The choice of operative procedures was determined by many factors, but the levator function is considered as the most important factor. Fox recommended that when the levator function was 2 to 9 mm, the patient should be treated by the levator resection and when the levator function was below 2 mm, the patient should be crated by frontalis suspension. But Collin recommended that when the levator function was below 4 mm, the brow suspension procedure got the better result. Beside that, many other authors recommended various opinions. Therefore, when levator function of the patients was between 2 and 4 mm, the choice of operative procedure was much confusing us. The aim of this study is to clarify which is better Procedures between levator resection and the frontalis transfer or orbicularis oculi muscle transfer among the patients with 2 to 4 mm of levator action. From Jan. of 1991 to Dec. of 1994, among 26 patients with 2 to 4 mm levator function, 13 cases of 10 patients were operated by levator resection, 21 cases of 16 patients were teated by frontalis transfer or orbicularis oculi muscle flap. The results were evaluated with the average 27 months of follow-up and we compared the result of the levator resection procedure with that of frontalis muscle transfer or orbicularis oculi muscle transfer. The preoperative average amount of ptosis is about 2.7 mm in cases with levator resection, about 4.0 mm in cases with frontalis muscle transfer or orbicularis oculi muscle flap transfer. The postoperative average amount of ptosis is about 1.7 mm in cases with levator resection about 2.14 mm in cases with frontail muscle transfer or orbicularis oculi muscle flap transfer and so the postoperative improvement of amount of ptosis is about 1.0 mm in cases with levator resection, about 1.86 mm in cases with frontails muscle transfer or orbicularis oculi muscle flap transfer. The major complication of levator resection method is undercorrection. However, the eyelid deformity due to excessive upward traction was more frequent in frontalis muscle flap technique.
Blepharoptosis* ; Congenital Abnormalities ; Eyelids ; Follow-Up Studies ; Humans ; Surgical Procedures, Operative ; Traction

PURPOSE: This study analyzed clinical characteristics of Staphylococcus aureus keratitis according to methicillin-resistance. METHODS: The authors performed a retrospective chart review of 46 isolates in 46 eyes with Staphylococcus aureus keratitis that were followed up for more than 2 months between January 1998 and December 2014. Comparative analyses of the epidemiology, predisposing factors, initial clinical manifestations, antibiotics susceptibility and clinical outcome between methicillin-resistant Staphylococcus aureus (MRSA) keratitis and methicillin-sensitive Staphylococcus aureus (MSSA) keratitis were performed. Risk factors of poor visual outcome were analyzed using logistic regression analysis. RESULTS: Among 46 eyes, MRSA was present in 15 eyes (33%) and MSSA in 31 eyes (67%). Male (61%) and older than 60 year-old group (48%) were common. Ocular surface disease/ocular surgery history and trauma were more common as a predisposing factor. Vancomycin was 100% sensitive to both the MRSA and MSSA groups. Antibiotics susceptibility to MRSA was significantly low in the oxacillin (0%), gentamicin (13.3%) and trimethoprim/sulfamethoxazole (53.3%) groups. Sensitivity to fluoroquinolone was 81.3% (MRSA 64.3% vs. MSSA 94.4%; p = 0.064). There were no differences in early corneal findings between the groups. The ratio of BCVA 0.5 or more was 24.4% initially and increased to 44.4% after treatment among all eyes (p = 0.046). Risk factors for poor visual outcomes included a BCVA less than 0.1 at initial evaluation (p = 0.033). CONCLUSIONS: Among eyes with Staphylococcus aureus keratitis, 33% were MRSA. The ratio of BCVA 0.5 or more increased after treatment among all eyes. There were no differences between MRSA and MSSA eyes in terms of epidemiology, predisposing factors, initial clinical manifestations or clinical outcome, except for antibiotic susceptibility. For positive patient outcomes, a treatment approach considering methicillin-resistance as well as various factors affecting clinical course is recommended.
Anti-Bacterial Agents ; Causality ; Epidemiology ; Gentamicins ; Humans ; Keratitis* ; Logistic Models ; Male ; Methicillin Resistance ; Methicillin-Resistant Staphylococcus aureus ; Oxacillin ; Retrospective Studies ; Risk Factors ; Staphylococcus aureus* ; Staphylococcus* ; Vancomycin

Purpose: To evaluate the effects and limitations of lacrimal endoscopy without silicone tube intubation in patients with epiphora. Methods: We conducted a retrospective chart review of 64 eyes in 49 patients who underwent lacrimal endoscopy between May 2021 and May 2022. The clinical characteristics, irrigation test results, lacrimal endoscopic findings, and type of surgery were analyzed. Results: The mean duration of symptoms was 31.2 months, and was significantly longer in the failure group than in the success group (p = 0.043). Irrigation tests showed passage, partial obstruction, and complete obstruction in 20 (31.3%), 16 (25.0%), and 28 (43.7%) eyes, respectively. Lacrimal endoscopy showed narrowing, mucus, fibrosis, granulation, and stones in 41 (64.0%), 12 (18.8%), 6 (9.3%), 3 (4.7%), and 2 (3.1%) eyes, respectively. Following lacrimal endoscopy, 32 (50.0%) eyes each were included in the success and failure groups. Preoperative irrigation test results did not affect the success rate (p = 0.203). Silicone tube intubation and dacryocystorhinostomy were performed in 5 (7.8%) and 8 (12.5%) eyes, respectively, because the symptoms did not improve after lacrimal endoscopy. Conclusions Lacrimal endoscopy, performed without silicone tube intubation, was effective in improving symptoms and may guide the choice of surgical technique, if required.

PURPOSE: To evaluate the efficacy of trabeculectomy using modified scleral flap suture technique METHODS: We retrospectively reviewed the medical records of 52 patients (55 eyes) who had undergone trabeculectomy from January 2003 to January 2007. Standard trabeculectomy was performed for 29 eyes of 27 patients, modified trabeculectomy for 26 eyes of 25 patients. We changed suture site of scleral flap corner about 1mm medially from original site and added tight suture to both lateral margins of scleral flap to prevent overflow in modified group. In both groups, most of patients were injected 0.1 ml of 0.02 mg/ml mitomycin-C (MMC) subconjunctivally and the others 0.1 ml of 0.04 mg/ml MMC. We evaluated intraocular pressure (IOP), complication, morphology of filtering bleb, cumulative success rates. RESULTS: Argon laser suturelysis was performed postoperatively in about half cases of both groups. The IOPs of modified group were consistently lower than those of standard group for 24 months except postoperative 1 day and 1 week. There was a significant difference of IOP at postoperative 2 months and 12 months (p<0.05). No significant difference of complications was found between two groups. The diffuse bleb with microcyst was found in 19 eyes (73%) of modified group and 17 eyes (59%) of standard group. From Kaplan-Meier survival analysis, cumulative success rates of modified group were higher than those of standard group (p<0.05). CONCLUSIONS: Trabeculectomy using modified scleral flap suture appears to give better IOP control than standard trabeculectomy.
Argon ; Blister ; Eye ; Humans ; Intraocular Pressure ; Medical Records ; Mitomycin ; Retrospective Studies ; Suture Techniques ; Sutures ; Trabeculectomy

PURPOSE: To report a patient with ocular syphilis, who showed variable ocular manifestations, including optic neuritis and chorioretinitis in both eyes over a short time period. CASE SUMMARY: A 44-year-male visited our clinic for central scotoma in the left eye. The visual acuity was 20/25 in the right eye and 20/40 in the left eye. The fundus of the left eye showed a slightly hyperemic optic disc and multiple yellowish deposits. One week later, visual acuity and fundus lesion improved to 20/20 without a definitive treatment. However, 1 month later, he reported a new deterioration of vision in his right eye to 20/40. The right eye had a relative afferent pupillary defect and the fundus examination showed a blurred optic disc margin. Serological work-up was recommended but the patient refused. He returned 3 weeks later with an improvement in the right eye vision (20/25) and a worsening in the left eye (20/200). The examination revealed an improvement of the previously blurred disc margin in the right eye and newly developed chorioretinitis with vasculitis in the left eye. A serological test was performed. The venereal diseases research laboratory titer was 1:32. The fluorescent treponemal antigen absorbance test as positive for IgG and IgM. He was diagnosed with ocular syphilis and referred to the infectious disease department. He was treated with antibiotics. Six months later, the visual acuity was 20/20 in both eyes and the previous fundus lesions had disappeared. CONCLUSIONS: Ocular syphilis should be considered in patients with atypical and variable clinical course.
Anti-Bacterial Agents ; Chorioretinitis* ; Communicable Diseases ; Humans ; Immunoglobulin G ; Immunoglobulin M ; Optic Neuritis* ; Pupil Disorders ; Scotoma ; Serologic Tests ; Sexually Transmitted Diseases ; Syphilis* ; Vasculitis ; Visual Acuity

BACKGROUND/AIMS: Planned endoscopic submucosal dissection with snaring (ESD-S) is thought to shorten operating time spent on submucosal dissection, but may lead to uncertainty of en bloc resection or to a possible increase in tumor-positive margins. The purpose of the present study is to investigate the feasibility of ESD-S as a planned procedure for gastric adenoma. MATERIALS AND METHODS: The medical records of 99 patients who underwent ESD-S or ESD for gastric adenoma between May 2011 and May 2012 were retrospectively reviewed. We analyzed the differences between the ESD-S and the ESD groups, focusing on rates of en bloc resection and pathologic complete resection, mean operation time, and complications. RESULTS: The mean operation time was significantly lower in the ESD-S group than in the ESD group (19.9+/-11.2 vs. 33.8+/-19.9, P=0.012). Cases with an operation time under 30 minutes were more frequent in the ESD-S group (88.9% vs. 48.1%, OR=8.615, 95% CI=2.949~25.168). There were no significant differences in en bloc resection, histologic complete resection, or complication rates between the two groups. CONCLUSIONS: ESD-S has a time advantage over ESD with a comparable compete resection rate. ESD-S can be considered a planned method for available early gastric adenoma.
Adenoma* ; Endoscopy ; Focus Groups ; Humans ; Medical Records ; Retrospective Studies ; SNARE Proteins* ; Uncertainty

PURPOSE: To establish the basis for a non-invasive and non-destructive assessment of the mechanical properties during natural fracture healing by analyzing the vibrational property of the fracture healing and comparing the vibrational property, the bone healing status (as determined by X-ray) and the mechanical strength parameters. MATERIALS AND METHODS: The tibial shafts of rabbits were broken under general anesthesia. The rabbits were sacrificed at 2, 4, 6 weeks after the fracture, then X-rays of the fractured tibias were sequentially taken to detect the fracture healing. The vibration mode and the biomechanical strength were measured. RESULTS: According to the results of a multiple regression analysis, the standardized coefficients of callus, apposition, lateral angulation, DAMP1, FREQ1 in the fractured tibias, were -0.80, -0.23, -0.21, -0.25, -0.25. In normal contralateral tibias, the standardized coefficients of the area, FREQ1, DAMP1, FREQ2, DAMP3 were -0.73, 0.28, 0.41, 0.39, -0.25. CONCLUSION: A monitoring of the fracture healing process that utilizes the frequency response function is thought to be useful in detecting the early phase of healing within 4 weeks. Additional studies on the vibrational characteristics of the healing bones after a clinical union or after simillar pathologies should be pursued so that future diagnostic applications ca be made.
Anesthesia, General ; Bony Callus ; Fracture Healing ; Fractures, Bone* ; Pathology ; Rabbits ; Tibia ; Vibration

Purpose: To evaluate the short-term ophthalmic side effects of bilateral same-day intravitreal bevacizumab injections. Methods: We retrospectively analyzed patients who underwent intravitreal bevacizumab injection in both eyes on the same day from January 2015 to June 2019. The patients were followed up at 1 day, 1 week, and 1 month after the injection. Results: A total of 281 patients (153 males and 128 females) and 562 eyes were included in the study, and 950 bilateral same-day intravitreal bevacizumab injections were performed. The mean age of patients was 58.87 ± 13.44 years. The most common cause of bilateral injection was that of complications due to diabetic retinopathy, which accounted for 66.3%, followed by age-related macular degeneration at 22.2%, retinal vein occlusion at 5.1%, and central serious chorioretinopathy at 2.1%. There were 0 cases of endophthalmitis after 950 injections, 13 cases of subconjunctival hemorrhage, and 17 patients with a temporary elevation of intraocular pressure. There were 11 patients with acute intraocular inflammation after bilateral injection, but none in both eyes. Patients with acute intraocular inflammation were followed up at short-term intervals until they improved. All patients showed complete improvement within 2 weeks after injection. Comparing the patients’ condition before and after injection, visual acuity improved (p < 0.001). Conclusions In terms of the frequency of short-term ophthalmic adverse events, bilateral same-day intravitreal bevacizumab injection is a safe procedure with fewer side effects and is more convenient for both the patient and the doctor.

Purpose: To evaluate the short-term ophthalmic side effects of bilateral same-day intravitreal bevacizumab injections. Methods: We retrospectively analyzed patients who underwent intravitreal bevacizumab injection in both eyes on the same day from January 2015 to June 2019. The patients were followed up at 1 day, 1 week, and 1 month after the injection. Results: A total of 281 patients (153 males and 128 females) and 562 eyes were included in the study, and 950 bilateral same-day intravitreal bevacizumab injections were performed. The mean age of patients was 58.87 ± 13.44 years. The most common cause of bilateral injection was that of complications due to diabetic retinopathy, which accounted for 66.3%, followed by age-related macular degeneration at 22.2%, retinal vein occlusion at 5.1%, and central serious chorioretinopathy at 2.1%. There were 0 cases of endophthalmitis after 950 injections, 13 cases of subconjunctival hemorrhage, and 17 patients with a temporary elevation of intraocular pressure. There were 11 patients with acute intraocular inflammation after bilateral injection, but none in both eyes. Patients with acute intraocular inflammation were followed up at short-term intervals until they improved. All patients showed complete improvement within 2 weeks after injection. Comparing the patients’ condition before and after injection, visual acuity improved (p < 0.001). Conclusions In terms of the frequency of short-term ophthalmic adverse events, bilateral same-day intravitreal bevacizumab injection is a safe procedure with fewer side effects and is more convenient for both the patient and the doctor.

No abstract available.
Gallbladder Neoplasms ; Gallbladder ; Liver Abscess ; Liver