Clinical Study on The Vitreous Hemorrhage

Vitreous hemorrhage acounted for 64 patients(67 eyes) seen during a eighteenmonth period from March 1, 1987, to August 31, 1988. In order of decreasing frequency, the major causes were diabetic retinopathy(19.4%), trauma(l1.9%), silent retinal tear(10.4%). retinal branch vein occlusion(7.5%), acute posterior vitreous detachment(7.5%), Eales' disease(6%), Hypertension(6%), central retinal vein occlusion(4.4%). And the minor causes were rhegmatogenous retinal detachment(3%), retinal angioma(3%), chronic renal failure(3%), subretinal neovascularization(1.5%), disc neovascularization with undetermined cause(1.5%). No cause could be determined in 14.9% of the cases.

Epikeratophakia for Adult Aphakia

Epikeratophakia is a newly developed refractive corneal surgery for the correction of aphakic vision. Two aphakic patients have received hyperopic epikeratophakia grafts. Three months postoperatively, two patients had visual acuities of 0.6 without spectacle overcorrection. Epikeratophakia appears to be effective for the correction of adult aphakia.

Clinical Observation of Congenital Blepharoptosis

The best results of ptosis surgery will be obtained by properly evaluating the types of ptosis, the degree of levator function, and the amount of ptosis. The authors reviewed 55 patients(79 eyes) of congenital blepharoptosis who received external levator resection and frontalis sling. The following results were obtained. 1. Simple ptosis cases were 85.5%, ptosis with other lid anomalies were 3.7%, ptosis with ophthalmoplegias were 9%, and synkinetic ptoses were 1.8%. 2. Mild ptosis(1.5 to 2 mm) cases were 0%, moderate ptosis(3 mm) cases were 5%, and severe ptosis(4 mm or more) cases were 95%. 3. 78.5% of congenital ptosis cases were poor levator function(4 mm or less), 19% were fair levator function(5 to 7 mm), and 2.5% were good levator function(8 mm or more). 4. Good results were obtained in 80% of the external levator resection cases. 5. Even when there was poor levator function(3 to 4 mm), a large levator resection(22 to 24 mm) was a good primary procedure.

Clinical Experence of Nd:Yag Laser Posterior Capsulotomy

The first clinical trial of the Q-switched Nd:Yag laser posterior capsulotomy by using of Coherent Model 9900 in Korea was carried out since March of 1985. And only 267 aphakic eye cases(257 patients, among 680 consecutive subjects could be followed up for clinical evaluations. The results obtained are as follows: (1) 143 aphakic eyes and 58 pseudophakic eyes with 66 traumatic aphakic eyes were subjected. (2) Good results could be obtained with minimal complications by lower setting (under 1.5 ml) with mean pulse energy of 40~149. (3) Vision improvement after Nd:Yag laser up to 0.9 or more showed in 110 eyes(63%) out of 175 eyes. (4) Complications were encountered in 51 eyes(19%) but most cases were transitory without permanent damages. Vitreous prolapse with rupture of the anterior hyaloid face (14.6%) was observed more frequently in aphakic eyes than in pseudophakic eyes.

Clinical Experience of Q-switched Nd:YAG Laser Iridectomy

The first clinical trial of the Q-switch Nd:YAG laser iridectomy using Coherent model 9900 in Korea was carried out since March of 1985. 51 eye cases(48 patients) of acute and subacute narrow angle glaucoma were treated with a Q-switched Nd:YAG laser during the last one year and half. The results obtained are as follows; 1) Good results could be obtained by setting 3.0~4.9 mj with mean pulse energy of under 50. 2) Nd:YAG laser iridectomy site and normal intraocular pressure were maintained well. 3) Complications were encountered in 7 eyes(13.7%) but most cases were transitory without permanent damages.

Marfan Syndrome Occurring in One Family / 대한정형외과학회잡지

Marfan syndrome is an uncommon congenital disease originally described by Marfan in 1896. It is inherited as an autosomal dominant trait and can affect the tissues of mesodermal origin, mainly skeletal, ocular, and cardio-vascular systems. We report 4 cases of Marfan syndrome occurring in one family, one of which was found to have an acute attack of glaucoma and underwent extract operation of a right dislocated lens. A brief summary of the literature is submitted.

Three Cases of Papillomas Occurring on the Outer Eye

Papilloma is a benign epithelial tumor and may be divided etiologically into two types: viral infectious and neoplastic; histologically the two types are indistinguishable. In the field of ophthalmology, Norris reported for the first time in 1879 that papilloma begins on the bulbar conjunctiva and spreads toward the cornea. Since then, many other cases of papilloma have been reported and these reports showed that it can occur on any portion of the epithelium of the external eye and has a predilection for sites where the epithelium undergoes a transition. We have seen three patients with papillomas: a 6 year old girl with a papilloma on the caruncle; a 29 year old man, on the lower fornix; and a 42 year old woman, on the limbus. The caruncle and lower fornix papillomas were asymptomatic; the limbal papilloma was accompanied by foreign body sensation, epiphora, photophobia, and mild visual disturbance. On examination, the lesion on the caruncle was grayish-red; the surface was smooth with diffuse small red spots The lesion on the lower fornix was bright red, smooth surfaced, pedunculated, strawberry-like in appearance and showed papillary vascular proliferations. The margins of the limbal lesion extended to bulbar conjunctiva and cornea and the masswas firmly adherent to the cornea. The strawberry-like mass was grayish-white in color, hard, slightly elevated and showed papillary vascular proliferations. We feel that the papillomas on caruncle and lower fornix are viral infectious type and the one on the limbus is neoplastic type, based on the site of lesion, clinical symptoms and signs, and the age of the patient. The lesions of the above cases were removed by simple excisional biopsy and the one on the limbus also received post-excisional radiation treatment with Strontium 90. There has been no sign of complication in the four months of follow-up on the caruncle papilloma and two months of follow-up on the lower fornix and limbal papilloma.

A Dysautonomia Simulating Riley-Day Syndrome

Familial dysautonomia, first described by Riley and co-workers in 1949, is a congenital, heritable syndrome. It is transmitted by a recessive autosomal gene which is generally limited to persons of Jewish extraction; however, rare occurrences among non-Jewish Caucasians and in a black girl have been reported. An eight-year old Korean boy was admitted to Severance Hospital with bulbar conjunctival injection OU for 1 month and visual disturbance OS for 10 days. Examination revealed exfoliated epithelium in an area of about 3mm in diameter in the center of the left cornea, multiple punctate erosions and edema of the corneal epithelium. Yet, he experienced no discomfort, blepharospasm, nor photophobia. He had decreased corneal sensation, decreased lacrimation by Schirmer test and miosis was induced biJaterally by 0.25% pilocarpine (equivalent to 2.5% methacholine). The patient had decreased deep tendon reflexes and postural hypotension, and showed emotional lability, indifference to pain, and abnormal temperature control. He also had marked anorexia, swallowing difficulty, cyclic vomiting, abdominal pain, headache, intermittent vascular hypertension and one episode of convulsive seizure. He was positive to histamine intradermal injection test and had abnormal EEG. EMG was suggestive of some form of neuropathy. He was treated with toplca 0.5% chloramphenicol solution and 10% dextran solution alternatively q.2 hrs., terramycin ophthalmic ointment q.h.s. and bilateral patching; he also received 50,000 units of vitamin A for 10 days. He showed marked improvement of his ocular symptoms in 6 days. The above patient shows many of the essential features of the familial dysautonomia syndrome as outlined by Riley; however, he also lacks some of the most important features. Therefore, we feel that the patient has a case of some other type of autonomic dysfunction simulating Riley-Day svndrome.

A Study of Ophthalmotonic Consensual Reaction in Rabbits

The purpose of the present study is to find out whether the ophthalmotonic consensual reaction really exists and through what channel the reaction is brought about in rabbits. Twenty-eight pigmented male rabbits were divided into four groups of seven rabbits each, and the intraocular pressure of each eye was measured at designated times in each group with a Mueller electronic tonometer under topical anesthesia (0.5% tetracaine hydrochloride). Retrobulbar anesthesia and compression were performed in each group as follows: Group 1: From 56 minutes to 60 minutes after the experiment had begun, the right eye was compressed for 4 minutes with a 50 gm weight by means of a Baillart ophthalmodynamometer Group 2: About one hour after the experiment had begun, 1.0 cc of 2% procaine hydrochloride was given by retrobulbar injection on the right side. Digital massage after retrobulbar injection was avoided and epinephrine was not employed, because they might influence the intraocular pressure. Group 3: After retrobulbar anesthesia had been performed for the right eye at 40 minutes, this eye was compressed by the above described method from 85 minutes to 90 minutes after the experiment had begun. Group 4: After retrobulbar anesthesia had been performed in the left eye at 40 minutes, the right eye was compressed by the above described method from 86 minutes to 90 minutes after the experiment had begun. The data of each experimental group were analyzed statistically by means of the t-test. Four groups of tonometric studies were done with the following results: 1. After the right eye had been compressed with a 50 gm, weight for 4 minutes, the right intraocular pressure was found to be lowered and then immdiately elevated. The intraocular pressure in the left eye was lowered beginning about 20 minutes after the right eye compression, and this phenomenon may be considered as the ophthalmotonic consensual reaction. 2. After retrobulbar anesthesia with 1.0 cc of 2% procaine hydrochloride had been performed for the right eye, the intraocular pressure was found to be lowered, but that of the left eye showed a slight rise and maintenance of the elevated pressure. 3. When the right eye was compressed after retrobulbar anesthesia had been performed, the grade of rising of the intraocular pressure was lower than when retrobulbar anesthesia had not been performed. The intraocular pressure in the left eye showed no significant change, so it can be postumted that the afferent pathway of the ophthalmotonic consensual reaction was blocked by the retrobulbar anesthesia in the compressed right eye. 4. When the right eye was compressed after retrobulbar anesthesia had been performed previously in the left eye, the change of the intraocular pressure in the right eye showed no difference as when retrobulbar anesthesia had not been performed in the left eye. The intraocular pressure in the left eye showed a similar change as when the right eye had not been compressed, so it can be postulated that the efferent pathway of the ophthalmotonic consensual reaction was blocked by the retrobulbar anesthesia in the non-compressed left eye.

Two Cases of Hereditary Crystalline Corneal Dystrophy of Schnyder

The authors present a family with two members affected by hereditary corneal dystrophy of Schnyder. A 45-year-old mother and her 15-year-old son visited our hospital with bilateral opacities which affected the center of the cornea symmetrically. They stated that they had found the abnormalities about one month previously, and had have no visual disturbances or inflammatory symptoms. The blood cholesterol of the two patients was essentially in the normal range, and no other systemic abnormalities were found. This is the first family with hereditary crystalline corneal dystrophy of Schnyder to be reported in Korea.

A Case of Sebaceous Carcinoma

In recent years, there appears to have been an increased incidence or recognition of sebaceous carcinomas of the ocular adnexa, which had been previously believed very rare. A 55-year-old male visited our hospital in April 1973 with a large lump in the right lower eyelid which had showed progressive enlargement of one year's duration. A biopsy was carried out and the histopathological examination revealed sebaceous carcinoma. He was treated with a total dosage of 6,000 rads of electron-beam by LINAC machine in October 1973, and the result was excellent.