This prospective observational case series study included 6 eyes of 6 consecutive glaucomatous patients. Each patient underwent trabeculectomy with mitomycin C, and received a 1.25 mg of subconjunctival bevacizumab injection at completion of the trabeculectomy. Study eyes included two with neovascular glaucoma, three with uveitic glaucoma, and one with secondary glaucoma following vitrectomy. All eyes had undergone failed glaucoma laser/surgical treatment or an intraocular surgical procedure. Intraocular pressure (IOP) at the following postoperative visits: preoperative, 1 week, 1 month, 2 months, 3 months, and 6 months, was measured. We also evaluated postoperative bleb findings and complications. IOP measured at each visit was 37.5+/-14.4 mmHg, 6.2+/-3.4 mmHg, 8.3+/-7.2 mmHg, 12.0+/-4.4 mmHg, 10.8+/-3.1 mmHg, and 12.2+/-3.3 mmHg, respectively, for each visit. All eyes had functioning blebs with normal IOP at postoperative 6 months with no additional IOP-lowering medication.
Adult ; Aged ; Angiogenesis Inhibitors/*administration & dosage ; Antibodies, Monoclonal/*administration & dosage ; Conjunctiva ; Female ; Glaucoma/*drug therapy/etiology/*surgery ; Glaucoma, Neovascular/drug therapy/surgery ; Humans ; Injections, Intraocular ; Male ; Middle Aged ; Prospective Studies ; Trabeculectomy/*methods ; Uveitis/complications ; Vascular Endothelial Growth Factor A/*antagonists & inhibitors ; Vitrectomy/adverse effects

Acute necrotizing encephalopathy is a recently established disease entity, proposed by Mizuguchi et al in 1995, that shows a characteristic symmetric and multifocal involvement of both thalamus, brainstem tegmentum, cerebral periventricular white matter, and cerebellar medulla. It is known to be prevalent in Japan and other Far Ease countries. The etiology of the acute necrotizing encephalopathy remains unknown. The typical course of acute necrotizing encephalopathy is the development of the irreversible neurologic symptoms related to brain lesions. The diagnosis can be made on the basis of the combination of a typical clinical profile and characteristic radiologic findings. We experienced a first case of acute necrotizing encephalopathy in a 9 month old boy in Korea. We report this case with the brief review of related literatures.
Brain ; Brain Stem ; Diagnosis ; Humans ; Infant ; Japan ; Korea ; Male ; Neurologic Manifestations ; Thalamus

PURPOSE: To compare conventional laser peripheral iridotomy (LPI) and LPI combined with laser peripheral iridoplasty in eyes with primary angle closure suspect (PACS) by assessment of anterior chamber dimensional changes using a Pentacam. METHODS: Forty-eight eyes of 24 subjects with bilateral PACS were recruited consecutively. Each eye was randomly allocated to treatment with conventional LPI, argon LPI only, or LPI plus iridoplasty, which consisted of simultaneous argon LPI and peripheral iridoplasty. Anterior chamber measurements were performed on each eye using a Pentacam, both before and after treatment. Mean anterior chamber depth (ACD), anterior chamber volume (ACV), and anterior chamber angle were measured, and topographic ACD analysis was performed. Results were compared between the two treatment groups. RESULTS: After treatment with either conventional LPI or LPI plus iridoplasty, the mean ACD and ACV increased significantly. Topographic ACD analysis revealed that the mid-to-peripheral ACD increase was significantly greater in the LPI plus iridoplasty group than in eyes treated with conventional LPI. Intraocular pressure changes and post-LPI complications did not differ between the groups. CONCLUSIONS: Compared with conventional LPI, our study showed that LPI plus iridoplasty improved the mid-to-peripheral ACD increase. This procedure may have a role as an adjunct for reducing angle closure by simultaneously eliminating pupillary and non-pupillary block components.
Adult ; Aged ; Anterior Chamber/*pathology/surgery ; Diagnostic Techniques, Ophthalmological/*instrumentation ; Equipment Design ; Female ; Follow-Up Studies ; Glaucoma, Angle-Closure/pathology/physiopathology/*surgery ; Gonioscopy ; Humans ; Intraocular Pressure ; Iridectomy/*methods ; Iris/pathology/*surgery ; Laser Therapy/*methods ; Lasers, Solid-State ; Male ; Middle Aged ; Prospective Studies ; Tonometry, Ocular

PURPOSE: To report a case of ab interno trabeculotomy with Trabectome(R) (NeoMedix Corp., CA, USA) conducted on a refractory primary open angle glaucoma (POAG) patient. CASE SUMMARY: Trabectome(R) has microelectrocautery with simultaneous infusion and aspiration of debris and ablates a segment of trabecular meshwork and the inner wall of Schlemm's canal. The patient, a 54-year-old man had uncontrolled intraocular pressure (IOP) with topical anti-glaucoma medications after trabeculectomy and Ahmed valve implantation for POAG. For the patient, ab interno trabeculotomy with Trabectome(R) was performed. There were no other postoperative complications except for microhyphema immediately after surgery. The IOP was controlled between 14 to 24 mm Hg up to 3 months postoperatively with topical anti-glaucoma medications (Cosopt(R), Alphagan-P(R), Lumigan(R)). CONCLUSIONS: Ab interno trabeculotomy with Trabectome(R) appears to offer a newer method of lowering IOP in POAG than conventional trabeculectomy and glaucoma drainage device surgery.
Drainage ; Glaucoma ; Glaucoma, Open-Angle ; Humans ; Intraocular Pressure ; Middle Aged ; Postoperative Complications ; Trabecular Meshwork ; Trabeculectomy

PURPOSE: To report two cases of trabeculectomy with biodegradable collagen material conducted on two post-vitrectomy patients. CASE SUMMARY: The first patient was a 43-year-old woman with uncontrolled increased intraocular pressure (IOP) after pars plana vitrectomy with scleral buckling for diabetic retinopathy and vitreous hemorrhage. Another patient, a 28-year-old woman with aphakia, also had uncontrolled increased IOP after pars plana vitrectomy with encircling scleral buckling for retinal detachment. For both of these patients, we performed trabeculectomy using mitomycin C and recently developed biodegradable collagen matrix. In the first case, the IOP was increased three months after the surgery, for which needling was done. After needling, the IOP was well controlled in the range of 16 to 19 mmHg up to eight months postoperatively with stilling anti-glaucomatous eyedrops (Cosopt(R), Xalatan(R)). In the second case, IOPwas increased one week after the surgery, but it was well controlled between 14 to 21 mmHg up to nine months postoperatively with anti-glaucomatous eye drops (Combigan(R)). CONCLUSIONS: Biodegradable collagen matrix can possibly reduce the surgical failure of trabeculectomy and it is especially suitable for high risk patients when combined with anti-metabolic agents like MMC.
Adult ; Aphakia ; Collagen ; Diabetic Retinopathy ; Female ; Humans ; Intraocular Pressure ; Mitomycin ; Ophthalmic Solutions ; Retinal Detachment ; Scleral Buckling ; Trabeculectomy ; Vitrectomy ; Vitreous Hemorrhage ; Wound Healing

PURPOSE: To report a case of optic neuropathy from vitamin B12 deficiency associated with chronic alcoholism and malnutrition. CASE SUMMARY: A 51-year-old man with a complaint of declining visual acuity in both eyes without pain was found to have a temporal optic disc pallor in the left eye. The patient had a history of chronic alcoholism and malnutrition for the previous 7 months. Visual field examination showed central scotoma in both eyes. The vitamin B12 level was undetectable by a blood biochemistry test. Blood dyscrasia such as anemia or thrombocytopenia was not found. The vitamin B12 level became normal after intramuscular cobalamin injections, and visual acuity and visual field tests recovered after 3 months. CONCLUSIONS: Optic neuropathy from vitamin B12 deficiency can be solely present without other systemic manifestations in a patient with chronic alcoholism and malnutrition. Prompt diagnosis by thorough history taking and vitamin B12 supplementation can reverse the disease.
Alcoholism ; Anemia ; Biochemistry ; Eye ; Humans ; Malnutrition ; Middle Aged ; Optic Nerve Diseases ; Pallor ; Scotoma ; Thrombocytopenia ; Visual Acuity ; Visual Field Tests ; Visual Fields ; Vitamin B 12 ; Vitamin B 12 Deficiency ; Vitamins

Segmental neurofibromatosis is a rare skin disorder characterized by neurofibromas and/or cafe-au-lait spots, limited to one dermatome of the body1. This disorder was first described by Gammel2 in 1931. The neurofibromas of segmental neurofibromatosis are commonly occupied by either a thoracic or a cervical dermatome and are unilateral, occuring more often on the right side than the left in young adults. According to Korean Dermatologic literature, 11 cases of segmental neurofibromatosis were reported. Among them, 7 cases showed unilateral involvement and 4 cases showed bilateral dermatomal involvement. We report a case of segmental neurofibromatosis which developed in a 76-year-old female. The skin lesions were situated on the left parietal scalp of the C2 dermatome, and had not been previously reported. We recommended surgical excision, but the patient refused further treatment.
Aged* ; Cafe-au-Lait Spots ; Female ; Humans ; Neurofibroma ; Neurofibromatoses* ; Neurofibromatosis 1 ; Rabeprazole* ; Scalp* ; Skin ; Young Adult

BACKGROUND: It used to induce hypercarbia that carbon dioxide insufflated into the peritoneum in laparoscopic surgery. It might stimulate sympathetic nervous system, and decrease splanchnic circulation, hepatic function, and metabolism of anesthetics. The purpose of the present study was to examine the influence of hypercarbia on concentrations of propofol at the time of eye opening and recovery of orientation after propofol target controlled infusion (TCI) during a laparoscopic cholecystectomy. METHODS: Fifty patients were divided randomly into a laparoscopic group (group 1, n = 25) and an exploratory group (group 2, n = 25). A propofol infusion was started at a propofol target concentration of 6microgram/ml, and anesthesia was maintained at 4microgram/ml by using a Diprifusor (TM) turing the operation, intraabdominal pressure was maintained automatically at 12 14 mmHg by a CO2 insufflator and controlled ventilation settings were adjusted about 50 mmHg of PaCO2 after peritoneal insufflation. This ventilatory setting was not changed throughout the operation. We evaluated the estimated plasma concentrations of propofol at the time of eye opening and recovery of orientation in each group using user interface of a Diprifusor (TM). RESULTS: In the laparoscopic group, PaCO2, and PetCO2 increased significantly at 5, 15, 30 minutes after carbon dioxide insufflation, but there was no significant difference in concentrations of propofol at eye opening and orientation after propofol TCI between the two groups. CONCLUSIONS: Hypercarbia induced by insufflation of carbon dioxide into peritoneum didn't give rise to an influence on awakening concentrations after propofol TCI during a laparoscopic cholecystectomy.
Anesthesia ; Anesthetics* ; Carbon Dioxide ; Cholecystectomy, Laparoscopic* ; Humans ; Insufflation ; Laparoscopy ; Metabolism ; Peritoneum ; Plasma ; Propofol* ; Splanchnic Circulation ; Sympathetic Nervous System ; Ventilation

PURPOSE: In Rett syndrome patients, the incidence of sudden death is greater than that of the general population, and cardiac electrical instability including fatal cardiac arrhythmia is a main suspected cause. In this study, we are going to find out the possible cause of the higher risk of sudden death in Rett patients by the evaluation of heart rate variability, a marker of cardiac autonomic activity and corrected QT intervals. METHODS: Diagnosis of Rett syndrome was made by molecular genetic study of Rett syndrome (MECP2 gene) or clinical diagnostic criteria of Rett syndrome. Heart rate variability and corrected QT intervals were measured by 24 h-Holter study in 12 Rett patients, and in 30 age-matched healthy children with chief complaints of chest pain or suspected heart murmurs. The were compared with the normal age-matched control. RESULTS: Patients with total Rett syndrome, classic Rett syndrome, and Rett variants had significantly lower heart rate variability(especially rMSSD)(P<0.05) and longer corrected QT intervals than age-matched healthy children(P<0.05). Sympathovagal balance expressed by the ratio of high to low frequency(LF/HF ratio) also showed statistically significant differences between the three groups considered(P<0.05). CONCLUSION: A significant reduction of heart rate variability, a marker of autonomic disarray, suggests a possible explanation of cardiac dysfunction in sudden death associated with Rett syndrome.
Arrhythmias, Cardiac ; Chest Pain ; Child ; Death, Sudden ; Diagnosis ; Heart Murmurs ; Heart Rate* ; Heart* ; Humans ; Incidence ; Molecular Biology ; Rett Syndrome*

Hibernoma is a rare slowly growing painless subcutaneous neoplasm, and predominates in the scapular and interscapular region, mediastinum, and upper thorax. Microscopically, hibernomas display a distinct lobular pattern and are composed of cells with varying degrees of differentiation, ranging from uniform, round to ovoid, granular eosinophilic cells to multivacuolated cells with multiple, small lipid droplets and centrally placed nuclei. We report a case of hibernoma occurred on the right scapular region in a 33-year-old man.
Adult ; Eosinophils ; Humans ; Lipoma* ; Mediastinum ; Thorax