PURPOSE: To report the clinical course and results of two cases of anterior segment manifestations associated with systemic lupus erythematosus (SLE). CASE SUMMARY: The first case was a 63-year-old female patient who was diagnosed with corneal ulcer and symblepharon on her left eye and dry eye in both eyes. Although the patient was treated with topical antibiotics, autologous serum and artificial tears, amniotic membrane transplantation and symblepharon removal were subsequently required. At 1 month after medical and surgical treatment, the corneal ulcer improved, but a descemetocele was formed because of persistent corneal thinning. The second case was a 24-year-old female patient diagnosed with filamentary keratitis and recurrent corneal erosion in both eyes and uveitis in her left eye. After treatment with therapeutic contact lenses, topical antibiotics and steroids, her symptoms were slightly improved. After 6 months of treatment, filamentary keratitis and corneal erosion recurred to being intractable. The patient received systemic evaluation and was diagnosed with SLE. After a combined therapy of oral and topical treatments, filamentary keratitis and recurrent corneal erosion improved significantly. CONCLUSIONS: Clinical manifestations of anterior segment associated with SLE rarely respond to topical treatment and are apt to recur easily; therefore, systemic treatment should be applied for better prognosis. Thus, the therapeutic strategy in intractable ocular diseases should be designed with consideration of accompanying systemic diseases.
Amnion ; Anti-Bacterial Agents ; Contact Lenses ; Corneal Ulcer ; Dimaprit ; Eye ; Female ; Humans ; Keratitis ; Keratoconjunctivitis Sicca ; Lupus Erythematosus, Systemic ; Middle Aged ; Ophthalmic Solutions ; Prognosis ; Steroids ; Transplants ; Uveitis ; Young Adult

A myxoma is a benign tumor found in the heart and in various soft tissues; however, a corneal myxoma is rare. A mucinous mass of unknown etiology was observed on the left cornea of a 32-year-old male patient. We performed deep anterior lamellar keratoplasty using acellular corneal tissue and concurrent amniotic membrane transplantation. Hematoxylin and eosin staining revealed vacuolation of the parenchyma and myxoid change in the corneal tissue that occurred in the anterior half of the corneal parenchyma. We identified a myxoid stroma by Alcian blue staining and observed collagen fibers with denatured stroma by Masson trichrome staining. The patient's visual acuity improved from light perception to 20 / 200, and the intraocular pressure remained within the normal range for one year after surgery. The transplanted cornea survived successfully with well-maintained transparency, and recurrence was not observed one year after surgery.
Adult ; *Cornea ; Corneal Stroma/cytology/*transplantation ; Corneal Transplantation/*methods ; Eye Neoplasms/diagnosis/*surgery ; Humans ; Male ; Myxoma/diagnosis/*surgery

A myxoma is a benign tumor found in the heart and in various soft tissues; however, a corneal myxoma is rare. A mucinous mass of unknown etiology was observed on the left cornea of a 32-year-old male patient. We performed deep anterior lamellar keratoplasty using acellular corneal tissue and concurrent amniotic membrane transplantation. Hematoxylin and eosin staining revealed vacuolation of the parenchyma and myxoid change in the corneal tissue that occurred in the anterior half of the corneal parenchyma. We identified a myxoid stroma by Alcian blue staining and observed collagen fibers with denatured stroma by Masson trichrome staining. The patient's visual acuity improved from light perception to 20 / 200, and the intraocular pressure remained within the normal range for one year after surgery. The transplanted cornea survived successfully with well-maintained transparency, and recurrence was not observed one year after surgery.
Adult ; *Cornea ; Corneal Stroma/cytology/*transplantation ; Corneal Transplantation/*methods ; Eye Neoplasms/diagnosis/*surgery ; Humans ; Male ; Myxoma/diagnosis/*surgery

PURPOSE: To report two cases of intractable superior limbic keratoconjunctivitis (SLK) treated with bevacizumab and triamcinolone injection. CASE SUMMARY: A 69-year-old female visited our clinic with pain in the left eye for 3 days and was diagnosed with SLK in her left eye. After 3 months of using steroid eye drops, artificial tears, and oral steroid intermittently, there was no improvement in symptoms and signs, thus this case was considered intractable with the conventional therapy. A mixture of bevacizumab (0.15 cc) and triamcinolone (0.05 cc) was injected into the sub-tenon's capsule of the left eye. After 1 week, all symptoms and signs disappeared, and there was no recurrence for 6 months. A 55-year-old female was transferred to our clinic due to SLK that did not respond to artificial tears, steroid eye drops, punctal occlusion, and botox injection for 3 months. A mixture of bevacizumab (0.15 cc) and triamcinolone (0.05 cc) was injected into the sub-tenon's capsule of the left eye. After 2 weeks, all symptoms and signs were improved, and there was no recurrence for 4 months. CONCLUSIONS: The presented 2 SLK cases are meaningful, because neovascularization disappeared and controlled inflammation was obtained following sub-tenon injection with both bevacizumab and triamcinolone.
Aged ; Female ; Humans ; Inflammation ; Keratoconjunctivitis* ; Middle Aged ; Ophthalmic Solutions ; Recurrence ; Triamcinolone* ; Bevacizumab

Congenital branchial anomalies are developmental defects resulting from incomplete obliteration of branchial clefts, arches and pouches, and usually found as cysts, fistulas and sinuses. The sinus or fistula is usually noted during infancy and young childhood due to recurrent infection. We have experienced a case of branchial cleft fistula in a 12-year-old male. It was a skin colored, nontender nodule which had mucus secreting from a small opening pore. We performed complete surgical removal and histopathologically the lumen was lined by pseudostratified columnar cells and the stroma was composed of aggregates of lymphocytes with many germinal centers. So we finally diagnosed it as branchial cleft fistula of second type branchial anomaly.
Branchial Region* ; Child ; Fistula* ; Germinal Center ; Humans ; Lymphocytes ; Male ; Mucus ; Skin

PURPOSE: To evaluate the clinical usefulness of the phenol red thread test as a diagnostic tool of dry eye by comparing the phenol red thread test, Schirmer's test and tear break-up time. METHODS: The present study included 30 dry eye patients belonging to dry eye workshop grade 1 or 2 and 25 normal subjects. Phenol red thread test, Schirmer's test, and tear break-up time were performed on each subject's right eye. The sensitivity, specificity and repeatability of each test were compared, and the correlations between the 3 tests were also analyzed. RESULTS: Tear break-up time was superior to the other tests in terms of sensitivity and repeatability. The phenol red thread test was better than Schirmer's test in terms of specificity and repeatability. In all 55 patients including dry eye patients and normal subjects, the phenol red thread test showed a greater correlation with tear break-up time than did Schirmer's test. In addition, in 25 dry eye patients, the correlation between the phenol red thread test and Schirmer's test increased significantly. CONCLUSIONS: The phenol red thread test is less irritating and requires a shorter testing time than Schirmer's test. Additionally, the phenol red thread test is superior to Schirmer's test in terms of specificity, repeatability, and relation to tear break-up time. In addition, the correlation between the phenol red thread test and Schirmer's test significantly increases in dry eye patients. Therefore, the phenol red thread test is a good substitute option for Schirmer's test in diagnosing dry eye.
Eye ; Humans ; Phenol ; Phenolsulfonphthalein ; Sensitivity and Specificity ; Tears

We report the case of a 37-year-old man with a high myopic keratoconus eye that was treated with a posterior chamber toric implantable collamer lens (ICL) in Korea. The patient had a history of contact lens intolerance and did not want to have a corneal transplantation. His uncorrected visual acuity (UCVA) and best spectacle corrected visual acuity were 0.02 and 0.4 in the left eye, respectively. Preoperatively, the manifest refraction was -12.0 -3.5 x 30A. Postoperatively, the manifest refraction was -1.75 x 180A. UCVA improved markedly after implantation. No intraoperative or postoperative complications were observed during 20 months of follow-up. Toric ICL implantation may be a possible alternative surgical option for the visual rehabilitation of high myopic astigmatism in keratoconus patients with rigid gas permeable contact lens intolerance and in patients who do not want to get a corneal transplant.
Adult ; Follow-Up Studies ; Humans ; Keratoconus/*rehabilitation/*surgery ; *Lens Implantation, Intraocular ; Male ; *Phakic Intraocular Lenses ; *Visual Acuity

PURPOSE: To report the clinical outcomes of deep anterior lamellar keratoplasty (DALK) when sterile gamma-irradiated acellular corneal tissues (VisionGraft) are used in combination with amniotic membrane transplantation (AMT) for intractable ocular surface diseases. METHODS: The medical records of fifteen patients who had DALK with AMT were retrospectively reviewed. Indications for surgery included ocular burn, bacterial keratitis, herpes simplex virus keratitis, corneal opacity with Stevens-Johnson syndrome, Mooren's ulcer, idiopathic myxoid degeneration of corneal stroma, and recurrent band keratopathy. DALK was performed using partial-thickness acellular corneal tissue and a temporary amniotic membrane patch was added at the end of the operation. RESULTS: All cases that underwent DALK with AMT became epithelialized within 2 postoperative weeks. Twelve patients showed favorable outcomes without graft rejection, corneal opacification, or neovascularization. The other three grafts developed corneal opacification and neovascularization, and required additional penetrating keratoplasty (PK). Unlike the results of previous PKs, there were no graft rejections and the graft clarity was well-maintained in these three cases for at least 8 months after PK. CONCLUSIONS: DALK using sterile acellular corneal tissues in combination with AMT may be a good therapeutic strategy for treating intractable ocular surface diseases because of lowered immune rejection, fibroblast activation, and facilitation of epithelialization. Furthermore, DALK can help stabilize the ocular surface, prolong graft survival, and may allow better outcomes when combined with subsequent PK.
Adult ; Aged ; Amnion/*transplantation ; Corneal Diseases/pathology/*surgery ; Corneal Stroma/radiation effects/*transplantation ; Female ; Graft Survival ; Humans ; Keratoplasty, Penetrating/*methods ; Male ; Middle Aged ; Retrospective Studies ; Visual Acuity ; Young Adult

BACKGROUND: The etiologies of ischemic cerebrovascular diseases are various-thrombosis or artery to artery embolism, cardiogenic embolism and lipohyalinosis. In the past embolic cerebral infarct was thought to occur uncommonly. But these days substantial portion of patients have been found to have potential embolic sources by transesophageal echo cardiography and carotid duplex doppler. As transesophageal echocardiography has a high yield for identification of potential sources of cardiac embolism in patients with ischemic cerbrovascular diseases, its use has been increasing. In Korea an increasing number of patients with ischemic cerebrovascular diseases have been examined by transesophageal echocardiography since 1990. But in all the previous studies transesophageal echocardiographic evaluation has been confined to the patients with high probability of embolic cerebral infarct. All kinds of ischemic cerebrovascular diseases patients have never been examined by transesophageal echocardiography and carotid duplex doppler and the prevalence of potential embolic sources in Korean ischemic cerebrovascular disease patients is not known. The aim of this study was to evaluate the prevalence of potential cardiovascular embolic sources by transesophageal echocardiography and carotid duplex doppler in unselected patients with ischemic cerebrovascular diseases. METHODS: We evaluated all kinds of ischemic cerebrovascular diseases patients admitted from 1994. 9. 1. until 1995 9. 31. to the Departments of Neurology and Internal Medicine of Kangnam General Hospital. We evaluated them by transesophageal echocardiography, carotid doppler, brain CT(or brain MRI). A significant carotid stenosis was defined as a duplex scandetected lesion producing at least 50% vessel narrowing. The following echocardiographic findings were defined prospectively as potential cardiac sources of embolism : atrial appendage or left atrial cavity thrombus, spontaneous echocardiographic contrast, atrial septal aneurysm, interatrial shunt, ventricular aneurysm, ventricular thrombus, myxomatous mitral valve and protruding atherosclerotic plaque in the ascending aorta or transverse aortic arch. RESULTS: Of 64 patients admitted during the study period, 30 were excluded(Three patients were critically ill, and twenty seven patients refused diagnostic work-up.). Thorough diagnostic work-up was performed in 34 patients. Transesophageal echocardiographic positive findings were present in six patients(17.6%). Of them four(4/34, 11.7%) had spontaneous echo contrast, two(2/34, 5.8%) had left atrial thrombi, one(1/34, 2.9%) had ascending aorta atheroma. Eleven patients(11/34, 32.3%) had abnormalities in carotid doppler study. Five patients(5/34, 14.7%) had abnormalities both in transesophageal echocardiography and carotid doppler study. CONCLUSIONS: The results suggest that among ischemic cerebrovascular diseases patients substantial portion of patients have potential embolic sources. The prevalence of potential embolic sources in Korea may be higher than previously expected. Because the relative small number of the patients studied make it difficult to generalize the results, further studies with a large number of patients are needed.
Aneurysm ; Aorta ; Aorta, Thoracic ; Arteries ; Atrial Appendage ; Brain ; Carotid Stenosis ; Critical Illness ; Echocardiography ; Echocardiography, Transesophageal ; Embolism ; Hospitals, General ; Humans ; Internal Medicine ; Korea ; Mitral Valve ; Neurology ; Plaque, Atherosclerotic ; Prevalence ; Prospective Studies ; Thrombosis

We evaluated the clinical results of 43 patients (47 eyes) who underwent cataract extraction and implantation of domestic posterior chamber intraocular lens manufactured by Universal Optics Co. (UNI(R) IOL) and could be followed up over 6 months. The mean follow-up period was 10.2 months with a range of 6 to 15 months. The results were as follows: 1. The final corrected visual acuity of 0.5 or better was noted in 41 eyes (87.2%). 2. The difference between the calculated postoperative refraction and the actual postoperative refraction was less than +/-1.00 D in 33 eyes (70.2%). 3. The corneal thickness increased 8.2% at postoperative period of 3 days and returned to preoperative level at postoperative period of 4 weeks. 4. The corneal endothelial cell density decreased 11.2% at postoperative period of 4 weeks and 12.8% at postoperative period of 6 months. 5. The early postoperative inflammatory reaction in anterior chamber and deposits on the surface of intraocular lens decreased gradually in the course of postoperative period. 6. The postoperative complications included posterior capsular opacification (7 eyes), fibrinous membrane (3 eyes), and hyphema (2 eyes). The above results showed that the visual outcome and the safety of UNI(R) IOL were favorable.
Anterior Chamber ; Cataract Extraction ; Endothelial Cells ; Fibrin ; Follow-Up Studies ; Humans ; Hyphema ; Lens Implantation, Intraocular* ; Lenses, Intraocular* ; Membranes ; Postoperative Complications ; Postoperative Period ; Visual Acuity