Thickness in Ganglion Cell-Inner Plexiform Layer on Spectral-Domain Optical Coherence Tomography after Cataract Surgery

PURPOSE: To assess changes in ganglion cell-inner plexiform layer (GCIPL) thickness after cataract surgery using spectral-domain optical coherence tomography (OCT). METHODS: Forty-three eyes of 33 patients, who underwent cataract surgery were imaged with spectral-domain OCT before and after surgery to measure peripapillary retinal nerve fiber layer (RNFL) and GCIPL thickness, signal strength (SS), quadrant, 12 clock-hour RNFL thickness and sectoral GCIPL thickness. RESULTS: The postoperative SS, RNFL and GCIPL thickness were higher than before surgery (p < 0.05). Multivariate analysis showed that endothelial cell count and preoperative SS were significantly correlated with SS changes in RNFL parameters and preoperative SS was significantly correlated with SS changes in GCIPL parameters. Univariate analysis indicated that age was significantly correlated with RNFL thickness changes in RNFL parameters and no factor was correlated with GCIPL thickness in GCIPL parameters (p < 0.05). CONCLUSIONS: Cataracts may decrease peripapillary RNFL and GCIPL thickness measurements and SS on OCT scans. Peripapillary RNFL and GCIPL thickness measurements should be interpreted with caution in eyes with significant cataracts.

Treatment Outcome of Triple Procedure in Open-Angle Glaucoma and Angle-Closure Glaucoma

PURPOSE: To compare the surgical outcomes of triple procedure in patients with open-angle glaucoma and angle-closure glaucoma. METHODS: The patients who underwent triple procedures for open-angle glaucoma and angle-closure glaucoma and were followed up for more than 1 year postoperatively were retrospectively reviewed. Preoperative and postoperative visual acuity, intraocular pressure (IOP), visual field mean deviation, refractive error, number of medications, and complications were analyzed. The effect of surgery on IOP reduction and refractive error correction was compared. RESULTS: The IOP at 1 year postoperatively was 13.39 +/- 2.25 mm Hg, 13.41 +/- 2.79 mm Hg (p = 0.981) and IOP reduction was 4.51 +/- 6.35 mm Hg, 9.11 +/- 8.27 mm Hg (p = 0.042) in the open angle glaucoma group and angle closure glaucoma group, respectively. No patient in either group required reoperation due to uncontrolled IOP. The percentage of patients showing postoperative IOP reduction of at least 10% and 20% from baseline IOP was statistically higher in the angle-closure glaucoma group than in the open-angle glaucoma group. Prediction errors were -0.84 +/- 0.88 D and -0.13 +/- 0.65 D in the open-angle glaucoma group and angle-closure glaucoma group, respectively. CONCLUSIONS: Triple procedure was effective in reducing IOP in both open-angle glaucoma and angle-closure glaucoma patients. The patients with angle-closure glaucoma showed better results in IOP control and refractive error correction compared with patients with angle-closure glaucoma.

Incidence of Steroid-Induced Ocular Hypertension Following Myopic Refractive Surgery

PURPOSE: To determine the incidence of steroid-induced ocular hypertension following myopic vision correction. METHODS: This study retrospectively reviewed the medical records of 6,087 patients (12,164 eyes) who underwent myopic refractive surgery (laser-assisted in-situ keratomileusis [LASIK]/photorefractive keratectomy [PRK]/phakic intraocular lens [IOL] implantation) at Eyereum Eye Clinic between July 2011 and February 2013. Ocular hypertension was defined when post-operative intraocular pressure (IOP) was increased more than 30% compared to predicted IOP adjusted according to corneal thickness. All preoperative IOPs were measured using Goldmann applanation tonometer (GAT). Postoperative IOPs were measured using non-contact tonometer first and with GAT when the IOP was suspiciously increased. RESULTS: Steroid-induced ocular hypertension after a myopic refractive surgery occurred in 680 eyes (5.58%) of 404 patients (6.64%). The incidence based on surgery was LASIK (0.06%, 2/3, 514 eyes) followed by PRK (7.63%, 575/7,533 eyes) and phakic IOL implantation (9.2%, 103/1,117 eyes). The average increased IOP level in patients with steroid-induced ocular hypertension was 5.62 +/- 3.73 mm Hg after PRK and 9.35 +/- 4.95 mm Hg after phakic IOL implantation. A statistically significantly higher change in IOP was observed in the phakic IOL group (p < 0.001). However, the PRK group had a longer treatment period for ocular hypertension and used more antiglaucoma medications than the phakic IOL group (p < 0.05). Most patients with ocular hypertension were successfully treated with cessation of topical steroid or use of antiglaucoma medications. Only 2 eyes required glaucoma surgery because IOP was not controlled. CONCLUSIONS: IOP measurements should be initiated no later than 1 week after surgery because steroid-induced ocular hypertension following myopic refractive surgery can occur in approximately 5.58% of patients and most cases of ocular hypertension can be controlled with careful follow-up and use of antiglaucoma medications.

Treatment Outcome of Triple Procedure in Open-Angle Glaucoma and Angle-Closure Glaucoma

PURPOSE: To compare the surgical outcomes of triple procedure in patients with open-angle glaucoma and angle-closure glaucoma. METHODS: The patients who underwent triple procedures for open-angle glaucoma and angle-closure glaucoma and were followed up for more than 1 year postoperatively were retrospectively reviewed. Preoperative and postoperative visual acuity, intraocular pressure (IOP), visual field mean deviation, refractive error, number of medications, and complications were analyzed. The effect of surgery on IOP reduction and refractive error correction was compared. RESULTS: The IOP at 1 year postoperatively was 13.39 +/- 2.25 mm Hg, 13.41 +/- 2.79 mm Hg (p = 0.981) and IOP reduction was 4.51 +/- 6.35 mm Hg, 9.11 +/- 8.27 mm Hg (p = 0.042) in the open angle glaucoma group and angle closure glaucoma group, respectively. No patient in either group required reoperation due to uncontrolled IOP. The percentage of patients showing postoperative IOP reduction of at least 10% and 20% from baseline IOP was statistically higher in the angle-closure glaucoma group than in the open-angle glaucoma group. Prediction errors were -0.84 +/- 0.88 D and -0.13 +/- 0.65 D in the open-angle glaucoma group and angle-closure glaucoma group, respectively. CONCLUSIONS: Triple procedure was effective in reducing IOP in both open-angle glaucoma and angle-closure glaucoma patients. The patients with angle-closure glaucoma showed better results in IOP control and refractive error correction compared with patients with angle-closure glaucoma.

Incidence of Steroid-Induced Ocular Hypertension Following Myopic Refractive Surgery

PURPOSE: To determine the incidence of steroid-induced ocular hypertension following myopic vision correction. METHODS: This study retrospectively reviewed the medical records of 6,087 patients (12,164 eyes) who underwent myopic refractive surgery (laser-assisted in-situ keratomileusis [LASIK]/photorefractive keratectomy [PRK]/phakic intraocular lens [IOL] implantation) at Eyereum Eye Clinic between July 2011 and February 2013. Ocular hypertension was defined when post-operative intraocular pressure (IOP) was increased more than 30% compared to predicted IOP adjusted according to corneal thickness. All preoperative IOPs were measured using Goldmann applanation tonometer (GAT). Postoperative IOPs were measured using non-contact tonometer first and with GAT when the IOP was suspiciously increased. RESULTS: Steroid-induced ocular hypertension after a myopic refractive surgery occurred in 680 eyes (5.58%) of 404 patients (6.64%). The incidence based on surgery was LASIK (0.06%, 2/3, 514 eyes) followed by PRK (7.63%, 575/7,533 eyes) and phakic IOL implantation (9.2%, 103/1,117 eyes). The average increased IOP level in patients with steroid-induced ocular hypertension was 5.62 +/- 3.73 mm Hg after PRK and 9.35 +/- 4.95 mm Hg after phakic IOL implantation. A statistically significantly higher change in IOP was observed in the phakic IOL group (p < 0.001). However, the PRK group had a longer treatment period for ocular hypertension and used more antiglaucoma medications than the phakic IOL group (p < 0.05). Most patients with ocular hypertension were successfully treated with cessation of topical steroid or use of antiglaucoma medications. Only 2 eyes required glaucoma surgery because IOP was not controlled. CONCLUSIONS: IOP measurements should be initiated no later than 1 week after surgery because steroid-induced ocular hypertension following myopic refractive surgery can occur in approximately 5.58% of patients and most cases of ocular hypertension can be controlled with careful follow-up and use of antiglaucoma medications.

Cytotoxicities and Anti-Fibrotic Effects of Pirfenidone and Mitomycin C on Human Fibroblasts

PURPOSE: The cytotoxicities and anti-fibrotic effects of mitomycin C and pirfenidone on human dermal fibroblast were evaluated. METHODS: Initially, 24-hour cell cultures were exposed to transforming growth factor (TGF)-beta1, different concentrations of mitomycin C, and pirfenidone solutions in order to evaluate cytotoxicity. Expressions of fibronectin, collagen type 1, alpha smooth muscle, and beta-actin were evaluated by real-time reverse transcription-polymerase chain reaction (RT-PCR) and western blot in mitomycin C solutions at concentrations of 4 microg/mL and 20 microg/mL, and in pirfenidone solutions at 250 microg/mL and 500 microg/mL. RESULTS: In comparison to cell cultures exposed to TGF-beta1 solutions, cytotoxicities were increased in solutions of mitomycin C at 4 microg/mL, 20 microg/mL, 40 microg/mL and pirfenidone at 500 microg/mL, 750 microg/mL, 1,000 microg/mL (p < 0.05, Mann Whitney U-test). The results of real-time RT-PCR show that expressions of fibronectin, collagen type 1, and alpha smooth muscle were significantly more decreased in all concentrations of mitomycin C and pirfenidone compared to those in TGF-beta1 solution. In western blot analysis, expressions of fibronectin and alpha smooth muscle were decreased in all concentrations of mitomycin C and pirfenidone compared to TGF-beta1 solution. CONCLUSIONS: Both drugs have cytotoxicities and anti-fibrotic effects, but pirfenidone was found to have less cytotoxicity and mitomycin C was found to have more anti-fibrotic effects when compared to each other.

Retinal Nerve Fiber Layer Defect Associated with Astrocytic Hamartoma in a Patient with Tuberous Sclerosis

PURPOSE: To report the progression of an astrocytic hamartoma of the right optic nerve head as well as the retina, and the progression of retinal nerve fiber defect associated with astrocytic hamartoma in a patient with tuberous sclerosis. CASE SUMMARY: A 6-year-old boy with tuberous sclerosis and an astrocytic hamartoma of the right optic nerve head, which was found at the time of ophthalmologie examinations, was referred from the pediatric neurologist for evaluation of the vigabatrin-associated visual field changes. Fundus examination revealed 1/2 disc diameter (DD)-sized astrocytic hamartoma located at the margin of the superior part of the optic nerve. The retina of the left eye was normal. Eighteen months after the first visit, enlarged optic disc hamartoma of the right eye and newly onset retinal astrocytic hamartoma located approximately 1.5 DD inferior to the fovea of the left eye were found. Three years later, an increase in the size of the astrocytic hamartoma of the right optic nerve and development of retinal nerve fiber defects were observed. CONCLUSIONS: Astrocytic hamartoma in patients with tuberous sclerosis is usually stable without progression. However, in our patient, astrocytic hamartoma showed progression, and development of retinal nerve fiber defects occurred. Regular follow-up is necessary for astrocytic hamartoma in patients with tuberous sclerosis.

Injection of porous polycaprolactone beads containing autologous myoblasts in a dog model of fecal incontinence / 대한외과학회지

PURPOSE: Few studies have examined whether bioengineering can improve fecal incontinence. This study designed to determine whether injection of porous polycaprolactone beads containing autologous myoblasts improves sphincter function in a dog model of fecal incontinence. METHODS: The anal sphincter of dogs was injured and the dogs were observed without and with (n = 5) the injection of porous polycaprolactone beads containing autologous myoblasts into the site of injury. Autologous myoblasts purified from the gastrocnemius muscles were transferred to the beads. Compound muscle action potentials (CMAP) of the pudendal nerve, anal sphincter pressure, and histopathology were determined 3 months after treatment. RESULTS: The amplitudes of the CMAP in the injured sphincter were significantly lower than those measured before injury (1.22 mV vs. 3.00 mV, P = 0.04). The amplitudes were not different between dogs with and without the injection of autologous myoblast beads (P = 0.49). Resting and squeezing pressures were higher in dogs treated with autologous myoblast beads (2.00 mmHg vs. 1.80 mmHg; 6.13 mmHg vs. 4.02 mmHg), although these differences were not significant in analyses of covariance adjusted for baseline values. The injection site was stained for smooth muscle actin, but showed evidence of foreign body inflammatory reactions. CONCLUSION: This was the first study to examine whether bioengineering could improve fecal incontinence. Although the results did not show definite evidence that injection of autologous myoblast beads improves sphincter function, we found that the dog model was suitable and reliable for studying the effects of a potential treatment modality for fecal incontinence.

The Use of a Staged Drainage Seton for the Treatment of Anal Fistulae or Fistulous Abscesses

PURPOSE: The aim of this retrospective study was to evaluate the rate of recurrence and incontinence after the treatment of fistulae or fistulous abscesses by using the staged drainage seton method. METHODS: According to the condition, a drainage seton alone or a drainage seton combined with internal opening (IO) closure and relocation of the seton was used. After a period of time, the seton was changed with 3-0 nylon; then, after another period of time, the authors terminated the treatment by removing the 3-0 nylon. Telephone interviews were used for follow-up. The following were evaluated: the relationship between the type of fistula and recurrence; the relationship between the type of fistula and the period of treatment; the relationship between the recurrence and presence of abscess; the relationship between IO closure and recurrence; the relationship between the period of seton change and recurrence; reported continence for flatus, liquid stool, and solid stool. RESULTS: The recurrence rate of fistulae or suppuration was 6.5%, but for cases of horseshoe extension, the recurrence rate was 57.1%. The rate of recurrence was related to the type of fistula (P = 0.001). Incontinence developed in 3.8% of the cases. No statistically significant relationship was found between the rate of recurrence and the presence of an abscess or between the closure of the IO and the period of seton change or removal. CONCLUSION: In the treatment of anal fistulae or fistulous abscesses, the use of a staged drainage seton can reduce the rate of recurrence and incontinence.

Long-term Change in Corneal Endothelium After Iris-fixed Phakic Intraocular Lens Insertion

PURPOSE:To investigate long-term endothelial changes in phakic eyes implanted with iris-claw phakic intraocular lens (IOL) (Artisan(R) lens Ophtec, Groningen, Netherlands) and to identify the associated factors. METHODS: Thirty-one eyes of 18 patients underwent Artisan phakic IOL implantation and were followed up for over 1 year. The authors retrospectively examined the endothelial cell density, percentage of hexagonal cells and coefficient of variation using the result of non-contact specular microscope. RESULTS: The mean endothelial cell loss was 0.9% at 23.9+/-9.44 months of the mean follow-up period. There was no statistically significant decrease in endothelial cell density (p=0.445). There was no statistically significant change in pleomorphism and polymegathism of the endothelial cells after the surgery. There was no statistically significant correlation between endothelial cell loss and anterior chamber depth (r2=0.0488, p=0.377). CONCLUSIONS: No clinically significant endothelial damage occurred after iris-claw phakic IOL implantation. However, special attention should be given to patients with shallow anterior chamber depth for iris-claw phakic IOL insertion to avoid unintended endothelial damage and long-term endothelial checkups using a specular microscope are critical for long-term protection of endothelial cells.

Primary Ectopic Mediastinal Goiter Combined with Papillary Microcarcinoma of the Cervical Thyroid Gland / 대한내분비외과학회지

True primary mediastinal ectopic goiters are quite rare, and they occur in less than 1% of all goiters. We report here on a case in which a primary mediastinal ectopic goiter was accompanied with papillary microcarcinoma of the cervical thyroid. The mediastinal ectopic goiter was not connected to the cervical thyroid and its blood was supplied from intrathoracic vessels, which necessitated a thoracotomy or sternotomy for removal rather than a standard cervical collar incision. We performed total thyroidectomy for the papillary microcarcinoma of the cervical thyroid gland and transsternal removal for the mediastinal goiter; this resulted in a favorable outcome.

The Usefulness of Preoperative Ultrasonography on Decision of Operative Extent in Patients with Papillary Thyroid Microcarcinoma / 대한내분비외과학회지

PURPOSE: Usually papillary microcarcinoma (PMC) grows very slowly with a good prognosis, although it frequently metastasizes to regional lymph nodes and shows multiple tumor formation in the thyroid. Therefore, how to treat papillary microcarcinoma has been controversial. Recently several studies reported that some ultrasonographic features may potentially reflect the biological aggressiveness of a lesion. We investigated which ultrasonographic findings can reflect aggressive characteristics and whether US can helpful in selecting the appropriate surgical treatment of PMC. METHODS: We retrospectively reviewed the preoperative ultrasonographic findings and pathologic risk factors of 68 patients who had undergone surgical treatment for PMC at the Wallace Memorial Baptist Hospital from January 2004 to December 2005. RESULTS: The incidences of multifocality, extrathyroidal extension, and lymph node metastasis of PMC were 42.6%, 48.5% and 20.6%, respectively. The Mean sizes of PMC were no significant differences according to age, multifocality, extrathyroidal extension, lymph node metastasis, stage and AMES risk group, and tumor size more than 5 mm was not linked to pathologic prognostic factors. Cases demonstrating multiple nodules in the unilateral or bilateral lobes, as well as those with fine strong calcifications in the tumor on US, were directly linked to multifocality on pathologic finding. US is insensitive technique for detecting lymph node metastasis and it's sensitivity was only 14.3%, but it's positive predictive value and specificity were high (100%). CONCLUSION: The date suggested that complete surgery with appropriate nodal dissection should be performed in patients with PMC which their US demonstrating multiple nodules in the unilateral or bilateral lobes, fine strong calcifications echoes in tumor and US-detected node metastasis.

Anatomic Study on the Cortical Branches of the Middle Cerebral Artery in Koreans / 체질인류학회지

The purpose of this study was to identify the branching patterns and the distribution of the cortical branches of the middle cerebral artery (MCA) in 100 cerebral hemispheres of Korean adults. The intracranial arteries were perfused with red latex compounds. The territory of the MCA was divided into 12 areas: orbitofrontal, prefrontal, precentral, central, anterior parietal, posterior parietal, angular, temporo -occipital, posterior temporal, middle temporal, anterior temporal and temporopolar. Branching pattern of the main trunk of the MCA was divided into five types: Type I: a single -trunk type of MCA in 34% of cases; Type II: bifurcation (57%); Type III: trifurcation (5%); Type IV: quadrifurcation (1%); Type V: two MCAs originated from the internal carotid artery (3%). The MCA of the bifurcation type was classified into equal bifurcation (20%), superior trunk dominant (11%) and inferior trunk dominant (26%) according to the cortical area. The superior trunk of the equal bifurcation supplied from the orbitofrontal to posterior parietal area. The outer diameter of the main trunk of the MCA was 3.15 +/-0.52 mm on average. The anatomical types of the MCA were discussed with the related symptoms in disease of the MCA.