COMPARISON OF SURGICAL OUTCOME OF 23-GAUGE AND 25-GAUGE MICROINCISION VITRECTOMY SURGERY FOR MANAGEMENT OF IDIOPATHIC EPIRETINAL MEMBRANE IN PSEUDOPHAKIC EYES.

PURPOSE: To compare the visual outcomes and occurrences of postoperative complications after 23-gauge (G) and 25-G microincision vitrectomy surgery (MIVS) for idiopathic epiretinal membrane in pseudophakic eyes. METHODS: A total of 239 pseudophakic eyes of 239 patients who underwent 23-G (n = 159) or 25-G MIVS (n = 80) for removal of idiopathic epiretinal membrane between March 2010 and March 2013 were included in this retrospective study. Patients were followed up on postoperative 1 day, 1 week, 1, 3, and 6 months. Postoperative visual acuity, intraocular pressure, and intraoperative or postoperative complications were compared between the 23-G and 25-G MIVS groups. RESULTS: Both groups showed a statistically significant improvement in best-corrected visual acuity at postoperative 1, 3, and 6 months (All P < 0.05). Furthermore, the mean change of best-corrected visual acuity was not significantly different between the 2 groups at postoperative 1, 3, and 6 months (P = 0.208, P = 0.547, and P = 0.519, respectively), but 25-G MIVS group showed faster visual recovery than 23-G MIVS group at postoperative 1 day and at 1 week (P = 0.015, and P < 0.001, respectively). Severe hypotony of intraocular pressure less than 6 mmHg (3 eyes, 1.9%) or intraocular pressure elevation over 30 mmHg at postoperative 1 day (3 eyes, 1.9%) was found in the 23-G group, but not in the 25-G group, and was not statistically different between the groups (P = 0.553). More eyes required intraoperative suturing of sclerotomy sites in the 23-G group (18 eyes, 11.3%), whereas none of the eyes in the 25-G group needed suturing of sclerotomy (P < 0.002). CONCLUSION: Both 23-G and 25-G MIVS yielded comparable visual outcomes for surgical treatment of idiopathic epiretinal membrane in pseudophakic eyes. The 25-G MIVS was associated with faster visual recovery and less postoperative hypotony than 23-G surgery.

Responsiveness to inhaled corticosteroid treatment in patients with asthma-chronic obstructive pulmonary disease overlap syndrome.

BACKGROUND: Inhaled corticosteroid (ICS) is recommended in the management of patients with asthma-chronic obstructive pulmonary disease overlap syndrome (ACOS), but its effectiveness has not been clearly proved. OBJECTIVE: To evaluate whether ICS has effects on outcomes of ACOS. METHODS: In this observational 12-year retrospective cohort study involving 125 patients with ACOS from Seoul National University Hospital, the annual rate of decrease in forced expiration volume in 1 second, the incidence rate of severe exacerbation, and overall mortality in an ICS-treated group were compared with those in a non-ICS-treated group. RESULTS: Of 125 patients with ACOS, 90 and 35 were categorized to the ICS and non-ICS treatment groups, respectively. There were no significant differences between the 2 groups in the annual rate of decrease in forced expiration volume in 1 second (9.61 mL/year in ICS treatment group vs 15.68 mL/year in non-ICS treatment group, P = .598). Compared with the non-ICS treatment group, the ICS treatment group did not show a decrease in the risk of severe exacerbation (adjusted incidence rate ratio 1.24, 95% confidence interval 0.44-3.46). Time to death also did not differ between the 2 groups. Even when analyses with propensity score matching were performed, the results were similar. CONCLUSION: In the management of ACOS, the use of ICS was not significantly associated with improvements in the annual rate of decrease in forced expiration volume in 1 second, the incidence of severe exacerbations, and overall mortality compared with the non-ICS treatment group.

Prolongation of activity of single intravitreal bevacizumab by adjuvant topical aqueous depressant (Timolol-Dorzolamide).

BACKGROUND: To evaluate the efficacy of timolol-dorzolamide drops used to decrease aqueous outflow from the eye on the prolongation of the biological activity of intravitreal bevacizumab. METHODS: Thirty-eight eyes of 38 patients with macular edema (ME) following retinal vein obstruction (RVO) were enrolled. These patients were randomly assigned into 2 groups: timolol-dorzolamide drops twice daily (n = 19) or no eyedrops (control; n = 19). All patients received 1.25 mg (in 0.05 mL) of bevacizumab intravitreally and were examined before treatment, 1 week after injection, and then every 4 weeks after injection. For each patient, visual acuity (VA), intraocular pressure (IOP), and central retinal thickness (CRT) by optical coherence tomography (OCT) were recorded before injection and at each visit after injection. The mean CRT at each timepoint was considered to directly reflect the biological activities of bevacizumab at those times. RESULTS: The mean CRT measured by OCT showed a significant decrease 1 week after treatment in both groups, and this difference was maintained for a total of 9 weeks (paired t-test, <0.001). The mean CRT at 1 week post-injection showed no significant between-group difference (p = 0.781). At 5 weeks post-injection, the timolol-dorzolamide group showed a significantly smaller mean CRT than the control group (p = 0.032). The difference in mean CRT between the 2 groups disappeared, however, at 9 weeks post-injection (p = 0.462). In both groups, VA improved significantly 1 week after injection, and these changes were maintained to 9 weeks post-injection in both groups. The mean VA of the 2 groups showed no difference at any time. CONCLUSIONS: Timolol-dorzolamide aqueous depressant drops may delay the elimination of intravitreal bevacizumab but clinical efficacy of the eyedrops have not been proven in this study.

Cytomegalovirus retinitis after intravitreous triamcinolone injection in a patient with central retinal vein occlusion.

To report a case of cytomegalovirus (CMV) retinitis after intravitreal injection of triamcinolone acetonide (IVTA). A 77-year-old woman with macular edema due to central retinal vein occlusion (CRVO) developed peripheral retinitis 4 months after IVTA. A diagnostic anterior chamber paracentesis was performed to obtain DNA for a polymerase chain reaction (PCR) test for viral retinitis. The PCR test was positive for CMV DNA. Other tests for infective uveitis and immune competence were negative. Four months after presentation, gancyclovir was intravitreously injected a total of 5 times, and the retinitis resolved completely. CMV retinitis is a rare complication of local immunosuppression with IVTA. It can be managed with timely injection of intravitreal gancyclovir until recovery from local immunosuppression.

Effects of pectin lyase-modified red ginseng extracts in high-fat diet-fed obese mice.

Red ginseng and its extracts have been used as traditional medicines and functional foods in countries worldwide. The aim of this study was to examine the bioavailability of pectin lyase-modified red ginseng extracts (GS-E3D), and the effects of GS-E3D on adipogenesis of 3T3-L1 adipocytes, as well as on metabolic disorders such as hyperglycemia, dyslipidemia, and fatty liver in high-fat diet fed obese C57BL/6 mice. Mice were divided into 5 groups: normal diet group, high fat diet-vehicle group, high fat diet + 0.1 g/kg GS-E3D (0.1-GS-E3D), high fat diet + 0.3 g/kg (0.3-GS-E3D), high fat diet + 1.0 g/kg (1.0-GS-E3D). Treatment of GS-E3D reduced differentiation of 3T3-L1 adipocytes with low cytotoxicity. In the animal model, compared to the high fat diet control, serum glucose, total cholesterol, LDL-cholesterol, HDL-cholesterol, TG, and leptin level were reduced in treatment animals in a dose-dependent manner. In addition, we found that GS-E3D could decrease total hepatic lipid droplets. These results suggest that GS-E3D, as a dietary supplement, has beneficial effects on obesity and may have useful effects in health-care products.

Lymphovascular and marginal invasion as useful prognostic indicators and the role of c-erbB-2 in patients with male extramammary Paget's disease: a study of 31 patients.

PURPOSE: Extramammary Paget's disease (EMPD) is a rare intraepithelial neoplasm arising in skin that bears apocrine glands. We analyzed clinical, pathological and immunohistochemical staining patterns in 31 cases of EMPD to assess possible predictors of outcome, including patient age, sex, involved organs, surgical margin status, invasion depth, lymphovascular invasion, adnexal invasion, and immunoreactivity for cytokeratin 7 and 20, carcinoembryonic androgen, androgen receptor, p53, c-erbB-2 (Dako, Carpinteria, California) and Ki67. MATERIALS AND METHODS: A total of 31 cases of EMPD were retrieved from the surgical pathology files of the department of pathology along with the medical records of the department of urology. Dermal invasion depth, tumor margin status, adnexal invasion and lymphovascular invasion were determined from the hematoxylin and eosin stained slides of each case. RESULTS: Eight of the 31 cases (25.8%) experienced local recurrence. Two of 3 patients with and 6 of 28 without lymphovascular invasion experienced recurrence (p = 0.029). Dermal invasion significantly correlated with Her-2 over expression (Wilcoxon 2-sample test p = 0.0007). When the criteria of 1 and 5 mm invasion were applied, each validly correlated with Her-2 over expression. Her-2 over expression (grades 2 and 3) significantly correlated with p53 over expression (Wilcoxon rank test p = 0.0015). C-erbB-2 was positive in 51.6% of EMPD cases, in which it was strongly associated with dermal invasion and p53 over expression. CONCLUSIONS: The most valid prognostic factor in male EMPD for predicting late recurrence is lymphovascular permeation and marginal status.