Sun Young Jang

Delayed-onset retinal detachment after an intravitreal injection of ranibizumab for zone 1 plus retinopathy of prematurity

Intravitreal injection of bevacizumab has been shown to satisfactorily treat retinopathy of prematurity; nevertheless, the safety of antivascular endothelial growth factor therapy in children remains uncertain. We report a patient with bilateral, zone 1, stage 3 plus retinopathy of prematurity who was treated with combined laser photocoagulation and intravitreal ranibizumab injection and demonstrated full regression at 3 months after injection but then developed bilateral retinal detachments 1 month later.

Evaluation of the central macula in commotio retinae not associated with other types of traumatic retinopathy.

Purpose To report on the anatomical and functional changes to the macula in nine patients suffering from commotio retinae not accompanied by any other types of traumatic retinopathy. Methods Nine injured eyes with commotio retinae were evaluated soon after ocular trauma with ophthalmic examination, including Spectral-domain optical coherence tomography (SD-OCT). In 12 eyes of 6 patients, Humphrey visual field (HVF) and multifocal electroretinogram (mfERG) were performed. Re-examinations were periodically performed for a mean of 26 days. Data from 9 injured eyes were collected and compared to data collected from the 9 non-affected eyes of the same patients. Results SD-OCT revealed no significant differences in the foveal thickness and total macular volume between traumatized and intact eyes in all 9 patients. Only 3 out of the 9 injured eyes showed abnormal findings in SD-OCT images such as discontinuity of the inner/outer segment (IS/OS) junction or abnormal hyper-reflectivity from the IS/OS and retinal pigment epithelium (RPE) lines in the macula. HVF and mfERG results did not show any functional deterioration in the injured eyes compared with intact eyes. During follow-up, the commotio retinae resolved in all 9 eyes. The changes to the outer retinal region detected in 3 patients by SD-OCT were also resolved. Conclusions Acute retinal changes in commotio retinae, not associated with other retinal pathologies, were resolved without histological and functional sequelae. In a few cases of commotio retinae, SD-OCT revealed transient abnormalities mainly observed at the IS/OS and RPE complexes.

Long-term surgical outcomes of Quickert sutures for involutional lower eyelid entropion

OBJECTIVES To determine the long-term surgical outcomes associated with the use of Quickert sutures (Q-sutures) for involutional entropion and elucidate the risk factors for postoperative recurrences. METHODS This is a retrospective, interventional case series. We recruited patients suffering from involutional entropion who were treated with Q-sutures during the period from January 2008 to August 2010. Preoperative clinical characteristics and surgical outcomes including recurrence at 1, 6, 12, and 24 months were investigated by reviewing the medical charts. RESULTS Of 85 patients, 69 attended each follow-up visit and were included in the analysis. Thirty-four patients (49.3%) experienced recurrences within 2 years. The recurrence rate was 5 of 69 (7.2%) at 1 month, 15 of 64 (21.6%) at 6 months, 9 of 49 (13%) at 12 months, and 5 of 40 (7.2%) at 2 years. Multiple logistic regression analysis showed that men and patients with lower-lid laxity (OR = 2.852 [95% CI: 1.005-8.092] and OR = 3.780 [95% CI: 1.231-11.614], respectively) were susceptible to postoperative recurrences. CONCLUSIONS The recurrence rate among patients treated with Q-sutures was highest at the 6-month follow-up visit. Alternative surgical options should be considered in males and those with lower-lid laxity in order to prevent recurrences.

Clinical features of thyroid-associated ophthalmopathy in clinically euthyroid Korean patients

AimTo compare clinical characteristics and thyroid-stimulating hormone receptor antibodies (TRAbs) in thyroid-associated ophthalmopathy (TAO) in euthyroid Korean patients with those in hyperthyroid patients.MethodsClinical activity scores (CASs), modified NOSPECS scores, exophthalmometry values, prevalence of optic neuropathy, restrictive myopathy and lid retraction, and the positivity and levels of TRAb (thyrotropin-binding inhibitor immunoglobulin (TBII) and thyroid-stimulating immunoglobulin (TSI)) were compared in 24 euthyroid (group A) and 139 clinical/subclinical hyperthyroid TAO patients (group B).ResultsGroup A presented more clinically unilateral involvement than group B (79.2% vs 27.3%, P<0.001), less active (CAS 1.50 vs 2.26, P=0.014) and less severe clinical course (NOSPECS 3.38 vs 4.13, P=0.037). Lid retraction was more prevalent in group A than group B (91.7% vs 66.2%, P=0.014). Prevalence of optic neuropathy and restrictive myopathy, and the mean value of exophthalmometry were not different. Mean TBII levels were lower (7.20 IU/l) in group A than in group B (44.58 IU/l, P<0.001). A similar difference was found in the TSI bioassay (201.40% vs 425.19%, P=0.001). The positive rate of TBII in group A (34.8%) was significantly lower than in group B (90.8%, P<0.001). The positive rate of TSI was high in both group A (83.3%) and B (91.7%), with no significant difference (P=0.337).ConclusionsPatients with euthyroid TAO showed a less active and severe clinical course, more unilateral involvement, and lower levels of TRAb than those in patients with hyperthyroid TAO. These distinct clinical and biochemical characteristics might be useful in assessment of euthyroid TAO, and the TSI might be more sensitive for diagnosing these patients.

Effects of silicon nitride passivation on isolation-blocking voltage in algan/gan high electron mobility transistors

The effects of plasma enhanced vapor deposited silicon nitride (SiNx) passivation layer thickness and the spacing between the contact windows openings in the SiNx layer on the isolation-blocking voltage of nitrogen ion implanted AlGaN/GaN high electron mobility transistors were studied. The isolation-blocking voltage was proportional to the thickness of the SiNx passivation layer. Early breakdown was observed for the samples without thick enough SiNx due to surface breakdown. The device was permanently damaged after the occurrence of this early breakdown. The dependence of the isolation-blocking voltage on the SiNx thickness was also modeled and the general trends of the simulated results were in good agreement with the experiment data. The effect of rf power used for depositing the SiNx layer on the isolation-blocking voltage was also studied. Ion bombardments during the SiNx deposition could cause the reduction of breakdown voltage. By employing optimized SiNx passivation conditions, a saturation drain ...

Effects of Nasopore Packing on Dacryocystorhinostomy

Purpose To investigate the effects of placement of the absorbable packing material Nasopore at the anastomosis site of newly formed mucosal flaps on postoperative re-bleeding, discomfort, and on the success rate of dacryocystorhinostomy (DCR). Methods A review of the medical records of patients with primary acquired nasolacrimal duct obstruction that underwent external or endonasal DCR by a single surgeon was performed. The degree of re-bleeding, discomfort, and postoperative results, including anatomical success, functional success and postoperative nasal findings such as granulation, synechiae, and membrane formation were compared in patients whose anastomosis site was packed with either Nasopore or Merocel, a non-absorbable packing material. Results A total of 77 patients (101 eyes) were included. Of the 101 eyes, 30 were packed with Nasopore, while 71 were packed with Merocel. The Nasopore group showed significantly better results than the Merocel group in the degree of re-bleeding and the level of patient discomfort (p = 0.000, 0.039, respectively; Pearsons chi-square test), whereas there were no statistically significant differences between the two groups in postoperative anatomical and functional success (p > 0.05). Conclusions Nasopore significantly reduced postoperative nasal re-bleeding and patient discomfort during the early post-surgical period, but failed to show an effect on the postoperative anatomical and functional success of DCR.

Chandelier retroillumination-assisted cataract extraction in eyes with vitreous hemorrhage.

We describe the surgical technique of using an illuminated infusion chandelier for cataract extraction in patients with absent red reflex due to vitreous hemorrhage. A 23-gauge illuminated infusion chandelier was used for cataract extraction in 6 consecutive patients (6 eyes) who underwent combined surgery: phacoemulsification and 23-gauge sutureless vitrectomy. During surgery, the light from the illuminated infusion chandelier was used to enhance the red reflex and to better visualize the lens structure and capsule. Continuous curvilinear capsulorhexis and phacoemulsification were successfully performed. Capsular polishing was also performed safely and easily. The posterior capsule remained intact and the intraocular lens was inserted into the bag in all cases. Thus, the use of the 23-gauge illuminated infusion chandelier can improve visualization of the lens structure and capsule, thereby facilitating successful cataract extraction in select patients with vitreous hemorrhage.

Comparison Between Continuous Buried Suture and Interrupted Buried Suture Methods for Double Eyelid Blepharoplasty.

Purpose:The objective of this study was to compare the surgical outcomes between interrupted and continuous buried suture methods in double eyelid blepharoplasty in Koreans. Methods:Medical records of 204 patients (392 eyes) who underwent double eyelid operation by buried suture method and who were followed up for at least more than 3 months were reviewed. Patients were divided into 2 groups according to the buried suture method; an interrupted group (88 patients) and a continuous group (116 patients). Results:The rate of loss of formed double eyelid is 19.3 % (17 of 88 patients) in interrupted buried method and 8.6 % (10 of 116 patients) in continuous group (P = 0.026). One patient experienced an exposure of suture knot in a continuous group, whereas 5 patients experienced an exposure of suture knot and 1 patient suffered from granuloma in an interrupted group (P = 0.021). Conclusions:The continuous buried suture method has a lower rate of the loss of double folds and less complication than the interrupted buried suture method for double fold formation in Koreans.

Comparison of Pain-relieving Effects of Fentanyl versus Ketorolac after Eye Amputation Surgery

Purpose To investigate the analgesic effect and incidence of postoperative nausea and vomiting (PONV) between the opioid fentanyl and the non-steroidal anti-inflammatory drug ketorolac in patients who underwent eye amputation surgery. Methods Retrospective observational case series. Eighty-two patients underwent evisceration or enucleation surgery by one surgeon over a 2-year period. Fentanyl by intravenous patient-controlled analgesia (IV-PCA) at 20 µg/kg with 12 mg/kg ondansetron or intravenous ketorolac at 2 mg/kg/day was administered to patients at postoperative days 0, 1, and 2. The pain score was measured using an 11-point visual analog scale (VAS). The incidence of severe nausea requiring anti-emetics and the incidence of vomiting were reviewed. Results The mean postoperative VAS in the fentanyl group was significantly lower than that in the ketorolac group on the day of operation for both types of surgery (p = 0.001 and p = 0.004, respectively). At postoperative days 1 and 2, the mean VAS was not different between the two groups for either surgical type (p > 0.05 for both days). The mean VAS was significantly higher in eviscerated patients than in enucleated patients at postoperative days 0 and 1 in the fentanyl group (p = 0.023 and p = 0.016, respectively). However, this was not observed in the ketorolac group. The incidence of PONV was higher in the fentanyl group than in the ketorolac group, although this was not statistically significant for either surgical type (p > 0.05 for both groups). Conclusions Fentanyl was more effective as an analgesic than was ketorolac on the day of operation for both surgical types. There was no difference between the two analgesics on postoperative day 1. The analgesic effect of fentanyl in enucleated patients was significantly higher than in eviscerated patients at postoperative days 0 and 1. The use of fentanyl by IV-PCA was associated with greater PONV despite co-administration with anti-emetics, although this finding was not significant.

Comparison of Surgical Outcome Between Quickert Suture and Quickert Suture With Modified Lateral Tarsal Strip in Involutional Lower Eyelid Entropion

Purpose:To evaluate the surgical outcome between Quickert suture and Quickert suture with modified lateral tarsal strip in involutional lower eyelid entropion. Methods:A retrospective study was performed on 76 patients (94 eyes) who had undergone Quickert suture (Group 1) and on 38 patients (44 eyes) who had undergone Quickert suture with modified lateral tarsal strip (Group 2) for correction of involutional lower eyelid entropion from January 2011 to December 2013. Results:In Group 1, recurrence rate is 25.5% (24 eyes) and mean duration to recurrence is 11.9 months in Group 1. For correction of recurrence, Quickert suture is performed in 50% (12 eyes), Quickert suture with lateral tarsal strip is performed in 37.5% (9 eyes), and lateral tarsal strip is performed in 12.5% (3 eyes). In Group 2, recurrence rate is 9.1% (4 eyes). For correction of recurrence, lower eyelid retractor reinsertion is performed in 50% (2 eyes), Quickert suture with lateral tarsal strip is performed in 25% (1 eye), and Quickert suture is performed in 25% (1 eye). Conclusions:Recurrence rate is lower in patients who had undergone Quickert suture with modified lateral tarsal strip than in a patient who had undergone Quickert suture for correction of involutional lower eyelid entropion.