• Journal of Biomedical Engineering Research
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• v.40 no.5
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• pp.143-150
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• 2019

To evaluate the toxicity of ophthalmic drug, the Draize test and Bovine Corneal Opacity and Permeability (BCOP) test commonly used. In Draize test, experimental animals were under stress and pain due to long-term exposure of drug. In addition, regarding physiological functions, animal model is not perfectly reflected a human eye condition. Although some models such as $EpiOcular^{TM}$, HCE model, LabCyte Cornea-Model, and MCTT $HCE^{TM}$ were already presented advanced cornea ex-vivo model to replace animal test. In this sense, cornea tissue structure mimicked ex-vivo toxicity model was fabricated in this study. The corneal epithelial cells (CECs) and keratocytes (CKs) isolated from rabbit eyeball were seeded on non-patterned silk film (n-pSF) and patterned silk film (pSF) at $32,500cells/cm^2$ and $6,500cells/cm^2$. Sequentially, n-pSF and pSF were stacked to mimic a multi-layered stroma structure. The thickness of films was about $15.63{\mu}m$ and the distance of patterns was about $3{\mu}m$. H&E stain was performed to confirm the cell proliferation on silk film. F-actin of CKs was also stained with Phalloidin to observe the cytoskeletal alignment along with patterns of the pSF. In the results, CECs and CKs were shown the good cell attachment on the n-pSF and pSFs. Proliferated cells expressed the specific phenotype of cornea epithelium and stroma. In conclusion, we successfully established the ex-vivo cornea toxicity model to replace the eye irritation tests. In further study, we will set up the human ex-vivo cornea toxicity model and then will evaluate the drug screening efficacy.

• Archives of Plastic Surgery
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• v.46 no.5
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• pp.421-425
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• 2019

Background The endoscopic transnasal approach is widely used for reconstructing the medial orbital wall by filling it with a silicone sheet or Merocel, but this technique has the disadvantage of retaining the packing for a long time. To overcome this drawback, a method of positioning an absorbable plate in the orbit has been introduced, but there is a risk of defect recurrence after the plate is absorbed. Here, the authors report the results of a novel surgical technique of placing a nonabsorbable titanium mesh with porous polyethylene into the orbit through the endoscopic transnasal approach. Methods Fourteen patients underwent surgery using the endoscopic transnasal approach. Preoperative computed tomography (CT) was used to calculate the size of the bone defect due to the fracture, and the titanium mesh was designed to be shorter than the anteroposterior length of the defect and longer than its height. The titanium mesh was inserted into the orbit under an endoscopic view. The authors then confirmed that the titanium mesh supported the orbital contents by pressing the eyeball and finished the operation. Immediately after surgery, CT results were evaluated. Results Postoperative CT scans confirmed that the titanium mesh was well-inserted and in the correct position. All patients were discharged without any complications. Conclusions We obtained satisfactory results by inserting a titanium mesh with porous polyethylene into the orbit via the transnasal approach endoscopically.

• The Journal of Internal Korean Medicine
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• v.40 no.2
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• pp.254-261
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• 2019

Internuclear Ophthalmoplegia (INO) is characterized by lesion side eye's adduction limitation in lateral horizontal gaze and nystagmus in the abducting eye due to lesions in the Medial Longitudinal Fasciculus (MLF). Brainstem infarction is one of the causes of INO, but related issues have seldom been reported in the Korean medical literature. The present case was a pontine infarction patient with INO who complained of diplopia and eye movement disorder. The patient was treated with Korean medicine treatment, including herbal medicine, acupuncture, cupping, and moxibustion for 30 days. Her changes in clinical symptoms were measured with a Numeric Rating Scale (NRS) and a length of External Ocular Movement (EOM), in which the patient's right eyeball moved to the left from the midline in the left gaze. After treatment, her clinical symptoms were improved. Diplopia decreased from NRS 10 to NRS 2, and eye movement disorder was improved such that EOM increased from 1mm to 5 mm. Therefore, integrative Korean medicine treatment may be effective in the treatment of INO patients caused by pontine infarction.

• Journal of Korean Neurosurgical Society
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• v.64 no.2
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• pp.282-288
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• 2021

Objective : Electrooculography (EOG) records eyeball movements as changes in the potential difference between the negatively charged retina and the positively charged cornea. We aimed to investigate whether reliable EOG waveforms can be evoked by electrical stimulation of the oculomotor and abducens nerves during skull base surgery. Methods : We retrospectively reviewed the records of 18 patients who had undergone a skull base tumor surgery using EOG (11 craniotomies and seven endonasal endoscopic surgeries). Stimulation was performed at 5 Hz with a stimulus duration of 200 μs and an intensity of 0.1-5 mA using a concentric bipolar probe. Recording electrodes were placed on the upper (active) and lower (reference) eyelids, and on the outer corners of both eyes; the active electrode was placed on the contralateral side. Results : Reproducibly triggered EOG waveforms were observed in all cases. Electrical stimulation of cranial nerves (CNs) III and VI elicited positive waveforms and negative waveforms, respectively, in the horizontal recording. The median latencies were 3.1 and 0.5 ms for craniotomies and endonasal endoscopic surgeries, respectively (p=0.007). Additionally, the median amplitudes were 33.7 and 46.4 μV for craniotomies and endonasal endoscopic surgeries, respectively (p=0.40). Conclusion : This study showed reliably triggered EOG waveforms with stimulation of CNs III and VI during skull base surgery. The latency was different according to the point of stimulation and thus predictable. As EOG is noninvasive and relatively easy to perform, it can be used to identify the ocular motor nerves during surgeries as an alternative of electromyography.

• Archives of Craniofacial Surgery
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• v.23 no.5
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• pp.228-231
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• 2022

Fibrin glue is a topical agent widely used for hemostasis, wound healing, and surgical adhesion. Complications of fibrin glue itself are extremely rare because it is absorbed over time, but can occur as a result of inappropriate application. We report a case of a postoperative complication caused by inappropriate application of fibrin glue in blow-out fracture surgery. A 65-year-old male patient presented with periorbital swelling and an open wound on the right infraorbital area. Computed tomography showed a right orbital floor fracture. After reduction of the herniated tissue into the orbit, an implant was inserted and fibrin glue was applied to stabilize the implant. This procedure was performed without difficulty, but the patient complained of persistent diplopia and limited eyeball movement after surgery. An imaging study showed a mass-like lesion, which was not a hematoma, in the orbital cavity. In a second operation, the mass was identified as clotted fibrin glue that had not been applied properly. After removal, the patient's symptoms were relieved without further complications. Appropriate and careful application of fibrin glue is necessary to avoid unnecessary complications.

• Journal of the Korean Society of Radiology
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• v.17 no.1
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• pp.47-52
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• 2023

In whole spine radiography using the stitching technique, overlapping parts occur in the process of synthesizing the three segmented images, so some anatomical structures may be repeatedly exposed, and it has been thought that the dose increases as the scan range increases. However, in the whole spine radiography using the stitching technique in this study, under the condition that the stitching range is taken in the same three splits, the overlapping area decreases as the stitching range increases, so in the case of breasts included in the overlapping range, the dose value decreased by almost half as the stitching range increased from 90 cm to 105 cm. During spinal full-length radiological examination using the stitching method, an appropriately long stitching range could be set to reduce the exposure dose of the breast.

• Journal of the Korean Society of Radiology
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• v.16 no.7
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• pp.857-862
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• 2022

The purpose of this study was to evaluate a three-dimensional conformal radiotherapy (3D-CRT) treatment plan with regard to head tilting in whole-brain radiotherapy (WBRT) using TomoDirect (TD) mode in Tomotherapy. WBRT 3D-CRT by TD was compared for a total of five head tilt angles (-20°, -10°, 0°. +10° and +20°). The dose homogeneity index (HI) and prescription dose index (CI) were calculated to confirm the target coverage. The maximum and average doses for critical organs such as the lens, eyeball and parotid glands were calculated for different angles of head tilting. The HI and CI were closet to the result value of 1 at the head tilted angle +10° and +20°. At a head tilted angle of +10°, the dose to the lens and eyeballs decreased by about 74% and about 30%, when compared with the reference angle (0°), respectively. The results of this study suggest that a head angle of +10 with chin-up would save adequate target coverage and reduce exposure dose to the lens.

• Korean Journal of Veterinary Service
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• v.45 no.3
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• pp.221-228
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• 2022

Cataracts occur commonly in older dogs, which can lead to partial or complete vision loss. In the present study, a 12-year-old male poodle presented for evaluation of ocular sinister (OS) cataract. This study was a clinical case report on the process of performing surgery using phacoemulsification (PHACO) and the problems that arise in patient diagnosed with OS cataract. In the oculus dexter (OD), the artificial eye was inserted because there was no electroretinography (ERG) response. In the OS, the ERG was 51.6 μV, so operation was performed because the visual pathway function remained. Slit-lamp biomicroscopy of the OS showed complete loss of vision as a hypermature cataract and that the lens was hardened. During the cataract surgery using PHACO, visco-elastic agents were used to maintain the shape of the eyeball, and the PHACO procedure took 3.13 minutes. The hardened lens and visco-elastic agents were removed from the eye through PHACO surgery, and the operation was completed by inserting an intraocular lens (IOL). As a result of managing IOP for 2 months after surgery, it remained stable at a maximum of 19 mmHg, and no postoperative ocular hypertension (POH) occurred. Currently, one year has passed since the operation, and the dog maintains its daily life with its left eye without any problems.

• Journal of Veterinary Clinics
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• v.40 no.4
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• pp.283-287
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• 2023

A 10-year-old spayed female beagle dog presented with a 2-month history of third-eyelid elevation in the left eye (OS). Ophthalmic examination revealed slightly diminished corneal and palpebral reflexes along with exophthalmos in the OS. Schirmer's tear test and intraocular pressure values were within the normal range for the OS. Slit-lamp biomicroscopy revealed protrusion of the third eyelid and corneal opacity in the OS. Fundoscopy revealed a prominent black mass in the OS covering the optic nerve. Tapetal hyper-reflectivity was also observed around the mass. Ocular ultrasonography showed a 0.74 × 0.67 cm echogenic posterior segment mass around the optic nerve protruding into the retrobulbar space. Computed tomography revealed a contrast-enhanced soft tissue lesion in the posteromedial aspect of the left eyeball protruding into the retrobulbar region, and the optic nerve was suspected to be involved. No evidence of osteolytic changes in the adjacent bone or distant metastasis was observed. Enucleation was performed to prevent potential metastasis or local invasion of the mass and to relieve discomfort due to exposure to keratopathy resulting from lagophthalmos. Histopathological examination revealed a central choroidal melanocytoma extending into the optic nerve. No local recurrence was detected until 16 months postoperatively.

• Archives of Plastic Surgery
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• v.50 no.6
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• pp.621-626
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• 2023

In the first half of the third century B.C., Herophilus and Erasistratus performed the first systematic dissection of the human body. For subsequent centuries, these cadaveric dissections were key to the advancement of anatomical knowledge and surgical techniques. To this day, despite various instructional methods, cadaver dissection remained the best way for surgical training. To improve the quality of education and research through cadaveric dissection, our institution has developed a unique method of perforator-preserving cadaver injection, allowing us to achieve high-fidelity perforator visualization for dissection studies, at low cost and high efficacy. Ten full body cadavers were sectioned through the base of neck, bilateral shoulder, and hip joints. The key was to dissect multiple perfusing arteries and draining veins for each section, to increase "capture" of vascular territories. The vessels were carefully flushed, insufflated, and then filled with latex dye. Our injection dye comprised of liquid latex, formalin, and acrylic paint in the ratio of 1:2:1. Different endpoints were used to assess adequacy of injection, such as reconstitution of eyeball volume, skin turgor, visible dye in subcutaneous veins, and seepage of dye through stab incisions in digital pulps. Dissections demonstrated the effectiveness of the dye, outlining even the small osseous perforators of the medial femoral condyle flap and subconjunctival plexuses. Our technique emphasized atraumatic preparation, recreation of luminal space through insufflation, and finally careful injection of latex dye with adequate curing. This has allowed high-fidelity perforator visualization for dissection studies.