Clinical Studies in Patients with HLA-B 27 Positive Uveitis

It is well known that HLA-B 27-associated uveitis is mostly anterior uveitis and has systemic manifestations.20 Patients [27 eyes]followed up at department of Ophthalmology of Kangnam St.Mary`s hospital, Catholic University Medical College from November 1989 to June 1998, were studied to delineate the clinical manifestations, treatments and prognosis in patients with HLA-B 27-associated uveitis.An HLA B27 associated systemic disorder was present in 10 patients, all of whom were ankylosing spondylitis. Systemic manifestations occurred in 19 patients included oral ulcer in 7 patients, genital ulcer in 3 patients, arthralgia in 16 patients, and skin lesion in 3 patients.Among the total 27 eyes, anterior uveitis was noted in 23 eyes and posterior segment involvement occurred in 4 eyes.The findings of posterior segment involvement included retinal vasulitis in 2 eyes and chorioretinitis in 1 eyes.Severe vitritis occurred in 1 eyes.Most of anterior uveitis was treated with topical steroid eyedrops and periocular steroid injections.In 3 eyes of posterior segment involvement, systemic steroid therapy was required for control of inflammation.After treatment, visual acuity in 23 eyes among 27 eyes was 20/40 or better.And, visual acuity in 4 eyes of posterior segment involvement was 20/25 or better following medical treatment.In conclusion, although HLA-B 27-associated uveitis was mostly related to anterior uveitis, posterior segment manifestations may be occurred in some patients;these patients may require the use of aggressive systemic immunosuppressive therapy to control inflammation and preserve vision.

Clinical Effect of Nd -YAG Synechiolysis

Patients who had posterior synechiae associated with uveitis,IOL mplantation, vitrectomy, underwent Nd-YAG synechiolysis had been treated with topical corticosteroids and surgical iridectomy. Even minimal dilatation of the pupil by Nd YAG synechiolysis enable the patient to read and the surgeon to postpone cataract surgery and evaluate optic disc or fundus. Also, pupil block may be treated by detaching the synechiae.18 Patients (20 eyes) with posterior synechiae underwent Nd-YAG synechiolysis at Kangnam St.Mary's Hospital from November 1997 to August 1998. An average of 17.14 +/-6.43mJ laser were used. The average prelaser pupil size was 3.78 +/-0.98 mm ;postlaser, 5.13 +/-1.27 mm.This change was statistically significant (p<0.01). Microhyphema and pigment dispersion developed in 4 eyes. However,no significant long-term complications occurred, and there were no obvious lenticular damage and pupil abnormality. Because this laser treatment is relatively safe and offers some possibility of visual improvement, we recom-mend Nd-YAG synechiolysis,but only if performed by an experienced laser microsurgeon.

2 cases of Corneal Ectasia Detected after LASIK

Laser Assisted In Situ Keratomileusis(LASIK) has been regarded as an effective treatment for the correction of high myopia. However, excimer laser refractive procedure, itself modifies the refracting power of the cornea by altering the anterior corneal curvature using photoablation. Therefore, The cornea treated by refractive surgery has a potentiality to be in pathologic condition. To impove effectiveness of LASIK, it is required to examine corneal state before operation using slit-lamp biomicroscopy, keratometry, photokeratoscopy, and topography. Also, a careful and conservative approach that ideally preserves 250 of posterior stromal bed after Lasik should be used until further research or experience indicates that corneal intergrity is pressved with less posterior tissue. In this study, we report two cases of corneal ectasia which cannot be anticipated before LASIK and appeared as a typical cornneal ectasia after LASIK. We reviewed useful methods to detec subclinial pathologic conditions of cormea prior to LASIK with literature and also recommed proper operative procedure to prevent cormeal ectasi after LASIK.

Short-Term Changes of Corneal Endothelium after LASIK

To investigate the effect of Laser Assisted In Situ Keratomileusis(LASIK) on Corneal endothelium, patients undergone LASIK at department fo Ophthalmology of Kangnam St. Mary`s Hospital, Catholic University Medical College from November 1997 to January 1998, were studied, retrospectively. VISX STAR laser and SCMD microkeratome were used. The corneal endothelial cell density, coefficient of variation in cell size, and hexagonality(43 eyes of 35 patients), using specular microscopy, were measured before and after 2 months and residual corneal thickness during LASIK was also measured. An average thickness of corneal bed following LASIK was 294.2+/-27.5micrometer(254.2-378.0micrometer). The changes of endothelial cell density, coefficient of variation in cell size, and hexagonality between before and after LASIK were statistically significant(P>0.05). Correlation between the change in endothelium morphology and the residual corneal thickness was not statistically significant(P>0.05). With these results, LASIK seems to be safe for myopic patients in case of the thickness of corneal bed following LASIK is over 250micrometer. However, more study is necessary to confirm the long-term effect of LASIK on corneal endothelial change.

Statistical Observation on In-patient in the Past 2 Years / 대한비뇨기과학회지

A statistical observation was made on 525 in-patients in the Department of Urology Catholic Medical College, during the period from the January 1. 1978 to December 31, 1979.