Limbal Lensectomy with or without Anterior Vitrectomy for the Management of Lens Subluxation / 영남의대학술지

PURPOSE: This study was conducted to assess the surgical outcomes of limbal lensectomy with or without anterior vitrectomy for the management of lens subluxation. MATERIALS AND METHODS: The medical records of 20 consecutive patients (33 eyes) with lens subluxation who had undergone limbal lensectomy with or without anterior vitrectomy from February 1999 to January 2004 were retrospectively reviewed. RESULTS: All the patients, except one high axial myopic patient, were implanted with scleral sutured posterior chamber intraocular lens. We evaluated the preoperative, postoperative visual acuity and postoperative complications and compared the results in group I (limbal lensectomy with anterior vitrectomy, 27 eyes) to those in group II (limbal lensectomy without anterior vitrectomy, 6 eyes). The preoperative best-corrected visual acuity was 0.21 and postoperative best-corrected visual acuity was improved by 2 lines or more in all 27 eyes in group I, and in 5 eyes in group II (p>0.05). The most frequent postoperative complication was intraocular lens dislocation in four eyes (14.8%) in group I alone. No retinal detachment occurred in either group, even in patients with high myopia. CONCLUSION: Limbal lensectomy without anterior vitrectomy improved visual acuity similarly to limbal lensectomy with anterior vitrectomy without significant increase of postoperative complications. This results of this study suggest that anterior vitrectomy is not necessarily required for the management of lens subluxation.

Refractive Accommodative Esotropia Associated with Mild Hyperopia

PURPOSE: To evaluate the clinical features, courses, and prognosis of refractive accommodative esotropia associated with mild hyperopia. METHODS: We reviewed the records of 14 patients who were diagnosed with refractive accommodative esotropia associated with hyperopia of +2.00 diopters (D) or less. Age at onset and wearing glasses, refractive errors, angle of deviation before and after wearing glasses, binocular sensory status and the presence of amblyopia were evaluated for each patient. RESULTS: The average onset of esotropia was 25.2+/-22.0 months of age, and the average first use of glasses occurred at 65.9+/-12.9 months. The average angle of deviation at distance and near without correction were 21.7+/-8.7 prism diopters (PD) and 24.6+/-6.4PD, respectively. The average refractive error was +1.28+/-0.52D in the right eye and +1.41+/-0.55D in the left eye. The average angles of deviation at distance and near with correction were 3.0+/-2.7PD and 6.0+/-3.0PD, respectively. Among 14 patients, 9 showed esophoria or esotropia of 10PD or less within 14 weeks after wearing glasses. Decompensation developed in 1 patient who underwent recession of medial rectus. CONCLUSIONS: Hyperopia of +2.00D or less can cause refractive accommodative esotropia, so we should recommend the correction of hyperopia of +2.00D or less with esotropia.

Three Cases of Orbitofrontal Cholesterol Granuloma

PURPOSE: To report three cases of orbitofrontal cholesterol granuloma. METHODS: The study subjects were three patients with chief complaints of proptosis and upgaze limitation of ocular movement. Exophthalmometric values were 4~8 mm by Hertel exophthalmometer. Orbital CT and MRI scans were taken in all patients, and regarded as orbitofrontal cholesterol granuloma. In all cases, excisional biopsy was done through the lateral approach. RESULTS: Orbital CT scan showed an isodense to hypodense, well-defined, homogeneous mass and osteolytic lesion in the adjacent superolateral bony orbit. Orbital MRI scan showed a mass with high signal intensity in both T1- and T2-weighted images. Histopathologically, the specimen showed numerous slits like cholesterol clefts surrounded by multinucleated, foreign body type, giant cells with hemosiderin pigments. CONCLUSIONS: Orbitofrontal cholesterol granuloma, although rare, has typical clinical and radiologic features. Surgical excision has a high success rate without recurrence.

Surgical Treatment of the Colonic Diverticulosis

PURPOSE: In Asia including Korea, colonic diverticulosis is a relatively uncommon disease. Recently, the incidences of left colonic diverticulosis in Korea has been increasing, mainly due to a westernized diet and life-style. This study was performed to analyze the clinical manifestations and surgical outcomes of patients with colonic diverticulosis. METHODS: We retrospectively reviewed the medical records of 39 patients with colonic diverticulosis who underwent surgery at Asan Medical Center during July 1989 and December 2001. RESULTS: The male to female ratio was 30:9, and the mean age was 52 (26~78) years. The most prevalent age group was people in fifth decade (13 cases, 33%). Twenty-three cases (59%) were in the right colon, 14 cases (36%) in the left and 2 cases (5%) were bilateral. The relative incidence of left colonic diverticulosis was higher in the elderly patients group (>or=50 years old) (57% vs 15%; P=0.002). Of the three diagnostic tools, the barium enema showed a 63% accuracy, the colonofiberscopy 62% and the abdomen-pelvic CT scan 59%. Bowel perforation (19 cases, 49%) and recurrent abdominal pain (10 cases, 16%) were the common surgical indications. Among 11 cases with bowel perforation accompanying the left colonic diverticulosis, two cases (18%), which underwent one-stage operation, developed complications, while 3 cases (27%) among the other 9 that underwent multi-staged operations, did so. CONCLUSION: The incidences of left colonic diverticulosis were relatively high (36%), especially in the elderly patients (P= 0.002). This study indicates that a tailored surgical procedure, depending on the severity of inflammation, is important in reducing postoperative complications.