Prostatic Arterial Embolization for Control of Hematuria in Patients with Advanced Prostate Cancer.

Nine patients with advanced prostate cancer (stage T4) underwent prostatic arterial embolization (PAE) for refractory prostatic hematuria. Angiograms showed prostatic neovascularity in all cases, and complete PAE was achieved in 8 cases (89% technical success rate). Gross hematuria ceased after PAE in 6 cases, translating to a 67% clinical success rate. There were no PAE-related complications. At 3-month follow-up, 2 cases showed recurrent hematuria, 4 patients had died from PAE-unrelated etiologies, and only 3 patients survived and were without gross hematuria. PAE could represent an alternative option for patients with advanced prostate cancer to control hematuria.

Transcatheter Arterial Embolization of Angiographically Visible and Occult Renal Capsular Artery Hemorrhage in 28 Patients.

PURPOSE: To evaluate the effectiveness and safety of transcatheter arterial embolization to control bleeding from the renal capsular artery (RCA). MATERIALS AND METHODS: Embolization was performed in 28 patients (14 men; mean age, 49.7 y). Presence and type of previous invasive procedures, initial presentation, and coagulation profile were reviewed. Any preceding abdominal computed tomography (CT) findings were analyzed. Angiographic findings were categorized as active bleeding, suspicious for bleeding, or no bleeding. Technical and clinical success and clinical outcomes were evaluated. Changes in hemoglobin level and transfusion volume of packed red blood cells (pBRCs) before and after embolization were evaluated with the paired t test and Wilcoxon signed-rank test, respectively. RESULTS: Technical and clinical success rates of therapeutic embolization for active bleeding (n = 11) were 90.9% and 80%, respectively. One case of technical failure (5.9%) and 3 cases of postembolization bleeding (18.7%) were noted in the prophylactic embolization group in patients with suspicion of bleeding (n = 13) or no bleeding (n = 4). Transient renal insufficiency occurred in 4 patients (14.3%). The average hemoglobin level and volume of transfused pBRCs changed from 8.1 g/dL to 9.9 g/dL and from 871 mL to 543 mL, respectively (P < .05). Extravasation of contrast media or acute hematoma in the right subhepatic or perirenal space on CT was noted in 21 patients (78%). CONCLUSIONS: Embolization can provide an effective and safe method to control RCA bleeding. Perirenal invasive procedures and signs of active or recent right subhepatic or perirenal hemorrhage should raise the suspicion of an RCA source.

The Clinical Study of Branch Retinal Vein Occlusion Associated with Systemic Hypertension

Branch Retinal Vein Occlusion(BRVO) is the second most retinal vascular abnormality after diabetic retinopathy. Systemic hypertension is the most common combined disease. The author evaluated 38 patients of BRVO with hypertension regarding the clinical manifestations, viual acuity changes and the results of treatment. Medical or Laser therapy was selected according to the degree of retinal nonperfusion, macular edema and neovascularization documented by fluorescein angiography. The most common age group was sixth decade(39.5%) and the most common affected site was superior temporal branch of retinal vein(60.5%). The sequelae were macular edema(39.4%), perifoveal non perfusion, retinal neovascularization and vitreous hemorrhage. There were no significant differences in visual prognosis due to the states of blood pressure, vein occlusion site and timing of laser therapy. The better visual prognosis was observed in cases of without soft exudate or without macular edema or capillary non perfusion less than 5 disc diameter. The increased visual acuity of 2 lines or more were noted in 10(71%), 13(76%), 9(60%) cases respectively and showed stastiscal correlations(p0.05). We suggest that the medical and laser therapy should be considered according to the status of high quality fluorescein angiography of retina.

Surgical Results of Lacrimal Surgery with or without Canalicular Stenosis

PURPOSE: To compare the surgical results of lacrimal surgery for nasolacrimal duct obstruction with and without canalicular stenosis. METHODS: We surveyed 175 eyes which underwent external dacryocystorhinostomy with silicone tube intubation from January 1996 through December 2000 retrospectively. Group 1 included 126 eyes in nasolacrimal duct obstruction without canalicular or commoon canalicular stenosis and group 2 included 47 eyes with canalicular or common canalicular stenosis. We checked the statistical significance with Chi-squre Test. RESULTS: Anatomical success rate was 96.0% (121/126) in group 1 and 85.7% (42/49) in group 2; It was statistically significant (p<0.05). And functional success rate was 91.3% (115/126) in group 1 and 73.5% (36/49) in group 2; it had statistic significance (p<0.05). The surgical success rate depending on the size of sac was not statstically significant in goup 1, but it had statstic significance in total group (p<0.05). In site of stenosis, anatomical and functional success rate ware 93.1% (27/29) and 79.37% (23/29) in common canalicular stenosis. It was higer surgical success rate than the other site, but it had no statistic significance. CONCLUSIONS: The canalicular or common canalicular stenosis is important factor in success of lacrimal surgery. Therefore it is recommendable to open the canalicular stenosis by probing prior to performing dacryocystorhinostomy.

Clinical Effect of Acyclovir Therapy on Herpetic Keratitis

Acyclovir is highly selective and relatively non-toxic anti-herpes agent. Thirt-y-seven patients with herpetic keratitis were treated with acyclovir. (23 patients with pure epithelial type, 4 patients with accompanying stromal keratitis, and 10 patients with accompanying keratouveitis). Acyclovir was very effective in 23 patients with pure epithelial herpetic keratitis. All epithelial defects healed in a mean healing time of 6.2 +/- 2.3 days. In 4 patients with stromal keratitis, 3 patients healed within 14 days and 1 patient healed on 27 days. In 10 patients with keratouveitis, 8 patients healed within 14 days, 1 patient healed on 21 days, and 1 patient was not healed even after one month. Four patients developed superficial punctate keratopathy during therapy, but no other serious adverse effects were seen.

Clinical Effect of Acyclovir Therapy on Herpetic Keratitis

Acyclovir is highly selective and relatively non-toxic anti-herpes agent. Thirt-y-seven patients with herpetic keratitis were treated with acyclovir. (23 patients with pure epithelial type, 4 patients with accompanying stromal keratitis, and 10 patients with accompanying keratouveitis). Acyclovir was very effective in 23 patients with pure epithelial herpetic keratitis. All epithelial defects healed in a mean healing time of 6.2 +/- 2.3 days. In 4 patients with stromal keratitis, 3 patients healed within 14 days and 1 patient healed on 27 days. In 10 patients with keratouveitis, 8 patients healed within 14 days, 1 patient healed on 21 days, and 1 patient was not healed even after one month. Four patients developed superficial punctate keratopathy during therapy, but no other serious adverse effects were seen.

Anterior Capsular Staining with a Mixture of Indocyanine Green Dye and Viscoelastic Material

PURPOSE: The authors used a mixture of ICG dye and viscoelastic material to perform continuous curvilinear capsulorhexis (CCC) in white cataract, in order to stain the anterior capsule with the minimal contact with the corneal endothelial cells. METHODS: In 10 eyes with white cataract, CCC was performed under the anterior capsular staining with ICG dye. The ICG solution was prepared by dissolving 25 mg of ICG in 1 mlof an aqueous solvent, which was mixed in 3 ml of balanced salt solution. With a three-way connector, one way was occluded, the other was connected with 1 ml of viscoelastic material, and the third was connected with 4 ml of the prepared ICG solution. One half percent mixture of ICG and viscoelastic material was made by alternate injection. The anterior chamber was filled with viscoelastic material, and then the anterior capsule was stained by slow spread of the prepared ICG mixture between anterior capsule and viscoelastic material. The remains of ICG mixture was removed by infusion and aspiration. The anterior chamber was filled with viscoelastic material again, CCC was performed with cystotome. Corneal edema and anterior chamber reaction was evaluated with slit lamp at 1 day, 1 week and 1 month after surgery. RESULTS: In all cases, CCC was successfully completed under the anterior capsular staining of the desired area with 0.5% ICG dye mixture and there was no contact with the corneal endothelial cells. Mild corneal edema and mild anterior chamber reaction that observed on the 1st postoperative day subsided within 1 week in all cases. CONCLUSIONS: Staining the anterior capsule with 0.5% ICG dye mixture, after the anterior chamber was filled with viscoelastic material, it was helpful to perform CCC in white cataract. Using this technique, we could minimize the contact with the corneal endothelial cells and stain the desired area.

The Complications of Silicone Tube Intubation after Lacrimal Surgery

We reviewed the complications associated with silicone tube intubation in the treatment of disorders of the lacrimal system in 68 cases from January 995 to December 1997. Complications included conjuctival and corneal irritation 7 cases, punctal erosion 6 cases, tube prolapse 5 cases, tube extrusion or breakage 4 cases, and intranasal irritation 3 cases. After silicone intubation complications occurred in 7 cases in the 1st month, 8 cases between 1 and 3 months. Among them each 3 cases had their tubes removed. Complications occurred in 4 cases between 3 and 6 months, 6 cases longer than 6 months. After 3 months, all patients with complications had their tubes removed. Operation result of patients with tube removed was good.

Fundus Fluorescein Photography Using Oral Fluorescein

Fundus fluorescein angiography has become a standard diagnostic test in ophthalmology. It is reported, however, that various side effects occur with intravenous administration of fluorescein sodium. After it was determined that the oral use of fluorescein sodium was harmless, it was applied to clinical cases. Fundus fluorescein photography was performed in 30 subjects. After fasting fluorescein sodium was administered in a dose of 20 mg/kg body weight followed by the ingestion of 50 ml of water. The first oral fluorogram was taken 10 minutes after peroral dye administration, and repeated 5 times at an interval of 10 minutes. The results of this study were as follows: 1. We obtained sufficient fluorescein images in 28 of the 30 subjects(93%). 2. The fluorescence in the fundus became detectable about 10 minutes after peroral administration. 3. Maximal intensity of fluorescence was usually seen at 30 minutes after peroral administration. 4. There were no adverse reactions from any subject. 5. This may be preferred in studies of children, patients with no visible veins, patients who are psychologically unsuitable for injections, unstable patients who have severe diseases(cardiovascular accident, myocardial infarction, hypertension etc) and in large scale surveys.

Autogenous Temporalis Fascia Graftin Exposure of Hydroxyapatite Implant

Hydroxyapatite recently has been used for its excellent results compared with other implant materials, but the tissue breakdown and exposure of the hydroxyapatite implant was reported due to hemorrhage or infection. Five patients with exposed hydroxyapatite implant after evisceration or enucleation were studied.The hydroxyapatite implant exposure occurred in 2 to 8 weeks (mean 4.2 weeks)after implantation.Conjunctival defects with various sizes were noted in all cases and purulent discharge in one case. An autogenous temporalis fascia patch graft was placed instead of preserved sclera or fascia lata for the intensification of the defect area.No reexposure occurred during a follow-up examination and we could keep the implant well in all cases. The temporalis fascia is advantageous over preserved sclera or fascia lata because it is firm and can be easily obtained from the same operative field as the primary surgery.Therefore, it is thought to be suitable for graft material in surgery of the exposed hydroxyapatite.No scars are visible after obtaining temporalis fascia.

Long-term follow-up of Conjunctivodacryocystorhinostomy

Conjunctivodacryocystorhinostomy(CDCR) with a Pyrex tube is an accepted procedure for the treatment of epiphora resulting from obstructed canaliculi. We analyzed the success rate, complications and it's treatment of 181 eyes who underwent CDCR with a Pyrex tube at Wallace Memorial Baptist Hospital between september 1986 and march 1996. Straight tubes, 18mm long(70 of 181 eyes; 38.7%) was most commonly used. Of 181 eyes, 172 eyes(95%) were successful. Complications of CDCR included submergence of Pyrex tube (13 of 181 eyes; 7.2%), tube extrusion(9 of 181 eyes; 4.9%), tube extraction(5 of 181 eyes; 8.9%). Of the 9 eyes of tube extraction, 7 eyes were 20mm in length, and the exchange of 20mm for 18mm was performed under topical anesthesia and two eyes, 18mm in length were replaced by 16mm in length. It was successful in 3 eyes but 6 eyes were dissatisfied because of residual tearing. In 13 eyes of tube submergence, tubes were sutured with 5-0 nylon to the skin of medial canthus and was successful in 10 eyes but was failed in 3 eyes. Of 181 eyes, 5 eyes(2.8%) lost their tube. 4 patients came for treatment 24 hours after tube loss and 1 patients came for treatment 72 hours after tube loss. A simple tube reinsertion was successful in all cases. Other complications were granuloma formation(16 of 181 eyes; 8.8%), conjunctival growth over the tube opening(8 of 181 eyes; 4.4%) and infection (5 of 181 eyes; 2.8%). Granuloma recurred two times in 4 eyes, three times in 2 eyes, four times in 1 eyes and was resected effectively each time under topical anesthesia. Conjunctival overgrowth was treated with conjunctival resection and tube manipulation. The infection resolved completely on consecutive treatment with topical and oral antibiotics.

Hand-held Laser Interferometric Prediction of Postoperative Visual Acuity in Cataractous Eye

The visual acuity measured preoperatively by hand-held laser interferometer was compared to the visual acuity measured postoperatively by Han s visual acuity in 86 cataractous eyes treated by phacoemulsification with posterior chamber IOL insertion in order to get the prediction of postoperatively corrected visual acuity. The follow up period was at least 4 weeks. In the 56 cases with immature cataract and normal retina, the postoperative visual acuity was predictable within 2 lines in 52 eyes (92.8%). In 20 eyes with mature cataract including nuclear sclerosis, postoperative Han's visual acuity was predictable within 2 lines in 7 eyes (35%), and one patient showed positive disparity. In 15 eyes with retinopathy, 10 eyes (66.7%) showed positive disparity and 3 eyes (20%) showed negative disparity. We concluded that the hand-held laser interferometer is a reliable method to predict the postoperative visual acuity in immature cataract with normal retina.

Autogenous Temporalis Fascia Grafting and Conjunctival Flap Transposition in Scleromalacia after Pterygium Excision

PURPOSE: To evaluate the result and complications of autogenous temporalis fascia grafting and conjunctival flap transposition as a treatment of scleromalacia after pterygium excision. METHODS: We used autogenous temporalis fascia and conjunctival flap to treat scleromalacia of 9 patients(9 eyes) who underwent pterygium excision and checked the postoperative result and complications. RESULTS: We could keep the temporalis fascia graft without necrosis during follow-up examination. Pain, inflammation and scleral discoloration were disappeared after temporalis fascia grafting in all cases. Postoperative complications were included 2 cases of progression of cataract and 1 case of mild chamber inflammation. CONCLUSIONS: We obtained good surgical result of scleromalacia after pterygium excision by autogenous temporalis fascia grafting with conjunctival flap transposition.

The Results of Pigtail Probe Canalicullar Reconstruction Surgery with Silicone Tube and Methylcellulose

We performed simple and successful canalicular reconstruction with smooth tip pigtail probe in 56 cases of inferior canalicular laceration. After general anesthesia or local anesthesia in inferior and superior canthal area, upper lacrimal sac area and lacerated inferior eyelid, methylcellulose mixed fluorescein was injected through the superior canaliculus under the surgical microscope with cobalt blue filter and simply found cutting end of the inferior canalicullus. Smooth tip pigtail probe was inserted and silicone stent was connected the superior and inferior canaliculi and the peri canalicular sheath was sutured with and to end anastomosis. Silicone tube was removed after postoperative 8 weeks and 86% of the patients(48/56 cases) was successful without epiphora. Smooth tip pigtail probe, methylcellulose mixed fluorescein, silicone stent, and end to end anastomosis of pericanalicular sheath under the surgical microscope would increase the success rate of pigtail probe canalicular reconstruction.

The Clinical Experience of Hydroxyapatite Implantation using Autologous Sclera and Vicryl Mesh

The hydroxyapatite implant, recetnly widely used new intraorbital implant, in light, highly biocompatible, characterized by easy fibrovascular proliferation. Thus, when inserted after evisceration, it has some beneficial effect cosmetically: it can cause less protrusion of implant or alteration of position and can have good artificial eye motion by linking to the implant. However, in case of hydroxyapatite implantation after evisceration with the cornea preserved, there is a risk of cornea melting by contact with the implant, and in case with the cornea preserved of the eyeball size being too small, hydroxyapatite implant is impossible after evisceration. Hydroxyapatite implantation is done after enucleation using donor sclera, which is not readily available in Korea. Thus we inserted hydroxyapatite implant covered with circular from of Vicryl mesh on endothelium after evisceration in 11 eyes, and inserted hydroxyapatite implant using autologous sclera with Vicryl mesh after enucleation in 3 eyes, in which 18 mm-sized implant could not be implanted after evisceration from August 195 to July 1996. Follow-up examination was done during 6 to 20 (mean 12.9) months postoperatively. Motion of extraocular muscle was very good. During follow-up examination, adverse effects such as conjunctival wound dehiscence and exposure or protrusion of hydroxyapatite implant through the conjunctiva didn`t occur. It should be considered an excellent operative method, because the hydroxyapatite implantation using autologous sclera with Vicryl mesh decreases the risk of exposure or protrusion of the implant and can be performed without the use of donor sclera.

The Clinical Study of Treatment of Blowout Fracture

The orbital blowout fractures has been increasing due to trauma and traffic accidents with time. The diagnostic confirmation is easily established by CT scan, but the indication for surgical treatment, the technique for repair, and timing of repair are still controversial. We have reviewed investigated the charts of 18 cases who had blowout fracture, including the clinical manifestation, surgical indication, surgical procedures, improvement of diplopia, and its complication. The follow up was at least 6 months in the past 5 years. In cases of diplopia only in the upward gaze limitation, or small orbital fracture in orbital CT scan and less degree of enophthalmos, these 8 cases were treated conservatively for 2 weeks and diplopia improved markedly. However, in 10 cases of severe diplopia and in large fracture and tissue incarceration, these were surgically managed using Silastic sheets. In these cases, the diplopia resolved within 1 month in 7 cases(70%). Residual diplopia waS seen in 3 cases, and we retreated surgically for the two cases of them. In the other non surgical cases, diplopia resolved on 6 months follow up except in 2 cases of mild diplopia. Therefore we should pay more attention to surgical indication.

Comparison of Surgically Induced Astigmatism between a No-Stitch Frown Incision and a No-Stitch Straight Incision

PURPOSE: This investigation was performed to evaluate the surgically induced astigmatism of no-stitch frown incision with 4.0 mm chord length, which was compared with no-stitch 3.2 mm straight incision. METHODS: Sixty eyes, which could be observed for 3 months, were divided into two groups. Both groups were composed of 30 eyes. Group 1 - a semicircular frown incision with 4.0 mm chord length was made 1 mm posterior and most convex to limbus. Group 2 - a 3.2 mm straight incision was made 2 mm posterior to limbus. No-stitch was done in both groups. The corneal astigmatism was evaluated at postoperative 1st day, 1st week, 2nd week, 1st month, 2nd month and 3rd month with Bausch & Lomb keratometry, calculated by values derived from Cravy's vector method and statistically analyzed by Student t-test. RESULTS: The change of surgically induced astigmatism in group 1 was 0.52 D, 0.45 D, 0.43 D, 0.38 D, 0.40 D, and 0.39 D at 1st day, 1st week, 2nd week, 1st month, 2nd month, and 3rd month, respectively. In group 2, it was 0.83 D, 0.72 D, 0.65 D, 0.52 D, 0.50 D, and 0.49 D at the same intervals. These differences of astigmatic change were not statistically significant(p>0.05). CONCLUSION: The astigmatic change in a no-stitch frown incision with 4.0 mm chord length was not enough to comparable with that of a no-stitch 3.2 mm straight incision. We could safely use PMMA intraocular lens by no-stitch frown incision. So, this method has some advantages over small incision with foldable intraocular lens.

Silicone Intubation for Treatment of Punctal Stenosis

PURPOSE: To evaluate the surgical results and complications of silicone intubation in patients with epiphora by punctal stenosis. METHODS: We reviewed the records of 35 eyes of 23 patients who had undergone silicone intubation from 1998 to 2002 and followed more than 1 year postoperatively. RESULTS: Following 1 year postoperatively, 33 eyes (94.3%) showed no epiphora, 2 eyes (5.7%) showed intermittent epiphora. Complications after silicone intubation included prolapse of tube in 3 eyes, punctal slitting in 1 eye, itching in 6 eyes, foreign body sensation in 2 eyes, discharge from punctum in 3 eyes and intranasal discomfort in 1 eye. CONCLUSIONS: Silicone intubation seemed to be an alternative method in patient with epiphora due to punctal stenosis and also a useful method to treat upper and lower punctum.

Ocular Findings in the Acquired Immunodeficiency Syndrome

The Acquired Immunodeficiency Syndrome(AIDS) is defined as a reliably diagnosed disease that is at least moderately indicative of an underlying cellular immunodeficiency in a person who has no known cause of underlying cellular immunodeficiency. The AIDS is caused by the human T-lymphotropic virus type III. We report here on a 32-year-old Korean male with AIDS. Detailed ophthalmic examinations were done and several cottonwool spots were found in both eyes. Other ocular findings of AIDS were not seen in this patient.

Clinical Study on Extracapsular Lens Extraction in Cataract Surgery

An extracapsular lens extra.ction usually provides an excellent functional result and leaves an eye whose anatomic integrity in some ways exceeds that seen after an intracapsular lens extraction. This technique has the advantage of a smaller incision and a shorter convalescence. In the prevention of certain complications such as operative vitreous loss and postoperative cystoid macular edema, well planned extracapsular lens extraction before surgery is followed by far fewer complications than the misfortune of a ruptured capsule of an immature cataract. Cataract extraction was performed as usual conventional method. Intracapsular lens extraction was performed in 21 eyes and extracapsular lens extraction in 15 eyes. Although the incidence of iris adhesion to the cornea or vitreous, iris peaking, vitreous adhesion to the posterior corneal wound and operative rupture of the anterior hyaloid membrane were higher than those of the intracapsular lens extraction, sorious complications were not resulted. Fundus fluorescein angiograms were taken in all patients within 6 months postoperatively. The incidence of cystoid macular edema in the extracapsular lens extraction (33%) was lower than that of the intracapsular lens extraction(43%).