Variation in Cataract Surgery Practice and Clinical Outcomes

PURPOSE: The purpose of this study was to examine the variations of the clinical outcomes of cataract surgery according to the characteristics of patients and surgeons and surgical technique. METHODS: The survey was conducted at 4 stages : preoperative period(389), perioperative period(344, 88.4%), postoperative 3~4 months(343, 88.2%), and postoperative 12 months(281, 72.2%). RESULTS: Eighty-five percent of surgery was performed by phacoemulsification and 14% by standard extracapsular (ECCE) techniques. The performance of phacoemulsification was associated with years of practice(11 years or more) and annual volume of cataract surgery(201 cases or more). The reported occurrence of posterior capsular opacification within 12 months of surgery was decreased in the patients operated by surgeons with years of practice(11 years or more). CONCLUSIONS: The factors influencing to better outcomes at 12 months after surgery were visual acuity of baseline operated eye(20/200 or less) and the absence of ocular morbidity. In this study, although there were some variations with cataract surgery practice, but the variations with cataract surgery practice did 434not give much influence to the patient's outcomes.

Electrophysiologic Study of the Hemifacial Spasm

There has been controversy between compression of the facial nerve in the cerebellopontine recess and focal demyelination of the facial nerve on the pathogenesis of hemifacial spasm(HFS). To know the pathophysiology of HFS, we performed the facial nerve stimulation test and blink reflex test in 15 patients with HFS. And then we analyzed change of electrophysiologic findings after botulinum toxin in jection. We could not find any differences of latency between affected and unaffected side in facial nerve stimulation test(p>0.05). In the blink reflex test, there were prolonged R1 latency(p<0.01) and occurance of late response on the affected side. There has no change after botulinum toxin injection. These results suggest that there is no facial neuropathy and no electrophysiological evidence of dysfunction in the blink reflex system. Also, there may be two pathophysiologic lesions in HFS. compression and focal demyelination of the facial nerve. And we think that the botulinum toxin is no effect on facial nerve conduction itself.

A Case of Late Complication of Binkhorst 4-Loop Lens Implantation Histopathologic Study

Despite of much advances in the design of the IOL and the method of the sterilization and the techniques in ophthalmic surgery, disastrous complications following cataract extraction have been reported occasionally. Such complications may occur with or without IOL implantation, and may be induced by artificial lens itself or by indirect effect of the lens such as mechanical trauma. A pseudophakic eyeball which was implanted iris-supported IOL 6 years ago was enucleated due to intractable ocular pain, and the eyeball exhibited a localized inflammation in the anterior uvea especially in iris. From those findings we could suspect a mechanical trauma of the IOL, that might cause noninfectious inflammation. The complication of the cataract extraction is reviewed with histopathologic findings.

A Case of Wegener's Granulomatosis with Ocular Involvement

Wegener's granulomatosis is characterized by necrotizing vasculitis and granuloma formation in both upper and lower respiratory tracts and in kidney. Other organs are also involved frequently. Ocular manifestations are Ehown in about 50% of patients with it. We experienced a case of Wegener's granulomatcsis developed prcgressive paranasal sinusitis and rhinitis combined with orbital and ocular involvement shown proptosis of both eyes, necrotic change of cornea and anterior portion of sclera in left eye and so forth. The diagnosis was confirmed by clinical findings and histopathologic features of tissue biopsy. The histopathology from periccular area of left eye had the typical findings of Wegener's granulomatosis with necrotizing vasculitis and granuloma formation. We had treated with oral cyclophosphamide(30~120mg/day) and corticosteroid(betamethaEcne 3mg 1M) and performed the enucleation of left eye due to widespread necrosis. The general condition and ocular findings were moderately improved with medical treatment but the eventual visual acuity was zero in right eye.

A Case of Wegener's Granulomatosis with Ocular Involvement

Wegener's granulomatosis is characterized by necrotizing vasculitis and granuloma formation in both upper and lower respiratory tracts and in kidney. Other organs are also involved frequently. Ocular manifestations are Ehown in about 50% of patients with it. We experienced a case of Wegener's granulomatcsis developed prcgressive paranasal sinusitis and rhinitis combined with orbital and ocular involvement shown proptosis of both eyes, necrotic change of cornea and anterior portion of sclera in left eye and so forth. The diagnosis was confirmed by clinical findings and histopathologic features of tissue biopsy. The histopathology from periccular area of left eye had the typical findings of Wegener's granulomatosis with necrotizing vasculitis and granuloma formation. We had treated with oral cyclophosphamide(30~120mg/day) and corticosteroid(betamethaEcne 3mg 1M) and performed the enucleation of left eye due to widespread necrosis. The general condition and ocular findings were moderately improved with medical treatment but the eventual visual acuity was zero in right eye.