PURPOSE: To assess the efficacy and safety of selective laser trabeculoplasty treatment (SLT) using Q-switched frequency doubled Nd: YAG laser at three year follow-up. METHODS: Fifteen eyes of 12 primary open angle glaucoma patients treated between July and August 1997 with Q switched frequency doubled Nd: YAG laser were evaluated. With clinical examinations including slit-lamp examination, applanation tonometry and funduscopy, we evaluated preoperative and postoperative intraocular pressure (IOP) of treated eyes, IOP response between treated and untreated eyes, and complications at 3 year follow-up retrospectively. RESULTS: IOP before treatment was 25.2 2.3 mmHg. At one year after treatment, IOP was 20.3 4.1 mmHg (19.6% reduction). At 2 and 3 years follow-up, IOP's were 21.1 3.5 mmHg (16.4%) and 19.7 4.9 mmHg (23.2%) respectively. In the comparison between treated eyes and untreated fellow eyes, the mean IOP reduction in the untreated eyes showed 12.1%, the treated eyes showed significant reductions in IOP at all follow-ups (P=0.0003). Complication included anterior uveitis in one eye at intermediate follow-up and transient increased IOP in seven eyes. CONCLUSIONS: SLT showed stable IOP compared with preoperative intraocular pressure during 3 years follow-up period without severe complication.
Follow-Up Studies* ; Glaucoma, Open-Angle ; Humans ; Intraocular Pressure ; Lasers, Solid-State* ; Manometry ; Retrospective Studies ; Trabeculectomy* ; Uveitis, Anterior

PURPOSE: Using a temporary keratoprosthesis(TKP), earlier surgical treatment became amenable in eyes with coexisting vitreoretinal and corneal disease. We analysed our experience with this type of surgery. METHOD: Medical records of patients who had undergone pars plana vitrectomy(PPV) using Eckardt TKP from 1994 to 2000 were reviewed. Analysis was focused on preoperative conditions, surgical outcome and complications. RESULT: Of 34 eyes of consecutive 34 patients, 25(73.5%) showed trauma-related indications and 4 had IOFB. Retinal detachments were present in 24(70.6%) eyes, proliferative vitreoretinopathy in 8(23.5%) and vitreous hemorrhage in 10(29.4%) eyes. Penetrating keratoplasty(PKP) with donor corneas were performed in only 3 patients at the time of surgery and patient's excised corneas were sutured to 31 patients, 9 of whom underwent PKP later. After mean follow up period of 14 months, retinas remained attached in 27(79.4%) eyes and 3 eyes were phthisical. Visual acuity improved in 18(53%) eyes and worsened in 5 eyes. CONCLUSIONS: In cases with coexisting corneal and vitreoretinal pathology, PPV using TKP was effective for preserving vision and globe. Timing of grafting clear cornea might be delayed when donor cornea was not available.
Cornea ; Corneal Diseases ; Follow-Up Studies ; Humans ; Keratoplasty, Penetrating* ; Medical Records ; Pathology ; Retina ; Retinal Detachment ; Tissue Donors ; Transplants ; Visual Acuity ; Vitreoretinal Surgery* ; Vitreoretinopathy, Proliferative ; Vitreous Hemorrhage

PURPOSE: Tamoxifen retinopathy is one of the uncommon side effects together with keratopathy, crystalline retinopathy and cystoid macula edema when tamoxifen is administered with high dose to breast cancer patients. We report here a case of retinopathy patient with five years of tamoxifen application. METHOD: A 46 year old female breast cancer patient complained about decreased visual acuity in both eyes after taking total amount of 37.28 g tamoxifen (20 mg/day) for 5 years. Whorl-like superficial corneal opacity was detected and yellowish white macular crystalline deposits were seen in both eyes. Moreover, decreased b wave amplitude of ERG was detected in electroretinography and RPE atrophy was found in FAG. RESULT: The patient stopped taking tamoxifen immediately after diagnosed with tamoxifen retinopathy. Two months later, it showed decreased corneal opacity and improved visual acuity in the left eye but also showed increased macular crystalline deposits in the left eye.
Atrophy ; Breast Neoplasms ; Corneal Opacity ; Crystallins ; Edema ; Electroretinography ; Female ; Humans ; Middle Aged ; Tamoxifen* ; Visual Acuity

BACKGROUND/AIMS: Increasing the susceptibility of young populations to HAV infection could result in an outbreak in a high-risk group. The author investigated the characteristics of hepatitis A outbreaks among Korean military personnel to obtain the fundamental data for determining the necessity for selective HAV vaccination. METHODS: A case was defined as a person who had an onset of an illness compatible with acute viral hepatitis A between 4 February and 6 April 1998. RESULTS: A widespread outbreak of hepatitis A affected 102 military personnel. The epidemic curve indicated a common-source exposure in the initial stage. At the end of the first month of the initial onset, the occurrence was specific to the location of the military post. Investigation suggested that contamination most likely occurred prior to the local distribution of food. The mean age was 23 years. The overall attack rate was 91 cases per 10000 persons at risk. All cases were jaundiced. The most frequently reported symptoms included icteric sclerae, dark urine, anorexia, malaise and fatigue, nausea, fever, abdominal pain, headache, upper respiratory symptoms, vomiting, itching, diarrhea, light-colored stools, myalgia, arthralgia, and skin rash. The laboratory test showed the serum total bilirubin of 5.5 mg/dL, AST of 344 IU/L, and ALT of 868 IU/L (mean value). CONCLUSION: All patients were clinically apparently diseased with jaundice and were completely recovered. The outbreak was food borne common-source exposure. The changing epidemiology hepatitis A in Korea calls for the economic evaluation of costs and benefits for selective HAV vaccination in high risk adult groups including military personnel.
Abdominal Pain ; Adult ; Anorexia ; Arthralgia ; Bilirubin ; Cost-Benefit Analysis ; Diarrhea ; Disease Outbreaks ; Epidemiologic Studies* ; Epidemiology ; Exanthema ; Fatigue ; Fever ; Headache ; Hepatitis A* ; Hepatitis* ; Humans ; Jaundice ; Korea ; Military Personnel* ; Myalgia ; Nausea ; Pruritus ; Sclera ; Vaccination ; Vomiting

BACKGROUND/AIMS: Chronic HBV infection is associated with a wide spectrum of clinical manifestations, including asymptomatic carrier state, chronic hepatitis, liver cirrhosis, and hepatocellular carcinoma. Genotypically, HBV genomes have been classified into seven groups, designated A to G. Several studies have suggested recently that HBV genotypic differences influence the severity of liver disease and clinical outcomes. The distribution of HBV genotypes in Korea and its clinical relevance are poorly understood. We investigated the prevalence of HBV genotypes in Korea and the association between the distinct genotypes and the severity of liver disease. METHODS: A total of 214 HBV-DNA positive serum samples, were used for the genotyping. All patients were HBV-bDNA positive chronic HBsAg carriers. 199 patients were histologically verified with liver cirrhosis (6), chronic hepatitis (192) and fatty liver (1). The other patients were clinically diagnosed with liver cirrhosis (13) or hepatocellular carcinoma (2). HBV genotype was determined by PCR using type-specific primers. RESULTS: Genotyping was possible in all patients. Out of 214 patients, 213 (99.5%) were HBV genotype C. Only one (0.5%) was genotype A. The patient with genotype A had minimal hepatitis as diagnosed by liver biopsy. CONCLUSIONS: These results indicate that almost all chronic HBV infections are genotype C in Korea. HBV genotypic difference therefore does not influence the clinical outcome of HBV infection in Korea. Because genotype C may be associated with more severe liver disease, the predominance of genotype C in Korea may result in more severe outcomes than in other countries where other genotypes are predominant.
Biopsy ; Carcinoma, Hepatocellular ; Carrier State ; Epidemiology ; Fatty Liver ; Genome ; Genotype* ; Hepatitis A ; Hepatitis B Surface Antigens ; Hepatitis, Chronic ; Humans ; Korea* ; Liver ; Liver Cirrhosis ; Liver Diseases ; Polymerase Chain Reaction ; Prevalence

BACKGROUND/AIM: A significant correlation between HBV DNA and liver damage was found in precore mutant strains but there was no significant association between viral replication and liver damage in HBeAg positive patients. Laboratory tests are often requested to predict hepatitis activity (grade) and fibrosis (stage) in HBeAg positive chronic hepatitis B. We assessed ALT, AST, and HBV-branched DNA to find which is the best for predicting hepatitis activity and fibrosis. METHODS: Routine biochemical liver function tests and HBV DNA in sera were assessed in 119 young patients positive with HBsAg and HBeAg. The mean age of patients was 21+/-2 years. All patients were male. By logistic regression analysis the relationships between laboratory data, hepatitis activity, fibrosis, or risk of chronic active hepatitis were analyzed. RESULTS: There was a significant correlation between aminotransferase (AST, ALT) and hepatitis activity/ fibrosis. A significant inverse relationship between the HBV bDNA and hepatitis activity was demonstrated (Pearson's correlation coefficient: lobular activity,-0.305; porto-periportal activity, -0.410). But HBV bDNA was not correlated with severity of fibrosis. AST and HBV bDNA was the important test for predicting the more severe hepatitis activity (lobular activity and porto-periportal activity: score> or =3, respectively) CONCLUSION: The higher AST, but the lower HBV bDNA, in sera shows the more severe hepatitis activity. AST and HBV bDNA could be helpful for assessing the hepatitis activity in young male patients with HBeAg positive chronic hepatitis B if proper reference values are used.
Adult ; Alanine Transaminase/blood ; Aspartate Aminotransferases/blood ; DNA, Viral/*analysis ; English Abstract ; Enzyme Tests ; Hepatitis B Virus/genetics/*isolation & purification ; Hepatitis B e Antigens/*blood ; Hepatitis B, Chronic/diagnosis/*pathology/virology ; Human ; Liver/pathology ; Male

Patients with systemic lupus erythematosus (SLE) have a chance of developing liver involvement in their lifetime. The main cause of liver involvement in SLE patients is previous treatment with hepatotoxic drugs or hepatotropic viral hepatitis. Wilson's disease is a hereditary disorder and is usually diagnosed in patients presenting either neuropsychiatric disorders or manifestations related to chronic liver disease. Fulminant hepatic failure as the initial manifestation of Wilson's disease is rare. The relationship between systemic lupus erythematosus and Wilson's disease has not been established. We report a case of a 12-year-old girl with SLE who presented fulminant hepatic failure as an initial manifestation of Wilson's disease. The diagnosis was established with decreased serum ceruloplasmin level and the presence of Kayser-Fleischer ring. We treated with repeated plasma exchange. Despite repeated plasma exchange she died of multi-organ failure on the 16th hospital day. Considering this case, Wilson's disease should be considered as a cause of fulminant hepatic failure, especially in juvenile age cases.
Child ; English Abstract ; Female ; Hepatolenticular Degeneration/*complications ; Human ; Liver Failure/*etiology ; Lupus Erythematosus, Systemic/*complications