The Results of Nation-Wide Registry of Age-related Macular Degeneration in Korea

PURPOSE: To evaluate the incidence and clinical features of age-related macular degeneration (AMD) in Korea. METHODS: Web-based (www.armd-nova.or.kr) registration was conducted for AMD patients aged 50 or more who were newly diagnosed by retinal specialists in Korea from August 20, 2005 to August 20, 2006. Patient data including ophthalmologic examination, fundus photography, fluorescein angiogram and/or indocyanin green angiogram (ICG), past medical history, behavioral habit, combined systemic diseases were up-loaded. RESULTS: Among finally enrolled 1,141 newly diagnosed AMD patients, 690 patients (60.5%) were male and 451 patients (39.5%) were female. The average age of AMD patients was 69.7+/-8.0. Early AMD was observed in 190 patients and 951 patients had late AMD. Classic choroidal neovascular membrane (CNVM) was observed in 18.6% of exudative AMD patients and 63.4 % had occult CNVM. Subfoveal CNVM was observed in 80.4% of the patients with CNVM. Among the 580 exudative AMD eyes that performed indocyanin green angiography (ICG), 184 eyes (31.7%) had polypoidal choroidal vasculopathy (PCV) and 36 eyes (6.2%) showed retinal angiomatous proliferation (RAP). Age, male gender, smoking, diabetes and hypertension significantly increased the risk of the AMD among Koreans. CONCLUSIONS: Because of the low rate of participation by retinal specialists, definite incidence of AMD was not obtainable. However, the estimated 1-year AMD incidence in the Pusan area of Korea is at least 0.4%. In contrast to Western people, 31.7% of exudative AMD cases were revealed to be PCV and 6.2% were revealed to be RAP. This discrepancy between ethnic groups should be considered in the diagnosis and treatment modality selection of Korean AMD patients.

Cup-to-Disc Ratio, Intraocular Pressure, and Occlusion Site in Branch Retinal Vein Occlusion

PURPOSE: To investigate correlations among the cup-to-disc ratio (CDR), intraocular pressure (IOP), and the occlusion site in branch retinal vein occlusion (BRVO). METHODS: This prospective study involved 62 eyes with a diagnosis of BRVO. Fundus photography, fluorescein angiography, Goldmann applanation tonometry, and optical coherence tomography were performed. Correlations among CDR, IOP, and the occlusion site were analyzed. RESULTS: A negative correlation was found between the occlusion site and IOP (p<0.001, Pearson's correlation analysis) and between the occlusion site and CDR (p<0.001, Pearson's correlation analysis). However, the correlation between IOP and CDR was poor (p=0.092, Pearson's correlation analysis). CONCLUSIONS: BRVOs with an occlusion site near the optic disc are associated with raised IOP and CDR values. This study suggests that the occurrence of BRVO with an occlusion site near the optic disc indicates that the patient should be evaluated for glaucoma.

Fluorescein Angiographic Features in Central Retinal Vein Occlusion With and Without Optic Nerve Head Swelling

PURPOSE: To investigate the characteristics of fluorescein angiograms (FAG) of the optic nerve head and retina according to the presence of optic nerve head swelling (ONHS) in central retinal vein occlusion (CRVO). METHODS: The records of 69 eyes were reviewed, confirmed with the diagnosis of CRVO, and compared for several features according to the presence of ONHS. The best-corrected visual acuities and intraocular pressures were recorded and patterns of retinal hemorrhage were described. The presence of fluorescein filling defects of the optic disc, time till fluorescein started to fill at the optic disc, arteriovenous transit time, and nonperfused areas were assessed using FAG. RESULTS: Forty-one patients without ONHS (group 1) and 28 patients with ONHS (group 2) were included. The mean ages for groups 1 and 2 were 61.4 and 56.9 years, respectively, and there was no significant difference the mean ages between the groups. The fluorescein filling defect of the optic disc was seen more often in group 1 (n=13) than in group 2 (n=2). Marginal irregularity of the foveal avascular zone due to perifoveal capillary drop out was seen significantly more often in group 1 (n=12) than in group 2 (n=2). CONCLUSIONS: Fluorescein filling defects of the optic disc and perifoveal capillary drop out were more frequently seen in CRVO patients without ONHS. However, longitudinal studies are needed to confirm the prognostic value of ONHS and the correlation of filling defects with progressive optic neuropathy in CRVO.

Central Retinal Vein Occlusion Associated with Thyroid Ophthalmopathy

PURPOSE: To report the first case of central retinal vein occlusion (CRVO) in association with thyroid ophthalmopathy. METHODS: A 40-year-old woman was came to the ophthalmologic clinic due to conjunctival injection, lid swelling and decreased visual acuity in the left eye. She was ill with hyperthyroidism and was recovered completely. At the first visit, best corrected visual acuity of her left eye was 0.3. The left eye showed proptosis, episcleral vessel dilation, and moderate limitation of ocular movement. Orbit MRI revealed the enlargement of extraocular muscles. Fundus examination showed diffuse retinal hemorrhages with macular edema and retinal veins were dilated and tortuous. Fluorescein angiogram showed the diffuse leakage from the retinal vessels on the posterior pole, but nonperfusion area was not seen. RESULTS: One month after the first visit, best corrected visual acuity of her left eye was improved to 0.6. Proptosis and limitation of ocular movement was improved, and retinal hemorrhages with macular edema were decreased remarkably. CONCLUSIONS: Possible retinal vascular complications such as CRVO may occur in patients with thyroid ophthalmopathy. Therefore, in these cases, fundus examination along with other ophthalmologic examinations are necessary.

Papilledema Associated with Anemia in a Patient with Paroxysmal Nocturnal Hemoglobinuria

PURPOSE: To report a case of bilateral optic disc edema associated with hemolytic anemia and paroxysmal nocturnal hemoglobinuria (PNH). METHODS: A 51-year-old woman visited our ophthalmologic clinic complaining of metamorphopsia. Twenty eight years ago, she had been diagnosed with PNH and hemolytic anemia and had received blood transfusion on an irregular basis. The best corrected visual acuity was initially 0.5 in the right eye and 1.0 in the left eye. Light reflex was intact and no afferent pupillary defect was found. Fundus examination revealed severe optic disc swellings with indistinct margins in both eyes. Papillary and peripapillary retinal hemorrhages were also present. RESULTS: A visual field test revealed the enlarged physiologic scotoma in both eyes. Fluorescein angiograms showed hyperfluorescence of the optic disc and blocked fluorescence due to the papillary hemorrhages. Optical coherence tomograms of the optic disc showed the loss of physiologic disc cupping and severe elevation. There was no evidence of an intracranial lesion upon brain magnetic resonance imaging. These findings were compatible with optic disc edema associated with anemia and the management was oriented towards the anemia. At the 2-months follow-up, the best corrected visual acuity of both eyes had improved to 1.0 and optic disc edema markedly decreased. However, the patient's overall physical condition deteriorated and she expired due to dyspnea and hepatic coma.

Rotation Flap of Tenon's Capsule for Treating Hypotony

PURPOSE: To report a case of rotational flap of Tenon's capsule for hypotony with choroidal detachment occurring after trabeculectomy and needle revision (NR) of a nonfunctioning bleb. METHODS: An 15-year-old female, suffering acute angle-closure glaucoma with lens dislocation into anterior chamber, underwent pars plana vitrectomy, lensectomy, and intraocular lens scleral fixation. Three months later, trabeculectomy with mitomycin C (MMC) and NR with MMC were performed to decrease intraocular pressure (IOP). After 5th NR, hypotony with choroidal detachment occurred. Consequently, bleb revision and rotation flap of the autologous Tenon's capsule were performed. RESULTS: One week after surgery, IOP was 18 mmHg, and a diffuse bleb was formed. Choroidal detachment improved with remaining vascular tortuisity and chorioretinal folds. At five months, best corrected visual acuity was 0.5, IOP was 20 mmHg, vascular tortuisity decreased, and chorioretinal folds disappeared in the macula. CONCLUSIONS: Hypotony with choroidal detachment occurring after needle revision was treated effectively with bleb revision and rotation at flap of autologous Tenon's capsule.

Prepapillary Vascular Loops associated with Branch Retinal Artery Occlusion and Vitreous Hemorrhage

PURPOSE: To report a case of prepapillary loops (PPLs) associated with branch retinal artery occlusion (BRAO) and vitreous hemorrhage in a patient with IgA nephropathy. METHODS: A 26-year-old woman presented with sudden loss of vision in her right eye. One year prior, she had been diagnosed as having IgA nephropathy. Examination of the right fundus revealed vitreous hemorrhage that appeared to be extending from the optic disc and a pale and edematous superior retina that was compatible with BRAO. Subretinal and intraretinal hemorrhage extending from the optic disc were also present. Laboratory tests of the factors associated with coagulation were normal. RESULTS: After spontaneous resolution of the vitreous hemorrhage and retinal edema, arterial PPLs and a venous PPL were detected at the superior portion of the optic disc. Fluorescein angiogram demonstrated slow filling of the superior branch of the retinal veins and the venous PPL. The filling of the arterial PPLs was normal and there was no delayed perfusion in the superior retina. These PPLs did not show any fluorescein leakage in the late phase of the angiogram. At the last follow-up visit, 18 months after the onset of symptoms, the vitreous hemorrhage and subretinal hemorrhage had been completely absorbed and no other ocular complications hd developed. CONCLUSIONS: PPL is usually asymptomatic; however, complications such as BRAO and vitreous hemorrhage can develop in some cases with causative factors.

Effects of Zinc and Hypothermic Process during the Light and Dark Adaptation of Vertebrate Retina

PURPOSE: The purpose of this study was to clarify the effects of zinc treatment and hypothermia on visual adaptation and visual sensitivity in bullfrogs (Rana catesbeiana), which are poikilothermal animals capable of adjusting quickly to environmental temperature changes. METHODS: The effects of both zinc treatment and hypothermia on visual sensitivity were studied by using electroretinogram (ERG) recording and absorption spectra scanning before and after zinc and TSQ (N-[6-methoxy-8-quinolyl]-p-toluene sulfonamide) treatment, with or without temperature changes. RESULTS: In spite of malnutrition due to hibernation, the optimal zinc concentration effect was obtained at 10-4 M (10-2 M 200 microliter ZnCl2 in 20 microliter Ringer's solution) according to ERG recording. After zinc treatment and hypothermia induction, increments of all ERG components and thresholds were taken by ERG recording. These results showed that both zinc treatment and hypothermia may increase visual sensitivity during visual adaptation. In spectral scans, the absorbance increment due to zinc treatment and hypothermia was shown over the whole spectral range (400~750 nm), and it was especially prominent at alpha-peak (about 500 nm). In addition, there was a decrease in absorption differences between dark adaptation and light adaptation after zinc treatment. Furthermore, according to the visual sensitivity decrement using TSQ as a zinc specific chelator, this visual sensitivity increase was shown to be caused by zinc. CONCLUSIONS: As the results suggest, both zinc treatment and hypothermic effects may improve visual sensitivity by promoting rhodopsin regeneration and inhibiting rhodopsin bleaching induced by light illumination. Zinc may activate the enzyme activity of retinol dehydrogenase and phosphodiesterase, while hypothermic effects may improve precursor transport, which is required for rhodopsin regeneration, by tightening membrane adhesion between retinas and retinal pigment epithelia. In addition, we believe that zinc treatment and hypothermic effects may work synergistically to accelerate visual sensitivity during visual adaptation.

Evaluation of Bilateral Visual Function after Vitrectomy for Complications of Proliferative Diabetic Retinopathy

PURPOSE: The author evaluated the impact of vitreoretinal surgery for proliferative diabetic retinopathy (PDR) on bilateral visual function. METHODS: Anatomic and visual acuity outcomes were reviewed by author for patients who underwent bilateral surgery for PDR. Bilateral visual function was evaluated using the American Medical Association (AMA) Guidelines for Disability scale to quantitate the impact of surgery on visual system disability. RESULTS: There were 18 patients (36 eyes) who underwent vitrectomy for complications of PDR, and the overall anatomic success rate was 100%. Mean visual impairment of the study eyes and visual system according to AMA Guidelines for Disability decreased postoperatively by 22.4% points, and 25.7% points, respectively. A higher functional level of the bilateral visual system resulted postoperatively in 83.2% of all patients, according to eyes with better visual acuity. CONCLUSIONS: Vitreoretinal surgery was associated with a reduction in bilateral visual disability and improved bilateral visual function in patients with PDR.

Cytomegalovirus Retinitis in a Child with Acute Lymphoblastic Leukemia

PURPOSE: To report a case of cytomegalovirus (CMV) retinitis in a child who had been managed by immunosuppressive chemotherapy for acute lymphoblastic leukemia (ALL). METHODS: An 8-year-old boy who had been managed by immunosuppressive chemotherapy for ALL was referred to the ophthalmologic clinic because of blurred vision in his right eye. Fundus examination showed hard exudates and white retinal leaion in the macular area of the right eye, white retinal lesion accompanied with retinal hemorrhage and exudates in the midperipheral retina of the left eye. Serologic tests demonstrated a positive response of CMV antibody IgG and a negative response of CMV antibody IgM. CMV was isolated upon the culture of bone marrow and peripheral blood. Immunosuppressive chemotherapy was discontinued and ganciclovir was administered. RESULTS: Administration of ganciclovir led to clinical stabilization of the retinitis lesion that was accompanied by scarring. We were able to discontinue the administration of ganciclovir after the retinal lesions were resolved, and no recurrence of CMV retinitis was noted. CONCLUSIONS: Ganciclovir treatment was clinically effective in improving CMV retinitis in an immunocompromised child with ALL. In addition, the improved systemic immune function achieved by discontinuing immunosuppressive chemotherapy permitted discontinuation of anticytomegalovirus therapy.

Lymphangiomatosis of Bone and Visceral Parenchyma : Report of Two Cases / 대한정형외과학회잡지

Lymphangiomatosis is a rare disorder that occurs mainly in children or during the first two decades of life. It is characterized by a diffuse proliferation of lymphatic channels involving the bones, visceral parenchyma, and soft tissue. Most cases of lymphangiomatosis have bone and visceral involvement and usually present with chylothorax, chylous ascites, chylous pericardial effusion, or acute symptoms that are related to the affected organs. The authors experienced two cases that presented with chylothorax and multiple lytic bone lesions. Chest drainage and chemical pleurodesis were performed for treatment of the chylothorax. In one case, lytic bone lesions were found only in the right scapula and bone lengthening with an Ilizarov frame was performed for growth arrest in the right humerus. In the other case, lytic bone lesions were found in both femurs and both humeri, the right tibia, and the right scapula; and were particularly severe in the right tibia and femur. The lytic bone lesion, osteosclerosis, pathologic fracture, and pseudoarthrosis were so severe that weight-bearing was impossible. Internal fixation was performed with an intramedullary nail in the left femur.

Emergency cervical cerclage in advanced cervical incompetence / 대한산부인과학회지

OBJECTIVE: To investigate the clinical effectiveness of emergency cervical cerclage in pregnant women with advanced cervical incompetence in the second trimester. METHODS: This study analyzed retrospectively the pregnancy outcomes of 20 patients who were offered emergency cerclage between June 2000 and April 2004. Group I was defined as the patients cervical dilatation without membrane prolapse. Group II was the patients with membrane prolapse into vagina, who were underwent amniocentesis to decrease intraamniotic pressure. RESULTS: The mean+/-SD gestational age at cerclage was 21.6+/-2.4 weeks (Group I: 21.0+/-2.5, Group II: 22.1+/-2.3). The mean cervical dilatation was 2.5+/-0.9 cm (Group I: 1.8+/-0.5, Group II: 3.2+/-0.8) and mean effacement was 79.0+/-12.9% (Group I: 68.8+/-11.6, Group II: 87.3+/-6.4). The mean interval from cerclage to delivery was 9.4+/-5.3 weeks (Group I: 11.1+/-6.1, Group II: 7.9+/-3.7) and mean gestational age at delivery was 31.0+/-6.0 weeks (Group I: 32.2+/-7.4, Group II: 30.0+/-4.9). The birth weight was 1.9+/-1.1 kg (Group I: 2.4+/-1.4, Group II: 1.6+/-0.8) and the perinatal survival rate was 75% (Group I: 77%, Group II: 73%). Cervix dilatation and effacement were significantly more advanced in group II compared to the group I (p<0.05). However, the duration of pregnancy prolongation and birth weight, gestational age at the delivery were not significantly different between both groups. CONCLUSION: This results suggest that emergency cervical cerclage might be an effective treatment in advanced cervical incompetence, and that the concomitant amniocentesis could help the cerclage in the patients with membrane prolapse.

Cilioretinal Artery Occlusion Following the Intranasal Injection of Corticosteroid

PURPOSE: To report a case of cilioretinal artery occlusion following the intranasal injection of corticosteroids. METHODS: A 52-year-old man was referred to the ophthalmologic clinic due to a marked loss of vision in his right eye immediately after endoscopic sinus surgery. At that time, his vision was noted to be counting fingers in the right eye. His pupil was mid-dilated, fixed, and did not respond to light on examination. On ophthalmoscopy, macula edema with retinal ischemia, and a cherry-red spot were seen in the posterior pole of the retina. Ocular massage was carried out immediately after ophthalmologic examination. Three days later, visual acuity in the right eye improved to 0.15. Fluorescein angiography revealed filling defects of the cilioretinal artery and peripheral branches of the retinal arteries. In addition, areas of nonperfusion were observed. RESULTS: During the follow-up periods, macula edema resolved and visual acuity in the right eye improved to 1.2 after 3 months. Fluorescein angiogram was repeated and showed that the filling defects had disappeared. CONCLUSIONS: Retinal artery occlusion can occur after an intranasal injection of corticosteroids due to embolization of retinal circulation. This condition can be improved without complications by no other specific therapy.

Midd-term effects of trabeculectomy with mitomycin C in neovascular glaucoma patients

Twenty four eyes from 23 neovascular glaucoma (NVG) patients, who underwent trabeculectomy with 0.2 or 0.4 mg/ml MMC in least the previous 6 months, were examined in order to evaluate the mid-term effects of a trabeculectomy with mitomycin C (MMC) in NVG. Success defined when an intraocular pressure (IOP) 5 mmHg with or without medication was observed. The mean IOP was reduced from 46.8+/-12.9 mmHg preoperatively to 18.2+/-12.0 mmHg at the last follow-up (mean = 25.8 months). The overall success rates at 1-, 3-, 6-, 9-, and 12-months after surgery were 71%, 58%, 50%, 29%, 29% respectively. The number of anti-glaucoma medications administered was significantly reduced from 2.6+/-0.7 preoperatively to 0.9+/-1.0 postoperatively (Wilcoxon signed rank test, p = 0.005). In addition both the intraoperative MMC concentration and application time had no influence on lowering the IOP (logistic regression analysis, p = 0.228, 0.910, respectively). There was a similar incidence of postoperative complications in both the success and failure group. These results suggest that a trabeculectomy with MMC is an effective surgical procedure in NVG patients and the MMC concentration is not crucial for reducing the IOP postoperatively.

The Effects of ADCON(R)-L on the Adhesion after Strabismus Surgery

PURPOSE: We investigated the effectiveness of ADCON-L in reducing the formation of adhesion after strabismus surgery in a rabbit model. METHODS: Bilateral recessions of superior rectus muscle (SR) were performed on 18 rabbits. ADCON-L was applied beneath and over the SR in 9 rabbits, while operative fields in the others were irrigated with a balanced salt solution (BSS). The degree of adhesion was recorded at 3 weeks postoperatively. All eyes were enucleated and histopathologic examination was done at 4 weeks postoperatively, and the degree of fibrous proliferation and inflammation were evaluated. RESULTS: A significant reduction in the degree of adhesion and fibrosis was noted in eyes treated with ADCON-L as compared with in those irrigated with BSS (p=0.003, p=0.028). However there was no statistical significance in the degree of inflammation between two groups (p=0.114). CONCLUSIONS: This study suggests that ADCON-L is effective in reducing postoperative adhesion for as long as 4 weeks after strabismus surgery in rabbits.

Polysomnographic study on sleep patterns of Korean normal young adult / 신경정신의학

No abstract available.

Polysomnographic study on sleep patterns of Korean normal young adult / 신경정신의학

No abstract available.

Derotational Osteotomy and External Fixation for Increased Femoral Anteversion / 대한정형외과학회잡지

PURPOSE: To describe a method of femoral derotational osteotomy using an external fixator. MATERIALS AND METHODS: A retrospective review was conducted of 6 patients with 12 femora treated by derotational osteotomy with a semicircular modified Ilizarov external fixator and Schanz screws. The mean follow-up period was 17 months (in the range 12-28 months). There were two boys and four girls of mean age 11 years (in the range 10 to 13 years). The deformities were all idiopathic and there was no combined disease. Mean preoperative femoral anteversion was 38 degrees (in the range 31-50 degrees) and mean internal and external hip rotation were 76 degrees (in the range 70-85 degrees) and 23 degrees (in the range 20-30 degrees), respectively. RESULTS: After operation, the mean internal rotation at the hip diminished to 47 degrees (in the range 40-50 degrees) and the mean external rotation increased to 52 degrees (in the range 45-55 degrees). In all cases, the mean varus angle 6 degrees (3-9 degrees) was made with conical washers on the osteotomy site to correct combined genu valgum. Mean clutch ambulation was started at 5 days postoperatively. The Ilizarov external fixator was removed at a mean 9 weeks after the operation and there was no refracture. No significant complication occured in any cases excepting 3 cases of superficial pin tract infection. CONCLUSION: Femoral derotational osteotomy using a semicircular modified Ilizarov external fixator with Schanz screws has the advantages of simplicity, an exact correction of deformity, early ambulation, and the freedom to alter the alignment postoperatively.

The Clinical Characteristics of Hypermetropia in Children

PURPOSE: It is generally believed that children with uncorrected hypermetropia are at risk for the development of unilateral or bilateral amblyopia and for the development of esotropia. We were, therefore, interested in the clinical manifestation in Korean children with hypermetropia. METHODS: We included the children with bilateral hypermetropia of greater than or equal to 3 diopters (D) by spherical equivalent. On the basis of initial visual acuity, children were divided into 3 groups: monocular amblyopia, binocular amblyopia, and normal visual acuity. All children were also divided into 2 groups: esotropia and orthotropia. We investigated the influences of factors such as age at initial visit, incidence of amblyopia, esotropia, anisometropia, degree of hypermetropia and anisometropia between each group. RESULTS: Of 50 children, there was only one child with normal visual acuity in both eyes as well as orthotropia. There was more marked difference in the degree of hypermetropia between both eyes in monocular amblyopic group (n=28) than binocular amblyopic group (n=13) (0.91:0.46 D, p=0.01). The age at initial visit was the most important parameter between esotropia (n=40) and orthotropia (n=8) (3.67:5.75 years, p=0.01). Otherwise, there were no significant parameters between each group. CONCLUSIONS: Forty-nine of 50 children (98.0%) had unilateral or bilateral amblyopia and/or esotropia. Initial visit was especially delayed in the children without esotropia. Therefore, we recommend the preschool vision screening examinations and optical correction at an early age. In any case with hypermetropia, they should be closely observed to prevent developement of amblyopia or esotropia.

Bilateral acute retinal necrosis that followed unilateral optic neuropathy

PURPOSE: There have been several reports of optic neuropathy preceding acute retinal necrosis(ARN) in patients with acquired immunodeficiency syndrome. We report one case of bilateral ARN that followed unilateral optic neuropathy in otherwise healthy person. METHODS: We report on a previous healthy 54-year old man who developed unilateral optic neuropathy 8 weeks after varicella-zoster dermatitis. Central retinal vascular obstruction developed subsequently in his ipsilateral eye. Later on, classic presentation of ARN appeared in his contralateral eye. RESULTS: The patient was diagnosed with bilateral ARN that followed unilateral optic neuropathy. Intravenous acyclovir stopped the progression of retinitis and resulted in healing of retinal lesions. CONCLUSIONS: ARN is a visually devastating clinical syndrome of which prompt diagnosis and early treatment are important in improvement the overall prognosis. This case suggests that optic neuropathy, especially with preceding shingles, should be suspected as prodrome of ARN which necessitates prompt initiation of antiviral therapy.