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Graft Adhesion and Recovery of Corneal Function after Posterior Lamellar Keratoplasty.

Journal of the Korean Ophthalmological Society.2006;47(7):1100-1109.

PURPOSE: Posterior lamella keratoplasty has been described as a new procedure to treat corneal conditions involving endothelial dysfunction by selective transplantation of only the posterior corneal tissue composed of the endothelium, Descemet membrane, and posterior stroma. This study has been conducted to evaluate the recovery of endothelial function and adhesion mechanism of transplanted posterior corneal tissue to the donor stroma after posterior lamella keratoplasty. METHODS: Dog corneal endothelium and posterior stroma were transplanted to recipient dog cornea stripped of endothelium and posterior stroma. The recovery of endothelial function and corneal thickness were measured by specular microscopy; pachymetry and slit lamp examination were done immediately after posterior lamella keratoplasty and at 1, 2, 4, 8 weeks post-operative. Eight weeks after operation, enucleation was performed and the histopathologic changes in the transplanted area of enucleated eyes were examined by light microscopy, fluorescent microscopy, and electron microscopy. RESULTS: Corneal thickness, endothelial function, and corneal transparency were recovered by the end of experiment. The newly produced collagen fibrils were absent at the corneal posterior flap and anterior stromal bed interface. The collagen fibrils adjacent to the flap interface were irregularly arranged and morphologically transformed in some cases (2 of 8 cases) and were linearly arranged in a parallel manner in others (6 of 8 cases). CONCLUSIONS: It can be suggested that the stability of transplanted posterior corneal flap is maintained by incomplete wound healing and recovery of corneal endothelial function.
Animals ; Collagen ; Cornea ; Corneal Transplantation* ; Descemet Membrane ; Dogs ; Endothelium ; Endothelium, Corneal ; Humans ; Microscopy ; Microscopy, Electron ; Tissue Donors ; Transplants* ; Wound Healing

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Anatomical Study of Medial Orbit in Human Cadavers.

Hyun Min SHIN ; Helen LEW ; Young Soo YUN

Journal of the Korean Ophthalmological Society.2006;47(7):1093-1099.

PURPOSE: This study investigated the anatomy of the anterior ethmoidal foramen, posterior ethmoidal foramen, optic foramen, and nasolacrimal duct located in the medial orbit. METHODS: The subjects of this investigation were 20 eyes of 10 cadavers, three were male and seven were female. After exenteration, anatomic evaluation of medial orbit and nasolacrimal duct were performed. The results were verified by Mann-Whitney U test. RESULTS: The distance from the posterior lacrimal crest is 16.10+/-1.07 mm to the anterior ethmoidal foramen, 30.35+/-4.08 mm to the posterior ethmoidal foramen and 37.40+/-2.03 mm to the optic foramen. The distance is 13.95+/-1.16 mm between the anterior and posterior ethmoidal foramen, 6.45+/-1.86 mm between the posterior ethmoidal foramen and optic foramen. The distance from the anterior ethmoidal foramen to its vertical contact point from the anterior ethmoidal foramen to the base line between the posterior lacrimal crest and optic foramen is 14.68+/-2.56 mm, from This vertical contact point to the posterior lacrimal crest is 4.00+/-1.35 mm and the angle between line from the anterior ethmoidal foramen to the posterior lacrimal crest and the line from the optic foramen to the posterior lacrimal crest is 16.15+/-7.03. The distance from the posterior ethmoidal foramen to its vertical contact point from the posterior ethmoidal foramen to the base line between the posterior lacrimal crest and optic foramen is 30.88+/-2.27 mm, from this vertical contact point to the posterior lacrimal crest is 2.30+/-0.71 mm and the angle between the line from the posterior ethmoidal foramen to the posterior lacrimal crest and the line from the optic foramen to the posterior lacrimal crest is 4.43+/-1.47. The total length is 33.55+/-5.34mm, the angle are 44.98+/-6.61 degrees between the coronal plane and 36.60+/-2.19 degrees between the sagittal palne in nasolacrimal duct. CONCLUSIONS: Our study evaluate normal anatomy of the medial orbit, suggest surgical index in Korean.
Cadaver* ; Female ; Humans* ; Male ; Nasolacrimal Duct ; Orbit*

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Needle Revision with and without Mitomycin C for the Teatment of Failed Filtering Blebs after Trabeculectomy.

In Ho ROH ; Sung Min HYUNG

Journal of the Korean Ophthalmological Society.2006;47(7):1087-1092.

PURPOSE: To evaluate the effects of needle revision (NR) with and without mitomycin C (MMC) for failed filtering blebs after trabeculectomy, and to identify risk factors for failure. METHODS: Thirty-one eyes whose intraocular pressure (IOP) did not decrease after cutting of scleral flap sutures were recruited. NR was performed with a 26-gauge needle under a slit-lamp. Immediately following NR, 15 eyes received subconjunctival injection of 0.002 mg (0.02 mg/ml) MMC at the adjacent conjunctiva. RESULTS: First NR was done at 1.3+/-1.2 months (range, 0.2~6.5 months) after trabeculectomy, and a mean of 1.6+/-1.6 NRs per patient were done. The follow-up period was 24.4+/-20.4 months (range, 6.0~87.4 months) after the last NR. Pre-NR mean IOP was 27.9+/-11.6 mm Hg and post-NR final IOP was 18.8+/-13.0 mm Hg (p=0.005). The success rate, defined as IOP < or =18 mm Hg with or without medication, was 80.3% (25 eyes of 31 eyes). The success rate was higher in the group receiving NR with adjunctive MMC (100%) than in the group receiving NR without MMC (62.5%) (p=0.018). Patients who underwent trabeculectomy without adjunctive MMC and those who had pre-NR IOP >25 mm Hg showed a higher failure rate, though with no statistical significance (p=0.141 and p=0.173, respectively). CONCLUSIONS: NR followed by subconjunctival injection of MMC is an effective and safe method for the treatment of the failed filtering blebs after trabeculectomy. Trabeculectomy without adjunctive MMC and pre-NR IOP higher than 25 mmHg were risk factors for failure of NR.
Blister* ; Conjunctiva ; Follow-Up Studies ; Humans ; Intraocular Pressure ; Mitomycin* ; Needles* ; Risk Factors ; Sutures ; Trabeculectomy*

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Fine-Needle Aspiration Biopsy of Intraocular Tumors.

Jong Hyun LEE ; Woo Ick YANG ; Sung Chul LEE

Journal of the Korean Ophthalmological Society.2006;47(7):1080-1086.

PURPOSE: To evaluate the efficacy and safety of fine-needle aspiration biopsy in the diagnosis of suspected intraocular malignancy and simulating conditions. METHODS: We performed a retrospective study of the medical records of patients who underwent diagnostic pars plana transvitreal biopsy. RESULTS: A total of 12 biopsies were performed in 11 eyes of 11 patients with intraocular tumor and the final diagnosis was confirmed by cytologic examination in 10 eyes. There was insufficient amount of material for cytologic examination in one case. In another case, biopsy was repeated to obtain the final result due to false negative result of the first biopsy. Localized intraocular hemorrhage was found to be the most common complication, but resolved spontaneously in most cases. Retinal detachment and tumor recurrence were not observed. CONCLUSIONS: Transvitreal fine-needle aspiration biopsy is an accurate diagnostic procedure in the evaluation of intraocular tumors difficult to diagnose with other non-invasive diagnostic technique and it can be performed safely with minimal complication.
Biopsy ; Biopsy, Fine-Needle* ; Diagnosis ; Hemorrhage ; Humans ; Medical Records ; Melanoma ; Recurrence ; Retinal Detachment ; Retrospective Studies

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Effects of Pars Plana Vitrectomy Comparing with Intravitreal Triamcinolone Acetonide Injection in Diabetic Macular Edema.

Yong Min KIM ; Sung Soo KIM ; Sung Chul LEE ; Oh Woong KWON ; Hyung Jun KOH

Journal of the Korean Ophthalmological Society.2006;47(7):1072-1079.

PURPOSE: The purpose of this study is to evaluate the benefit of pars plana vitrectomy (PPV) and removal of the internal limiting membrane (ILM) in diabetic macular edema, and to compare the effects of PPV and removal of ILM with intravitreal triamcinolone acetonide injection. METHODS: Fifteen eyes of 14 patients on whom PPV and removal of the ILM (group A) were performed and 14 eyes of 14 patients who received single intravitreal triamcinolone acetonide injection (group B) for diabetic macular edema over six months were included in this study. The main outcome measures were macular thickness, as measured by optical coherence tomography and visual acuity at 1, 3, and 6 months postoperatively. RESULTS: The mean preoperative visual acuity was 0.06+/-0.05 and macular thickness 516.01+/-120.29 micrometer in group A. At 1 month postoperatively, this group showed no significant improvement of visual acuity. However, there was significant improvement at 3 and 6 months postoperatively. Macular thickness also decreased significantly at 1, 3, and 6 months postoperatively. In group B, the mean preoperative visual acuity was 0.10+/-0.08 and macular thickness was 548.82+/-116.44 micrometer. At 1 and 3 months postoperatively, significant improvement of visual acuity was noted in this group. However, there was no significant difference at 6 months postoperatively. Macular thickness also decreased significantly at 1, 3, and 6 month postoperatively. Between two groups, visual acuity and macular thickness improved in Group B at 1 month postoperatively but at 6 months, visual acuity improved in Group A and there was no significant difference of macular thickness between the two groups. CONCLUSIONS: PPV and removal of the ILM are good therapeutic options for diabetic macular edema to improve visual acuity and macular thickness. These also offer more long term efficacy than intravitreal tiamcinolone acetonide injection.
Humans ; Macular Edema* ; Membranes ; Outcome Assessment (Health Care) ; Tomography, Optical Coherence ; Triamcinolone Acetonide* ; Triamcinolone* ; Visual Acuity ; Vitrectomy*

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Clinical Results of Implantation of Hydrophilic Acrylic Intraocular Lenses.

Yong Sok JI ; Kwang Hoon LEE ; Yeoung Geol PARK ; Kyung Chul YOON

Journal of the Korean Ophthalmological Society.2006;47(7):1065-1071.

PURPOSE: To evaluate the clinical results of Akreos(R) hydrophilic acrylic intraocular lens (IOL) implantation compared with implantation of Acrysof(R) hydrophobic acrylic IOL. METHODS: We retrospectively analyzed each fifty eyes in 50 patients who had undergone phacoemulsification and implantation of Akreos(R) and Acrysof(R) IOLs, with a minimum follow-up period of one year. RESULTS: Final visual acuity better than 0.5 and 0.8 was 70% and 27% in the Akreos(R) implanted group, and 82% and 46% in the Acrysof(R) group. Predictability less than 1.0D was seen in 23 eyes (46%) in the Akreos(R) group. This is a significantly low percentage compared with that seen in 43 eyes (86%) in the Acrysof(R) group. The final spherical equivalent of -0.93+/-0.92D in the Akreos(R) group represented statistically significant myopic refractive error compared with -0.49+/-0.82D in the Acrysof(R) group. CONCLUSIONS: It is necessary to consider the myopic refractive error toDetermine the proper target refraction for the implantation of Akreos(R) IOL.
Follow-Up Studies ; Humans ; Lenses, Intraocular* ; Phacoemulsification ; Refractive Errors ; Retrospective Studies ; Visual Acuity

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Onset of Retinal Detachment in Eyes with Phacoemulsification and Posterior Chamber Lens Implantaton.

Je Hyun SEO ; Jin Hak LEE

Journal of the Korean Ophthalmological Society.2006;47(7):1057-1064.

PURPOSE: To evaluate the onset of retinal detachment (RD) in eyes with phacoemulsification and post chamber lens (PE & PCL) implantation. METHODS: We retrospectively analyzed 3023 eyes that had undergone clear cornea incision and PE and PCL implantation and 116 eyes that had undergone scleral incision and PE and PCL implantation. They had been operated from January 1995 to December 2000 by one surgeon and followed up for 4 years or more. RESULTS: Eighteen eyes (0.57%) of the 3139 eyes developed pseudophakic RD within a mean period of 663 days. In the scleral incision group, there were 4 cases of pseudophakic RD (3.4%) of 116 eyes developed in a mean period of 185.2 days. In the clear cornea group, there were 14 pseudophakic RD eyes (0.46%) of the 3023 eyes and the mean period was 799 days. Of these, 3 eyes made up the intraoperative complication group with a mean period 205.6 days. But in the group of cases with no intraoperative complications, the mean period was 962 days. CONCLUSIONS: In high myopic eyes, retinal detachment developed in the earlier postoperative period and at a higher rate than those of non-high myopic eyes after PE and PCL implantation.
Cornea ; Intraoperative Complications ; Phacoemulsification* ; Postoperative Period ; Retinal Detachment* ; Retinaldehyde* ; Retrospective Studies

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Surgical Techniques and Postoperative Complications in Pediatric Cataract Surgery.

Jung Hyo AHN ; Wan Soo KIM

Journal of the Korean Ophthalmological Society.2006;47(7):1049-1056.

PURPOSE: To evaluate postoperative complications of different surgical techniques in pediatric cataract. METHODS: We retrospectively reviewed 105 eyes of 72 patients who had undergone irrigation and aspiration of cataracts with posterior chamber intraocular lens (IOL) implantation from January 1994 to June 2004. All the eyes were divided into three groups according to the surgical techniques used: group 1 (n=39), IOLs in the bag + intact posterior capsule; group 2 (n=24), IOLs in the bag + posterior continuous curvilinear capsulorhexis (PCCC) + anterior vitrectomy; group 3 (n=42), IOLs in the bag + PCCC + optic capture. Postoperative posterior capsular opacity (PCO), secondary intervention for PCO, strabismus, inflammation, glaucoma, vitreoretinal complications were evaluated. RESULTS: Different from those in the past, current surgical methods for pediatric cataract entail either the optic capture of IOL or anterior vitrectomy through PCCC. PCO is the most frequent postoperative complication. Thirty-five eyes (87.1%) in group 1, 2 eyes (8.3%) in group 2, and no eyes in group 3 developed PCO. Five eyes (33.3%) had recurrence of PCO when PCO was treated by Nd:YAG laser posterior capsulotomy. None had PCO recurrence with secondary optic capture of IOL. Postoperative inflammation and IOL decentration were more common in group 2 than in the other groups. There was no statistically significant difference in the prevalence of postoperative glaucoma between the groups. Neither vitreoretinal complication nor infection was found in our series. CONCLUSIONS: Optic capturing of IOL through PCCC permanently maintains the visual axis with the anterior vitreous face preserved.
Axis, Cervical Vertebra ; Capsulorhexis ; Cataract* ; Glaucoma ; Humans ; Inflammation ; Lenses, Intraocular ; Posterior Capsulotomy ; Postoperative Complications* ; Prevalence ; Recurrence ; Retrospective Studies ; Strabismus ; Vitrectomy

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Clinical Outcomes 10 Years after Penetrating Keratoplasty.

Seung Jae LEE ; Eun Young CHO ; Man Soo KIM

Journal of the Korean Ophthalmological Society.2006;47(7):1043-1048.

PURPOSE: To evaluate clinical outcomes 10 years after penetrating keratoplasty. METHODS: We analyzed 69 eyes of 68 patients who had undergone penetrating keratoplasty by one surgeon between 1994 and 1995. We evaluated long-term outcome of corneal graft and follow-up rates for 10 years after surgery. Slitlamp biomicroscopy was performed to assess the condition of grafts. Visual acuity, manifest refraction, central corneal thickness, and endothelial cell count were measured if the patient visited the clinic. The patients who did not visit the clinic were asked to subjectively assess visual acuity and gross corneal clarity to gauge the condition of the graft cornea by telephone survey. RESULTS: The mean age was 42.5 years and the sex distribution of recipients was predominantly male (M:F=48:20). At 10 years after surgery, 28 grafts were clear, 28 grafts were known to have failed, and the status of 13 grafts remained unknown. The highest survival rate was noted in keratoconus, and the major preoperative diseases of graft failure were bullous keratopathy and infectious keratitis. Fifty percent of patients attended all follow-up visits over the 10 years. CONCLUSIONS: The graft survival rate at 10 years after keratoplasty was 50%.
Cornea ; Corneal Transplantation ; Endothelial Cells ; Follow-Up Studies ; Graft Rejection ; Graft Survival ; Humans ; Keratitis ; Keratoconus ; Keratoplasty, Penetrating* ; Male ; Sex Distribution ; Survival Rate ; Telephone ; Transplants ; Visual Acuity

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Clinical Study of the Complications in Titanium Motility Pegged Hydroxyapatite Orbital Implant.

Jin Pyo HONG ; Jin Sook YOON ; Sang Hoon LA ; Sang Yeul LEE

Journal of the Korean Ophthalmological Society.2006;47(7):1037-1042.

PURPOSE: To evaluate the complications of titanium motility pegged hydroxyapatite orbital implant. METHODS: We retrospectively reviewed the records of 77 patients who underwent drilling with titanium motility peg hydroxyapatite orbital implant from May 2000 to April 2005. RESULTS: Of 77 patients (77eyes), 22 complications in 14 eyes (18.2%) occurred: 8 cases of major discharge (10.4%), 7 cases of granulation tissue overgrowth (9.1%), 3 cases of sleeve head exposure (3.9%), 4 cases of peg extrusion (5.2%) and 2 cases of hydroxyapatite exposure around pegged hole (2.6%). CONCLUSIONS: Hydroxyapatite exposure around pegged hole was most infrequent among complications of titanium motility peg system. It is considered that the use of titanium motility pegs will increase, as a bioinert material.
Durapatite* ; Granulation Tissue ; Head ; Humans ; Orbit* ; Orbital Implants* ; Retrospective Studies ; Titanium*

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