New synergistic efficacy of combination of romiplostim and steroid in refractory immune thrombocytopenia patients

No abstract available.

Angiotensin II Modulates p130Cas of Podocytes by the Suppression of AMP-Activated Protein Kinase

Angiotensin II (Ang II) induces the pathological process of vascular structures, including renal glomeruli by hemodynamic and nonhemodynamic direct effects. In kidneys, Ang II plays an important role in the development of proteinuria by the modification of podocyte molecules. We have previously found that Ang II suppressed podocyte AMP-activated protein kinase (AMPK) via Ang II type 1 receptor and MAPK signaling pathway. In the present study, we investigated the roles of AMPK on the changes of p130Cas of podocyte by Ang II. We cultured mouse podocytes and treated them with various concentrations of Ang II and AMPK-modulating agents and analyzed the changes of p130Cas by confocal imaging and western blotting. In immunofluorescence study, Ang II decreased the intensity of p130Cas and changed its localization from peripheral cytoplasm into peri-nuclear areas in a concentrated pattern in podocytes. Ang II also reduced the amount of p130Cas in time and dose-sensitive manners. AMPK activators, metformin and AICAR, restored the suppressed and mal-localized p130Cas significantly, whereas, compound C, an AMPK inhibitor, further aggravated the changes of p130Cas. Losartan, an Ang II type 1 receptor antagonist, recovered the abnormal changes of p130Cas suppressed by Ang II. These results suggest that Ang II induces the relocalization and suppression of podocyte p130Cas by the suppression of AMPK via Ang II type 1 receptor, which would contribute to Ang II-induced podocyte injury.

Malignant Neuroleptic Syndrome following Deep Brain Stimulation Surgery of Globus Pallidus Pars Internus in Cerebral Palsy / 대한중환자의학회지

Neuroleptic malignant syndrome (NMS) is a rare but potentially lethal outcome caused by sudden discontinuation or dose reduction of dopaminergic agents. We report an extremely rare case of NMS after deep brain stimulation (DBS) surgery in a cerebral palsy (CP) patient without the withdrawal of dopaminergic agents. A 19-year-old girl with CP was admitted for DBS due to medically refractory dystonia and rigidity. Dopaminergic agents were not stopped preoperatively. DBS was performed uneventfully under monitored anesthesia. Dopaminergic medication was continued during the postoperative period. She manifested spasticity and muscle rigidity, and was high fever resistant to anti-pyretic drugs at 2 h postoperative. At postoperative 20 h, she suffered cardiac arrest and expired, despite vigorous cardiopulmonary resuscitation. NMS should be considered for hyperthermia and severe spasticity in CP patients after DBS surgery, irrespective of continued dopaminergic medication.

Malignant Neuroleptic Syndrome following Deep Brain Stimulation Surgery of Globus Pallidus Pars Internus in Cerebral Palsy / 대한구급학회지

Neuroleptic malignant syndrome (NMS) is a rare but potentially lethal outcome caused by sudden discontinuation or dose reduction of dopaminergic agents. We report an extremely rare case of NMS after deep brain stimulation (DBS) surgery in a cerebral palsy (CP) patient without the withdrawal of dopaminergic agents. A 19-year-old girl with CP was admitted for DBS due to medically refractory dystonia and rigidity. Dopaminergic agents were not stopped preoperatively. DBS was performed uneventfully under monitored anesthesia. Dopaminergic medication was continued during the postoperative period. She manifested spasticity and muscle rigidity, and was high fever resistant to anti-pyretic drugs at 2 h postoperative. At postoperative 20 h, she suffered cardiac arrest and expired, despite vigorous cardiopulmonary resuscitation. NMS should be considered for hyperthermia and severe spasticity in CP patients after DBS surgery, irrespective of continued dopaminergic medication.

Diabetic conditions modulate the adenosine monophosphate-activated protein kinase of podocytes

BACKGROUND: Adenosine monophosphate-activated protein kinases (AMPKs), as a sensor of cellular energy status, have been known to play an important role in the pathophysiology of diabetes and its complications. Because AMPKs are known to be expressed in podocytes, it is possible that podocyte AMPKs could be an important contributing factor in the development of diabetic proteinuria. We investigated the roles of AMPKs in the pathological changes in podocytes induced by high-glucose (HG) and advanced glycosylation end products (AGEs) in diabetic proteinuria. METHODS: We prepared streptozotocin-induced diabetic renal tissues and cultured rat and mouse podocytes under diabetic conditions with AMPK-modulating agents. The changes in AMPKalpha were analyzed with confocal imaging and Western blotting under the following conditions: (1) normal glucose (5mM, =control); (2) HG (30mM); (3) AGE-added; or (4) HG plus AGE-added. RESULTS: The density of glomerularphospho-AMPKalpha in experimental diabetic nephropathy decreased as a function of the diabetic duration. Diabetic conditions including HG and AGE changed the localization of phospho-AMPKalpha from peripheral cytoplasm to internal cytoplasm and peri- and intranuclear areas in podocytes. HG reduced the AMPKalpha (Thr172) phosphorylation of rat podocytes, and similarly, AGEs reduced the AMPKalpha (Thr172) phosphorylation of mouse podocytes. The distributional and quantitative changes in phospho-AMPKalpha caused by diabetic conditions were preventable using AMPK activators, metformin, and 5-aminoimidazole-4-carboxamide-1beta-riboside. CONCLUSION: We suggest that diabetic conditions induce the relocation and suppression of podocyte AMPKalpha, which would be a suggestive mechanism in diabetic podocyte injury.

The Relationship of Liver Function Tests to Mixed Exposure to Lead and Organic Solvents

OBJECTIVE: This study aims to compare liver function indices (aspartate aminotransferase [AST], alanine aminotransferase [ALT], and gamma glutamyl transferase [GGT]) among males who work with lead, organic solvents, or both lead and organic solvents, under the permissible exposure limit (PEL). METHODS: A total of 593 (out of 2,218) male workers who agreed to share their personal health information for medical research were selected for this study. Those excluded were hepatitis B carriers, individuals exposed to occupational risk factors other than lead and organic solvents, and individuals without liver function results. The 593 were divided into five groups: a lead-exposed group, an organic solvent-exposed group exposed to trichloroethylene (TCE co-exposed solvent group), an organic solvent-exposed group not exposed to trichloroethylene (TCE non-exposed solvent group), a lead and organic solvent-exposed group (mixed exposure group), and a non-exposed group (control group). We performed a one way-analysis of variance (one way-ANOVA) test to compare the geometric means of liver function indices among the groups, using a general linear model (GLM) to adjust for age, work duration, body mass index (BMI), smoking, and alcohol intake. In addition, we performed a binary logistic regression analysis to compare the odds ratios among groups with an abnormal liver function index, according to a cut-off value. RESULTS: The ALT and AST of the mixed exposure group were higher than those of the other groups. The GGT of the mixed exposure group was higher than the TCE co-exposed solvent group, but there was no difference among the control group, TCE non-exposed solvent group, lead-exposed group, and mixed exposure group. The same result was evident after adjusting by GLM for age, work duration, BMI, smoking, and alcohol intake, except that ALT from the mixed exposure group showed no difference from the TCE co-exposed solvent group. When the cut-off values of the AST, ALT, and GGT were 40 IU/L, 42 IU/L, and 63 IU/L, respectively, a logistic regression analysis showed no differences in the odds ratios of those who had an abnormal liver function index among the groups. However, if the cut-off values of the AST, ALT, and GGT were 30 IU/L, 30 IU/L, and 40 IU/L, respectively, the odds ratio of the AST in the mixed exposure group was 4.39 (95% CI 1.86-10.40) times higher than the control. CONCLUSION: This study indicates that a mixed exposure to lead and organic solvents is dangerous, even if each single exposure is safe under the permissible exposure limit. Therefore, to ensure occupational health and safety in industry, a continuous efforts to study the effects from exposure to mixed chemicals is needed.

Puromycin aminonucleoside modulates p130Cas of podocytes / 소아과

PURPOSE: Puromycin aminonucleoside (PAN) specifically injures podocytes, leading to foot process effacement, actin cytoskeleton disorganization, and abnormal distribution of slit diaphragm proteins. p130Cas is a docking protein connecting F-actin fibers to the glomerular basement membrane (GBM) and adapter proteins in glomerular epithelial cells (GEpCs; podocytes). We investigated the changes in the p130Cas expression level in the PAN-induced pathological changes of podocytes in vitro. METHODS: We observed changes in the p130Cas expression in cultured rat GEpCs and mouse podocytes treated with various concentrations of PAN and antioxidants, including probucol, epigallocatechin gallate (EGCG), and vitamin C. The changes in the p130Cas expression level were analyzed using confocal immunofluorescence imaging, Western blotting, and polymerase chain reaction. RESULTS: In the immunofluorescence study, p130Cas showed a diffuse cytoplasmic distribution with accumulation at distinct sites visible as short stripes and colocalized with P-cadherin. The fluorescences of the p130Cas protein were internalized and became granular by PAN administration in a dose-dependent manner, which had been restored by antioxidants, EGCG and vitamin C. PAN also decreased the protein and mRNA expression levels of p130Cas at high doses and in a longer exposed duration, which had been also reversed by antioxidants. CONCLUSION: These findings suggest that PAN modulates the quantitative and distributional changes of podocyte p130Cas through oxidative stress resulting in podocyte dysfunction.

Ginseng Total Saponin Improves Podocyte Hyperpermeability Induced by High Glucose and Advanced Glycosylation Endproducts

Early diabetic nephropathy is characterized by glomerular hyperpermeability as a result of impaired glomerular filtration structure caused by hyperglycemia, glycated proteins or irreversible advanced glycosylation endproducts (AGE). To investigate the effect of ginseng total saponin (GTS) on the pathologic changes of podocyte ZO (zonula occludens)-1 protein and podocyte permeability induced by diabetic conditions, we cultured mouse podocytes under: 1) normal glucose (5 mM, = control); 2) high glucose (HG, 30 mM); 3) AGE-added; or 4) HG plus AGE-added conditions and treated with GTS. HG and AGE increased the dextran filtration of monolayered podocytes at early stage (2-8 hr) in permeability assay. In confocal imaging, ZO-1 colocalized with actin filaments and beta-catenin at cell contact areas, forming intercellular filtration gaps. However, these diabetic conditions suppressed ZO-1 immunostainings and disrupted the linearity of ZO-1. In Western blotting, diabetic conditions also decreased cellular ZO-1 protein levels at 6 hr and 24 hr. GTS improved such quantitative and qualitative changes. These findings imply that HG and AGE have an influence on the redistribution and amount of ZO-1 protein of podocytes thereby causing hyperpermeability at early stage, which can be reversed by GTS.

The Change of Podocyte beta-Catenin by Puromycin Aminonucleoside

PURPOSE: To test whether the expression of beta-catenin, a component of podocyte as a filtration molecule, would be altered by puromycin aminonucleoside (PAN) in the cultured podocyte in vitro. METHODS: We cultured rat glomerular epithelial cells (GEpC) with various concentrations of PAN and examined the distribution of beta-catenin by confocal microscope and measured the change of beta-catenin expression by Western blotting and reverse transcriptase-polymerase chain reaction (RT-PCR). RESULTS: We found that beta-catenin relocalized from peripheral cytoplasm to inner cytoplasm, therefore, intercellular separations were seen in confluently cultured cells by high concentrations of PAN in immunofluorescence views. In Western blotting of GEpC, PAN (50 microg/mL) decreased beta-catenin expression by 34.9% at 24 hrs and 34.3% at 48 hrs, compared to those in without PAN condition (P<0.05). In RT-PCR, high concentrations (50 microg/mL) of PAN also decreased beta-catenin mRNA expression similar to protein suppression by 25.4% at 24 hrs and 51.8% at 48 hrs (P<0.05). CONCLUSION: Exposure of podocytes to PAN in vitro relocates beta-catenin internally and reduces beta-catenin mRNA and protein expression, which could explain the development of proteinuria in experimental PAN-induced nephropathy.

Detection of Hepatic Lesion: Comparison of Free-Breathing and Respiratory-Triggered Diffusion-Weighted MR imaging on 1.5-T MR system

PURPOSE: To compare free-breathing and respiratory-triggered diffusion-weighted imaging on 1.5-T MR system in the detection of hepatic lesions. MATERIALS AND METHODS: This single-institution study was approved by our institutional review board. Forty-seven patients (mean 57.9 year; M:F = 25:22) underwent hepatic MR imaging on 1.5-T MR system using both free-breathing and respiratory-triggered diffusion-weighted imaging (DWI) at a single examination. Two radiologists retrospectively reviewed respiratory-triggered and free-breathing sets (B50, B400, B800 diffusion weighted images and ADC map) in random order with a time interval of 2 weeks. Liver SNR and lesion-to-liver CNR of DWI were calculated measuring ROI. RESULTS: Total of 62 lesions (53 benign, 9 malignant) that included 32 cysts, 13 hemangiomas, 7 hepatocellular carcinomas (HCCs), 5 eosinophilic infiltration, 2 metastases, 1 eosinophilic abscess, focal nodular hyperplasia, and pseudolipoma of Glisson's capsule were reviewed by two reviewers. Though not reaching statistical significance, the overall lesion sensitivities were increased in respiratory-triggered DWI [reviewer1: reviewer2, 47/62(75.81%):45/62(72.58%)] than free-breathing DWI [44/62(70.97%):41/62(66.13%)]. Especially for smaller than 1 cm hepatic lesions, sensitivity of respiratory-triggered DWI [24/30(80%):21/30(70%)] was superior to free-breathing DWI [17/30(56.7%):15/30(50%)]. The diagnostic accuracy measuring the area under the ROC curve (Az value) of free-breathing and respiratory-triggered DWI was not statistically different. Liver SNR and lesion-to-liver CNR of respiratorytriggered DWI (87.6+/-41.4, 41.2+/-62.5) were higher than free-breathing DWI (38.8+/-13.6, 24.8+/-36.8) (p value <0.001, respectively). CONCLUSION: Respiratory-triggered diffusion-weighted MR imaging seemed to be better than free-breathing diffusion-weighted MR imaging on 1.5-T MR system for the detection of smaller than 1 cm lesions by providing high SNR and CNR.

Detection of Hepatic Lesion: Comparison of Free-Breathing and Respiratory-Triggered Diffusion-Weighted MR imaging on 1.5-T MR system

PURPOSE: To compare free-breathing and respiratory-triggered diffusion-weighted imaging on 1.5-T MR system in the detection of hepatic lesions. MATERIALS AND METHODS: This single-institution study was approved by our institutional review board. Forty-seven patients (mean 57.9 year; M:F = 25:22) underwent hepatic MR imaging on 1.5-T MR system using both free-breathing and respiratory-triggered diffusion-weighted imaging (DWI) at a single examination. Two radiologists retrospectively reviewed respiratory-triggered and free-breathing sets (B50, B400, B800 diffusion weighted images and ADC map) in random order with a time interval of 2 weeks. Liver SNR and lesion-to-liver CNR of DWI were calculated measuring ROI. RESULTS: Total of 62 lesions (53 benign, 9 malignant) that included 32 cysts, 13 hemangiomas, 7 hepatocellular carcinomas (HCCs), 5 eosinophilic infiltration, 2 metastases, 1 eosinophilic abscess, focal nodular hyperplasia, and pseudolipoma of Glisson's capsule were reviewed by two reviewers. Though not reaching statistical significance, the overall lesion sensitivities were increased in respiratory-triggered DWI [reviewer1: reviewer2, 47/62(75.81%):45/62(72.58%)] than free-breathing DWI [44/62(70.97%):41/62(66.13%)]. Especially for smaller than 1 cm hepatic lesions, sensitivity of respiratory-triggered DWI [24/30(80%):21/30(70%)] was superior to free-breathing DWI [17/30(56.7%):15/30(50%)]. The diagnostic accuracy measuring the area under the ROC curve (Az value) of free-breathing and respiratory-triggered DWI was not statistically different. Liver SNR and lesion-to-liver CNR of respiratorytriggered DWI (87.6+/-41.4, 41.2+/-62.5) were higher than free-breathing DWI (38.8+/-13.6, 24.8+/-36.8) (p value <0.001, respectively). CONCLUSION: Respiratory-triggered diffusion-weighted MR imaging seemed to be better than free-breathing diffusion-weighted MR imaging on 1.5-T MR system for the detection of smaller than 1 cm lesions by providing high SNR and CNR.

Improvement of Bilateral Parkinsonian Symptoms After Unilateral Intracerebral Hemorrhage

No abstract available.

Short-term Effect of the Diabetes Education Program in Children and Adolescents with Type 1 Diabetes Mellitus / 대한소아내분비학회지

PURPOSE: Diabetes mellitus is a chronic disorder and strict glycemic control, which cannot be successfully obtained without behavior modification, is the most important factor in prevention and management of complications. The purpose of this study was to investigate the short-term effects and associated factors of the diabetes education program and to assess the necessity of regular and structured education and support in diabetic children and adolescents. METHODS: Thirty patients (10.0-18.9 years) with type 1 diabetes mellitus (T1DM), attending the diabetes clinic in Seoul National University Children's Hospital, were included in the diabetes education program with intensified treatment. A six-day-course program was provided by a diabetes care team with doctors, a specialist diabetes nurse, a clinical dietitian, and a social worker. Patient data of disease duration and complication studies at the time of enrollment were reviewed and changes in HbA1c levels before and after the education program were analyzed. RESULTS: In 28 of 30 patients, significant decrease of average HbA1c levels (average 0.9%, median 0.8%, P < 0.001) was observed after education. The changes in average HbA1c levels were prominent in patients who were educated for the first time. On follow-up, HbA1c level at 3 months was significantly decreased (P = 0.009) but after 9 months, it tended to increase again. The decrease of average HbA1c levels after education was negatively correlated with disease duration (r = -0.60, P = 0.001). CONCLUSION: The short-term effect of the diabetes education program with intensified treatment in diabetic children and adolescents was optimistic but regular education and support in these patients should be sustained.

A Case of Posterior Ischemic Optic Neuropathy and Abducens Nerve Palsy

PURPOSE: To report a case of a patient with posterior ischemic optic neuropathy and abducens nerve palsy who responded to steroid therapy. CASE SUMMARY: A 47-year-old man visited our clinic with decreasing visual acuity and abduction limitation in his right eye, which suddenly started 4 days earlier. The best corrected visual acuity (BCVA) was 20/250 in the right eye and 20/20 in the left eye. Fundus examination showed normal in both eyes, and relative afferent pupillary defect was positive in the right eye. The visual field test showed a right central scotoma with inferior altitudinal field defect. In addition, the brain magnetic resonance imaging (MRI) was done. Orbit MRI, fluorescein angiography (FAG), and carotid ultrasonography results were normal. Therefore, the patient was diagnosed with non-arteritic posterior ischemic optic neuropathy. The systemic steroid therapy was started and tapered over a period of 5 weeks. At one month after treatment, the BCVA was 20/20 and abduction limitation in the right eye improved.

A multidisciplinary approach for the treatment of child abuse in Korea / 소아과

PURPOSE: To review and determine the complications in 76 child abuse cases recorded by a multidisciplinary hospital-based child protection team between 1987 and 2007. METHODS: We retrospectively reviewed the reports and medical records of child abuse cases maintained by a university hospital-based child protection team. We devised a questionnaire for standardized interviews with the victims' guardians to determine the current physical and mental status of the children; questionnaires were answered by social workers of the child protection team who interviewed the present fosterers of 24 (35.8%) children. RESULTS: Of the 76 children, 6 were infants, 10 were 1-3 years old, were 3-10 years old, and 19 were over 10 years old. Seven children (9.2%) were neglected and 27 (35.5%) and 44 (57.9%) were sexually and physically abused, respectively. In more than half of the cases, the perpetrators were the father or mother of the children. Most children (41 cases, 53.9%) were abused at their homes. The mean follow-up duration from the time of abuse infliction was 54.3+/-49.2 months, and the current mean age of the children was 8.3+/-6.4 years. Moderate and severe developmental delay and physical disability were observed in 6 (25.0%) and 3 (12.5%) cases, respectively. In 13 children (54.2%), the Global Assessment of Functioning Scale (GAF) score was less than 60, which indicates mild mental disability. CONCLUSION: A hospital-based child protection team may witness the different proportion of abuse types and patterns by conducting a nation-wide survey of child abuse cases.

A multidisciplinary approach for the treatment of child abuse in Korea / 소아과

PURPOSE: To review and determine the complications in 76 child abuse cases recorded by a multidisciplinary hospital-based child protection team between 1987 and 2007. METHODS: We retrospectively reviewed the reports and medical records of child abuse cases maintained by a university hospital-based child protection team. We devised a questionnaire for standardized interviews with the victims' guardians to determine the current physical and mental status of the children; questionnaires were answered by social workers of the child protection team who interviewed the present fosterers of 24 (35.8%) children. RESULTS: Of the 76 children, 6 were infants, 10 were 1-3 years old, were 3-10 years old, and 19 were over 10 years old. Seven children (9.2%) were neglected and 27 (35.5%) and 44 (57.9%) were sexually and physically abused, respectively. In more than half of the cases, the perpetrators were the father or mother of the children. Most children (41 cases, 53.9%) were abused at their homes. The mean follow-up duration from the time of abuse infliction was 54.3+/-49.2 months, and the current mean age of the children was 8.3+/-6.4 years. Moderate and severe developmental delay and physical disability were observed in 6 (25.0%) and 3 (12.5%) cases, respectively. In 13 children (54.2%), the Global Assessment of Functioning Scale (GAF) score was less than 60, which indicates mild mental disability. CONCLUSION: A hospital-based child protection team may witness the different proportion of abuse types and patterns by conducting a nation-wide survey of child abuse cases.

Free-floating Pigmented Iris Cyst in the Anterior Chamber

PURPOSE: The aim of this project is to report the successful removal of a free - floating pigmented iris cyst in a patient ' s anterior chamber, which was causing visual disturbance. CASE SUMMARY: A 27 - year - old man visited our hospital because of an intermittent visual disturbance in his right eye developed two months prior to admission. There was no history of ocular trauma, surgery, inflammation, or a general medical problem. On slit lamp examination, we found a free - floating translucent pigmented iris cyst, which was ovoid in shape and about 3 mm in size in the right eye near the pupil margin. Moving in the anterior chamber, the cyst caused visual disturbance because it partly covered the pupil. It was also near the endothelium. Through the clear cornea incision, the iris cyst was removed successfully. From histopathologic investigation of the cyst, the tissue was found to consist of mature pigment epithelium, including pigment granules CONCLUSIONS: A free - floating pigmented iris cyst in the anterior chamber generally does not result in any complications and maintains its condition stably without changing in size. Hence, as long as it does not cause complications, no treatment is necessary. However, if it causes visual disturbance or it damages endothelial cells or causes glaucoma or any other intraocular complication, it needs to be treated. In the case of our patient, visual disturbance did occur and we removed the iris cyst through an operation. Such a case has not been reported before in South Korea.

Differential promoter methylation may be a key molecular mechanism in regulating BubR1 expression in cancer cells

The BubR1 mitotic-checkpoint protein monitors proper attachment of microtubules to kinetochores, and links regulation of chromosome-spindle attachment to mitotic-checkpoint signaling. Thus, disruption of BubR1 activity results in a loss of checkpoint control, chromosomal instability caused by a premature anaphase, and/or the early onset of tumorigenesis. The mechanisms by which deregulation and/or abnormalities of BubR1 expression operate, however, remain to be elucidated. In this study, we demonstrate that levels of BubR1 expression are significantly increased by demethylation. Bisulfite sequencing analysis revealed that the methylation status of two CpG sites in the essential BubR1 promoter appear to be associated with BubR1 expression levels. Associations of MBD2 and HDAC1 with the BubR1 promoter were significantly relieved by addition of 5-aza-2'-deoxycytidine, an irreversible DNA methyltransferase inhibitor. However, genomic DNA isolated from 31 patients with colorectal carcinomas exhibited a +84A/G polymorphic change in approximately 60% of patients, but this polymorphism had no effect on promoter activity. Our findings indicate that differential regulation of BubR1 expression is associated with changes in BubR1 promoter hypermethylation patterns, but not with promoter polymorphisms, thus providing a novel insight into the molecular regulation of BubR1 expression in human cancer cells.

A Case of Sudden Refractive Change with Intraocular Pressure Change Following Trauma

PURPOSE: To report a case of refractive change with intraocular pressure change following trauma. METHODS: Changes in intraocular pressure, refractive power, lens thickness, depth of anterior chamber, and axial length of an 8-year-old girl were measured. RESULTS: During the early period after trauma, the patient showed low intraocular pressure and shallow anterior chamber depth. The refractive power changed to transient high myopia. With temporary high intraocular pressure, the refractive power changed to hyperopia and the refractive power recovered toward emmetropia as the intraocular pressure fell to the normal level. Refractive alteration is a result of changes in intraocular pressure and depth of the anterior chamber by cyclodialysis cleft and its adhesion is induced by trauma to the eye. Herein, the authors show evidence for a relationship between refractive change and posttraumatic ocular change.

Comparison of Surgical Results Between Unilateral Recession-Resection and Bilateral Resections in Recurrent Exotropia

PURPOSE: The purpose of this study was to compare the surgical results between unilateral lateral rectus recession-medial rectus resection (R and R) and bilateral medial rectus resections in recurrent exotropia. METHODS: In this retrospective study, 22 patients with recurrent exotropia of the basic or pseudodivergence excess types were enrolled. In group A (14 patients), unilateral R and R was performed during the first operation, and R and R was performed in contralateral eyes during the second operation. In group B (8 patients), bilateral lateral rectus recessions were performed during the first operation and bilateral medial rectus resections during the second operation. RESULTS: The mean time interval between the first and second operations was 28.9 months (range, 5 to 64 months) in Group A and 59.9 months (range, 35 to 75 months) in Group B, which was a significant difference between the two groups (p=0.006). The success rates at last follow-up after the second operation were 85.7% in Group A and 87.5% in Group B, which was not statistically different between the two groups (p<1.000). CONCLUSIONS: There was no difference in success rate after the second operation between the two groups. Therefore, the operation method for recurrent exotropia can be chosen according to the operator's preference.