Internal Limiting Membrane Peeling In Surgical Treatment of Macular Epiretinal Membrane

PURPOSE: To evaluate the additional effect of internal limiting membrane (ILM) peeling in patients with idiopathic macular epiretinal membrane (ERM) who underwent ERM removal without ILM peeling. METHODS: The subjects were those patients with idiopathic macular ERM who underwent pars plana vitrectomy, whose ERM was completely removed without peeling of the ILM. Additional ILM peeling was carried out randomly in some patients. Anatomical outcomes, functional results, recurrence, and complications were compared between the eyes with and without ILM peeling. Anatomical outcome included the macular thickness from optical coherence tomography (OCT). Functional results included the change in best-corrected visual acuity (BCVA) and the responses from multifocal electroretinograms (mfERG). RESULTS: Postoperative BCVA improved and macular thickness decreased in both groups but there were no statistically significant differences between the two groups. There was no recurred case in either group. Furthermore, in comparison of P1 amplitudes and peak times in mfERG, there were no differences between the two groups. CONCLUSIONS: The additional ILM peeling in patients with complete ERM removal without ILM peeling doesn't affect the postoperative results in visual acuity, macular thickness, recurrence, and complications.

Fibrovascularization of Intraorbital Hydroxyapatite-Coated Alumina Sphere in Rabbits

We investigated the fibrovascular ingrowth and fibrovascular tissue maturation of hydroxyapatite-coated, porous alumina sphere (Alumina sphere) in comparison with the hydroxyapatite sphere (HAp sphere) in rabbits. Alumina spheres and HAp spheres were implanted in the left orbits of 42 New Zealand white rabbits after enucleation. Fibrovascular ingrowth and maturation were graded from 1 to 5 at postoperative 1, 2, 3, 4, 8, 12 and 24 weeks. We defined 4 phases: postoperative 1-2 weeks as phase I, 3-4 weeks as phase II, 8-12 weeks as phase III, and 24 weeks as phase IV. The grade was analyzed at each phases. There was no significant difference in fibrovascular ingrowth and maturation between the two groups at all 4 phases, except phase II at which the Alumina sphere showed significantly lower maturation grade (p< 0.05). We concluded that the Alumina sphere is an ideal orbital implant material and an ideal substitute for the HAp sphere in clinical practice.

The Effect of Ginkgo Biloba Extract (Ginexin(R)) on Experimental Central Retinal Vein Occlusion

PURPOSE: To investigate the beneficial effect of ginkgo biloba (Ginexin(R)) on ischemic retina model by retinal vein occlusion after photodynamic injury. METHODS: Ginkgo biloba 20 mg/kg/day, 100 mg/kg/day or carboxymethyl cellulose as a control group was administrated orally from 1week before the retinal vein occlusion to 2weeks after. After rose bengal was injected through vein of tail, retinal vein was occluded with argon laser. And then venous occlusion was confirmed by fluorescein angiogram. Rats were examined by using an indirect ophthalmoscopy and fluorescein angiography to detect reperfusion and new vessels. Eyeballs were enucleated for histological examination, retinal ganglion cell count and intravitreal glutamate level. RESULTS: The reperfusion of occluded vein was faster in the ginkgo biloba-treated group than the control group. In the ginkgo biloba-treated group, damage of the inner retina and TUNEL-positive cells were smaller than the control group on histologic examination. The concentration of retinal ganglion cells in the control group was lower than in the ginkgo biloba-treated group. CONCLUSIONS: Ginkgo biloba has protective effects in experimental ischemic retina after vein occlusion.

Surgical Results of Segmental Scleral Buckling in Pseudophakic Retinal Detachments

PURPOSE: To evaluate the surgical results of segmental scleral buckling procedures in pseudophakic retinal detachments. METHODS: We retrospectively analyzed the surgical results of 35 patients (35 eyes) undergoing only segmental scleral buckling procedures in pseudophakic retinal detachments, who had been postoperatively followed up 6 months or longer. RESULTS: The average age of patients was 58.4 +/- 14.8 and twenty-five of the 35 patients were male. Posterior capsule was ruptured in 14 eyes, and among the 14, 5 eyes had vitreous prolapse. The primary success rate of segmental scleral buckling procedures was 100% (21/21 eyes) in intact posterior capsules, and 64.3% (9/14 eyes) in ruptured posterior capsules. The causes of failure were proliferative vitreoretinopathy (2 eyes) and failure to close the retinal breaks (3 eyes). CONCLUSIONS: We suggest that segmental scleral buckling procedure may be an effective method for the management of retinal detachments in pseudophakia if without posterior capsule ruptures.

The Role of PVD on Visual Recovery after Laser Treatment in BRVO with Macular Edema

PURPOSE: To investigate the role of the posterior vitreous detachment as a factor affecting visual acuity after laser treatment on macular edema in eyes with branch retinal vein occlusion (BRVO). METHODS: We retrospectively studied the medical records of 55 BRVO patients who were treated with argon laser photocoagulation for macular edema. The eyes were classified as those with posterior vitreous detachment (PVD, group I, 21 eyes) and those with no or partial PVD (group II, 34 eyes). The visual acuity before and after laser treatment was compared according to the posterior vitreous status. RESULTS: The eyes with visual acuity gaining two or more lines, final visual acuity of 0.5 or better, and mean change of visual acuity after laser treatment were 66.0%, 38.1%, and 1.8 lines in group I and 41.2%, 32.4%, and 1.6 lines in group II, respectively (p>0.05). Factors responsible for no change or decrease of visual acuity after laser treatment were macular ischemia, macular degeneration or exudate, and epiretinal membrane. CONCLUSIONS: PVD can be a prognostic factor for macular edema with BRVO. We should carefully examine for the presence of PVD in eyes with BRVO.

Clinical Features and Surgical Results of Rhegmatogenous Retinal Detachment in Children

PURPOSE: The purpose of this study is to evaluate clinical characteristics and surgical outcomes of rhegmatogenous retinal detachment in children. METHODS: The medical records of 29 children (30 eyes, younger than 15 years of age) who underwent the surgery for retinal detachment at our hospital were reviewed retrospectively. RESULTS: Twenty-six (90%) of the 29 patients were male, and three (10%) were female. Their average age was 11 years old (range 4years~15years). Retinal detachment was caused by, in order of frequency, trauma, high myopia, Morning glory disc anomaly, previous intraocular surgery and had an unknown cause in 6 eyes. Proliferative vitreoretinopathy (PVR) was involved in eleven (37%) of the 30 eyes at presentation. The overall reattachment rate was 73% after the first operation and 93% after the second operation. CONCLUSIONS: Retinal detachments in children have poor surgical outcomes than that in adults due to delayed diagnosis, frequent macular involvement and presence of PVR. For the children with certain diseases, we should exam carefully and regularly for the subtle changes even in the absence of specific complaints.

Surgical Results in Asymmetric Congenital Ptosis

PURPOSE: Achieving good eyelid position and symmetric palpebral fissure for asymmetric bialteral congenital ptosis would require skillful technique and a lot of experiences of surgeon. Patients were divided into two groups, A and B, in terms of preoperative MRD and the possible relationship between preoperative MRD difference. The outcome of the surgery was studied. METHODS: External levator resection with apponeurotic approach was performed for 19 patients with asymmetric bilateral congenital ptosis from October 1994 to June 2000. According to differences of MRD between the both eyes, patients were divided into two groups. Group A included 8 patients with 1.0~2.0 mm of MRD differences, and group B included 11 patients with more than 2.0 mm of MRD differences. RESULTS: Age of patients ranged from 3 to 20 years (mean 6.1 years) and follow-up period was 9 to 60 months (mean 20 months). Six patients of group A and seven patients of group B showed almost excellent symmetric palpebral fissure. Only one patient of group B had postoperative MRD difference more than 2.0 mm, and none in group A. CONCLUSIONS: Success rate was 100% in group A and 91% in group B, but no statistical difference was found between group A and group B (p>0.05).

The Photophobia Incidence, Stereopsis and Suppression in Intermittent Exotropia

Intermittent exotropia is the most common form of strabismus in Korea. Though monocular photophobia is considered as a typical finding in patients with intermittent exotropia, its incidence is still not precisely reported. We consecutively examined 110 patients with intermittent exotropia ages 3~28 years, and monocular photophobia was reported in 72 (65.5%)of them. In statistical study, the occurrence of photophobia has no significant relationship with sex, amount of deviation, distant stereoacuity or presence of suppression.