To evaluate surgically induced astigmatism in cataract surgery, we studied retrospectively a series of 30 eyes with 6.5mm sutureless frown incision(Group 1) and 30 eyes with linear scleral tunnel incision and 3 interrupt sutures using 100 nylon(Group 2). In all cases phacoemulsifications were performed and posterior chamber lenses were implanted. Group 1 showed the against-the-rule astigmatism at postoperative 2 week, and then the change of the astigmatism was minimal and still against-the-rule by postoperative 6 week and 3 month. In contrast, Group 2 showed with-therule astigmatism at postoperative 2 week and then showed the against-the-rule by postoperative 6 week and 3 month. There was no significant difference in the proportion of corrected visual acuity of 0.5 or better between two groups at postoperative 3 month, while uncorrected visual acuity of 0.5 or better was 93.3% in group 2, and 30.0% in group 1 at postoperative 3 month. In this study, it was found that the pattern of surgically induced astigmatism and uncorrected visual outcome in cataract surgery were different according to incision and suture techniques.
Astigmatism ; Cataract ; Nylons* ; Phacoemulsification ; Retrospective Studies ; Suture Techniques ; Sutures* ; Visual Acuity

In order to evaluate risk factors (sex, age, preoperative diagnoses, graft size, neovascularization of the recipient cornea, bilaterality, history of the previous graft failure, doner corneal preservation method, phakic status, glaucoma and enucleation time after death) influencing graft rejection, we reviewed 96 eyes underwent penetrating keratoplasty at the Chonnam University Hospital from May 1992 to December 1995, retrospectively. The rate of the graft rejection in penetrating keratoplasty was 34.3% (33 eyes). In detail, graft rejection occurred in 16 eyes(47%) among 34 vascularized corneas of recipient(R=18.0, P=0.000), 23 eyes(69.7%) among 33 vascularized orneas of donor side after operation (R=0.3, P=0.010), 5 eyes(35.7%) among 14 bilateral grafts, 4 eyes (57.1%) among 7 eyes having a history of graft failure, 6 eyes(40.0%) among 15 aphakic eyes(R=3.84, P=0.033), and 14 eyes among 32 eyes enucleated longer than 6 hours after death (R=10.1, P=0.002). In contrast, graft rejection occurred in 13 eyes (76.5%) among 17 postoperative glaucomatous eyes and in 20 eyes (25.3%) among 79 postoperative non-glaucomatous eyes, there was no statistically significant difference between two groups(P>0.05). These results suggest that neovascularzation of the either donor or recipient cornea, aphakic status of the recipient eyes, and enucleation time longer than 6 hours after death are high risk factors for graft rejection.
Cornea ; Diagnosis ; Glaucoma ; Graft Rejection* ; Humans ; Jeollanam-do ; Keratoplasty, Penetrating* ; Retrospective Studies ; Risk Factors ; Tissue Donors ; Transplants*

PURPOSE: To evaluate the primary indications, surgical outcomes, causes and risk factors for failure in patients with repeat corneal transplantation. METHODS: We retrospectively analyzed indications for the initial corneal graft, best corrected visual acuity, survival period, corneal clarity, cause and risk factor for failure in 42 patients (45 eyes) who underwent repeat penetrating keratoplasty with a minimum follow-up period of 6 months. RESULTS: The most common primary indications were herpes simplex keratitis (21.4%), followed by corneal scar (19.0%) and pseudophakic bullous keratopathy (9.0%). The average period of repeat corneal transplantation was 19.1 +/- 24.9 months. The most common cause of the failure of penetrating keratoplasty was allograft rejection(79.3%). The risk factors of graft failure were corneal neovascularization, chronic inflammation and the number of regrafts. CONCLUSION: The most common primary indication of repeat corneal transplantation was herpes simplex keratitis. The mean survival period was about 19 months. The factors that appeared to influence the survival period of repeat corneal transplantation were the corneal neovascularization, chronic inflammation and the number of regrafts.
Allografts ; Cicatrix ; Corneal Neovascularization ; Corneal Transplantation ; Follow-Up Studies ; Humans ; Inflammation ; Keratitis, Herpetic ; Keratoplasty, Penetrating* ; Retrospective Studies ; Risk Factors* ; Transplants* ; Visual Acuity

We report on a case of necrotizing keratoscleritis in primary Sjogren's syndrome. A 66-year-old female patient who was complaining of ocular pain, tearing and decreased vision in her right eye for the previous two days was admitted to our hospital. Visual acuity in the right eye was hand movement, and initial examination showed a 3.0 x 1.8 mm uveal mass bulging through a corneoscleral melting site in the nasal region of the right eye. Positive anti-nuclear antibody was identified at a titer of 1:320 with a speckled pattern, and both Sjogren's syndrome A and Sjogren's syndrome B antibody tests were positive, with titers >200 U/mL. A technetium 99m pertechnetate salivary scan revealed chronic sialoadenitis in the submandibular glands. We diagnosed the lesion as necrotizing keratoscleritis due to primary Sjogren's syndrome. A corneoscleral patch graft was performed, followed by immunosuppression including oral cyclosporin and topical prednisolone. During a follow-up period of 12 months, the corneoscleral graft was well maintained with no recurrence.
Aged ; Diagnosis, Differential ; Disease Progression ; Female ; Follow-Up Studies ; Glucocorticoids/administration & dosage ; Humans ; Keratitis/drug therapy/*etiology/pathology ; Necrosis ; Ophthalmic Solutions ; Scleritis/drug therapy/*etiology/pathology ; Sjogren's Syndrome/*complications/drug therapy/pathology ; Visual Acuity

BACKGROUND/AIMS: There are few data supporting the diagnostic yield of brush cytology depending on the order of cytologic preparation method or the location or shape of tumors in biliary strictures. We investigated diagnostic yields and variations in brush cytology with direct smear and cell-block preparations according to sampling preparation sequence and tumor location and shape in biliary strictures. METHODS: Patients who had undergone ERCP with tissue sampling between August 2009 and April 2013 were analyzed retrospectively. Group A was examined using brush cytology with direct smear followed by cell-block with or without biopsy, while the reverse order was performed for group B. RESULTS: Among 138 enrolled patients, 92 patients (A: 36, B: 56) underwent both brush cytology with direct smear and cell-block preparations. No differences in sensitivity, specificity, or accuracy were observed according to the sampling preparation method and the location or shape of tumors in biliary strictures. The cellularity observed from brush cytology with direct smear was better than that from cell-block according to the location of the tumor (p<0.01). The diagnostic yield was increased in both groups with addition of an endobiliary biopsy. CONCLUSIONS: No difference in diagnostic accuracy was observed between the sequences of preparation for brush cytology with direct smear and cell-block techniques. Brush cytology showed better cellularity for diagnosis.
Aged ; Aged, 80 and over ; Bile Duct Neoplasms/*pathology ; Cholangiocarcinoma/pathology ; Cholangiopancreatography, Endoscopic Retrograde ; *Cytodiagnosis ; Female ; Gallbladder Neoplasms/pathology ; Humans ; Male ; Middle Aged ; Neoplasm Staging ; Pancreatic Neoplasms/pathology ; Retrospective Studies ; Sensitivity and Specificity

BACKGROUND/AIMS: Delayed post-endoscopic submucosal dissection (ESD) bleeding (DPEB) is difficult to predict and there is controversy regarding the usefulness of prophylactic hemostasis during second-look endoscopy. This study evaluated the risk factors related to DPEB, the relationship between clinical outcomes and the Forrest classification, and the results of prophylactic hemostasis during second-look endoscopy. METHODS: Second-look endoscopy was performed on the day after ESD to check for recent hemorrhage or potential bleeding and the presence of artificial ulcers in all patients. RESULTS: DPEB occurred in 42 of 581 patients (7.2%). Multivariate analysis determined that a specimen size ≥40 mm (odds ratio [OR], 3.03; p=0.003), and a high-risk Forrest classification (Forrest Ib+IIa+IIb; OR, 6.88; p<0.001) were risk factors for DPEB. DPEB was significantly more likely in patients classified with Forrest Ib (OR, 24.35; p<0.001), IIa (OR, 12.91; p<0.001), or IIb (OR, 8.31; p<0.001) ulcers compared with Forrest III ulcers. There was no statistically significant difference between the prophylactic hemostasis and non-hemostasis groups (Forrest Ib, p=0.938; IIa, p=0.438; IIb, p=0.397; IIc, p=0.773) during second-look endoscopy. CONCLUSIONS: The Forrest classification of artificial gastric ulcers during second-look endoscopy seems to be a useful tool for predicting delayed bleeding. However, routine prophylactic hemostasis during second-look endoscopy seemed to not be useful for preventing DPEB.
Classification* ; Endoscopy* ; Hemorrhage ; Hemostasis ; Hemostasis, Endoscopic ; Humans ; Multivariate Analysis ; Risk Factors ; Stomach Neoplasms ; Stomach Ulcer ; Ulcer*

Acute colonic pseudo-obstruction (Ogilvie syndrome) associated with herpes zoster is extremely rare, and few cases have been reported. An 81-year-old woman diagnosed with herpes zoster was referred for accompanying colonic ileus. The diameter of the cecum was 7 cm and a computed tomographic scan showed no definite obstructive cause. Because the patient showed minimal improvement with conservative treatment, endoscopic colonic decompression was performed successfully. Previous studies revealed that the treatment of Ogilvie syndrome associated with herpes zoster does not differ from that of other conditions, and the role of the varicella-zoster virus in this syndrome is unclear. Here, we present the first case of Ogilvie syndrome associated with herpes zoster in Korea, which was improved by endoscopic colonic decompression.
Aged, 80 and over ; Cecum ; Colon ; Colonic Pseudo-Obstruction ; Decompression ; Female ; Herpes Zoster ; Herpesvirus 3, Human ; Humans ; Ileus ; Korea

Background: Current international guidelines recommend against deep sedation as it is associated with worse outcomes in the intensive care unit (ICU). However, in Korea the prevalence of deep sedation and its impact on patients in the ICU are not well known. Methods: From April 2020 to July 2021, a multicenter, prospective, longitudinal, noninterventional cohort study was performed in 20 Korean ICUs. Sedation depth extent was divided into light and deep using a mean Richmond Agitation–Sedation Scale value within the first 48 hours. Propensity score matching was used to balance covariables; the outcomes were compared between the two groups. Results: Overall, 631 patients (418 [66.2%] and 213 [33.8%] in the deep and light sedation groups, respectively) were included. Mortality rates were 14.1% and 8.4% in the deep and light sedation groups (P = 0.039), respectively. Kaplan-Meier estimates showed that time to extubation (P < 0.001), ICU length of stay (P = 0.005), and death P = 0.041) differed between the groups. After adjusting for confounders, early deep sedation was only associated with delayed time to extubation (hazard ratio [HR], 0.66; 95% confidence inter val [CI], 0.55– 0.80; P < 0.001). In the matched cohort, deep sedation remained significantly associated with delayed time to extubation (HR, 0.68; 95% 0.56–0.83; P < 0.001) but was not associated with ICU length of stay (HR, 0.94; 95% CI, 0.79–1.13; P = 0.500) and in-hospital mortality (HR, 1.19; 95% CI, 0.65–2.17; P = 0.582). Conclusion In many Korean ICUs, early deep sedation was highly prevalent in mechanically ventilated patients and was associated with delayed extubation, but not prolonged ICU stay or in-hospital death.