One Case of Tuberous Sclerosis

Tuberous sclerosis is a rare, autosomal dominant syndrome, in which tumors of the brain, skin, viscera,and eye are found. The classical diagnostic triad included epilepsy, mental retardation, and adenoma sebaceum. Retinal harmatomas are the most common ocular abnormalities in patients with tuberous sclerosis. We experienced one case of tuberous sclerosis that showed adenoma sebaceum of the face, history of epilepsy. The 18 year old male patient also had optic nerve phakoma in his right eye, retinal harmatomas in his left eye, Shagreen patch on the left lumbar area, subependymal nodules along the lateral ventricle and cortical tuber of frontal lobe.

3 DFT Magnetic Resonance Dacryocystography in the Evaluation of Epiphora

PURPOSE: To evaluate the feasibility of 3-dimensional Fourier transformation magnetic resonancedacryocystography (3DFT MR DCG: MR DCG) and its diagnostic efficacy in patients with epiphora. MATERIALS AND METHODS: Three normal volunteers and ten patients complaining of epiphora were studied by MR DCG using 3DFT CISSand 3DFT FLASH techniques. In normal volunteers, MR DCG was obtained by instillation of diluted Gd-DTPA solutionsof different concentrations (Gd-DTPA : saline=1:100, 1:50, 1:25) using various instillation methods. In patientswith epiphora, MR DCG was compared with conventional D C G . RESULTS: In normal volunteers, the best image wasobtained with the continuous instillation method during MR scanning. In all normal volunteers, MR DCG demonstratedthe entire course of the nasolacrimal duct (NLD). In patients with epiphora, however, there were five cases inwhich MR DCG failed to visualize the NLD, as well as five cases of occlusion and two of stenosis at the level ofthe proximal NLD. These findings corresponded with conventional DCG findings as four cases of occlusion at thelevel of the common canaliculi, one case of lacrimal sac, five cases of occlusion and two cases of stenosis at thelevel of the proximal NLD. There was no significant difference between MR DCG findings using 3DFT CISS and 3DFTFLASH MR techniques. CONCLUSION: MR DCG can detect the correct level of obstruction and differentiate betweenocclusion and stenosis of the NLD in patients with obstruction of the lacrimal drainage system. It may be a usefuldiagnostic method for investigating complicated cases in which conventional DCG is not possible due topost-surgical or traumatic obstruction.

Distribution of MHC class II Positive Cells and Macrophages in the Iris and Ciliary Body in Endotoxin Induced Uveitis

Acute anterior uveitis was induced by footpad injection of bacterial lipopolysaccharide(LPS) in the Lewis rats. To evaluate the distribution and density of MHC class II positive cell, macrophages, B lymphocytes infiltration in the iris and ciliary body 24 hours after injection of bacterial LPS, immunohistochemical study was performed in the wholemount tissues with monoclonal antibodies. Quantitative analysis reveals that the density of MHC class II positive dendritic cells in the iris was 348.5+/-55cells/mm2 in the control group and 448.0+/-176cells/mm2 in the LPS injected group(p<0.05). The density of ED2 positive resident tissue macrophages was higher in the LPS injected group(761.9+/-82cells/mm2) than the control group(620.8+/-57cells/mm2)(p<0.05). ED1 positive macrophages infiltrated significantly in the LPS results in increased group(3225.0+/-522cells/mm2) than in the control group(590.5+/-52cells/mm2).OX33 positive cells were not observed in both control and LPS injected eyes. In conclusion, destruction of blood ocular barrier by infection of LPS results in increased infiltration of OX6 positive cells and macrophages, particularly massive influx of blood monocytes into the iris and ciliary body in acute phase of inflammation. This study confirmed that dendritic cells and macrophages play important roles in acute phase of endotoxin induced uveitis.

MHC Class II Positive Cells and Macrophages in the Iris of normal Lewis Rats

To identify the MHC class II expressing cells and macrophages in the iris, immunohistochemistry was carried out using monoclonal antibodies specific to MHC class II antigens(OX6), resident tissue macrophages(ED2) and monocyte-macrophage lineage(ED1) on wholemounts of iris from normal Lewis rats. A number of OX6 positive cells are distributed evenly in the iris. Morphology of OX6 positive cells are dendritiform, round, or pleomorphic. OX6-positive and dendritiform cell are presumed to be dendritic cells. ED2 positive cells are more closely arranged than OX6 positive cells. Most of ED2 positive cells are dendritiform. Most of ED1 positive cells are round. These cells might have important roles in the process of immune mechanism to various antigens in the anterior segment of the eye.

A Case of Tuberous Sclerosis

Tuberous sclerosis is a heredofamilial disease associated with the diagnostic triad of epilepsy, mental retardation, and skin lesions, adenoma sebaceum. Retinal hamartomas are the most common ocular abnormalities in patients with tuberous sclerosis and are classified as three types: 1) large whitish calcified nodular masses, 2) flat transluscent noncalcified smooth tumors, and 3) intermediate type. We introduce a case on 22 year-old male of tuberous sclerosis who was manifested by epilepsy, adenoma sebaceum without mental retardation. And he was characterized by multiple flat transluscent noncalcified type of retinal astrocytic hamartoma accompanied by Shagreen patch, sclerotic calcification in skull and angiomyolipoma on both kidneys.

A Clinical Study of Retinopathy of Prematurity

One hundred premature infants with birth weight less than 2000 gm or with gestational ages less than 37 weeks who admitted to Ewha Womans University from January 1991 to May 1993 were examined by indirect ophthalmoscope. We analysed the incidence and the risk factors of retinopathy. The results were as follows: 1. Twenty one infants(21.0%) were diagnosed as retinopathy of prematurity. Among them, six infants(28.6%) presented stage 1, three infants(14.3%) at stage 2, twelve infants(57.1%) at stage 3. 2. Male patients were 11(52.4%) and female patients were 10(47.6%). There was no significant difference in incidence between male and female. 3. The incidence of retinopathy of prematurity increased with low birth weight(<1500 gm), small gestational age(33 weeks) and oxygen administration. 4. The risk factors associated with oxygen therapy besides the duration of oxygen exposure were hyperoxia, hypoxia, hypercarbia, hypocarbia and acidosis. 5. The retinopathy of prematurity was initially diagnosed at 5.6 weeks in average(36.3 weeks by postconceptional age). The onset of retinopathy of prematurity was timed according to postconceptional age rather than chronologie age since birth. 6. Other possible associated risk factors were spontaneous premature rupture of membrane, sepsis, hyaline membrane disease, neonatal hyperbilirubinemia, transfusion and low 5-minute Apgar scores.

Laser Photocoagulation in Diabetic Macular Edema

Diabetic macular edema is the leading cause of decreased vision from diabetic retinopathy. The most promising treatment for diabetic macular edema has been photocoagulation and we have reviewed 18 cases, 25 eyes, of macular edema which were treated either by focal laser photocoagulation or grid-pattern photocoagulation between January 1988 to December 1990 and followed for at least 4 months. Visual acuity improved in 8 eyes(57.1%) of 14 eyes treated with focal laser photocoagulation and 4 eyes(36.4%) of 11 eyes treated with grid-pattern photocoagulation. Visual acuity was stable in 6 eyes(42.9%) treated with focal laser photocoagulation and 4 eyes(36.4%) treated with grid-pattern photocagulation. Of 3 eyes(27.3%) with diffuse macular edema was worsened visual acuity although treated with grid-pattern photocoagulation.

A Case of Incontinentia Pigmenti Associated with Ocular Complications

A Case of lncontinentia pigmenti. Incontinentia pigmenti is a hereditary disorder of abnormal skin pigmentation with associated ocular, skeletal, and central nervous system abnormalities. Ocular findings are present in up to 35% of cases, but in Korea only two cases have been reported. Recently, the authors have experienced one case of incontinentia pigmenti in a five-day old female patient who manifested both the typical dermatologic findings and ocular abnormalities in the right eye. The fundus showed markedly dilated and tortuous vessels with flat retinal neovascularization, scattered retinal hemorrhage of right macular area. Retinal cryopexy and posterior vitrectomy were performed.

Morphological Changes of Retinal Pigment Epithelium After Experimental Retinal Detachment

After the rhegmatogenous retinal detachment was induced experimentally in the rabbit eyes, ultrastructural changes in the retinal pigment epithelium (RPE) were studied with electron microscope. After 3 days of retinal detachment, apical portion of the retinal pigment epithelium was mounded and apical processes were shortened, widened and reduced in number. In other areas proliferative changes were observed in the RPE and some of the proliferated cells migrated into the vitreal space. These changes were more progressed with time. Three weeks after retinal detachment, there were areas of fibroblast-like cells proliferation with production of collagen fibers. From the evidence of cell junctions, melanin granules in the Cytoplasm and basement membrane formation, proliferated fibroblast-like cells were thought to be originated from the RPE cells.

Laser Photocoagulation in Diabetic Macular Edema

Diabetic macular edema is the leading cause of decreased vision from diabetic retinopathy. The most promising treatment for diabetic macular edema has been photocoagulation and we have reviewed 18 cases, 25 eyes, of macular edema which were treated either by focal laser photocoagulation or grid-pattern photocoagulation between January 1988 to December 1990 and followed for at least 4 months. Visual acuity improved in 8 eyes (57.1 %) of 14 eyes treated with focal laser photocoagulation and 4 eyes (36.4%) of 11 eyes treated with grid-pattern photocoagulation. Visual acuity was stable in 6 eyes (42.9%) treated with focal laser photocoagulation and 4 eyes (36.4%) treated with grid-pattern photocagulation. Of 3 eyes (27.3%) with diffuse macular edema was worsened visual acuity although treated with grid-pattern photocoagulation.

Two Cases of Congenital Hypertrophy of Retinal Pigment Epithelium Associated with Familial Adenomatous Polyposis

Familial adenomatous polyposis (FAP) is a rare hereditary disease that undergo malignant change and recent reports have described a very high incidence (87.5%-100.0%) of congenital hypertrophy of the retinal pigment epithelium (CHRPE) in Gardner's syndrome and familial adenomatous polyposis. Recognization of CHRPE lesion in ophthalmological screening test for the familial members with FAP is helpful not only in prediciting the presence of adenomatous polyposis and malignant carcinoma but also in genetic counselling. Authors have examined and report 2 female patients with similar CHRPE lesions in both fundus and thus diagnosed FAP following surgical examination.

A Comparison of the Posterior Vitreous Detachments in Normal and Diabetic Retinopathy

Among the panents who visited Ewha Womens Universty Hospital from Dec 1988 to Oct 1989, the authors investigated the presence of posterior vitreous detachment(PVD) in 181 eyes Wlth nomal fundus flnd1ngs and 160 eyes wlth diabetic retinopathy. In normal eyes, the incidence of complete PVD increased with age but that of partlal PVD was not related to age. In non prolderative diabetic retinopathy, complete PVD was 15.6% and partial PVD was 5.6%, And in proliferative diabetic retinopathy, complete PVD was 8.6% and partial PVD was 41.4%. It is suggested that there is a close relationship between proliferative diabetic retinopathy and partial PVD.

A Case of Ethmoid Mucocele

Mucocele is a chronic, expansile, cyst-like lesion of the paranasaI sinuses. They contain sterile mucoid material and are lined by mucosa of the affected cavity. Mucocele develops when drainage of normal sinus secretion is obstructed usually by scarring, inflammation, trauma, and tumor. Most of the mucocele are found in the frontal sinus and anterior ethmoid sinus. They may present ophthalmic manifestations such as exophthalmos, displacement of the eye, and limitation of eyeball movement. We experienced a case of left ethmoid mucocele in a 48-year old man. Histologic examination confirmed the mass to be mucocele of the ethmoid Sinus.

Relationship of Diabetic Retinopathy and Serum Angiotensin-Converting Enzyme

In 1980 Liebennan reported that elevated levels of serum angiotensin converting enzyme(ACE) were associated with diabetes mellitus and strongly correlated with the presence of severe retinopathy. Other investigators also suggested that the increased levels of serum ACE might be associated with a widespread microvascular damage. Therefore, the severer diabetic retinopathy can be anticipated the higher serum ACE level. In order to study the relationship between serum ACE levels and severity of diabetic retinopahty, we divided 44 diabetic patients into 4 patients without retinopathy. 21 patients with background retinopathy, 8 patients with preprolifearvie retinopathy, and 11 patients with proliferative retinopathy according to the advancement of retinopathy. The results were as follows: 1. Serum ACE levels of diabetes mellitus patients showed significantly higher than that of nondiabetic controls(21.8 +/- 12.89 vs 14.3 +/- 4.25 U/mL, p<0.05). 2. Serum ACE levels of presence of retinopathy showed significantly higher than that of no retinopathy(23.0 +/- 12.76 vs, 9.7 +/- 7.02 U/mL, p<0.05). 3. Serum ACE levels were significantly elevated in order of preproliferative, background, and no retinopathy(30.3 +/- 17.18, 19.4 +/- 8.75, 9.7 +/- 7.02 U/mL, p<0.05), but serum ACE levels of proliferative retinopathy were not higher than that of background and preproliferative retinopathy. 4. Serum ACE levels were not offectd by age, sex, type of control, required insulin dose and blood sugar level.

A case of congenital orbital teratoma

A case of congenital orbital teratoma with marked unilateral proptosis was noted at birth, Patients with congenital orbital teratoma had a uniform clinical picture and were very similar in their morphological pattern, often polycystic and with varied amounts of solid tissue. Six months after birth, the orbital tissues were totally extirpated. Histological examination revealed components from all three germinal layers and no sign of malignancy. Within the first year, the condition of the patient has been satisfactory.

A Clinical Study of Ocular Injuries

1,072 cases of ocular injuries, including 271 cases of in-patients, who visited department of ophthalmology of Chungnam National University Hospital from January 1,1981 to December 31, 1985, were clinically analyzed. The results were as follows: 1. The incidence of ocular injuries was 8.1% of all eye patients and 16.0% of all patients admitted to this ophthalmologic department. 2. The incidence was more common in male(82.0%) and in the age of 3rd to 4th decades(53.7%). 3. Monocular injuries accounted for 90.4% of ocular injuries. There was no significant difference in the incidence between the right and left eye. 4. Tho ocular injuries were more common in the spring(27.4%), but in children the incidence was higher during the vacation. 5. The patients who visited this hospital within 24 hours after injury accounted for 89.8%. 6. The most common cause of ocular injuries was fist or finger(15.9%), followed by iron products(12.6%) and traffic accident(10.9%), but the injuries by iron products(32.1%) were most common in the admitted patients. 7. The most common ocular injury was eyelid laceration (15.3%), followed by subconjunctival hemorrhage(12.5%) and conjunctival foreign body(8.6%). In the cases of in-patients, corneal laceration(21.2%) was most common, followed by corneoscleral laceration(14.9%) and lens perforation(10.2%). The corneal perforation was 52.1% of all perforating eye injuries. 8. Surgical procedure included corneal suture(21.1%), lensectomy(12.5%), enucleation or evisceration(11.2%), and others. 9. Visual acuity was improved in most cases by treatment, but the corrected vision after treatment was less than 0.1 in 33.2%, which was mainly due to the perforating eye injuries. 10. The most common complication of ocular injuries after treatment was corneal opacity(36.3%), followed by secondary glaucoma(14.6%) and traumatic cataract(6.4%).

Pseudohypopyon in Vitelliform Macular Dystrophy

We examined a 28-year-old male patient with pseudohypopyon in vitelliform macular dystrophy. The ocular fundi showed round cystoid lesions in the macula with clear fluid superiorly and yellow material inferiorly. Fluorescein angiography showed hyperfluorescent defects in the retinal pigment epithelium of the superior half of the lesion and blocked fluorescence in the area of the yellow material in feriorly. The electroretinography was normal and the electro-oculographic findings were abnormal.

The long-term effects of experimental total retinectomy

Experimental total retinectomy was performed in pigmented rabbit eyes to in vestigate its long-term effects on the operated and nonoperated opposite eyes from both clinical and histological aspects. There was no significant change in intraocular pressure between the preoperative and postoperative measurements during the six months after surgery. Rubeosis iridis, intraocular hemorrhage and phthisis bulbi were not evident in the operated and opposite eyes. Light microscopic examination revealed congestion of the choroidial vessels. There were scattered areas of retinal pigment epithelial cell proliferation. Transmission electron microscopic examination showed apiral mounding of the retinal pigment epithelium. Apical processes were short and reduced in number. Apical processes of the retinal pigment epithelial cells interdigitated with surface processes of the proliferating retinal pigment epithelial cells. There were numerous melanosomes in the cytoplasm of the proliferating retinal pigment epithelial cells. Cell junctions between the retinal pigment epithelial cells were well preserved.

The Post-cataract Astigmatism According to the Tightness of Suture

The post-cataract astigmatism was evaluated clinically between the groups with loose and tight suture in 47 patients(48 eyes) who had taken intraocular lens implantation with extracapsular cataract extraction. The results were as follows; 1. The post-cataract astigmatism in the tight suture group was significantly larger than the loose suture group in the early postoperative period. 2. There was no significant difference of the degree of astigmatism between the groups with loose and tight suture at postoperative 8th week. 3. Postoperative astigmatism was smaller than preoperative astigmatism in both groups at postoperative 8th week. 4. Decreasing velocity of with the rule astigmatism after operation is similar in both groups. Changing time of astigmatism axis: Tight suture group; 6th-8th week. Loose suture group; 3rd-4th week.