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To compare the efficacy of nonsteroidal anti-inflammatory drugs (NSAIDs) and steroidal eyedrops for inflammation management after cataract surgery using slitlamp indicators.11 eye centers in South Korea.Randomized prospective multicenter study with a blinded evaluator.In 125 (250 eyes) patients who underwent cataract surgery, bromfenac sodium hydrate 0.1% (NSAID group) was applied twice a day in 1 eye, whereas the other eye was treated with fluorometholone 0.1% (steroid group), 4 times a day for 4 weeks postoperatively. The primary efficacy outcome was the presence of anterior chamber cells and flare at 1 week postoperatively. Anterior chamber cells and flare at 4 to 8 weeks, corrected distance visual acuity, central corneal thickness, conjunctival hyperemia, dry eye parameters, foveal thickness, and ocular and visual discomfort were evaluated as secondary outcomes.At week 1, residual anterior chamber inflammation was not statistically significantly different between the groups (-1.03 ± 1.27 vs -0.95 ± 1.24, P = .4850). However, the NSAID group recovered from conjunctival hyperemia more rapidly than the steroid group (0.30 ± 0.52 vs 0.44 ± 0.81, P = .0144 at week 1). The increase in central corneal thickness in the NSAID group was less than that in the steroid group 1 week postoperatively (7.87 ± 22.46 vs 29.47 ± 46.60 μm, P.0001). The change in foveal thickness in the NSAID group was significantly less than that in the steroid group (18.11 ± 68.19 vs 22.25 ± 42.37 μm, P = .0002). Lower levels of postoperative ocular and visual discomfort were reported in the NSAID group than in the steroid group under treatment.Preservative-free bromfenac was as effective as preservative-free fluorometholone eyedrops in anterior chamber inflammation control and showed better signs and symptoms after cataract surgery.

Purpose To study the incidence of and risk factors for pupillary capture after transscleral fixation of a posterior chamber intraocular lens (PC IOL) for dislocated IOLs. Setting Department of Ophthalmology, Kyungpook National University Hospital, Daegu, South Korea. Design Retrospective case series. Methods Charts of patients who had PC IOL transscleral fixation for the treatment of dislocated IOLs between January 2010 and August 2015 were reviewed. Demographic data, anterior chamber depth (ACD), axial length (AL), anterior chamber volume (ACV), and anterior chamber angle (ACA) were recorded. The cases of postoperative pupillary capture were collected and the characteristic clinical findings evaluated. Results Charts of 63 eyes of 63 patients were reviewed. The mean age was 63 years ± 11 (SD). The mean follow-up after transscleral fixation was 47.8 ± 25.3 months. There were 5 cases of postoperative pupillary capture (incidence 7.8%). A deeper anterior chamber was statistically correlated with an increased incidence of pupillary capture (β coefficient: 0.423; 95% confidence interval, 0.043-0.379; P Conclusion To reduce the incidence of pupillary capture when ACD values are large, the scleral penetrating point should be adjusted from the corneal limbus. Financial Disclosure Neither author has a financial or proprietary interest in any material or method mentioned.

Purpose. To study the correlation between ocular parameters and subjective pain that patients perceived during phacoemulsification.Methods. Medical records of 142 patients who underwent standard phacoemulsification under topical anesthesia between March and August 2016 were retrospectively reviewed. The pain during phacoemulsification and 1 h after surgery was assessed and compared using a visual analog scale. In addition, demographic data, preoperative biometric parameters, and intraoperative surgical parameters were recorded.Results. Mean age of patients was 67.49 ± 12.50 years. The mean pain score was 2.26 ± 0.85 during phacoemulsification and 0.40 ± 0.69 postoperatively. Intraoperative pain was significantly associated with higher preoperative intraocular pressure (β = 0.220,P=0.016), greater anterior chamber depth (β = 0.210,P=0.028), and greater axial length (β = 0.181,P=0.043).Conclusions. To reduce the subjective pain when patients have high preoperative intraocular pressure, large anterior chamber depth, or great axial length, supplementary procedures may be required.

Arthroscopic ankle arthrodesis has shown high rates of union comparable to those with open arthrodesis but with substantially less postoperative morbidity, shorter operative times, less blood loss, and shorter hospital stays. To easily perform arthroscopic resection of the articular cartilage, sufficient distraction of the joint is necessary to insert the arthroscope and instruments. However, sometimes, standard noninvasive ankle distraction will not be sufficient in post-traumatic ankle arthritis, with the development of arthrofibrosis and joint contracture after severe ankle trauma. In the present report, we describe a technique to distract the ankle joint by inserting a 4.6-mm stainless steel cannula with a blunt trocar inside the joint. The cannula allowed sufficient intra-articular distraction, and, at the same time, a 4.0-mm arthroscope can be inserted through the cannula to view the joint. Screws can be inserted to fix the joint under fluoroscopic guidance without changing the patient's position or removing the noninvasive distraction device and leg holder, which are often necessary during standard arthroscopic arthrodesis with noninvasive distraction.

Purpose: Too develop a flexible drill device that can be inserted into the shoulder joint so that arthroscopic transosseous suture repair for Bankart lesion is possible. Materials and Methods: We created a device composed of a flexible drill unit and a guide pipe unit. The flexible drill unit was made of flexible multifilament wires (1.2 mm in diameter) that was twisted into one cord so that it can flex in any direction and a drill bit (1.2 mm in diameter) that is attached onto one end of the flexible wire. The guide pipe unit was a 150 mm long metal pipe (2.0 mm in inner diameter and 3.0 mm in outer diameter), with one end bent to 30 degrees. The flexible drill set was inserted into the shoulder joint through the posterior portal of the joint. The guide pipe component was placed onto the medial wall of the glenoid so that the pipe was placed 5 mm posterior to the margin of the anterior glenoid rim. The flexible drill was driven through the glenoid by the power drill so that holes were made in the glenoid. A non- absorbable suture was passed through the hole. Tying of a sliding knot tying was accomplished over the capsule and labrum after making a stitch through the capsule and labrum with a suture hook loaded with suture passer. The same procedures were done at the 2 and 4 O`Clock positions of the glenoid. Results: Five cases with Bankart lesion received arthroscopic transosseous repair with our flexible drill device. There were no intraoperative problems. Neither redislocation nor subluxation was reported at final follow-up. Conclusion: Arthroscopic transosseous suture repair without suture anchors and easy tying of a sliding knot are possible with a flexible drill set.

Objectives Although there is an agreement of using long-level construct than short-level construct to correct the kyphosis, no literature mentioned the success of this treatment based on timing of surgery after the injury. Objective of this paper was to study the effect of ligamentotaxis on preventing the development of postoperative kyphosis in unstable thoracolumbar burst fractures based on injury surgery interval (ISI).

The purpose of this study was to evaluate the efficacy and safety of biodegradable intrascleral implants for the slow release of triamcinolone acetonide (TA). Intrascleral implant (1 mm thick; 3 mm diameter) was made of PLA (poly(D,L-lactide)) containing 6.4 mg of TA with one-side coating of high molecular weight PLA to render unidirectional drug absorption through the sclera. In vitro TA release was evaluated by liquid chromatography-mass spectroscopy for 90 days. In vivo release of TA was measured in aqueous humor, vitreous, and retina-choroid at 1, 2, 4, 8, and 12 weeks after intrascleral implantation in 20 rabbit eyes. Implant toxicity and biocompatibility were evaluated by slit lamp examinations, indirect ophthalmoscopy, intraocular pressure measurements, electroretinography, and histological examinations. In vitro studies demonstrated that the implants released TA in a controlled manner over 90 days. In vivo, TA was detected in aqueous humor until 4 weeks and in retina-choroid until 8 weeks after implantation, but was detected constantly over 12 weeks in vitreous. No significant retinal toxicity was observed. These results suggest that the devised intrascleral implant offers a promising controlled release system for the delivery of TA to the posterior segment of the eye.

Purpose To study the incidence of and risk factors for postoperative capsular block syndrome (CBS) and propose a new classification based on etiology. Setting Department of Ophthalmology, Kyungpook National University Hospital, Daegu, Republic of Korea. Methods Charts of 1100 eyes of 990 patients who had phacoemulsification and posterior chamber intraocular lens (PC IOL) implantation between January 2003 and June 2006 were retrospectively reviewed. Demographic data, axial length (AL), type of PC IOL implanted, and intraoperative ophthalmic viscosurgical devices (OVDs) were recorded. The cases of postoperative CBS were collected and the characteristic clinical findings evaluated. Results There were 8 cases (7 patients) of postoperative CBS (incidence 0.73%). Longer AL (≥25.0 mm) was a risk factor for postoperative CBS ( P = .008; odds ratio [OR], 5.75, 95% confidence interval [CI], 1.353-24.413). The PC IOL with 4 haptics (Akreos Adapt, Bausch & Lomb) was also associated with an increased incidence of postoperative CBS ( P = .001; OR, 7.388; 95% CI, 1.751-31.168). The CBS was classified as noncellular, inflammatory, or fibrotic according to the clinical characteristics. Conclusions Although postoperative CBS was a rare complication after cataract surgery, AL and PC IOL design had a significant influence on the incidence. Evaluation of clinical characteristics showed 3 distinct types of CBS.

A newly introduced implant-mediated drug delivery system (IMDDS) showed promising results in a rabbit tibia model. The aim of the present study is to evaluate whether dexamethasone administered by the IMDDS has sustained effects in the canine mandible - a different anatomic location, in a different species.IMDDS was installed at the mesial root of the second premolar site in the mandibles of six beagle dogs. After complete healing, 10 mg dexamethasone was administered through the IMDDS. The same amount of drug was administered to five control animals by intramuscular injection. The release pattern was monitored for 2 weeks by measuring plasma drug concentrations.A sustained plasma dexamethasone concentration was detected after a peak at 6 hours until the end of the observation period, despite individual variations. The concentration was lower than reported in the rabbit tibia model. In contrast, plasma concentration of the control group showed an early peak at 2 hours and decreased rapidly.Dexamethasone was effectively released from the IMDDS for a prolonged time in the canine mandible model.

Purpose. To evaluate surgical efficacy of in situ refixation technique for dislocated posterior chamber intraocular lens (PCIOL).Methods. This was a single-center retrospective case series. 34 patients (34 eyes) who underwent sclera fixation for dislocated IOLs combined with vitrectomy were studied. Of 34 eyes, 17 eyes underwent IOL exchange and the other 17 eyes underwent in situ refixation.Results. Mean follow-up period was 6 months. Mean logMAR best corrected visual acuity (BCVA) was not significantly different between the groups 6 months after surgery (0.10±0.03in the IOL exchange group and0.10±0.05in the refixation group;p=0.065). Surgically induced astigmatism (SIA) was significantly lower in the refixation group (0.79±0.41) than in the IOL exchange group (1.29±0.46) (p=0.004) at 3 months, which persisted to 6 months (1.13±0.18in the IOL exchange group and0.74±0.11in the refixation group;p=0.006). Postoperative complications occurred in 3 eyes in the IOL exchange group (17.6%) and 2 eyes in the refixation group (11.8%). However, all of the patients were well managed without additional surgery.Conclusion. The in situ refixation technique should be preferentially considered if surgery is indicated since it seemed to produce a sustained less SIA compared to IOL exchange.

62 year old female underwent closed reduction of subtrochanter fracture by the minor trauma. She was checked quantitative computerized tomography (QCT) for the bone mineral density. It showed highly elevated density above the normal range. She could easily take the bisphosphonate for 3 and half years without regular evaluation of the bone mineral density. The fracture was bilateral and atypical fracture pattern in the subtrochanter area. These kinds of fracture were occurred in the osteoporotic bones in the previous literature, so we hardly conclude the culprit of bisphosphonate related atypical fractures. The prevalence of these kinds of insufficiency fracture among the normal population and bisphosphonate medicated patients has been still debated but we can strongly suggest that our fractures were related to the bisphosphonate medication because she was a nonosteoporotic bone who took a bisphosphonate medication.

Purpose To evaluate the effect of platelet-rich plasma (PRP) eye drops in the treatment of recurrent corneal erosions (RCE). Methods A total of 47 eyes were included in this retrospective study. Clinical records of 20 consecutive patients with RCE who had been treated with conventional lubricant eye drops (conventional treatment group) from June 2006 to December 2008 and 27 consecutive patients treated with autologous PRP eye drops in addition to lubricant eye drops (PRP eye drops treated group) from January 2009 to September 2014 were reviewed. Major and minor recurrences were recorded and compared between two groups. Results This study included 31 men and 16 women. The mean age was 44.5 ± 14.5 years (range, 19 to 86 years), and the mean follow-up duration was 14.9 ± 14.4 months (range, 6 to 64 months). Of the 27 cases in the PRP eye drops treated group, there were seven major recurrences in six eyes (22.2%) and ten minor recurrences in seven eyes (25.9%). In contrast, 16 eyes (80.0%) from the 20 patients in the conventional lubricant eye drops treated group had major recurrences, and all patients in this group reported minor recurrences. The mean frequency of recurrence was 0.06 ± 0.08 per month in the PRP eye drops treated group and 0.39 ± 0.24 per month in the conventional treatment group (p = 0.003). No side effects were noted in any of the patients over the follow-up period. Conclusions The use of PRP eye drops for the treatment of RCE was shown to be effective in reducing the recurrence rate without any significant complications.

Objective To report successful vision restoration after Descemet membrane stripping endothelial keratoplasty (DSEK) for 3 cases with extensive Descemet membrane detachment (DMD) after phacoemulsification. Design Retrospective case series. Participants Three patients with extensive DMD after phacoemulsification. Methods Three patients with DMD after phacoemulsification were reviewed. All patients developed DMD affecting more than 70% of the cornea and showed significant corneal edema, which did not resolve with air bubble tamponade. To resolve corneal edema, we performed DSEK. Results Successful postoperative resolution of corneal edema was achieved for all 3 patients. Best corrected visual acuity improved from 2.20 ± 0.72 (logMAR) to 0.24 ± 0.06 (logMAR). No complications were noted during 24.7 ± 3.2 months of follow-up (range 21–27 months). The change in spherical equivalent from pre-DSEK to 1 year postoperatively was +0.87 D (range +0.63 to +1.25 D). Conclusions DSEK may be a viable surgical option for treatment of patients with extensive DMD after phacoemulsification. However, when DSEK is contemplated, intraocular lens exchange for hyperopic shift after DSEK must be considered.

The purpose of this study was to assess the results of a novel surgical technique for the treatment of chronic lateral ankle instability with attenuated or deficient ligamentous tissue that the modified Brostrom procedure could not be performed. A lateral ankle ligament reconstruction using the anterior half of the peroneus longus tendon has been performed. Thirty-four consecutive patients treated with lateral ankle ligament reconstruction using anterior half of the peroneus longus tendon were enrolled. Median age at surgery was 24 years (range 19–46 years). The clinical and radiologic outcomes were evaluated preoperatively and at a median of 21 months (range 12–51 months) follow-up. The Karlsson–Peterson ankle score significantly improved from 58.2 ± 10.9 points preoperatively to 83.9 ± 7.0 points at the last follow-up. Mechanical stability was achieved. The mean talar tilt angle significantly improved from 15.7° ± 3.5° preoperatively to 4.6° ± 1.7° at the last follow-up, and the mean anterior talar translation significantly improved from 7.3 ± 2.6 mm preoperatively to 4.1 ± 1.7 mm at the last follow-up. Fifteen patients (52 %) were very satisfied with the results, nine patients (31 %) were satisfied, four patients (14 %) were fair, and one patient (3 %) was dissatisfied with the results. Lateral ankle ligament reconstruction using the anterior half of the peroneus longus tendon can be a surgical option for chronic lateral ankle instability with attenuated or deficient ligaments. Case-series, Level IV.

87-year-old female underwent open reduction of distal femoral fracture and internal fixation with locking compression plate and bone graft. She was operated for ipsilateral proximal femoral fractures and stabilized by intramedullary interlocked nail 5 years ago. She developed stress fracture proximal to locked plate. We inserted Huckstep nail after removal of the previous operated proximal femoral nail without removing the remaining plate and screws. At 15 month followup the fractures have united. The Huckstep nail has multiple holes available for screw fixation at any level in such difficult situations.

Purpose. The purpose of this study was to evaluate the efficacy of dried human amniotic membrane (AM) in reducing the postoperative inflammatory response and scarring after strabismus surgery.Methods. The inflammatory response at the extraocular muscle reattachment site was analyzed after superior rectus (SR) resection in 12 rabbits. Dried human AM (Ambiodry2) was applied between the resected SR muscle plane and Tenon’s capsule of the left eyes of rabbits. As a control, the right eyes of rabbits underwent SR resection only. The surgeon randomly ordered which eye gets operated first during the experiment. Two weeks later, enucleation was performed. Six sagittal sections were made for each eye at the insertion of the SR muscle. The grade of postoperative inflammation and the presence of fibrosis were evaluated in histological examinations.Results. There was no statistically significant difference in the intensity of inflammation and fibrous proliferation between the eyes treated with dried human AM after SR resection and those treated with SR resection only.Conclusions. The use of dried human AM was not effective in controlling the postoperative inflammation and scarring in rabbit eyes after extraocular muscle surgery. However, this may be due to the devitalized dry preparation of human AM (Ambiodry2), which may have lost the expected anti-inflammatory and anti-scarring properties, and further studies on humans may be necessary.

Recently, the approval of the hydrophilic acrylic intraocular lens (IOL; Akreos AO MI60; Bausch & Lomb, Rochester, New York) made microcoaxial surgery possible through a sub-2 mm incision. Although hydrophilic acrylic IOLs have proven to be highly biocompatible,1 several studies reported a late opacification of IOLs due to calcium deposits.2 3 The authors report five patients with calcium deposits on the anterior surface of Akreos AO MI60 IOLs which occurred after phacoemulsification and 23-gauge transconjunctival sutureless vitrectomy (TSV) for diabetic vitreous haemorrhage (VH). To our knowledge, opacification for this IOL design has not been reported before. One of the authors (SYK) implanted the Akreos AO MI60 IOLs in 208 cases between November 2008 and December 2009. Eighty-nine cases had phacoemulsification and 23-gauge TSV for diabetic VH. The authors observed five patients (2.4%) with IOL opacification from the 208 cases. Clinical characteristics of the five patients who had IOL opacification are shown in table 1 …

I describe a technique to improve the control and safety of phacoemulsification during hard nucleus cataract surgery. Whereas the goal of the conventional nucleofractis technique is complete fragmentation of the lens, the technique aims to separate the endonuclear core from the epinucleus. This is done in 3 steps: circumferential disassembly, decreasing the central nucleus volume, and conquering the remnant. The technique offers safer and more effective phacoemulsification in patients with hard nucleus cataracts.

BackgroundTreatment of unstable thoracolumbar fractures is controversial regarding short or long segment pedicle screw fixation. Although long level fixation is better, it can decrease one motion segment distally, thus increasing load to lower discs.MethodsWe retrospectively analyzed 31 unstable thoracolumbar fractures with partial or intact neurology. All patients were operated with posterior approach using pedicle screws fixed two levels above and one level below the fracture vertebra. No laminectomy, discectomy or decompression procedure was done. Posterior fusion was achieved in all. Post operative and at final follow-up radiological evaluation was done by measuring the correction and maintenance of kyphotic angle at thoracolumbar junction. Complications were also reported including implant failure.ResultsAverage follow-up was 34 months. All patients had full recovery at final follow-up. Average kyphosis was improved from 26.7° to 4.1° postoperatively and to 6.3° at final follow-up. And mean pain scale was improved from 7.5 to 3.9 postoperatively and to 1.6 at final follow-up, All patients resumed their activity within six months. Only 4 (12%) complications were noted including only one hardware failure.ConclusionTwo levels above and one level below pedicle screw fixation in unstable thoracolumbar burst fracture is useful to prevent progressive kyphosis and preserves one motion segment distally.

The aim of this article is to evaluate and classify pathogenetic origins based on morphologic reproliferative patterns in patients who underwent pterygium excision with a conjunctival autograft. In this retrospective, observational case series, a total of 116 eyes of 116 patients with pterygium who underwent pterygium excision with a conjunctival autograft between February 2009 and May 2011 were reviewed. Using consecutively recorded photographs, we evaluated preoperative morphologic severity, postoperative complications, recurrences, and growth patterns. The regrowth of fibrovascular tissue was observed in 14 of our study cases (12.1%). Of these, 5 cases (4.3%) showed clinically significant recurrences. We observed 3 different morphologic patterns of recurrence: regrowth over the epithelial defect; transformation of the conjunctival graft into the pterygial tissue; and regrowth from unexcised pterygial tissue. Each recurrence pattern showed characteristic fibrovascular growth, the origin of this regrowth, and grade of severity. In 25 cases (21.6%), postoperative complications were observed. Of the analyzed variables, age

Purpose: To report a case of peripheral ulcerative keratitis in a case of primary herpes simplex infection. Case summary: A 7-year-old male complaining of pain, redness, and decreased vision in the left eye 5 days in duration visited our clinic. The patient had also vesicular lesions over the edematous left upper eyelid. Slit-lamp examination revealed peripheral ulcerative keratitis with stromal infiltration involving the superior peripheral cornea. Corneal sensation in the left eye was decreased. The patient was advised to use topical and oral antiviral agents and a topical steroid. After 5 days of follow-up, the corneal lesions were decreased and vesicles were absent. Six months later, only minor opacities remained in the cornea. Conclusions: We report the first case report in Korea of peripheral ulcerative keratitis with blepharoconjunctivitis presented as primary herpes simplex infection which responded to antiviral and steroid treatment in a young male. J Korean Ophthalmol Soc 2014;55(5):761-765

A 55-year-old obese man (body mass index, 31.6 kg/m(2)) presented radiating pain and motor weakness in the left leg. Magnetic resonance imaging showed an epidural mass posterior to the L5 vertebral body, which was isosignal to subcutaneous fat and it asymmetrically compressed the left side of the cauda equina and the exiting left L5 nerve root on the axial T1 weighted images. Severe arthritis of the left facet joint and edema of the bone marrow regarding the left pedicle were also found. As far as we know, there have been no reports concerning a solitary epidural lipoma combined with ipsilateral facet arthorsis causing lumbar radiculopathy. Solitary epidural lipoma with ipsilateral facet arthritis causing lumbar radiculopathy was removed after the failure of conservative treatment. After decompression, the neurologic deficit was relieved. At a 2 year follow-up, motor weakness had completely recovered and the patient was satisfied with the result. We recommend that a solitary epidural lipoma causing neurologic deficit should be excised at the time of diagnosis.

Paget disease is a well-documented skeletal disease and it has an increased rate of tissue breakdown due to the excessive turnover of osteoblasts and osteclasts. Stress fracture is one of the most common complications in the late phase of Paget disease, but the clinical presentation of incomplete pathologic fracture is rare and this is an important clue to plan the treatment. We experienced a case of Paget’s disease in a 74 year old woman with a periprosthetic fracture from the undetected, imcomplete stress fracture in the proximal femur.

Brucellosis is a well known systemic, zoonotic disease that can affect many organs. We report a rare case of spondylodiscitis with an epidural abscess caused by brucellosis. The patient was treated surgically for severe pain and concomitant devastating neurological deficit. A diagnosis of spondylodiscitis or an epidural abscess due to brucellosis must be considered when acute back pain, radiating pain and febrile episodes occur, particularly in people in a high risk group.

대퇴 근위부 골절은 노인 골절에서 원위 요골 골절 다음 으로 흔한 골절이며 가장 치명적인 손상 중 하나이다. 대퇴 경부 골절은 아직도 그 치료에 많은 견해들이 대두되 고 있다. 해부학적 정복 후 내 고정술과 인공 관절 치환술, 인공 관절 치환술의 반 치환술과 전 치환술 그리고 인공 관절의 시멘트형과 무시멘트형 주대 간의 여러 논란은 지 속되고 있다. 특히 노령과 동반된 골다공성 변화에 따른 시멘트형 고정술은 수술 직후 빠른 보행과 완전 체중 부하를 가능하게 하여 많은 정형외과 의사들에게 선호되 는 술식이었다. 그러나 최근에는 무시멘트형 대퇴 주대 가 시멘트형에 비해 생존율 및 합병증이 현저히 줄었음을 주장하였고 최근 대퇴 주대의 재질이나 디자인, 술기 등의 발달에 따라 노령 환자의 무시멘트형 대퇴 주대의 삽입은 증가하고 있다. 그러나 대퇴 주대 삽입시 발생하는 대퇴 근위부 골절은 무시멘트형에서 흔히 발생할 수 있는 합병증 중의 하나이다. 본 연구에서는 65세 이상의 노인 연령층에서 예방적으로 강선을 보강함으로써 대퇴 주대 Submitted: October 20, 2008 1st revision: November 3, 2008 2nd revision: February 12, 2009 3rd revision: March 11, 2009 Final acceptance: May 22, 2009

Traumatic anterior dislocation of the hip is rare. Bilateral traumatic anterior dislocation is an even rarer injury; indeed, only 5 cases have been reported in the English literature. We describe a case of a bilateral traumatic anterior dislocation of the hip and a concomitant unstable lumbar burst fracture following a mechanism of injury distinctly different from other reports.

Purpose: To evaluate the effect of a preoperative subconjunctival injection of mitomycin C or triamcinolone in patients with recurrent pterygium. Methods: The records of 50 eyes of 50 patients who received excision of recurrent pterygium between June 2006 and January 2007 were reviewed. The recurrence rate and postoperative fibrovascular growth were compared in the preoperative subconjunctival mitomycin C, or triamcinolone injection group and non-treated control group. Additionally, the quantitative expression level of the transforming growth factor-1, -2 (TGF-1, -2), connective tissue growth factor (CTGF), and vascular endothelial growth factor (VEGF) in excised sample of the pterygium was assessed. Results: There was no statistically significant difference in the recurrence rate and the relative gene expression level of growth factors in the triamcinolone group and the mitomycin group when compared with the non-treated control group. Postoperative fibrovascular proliferation was more severe in the triamcinolone group than other groups. Conclusions: Subconjunctival mitomycin C or triamcinolone as adjunctive therapy before pterygium excision did not influence the recurrence rate of pterygium.

Purpose: To report the results of femtosecond laser-assisted‘mushroom-shaped wound-configurized keratoplasty’in 6 patients based on the results of experimental models in rabbits’and enucleated porcine eyes. Methods: Mushroom-shaped donor corneal grafts were designed and transplanted in 3 rabbit eyes and 10 enucleated porcine eyes. The histologic findings were observed and wound burst pressure compared between penetrating keratoplasty (PKP) and mushroom-shaped keratoplasty. The‘mushroom-shaped wound-configurized keratoplasty’was subsequently performed in 6 eyes of 6 patients. Results: In all eyes of the rabbits, histologic findings showed stable wound structure. In the porcine models, mushroom-shaped keratoplasty showed a better resistance to IOP than PKP after complete suture. Patients who underwent the surgery showed an improvement of over 2 lines in Snellen visual acuity after the operation. The mean follow-up period was approximately 11 months. Complete suture removal was performed within 6 months and accurate and stable wound structure was identified. Conclusions: Wound-configurized keratoplasty with femtosecond laser and mechanical dissection’has shown several advantages in the lamellar structure of the wound. Stable wound structure, less astigmatism, rapid suture removal and visual rehabilitation was achieved.

Purpose: To report the first cases of Descemet’s stripping endothelial keratoplasty in patients with pseudophakic bullous keratopathy. Methods: Four eyes of 4 patients who had corneal edema from pseudophakic bullous keratopathy were enrolled. We performed femtosecond laser-assisted Descemet's membrane stripping endothelial keratoplasty (DSEK). We then evaluated preoperative and postoperative best corrected visual acuities (BCVA), manifest refractions, keratometries, topographic astigmatisms, corneal pachymetries, and perioperative complications. Results: The mean follow-up period was 6 months. Three of the four eyes had successful transplantations. Since the operation, these patients have shown improvement in visual acuity and have recovered from corneal edema. However, in one patient, the transplanted corneal disc was dislocated, and he needed an additional procedure for reattachment. Conclusions: The lack of corneal incisions or sutures in DSEK was helpful for maintaining corneal curvature and globe integrity after surgery. The surgery resulted in rapid visual rehabilitation and prevented suture-induced complications. With a femtosecond laser, we could prepare donor cornea in an automated and standardized fashion. In conclusion, femtosecond laser-assisted DSEK has significant advantages over standard penetrating keratoplasty for patients with pseudophakic bullous keratopathy.

Pur p ose: This study evaluated the relationship between D upuytrens disease and smoking and alcohol intake. Mat e r ia ls and Met h ods: F orty eight patients with D upuytrens disease, who underwent a partial fasiectomy were examined retrospectively through a chart review and a telephone interview. The minimum follow-up period was 12 months. The relationship between D upuytren's disease and smoking and alcohol intake were analyzed using multivariate logistic regression with significance set at p ＜0.05. Resul ts : Dupuytren' s disease requiring surgery in these patients was associated with heavy alcohol intake (odds ratio 2.91) and alcohol intake per week (odds ratio 1.22). The average smoking level was 24.7 pack-year for cases compared with 16.1 pack-year for controls (p ＜0.05). The average alcohol intake was 3.0 units per week for the cases compared with 1.2 units per week for controls (p ＜0.05). S moking was not an independent risk factor but increased the risk when combined with