A Case of Secondary Macular Hole Formation after Phacoemulsification in a Vitrectomized Eye

PURPOSE: To report a case of secondary macular hole formed after phacoemulsification in a vitrectomized eye which was treated with macular hole surgery. CASE SUMMARY: A 53-year-old man with a history of pars plana vitrectomy developed a cataract in his left eye. Uncomplicated cataract surgery involving phacoemulsification with posterior chamber intraocular lens implantation was performed. At his routine 3-month post-operative visit, he reported metamorphopsia. Fundus examinations and optical coherence tomography revealed a cystoid macular edema and a full thickness macular hole. He underwent repair of the macular hole including internal limiting membrane peeling and gas injection. Three months later, post-operative examinations showed anatomical closure of the macular hole. CONCLUSIONS: When performing cataract surgery, even in a previously vitrectomized eye, clinicians should be aware of the possibility of cystoid macular edema. A thorough pre- and post-operative assessment, including fundus examinations and optical coherence tomography must be carefully performed in order to detect a macular hole associated with cystoid macular edema. And prompt treatment is required when a macular hole is detected.

A Case of Secondary Macular Hole Formation after Phacoemulsification in a Vitrectomized Eye

PURPOSE: To report a case of secondary macular hole formed after phacoemulsification in a vitrectomized eye which was treated with macular hole surgery. CASE SUMMARY: A 53-year-old man with a history of pars plana vitrectomy developed a cataract in his left eye. Uncomplicated cataract surgery involving phacoemulsification with posterior chamber intraocular lens implantation was performed. At his routine 3-month post-operative visit, he reported metamorphopsia. Fundus examinations and optical coherence tomography revealed a cystoid macular edema and a full thickness macular hole. He underwent repair of the macular hole including internal limiting membrane peeling and gas injection. Three months later, post-operative examinations showed anatomical closure of the macular hole. CONCLUSIONS: When performing cataract surgery, even in a previously vitrectomized eye, clinicians should be aware of the possibility of cystoid macular edema. A thorough pre- and post-operative assessment, including fundus examinations and optical coherence tomography must be carefully performed in order to detect a macular hole associated with cystoid macular edema. And prompt treatment is required when a macular hole is detected.

A Case of Bilateral Pneumoparotitis in the Children / 대한이비인후과학회지

There are multiple causes of acute parotid swelling, including tumors, viral and bacterial infections, enlargement accompanying connective tissue and obstruction to salivary flow. A rare but well-documented cause of parotid swelling is pneumoparotitis. This is a condition in which there is insufflation of air into the acini of the parotid gland via Stensen's duct. The air may rupture through the parotid capsule, spread into the subcutaneous tissues of the face and neck, and even cause pneumomediastinum. We present a case of pneumoparotitis caused by flute playing. The clinical presentation, proposed pathophysiology, diagnosis and management of this rare condition are presented and discussed.

The Usefullness of Ultrasonography in the Treatment of Zygomatic Arch Fractures / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The zygomatic arch of midface is related to facial contour between skull base and zygomatic bone. The inadequate reduction of zygomatic arch fractures induces cosmetic problems like facial asymmetry and functional problems like limitation of mouth opening. Therefore, the correct diagnosis and adequate treatment of zygomatic arch fractures are needed in early stage and the correct evaluation of repositioned fragment during operation is important for the recovery of cosmetic and functional problem. The aim of this study is to estimate the value of ultrasonography as an intraoperative repositioning monitor in the reduction of zygomatic arch fractures. SUBJECTS AND METHOD: In the period from March of 2005 to October of 2006, 11 patients who had underwent ultrasonography guided reduction for zygomatic arch fractures were selected for clinical analysis. We repositioned depressed bony fragments via Gillies approach and evaluated continuously the repositioned state of bony fragments during operation using ultrasonography with 7.5 MHz linear transducer. RESULTS: There were 10 men and one woman, ranging in age from 19 to 74 years. All patients had chief complaints for trismus and pain of affected site and on physical examination, facial swelling, tenderness and depression of affected site were observed. In postoperative photographs and computed tomography scans, which were checked after postoperative 3 months, all patients showed good facial contour, well stabilized bony fragments and good alignment of zygomatic arch. CONCLUSION: The authors suggest that ultrasonography is a very useful tool for the treatment of an intraoperative repositioning monitory of zygomatic arch fractures.

The Stabilizing Method of Zygomatic Arch Fracture Using Aqua Splint Suture Technique / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The zygomatic arch is the bony arch on both sides of the face consisting of the zygomatic bone. The zygomatic fractures are common maxillofacial injuries second only to nasal fractures due to its anatomical location of its structures. Various techniques have been applied for the treatment of zygomatic arch fractures but there is no desirable modality not only for the reduction but also for supporting depressed bony fragments without esthetic problems. The authors suggest aqua splint suture method, which is a new modality for the treatment of zygomatic arch fractures. SUBJECTS AND METHOD: In the period from March of 2004 to March of 2005, nine patients who had been performed reduction for zygomatic arch fractures were selected for clinical analysis. We repositioned depressed bony fragments by Gillies approach and stabilized repositioned bony fragments by external & internal fixation using aqua splint suture method. RESULTS: There were eight men and one woman, ranging in age from 19 to 68 years. All patients had chief complaints for trismus and facial deformities. Postoperative photographs and computed tomography, checked after 3 postoperative months, showed that all patients had the good facial contour and well stabilized bony fragments. CONCLUSION: The authors suggest that aqua splint suture method is a very simple, quick & effective technique for stabilizing repositioned zygomatic arch fractures.

A Case of Oroantral Fistula Complicating Fungal Sinusitis

Maxillary sinusitis of dental origin is a rare entity when compared to sinus diseases of rhinogenic origin. It may be caused by the following : oroantral fistula, foreign bodies, periapical granulomas or small inflammatory cysts, and odontogenic cysts occupying the maxillary sinus. In rare cases, antral aspergillosis, following tooth extraction or endodontics, results in symptoms of localized pain, tenderness, and nasal discharge. However, unlike most fungal diseases, aspergillosis is often found without predisposing systemic factors. In such cases, local factors usually predispose patients to this opportunistic infection. More recently, many cases are reported to have been discovered inadvertently after an endoscopic sinus surgery. We experienced a case of fungal sinusitis subsequent to an oroantral fistula following a tooth extraction that was repaired with a simple closure and treated via an endoscopic approach. So we are reporting it with the review of the literature.

A Case of Cancer-Associated Retinopathy with Small Cell Lung Cancer

PURPOSE: To report a case of cancer-associated retinopathy developed in a patient with small cell lung cancer, which is a kind of paraneoplastic syndrome. METHODS: A 78-year-old woman presented complaining of decreased visual acuity and visual field that had developed about 15 days previously. She was diagnosed with small cell lung cancer 1.5 years ago and underwent 3 cycles of chemotherapy. At presentation, the best-corrected visual acuity was hand motion in both eyes and there was no afferent pupillary defect. Slit-lamp biomicroscopic examination revealed no specific abnormality in the anterior segment of either eye, and intraocular pressure was normal. Posterior segment examination demonstrated remarkable arteriolar narrowing in both eyes, but there was little doubt about the presence of an optic nerve lesion such as optic disc edema or pallor. RESULTS: Fluorescein angiography and brain magnetic resonance imaging (MRI) revealed no significant abnormalities. However, electroretinograms (ERG) demonstrated marked reduction in the a and b waves. Visual evoked response was delayed for the latency period. She was treated with systemic steroid, after which her visual acuity gradually improved.

Inadvertent Ocular Perforation during Lid Anesthesia for Hordeolum Removal

PURPOSE: Ocular perforation during lid anesthesia is rarely reported. We describe here a case of inadvertent corneal perforation and traumatic cataract that occurred during lid anesthesia in a procedure for hordeolum removal. METHODS: A 33-year-old woman presented with a sudden visual loss of her left eye. She had undergone hordeolum removal the day before at a local clinic. On ophthalmologic examination, the cornea was perforated and the lens cortex was extruded into the anterior chamber. After cataract removal and IOL implantation, antibiotics were injected into the vitreous. RESULTS: Her final visual acuity of the left eye was 20/20. Postoperative specular microscopic examination revealed a normal-range endothelial cell count, coefficient of variation, and hexagonality despite the intracameral lidocaine injection. CONCLUSIONS: Anesthetic injection of an infected lid should be done with great caution. Although there are possibilities of corneal endothelial toxicity and endophthalmitis in case of intracameral lidocaine injection through the infected lid, yet proper management may save the patient's vision without complications.

The Usefulness of Duochrome Test for Prevention of Overcorrection in Refraction Tests of Myopic Children

PURPOSE: This study investigates the usefulness of the duochrome test for the prevention of overcorrection in refraction tests of myopic children. METHODS: This prospective study comprises 44 subjects (88 eyes, aged 6 to 10 years) with simple myopia and best-corrected visual acuity of 20/20. After the manifest refraction (MR) was measured with an autorefractometer (KR-8100, Topcon), the refractive error of the duochrome test (DR) was measured at the end point when targets of red and green appeared equally clear. The cycloplegic refraction (CR) was then measured. A statistical analysis and comparison of MR, DR, and CR were conducted using a paired t-test. With strabismus, amblyopia and astigmatism (>or=0.5D), it was excluded. RESULTS: The mean age of the subjects was 8.7+/-1.70 years (range, 6 to 12 years). Mean refractive errors found by MR, DR, and CR were -1.9D+/-0.89 (range, -0.75 to -4.75D), -1.5D+/-0.83, -1.5D+/-0.85 in the right eye, respectively. Those found by MR, DR, and CR in the left eye were -2.0D+/-0.79 (range, -0.75 to -4.75D), -1.7D+/-0.76, and -1.6D+/-0.77, respectively. Differences in the refractive errors of MR and DR, MR and CR were statistically significant (p=0.000, p=0.000 respectively), but there was no statistically significant difference between the refractive errors of DR and CR.(p=0.102) CONCLUSIONS: We found the duochrome test to be an easy and simple method to prevent overcorrection of myopia.

Epidemiologic Studies of Keratoplasty in Korea

PURPOSE: To report an epidemiologic study of keratoplasty in which we analyze basic data of corneal transplants and corneal donations in Korea. METHODS: From June 2004 through October 2004, questionnaires were distributed to 25 hospitals. The questionnaires were about the characteristics of patients registered in eye banks for keratoplasty from May 2001 to April 2003, and about the results of keratoplasties performed from May 2002 to April 2003. RESULTS: The leading corneal diseases in patients registered for keratoplasty were infectious keratitis (22.0%), trauma (21.0%), and pseudophakic and aphakic bullous keratopathy (13.8%), in that order. The leading indications in corneal recipients were: trauma (15.5%), pseudophakic and aphakic bullous keratopathy (13.7%), and infectious keratitis (10.7%), in that order. In 233 cases of keratoplasties, penetrating keratoplasty was performed in 229 cases (98.3%) and lamellar keratoplasty was performed in 4 cases (1.7%). The most common combined surgery was cataract extraction. Common causes of graft failure were rejection of donor cornea and infection. Imported donor corneas were used in sixty-one cases (26.2%) among the 233 total keratoplasties. CONCLUSIONS: We constructed an epidemiologic data base of patients registered for keratoplasty, corneal donation, and the results of keratoplasties throughout Korea.

Epidemiologic Studies of Keratoplasty in Korea

PURPOSE: To report an epidemiologic study of keratoplasty in which we analyze basic data of corneal transplants and corneal donations in Korea. METHODS: From June 2004 through October 2004, questionnaires were distributed to 25 hospitals. The questionnaires were about the characteristics of patients registered in eye banks for keratoplasty from May 2001 to April 2003, and about the results of keratoplasties performed from May 2002 to April 2003. RESULTS: The leading corneal diseases in patients registered for keratoplasty were infectious keratitis (22.0%), trauma (21.0%), and pseudophakic and aphakic bullous keratopathy (13.8%), in that order. The leading indications in corneal recipients were: trauma (15.5%), pseudophakic and aphakic bullous keratopathy (13.7%), and infectious keratitis (10.7%), in that order. In 233 cases of keratoplasties, penetrating keratoplasty was performed in 229 cases (98.3%) and lamellar keratoplasty was performed in 4 cases (1.7%). The most common combined surgery was cataract extraction. Common causes of graft failure were rejection of donor cornea and infection. Imported donor corneas were used in sixty-one cases (26.2%) among the 233 total keratoplasties. CONCLUSIONS: We constructed an epidemiologic data base of patients registered for keratoplasty, corneal donation, and the results of keratoplasties throughout Korea.

Spontaneous Rupture of the Left External Iliac Vein

Recently, we have experienced a case of spontaneous rupture of the left iliac vein in a 62-year-old woman, who had been suffering from hemiparesis and chronic constipation. An urgent laparotomy was performed for massive hemoperitoneum without knowing the bleeding point, and laceration on the left external iliac vein was repaired. Spontaneous rupture of the iliac vein is extremely rare. However, it should be included in differential diagnoses of the patient with massive hemoperitoneum who have no known pathology or any evidence of blunt trauma.

Pararenal Leiomyosarcoma of the Inferior Vena Cava

A complete surgical resection is the only proven therapeutic modality that prolongs the survival in patients with leiomyosarcoma of the inferior vena cava (IVC). Reconstruction of the IVC is not always necessary but is often required to facilitate venous drainage of the kidney for the tumors at the pararenal area of the IVC. Controversy exists in postoperative adjuvant therapy. Recently, we experienced four cases of pararenal leiomyosarcoma of the IVC, of which treatment consisted of a complete resection of the tumor, ringed polytetrafluoroethylene (PTFE) graft interposition, and bilateral renal vein reconstructions in all patients. Postoperative radiation therapy was instituted in 3 of 4 patients. One patient who did not receive the postoperative radiation therapy was treated with adjuvant chemotherapy. The kidneys were preserved in all patients and no deep vein thrombosis (DVT) or venous insufficiency of the lower extremity veins developed. Distant metastasis to the lung was noted in one patient at 18 months after surgery, who was not received the postoperative radiation therapy but chemotherapy. In conclusion, a complete resection of the tumor, IVC reconstruction, and bilateral renal vein reconstruction followed by adjuvant radiation therapy is recommended for the treatment of pararenal leiomyosarcoma of the IVC.

Ruptured Renal Artery Stump Aneurysm in a Renal Autotransplanted Behcet's Disease Patient

A recurrent aneurysm at the anastomosis site or the remaining artery frequently occurs after the operative treatment of an aneurysm in Behcet's disease despite anti-inflammatory medication. Herein, a ruptured left renal artery stump aneurysm in a patient with Behcet's disease, who received a left nephrectomy, aorto-biiliac bypass and heterotopic autotransplantation of the right kidney for the treatment of an abdominal aortic aneurysm and renal hypertension one year prior to this admission, is reported. An aneurysm and rupture occurred despite the administration of anti-inflammatory medications while monitoring of the clinical findings, such as skin manifestations, erythrocyte segmentation rate (ESR) and C-reactive protein (CRP). Although there is no definite proven treatment modality to prevent recurrent aneurysms at the anastomosis site or a remote artery, close follow-up with anti-inflammatory medications, and surveillance with regular intervals are the only current methods for the prevention and/or to treatment of an arterial complication in patients with Behcet's disease.

A Case of Lingual Thyroid Treated by Surgical Excision through Transcervical Approach / 대한이비인후과학회지

Lingual thyroid is the most common benign ectopic thyroid tissue but is a rare clinical entity. This developmental anomaly is due to the failure of descent of the gland anlage early in the course of embryogenesis. Patients may have symptoms of dysphagia due to obstruction or even hemorrhage. These symptoms can occur at any time from infancy through adulthood. The clinical findings, laboratory tests, and radiographic imaging studies employed in confirming the diagnosis and in planning appropriate treatment have been evaluated. The primary therapeutic goal is to restore thyroid function but surgical excision of the gland is reserved for more advanced cases of gland enlargement resulting in airway compromise, severe dysphagia that limits oral intake, or hemorrhage. We experienced a case of lingual thyroid that was successfully treated by transcervical approach and summarized the principles of current management for this condition.

Two Cases of Jugular Phlebectasia / 대한이비인후과학회지

Anterior or lateral neck mass that appears on straining should be differentiated from laryngocele, jugular phlebectasia and superior mediastinal cysts or masses. The most common cause of aneck masses which that appears on straining is alaryngocele. The jugular phlebectasia may present itself in a similar manner, although it occurs rarely. The cause of the jugular phlebectasia is unclear. The diagnosis is made on a clinical basis and confirmed by the less invasive radiological technique. No treatment is indicated because of its self-limiting, benign condition. However, the surgical removal is needed for cosmetic purposes by a unilateral excision of the jugular vein. We experienced two cases of jugular phlebectasia, one anterior and the other internal. One case of The anterior jugular phlebectasia was successfully treated by surgical excision, and the other case of internal jugular phlebectasia was treated conservatively.

Surgical treatment of Solid and Papillary Epithelial Neoplasm of the Pancreas / 한국간담췌외과학회지

BACKGROUND: Solid and papillary epithelial neoplasm(SPEN) is a rare malignant tumor of the pancreas that typically occurs in young females and has an excellent prognosis. This tumor has a low malignant potential, and is highly curable with surgical treatment. METHODS AND MATERIALS: From January 1986 to July 1999, ten patients of solid and papillary epithelial neoplasm of the pancreas pathologically verified at Kyung Hee University Hospital were retrospectively analyzed. Pre-, intra-, and post-operative data were evaluated in all patients to determine optimal management with specific reference to surgical strategy. RESULTS: Nine patients out of ten were females, with a mean age of 21.8 years (range 12-38). Six patients presented with a palpable abdominal mass and four patients with abdominal pain. Remaining patients presented with fever, low back pain, and no specific symptom. Abdominal ultrasonography and/or CT scan showed an abdominal mass in all patients. The correct preoperative diagnosis of SPEN was made in six patients. Incorrect diagnosis included pseudocysts in two and cystadenoma in two. The tumor size ranged from 5 to 14.5 cm in diameter (average 8.85 cm). Four patients with tumor in the pancreatic head had a pylorus preserving pancreaticoduodenectomy (PPPD). Four patients with tumor in the pancreatc tail underwent distal pancreatectomy and splenectomy(without in one). Two patients were performed mass enucleation only. The histologic diagnosis was confirmed in all patients. There were no nuclear atypia and pleomorphism in microscopic findings. Postoperative complications were intraabdominal abscess in one, lymphatics leakages in one, and wound infection in one. All ten patients are alive without sign of recurrence with a mean follow-up of 5.36 years (range 0.1 to 13 years). CONCLUSIONS: SPEN is an indolent tumor of the pancreas with low malignant potential and excellent long-term prognosis and should be considered in the differential diagnosis of large pancreatic masses, especially in young females. Resection is the treatment of choice that is resectable.