PURPOSE: We report a case of sphenoid and ethmoid mucocele causing orbital apex syndrome, which was successfully treated with drainage under nasal endoscopy. METHODS: A 82-year-old female visited the hospital complaining of decreased visual acuity in her left eye for 15days. Visual acuity of the left eye was hand motion . She also complained of left ocular pain and headache. In ophthalmologic examination, exophthalmos, mild ptosis, extraocular muscle movement limitation and RAPD (relative afferent pupillary defect) of the left eye were found. Orbital CT showed a 3.3 X 2.9 X 4.1 cm sized well-demarcated cystic lesion involving the left sphenoid sinus, left ethmoid sinus, and posterior portion of the right ethmoid sinus. The ethmoid air cell was remodeled by this cystic mass. The medial wall of the left orbit was protruded outward. So, the medial rectus muscle and optic nerve in the left orbit were compressed. We found a bulging yellowish cystic mass supero-posterior to the middle turbinate under nasal endoscopy. We performed incision and drainage under nasal endoscopy. RESULTS: At post-operative 2days, orbit CT showed the removed large mucocele in the sphenoid and ethmoid sinuses. At post-operative 2weeks, corrected visual acuity of the left eye was 0.6. There was no exophthalmos, ptosis, or extraocular muscle movement limitation. CONCLUSIONS: Endoscopic surgery in the treatment of paranasal mucocele can be performed during a short time under local anesthesia and anatomical change of the paranasal sinus can be minimized. We therefore suggest that drainage through nasal endoscopy is effective method in the treatment of paranasal sinus mucocele.
Aged, 80 and over ; Anesthesia, Local ; Drainage ; Endoscopy ; Ethmoid Sinus ; Exophthalmos ; Female ; Hand ; Headache ; Humans ; Mucocele* ; Optic Nerve ; Orbit ; Sphenoid Sinus ; Turbinates ; Visual Acuity

We studied the effect of LASIK(laser in situ keratomileusis) on the correction of astigmatism for patients with simple myopia & compound myopic astigmatism. LASIK was performed on 147 eyes of 108 patients using VISX STAR. All the cases were divided into two groups by the amount of underlying astigmatism: 64 eyes for simple myopic group(equal or less than 0.5D) and 83 eyes for compound myopic astigmatism group(more than 0.75D). The attemped correction for refractive error was determind by cycloplegic refraction. We evaluated the changes of refractive error, uncorrected visual acuity, best corrected visual acuity, corneal topography, corneal thickness and keratometry before operation, one day, one week,two months and six months after operation. Uncorrected visual acuity improved from 0.062+/-0.056 before operation to 0.821+/-0.215 at six months after operation in simple myopic group and from 0.069+/-0.068 to 0.735+/-0.224 in compound myopic group. Spherical equivalent was reduced from -8.135+/-2.096D before operation to -0.765+/-1.186D at six months after operation in simple myopic group and from -9.498+/-3.181D to -1.022+/-1.504D in compound myopic astigmatic group. Mean astigmatism increased from -0.300+/-0.205D before operation to -0.703+/-0.553D at six months after operation in simple myopic group and was reduced from -1.640+/-1.047D to -1.075+/-0.811D in compound myopic astigmatic group. Decentration of ablation from the pupil center was ranged between 0.00 and 1.42mm(mean 0.449+/-0.341mm) in all the patients by corneal topography. It was 0.446+/-0.333mm in simple myopic group and 0.452+/-0.353mm in compound myopic astigmatic group respectively. The patients with a decentration more than 1.00mm showed a statistically significant astigmatism than those with a decentration equal or less than 1.00mm.With these results it is suggested that LASIK with VISX STAR would be effective in correction of astigmatism equal or more than 0.75D. In contrast, it is not effective in correction of astigmatism equal or less than 0.5D.
Astigmatism ; Corneal Topography ; Humans ; Keratomileusis, Laser In Situ ; Myopia ; Pupil ; Refractive Errors ; Visual Acuity

This study evaluated the risk factor of glaucoma progression despite of adequate intraocular pressure[IOP]and that of glaucomatous optic nerve head progression before visual field progression with minimum treatment regimen. Inclusion criteria included subjects with elevated intraocular pressure and glaucomatous optic nerve head in fundus examination. Patients were main-tained their IOP by medication or filtering surgery. Baseline assessment included routine ocular examination, Heidelberg Retina Tomograph[HRT]and visual field. All patients were reexamined 6 months after the first examina-tion. We review the results of 61 patients[118 eyes]. In multiple logistic regression analysis, the risk factors of glaucoma progression were age[p=0.027] and the intraocular pressure at the first HRT examination[p=0.0216]. Glaucomatous visual field progression correlated significantly with HRT progres-sion[p=0.0216]. If the early glaucoma progression is detected with HRT, progression of glaucoma can be prevented. In the groups with the risk factors, the target pressure should be lower to prevent further loss or blindness with agressive treatment. In groups without risk factor, the quality of patient's life can be improved with minimum treatment. We may be able to prevent the progression of glaucomatous field defect, if we can recognize the early change of their optic nerve head morphology. Their findings may help us to differentiate non-risk group from risk group. We hope that we would improve our patient's life quality by minimizing glaucoma treatment especially in the non-risk group.
Blindness ; Filtering Surgery ; Glaucoma ; Hope ; Humans ; Intraocular Pressure ; Logistic Models ; Optic Disk* ; Optic Nerve* ; Quality of Life ; Retina* ; Risk Factors* ; Visual Fields

We evaluated the degree and mechanism of regression after laser in situ keratomileusis[LASIK]on moderate to highly myopic eyes during the first postopserative 6 months. Betwwen January 1997 and October 1998, 61 eyes operated on with LASIK for myopia, with 2 diopter or more myopic regres-sion occuring during than first 6 months were included in this study. And 79 eyes in control group with less than 1 diopter were included. The attemped correction for refractive error was determined by cycloplegic refraction. We evaluated the changes of refractive error, uncorrected visual acuity, best corrected visual acuity, corneal topography, corneal thickness and keratometry before operation, one day, one week, two months and six months after operation. In regression group, corneal thickness was significantly incresed from 0.425 +/-0.048millimeter at postoperative 1 week to 0.444 +/-0.050millimeter postoperative 6 month[p=0.003]and central corneal power was significantly increased from 36.45 +/-2.03 dopter at 1 week to 37.45 +/-5.52 diopter.[p<0.01]The larger sperical equivalent and cylinder were, the more amount myopic regression was in contrast with control group. Early regression of refractive effect after LASIK appears to be a consequence of an increase in corneal thickness associated with central corneal steepening.
Corneal Topography ; Keratomileusis, Laser In Situ* ; Myopia ; Refractive Errors ; Visual Acuity

PURPOSE: The purpose of this study was to assess the satety and effectiveness of lacrimal trephination and balloon dilatation in treatment of obstruction of the lacrimal canaliculus. METHODS: Lacrimal trephination and subsequent balloon dilation was performed in 7 eyes of 7 consecutive patients with epiphora due to lacrimal canalicular obstruction and common canalicular obstruction. RESULTS: The average age of patients was 50.3 years old and the average follow-up period was 17.7 months. Anatomical success was 7 of 7 eyes (100%) and functional success , resolution of epiphora was 5 of 7 eyes (71%) CONCLUSIONS: Lacrimal trephination and subsequent ballooning canaliculoplasty in treatment of obstruction of the lacrimal canaliculus seems to be safe and valuable as an primary procedure before Jones tube bypass surgery.
Dilatation ; Follow-Up Studies ; Humans ; Intubation* ; Lacrimal Apparatus Diseases ; Silicones* ; Trephining*

OBJECTIVE: The purpose of this study was to evaluate the clinical efficacy of the early pelviscopic intervention in the acute pelvic inflammatory disease of reproductive aged female. METHODS: A clinical evaluation for 30 women who underwent pelviscopic pus drainage in the pelvic inflammatory disease from September 2001 to December 2004 was done. This study group was compared with the control group that 34 cases of intravenous antibiotics treatment performed and we evaluated the clinical and laboratory findings were recorded for all patients before and after treatment. RESULTS: The mean hospital stay was 7.8 days and 6.9 days respectively (p=0.25). There was statistical difference in regarding to febrile status period, that is febrile status was significantly improved in pelviscopy group. The febrile status of the study group was normalized within postoperative third day except 1 case that postoperative hematoma was formed in cul de sac, but it was not normalized within hospital fifth day in 6 cases (27%) of the control group (p=0.05). But there was no statistical difference between the two groups in regarding to clinical symptom free period except febrile status, WBC count change, and ESR/CRP count change. CONCLUSION: In this study, no significant difference was found between the two groups in regarding to clinical progress. But this study suggested that the early pelviscopic pus drainage was effective first line treatment method for the acute pelvic inflammatory disease with less complications and relatively rapid clinical improvement. However further study with more expanded cases that early pelviscopic intervention was done for the prevention of long term complications of pelvic inflammatory disease will be needed.
Anti-Bacterial Agents ; Drainage* ; Early Intervention (Education)* ; Female ; Hematoma ; Humans ; Length of Stay ; Pelvic Inflammatory Disease* ; Suppuration*

PURPOSE: We report a case of orbital abscess secondary to acute dacryocystitis in which the patient had been cared for chronic dacryocystitis. METHODS: A 59-year-old woman presented to our clinic with a history of chronic sinusitis from childhood and right chronic dacryocystitis treated for 6 years. She had sufferred from influenza 2 weeks previously and complained of painful lid swelling, limitation of ocular movement, exophthalmos, chemosis, and decreased vision of the right eye for 2 weeks. An orbital CT scan was taken and bacterial culture and sensitivity tests were done from the discharge. RESULTS: CT scan showed inflammation and abscess formation around the right nasolacrimal duct orifice which was swollen and widened. Some of the inflammation tissues extended into the retrobulbar portion. Streptococcus pyogenous was cultured. Lid swelling, pain, exophthalmos, and visual acuity improved after external dacryocystorhinostomy, and surgical drainage. CONCLUSIONS: We should be careful in a case of acute dacryocystitis underlying chronic dacryocystitis as it easily causes complications, and in such a case early surgical management as well as antibiotics therapy is more effective.
Abscess* ; Anti-Bacterial Agents ; Dacryocystitis* ; Dacryocystorhinostomy ; Drainage ; Exophthalmos ; Female ; Humans ; Inflammation ; Influenza, Human ; Middle Aged ; Nasolacrimal Duct ; Orbit* ; Sinusitis ; Streptococcus ; Tomography, X-Ray Computed ; Visual Acuity

PURPOSE: In a preliminary series of 36 eyes with partial nasolacrimal duct obstruction, the types of dacryoscintigraphy result were classified and the results of silicone tube intubation were analysed. METHODS: The results of dacryoscintigraphy, performed in 36 eyes of 29 patients with partial nasolacrimal duct obstruction, were classified into the following 3 types: pre-lacrimal sac type, proximal nasolacrimal duct type and distal nasolacrimal duct type. Punctoplasty accompanied by silicone tube intubation was conducted selectively. RESULTS: In dacryoscintigraphy, symptoms improved in 6 eyes among 6 in distal nasolacrimal duct type (100%), 14 eyes among 18 in proximal nasolacrimal duct type (77.8%) and 8 eyes among 12 in pre-lacrimal sac type (66.7%). CONCLUSIONS: We conclude that dacryoscintigraphy predicts the results of silicone tube intubation. Furthermore, silicone tube intubation was effective in proximal nasolacrimal duct type and distal nasolacrimal duct type, but less effective in pre-lacrimal sac type of partial nasolacrimal duct obstruction.
Humans ; Intubation* ; Nasolacrimal Duct* ; Silicones*

Most of anti-incontinence surgeries bear the risk of postoperative complication such as voiding dysfunction due to urethral obstruction. Fortunately, Tension Free Vaginal Tape(TVT) procedure has much lower incidence of postoperative urethral obstruction than other surgical procedures for stress urinary incontinence. There are many reports about the surgical treatments for short-term urethral obstruction after TVT procedure. However, there are few reports on the effect of surgical releasing of the obstruction lasting for a long period. In our case, the patient had urethral obstruction for 32 months after TVT procedure and she was able to void well after surgical releasing of the tape. We suggest that releasing of the tape will be a treatment of choice for long-term urethral obstruction after TVT procedure.
Humans ; Incidence ; Postoperative Complications ; Suburethral Slings* ; Urethral Obstruction* ; Urinary Incontinence

Immunosuppressive agent has been used as a therapeutic agent for Endogeneous posterior uveitis[EPU]. But serious side effect of steriod or cyclosporine and frequent recurrence of ocular inflammation warrant the addition of other immunosuppressive agents. In this study, we evaluated the therapeutic effectiveness of low dose triple therapy using steroid, cyclosporine and azathioprine when combination therapy with steroid and cyclosporine had failed. We reviewed the records of 10 Behcet's patients[18 eyes]and 2 sympathetic ophthalmia patients[2 eyes]who had been resistant to steroid and cyclosporine combination therapy. The median follow up duration of triple therapy was 16.3 months. Recurrence, severity of inflammation, systemic manifestations associated with Behcet's disease, and side effect of therapeutic agents were evaluated. There was a significantly decrease in the frequency[0.37/month during pretriple therapy and 0.14/month after triple therapy]and severity of ocular inflammation[p<0.01]. The frequency and severity of systemic manifestations also decreased. Visual acuity remained stable in 7 eyes[35%]and improved in 13 eyes[65%]. No serious side effects or newly developed side effect were developed during triple therapy except reversible mild anemia in 1 patient. The results of our study suggest that triple agent immunosuppressive therapy is well tolerated and appears to be effective for the severe uveitis which is refraction to steroid and cyclosporine combination therapy.
Anemia ; Azathioprine ; Cyclosporine* ; Follow-Up Studies ; Humans ; Immunosuppressive Agents ; Inflammation ; Ophthalmia, Sympathetic ; Recurrence ; Uveitis* ; Visual Acuity