PURPOSE: To compare the survival of corneal grafts and the changes in endothelial cell density in penetrating keratoplasty using domestic or imported corneas. METHODS: Medical records of 236 eyes of 211 patients who underwent penetrating keratoplasty from November 2004 to August 2011 in Seoul National University Hospital and were followedup at least 1 year were retrospectively reviewed. After excluding the patients who received the combined surgeries with other surgeries except cataract surgery, the eyes were divided into 2 groups depending on the origin of donor tissue resulting in a domestic cornea group (108 eyes) and an imported cornea group (128 eyes). Recipient demographics, preoperative diagnosis, donor age, death-to-preservation time, death-to-operation time and pre-and postoperative visual acuities were compared between the 2 groups. Kaplan-Meier survival and changes in endothelial cell density were analyzed at 3, 6 and 12 months and then every year. RESULTS: The most common preoperative diagnoses were regraft and corneal opacity in the domestic and imported cornea groups, respectively, without statistical difference. Death-to-preservation time was 8.9 hours and 8.0 hours in the domestic and imported cornea groups, respectively, without statistical difference. However, death-to-operation time was longer in the imported cornea group (4.98 days) than in the domestic cornea group (2.18 days). There were no differences in pre- and postoperative visual acuities, decrease in annual changes in endothelial densities and survival up to 3 years between the 2 groups. In addition, the survival and decreased annual changes in endothelial densities were not different from each other in penetrating keratoplasty combined with cataract surgery or in penetrating keratoplasty for a corneal edema. CONCLUSIONS: Our study results suggest that clinical outcomes of the penetrating keratoplasty using imported corneas are comparable in efficacy when compared with the clinical outcomes using domestic corneas.
Cataract ; Cornea* ; Corneal Edema ; Corneal Opacity ; Demography ; Diagnosis ; Endothelial Cells ; Humans ; Keratoplasty, Penetrating* ; Medical Records ; Retrospective Studies ; Seoul ; Tissue Donors ; Transplants ; Visual Acuity

PURPOSE: To evaluate the clinical efficacy and shortcomings of neodymium-doped yttrium aluminum garnet (Nd-YAG) laser membranotomy in inadvertently retained host membrane. METHODS: Among 742 patients who underwent penetrating keratoplasty (PKP) and deep anterior lamellar keratoplasty (DALK) surgery at Seoul St. Mary's Hospital between January 2007 and May 2013 by a single surgeon, 10 patients had a thin, opaque membrane in the anterior chamber observed under slit lamp examination and both a subjective decrease in visual acuity and decrease i best corrected visual acuity. A single surgeon performed membranotomy using the Nd-YAG laser at 4.9 months after graft surgery. In this study we compared the differences in visual acuity, endothelial cell count and correlations between distance from donor endothelium and retained host membrane and endothelial loss before and after the graft surgery. RESULTS: Patients who had Nd-YAG laser membranotomy performed on the retained host membrane showed significant improvements in visual acuity (p = 0.039). Donor endothelial cell count was significantly reduced 1 month after Nd-YAG laser. The average distance between donor endothelium and retained host membrane was 712.0 +/- 217.5 microm. The distance and the decreased donor endothelial cell count were not statistically correlated (R2 = 0.39, p = 0.072). There were no significant complications after the laser membranotomy. CONCLUSIONS: Inadvertently retained host membrane forms close to the donor endothelium as identified on optical coherence tomography (OCT) images. Nd-YAG laser membranotomy significantly affected clear vision but endothelial cell count loss was also observed.
Aluminum ; Anterior Chamber ; Corneal Transplantation* ; Endothelial Cells ; Endothelium ; Humans ; Keratoplasty, Penetrating ; Lasers, Solid-State* ; Membranes* ; Seoul ; Tissue Donors ; Tomography, Optical Coherence ; Transplants ; Visual Acuity ; Yttrium

PURPOSE: The purpose of this study was to investigate the clinical efficacy of Cutanplast(R) nasal packing after endonasal dacryocystorhinostomy. METHODS: The present study included a total of 76 adult patients (98 eyes) with primary acquired nasolacrimal duct obstruction who underwent endonasal dacryocystorhinostomy. Fifty-four eyes were packed with Cutanplast(R) and 44 eyes were packed with Merocel(R). Patient discomfort while the packing was in situ, degree of bleeding during the day after operation, functional and anatomical success rate, and postoperative complications such as synechiae, granulation, wound healing (osteal mucosal epithelium epithelization), and revision rate were compared between the packing materials. RESULTS: The Cutanplast(R) was significantly more comfortable and effective at preventing hemorrhage after endonasal dacryocystorhinostomy during the day following the operation. There was no significant difference between the two groups in postoperative anatomical and functional surgical success rate at 1 week, 1 month and 3 months. In comparison with postoperative complications, the Cutanplast(R) group showed a lower incidence of delayed wound healing (delayed epithelialization of the osteal mucosal epithelium) than the Merocel(R) group, whereas there was no difference in granulation, synechiae, or revision rate. CONCLUSIONS: The Cutanplast(R) nasal pack resulted in significantly less discomfort and less bleeding compared to the Merocel(R) nasal pack. Moreover, the Cutanplast(R) showed a lower proportion of delayed wound healing after endonasal dacryocystorhinostomy and had the advantage of low cost compared to other hemostatic nasal packing materials. Therefore, Cutanplast(R) nasal packing after endonasal dacryocystorhinostomy can be considered a comfortable, cost-effective and clinically-effective method.
Adult ; Dacryocystorhinostomy* ; Epithelium ; Hemorrhage ; Humans ; Incidence ; Nasolacrimal Duct ; Postoperative Complications ; Wound Healing

PURPOSE: To evaluate the causes of failed dacryocystorhinostomy (DCR) and the effects of transcanalicular diode laser-assisted endonasal revision surgery according to the number of silicone tubes. METHODS: Sixty-seven patients (70 eyes) who underwent revision surgery using transcanalicular diode laser for failed primary endonasal DCR at Sungmo Eye Hospital between March 2007 and December 2012 were studied retrospectively. The causes of failed DCR and the time of recurrence were evaluated. The revision surgeries were endoscopic removal of granuloma and membrane and synechiolysis with intubation of 1 or 2 silicone tubes. We compared the results of revision surgery with 1 silicone tube and 2 silicone tube intubations. RESULTS: Recurrence occurred after a mean duration of 4.6 months following the first DCR. The causes of surgical failure were granuloma (35 eyes), membranous obstruction (23 eyes), synechia (7 eyes), and functional obstruction (5 eyes). We performed revision surgery with 1 silicone tube intubation in 45 eyes (group A) and 2 silicone tube intubations in 25 eyes (group B). The final success rates in groups A and B were 75.6% (34/45) and 84% (21/25), respectively (chi-square test, p = 0.828). CONCLUSIONS: Transcanalicular diode laser-assisted endonasal revision surgery with 2 silicone tubes is not recommended.
Dacryocystorhinostomy ; Granuloma ; Humans ; Intubation ; Lasers, Semiconductor ; Membranes ; Recurrence ; Retrospective Studies ; Silicones*

Two cases of hysteric amaurosis are reported. The first case is a male, 38 years of age, who had suffered from hysteric amaurosis three times during the last three years. His inability to pay the alimony to his divorced wife is considered as a causative factor. The second case is also a male, 30 years of age. He had once been attacked prior to the admission. The shock and solicitude for his missed parents during the Korean War are possibly the causative factor. Generally visible ocular symptoms in hysterica are not only amblyopia or amaurosis but also night blindness, diplopia, polyopia, metamorphopsia, metachromatopsia and differentiated various changes in visual field are found. In addition, we can easily find out in it, such as derealization, depersonalization, affective loss which are due to the disturbance of cognition, blepharoptosis, blepharospasm, strabismus, ophthalmoplegia, nystagmus, convergence insufficiency, spasm or paresis of accommodation which are resulted from motor function disturbance, headache, sensory paralysis in eye lid, conjunctiva and cornea which are followed by disturbance of perception and excessive lacrimation due to excrete disturbance. It may be needed to differentiate from simulation, malingering, retrobulbar optic neuritis. Treatment is referable to authorized suggestion with active understanding and sympathy.
Amblyopia ; Blepharoptosis ; Blepharospasm ; Blindness* ; Cognition ; Conjunctiva ; Cornea ; Depersonalization ; Diplopia ; Divorce ; Headache ; Humans ; Korean War ; Male ; Malingering ; Night Blindness ; Nystagmus, Pathologic ; Ophthalmoplegia ; Optic Neuritis ; Paralysis ; Parents ; Paresis ; Shock ; Spasm ; Spouses ; Strabismus ; Vision Disorders ; Visual Fields

PURPOSE: In this study we evaluated the long-term outcomes and prognostic factors of trabeculectomy with mitomycin C (MMC) in eyes with uveitic glaucoma (UG) compared with primary open-angle glaucoma (POAG). METHODS: We performed a retrospective chart review of 60 eyes with UG and 402 eyes with POAG that were followed up for at least 1 year after trabeculectomy with MMC between June 2000 and December 2012. The review included intraocular pressure (IOP), number of anti-glaucoma medications, and postoperative complications. Surgical success was analyzed using the Kaplan-Meier life-table method based on 2 definitions of successful IOP control with topical anti-glaucoma medications: Definition A (IOP < or = 15 mm Hg) and Definition B (IOP < or = 18 mm Hg). Risk factors for surgical failure of trabeculectomy were analyzed using the Cox proportional hazards model. RESULTS: Success rate at 5 years after trabeculectomy was lower in UG than in POAG (65.8% vs. 76.4%, Definition B), but without significant difference. However, UG had a significantly lower cumulative probability of success than POAG based on Kaplan-Meier survival curves (p = 0.049 and 0.044, respectively). Postoperative hypotony and hypotony maculopathy was more frequent in UG (p = 0.044 and 0.044, respectively). In UG, the Cox proportional hazards model showed postoperative shallow anterior chamber was associated with surgical failure in both Definition A and B. CONCLUSIONS: Long-term results of trabeculectomy with MMC in eyes with UG showed successful IOP control similar to POAG. Trabeculectomy with MMC is a reasonable surgical option for the management of UG.
Anterior Chamber ; Glaucoma* ; Glaucoma, Open-Angle* ; Intraocular Pressure ; Kaplan-Meier Estimate ; Mitomycin* ; Postoperative Complications ; Proportional Hazards Models ; Retrospective Studies ; Risk Factors ; Trabeculectomy*

PURPOSE: To assess the distinction ability for differentiating glaucoma patients based on optic disc, retinal nerve fiber layer (RNFL) and ganglion cell-inner plexiform layer (GCIPL) measured using spectral domain optical coherence tomography (SD-OCT). Additionally, the diagnostic ability of these parameters was evaluated by comparing preperimetic glaucoma patients who frequently visited the clinic and normal patients with and without a large physiologic cup/disc (C/D) ratio. METHODS: Using SD-OCT, the optic disc, RNFL and GCIPL of preperimetic glaucoma patients were compared with normal people with and without a large C/D ratio from March, 2011 to December, 2014 at Department of Ophthalmology, Inha University Hospital. Preperimetic glaucoma was defined using the normal standard automated perimetry for glaucomatous optic nerve changes such as asymmetry of vertical C/D ratio, rim thinning, notching, excavation and RNFL defect. RESULTS: When comparing preperimetic glaucoma patients to normal people without large disc cupping, the most reliable parameter for optic disc parameters, vertical C/D ratio (0.89), showed more reliable diagnostic ability than the most reliable parameter for retinal nerve fiber, inferior RNFL thickness (0.79) and superonasal and inferonasal GCIPL thickness were the most reliable GCIPL parameters (p = 0.005 and 0.002, respectively). When comparing preperimetic glaucoma patients to normal people having a large physiologic disc cupping, average C/D ratio among optic nerve parameters, inferior RNFL thickness among RNFL thickness parameters and inferior GCIPL thickness among GCIPL parameters showed highly reliable diagnostic abilities. These 3 parameters were not statistically different (all p > 0.05) and had lower distinction ability than reported in previous studies. CONCLUSIONS: Diagnostic abilities of SD-OCT for distinguishing preperimetric glaucoma from normal people having large physiologic disc cupping were similar for optic disc, RNFL and GCIPL and showed low diagnostic ability than compared to normal people without large disc cupping.
Ganglion Cysts ; Glaucoma* ; Humans ; Nerve Fibers ; Ophthalmology ; Optic Nerve ; Retinaldehyde ; Tomography, Optical Coherence ; Visual Field Tests

PURPOSE: In this study we compared the intraocular pressures (IOPs) measured using dynamic contour tonometry (DCT) and Goldmann applanation tonometry (GAT) and investigated the correlation between central corneal thickness (CCT) and IOP. METHODS: In a prospective study, 178 eyes of 91 subjects with glaucoma and glaucoma suspect were enrolled. IOP was measured using DCT and GAT and CCT was measured using ultrasound pachymetry. Each eye was classified into 1 of 3 groups according to their CCT: low CCT (Group A; CCT < 525 microm), normal CCT (Group B; 525 < or = CCT < 561 microm), and high CCT (Group C; CCT > or = 561 microm). In each group, we investigated the correlation between CCT and IOP measurement using GAT and DCT. RESULTS: A significant correlation was found between CCT and IOP measured using GAT (p < 0.001), but not between CCT and IOP measured using DCT (p = 0.108) in all patients. Subgroup analysis showed that CCT affected IOP measured with GAT only in Group A (p = 0.027) and IOP measured with DCT was not affected by CCT in all 3 groups. CONCLUSIONS: IOP measured using GAT and DCT were significantly affected by CCT, especially when the CCT was low. CCT may have no effect on DCT thus, IOP measured using DCT is more reliable than GAT in patients with thin corneas.
Cornea ; Glaucoma ; Humans ; Intraocular Pressure ; Manometry* ; Prospective Studies ; Ultrasonography

PURPOSE: To investigate the ability to determine the postoperative status of macular hole (MH) in gas-filled eyes using swept source optical coherence tomography (SS-OCT). METHODS: Ten eyes of 10 patients who underwent vitrectomy, internal limiting membrane peeling and gas tamponade for idiopathic MH were included in this study. The macular area was examined using SS-OCT on postoperative days 1, 2 and 30. RESULTS: MH status was assessed in 6 eyes (60%) on postoperative day 1 and MH closure was confirmed in 5 of the 6 eyes (83%). MH remained closed in all 5 eyes at 1 month after surgery. Only gas-retinal interface was obtained in 4 eyes (40%) and unclosed MH was found in 1 of the 4 eyes (25%) at 1 month after surgery. CONCLUSIONS: The MH status can be determined using SS-OCT in the early postoperative period even in gas-filled eyes. Confirming early MH closure with SS-OCT can serve as an important guide to significantly shorten the duration of prone positioning while maintaining high closure rates.
Humans ; Membranes ; Postoperative Period ; Retinal Perforations* ; Tomography, Optical Coherence* ; Vitrectomy

PURPOSE: To assess the association between decreased visual acuity (VA) and diagnosis of depressive disorder by a physician or experience of depressive mood using self-report questionnaires. METHODS: We conducted a cross-sectional analysis using nationally representative data from the Korean National Health and Nutrition Examination Survey (KNHANES, 2008-2012). A total of 28,919 adults who had sociodemographic and health behavioral risk factors available were included. An association between decreased VA and depression was identified using multivariate logistic regression analysis after adjusting for possible confounders. Depression was defined as a depressive disorder with a diagnosis by a physician or depressive mood lasting more than 2 weeks using self-report questionnaires. RESULTS: The prevalence of depressive disorder and depressive mood in Koreans was 1,160 (4.0%) and 4,063 (14.1%), respectively. In univariable logistic regression, there was significant association between VA and depressive disorder or depressive mood. However, in multivariable logistic regression analysis, this study found no statistically significant association between VA status and the prevalence of depressive disorder or depressive mood in Koreans. CONCLUSIONS: No association between decreased VA and a depressive disorder/depressive mood in Korean adults after adjusting for possible confounders was found. Therefore, further longitudinal cohort studies examining the causal relationship between decreased VA and depression in Korean adults are necessary.
Adult ; Cohort Studies ; Cross-Sectional Studies ; Depression ; Depressive Disorder* ; Diagnosis ; Health Behavior ; Humans ; Logistic Models ; Nutrition Surveys ; Prevalence ; Risk Factors ; Vision, Low ; Visual Acuity*