A retrospective analysis of long-term follow-up of sacral neuromodulation in the management of refractory interstitial cystitis/bladder pain syndrome / 中华泌尿外科杂志

Objective:To summarize long-term outcome of sacral neuromodulation (SNM) for refractory interstitial cystitis/bladder pain syndrome (IC/BPS).Methods:Between January 2013 and October 2020, 28 patients with IC / BPS who received SNM in Beijing Chaoyang Hospital and Hebei Yanda Hospital were retrospectively analyzed. There were 5 males and 23 females, with median age 63.00 (47.50, 66.75) years old. The urgency score was 4 (3, 4) points, 24-hour micturition frequency was 26 (20.50, 32.50) times, nocturia was 9 (7, 12) times, single urine volume was 59.00 (41.25, 79.50) ml, VAS score was 9.0 (8.0, 9.0) points, O′Leary-Sant score was 31.00 (20.25, 33.00) points, and single maximum urine volume was 100.0 (80.0, 127.5) ml. The improvement of symptoms before operation, test period and last follow-up were compared.Results:The urgency score was 2 (1, 3), the 24-hour micturition frequency was 17.00 (15.00, 22.75), the frequency of nocturia was 5.5 (4.0, 7.0), the single urine volume was 87.50 (70.25, 110.00) ml, the VAS score was 4.0 (3.0, 6.0) and the O′Leary-Sant score was 20.00 (17.00, 23.00) in 28 patients during the test period, which were significantly improved compared with those before operation ( P < 0.05). There was no significant difference in the single maximum urine volume of 135.0 (102.5, 160.0) ml between the two groups ( P > 0.05). 28 patients received SNM Ⅱ permanent stimulator implantation. The median follow-up time was 29.5 (21.25, 61.75) months. Among the 28 patients, 3 patients underwent cystectomy and ileal conduit after removal of the complete SNM system due to the unsatisfied results. Twenty-five cases (89.3%) were still treated with SNM. Among them, 6 cases accepted combinative therapy of oral medicine (antihistamines, sodium pentose polysulfate, hormones, immunosuppressants, etc.). Two cases accepted combinative therapy of intravesical instillation, including heparin in one case and sodium hyaluronate in the other one. Three cases accepted combinative therapy of botulinum toxin injection.One case accepted combinative therapy of bladder augmentation. Two cases accepted combinative therapy of traditional Chinese medicine (TCM). One case accepted combinative therapy of oral medicine and TCM. The remaining 10 cases didn't accept any treatment. Among them, 3 cases were still treated with SNM even though they were not satisfied with the effect, including 1 case due to electrode displacement. At the last follow-up of 25 patients, the urgency score was 2 (1, 3), the 24-hour micturition frequency was 16.50 (13.00, 19.75), the frequency of nocturia was 5.5 (4.0, 9.0), the single urine volume was 105.0 (72.5, 120.0) ml, the VAS score was 4.5 (3.0, 6.0) and the O'Leary Sant score was 16.00 (14.00, 22.50), which were significantly improved compared with those before operation ( P < 0.05), but no difference with those during test period ( P>0.05). There was no significant difference in the single maximum urine volume of 125.0 (102.5, 150.0) ml at the last follow-up compared with preoperative and test period ( P>0.05). Conclusions:As a treatment option for refractory IC / BPS, SNM can improve the symptoms of most patients and maintain good long-term efficacy combined with other.

The similarities and differences between air-charged catheters and water-filled catheters in the application of pressure-flow study / 中华泌尿外科杂志

Objective:We compare the consistency, similarities and differences of operating procedures, data and conclusions of air-charged catheters(ACC) and water-filled catheters(WFC), as simultaneously using ACC and WFC in pressure-flow study(PFS).Methods:This study was a prospective, synchronously controlled study, including eligible patients who underwent PFS in the Department of Urology, Beijing Chaoyang Hospital from January 2021 to March 2021. Inclusion criteria: ① Patients need PFS for lower urinary tract symptoms like frequency of urination, urgent urination, urinary incontinence and dysuria; ② Age over 18 years old. Exclusion criteria: ① Unable to complete or cooperate during the urodynamic test; ② Patients with severe urethral stricture or acute stage urinary tract infection; ③ Pregnant women. The bladder pressure was measured continuously by using a 7FDR T-DOC ?AC three-chamber bladder pressure tube, which linked to ACC sensor and improved WFC pressure conduction module. At the same time, 7FA T-DOC ?AC single-lumen rectal pressure tube and 7F Labori-CAT411 double-lumen water sac abdominal pressure tube was used to measure the ACC and WFC rectum pressure, respectively. We recorded the Pdet, Pves and Pabd measured by ACC and WFC, at the point of initial sitting position, bladder filling at 100 ml, 150 ml, 200 ml, cough, Q max, maximum Pdet and the end of urination, and compared the mean values, differences, and consistencies of our data. Result:A total of 63 patients (26 female, 37 male) were included in this study, with an average age of 59.19 years (25-86 years old). During bladder filling phase, the mean values of Pves measured by ACC and WFC were 30.78/24.67cmH 2O (initial sitting position), 29.79/25.13cmH 2O (100 ml), 30.87/25.90cmH 2O (150 ml) and 30.95/26.17cmH 2O(200 ml), respectively, the mean value of Pabd were 30.03/24.17cmH 2O (initial sitting position), 28.81/21.78cmH 2O (100ml), 28.89/21.38cmH 2O (150ml), 28.44/21.60cmH 2O (200ml), respectively, and were significantly different at each sampling point ( P<0.01). During urination period, no significant differences were found in data( P>0.05), and the data measured with ACC and WFC system have good consistency. There were significant differences in Pves(mean 57.30/49.95 cmH 2O, respectively) and Pdet(mean 54.21/43.10 cmH 2O, respectively) between ACC and WFC in cough ( P<0.01), but there was a strong linear correlation between these data between two systems(R 2=0.792 in Pves and 0.756 in Pabd). Bland-Altman analysis showed that detrusor pressure at the maximum urine flow rate maintained good consistency between ACC and WFC, which 95% CI was -13.9 cmH 2O to 15.8 cmH 2O. Conclusions:In PFS, although the ACC measurement values (Pves and Pabd) during the filling phase are higher than those WFC readings, but the absolute measurement difference is small, so there is no practical meaning in clinical practice. There was no significant difference in detrusor pressure measured during voiding phase, which indicated that the urodynamic judgment and clinical conclusions of the two systems are highly consistent in judgment of the detrusor contractility and the bladder outlet obstruction.

The relationship of MEOX2 and neurovascular dysfunction in Alzheimer's disease model / 药学学报

Present study investigated the role of mesenchyme homeobox 2 (MEOX2) gene in neurovascular dysfunction in Alzheimer's disease (AD) model rats by bilateral intracerebroventricular injection of Aβ1-42. One week after surgery, Morris water maze, immunohistochemistry, biochemical detection, Western blot and real-time PCR were used to detect the indexes. The animal studies were conducted in accordance with the Regulations of Experimental Animal Administration issued by the State Committee of Science and Technology of the People's Republic of China. Compared to the Sham-operated rats, Aβ1-42-operated rats showed obviously cognitive dysfunction, accompanied by increased Aβ, glial fibrillary acidic protein (GFAP), allograft inflammatory factor 1 (AIF1), endothelial nitric oxide synthase (eNOS) and decreased neuron specific enolase (NSE), synaptophysin (SYN), CD34, vascular endothelial growth factor (VEGF) expressions of brain. Aβ1-42-operated rats also increased the endothelin (ET) level and decreased nitric oxide (NO) level in brain tissue. Moreover, MEOX2 expression was decreased correlated with low density lipoprotein receptor-related protein 1 (LRP-1) decreasing and receptor for advanced glycation end products (RAGE) increasing in brain tissues of AD model rats. We found the correlation between MEOX2 gene expression and neurovascular dysfunction, in addition, the decreased MEOX2 may involve in increasing the accumulation of Aβ in brain by relating to the decreased LRP-1 and increased RAGE which is located in blood-brain barrier (BBB) in senescence-accelerated mice.

Long-Term Binocularity in Accommodative Esotropia

PURPOSE: To find clinical factors related to the long-term outcome of binocularity in accommodative esotropia. METHODS: Forty-nine patients with accommodative esotropia who were followed over 5 years after successful optical alignment within 8 prism diopters of orthophoria at near and distance with glasses including bifocals were included. The patients who had stereo acuity better than 50 seconds/arc and central fusion without suppression scotoma at the final visit were divided into the bifoveal fusion group and the others were divided into the peripheral fusion group. Clinical factors were analyzed between the two groups (Chi-square test, student t-test). RESULTS: Of the 49 patients, 15 patients were included in the bifoveal fusion group and 34 patients were included in peripheral fusion group. Mean follow-up was 88.9 +/- 25.4 months. Clinical factors that were significantly related to the bifoveal fusion group were older age of onset, shorter duration of misalignment, intermittent esotropia at the initial visit and after initial optical correction, smaller residual deviations at distance after initial optical correction and at the final visit, and lesser amblyopia. CONCLUSIONS: To obtain better levels of long-term binocularity, optical correction should be done as early as possible, before the presence of constant eye misalignment or amblyopia, and the residual esodeviations after optical correction should be kept as small as possible.

Multilobular Lacrimal Sac Diverticulum Presenting as a Lower Eyelid Mass

Lacrimal sac diverticulum is a rare condition, and its various symptoms complicate differential diagnosis. We present cases of a peculiar type of lacrimal diverticulum. A 5-year-old girl and a 50-year-old woman presented with a protruding mass inferior to the medial canthus. Each lacrimal system was patent to irrigation. The masses compressed and distorted the lacrimal passage and had no apparent connection with the lacrimal sac in dacryocystography or computed tomography. Surgical exploration and complete excision of the masses were completed. Each patient had an inverted Y- and an inverted V-shaped multilobular cystic mass that was pathologically confirmed as a lacrimal sac diverticulum. Lacrimal sac diverticula may rarely take the form of a multilobular cyst and can present as a lower lid mass. We speculate that an abnormality in lacrimal embryogenesis resulted in multiple blind pouches, a peculiar type of lacrimal sac diverticulum.

Decreased Visual Acuity of Dominant Eye Compared to Amblyopic Eye During Occlusion Therapy

PURPOSE: To investigate the clinical features of patients with decreased visual acuity (VA) of the dominant eye as compared to that of the amblyopic eye during occlusion therapy. METHODS: The authors analyzed clinical features of 28 patients with VA reversed between the two eyes during occlusion therapy among 500 patients treated with occlusion therapy under the diagnosis of monocular amblyopia. RESULTS: Twenty-one patients with strabismic amblyopia (SA), five patients with anisometropic amblyopia (AA) and two patients with combined amblyopia (CA) were enrolled in the present study. Decreased VA of the dominant eye as compared to that of the amblyopic eye occurred 66.75 +/- 83.63 weeks after the onset of occlusion therapy. Reversion of VA between both eyes occurred during amblyopia treatment in 17 patients and during maintenance therapy in 11 patients. The reversed VA was recovered in all patients. The mean duration (MD) of reversed VA was 15.00 +/- 24.43 weeks, and the number of clinic visits (CV) was 4.68 +/- 8.65. In five patients, the MD of reversed VA (59.80 +/- 30.14 weeks, p = 0.016) and the number of CVs (18.40 +/- 14.48, p < 0.001) were significantly longer than those of the other 23 patients (MD of reversed VA: 5.78 +/- 4.04 weeks, number of CV: 1.70 +/- 1.22); those five patients had low compliances and SAs. CONCLUSIONS: Visual acuity was recovered in all patients with decreased VA of the dominant eye as compared to that of the amblyopic eye during occlusion therapy, rapid recovery was observed in most patients except in several patients with low compliance.

Long-Term Visual Outcome Following Cessation of Occlusion Therapy in Unilateral Amblyopia

PURPOSE: To evaluate a long-term visual outcome following cessation of occlusion therapy in unilateral amblyopia. METHODS: A total of 70 patients who successfully finished occlusion therapy (including maintenance therapy) for unilateral amblyopia and were followed up for at least 1 year after cessation of occlusion were retrospectively reviewed. Even after the success of occlusion therapy, maintenance therapy or regular examinations were performed until the visual development of the normal fellow eye (NE) was completed. The recurrence of amblyopia was defined as a 2 or more logarithm of the minimum angle of resolution (LogMAR) levels of visual acuity (VA) reduction of the amblyopic eye (AE), as compared to the NE, at the last evaluation. RESULTS: Amblyopia was associated with strabismus in 19 patients, anisometropia in 33 patients, and both in 39 patients. The mean age at the cessation of occlusion and at the last evaluation was 7.7 +/- 1.9 years and 11.4 +/- 2.9 years, respectively. The mean VA of the AE was 0.01 +/- 0.03 and mean stereopsis was 101.7 +/- 87.5 seconds of arc at the cessation of occlusion, and both improved at the last evaluation. However, the improvement of mean VA of the AE was not statistically significant (p = 0.21). The mean duration of maintenance therapy was 25.6 +/- 21.0 months, and was 3 times longer than the duration required to achieve success in the treatment of amblyopia. At the last evaluation, the recurrence of amblyopia was not found, while 3 patients (4.3%) lost 1 LogMAR level of VA in the AE, as compared to the NE. CONCLUSIONS: Visual outcome following successful cessation of occlusion therapy for unilateral amblyopia was favorable without recurrence of amblyopia.

The Prevalence and Predictive Factors of Deterioration in Accommodative Esotropia

PURPOSE: A number of patients with accommodative esotropia who were initially well controlled with their optical correction will deteriorate. This study aims to examine the cautious clinical features of patients with accommodative esotropia during follow-up period by obtaining the prevalence and the predictive factors of deterioration in accommodative esotropia. METHODS: The records of 89 patients with accommodative esotropia whose eyes were aligned with optical correction (including bifocals) to 8 prism diopters (PD) of esotropia or less were reviewed. All patients were followed for a period of at least 2 years. The patients whose alignment was increased to 10PD of esotropia or greater during the follow-up period were included into the deteriorated group. We obtained the rate of deterioration and compared the clinical features of the deteriorated and controlled group. RESULTS: The mean follow-up period was 64.1+/-29.3 months. Seven (7.8%) of 89 patients was deteriorated. The mean interval of deterioration after initial optical correction was 41.8+/-26.9 months. The stereopsis was significantly worse in the deteriorated group (p=0.024). The frequency of high AC/A ratio was also significantly higher in the deteriorated group (p=0.003). CONCLUSIONS: This study indicates that accommodative esotropia with high AC/A ratio or worse sensory status has an increased likelihood of deterioration.

The Prevalence and Predictive Factors of Deterioration in Accommodative Esotropia

PURPOSE: A number of patients with accommodative esotropia who were initially well controlled with their optical correction will deteriorate. This study aims to examine the cautious clinical features of patients with accommodative esotropia during follow-up period by obtaining the prevalence and the predictive factors of deterioration in accommodative esotropia. METHODS: The records of 89 patients with accommodative esotropia whose eyes were aligned with optical correction (including bifocals) to 8 prism diopters (PD) of esotropia or less were reviewed. All patients were followed for a period of at least 2 years. The patients whose alignment was increased to 10PD of esotropia or greater during the follow-up period were included into the deteriorated group. We obtained the rate of deterioration and compared the clinical features of the deteriorated and controlled group. RESULTS: The mean follow-up period was 64.1+/-29.3 months. Seven (7.8%) of 89 patients was deteriorated. The mean interval of deterioration after initial optical correction was 41.8+/-26.9 months. The stereopsis was significantly worse in the deteriorated group (p=0.024). The frequency of high AC/A ratio was also significantly higher in the deteriorated group (p=0.003). CONCLUSIONS: This study indicates that accommodative esotropia with high AC/A ratio or worse sensory status has an increased likelihood of deterioration.

Comparison of Clinical Appearance of Pediatric Ocular Injury, According to Grade Level

PURPOSE: To compare the causes and clinical manifestations of pediatric ocular injuries according to grade level. METHODS: We retrospectively reviewed the medical records of 78 children, 15 years and younger, who had been hospitalized for pediatric ocular injuries, classified them into three groups according to grade level, and compared their clinical manifestations. RESULTS: Eighteen (23.1%) were preschoolers, 39 (50.0%) were elementary school students, and 21 (26.9%) were middle and high school students. The most common causes of injury included toys and household goods at home in the preschool group, toys and sporting activity at home and school in the elementary school group, and sporting activity at school in the middle and high school group. The incidence of ocular injury was higher in the 'without supervision group' (57.7%); however, in the preschool group, it was higher (72.2%) even in the 'supervision group' (P<0.05). In the preschool group, the incidence of perforating ocular injury (P<0.05) and the rate of surgical treatment (P<0.05) were higher than those of other groups. CONCLUSIONS: The causes and clinical manifestations of pediatric ocular injury were different according to school degree. The incidence of pediatric ocular injuries can be decreased more efficiently by recognizing these differences.

The Frequency and Aspects of Ptosis in Korean Old Age

PURPOSE: To study the frequency and aspects of ptosis in Koreans aged 50 years or older. METHODS: In this study, 377 elderly people visiting retirement center were included. Margin-reflex distance 1 (MRD1) and palpebral fissure (PF) were evaluated with an attempt to eliminate eyebrow elevation. Levator function (LF) was measured with Berke's method. If the measured MRD1 was less than 2 mm, ptosis was diagnosed and its frequency, relation to sex, age, levator function and superior deep sulcus were investigated. RESULTS: There was a correlation between decreasing MRD1, PF and LF with increasing age. Ptosis was observed in 207 subjects (54.9%), and its frequency was augmented as age increased. Although it was not statistically significant, the levator function of those with ptosis (10.0+/-1.9 mm) was lower than those without ptosis (11.3+/-1.9 mm). Questionnaires were administered and 196 respondents (51%) said that their eyelid droop had become more pronounced over time. Among these respondents, 33 (16.1%) indicated that their droopy eyelid causes discomfort by blocking their vision. Their MRD1 was 1.2+/-1.0 mm, which was significantly lower than that of the other 163 respondents (1.8+/-1.1 mm, P<0.05). CONCLUSIONS: Koreans aged 50 years or older showed a very high frequency (54.9%) of ptosis and as age increased, the frequency of ptosis also increased. Surgical correction is recommended when the ptosis causes patient discomfort due to impaired vision.

The Frequency and Aspects of Ptosis in Korean Old Age

PURPOSE: To study the frequency and aspects of ptosis in Koreans aged 50 years or older. METHODS: In this study, 377 elderly people visiting retirement center were included. Margin-reflex distance 1 (MRD1) and palpebral fissure (PF) were evaluated with an attempt to eliminate eyebrow elevation. Levator function (LF) was measured with Berke's method. If the measured MRD1 was less than 2 mm, ptosis was diagnosed and its frequency, relation to sex, age, levator function and superior deep sulcus were investigated. RESULTS: There was a correlation between decreasing MRD1, PF and LF with increasing age. Ptosis was observed in 207 subjects (54.9%), and its frequency was augmented as age increased. Although it was not statistically significant, the levator function of those with ptosis (10.0+/-1.9 mm) was lower than those without ptosis (11.3+/-1.9 mm). Questionnaires were administered and 196 respondents (51%) said that their eyelid droop had become more pronounced over time. Among these respondents, 33 (16.1%) indicated that their droopy eyelid causes discomfort by blocking their vision. Their MRD1 was 1.2+/-1.0 mm, which was significantly lower than that of the other 163 respondents (1.8+/-1.1 mm, P<0.05). CONCLUSIONS: Koreans aged 50 years or older showed a very high frequency (54.9%) of ptosis and as age increased, the frequency of ptosis also increased. Surgical correction is recommended when the ptosis causes patient discomfort due to impaired vision.

Delayed Canaliculoplasty in Unrepaired Canalicular Laceration

PURPOSE: Conjunctivodacryocystorhinostomy with a Jones tube has been the standard treatment for canalicular obstruction secondary to unrepaired canalicular laceration. We sought to evaluate the efficacy of delayed canaliculoplasty with bicanalicular silicone intubation for patients whose canaliculi were not repaired by initial surgery. METHODS: We retrospectively studied the medical records of 4 patients who had bicanalicular obstruction from previous unrepaired canalicular laceration. After careful dissection through the scarred medial canthal region, canaliculoplasty with bicanalicular silicone intubation was performed. The time interval from initial trauma to canaliculoplasty was between 5 months and 10 years. Follow-up periods ranged from 3 weeks to 13 months. RESULTS: All of the canaliculi were reanastmosed. Epiphora disappeared in two, occurred intermittently in one, and persisted in the last at 3 weeks postoperatively. CONCLUSIONS: Delayed canaliculoplasty was functionally effective in three out of four patients. Even though canalicular reconstruction was delayed for a long time, attempting canalicular reconstruction would be recommendable before considering conjunctivodacryocystorhinostomy with a Jones tube.

T-Cell Lymphoma Presenting as Painful Ophthalmoplegia

PURPOSE: To present a case of peripheral T-cell lymphoma presenting as painful ophthalmoplegia. METHODS: A 61-year-old woman presented with a 2-week history of headache and eyeball pain. Examination showed mild exophthalmos, complete ophthalmoplegia, and ptosis of the left eye. Under the impression of nonspecific orbital inflammation, she was treated with oral prednisone with initial response. Two months later, she revisited the clinic with exacerbated symptoms. Anterior orbitotomy and incisional biopsy was performed for the inferior rectus muscle lesion. RESULTS: Histopathologic examination revealed an infiltrate of atypical lymphoid cells between degenerative muscle bundles. It was consistent with peripheral T-cell lymphoma. A metastatic workup was performed without any evidence of extraorbital tumor. The patient was recommended to be treated with chemotherapy, however, refused to take the treatment. The patient died of progression of the disease in a month. CONCLUSIONS: T-cell lymphoma in the orbit can present as painful ophthalmoplegia and take a rapid clinical course. The disease should be regarded as one of the differential diagnosis for painful ophthalmoplegia refractory to corticosteroid therapy.

Changes in Astigmatism after Surgery for Congenital Ptosis

PURPOSE: To determine postoperative astigmatic changes after surgery for congenital ptosis and the astigmatic changes depending on surgical method and to discern cases of postoperatively developed anisometropia or amblyopia. METHODS: Fifty-one patients who underwent surgery due to congenital ptosis were reviewed. Refraction or cycloplegic refraction was conducted preoperatively and 3 to 6 months after surgery to measure astigmatic changes. Astigmatic changes in operated eyes were compared to control eyes. Astigmatic changes were compared depending on surgical method. RESULTS: The mean astigmatism was 1.33+/-1.29D preoperatively and 1.48+/-1.13D postoperatively (P=0.10) and the mean astigmatic change in the ptotic and control eye was an increase in cylinder +0.56+/-0.55D and +0.68+/-0.72D (P=0.37). The mean astigmatic change of patients receiving frontalis sling was +0.57+/-0.67D which was similar to those who received levator resection (+0.56+/-0.50D). Newly developed anisometropia was found in three patients postoperatively due to an increase in astigmatism, but newly developed amblyopia was not found. CONCLUSIONS: The increase of astigmatism by ptosis surgery was not statistically significant and there was no statistically significant difference when accounting for surgical method. However, it is necessary to monitor refractive error carefully in younger patients to prevent amblyopia because postoperative increase of astigmatism can cause anisometropia.

CYP19 Gene Polymorphism in Patients with Endometriosis / 대한산부인과학회지

OBJECTIVE: To explore the association of the CYP19 gene polymorphism with the risk of endometriosis. METHODS: Two hundred seventy-nine women with surgically or histologically diagnosed endometriosis of stages I-IV (ASRM, 1997) were recruited, and two hundred eighteen patients with no evidence of endometriosis by laparoscopy or laparotomy served as control. We analysed the frequency and distribution of a TTTA repeat polymorphism and a 3 bp insertion (I)/deletion (D) polymorphism in intron 4 of the CYP19 gene. RESULTS: Six alleles of the CYP19 gene tetranucleotide repeat polymorphism were found in subjects: from 7 repeats to 13 repeats except 9 repeats. There was no statistically significant difference in the allele distribution of tetranucleotide repeat polymorphism in intron 4 of the CYP19 gene between patients with endometriosis and controls. Also there was no statistically significant difference in the 3 bp insertion (I)/deletion (D) polymorphism in intron 4 of the CYP19 gene between patients with endometriosis and controls. CONCLUSION: These results suggest that tetranucleotide repeat polymorphism and a 3 bp insertion (I)/deletion (D) polymorphism of the CYP19 gene are not associated with the risk endometriosis in the Korean population.

CYP1A1 Gene Polymorphism in Korean Women with Endometriosis / 대한산부인과학회지

OBJECTIVE: To explore the association of the CYP 1A1 gene polymorphism with the risk of endometriosis in a Korean population. DESIGN: Case-control study METHODS: Two-hundred fifty two Korean women with surgically or histologically diagnosed endometriosis of stage I-IV (ASRM, 1997) were recruited, and 203 women with no evidence of endometriosis served as controls. CYP1A1 gene MspI polymorphism was analyzed by polymerase chain reaction (PCR) and restriction fragment length polymorphism analysis. RESULTS: There was no significant difference in the genotype or allele distribution of CYP1A1 gene polymorphism between patients with endometriosis and controls. And when classified by stage, there was also no significant difference in the genotype and allele distribution of CYP1A1 gene MspI polymorphism between patients with stage I-II or stage III-IV endometriosis and controls. CONCLUSION: These results suggest that CYP1A1 gene MspI polymorphism is not associated with the risk of endometriosis in the Korean women.

Eyelid Incision for Dacryocystorhinostomy in Asians

PURPOSE: Dacryocystorhinostomy via an eyelid incision has been described in Western literature. This study was undertaken to confirm that eyelid incision for dacryocystorhinostomy is suitable in Asians, because Asians have anatomic features that differ from those of Westerners. METHODS: We performed dacryocystorhinostomy with an eyelid incision along skin wrinkles or relaxed skin tension lines in 57 eyelids of 49 patients from July 2003 to December 2004. The medical records of the patients were reviewed retrospectively. RESULTS: Postoperative scars were easily camouflaged by wrinkles or relaxed skin tension lines of the eyelid without major complications. CONCLUSIONS: An eyelid incision can be used for dacryocystorhinostomy in Asians, regardless of the lack of a definite lower eyelid crease and the presence of epicanthus.

Surgical Correction for Upper Lid Epiblepharon and Epicanthal Fold in Children

PURPOSE: We evaluated the surgical correction for upper lid epiblepharon and epicanthal fold. METHODS: Epiblepharon repair of the upper lid and epicanthoplasty were performed for patients who had a significant epicanthal fold, by which resultant cilia-cornea touch would be expected of the epiblepharon repair alone. From June, 1998 to February, 2004, 21 patients were operated on and 7 of the patients had Down's syndrome. RESULTS: The mean age of the patients at the time of the surgery was 8.6 years. In all the patients, the epicanthal folds were type 3, according to the Park's classification. Thirteen patients, including Down's syndrome patients, underwent modified Y-V advancement and eight patients underwent root Z-epicanthoplasty. The cilia-cornea touch was relieved in all of the patients except for those with Down's syndrome. Hypertrophic scar was seen in 7 patients with modified Y-V advancement and in 1 patient with root Z-epicanthoplasty until postoperative 3 months. CONCLUSIONS: Epiblepharon repair along with epicanthoplasty was effective in relieving cilia-cornea touch in children with upper lid epiblepharon and significant epicanthal fold. Root Z-epicanthoplasty can be recommended for growing children, considering that it provides moderate degree epicanthal correction and does not leave noticeable scar.

Position-induced Cyclotorsion under Monocular Fixation

PURPOSE: To determine whether cyclotorsion occurs when a patient moves from the seating to supine position fixating with one eye. METHODS: The axis of astigmatism was measured with the handheld automated refractometer (Retinomax K-plus, Nikon, Japan) in 33 eyes having more than -1.0D cylinder in seated and supine positions under monocular fixation. RESULTS: There was a cyclotorsional deviation in 30 eyes (90.90%). Excyclotorsion was shown in 22 eyes (66.67%) and incyclotorsion in 8 (24.24%). Seventeen eyes (51.50%) had a torsional deviation less than 4 degrees, 5 eyes (15.15%) from 5 to 6 degrees, 7 eyes (21.21%) from 7 to 14 degrees and one eye greater than 15 degrees. CONCLUSIONS: Positionally induced cyclotorsion occurs under fixation with one eye simulating refractive surgery. Surgeons should therefore make an effort to align the wavefront measurement to the ablation onto the cornea.