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Lee S.J.,Haeundae Paik Hospital | Kim I.G.,Maryknoll Medical Center | Park J.M.,Maryknoll Medical Center
Journal of Cataract and Refractive Surgery | Year: 2013

We describe a technique that uses a 23-gauge transconjunctival sutureless vitrectomy with perfluorocarbon liquid (PFCL) and phacoemulsification to manage a dropped nucleus. The PFCL is injected into the vitreous space until the dislocated lens reaches the iris plane and is then removed using phacoemulsification in the anterior chamber. After intraocular lens (IOL) implantation, a 23-gauge forceps is passed through the sclerotomy to grasp the IOL haptic, which is pulled onto the ocular surface. Tunnels are made at the edge of the flap with a 26-gauge needle into which the 2 haptics are tucked for additional stability. The scleral flaps and conjunctiva are then glued using biological glue. Perfluorocarbon liquid reduces lens repulsion and blocks the transmission of the ultrasound stream to the retina. The fibrin glue-assisted sutureless IOL implantation technique could reduce complications and suture-related problems. Financial Disclosure: No author has a financial or proprietary interest in any material or method mentioned. © 2012 ASCRS and ESCRS Published by Elsevier Inc.

Kim K.H.,Maryknoll Medical Center | Kim W.S.,Maryknoll Medical Center | Kim W.S.,Inje University
Ophthalmology | Year: 2010

Purpose: To evaluate the amount of intraocular lens (IOL) decentration and refractive changes after cataract surgery using posterior continuous curvilinear capsulorrhexis (PCCC). Design: Prospective comparative case series. Participants: We included 86 eyes of 77 patients who had cataract surgery using PCCC (the PCCC group), and 79 eyes of 68 patients treated without PCCC (the control group). Methods: Foldable IOLs with polymethylmethacrylate haptics (VA-60BB, Hoya Corporation, Tokyo, Japan) were implanted in both groups. The best-corrected visual acuity (BCVA) was assessed. Automated refractokeratometry, Scheimpflug imaging (Pentacam; Oculus, Wetzlar, Germany), and slit-lamp photography with retroillumination were performed at each follow-up visit over 6 months. The axial shift of each IOL was measured as the distance between the corneal endothelium and the anterior surface of the IOL on Scheimpflug images. The horizontal shift was assessed as the distance between the geometric center of the IOL and the centers of the pupil and the limbus. Main Outcome Measures: Best-corrected visual acuity, horizontal and axial shift of the IOL, and automated refraction. Results: There was no difference between the 2 groups in the mean BCVA before surgery and at any postoperative follow-up. The mean horizontal shift of the IOL after 6 months was 0.25±0.14 mm for the pupil and 0.31±0.17 mm for the limbus in the PCCC group (P = 0.315), and 0.26±0.09 mm and 0.31±0.13 mm, respectively, in the control group (P = 0.115). These were not different from the measurement on the postoperative day 1 (P = 0.515, P = 0.263, P = 0.421, and P = 0.875, respectively). At each follow-up visit over 6 months, there was no difference in the horizontal shift between the 2 groups (P>0.05). The IOL shifted insignificantly in the PCCC group (-0.08±0.24 mm anterior shift), but the shift was significant in the control group (-0.42±0.27 mm anterior shift; P = 0.009). The mean postoperative refractive shift 6 months after surgery compared with refraction on the first day after surgery was -0.16±0.67 diopter (D) in the PCCC group and -0.60±0.70 D in the control group (P = 0.042). Conclusions: During cataract surgery, PCCC is useful to stabilize and minimize postoperative refractive changes. The IOL displacement attributable to capsular contraction is less when cataract surgery involves PCCC. Financial Disclosure(s): The authors have no proprietary or commercial interest in any of the materials discussed in this article. © 2010 American Academy of Ophthalmology.

Jang J.H.,Maryknoll Medical Center | Park J.M.,Maryknoll Medical Center | Lee S.J.,Inje University
Graefe's Archive for Clinical and Experimental Ophthalmology | Year: 2012

Background To investigate the incidence of and factors predisposing to consecutive esotropia after intermittent exotropia surgery, and to prevent the onset of consecutive esotropia. Methods We retrospectively surveyed 226 patients who had been followed up for more than 1 year after surgery for intermittent exotropia conducted between February 2005 and September 2010. Consecutive esotropia was defined as an esotropia of at least 10 prism diopters (PD) at distance or near at least once in 2 weeks after surgery. Presumed risk factors for consecutive esotropia were analyzed. Gender, age at surgery, average binocular spherical equivalent, anisometropia, high myopia, amblyopia, preoperative angle of deviation, vertical deviation, A-V pattern strabismus, exotropia type, type of surgery, stereopsis, and suppression were investigated to evaluate factors influencing the onset of consecutive esotropia. Results Consecutive esotropia occurred in 22 patients (9.7 %). Significant correlations with occurrence of the condition were found with high myopia (P=0.013), amblyopia (P=0.047), preoperative angle of deviation of 25-40 PD at distance (P=0.016), deviation at distance - deviation at near > 10 PD (P=0.041), lateral incomitance (P=0.007), tenacious proximal convergence fusion type (P=0.001), unilateral lateral rectus muscle recession and medial rectus muscle resection (P=0.001). Conclusions High myopia, amblyopia, and lateral incomitance were predisposing factors for consecutive esotropia. Furthermore, the preoperative angle of deviation at distance, differences between the angle of deviation at near and at distance, the type of intermittent exotropia, and the type of surgery affected the incidence of consecutive esotropia. More attention must be paid to patients with such factors. © Springer-Verlag 2012.

Kim S.-M.,Maryknoll Medical Center | Cho K.-I.,Kosin University
Cardiovascular Therapeutics | Year: 2013

Summary: Background: Cilostazol, a selective phosphodiesterase three inhibitor, has been proposed to have beneficial effects in the prevention of atherosclerosis. Aims: We aimed to investigate the effects of cilostazol on carotid intima-media thickening (IMT) and total plaque area (TPA) in patients with retinal vascular occlusion. Methods: A total of 63 consecutive vascular occlusive retinopathy patients with carotid atherosclerosis were enrolled. We examined changes in the carotid IMT/TPA and visual acuity/macular thickness before and after 1-year treatment with cilostazol (200 mg/day). Results: The mean IMT of both common carotid arteries (CCAs) and internal carotid arteries (ICAs) were significantly reduced after cilostazol treatment. There was no significant difference in the TPA of both CCAs before and after the treatment (before; 0.61 ± 0.94 vs. after; 0.45 ± 0.79 cm2, P = 0.291); however, significant plaque regression (before; 0.14 ± 0.15 vs. after; 0.25 ± 0.14 cm2, P = 0.004) was observed in selected patients (n = 30) with a TPA <0.5 cm2. The improvement in macular thickness was significantly associated with an improvement in carotid IMT (r = 0.42, P = 0.001) and TPA (r = 0.23, P = 0.04). Conclusion: Cilostazol potently inhibited the progression of carotid IMT and may play a role in the early carotid plaque regression in patients with retinal vascular occlusion. © 2013 John Wiley & Sons Ltd.

Lee J.H.,Maryknoll Medical Center | Im Cho K.,Kosin University
Journal of Cardiology | Year: 2014

The aim of this study is to evaluate the role of arterial stiffness in pulmonary arterial hypertension (PAH) in systemic lupus erythematosus (SLE) patients and its relationship with antiphospholipid antibody (aPL). Methods: Measurement of brachial ankle pulse wave velocity (baPWV), carotid arterial stiffness, and pulmonary vascular resistance (PVR) was performed in 51 patients with SLE. PAH was diagnosed if the pulmonary artery systolic pressure was >40. mmHg. Information concerning SLE duration, medication, and serum autoantibodies was recorded. SLE activity was assessed by the SLE disease activity index (SLEDAI). Results: aPL was present in 10 patients (20%), and PAH was detected in 6 patients (12%). The prevalence of Raynaud's phenomenon, baPWV, positive aPL, and titers of IgG anticardiolipin antibody (aCL) were increased in SLE with PAH; however, no difference was found in inflammatory markers, disease duration, and SLEDAI compared to SLE without PAH. Carotid artery deformation and right ventricular function were reduced in patients with PAH (all p<. 0.05). Carotid artery circumferential strain (r = 0.34, p = 0.021), radial strain (r = -0.30, p = 0.045), and baPWV (r = 0.46, p = 0.001) showed significant correlation between IgG aCL. Univariate and multiple regression analysis revealed that the only significant independent predictors of the presence of PAH were baPWV, carotid artery stiffness, and IgG aCL. Conclusion: Arterial stiffness might contribute to the pathogenesis of PAH related to SLE as well as aPLs. Furthermore, the significant association of aPL with arterial stiffness suggests its important role in PAH with SLE. © 2014 Japanese College of Cardiology.

Kim I.G.,Maryknoll Medical Center
Korean journal of ophthalmology : KJO | Year: 2012

To evaluate factors associated with the direction of horizontal deviation in the sensory strabismus of patients with unilateral organic amblyopia. The medical charts of 53 patients who had been diagnosed with sensory strabismus between 2000 and 2009 were reviewed retrospectively. The underlying ocular disease, time of onset and the duration of vision impairment, refractive error and axial length of the fixing eye, and the direction and angle of deviation were analyzed to determine the distribution of underlying diseases and any factors relevant to determining the direction of the horizontal deviation. Congenital cataracts were the most common underlying disease, found in 33 patients, followed by acquired cataracts, optic nerve disorders, retinal detachment, glaucoma and lens subluxation. Among the 50 patients with horizontal strabismus, 11 had esotropia and 39 had exotropia. The incidence of esotropia was significantly higher when the fixing eye had hyperopia or emmetropia, than when the eye was myopic. Age of onset of vision deterioration and at diagnosis of sensory strabismus, and the axial length of the fixing eye had no relationship to the direction of horizontal deviation. In addition, the duration of visual impairment had no significant relationship with the direction or extent of horizontal deviation. The most common cause of sensory strabismus was congenital cataracts and the most frequent type of strabismus was exotropia. With respect to the direction of horizontal strabismus, esotropia occurred significantly more often when the refractive error of the fixing eye was hyperopia or emmetropia than when the fixing eye was myopic.

Le J.H.,Maryknoll Medical Center | Cho K.I.,Kosin University
Clinical Rheumatology | Year: 2014

Nailfold capillaroscopy (NC) represents the method to analyze microvascular abnormalities in autoimmune rheumatic diseases, but the pathophysiological link between the microvascular derangement which is seen in NC and endothelial function is yet to be discovered. We investigated the association between endothelial function and microvascular derangement in patients with Raynaud’s phenomenon (RP). Postmenopausal women (n = 37) with secondary RP and age-matched healthy controls (n = 25) were evaluated with NC. Microvascular alterations were assessed by microangiopathy evolution score. Endothelial function was examined by brachial artery flow-mediated dilatation (reactive FMD, endothelium-dependent) and response to 40 μg of sublingual nitroglycerine (NTG-induced dilatation, endothelium-independent). There was significant capillary loop dilatation (apical width; 14.1 ± 5.6 vs. 10.4 ± 1.7 μm, p = 0.001 and total width; 40.6 ± 15.1 vs. 31.6 ± 4.6 μm, p = 0.002) and lengthening (316.0 ± 78.5 vs. 270.4 ± 34.7 μm, p = 0.004) in secondary RP compared to controls. Additionally, giant capillaries, loss of capillaries, hemorrhage, and background pallor were much more prevalent in secondary RP as compared to controls (all p’s < 0.05). Although there were no significant differences in NTG-induced dilatation between secondary RP and controls (16.1 ± 5.9 vs. 19.6 ± 9.0 %, p = 0.091), significant decreases in the reactive FMD value (6.1 ± 3.5 vs. 9.0 ± 2.2 %, p = 0.001) were noted. Both FMD and NTG-induced dilatation showed a significant inverse association with microangiopathy evolution score (r = −0.355, p = 0.005 and r = −0.285, p = 0.028). Significantly impaired endothelial function was found in secondary RP, and microvascular derangement was associated with endothelial dysfunction. © 2014, Clinical Rheumatology.

Choroidal osteoma is a benign ossified tumor that is found predominantly in healthy young women during their second and third decades of life. The lesions are white-to-cream or orange in color, are located in the peripapillary and macular areas, and are unilateral in most patients. The symptoms of choroidal osteoma include decreased visual acuity and metamorphopsia or scotoma corresponding to the location of the osteoma, but some patients have no symptoms. Prognosis of vision varies according to tumor location, retinal pigment epithelial and sensory retinal degeneration, subretinal fluid and hemorrhage, and development of a subretinal neovascular membrane.

Lee M.C.,Maryknoll Medical Center
Pediatric Gastroenterology, Hepatology and Nutrition | Year: 2014

It is more difficult to achieve cooperation when conducting endoscopy in pediatric patients than adults. As a result, the sedation for a comfortable procedure is more important in pediatric patients. The sedation, however, often involves risks and side effects, and their prediction and prevention should be sought in advance. Physicians should familiarize themselves to the relevant guidelines in order to make appropriate decisions and actions regarding the preparation of the sedation, patient monitoring during endoscopy, patient recovery, and hospital discharge. Furthermore, they have to understand the characteristics of the pediatric patients and different types of endoscopy. The purpose of this article is to discuss the details of sedation in pediatric endoscopy. © 2014 by The Korean Society of Pediatric Gastroenterology, Hepatology and Nutrition.

Lee J.H.,Maryknoll Medical Center | Cho K.I.,Maryknoll Medical Center | Kim S.M.,Maryknoll Medical Center
Clinical and Experimental Rheumatology | Year: 2012

Objective: Although a series of trials support the intima-media thickness (IMT) of carotid artery as a good predictor for the cardiovascular events in patients with rheumatoid arthritis (RA), the link between IMT, vascular elastic property and the disease activity of RA is not defined. We investigated the association between carotid atherosclerosis, elastic properties of the carotid arterial wall and clinical parameters of RA. Methods: One hundred and twenty RA patients and fifty healthy controls were included. Peak systolic global circumferential and posterior radial strain of carotid artery were measured to assess the elastic properties. Beta stiffness index was used as conventional method for the distensibility of the carotid artery. RA activity was assessed by high sensitivity C-reactive protein (hsCRP) and disease activity score with 28 joints (DAS 28) and health assessment questionnaire (HAQ). Results: Carotid plaques were more common in RA patients. RA patients with plaques were older and had an increased mean IMT, hsCRP, DAS 28, and longer disease duration compared with those without plaques. Peak systolic global circumferential and posterior radial strain were congruent with β stiffness index, and significantly lower in the RA group. Age, disease duration, hsCRP, DAS 28 showed significant correlations with mean IMT and parameters of carotid elastic property. Conclusions: Carotid atherosclerosis was more common in RA patients, and carotid arterial stiffness had significant correlation with disease duration and disease activity of RA. Speckle tracking strain imaging is a comparative method for the assessment of elastic properties of carotid artery of RA patients. © Copyright CLINICAL AND EXPERIMENTAL RHEUMATOLOGY 2012.

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