Management of Complication after Hyperopic Laser-assisted in-situ Keratomileusis

PURPOSE: We present a case of a patient who underwent corneal refractive surgery to improve their corrected visual acuity due to a complication of hyperopic laser-assisted in-situ keratomileusis (LASIK). CASE SUMMARY: The patient complained of decreased vision after hyperopic LASIK surgery 12 years prior. The corrected distance visual acuity (CDVA) was 20/200 in the right eye and 20/32 in the left, with manifested refractions of +1.25 +2.00 × 90 and -0.25 +2.00 × 80, respectively. The patient had a with-the-rule astigmatism. The values of corneal and total spherical aberration, which can be determined as coefficients of the Zernike polynomials, were respectively -1.027 µm and -0.773 µm in the right eye and -0.965 µm and -0.881 µm in the left eye. Slit lamp biomicroscopy revealed no remarkable findings. We performed surface ablation surgery to flatten the central cornea of the patient's right eye. At 12 months after surgery, the CDVA of the patient's right eye was 20/30 and the negative corneal spherical aberration was reduced. CONCLUSIONS: Corneal refractive surgery to reduce negative corneal spherical aberration by flattening the central cornea is one of possible treatment options for the reduced corrected distance visual acuity after hyperopic LASIK.

Clinical Outcomes of Cataract Surgery Using Nasal Clear Corneal Incision: Safety and Efficacy

PURPOSE: To compare the safety and efficacy of cataract surgery using nasal clear corneal incision (CCI) versus superior or temporal CCIs in Korean patients. METHODS: A retrospective comparative study was conducted. Patients underwent cataract surgery using CCI performed by 3 surgeons between January 2012 and December 2013.The patients were divided into the following 3 groups based on CCI direction: nasal CCIs (group I), superior CCIs (Group II), and temporal CCIs (Group III). To assess usability, surgically induced astigmatism (SIA), best-corrected visual acuity (BCVA), intraocular pressure (IOP), keratometry reading, and refractive errors at baseline and 1 month after surgery were compared. Operation times were compared between groups. To assess safety, intraoperative complications and wound stability were compared. RESULTS: A total of 1,374 eyes (Group I, 283 eyes; Group II, 587 eyes; Group III, 504 eyes) were included in the present study. The SIA was not significantly different among the 3 groups. The postoperative mean BCVA, IOP, keratometry reading and spherical equivalent as well as the mean operation times were not significantly different between the 3 groups (14.04 ± 3.79 vs. 13.80 ± 3.27 vs. 13.80 ± 3.70; p = 0.473). The rate of intraocular complications and incidence of corneal wound suture were not significantly different between the 3 groups (1.7% vs. 3.2% vs. 2.3%; p = 0.378). CONCLUSIONS: The safety and efficacy of cataract surgery using nasal CCI were not significantly different compared with the use of temporal or superior CCI. Our results showed that cataract surgery using nasal CCI can be performed safely and conveniently in Korean patients.

Transesophageal echocardiographic guidance for percutaneous closure of aortic pseudoaneurysm using a type II Amplatzer vascular plug: a case report / 대한마취과학회지

Aortic pseudoaneurysm after cardiac surgery is a rare entity, but it is potentially fatal due to its clinical course along with higher morbidity and mortality rates. Instead of open surgical repair, percutaneous procedures have been introduced as other options for managing an aortic pseudoaneurysm. In this case report, we describe transesophageal echocardiography guidance for successful percutaneous closure of an aortic pseudoaneurysm located in the left ventricular outflow tract by using a type II Amplatzer vascular plug in a patient in whom open surgical repair was not recommended.

Erratum: Central Toxic Keratopathy after LASEK J Korean Ophthalmol Soc 2010;51(5):769-773, DOI:10.3341/jkos.2010.51.5.769

No abstract available.

Central Toxic Keratopathy After LASEK

PURPOSE: We report a case of transient corneal opacity and hyperopia after LASEK surgery. CASE SUMMARY: A 21-year-old female visited our clinic complaining of decreased visual acuity in the left eye. The patient had undergone LASEK surgeryten days previously. Before LASEK surgery, the central corneal thickness of the left eye was 540 micrometer, and the refractive error was -2.00 Dsph=-0.75 Dcyl x80A with an estimated ablation depth of 52.2 micrometer. At the time of visit (on the tenth day after surgery), the best corrected visual acuity (BCVA) was 0.07, the central corneal thickness was 404 micrometer, and the refractive error was +1.00D=+1.25D x90. Slit-lamp biomicroscopy showed round central corneal haziness, but there were no signs of inflammation. At the third weeks after surgery, the central corneal thickness was 401 micrometer and the refractive error was +11.25D=-4.00D x145. Slit-lamp biomicroscopy showed sustained round central corneal haze. Twenty-two weeks after surgery, the central corneal thickness was 445 micrometer and the refractive error was -0.75D=-1.25D x180. The corneal opacity had disappeared. CONCLUSIONS: In case of transient corneal opacity, stromal loss and hyperopic change after LASEK surgery, central toxic keratopathy should be considered.

Changes in the Cornea and Anterior Chamber After LASEK: Pentacam Findings

PURPOSE: We evaluated changes in the cornea and anterior chamber after LASEK using Pentacam to search for signs of subclinical keratectasia occurrence. METHODS: Seventy-one eyes of 36 patients who had received LASEK were enrolled in this study. All eyes were examined for asphericity of the anterior and posterior cornea (Q-value), anterior and posterior corneal displacement, central corneal thickness, anterior chamber depth, angle, and volume using Pentacam before surgery and again one month after the operation. RESULTS: The postoperative changes in the asphericity of the posterior cornea and posterior corneal displacement were not statistically significant(p=0.668, p=0.101). The anterior chamber depth, angle, and volume decreased by 0.088 mm, 0.983degrees, 7.21 mm3 after LASEK, respectively. (p=0.000) The postoperative changes in asphericity of the anterior cornea, anterior corneal displacement, and central corneal thickness were statistically significant(p=0.000). CONCLUSIONS: In this study, we compared changes in the anterior chamber and cornea after LASEK using Pentacam. Changes in the anterior cornea were significant; however, the posterior cornea did not change significantly. The anterior chamber depth, anterior chamber angle, and volume were decreased one month after the operation, although further long-term follow-ups will be necessary to verify these findings.

A Case of Cataract Operation Using Iris Retractor in Congenital Microcoria

PURPOSE: To report an case regarding phacoemulsification and intraocularlens (IOL) implantation using an iris retractor in a congenital microcoria patient. CASE SUMMARY: A 53-year-old male patient visited the office with a complaint of gradual decrease of visual acuity. The patient's best corrected visual acuity (BCVA) was 0.3, and his refractive index could not be measured, as a very small pupil was observed in both eyes. After applying tropicamide and phenylephrine four times, the refractive index of both eyes remained immeasurable. In addition, on slit-lamp biomicroscopic examination, a nucleosclerotic cataract was observed in both eyes. Any signs of increased intraocular pressure or gonioscopic findings seen in glaucomatous patients was not detected in either eyes. Using an ultrasound biomicroscope and Pentacam, the pupil diameter were 0.31 mm in both eyes, and changed to 0.92 mm in the right eye, and 1.0 mm in the left eye, after applying mydriatics. Phacoemulsification and IOL implantation were performed one month apart from each other, using an iris retractor. On the follow-up examination 2 to 3 months postoperatively, BCVA was 0.7 in the right eye, and 1.0 in the left eye. After the operation, the pupil diameter was not changed before and after mydriasis, and measured 2.53 mm in the right eye, and 2.83 mm in the left eye. CONCLUSIONS: The authors have reported a case regarding visual acuity that improved in a congenital microcoria patient performing a phacoemulsification and IOL implantation operation using an iris retractor.

Bone Formation By Human Alveolar Bone Cells

Cultures of primary human alveolar bone-derived cells were established from alveolar bone chips obtained from normal individuals undergoing tooth extraction. These cells were expanded in vitro until passage 3 and used for the in vivo assays. Cells were loaded into transplantation vehicles, and transplanted subcutaneously into immunodeficient mice to study the capacities of human alveolar bone-derived cells to form bone in vivo. Transplants were harvested 12 weeks after transplantation and evaluated histologically. Of 10 human alveolar bone-derived cell transplants, two formed a bone-like tissue that featured osteocytes and mineral. Eight of the ten formed no osseous tissue. These results show that cells from normal human alveolar bone are capable of forming bone-like tissue when transplanted into immunodeficient mice.

A photoelastic study on effects of bone reduction forceps on mandibular fracture reduction

The purpose of this study was to evaluate the stress patterns within fractured mandibles generated by reduction forceps and to determine the optimal position of the reduction forcep. Twenty-seven mandibular models were fabricated using a photoelastic resin. Each of the three sets of mandible models prepared was osteotomized according to one of three different fracture types(symphysis, parasymphysis and body fractures). After reducing the cut segments, a reduction forcep was placed into different engagement holes to compress the segments. Photoelastic stress analysis was used to visualize the stress patterns within the fractured mandiblular models generated by the reduction forcep. In the case of symphysis or parasymphysis fractures, an optimum distribution of stress over the fracture site was achieved when placing the reduction forcep more than 12.5 mmon either side of the fracture line between the midway level bisecting the mandible and 5 mm below the level. In the case of body fractures, optimum stress distribution was achieved when the reduction forcep was placed more than 15 mm from the fracture line on the midway level. In conclusion, a correct use of reduction forceps helps to provide a precise three-dimensional reduction for mandibular fractures.

Isolation Of Human Alveolar Bone-Derived Cells And In Vitro Amplification For Tissue Engineering

BACKGROUND: Autogenous alveolar bone cell transplantation may be suitable for tissue engineering for alveolar bone reconstruction. This study aimed to isolate human alveolar bone-derived cells (HABDCs) and to evaluate the ability of collagen gels to support HABDC proliferation and differentiation for human alveolar bone tissue engineering applications. METHOD: Cultures of primary HABDCs were established from alveolar bone chips obtained from 10 persons undergoing tooth extraction. These cells were expanded in vitro until passage 3 and used for the in vitro characterization of HABDCs and the in vitro analysis of collagen gels for alveolar bone tissue engineering. RESULTS: Of the 10 attempts made to obtain HABDC cultures, eight were successful. HABDCs expressed the osteoblastic phenotype characterized by alkaline phosphatase activity, osteocalcin expression and the mineralization of the extracellular matrix in vitro. When seeded on collagen gels, HABDCs penetrated into the collagen gel matrices and proliferated inside the gels. Significantly, when HABDCs were embedded into the gels, collagen fibers and mineralization were produced within the gels. CONCLUSION: This study demonstrates the feasibility of using cultured HABDCs and collagen gels for human alveolar bone tissue engineering applications.

Auditory Late Response (ALR) and P300 in normal adults / 대한이비인후과학회지

BACKGROUND: Auditory evoked potentials (AEPs) have assumed an essential role in the clinical practice of auditory and several other professions. AEP classification and nomenclature systems are generally based on such aspects as the time domain (short, middle, long), anatomic origin, stimulus-response relationship. The P300 component of the human event related potential is an endogenous positive wave with a latency of 300msec or greater. OBJECTIVES: Our purpose of this study was to estimate normal values of auditory late response (ALR) and P300 in adults and use them in mapping of the brain. MATERIALS AND MEHTODS: An auditory evoked potential was performed on 40 normal adults, and a scalp surface electrode with 30 electrodes was attempted. Forty adults with normal hearing were divided into 2 groups, one consisting of thirty persons under 30 years of age and the other consisting of ten persons over 30 years of age. RESULTS: The latencies of P1, N1, P2, N1-P2 were 53.17 +/- 19.57 msec, 98.25 +/- 32.68 msec, 166.12 +/- 44.0 msec, 65.12 +/- 23.68 msec, respectively, in the whole group and 54.23 +/- 20.86 msec, 98.7 +/- 34.35 msec, 160.93 +/- 44.02 msec 62.23 +/- 25.36 msec, respectively, in the group under 30 years old, and 50.0 +/- 15.57 msec, 96.9 +/- 28.69 msec, 181.7 +/- 42.28 msec 73.8 +/- 15.69 msec, respectively, in the group over 30 years old. The P300 latencies for the whole group and the two groups were 299.37 +/- 34.01 msec, 295.16 +/- 33.36 msec, 312.0 +/- 34.49 msec, respectively. There was no significant difference in the latency and amplitude of the ALR and P300 between the two groups (p>0.05). CONCLUSION: ALR and P300 were measured in 40 normal adults. Description of the normal topography of P300 may facilitate the examination of the P300 topography in cognitive disorders. Such an examination might help ALR and P300 to serve as better diagnostic tools of cognitive disorder in adults.

Further characterization of bombesin like immunoreactivities from the skin of Korean fire-bellied toad, Bombina orientalis

Previously, we have isolated authentic bombesin and another bombesin like peptide named bombesin like immunoreactivity (BLI)-K2 from the skin of Korean fire-bellied toad, Bombina orientalis. In the present study, we have newly purified three heterogeneous forms of BLI named BLI-K3, BLI-K4, and BLI-K5 from side fractions obtained in previous isolation of bombesin like peptide. The BLIs were separated into five peaks on a column of C18 preparative HPLC. Among them, three minor peaks containing BLI-K3, K4, and K5 were purified by means of sequential chromatography on the columns of SP cation exchange HPLC and C18 reverse phase HPLC. The purified BLI-K3 and K4 showed high binding affinity to an anti-bombesin serum (LBE 2G-2) with binding potency of 72 and 95%, respectively, relative to that of bombesin. However, they did not possess any distinctive biological activity of bombesin like peptide. On the contrary, the biological activity of BLI-K5 was similar to that of bombesin but its binding affinity to an anti-bombesin serum was low. The results indicate that three heterogeneous forms of BLI were coexpressed with bombesin and BLI-K2 in the skin of B. orientalis. All forms of the purified BLI in the present study were immunologically active but only BLI-K5 possessed the distinctive biological activity of bombesin like peptide.