Ischemic Retinopathy Due to Suspicious Gentamicin Retinal Toxicity after Primary Repair of Scleral Laceration

PURPOSE: To report a case of ischemic retinopathy due to suspicious gentamicin retinal toxicity after primary repair of a scleral laceration. CASE SUMMARY: A 45-year-old man presented to our department with decreasing vision in his right eye after ocular trauma. Best corrected visual acuity (BCVA) was 0.02 in the right eye and slit lamp examination revealed scleral laceration. Both intravenous and topical antibiotics (10% cefazolin and 2% gentamicin) were immediately administered. On intraoperative examination, a scleral laceration located 5 mm to 11 mm from nasal limbus, prolapsed vitreous body and partial division of medial rectus muscle were observed. After irrigation with gentamincin 0.2% around the wound, primary repair was performed. On postoperative day 3, fundus examination revealed a retinal break, barrier laser was performed. On postoperative day 4, diffuse retinal edema with intraretinal hemorrhage was observed as well as, superonasal ghost vessels. Subsequently, fluorescein angiography showed diffuse leakage of retinal vessels and a nonperfusion area at the periphery, especially on the nasal side. As vitreous opacity became worse, the patient underwent pars plana vitrectomy with endolaser. One month later, vitreous cavity was clearer and best visual acuity was 0.2. CONCLUSIONS: Large doses of intraocular gentamicin ccan cause retinal toxicity. Increased gentamicin application through a scleral laceration may lead to toxic antibiotic levels. When a scleral laceration wound irrigation is performed, precautions are necessary to prevent retinal ischemia associated with gentamicin toxicity.

Spontaneous Reattachment of Descemet's Membrane Detachment at Postoperative Two Months, Which Occurred During Cataract Surgery

PURPOSE: To report a case of spontaneously reattached Descemet's membrane detachment, which first occurred during the cataract surgery, and still remained after injection of 100% air into the chamber. CASE SUMMARY: A 78-year-old woman came to the clinic with decreased visual acuity. She had a brunescent cataract and underwent extracapsular cataract extraction with a posterior chamber lens implantation. During the irrigation and aspiration procedure, the Descemet's membrane was torn and detached. An anterior chamber injection of 100% air was performed prior to the conclusion of surgery. Descemet's membrane detachment remained at the center of the cornea and was naturally reattached without any surgical procedure. At 2 months after the surgery, a well-reattached Descemet's membrane and a clear central cornea were observed. CONCLUSIONS: Descemet's membrane detachment is a rare but potentially serious complication of intraocular surgery. The authors report a case of naturally reattached Descemet's membrane detachment which remained after injection of 100% air into the chamber.

A Case of Severe Vaso-Occlusive Retinopathy as the First Manifestation Associated with Systemic Lupus Erythematosus

PURPOSE: To report a case of severe vaso-occlusive retinopathy with significant decrease of bilateral visual acuity as the first manifestation associated with systemic lupus erythematosus (SLE). CASE SUMMARY: A 23-year-old man was referred to our clinic with bilateral visual impairment of hand motion (HH). Fundus examination revealed severe retinal hemorrhage, cotton-wool patch, occlusive retinal vasculitis with vascular engorgement, and diffuse retinal edema in both eyes. Because of a malar rash on both cheeks, generalized edema was observed on initial examination with hypertension, azotemia, anemia, and thrombocytopenia, The patient was diagnosed with SLE, strongly positive to antinuclear antibody (ANA), and received an intravitreal injection of Bevacizumab (Avastin, Genentech Inc., San Francisco, CA, USA) in the left eye in addition to hemodialysis, transfusion, systemic corticosteroid and immunosuppressant treatment due to lupus nephritis. Eighteen months later, the retinal edema, cotton-wool patch and hemorrhage resolved, leaving epiretinal membrane without traction in his left eye and diffuse degeneration of the right eye. Final visual acuity was HM in the right eye and 20/100 in the left eye. CONCLUSIONS: Vaso-occlusive retinopathy in SLE can result in permanent visual impairment. In a patient with a high possibility of SLE retinopathy, a periodic fundus examination and intensive management of systemic disease should be considered.

Retinal Nerve Fiber Layer Thickness and Optic Disc Parameters in Dominant Compared with Non-Dominant Eyes

PURPOSE: To investigate the comparison of retinal nerve fiber layer (RNFL) thickness and optic disc parameters measured by optical coherence tomography (Cirrus HD-OCT(R)) in dominant and non-dominant eyes. METHODS: Seventy-one subjects without underlying ocular disease were recruited for the present study. Ocular dominance was determined using the hole-in-the-card test. Comprehensive standardized eye examinations were performed. Scans of the optic disc and RNFL were performed using OCT. RESULTS: The mean intraocular pressure (IOP) of the dominant eye was higher than its counterpart (p = 0.025). No significant differences were observed in uncorrected visual acuity, refractive error and axial length between dominant and non-dominant eyes (p = 0.235, 0.180, 0.850). No RNFL and optic disc features were identified in the dominant from non-dominant eyes. CONCLUSIONS: Although dominant eyes tended to have higher IOP than non-dominant eyes, no consistent ocular structural differences between dominant and non-dominant eyes with the use of OCT were found.

A Statistical Observation of Non-Penetrating Ocular Injuries

PURPOSE: To investigate the clinical and social characteristics of non-penetrating ocular injuries and use the results for treatment and prevention. METHODS: A retrospective survey was performed on 468 eyes of 421 patients, who visited our clinic due to non-penetrating ocular injuries from January 2010 to December 2010. The incidence of ocular injuries, sex, age, monthly and seasonal distribution, side, cause, influence of alcohol, and change in visual acuity were reviewed statistically. RESULTS: The incidence of non-penetrating ocular injuries was 4.9%. The incidence was more common in males (82.9%), in the 3rd decade of life (23.5%) and in summer (30.8%). Minor injuries (36.1%) were the most common caused by scratches, finger pricks, nails, or small foreign bodies. The second common cause was violence (16.4%), followed by traffic accidents (14.7%). The injuries related to alcohol represented 12.6% of all cases. When considering initial diagnoses, periorbital contusion and corneal abrasion were the most common. The initial visual acuity was less than 20/200 in 9.4% of the eyes and the final acuity after a 6-months of treatment was less than 20/200 in 3.0% of the eyes. CONCLUSIONS: This survey gathered the clinical and social characteristics as well as new insights into non-penetrating ocular injuries which can be used for treatment and prevention.

Preoperative Factors related to Corneal Flap Thickness in LASIK using Microkeratome

PURPOSE: To identify factors that may be related to variations in corneal flap thickness in LASIK using the Moria M2 microkeratome. METHODS: The charts of patients having LASIK based on steep keratometry nomogram using Moria M2 microkeratome (head : 110 micrometer) and excimer laser (VISX STAR S2, USA) in our department of ophthalmology from March, 2003, to May 2005, were reviewed retrospectively. A total of 195 eyes were enrolled in the investigation. We analyzed relationship between corneal flap thickness and preoperative factors including central corneal thickness, steep keratometer, corneal diameter, suction ring using multiple regression analysis. RESULTS: Mean corneal flap thickness was 119.37+/-21.21 micrometer. There was a statistically significant positive correlation between flap thickness and central corneal thickness (p<0.05). No correlation was found between flap thickness and other preoperative factors including steep keratometer, corneal diameter and suction ring. CONCLUSIONS: Mean corneal flap thickness using the Moria M2 110 micrometer head was 119.37+/-21.21 micrometer, little thicker than our expectation. When surgery is performed based on steep keratometry nomogram using Moria M2 microkeratome, if intraoperative factors are excluded, there is a trend toward thicker flap thickness with thicker central corneal thickness, whereas steep keratometer, corneal diameter or suction ring have no influence on flap thickness.

Three Cases of Pneumoretinopexy for Rhegmatogenous Retinal Detachment by Multiple Retinal Tears over 1 Hour in Distance

PURPOSE: To determine the effects of performing pneumoretinopexy in patients without the conventional indication of pneumoretinopexy but with rhegmatogenous retinal detachment by multiple retinal tears separated over 1 hour in distance. METHODS: Three patients with rhegmatogenous retinal detachment by multiple retinal tears separated over 1 hour in distance from November 2003 to December 2003 were the subject of this study. Treatment records of the patients were examined retrospectively. In one case, when performing pneumoretinopexy, 0.5 cc of vitreous was aspirated followed by an injection of 0.8 cc SF6 gas. In the other two cases, after injecting 0.5 cc of SF6 gas, one retinal tear was adhered in the proper position. Then, sequential retinal adhesion was attempted by changing the position. RESULTS: In all three cases, anatomical retinal adhesion was maintained, and visual acuity functionality was improved. CONCLUSIONS: Both sequential retinal adhesion by changing the position and performing pneumoretinopexy after vitreous aspiration are successful method of retinal adhesion. Therefore, pneumoretinopexy can be used as an effective medical treatment in patients with rhegmatogenous retinal detachment by multiple retinal tears separated over 1 hour in distance.

Cost-benefit Analysis of Health Screening Test for the Insured / 예방의학회지

As a result of cost-benefit analysis by making a macroscopic approach to the health screening projects conducted 4 times since 1980 for the insured people of the Korea Medical Insurance Corporation, the following conclusions were reached. 1. The direct costs put into the health screening project, and the time costs which were paid by examines or calculated in terms of social costs have been estimated. The results is that the lowest estimation was 10,337 million won and the highest 15,141 million won when a minimum of 1.5 hours of time spent and a maximum 4 hours were applied. 2. In terms of the psychiatric benefits, the lowest estimation was 5,341 million won while the highest was 5,585 million won. 3. In terms of the benefits for each kind of diseases, the lowest estimation of 37,188 million won and highest estimation of 74,383 million won have been calculated for the liver diseases. And for the cardiovascular diseases, the minimum estimation was 14,475 million won while the maximum was 20,532 million won. In case of pulmonary tuberculosis, with external effect benefits being included, the estimation ranged from the minimum of 1,649 million won to the maximum of 1,832 million won. And the estimation of benefits for diabetes mellitus and renal diseases ranged from 89 million won to 92 million won and from 4,567 million won respectively. 4. In comparing costs and benefits, as a results of comparing each highest and lowest estimation, a range of minimum 46,708 million won and maximum 98,071 million won of benefits has been gained.