A Case of Congenital Toxoplasmosis in the Neonate

Congenital toxoplasmosis is caused by vertical transmission of Toxoplasma gondii from the mother during pregnancy. The road clinical spectrum of congenital toxoplasmosis ranges from stillbirth or death shortly after birth to survival with either cerebral damage or mild or subclinical disease, consisting usually of ocular involvement. Recently we experienced a neonate with congenital toxoplasmosis. The diagnosis of congenital toxoplasmosis was confirmed on the basis of clinical findings such as chorioretinitis, CT findings of multiple cerebral calcifications calcifications, hydrocephalus, and positive serologic test for toxoplasma IgM anti body. Therefore, we report our case with a review of related literature.

Surgical Aspiration of Orbital Abscess in a 4-month-old Neonate: 1 Case Report

Orbital abscess is an inflammatory disease of the orbit which usually aries in children or adults. However, it also arises in infants and an appropriate treatment is needed because it often accompanies more severe symptoms, complications, and permanent sequales. Systemic administration of antibiotics and surgical therapy can be enployed as means of treatment. When one uses surgical therapy in addition to using systemic antibiotics, one can obtain good results with rapid improvement of symptoms and prevention of complications. Surgical aspiration and antibiotic treatment showed good results in an infant who was admitted due to proptosis, chemosis, eyelid edema, and drythema.

Surgical Aspiration of Orbital Abscess in a 4-month-old Neonate: 1 Case Report

Orbital abscess is an inflammatory disease of the orbit which usually aries in children or adults. However, it also arises in infants and an appropriate treatment is needed because it often accompanies more severe symptoms, complications, and permanent sequales. Systemic administration of antibiotics and surgical therapy can be enployed as means of treatment. When one uses surgical therapy in addition to using systemic antibiotics, one can obtain good results with rapid improvement of symptoms and prevention of complications. Surgical aspiration and antibiotic treatment showed good results in an infant who was admitted due to proptosis, chemosis, eyelid edema, and drythema.

A Case of Alveolar Soft Part Sarcoma in the Orbit Diagnosed as C avernous Hemangioma befo re Operation

Alveolar soft part sarcoma is a very rare malignant neoplasm which originates from the soft tissue. The common site is lower extremity and it is especially rare to occur primarily in the orbit. It is characterized that tumor shows organoid arrangement of lobules separated by numerous delicate vascular septa and individual tumor cell contained PAS positive crystalline granules in the cytoplasm. Moreover, because of hypervascular tumor, it is easy to misdiagnosed as a cavernous hemangioma which commonly occurs in the orbit. We experienced a 29-year-old male who had suffered from unilateral proptosis.Before operation, ultrasonography, MRI and single photon emission computed tomography (SPECT) were performed and we suspected that the retro-orbital mass was a cavernous hemangioma. Using Kr onlein method,lateral orbitotomy was performed and large well encapsulated tumor mass (2.5 x2.5 x2.0 cm)was excised. On histopathological examination the tumor was confirmed as an alveolar soft part sarcoma. Therefore, we report this interesting case with review of the literature.

A Case of the Sino-Orbital-Cerebral Aspergillosis

Aspergillus is a relatively uncommon and saprophytic, ubiquitous fungus that is normally not pathogenic in human. Usually arising from the paranasal sinuses, it may present in manifold ways within the orbit. Some severe presentation, such as cerebral involvement, may lead to fatal outcome in immunocompromised patients. As a result, when it occurs it requires early recognition, aggressive surgical management, and prolonged antifungal therapy. Recently authors experienced a case of sino-orbital-cerebral Aspergillosis in a healthy woman. Therefore we report our case with a review of related literature.

An Ultrastructural Study on the Early Morphologic Changes of the Retina in Streptozotocin-induced Diabetic Rats

There have been many theories for pathogenesis of diabetic retinopathy. However,no one theory can explain all of the pathogenesis. That means many factors contribute to the pathogenesis of the diabetic retinopathy. Many studies have shown the retinal changes in long-term hyperglycemia, yet relatively few in short-term hyperglycemia. To study the changes of the retinal capillary and retinal pigment epithelium in diabetic retinopathy, we measured the thickness of the basement membrane of the retinal capil-lary endothelial cells in streptozotocin-induced diabetic rats. An morphological alterations of the retinal pigment epithelium were also examined on the 2 month-old diabetic rats. The measurement was made using 0.1 mm calibrated ruler overlaying the electron micrograph with a transparent plastic sheet on which 20 radiating lines were etched exactly 18 .apart. The SPSS and Instat program were used for statistical evaluation of the data. Comparing with the control, the increase of the thickness of the endothelial basement membrane at the 2 month-old diabetic rats was statistically significant (p<0.05). Cytoplasmic alterations such as vacuolization of capillary endothelium, changes in mitochondria and increasement of capillary endothelialcytoplasm were more prominent in diabetic rats than in control rats. Basal infoldings of retinal pigment epithelium appeared to be more frequent and deeper in diabetic rats than in control rats.

Retroprosthetic Membrane Formation after Implantation of Experimental Keratoprothesis in Rabbit

The studies about factors influencing the retroprostheic membrane formation, one of major complications after keratoprosthesis implantation, and about histological characteristics of the retroprosthetic membrane were performed. The methods to inhibit formation and proliferation of membrane were also tried. Formation of the membrane according to corneal trephination size and the effects of lens removal to membrane formation were studied. The influence by the design of keratoprosthesis was also studied. Corticosteroid and SIMP (synthetic inhibitor of metalloproteinase) were applied topically to see the inhibitory effects of drugs to membrane. To evaluate the postoperative intraocular inflammation. Interleukin-1beta was assessed in the aqueous humor at postoperative 3 weeks. Regardless of trephination size, all trephination sites were replaced with opaque fibrous membranes. Histologically, in small trephination group (under 6mm) the membrane was regeneration of cornea showing corneal stromal fibroblast migration and proliferation and mature collagen. In large trephination group (over 7mm), the periphery of the membrane was compatible with corneal regeneration, but central portion was filled with granulation tissue. The removal of lens didn`t influenced the formation of membrane formation. In disc type keratoprosthesis implantation group, all the implants were extruded within 1 month due to retroprosthetic membrane formation. In cylinder type keratoprosthesis implantation group, the physical barrier of cylinder stopped the retroprosthetic membrane proliferation and spared the posterior surface of optic portion. The implants were not extruded for average 10 weeks. Corticosteroid and SIMP showed the effects of decreasing mature collagen formation in the membrane. The level of Interleukin-1beta at postoperative 3 weeks showed no difference according to different drugs and the highest level was checked in cylinder type keratoprosthesis implantation group.

A Case of Bilateral Tuberous Sclerosis

Tuberous sclerosis is a rare multisystem syndrome characterized by hamartomatous tumors of the brain, skin, viscera, and eye. The diagnostic triad for this disease, proposed by Vogt, included epilepsy, mental retardation, and adenoma sebaceum. In eyes, retinal hamartomas and optic nerve phacoma are observed over 50% and hypopigmented areas of peripheral retina and iris are often found. We introduce an 18-year old girl with adenoma sebaceum of the face, history of epilepsy and insignificant mental retardation status. She also had a retinal hamartoma in her right eye, optic nerve phacoma in her left eye, shagreen patch on lumbosacral area, angiomyolipoma of both kidneys, periventricular subependymal nodules and calcified cortical nodule of occipital lobe of brain.

The Effects of Mitomycin C on Anterior Chamber Tube Shunt to a Surgical Membrane Surgery in Rabbits

To evaluate the effects of mitomycin C(MMC) on the fibrous capsule of the anterior chamber tube shunt to a surgical membrane(ACTSSM) surgery, 0.04% MMC solution was applied on the episclera for 5 minutes before ACTSSM surgery(group A, 9 rabbits). At postoperative 2, 4 and 8 weeks, 6 eyes of the 3 rabbits from each group were enucleated and light microscopic examinations of the fibrous capsules were done. In group A, fibrous capsules had many microcystic spaces and fibrous tissues between twofold surgical membranes were scanty. But in control group(group B, 9 rabbits), fibrous capsules showed higher density of fibroblast and less microcystic spaces than group A, suggesting low permeability of the fibrous capsule to aqueous humor. These results suggest that MMC may increase the success rate of the ACTSSM surgery.

Mitomycin C in anterior chamber tube shunt to a surgical membrane

To increase the success rate of intraocular pressure control in recalcitrant glaucoma, anterior chamber tube shunt to a surgical membrane (ACTSSM) surgery using silicone tube and expanded polytetrafluoroethylene (e-PTFE) can be performed. Applying mitomycin C (MMC) during ACTSSM surgery may increase the success rate by decreasing the fibroblast proliferation and collagen in the fibrous capsule. To evaluate the effects of MMC on the fibrous capsule formed after ACTSSM surgery, operations were performed on 18 white rabbits. Nine rabbits were treated with 0.04% MMC solution on the episclera for 5 minutes before ACTSSM (group A) and the others were not treated (group B). At postoperative 2, 4 and 8 weeks successively, 6 eyes of the 3 rabbits were enucleated from each group. Light microscopic examinations were performed after hematoxylin

The Histologic Change of Retina Induced by Intravitreal Silicone Oil

We evaluated the histologic change of retina after gas compression of the vitreous followed by intravitreal injection of silicone oil in albino rabbits. The retinal architecture was well preserved and no abnormal findings could be demonstrated by light microscopic and electron microscopic examinaions 8 weeks after surgery.

The Effect of Pneumoretinopexy on the Retinal Detachment with a Macular Hole

Fourteen eyes of retinal detachment with macular hole were treated with pneumoretinopexy on the outpatient basis. Under the retnbu1bar anesthesia, 0.2ml of perfluoropropane(C3F8) gas was injected into the subretinal fluid was aspirated with the same needle through the macular hole under the careful control by indirect ophthalmoscopy with temporal lying position. Average amount of subretinal fluid aspirated was 0.35ml (O.35-1.00ml) and retinal elevations were reattached after pneumoretinopexy and three of four failed patients agreed to reoperation were reattached after scleral buckling or vitrectomy. Postoperative complications after pneumoretinopexy were transient elevation of intraocular pressure (2/14 eyes) and new break formation (3/14 eyes). We think the pneumoretinopexy is a good choice of primary procedure for the retinal detachment with a macular hole because it is a simple procedure with a relatively good results.

Aging and Ocular Dimensions

In order to measure the ocular dimensions with aging, the anterior chamber depth and the lens thickness were measured using contact ultrasonography and anterior chamber photography in normal human eyes. There were 141 women (241 eyes) and 76 men (130 eyes) between the ages of 10 and 70 years. The lens thickness was increased and the anterior chamber depth was decreased with aging in both sexes. The anterior chamber depth showed an accelerated decrease between the 4th and 5th decades in females and the ratio of anterior chamber depth to axial length was smaller in females than in males after the 5th decade. The results suggest that the prevalence of angle closure glaucoma increased in female after middle age.

Progressive Loss of Power After Myopic Epikeratoplasty

It has been widely accepted due to its simplicity, safety and effectiveness to correct high myopia by epikeratoplasty. We evaluated clinical results of 23 cases of myopic epikeratoplasty over one year follow up. The uncorrected visual acuity improved in all cases and corrected visual acuity improved in 20 cases (91%). But, in 5 cases (22%), we experienced progressive loss of lenticular power more than 4 diopter of emmetropia and their clinical courses were also reviewed Two cases were both eyes of the same patient. The loss of lenticular power appeared as early in 5th week and even in 6th month postoperatively. We could not find any differences between this grolp of power loss and that of remained well corrected within 4 diopter of emmetropia, except preoperative spherical equivalent (-19 diopter vs -15 diopter), period of reepithelization (8.2 days vs 5.9 days), and mean age (25.8 years vs 31.1 years). But, only the difference of mean age was statistically significant (p<0.05). In addition, the surgical techniques the process of manufacturing tissue lenticule, and postoperative care might be document2d as possible factors.

Clinical Evaluation of Recent 4 years' Posterior-Chamber Lens Implantation

From October, 1984 to December, 1988, 1177 cases of posterior chamber lens were implanted. Clinical study was done on 1030 cases which could be followed up for more than 2 months. The results were as follows: 1. The best corrected visual acuity of 0.5 or better was in 981 cases(95.2%) and 1.0 or better was in 676 cases(65.6%). 2. the best corrected visual acuity was achieved with the correction of average -1.07 +/- 1.28D by spherical equivalent. 3. The postoperative astigmatism was average 1.57 +/- 1.70D. 4. The difference between the calculated prediction of postoperative refraction and the actual postoperative refraction was less than 1.00D in 64.1% and calculated prediction tended to be biased toward hypermetropia with mean error of 0.37 +/- 1.21D.

Effect of Intravitreal Silicone Oil and Gas Tamponade to Proliferative Vitreoretinopathy(PVR)

Silicone oil is widely used as a retinal tamponade in the treatment of PVR. But reproliferation of membrane can occur under the silicone oil. Formerly, silicone oil was believed to suppress the proliferation of membrane, but recently, there were reports that silicone oil might actually promote proliferation of membrane, and recommended to use long-lasting gas rather than silicone oil. But it is known that proliferation of membrane can also occur in the eye in which intraocular gas has been used. So a careful study to compare the effect of intraocular gas and silicone oil to proliferation of membrane is needed. Rabbits are divided into three groups. Retinal tears were made in all the groups. in control group, no further surgery was done, and in the other two group, perfluoropropane gas was injected into the vitreous cavity. The intraocular gas was left unchanged(gas group), or it was exchanged with silicone oil 3 days later(silicone oil group). The fundus was examined periodically, and the eyeball was removed at 1, 2, 4, and 8 weeks after surgery for histopathologic study with light and electron microscope. Both intravitreal gas and silicone oil were shown to increase the formation of proliferative membrane compared to control group, but there was no statistically significant difference between them.

Blinking Frequency in Normal and Dry Eye

Spontaneous blinking of a normal human being has a regular rhythm, but in dry eye syndrome, unstable tear film, foreign body sensation, and corneal erosion, etc. may stimulate the reflex blinking, resulting in increased blinking frequency. Blinking frequency of 160 normal persons and that of 20 dry eye syndrome patients were checked to investigate the differences of blinking frequency between normal and dry eyes. Results are as follows; 1. Average blinking frequency in normal male and female group was 22.7 +/- 11.4 per min. and 25.6 +/- 12.3 per min. respectively. 2. There was no sexual difference in normal group. 3. Average blinking frequency of dry eye patients was 38.4 +/- 12.0 per min. which was significantly higher than that of normal control group, 26.5 +/- 12.3 per min.

Refractive State of the Newborn

Refractions were performed in healthy 60 newborn babies, 31 males and 29 females, by retinoscopy after instillation of 1% tropicamide in order to investigate the distribution of refractive states of newborn babies. Average refractive error is +1.51 +/- 2.23D in male, +1.93 +/- 1.78D in female, and +1.17 +/- 2.03D in general. 72.5% of them were hypermetropia, 10.0% were emmetropia, and 12.5% were myopia. There was no significant difference according to sex, laterality, birth weight, and method of delivery(p>0.1).

Color Vision Defect Associated with Diabetic Retinopathy

From May to October 1987, 32 patients of diabetic retinopathy were studied with visual acuity, Farnsworth-Munsell 100-hue test, urine glucose test, standard fundus color photography, and fluorescein angiography to assess the type and extent of color vision defect associated with diabetic retinopathy, mainly nonproliferative, and the presence of macular edema. Nine patients showed significantly higher error scores in Farnsworth-Munsell 100-hue test than expected in non-diabetic individuals and tendency of a tritan axis. Eyes with macular edema showed higher Farnsworth-Munsell 100-hue scores than those without macular edema, but the differences were insignificant. Only one patient made an error in reading of urine glucose test by himself.

Color Vision Defect Associated with Diabetic Retinopathy

From May to October 1987, 32 patients of diabetic retinopathy were studied with visual acuity, Farnsworth-Munsell 100-hue test, urine glucose test, standard fundus color photography, and fluorescein angiography to assess the type and extent of color vision defect associated with diabetic retinopathy, mainly nonproliferative, and the presence of macular edema. Nine patients showed significantly higher error scores in Farnsworth-Munsell 100-hue test than expected in non-diabetic individuals and tendency of a tritan axis. Eyes with macular edema showed higher Farnsworth-Munsell 100-hue scores than those without macular edema, but the differences were insignificant. Only one patient made an error in reading of urine glucose test by himself.