Change of Corneal Epithelial and Stromal Thickness after Cataract Surgery through Scleral Tunnel Incision

PURPOSE: To compare preoperative and postoperative thickness and to investigate the difference in the thickness change of corneal epithelium and stroma after cataract surgery through scleral tunnel incision. METHODS: Forty eyes of forty patients who were 40 years old or older and underwent small-incision superior scleral tunnel cataract surgery with phacoemulsification were included. Using the RTVue instrument (Optovue Inc., Fremont, CA, USA), corneal epithelial (ET) and stromal thicknesses (ST) of all subjects were measured preoperatively and at 3 days, 1 week, and 1 month postoperatively. Thicknesses were classified into 3 zones according to the distance from the vertex: central zone (within 2 mm), paracentral zone (2-5 mm diameter) and midperipheral zone (5-6 mm diameter). RESULTS: Mean central ST was 486.68 ± 25.15 µm, 535.16 ± 48.13 µm, 515.98 ± 44.07 µm, and 502.28 ± 34.87 µm preoperatively, and at 3 days, 1 week, and 1 month postoperatively, respectively (p < 0.001 for all). ST showed significant thickening in all three zones from 3 days to 1 month postoperatively (p < 0.001 for all). Mean central, paracentral, and midperipheral ET was 52.13 ± 3.41 µm, 50.42 ± 2.97 µm, 49.12 ± 3.05 µm at preoperatively and 51.03 ± 3.63 µm, 48.96 ± 3.62 µm, 47.67 ± 3.81 µm at 1 month postoperatively, respectively (p = 0.061, 0.006, 0.001, respectively), while there were no signficant changes in all three zones at 3 and 7 days postoperatively. Changes in ET and ST were prominent at the superotemporal incision site. CONCLUSIONS: After scleral tunnel cataract surgery, corneal edema was observed in the stroma immediately after surgery. There was no significant change at early times after surgery in the epithelium, and there was a decrease in the peripheral cornea at 1 month postoperatively. The change in ET was considered a compensatory change due to stromal edema and appeared between 1 week to 1 month postoperatively.

Clinical Outcome of Ciliary Sulcus-Implanted Single-Piece Foldable Acrylic Intraocular Lens

PURPOSE: To evaluate complications and refractive outcomes of implantation of a single-piece acrylic intraocular lens (SPA-IOL) in the ciliary sulcus during phacoemulsification complicated with posterior capsule tear (PCT). METHODS: This retrospective study included patients who visited our hospital from 2014 January to 2015 June with implantation of a SPA-IOL (RAYNER 920H Superflex) in the ciliary sulcus during phacoemulsification complicated with PCT. Patients had their IOL power reduced by 1 diopter (D) from that calculated for in-the-bag implantation. At 3 months after operation, best corrected visual acuity (BCVA), uncorrected visual acuity (UCVA) and a refraction test were performed. RESULTS: PCT requiring implantation of IOL in the ciliary sulcus occurred in 17 eyes. Postoperative complications included corneal edema (3 eyes), anterior segment inflammation (1 eye), intraocular pressure elevations (3 eyes). However, improvements resulting from proper management and no significant IOL decentration were observed. At 3 months after operation, the mean spherical equivalent was -0.79 ± 0.39 D (-0.25 to -1.5 D), the mean UCVA was 0.77 ± 0.22 (0.4 to 1.0), and the mean BCVA was 0.94 ± 0.08 (0.8 to 1.0). CONCLUSIONS: Sulcus implantation of a SPA-IOL (RAYNER 920H Superflex) has no clinically significant complication, and the mean spherical equivalent after 3 months with a power reduction of 1.0 D was -0.79 ± 0.39 D (-0.25 to -1.5 D).

Eye Fixation in Patients with Dissociated Vertical Diviation

PURPOSE: To clinically determine the proportion of people with a fixed dissociating eye in patients with dissociated vertical deviation (DVD). METHODS: Medical records of 86 patients diagnosed with DVD in our department of ophthalmology from 2001 to November 2011 were retrospectively analyzed. RESULTS: Of the 71 patients, 25 (35.21%) showed a higher degree of dissociation in the fixating eye, 26 (36.62%) had higher dissociation in the non-fixating eye; 20 of 25 patients with a higher level of dissociation in the fixating eye and 22 of 26 patients with a higher level of dissociation in the non-fixating eye received surgical correction for DVD, such as superior rectus muscle recession or inferior oblique muscle anterior transposition. CONCLUSIONS: In DVD, the proportion of patients showing a higher level of dissociation in the fixating eye was significant. Patients with DVD require thorough evaluation; measurement of the level of dissociation and determination of the fixating eye is beneficial for management and surgical intervention.

The Effects of Stress on Intraocular Pressure and Lacrimal Secretion

PURPOSE: To evaluate the effects of psychosocial stress on intraocular pressure and lacrimal secretion. METHODS: Twenty normal adult volunteers (40 eyes) who had no history of systemic or ocular disease such as dry eye syndrome or glaucoma were recruited from clinical research participants. Heart rate, intraocular pressure and lacrimal secretion were measured after the Trier Social Stress Test (TSST) which induces psychosocial stress. The same measurements were taken 1 week later and the recorded measurements were considered as the control group. RESULTS: Heart rate was elevated significantly after the TSST, indicating psychosocial stress was induced by the TSST. Compared to stress resolution status, intraocular pressure and lacrimal secretion were increased after the TSST (p = 0.027, p = 0.011). Elevation of intraocular pressure and lacrimal secretion was statistically significant in males (p = 0.031, p = 0.007), but not significant in females (p = 0.336, p = 0.554). CONCLUSIONS: Psychosocial stress can increase intraocular pressure and lacrimal secretion.

Postoperative Exotropic Drift: Comparison of Surgical Methods Combined with Lateral Rectus Muscle Recession in Exotropia

PURPOSE: To assess the difference in the change of postoperative ocular alignment in intermittent exotropia corrected by horizontal muscle transposition or inferior oblique muscle recession together with lateral rectus muscle recession. METHODS: A total of 110 patients with intermittent exotropia with a follow-up period of more than 6 months after lateral rectus muscle recession were enrolled in the present study. The patients who received lateral rectus muscle recession only were classified as group 1, patients who received both lateral rectus muscle recession and horizontal muscle vertical transposition in both eyes were classified as group 2, and patients who underwent lateral rectus muscle and inferior oblique muscle recession were classified as group 3. The differences in postoperative ocular alignment among the patient groups were compared. RESULTS: Among the 3 groups, group 2 demonstrated the smallest amount of esotropic deviation in mean postoperative ocular alignment measured 1 day and 1 month after surgery. There was no significant difference among the groups in the mean postoperative ocular alignment and mean amount of exotropic drift at 6 months. The difference in the amount of postoperative exotropic drift 1 year after surgery among the 3 groups was statistically significant. The largest amount of postoperative exotropic drift was observed in group 1. CONCLUSIONS: In correcting intermittent exotropia, the largest amount of postoperative exotropic drift was observed in patients who received only lateral rectus muscle recession. By contrast, the smallest amount of postoperative exotropic drift was observed in patients who received lateral rectus muscle recession with vertical transposition of the horizontal muscle.

Macular Infarction Associated with Reactive Arthritis

A 53-year-old woman visited the Department of Rheumatology with a chief complaint of a 3-day history of fever and chills and also presented with pain occuring in both knees at the time of outpatient visit. Based on rheumatologic and hematological lab studies, ultrasonography, and a needle aspiration biopsy of the articular cavity, the patient was diagnosed with reactive arthritis. On hospitalization day 3, consultation with the Department of Ophthalmology was requested regarding decreased visual acuity lasting for 3 days. Upon ophthalmologic examination, the corrected visual acuity was 0.1 in the right eye and 0.05 in the left eye. Upon slit lamp microscopy, there were no abnormal findings in the anterior segment. Upon fundus examination, however, there were yellow-white lesions in the macular area of both eyes. Fluorescein angiographywas performed to assess the macular lesions, and the findings were suggestive of macular infarction in both eyes. Due to a lack of other underlying disease, a past surgical history, and a past history of drug administration, the patient was diagnosed with macular infarction in both eyes associated with reactive arthritis. To date, there have been no other such cases reported. In a patient with reactive arthritis, we experienced a case of macular infarction in both eyes, which occurred without association with a past history of specific drug use or underlying disease. Herein, we report our case, with a review of the literature.

Electron Microscopy of Needle Tips Following Intravitreal Injections Using 30-Gauge Needles

PURPOSE: To observe the degree of damage in a 30-gauge injection needle by observing the changes in needle tip following an intravitreal injection with the use of a scanning electron microscope. METHODS: The present study evaluated 11 injection needles collected following the use of an intravitreal injection of bevacizumab. Ten unused injection needles were selected as the control group. Needle examination was performed using a scanning electron microscope. RESULTS: Following 11 intravitreal injections, seven bent needle tips, two stubbed needle tips and two almost normal needle tips were observed following intravitreal injections. In the control group, a single damaged needle tip was observed. CONCLUSIONS: Significant damage to the needle tip was observed following intravitreal injection using a 30-gauge injection needle. The results indicate that needles should be manipulated carefully during an intravitreal injection. Additionally, in the control group where no procedures were performed, a single injection needle with damaged status was found. These results indicate that needles should be replaced in cases in which resistance is perceived during the procedure.

Comparison of Damage Degrees After Corneal Epithelial Debridement Using Different Instruments in Rabbit Eyes

PURPOSE: A corneal epithelial debridement using three different instruments was performed in rabbits, and the rates of corneal epithelium recovery were compared. Additionally, the extent of corneal damage as determined by the scanning electron microscopy was evaluated in each group. METHODS: Nineteen eyes of ten rabbits were classified into three groups according to the instruments used. The corneal epithelial debridement was performed using three different instruments: a Beaver blade (group A), a Bard-Parker blade No.15 (group B) and a dry cotton-tipped ap plicator (group C). After epithelial debridement, each cornea was observed every 24 hours for three days. After completion of the corneal recovery, each cornea was severed along the limbus and observed under the scanning electron microscope. RESULTS: The rate of corneal epithelial healing of the group C (dry cotton-tipped applicator) showed no statistical significance from those of the other groups. However, according to the corneal status observed under scanning electron microscope after debridement, cracks in the corneal surface in portions of group A and B were observed in contrast with no creaks in group C. CONCLUSIONS: Based on these results, corneal epithelial debridement using a cotton-tipped applicator is expected to reduce the occurrence of postoperative corneal complications. Use of a dry cotton-tipped applicator for corneal epithelial debridement in vitreoretinal surgery is suggested.

Change in Angle Deviation After Visual Acuity Improvement in Monocular Deviated Patients

PURPOSE: Anisometropia can lead to monocular deviation if the refractive error is not corrected. Therefore, the authors evaluated the change in angle deviation after visual acuity improvement by refractive correction in monocular deviated patients with anisometropia. METHODS: Changes in angle deviation were collated retrospectively for 9 patients with anisometric monocular deviation, 7 with monocular exotropia and 2 with monocular esotropia, according to medical records. The patients were admitted for strabismus surgery performed using cataract extraction or clear lens extraction (8 patients) or were treated nonsurgically using contact lenses for visual acuity recovery (1 patient). RESULTS: Prior to corrective measures, patients with exotropia had, on average, exodeviation of 40.43 PD, and those with esotropia had, on average, esodeviation of 27.50 PD. After corrective measures were taken, all 7 exotropia patients had decreased angle deviation, and, upon final evaluation, exodeviation had decreased to 21.71 PD, on average. In two exotropia patients, measures taken to correct refractive error shifted the exotropia to exophoria. There was no change in angle deviation after Corrective measures in 2 esotropia patients. CONCLUSIONS: In cases of exotropia caused by decreased visual acuity, correction of the visual acuity should be performed first if the correction is possible. After the recovery of visual acuity, a significant decrease in angle deviation occurs.

Valsalva Retinopathy Associated With an Oratorical Contest

A 17-year-old man presented to us with a chief complaint of decreased visual acuity accompanied by central scotoma. There was nothing unusual in his medical history other than a recent oratorical contest. At the time of initial diagnosis, the corrected visual acuity was 20/20 in the right eye and 20/100 in the left eye. No significant findings were apparent on ophthalmic evaluation. On fundoscopy, there was a dumbbell-shaped macular bleed with a well-defined margin in the left eye. The clinical course was closely monitored along with drug therapy. Four weeks post presentation, the pre-retinal hemorrhage had nearly resolved. On fluorescein angiography, no significant findings were observed. In the left eye, the corrected visual acuity had improved to 20/25. Valsalva retinopathy is a pathology that occurs when a sudden increase in intra-thoracic pressure or abdominal pressure occurs in an otherwise healthy person. Here we report a case of Valsalva retinopathy occurring following an oratorical contest along with a review of the relevant literature.

Identification of P2Y11 Receptor Expressed in Human Retinoblastoma Cells

PURPOSE: The present study aimed to identify the characteristics and physiological function of the P2Y11 receptor, a receptor likely expressed in human retinoblastoma cells. METHODS: We measured possible P2Y11 signaling in WERI-Rb-1 cells using a Ca2+ imaging technique and RT-PCR. RESULTS: 1) 10 micro M ATP elicited a strong but transient increase in Ca2+ in the WERI-Rb-1 cells, and this Ca2+ rise was well maintained after external Ca2+-depletion. 2) ATP-induced Ca2+ response arose entirely through Ca2+ mobilization. 3) P2Y11 agonist (BzATP, 100 micro M) increased Ca2+ by 31.2+/-3.7 % of ATP effect. 4) mRNA for P2Y11 subtype was identified using RT-PCR. CONCLUSIONS: P2Y11 purinergic activation can increase the intracellular calcium level through calcium mobilization in undifferentiated retinoblastoma cells, which may play an important role in cell proliferation, differentiation, and even pathologic processes.

The Effect of Scleral Buckle in Experimental Penetrating Eye Injury

PURPOSE: Scleral buckles are frequently performed as an additional procedure in perforated ocular injury surgery, but little is known about their independent effect after ocular trauma. The authors made a posterior penetrating ocular injury model in rabbits to evaluate the isolated role of primary scleral buckle placement. METHODS: Twenty eyes underwent surgery. The penetrating injury consisted of two 5 mm circumferential incisions placed five clock hours apart and 7 mm behind the limbus. A segmental scleral buckle was placed over a randomly chosen penetrating injury site after wound closure. The degree of the fibrous proliferation, traction, and the presence of retinal detachment were evaluated on follow-up examination. After enucleation and fixation, tissue sectioning was performed including injury sites. The greatest dimension of the fibrous proliferation at both wound sites was measured. RESULTS: Two eyes were excluded from the study due to unsuccessful buckling. Four eyes developed a retinal detachment. The remaining 14 eyes showed varying degrees of proliferation and traction on the retina. The greatest dimension of the fibrous proliferation at the buckle site (1.69 +/- 0.29 mm) was significantly different from that at the non-buckle site (2.07 +/- 0.37 mm, P<0.05). CONCLUSION: Primary scleral buckle placement at the time of surgical repair reduces vitreous traction and decreases the degree of fibrous proliferation.

The Effect of 9 mm, 7 mm Bilateral Superior Rectus Recession for Bilateral Dissociated Vertical Deviation

PURPOSE: To evaluate the effect of 9 mm and 7 mm bilateral recession of the superior rectus muscle in patients with bilateral dissociated vertical deviation (DVD) who had a deviation difference between the non-fixing and fixing eyes of less than 8PD. METHODS: The subjects were chosen from the patients who visited our hospital for DVD between January 2001 and November 2003. We reviewed the surgical records of 19 patients who had undergone 9 mm recession of superior rectus muscle in the non-fixing eye and 7 mm in fixing eye, and who had been followed up for at least 6 months. RESULTS: A residual DVD less than 8PD was regarded as successful. The overall success rate was 73.7%. The success rate of 10~14PD preoperative deviation of the non-fixing eye was 80.0%, and that of 15~19PD preoperative deviation of the non-fixing eye was 75.0%. However, the success rate was 66.7% in recession for the deviation over 20PD. CONCLUSIONS: Bilateral recession of 9 mm and 7 mm of the superior rectus muscle was effective for bilateral DVD in which the deviation difference of the non-fixing eye and fixing eyes was less than 8PD.

The Frontalis Sling Operation Using Preserved Fascia Lata: Modified Crawford Technique

PURPOSE: For the correction of ptosis with very poor levator function, frontalis sling operation with various materials has been used. The purpose of this study was to evaluate the effect of the modified Crawford technique using preserved fascia lata. METHODS: The photographs and charts of 46 patients who underwent frontalis sling operation using preserved fascia lata from June 2001 to February 2004 at our hospital were retrospectively reviewed. The eyelid crease approach was used with the suturing of the sling material directly to the tarsus. RESULTS: The patients were 27 males and 19 females. There were 20 (44%) unilateral cases and 26 (56%) bilateral cases. The age of the patients ranged from 1 to 65 years at the time of surgery, with an average age of 8.3 years. The success rate was 93% (43/46 patients) for a mean postoperative follow-up of 9 months (range 4~26 months). The complications consisted of one case of overcorrection and 2 cases of undercorrection. Knot exposure occurred in 2 cases. CONCLUSIONS: The modified Crawford technique using preserved fascia lata appears to be an effective treatment for severe ptosis. The lid crease formation provides good cosmetic results and the direct suturing of the preserved fascia lata to the tarsus prevents its migration.

Therapeutic Effect of Topical Autologous Serum in Recurrent Punctate Corneal Erosion

PURPOSE: To study the effect of topical autologous serum in the treatment of recurrent punctate corneal erosions. METHODS: A total of 10 eyes from recurrent corneal erosion patients, who had suffered from recurrence after initial treatment with conventional therapy were treated using topical autologous serum from October 2001 to April 2003. We investigated the efficacy of this method over conventional therapy by retrospective review of their medical records. RESULTS: The recurrence rate of erosions before treatment with autologous serum eyedrops ranged from once every 2months to twice a month. Mean follow-up time was 11.0 +/- 4.6 months (range, 6~19 months). There was one case of recurrence 3 months after first treatment with autologous serum eyedrops which was effectively cured with autologous serum eyedrops. No side effects were noted in any of the treated patients. CONCLUSIONS: Topical autologous serum application may be considered as an effective and safe treatment modality in recurrent corneal erosions.

Neuromyelitis Optica in Children after Steroid Therapy

PURPOSE: Neuromyelitis optica (Devic's disease) is a rare clinical syndrome of unknown etiology in which unilateral or bilateral optic neuritis and transverse myelitis occur within an 8-week time interval. It is a disorder that occurs more commonly in adults than in children. The authors report a case of neuromyelitis optica in a patient who had been treated for transverse myelitis with steroid. METHODS: An 11-year-old female who had been treated for transverse myelitis with steroids for 2 weeks developed visual loss in her left eye with viral prodromes. An afferent pupillary defect was noticed and papilledema and leakage from the optic disc were noticed on fundus examination and fluorescein angiography. We confirmed neuromyelitis optica. RESULTS: Symptoms were improved with high-dose corticosteroid therapy but the visual field remained decreased. CONCLUSIONS: The prognosis of neuromyelitis optica is better in children than in adults. It was better that the child with transverse myelitis had undergone ophthalmologic evaluation and close observation for more than 8 weeks. When optic neuritis was developed, high dose steroid therapy was performed for a sufficient period.

Rheological properties of resin composites according to the change of monomer and filler compositions / 대한치과보존학회지

OBJECTIVES: The aim of this study was to investigate the effect of monomer and filler compositions on the rheological properties related to the handling characteristics of resin composites. METHODS: Resin matrices that Bis-GMA as base monomer was blended with TEGDMA as diluent at various ratio were mixed with the Barium glass (0.7 um and 1.0 um), 0.04 um fumed silica and 0.5 um round silica. All used fillers were silane treated. In order to vary the viscosity of experimental composites, the type and content of incorporated fillers were changed. Using a rheometer, a steady shear test and a dynamic oscillatory shear test were used to evaluate the viscosity (eta) of resin matrix, and the storage shear modulus (G'), the loss shear modulus (G"), the loss tangent (tandelta) and the complex viscosity (eta*) of the composites as a function of frequency omega = 0.1-100 rad/s. To investigate the effect of temperature on the viscosity of composites, a temperature sweep test was also undertaken. RESULTS: Resin matrices were Newtonian fluid regardless of diluent concentration and all experimental composites exhibited pseudoplastic behavior with increasing shear rate. The viscosity of composites was exponentially increased with increasing filler volume%. In the same filler volume, the smaller the fillers were used, the higher the viscosities were. The effect of filler size on the viscosity was increased with increasing filler content. Increasing filler content reduced tandelta by increasing the G' further than the G". The viscosity of composites was decreased exponentially with increasing temperature.

The Change of the Tobramycin Concentration in Aqueous Humor According to the Administration Routes

PURPOSE: To determine the best routes of administration of Tobramycin, the intracameral concentrations was assessed as time progressed after administering identical amounts and concentrations of tobramycin through various methods. METHODS: 40 eyes from 20 house rabbits were administered the same amount (200 micro liter) of 0.3% tobramycin. The first group was administered topically, and the second group was administered by subconjunctival injection. Contact lenses were soaked in tobramycin for 30 minutes and were covered over the corneas of the third group. While amniotic membranes were transplanted onto the corneas and tobramycin was topically administered in the fourth group. 100 micro liter of aqueous fluid was extracted 30 min, 1 hr, 2 hr and 3 hr after the administration and intracameral concentrations of tobramycin were measured using FPIA (fluorescence polarization immunoassay). RESULTS: After topical administration and subconjunctival injection, statistically significant decreases of average concentrations were observed after 2~3 hours. The group that was covered with flexible hydrophilic contact lenses showed high concentrations after 30 minutes, and a statistically significant increases of concentration was observed after 2 hours. The group that was topically administered with 0.3% tobramycin after amniotic transplantation on the cornea, showed a gradual increase of concentration as time progressed, and statistically significant increase of concentration was observed after 1~2 hours. CONCLUSIONS: Topical administrations with more frequent instillations increased intracameral concentrations, exceeding the MIC90 concentration of Staphylococcus aureus. while low concentration (0.3%) of subconjunctival injections did not significantly increases intracameral concentrations. Using flexible contact lenses, high concentrations were observed in the early stages, exceeding the MIC90 concentrations of Staphylococcus aureus, Staphylococcus epidermidis, and Pseudomonas aeruginosa. Concentrations exceeded MIC90 concentration of Staphylococcus epidermidis 30 minutes after amniotic membranes transplantation, and continued to increases after 3 hours, Therefore, we can conclude that amniotic membrane can be used as a reservoir for transferring drugs.

The Fungal Infection of Nasal Cavity After Endonasal Dacryocystorhinostomy

PURPOSE: To achieve the higher success rate of Dacryocystorhinostomy, Adjunctively, Mitomycin C has been widely used. There have been many complications with the administration of mitomycin C, such as delayed wound healing, wound infection and recurrent nasal bleeding. We are reporting a case of fungal infection in the nasal cavity after the administration of mitomycin C in the endoscopic dacryocystorhinostomy. METHODS: Under the general anesthesia, 63 year old female patient underwent endoscopic Dacryocystorhinostomy. At the end of this operation, a piece of neurosurgical cottonoid soaked with 0.04% mitomycin C was applied at the osteotomy site for 30 mins. During the postoperative follow-up, we executed incisional biopsy for some mass-like lesion in nasal cavity. RESULTS: Pathologic finding of inflammatory fibrinoid exudate due to Candida albicans was found. The evacuation of the mass was carried out without postoperative recurrence.

Surgical Results of Inferior Tarsotomy for Diffuse Lower Lid Trichiasis

PURPOSE: To evaluate the functional and cosmetic results of trichiasis treatment between the argon laser epilation(Group A) and tarsotomy(Group B). METHODS: Twenty-seven patients with diffuse lower lid trichiasis, whose post-treatment follow-up periods were longer than 3 months, were reviewed retrospectively. Functionally, 14 of 16 patients(89.6%) in group A were satisfied, whereas 9 of 11 patients(84.0%) were in group B. And cosmetically, 10 of 16 patients(62.9%) in group A were satisfied, whereas 8 of 11 patients(79.0%) were in group B. The functional results were similar between the two groups(p>0.05), but the cosmetic results were better in group B than in group A(p<0.05) CONCLUSIONS: The inferior tarsotomy appears to be an effective surgical procedure in patients with diffuse lower lid trichiasis.