Comparing postoperative pain in various pressure pneumoperitoneum of laparoscopic cholecystectomy:a double-blind randomized controlled study

Purpose@#This study aims to evaluate the effect of different pneumoperitoneum pressures on postoperative pain, especially by subcategorizing the pressures into 3 groups during laparoscopic cholecystectomy (LC). @*Methods@#We conducted a prospective randomized, double-blinded study of 150 patients with benign and uncomplicated gallbladder disease. They were categorized into 3 groups. Each group (50 patients) underwent LC with different pneumoperitoneum methods: group VLP, very-low pressure (6–8 mmHg); group LP, low pressure (9–11 mmHg); and group SP, standard pressure (12–14 mmHg). The 3 groups were compared for pain intensity, duration, analgesic requirement, and complications. @*Results@#The characteristics of the patients were similar among all groups. Postoperative pain scores at each time point (1, 2, 4, 6, 12, 24, and 48 hours) were not significantly different among the 3 groups. Further, operation time, hospital stay, the number of analgesic consumption doses, and postoperative complications were not significantly different among the 3 groups. @*Conclusion@#This study demonstrates no difference in postoperative pain among various pneumoperitoneum pressures during LC. Therefore, routine use of lower-pressure pneumoperitoneum is not recommended unless in selected patients who require low-pressure pneumoperitoneum surgery.

Comparing postoperative pain in various pressure pneumoperitoneum of laparoscopic cholecystectomy:a double-blind randomized controlled study

Purpose@#This study aims to evaluate the effect of different pneumoperitoneum pressures on postoperative pain, especially by subcategorizing the pressures into 3 groups during laparoscopic cholecystectomy (LC). @*Methods@#We conducted a prospective randomized, double-blinded study of 150 patients with benign and uncomplicated gallbladder disease. They were categorized into 3 groups. Each group (50 patients) underwent LC with different pneumoperitoneum methods: group VLP, very-low pressure (6–8 mmHg); group LP, low pressure (9–11 mmHg); and group SP, standard pressure (12–14 mmHg). The 3 groups were compared for pain intensity, duration, analgesic requirement, and complications. @*Results@#The characteristics of the patients were similar among all groups. Postoperative pain scores at each time point (1, 2, 4, 6, 12, 24, and 48 hours) were not significantly different among the 3 groups. Further, operation time, hospital stay, the number of analgesic consumption doses, and postoperative complications were not significantly different among the 3 groups. @*Conclusion@#This study demonstrates no difference in postoperative pain among various pneumoperitoneum pressures during LC. Therefore, routine use of lower-pressure pneumoperitoneum is not recommended unless in selected patients who require low-pressure pneumoperitoneum surgery.

Proximal Resection Margins: More Prognostic than Distal Resection Margins in Patients Undergoing Hilar Cholangiocarcinoma Resection / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: Even though the therapeutic gold standard of hilar cholangiocarcinoma (HCCA) resection is cancer-free resection margin (RM), surgical treatment still remains challenging. This study evaluated the prognostic significance of RM status in resected HCCA patients and identified survival prognostic factors. MATERIALS AND METHODS: We reviewed records of 96 HCCA patients who underwent surgery from 2001 to 2012 and analyzed the RM status and prognostic factors that affecting survival. RESULTS: Negative RM (n=31, 33%) was significantly associated with better survival vs. positive RM (n=65, 67%) (mean survival time [MST], 33 months vs. 21 months; p=0.011). Margins with histological findings of non-dysplastic epithelium, low-grade dysplasia, and carcinoma in situ were not associated with survival differences (MST, 33 months vs. 33 months vs. 30 months; p=0.452), whereas positive margins were associated with poorer survival relative to carcinoma in situ (MST, 30 months vs. 21 months; p=0.050). Among patients with R0 resection, narrow (≤ 5 mm) and wide (> 5 mm) margins were not associated with survival differences (MST, 33 months vs. 30 months; p=0.234). Although positive proximal RM was associated with poorer survival compared to negative RM (MST, 19 vs. 33; p=0.002), no survival difference was observed between positive and negative distal RMs (MST, 30 vs. 33; p=0.628). Proximal RM positivity (hazard ratio [HR], 2.688; p=0.007) and nodal involvement (HR, 3.293; p < 0.001) were independent survival prognostic factors. CONCLUSION: A clear RM, especially proximal RM status, was significant prognosticator, and proximal bile duct resection to the greatest technically feasible extent may be necessary, with careful consideration of the potential morbidity and oncologic outcomes after resection. However, an aggressive approach to obtain a negative distal RM might be controversial and should be considered carefully, depending on the patient's status.

Peri-Transplant Change in AFP Level: a Useful Predictor of Hepatocellular Carcinoma Recurrence Following Liver Transplantation

Pretransplant alpha-fetoprotein (AFP) is a useful tumor marker predicting recurrence of hepatocellular carcinoma (HCC). Little is known, however, about the relationship between changes in AFP concentration and prognosis. This study investigated the clinical significance of change in peri-transplant AFP level as a predictor of HCC recurrence. Data from 125 HCC patients with elevated pretransplant AFP level who underwent liver transplantation (LT) between February 2000 and December 2010 were retrospectively reviewed. Patients with AFP normalization within 1 month after LT were classified into the rapid normalization group (n = 97), with all other patients classified into the non-rapid normalization group (n = 28). Tumor recurrence was observed in 17 of the 97 patients (17.5%) with rapid normalization; of these, 11 patients had high AFP levels and six had normal levels at recurrence. In contrast, tumor recurrence was observed in 24 of the 28 patients (85.7%) without rapid normalization, with all 24 having high AFP levels at recurrence. Multivariate analysis showed that non-rapid normalization (harzard ratio [HR], 4.41, P < 0.001), sex (HR, 3.26, P = 0.03), tumor size (HR, 1.15, P = 0.001), and microvascular invasion (HR, 2.65, P = 0.005) were independent risk factors for recurrence. In conclusion, rapid normalization of post-LT AFP level at 1 month is a useful clinical marker for HCC recurrence. Therefore, an adjuvant strategy and/or intensive screening are needed for patients who do not show rapid normalization.

Heterogeneous living donor hepatic fat distribution on MRI chemical shift imaging

PURPOSE: We evaluated the heterogeneity of steatosis in living donor livers to determine its regional differences. METHODS: Between June 2011 and February 2012, 81 liver donors were selected. Fat fraction was estimated using magnetic resonance triple-echo chemical shifting gradient imaging in 13 different regions: segment 1 (S1), S2, S3, and each peripheral and deep region of S4, S5, S6, S7, and S8. RESULTS: There were differences (range, 3.2%-5.3%) in fat fractions between each peripheral and deep region of S4, S6, S7, and S8 (P < 0.001, P = 0.004, P < 0.001, and P = 0.006). Fat deposit amount in S1, S2, S3 and deep regions of S4-S8 were significantly different from one another (F [4.003, 58.032] = 8.684, P < 0.001), while there were no differences among the peripheral regions of S4-S8 (F [2.9, 5.3] = 1.3, P = 0.272) by repeated measure analysis of variance method. And regional differences of the amount of fat deposit in the whole liver increased as a peripheral fat fraction of S5 increased (R2 = 0.428, P < 0.001). CONCLUSION: Multifocal fat measurements for the whole liver are needed because a small regional evaluation might not represent the remaining liver completely, especially in patients with severe hepatic steatosis.

Preoperative Selective Desensitization of Live Donor Liver Transplant Recipients Considering the Degree of T Lymphocyte Cross-Match Titer, Model for End-Stage Liver Disease Score, and Graft Liver Volume

Several studies have suggested that a positive lymphocyte cross-matching (XM) is associated with low graft survival rates and a high prevalence of acute rejection after adult living donor liver transplantations (ALDLTs) using a small-for-size graft. However, there is still no consensus on preoperative desensitization. We adopted the desensitization protocol from ABO-incompatible LDLT. We performed desensitization for the selected patients according to the degree of T lymphocyte cross-match titer, model for end-stage liver disease (MELD) score, and graft liver volume. We retrospectively evaluated 230 consecutive ALDLT recipients for 5 yr. Eleven recipients (4.8%) showed a positive XM. Among them, five patients with the high titer (> 1:16) by antihuman globulin-augmented method (T-AHG) and one with a low titer but a high MELD score of 36 were selected for desensitization: rituximab injection and plasmapheresis before the transplantation. There were no major side effects of desensitization. Four of the patients showed successful depletion of the T-AHG titer. There was no mortality and hyperacute rejection in lymphocyte XM-positive patients, showing no significant difference in survival outcome between two groups (P=1.000). In conclusion, this desensitization protocol for the selected recipients considering the degree of T lymphocyte cross-match titer, MELD score, and graft liver volume is feasible and safe.

Living Donor Liver Transplantation for an Infant with Osteogenesis Imperfecta and Intrahepatic Cholestasis: Report of a Case

Osteogenesis imperfecta (OI) is a group of genetic disorders characterized by bone fragility and connective tissue manifestations. We report a successful liver transplantation (LT) in an 8-month-old boy with OI and cholestatic biliary cirrhosis. After 4 cycles of intravenous pamidronate, LT was performed under intravenous anesthesia using a left lateral section from his mother without mechanical retractors. The operation time was 420 min and estimated blood loss was 520 mL requiring one unit of RBC transfusion. He was discharged without surgical complications. Therefore, LT should be considered for patients with end stage liver disease and OI under organic multidisciplinary cooperation.

Long Term Outcomes of Pediatric Liver Transplantation According to Age

Liver transplantation (LT) has been the key therapy for end stage liver diseases. However, LT in infancy is still understudied. From 1992 to 2010, 152 children had undergone LT in Seoul National University Hospital. Operations were performed on 43 patients aged less than 12 months (Group A) and 109 patients aged over 12 months (Group B). The mean age of the recipients was 7 months in Group A and 74 months in Group B. The patients' survival rates and post-LT complications were analyzed. The mean Pediatric End-stage Liver Disease score was higher in Group A (21.8) than in Group B (13.4) (P = 0.049). Fulminant hepatitis was less common in Group A (4.8%) than in Group B (13.8%) (P = 0.021). The post-transplant lymphoproliferative disorder and portal vein complication were more common in Group A (14.0%, 18.6%) than in Group B (1.8%, 3.7%) (P = 0.005). However, the 1, 5, and 10 yr patient survival rates were 93%, 93%, and 93%, in Group A and 92%, 90%, and 88% in Group B (P = 0.212). The survival outcome of pediatric LT is excellent and similar regardless of age. LTs in infancy are not riskier than those of children.

The Model for End-Stage Liver Disease Score-Based System Predicts Short Term Mortality Better Than the Current Child-Turcotte-Pugh Score-Based Allocation System during Waiting for Deceased Liver Transplantation

To adopt the model for end-stage liver disease (MELD) score-based system in Korea, the feasibility should be evaluated by analysis of Korean database. The aim of this study was to investigate the feasibility of the MELD score-based system compared with the current Child-Turcotte-Pugh (CTP) based-system and to suggest adequate cut-off to stratify waiting list mortality among Korean population. We included 788 adult patients listed in waiting list in Seoul National University Hospital from January 2008 to May 2011. The short-term survival until 6 months after registration was evaluated. Two hundred forty six (31.2%) patients underwent live donor liver transplantation and 353 (44.8%) patients were still waiting and 121 (15.4%) patients were dropped out due to death. Significant difference was observed when MELD score 24 and 31 were used as cut-off. Three-months survival of Status 2A was 70.2%. However, in Status 2A patients whose MELD score less than 24 (n=82), 86.6% of patients survived until 6 month. Furthermore, patients with high MELD score (> or =31) among Status 2B group showed poorer survival rate (45.8%, 3-month) than Status 2A group. In conclusion, MELD score-based system can predict short term mortality better and select more number of high risk patients in Korean population.

Status and Current Problems in the Allocation System for Pediatric Liver Transplantation in Korea / 대한이식학회지

BACKGROUND: The aim of this study was to investigate the current status and identify any existing problems in the allocation system of liver transplantation (LT) for children in Korea. METHODS: The information for the period between January 2006 and March 2012 contained in the Korean Network for Organ Sharing (KONOS) database, and the 2008 and 2010 annual reports from KONOS were analyzed. Detailed information about split LT (SLT) was analyzed using the SLT database which contains data collected since 2010. RESULTS: Of 4,462 cases of LT between January 2006 and December 2010, 243 were pediatric cases (5.4%). Of these pediatric cases, 195 (80.2%) were living donor LT. Of the liver grafts from deceased pediatric donors, 68% were donated to adults and 3.9% were shared with children. Of the 104 splittable donors from January 2010 to March 2012, a split was performed only in 4.6% of cases. The main reason for the low split rate was few pediatric candidate(s) in the waiting list due to strict Korean regulatory requirements for split candidate registration. CONCLUSIONS: Under the current liver transplant allocation system, Korean children have less chance to receive a liver graft from a deceased donor. With improvement of the allocation system and the rules governing SLT, children in need may have greater opportunity to receive a deceased donor graft without negatively affecting adult recipients.

Effects of Mannose on Pathogenesis of Acanthamoeba castellanii

Acanthamoeba spp. are single-celled protozoan organisms that are widely distributed in the environment. In this study, to understand functional roles of a mannose-binding protein (MBP), Acanthamoeba castellanii was treated with methyl-alpha-D-mannopyranoside (mannose), and adhesion and cytotoxicity of the amoeba were analyzed. In addition, to understand the association of MBP for amoeba phagocytosis, phagocytosis assay was analyzed using non-pathogenic bacterium, Escherichia coli K12. Amoebae treated with mannose for 20 cycles exhibited larger vacuoles occupying the most area of the amoebic cytoplasm in comparison with the control group amoebae and glucose-treated amoebae. Mannose-selected amoebae exhibited lower levels of binding to Chinese hamster ovary (CHO) cells. Exogenous mannose inhibited >50% inhibition of amoebae (control group) binding to CHO cells. Moreover, exogenous mannose inhibited amoebae (i.e., man-treated) binding to CHO cells by <15%. Mannose-selected amoebae exhibited significantly decreased cytotoxicity to CHO cells compared with the control group amoebae, 25.1% vs 92.1%. In phagocytic assay, mannose-selected amoebae exhibited significant decreases in bacterial uptake in comparison with the control group, 0.019% vs 0.03% (P<0.05). Taken together, it is suggested that mannose-selected A. castellanii trophozoites should be severely damaged and do not well interact with a target cell via a lectin of MBP.

Aspirin Resistance May Not Be Associated with Clinical Outcome after Acute Ischemic Stroke: Comparison with Three Different Platelet Function Assays / 대한뇌졸중학회지

BACKGROUND: Aspirin resistance (AR) in platelet function assays showed substantial variation depending on the methods used to evaluate it. METHODS: In this study, we prospectively compared the results of Multiplate impedance platelet aggregometry (IPA) with those of light transmission aggregometry (LTA) and VerifyNow(R) system in determination of the prevalence of aspirin resistance (AR) and investigated the correlation between its presence and poor outcome (modified Rankin scale >2) in 105 patients with aspirin after acute ischemic stroke (AIS). RESULTS: After 5 days of using aspirin, 15 patients (14.3%) were classified as aspirin-resistance with the use of IPA, 24 patients (22.9%) by the LTA, and 14 patients (13.3%) by VerifyNow. Good agreement between the results of IPA and VerifyNow, was found (R=0.674, P<0.01). The concordance rate of AR detection was high between VerifyNow and IPA (k=0.72, P<0.01), albeit quite low between LTA and IPA. Regarding on its influence on clinical outcome after AIS, there wasn't any significant relationship between occurrence of poor outcome and the presence of AR in three platelet function assays. CONCLUSION: This study reveals that the incidence of AR in AIS might be highly test-specific. IPA seems to be similar to VerifyNow as a platelet function test.

Clinical Characteristics and Comorbidities of Hereditary Hemorrhagic Telangiectasia / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Hereditary hemorrhagic telangiectasia (HHT), often manifested as epistaxis, is also manifested in combination with serious comorbid diseases. The authors reviewed 12 cases of HHT and investigated the manifestations and comorbid diseases of HHT in the Korean population. SUBJECTS AND METHOD: Medical records of the HHT patients in our department from July 2004 to December 2011 were reviewed retrospectively. Twelve patients who had been classified as definite or possible HHT according to the Curacao criteria were enrolled in this study. Clinical manifestations, treatment methods, results, and comorbid diseases were investigated. RESULTS: Recurrent epistaxis occurred in 100% of the patients. Epistaxis was managed by bipolar or laser cauterization (n=9), embolization of the feeding vessel (n=1), intranasal application of bevacizumab (Avastin(R))(n=2) or septodermoplasty (n=1). The symptoms of seven patients showed much improvement while the other two did not. Comorbid diseases included pulmonary arteriovenous malformation (AVM) in 5 patients (41.7%) and cerebral AVM in 2 patients (16.7%). Three patients with pulmonary AVM received embolization and one patient with cerebral AVM received gamma knife surgery with good prognosis. CONCLUSION: Epistaxis by HHT can be improved by active treatment using various methods. Pulmonary and cerebral AVMs are common comorbid diseases and should be considered in the management of HHT.

A Case of Schwannoma of the Mouth Floor Mistaken as a Ranula / 대한이비인후과학회지

Schwannoma is a relatively slow-growing, encapsulated benign tumor that is derived from the Schwann cell of the nerve sheath. We report here on a case of schwannoma of the mouth floor with a review of the literature. A 67-year-old woman presented with a right mouth floor mass, which was first detected 5 years ago. The preoperative diagnosis was ranula on the basis of the physical findings and the computerized tomographic findings. However, the mass was found to be a true neoplastic lesion rather than a cystic lesion in the course of surgical dissection. The permanent pathologic report of the mass was schwannoma. Postoperatively, although the patient had no problem with taste, the pain-sense, speech and swallowing, she had mild deviation of the tongue towards the same side of the mass, which means that the function of the hypoglossal nerve was somewhat impaired. Her tongue deviation was spontaneously resolved within 6 weeks postoperatively.

The Difference in Aspirin Resistance Based on an Optical Platelet Aggregometer and the PFA-100 in Patients with Acute Ischemic Stroke / 대한뇌졸중학회지

BACKGROUND: There are many causes for the failure of aspirin therapy in patients with acute ischemic stroke. Laboratory aspirin resistance (AR) might be involved in clinical aspirin non-response. The PFA-100 is a laboratory method to evaluate AR in the clinical setting. However, there has been limited data regarding concordance with optical platelet aggregometry, which is considered the gold standard for detecting AR. We retrospectively analyzed platelet function tests using the PFA-100 and an optical platelet aggregometer in 86 patients with acute ischemic stroke. METHODS: Eighty six patients were enrolled in the study and were evaluated the platelet function test by optical aggregometer and a PFA-100. We determined the variability in the prevalence of AR and the kappa value between the two tests in patients with acute ischemic stroke. RESULTS: Among 86 patients, 27 (31.4%) were detected as AR by the optical aggregometer and 31 (36.0%) by the PFA-100. There were 13 cases of AR (15.1%) in both laboratory methods. The optical platelet aggregometer results showed that female gender (P=0.03), aspirin monotherapy (P =0.05), and NIHSS at baseline (P=0.04) were related with AR in acute ischemic stroke. Multiple logistic regression analysis showed that NIHSS was independently associated with AR of the optical platelet aggregometer (OR=1.12 95%, CI: 1.00-1.25, P=0.05). CONCLUSION: The prevalence of AR was similar between the PFA-100 and the optical platelet aggregometer in patients with acute ischemic stroke. However, the concordance rate of these two tools is low.

Prehospital Notification from the Emergency Medical Service Reduces the Transfer and Intra-Hospital Processing Times for Acute Stroke Patients

BACKGROUND AND PURPOSE: There is little information available about the effects of Emergency Medical Service (EMS) hospital notification on transfer and intrahospital processing times in cases of acute ischemic stroke. METHODS: This study retrospectively investigated the real transfer and imaging processing times for cases of suspected acute stroke (AS) with EMS notification of a requirement for intravenous (IV) tissue-type plasminogen activator (t-PA) and for cases without notification. Also we compared the intra-hospital processing times for receiving t-PA between patients with and without EMS prehospital notification. RESULTS: Between December 2008 and August 2009, the EMS transported 102 patients with suspected AS to our stroke center. During the same period, 33 patients received IV t-PA without prehospital notification from the EMS. The mean real transfer time after the EMS call was 56.0+/-32.0 min. Patients with a transfer distance of more than 40 km could not be transported to our center within 60 min. Among the 102 patients, 55 were transferred via the EMS to our emergency room for IV t-PA. The positive predictive value for stroke (90.9% vs. 68.1%, p=0.005) was much higher and the real transfer time was much faster in patients with an EMS t-PA call (47.7+/-23.1 min, p=0.004) than in those without one (56.3+/-32.4 min). The door-to-imaging time (17.8+/-11.0 min vs. 26.9+/-11.5 min, p=0.01) and door-to-needle time (29.7+/-9.6 min vs. 42.1+/-18.1 min, p=0.01) were significantly shorter in the 18 patients for whom there was prehospital notification and who ultimately received t-PA than in those for whom there was no prehospital notification. CONCLUSIONS: Our results indicate that prehospital notification could enable the rapid dispatch of AS patients needing IV t-PA to a stroke centre. In addition, it could reduce intrahospital delays, particularly, imaging processing times.

A Case of Unknown Primary Malignant Melanoma with Pulmonary and Endobronchial Metastasis / 결핵

Malignant melanoma is a highly malignant form of cutaneous cancer derived from melanocytes. The lesion frequently metastasizes to the lymph nodes, lung, liver and bone. However, an endobronchial metastasis and a primary malignant melanoma of the lung are quite rare. We report a case of an unknown primary malignant melanoma with a pulmonary and endobronchial metastasis in a 34 years old male. He complained of coughing and black-colored sputum. Abnormal skin and mucosal lesions were not found during a physical examination. A chest X-ray revealed multiple nodular masses in both lung fields. A flexible bronchoscopy showed two yellowish small nodules at the entry of left lower bronchus. Vimentin, the S-100 protein, and HMB-45 stain positive melanoma cells were detected at the bronchoscopic biopsy specimen.

A Case of Unknown Primary Malignant Melanoma with Pulmonary and Endobronchial Metastasis / 결핵

Malignant melanoma is a highly malignant form of cutaneous cancer derived from melanocytes. The lesion frequently metastasizes to the lymph nodes, lung, liver and bone. However, an endobronchial metastasis and a primary malignant melanoma of the lung are quite rare. We report a case of an unknown primary malignant melanoma with a pulmonary and endobronchial metastasis in a 34 years old male. He complained of coughing and black-colored sputum. Abnormal skin and mucosal lesions were not found during a physical examination. A chest X-ray revealed multiple nodular masses in both lung fields. A flexible bronchoscopy showed two yellowish small nodules at the entry of left lower bronchus. Vimentin, the S-100 protein, and HMB-45 stain positive melanoma cells were detected at the bronchoscopic biopsy specimen.

Subdural Fluid Collection after Intracranial Aneurysmal Surgery

The clinical course of subdural fluid collection(SDGC) was studied in 32 cases of patients which underwent craniotomy for intracranial aneurysm and analysed regard to patients' age, sex, degree of initial subarachnid hemorrhage, the operating time of aneurysm, duration to appearance of SDFC from craniotomy, changes of clinical state, disappearance time, site, maximal thickness and changes of SDFC, management and prognosis. The results were summarized as followings. 1) SDFC was found in 33 of 85 patients(38.8%). 2) The older age group had higher incidence of SDFC than the younger age group. 3) The older age grop had thicker SDFC than the younger age group in the maximal thickness of SDFC, and that was statistically significant. 4) The early surgery group of aneurysm had lower incidence of SDFC compared with the delayed surgery group. 5) There were minimal changes of clinical states when SDFC was diagnosed by brain CT. 6) The frontal area was involved in all cases and bilateral involvement was noted in 15 cases(45.5%). 7) Surgical procedures were needed in 8 cases(24.2%) of SDFC, including 2 cases of chronic subdural hematoma. 8) Ventricular dilatation with spontaneous improvement of SDFC were noted in 8 cases(24.2%) and lumboperitoneal shunt for hydrocephalus was needed in only 2 cases of them.

The Rate of Posterior Capsular Opacification with Three Different Sizes of Capsular Intraocular Lenses

A prospective study was carried out in 124 cataract patients(140 eyes) to evaluate the rate and degree of the opacification and/or wrinkling of the posterior capsule after in-the-bag placement of 6 mm optic capsular IOLs-12.0mm, 12.5mm and 13.0mm loop to loop total length were inserted. Cases only with intact CCC(continuous curvilinear capsulorhexis) and in-the-bag placement of PCLs (posterior chamber lenses) were included but any case of operative complications were not included. The rate and degree of opacification and/or wrinkling of the opsterior capsule were observed at 1 week, 1 month, 2 months, 3 months, 6 months, and 12 months after operation, respectively. Posterior capsular wrinkling with striae increased with total length of capsular IOL up to postoperative 1 month but thereafter there were no significant differences among the three different sizes of I0Ls througthout the follow up periods. The differences of rate and degree of posterior capsular opacification among IOLs were not statistically significant during the follow up periods. Mild degree of IOL decentration -0.5mm to 1.0mm pccired in 10 eyes(7%). Nd/Yag laser posterior capsulotomy was done in 3 eyes(2%).