Torsion of the gallbladder is a uncommon disease. Since Wendel reported the first case of torsion of the gallbladder in 1898, approximately 400 or more cases have been reported on. A mobile gallbladder with abnormal anatomical fixation to the liver is required for this torsion. Twisting of the mobile gallbladder on its pedicle creates occlusion of the blood supply or bile flow to the organ, and gangrene and necrosis finally occurs. Prompt surgery is required for this condition. Unless cholecystectomy is performed, this condition could cause severe postoperative complications or death to the patient. Torsion of the gallbladder has been known to occur frequently in thin, elderly females. Because of its medical rarity, diagnosis of torsion prior to operative exploration is extremely difficult and the diagnosis is generally maded by laparotomy. We report here on a case of torsion of the gallbladder. The patient was an 82 years old female who complained of severe epigastric pain, nausea, and vomiting. Ultrasonography and computed tomography were performed and these modalities demonstrated a distended gallbladder with wall thickening; the gallbladder didn't contain stones. Explorative laparotomy and cholecystectomy was then performed. We found that the necrotized gallbladder was twisted around its pedicle. We report here on a case of gallbladder torsion and we discuss the clinical features and diagnostic methods for this malady.
Aged ; Aged, 80 and over ; Bile ; Cholecystectomy ; Diagnosis ; Female ; Gallbladder* ; Gangrene ; Humans ; Laparotomy ; Liver ; Nausea ; Necrosis ; Postoperative Complications ; Ultrasonography ; Vomiting

PURPOSE: Although the treatment of choice for bullous keratopathy is typically penetrating keratoplasty (PKP), not all patients are suited for this treatment. Thus, we evaluated the clinical effects of phototherapeutic keratectomy (PTK) on pain relief and on the improvement of photophobia and visual acuity in patients suffering from bullous keratopathy. METHODS: Twenty-three patients with bullous keratopathy who were awaiting PKP and suffering from ocular pain, photophobia, and cosmetic problems, were assessed. Twelve eyes were treated with PTK using the excimer laser (VISX STAR S3, Irvine, CA, U.S.A). Another 11 eyes were treated with eye drops or other conservative modalities. Statistically significant differences in pain relief, photophobia improvement, and cosmetic improvement between two groups were assessed by Fisher's exact test. RESULTS: Twelve eyes with bullous keratopathy underwent PTK. At post-operative 1 month, 83% of patients showed relief of pain, 75% of patients showed improvements in photophobia, and 58% of patients had increased visual acuity of one or more line. The overall satisfaction rate of PTK was 91%, but 67% of patients showed recurrence of corneal opacity and bullae formation at 6 months after the procedure. CONCLUSIONS: Phototherapeutic keratectomy (PTK) reduced pain and improved visual acuity slightly in patients with bullous keratopathy. This procedure could be considered a valuable alternative treatment modality while awaitng PKP.
Corneal Opacity ; Corneal Transplantation ; Humans ; Keratoplasty, Penetrating ; Lasers, Excimer ; Ophthalmic Solutions ; Photophobia ; Recurrence ; Visual Acuity

PURPOSE: To evaluate the clinical results of monovision treatment applied to cataract patients who planned to undergo phacoemulsification and posterior chamber intraocular lens (PC IOL) implantation. METHODS: Phacoemulsificaiton and implantation of a monofocal PC IOL were performed in 40 patients between January 2005 and January 2006. Surgeries were performed on the dominant eye with the postoperative goals of emmetropia and on the nondominant eye with the postoperative goals of mild myopia. Patients' satisfaction, refractive change, and visual acuity were evaluated for at least 3 months after the surgery. RESULTS: The mean postoperative uncorrected near visual acuity (UCNVA) of binocular eyes was 0.56+/-0.52, which was a statistically significant improvement compared with the mean preoperative UCNVA (P<0.001). The mean postoperative uncorrected far visual acuity(UCFVA) of binocular eyes was 0.70+/-0.34, which was a statistically significant improvement compared with the mean preoperative UCFVA (P<0.001). In all, 77.5% (31 of 40) of patients were satisfied with the results. CONCLUSIONS: Monovision induced by phacoemulsification and implantation of a monofocal PC IOL is suggested to be a good option in patients with presbyopia and cataract.
Cataract ; Emmetropia ; Eye ; Humans ; Lenses, Intraocular ; Myopia ; Phacoemulsification ; Presbyopia ; Telescopes ; Visual Acuity

PURPOSE: To evaluate of the mesopic vision and glare in normal subjects and post-LASIK patients by using mesoptometer. METHODS: One hundred sixty eyes of eighty subjects with normal vision and no ocular disease were divided into four groups. Each twenty subjects were followed up for more than 3 months and the authors tested the mesopic vision and glare disability with Mesotest II. The authors also measured eighty eyes of forty patients by same means depending on pupil size and high order root mean square (RMS) values before LASIK surgery in 1st and 3rd months postoperatively and compared with data of normal subjects. RESULTS: The mesopic vision and glare disability at 1: 5 contrast level were extremly reduced in the group over 60 age old but there was no statistical significance. In post-LASIK patients, mesopic vision and glare disability were significantly reduced in 1st month after surgery. However the values returned nearly to preoperative figures in 3rd month. Patients with large pupil and high order RMS values reduced more in mesopic vision and glare disability but there was not statistical significance. CONCLUSIONS: The mesopic vision and glare disability were reduced in older age group and they were reduced in the patients with large pupils and high order RMS values in the early postoperative period after LASIK.
Glare* ; Humans ; Keratomileusis, Laser In Situ ; Mesopic Vision* ; Postoperative Period ; Pupil

PURPOSE: This study was designed to evaluate the efficacy of intracameral lidocaine injection on patient' s pain relief during phacoemulsification in vitrectomized eyes and the influence on the corneal endothelial cells. METHODS: A prospective, double blind clinical trial was performed on 60 eyes of 60 patients who had undergone phacoemulsification from October 2000 to February 2001 at Busan PAIK Hospital. Thirty eyes had prior vitrectomy. Before surgery specular microscopic examination was performed. The patients were divided into vitrectomized and nonvitrectomized groups, and the lidocaine or placebo (BSS) was injected into the anterior chamber of 15 eyes each in two subgroups within each group. Pain was assessed using a visual analogue scale before, during and after operation. Endothelial cells were examinined at one week, one month, and three months after operation with a specular microscope. RESULTS: In vitrectomized patients, intracameral lidocaine injection resulted in significantly lower intraoperative pain score. There were no significant differences in morphological changes of endothelium between lidocaine and placebo groups. CONCLUSIONS: Intracameral lidocaine injection with topical anesthesia had significant effect in intraoperative pain relief during phacoemulsification in vitrectomized eyes. There was no significant effects on corneal endothelium. We conclude that intracameral anesthesia is safe and reduces intraoperative pain in vitrectomized eyes.
Anesthesia ; Anterior Chamber ; Busan ; Cataract ; Endothelial Cells ; Endothelium ; Endothelium, Corneal ; Humans ; Lidocaine* ; Phacoemulsification* ; Prospective Studies ; Vitrectomy

PURPOSE: To investigate quantitative and morphometric endothelial changes in phakic eyes implanted with an iris-fixed phakic intraocular lens in Korean patients. METHODS: We prospectively examined the endothelial cell density (ECD), ECD loss (ECL), coefficient variations (CV), and frequency of Hexagons (6A) in 46 phakic eyes implanted with an iris-fixed phakic intraocular lens. The effect of anterior chamber depth (ACD) and diopter of iris-fixed phakic intraocular lens on ECD was statistically analyzed. RESULTS: Preoperative mean ECD was 2923+/-257 cells/mm2. ECL at postoperative 1, 3, 6, 12, and 24 monthswas 0.71%, 0.88%, 0.70%, 0.64%, and 2.34%. It was significant only in the month 24 results. The mean CV value at the same time was 0.343, 0.342, 0.334, 0.329, 0.326, and 0.338. The change was significant at the 12th month. The mean 6A value at the same time was 58.2%, 57.8%, 59.7%, 59.6%, 60.1%, and 58.8%. There was no significant change in 6A value. Preoperative ACD and diopter of iris-fixed phakic intraocular lens didn't affect the ECD change. CONCLUSIONS: This two-year follow-up study of changes in endothelial cells after implantation iris-fixated phakic intraocular lens showed statistically significant decreases in the cells, which is not very significant considering the physiologic reduction rate of the cells. Thses decreases showed a tendency to be stabilized with recovery of morphological changes. Further long-term follow-up is needed to determine its long-lasting effect.
Anterior Chamber ; Endothelial Cells ; Eye ; Follow-Up Studies ; Humans ; Iris ; Phakic Intraocular Lenses ; Prospective Studies

PURPOSE:To report a case of a granular cell tumor in the form of cilliary body tumor. CASE SUMMARY: A 42-year-old women visited our clinic with blurred vision of the right eye, which began was 1 month earlier ago. Her medical history was unremarkable. Slit-lamp examination revealed a ciliary body tumor and complicated cataract due to a mass lesion. For treatment, an excisional biopsy of the ciliary body tumor and phacoemulsification were performed. The pathologic finding confirmed the diagnosis of a granular cell tumor. There was no evidence of a recurrent lesion of the tumor at the 6-month postoperative follow-up. CONCLUSIONS: We confirmed a granular cell tumor in the form of a cilliary body tumor based on pathologic findings.
Adult ; Biopsy ; Cataract ; Ciliary Body ; Eye ; Female ; Follow-Up Studies ; Granular Cell Tumor ; Humans ; Phacoemulsification ; Vision, Ocular

BACKGROUND: Korean mistletoe (Viscum album) extract has been found to posses immunostimulatory activity. In this study, Korean mistletoe extract, M11C (non-lectin components), was used to know whether this extract might activate mouse peritoneal macrophages to produce interleukin 1 beta (IL-1 beta). METHODS: Hemagglutination assay was carried out to examine whether M11C contained a lectin or not . To know the effect of M11C on the production of IL-1 beta, the macrophages were treated by the M11C, and then collected the supernatant (M11C stimulated macrophages-conditioned media; MMCM). MMCM was analyzed for the IL-1 beta quantification and mRNA expression by means of ELISA and RT-PCR, respectively. RESULTS: Maximum effective dose and time of M11C on IL-1 beta production from macrophages were 20 micro gram/ml and 8 hours, respectively . This ELISA data was reconfirmed by immunoblotting assay . indicating that M11C is a good candidate for an immunomodulator. The dose and time dependent effect s of M11C on the expression of IL-1 beta mRNA from macrophages was also shown in expression of mRNA detected by RT-PCR. Treatment dose and time for the maximum expression of IL-1 beta mRNA were 20 micro gram/ml and 4 hours, respectively . Maximum gene expression of IL-1 beta was much earlier than maximum production of it. CONCLUSION: As results, Korean mistletoe extract, M11C, may be used for an immunomodulator. This will be able to make up for and solve the problems caused by existent immunoagent with many adverse effects through many other studies in future including one molecule extraction.
Animals ; Enzyme-Linked Immunosorbent Assay ; Gene Expression ; Hemagglutination ; Immunoblotting ; Interleukin-1beta ; Macrophages* ; Macrophages, Peritoneal ; Mice ; Mistletoe* ; RNA, Messenger

PURPOSE: We describe 2 cases of bilateral acute myopia associated with topiramate, a drug that has recently been prescribed for epilepsy or weight reduction. CASE SUMMARY: A 24-year-old woman and a 25-year-old woman, both previously devoid of ocular problems, visited our hospital with blurry vision after taking topiramate for weight reduction. A thorough medical history review and ocular examinations, including a slit lamp examination, were performed. CONCLUSIONS: Slit-lamp examinations revealed forward displacement of the lens-iris diaphragm, which resulted in myopia and anterior chamber shallowing. Discontinuation of topiramate and the administration of cycloplegic agents successfully resolved the symptoms.
Adult ; Anterior Chamber ; Diaphragm ; Displacement (Psychology) ; Epilepsy ; Female ; Fructose ; Humans ; Myopia ; Vision, Ocular ; Weight Loss ; Young Adult

PURPOSE: To report the outcomes after the implantation of intrastromal corneal ring segments (KeraRing(R)) by manual tunnel creation for the correction of keratoconus. METHODS: The present retrospective case series was comprised of 12 eyes of 11 consecutive keratoconic patients. Intrastromal corneal ring segments (KeraRing(R)) were implanted for keratoconus correction after manual tunnel creation. Uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), refractive outcome, and complete ophthalmologic examinations were performed before and after surgery at 1 day, 1 week, 3 months, and 6 months. Corneal topography was measured before surgery, 6 months after surgery and during any necessary follow-up visits. RESULTS: Intrastromal corneal ring segments (KeraRing(R)) implantation significantly increased BCVA from logMAR 0.47 +/- 0.19 to logMAR 0.28 +/- 0.17 (P < 0.05) and decreased the spherical equivalent from -6.03 +/- 3.24 D to -2.24 +/- 1.96 D. The simulated keratometric value in the Orbscan IIz significantly decreased in K maximum from 50.7 +/- 2.93D to 47.65 +/- 3.15 D and in K minimum from 47.65 +/- 3.15 D to 44.92 +/- 2.80 D. CONCLUSIONS: Intrastromal corneal ring segments implantation (KeraRing(R)) by manual tunnel creation appears to be effective in improving BCVA and reducing corneal astigmatism and keratometric value in keratoconic patients. KeraRing(R) may delay or prevent the need for a corneal graft, and reduce the contact lens intolerance.
Astigmatism ; Corneal Topography ; Eye ; Follow-Up Studies ; Humans ; Keratoconus ; Retrospective Studies ; Transplants ; Visual Acuity