Effect of Amniotic Membrane on Epithelial Thickness and Formation of Hemidesmosomes after Corneal Stromal Wound

PURPOSE: To investigate the effects of an amniotic membrane patch on corneal epithelial thickness and formation of hemidesmosomes during corneal stromal wound healing. METHODS: A stromal wound 9 mm in diameter and 130 microm in depth was created on rabbit cornea using a microkeratome. The changes in corneal epithelial thickness and hemidesmosome formations were compared between the amniotic membrane, contact lens, and control groups. Changes in the corneal epithelium were examined using H&E staining and hemidesmosome formation was examined using an electron microscope at 2 and 4 weeks after flap removal. RESULTS: Two weeks after treatment, the corneal epithelial thickness was 95.3 +/- 6.3 microm in the amniotic membrane group being significantly thicker than 76.4 +/- 5.1 microm in the contact lens group and 68.3 +/- 6.1 microm in the control group. Furthermore, more hemidesmosome formations were observed in the amniotic membrane group compared to the other 2 groups. However, there were no significant differences in corneal epithelial thickness or hemidesmosome formation among the 3 groups at week 4. CONCLUSIONS: The amniotic membrane group showed a thicker corneal epithelium and more hemidesmosome formation than the other 2 groups 2 weeks after flap removal. Thus, the use of an amniotic membrane patch appears to be effective in the early stages of corneal stromal wound healing.

Intraocular Lens Power Calculation Using Haigis-L Method After Corneal Refractive Surgery

PURPOSE: To evaluate the Haigis-L method of IOL Master that does not require preoperative data for intraocular lens (IOL) power calculations and compare the results with other methods requiring preoperative data. METHODS: Fifty eyes of 25 patients who had undergone laser-assisted subepithelial keratectomy (LASEK) and were followed for 1 month or longer were selected for this study. IOL power was calculated by four different methods: clinical history method, Feiz-Mannis method, modified Masket method, and Haigis-L method. RESULTS: The mean calculated IOL powers showed the following results: clinical history method; 23.65D, Feiz-Mannis method; 24.45D, modified Masket method; 22.89D, and Haigis-L method; 23.80D. Each IOL power differed statistically from others (p=0.000). The difference between each method was analyzed by the Bonferroni test, with the Feiz-Mannis method showing the highest result and the modified Masket method, the lowest. The clinical history method and Haigis-L method presented similar results. CONCLUSIONS: For patients without data prior to corneal refractive surgery, the Haigis-L method is as accurate as the clinical history method. Therefore, comparatively accurate results can be produced in IOL power calculations using the Haigis-L method after corneal refractive surgery.

Valsalva Maneuver-induced Amaurosis Fugax

PURPOSE: To report the case of a patient with amaurosis fugax that occurred following a Valsalva maneuver. CASE SUMMARY: A 40-year-old man presented with amaurosis fugax of the right eye, which had occurred several times during the previous month. After coughing, the visual acuity of the right eye decreased temporarily during the first episode. Subsequently, any time a Valsalva maneuver, such as coughing, occurred, this symptom reappeared. Initially, this symptom persisted for five to ten minutes and occurred once or twice a day, but it gradually increased in frequency. The physical examination was normal, and his best corrected visual acuity was 20/20 bilaterally. Neither specific findings in the slit lamp examination nor abnormal findings in the fundus examination were detected. On fluorescein fundus angiography, no abnormal finding was observed before the symptom was triggered by a Valsalva maneuver, but after the symptom was triggered by coughing, the choroidal and retinal arterial phases were delayed. Hematological and neurological examinations, including magnetic resonance imaging, magnetic resonance angiography, and cerebral angiography, were all normal. Therefore, he was diagnosed with amaurosis fugax generated by a Valsalva maneuver. CONCLUSIONS: In any patient who complains of amaurosis fugax repeatedly, as seen in this case, one must consider the possibility that it results from a Valsalva maneuver, after eliminating occlusive vascular diseases, such as carotid stenosis or atherosclerotic disease.

Primary Pars Plana Vitrectomy With 360-Degree Endolaser Photocoagulation for Pseudophakic Rhegmatogenous Retinal Detachment

PURPOSE: To report the results of primary pars plana vitrectomy with 360-degree endolaser photocoagulation for pseudophakic rhegmatogenous retinal detachment. METHODS: We retrospectively reviewed the medical records of 35 eyes of 35 patients who hadundergone vitrectomy without scleral bucking as a primary operation for pseudophakic rhegmatogenous retinal detachment with a follow-up period of more than 12 months. We also analyzed the anatomical success rate and the patients' final visual acuities. In all patients, endolaser photocoagulation was applied to the retinal tears, as well as to 360-degrees of the peripheral retina, using a curved illuminating endolaser probe intraoperatively. RESULTS: The mean patient age was 61 years, and the mean follow-up period was 20 months. The mean preoperative visual acuity (logMAR) was 1.06, while the mean postoperative visual acuity (logMAR) was 0.23. Twenty-four (69%) of the 35 patients showed macular detachment, and 34 (97%) of the 35 eyes experienced retinal reattachment and visual improvement after a single operation. Complications included epiretinal membrane (6%) and cystoid macular edema (3%). CONCLUSIONS: Primary pars plana vitrectomy with 360-degree endolaser photocoagulation, instead of sclera buckling, seemsto be an effective method in managing pseudophakic rhegmatogenous retinal detachment.

A Case of Convergence Spasm After Head Trauma

PURPOSE:We report a case of convergence spasm that occurred after head trauma. CASE SUMMARY: A 18-year-old female presented with intermittent diplopia and decreased vision shortly after head trauma. Her past medical history was non-specific, except myopia in the left eye. On the initial examination, her uncorrected visual acuity and was variable (0.1~1.2 in the right eye, 0.05~0.1 in the left), but the corrected visual acuity was 1.2 in both eyes. Manifested refraction was also variable (-0.50~-5.50 diopters (D) in the right eye, -4.50~-6.50D in the left eye). Cycloplegic refraction was -0.50D in the right eye, and -4.50D in the left eye. The patient showed a variable esotropia (4~16 prism diopters (PD) at distance, 4~30PD at near). There was no limitation on abduction. There was no abnormality in the brain MRI. Five months after the initial visit, diplopia and blurred vision persisted.

Iatrogenic Horner's Syndrome After Procedure in the Neck and Upper Thoracic Area

PURPOSE: To investigate the natural course of iatrogenic Horner's syndrome induced by procedures in the neck and upper thoracic areas. METHODS: Four patients who developed ptosis after undergoing procedures near the neck and upper thoracic areas were diagnosed with iatrogenic Horner's syndrome. We evaluated the clinical courses of the patients retrospectively. We also performed a systematic Medline search through Pubmed to find patients with iatrogenic Horner's syndrome. We summarized onset times and natural courses of reported cases. RESULTS: In two cases, ptosis improved completely within 2 and 4 months. In the other two cases, ptosis persisted through the last follow-up. As a result of our Medline search, we identified 51 cases in 47 journals. In 31 patients (62%), symptoms improved from 17 minutes to 3 months after surgery. However, in 20 patients (38%), symptoms persisted for up to 20 months. CONCLUSIONS: Although the mechanism underlying iatrogenic Horner's syndrome induced by procedures in the neck and upper thoracic area is not clearly understood, the syndrome may occur when the sympathetic nerve pathway is damaged directly or indirectly. Surgical correction should be postponed because this rare complication may resolve spontaneously within 4 months. The surgeon should explain the possibility of Horner's syndrome to patients after neck and upper thoracic surgery.

Central Retinal Artery Obstruction in Protein S Deficiency

PURPOSE: To report a case of central retinal artery obstruction (CRAO) caused by protein S deficiency. CASE SUMMARY: A 36-year-old man presented with acutely reduced visual acuity in the right eye. The patient had no other diseases such as diabetes mellitus or hypertension. The visual acuity was 20/20 in the right eye and light perception in the left eye. Afferent pupillary defect was observed in theleft eye. Fundus examination showed diffuse retinal opacification and a cherry-red spot at the macula. Thus the patient was diagnosed with CRAO in the left eye. There were no abnormal findings on routine hematologic tests including blood coagulation test. Protein C activity, antithrombin III activation, anticardiolipin antibody were within normal limits but protein S activity was decreased. Thus, the patient was diagnosed with CRAO with protein S deficiency. CONCLUSIONS: Coagulation factors such as protein S need to be measuredin cases of CRAO in young patients without medical problems.

Central Retinal Artery Obstruction in Protein S Deficiency

PURPOSE: To report a case of central retinal artery obstruction (CRAO) caused by protein S deficiency. CASE SUMMARY: A 36-year-old man presented with acutely reduced visual acuity in the right eye. The patient had no other diseases such as diabetes mellitus or hypertension. The visual acuity was 20/20 in the right eye and light perception in the left eye. Afferent pupillary defect was observed in theleft eye. Fundus examination showed diffuse retinal opacification and a cherry-red spot at the macula. Thus the patient was diagnosed with CRAO in the left eye. There were no abnormal findings on routine hematologic tests including blood coagulation test. Protein C activity, antithrombin III activation, anticardiolipin antibody were within normal limits but protein S activity was decreased. Thus, the patient was diagnosed with CRAO with protein S deficiency. CONCLUSIONS: Coagulation factors such as protein S need to be measuredin cases of CRAO in young patients without medical problems.