The Effect of Intravitreal Triamcinolone Acetonide and Bevacizumab Injection on Intraocular Pressure

PURPOSE: To compare intraocular pressure (IOP) changes after intravitreal triamcinolone acetonide versus bevacizumab injection. METHODS: IOP was measured in 40 patients who received an intravitreal injection of 0.1 ml triamcinolone and 40 patients who received 2 consecutive intravitreal injections of bevacizumab (0.05 ml and 0.1 ml). Patients were divided into three groups : 0.1 ml triamcinolone group (0.1 IVTA group), 0.05 ml bevacizumab group (0.05 IVB group), and 0.1 ml bevacizumab group (0.1 IVB group). IOPs were compared within groups at different time points (before, 1 day after, and 30 days after the injection) and between groups at the same time points. RESULTS: In the 0.05 IVB and 0.1 IVB groups, IOP at 1 day after injection was significantly lower than before injection (P< 0.01, P = 0.03), and IOP at 30 days after injection was significantly higher than IOP at 1 day after injection (P < 0.01, P < 0.01). In the 0.1 IVTA group, IOP at 30 days after injection was significantly higher than before injection (P = 0.01). Between groups, IOP at 1 day after injection in the 0.05 IVB group was significantly lower than IOP in the 0.1 IVTA group (P = 0.03). CONCLUSIONS: IOP was decreased at 1 day after intravitreal bevacizumab injection, whereas in intravitreal triamcinolone acetonide IOP elevation persisted after 1 month.

Learning Curve for a Laparoscopic Appendectomy by a Surgical Trainee

PURPOSE: The laparoscopic appendectomy has been a basic part of the principal of a more complex laparoscopic technique for the surgical trainee. As the number of laparoscopic appendectomies performed by surgical trainees has increased, we are trying to check the stability of, which is controversial, and the learning curve associated with a laparoscopic appendectomy. METHODS: We studied the demographics, histologic diagnoses, operative time, the number of complicated cases, and hospital duration of one hundred and three patients who underwent an open appendectomy (group A, 53) or a laparoscopic appendectomy (group B, 50) retrospectively through a review of their medical records. The learning curve for the laparoscopic appendectomy was established through the moving average and ANOVA methods. RESULTS: There were no differences in the operative times (A, 64.15 +/- 29.88 minutes; B, 58.2 +/- 20.72 minutes; P-value, 0.225) and complications (A, 11%; B, 6%; P-value, 0.34) between group A and group B. Group B was divided into group C who underwent the operation in the early period (before the learning curve) and group D who underwent the operation in the later period (after the learning curve). The average operative time for group C was 66.83 +/- 21.55 minutes, but it was 45.25 +/- 10.19 minutes for group D (P-value < 0.0001). Although this difference was statistically significant, no significant difference in the complication rate was observed between the two groups. CONCLUSION: A laparoscopic appendectomy, compared with an open appendectomy, performed by a surgical trainee is safe. In this study, the learning curve for a laparoscopic appendectomy was thirty cases.

Analysis of Factors Affecting the Change in Axial Length of Premature Infant's Eye

PURPOSE: To analyze the effect of presence with or absent of retinopathy of prematurity (ROP) and its stage, birth weight, conceptual age and associated diseases on the axial length of premature infants' eye. METHODS: A total of 102 eyes of 51 premature infants less than 36 weeks of conceptual age were evaluated in this study. Fundus examination for ROP and axial length measurement were conducted at 40, 52 and 64 weeks of postconceptual age. The medical records were reviewed retrospectively. Independent t-test analysis, simple regression analysis, and one-way ANOVA were performed to assess the influence of each factor on axial length. RESULTS: The mean axial length at 40, 52 and 64 weeks were 17.35, 18.80 and 19.78 mm, respectively. The mean axial length with and without ROP at 40 weeks were 17.10 mm and 17.54 mm, respectively, which were statistically significant (p=0.000). There was a significant decrease in axial length at 40 weeks in the higher ROP stage (p<0.05). Axial length and birth weight showed positive correlation with statistical significance at 40 weeks, while these parameters showed no significant correlation at 64 weeks. Axial length and conceptual age showed a positive correlation with statistical significance at 40 weeks (p=0.000), yet a negative correlation at 64 weeks with no statistical significance (p=0.306). A significant difference was not observed between sex and the associated diseases. CONCLUSIONS: The factors that affect the axial length of an infants'eye at 40 weeks were ROP and its stage, birth weight, and conceptual age. Additionally, there was no significant relationship between sex and the associated diseases.

Structural and Functional Relationships in Glaucoma Using Standard Automated Perimetry and the Humphrey Matrix

PURPOSE: To evaluate and compare correlations between structural and functional loss in glaucoma as assessed by optical coherence tomography (OCT), scanning laser polarimetry (GDx VCC, as this was the model used in this study), standard automated perimetry (SAP), and the Humphrey Matrix (Matrix). METHODS: Ninety glaucomatous eyes identified with SAP and 112 eyes diagnosed using Matrix were independently classified into six subgroups, either S1/M1 (MD>-6dB), S2/M2 (-12

Comparison Between Dynamic Contour Tonometry and Goldmann Applanation Tonometry

PURPOSE: To compare the intraocular pressures (IOPs) measured by dynamic contour tonometry (DCT) and Goldmann applanation tonometry (GAT), and to investigate the association of IOPs on eyes of varying central corneal thickness (CCT). METHODS: In this prospective study, 451 eyes of 233 subjects were enrolled. IOPs were measured by GAT and DCT. CCT was measured three times and the average was calculated. Each eye was classified into one of three groups according to CCT: low CCT (group A, CCT550 micrometer, n=142). In each group, we investigated the association of CCT with IOP measurement by GAT and DCT. RESULTS: The IOPs measured by GAT and DCT were significantly associated for all eyes (R=0.853, p<0.001, Pearson correlation). CCT was related with both IOP measurement by GAT and DCT with statistical significance (mixed effect model, p<0.001). However, subgroup analysis showed that CCT affected IOP measured by GAT for groups B and C, whereas it affected IOP measured by DCT only for group C. CONCLUSIONS: IOP measured by DCT was not affected by CCT in eyes with low to normal CCT, whereas this measurement was affected in eyes of high CCT range. CCT may have less effect on IOP measurements using DCT than those obtained by GAT, within a specified range of CCT.

Twenty-Four Hour Blood Pressure Pattern in Patients With Normal Tension Glaucoma in the Habitual Position

PURPOSE: To investigate the relationship between blood pressure (BP) parameters in the habitual position and glaucomatous damage at initial presentation in patients with untreated normal tension glaucoma (NTG). METHODS: Fifty-four eyes from 54 subjects diagnosed with NTG were consecutively enrolled. BP was measured with an automated ambulatory monitoring device in the habitual position during 24-hour in-hospitalization. Patients were classified into three groups: non-dippers, dippers, and over-dippers. corresponded to the degree of reduction in their nocturnal mean arterial pressure (MAP) compared with their diurnal MAP. Regression models were used to evaluate potential risk factors, including: age, pre-admission office intraocular pressure (IOP), central corneal thickness (CCT), and BP parameters. Functional outcome variables for glaucomatous damage included mean deviation (MD) and pattern standard deviation (PSD) on a Humphrey field analyzer (HFA). Anatomic outcome variables were TSNIT score (temporal, superior, nasal, inferior, and temporal) average, superior average, inferior average, and nerve fiber indicator (NFI) score on scanning laser polarimetry with variable corneal compensation (SLP-VCC; GDx-VCC). RESULTS: Marked systolic blood pressure (SBP), diastolic blood pressure (DBP), and MAP fluctuation were noted in the over-dipper group (p<0.05). A linear regression analysis model revealed that nocturnal trough DBP and MAP, average nocturnal SBP, and MAP were all significantly associated with a decreased average TSNIT score and an increased NFI score. CONCLUSIONS: Nocturnal BP reduction estimated in the habitual position was associated with structural damage in eyes with NTG. This finding may suggest systemic vascular etiology of NTG development associated with nocturnal BP reduction.

Surgical Results in Duane Retraction Syndrome

PURPOSE: To report the clinical characteristics and the results of a series of patients treated with various strabismus surgery techniques for Duane retraction syndrome (DRS). METHODS: Thirty-eight patients with DRS undergoing surgical treatment were retrospectively reviewed. In all patients, ocular alignment, abnormal head posture and ocular motility disturbance were assessed both preoperatively and postoperatively. The patients were treated with appropriate horizontal muscle recession, Y-splitting combined with horizontal muscle recession, medial rectus recession and lateral rectus resection. RESULTS: The incidence of DRS was greater in females and in the left eye. Type 1 was the most common, and esodeviation was seen most frequently in the primary position. The esotropic patients with DRS turned their faces toward the affected eyes, while the exotropic patients with DRS turned away from the affected eyes. The deviation in the primary position was reduced from an average of 15.0 prism diopters (PD) to 1.5PD. The face turn was reduced from an average of 17.5 degrees to 1.2 degrees. CONCLUSIONS: The primary deviation and abnormal head posture found in DRS can be improved by proper preoperative evaluation and adequate choice of surgical methods.

Performance of Humphrey Matrix Frequency Doubling Technology Perimetry and Standard Automated Perimetry Global Indices

PURPOSE: To evaluate and compare the diagnostic performance of Humphrey Matrix frequency doubling technology perimetry (Matrix) global indices with standard automated perimetry (SAP) for glaucoma discrimination. METHODS: Forty-seven healthy and 63 glaucomatous subjects were included in this study. Glaucoma was defined as having glaucomatous optic disc and glaucomatous visual field defect. Correlations of mean deviation (MD) and pattern standard deviation (PSD) between Matrix and SAP were evaluated. Areas under receiver operating characteristic curves (AUCs) for discriminating healthy from glaucoma, sensitivity, and cut-off value at fixed specificity of MD and PSD were determined in Matrix and SAP. RESULTS: MD and PSD from Matrix were highly correlated with SAP data in glaucomatous eyes (r=0.80, 0.69 p<0.001, <0.001). The AUCs of MD and PSD from Matrix (0.941, 0.921) were of comparable diagnostic capability to SAP data (0.876, 0.923, p=0.068, 0.927). The sensitivity at 90% specificity of MD was 67.9% in SAP, 76.4% in Matrix, with the cut off value of MD at 90% specificity at -3.10dB in SAP and -3.72dB in Matrix. CONCLUSIONS: MD and PSD data from Matrix and SAP significantly correlated in glaucomatous eyes and showed similar diagnostic performance for discriminating healthy from glaucoma however, both MD and PSD are scaled differently on SAP and Matrix, which suggests that application of these parameters in a manner similar to that used in SAP should be employed with caution.

Effects of Amniotic Membrane after LASEK on Epithelial Healing, Clinical and Refractive Outcomes

PURPOSE: To evaluate the effect of amniotic membrane (AM) on the outcome of laser subepithelial keratomileusis (LASEK). METHODS: One hundred fifty-two eyes of 84 patients with myopia or myopic astigmatism were evaluated. Following LASEK, AM was placed on the inferior limbus as a strip in 94 eyes of 54 patients. Fifty eight eyes of 30 patients served as control. Postoperative epithelial healing time, uncorrected visual acuity (UCVA), best spectacle corrected visual acuity (BSCVA), manifest refraction and corneal haze were examined in both groups. RESULTS: AM-treated group showed shorter reepithelialization time (2.40 +/- 0.94 days vs 3.90 +/- 0.97 days, p<0.001) after LASEK. At 6 months, 48 eyes (82.8%) and 53 eyes (91.4%) of control group had a UCVA of 20/25 and 20/40 or better respectively. In AM-treated group, 86 eyes (91.5%) had 20/25 or better and 90 eyes (95.7%) had 20/40 or better. Mean spherical equivalents (SE) was 0.480.54 diopter (D) vs -0.94 +/- 0.60D (p<0.001). The corneal haze was significantly less in the AM-treated group than in the control group (p<0.001). CONCLUSIONS: The use of AM after LASEK induced rapid epithelial healing with more favorable visual and refractive outcome and reduced score in corneal haze, compared with conventional LASEK.

Kearns-Sayre Syndrome: 3 Case Reports and Review of Clinical Feature

Kearns-Sayre syndrome, first described by Kearns and Sayre in 1958, is a rare disorder consisting of ptosis, limited movement of both eyes and atypical retinal pigmentary change (salt-pepper like appearance). Most cases have shown an increase in the concentration of mitochondria and ragged-red fiber under Gomori-trichrome staining on muscle biopsy. Occasionally, it is combined with other neurologic and endocrinologic symptoms such as ataxia, dementia, diabetes, and hyperaldosteronism. We recently experienced three cases of male teenaged patients who expressed the clinical features of Kearns-Sayre syndrome.

The Change of Contrast Sensitivity in Amblyopic Patient after Occlusion Therapy using ACV

PURPOSE: This study was designed to evaluate the change of contrast sensitivity under the photopic and mesopic illumination in amblyopic patient after occlusion therapy. METHODS: The subjects comprised 32 pediatric patients with strabismic or anisometropic amblyopia who were followed up at the clinic. We measured the best corrected visual acuity and contrast sensitivity under the photopic and mesopic illumination using ACV instrument before and three months after occlusion therapy. RESULTS: Mean best corrected visual acuity of amblyopic eyes before occlusion therapy was 0.54 +/- 0.21. In 17 eyes with improvement in best corrected visual acuity (mean: 0.21 +/- 0.05), there was improvement in photopic and mesopic contrast sensitivity (p0.05). CONCLUSIONS: From above mentioned results, we can conclude that the contrast sensitivity using ACV instrument is responsive to short term (three months) occlusion therapy for amblyopic eyes.

Classification of Human Papillomavirus (HPV) Risk Type via Text Mining

Human Papillomavirus (HPV) infection is known as the main factor for cervical cancer which is a leading cause of cancer deaths in women worldwide. Because there are more than 100 types in HPV, it is critical to discriminate the HPVs related with cervical cancer from those not related with it. In this paper, the risk type of HPVs using their textual explanation. The important issue in this problem is to distinguish false negatives from false positives. That is, we must find high-risk HPVs as many as possible though we may miss some low-risk HPVs. For this purpose, the AdaCost, a cost-sensitive learner is adopted to consider different costs between training examples. The experimental results on the HPV sequence database show that the consideration of costs gives higher performance. The improvement in F-score is higher than that of the accuracy, which implies that the number of high-risk HPVs found is increased.

A Clinical Study of Stroke in Chronic Renal Failure

The clinical characteristics arld prognosis of stroke were observed on 37 patients (25 men and 12 women) with chronic renal failure (CRF), who were admitted to Keimyung University Dongsan Hospital from Jan. 1984 to Aug. 1991. The results were as follows: 1. Their mean age was 50 years and the peak incidence was in the 5th and 6th decades. Male to female ratio was 2.1:1. 2. The stroke was complicated in 23 patients(2.0%) arnong 1179 hemodialized ones, and the mean duration of hemodialysis before attack of stroke was 15.7 months (1 week 46 months). 3. The causative renal diseases of CRF patients were as follows: 29 chronic glomerulonephritis, 6 hypertensive and 2 diabetic nephrosclerosis. 4. The major risk factors of stroke were hypertension, smoking, old age, hypercholesterolemia and it was suggested that heparin administration was also important factor in hemodialysis group. 5. The types of stroke were as follows: 11 intracerebral hemorrhage, 3 subdural hematoma, 2 subarachnoid hemorrhage and 4 cerebral infarction in hemodialysis group, and 6 cerebral infarction. 4 intracerebral hemorrhage, 2 subarachnoid hemorrhage and 1 transient ischemic attack in conservative treatment group. 6. The stroke was the most common cause of death in hemodialysis group. 7. The mortality rate of stroke was 82.6% in hemodialysis group and 7.1% in conservative treatment group.

The Findings of Cerebrospinal Fluids in 338 parients with Syphilis / 대한피부과학회지

We examined cerebrospinal fluids of 338 patients with syphilis who underwent the routine physical examinations or visited out-patient skin clinic at Kyunghee University hospital from January, 1978 to December, 1979. They were diagnosed as syphilis only with serological tests such as VDRL and TPHA tests. The patients did not have any neurologic symptoms associated with syphilis or any other clinical syphilitic syrnptoms. They did not have any history of receiving antisyphilitic treatment. The VDRL test, cell count, protein value, sugar and chloride levels in cerebr-ospinal fluid were tested in these patients. The results were as follows. 1) CSF VDRL reactive rate was 2. 1% among 388 patients with syphilis. 2) CSF celI count was not less than 5/mm in 2 patients (28. 6%) among the 7 patients with syphilis, who showed the positive reactivity of CSF VDRL, and in 13 patients (3. 9%) among the 331 patients with syphilis who did not show the positive reactivity of CSF VDRL. 3) CSF protein level was more thnn 45ml/dl in 3 patients (42. 9%) among the 7 patients with syphilis who showed the positive reactivity of CSF VDRL anct ig, 65 patients (19. 6%) among the 331 patients with syphilis who did not show the positive reactivity of CSF VDRL. 4) Both CSF sugar and chloride levels were within norrnal limits in all of the 7 patients who showed the positive reactivity of CSF VDRL.

Syphilis Prevalence in Young Men who want Oversea Employment / 대한피부과학회지

Serologic tests for syphilis, including the qualitative and quantitative VDRL test and TPHA test, were carried out on 18, 151 healthy young men, who took a medical check-up for the overseas employment at Kyunghee University Hospital from April, 1978 to February, 1979. The syphilitics who revealed TPHA reactive, were given a questionare that dealt with three items. The results are summarized as follows. 1) The reactive rate of VDRL test was 3. 1% among 18, 151 healthy young men, 2) The biologic false positive rate of VDRL test was 7. 7% among the 520 men in whom TPHA test was carried out, using TPHA as standard. 3) The reactive rate of TPHA test was 2. 7% among 18, 109 men. On 42 men the TPHA test was not carried out. 4) With regard to the VDRL quantitative test, the reactive rate of the group with a titration of 1: 4 or lower was 85,2% out of 480 syphilitics. 5) In 480 syphilitics, 45. 8% (220) had a history of venereal 72.3%(347) had no general knowledge of syphilis, and 86. 2% (414) was unaware of his syphilitic infection.

A Case of Subcutaneous Dermoid Cyst / 대한피부과학회지

Authors observed one case of subcutaneous dermoid cyst which did not seem to have been described in the Korean literature. A 11 year old female patient complained of a asymptomatic mass near the left sternoclavicular joint in January 1978. The mass was discovered at the age of 5 when that was pea-sized and had been slowly growing. In January 1978, the mass was palpable as a peanut-sized subcutaneous solitary round mass, and overlying skin was freely movable and slightly elevated. There was no trauma history and family history was negative except her elder sister had a, axillary accessory breast. Histopathologic studies revealed a keratinizing stratified squamous epithelium lining the cystic wall, and sebaceous glands, hair follicle and eccrine glands in the surrounding tissues, and keratinous materials in the cyst. There was no evidence of malignancy. Diagnosis was confirmed by clinical features and histopathological findings, and surgical excision of tumor mass was performed.