Evaluation of the Relationship between Incision Location and Change of Posterior Corneal Astigmatism

PURPOSE: To determine if there is a difference in surgically induced astigmatism (SIA) of the posterior corneal surface between superior and temporal incision and its effect on total corneal power in patients who underwent clear corneal incision cataract surgery. METHODS: A retrospective study of 81 patients (84 eyes) who underwent clear corneal incision phacoemulsification by one surgeon. Patients were divided into two groups according to the steep axis: the temporal and superior groups. Anterior, posterior and total corneal SIA (simulated keratometry [Sm K], posterior keratometry [PK] and total corneal power [TCP] respectively) were measured using autorefractive keratometry (ARK) and dual Scheimpflug imaging before and after surgery. RESULTS: There were 61 eyes with temporal incision and 23 eyes with superior incision. The mean SIA was larger in the superior incision group than in the temporal incision group according to ARK, Sm K, PK and TCP (p < 0.05). There were no significant cylindrical changes in ARK in the temporal incision group, however, there was a significant decrease in the superior incision group before and after the operation (p < 0.05). Change in the amount and axis of PK before and after operation were not significantly different, for both incision groups. There was a significant correlation between post-operative TCP and both pre-operative ARK and Sm K for both groups. However, there was no correlation between post-operative TCP and pre-operative PK. In all patients, when pre-operative PK was more than 0.5 D, SIA-ARK, SIA-Sm K and SIA-TCP were all significantly larger than when pre-operative PK was less than 0.5 D, whereas SIA-PK was not. When pre-operative PK was more than 0.5 D, there were no significant differences in SIA-ARK, SIA-Sm K, SIA-PK or SIA-TCP in the temporal incision group. However, SIA-ARK was significantly larger in the superior incision group. CONCLUSIONS: There was no significant cylindrical change in PK before and after operation in both the temporal and superior incision groups. Therefore, when predicting post-operative TCP, it might be meaningful to consider SIA-ARK and SIA-Sm K.

Bilateral Simultaneous Central Retinal Vein Occlusion in a Patient with Waldenstrom's Macroglobulinemia

PURPOSE: The authors report a case of bilateral simultaneous central retinal vein occlusion caused by Waldenstrom's macroglobulinemia. CASE SUMMARY: A 65-year-old man presented to our department complaining of decreased visual acuity for the duration of about 6 months. On his initial visit, best-corrected visual acuity was 0.02 in the right eye and 0.06 in the left eye. Based on the findings of a funduscopic examination, the patient had bilateral diffuse retinal hemorrhages, dilated tortuous veins, and macular edema. He had experienced recurrent spontaneous epistaxis 6 months previously and had undergone treatments such as intravitreal bevacizumab injection and intravitreal dexamethasone implantation at another hospital. Laboratory tests at that hospital showed anemia and hyperproteinemia, for which he was referred to our hemato-oncology department. Bone marrow biopsy was consistent with Waldenstrom's macroglobulinemia/lymphoplasmacytoid lymphoma, and he was treated with systemic chemotherapy. One year after the systemic chemotherapy, his best-corrected visual acuity was 0.15 in the right eye and 0.6 in the left eye. Funduscopy showed decreased bilateral retinal hemorrhages and macular edema. CONCLUSIONS: When simultaneous bilateral central retinal vein occlusion occurs in a patient with no other underlying disease such as hypertension or diabetes, it might be a sign of serum hyperviscosity, and there should be a very high level of suspicion for presence or progression of systemic disease. If such a disease is properly and timely diagnosed, effective early systemic evaluation and therapy can be administered, and it is important to have initial general treatment as well as ophthalmic treatment.

A Case of Term Delivery in Heterotopic Pregnancy following a Natural Conception / 대한산부인과학회지

Heterotopic pregnancy, simultaneous intrauterine and extrauterine gestations, is a relatively rare conditon with an estimated incidence of 1 in 30,000 pregnancies in a natural cycle. But the incidence of heterotopic pregnancies has been increased because of rising incidence of pelvic inflammatory disease, pelvic surgery, intrauterine device, the use of various ovulation induction and assisted reproductive technologies, such as in vitro fertilization and embryo transfer, gamate intrafallopian insemination. The early diagnosis of heterotopic pregnancy is very difficult. So there is a higher maternal morbidity, mortality and fetal loss. Thus careful pelvic examination, combined with serial beta hCG determinations and transvaginal sonography to evaluate the adnexal region are important. We experienced a case of 34-years-old multiparous women with heterotopic pregnancy in natual cycle confirmed by surgical removal of ruptured right tubal pregnancy and sonographic finding of the intrauterine pregnancy, which carried the intrauterine pregnancy to term delivery without complication at 39+5 weeks of gestation, and report this case with a brief review of the literature.

A Case of Primary Cutaneous Endometriosis at the Unbilicus / 대한산부인과학회지

Cutaneous endometriosis seems to be more common in women who have had a pelvic or abdominal operation and primary cutaneous endometriosis is very rare. In our hospital we experienced a 41-year-old woman who complained of the appearance at the umbilicus of a nodule and had not had operation. This nodule was responsible for recurrent pain and increasing in size and it was excised. Pathology findings revealed cutaneous endometriosis. So we present a case of primary cutaneous endometriosis with a brief review of literature.

Differences of Bone Mineral Density between Spine and Hip in Osteoporotic Patients

PURPOSE: To evaluate differences and correlations of spine and hip region BMD in osteoporotic patients with or without spine fracture. MATERIALS AND METHODS: From January 1999 to December 2002, We measured and evaluated BMD of L3 and hip by DXA in 52 patients with spine fracture (fracture group) and 96 osteoporotic patients without spine fracture (non-fracture group) above 60 years. RESULTS: The average age of patients with spine fracture is 72.1 years and without spine fracture is 66.9 years. There were no statistical significant differences of BMD of spine, neck of femur and trochanteric area between 2 groups. But the BMD of Ward triangle of fracture group decreased significantly in statistics. The correlation coefficient between the lumbar spine and trochanteric area were 0.674 in fracture group and 0.794 in non-fracture group. They had statistical significance (<0.01). CONCLUSION: The BMD of Ward triangle of fracture group had lower value, but the BMD of lumbar spine had no differences between 2 groups. Therefore in these persons who have decreased BMD in Ward triangle should be concerned about high vertebral compression fracture risk vertebral compression fracture.

A Comparison of Vertebroplasty Versus Conservative Treatment in Osteoporotic Compression Fractures

PURPOSE: To compare clinical and radiological results between vertebroplasty and conservative treatment in osteoporotic compression fractures of thoracolumbar spine. MATERIALS AND METHODS: 34 patients were reviewed with at least 1 year follow up. Vertebroplasty was used in 14 and conservative treatment was done in 20 fractures. These groups were compared by clinical results which were evaluated by the scoring system according to pain, mobility and analgesic usage at preoperative, postoperative 1 month and postoperative 1 year. And also compared by the increment of kyphosis and loss of vertebral body height in lateral films at the same time. We compared duration of hospitalization between two groups. RESULTS: Vertebroplasty group showed statistically significant less pain and mobility than conservative treatment (p<0.05), but there was no differences in analgesic usage at postoperative 1 year while significant difference at 1 month. In radiological comparison, vertebroplasty showed less increment of kyphosis and loss of body height significantly (p<0.05). Also vertebroplasty group had shorter hospitalization stay significantly (p<0.05). CONCLUSION: Our retrospective analysis demonstrated that vertebroplasty provided significant pain relief, improvement of motion and reduction of analgesic usage and also provided considerable spinal stabilization that prevented further kyphosis and collapse.

A Case Of Ruptured Omental Pregnancy / 대한산부인과학회잡지

Abdomianl pregnancy is rare, occurring 9.2 cases per 1,000 ectopic pregnancies and encountered in 1 in 10,000-25,000 births. Omental pregnancy is extremely rare form of abdominal pregnancy that may cause life-threatening massive hemorrhage in case of rupture. The clinical characteristics is variable and physical examination by itself may be insufficient for diagnosis. Early and accurate diagnosis is necessary to decrease fetal and maternal mortality and morbidity, serious complications. We report a case of ruptured early omental pregnancy with a review of literature.

Clinical Study of cornual pregnancy and comparative Study of Laparoscopic surgery versus Laparotomy / 대한산부인과학회잡지

Most of treatments have been performed laparotomy, but the rapid advances in laparoscopic operative and laboratory techniques and instrument allowed to apply laparoscopic surgery to this disease. We have reviewed 342 cases of ectopic pregnancy from march 1994 to march 2001.The cornual pregnancies were 21 case (6.1%), and the laparoscopic management in 11 cases. The mean gestational age at the time of laparoscopic surgery was 9.1 1.2 (n=11) weeks, and laparotomy was 9.4 1.3 (n=10) weeks. There were no significant difference. The mean operation time of laparoscopic surgery was 72.8 25.5minutes, and laparotomy was 68.3 24.3minutes. The mean hospital days of laparoscopic surgery were 4.9 2.4days, and laparotomy were 6.6 2.3days. In conclusion, laparoscopic surgery can be used as effective and safe as laparotomy for cornual pregnancy.

A Case of Rudimentary Uterine Horn Pregnancy with clinical review / 대한산부인과학회잡지

The pregnancy on the rudimentary uterine horn is uncommon condition, its incidence is reported nearly as 1 case per 100,000 normal pregnancy. We experienced a case of noncommunicating uterine horn pregnancy at 10-gestational week. Here we present the case with brief review of literatures.