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

PURPOSE: To perform biological safety test of the Seoul-type keratoprosthesis (SKpro) according to the international standards. METHODS: Mouse fibroblasts were used to assess the cellular toxicity, and albino rabbits were used for the irritation test, intradermal test, ocular toxicity test, pyrogenic test and transplantation test. Albino guinea pigs were used for the sensitization test, and rats were used for the acute toxicity test and chronic toxicity test. All tests were performed using the SKpro extracts, which was extracted under 121degrees C for 1 hour using a 0.9% normal saline as the solvent. RESULTS: For the cellular toxicity test, all the rat fibroblasts showed cell proliferation inhibition of less than 29%, which proved to be non-cellular toxic. For the irritation test and the intradermal reaction test, none of the albino rabbits showed skin rash, crust or edema. On the ocular irritation test, there were no conjunctival, corneal or iris abnormalities among the albino rabbits. On the sensitization test, none of the guinea pigs showed skin rash, crust or edema. On the acute systemic toxicity test, there were no signs of lethargy or coma among rats. On the pyrogenic test, no temperature increase was observed in the albino rabbits. On the transplantation test, there was no evidence of graft reaction around the cornea. On the chronic toxicity test, complete blood analysis, urinalysis and histological findings 6 month after exposure showed no signs of abnormalities. CONCLUSIONS: The result of this study shows that SKpro is non-toxic and biologically safe.
Animals ; Cell Proliferation ; Coma ; Cornea ; Edema ; Exanthema ; Fibroblasts ; Guinea Pigs ; Intradermal Tests ; Iris ; Lethargy ; Mice ; Rabbits ; Rats ; Toxicity Tests ; Toxicity Tests, Acute ; Toxicity Tests, Chronic ; Transplants ; Urinalysis

Recently, the external cephalic version procedure has attracted attention as an alternative for the operative or vaginal delivery of a breech-presenting fetus. Although this procedure has many benefits, including its comparative safety and economical efficiency, it is not free from complications. We report two cases of external versions attempted under epidural anesthesia. These cases demonstrate that the use of a neuraxial blockade during a version attempt can provide the appropriate conditions necessary for this procedure, as well as the ability to deal with complications in a timely and safe manner.
Anesthesia, Epidural ; Breech Presentation ; Female ; Fetus ; Pregnancy ; Version, Fetal

Exposure to light can induce photoreceptor cell death and exacerbate retinal degeneration. In this study, mice with genetic knockout of several genes, including rhodopsin kinase (Rhok-/-), arrestin (Sag-/-), transducin (Gnat1-/-), c-Fos (c-Fos-/-) and arrestin/transducin (Sag-/-/Gnat1-/-), were examined. We measured the expression levels of thousands of genes in order to investigate their roles in phototransduction signaling in light-induced retinal degeneration using DNA microarray technology and then further explored the gene network using pathway analysis tools. Several cascades of gene components were induced or inhibited as a result of corresponding gene knockout under specific light conditions. Transducin deletion blocked the apoptotic signaling induced by exposure to low light conditions, and it did not require c-Fos/AP-1. Deletion of c-Fos blocked the apoptotic signaling induced by exposure to high intensity light. In the present study, we identified many gene transcripts that are essential for the initiation of light-induced rod degeneration and proposed several important networks that are involved in pro- and anti-apoptotic signaling. We also demonstrated the different cascades of gene components that participate in apoptotic signaling under specific light conditions.
Animals ; Apoptosis/radiation effects ; G-Protein-Coupled Receptor Kinase 1/genetics ; GTP-Binding Protein alpha Subunits/genetics ; *Gene Expression Profiling ; Genes, fos/genetics ; Light/adverse effects ; Light Signal Transduction/*genetics/physiology/radiation effects ; Mice ; Mice, Knockout ; Oligonucleotide Array Sequence Analysis ; Retina/metabolism/pathology/radiation effects ; Retinal Degeneration/etiology/*genetics/physiopathology ; Transducin/genetics

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

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