Delayed Recovery of Motor Block Following Radiofrequency Ablation of Varicose Veins with Femoral Nerve Block and Tumescent Anesthesia

Femoral nerve block with tumescent anesthesia is used to perform the radiofrequency ablation of varicose veins. The surgery can be done as day-case. But if recovery from motor block is delayed, it can make hospital discharge difficult. Prolonged femoral nerve blocks with motor blockade of the quadriceps have been noted after the use of bupivacaine. The motor blockade lasted up to 30–40 hours when 15–30 mL of 0.5% bupivacaine was used. However, it was rarely reported in ropivacaine. We report that femoral nerve block with 15 mL of 0.375% ropivacaine induced prolonged motor blockade up to 30 hours.

Effect of Cyclosporin A on Tear Film and Corneal Aberration after Cataract Surgery

PURPOSE: To evaluate the efficacy of 0.05% cyclosporine A on tear film parameters and corneal aberration after cataract surgery. METHODS: Patients who underwent cataract surgery were divided into 2 groups. Patients in Group I (23 eyes) were treated with cyclosporine A from 1 week before surgery to 3 months after surgery. Patients in Group II (24 eyes) underwent surgery without cyclosporine treatment. Tear film break-up time (BUT), Schirmer's test I, Oxford scheme, Ocular surface disease index (OSDI), and corneal aberrations were evaluated before surgery and at 1 and 3 months after surgery. RESULTS: In Group I, BUT was significantly improved at 3 months (p = 0.026) after surgery compared with the preoperative value. OSDI decreased significantly at 1 (p = 0.033) and 3 months (p = 0.003) after surgery compared with the preoperative value. However, there were no significant differences between preoperative and postoperative values of BUT and OSDI in Group II. Schirmer's test results and the Oxford scheme were not significantly changed in either group. Preoperative root mean square (RMS) total values were not different between the 2 groups, but was different at postoperative 3 months (p = 0.015). Group I had a significantly lower value for total RMS than Group II. In Group I, Coma 7 (Z3(-1)) (p = 0.018) and spherical aberration (Z4(0)) (p = 0.031) were significantly decreased after surgery. In Group II, Trefoil 6 (Z3(-3)) (p = 0.033) was significantly increased after surgery. CONCLUSIONS: 0.05% cyclosporine A may be effective for improving dry eye syndrome and corneal aberration after cataract surgery.

Two Cases of Laparoscopic Adhesiolysis for Chronic Abdominal Pain without Intestinal Obstruction after Total Gastrectomy

Chronic abdominal pain remains a challenge to all known diagnostic and treatment methods with patients undergoing numerous diagnostic work-ups including surgery. However, the surgical treatment of patients with chronic intractable abdominal pain is controversial. There has been no discussion of the indications for adhesiolysis in cases of obstruction or strangulation of the bowel, and adhesiolysis by laparotomy has never gained acceptance as a treatment modality for chronic abdominal pain. One of the reasons for this lack of acceptance is the high complication rate during and after adhesiolysis. Laparoscopic surgery has been accepted as a technique for diagnostic and therapeutic procedures in general surgery. Laparoscopy allows surgeons to see and treat many abdominal changes that could not otherwise be diagnosed. Here we report two cases of successful symptomatic improvement through laparoscopic adhesiolysis for chronic abdominal pain without intestinal obstruction after total gastrectomy.

Two Cases of Laparoscopic Adhesiolysis for Chronic Abdominal Pain without Intestinal Obstruction after Total Gastrectomy

Chronic abdominal pain remains a challenge to all known diagnostic and treatment methods with patients undergoing numerous diagnostic work-ups including surgery. However, the surgical treatment of patients with chronic intractable abdominal pain is controversial. There has been no discussion of the indications for adhesiolysis in cases of obstruction or strangulation of the bowel, and adhesiolysis by laparotomy has never gained acceptance as a treatment modality for chronic abdominal pain. One of the reasons for this lack of acceptance is the high complication rate during and after adhesiolysis. Laparoscopic surgery has been accepted as a technique for diagnostic and therapeutic procedures in general surgery. Laparoscopy allows surgeons to see and treat many abdominal changes that could not otherwise be diagnosed. Here we report two cases of successful symptomatic improvement through laparoscopic adhesiolysis for chronic abdominal pain without intestinal obstruction after total gastrectomy.

Cataract and Refractive Surgery in ; a Survey of KSCRS Members From 1995~2006

PURPOSE: This purpose of this report was to study trends in cataract and refractive surgeries conducted during the past twelve years and to compare results to previous reports from the ASCRS and New Zealand (NZ) in order to forecast future medical services. METHODS: We surveyed members of the Korean Society of Cataract and Refractive Surgery (KSCRS) every year from 1995 to 2006, and studied changes in cataract and refractive surgeries (RS). RESULTS: The duration of hospitalization has been gradually decreasing to the point that a one day hospitalization following surgery has become common. The rate of topical anesthesia use has significantly increased since 1998. Sutureless incision methods are now commonly practiced. The use of acryl IOL as an optic material has been gradually increasing for cataract surgeries. KSCRS members showed an interest in the special intraocular lenses as multifocal IOL. While Excimer laser PRK was the most popular refractive surgery during the first stage, KSCRS members increasingly prefer LASIK to the Excimer laser PRK. Regression of the corrected visual acuity, dry eye, night halo, and flashes were the most common complications following refractive surgeries. Medical disputes related to PRK and LASIK have been gradually increasing throughout the study period. CONCLUSIONS: We confirm that the KSCRS practice styles for cataract and RS are similar to those of the ASCRS and NZ. We infer a world-wide trend from the comparison of these three societies.

Refractive Surgery 2005 in Korea

PURPOSE: This study investigates the current situation and future trends in the field of refractive surgery in Korea. METHODS: Since 1995, members of the Korean Society of Cataract and Refractive Surgery (KSCRS) have been surveyed annually on cataract and refractive surgery. The 2005 annual survey, consisting of 63 multiple-choice questions, was mailed in June 2005 to 300 KSCRS members. Fifty-four (18.0%) members responded. Current data were compared with those of previous annual surveys and with data from the USA. RESULTS: The highest percentage of patients were in their forties (37%), and LASIK accounted for the highest percentage of refractive surgeries (81%). Of complications arising after refractive surgery, the degeneration of corrected vision after PRK and dry eye syndrome after LASIK accounted for the high proportions. LASIK was preferred for myopia less than -12 diopter, and phakic IOL was preferred for myopia greater than -12 diopter. Almost all respondents answered that the most promising refractive surgery is LASIK or phakic IOL. CONCLUSIONS: This survey summarized the current trends and changes in cataract and refractive surgery in Korea.

Macular Thickness in Healthy Korean Eyes Using OCT3 Comparing with Normative Data

PURPOSE: To determine whether there are significant differences between the retinal thicknesses of the macular area in eyes of healthy Koreans compared with normative data using OCT3 (version 4.0). METHODS: The study was performed in 111 eyes of 71 adults between the ages of 20 and 69 with corrected vision of 0.8 or greater and no systemic or ocular disease. The subject group was designed to have a similar age distribution to that of normative data. An OCT3 fast macular map was used to measure macular thickness. The results were further analyzed and compared with the normative data. RESULTS: The overall results from the subject group were similar to the normative data. However, the nasal parts of the outer ring were thicker than the normative data and the temporal parts of the outer ring were thinner (p<.0001). When each age group was compared, the thickness of the superior part of the inner ring and the nasal part of the inner and outer rings were thicker than the normative data in the age groups of twenties and thirties (p<.05). For the nasal parts of outer ring, the macula were thicker by OCT examination than the normative data in 25.2% of subjects, although they were clinically normal. CONCLUSIONS: Macular thickness in healthy Koreans was generally similar to the normative data of OCT3. However, a slight difference may exist and must be considered when measuring and interpreting macular thickness measurements.

The Effect of Intravitreal Triamcinolone Injection According to the OCT Patterns of Diabetic Macular Edema

PURPOSE: To determine the preoperative factors of different types of diabetic macular edema (DME) classified using Optical Coherence Tomography (OCT) and to evaluate the short-term therapeutic effects and pattern changes of intravitreal triamcinolone acetonide injection (IVTA). METHODS: Seventy-seven eyes of 60 patients, who had been previously diagnosed with DME through fundoscopy and fluorescein angiography, were enrolled, and each patient was classified as one of three DME types according to his/her OCT features: Type 1, diffuse retinal thickening; Type 2, cystoid macular edema; and Type 3, serous macular detachment. We compared age, sex, the duration of diabetes mellitus (DM), and decreased visual acuity (VA). We analyzed VA, intraocular pressure (IOP), foveal thickness (FT), total macular volume (TMV), and pattern changes that occurred between pre-operation and 1 month post-operation. RESULTS: The duration of DM was short in Type 3 DME patients. There were no differences in age or the duration of decreased VA. Pre-operative VA was higher in Type 1 than in Type 2 or 3 patients. FT and TMV increased in thickness from Type 1 through Type 3. VA after IVTA improved in Types 2 and 3. FT and TMV after IVTA decreased in each type. However, the extent of the changes in Types 2 and 3 was greater than that in Type 1. Seventy-four percent of Type 2 and 83% of Type 3 changed to Type 1 after IVTA. CONCLUSIONS: This study found that there were differences in the therapeutic effect of IVTA among patients with different DME patterns. According to our results, the effectiveness of IVTA can be predicted, which we believe will help to objectively determine DME treatment.

The Post-operative Changes of Stereopsis in Adult Strabismus

PURPOSE: To evaluate the postoperative changes of stereopsis after surgical correction of adult strabismus. METHODS: We retrospectively evaluated strabismus patients older than 16 years at the time of operation at our hospital between April of 1999 and December of 2006. We retrospectively examined the medical records of 53 exotropia and 11 esotropia patients. We divided the pre-operative stereopsis into three groups:above 3000 arc of sec, between 3,000 to 100 arc of sec, and below 100 arc of sec. We analyzed the correlation between the post-operative status of stereopsis and the pre-op type of strabismus, the onset and duration of strabismus, and the presence or absence of amblyopia. RESULTS: In patients who had pre-op stereopsis above 3,000 arc of sec, 31.6% showed improvement, whereas 77.8% of patients who had pre-operative stereopsis between 3,000~100 showed improvement; this value was 89.5% for patients with pre-operative stereopsis below 3000. 94.5% of patients in the intermittent exotropia group who had a good pre-operative stereopsis condition showed postoperative improvement and maintenance. For those patients with poor stereopsis at pre-operative, 32.2% of patients with exotropia and 18.1% of patients with esotropia showed improvement. Stereopsis decreased when consecutive esotropia occurred. CONCLUSIONS: This study showed deterioration of stereopsis in patients with consecutive esotropia. Post-operative stereopsis was correlated with the pre-operative stereopsis status and with the type of strabismus. No other factors that we examined were correlated with stereopsis. Post-operative stereopsis in exotropiaand intermittent exotropia were better than esotropia and constant exotropia.

A Case of Leiomyosarcoma of the Conjunctiva

PURPOSE: We describe a very rare the leiomyosarcoma that developed in the conjunctiva. METHODS: A 59-year-old man was treated at another hospital two months before presenting to our institution. He had not gotten any better and so was admitted to our hospital. He had normal visual acuity and intraocular pressure. However, we found a geographic, highly vascularized mass involving the corneal limbus in the medial bulbar conjunctiva, from which a pterygium had been removed a year previously. An excision of the mass was carried out to detect a suspected conjunctival intraepithelial neoplasm. RESULTS: Tissue obtained from operation had cells with thin nuclei, spindle cells with pleomorphic cigar-shaped nuclei and eosinophilic cytoplasm, atypical cells, and from four to five mitotic figures under ten high power field. In immunohistochemical staining, Vimentin, Smooth muscle actin (SMA), Desmin, CD68 stained positively and cytokeratin, Cam5.2, S-100, HMB-45, CD 34 stained negatively. We found no clues of other origins from the general physical examination. Considering these factors, we conclude that this was a Stage I, G2T1aN0M0 leiomyosarcoma with moderate differentiation. CONCLUSIONS: Analysis by immunohistochemical staining is necessary to detect leiomyosarcoma in the conjunctiva, as it is very rare and hard to diagnose by the histologic method alone. We report a leiomyosarcoma of the conjunctiva after pterygium excision, and suggest that it be considered a differential diagnosis of conjunctival masses, even though it is very rare.