A Clinical Results of Combined Vitrectomy, Cataract Extraction, and Posterior Chamber Intraocular Lens Implantation

Thirty eyes of thirty patients with coexisting cataract and vitreoretinal disease underwent combined cataract extraction, pars plana vitrectomy and posterior chamber intraocular lens implantaion.Surgical procedures of cataract extraction included phacoemulsification(14 eyes), pars plana lensectomy(11 eyes) and extracapsular lens placed in the capsular bag in 19 eyes following phacoemulsification or extracapsular cataract extraction. Eleven eyes had sulcus fixation of posterior chamber lens following lensectomy.Postoperatviely visual acuity improved in 26 eyes(86.7%), unchanged in 3 eyes(10%) and decreased in 1 eye(3.3%). Final visual acuity was 20/200 or better in 26 eyes(86.75), and 20/40 or better in 11 eyes(36.7%). Postoperative complications included rhegmatogenous retinal detachment with proliferative vitreoretinopathy, neovascular glaucoma and endophthalmitis.Pars plana vitrectomy combined with cataract extraction with posterior chamber intraocular lens implantation maybe useful in reducing cost and providing rapid visual rehabilitation.

The Etiology of Optic Neuropathy

In order to investigate causative mechanisms of optic neuropathy, retrospective clinical studies including ophthalmologic examination, imaging study, and molecular biologic analyses were performed on 322 patients with optic neuropathy. The causes include hereditary optic neuropathy(71 patients, 22.1%), optic neuritis(66 patients, 20.5%), traumatic optic neuropathy(40 patients, 12.5%), ischemic optic neuropathy(35 patients, 10.9%), compressive optic neuropathy(31 patients, 9.6%), toxic optic neuropathy(23 patients, 7.1%), etc. In 29 patients of bilateral optic atrophy and 18 patients of unilateral optic atrophy, the causative mechanism was not clear. In conclusion, hereditary optic neuropathy was the most common causative mechanism of optic neuropathy in this study. The importance of meticulous history taking and molecular biologic test should be stressed in differential diagnosis of optic neuropathy.

The Etiology of Optic Neuropathy

In order to investigate causative mechanisms of optic neuropathy, retrospective clinical studies including ophthalmologic examination, imaging study, and molecular biologic analyses were performed on 322 patients with optic neuropathy. The causes include hereditary optic neuropathy(71 patients, 22.1%), optic neuritis(66 patients, 20.5%), traumatic optic neuropathy(40 patients, 12.5%), ischemic optic neuropathy(35 patients, 10.9%), compressive optic neuropathy(31 patients, 9.6%), toxic optic neuropathy(23 patients, 7.1%), etc. In 29 patients of bilateral optic atrophy and 18 patients of unilateral optic atrophy, the causative mechanism was not clear. In conclusion, hereditary optic neuropathy was the most common causative mechanism of optic neuropathy in this study. The importance of meticulous history taking and molecular biologic test should be stressed in differential diagnosis of optic neuropathy.

Clinical Evaluation of Traumatic Wound Dehiscence Following Cataract Surgery

In 38 patients with traumatic wound dehiscence after cataract surgery, we evaluated the causes and degrees of the injury, surgical methods of repair and the final visual outcome from Aug. 1993 to Apr. 1977. Among 38 patients, twenty-five were men and thirteen were women. In 34 patients, wound dehiscence occurred within one month after cataract surgery. The common causes of wound dehiscence were trauma by the finger or fist (9 patients) and by the contusion (7 patients). But in 16 patients, the exact causes of trauma were not identified. Accompanied ocular findings were prolapsed iris (29 patients) , hyphema (9 patients) , and dislocation of intraocular lens (7 patients). All patients received operations for wound closure, iris reposition, anterior vitrectomy, intraocular lens reposition or removal, and iris partial resection. At the end of follow-up, 27 patients achieved corrected visual acuity 20/40 or over. To prevent wound dehiscence after cataract surgery, we suggest that protective eye shield should be applied at least for a month after surgery.

Optic Neuropathy in Koreans I. Leber's Hereditary Optic Neuropathy

No abstract available.

A Clinical Analysis of Vitrectomy for the Proliferative Diabetic Retinopathy Patients

The authors reviewed the charts of 128 patients(160 eyes) who underwent vitrectomy for the proliferative diabetic retinopathy from January 1993 to December 1995 and the results were analyzed in terms of visual efficiency. At the conclusion of the study, visual acuity improved in 96 eyes(60%), unchanged in 33 eyes(21%) and in 31 eyes(19%) became worse. Visual efficiency was increased from 11.9% preoperatively to 37.2% postoperatively in all patients. Patients under the age of 40 showed better results than the patients above the age of 40. The factors which affected the change in visual efficiency were age and preoperative intraocular conditions. The patients who had non-clearing vitreous hemorrhage without proliferative membrane revealed better prognostic results than the other patients. In 50 eyes (31.3%) of cases, maximal postoperative visual acuity was achieved in 4 weeks to 3 months after operation.

Cataract Surgery Using a Sleral Pocket Incision of 7 mm in Length

During a eight-month period from june 1993, cataract surgery using a scleral pocket of 7 mm in length was performed on 30 eyes of 26 patients. In order to evaluate the effect of chamber entry length and closure technique on astigmatic changes and visual recovary, three different surgical procedures were carried out and compared retrospectively. The visual acuity, refraction and keratometry were assessed at every week. The H group(15 eyes) had a single horizontal suture after phacoemulsification followed by implantation of a one piece of PMMA lens through 7 mm chamber entry. The F group(6 eyes) had a single horizontal suture followed by implantation of a foldable lens through 4 mm chamber entry. The R group(9 eyes) had a single radial suture followed by implantation of one piece of PMMA lens through 7 mm chamber entry. Overall uncorrected visual acuity of 20/40 or better was 67% at 1 week, 93% at 8 weeks postoperatively and there was no statistically significant difference among the three groups(p>0.05). The overall change of mean refractive astigmatism from 1 to 8 weeks postoperatively was 0.69D and there was no statistically significant difference among the three groups(p>0.05). The overall change of mean keratometric astigmatism method from 1 to 8 weeks postoperatively was 0.12D and there was no statistically significant difference among the three groups(p>0.05). Early clinical observations indicate that cataract surgery using a scleral pocket of 7 mm in length shows early visual recovery and minimizes surgically induced astigmatism without serious complications.

Implantation of Intraocular Lenses in Traumatic Cataract

We implanted intraocular lenses in 41 eyes of 41 patients with traumatic cataract without associated retinal injury. All the enrolled patients had sustained injury visited the Incheon Gil Hospital between August 1988 and June 1992. We analyzed age and sex distribution, mode and site of injuries, associated injuries, postoperative complications, methods of operation, final visual results and causes of decreased vision. Nineteen patients(46.4%) achieved final visual acuity of 0.5 or better, 11 patients(26.8%) between 0.1 and 0.5, and the remaining 11(26.8%) below 0.1. Major visual prognostic factors were associated ocular injuries, the state of the posterior lens capule, intraoperative and early postoperative complications. The interval between the first and second operation had little effect on the final vision.

A Clinical Study on Implantation of Anterior Chamber Intraocular Lens and Posterior Chamber Intraocular Lens by Scleral Fixation in Eyes without Capsular or Zonular Support

The study was performed retrospectively to compare the results of anterior chamber IOL(Intraocular Lens) implantation and posterior chamber IOL implantation by scleral fixation in cases of inadequate zonular or capsular support during the extracapsular cataract extraction. A total of 27 cases were reviewed of which 11 cases had anterior chamber IOL implantation and 16 cases had posterior chamber IOL implantation by scleral fixation. The follow-up period ranged from two to twenty-four months. Nine of eleven in anterior chamber IOL group and thirteen of sixteen in posterior chamber IOL group had the final corrected vision of 0.5 or better. Vision-threatening complications included two cases of cystoid macular edema in anterior chamber IOL group, whose visual acuity was 0.1 and 0.5, and three cases of vitreous hemorrhage in posterior chamber IOL group, which had little effect on visual outcome The final visual acuity didn't show statistically significant difference between the two groups.

Forehead augmentation with hydroxyapatite

No abstract available.

Refined correction method of unilateral cleft lip nasal deformity

No abstract available.

A Clinical Study of Traumatic Hyphema

Traumatic hyphema accounts for about 6.7% of ocular trauma and its visual threatening associated ocular injuries are commotio retinae, retinal detachment, macular hole. cataract and rebleeding. The authors reviewed the medical records of 98 patients (98 eyes) having been admitted to the Joongang Gil Hospital between March 1989 and February 1991 with the diagnosis of nonperforating traumatic hyphema. Prospective study was performed as to the effect of epsilon-aminocaproic acid (EACA) in the clearance time of blood clot in the anterior chamber and the frequency of rebleeding. The avlrage clearance time of blood clot was significantly longer in the EACA treated group (5.8 days) than in the control group (3.5 days)(t-Test P0.05).

A Case of Herpes Zoster Ophthalmicus Complicated by Abducens Palsy

The complications of herpes zoster ophthalmicus vary greatly among different patients. The major portion of the complications fall under four types; (1) keratitis, (2) iridocyclitis, (3) muscular palsies, and (4) optic neuritis. We have experienced a case of herpes zoster ophthalmicus complicated by abducens palsy, sectorial paralysis of iris sphincter, iritis, and transient increase of intraocular pressure. The case was reviewed and the pathogenesis of the complications were discus sed.

Experimental Strabismus Surgery using N-Butyl-2-Cyanoacrylate(Histoacry(R))

Strabimus surgeries using n-butyl-2-cyanoacrylate and 6-0 vicryl suture material were performed in 16 albino rabbits. Both eyes of 16 rabbits were used. The superior and inferior rectus muscles were recessed and resected 5 mm. In 12 rabbits, n-butyl-2-cyanoacrylate was used and those rabbits were divided into 3 groups, each group(4 rabbits, 8 eyes) was sacrificed 1, 2, and 3 weeks after operation respectively. The eyes were enucle ated to examine the tensile strength and pathologic findings of the attached area. In 4 rabbits, 6-0 vicryl suture material was used a control group in this study. This group was sacrificed and examined 3 weeks following the operation. In the cyanoacrylate groups, there were statistically significant differences and a chrono-logically increasing thendency of tensile strength between groups. Between the cyanoacrylate and the suture material group at 3 weeks post operation, there was no statistically significant difference in the tensile strength. Pathologically, extraocular muscle bundles revealed patchy areas of interstitial inflammatory infiltration and fibrosis in the cyanoacrylate groups. Capillary telangiectasia and muscle fiber regeneration were commonly observed. The findings in specimens 3 weeks after operation revealed rather mild changes, suggesting healed lesions. In the suture material group, mild inflammatory reactions were found.

Silicone Oil for Retinal Detachment with Advanced Proliferative Vitreoretinopathy Following Vitrectomy

We reviewed 71 cases of silicone oil injection for retinal detachment surgery with advanced proliferative vitreoretinopathy following failed vitrectomy between November 1982 and March 1986 in order to identify the anatomic and functional success rate and its complications. The causes of vitrectomy were as follows: advanced proliferative vitreoretinopathy after retinal detachment surgery and retinal vascular diseases(34 eyes), giant dialysis(10 eyes), severe perforating injuries and intraocular foreign bodies(17 eyes), and traction retinal detachments associated with proliferative diabetic retinopathy(10 eyes). In 71 cases of silicone oil injection, anatomic success rate was 34.8%(23/66) and functional success rate was 16.9%(16/71) and its complications were lens opacities(28.1%, 9/32) in phakia and corneal opacities(20.5%. 8/39) and increased intraocular pressure(17.9%, 7/39) in aphakia.

The Antibacterial Sensitivity of Domestic Topical Antibiotics: in vitro test

The antibacterial activity of 11 domestic topical antibiotic eye drops were examed by use of Reddish method, in vitro test. 5 clinical strains which were recovered as common pathogens of corneal ulcer, were inoculated into the diluted antibiotics added with 1% human serum, and 0.01 ml were plated for bacterial survival at 0.5, 1, 2, 4, 8, 16. and 24 hours. Our result showed that gentamicin eye drops effective in Gram negative strains and penicil-line and cefazoline eye drops were effective in Gram positive strains. These results indicated that gentamicin and cefzolin eye drops in combination would be covered the common ocular pathogenic bacteria.

Experimental strabismus surgery using N-butyl-2-cyanoacrylate (Histoacryl(R))

Strabismus surgeries using n-butyl-2-cyanoacrylate and 6-0 vicryl suture material were performed in 16 albino rabbits. Both eyes of 16 rabbits were used. The superior and inferior rectus muscles were recessed and resected 5 mm. In 12 rabbits, n-butyl-2-cyanoacrylate was used and those rabbits were divided into 3 groups, each group (4 rabbits, 8 eyes) was sacrificed 1, 2, and 3 weeks after operation respectively. The eyes were enucleated to examine the tensile strength and pathologic findings of the attached area. In 4 rabbits, 6-0 vicryl suture material was used as a control group in this study. This group was sacrificed and examined 3 weeks following the operation. In the cyanoacrylate groups, there were statistically significant differences and a chronologically increasing tendency of tensile strength between groups. Between the cyanoacrylate and the suture material group at 3 weeks post operation, there was no statistically significant differences in the tensile strength. Pathelogicallyr extraocular muscle bundles revealed patchy areas of interstitial inflammatory infiltration and fibrosis in the cyanoacrylate groups. Capillary telangiectasia and muscle fiber regeneration were commonly observed. The findings in specimens 3 weeks after operation revealed rather mild changes, suggesting healed lesions. In the suture material group, mild inflammatory reactions were found.

Pathogens of Corneal Ulcer (II)

One hundred and thirty-two cases(132 eyes) of corneal ulcer were analysed on the clinical and etiologic basis. The history of evident ocular trauma was found in 28.8% of the cases and ocular disease was found in 7.6% of the cases. Positive results were 16/55 in smear and 33/61 in culture, and the most common isolate was coagulase negative staphylococcus in bacteriologic studies. In fungal studies, positive results were 1/42 in smear and 5/42 in culture, and Aspergillus was the most common isolate. Cephalexin was the most sensitive antibiotics for Gram positive organism and carbenicillin and gentamicin were the most sensitive antibiotics for Gram negative orgamsm. These results indicate that gentamicin and cephalexin in combination would be recommended as the initial treatment of wide-spectrum antibiotics coverage for bacterial corneal ulcer until the final culture results and senitivity are available.

Clinical Evaluation of Bausch and Lomb O3/O4 Soft Contact Lenses for Extended Wear

The clinical evaluation of the "O3/O4" series of Bausch and Lomb company for extended wear were performed in 138 eyes of 69 patients. In 128 eyes(92.1%) of them the corrected visual acuity over 0.8 was obtained and wearing periods of contact lenses were ranged from 1 day to 3 weeks (mean: 9.2 days). 117 eyes were satified with the contact lenses having no remarkable complications. There were no significant changes in corneal curvature between the examinations before and after contact lens wearing. From the above results, it can be suggested that the O3/O4 extended wear soft contact lenses are clinically available with excellent improvement of visual acuity.

4 Cases of Acute Retinal Necrosis

The Acute Retinal Necrosis(A.R.N.) syndrome is characterized by necrotizing retinitis, vitritis, and retinal vasculitis. We experienced 5 eyes of 4 cases with Acute Retinal Necrosis in otherwise healthy patients. In this study, 3 of 4 cases(75%) were male, retinal detachment developed in 3 eyes(60%), and 3 of 4 cases(75%) were unilateral. 4 of 5 eyes(80%) had a final visual acuity of less than 0.1.