Wavefront Aberration Changes after the Instillation of Artificial Tear in Dry Eyes

PURPOSE: To identify the effects of artificial tear instillation on tear film changes using wavefront aberrations. METHODS: Artifical tear was instilled every 2 hours for 14 days into 20 normal eyes and 20 dry eyes. The changes in tear film using wavefront aberrations were analyzed 1 minute after the final instillation of artifical tear. RESULTS: In dry eyes, total wavefront aberration and total high order wavefront aberration decreased significantly (p<0.05). In normal eyes, total wavefront aberration and high order wavefront aberration did not decrease. CONCLUSIONS: Stabilization of the tear film after instillation of artificial tear may be responsible for the decrease of wavefront abberation in dry-eye patients.

Effects of Quetiapine on the Immobilization Stress-induced BDNF and CRF Expression in Rat Brain / 대한정신약물학회지

OBJECTIVE: In this study we examined the effects of quetiapine on the immobilization stress-induced brain-derived neurotrophic factor (BDNF) and corticotropin-releasing factor (CRF) expression in rat brain. We also assessed the antidepressant activity of quetiapine. METHOD: We used in situ hybridization to examine the effects of chronic administration of quetiapine in gene transcription. This study also examined the influence of quetiapine in an animal model of depression, the forced swimming test (FST). RESULTS: 1) Repeated immobilization stress (2 hr daily for 3 weeks) decreased mRNA levels of BDNF in the hippocampus (p<0.01), parietal cortex (p<0.01) and pyriform cortex (p<0.05). 2) Repeated immobilization stress increased mRNA levels of CRF in the hypothalamic paraventricular nucleus (PVN)(p<0.01). 3) Chronic quetiapine (10 mg/kg) treatment (daily for 3 weeks) alone significantly increased BDNF mRNA expression in the dentate gyrus of hippocampus when compared to controls under basal conditions (p<0.01), whereas no such effect was observed in the neocortex. 4) Chronic pretreatment of quetiapine also markedly increased the stress-induced decrease of BDNF mRNA expression in the hippocampus (p<0.01) and neocortex (p<0.01). 5) Moreover, the stress-induced elevation of CRF mRNA expression was blocked by chronic quetiapine pretreatment in PVN (p<0.01) although chronic quetiapine treatment alone did not significantly reduce CRF mRNA levels in comparison to controls under basal condition. 6) When rats received acutely quetiapine, quetiapine did reduce the immobility time at 10 mg/kg, as compared with the control group (p<0.05). CONCLUSION : These results suggest that quetiapine has not only potentially an antidepressant effect but also a neuroprotective action in schizophrenia and this effect may be related to its antipsychotic effect in patients with schizophrenia.

A Successful Case of Cardona's Prothokeratoplasty on Alkali Burn for 16 Years

PURPOSE: To report one case which has been showed successful results after prosthokeratoplasty using `Cardona Bolt and Nut' model. Even though prosthokeratoplasty has a high rate of failure within 5 years after surgery because of many complications, But there was no complications over a 16-year period in this case since surgery by one of the authors (J-H K). METHODS: This patient had an alkali burn on both his eyes due to the accidental explosion of carbamate in 1979 when he was 26 years old. His corneas were densely pacified with neo-vascularization despite undergoing keratoplasty once on his right eye, and twice on his left eye. To improve his vision, we performed ultimately a successful Cardona Bolt and Nut prosthokeratoplasty on his right eye in 1988. RESULTS: During the period of to 16-year follow-up the visual acuity of his right eye was maintained at 0.1 without correction, and 0.15 with correction (+7.0 D.), even though his visual field narrowed(within 10 degree) due to the long and narrow optical cylinder.

Microbiologic Study of Imported Donor Corneas and Preserved Solutions

PURPOSE: To evaluate the prevalence of contamination of imported donor corneas and their preserved solutions, and to characterize the spectrum of contaminating microorganisms. METHODS: Thirty-seven imported donor corneas and their preserved solutions imported between December 2003 and June 2005 were included in this study. RESULTS: Five imported donor corneas (13.5%) had positive bacterial cultures, and none had positive fungal or mycobacterial cultures. On the other hand, the preserved solutions did not have positive bacterial, fungal, or mycobacterial cultures. One of the 5 imported donor corneas with positive bacterial culture had a mixed bacterial culture. There were 3 isolates of Staphylococcus epidermidis, 1 isolate of Streptococcus viridans, 1 isolate of Enterobacter cloacae, and 1 isolate of Pseudomonas aeruginosa. CONCLUSIONS: The prevalence of contamination of imported donor corneas is low; however, there is a risk of postkeratoplasty infection by contaminated donor corneas. Thus, careful management should be practiced during and after corneal transplant operations.

A Case of Chronic Granulomatous Canaliculitis Induced by Herrick Silicone Punctual Plug

PURPOSE: To report the experience of treating chronic granulomatous canaliculitis induced by permanent silicone punctal plugs used for dry eye syndrome treatment. METHODS: The transformation of puncta below both eyes and secretions in the lacrimal duct were observed for a 56-year-old female patient who had attended hospital for 4 months due to epiphora and secretions. Under the diagnosis of lacrimal duct inflammation for the lower lacrimal duct of both eyes, three-snip punctoplasty, curettage in the lacrimal duct, and pathological examination on the part of the lacrimal duct obtained from the three-snip punctoplasty were carried out. RESULTS: The lacrimal silicone plugs were removed from the lacrimal duct at the time of the lacrimal duct curettage, and a diagnosis was made based on tissue biopsy of chronic granulomatous canaliculitis induced by permanent silicone punctal plugs. After the above surgical operations, the epiphora and the anterior eye segment symptom both disappeared. CONCLUSIONS: The permanent silicone punctal plug used to permanently close the lacrimal punctum scarcely causes disorder in the lacrimal drainage system with epiphora and inflammation by acting as a foreign substance. It therefore should only be used when essential.

Two Cases of Boston (Dohlman-Doane) Type I Keratoprosthesis

PURPOSE: This article reports two cases of Boston (Dohlman-Doane) Type I Keratoprosthesis procedures that were performed for the first time in Korea. METHODS: Using the Boston Type I keratoprosthesis, we implanted ultimately these to two cases of corneal blinded patients. RESULTS: Two Boston (Dohlman-Doane) Type I Keratoprosthesis procedures were performed successfully. The first case had poor visual prognosis due to preexisting optic neuropathy and vitreous hemorrhage, but was showed better for cosmetic effect. The second case had maintained an uncorrected visual acuity of 0.1 at postoperative 3 months. CONCLUSIONS: We hope to perform additional procedures and long-term follow-ups to further evaluate this new surgical technique for stability and efficiency.

The Antibiotic Effect of BAC-STAT LASIK Ring in LASIK

PURPOSE: An attempt was made to determine if the pre-LASIK operative BAC-STAT LASIK Ring plays a role in reducing postoperative infection. METHODS: Candidates for this study were 72 eyes of 36 patients, scheduled to undergo LASIK operation. Eyes were divided into two groups: right eyes with preoperative BAC-STAT bacteriostatic LASIK Ring (BAC-STAT LASIK Ring: American Optisurgical Inc., Lake Forest, California, U.S.A.) and one minute of irrigation (experimental group), and left eyes with only preoperative BSS irrigation (control group). The authors tried to demonstrate a difference of identified pathogens between the two groups after a growth of bulboconjunctival lesion in blood agar plate (BAP), MacConkey agar plate (MCA), Thioglycolate medium broth (TG), and Ogawa egg medium. RESULTS: Among the patients receiving only BSS irrigation, pathogens were identified in eight eyes before surgery and in four eyes after surgery in BAP and MCA medium. Among the patients receiving BAC-STAT LASIK Ring and irrigation, pathogens were identified in nine eyes before surgery and in three eyes after surgery in BAP and MCA culture medium. In addition, among the control population, pathogens were found in 21 eyes both before and after surgery in TG culture medium. However, among the experimental population, pathogens were grown in 23 eyes before surgery but in only 14 eyes after surgery. No growth of pathogens was reported in all patients before and after surgery in a 4-week Ogawa egg culture medium. CONCLUSIONS: This study suggests that preoperative BAC-STAT LASIK Ring insertion followed by irrigation decreases the incidence of postoperative infection.

Results of Scleral Allografting on Scleral Necrosis Following Pterygium Excision

PURPOSE: To emphasize the importance of conjunctival flap or amniotic membrane covering on the scleral allograft for scleral necrosis following pterygium excision. METHODS: Five eyes in four patients showed signs of impending perforation caused by scleral necrosis following pterygium excision, with strontium irradiation in four eyes and with instillation of mitomycin C in the other eye for preventing recurrence of pterygium. All cases were transplanted human sclera stored at -20 degrees C in Eye-Bank. Among them, the patient's own conjunctiva was used to cover the scleral allograft with interrupted sutures in four eyes, where in the other eye the scleral allograft was alternatively covered over by using human amniotic membrane stored at -70 degrees C. RESULTS: The results of all five cases were very successful without any complications during an average follow-up of 19 months (range 6~25 months). CONCLUSIONS: Based on the clinical experiences of these five cases, we concluded that the covering of the scleral allograft with conjunctiva or amniotic membrane is a very important procedure to ensure the successful viability of the scleral allograft, which is a natural structure of the conjunctiva and sclera.

A Case of Valsalva Retinopathy following Normal Delivery

PURPOSE: We report a case of Valsalva retinopathy following normal delivery. METHODS: A 32-year-old woman presented with visual blurring in her right eye which had developed on the previous day. At the first visit, visual acuity was 0.02 with correction. Anterior segment examination was unremarkable and dilated fundus examination revealed a dumbbell-shaped preretinal hemorrhage in the macula. Preretinal hemorrhage was a well-demarcated, red-colored subinternal limiting membrane hemorrhage. Fluorescein angiography demonstrated blocked fluorescence due to hemorrhage. The patient was followed up for two years. RESULTS: Two weeks after the first visit, the size of the preretinal hemorrhage decreased. Three weeks after the first visit, there was marked resolution of the hemorrhage with yellowish degeneration, but visual acuity did not improve. Six weeks after the first visit, the preretinal hemorrhage was resolved completely and visual acuity returned to normal with no specific treatment.

The Effect of Nerve Growth Factor on Corneal Sensitivity after Laser in Situ Keratomileusis

PURPOSE: To determine if topically administered nerve growth factor (NGF) plays a role in accelerating the recovery of corneal sensitivity after laser in situ keratomileusis (LASIK). METHODS: A prospective double-masked study comparing the effect of topical NGF or balanced salt solution on corneal sensitivity after LASIK in rabbits was performed. Pre- and postoperative corneal sensitivity was assessed using the Cochet-Bonnet esthesiometer. RESULTS: Eyes that were treated with topical NGF demonstrated an earlier and faster recovery of corneal sensitivity after LASIK (p=0.0071). A statistically significant difference in corneal sensitivity was found between the topical NGF and control group at the postoperative time points of 2 weeks (p=0.0098), 3 weeks (p=0.0309), and 4 weeks (p=0.0276). CONCLUSIONS: Our results suggest that topically administered NGF plays a significant role in accelerating corneal reinnervation after LASIK.

Rupture of Metastatic Omental Hepatocellular Carcinoma Following the Treatment of Ruptured HCC / 한국간담췌외과학회지

Hepatocellular carcinoma (HCC) has a tendency of rupturing, which can lead to massive hemorrhage. Although the majority of HCC ruptures occur in the liver, some reports have shown that HCC ruptures developed at various metastatic sites including the lung, pleura, rib, sternum, spleen, kidney, adrenal gland, mediastinal lymph node, peritoneum, ileum, and peripancreatic lymph node. Here, we reported a case of HBV-related HCC rupture that was treated by operation and recurred in the form of ruptured omental metastasis. A 55- year-old man, who complained of diffuse abdominal pain, was admitted to our hospital in a state of shock. Abdominal CT showed massive hemoperitoneum with a HCC of 6 cm size in diameter in the left lobe of the liver. The alphafetoprotein level was above 300 ng/ml. After transarterial chemoembolization for hemostasis, left lateral segmentectomy was performed. Resected tumor showed complete tumor necrosis. Four months later, the follow-up CT revealed an extrahepatic abdominal tumor near the transverse colon. With surgery, a ruptured tumor implanted on the great omentum near the transverse colon was found and removed along with the segmental transverse colon. The pathologic result reported that the omental tumor was a poorly differentiated hepatocellular carcinoma.

Thyroid MALT Lymphoma Associated with Thyroid Papillary Cancer / 대한내분비외과학회지

There are thyroid lymphoma and thyroid papillary cancer in thyroid disease which can happen being associated with Hashimoto's thyroiditis. Thyroid lymphoma is a rare disease consisting of less than 1% of lymphoma and of 5% of thyroid cancer. It occurs with Hashimoto's thyroiditis in 75%, and the cause is the immune reaction in which autoantibodies originated from thyroid are exposed B-cell continually. Also, the incidence of thyroid cancer, especially thyroid papillary cancer, increases in Hashimoto's thyroiditis. The reason is that the genetic change-RET/PTC mutation- of Hashimoto's thyroiditis is specific to thyroid papillary cancer than to other cancer. Patients usually complain neck nodule or sudden neck mass growing, hoarseness and respiratory difficulty. FNA, USG, Neck CT, MRI, and RI scan can be used for diagnosis. We can choose radiation, operation, and chemotherapy in single form or combined form according to the stage and the location of disease. If a patient who has neck mass, the pathologic finding of it is similar to that of Hashimoto's thyroiditis, and it is resistant to thyroid hormonal therapy, we should consider that it can be thyroid lymphoma or thyroid papillary cancer associated with Hashimoto's thyroiditis. We report a case of thyroid MALT lymphoma combined with occult papillary cancer which was resistant to thyroid hormonal therapy and which was successfully treated by operation and radiation therapy.

Anterior Chamber Depth, Corneal Thickness and Corneal Endothelial Change following Decreased Intraocular Pressure

PURPOSE: To determine the intraocular pressure (IOP) lowering effects on the change of anterior chamber depth (ACD), corneal thickness, corneal cell area and density in normal eyes. METHODS: We investigated 58 eyes of 29 volunteers for this study whose refractive error was +/-3 D, IOP was below 21 mmHg, anterior segment and fundus was within normal limit. All of them had normal visual fields. They were randomly classified into two groups. Anterior chamber depth, IOP, central corneal thickness, cell density, cell area, and coefficient of variation of corneal endothelium were measured by single observer in each group. After oral medication of 50% glycerin 1 cc/kg (body weight) in group 1 and Diamox 500 mg and K-contin 600 mg in group 2, IOP, anterior chamber depth, central corneal thickness, cell density, cell area, and coefficient of variation were measured at 1, 2, and 3 hours. RESULTS: In glycerin group after 1 hour, decreased IOP was stastically significant (P0.05). There was no significant correlation between decreased IOP and the change of anterior chamber depth, central corneal thickness, cell density, cell area, and coefficient of variation. The IOP change was not statistically different between the two groups. CONCLUSIONS: There was no stastically significant correlation between decreased IOP in normal range and the change of ACD, central corneal thickness, cell density, cell area, and coefficient of variation.

Endotoxin of Gram Positive Bacteria Induced Acute Uveitis in the Rat

The purpose of this study is to examine the capacity of lipoteichoic acid (LTA) to induce intraocular inflammation in the rat. LTAs, obtained from Staphylococcus aureus, Streptococcus pyogenes, and Streptococcus faecalis, were suspended in saline solution in 15 mg/kg concentration and injected into both footpads of female Lewis rats. Lipopolysaccharide (LPS) was injected in the same way. It has been known that LPS induced acute uveitis experimentally in the rat. The uveitis changes were assessed by protein concentration in the aqueous humor and pupil size after injection. Twenty four hours after administration, the protein concentration of LPS injected rats was 667.00+/-45.13 mg/dl, and those of LPA injected rats Staphylococcus aureus, Streptococcus pyogenes, and Streptococcus faecalis were 167.67+/-17.75 mg/dl, 63.00+/-8.85 mg/dl, and 53.93+/- 13.76 mg/dl, respectively. Anterior uveitis induced by LTAs was weaker than that induced by LPS. This model may be useful for investigation of Gram-positive bacterial infection and uveitis.

A Chondromyxoid Fibroma of the Fibula: A Case Report

Chondromyxoid fibroma is the least common benign bone tumor, accounting for less than 1% of all bone tumors. Pathologically, it is composed of varying proportions of chondroid, myxoid and fibrous elements. The most common anatomical site is the metaphyseal region of the long bone, and the typical radiologic appear-ance is a cortical expansile osteolytic lesion with a lobulated sclerotic margin, and septa. We report the plain and MRI findings of a relatively typical chondromyxoid fibroma occuring in the proximal fibula.

Clinicopathologic Significance of Multidrug Resistance Protein Expression in Patients with Stage III Gastric Adendegrees Carcinoma / 대한암학회지

PURPOSE: We wanted to determine the prognostic significance of P-glycoprotein (Pgp) and multi drug resistance-assdegrees Ciated protein (MRP) in stage III gastric adendegrees Carcinoma by evaluating whe ther the Pgp and/or MRP expression correlate with various clinicopathological parameters and survival rates. MATERIAL AND METHODS: The expression of Pgp and/or MRP were studied immunohistdegrees Chemi cally by ABC method with paraffin-embedded tissue specimens which were surgically obtained from 64 cases of stage III gastric adendegrees Carcinomas at the Department of Surgery, Presbyterian Medical Center from 1991 to 1992. Statistical differences of both expression in various factors including survival rates and clinicopatholgical parameters were sought. RESULTS: Expression rates of Pgp and MRP group were 50.0% and 43.7% respectively. There was no significant correlation between expression of two proteins and various clinicopathological variables such as age, sex, stage, tumor depth, number of metastatic node, tumor size, site and method of operation. However, in case of the degree of differenciation, the expression of Pgp and/or MRP was significantly greater in well differenciated adendegrees Carcinoma than in poorly dif ferenciated adendegrees Carcinoma (p=0.001, p=0.012). Statistically, no significant correlations between the expression of Pgp and/or MRP and overall survival rates were found. CONCLUSION: These results suggest that the Pgp and/or MRP expression in patients with stage III gastric adendegrees Carcinomas are not useful in determining postoperative chemotherapy and as an independent predictor of survival.

MR Imaging of Cerebral Aspergillosis in an Infant with Normal-Immunity: A Case Report

Cerebral aspergillosis is a rare condition, and like other opportunistic fungal infections, it most commonly occurs in immunocompromised patients. Because of the increasing use of chemotherapy in organ transplanta-tion, cases involving neoplasms, corticosteroid therapy, and cases of lymphoma and leukemia, the incidence of fungal infections in the brain has recently increased. Cerebral aspergillosis in an infant with normal immunity is a very rare condition, and has not been reported in Korea. We report the MR findings of this condition in an infant with normal immunity.

Imaging Findings of Cerebellopontine Angle Cistern Melanocytoma: A Case Report

Because melanocytes are found throughout the leptomeninges, primary melanotic pigmented tumors such as pigmented meningioma, malignant melanoma, melanoblastosis, and melanocytoma can arise from this region. Melanocytomas have been described in the literature as isodense or hyperdense compared with brain parenchyme, as seen on noncontrast-enhanced CT, and as showing relatively homogeneous enhancement. MR imaging demonstrates a high signal on T1-weighted images, and an iso to hypointense signal on T2- weighted images. We report the imaging findings of a melanocytoma that showed hyperdense attenuation on precontrast CT with homogeneous enhancement and hyperintense signal intensity on T1-weighted images and dark signal intensity enhancement on T2-weighted images, and also review the literature.

Quadruple Thera py of Behcet's Disease

Behcet's disease is a multisystematic inflammatory disorder affecting eyes. Visual loss is the most serious effect of Behcet's disease with posterior segment involvement.Because of the disorder's devastating visual consequences, its treatment has received considerable attention.Since the treatment of Behcet's disease has often been unsatisfactory, many different types of treatment have been attempted. We retrospectively reviewed the charts of 28 patients with severe ocular Behcet's disease involving posterior segment.The patients with posterior segment involvement were initially treated with triple regimen (corticosteroid, colchicines, and azathioprine).If intraocular inflammation does not resolve or the inflammatory process recurs, combination with low doses of cyclosporine should be considered (quadruple therapy).Over the course of therapy, visual acuity improved in 25 of 51 eyes (49.01%), remained stable in 14 of 51 eyes (27.45%), and declined in 12 of 51 eyes (23.52%).It improved or maintained the visual acuity in 39 of 51 eyes.There were no serious side effects attributable to triple or quadruple therapy that required withdrawal. The use of corticosteroids, colchicines, azathioprine, and cyclosporine may improve therapeutic efficacy and limit the adverse drug effects, and this combination method appears to be an effective treatment for the ocular complications of Behcet's disease.

Nitric Oxide-Mediated Neurotoxicity after Excimer Laser Photorefractive Keratectomy

The aim of this study was to evaluate neurotoxicity of Nitric oxide(NO) on cornea after excimer laser photorefractive keratectomy(PRK). PRK was performed on rabbit eyes. According to the time table, tear samples were collected with microcapillary tubes and corneal sensitivity was measured with a Cochet-Bonnet esthesiometer. No generation in the tear fluid was analyzed. To demonstrate NO Synthase(NOS), immunohistochemical localization was performed on frozen sections from rat eyeball tissue. Western blot analysis was used for detection of peroxynitrite, powerful oxidant of NO. NO generation was increased and reached to a maximum value(0.69+/-0.22micrometer/microgram) after 96 hours of PRK, as compared with in normal subjects(Mean: 0.30+/-0.08micrometer/microgram) and was not increased in the treated group with topical application of Ng-nitro-L-arginine methyl ester(L-NAME), a competitive inhibitor of constitutive NOS(cNOS) and inducible NOS(iNOS). Corneal sensitivity decreased below pretreatment levers after three postoperative days, but it was not observed in the L-NAME applied group. We have confirmed that a very strong iNOS and BNOS immunoreactivity was present in corneal keratocytes. Western blot analysis identifed the bands of nitrotyro-sine-proteins suggesting in vivo peroxynitrite toxicity. Our results suggested that NO generated from the enzyme after PRK decreased corneal sensitivity by damaging corneal sensory nerve through the NO and iths oxidant peroxitrite. Therefore topical application of a NOS inhibitor may be effective in maintaining corneal sensitivity.