The Clinical Manifestations and Treatment Results of Congenital Lacrimal Fistula

PURPOSE: To evaluate the clinical manifestations and the results of treatment in congenital lacrimal fistula. METHODS: We retrospectively evaluated the symptoms, associated anomalies, and results of treatment in patients with congenital lacrimal fistula. RESULTS: The mean age of the 22 total patients was 22.5+/-24.6 years (4 months~77 years). Associated anomalies were shown in two patients - one with hearing loss and upper punctal atresia, and the other with imperforate anus and undescended testes. Symptoms were tearing in 18 eyes and subcutaneous nodule in 3 eyes. Most of the external ostium of the fistula were located at the skin inferomedial (16 eyes) or medial (5 eyes) to the medial canthus, but one case had external ostium at the medial palpebral conjunctiva. Symptom improved in all patients after fistulectomy with bicanalicular intubation in 12 eyes, fistulectomy in 1 eye, bicanalicular intubation in 1 eye, and dacryocystorhinostomy combined fistulectomy with bicanalicular intubation in 2 eyes. However, the fistula recurred in 3 cases (19%). CONCLUSIONS: Lacrimal fistula is a congenital anomaly which can cause tearing or subcutaneous nodule. Treatment appropriate to the patient is required to get favorable result.

Effects of Smoking on Tear Film and Ocular Surface

This study was performed to evaluate the changes of tear film and ocular surface caused by smoking. Symptom scoring, tear film break-up time (BUT), basal tear secretion test, corneal sensitivity test, keratoepitheliopathy scoring, and conjunctival impression cytology were performed in 29 smokers (58 eyes) and 26 non-smokers (52 eyes). Tear film BUT, basal tear secretion, corneal sensitivity, and squamous metaplasia were 7.71 +/- 2.66 sec, 6.29 +/- 2.85 mm, 53.69 +/- 5.69 mm, and 2.45 +/- 1.26 in smokers and 9.62 +/- 3.14 sec, 10.04 +/- 3.87 mm, 56.46 +/- 4.79 mm, and 1.12 +/- 0.83 in non-smokers, respectively (p< 0.05). Symptom score, keratoepitheliopathy score, and goblet cell density were not significantly different between the two groups. Tear film BUT was shorter, basal tear secretion and corneal sensitivity were lower, and squamous metaplasia was higher in heavy smokers than in light smokers. In conclusion, smoking deteriorates the tear film and ocular surface with decreased quantity and quality of tear film, decreased corneal sensitivity, and squamous metaplasia, and this deterioration is related to the amount of smoking.

Accuracy of Partial Coherence Interferometry in Intraocular Lens Power Calculation

PURPOSE: To evaluate the accuracy and the influencing factors of partial coherence interferometry in intraocular lens (IOL) power calculation for cataract surgery. METHODS: In 86 eyes of 69 patients who had undergone cataract surgery, we measured axial length using both IOLMaster and contact type ultrasonography, calculated the target refraction with SRK II formula and compared the result with the measured value after operation. We also evaluated the factors influencing the accuracy of the power calculation such as age, sex, type of cataract, severity of nucleosclerosis, corneal power, and preoperative refraction. RESULTS: In IOLMaster and contact type ultrasonography, the mean axial lengths were 23.70 +/- 1.27 mm and 23.55 +/- 1.28 mm (p<0.01), and the mean absolute errors (MAE) of refraction were 0.53 +/- 0.26D and 0.66 +/- 0.39D (p<0.01) respectively. The eyes of longer axial length showed larger MAE than those of shorter axial length (p=0.02). CONCLUSIONS: Partial coherence interferometry was more accurate than contact type ultrasonography in IOL power calculation. The factor associated with the accuracy of partial coherence interferometry was the axial length.

The Role of Ultrasound Biomicroscopy in Operation for Limbal Dermoid

PURPOSE: To evaluate the result of excision and lamellar keratoscleroplasty using ultrasound biomicroscopy in limbal dermoid. METHODS: We retrospectively analyzed in 10 patients with limbal dermoid, who were performed preoperative ultrasound biomicroscopy to access the extent of the lesion and the depth of corneal involvement, and underwent excision and superficial keratoscleroplasty with a minimum follow-up period of 6 months RESULTS: On ultrasound biomicroscopic examination, the dermoid showed highly reflective, homogeneous echo density than surrouding tissue, leading to identifying the lateral margin of the lesion and depth of involvement. The mean maximun thickness of the lesion was 1.1 +/- 0.2mm. The six of 8 patients, who were feasible to test visual acuity, had no change in best corrected visual acuity, and 2 of 8 patients gained less than 1 line. Most patients (9 of 10), except one, had good or excellent cosmetic results with no haze (5 of 10) or minimal haze (4 of 10). CONCLUSIONS: In limbal dermoid, ultrasound biomicroscopy was helpful in accessing the extent of the lesion and the depth of involvement preoperatively, and excision and lamellar keratoscleroplasty leads to good results without complication.

Internal Limiting Membrane Peeling Using Indocyanine Green in Vitrectomy for Idiopathic Macular Hole

PURPOSE: To evaluate the effectiveness of internal limiting membrane (ILM) peeling using indocyanine green (ICG) on the surgical results of the vitrectomy for idiopathic macular holes. METHODS: We analyzed the anatomical and functional results of the macular hole surgeries without internal limiting membrane (ILM) peeling (group I; 32 eyes) and with ILM peeling using ICG (group II; 22 eyes). RESULTS: In group I and group II, mean age was 62 years and 64 years, and follow-up period was 17 months and 8 months, respectively. Anatomical success (P=0.528); 28 eyes (87.5%) vs. 20 eyes (90.9%), mean best visual acuity (P=0.004); 0.41 vs. 0.26, final visual acuity (P=0.006); 0.32 vs. 0.16, improvemant of best visual acuity (P=0.051); 2.88 lines vs. 1.59 lines, improvement of final visual acuity (P=0.048); 1.97 lines vs. 0.82 lines, and functional success rate (P=0.063); 24 eyes (75.0%) vs. 12 eyes (54.5%) were shown. Visual acuities better than 0.4 were found in 12 eyes (37.5%) of group I and in 5 eyes (22.7%) of group II (P=0.001). CONCLUSIONS: ILM peeling using ICG might produce a negative effect on the functional results, thereby requiring care with handling ICG.

Study of Tear Film and Ocular Surface in Keratoconus

PURPOSE: To evaluate the changes of tear film and ocular surface in keratoconus patients. METHODS: Twenty-eight eyes of 18 patients with keratoconus and 32 eyes of 16 normal subjects were included. We performed corneal sensitivity test, tear film break-up time (BUT), Schirmer test, fluorescein and rose bengal staining, and conjunctival impression cytology, and compared the results between the two groups. According to the central corneal power, we classified the patients into 3 groups and compared these parameters between groups. RESULTS: Corneal sensitivity was 5.56 +/- 0.34 mm and 5.88 +/- 0.25 mm (p<0.001), BUT was 9.64 +/- 2.51 sec and 10.69 +/- 2.89 sec (p=0.008), basal tear secretion was 9.00 +/- 3.06 mm and 10.88 +/- 3.95 mm (p=0.025), fluorescein staining score was 1.43 +/- 1.87 and 0.69 +/- 1.20 (p=0.105), and rose bengal staining score was 0.86 +/- 0.97 and 0.22 +/- 0.55 (p=0.003) in the patients and control subjects, respectively. The degree of conjunctival squamous metaplasia was 1.04 +/- 0.51 and 0.62 +/- 0.43 (p=0.039), and goblet cell density was 762.65 +/- 76.32 cells/mm2 and 880.21 +/- 82.06 cells/mm2 (p=0.041) in the patients and control subjects respectively. All parameters except basal tear secretion and fluorescein staining score were related to the severity of keratoconus. CONCLUSIONS: Tear film and ocular surface changes in patients with keratoconus are composed of decreased corneal sensitivity, decreased quantity and quality of tear film, and damages to corneal and conjunctival epitheliums, which are similar to the findings in keratoconjunctivitis sicca.

The Surgical Effects of Inferior Oblique Anteriorization

PURPOSE: To find out the effect and proper indications, we studied the effect and complications of anteriorization of the inferior oblique muscle in each type of strabismus. METHODS: We retrospectively studied 33 cases (50 eyes) of primary inferior oblique overaction (IOOA), 17 cases (17 eyes) of superior oblique muscle palsy, and 20 cases (27 eyes) of dissociated vertical deviation (DVD), who received inferior oblique anterior transposition at Chonnam National University Ophthalmology Department from January 1996 to December 2001. RESULTS: In the cases of primary IOOA, the success rate for IOOA of +3~4 was 88%. In the cases of superior oblique palsy, the mean correction of vertical deviation was 14.4 delta. In superior oblique palsy of preoperative vertical deviation less than 15 delta, the success rate was 83%. In DVD, the mean correction of vertical deviation was 9.6 delta and the success rate of preoperative deviation less than 10 delta was 80%. In 11 eyes of 11cases out of 70 cases, complications, including like elevation limitation, IOOA of opposite eye, and hypotropia at primary position, occurred. CONCLUSIONS: In cases of IOOA of +3~4, with superior oblique palsy of preoperative vertical deviation about 15 delta, and DVD of preoperative deviation less than 10 delta, good results were obtained by inferior oblique anteriorization.