Outcomes after Implantable Contact Lens for Moderate to High Myopia

PURPOSE: To evaluate the efficacy, safety, predictability and subjective symptoms of the implantable contact lens to treat moderate to high myopia. METHODS: A Staar Collamer posterior chamber phakic IOL was implanted in 83 eyes of 44 patients with spherical equivalent -10.10D (-3.87~-19.37D). Uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), refraction, adverse events, subjective quality of vision and satisfaction were evaluated. Mean follow-up was 4.9 months (3~9 months). RESULTS: All patients had a UCVA of 0.7 or better, and 61.4% had UCVA of 1.0 or better. Gains of 2 or more lines of BCVA occurred in 15 eyes (18.1%). Mean spherical equivalent refraction at postoperative 3 months was -0.37D (+0.25~-1.75D) and remained stable. There was no change in cylinder diopters. 81.9% of eyes were within +/-0.5D, and 97.6% were within +/-1.0D of predicted refraction. Glare and halo was observed in 5 eyes (6%) after laser iridotomy, lens flipping in 1 eye (1.2%), corneal edema in 2eyes (2.4%), drug induced ocular hypertension in 4eyes (4.8%). There was no case of cataract, glaucoma, retinal detachment, and lens dislocation. There was significant decrease of pupil diameter at postoperative 1 month and decreased pupil diameter was maintained until the last examination. Generally patient satisfaction was very good. But, some patients reported poor in the category of glare and halo. CONCLUSIONS: ICL implantation had good visual, refractive results, and stability. Long term follow-up is required to confirm the significant complications that do not occur in most patients over time.

Evaluation of the Ocular Cyclotorsion During Laser in Situ Keratomileusis

PURPOSE: To evaluate the presence, degree and direction of ocular cyclotorsion in eyes undergoing laser in situ keratomileusis (LASIK). METHODS: We measured the presence, degree and torsional direction of 161 eyes of 88 patients who underwent LASIK for myopic and hyperopic astigmatism with LADARVision 4000 excimer laser (Alcon Summit Autonomous). Preoperatively, each eye was marked at the 3, 9-o'clock conjunctival area with marking pen under the slit lamp observation with a horizontal beam while the patient was seated upright. After lifting of corneal flap and acquiring of LADARVision4000 auto-tracking system, the presence and torsional direction was confirmed on the computer monitor and the rotational deviation degree was measured from horizontal reference line by software program built in laser computer system before the laser exposure. RESULTS: There was a cyclotorsional deviation in 144 eyes (89%). The counter-clockwise rotation was shown in 99 eyes (69%) and clockwise rotation in 45 eyes (31%). Mean ocular torsional misalignment was 3.8 +/- 2.9 degrees (right eye; 4.7 +/- 2.9 degrees, left eye; 3.5 +/- 2.4 degrees). 85 eyes (53%) had a torsional deviation less than 4 degrees and 5 eyes (3%) had a deviation greater than 10 degrees. CONCLUSIONS: A misalignment of astigmatism axis caused by ocular cyclotorsion was known as a reason of astigmatism undercorrection during LASIK. Thus, preoperative marking on conjunctiva and cyclotorsional axis alignment before laser treatment may reduce the incomplete astigmatism correction in LASIK.

Stress reduction protocol for proper extraction of advanced infected teeth in medically compromised patients: Review of literature & report of cases

Common dental procedures(dental extraction & minor operation) are potentially stress-inducing in many patients, especially medically compromised patients. The body's response to dental stress involves the cardiovascular system(an increase in cardiovascular workload), the respiratory organ and the endocrine system(change in metabolism). To minimize the stress to the medical risk patient, the stress reduction protocol was established. The obtained contents were as follows: (1) Recognize the patient's degree of medical risk (2) Complete medical consultation before dental therapy (3) Schedule the patient's appointment in the morning (4) Monitor and record preoperative and postoperative vital signs (5) Use psychosedation during therapy (6) Use adequate pain control during therapy (7) Short length of appointment: do not exceed the patient's limits of tolerance (8) Follow up with postoperative pain/anxiety control (9) Telephone the higher medical risk patient later on the same day that treatment was given Though the stress reduction protocol above was applied to the dental extraction in medically compromised patients with the advanced infected teeth, the final responsibility for the complications (syncope, bleeding & infection, etc.) in a patient rests with the dentist who ultimately treats him. For the prevention of postextraction complications & poor prognosis, the authors treated the advanced infected teeth with the pulp extirpation, opening drainage through the canal and complete occlusal reduction. The final extraction and wound closure were then done after 1~2 weeks. The final prognosis was comfortable without common complications.

Epidemiology of Risk Factors for Cataract at Chang-Nyung District, Kyung-Nam Province

The epidemiologic study to evaluate the risk factors and types of cataract had been performed in 210 cataract patients and in 103 normal controls at Chang-Nyung District, Kyung-Nam Province, from September 1995 to April 1996, using the slitlamp biomicroscopy and Scheimpflug camera(EAS-1000, Nidek, Japan). All the patients were asked to fill out a questionnaire. The results obtained are as follows: 1. The most common type of cataract in Chang-Nyung District was nucleosclerotic opacity. 2. The dominant jobs were farmer and housewife. 3. The more sunlight exposure and heavy drinker were related to nucleosclerotic opacity and smoking habit also related to peripheral cortical opacity of lens. 4. The patients with diabetes mellitus were related with posterior subcapsular opacity ; those with arthritis related with nucleosclerotic opacity. 5. The patients with long-term use of herb medicine were related with peripheral cortical and nucleosclerotic opacity ; those with corticosteroid related with posterior subcapsular opacity. 6. There was no relationship between cataractogenesis and family history of cataract and parity in female. 7. The patients with nucleosclerotic opacity preferred grain and vegetables and those with posterior subcapsular opacity, fruit, meats and coffee. In conclusion, multi-factors are involved in the cataractogenesis including age, occupation, outdoor working hours, smoking, drinking habits, systemic disease, long-term used drug, family history, parity, favorite food, etc. Each factor is considered to be related to specific type of lens opacity.

A Clinical Evaluation of Removal of Intraretinal Foreign Bodies Through Pars Plana Vitrectomy

Penetrating ocular injuries with intraretinal foreign body(IRFB) are increasing and may result in significant visual morbidity. We evaluated retrospectively 22 eyes of 22 patients who had undergone pars plana vitrectomy for removal of IRFB at Dong-a University Hospital from July 1990 to June 1996. The majority of patients were adult male(95.5%). The nature of all IRFB was magnetic property and the causes of injury were hammering and cutting work(77.3%). Preoperatively, eyes were complicated with vitreous hemorrhage and opacity(59.1%), traumatic cataract(45.%), retinal detachment(36.4%), and corneal opacity(22.7%). Postoperative complications included vitreous hemorrhage and opacity(36.4%), retinal detachment(22.7%), and proliferative vitreoretinopathy(18.2%). In our study, poor visual prognosis was obtained in cases of corneal entrance site, IRFB larger than 2mm in size, IRFB located posterior to equator and IRFB associated with retinal detachment.

Anticataract Effects of Bendazac Lysine on Ultraviolet Induced Rat Cataract Based on Scheimpflug Camera

It has been known that ultraviolet B(UVB) light made an oxidative damage to lens proteins, lipids and nucleic acids to induce lens opacity. The aim of the study was to investigate the effect of bendazac lysine salt (Bendaline) tot the experimental cataract developed by UV irradiation. Forty rats were exposed to 0.1mW/cm2 of UVB radiation in the range 300-320 mm for 24 hours per day. Five control rats were not exposed UVB radiation. During the investigative period, we measured lens opacity with Scheimpflug camera every other week. Rats were divided into 9 groups according to the duration of UV radiation and initial time of bendazac lysine medication. Bendazac lysine was administered orally by 25mg/kg per day for 2 months. The opacities on anterior cortex, nucleus and posterior capsule began to appear 4 months after UVB irradiation. The longer duration of radiation, the more severe opacity of lens was observed, especially at the layers of posterior supranucleus, posterior cortex and posterior capsule and in the opacity area by retroillumination image. After UVB induced cataract was developed, the lens opacity was not changed nevertheless stop the UV irradiation. Lens opacity of bendazac lysine-treated groups was not severer than that of no medication groups. There were less opacities on 4 month irradiated group rather than 6 month irradiated group at the layers of nucleus and posterior cortex and in the opacity area. Anticataract action of bendazac lysine was effective in earlier cataract. In the group of bendazac lysine medication with UVB irradiation on same time, the prophylactic evidence of bendazac lysine was not observed.

Clinical Experiences of Hydroxyapatite Implant

The hydroxyapatite has been used as an orbital implant for reconstruction after enucleation or evisceration. It has been known to be a biocompatible and nontoxic implant with good fibrovascular ingrowth, few postoperative complications, excellent prosthesis motility, and good cosmesis. We performed 36 cases of hydroxyapatite implantation with enucleation or evisceration from July 1992 to August 1994. The mean follow-up period was 7.4 months(range, 4 to 13 months). There were nine cases of implant exposure. three cases of peg extrusion, three cases of superficial conjunctival wound dehiscence, and one case of granulation tissue overgrowth. There was no infection of implant. Improving the postoperative results and reducing the postoperative complications, it requires proper surgical techniques including the selection of adequate implant size and good doctor-patient relationship.

The Effects of Mitomycin C on Trabeculectomy

Mitomycin C (MMC) is an antimetabolite, antibiotic which prevents the proliferation of fibroblast and fibrosis by inhibition of DNA-dependent RNA synthesis. It has been used to increase the success rate of filtering surgery. We performed trabeculectomy and peripheral iridectomy with 0.4 mg/ml MMC application for 3 minutes in poor prognostic glaucoma patient, 26 eyes of 24 patients from February 1992 to December 1994. The postoperative change of intraocular pressure (IOP) and complications were followed up from 3 to 30 months (mean 12.4 months). The preoperative and postoperative mean IOP after 24 months were 32.3 +/- 11.4 mmHg and 12.7 +/- 3.1 mmHg, respectively. The decrease rate of IOP was 60.7% and the success rate was 71.7%. The postoperative complications were 15 eyes including 5 eyes of shallow anterior chamber, 5 eyes of hyphema, 2 eyes of conjunctival wound leakage, one eye of bleb rupture, one eye of choroidal detachment, and one eye of cataract formation.