Intra-abdominal necrotic lipoma diagnosed by computed tomography as a paraprostatic cyst

A dog with a history of diarrhea and dyschezia exhibited an oval-shaped, soft-tissue opacity mass in the abdomen on radiographs. CT examination revealed a large fluid-filled structure displacing the urinary bladder, prostate, and colon. The mass had continuity with the prostate; therefore, it was tentatively diagnosed as a paraprostatic cyst. Cytologic examination was performed and the mass was considered a non-inflammatory cyst. However, after surgery, histopathologic examination revealed a necrotic, inflamed cystic lipoma. This case shows that unusual intra-abdominal lipomas may have a cystic appearance.

Results of Triple Surgery: Cataract Extraction, Intraocular Lens Implantation and Vitrectomy for Retinal Detachment

PURPOSE: To report the anatomic and visual results of triple surgery in patients with cataract and rhegmatogenous retinal detachment. METHODS: This retrospective study examined 11 cases of phakic detachment. All 11 eyes had both rhegmatogenous retinal detachment and cataract. For these, a triple procedure involving pars plana vitrectomy, cataract surgery and posterior chamber intraocular lens (PCL) insertion was performed. Intraocular lens (IOL) power calculation was performed in the diseased or both eyes. RESULTS: A clear intraoperative view of the fundus was obtained in all cases. The retina was reattached by triple surgery in 9 eyes. In one failed case, there had been extensive detachment with preoperative proliferative vitreoretinopathy grade C type 1. In the other case, retinal detachment recurred due to a new break. The two failed eyes obtained anatomic success by reoperation. Preoperative visual acuity (hand movement/10cm to 0.2) was improved (finger count/20cm to 0.8). There were 2 visual imbalances of -8.0 diopter and -10.0 diopter due to miscalculation of IOL power. CONCLUSIONS: In selective cases, combined triple surgery spares the patient repeat surgery and can offer a more rapid visual rehabilitation by clearly identifying the breaks and avoiding delays in detachment repair. To avoid miscalculation, IOL power must be calculated in both eyes, especially in cases of macular detachment.

Management of Macular Folds Using Submacular BSS Injection and Partial Fluid-Gas Exchange

PURPOSE: To report five cases with management of macular folds by submacluar BSS injection and partial fluid-gas exchange. METHODS: This prospective study report 5 patients (5 eyes). Between December 1999 and October 2002, 5 patients with macular folds underwent submacular BSS injection and partial fluid-gas exchange. We analysed the preoperative and postoperative best corrected visual acuity, color fundus photography, FAG and Amsler-Grid test. RESULTS: Four cases developed macular folds postoperatively and one case was due to secondary macular folds;complicated with fibrovascular traction by proliferative diabetic retinopathy. The surgery was anatomically successful in all 5 cases. Visual acuity increased two line or more in 4 cases. Subjective metamorphopsia decreased in all 5 patients. CONCLUSIONS: It is thoughted that submacluar BSS injection and partial fluid-gas exchange can be new and effective method in selective cases of macular folds.

Nonvitrectomizing Epiretinal Membrane Peeling Surgery

PURPOSE: To report the results of nonvitrectomized peeling surgery in patients who have idiopathic epiretinal membrane(ERM). METHODS: This prospective, nonrandomized study covered 4 cases. From June 1999 through January 2000, 4 patients with idiopathic ERM underwent unilateral nonvitrectomizing peeling surgery. Two sclerotomy sites were made. The membrane was separated from the surface of the retina with endoilluminator and pick. It was removed from the eye in all cases with intraocular forceps. RESULTS: Postoperative average follow-up period is 14 months(12 to 21 months). Preoperative subjective symptoms were decreased vision and metamorphopsia. Preoperative visual acuity(0.4 to 0.6) was improved(0.7 to 0.9). Refractive changes did not occur. Postoperatively, metamorphopsia disappeared in 3 eyes. There were no developments of cataract during postoperative follow-up periods. No serious complications were noted. CONCLUSIONS: Although interpretation of the results of this study is limited due to its small size and short follow-up period, nonvitrectomized ERM peeling surgery appears to be safe and effective in selective patients with idiopathic ERM.

Effect of Internal Limiting Membrane Peeling in Idiopathic Macular Holes Stage 3, 4

PURPOSE: The purpose of this study was to assess the surgical results of internal limiting membrane peeling during pars plana vitrectomy for the treatment of idiopathic macular holes. METHODS: Ten patients(10 eyes) with idiopathic macular hole stage 3 or 4 underwent pars plana vitrectomy with peeling of the macular internal limiting membrane, and total fluid-gas exchange, and were positioned face-down for 2 weeks. RESULTS: Anatomic success was achieved in 10 eyes(100%), and visual improvement of 2 or more lines on Han Chun Suk visual acuity chart was achieved in 5 eyes(50%). Eyes with symptoms of less than 6 months showed better functional recovery than eyes with symptoms of more than 6 months. Transmission electron microscopic examination showed internal limiting membrane in the removed specimens. Complications attributed to the operation included nucleosclerosis, transient high intraocular pressure, and retinal pigment epithelial degeneration. CONCLUSIONS: Internal limiting membrane peeling may be a useful adjunct for the successful macular hole surgery.

Intermediate-term Result of e-PTFE Membrane Implant Surgery for Refractory Glaucomas

Recently, various tube-shunt implants have been used in treating refractory glaucomas.They have large volumed reservoir portion made of hard materials.We made a new implant with soft and freely malleable membrane[expanded polytetrafluoroethylene, e-PTFE]as a reservoir portion attached to the conventional silicone tube. Based on the encouraging result from experimental animal study, we performed a clinical trial for the membrane-tube implant.We performed Glaucoma Tube-Shunt Implant surgery using double layers of e-PTFE membrane and silicone tube with its one end fixed between the two layers.The subjects had refractory glaucomas without useful vision who visited our hospital from May 1991 to Sep.1995. There were 40 eyes of 37 patients and their mean follow-up period was 32.6 months.We could control the IOP within 6~21 mms of mercury in 26 eyes[65.0%, Success].In remaining 14 eyes, we could not control the IOP or additional surgery was needed to control the IOP or treat severe complications[35.0%, Failure].The Kaplan-Meier Survival for IOP control was 78.4% at 1 yr, 71.6%at 2 yr, and 60.3%at 3 yr.The complications were similar to those of other commercially available Glaucoma implants. This new implant is made of soft, freely malleable membrane for the reservoir portion with small volume which can be inserted with smaller incision on the conjunctiva with less complication.We have obtained comparable result from this membrane-tube implant to other implants, and it may be considered as an another substitute for the treatment of refractory glaucomas.

Retinal Detachment after Transscleral Fixation of Posterior Chamber Intraocular Lens

To determine clinical features and outcomes of retinal detachments[RDs] following trans-scleral fixation of posterior chamber intraocular lens[PC-IOL], we reviewed the medical records of 249 eyes[239 patients] which had undergone trans-scleral fixation of PC-IOL and had been followed 6 months or longer. Retinal detachment occurred in 8 out of 249 eyes[3.2%]. The incidences of RDs were as follows:in 2/19 eyes[10.5%] with PC-IOL exchange for PC-IOL tilt, in 1/16 eyes[6.3%] with posterior capsule rupture during ECCE, in 1/26 eyes[3.8%] with ICCE, in 2/78 eyes[2.6%] with posterior capsule rupture during phacoemusification, in 2/106 eyes[1.9%] with aphakia, and in 0/4 eyes[0%] with anterior IOL exchange with PC-IOL. The sites of retinal break corresponded with the directions of needle during fixation in 5/8 eyes[62.5%] and all retinal breaks were located anterior to the equator. The timing of RD was between 2 weeks and 4.8 years after fixation although it occured within 2 months in most cases. Pars plana vitrectomy and scleral buckling were performed in 7 eyes and scleral buckling only in one eye. Retinal reattachment was achieved in seven eyes including three eyes which required two surgical interventions. The vitrectomy should be performed with meticulous care to reduce vitreous traction as much as possible during trans-scleral fixation of PC-IOL and a close follow-up examination for RD is required during the first two months.

New Strabismus Surgery with an Absorbable Jaw Clip

The most common complications of the strabismus surgery are related to the muscle sagging, lost muscle in suturing procedure and needle trauma endophthalmitis, retinal detachment, scleral necrosis result from scleral perforation. The authors developed the muscle clamping system with absorbable jaw clip, and operated on 8 rabbits using the clips. The right superior rectus was recessed by conventional recession and the other superior rectus was recessed with an absorbable jaw clip. We examined the conjunctival injection, muscle adhesion power (bond strengths) and light microscopic findings at postoperative I week, 2, 4, and 8 weeks. Conjunctival injection was diminished with time and bond strengths ranged 400-500gm in right eye and 380-600gm in the left eye. Microscopically there were some inflammatory cells and less foreign body reactions in jaw clipped eye. According to these results, muscle clamping method employing the newly invented clip could be an innovatory surgery which may overcome many difficulties of the surgery and avoid any possibility of misleading practice along with convenience.

Two Cases of Correction of Excyclotorsion Remained after Harada-Ito Procedure

Authors performed horizontal transposition of superior and inferior rectus muscle in 3.0 mm, to eliminate excyclotorsion of the 5 degrees which remained after Harada-Ito procedure in two patients with superior oblique palsy. The medial and lateral edges of the proximal part of tendon were reattached at the temporally and the inferior retus nasally. This operation was performed 3 or 4 months ater Harada-Ito procedure in 2 patients, respectively. The amount of horizontal transposition was made according the degree of excyclotorsion measured by double maddox rod test. The results showed no cyclotorsion at head tilt to the right and double maddox rod test. In conclusion, the horizontal transposition of vertical rectus muscles is effective in the elimination of excyclotorsion remained after Harada-Ito procedure for superior oblique palsy.

Causes of Failure after Initial Vitreoretinal Surgery

We reviewed the records of 23 patients who underwent repeat operation after initial vitreoretinal surgery in Chungnam National University Hospital between January 1993 and December 1993. Of 193 eyes who underwent vitreoretinal surgery in that period, 23(12%) had undergone reoperation. The most common cause of initial anatomic failure and reoperation was either new or recurrent proliferative vitreoretinopathy(10 eyes). Other causes included iatrogenic retinal tears(5 eyes), hidden retinal breaks(4 eyes), vitreous traction(1 eye), inappropriate chorioretinal adhesion(1 eye), and new break(1 eye). We performed vitreous base dissection on all 9 eyes with anterior proliferative vitreoretinopathy. With additional surgery and after a mean follow-up period of 10.4 months, 21(91%) of 23 retinas were reattached. The final cause of anatomic failure was anterior proliferative vitreoretinopathy. Of the 23 reoperated eyes, 20(87%) had postoperative visual acuity of 0.05 or better.

Two cases of Multiple Evanescent White Dot Syndrome

Multiple evanscent white dot syndrom(MEWDS) has the characteristic clinical, funduscopic, fluorescein angiographic and electrophysiologic findings. The etiology of MEWDS remains unknown. The authors report on two patients with MEWDS. They were young females. Funduscopic examination showed that multiple, white dots are found at the level of the retinal pigment epithelium. These dots extended from macula into mideriphery. Also, the patients had a tiny, granular gray-white dots in the fovea. Fluorescein angiography showed an early hyperfluorescence in the areas corresponding to the white dots with late staining. Two patients had spontaneous recovery of vision in four to seven weeks. They had persistent enlargement of the physiologic blind spot or paracentral scotoma in their visual field, respectively.

Repetitive low-dose tissue plasminogen activator for the clearance of experimental vitreous hemorrhage

Our previous experimental work with tissue plasminogen activator (TPA) suggested the possibility of the clearance of vitreous hemorrhage by repetitive injections of low-dose TPA. We therefore investigated in rabbits the effect of both repeated injections of TPA and the change of the integrity of the vitreous body on the clearance of vitreous hemorrhage. Vitreous hemorrhage was produced by intravitreal injection of 0.05 ml of autologous whole blood in the pigmented rabbit eyes with intact vitreous or gas-compressed vitreous. Three intravitreal injections of 3-g TPA (total dose of 9 microgram), separated by 7-day intervals, were performed. The endpoint for vitreous hemorrhage clearance was defined as clear visualization of the posterior central retina of the rabbits. Regardless of whether gas compression vitrectomy was performed, repeated injections of low-dose TPA resulted in rapid clearance of fresh vitreous hemorrhage in approximately two to three weeks after the last TPA injection. No evidence of retinal toxicity was seen in all experimental groups. Repetitive injections of low-dose TPA may be effective in the treatment of fresh vitreous hemorrhage.

Metastatic bone tumor and pathologic fracture in long bone / 대한정형외과학회잡지

No abstract available.

Transecleral Suture Fixation for a Posterior Chamber Intraocular Lens Implantation

Posterior chamber intraocular lenses were implanted into 20 eyes without the posterior capsular capsular support by securing both haptics of the lens to the sclera with 10-0 prolene suture. The follow-up period ranged from 6 to 24 months(average 9.4 months). At the last follow-up visit, 17 eyes(85%) had a vision of 0.7 or better. The position of the implanted lens was proved satisfactory when compard with eyes with posterior chamber intraocular lens without scleral fixation suture by postoperative A-scan measurement of the anterior chamber depth, the results of refraction and slit-lamp examination. There were no eyes with remarkable decentration or tilt of the implanted lens. In two eyes, intraoperative bleeding occurred from the inferior chamber angle and ceased spontaneously. Postoperatively there were no remarkable inflammatory responses or complications. From the results, we suggest that the position of scleral puncture with a hypodermic needle is 1.2 - 1.4mm from the posterior surgical limbus in the upper quadrant and the advancement of the needle is directing parallel to the posterior surface of the iris.

Use of e-PTFE Membrane for Glaucoma Drainage Surgery

A new glaucoma drainage implant, expanded polytetrafluoroethylene(e-PTFE) membrane implant, and e-PTFE-silicone tube implant were used in 11 eyes of 11 patients with recalcitrant glaucomas including neovascular glaucoma. After an average follow-up of 13 months, intraocular pressures(IOPs) decreased to the level ranging from 10 to 20mmHg in all the eyes. Five patients were not on antiglaucoma medication. Four patients required one beta blocker and/or pilocarpine. The remaining two patients still required the maximum tolerated medical therapy and were considered to have a failed drainage surgery. A temporary obstruction of the drainage tube occurred in 2 eyes with neovascular glaucoma which developed a minimal hyphema and fibrinous aqueous after surgery. Postoperative hypotony and shallow anterior chamber developed in 4 eyes, but their situations were not dangerous. The patients each had a filtration bleb postequatorially after surgery. These blebs disappeared one to seven months later. In spite of the presence of a filtration bleb, 7 eyes developed an increased IOP temporarily. The required conjunctival incision for installation of an e-PTFE drainage implant was less than 90 degrees and the overall surgical procedures seemed to be simple.

Clinical Evaluation of Sensory Heterotropia

Sensory Heterotropia is defined as a secondary deviation following loss or severe reduction in visual function in one eye. We have analyzed the records of 68 patients with sensory heterotropia in order to find the incidence, etiologic causes, the factors influencing the direction of the deviation, and the amount of deviation. The incidence of sensory heterotropia was 1.1% of total out patients, and 10.5% of strabismic patients. The major causative factors of sensory heterotropia was anisometropia(33.8%) followed in frequency by uncorrected aphakia(25.0%), cataract(16.2%), retina and vitreous diseases(16.2%), optic nerve atrophy(8.8%) and corneal opacity(2.9%). Esotropia and exotropia were encountered with almost equal frequency when the onset of visual impairment occured between birth and 5 years of age, but exotropia predominated in older children and adult. Those was statistically significant(p<0.01). The direction of a sensory heterotropia was determined by the refractive error of the sound eye, i.e., if the sound eye was emmetropic or myopic, thd blind eye was predominantly exotropic, and if it is hyperopic, it was predominantly esotropic. Also, duration of visual impairment was related to the amount of deviation in exotropic patients. If the duration was under 5 years, the amounts of deviation was 16.3 prism, and over 5 years, it was 25.5 prism, and difference was statistically significant.