Relationship between the Prevalence of Dry Eye Syndrome and the Parity of Women Using KNHANES-V

Purpose@#We explored the relationship between dry eye syndrome (DES) and parity in women over 20 years of age. @*Methods@#We retrieved data from the Fifth Korean National Health and Nutrition Examination Survey. Of women over 20 years of age, 7,573 diagnosed with DES by ophthalmologists and 7,347 who self-diagnosed DES were included. We used logistic regression to explore the relationship between DES prevalence and parity, and the chi-squared test to compare differences in DES prevalence by someo children. @*Results@#On univariate logistic regression, the DES incidence was significantly affected by residential status, educational level, hours of sleep, and hyperlipidemia, osteoarthritis, thyroid disorder, and menopause status. We subjected these parameters (and age) to multivariate logistic regression. We found no significant relationship between the doctor-diagnosed DES rate and the number of children. Subjectively, the number of children significantly reduced the prevalence of self-diagnosed DES but not that diagnosed by ophthalmologists. The self-diagnosed DES prevalence was significantly lower in women with than without children. @*Conclusions@#The KNHANES-V data showed that the prevalence of self-diagnosed DES decreased with the number of children in women aged over 20 years. The prevalence of self-diagnosed DES in women with children was significantly less than that in women without children. However, we found no significant correlation between the number of children and DES status, because DES does not simply reflect poor tear secretion, being rather multifactorial.

Repeat Descemet Membrane Endothelial Keratoplasty after Descemet Membrane Endothelial Keratoplasty Graft Failure

Purpose@#To report a case of secondary Descemet membrane endothelial keratoplasty (DMEK) for graft failure after primary DMEK.Case summary: A 47-year-old female underwent primary DMEK in her left eye with a diagnosis of Fuchs’ endothelial dystrophy. At 6 weeks later, corneal stromal edema with epithelial and subepithelial bullae was first observed. From that point on, the condition of the cornea and the visual acuity continued to degrade. After 7 months, a second DMEK procedure (i.e., a repeat DMEK) for graft failure was performed successfully without any complications. Since the second procedure, the cornea has been clear, and the best-corrected visual acuity has remained at 0.6 for 8 months. @*Conclusions@#To manage graft failure after primary DMEK, we performed a second DMEK procedure. The removal of the previous graft was easy, and there were no complications. Thus, repeat DMEK may be a feasible procedure.

Descemet Stripping Automated Endothelial Keratoplasty for Repeated Penetrating Keratoplasty Graft Failure

Purpose@#To report a case of Descemet stripping automated endothelial keratoplasty (DSAEK) for graft failure after re-penetrating keratoplasty (PK).Case summary: A 33-year-old man of Indian nationality who had developed right eye amoeba keratitis and had received two penetrating keratoplasties and allogeneic kerato-limbal transplant in India sought treatment at our hospital. During the follow-up, Ahmed valve transplantation was performed under the diagnosis of secondary glaucoma in his right eye; the patient also underwent conjunctival recession and conjunctival permanent amniotic membrane transplantation as corneal neovascularization had progressed. Subsequently, the corneal transplantation failed and DSAEK was performed. At 7 months after the operation, the right-eye visual acuity was 20/320 without any complications. @*Conclusions@#DSAEK may restore good vision without complications in patients with repeated corneal graft failure after PK from corneal endothelial cell failure followed by corneal neovascularization and glaucoma surgery but with good stromal conditions. We present this case, along with a review of the literature. Future studies will require more surgical patients.

Repeat Descemet Membrane Endothelial Keratoplasty after Descemet Membrane Endothelial Keratoplasty Graft Failure

Purpose@#To report a case of secondary Descemet membrane endothelial keratoplasty (DMEK) for graft failure after primary DMEK.Case summary: A 47-year-old female underwent primary DMEK in her left eye with a diagnosis of Fuchs’ endothelial dystrophy. At 6 weeks later, corneal stromal edema with epithelial and subepithelial bullae was first observed. From that point on, the condition of the cornea and the visual acuity continued to degrade. After 7 months, a second DMEK procedure (i.e., a repeat DMEK) for graft failure was performed successfully without any complications. Since the second procedure, the cornea has been clear, and the best-corrected visual acuity has remained at 0.6 for 8 months. @*Conclusions@#To manage graft failure after primary DMEK, we performed a second DMEK procedure. The removal of the previous graft was easy, and there were no complications. Thus, repeat DMEK may be a feasible procedure.

Descemet Stripping Automated Endothelial Keratoplasty for Repeated Penetrating Keratoplasty Graft Failure

Purpose@#To report a case of Descemet stripping automated endothelial keratoplasty (DSAEK) for graft failure after re-penetrating keratoplasty (PK).Case summary: A 33-year-old man of Indian nationality who had developed right eye amoeba keratitis and had received two penetrating keratoplasties and allogeneic kerato-limbal transplant in India sought treatment at our hospital. During the follow-up, Ahmed valve transplantation was performed under the diagnosis of secondary glaucoma in his right eye; the patient also underwent conjunctival recession and conjunctival permanent amniotic membrane transplantation as corneal neovascularization had progressed. Subsequently, the corneal transplantation failed and DSAEK was performed. At 7 months after the operation, the right-eye visual acuity was 20/320 without any complications. @*Conclusions@#DSAEK may restore good vision without complications in patients with repeated corneal graft failure after PK from corneal endothelial cell failure followed by corneal neovascularization and glaucoma surgery but with good stromal conditions. We present this case, along with a review of the literature. Future studies will require more surgical patients.

Perioperative management of tracheal injury following endotracheal intubation in a neonate: A case report

Tracheal injury in neonates is a rare but serious complication of endotracheal intubation. The morbidity and mortality are associated with early recognition and adequate management. Herein, we reported a case of perioperative management of neonatal tracheal injury following multiple attempts at endotracheal intubation caused by unanticipated difficulty.

Systemic fungal infection following effective pain relief with high-dose steroid therapy for terminal cancer pain: A case report

High-dose steroid therapy is known as effective adjuvant therapy for refractory bone pain due to metastasis of solid cancer. However, the standard dose and duration have not been established to date. Long term maintenance with steroid therapy is not encouraged due to its potential adverse effects. Here, we report a case of a terminal cancer patient who maintained high dose steroid therapy to alleviate refractory bone pain with complication of systemic fungal infection.

A Case of Korean Patient with Macular Corneal Dystrophy Associated with Novel Mutation in the CHST6 Gene

To report a novel mutation within the CHST6 gene, as well as describe light and electron microscopic features of a case of macular corneal dystrophy. A 59-year old woman with macular corneal dystrophy in both eyes who had decreased visual acuity underwent penetrating keratoplasty. Further studies including light and electron microscopy, as well as DNA analysis were performed. Light microscopy of the cornea revealed glycosaminoglycan deposits in the keratocytes and endothelial cells, as well as extracellularly within the stroma. All samples stained positively with alcian blue, colloidal iron, and periodic acid-Schiff. Electron microscopy showed keratocytes distended by membrane-bound intracytoplasmic vacuoles containing electron-dense fibrillogranular material. These vacuoles were present in the endothelial cells and between stromal lamellae. Some of the vacuoles contained dense osmophilic whorls. A novel homozygous mutation (c.613 C>T [p.Arg205Trp]) was identified within the whole coding region of CHST6. A novel CHST6 mutation was detected in a Korean macular corneal dystrophy patient.

Comparison of Intraocular Pressure Correction Programs in Pentacam after Corneal Refractive Surgery

PURPOSE: To evaluate the accuracy of Pentacam(R) built-in 5 intraocular pressure (IOP) correction programs used to measure the IOP of patients who received corneal refractive surgery. METHODS: IOP of 124 eyes from 62 patients who underwent epipolis laser in situ keratomileusis was measured with Goldmann applanation tonometry (GAT) at 6 months pre- and post-operatively. The collected data was input into Pentacam(R), calculated by 5 correction programs, Ehlers, Shah, Dresden, Orssengo / Pye, Kohlhaas, and compared. RESULTS: The GAT-based pre- and post-operative IOP was 15.75 +/- 2.24 mm Hg, and 10.72 +/- 2.31 mm Hg, respectively, revealing the post-operative IOP to be significantly lower than the pre-operative IOP (p < 0.001). Among the 5 correction programs within Pentacam(R), Ehlers program showed little difference between pre- and post-operative IOP values (p = 0.228) and the post-operative correction value showed no significant difference with the pre-operative GAT value (p = 0.413). CONCLUSIONS: The Ehlers program is the most accurate among the 5 Pentacam(R) correction programs evaluated in the present study, and can be a useful tool for correcting the true IOP of patients which tends to be higher after corneal refractive surgery.

The Importance of Evaluation of Corneal Endothelial Cell Count in Glaucoma Patients

PURPOSE: To evaluate the possible causes of decreased central corneal endothelial cell count in glaucoma patients and to acknowledge the importance of central corneal endothelial cell count evaluation. METHODS: This retrospective case-control study included 60 glaucomatous eyes that were being treated with topical anti-glaucoma drugs, 30 eyes that underwent laser iridotomy or trabeculectomy, and 60 control eyes. Intraocular pressure, duration of topical anti-glaucoma medications, mean number of topical anti-glaucoma drugs, and preoperative central corneal endothelial cells were analyzed. RESULTS: The numbers of central corneal endothelial cells in the topical anti-glaucoma medication group, the surgical group and the control group were 2681.30 +/- 355.33, 2435.57 +/- 646.81 and 2822.08 +/- 330.17 cells/mm2, respectively. The numbers in the topical anti-glaucoma medication group and the surgical group were significantly lower than that of the control group. The number of central corneal endothelial cells was significantly low in patients with longer duration of disease and in those taking a greater number of topical anti-glaucoma drugs (p = 0.003, p = 0.010) CONCLUSIONS: In glaucoma patients, corneal endothelial cell count is decreased by glaucoma surgery, laser therapy, long-term or multiple topical anti-glaucoma medications. When performing cataract surgery in glaucoma patients, preoperative corneal endothelial evaluation is essential.

Current and future options for myopia correction

Myopia is a major public health problem and its prevalence is increasing over time in Korea. The main treatment options of myopia correction are spectacle lenses, contact lenses, refractive surgeries such as photorefractive keratec-tomy (PRK), laser in situ keratomileusis (LASIK), and laser epithelial keratomileusis (LASEK), phakic intraocular lenses and clear lens extraction. Each treatment option has its own indications and contraindications, and not only has some advantages over the others but also some disadvantages. The evidence shows that most therapies for myopia have stable and safe results, although some do not. Customized therapy, real time tracking and sensing, and femtosecond laser-assisted surgeries might be ubiquitous in the near future. This review will discuss current treatment options for myopia and will introduce possible future therapies.

Anesthetic management in patients suspected of Creutzfeldt-Jakob disease -A case report- / 대한마취과학회지

Creutzfeldt-Jakob disease (CJD) is a fatal neurodegenerative disorder in which accumulation of the pathogenic prion protein induces neuronal damage and results in distinct pathologic features. This abnormal prion is an infectious protein and resistant to methods of sterilization currently being used. Therefore, management of definite, or suspected CJD patients requires additional precautions. We report our experience of a patient who had undergone brain biopsy for suspected of CJD. The patient was confirmed to have sporadic CJD.

Effect of Charcoal Filter on the Emergence from Sevoflurane Anesthesia in a Semi-Closed Rebreathing Circuit

PURPOSE: A charcoal filter attached within the anesthetic circuit has been shown to efficiently adsorb halothane or isoflurane, thus hastening anesthetic recovery in low or minimal flow system. This study was intended to demonstrate whether the charcoal filter enhances the recovery time from sevoflurane anesthesia using a semi-closed circuit system. MATERIALS AND METHODS: Thirty healthy patients scheduled for elective surgery under sevoflurane anesthesia were randomly assigned to the charcoal filter or control group. Upon completion of surgery, the end-tidal concentration of sevoflurane was maintained at 2.0 vol%. A charcoal filter was attached to the expiratory limb of the breathing circuit of charcoal filter group subjects. After sevoflurane was discontinued, ventilation was controlled with the same minute volume as the intra-operative period at a fresh gas flow rate of 5 L.min(-1) with 100% O2. The elimination kinetics of sevoflurane from end-tidal concentration, Bispectral index and times of eye opening and extubation were obtained. RESULTS: The exponential time constant (tau) of alveolar sevoflurane concentration in the charcoal filter group was significantly shorter than that in the control group (1.7+/-0.5 vs. 2.5+/-1.1 min, p=0.008). The charcoal filter hastened rapid eye opening (11.1+/-3.8 vs. 14.8+/-3.0 min, p=0.007) and extubation (11.9+/-3.9 vs. 15.3+/-3.2 min, p=0.014), compared to the control group. CONCLUSION: A charcoal filter enhances the recovery from sevoflurane anesthesia with a semi-closed rebreathing circuit.

A Case of Acute Endophthalmitis After 23-gauge Transconjunctival Sutureless Vitrectomy

PURPOSE: To report a case of acute endophthalmitis associated with 23-gauge transconjunctival sutureless vitrectomy and gas tamponade for macular hole surgery. CASE SUMMARY: A 66-year-old female patient who presented with a macular hole in the left eye was treated with 23-gauge transconjunctival sutureless vitrectomy. On postoperative day 2, the patient developed acute endophthalmitis and was treated with gas-fluid exchange, lensectomy and intravitreal antibiotic injection. Staphylococcus epidermidis was detected in the vitreous fluid of the operated eye. Intraoperative fundus findings showed severe retinal hemorrhage, vascular occlusion and fibrous membranes due to inflammatory response. After treatment, the patient's fundus findings markedly improved and the inflammatory response was controlled. CONCLUSIONS: Acute endophthalmitis after sutureless vitrectomy performed via intraocular gas injection may quickly result in inflammation and disease due to infection. Immediate reoperation and intravitreal antibiotic injections are recommended in such cases.

During the treatment for thoracic postherpetic neuralgia, penetrating atherosclerotic ulcerations occurred: A case report

Treatment for thoracic postherpetic neuralgia can cause penetrating atherosclerotic ulcerations Postherpetic neuralgia is a frequent complication of herpes zoster.It is more common in the elderly population.If the pattern of pain changes especially in the older patients, differential diagnosis is important because the symptoms of some diseases which may be life threatening is similar with that of postherpetic neuralgia.An 83-year-old woman was admitted presenting aggravated pain, dyspnea and poor oral intake during treatment for postherpetic neuralgia involving the left T3 dermatome. She had a previous history of hypertension, congestive heart failure, and pulmonary embolism.Penetrating atherosclerotic ulceration involving the thoracic aorta was diagnosed by CT angiography and her clinical outcome improved through medical treatment.

Effect of various anesthetic induction agents on blood magnesium and calcium concentration / 대한마취과학회지

BACKGROUND: Decrease in blood magnesium and calcium concentration is associated with an increase in the incidence of arrhythmia, especially during the induction period. Therefore, it is important to evaluate the effects of propofol, pentothal sodium, and sevoflurane on calcium and magnesium concentration. METHODS: Thirty-six premedicated, ASA grade I patients were selected and randomly allocated into 3 groups. Six percent sevoflurane inhalation (sevo group), propofol 1.5 mg/kg (propofol group), and 5 mg/kg of pentothal sodium (pento group) were administered for anesthetic induction and anesthetic maintenance was done with end-tidal sevoflurane concentration at 3.5%. Blood sampling was performed during the pre-induction period (pre-induction), just before tracheal intubation (pre-intubation), and 2 min after intubation (post-intubation). pH corrected ionized magnesium and calcium were calculated and analyzed simultaneously. RESULTS: Both total calcium and magnesium concentrations decreased significantly in all groups during the pre-intubation and post-intubation periods compared with the pre-induction period. Ionized calcium only decreased significantly during pre-intubation and post-intubation in the pento group, and did not change throughout the study period in the sevo and propofol groups. Ionized magnesium did not change throughout the study period in any of the groups. pH corrected ionized calcium decreased significantly only at post-intubation in the pento group. CONCLUSIONS: All anesthetic induction agents administered in this study can be used safely in terms of magnesium-associated arrhythmia. However, ionized calcium concentration decreased in the pento group, but all values were within normal limits. This finding indicated that it is safe to use propofol, pentothal sodium, and sevoflurane for anesthetic induction

Pulmonary hemorrhage accompanied with pulmonary edema induced by endotracheal tube occlusion in a child: A case report / 대한마취과학회지

Negative pressure induced pulmonary edema due to upper airway obstruction is a well-recognized problem. However, negative pressure pulmonary hemorrhage is extremely uncommon. We report a child who developed negative pressure pulmonary hemorrhage following acute airway obstruction caused by clench of endotracheal tube during emergence of anesthesia. The patient was treated with positive pressure ventilation and frequent tracheal suction. Hemorrhage from endotracheal tube was gradually decreased after 4 hours. The patient was extubated after 7 hours.

The job values and expected tendencies that anesthesiologists thought importantly

BACKGROUND: This study was designed to figure out how anesthesiologists think about their job values and expected tendencies through questionnaires. METHODS: The directions for completing internet questionnaires were sent to all members and semi-members of the Korean Society of Anesthesiologists by email. Paper version of the same questionnaires was sent to residents of some university hospitals, who did not answer the internet questionnaires. The questionnaires consisted of items of basic, 14 job values and 80 expected tendencies. The answerers were asked to choose 4 items among job values and 10 items among 80 tendencies. The answers were analyzed according to the groups of job positions, subspecialties, ages and gender. RESULTS: Among items of job values, 'decision making', 'taking care of people', 'working with my hands' and 'working with my mind' were chosen by more than 40% of answerers, and answer rates were similar between each comparative groups. Among items of expected tendencies, 'be calm in crisis', 'make decisions rapidly', 'be perfectionistic', 'be good coordinators', 'be self-confident', 'think logically', 'be tolerant of others', 'be able to do more than one thing at a time', and 'be persevering' showed high answer rate, but the answer rate of individual items showed some differences between groups. CONCLUSIONS: Although there were some items that showed different answer rates between groups, there was little difference in job values and expected tendencies between groups on the whole.

Blepharoptosis Repair by Small Cutaneous Incision and Minimal Dissection Technique

PURPOSE: To present a simple method of acquired ptosis correction by small-incision minimal dissection technique and assess the results of the operation. METHODS: The charts of 23 patients (29 eyes) with acquired ptosis who underwent ptosis correction by small-incision minimal dissection technique were reviewed. Pre and postoperative MRD1, success rate, complications and reoperation rates were investigated. RESULTS: The average of pre- and postoperative MRD1 were 0.9+/-0.9 mm and 2.7+/-0.8 mm respectively. Of the 17 patients who underwent unilateral surgery, 15 eyes (88.2%) showed successful outcomes, and of the 12 eyes who underwent bilateral surgery, 8 eyes (66.6%), 2 eyes (16.7%), and 2 eyes (16.7%) showed excellent, good, and poor outcomes, respectively. Out of 29 eyes, 25 eyes (86.2%) showed satisfactory results. Two eyelids of unsatisfactory contour were corrected by reoperation. CONCLUSIONS: Although the small-incision minimal dissection technique for ptosis correction is applicable to a restricted group of patients compared to the conventional method, this technique is very useful and efficient, and has many advantages including less tissue damage, bleeding, edema, a short operation time and rapid recovery.

Blepharoptosis Repair by Small Cutaneous Incision and Minimal Dissection Technique

PURPOSE: To present a simple method of acquired ptosis correction by small-incision minimal dissection technique and assess the results of the operation. METHODS: The charts of 23 patients (29 eyes) with acquired ptosis who underwent ptosis correction by small-incision minimal dissection technique were reviewed. Pre and postoperative MRD1, success rate, complications and reoperation rates were investigated. RESULTS: The average of pre- and postoperative MRD1 were 0.9+/-0.9 mm and 2.7+/-0.8 mm respectively. Of the 17 patients who underwent unilateral surgery, 15 eyes (88.2%) showed successful outcomes, and of the 12 eyes who underwent bilateral surgery, 8 eyes (66.6%), 2 eyes (16.7%), and 2 eyes (16.7%) showed excellent, good, and poor outcomes, respectively. Out of 29 eyes, 25 eyes (86.2%) showed satisfactory results. Two eyelids of unsatisfactory contour were corrected by reoperation. CONCLUSIONS: Although the small-incision minimal dissection technique for ptosis correction is applicable to a restricted group of patients compared to the conventional method, this technique is very useful and efficient, and has many advantages including less tissue damage, bleeding, edema, a short operation time and rapid recovery.