PURPOSE: To evaluate the ocular manifestations of patients with rheumatic disease and dry eye symptom. METHODS: We analized the results of ocular examinations and complications of 78 rheumatoid disease patients who were refered for dry eye symptom from the general medicine from 1998, May to 1999, May. RESULTS: Ocular complications were seen in 47 patients (60.3%). Keratoconjunctivitis sicca was the most common ocular finding (48.7%). Other lesions were episcleritis, scleritis, peripheral corneal erosion, marginal keratitis, stromal corneal opacity, and so on. Thirty six patients (46.2%) showed sero-positivity for RA, ANA or CRP. The result was 6.87+/-4.44 mm (mean+/-standard deviation) in Schirmer test,6.64+/-2.27 sec in Tear Film Break Up Time (TBUT). Among sero-positive patients, Schirmer test was 5.46+/-4.05 mm and TBUT was 5.64+/-2.38 sec, while among sero-negatives the result was 8.21+/-4.33 mm, 7.40+/-1.89 sec respectively. It was statistically significant (P< 0.05). Schirmer test was 4.60+/-3.55 mm in RA positive, 2.50+/-1.60 mm in RA and ANA positive, 7.35+/-4.92 mm in CRP positive. TBUT was 5.57+/-2.39 sec, 4.00+/-1.31 sec, 5.69+/-2.04 sec in each group. CONCLUSIONS: Ocular complications were increased in rheumatoid patients, especially with sero-positive for RA, ANA or CRP. The results of Schirmer test and TBUT were most decreased in patients with RA and ANA positivity.
Corneal Opacity ; Humans ; Keratitis ; Keratoconjunctivitis Sicca ; Rheumatic Diseases* ; Rheumatoid Factor ; Scleritis ; Tears

We have investigated the therapeutic effectiveness of T-lens(Soflens(R)) in 105 patients(110 eyes) with various corneal diseases. The results are as follows: 1. Cornea diseases, which revealed the good therapeutic effectiveness, are ccrneal perforation, postoperative uses, corneal ulcer, corneal erosion, and corneal edema. 2. Corneal disease, which revealed the rapid therapeutic effectiveness, is corneal edema. 3. Corneal diseases, which revealed no response, are neuroparalytic keratitis and radiation keratitis.
Cornea ; Corneal Diseases* ; Corneal Edema ; Corneal Ulcer ; Keratitis ; Therapeutic Uses*

Needless to say, the essence of keratoplasty is the maintenance of the vitality and clarity of the graft. About 60 years ago, Dr. Elschnig performed the first successful and well-documented partial iso- and allografts of human cornea with von Hippel's original trephine. In Korea, the first successful corneal graft was performed 40 years ago by Drs. Hayano and Sadake, Japanese ophthalmologists in Seoul. They used an 8mm trephine and fixed the graft by the overlapping method in which a square thin rubber piece was fixed to the subconjunctival tissues by direct suture at its four corners. After the World War II, the keratoplasty was not very popular in Korea untill about 1960, for various reasons, including the Korean war, lack of available donor corneas and above all well-trained corneal surgeons. Only scattered cases of keratoplasty were reported by a few Korean ophthalmologists with some successful results. The recent advances in keratoplasty in Korea has been greatly stimulated by the lectures and practice courses on keratoplasty which were conducted by Drs. David Paton and Miguel Martinez, expert corneal surgeons of Johns Hopkins Hospital, U.S.A., and by the donation to the EyeBank of St. Mary's Hospital of a set of instrument and basic equipment from Dr. J. H. King, Jr. in Washington, D.C. in 1967. Although a few eye banks were launched in Korea in the sixties, their activities have been. greatly restricted on account of the peculiar custom of the Korean people's reluctance to donate their eyes after death. In Korea, 231 cases of keratoplasty have been performed until 1975, which means that only about twenty patients per year undergo corneal grafts althogh many more registered patients are waiting for operation. CORNEAL BLINDNESS AND ITS STATISTICS ON HOSPITAL EYE PATIENTS. The population of South Korea is about thirty-five millions, among whom the number of the blind is estimated to amount to 100,000 equivalent to 0.3% of the total population. According to a survey of blindness (the definition of blindness applies to corrected visual acuity under 20/200) on 94,799 hospital patients selected at ramdom in seventeen hospitals in Korea (Koo and Chai, 1974). the estimated number of blind patients was 1,763 (1.9%) in binocular and 4,585 (4.8%) in monocular blindness, the proportional percentages of the causes being in the descending order of senile cataract (36.10% in binocular and 25.5% in monocular), retinal diseases (13.18%,10.70%), corneal diseases (8.16%, 17.88%), and others such as glaucoma (7.78%, 6.13%), myopia (8.16%, 6.17%) and optic nerve diseases (9.33%, 4.03%) etc. (Table 7) The main causes of corneal blindness were infectious diseases such as herpes simplex keratitis and bacterial ulcers (0.65% in binocular, 6.06% in monocular), of corneal opacities from injuries and burns (2.07%, 5.83%) and general diseases (1.56%, 2.72%). The most prevalent area was Kangwon-do Province, where binocular corneal blindness was 16.05% and monocular blindness 28.73% of the whole blind patients. Comparing this data with that of other advanced countries, the corneal blindness in Korea occupies the same position as in the case of Sweden, representing the third largest causes of blindness among all the causes of blindness. However, the combined percentage of monocular and binocular blind patients was 6.7% (6,348 patient among the total of 94,799) in the survey of 1971-72. Although the present demand for keratoplasty increases day by day, the supply of donor corneas is still in great shortage. THE EYE BANK AND SUPPLY OF CORNEAS. In answer to the large demand of donor corneas, an eye bank was first opened at the Department of Ophthalmology, Seoul National University Hospital in 1962. But the supply of corneas by the eye bank was scanty due to the lack of donors and traditional Korean customs. A few years later, two more eye banks were launched. Thereafter, the Central Eye Bank attached to the Department of Ophthalmology, St. Mary,s Hospital, Catholic Medical College, Seoul, was inaugurated on April 19, 1967 with the help and contribution from Dr. J.H.King, Jr. Director of Interilational Eye Foundation, Washington, D.C. At the request of Dr. B.S.Koo, former professor of ophthalmology, Catholic Medical College, Dr. King sent in November, 1965, two corneal surgeons, Drs. David Paton and Miguel Martinez of Baltimore, to Korea for the instruction of keratoplasty and opening of the Central Eye Bank of St. Mary's Hospital which was designed to supply corneas to all hospitals of korea. This served as a big stimulus for Korean ophthalmologists. Table 2 shows data regarding donor eyes supplied by the Central Eye Bank from 1967 to 1975. The Central Eye Bank has enucleated 182 eyes from donors and supplied 90 corneas for keratoplasty at St. Mary's Hospital. It also supplied corneas to many eye surgeons of other hospitals or corneal graft operations. Pamphlets for enlightenment and publicity were distributed among hospitals, clinics, and varlous other organizations, and in response to the publicity activities, so far 300 noted persons desiring to give their eyes have been registered with this eye bank. Although a considerable number of willed persons registered as would-be donors, practically almost all the donor eyes in the past were obtained from such cadavers as hae no relatives and families and died of chronic or senile diseases in hospitals. Because of such limited supply of donor corneas, and of the socioeconomic problems of poor patients in my country where no medical insurance system has been established yet, the activities of the eye banks in Korea are very inactive although the Enucleation Act for research was put into practice in 1973 by the Ministry of Health and Wellfare of Korea. RETROSPECTIVE CUNICAL REVIEW. In Korea, 231 cases of keratoplasty have been performed by different surgeons and different techniques from 1935 to the present time. Among them, the most common grafting method was penetrating keratoplasty which was performed on 208 patients. The rates of clear grafts greatly differ depending upon surgeons and the time of operations, ranging from 60% to over 90%. Fig. 1 shows the total numbers of cases of penetrating and lamellar keratoplasty which were performed during the past 40 years in Korea. 90% (208 eyes) of them were performed by penetrating keratoplasty. As memiomed above in the introduction, the first penetrating keratoplasty using a square thin rubber for overlapping fixation was performed separately in Korea by Drs. Hayano and Sadake in Seoul between 1935-40. But the postoperative results for these patients are not known. During about 10 years following the Second World War, Dr. S.M.Hong, former professor of ophthalmology, Chun Nam University and his assistants performed 5-7mm small penetrating grafts with good results in two cases out of four. They used a conservative fixation method such as thick sutures for fixatian of an overlapped rubber piece to the bulbar subconjunctival tissues. Practically, keratoplasty has become popular since 1963. During this revival stage of keratoplasty, Dr. Ko, C.J., former chief of ophthalmology, Seoul Red Cross Hospital, made operations by himself for sixty eyes of all penetrating grafts with a success rate of about 70%. Inconsideration of the various disadventages mentioned above, it can be said to be exceptional that a surgoon should have performed sixty grafts singlehandedly. Four fresh donor corneas were sent to Yun Sei University Hospital via air mail from an International Eye Bank of Sliranka. Only two cases out of four eyes maintained a clear graft after penetrating keratoplasty. Direct suture technique with 6-0 silk around the margin of a corneal button was popularized since 1957. But ten years later, 8-0 virgin silk (or chromic gut) for direct or continuous sutures was then introduced in keratoplasty. Since this time an operating microscope with fine micro-surgical instruments and sutures has been used as an essential surgical instrument in our operating rooms. Continuous suturing technique with 10-0 monofilament nylon under the operating microscope is now a common practice and has increases the success rate greatly since 1971. With the opening of the Central Eye Bank of St. Mary's Hospital in 1967, our activities in keratoplasty have been greatly accelerated and we have been given more opportunities to collect patients indicated for keratoplasty. Anyhow, during the period of 1967-1975, we performed keratoplasty in 90 recipient eyes which correspond to two thirds of the total 135 grafts in this period. Table 1 shows incidence of causative diseases of corneal opacity and corneal conditions at the time of keratoplasty seen in 90 eyes (87 patients; one patient received two grafts on both eyes, and two patients received regrafts because of an opaque graft). The successful results of our early cases showed 71% (19 of 27 grafted eyes); however, due to the improvement of surgical techniques, careful selection of donor-recipients, and the use of fine microsurgical instruments, sutures and needles under the operating microscope since 1970, the results are getting better; 55 eyes, which amounted to 87.3% of 63 eyes grafted successfully, maintained their clarity. Fourteen eyes of clear grafts that did not improve vision had reasons such as amblyopic eye (cosmetic graft, 7 eyes), therapeutic pterygium(2), progressive cataract (1) and cloudy host tissues under lamellar graft(4). Most cases of opaque grafts resulted from irreversible graft rejection which was seen in eleven eyes. Another four eyes showing graft rejection were controlled by topical (0.5% hydrocortisone drop per hour) and systemic use (60mg. of prednisone per day in adult) of corticosteroids and three eyes by systemic use of Azathioprine (100-200mg per day in adult). Another complications were as follows; bullous keratopathy(5 eyes), wound gapping with or without iris incarceration (5), anterior or posterior synechia(5), neovascularization(3), complicated cataract(1), complicated glaucoma (1) and retrocorneal membrane (1). Almost all donor corneas which were used for keratoplasty in Korea were supplied as the condition of a fresh or a 40 degrees C wet chamber stored fresh cornea. Only a few glycerine preserved corneas were used for lamellar grafting with good results. Recently, I have experienced one successful case of 7mm partial penetrating keratoplasty by using of full 5 days wet-chamber stored cornea. obtained from 24 year old young donor. This 5 days stored cornea was, anyhow, grafted to a man (29 year old) whose right eye had been blind from leucoma cornea adherens since childhood because of measles. The graft retained crystal clear after operation, postoperative vision being 20/100 without a contact lens. SUMMERY. In Korea, the first successful keratoplasty was performed 40 years ago by two Japanese ophthalmologists in Seoul. The combined percentage of monocular and binocular blind patients was 6.7% in a survey of hospital patients of year 1971-72. Among them, the combined percentage of monocular and binocular corneal blind patients was 26.58%. The recent progress of keratoplasty in Korea has been greatly stimulated by the intensive lectures, experiments and technical practice on keratoplasty which were conducted by the intensive lectures, experiments and technical practice on keratoplasty which were conducted by Drs. D. Paton and M. Martinez of Johns Hospkins Hospital in 1967. At the same time, through these two doctors, Dr. J.H. King, Jr. of Internationsl Eye Foundation, Washington, D.C. donated many medical instruments and a great deal of materials, including eye preservation containers, preserved corneas, atc. The Central Eye Bank of Catholic Medical College has enucleated 182 eyes from donors and supplied 124 fresh corneas for keratoplasty during the last 7 years. 231 cases of keratoplasty have been performed by different surgeons and different techniques from 1935 to 1975. The most common grafting method has been penetrating keratoplasty(90%). Continuous suturing technique with 10-0 monofilsment nylon under the operating microscope is now a common procedure and has increased the success rate greatly. In our hospital, we performed keratoplasty in 90 recipient eyes during the improvement of surgical techniques, careful selection of donor-recipients, and the use of fine microsurgical instruments, sutures and needles under the operating microscope since 1971, the results are getting better; 55 eyes, which amounted to 87.3% of 63 eyes grafted successfully, maintained their clarity.
Adrenal Cortex Hormones ; Allografts ; Asian Continental Ancestry Group ; Azathioprine ; Blindness ; Burns ; Cadaver ; Cataract ; Communicable Diseases ; Cornea ; Corneal Diseases ; Corneal Opacity ; Corneal Transplantation* ; Eye Banks ; Gangwon-do ; Glaucoma ; Glycerol ; Graft Rejection ; Humans ; Hydrocortisone ; Incidence ; Insurance ; Iris ; Keratitis, Herpetic ; Keratoplasty, Penetrating ; Korea ; Korean War ; Lectures ; Measles ; Membranes ; Myopia ; Needles ; Nylons ; Operating Rooms ; Ophthalmology ; Optic Nerve Diseases ; Pamphlets ; Postal Service ; Prednisone ; Red Cross ; Retinal Diseases ; Retrospective Studies ; Rubber ; Seoul ; Silk ; Surgical Instruments ; Suture Techniques ; Sutures ; Sweden ; Telescopes ; Tissue Donors ; Transplants ; Ulcer ; Visual Acuity ; Washington ; World War II ; Wounds and Injuries ; Young Adult

PURPOSE: This study analyzed the efficacy of Scion Image(R)program, the measurement of area of cornea lesion in the process of corneal diseases. METHODS: Photographs were processed digitally from three corneal wound lesions, and the Adobe Photoshop(R) and Scion Image(R) were used to calculate the area. These measured automatically the area of the damaged corneal lesion in numerical values, allowing precise calculation of the ratio of the wounded area to the entire cornea. RESULTS: In the first case of corneal abrasion by contact lenses, we were able to measure the ratio of the lesion, improving from 45% to 9% after two days of treatment. In the second case of the typical corneal ulcer, the infected area was 23.6% of the cornea before treatment, and decreased to 14.5% after treatment. In the third case of the ring shaped corneal ulcer, we were able to measure the lesion accurately using the Scion Image(R) CONCLUSIONS: The Scion Image(R)program may be used for the measurement of corneal surface lesion. It seemed to allow objective and accurate measurement.
Contact Lenses ; Cornea ; Corneal Diseases ; Corneal Ulcer ; Wounds and Injuries

PURPOSE: To report cases of transplanting a donor's 2 corneas to 5 patients suffering from several corneal diseases. CASE SUMMARY: Two corneas were donated from a 66-year-old donor, who suffered from brain damage due to asphyxia, one hour after being pronounced dead by doctors. Two penetrating keratoplasties and 3 partial lamellar keratoplasties were performed for patients with corneal opacity, corneal ulcer and corneal perforation. After the procedure all grafts were stable. CONCLUSIONS: Under the present circumstances of decreasing donations of corneas after death and the increasing demand for keratoplasty in Korea, the mutual cooperation among hospitals to treat more than one patient using one donated cornea is a method the authors believe can alleviate this situation.
Aged ; Asphyxia ; Brain ; Cornea ; Corneal Diseases ; Corneal Opacity ; Corneal Perforation ; Corneal Transplantation ; Corneal Ulcer ; Humans ; Keratoplasty, Penetrating ; Korea ; Stress, Psychological ; Tissue Donors ; Transplants

PURPOSE: To report a case of the keratoconjunctivitis sicca (KCS) associated idiopathic hypereosinophilic syndrome (IHES). METHODS: We present a report and review of a 53-year-old man who suffered from IHES and KCS. The ocular examination showed conjunctival papillary hypertrophy, interpalpebral corneal and conjunctival punctate staining with fluorescein dye, and peripheral corneal neovascularization. His Schirmer I test results were nearly zero mm of wetting in both eyes. Impression cytology showed squamous metaplasia. RESULTS: He had treated with low dose systemic steroid since October 2003. Because he showed a side effect of steroid induced myopathy, we could not increase the dosage. We added topical steroid (Pred Forte(R)), conservative free artificial tear and topical antibiotics, after which his ocular condition improved. Neovascularization was regressed, punctate staining decreased, and his visual acuity increased to 20/25 2 months later. CONCLUSIONS: This case demonstrates that the KCS can be associated with IHES and be treated with systemic and topical steroid.
Anti-Bacterial Agents ; Corneal Neovascularization ; Fluorescein ; Humans ; Hypereosinophilic Syndrome* ; Hypertrophy ; Keratoconjunctivitis Sicca* ; Keratoconjunctivitis* ; Metaplasia ; Middle Aged ; Muscular Diseases ; Tears ; Visual Acuity

We conducted a retrospective study of 30 penetrating keratoplasties (30 patients) for corneal opacity due to herpes simplex keratitis from Jan. 1980 to Dec. 1989 at St. Mary's Hospital. The follow-up periods ranged from 1.3 years to 11 years (mean; 4.8 years). Overall, 23 out of the 30 transplants (76.7%) remained clear grafted cornea and 18 eyes (60%) achieved good to excellent visual acuities (0.3 or better). Herpes simplex keratitis was inactive at the time of corneal transplantation in 27 eyes (90%) and the recurrent rate after surgery was 18.5%. Patients with active ulceration or perforation, had particularly poor success rates. The overall rate of recurrent herpetic keratitis after transplantation for herpes was 26.6% Preoperative corneal neovascularization was not a statistically significant prognostic factor with regard to final visual outcome, graft clarity, graft rejection or recurrent herpetic keratitis.
Cornea ; Corneal Neovascularization ; Corneal Opacity ; Corneal Transplantation* ; Follow-Up Studies ; Graft Rejection ; Herpes Simplex* ; Humans ; Keratitis, Herpetic* ; Keratoplasty, Penetrating ; Recurrence* ; Retrospective Studies ; Transplants ; Ulcer ; Visual Acuity

We conducted a retrospective study of 30 penetrating keratoplasties (30 patients) for corneal opacity due to herpes simplex keratitis from Jan. 1980 to Dec. 1989 at St. Mary's Hospital. The follow-up periods ranged from 1.3 years to 11 years (mean; 4.8 years). Overall, 23 out of the 30 transplants (76.7%) remained clear grafted cornea and 18 eyes (60%) achieved good to excellent visual acuities (0.3 or better). Herpes simplex keratitis was inactive at the time of corneal transplantation in 27 eyes (90%) and the recurrent rate after surgery was 18.5%. Patients with active ulceration or perforation, had particularly poor success rates. The overall rate of recurrent herpetic keratitis after transplantation for herpes was 26.6% Preoperative corneal neovascularization was not a statistically significant prognostic factor with regard to final visual outcome, graft clarity, graft rejection or recurrent herpetic keratitis.
Cornea ; Corneal Neovascularization ; Corneal Opacity ; Corneal Transplantation* ; Follow-Up Studies ; Graft Rejection ; Herpes Simplex* ; Humans ; Keratitis, Herpetic* ; Keratoplasty, Penetrating ; Recurrence* ; Retrospective Studies ; Transplants ; Ulcer ; Visual Acuity

Case of traumatic wound dehiscence after penetrating keratoplsty were evaluated. Six eyes of six patients which had sustained traumatic wound dehiscence after penetrating keratoplasty done between 1994 and 1997 were included in the study. Among the six patients, four were men,two were women and age ranged from 13 to 62 years (average, 36 years). Penetrating keratoplasty was performed due to visual loss from keratoconus (n=3), herpes keratitis (n=2), leukoma cornea (n=1). The mean duration between penetrating keratoplasty and traumatic wound dehiscence was 10.83 months. Direct hit in the eyes by fist, elbow, bumping against iron post and door handle were the cause leading to wound dehiscence. Corneal donor-recipient junction is known to be vulnerable to trauma and all the wound dehiscence in the six eyes developed at donor-recipient junction, especially at inferior portion. Vision recovered after primary closure of the wound but was worse than before the traum due to the development of corneal opacity and astigmatism.
Astigmatism ; Cornea ; Corneal Opacity ; Elbow ; Female ; Humans ; Iron ; Keratitis ; Keratoconus ; Keratoplasty, Penetrating* ; Wounds and Injuries*

Herpes simplex virus keratits(HSK) is one of the most common external eye diseases that cause corneal blindness, Therefore early diagnosis and proper treatment of HSK are essential. However it is frequently misdiagnosed because it shows non-specific corneal lesion than other infectious corneal disease. And also diagnosis of HSK mostly rely on clinical examination and patient history. We evaluated suspicious HSK patients by indirect immunofluofluorescent(IF) antibody test and analyzed its efficacy in the early diagnosis of HSK. Among 47 patients(47 eyes), 37 patients were suspicious heretic keratitis and others not. Dendritic keratitis patients existed in 17 out of 37 patients and they were evaluated with virus culture and indirect IF test. The result of indirect IF test was confirmed under the immunofluorescent microscope and for virus culture the specimens were inoculated on Vero cells(monkey kidney cells). The positive results of indirect IF test was 28 out of 37 suspicious HSK patients and 1 out of 10 non-suspicious HSK patients. Dendritic HSK patients showed IF positive in 15 out of 17 patients(82.3%). Sensitivity of indirect IF test in suspicious HSK patients was 75.7%(2837) and 88.2%(15/17) in dendritic HSK patients. Indirect IF test was all positive(14/14) in dendritic HSK patients that showed culture positive. From these results, indirect IF test has a high sensitivity in early diagnosis of HSK and might be ussful as a rapid diagnostic tool in HSK patients.
Blindness ; Corneal Diseases ; Diagnosis ; Early Diagnosis ; Eye Diseases ; Herpes Simplex* ; Humans ; Keratitis ; Keratitis, Dendritic ; Keratitis, Herpetic* ; Kidney ; Simplexvirus