The Accuracy of Estimating Postoperative Deviation in Exotropia With over 40 Prism Diopters

PURPOSE: To assess the accuracy of estimating postoperative deviation in large-angle exotropia over 40 prism diopters (PD). METHODS: A retrospective analysis was performed on 61 exotropia patients with over 40 PD exotropia who had undergone 2-muscle surgery by two surgeons and with at least 6 months follow-up. The accuracy was assessed by analyzing the discrepancy between preoperatively predicted residual deviation and deviation at postoperative 6weeks. Successful surgery was defined as deviation within +/- 10 PD at the last postoperative visit. RESULTS: More accurate residual deviation was predicted in exotropia with prism diopters between 40 and 59 (97.8%) than in exotropia with 60 PD or more (62.5%). And there was no significant difference between two surgeons. Surgical success rates at six months and one year after surgery were 96.8%, 94.7% in exotropia with 40 to 49 PD, 71.4%, 60.0%, 50 to 59 PD, 50.0%, 45.5%, 60 PD or more, respectively. There were four patients of whom the postoperative deviation angle exceeded more than 10 PD of the estimated deviation. CONCLUSIONS: The accuracy of estimating residual deviation prior to surgery was higher and more successful surgery was achieved in exotropia ranging in 40 to 59 PD than in exotropia with 60 PD or more. Therefore, 2- muscle surgery will be suitable for large-angle exotropia with less than 60 PD.

Asymmetry Analysis of the Retinal Nerve Fiber Layer Thickness in Normal Eyes using Optical Coherence Tomography

PURPOSE: To investigate the asymmetry of the retinal nerve fiber layer thickness (RNFLT) with respect to the horizontal and vertical meridian and between the right and left eye in normal subjects. METHODS: The RNFLT was measured in 121 normal volunteers by optical coherence tomography (OCT). The RNFLT was analyzed by dividing the circle scanning area (diameter 3.4 mm) around the optic disc into 4 quadrants and 12 sectors. RESULTS: There was a significant difference between the RNFLT of the nasal and temporal quadrant in individual eyes. There was a significant difference between the RNFLT of corresponding sectors with respect to the vertical or horizontal meridian in individual eyes. The nasal and temporal RNFLTs were asymmetrical between the right and left eye in the quadrant and sector analysis. The RNFLT of the nasal and temporal quadrant was thicker in the right eye. The nasal and inferior RNFLT measured by OCT had a significant correlation with degree of refractive error. CONCLUSIONS: In normal subjects without significant anisometropia, there was significant asymmetry of the RNFLT for each eye as well as between the right and left eye.

Papillary Stenosis and Cholangitis Caused by Endoscopic Mucosal Resection of Ampullary Adenoma / 대한소화기내시경학회지

Adenomas of the major duodenal papilla are rare but clinically important since they are a premalignant condition. Endoscopic mucosal resection has emerged as the first line therary for ampullary adenoma. However, various complications such as pancreatitis, bleeding or duodenal perforation have been reported after endoscopic mucosal resection. To our knowledge, cholangitis has not been reported as a complication of the procedure in the literature. We report a case of papillary stenosis and cholangitis caused by endoscopic mucosal resection of ampullary adenoma. We performed the endoscopic biliary spincterotomy followed by biliary stenting and cholangitis was successfully controlled.

Papillary Stenosis and Cholangitis Caused by Endoscopic Mucosal Resection of Ampullary Adenoma / 대한소화기내시경학회지

Adenomas of the major duodenal papilla are rare but clinically important since they are a premalignant condition. Endoscopic mucosal resection has emerged as the first line therary for ampullary adenoma. However, various complications such as pancreatitis, bleeding or duodenal perforation have been reported after endoscopic mucosal resection. To our knowledge, cholangitis has not been reported as a complication of the procedure in the literature. We report a case of papillary stenosis and cholangitis caused by endoscopic mucosal resection of ampullary adenoma. We performed the endoscopic biliary spincterotomy followed by biliary stenting and cholangitis was successfully controlled.

Visual Outcome of Central Retinal Vein Occlusion

This study was performed to investigate the visual prognosis in ischemic and nonischemic central retinal vein occlusion(CRVO), to investigate the difference in clinical course of two types, and to identify prognostic factors for poor visual outcome. Fifty seven patients with CRVO were included. Eyes were classified into ischemic or nonischemic type by indirect ophthalmoscopy and fluorescein angiography. Among 58 eyes, 27 eyes(46.6%) were of the nonischemic CRVO and 31 eyes(53.4%) of the ischemic CRVO. Nonischemic CRVO was more common in patients under 45 years and had more benign clinical course than ischemic CRVO. Factors significantly related to visual outcome were initial visual acuity in ischemic CRVO(P<0.01) and the presence of systemic disease in nonischemic CRVO(P<0.01). Hypertension and diabetes were the most commonly associated systemic diseases. The leading causative factors for poor visual outcome were chronic macular edema and neovascular glaucoma in ishemic CRVO, and chronic macular edema in nonischemic CRVO.

The Clinical Aspect of Breaks Responsible for Retinal Derachment Associated with Lattice Degeneration

This study was undertaken to evaluate the retinal detachment related to lattice egeneration. We reviewed 54 eyes of 54 patients who had undergone retinal reattachment procedure from May 1992 to May 1995 at Yeungnam university hospital. Forty cases (74%) were due to atrophic holes in the lattice degeneration and 14 cases (26%) were due to tears at the lateral or posterior margin of lattice degeneration. Among 40 patients with atrophic hole, 25 patients (62.5%) were under 30-year-old and 26 patients (70.2%) were myopic over -3.0D. Among 14 patients with marginal tear, 9 patients (64.2%) were over 50-year-old and 8 patients had a refractive error of under -3.0D. Lattice degenerations were located most frequently in the temporal quadrants (46 cases, 85%). Retinal detachment related to lattice degeneration occurred in 30 eyes (56%) at superior retina, 20 eyes (37%) at inferior retina, 4 eyes (7%) at total retina, and had a much less serious prognosis in cases of atrophic hole compared with tear due to macula was less frequently involved in atrophic hole.