Sustainability of Orthokeratology as Demonstrated by Corneal Topography

PURPOSE: To determine the sustaining effects of orthokeratology. METHODS: This study enrolled 58 eyes with moderate myopia. LK-DM lenses (Lucid Korea Dream Lens(TM)) were fitted daily for at least eight hours on an overnight regimen. The effects of orthokeratology and it's sustainability throughout the day were recorded twice; immediately after removal in the morning and eight hours later. Sustainability was measured by comparing the changes from morning to afternoon for best uncorrected visual acuity, apical corneal power, keratometric values, spherical equivalent and induced astigmatism. RESULTS: UCVA demonstrated improved values at all follow up periods. Fluctuations during the day stabilized after 4 weeks of lens wear. K values averaged a mean of 42.4 mm at baseline, and reduced to 40.9 mm by week 12. Unaided logMAR visual acuity changed from 0.94+/-0.14 at baseline to -0.11+/-0.17 by week 12. The sustainability of orthokeratology, defined as the difference between morning and afternoon values of unaided logMAR visual acuity, increased from -0.82 on day 1 to -0.11 on week 12. CONCLUSIONS: UCVA and spherical refractive error did not change to a significant degree after 4 weeks. Although statistically insignificant minute fluctuations during the day were observed up to week 12, these fluctuations decreased to a statistically significant level after week 4.

Sustainability of Orthokeratology as Demonstrated by Corneal Topography

PURPOSE: To determine the sustaining effects of orthokeratology. METHODS: This study enrolled 58 eyes with moderate myopia. LK-DM lenses (Lucid Korea Dream Lens(TM)) were fitted daily for at least eight hours on an overnight regimen. The effects of orthokeratology and it's sustainability throughout the day were recorded twice; immediately after removal in the morning and eight hours later. Sustainability was measured by comparing the changes from morning to afternoon for best uncorrected visual acuity, apical corneal power, keratometric values, spherical equivalent and induced astigmatism. RESULTS: UCVA demonstrated improved values at all follow up periods. Fluctuations during the day stabilized after 4 weeks of lens wear. K values averaged a mean of 42.4 mm at baseline, and reduced to 40.9 mm by week 12. Unaided logMAR visual acuity changed from 0.94+/-0.14 at baseline to -0.11+/-0.17 by week 12. The sustainability of orthokeratology, defined as the difference between morning and afternoon values of unaided logMAR visual acuity, increased from -0.82 on day 1 to -0.11 on week 12. CONCLUSIONS: UCVA and spherical refractive error did not change to a significant degree after 4 weeks. Although statistically insignificant minute fluctuations during the day were observed up to week 12, these fluctuations decreased to a statistically significant level after week 4.

FAG, ICG and OCT Findings in Multiple Evanescent White Dot Syndrome

PURPOSE: We evaluated one patient with multiple evanescent white dot syndrome (MEWDS), using fundus fluorescein angiography (FAG), indocyanine green angiography (ICGA), optical coherence tomography (OCT) on acute phase of the disease, at 2 weeks after onset and at 10weeks. METHODS: Each diagnostic images were compared with patient's clinical course .OCT measurements of serial retinal thickness were done to assess the change in retinal thickness over the disease process. RESULTS: White dots on fundoscopic examination showed hypofluorescent on ICGA and imaged hyperreflective on OCT without presence of neither subretinal fluid nor neuroretinal increase in thickness. These ICGA and OCT findings suggest that lesions of perfusion defect on ICGA may be caused by interstitial precipitations of inflammatory cells in choriocapillaries and the underlying mechanism is not due to vasculitis with edema or serous exudation. CONCLUSIONS: ICGA and OCT allowed more precise anatomic evaluation than FAG in diagnosis and correlated well with clinical symptoms.

Retinal Thickness After Cataract Surgery Measured by Optical Coherence Tomography

PURPOSE: To report the early postoperative macular change in uncomplicated phacoemulsification cataract surgery. METHODS: A retrospective study of 36 consecutive eyes of 36 patients, who underwent phacoemulsification cataract surgery and OCT, preoperatively and postoperatively was made. In 16 eyes from group 1, nonproliferative diabetic retinopathy without macular edema was present before the cataract surgery. In the other 20 eyes (group 2), no systemic or ocular pathology was present . RESULTS: The mean +/- standard deviation (SD) follow up after cataract surgery was 4 +/- 1 weeks in each group. In group 1, the mean +/- SD retinal thickness increased from 201 +/- 14 micro meter preoperatively to 243 +/- 22 micro meter 3 hrs after cataract surgery (P=0.38). In group 2, the mean +/- SD retinal thickness increased from 212 +/- 10 micro meter preoperatively to 246 +/- 24 micro meter 3 hrs after cataract surgery (P=0.55). CONCLUSIONS: This study showed that uncomplicated phacoemulsification cataract surgery has no immediate influence on retinal thickness.

The Incidence of after-cataract in Eyes with Silicone and Hydrophilic Acryl-soft IOLs

PURPOSE: To determine the incidence of after cataract. following inserting foldable IOL (silicone or hydrophilic acryl IOL) after phacoemulsification. METHODS: Patients who were diagnosed with senile cataract and had undergone phacoemulsification and foldable IOL (silicone or hydrophilic acryl IOL) insertion were included. Among the respective 80 and 82 subjects, we conducted a prospective study on 51 subjects with silicone IOL and 52 with hydrophilic acryl IOL without complications such as operative posterior capsular rupture, postoperative macular edema and endophthalmitis. We measured the best corrected visual acuity and the development of posterior capsular opacity in 1day, 1month, 3months, 6months, 1year after surgery. RESULTS: The incidence of after catatract was 19.5% (10eyes) in silicone-IOL group and 3.8% (2eyes) in hydrophilic acryl IOL group. Values in two groups showed statistically significant difference. CONCLUSIONS: The incidence of after cataract was lower in hydrophilic acryl IOL group than in silicone IOL group.

The Normal Value of Adult Korean Orbital Volume in Three-Dimensional Computerized Tomography

PURPOSE: This study is to know a normal orbital volume of adult Koreans. METHODS: We had taken 3-dimension orbital CT of 100 patients who had visited the department of ophthalmology and emergency room. Among them 30 patients who were reported to show abnormal orbital CT finding were excluded. Thereafter we measured orbital CT volume in eyes of 70 patients. We appointed inner sides of orbital wall in coronal plane image and reconstructed 3-dimension images by means of soft ware program(silhouette) in CT to measure the orbital volume. RESULTS: Average of orbital volume was 24.5 mm 3(left orbital vol. 24.25 mm 3, right 24.75 mm 3), in males and 23.5 mm3(left 23.25 mm 3 , right 23.75 mm 3)in females. Difference between right orbit and left orbit was 2% and average of male orbital volume was bigger than female by 4%. CONCLUSION: Adult Korean orbital volume measure was useful for differential diagnosis in orbital desease.

Limbal-Conjunctival Autograft Transplantation for the Treatment of Primary Pterygium

Pterygium is a common surgical ocular disease which recurs frequently. Various different techniques have been developed for the successful surgical treatment of pterygium and among them, autograft transplantation is known as the best successful surgical method. For the prevention of recurrence, the corneal epithelium must heal before the fibrovascular tissue grows and reaches to limbus. For this, we have believed that limbal transplanta- tion is more suitable than conjunctival transplantation. We had performed limbal-conjunctival autograft trasplata- tion for 52 patients with primary pterygia whose age was under 40 years old,or whose pterygia had involved above 5mm beyond limbus and had shown diffuse subconjunctival fibrovascular tissue. The recurrence rate was 1.9%and therewere no complications and no surgical problems. Therefore,we recommend this surgical technique as a safe and effective method of treating primary pterygia with the risk factors of recurrence.

Comparision of central Corneal Endotherial Cell Density with Peripheral Areas According to Age by Specular Microscopy

We measured corneal endothelial cell density of 100 normal eyes of 50 Korean volunteers on central, superior, inferior, nasal and temporal aspect, respectively. Non-contact specular microscopy were used for measurement. The data thus obteined were analyzed according to the following parameters: age, laterality, sex and location(central vs. peripheral). Corneal endothelial cell density showed gradual decrement with age, but no significant statistically differences with laterality and sex. The results showed a large difference in corneal endothelial cell density depending on the location, although they failed to show statistical significant(P>0.05).

Comparison of Ocular Pain during Cataract Surgery Using a Scleral Pocket Incision under Pinpoint versus Intracameral Anesthesia

We compared the pain produced during different phases of phacoemulsification cataract surgery using a scleral pocket incision under pinpoint anesthesia with that under intracameral anesthesia. This prospective study comprised each 100 cataract patients who had no complications influencing the degree of pain during surgery. Patients were asked about pain immediately after each phase and pain occurring during each phase was measured using 4 step verbal scale(from 0 to 4). In both anesthesia,conjunctival reposition was the most painful.Pinpoint injection was statistically significantly more painful than induction of intracameral anesthesia.The pain score during conjunctival reposition and at 1hr after surgery were significantly higher under intracameral anesthesia than under pinpoint, but during most of phases under both anesthesia,the pain score was relatively low. Intracameral anesthesia is easy,safety and dose not require additional ocular damage during induction of anesthesia,so if combined with topical anesthesia,it is very effective during cataract surgery using scleral pocket incision.

A Case of Choroidal Metastasis of Pancreatic Carcinoma

Metastatic tumor to the eye is the most common type of intraocular malignancy. The most common primary site of the intraocular metastatic tumor is the breast in women and the lung in men respectively and the choroid is by far the most common site for intraocular metastasis. We experienced a case of chroidal metastasis in a patient with pancreatic carcinoma which is not published in Korea. So, we review that case with the literatures related with metastatic pancreatic cancer to the choroid.

A Case of Choroidal Metastasis of Pancreatic Carcinoma

Metastatic tumor to the eye is the most common type of intraocular malignancy. The most common primary site of the intraocular metastatic tumor is the breast in women and the lung in men respectively and the choroid is by far the most common site for intraocular metastasis. We experienced a case of chroidal metastasis in a patient with pancreatic carcinoma which is not published in Korea. So, we review that case with the literatures related with metastatic pancreatic cancer to the choroid.

The Effects of Unpreserved Lidocaine on the Corneal Endothelium during Cataract Surgery

Recently, intracameral injection of 1% unperserved lidocaine was intro-duced as a supplement to the topical anesthesia in cataract operations. We evaluated the effect of intracameral lidocaine on the corneal endothelium. One hundred eyes of 90 patients undergone scleral tunnel incision and phacoemulsification with posterior chamber intraocular lens implantation were divided into 2 group according to the methods of anesthesia. Topical anesthesia with intracameral injection of 0.2 of 1% unpreserved lidocaine was used to the 50 eyes of 45 patients[group 1] and pinpoint anestesia to the rest[group 2]. Specular microscopy using non-contact specular microscope was done preoperatively, 1 week, 1 month and 3 months postoperatively to compare the endothelial morphologic changes between the 2 groups. The reduction of central corneal endothelial cell density at 3 months postoperatively was 9.45% in Group 1 and 8.74% in Group 2. The difference between the 2 groups was not significant statistically[p>0.1]. Postoperative changes in coefficient of variation[polymegathism] and hexagonality[pleomorphism] were not significantly different between the 2 groups either[p>0.1]. We therefore concluded that intracameral injection of 1% unpreserved lidocaine does not adversely affect the corneal endothelial cell function and morphology and may safely be used as a supplement to topical anesthesia in cataract surgeries.

Moyamoya Disease with Characteristic Funds Findings of Retinal Vascular Insufficiency

Moyamoya disease is characterized by progressive stenosis of internal carotid artery and shows unique angioraphic findings. Its etiology is still unknown, and theories of immunophysiologic and inflammatory mechanisms remain unproven. These patients show various neurologic symptons by cerebral ischemia, infarction and gemorrhage. and they also show various ophthalmologic symptoms. We experienced that a 21-year-old female who was diagnosed to have moyamoya disease presented with a suddenly developed occipital headache and neurologic deficit. The etiology of her characteristic fundus findings was thought to be retinal vascular insufficiency.

Optical Opacity by Interaction of Silicone Material and Silicone Oil in Vitro

Although the results of foldable intraocular lens are generally excellent, there are several complications. After cataract surgery with silicone lens, the patients with vitreoretinal surgery using silicone oil have not only visual acuity decrease, but also visual abberations such as halos and rainbow patterns. To report a newly defined complication, we studied the silicone lens-silicone oil interaction. The nonimplanted ilicone, acryl and PMMA lens, ten cases each, had been incubated in silicon oil at 36C for 9 months. After removal from the oil, each lens was examined and photograp hed by scanning electron microscopy every week. Appearance of lens surface and degree of adherence of the silicone oil to each IOL`s optic were estimated. Oily residue on the PMMA and acryl lens was removed easily and shown clear surface. In case of silicone lens, presence of distinct film or coating of oil was shown on the surface of both the optic and haptic component of IOL`s. They could not be removed with mechanical pressure with injected balanced saline solution and the oily residue remained strongly adherent to the optic surface. After 9 weeks, gelly-like adherence was appe ared on the silicone lens surface. As a result, the use of silicone IOL`s in patients with current vitreoretinal disease or those who are at high risk for future vitreoretinal disease that may require silicone oil as part of the therapy should be reconsidered.

Dacryocystorhinostomy with Intraoperative Mitomycin C

Nowadays endscopic transnasal dacryocystorhinostomy(DCR) has been done popularly in patients who had epiphora chronically because of lacrimal obstruction. The most frequent cause of DCR failure is obstruction of osteotomy site due to formation of granuloma. We used the mitomycin C to suppress proliferation of fibroblast to increase success rate. Between July 1996 and september 1997, 15 patients(16 eyes) who had visited ophthalmology department in Seoul Advantist Hospital made went endoscopic transnasal DCR and packed merocel socked with 0.2mg/ml between 3 months to 18 months(mean 11.5 months). One case showed recurrent epiphora 2 months after surgery, and success rate was 94%. In conclusion, endoscopic transnasal DCR with Mitomycin C should be considered to suppress proliferation of granuloma and increase success rate.

Clinical Results of silicone Intubation for Nasolacrimal Duct Obstruction in Adult

On this study, silicone intubation was performed for punctal stenois in 10 patients(group 1), incomplete nasolacrimal duct obstruction in 47 patients (group 2), and complete nasolacrimal duct obstruction in 18 patients(group 3) in adults. Silicone tube was removed between 3-6 months(mean 5.7 months) after intubation. Mean follow-up period of 9.5 months, 9 patients(90%)in group 1,39 patients(83%)in group 2,and 8 patients(44%) in group 3 showed no epiphora, and 1 patient(10%)in group 1, 8 patients (17%) in group 2, and 4 patients(22%) in group 3 showed intermittent epiphora. 6 patients(33%) in group 3 showed persistent epiphora. In summary, silicone intubation can be an alternative to dacryocystorhinostomy in selected adult patients who have punctal stenosis and incomplete obstruction of nasolacrimal duct system. It is safe, and less traumatic with high success rate in these patients.

Dacryoscintigraphy: The Assessment of Epiphora in Children

The value of dacryoscintigraphy in the assessment of lacrimal drainage system was examined in 20 children below 34 months of age, 28 symptomatic eyes and 12 asymptomatic eyes. Of 28 symptomatic eyes, 20(71%) had abnormalities of tear drainge on dacryoscintigraphy. Of 12 asymptomatic eyes, 10 had normal tear drainage systems on dacryoscintigraphy. Because of the good natural physiological character and simplicity of this procedure and lower risk of radiation hazard. dacryoscintigraphy is a useful technique in the assessment of lacrimal drainage systems in children with symptom of epiphora.

Prismatic Effect and Visual Acuity Degradation

Prisms have been used as tools with which to treat and diagnose many diseases in strabismology. But, because of prismatic distortion and dispersion, the visual acuities are declined. The purpose of this study is to show the relationship between prismatic effect and visual acuity degradation. Visual acuities were measured through a series of prisms of CR-39 to quantify the blur induced by prism. The mean visual acuities of myopias and amblyopias(with or without correction), and emmetropias were reduced as prism diopters were increased. The declines were linear. There was no significant difference among the declines of visual acuities of each group. Whenever to prescribe prisms and to test with prisms, we should remind that prisms could reduce visual acuities.

UV Protection Effect of Commonly Used Sunglasses and Guideline for Selecting Sunglasses

Although it is well known that ultraviolet and short wavelength visible rays are harmful to the human lens and the retina, consumers still tend to select sunglasses on the basis of fashion rather than protective quality. In order to provide guidelines for selecting appropriate sunglasses, we studied the mechanism of phototoxic damage and UV protective quality of commonly used sunglasses. Commonly used sunglasses were chosen by random sampling, and their UV transmittance was examined by spectrophotometer using neutral density filter method. UV transmittance was shown to be 3.0% to 40.8% and there was no significant relationship between UV transmittance and the tint or darkness of the sunglasses.

A case of human thelaziasis in Korea

The 15th case of human thelaziasis is reported from Korea. The patient was a 15-year-old girl from Seoul. Both of the worms which were removed from her eye were female and were identified by the number of transverse cuticular striations (281, 172 and 162/mm in the oesophageal, middle and posterior portions, respectively), as Thelazia callipaeda. The patient owned a pet dog ADDITIONAL ABSTRACT: The 15-year-old patient had herself removed a worm from one eye. Two worms were identified morphologically as Thelazia callipaeda. The source of infection was uncertain, but the patient was known to have close contact with a dog. The authors refer to 14 previously reported cases of thelaziasis in Korea.