Comparative Clinical Analysis of Polymicrobial and Monomicrobial Bacterial Keratitis

Purpose@#We comparatively analyzed the microbiological profiles, predisposing factors, clinical aspects, and treatment outcomes of patients with polymicrobial and monomicrobial bacterial keratitis. @*Methods@#A total of 194 cases of culture-proven bacterial keratitis treated between January 2007 and December 2016 were reviewed. Microbiological profiles, the epidemiology, predisposing factors, clinical characteristics, and treatment outcomes were compared between the polymicrobial group (polymicrobial bacterial keratitis [PBK]; 29 eyes, 62 isolates) and monomicrobial (monomicrobial bacterial keratitis [MBK]; 165 eyes, 165 isolates) group. @*Results@#The most common isolates were Enterobacter (24%) in the PBK group and Staphylococcus (22%) in the MBK group. There were no significant differences between the two groups in previous ocular surface disease, previous ocular surgery, prior topical steroid use, epithelial defect size, and hypopyon. Age ≥60 years (PBK vs. MBK, 31% vs. 51%, p = 0.048), symptom duration (4.7 days vs. 8.0 days, p = 0.009), and contact lens use (34% vs. 18%, p = 0.036) were significantly different between the two groups. Regarding treatment outcomes, epithelial healing time ≥10 days, the final best-corrected visual acuity (BCVA), a need for surgical intervention, and the rate of poor clinical outcome were not significantly different between the two groups. Significant risk factors for a poor clinical outcome in all patients were an initial BCVA <0.1 (Z = 6.33, two-proportion Z-test), an epithelial defect size ≥5 mm2 (Z = 4.56), and previous ocular surface disease (Z = 4.36). @*Conclusions@#Polymicrobial bacterial keratitis, compared to monomicrobial bacterial keratitis, was more significantly associated with younger age, contact lens use, and shorter symptom duration.

Presumed Ischemic Unilateral Oculomotor Nerve Palsy Developing after a Snake Bite

Purpose@#We report a patient with presumed ischemic unilateral oculomotor nerve palsy developing after a snake bite on the right finger.Case summary: A 58-year-old male visited our emergency department complaining of right ptosis and binocular diplopia that had developed after a snake bite. He had been bitten on a finger of the right hand by an unidentified snake about 6 hours prior to symptom onset. He lacked neurological symptoms such as headache, nausea, vomiting, or an altered consciousness level. The right hand exhibited severe swelling, oozing, and inflammation. The visual acuity was 20/25 in both eyes. Ptosis was evident in the right eye. Both pupils responded normally to light and near stimulation. Extraocular examination revealed movement limitations in all right-eye gaze fields except abduction. A serological test revealed coagulopathy. Pyridostigmine was prescribed, but the ocular symptoms did not immediately improve; however, they did improve gradually during follow-up. At 8 months after the initial visit, the patient exhibited an ortho primary gaze with an adduction limitation of -1. No aberrant regeneration was apparent. @*Conclusions@#Unilateral oculomotor nerve palsy can develop after a snake bite, possibly attributable to microvascular ischemia caused by coagulopathy.

Clinical Experiences of Photodynamic Therapy in the Extramammary Paget's Disease / 대한피부과학회지

BACKGROUND: Photodynamic therapy(PDT) is a kind of non-invasive photochemotherapy, which is designed to kill the target cells through photodynamic reaction. It has been reported that PDT is very effective in superficial lesions, including extramammary Paget's disease. Yet, there has been no clinical trial for the treatment of extramammary Paget's disease using PDT in Korea. OBJECTIVE: The purpose of this study was to evaluate the effectiveness of PDT in treating extramammary Paget's disease METHOD: Seven patients with anogenital extramammary Paget's disease were treated repeatedly with local PDT using topical ALA 20% and intralesional injection of hematoporphyrin derivative (HpD), and systemic PDT using HpD. Fluences of 125-200J/cm2 and intensities of 50-100mW/cm2 were used. RESULT: The clinical outcomes were disappointing. All the patients experienced only partial responses despite repeated treatments. But side effects were minimal. CONCLUSION: PDT is not effective enough for the treatment of extramammary Paget's disease to be used as a primary therapy. It would be better to use as an adjuvant to other treatment methods. Photodynamic sensitization, also known as photodynamic diagnosis, might help us define a more reliable border of the extent involved and the surgical margin to be excised.

Clinical Experiences of Photodynamic Therapy in the Extramammary Paget's Disease / 대한피부과학회지

BACKGROUND: Photodynamic therapy(PDT) is a kind of non-invasive photochemotherapy, which is designed to kill the target cells through photodynamic reaction. It has been reported that PDT is very effective in superficial lesions, including extramammary Paget's disease. Yet, there has been no clinical trial for the treatment of extramammary Paget's disease using PDT in Korea. OBJECTIVE: The purpose of this study was to evaluate the effectiveness of PDT in treating extramammary Paget's disease METHOD: Seven patients with anogenital extramammary Paget's disease were treated repeatedly with local PDT using topical ALA 20% and intralesional injection of hematoporphyrin derivative (HpD), and systemic PDT using HpD. Fluences of 125-200J/cm2 and intensities of 50-100mW/cm2 were used. RESULT: The clinical outcomes were disappointing. All the patients experienced only partial responses despite repeated treatments. But side effects were minimal. CONCLUSION: PDT is not effective enough for the treatment of extramammary Paget's disease to be used as a primary therapy. It would be better to use as an adjuvant to other treatment methods. Photodynamic sensitization, also known as photodynamic diagnosis, might help us define a more reliable border of the extent involved and the surgical margin to be excised.

Giant cell tumor of tendon sheath on the fingertip / 대한피부과학회지

Giant cell tumor of tendon sheath is a benign histiocytic proliferation of the articular and peritendinous synovial tissue and manifests as a painless, firm, smooth, subcutaneous mass which occurs predominantly on the hand where it is typically located adjacent to the interphalangeal joints of the hands, especially the terminal interphalangeal joints. Histologically, it is characterized by the presence of multinucleated giant cells. We herein report a case of giant cell tumor of tendon sheath located on the fingertip with the involvement of overlying skin, which shows rare location and unusual clinical manifestation.

Lipoid Proteinosis / 대한피부과학회지

Lipoid proteinosis is a rare autosomal recessively inherited disorder that is characterized by the deposition of hyaline-like material in the skin, oral cavity, and other organs. Microscopically, there is extensive deposition of amorphous eosinophilic material surrounding capillaries, sweat glands and in papillary dermis. Although the pathogenesis of this disease is not well understood, it is believed that it may result from the defect of collagen metabolism leading to abnormal accumulation of noncollagenous glycoprotein. We report a case of lipoid proteinosis in a 20-year-old female that demonstrates the characteristic clinical, histopathological, and ultramicroscopic features of this disease.

Assessment of Quality of Life in Patient with Toenail Onychomycosis in Korea / 대한의진균학회지

BACKGROUND: Onychomycosis, especially toenail onychomycosis has become one of the common fungal infection and has historically been regarded as a cosmetic rather than medical problem by many patients, even by physicians. Recently, however, there are several reports that this is a refractory disease which may cause a deleterious effect on patients' quality of life (QOL). OBJECTIVE: The purpose of this study was to investigate the impact of toenail onychomycosis on QOL in Korea and to assess the changes of QOL after treatment. METHODS: Total 1004 patients with toenail onychomycosis which was confirmed by clinical findings and KOH preparation were enrolled at 47 dermatologic centers in Korea, and interviewed with standardized QOL questionnaire before and after systemic antifungal treatment. Responses to the questionnaire were scored by f-point scale (0~4) and averaged, and were analyzed for 5 dimensions of emotional impact, social impact, symptom and functional impact, patients' views concerning treatment, and relationship with doctor. RESULTS: 1. Before and after treatment, the most serious impact was emotional dimension showing 1.90 and 1.30 in average score (AS), and social (AS: 1.14 and 0.83) and symptom and functional impact (AS: 1.05 and 0.92) was also affected. 2. In female rather than male, statistically more significant impact on patients' QOL was observed in all dimensions. 3. After treatment, 3 of 5 dimensions were improved significantly - emotional dimension (AS: from 1.90 to 1.30), social dimension (AS: from 1.14 to 0.83), patients' view concerning treatment(AS: from 1.34 to 1.02) 4. The degree of patients' satisfaction at the therapeutic effect was very high - 62.4% (immediately after. treatment) and 65.8% (9 months after initiation of treatment) of patients answered excellent or good. CONCLUSION: This study confirms that toenail onychomycosis has significant Impact on the overall QOL of patients. Also the effect of antifungal therapy on patients' QOL were satisfactory. Therefore, both doctor and patient should pay more attention to the treatment of onychomycosis.

Clinical Effects of Photodynamic Therapy on Carcinoma In Situ of the Skin / 대한피부과학회지

BACKGROUND: Photodynamic therapy(PDT) is a type of photochemotherapy that is designed to kill targeted tumor cells. OBJECTIVE: The Clinical effects of PDT were analysed for response rates, post-treatment healing and adverse effects on several cutaneous carcinoma in situ. METHOD: PDT with topical 5-aminolevulinic acid-based irradiation of corresponding 630+5nm light was performed in 6 carcinoma in situ patients who had actinic keratosis, Bowen' disease or cutaneous squamous cell carcinoma. RESULT: In all patients the clinical results were exellent with respect to initial complete responses and cosmetic outcome. CONCLUSION: PDT might be chosen as a first line treament for cutaneous carcimoma in situ.