PURPOSE: To evaluate the postoperative higher-order aberrations (HOAs) and factors affecting postoperative changes in HOAs in eyes that underwent wavefront-guided LASEK (laser-assisted subepithelial keratectomy), compared with the eyes that underwent conventional LASEK. METHODS: We reviewed the medical records of 221 patients who had undergone LASEK or wavefront guided LASEK with VISX WaveScan and VISX Star S4 eximer laser by a single surgeon (427 total eye operations). We matched 29 eyes of the LASEK and the wavefront LASEK groups (58 eyes total) according to the guideline: preoperative refractive power differences must be within 1 diopter and preoperative root-mean-square (RMS) of total HOAs differences must be within 0.01 micrometer. Preoperative wavefront aberrations and two-months postoperative wavefront aberrations and associated factors were compared and analyzed. RESULTS: Postoperative total HOAs, comas, and spherical aberrations increased significantly from 0.36+/-0.10 micrometer to 0.49+/-0.16 micrometer (p=.001), 0.21+/-0.09 micrometer to 0.31+/-0.14 micrometer (p=.003), and 0.03+/-0.10 micrometer to 0.10+/-0.20 micrometer (p=.043), respectively, in the conventional LASEK group. In the wavefront LASEK group, postoperative HOAs, comas, and spherical aberrations significantly increased from 0.36+/-0.10 micrometer to 0.46+/-0.14 micrometer (p=.004), 0.18+/-0.10 micrometer to 0.29+/-0.14 micrometer (p=.002), and 0.09+/-0.14 micrometer to 0.19+/-0.14 micrometer (p=.006), respectively. There were no significant differences in HOAs between the two groups. A strong negative correlation between preoperative total HOAs and a multiple of increase in total HOAs postoperatively was found, with the negative correlation being stronger in the wavefront-guided LASEK group (Pearson's correlation coefficient =-0.697, p<.001) than in the LASEK group (Pearson's correlation coefficient =-0.632, p<.001). CONCLUSIONS: There were no significant decreases in HOAs in the eyes that underwent wavefront-guided LASEK compared with the matched control eyes of patients that underwent conventional LASEK. Analyzing the tendency of a multiple of increase in total HOAs according to the preoperative HOAs, it suggests that the wavefront-guided LASEK may be more effective in suppressing an increase in total HOAs in the eyes with higher preoperative HOAs.
Case-Control Studies ; Coma ; Humans ; Keratectomy, Subepithelial, Laser-Assisted* ; Medical Records

PURPOSE: To report 2 cases of Comamonas acidovorans keratitis in immunocompromised cornea. METHODS: A complete review of the medical records of the two cases of Comamonas acidovorans keratitis. RESULTS: We found some similarities in clinical courses of two cases. Both of them showed development of keratitis during the management with corticosteroids, delayed onset, slow response to antibiotics, and relatively less affected corneal epithelium. CONCLUSIONS: Comamonas acidovorans is known as a less virulent organism. However it can cause an indolent infection that responds slowly even to adequate antibiotics therapy in immunocompromised corneas.
Amikacin/therapeutic use ; Anti-Bacterial Agents/therapeutic use ; Ceftazidime/therapeutic use ; Ciprofloxacin/therapeutic use ; Corneal Ulcer/diagnosis/drug therapy/*microbiology ; Delftia acidovorans/*isolation & purification ; Drug Therapy, Combination ; Eye Infections, Bacterial/diagnosis/drug therapy/*microbiology ; Gram-Negative Bacterial Infections/diagnosis/drug therapy/*microbiology ; Humans ; *Immunocompromised Host ; Male ; Microbial Sensitivity Tests ; Middle Aged

PURPOSE: To report 2 cases of Comamonas acidovorans keratitis in immunocompromised cornea. METHODS: A complete review of the medical records of the two cases of Comamonas acidovorans keratitis. RESULTS: We found some similarities in clinical courses of two cases. Both of them showed development of keratitis during the management with corticosteroids, delayed onset, slow response to antibiotics, and relatively less affected corneal epithelium. CONCLUSIONS: Comamonas acidovorans is known as a less virulent organism. However it can cause an indolent infection that responds slowly even to adequate antibiotics therapy in immunocompromised corneas.
Amikacin/therapeutic use ; Anti-Bacterial Agents/therapeutic use ; Ceftazidime/therapeutic use ; Ciprofloxacin/therapeutic use ; Corneal Ulcer/diagnosis/drug therapy/*microbiology ; Delftia acidovorans/*isolation & purification ; Drug Therapy, Combination ; Eye Infections, Bacterial/diagnosis/drug therapy/*microbiology ; Gram-Negative Bacterial Infections/diagnosis/drug therapy/*microbiology ; Humans ; *Immunocompromised Host ; Male ; Microbial Sensitivity Tests ; Middle Aged

PURPOSE: To report a case of a patient with infectious endophthalmitis associated with necrotizing scleritis that was treated with pars plana vitrectomy and permanent amniotic membrane transplantation. CASE SUMMARY: A 76-year-old man with pain and visual loss in the right eye was diagnosed with infectious endophthalmitis and necrotizing scleritis. The visual acuity in the right eye was hand motion, and the slit lamp examination showed infection of the conjunctiva and sclera, corneal edema, hypopyon, and necrosis of nasal sclera. An intravitreal antibiotic injection was given, and Pseudomonas aeruginosa was cultured in vitreous fluid. Two days afterward, when vitrectomy was performed, leakage from the scleral microperforation and necrosis of the peripheral cornea was observed. Thus, a 10-layered permanent amniotic membrane transplantation was performed. The patient was given topical antibiotics and steroids, oral prednisolone, and cyclophosphamide postoperatively. After 74 days, endophthalmitis was remitted, and scleritis was well controlled. His visual acuity recovered to 20/40. CONCLUSIONS: Infectious endophthalmitis due to scleral microperforation by necrotizing scleritis can be treated effectively with vitrectomy combined with permanent amniotic membrane transplantation.
Aged ; Amnion ; Anti-Bacterial Agents ; Conjunctiva ; Cornea ; Corneal Edema ; Cyclophosphamide ; Endophthalmitis ; Eye ; Hand ; Humans ; Necrosis ; Prednisolone ; Pseudomonas aeruginosa ; Sclera ; Scleritis ; Steroids ; Transplants ; Visual Acuity ; Vitrectomy

"Pseudomyxoma peritonei is a clinical entity in which the peritoneal surface and omentum are involved with gelatinous, mucinous implants, and often massive gelatinous ascites. Most cases originate from ruptured ovarian mucinous cysts or appendiceal mucoceles, and involve only the intraperitoneal cavity. But there is much confusion about its etiology, clinical manifestation, treatment, and prognosis. We experienced a case of pseudomyxoma peritonei originating from the mucinous cystic tumor of borderline malignancy in unilateral ovary with rupture. A case of pseudomyxoma peritonei is reported with a brief review of the literature."
Female ; Gelatin ; Mucins ; Mucocele ; Omentum ; Ovary ; Prognosis ; Pseudomyxoma Peritonei* ; Rupture

Cryoneurolysis to peripheral neuralgia has been tried in selected postoperative pain and chronic pain patient; post-thoracotomy pain, post-herniorrhapy pain and trigeminal neuralgia. Here we report first two cases those were effectively controlled by percutaneous cryoneurolysis. Intercostal neuralgia was confirmed by intercostal nerve block with 1% mepivacaine and then we applied cryoneurolysis. Those pains could be relieved for more than two or three months. We suggest that cryoneurolysis can be an useful, simple and safe neurolytic method to intercostal neuralgia in outpatient pain clinic.
Chronic Pain ; Humans ; Intercostal Nerves ; Mepivacaine ; Neuralgia* ; Outpatients ; Pain Clinics ; Pain, Postoperative ; Trigeminal Neuralgia

The main feature of acute renal failure is a decline in the glomerular filtration rate. However, urine leakage into the peritoneal cavity due to bladder rupture may cause pseudo-renal failure. This is a situation in which renal function is normal, along with the presence of elevated serum creatinine. A 47-year-old woman presented with abdominal distension and pretibial pitting edema on both lower extremities. She had no traumatic history. She did not complain of abdominal pain, and exhibit neither oliguria nor anuria. Her blood urea nitrogen (BUN) and serum creatinine was 105 and 11.2 mg/dL. Ascites showed that urea nitrogen and creatinine were 160 and 29 mg/dL, respectively. We confirmed bladder rupture by an abdominal CT scan and retrograde cystography. She underwent an emergency laparotomy to repair the ruptured bladder. Azotemia was normalized 2 days after the operation. Here we present a rare case of uremia due to bladder rupture.
Abdominal Pain ; Acute Kidney Injury ; Anuria ; Ascites ; Azotemia ; Blood Urea Nitrogen ; Creatinine ; Edema ; Emergencies ; Female ; Glomerular Filtration Rate ; Humans ; Laparotomy ; Lower Extremity ; Middle Aged ; Nitrogen ; Oliguria ; Peritoneal Cavity ; Rupture ; Urea ; Uremia ; Urinary Bladder

Autonomic dysreflexia is a syndrome of uninhibited sympathetic spinal reflexes in response to stimuli below the level of injury in the patients with high spinal lesions. During labor, it can cause uteroplacental vasoconstriction resulting in fetal distress or devastating maternal complications including retinal hemorrhage, cerebrovascular accident and hypertensive encephalopathy. Neuraxial blockade has proven to be an effective method to attenuate or prevent it. We present a case detailing the use of epidural analgesia in managing the delivery of a quadriplegic parturient with a history of autonomic dysreflexia.
Analgesia, Epidural* ; Autonomic Dysreflexia ; Fetal Distress ; Humans ; Hypertensive Encephalopathy ; Reflex ; Retinal Hemorrhage ; Spinal Cord Injuries* ; Spinal Cord* ; Stroke ; Vasoconstriction

PURPOSE:To compare the accuracy of myopic refraction using an aberrometer (WaveScan, Visx, Santa Clara, CA, USA) with manifest refraction using retinoscopy and an autorefractor. METHODS: The medical records of 200 eyes in 100 patients who visited our clinic from February 2005 to February 2007 for refractive surgery were reviewed retrospectively. We compared the refractive errors obtained using an aberrometer, retinoscopy, and an autorefractor (KR-7100, Topcon, Tokyo, Japan). All of the measured refractive errors were converted to power vectors for statistical analysis. The power vectors consisted of the M vector (M), J0 vector (J0), and J45 vector (J45). RESULTS: The mean sphere was -4.75 diopters (D) and the mean cylinder was -0.66D with retinoscopy. Power vectors of the aberrometer (PVw) were highly correlated with power vectors of retinoscopy (PVr) and the autrorefractor (PVa). The correlation coefficients (R2) between PVw and PVr were 0.960 (M), 0.852 (J0), and 0.679 (J45) and the correlation coefficients between PVw and PVr were 0.963 (M), 0.685 (J0), and 0.516 (J45). Mean differences were -0.247+/-0.412D (M), 0.034+/-0.120D (J0), and -0.017+/-1.07D (J45) between PVw and PVr, and were -0.068+/-0.403D (M), -0.055+/-0.194D (J0), and -0.052+/-0.165D (J45) between PVw and PVa. CONCLUSIONS: The measurement of refractive errors using a WaveScan aberrometer seems to be reliable and accurate, although some myopic shift was observed.
Eye ; Humans ; Medical Records ; Refractive Errors ; Refractive Surgical Procedures ; Retinoscopy ; Retrospective Studies ; Tokyo

PURPOSE: To report the clinical manifestation, predisposing factors, microbiological profiles and treatment outcome of infectious keratitis following penetrating keratoplasty (PK). METHODS: Medical records of the post-PK patients later diagnosed with culture-positive keratitis, between January 2003 and June 2008 at our hospital were retrospectively reviewed. RESULTS: Among 228 eyes of 226 patients who previously had PK, 18 eyes (7.89%) of 16 patients developed microbial keratitis. Fifteen patients had a bacterial infection, of which a Streprococcus species was the most common causative microorganism (6 eyes, 33.3%). Three eyes had fungal infection; one case was co-infected with bacteria. Six eyes (33.3%) presented with a suture-related problem, and sixteen eyes (88.9%) had been using topical glaucoma medications. The suture-related problem and use of glaucoma medication were significantly associated with the development of infectious keratitis (p=0.040 and 0.013, respectively). Remission was achieved in all cases within the mean duration of 2.47 months after treatment initiation. However, visual improvement was not achieved in 11 eyes (68.7%) due to graft opacity. CONCLUSIONS: Early identification of predisposing factors and appropriate management at an early stage may prevent the occurrence of graft infection and improve graft survival.
Bacteria ; Bacterial Infections ; Cornea ; Eye ; Glaucoma ; Graft Survival ; Humans ; Keratitis ; Keratoplasty, Penetrating ; Medical Records ; Retrospective Studies ; Transplants ; Treatment Outcome