual acuity test, angle of strabismus as well as operative result. After through study and analytical review of our data, we report these results of our study. 1. Sex distribution was 161 male(47.6%) and 177 female(52.4%), too redundant. Average age(year) at time of detection of esotropia, exotropia and hypertropia was 2.4, 3.8, 2.4 respectively. 2. Distribution according to type of strabismus was 103 cases(30.5%) of esotropia, 230 cases(68.0%) of exotropia, 5 cases(1.5%) of hypertropia. Again, too redundant. In esotropia, nonaccommodative esotropia included 65 cases(63.1%) and in exotropia, intermittent exotropia included 145 cases(63.0%). 3. Preoperative angle deviation of 25-40 delta in esotropia was observed in 58 cases(56.3%), but was observed 79.6% in 183 cases of exotropia. In those involving hypertropia 32 cases(60.0%) have had preoperative angle deviation below 20 delta, the largest number. 4. Type of refractory abnormality in esotropia was mostly hyperopic. Range of +2.0D - +4.0D was measured in 32 cases(32.3%) and showed variable distribution in exotropia, but the range of -1.0D - +1.0D in 119 cases(55.9%) was the greatest in number. 5. The number of patients who underwent surgery was 234(69.2%) and 104(30.8%) had no operation. Average age(year) at the time of the operation was 3.4 for esotropia, 5.4 for exotropia and 5.5 for hypertropia. Again, too redundant/obvious. 6. In esotropia medial rectus recession(65.3%) was performed, most frequently. In exotropia lateral rectus recession(86.2%) was performed, most often. As a result of primary operative repair of esotropia, normal position was achieved in 12 cases(24.5%). In 34 cases(69.4%), there was undercorrection, one hundred- five and overcorrection was observed in 3 cases(6.1%). 105 cases of exotropia attained normal position, 54 cases had undercorrection, and 22 cases had overcorrection. In vertical strabismus, 3(75%) attained normal position, and one(25%) undercorrection was observed. 7. Amblyopia occurred in 64 cases(18.9%), its distribution was 37 cases of esotropia, 26 cases of exotropia, and 1 case of hypertropia. After performing occlusion, at least a two-level vision test chart improvement was attained in 84.4% of cases.

A Case of Unilateral Blindness Following Subcutaneous Injection of the silicone Oil on the Glabellar Area

We recently observed an unusual case of visual loss after periocular injection of silicone oil. A 31-year-old woman immediately experienced total loss of vision in the left eye with ipsilateral headache and ocular pain, dyspnea, abdominal pain, general weakness, and transient coma after subcutaneous injection of silicone oil on the glabellar area to reduce the facial wrinkles. We believe that the cause of blindness was multiple embolization in the central retinal artery and posterior ciliary branches of the ophthalmic artery.

A Clinical Study of 3M Multifocal Intraocular Lens Implant

Recently, it has been widely recognized that the newly developed multi focal intraocular lens provides good near and far vision. Therefore, among 70 eyes who underwent 3M multifocal intraocular lens insertion procedure at our hospital from July 1989 to may 1990, 50 eyes that could be closely followed up for at least 3 months postoperatively were chosen as our study subjects. After careful analytical review of data such as postoperative near and far vision, refractory power, spherical equivalent of diopter of spectacles needed for correction of vision, change of vision according to size of pupil as well as relationship between central location of intraocular lens(IOL) and vision, and multifocusing ability of IOL, we have attained the following results. 1. 36(72.0%) males and 14 females(28.0%) have received multifocal IOL. According to age, 16 eyes(32.0%) were in their 40's, comprising the greatest number, followed by those in the 50's(24.0%) and 60's(24.0%). 2. Postoperatively, 23 eyes(46.0%) have attained emmetropia. 12 eyes(24.0%) were hyperopic, and 15 eyes(30.0%) were myopic. Spherical equivalent of corrected spectacles was -0.35D. The number of eyes attaining corrected vision over 1.0 was 36(72.0%),44 eyes over 0.5(88.0%), and 6 eyes less than 0.4(12.0%). 3. The number of near vision J1 with corrected vision over 1.0 were 33 eyes(66.0%), greater than J2 were 36(72.0%), and in the case of vision of 0.9-0.8 J1 and J2 were 2 eyes(4.0%) and 3 eyes(6.0%), respectively; vision of 0.7-0.5 J2 was 1 eye(2.0%), J3 were 2 eyes(4.0%). In vision less than 0.4, J3 and less than J3 were 3 eyes(6.0%) in each cases. 4. Corrected near vision attained by additional diopter in 15 eyes that have a near vision of less than J2 are as follow: 7 eyes of J1(14.0%), 4 eyes of J2(8.0%) 2 eyes of J3(4.0%) and 2 eyes of less than J3(4.0%). Average additional diopter required to obtain J1 was +0.64D. 5. In the group that has corrected vision over 1.0, the number of eyes that had matched center of IOL and center of pupil was 17(34.0%), number of eyes that has a deviation of 0.5 mm was 6(12.0%), 8 eyes with a deviation of 1.0 mm(16.0%), 5 eyes with a deviation of 1.5 mm(10.0%); but, none have affected vision. 6. Change of vision according to the size of pupil was measured. In the case of corrected vision over 1.0, pupil size of 2.0-4.0 mm and dilated pupil size over 5.0 mm occurred in 36 eyes in each case, and a constricted pupil size less than 2.0 mm occurred 35 eyes with no vision change observed. 7. In the case of corrected vision over 1.0, additional use of lens from +1.0D to -3.0D has not affected vision when maintained at a level of over 0.8 but use of any lens out of this range has dramatically decreased vision. 8. After inserting vultifocal IOL, complaints of diplopia, glare, dizziness and seeing rings were observed in 10 eyes(20.0%); but, 5 months later symptoms had disappeared in all cases.

A Clinical Study of 3M Multifocal Intraocular Lens Implant

Recently, it has been widely recognized that the newly developed multi focal intraocular lens provides good near and far vision. Therefore, among 70 eyes who underwent 3M multifocal intraocular lens insertion procedure at our hospital from July 1989 to may 1990, 50 eyes that could be closely followed up for at least 3 months postoperatively were chosen as our study subjects. After careful analytical review of data such as postoperative near and far vision, refractory power, spherical equivalent of diopter of spectacles needed for correction of vision, change of vision according to size of pupil as well as relationship between central location of intraocular lens(IOL) and vision, and multifocusing ability of IOL, we have attained the following results. 1. 36(72.0%) males and 14 females(28.0%) have received multifocal IOL. According to age, 16 eyes(32.0%) were in their 40's, comprising the greatest number, followed by those in the 50's(24.0%) and 60's(24.0%). 2. Postoperatively, 23 eyes(46.0%) have attained emmetropia. 12 eyes(24.0%) were hyperopic, and 15 eyes(30.0%) were myopic. Spherical equivalent of corrected spectacles was -0.35D. The number of eyes attaining corrected vision over 1.0 was 36(72.0%),44 eyes over 0.5(88.0%), and 6 eyes less than 0.4(12.0%). 3. The number of near vision J1 with corrected vision over 1.0 were 33 eyes(66.0%), greater than J2 were 36(72.0%), and in the case of vision of 0.9-0.8 J1 and J2 were 2 eyes(4.0%) and 3 eyes(6.0%), respectively; vision of 0.7-0.5 J2 was 1 eye(2.0%), J3 were 2 eyes(4.0%). In vision less than 0.4, J3 and less than J3 were 3 eyes(6.0%) in each cases. 4. Corrected near vision attained by additional diopter in 15 eyes that have a near vision of less than J2 are as follow: 7 eyes of J1(14.0%), 4 eyes of J2(8.0%) 2 eyes of J3(4.0%) and 2 eyes of less than J3(4.0%). Average additional diopter required to obtain J1 was +0.64D. 5. In the group that has corrected vision over 1.0, the number of eyes that had matched center of IOL and center of pupil was 17(34.0%), number of eyes that has a deviation of 0.5 mm was 6(12.0%), 8 eyes with a deviation of 1.0 mm(16.0%), 5 eyes with a deviation of 1.5 mm(10.0%); but, none have affected vision. 6. Change of vision according to the size of pupil was measured. In the case of corrected vision over 1.0, pupil size of 2.0-4.0 mm and dilated pupil size over 5.0 mm occurred in 36 eyes in each case, and a constricted pupil size less than 2.0 mm occurred 35 eyes with no vision change observed. 7. In the case of corrected vision over 1.0, additional use of lens from +1.0D to -3.0D has not affected vision when maintained at a level of over 0.8 but use of any lens out of this range has dramatically decreased vision. 8. After inserting vultifocal IOL, complaints of diplopia, glare, dizziness and seeing rings were observed in 10 eyes(20.0%); but, 5 months later symptoms had disappeared in all cases.

Clinical Study of Posterior Chamber Lens Implant in 1000 Eyes

The authors compared and analysed planned extracapsular cataract extraction(ECCE) and Kelman phacoemulsification(KPE) on the 1000 cases out of 1546 cases which had undergone cataract operation during the period of September, 1983 through June, 1989. The results were as follows; 1. Postoperative visual acuity of 0.5 or better was achieved in 96%(960 eyes) and 1.0 or better in 67.6%(676 eyes). Average of visual acuity was similar each other: 0.92 +/- 0.24 in planned ECCE and 1.00 +/- 0.21 in KPE. 2. The mean spherical equivalent of required spectacle lens power was similar too: -1.07D +/- 1.51 in total, -1.08D +/- 1.57 in planned ECCE and -1.05D +/- 1.42 in KPE. 3. The mean postoperative astigmatism was -0.81D +/- 1.05 in total, -0.98D +/- 1.15 in planned ECCE and -0.54D +/- 0.79 in KPE. There was significant correlation between two groups(P<0.01). 4. The difference between predicted and postoperative refraction in terms of spherical equivalent was -0.36D +/- 1.12 in total, -0.36D +/- 1.12 in planned ECCE and -0.37D +/- 1.11 in KPE with no significant different value. The difference by Binkhorst formula was -0.50D +/- 1.10, and -0.06D +/- 1.09, the significant correlative value by regression SRK formula(P<0.05). 5. Mean changes of corneal refractive power was 0.43D +/- 0.99 in horizontal meridian and -0.21D +/-1.14 in vertical meridian in planned ECCE and 0.23D +/- 0.72 in horizontal meridian and 0.01D +/- 0.90 in vertical meridian in KPE. There was significant correlation between two groups(P<0.01). 6. The correlation between postoperative corneal astigmetism and actual astigmatism by skiascopy was very close: regression coefficient was 0.64087 in total, 0.62698 in planned ECCE and 0.62026 in KPE respectively(P<0.01).

Effect of A Constant in SRK(TM) Formula on the Determination of Intraocular Lens Power

There are a number of formulas to calculate the implant power in cataract surgery, but SRK(TM) regression formula has been used to calculate the power of over 90% of all IOLs implanted in U.S.A.. The same may be said of our country. A constant in the SRK(TM) formula exerts an influence on the accuracy of any implant power calculation by various factors. Furthermore, it is suspicious that A constant designated in West shall apply to the Koreans, because anatomical structure of the eye between the two is more or less different. Therefore, in order to achieve the desired postoperative refractive state, it is desirable to individualize the SRK(TM) regression formula by calculating a revised A constant using a given style of lens implant from the same manufacturer. This study included 418 posterior chamber lenses of 5 different styles undergoing cataract surgery with IOL implantion in the Department of Ophthalmology, Chonnam University Hospital. Revised A constants were calculated retrospectively by evaluating the results. Predicted postoperative refractive state after IOL implantation of the power given by using Binkhorst formula, SRK(TM) formula with designated A constant and SRK(TM) formula with revised A constant, respectively, and actual postoperative refractive state were compared and analyzed to evaluate the accuracy among those three groups. The results were as follows: 1. The revised A constants obtained from retrospective analysis were as follows: IOLAB, 116.1; 3M, 115.1; Cilco with angulated haptics, 116.4: Copeland, 116.1; Cilco with uniplanar haptics, 115.2. The revised A constants in all the styles of implants were more or less reduced than the designated A constants. 2. There were no difference in the revised A constants between phacoemulification group and planned extracapsular cataract extraction group. 3. In all the styles of IOLs, the SRK(TM) formulas with revised A constants weremore accurate than the Binkhorst formulas and the SRK(TM) formulas with designated A constants in deternining IOL power. 4. In accuracy according to variable axial lengths and corneal refractive powers among those three groups, better result was obtained in the SRK with revised A constant.

Effect of Subconjunctival Injection of 5-Fluorouracil after Trabeculectomy

5-Fluorouracil(5-FU), an antimetabolite capable of inhibiting fibroblast proliferation, was administered subconjunctivally after trabeculectomy(with or without lens extraction) on 8 eyes of 8 patients with neovascular or aphakic glaucoma, with poor visual acuity and poor surgical prognosis. The follow-up period ranged from 4 to 12 months. The mean intraocular pressure was reduced by approximately 65.5%, from 45.3 mmHg preoperatively to 15.6 mmHg postoperatively. Four of 8 eyes required no medication, but 3 needed some topical medication to achieve an intraocular pressure of <21 mmHg, and the remainder was 24 mmHg with hypotensive medication, postoperatively. The postoperative visual acuities improved in 3 of 8 eyes and remained unchanged in 5. Postoperative complications were hyphema in 4 cases, delayed formation of anterior chamber in 1 case, and serious inflammatory reaction in anterior chamber and severe longstanding conjunctival hyperemia in all the cases.

A Case of Orbital Neurnemoma

The authors experienced a case of orbital neurilemoma, which is a rare benign tumor of the orbit, in a 31-year-old Korean female. At her first visit, she complained of decreased visual acuity for 3 years and protruded eyeball for 1.5 years in her left eye. After removal of mass, histopathologic examination confirmed neurilemoma.