The Results of Nation-Wide Registry of Age-related Macular Degeneration in Korea

PURPOSE: To evaluate the incidence and clinical features of age-related macular degeneration (AMD) in Korea. METHODS: Web-based (www.armd-nova.or.kr) registration was conducted for AMD patients aged 50 or more who were newly diagnosed by retinal specialists in Korea from August 20, 2005 to August 20, 2006. Patient data including ophthalmologic examination, fundus photography, fluorescein angiogram and/or indocyanin green angiogram (ICG), past medical history, behavioral habit, combined systemic diseases were up-loaded. RESULTS: Among finally enrolled 1,141 newly diagnosed AMD patients, 690 patients (60.5%) were male and 451 patients (39.5%) were female. The average age of AMD patients was 69.7+/-8.0. Early AMD was observed in 190 patients and 951 patients had late AMD. Classic choroidal neovascular membrane (CNVM) was observed in 18.6% of exudative AMD patients and 63.4 % had occult CNVM. Subfoveal CNVM was observed in 80.4% of the patients with CNVM. Among the 580 exudative AMD eyes that performed indocyanin green angiography (ICG), 184 eyes (31.7%) had polypoidal choroidal vasculopathy (PCV) and 36 eyes (6.2%) showed retinal angiomatous proliferation (RAP). Age, male gender, smoking, diabetes and hypertension significantly increased the risk of the AMD among Koreans. CONCLUSIONS: Because of the low rate of participation by retinal specialists, definite incidence of AMD was not obtainable. However, the estimated 1-year AMD incidence in the Pusan area of Korea is at least 0.4%. In contrast to Western people, 31.7% of exudative AMD cases were revealed to be PCV and 6.2% were revealed to be RAP. This discrepancy between ethnic groups should be considered in the diagnosis and treatment modality selection of Korean AMD patients.

Genotype, Coagulase Type and Antimicrobial Susceptibility of Methicillin-Resistant Staphylococcus aureus Isolated from Dermatology Patients and Healthy Individuals in Korea

Methicillin-resistant Staphylococcus aureus (MRSA) is one of the most prevalent dermatology pathogens in hospitals and increasingly recognized in communities. We determined PFGE pattern of SmaI-restricted genomic DNA, coagulase type, and antimicrobial susceptibility of MRSA isolated in 2008 from dermatology inpatients and healthy hospital employees in A Hospital and from primary school children in Iksan city, Korea. Overall, the isolation rate of MRSA was 3.8% from the 788 normal persons: 4.9% from hospital employees and 1.1% from primary school children. MRSA was isolated in six of 13 (46.2%) family members of four school children with MRSA. The most prevalent coagulase serotype was II from patients and V from healthy individuals. Ten of twenty and six of twenty MRSA isolates from patients and from healthy personnel, respectively, had identical PFGE patterns, suggesting that these are originated from identical clones. Against MRSA from patients, only vancomycin was the most active (MIC range or =90% to amikacin, clindamycin, ciprofloxacin, erythromycin, fusidic acid, gentamicin and tetracycline. In conclusion, the MRSA carriage rates of healthy hospital workers were relatively high, 2.3~7.7%, depending on groups. Family members of a few primary school children with MRSA showed a high carriage rate, suggesting that intrafamily transmission occurred. MRSAs isolated from dermatology inpatients were relatively more resistant to various antimicrobial agents, including mupirocin, but all isolates were susceptibility to vancomycin.

A Case of Ocular Manifestation of Anhidrotic Ectodermal Dysplasia

PURPOSE: This clinical report describes the characteristics and ophthalmic treatment of a patient with anhidrotic ectodermal dysplasia showing bilateral upper eyelid entropion, conjunctival mass and dry eye syndrome. METHODS: A 12-year-old boy presented to our clinic complaining of a white mass on the lower tarsal conjunctiva, foreign body sensation, and an itching in his right eye of one-year duration. He had developmental defects in his hair, teeth, nails and sweat glands. He had dry skin, a flat upper-lip, heat intolerance, a saddle-backed nose, and hypohidrosis. Ophthalmic examination showed blepharitis, a conjunctival mass, and bilateral upper eyelid entropion. RESULTS: Upper eyelid entropion surgery was performed. An excisional biopsy of the conjunctival mass showed nonspecific acute and chronic inflammation. CONCLUSIONS: We concluded that the conjunctival mass developed as a result of chronic inflammation caused by chronic conjunctivitis and dry eye syndrome. Regular lid-hygiene with swab and lubrication is useful to minimize recurrent ocular inflammation in anhidrotic ectodermal dysplasia.

A Solitary Fibrofolliculoma in the Eyelid

PURPOSE: To report the first case of a solitary eyelid fibrofolliculoma and to review the literature. METHODS: A 37-year-old female patient visited the outpatient department with a lesion in the right upper lid that had been growing steadily for a year. The patient had visited the local clinic, and under the diagnosis of chalazion had received incision and curettage twice, but the lesion had recurred. RESULTS: The 5 x 5 mm lesion was located near the upper lid margin. It was a red, hemispheric, smooth nodule, relatively solid to palpation and not painful. Excision and biopsy were performed, and through a histological exam, the diagnosis of fibrofolliculoma was later confirmed. CONCLUSIONS: Solitary fibrofolliculoma is rare, and to the authors' knowledge, a lesion arising in the eyelid has not yet been reported. Fibrofolliculoma should be included in the differential diagnosis when a localized mass lesion arising in the eyelid is encountered.

A Case of Optic Neuropathy Associated with MELAS Syndrome

PURPOSE: The purpose of this case report is to describe accompanying ocular findings, especially optic neuropathy, in a patient with MELAS syndrome. METHODS: A 10-year-old male patient who had lactic acidosis and neurological symptoms (loss of consciousness, vomiting, epilepsy, decreased vision, and constricted visual field), underwent a brain magnetic resonance imaging (MRI) scan and a molecular genetic analysis. RESULTS: A diagnosis of cerebral infarction due to occlusion in the right posterior cerebral artery was made and confirmed by MRI scan. The diagnosis of MELAS syndrome was confirmed by performing molecular genetic analysis demonstrating the transformation of the mitochondrial tRNAleu(UUR) gene (MTTL1) A to G(3243). According to the ocular examinations, the patient's left eye showed decreased vision, hemianopsia, relative afferent pupillary defects, mild swelling of optic nerve, and decreased amplitude on visual evoked potential exam. CONCLUSIONS: We encountered a case of MELAS syndrome involving optic neuropathy, which can (although rarely) occur with this syndrome. Therefore, in patients with an optic neuropathy of uncertain etiology, clinicians should consider performing comprehensive ocular exams and molecular genetic exams to rule out the possibility of genetic diseases.

A Case of Optic Neuropathy Associated with MELAS Syndrome

PURPOSE: The purpose of this case report is to describe accompanying ocular findings, especially optic neuropathy, in a patient with MELAS syndrome. METHODS: A 10-year-old male patient who had lactic acidosis and neurological symptoms (loss of consciousness, vomiting, epilepsy, decreased vision, and constricted visual field), underwent a brain magnetic resonance imaging (MRI) scan and a molecular genetic analysis. RESULTS: A diagnosis of cerebral infarction due to occlusion in the right posterior cerebral artery was made and confirmed by MRI scan. The diagnosis of MELAS syndrome was confirmed by performing molecular genetic analysis demonstrating the transformation of the mitochondrial tRNAleu(UUR) gene (MTTL1) A to G(3243). According to the ocular examinations, the patient's left eye showed decreased vision, hemianopsia, relative afferent pupillary defects, mild swelling of optic nerve, and decreased amplitude on visual evoked potential exam. CONCLUSIONS: We encountered a case of MELAS syndrome involving optic neuropathy, which can (although rarely) occur with this syndrome. Therefore, in patients with an optic neuropathy of uncertain etiology, clinicians should consider performing comprehensive ocular exams and molecular genetic exams to rule out the possibility of genetic diseases.

A Case of Angiographically Angiitis with Acquired Toxoplasmosis in Elderly Patient

To described a case of angiographically angiitis with acquired toxoplasmosis in elderly patient. We experienced a 72-year-old male patient who visited our clinic because of insidious decrease of visual acuity and metamorphopsia, inferior visual field defect in left eye. Ophthalmic examination showed a large, white, fluffy, retinal exudative lesion at superior area of optic nerve. We diagnosed a acquired toxoplasmic chorioretinitis developed in elderly patient without any systemic and immunologic diseases by serologic test and fluorescein angiography. Toxoplasmosis should be considered as a cause of diffuse necrotizing chorioretinitis in elderly patients. Older patients may be more susceptible to severe acquired ocular Toxoplasma infections because of age-related decline in cell-mediated immunity and chronic underlying diseases.

Preoperative Factors related to Corneal Flap Thickness in LASIK using Microkeratome

PURPOSE: To identify factors that may be related to variations in corneal flap thickness in LASIK using the Moria M2 microkeratome. METHODS: The charts of patients having LASIK based on steep keratometry nomogram using Moria M2 microkeratome (head : 110 micrometer) and excimer laser (VISX STAR S2, USA) in our department of ophthalmology from March, 2003, to May 2005, were reviewed retrospectively. A total of 195 eyes were enrolled in the investigation. We analyzed relationship between corneal flap thickness and preoperative factors including central corneal thickness, steep keratometer, corneal diameter, suction ring using multiple regression analysis. RESULTS: Mean corneal flap thickness was 119.37+/-21.21 micrometer. There was a statistically significant positive correlation between flap thickness and central corneal thickness (p<0.05). No correlation was found between flap thickness and other preoperative factors including steep keratometer, corneal diameter and suction ring. CONCLUSIONS: Mean corneal flap thickness using the Moria M2 110 micrometer head was 119.37+/-21.21 micrometer, little thicker than our expectation. When surgery is performed based on steep keratometry nomogram using Moria M2 microkeratome, if intraoperative factors are excluded, there is a trend toward thicker flap thickness with thicker central corneal thickness, whereas steep keratometer, corneal diameter or suction ring have no influence on flap thickness.

Wernicke-Korsakoff Syndrome Associated with Hyperemesis Gravidarum

PURPOSE: The authors hereby describe a case of Wernicke-Korsakoff syndrome with accompanying ocular findings that is caused by hyperernesis gravidarum. METHODS: We experienced a 27-year-old female at 12 weeks of pregnancy, who visited our clinic because of weight loss, gait disturbance, decreased mentality and dizziness after prolonged vomiting for 2 months. Neurological examination demonstrated ataxia of gait and loss of orientation. Ophthalmologic examination showed decreased visual acuity, upbeat nystagmus, diplopia and retinal hemorrhage. RESULTS: We report a relatively rare case of Wernicke-Korsakoff syndrome with ophthalmic symptoms induced by hyperemesis gravidarum. CONCLUSIONS: If a pregnant women has symptoms of severe vomiting along with other ocular findings such as retinal hemorrhage or restricted extraocular movement, one must suspect the diagnosis of Wernicke-Korsakoff syndrome, and should start appropriate treatment immediately.

Investigation of Early Protein Changes in the Urinary Bladder Following Partial Bladder Outlet Obstruction by Proteomic Approach

We investigated the pathophysiological mechanism by proteomic approach as a possible tool to detect the marker proteins to develop lower urinary tract symptoms following bladder outlet obstruction (BOO). Rats were randomized into 3 groups; control, sham operation and BOO groups. BOO group was divided into 1, 3, and 5 day-group. Conventional proteomics was performed with high resolution 2-D gel electrophoresis followed by computational image analysis and protein identification using mass spectrometry using rat urinary bladders. A comparison of bladder of BOO group with control bladder showed that three proteins of optineurin, thioredoxin and preprohaptoglobin were over-expressed in the bladder of BOO group. In addition, four proteins, such as peroxiredoxin 2, transgelin, hippocampal cholinergic neurostimulating peptide (HCNP) and beta-galactoside-binding lectin, were under-expressed in the bladder of BOO group. These data supported that downregulation of HCNP might make detrusor muscle be supersensitive to acetylcholine, up-regulation of optineurin means the protection of nerve injury, and down-regulation of transgelin means the decreased contractility of detrusor muscle. Beside these proteins, other proteins are related to oxidative stress or have a nonspecific function in this study. However more information is needed in human bladder tissue for clinical usage.

Three Cases of Pneumoretinopexy for Rhegmatogenous Retinal Detachment by Multiple Retinal Tears over 1 Hour in Distance

PURPOSE: To determine the effects of performing pneumoretinopexy in patients without the conventional indication of pneumoretinopexy but with rhegmatogenous retinal detachment by multiple retinal tears separated over 1 hour in distance. METHODS: Three patients with rhegmatogenous retinal detachment by multiple retinal tears separated over 1 hour in distance from November 2003 to December 2003 were the subject of this study. Treatment records of the patients were examined retrospectively. In one case, when performing pneumoretinopexy, 0.5 cc of vitreous was aspirated followed by an injection of 0.8 cc SF6 gas. In the other two cases, after injecting 0.5 cc of SF6 gas, one retinal tear was adhered in the proper position. Then, sequential retinal adhesion was attempted by changing the position. RESULTS: In all three cases, anatomical retinal adhesion was maintained, and visual acuity functionality was improved. CONCLUSIONS: Both sequential retinal adhesion by changing the position and performing pneumoretinopexy after vitreous aspiration are successful method of retinal adhesion. Therefore, pneumoretinopexy can be used as an effective medical treatment in patients with rhegmatogenous retinal detachment by multiple retinal tears separated over 1 hour in distance.

The Effect of Low-Dose Doxycycline Therapy in Chronic Meibomian Gland Dysfunction

PURPOSE: The aim was to investigate the effect of low dose doxycycline (20 mg) therapy in patients with chronic meibomian gland dysfunction that were refractory to conventional therapy. METHODS: The randomized prospective study enrolled 150 patients (300 eyes) who have chronic meibomian gland dysfunction and who didn't respond to lid hygiene and topical therapy for more than 2 months. All topical therapy was stopped for at least 2 weeks prior to beginning the study. After conducting the tear break up time test (TBUT) and Schirmer test, the authors randomly divided the patients into three groups a high dose group (doxycycline, 200 mg, twice a day), a low dose group (doxycycline, 20 mg, twice a day) and a control group (placebo). After one month, the author repeated the TBUT and Schirmer tests, and analyzed the degree of symptomatic improvement. RESULTS: Compared to the control group, both the high and low dose group showed statistically significant differences after treatment in TBUT, Schirmer test, the number of symptoms reported and the degree of improvement of subjective symptoms. However, there was no statistically significant difference between the high and low dose group after treatment in TBUT (9.42+/-2.87 sec, 9.54+/-1.58 sec, p=0.726), Schirmer test (19.98+/-4.05 mm, 19.65+/-5.02 mm, p=0.624), the number of symptoms reported (1.45+/-0.62, 1.53+/-0.52, p=0.304), as well as the degree of improvement of subjective symptoms (p=0.288). The high dose group (18 patients, 39.13%) reported side effects more frequently than did the low dose group (8 patients, 17.39%) (P=0.002). CONCLUSIONS: Low dose doxycycline (20 mg twice a day) therapy was effective in patients with chronic meibomian gland dysfunction that were refractory to conventional therapy.

The Comparison of Success Rate by Timing of Subconjunctival Injection of Mitomycin C in Glaucoma Filtering Surgery

We conducted a retrospective study to compare surgical outcome and postoperative complications based on the time of subconjunctival injection of mitomycin C (MMC)in glaucoma filtering surgery. 10 eyes of 10 patients with glaucoma was injected subconjunctivally with 0.1 ml of 0.02 mg/ml MMC 12 hours before surgery (preoperative group).13 eyes of 12 patients was injected subconjunctivally with 0.1 ml of 0.02 mg/ml MMC just before making the conjunctival incision and waited 2 minutes before performing trabeculectomy (intraoperative group). Postoperative mean follow-up period were 15.3 months in preoperative group, and 14.2 months in intraoperative group. Preoperative mean IOPs were 25.9 +/-10.9 mmHg in preoperative group, and 37.5 +/-13.1 mmHg in intraoperative group.Postoperative mean IOP in 1, 3, 6, 12 months were 8.4 +/-6.8, 10.1 +/-5.1, 10.4 +/-4.9, 11 +/-3.7 mmHg in preoperative group, and 11.4 +/-7.8, 12.1 +/-8.2, 15.5 +/-5.2, 12.1 +/-7.0 mmHg in intraoperative group.There were statistically significant decreases of IOPs in both groups during follow-up period. We defined surgical success as following :1)IOP below 21 mmHg without any antiglaucomatous therapies ;2)postoperative intraocular pressure reduction exceeding 30%of preoperative intraocular pressure. The success rate by Kaplan-Meier method showed no statistical significance between two groups in each definition (p>0.05, log rank test). In conclusion, there was no difference in success rate between two groups. This result suggests that the antiproliferative effect of MMC persists at least 12 hours after subconjunctival injection and the preoperative subconjuctival injection can be more quantitative application method.Futher studies should be done to reduce avascular filtering bleb related complications.

A Case of Alveolar Soft Part Sarcoma in the Orbit Diagnosed as C avernous Hemangioma befo re Operation

Alveolar soft part sarcoma is a very rare malignant neoplasm which originates from the soft tissue. The common site is lower extremity and it is especially rare to occur primarily in the orbit. It is characterized that tumor shows organoid arrangement of lobules separated by numerous delicate vascular septa and individual tumor cell contained PAS positive crystalline granules in the cytoplasm. Moreover, because of hypervascular tumor, it is easy to misdiagnosed as a cavernous hemangioma which commonly occurs in the orbit. We experienced a 29-year-old male who had suffered from unilateral proptosis.Before operation, ultrasonography, MRI and single photon emission computed tomography (SPECT) were performed and we suspected that the retro-orbital mass was a cavernous hemangioma. Using Kr onlein method,lateral orbitotomy was performed and large well encapsulated tumor mass (2.5 x2.5 x2.0 cm)was excised. On histopathological examination the tumor was confirmed as an alveolar soft part sarcoma. Therefore, we report this interesting case with review of the literature.

A Case of the Sino-Orbital-Cerebral Aspergillosis

Aspergillus is a relatively uncommon and saprophytic, ubiquitous fungus that is normally not pathogenic in human. Usually arising from the paranasal sinuses, it may present in manifold ways within the orbit. Some severe presentation, such as cerebral involvement, may lead to fatal outcome in immunocompromised patients. As a result, when it occurs it requires early recognition, aggressive surgical management, and prolonged antifungal therapy. Recently authors experienced a case of sino-orbital-cerebral Aspergillosis in a healthy woman. Therefore we report our case with a review of related literature.

A Case of Congenital Toxoplasmosis in the Neonate

Congenital toxoplasmosis is caused by vertical transmission of Toxoplasma gondii from the mother during pregnancy. The road clinical spectrum of congenital toxoplasmosis ranges from stillbirth or death shortly after birth to survival with either cerebral damage or mild or subclinical disease, consisting usually of ocular involvement. Recently we experienced a neonate with congenital toxoplasmosis. The diagnosis of congenital toxoplasmosis was confirmed on the basis of clinical findings such as chorioretinitis, CT findings of multiple cerebral calcifications calcifications, hydrocephalus, and positive serologic test for toxoplasma IgM anti body. Therefore, we report our case with a review of related literature.

An Ultrastructural Study on the Early Morphologic Changes of the Retina in Streptozotocin-induced Diabetic Rats

There have been many theories for pathogenesis of diabetic retinopathy. However,no one theory can explain all of the pathogenesis. That means many factors contribute to the pathogenesis of the diabetic retinopathy. Many studies have shown the retinal changes in long-term hyperglycemia, yet relatively few in short-term hyperglycemia. To study the changes of the retinal capillary and retinal pigment epithelium in diabetic retinopathy, we measured the thickness of the basement membrane of the retinal capil-lary endothelial cells in streptozotocin-induced diabetic rats. An morphological alterations of the retinal pigment epithelium were also examined on the 2 month-old diabetic rats. The measurement was made using 0.1 mm calibrated ruler overlaying the electron micrograph with a transparent plastic sheet on which 20 radiating lines were etched exactly 18 .apart. The SPSS and Instat program were used for statistical evaluation of the data. Comparing with the control, the increase of the thickness of the endothelial basement membrane at the 2 month-old diabetic rats was statistically significant (p<0.05). Cytoplasmic alterations such as vacuolization of capillary endothelium, changes in mitochondria and increasement of capillary endothelialcytoplasm were more prominent in diabetic rats than in control rats. Basal infoldings of retinal pigment epithelium appeared to be more frequent and deeper in diabetic rats than in control rats.

Laser Photocoaculation Treatment in a Case of Circumscribged Choroidal hmangioma Associated with Serous Retinal Detachment

Circumscribed choroidal hemangioma is a rare, benign, vascular hamartom located frequently at the posterior pole. This may lead to symptomatic visual loss when serous retinal detachment occurs at macular area. WE treated successfully a case of circumscribed choroidal hemangioma associated with serous retinal detachment with laser photocoagulation. So, we report this case with a review of the literatures.