Behcet's Disease in Korean

PURPOSE: Behcet's disease is a chronic, recurrent, multisystemic disorder, which visual prognosis is poor. The clinical and epidemiological characteristics of Behcet's disease in Korean were evaluated. METHODS: The clinical records on 3,175 patients with Behcet's disease diagnosed at Behcet's disease clinic in Severance Hospital between November 1983 and December 1999 were reviewed. RESULTS: Among all 3,175 patients, the men/women ratio of Behcet's disease was 1:1.6. The age of disease onset was the highest in the thirties (33.8%). The most frequent major and minor symptom was oral ulcer (97.7%) and arthritis (32.8%) respectively, and the proportion of ocular symptom was 19.3%. The most frequent initial symptom was oral ulcer (77.4%). The ratio of men/women with ocular symptom was 1:0.98. The mean interval between the initial symptom and ocular symptom was 34 months, and the most common ocular symptom was iritis (79.0%). The most frequent systemic drug administered in patients with ocular involvement was colchicines (35%). Visual acuity was worsened in 56% of the eyes followed for over 24 months. CONCLUSIONS: The authors notice the characteristics of Behcet's disease in Korean and suggest that the continuous and nationwide survey is further necessary.

Clinical Results of Unilateral Implantation of AMO Array Multifocal Intraocular Lens

PURPOSE: We evaluated the clinical results of unilateral implantation of AMO Array(r) intraocular lens in unilateral or bilateral cataract patients with minimum follow-up of 6 months. METHODS: This prospective study comprised two groups of 20 eyes each: one with AMO Array(r) intraocular lens(multi group) and the other with monofocal silicone intraocular lens(mono group). Main outcome measures were Snellen distance visual acuities; near acuities with Birkhauser reading chart. RESULTS: The difference between two groups in mean distance visual acuity was not statistically significant. Both monocular and binocular uncorrected near visual acuity in the multi group were significantly better than mono group. Four of 20 patients(20%) in monofocal group and 13 of 20 patients(65%) in multifocal group noticed light sensation(glare, halo etc.) after surgery, with the majority not being bothered by all of these. More than 90% patients were satisfied after surgery in both groups. CONCLUSIONS: With appropriate patient selection, near vision without spectacles was functionally acceptable in a majority of unilateral multifocal intraocular lens implantation cases. And, there was no significant problem in unilateral implantation of AMO Array intraocular lens. AMO Array lens can be used in unilateral cataract surgery.

Clinical Results of AMO Array(R) Multifocal Intraocular Lens

PURPOSE: To evaluate the clinical results of a AMO Array mutifocal lens. METHOD: we performed a prospective clinical trial of 20 bilateral cataract patients for at least 6 months. RESULT: Mean monocular uncorrected distance acuity(Snellen) was 0.75, which increased to 0.9 with best correction. Mean biocular uncorrected distance acuity was 0.85,which increased to 1.0 with best correction. Mean monocular near acuity was 0.62, which reached 0.88 with best correction. Mean biocular near acuity was 0.71, which reached 1.00 with best correction. Mean contrast sensitivities were within normal range for all spacial frequencies. In glare discomfort, 10 patients had no complaint, 7 patients had no idea, and only 3 patients had some problem. Reading newspaper without glasses was achieved by 28 of 40 eyes(70%) and 15 of 20 patients(75%). CONCLUSION: AMO Array lens can be used as a method of treatment of presbyopia, when combined with correct biometry.

A Comparison of Clinical Results in Unilateral and Bilateral Cataract Surgerys

PURPOSE: This study compares the outcomes of unilateral cataract surgery to those of bilateral cataract surgery in patients with cataract of both eyes. METHODS: Among a total of 153 patients, 61 underwent unilateral surgery and 92 bilateral surgery. RESULTS: The unilateral and bilateral surgeries were similar in demographic and ocular characteristics including visual acuity and visual function-14, except patient-reported factor, such as trouble with vision at baseline. The patient-reported factor was more serious in bilateral surgery than in unilateral surgery. The changes of three outcomes were associated not with unilateral eye or bilateral eye surgery, but with each baseline condition. CONCLUSION: The patient-reported factors such as symptom score, trouble with vision were the significant outcomes to decide unilateral or bilateral surgery in patients with cataract of both eyes. The result of unilateral or bilateral surgery did not affect the outcomes of cataract surgery after 12 months.

Clinical Results of Cataract Operations using Piggy-back Method

PURPOSE: To attain adequate intraocular lens power during cataract surgery in patients with high myopia or hyperopia, the implantation of two intraocular lenses by the piggy-back method are being widely attempted. Therefore, we report the clinical results of implantation of two intraocular lenses by the piggy-back method. MATERIALS AND METHODS: We illustrate a case of a 62-year old high myopic patient with cataract who received lens insertion of -5.0 diopter and -4.0 diopter piggy-back style in the capsular bag. Also, we illustrate a case of a 7-year old female with congenital cataract who received lens insertion in the capsular bag of +18.0 diopter and +17.0 diopter in the right eye and +17.0 diopter and +16.0 diopter in the left eye. RESULTS: Postoperative findings at 2 months showed well positioning of both lenses without noticeable complications.

Intraocular Pressure following Cataract Surgery using Sutureless Clear Corneal Incision

PURPOSE: The purpose of this study is to investigate the effect on intraocular pressure (IOP) of sutureless clear corneal phacoemulsification with foldable posterior intraocular lens implantation. METHODS: We measured the IOP using both a non-contact pneumotonometer and a Goldmann applanation tonometer preoperatively and postoperatively (1, 3, 10, 30, 60 and 90 days). In operation, the incision site was determined depending on the axis of preoperative corneal astigmatism and divided into two groups: Temporal (Group 1) and Superior clear corneal incision (Group 2). It is postulated that if there is more damage to the surrounding tissue in superior incision group due to poorer surgical accessibility than temporal group, it may affect on postoperative IOP. RESULTS: The mean preoperative IOP of Group 1 (59 eyes) and Group 2 (41 eyes) were 14.6 mmHg and 14.3 mmHg respectively. At postoperative 1 day, the IOP decreased in both groups by 14.2 mmHg and 14.0 mmHg respectively (p>0.05), and at 3 days, 13.1 mmHg and 13.2 mmHg respectively (p<0.05). And from then on, there was no statistically significant change to 3 months. The mean IOP of postoperative 3 months was 12.9 mmHg in both groups; decreased to 1.7 mmHg and 1.4 mmHg respectively compared to preoperative value (p<0.05). In all periods of this study, there was no significant difference between two groups and between two methods of measurement. CONCLUSIONS: These results suggest that in case of uncomplicated senile cataract, sutureless clear corneal phacoemulsification with foldable posterior intraocular lens implantation reduces the IOP in short term follow up period.

Clinical Result of Planned posterior Continuous Curvilinear Capsulorrhexis in Adult Cataract patients: 1 year follow-up

No Abstract Available.

Five Cases of Severe Allergic Keratoconjunctivits Not Respond to Treatment / 소아알레르기및호흡기학회지

Conjunctivitis of allergic origin is associated with a diversity of clinical presentation. The common features include pronounced itching, a milky conjunctival appearance, a stringy or ropy discharge & papillary hypertrophy of the tarsal conjunctiva in severe cases, and a family history of allergy. The pathogenesis of ocular allergy involves multiple mechanisms, which lead to mast cell degranulation & the release of chemical mediators. The current therapy of ocular allergy involves elimination of the offending allergen, modulation of the immune system, & pharmacologic inhibition of chemical mediators. We are reporting 5 cases of severe allergic keratoconjunctivitis.

Prediction of the Refractive Power after Cataract Surgery on Myopic Eyes

After extracapsular cataract extraction and posterior chamber intraocular lens implantation on 62 high myopic patients(79 eyes) whose axial lengths were more than 26.0mm, the authors investigated the differences between the calcualted, predicted, peroperative values and measured postoperative values retrospectively. The patients were divided into 2 groups according to their axial lengths; Group C is 35 patients (44 eyes) with 26.0-28.4mm. Group D is 27 patients(35 eyes) with more than 28.4mm. Group A, as control group, is 70 patients(81 eyes) with 22.0-24.4mm and group B, as control group, is 37 patients(44 eyes) with 24.5-25.9mm. Autorefractive examination and manifest refraction was done at 1week, 1month, 3 months postoperatively. Preoperative intraocular lens diopter was calculated by SRK-II and SRK/T formula. After the scleral incision, continuous circumlinear capsulorhexis, and phacoemulsification, one-piece PMMA lens was implanted in the bag. At postoperative 3 months, all patients had the tendency of myopic shift and the shift calculated by SRK-II was much more than that by SRK/T. The difference was statistically significant. In conclusion, it is better to apply SRK/T formula when axial length is more than 26.0mm, in order to acheive goal diopter postoperatively.

Corneal Astigmatism Change after Simultaneous Surgery for Cataract and Pterygium

It is known that surgically induced astigmatism can be reduced by incision along the steep axis. Also, high grade astigmatism can be induced by pterygium. We evaluated the amount of corneal astigmatism according to the severity of pterygium in cataract patients. We retrospetively analysed the change of astigmatism after simultaneous surgery for cataract and pterygium retrospectively. We divided patients into two groups, temporal incision group. We confirmed that astigmatism is induced by moderate to severe pterygium. The more severe the pterygium, the more the amount of astigmatism. The amount of astigmatism was reduced after surgery irrespective of the incision. Postoperative astigmatic change was stabilized earlier in the temporal incision group than in the superior incision group. We concluded thath simultaneous surgery for cataract and pterygium can be considered when the severity of the pterygium is moderate to severe. Incision location in those surgeries should be decided according to whether the previous astigmatism was with-the-rule or aganinst-the-rule and this can be assumed by the state of astigmatism of the healthy, fellow sys. If the assumption is not possible, temporal incision is more desirable in aspectes of stability and predictability of postoperative astigmatism.

Digitalized Eye Movement recording and Verification of its Reproducibility

Many diagnostic tools, which record eye movement, are available for diagnosis and treatment of the patients with impaired eye movement. Most of these tools cannot record directly the eye movement but record electrical analog signal developed when eyeball moves through electrode attached on skin or sclera. Because they need a fixation device, they may bring a patient discomfort. It is well known that digital recording device is not interfered by external noise signal and that its reproducibility is acceptable. We have developed a noninvasive, direct, and precise technique for recording eye movement and verified its reproducibility. We video-taped the horizontal and vertical eye movement and processed the captured images digitally using a image analysis program. the result showed the frequency energy of eye movement in the range within 6Hz and at 10 or 11Hz. The eye movement was observed more clearly after filtering the low frequency energy by inverse Fourier transformation. The reproducibility for measurements of total variability were as follows; vertical displacement measurements, 1.21%; horizontal displacement measurements, 0.68%. In conclusion, this new technique is easy and comfortable to examiner and patient. Its reproducibility was acceptable. Thus it may served as a substitute of conventional tools for recording eye movement.

The Effect of Antimetabolites for Inhibiting the Proliferation of Rabbit Lens Epithelial Cells in Vitro

The most common cause of blurred vision after extracapsular cataract extraction is known to be an opacification of the posterior lens capsule. The pathogenesis of posterior lens capsule opacification is primarily caused by residual lens epithelial cells. For the prevention of posterior capsular opacification, several kinds of anti-mitotic drugs is being actively investigated. But the antimitotic drugs are not clinically used due to toxicity towards the intraocular tissues. The objectives of this study is to evaluate the effect of mitomycin C and tirilazad mesylate(FREEDOX(TM)) respectively for inhibiting the proliferation of rabbit lens epithelial cells when it is administered in a short period. Lens epithelial cells from white rabbits were harvested andcultured for 4 passages. Mitomycin C was applied for 3 minutes with 0.025mg/ml and 0.05mg/ml in concentration respectively. The proliferation assay was performed by [(3)H]-thymidine uptake test. Significant decrease of lens epithelial cell proliferation appeared in both drugs.When Mitomycin-C was applied with 0.025mg/ml for 3 minutes, cell proliferation was reduced to 31.5% compared with control and in 0.05mg/ml concentration, to 12.5%. When tirilazad mesylate was applied 0.15mg/ml for 3 minutes, cell proliferation was reduced to 46.5% compared with control and in 1.5mg/ml concentration, to 7.5%. If futher investigation would show the effectives and safety of these drugs, these agents could be applied into the lens capsular bad at the time of surgery to prevent the posterior capsular opacification after cataract surgery.

Clinical Evaluation of AMO Phacoflex SI-30NB in the Aspect of A-constant

We inspected reliability of A-constant of AMO SI-30NB by comparing target diopter and actual postoperative refractive status. Group 1 comprised 191 eyes which were implanted AMO PhacoFlex SI-30NB with corneal incision. Group 2 comprised 45 eyes implanted Pharmacia 812C with scleral incisions. Group 3 comprised 17 eyes implanted AMO OgaciFlex SI-30NB with corneal incision. Refraction was performed on post operative day 1, day 5, day 14, 1 month, and 3 month. It revealed hyperopic shift of 0.31 to 0.40 diopter compared to the target diopters in both Group 1 and Group 3 and no statistical difference was found between two groups(p value>0.05). On the other hand, Group 2 were statistically significant(p value<0.01). We attempted mathematical modelling of this phenomenon and the cause of hyperopylene haptics, structural weakness of haptic-optic junction, and the structure of SI-30NB itself.

Ciliary Malignant Melanoma with Neovascular Glaucoma

Malignant melanoma is a rare tumor of the eye occuring anywhere on the uvea. Due to its fatal prognosis when it metastasizes to the liver, early diagnosis and treatment are needed.Glaucoma is frequently noted when the tumor is located on the ciliary body. A 73-year-old man who had com-plained of foreign body sensation for 4 months showed increased intraocular pressure, moderate anterior chamber reaction, and rubeosis iridis accompanied by a white exudative mass. The result of localized tumor excision and anterior chamber aspiration proved to be a malignant tumor. Therefore, enucleation was done and pathological examination showed ciliary malignant melanoma with seeding on the iris and anterior chamber angle structures.

Clinical Results after Surgical Treatment in Congenital Cataract

There are many unknown factors in the surgical treatment of congenital cataract such as time of surgery, surgical problems, and aphakic visual correction. Recently, the advancement of microsurgical technique and visual rehabilitation have reduced the rate of postoperative complications and visual losses. We have studied 81 eyes of 55 patients who had recieved cataract surgery from January 1994 to January 1998 at the department of ophthalmology, Yonsei University College of Medicine. These eyes have been categorized by age into three groups : Group l (0~1 year), Group ll (2~5 years), and Group lll(6~10 years). Cataract extraction was done in all eyes and posterior chamber intraocular lens implantation was performed in groups ll and lllfor aphakic visual correction and the followings were investigated : preoperative vision; surgical method; postoperative vision; refractive error;and complications. Improvements in surgical procedures such as lens aspiration, posterior continuous circular capsulorhexis, anterior vitrectomy, intraocular lens implantation, and intraocular lens capture (Group ll) have brought better visual outcomes in groups II and III as well as decreased incidence of after-cataract. Thus, intraocular lens implantation in congenital cataract of 1year and older should actively be considered.

The effect of the haptic portion of intraocular lens on the development of posterior capsular opacification in rabbit

Using a white rabbit model, the effect of the haptic portion of the intraocular lens (IOL) and intracapsular ring on the development of posterior capsular opacification (PCO) after extracapsular cataract extraction (ECCE) with phacoemulsification was studied. Implantation of both the intracapsular ring and IOL developed less PCO than implantation of the IOL alone. ECCE followed by implantation of the intracapsular ring alone also developed less PCO than ECCE alone. Through this experimental work in a rabbit model, it could be conceived that the haptic portion of IOL and the intracapsular ring can prevent the development of PCO.

The Change of the Anterior Chamber Inflammation by Lens Epithelial Cell Revoval in Cataract Surgery

Remained lens epithelial cells after the cataract surgery can cause anterior and posterior capsular opacity and other complications from the postoperative anterior chamber inflammation. The removal of lens epithelial cells(LEC) during the cataract surgery is important clinically. We measured the degree of the anterior chamber inflammation after the removal of LEC in 360 degree and the removal of LEC in 180 degree. The anterior chamber inflammation was measured by flare-cell meter postoperatively the 1st day, 4th day, 1st week, 2nd week, 3rd week, 4th week, and 3rd month, and compared the results with the anterior chamber inflammation after the cataract surgery without the removal of LEC. There were no significant differencies among the groups before the 2nd week. The degree of inflammation was decreased significantly in the groups postoperatively compared to the group in which LEC were not removed. And the inflammation was lower significantly in the group of the 360 degree removal than the group of 180 degree removal after the 2nd week postoperatively. We conclude that LEC removal in cataract surgery decreased the anterior chamber inflammation significantly after the 2nd week postoperatively.

Comparison of corneal centering in photorefractive keratectomy

The present study compares three centering methods for excimer laser photorefractive keratectomy (PRK. VISX 20/20) by analyzing the corneal topography. The subjects were grouped according to three different centering methods used in the procedure: an ablation using a light reflex from the patient's cornea pursued by both eyes of the surgeon (Group 1, n = 49); an ablation using a red light reflex from the patient's cornea pursued by the surgeon's left eye only while the right eye remained closed (Group 2, n = 27); an ablation using the patient's center of the pupil pursued by the surgeon's left eye only while the right eye remained closed (Group 3, n = 21). The mean distance from the center of ablation zone to the center of the pupil were; 0.69 +/- 0.45 mm for Group 1, 1.05 +/- 0.48 mm for Group 2 and 0.63 +/- 0.28 mm for Group 3. The degree of deviation in Group 2 was significantly greater than in Group 1 or Group 3. The deviation was greater in the right eyes than the left eyes in Group 2 only. The decentration of the right eye in Group 2 was due to angle Kappa with misalignment of the fixation light and viewing tube containing reticule.

Ophthalmologic manifestation of Behcet's disease

Loss of vision in Behcet's disease is one of the most common, as well as one of the most serious, of its varied manifestations. Total blindness may often be the eventual outcome. The underlying problem in the eye, as well as in other organ systems, is an occlusive vasculitis. Although the most common ocular symptom is that of iridocyclitis, the presence of retinovascular lesions, especially necrotizing retinitis, is well known but often obscured by the severity of the anterior reaction, which precludes a good view of the retina. While Behcet's disease is characterized by spontaneous remissions and relapses, no external factors have been found to explain the length of remissions. Blindness, which occurs in up to 25% of patients, is one of the major causes of permanent disability.

Clinical Study on Cataracts in Renal Transplant Patients

Development of cataract is a well-documented ocular complication of systemic cortico steroid use in renal transplant patients. The purpose of this paper was to examine the result of cataracts in these patients and its correlation between development of cataract and steroid dose, rejection episodes, and human leukocyte antigen (HLA) type. Thirty patients (50 eyes) received cataract surgeries after renal transplantation. Thirty eight eyes (76%) were found to have posteiror subcapsular opacity. Forty seven eyes (96%) had a good postoperative visual acuity. Two eyes had a minimal macular edema, and other two eyes showed transient increase of intraocular pressure. The daily steroid dose of study group was significantly lower than that of control group. There was no significant correlation between cataract formation and rejection episode, cyclosporin dose and azathioprine use. HLA B13 was present in control group to a great extent (p<0.05). The surgical results of cataract in renal transplant patients were relatively good, and careful attention was needed when steroid dose was changed. We need further study about to prevent the formation of cataract.