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Clinical Results of Endoscopic Dacryocystorhinostomy using a Microdebrider.

Sung Wook YOON ; Young Sun YOON ; Su Hyung LEE

Korean Journal of Ophthalmology.2006;20(1):1-6. doi:10.3341/kjo.2006.20.1.1

PURPOSE: The success rate of endoscopic dacryocystorhinostomy has been increasing with the development of better instruments and techniques. We conducted this study to evaluate the clinical results of endoscopic dacryocystorhinostomy using a Microdebrider, which has also been used for functional endoscopic sinus surgery. METHODS: We selected 76 patients (with a total of 84 affected eyes) who had been diagnosed with a nasolacrimal duct obstruction. These patients underwent an endoscopic dacryocystorhinostomy using a Microdebrider, which removed both nasal mucosa and lacrimal sac mucosa and also trimmed the margins of the ostotomy site. We assessed patients' outcomes on an anatomical basis using a dye test and endoscopy, which were used to define the anatomical success. We also arbitrarily defined functional success as whether the subjective epiphora was absent. At a four to 18 month follow-up, we monitored the clinical course to examine any recurrent episodes. RESULTS: The symptoms were alleviated in 72 eyes, with a primary success rate of 85.7%. On nasal endoscopy, a functional failure was seen in four eyes. In these four eyes, the orifice was narrowed by the presence of either granulation tissue or conjunctivochalasis. By contrast, surgical outcomes were the anatomical failure in eight eyes. In these eight eyes, the orifice was obstructed by the presence of granulation tissue as well as the adhesion of nasal mucosa. CONCLUSIONS: Endoscopic dacryocystorhinostomy using a Microdebrider enabled us to make the large fistula while minimizing the damage of adjacent tissue. It might be the recommended surgery that reduces the complications and enhances the success rate.
Treatment Outcome ; Retrospective Studies ; Miniaturization ; Middle Aged ; Male ; Lacrimal Duct Obstruction/*surgery ; Humans ; Follow-Up Studies ; Female ; Equipment Design ; *Endoscopy ; Debridement/*instrumentation ; Dacryocystorhinostomy/*methods ; Aged ; Adult ; Adolescent

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Congenital Ocular Anomaly in an Infant with Trisomy 14 Mosaicism.

Jun Ho CHOI ; Youn Joo CHOI ; So Young KIM

Korean Journal of Ophthalmology.2012;26(4):316-318. doi:10.3341/kjo.2012.26.4.316

Trisomy 14 mosaicism is a rare chromosomal abnormality with distinct and recognizable clinical features. We report a patient with presumed retinal dystrophy having diffuse retinal pigment epithelial abnormalities, which has not been previously reported in association with trisomy 14. This case expands the clinical spectrum of this rare entity.
Abnormalities, Multiple/genetics ; Chromosomes, Human, Pair 14 ; Female ; Humans ; Infant, Newborn ; Mosaicism ; Retinal Diseases/*congenital/genetics ; *Trisomy

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Resolution of Macular Edema after Systemic Treatment with Furosemide.

Nam Kyun KOO ; Yu Cheol KIM

Korean Journal of Ophthalmology.2012;26(4):312-315. doi:10.3341/kjo.2012.26.4.312

We report two cases of macular edema treated with the oral administration of furosemide. The first case presented here was a 78-year-old male patient with visual disturbance of the left eye. He had been taking an oral agent for diabetes and had chronic renal failure for 7 years. From 10 days prior to the visit, he had visual disturbance of the left eye accompanied by systemic edema. There were no specific findings in the anterior segment, but sub-retinal fluid was observed in the left fundus. Macular edema was observed on fluorescein angiography and optical coherence tomography; therefore, the oral administration of furosemide was initiated. After seven days, the sub-retinal fluid disappeared. The second case was a 43-year-old female patient with visual disturbance of the left eye who had been taking hypoglycemic agents for diabetes for 13 years. There were no specific findings in the anterior segment, but flame-shaped retinal hemorrhages were scattered over both posterior poles, neovascularization was observed in the left eye, and, of particular note, sub-retinal fluid was detected in the macula of the left eye. Macular edema was also observed on fluorescein angiography and optical coherence tomography, and oral administration of furosemide was initiated. After 3 weeks, the macular edema had significantly decreased.
Administration, Oral ; Adult ; Aged ; Diabetes Complications/diagnosis/*drug therapy ; Diuretics/administration & dosage/*therapeutic use ; Female ; Fluorescein Angiography ; Furosemide/administration & dosage/*therapeutic use ; Humans ; Macular Edema/diagnosis/*drug therapy ; Male ; Tomography, Optical Coherence

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Recurrent Bilateral Retinal Vasculitis as a Manifestation of Post-streptococcal Uveitis Syndrome.

Jinu HAN ; Sung Chul LEE ; Won Kyung SONG

Korean Journal of Ophthalmology.2012;26(4):309-311. doi:10.3341/kjo.2012.26.4.309

We report a case of post-streptococcal uveitis mainly presenting with bilateral recurrent retinal vasculitis in Korea. A 14-year-old Asian female presented with decreased visual acuity of 20 / 30 in the right eye and 20 / 25 in the left eye. The patient had a history of glomerulonephritis nine months before onset of uveitis. The manifestation of uveitis was predominantly retinal vasculitis. We presumed post-streptococcal uveitis because probable streptococcal infection was confirmed by anti-streptolysin O titer elevation. With topical and oral steroid treatments, the patient experienced complete vision recovery. Post-streptococcal uveitis occurs rarely and mostly involves young patients in the form of non-granulomatous anterior uveitis. However, as this case shows, it may primarily involve the posterior uvea without anterior inflammation and may recur.
Adolescent ; Diagnosis, Differential ; Female ; Humans ; Recurrence ; Retinal Vasculitis/drug therapy/*microbiology ; Steroids/therapeutic use ; Streptococcal Infections/*diagnosis ; Uveitis/drug therapy/*microbiology ; Visual Acuity

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A Case of Postoperative Endophthalmitis by Extended-spectrum Beta-lactamase-producing Escherichia coli.

Yu Cheol KIM ; Kwang Soo KIM

Korean Journal of Ophthalmology.2012;26(4):306-308. doi:10.3341/kjo.2012.26.4.306

A 75-year-old female was transferred to our clinic three days after uneventful phacoemulsification with intraocular lens (IOL) implantation in the right eye that had been carried out at a local clinic. Under the diagnosis of postoperative endophthalmitis, the patient underwent pars plans vitrectomy, IOL explantation, silicone oil tamponade, and intravitreal antibiotic injection. Even after the procedure, the patient's condition was further aggravated, and extended-spectrum beta-lactamase-producing Escherichia coli were identified on bacterial identification test. Although meropenem was applied locally and systemically, the patient had no-light perception visual acuity.
Aged ; Anti-Bacterial Agents/therapeutic use ; Endophthalmitis/drug therapy/*microbiology ; Escherichia coli/*isolation & purification ; Female ; Humans ; Phacoemulsification ; Postoperative Complications/diagnosis/*microbiology ; Visual Acuity ; beta-Lactamases

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A Novel Decorin Gene Mutation in Congenital Hereditary Stromal Dystrophy: A Korean Family.

Jung Hye LEE ; Chang Seok KI ; Eui Sang CHUNG ; Tae Young CHUNG

Korean Journal of Ophthalmology.2012;26(4):301-305. doi:10.3341/kjo.2012.26.4.301

A 43-year-old man developed decreased vision in the right eye that had persisted for seven years. Under slit lamp examination, corneal clouding was noted with normal endothelium and ocular structure. From the clinical evidence, we suspected that the patient had congenital hereditary stromal dystrophy (CHSD). He and his family underwent a genetic analysis. Penetrating keratoplasty was conducted, and the corneal button was investigated for histopathologic confirmation via both light and electron microscopy. The histopathologic results revealed mildly loosened stromal structures, which exhibited an almost normal arrangement and differed slightly from the previous findings of CHSD cases. With regard to the genetic aspects, the patient and his mother harbored a novel point mutation of the decorin gene. This genetic mutation is also distinct from previously described deletion mutations of the decorin gene. This case involved delayed penetration of mild clinical symptoms with the histological feature of a loosened fiber arrangement in the corneal stroma. We concluded that this condition was a mild form of CHSD. However, from another perspective, this case could be considered as "decorin gene-associated corneal dystrophy," which is distinct from CHSD. Further evaluation will be required for appropriate clinical, histopathologic and genetic approaches for such cases.
Adult ; Corneal Dystrophies, Hereditary/diagnosis/*genetics ; Decorin/*genetics ; Humans ; Male ; Microscopy, Electron ; Pedigree ; *Point Mutation ; Republic of Korea

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Multilobular Lacrimal Sac Diverticulum Presenting as a Lower Eyelid Mass.

Jung Hoon KIM ; Hae Ran CHANG ; Kyung In WOO

Korean Journal of Ophthalmology.2012;26(4):297-300. doi:10.3341/kjo.2012.26.4.297

Lacrimal sac diverticulum is a rare condition, and its various symptoms complicate differential diagnosis. We present cases of a peculiar type of lacrimal diverticulum. A 5-year-old girl and a 50-year-old woman presented with a protruding mass inferior to the medial canthus. Each lacrimal system was patent to irrigation. The masses compressed and distorted the lacrimal passage and had no apparent connection with the lacrimal sac in dacryocystography or computed tomography. Surgical exploration and complete excision of the masses were completed. Each patient had an inverted Y- and an inverted V-shaped multilobular cystic mass that was pathologically confirmed as a lacrimal sac diverticulum. Lacrimal sac diverticula may rarely take the form of a multilobular cyst and can present as a lower lid mass. We speculate that an abnormality in lacrimal embryogenesis resulted in multiple blind pouches, a peculiar type of lacrimal sac diverticulum.
Child, Preschool ; Diagnosis, Differential ; Diverticulum/radiography/*surgery ; Eyelids/radiography/surgery ; Female ; Humans ; Lacrimal Apparatus Diseases/radiography/*surgery ; Middle Aged ; Tomography, X-Ray Computed

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Safety of Bevacizumab on Extraocular Muscle in a Rabbit Model.

Jae Ho JUNG ; Jung Hoon LEE ; Ji Eun LEE ; Hee Young CHOI

Korean Journal of Ophthalmology.2012;26(4):290-296. doi:10.3341/kjo.2012.26.4.290

PURPOSE: The purpose of this study was to investigate the myotoxicity of bevacizumab on extraocular muscles in a rabbit model. METHODS: Thirty New Zealand white rabbits were used for this study. The animals were evenly divided into two groups. In the first group, 15 rabbits were treated with intramuscular injections of bevacizumab (1.25 mg/0.05 mL) in the right superior rectus muscle and normal saline solution (0.05 mL) in the left superior rectus muscle. In the second group, 15 rabbits were treated with subconjunctival injections of bevacizumab (2.5 mg/0.1 mL) in the right superior subconjunctival area and normal saline solution (0.1 mL) in the left superior subconjunctival area. Five rabbits in each group were sacrificed at one day, two weeks and four weeks after the injections. Extraocular muscle samples were prepared for light microscopic (LM) and electron microscopic (EM) examination. Degrees of acute inflammation were evaluated via CD-11b immunohistochemistry, and global muscle change was investigated using hematoxylin and eosin stains. Intensity of fibrosis was evaluated using Masson trichrome stains, and ultrastructural changes were observed on EM. RESULTS: We observed no significant inflammatory cell infiltration, muscle necrosis or fibrotic change in treated and control eyes. EM findings revealed no significant damage to muscle or vascular tissue after bevacizumab injection. CONCLUSIONS: We found no signs of extraocular muscle toxicity after LM and EM intramuscular and subconjunctival bevacizumab injections in a rabbit model.
Angiogenesis Inhibitors/*administration & dosage/toxicity ; Animals ; Antibodies, Monoclonal, Humanized/*administration & dosage/toxicity ; Conjunctiva/drug effects ; Injections ; Oculomotor Muscles/*drug effects ; Rabbits

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Superior Rectus Muscle Recession for Residual Head Tilt after Inferior Oblique Muscle Weakening in Superior Oblique Palsy.

Seong Joon AHN ; Jin CHOI ; Seong Joon KIM ; Young Suk YU

Korean Journal of Ophthalmology.2012;26(4):285-289. doi:10.3341/kjo.2012.26.4.285

PURPOSE: Residual head tilt has been reported in patients with superior oblique muscle palsy (SOP) after surgery to weaken the inferior oblique (IO) muscle. The treatments for these patients have not received appropriate attention. In this study, we evaluated the superior rectus (SR) muscle recession as a surgical treatment. METHODS: The medical records of 12 patients with SOP were retrospectively reviewed. Each of these patients had unilateral SR muscle recession for residual head tilt after IO muscle weakening due to SOP. The residual torticollis was classified into three groups on the basis of severity: mild, moderate, or severe. Both IO muscle overaction and vertical deviation, features of SOP, were evaluated in all patients. The severity of the preoperative and postoperative torticollis and vertical deviation were compared using a paired t-test and Fisher's exact test. RESULTS: The torticollis improved in nine of 12 (75%) patients after SR muscle recession. The difference between the preoperative and postoperative severity of torticollis was statistically significant (p = 0.0008). After surgery, the mean vertical deviation was significantly reduced from 12.4 prism diopters to 1.3 prism diopters (p = 0.0003). CONCLUSIONS: Unilateral SR muscle recession is an effective method to correct residual head tilt after IO muscle weakening in patients with SOP. This surgical procedure is believed to decrease head tilt by reducing the vertical deviation and thereby the compensatory head tilt.
Adolescent ; Adult ; Child ; Child, Preschool ; Diplopia/*surgery ; Female ; Head Movements ; Humans ; Infant ; Male ; Oculomotor Muscles/*surgery ; Retrospective Studies ; Strabismus/*surgery ; Torticollis/*surgery ; Treatment Outcome ; Trochlear Nerve Diseases/*surgery

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Long-term Results of Lens-sparing Vitrectomy for Progressive Posterior-type Stage 4A Retinopathy of Prematurity.

Jin CHOI ; Jeong Hun KIM ; Seong Joon KIM ; Young Suk YU

Korean Journal of Ophthalmology.2012;26(4):277-284. doi:10.3341/kjo.2012.26.4.277

PURPOSE: To assess the long-term anatomic and visual outcomes and associated complications of lens-sparing vitrectomy (LSV) in infants with progressive posterior-type tractional retinal detachment (TRD) associated with stage 4A retinopathy of prematurity (ROP). METHODS: In a retrospective case series, the medical records of consecutive patients who presented with progressive posterior-type stage 4A ROP and underwent LSV between 1999 and 2007 were reviewed. Retinal attachment status, visual acuity, and development of postoperative complications were assessed. RESULTS: Eleven eyes of 9 patients were included. The mean follow-up period was 4.6 years. In 8 eyes (73%), plus disease was present at the time of LSV. In 3 eyes (27%), 2 (66%) without plus disease and 1 (13%) with plus disease, the retina remained reattached in the end, while 8 eyes (73%) had TRD on final examination. Two eyes with reattached retinas showed favorable visual acuity. In those eyes with detached retinas, 5 (68%) showed no light perception. When surgery for ROP was unsuccessful, development of cataract, corneal opacity, or glaucoma was common. CONCLUSIONS: The long-term anatomic success rate of LSV for progressive posterior-type stage 4A ROP was low, especially in the presence of plus disease at the time of LSV. Anatomical reattachment is very important for preventing complications and gaining better visual outcomes.
Disease Progression ; Female ; Humans ; Infant ; Infant, Newborn ; Male ; Postoperative Complications/epidemiology ; Retinal Detachment/epidemiology ; Retinopathy of Prematurity/*surgery ; Retrospective Studies ; Treatment Outcome ; Visual Acuity ; Vitrectomy/*methods

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