Peripapillary Retinal Nerve Fiber Layer Thicknesses Did Not Change in Long-term Hydroxychloroquine Users

PURPOSE: To evaluate changes in the peripapillary retinal nerve fiber layer (RNFL) thicknesses using spectral-domain optical coherence tomography (SD-OCT) in hydroxychloroquine (HCQ) users. METHODS: The medical records of HCQ users were retrospectively reviewed. In these HCQ users, an automated perimetry, fundus autofluorescence photography, and SD-OCT with peripapillary RNFL thickness measurements were performed. The peripapillary RNFL thicknesses were compared between the HCQ users and the control groups. The relationships between the RNFL thicknesses and the duration or cumulative dosage of HCQ use were analyzed. RESULTS: This study included 77 HCQ users and 20 normal controls. The mean duration of HCQ usage was 63.6 ± 38.4 months, and the cumulative dose of HCQ was 528.1 ± 3.44 g. Six patients developed HCQ retinopathy. Global and six sectoral RNFL thicknesses of the HCQ users did not significantly decrease compared to those of the normal controls. No significant correlation was found between the RNFL thickness and the duration of use or cumulative dose. The eyes of those with HCQ retinopathy had temporal peripapillary RNFL thicknesses significantly greater than that of normal controls. CONCLUSIONS: The peripapillary RNFL thicknesses did not change in the HCQ users and did not correlate with the duration of HCQ use or cumulative doses of HCQ. RNFL thickness is not a useful biomarker for the early detection of HCQ retinal toxicity.

Frequency and Clinical Characteristics of Hydroxychloroquine Retinopathy in Korean Patients with Rheumatologic Diseases

This study aimed to evaluate the frequency and clinical characteristics of hydroxychloroquine (HCQ) retinopathy in Korean patients with rheumatologic diseases. We retrospectively reviewed medical records of 310 patients taking HCQ. Ophthalmic examinations included spectral-domain optical coherence tomography (SD-OCT), automated visual field test, and fundus autofluorescence. The severity of retinopathy was categorized as early, moderate, or severe, and the location was categorized as parafoveal, pericentral, or mixed pattern. Among 310 patients, 9 patients (2.9%) were diagnosed as HCQ retinopathy. Among the patients with HCQ use ≥ 5 years (n = 174), the frequency was 5.2%. Only 1 (11.1%) of the 9 patients was symptomatic. The mean daily dose per kilogram of real body weight of the 9 patients was 5.6 mg, and only 3 had used 6.5 mg or more. Four of the 9 patients had severe HCQ retinopathy. Six of the 9 patients showed pericentral or mixed pattern of retinal damage. Consequently, the frequency of HCQ retinopathy in Korean patients was not low, especially when administered at a high cumulative dose and for a long duration. Screening of HCQ retinopathy by the recommended guidelines that include SD-OCT seems useful and should be done to detect retinal damage earlier in patients with chronic exposure to HCQ.

Second-Eye Refractive Error Depending on the Reflection Rate of First-Eye Refractive Error in Cataract Surgeries

PURPOSE: To evaluate the reflection rate of the first eye in order to minimize the real refractive error in the second eye in bilateral consecutive cataract surgeries. METHODS: A retrospective analysis was performed with 248 patients who underwent bilateral sequential uncomplicated phacoemulsification and posterior chamber intraocular lens implantation. Predicted spherical equivalent was compared with postoperative spherical equivalent, and the range of real refractive error was analyzed by calculating the reflection rate of the first eye. RESULTS: When the difference between predicted spherical equivalent and postoperative spherical equivalent was greater than 0.5 D as calculated with the formula of Sanders-Retzlaff-Kraff Theoretical (SRK)-T and SRK II, application of 50-60%, 40-50% of the difference of the first eye was high probability to reduce the second-eye real refractive error (75%, 100%). CONCLUSIONS: Application of 40-60% of the real refractive error in the first-eye can minimize the real refractive error in the second-eye in bilateral sequential cataract surgeries.

Two Cases of Actinomyces Infection in a Hydroxyapatite Orbital Implant with a Motility Peg

PURPOSE: To report 2 cases of Actinomyces infection in a hydroxyapatite orbital implant with a motility peg. CASE SUMMARY: A 44-year-old male and a 55-year-old male who underwent evisceration and implantation of a hydroxyapatite implant in the left eye 17 and 15 years prior, respectively, presented with a conjunctival sac granuloma with discharge and bleeding of 1 year duration. Both patients had a history of motility peg implantation. A large-area of the hydroxyapatite implant was exposed after removal of the granuloma. The previous orbital implant was removed, and the exposed area was covered with a dermis fat graft in both patients. On histopathological examination, Actinomyces infection in the orbital implant was observed in both patients. CONCLUSIONS: To the best of our knowledge, this is the first case report of actinomycosis of hydroxyapatite orbital implant in Korea. In a patient with a porous orbital implant, the possibility of Actinomyces infection of the orbital implant should be considered after a long-duration and large-area exposure of the implant.

Clinical Manifestations and Risk Factors of Ocular Graft-versus-Host Disease (GVHD) after Hematopoietic Stem Cell Transplantation

PURPOSE: To investigate the incidence, clinical manifestations, and risk factors of ocular graft-versus-host disease (GVHD) as well as the survival of the patients after allogeneic hematopoietic stem cell transplantation (HSCT). METHODS: The medical records of 99 patients who visited our clinic and were screened for ocular GVHD after allogeneic HSCT were reviewed retrospectively. Subjects were divided into 2 groups depending on the occurrence of ocular GVHD on slit-lamp biomicroscopy. We compared clinical manifestations and survival between the 2 groups and analyzed the risk factors associated with the development of ocular GVHD. RESULTS: Ocular GVHD was diagnosed in 38 patients (38.38%) at a mean of 315 days after HSCT. Out of the 38 patients who developed ocular GVHD, 22 patients (57.89%) were diagnosed with dry eye only and 16 patients (42.11%) were diagnosed with conjunctival disease. The presence of extraocular GVHD (hazard ratio (HR) 35.76, p < 0.001), the number of extraocular GVHD (HR 3.07, p < 0.001), skin GVHD (HR 2.31, p = 0.029), oral GVHD (HR 8.16, p < 0.001), and gastrointestinal tract GVHD (HR 5.00, p = 0.002) were independent risk factors of ocular GVHD. Comparisons of the survival demonstrated decreased survival of patients with conjunctival disease compared to patients without ocular GVHD and patients with dry eye only, but there was no statistically significant differences (log rank test, p = 0.208). CONCLUSIONS: Ocular GVHD is common after allogeneic HSCT. The majority of ocular GVHD occurs in the chronic stage and is associated with decreased survival. Therefore, more intensive and long-term follow-up with ophthalmic and systemic monitoring is necessary, especially in patients who have extraocular GVHD, for early recognition and proper treatment of ocular GVHD.

Ankyloblepharon Filiforme Adnatum : a Case Report

PURPOSE: To report a case of ankyloblepharon filiforme adnatum in a newborn male. CASE SUMMARY: A 4-day-old male was referred for fused right eyelids with unremarkable other pediatric examinations. Ocular examination under general anesthesia revealed partial fusion of his right upper and lower eyelids by a 4 mm-wide band of tissue which arose from the skin of the upper and lower eyelids. The adhesion was separated by sharp scissors and no other ocular abnormalities were revealed. CONCLUSIONS: Ankyloblepharon filiforme adnatum is a rare congenital malformation. In this case, the band of tissue connecting the upper and lower eyelids arose not from the eyelid margin but from the eyelid skin, which is even rarer, thus supporting the theory that this condition is due to the fusion of eyelids at abnormal positions, and not due to problems during the separation of eyelids.

Pulmonary Edema Caused by Massive Intraarterial Infusion and Flushing of Heparinized Saline during the Endovascular Embolization in a Patient with a Cerebral Aneurysm: A case report / 대한마취과학회지

Here we report, along with a review of the literature, our experience with a patient suffering from a cerebral aneurysm and developed volume overloading pulmonary edema during endovascular coiling. A 51-year-old female patient who had an aneurysm in the basilar artery tip and subarachnoid hemorrhage was scheduled for endovascular embolization under general anesthesia. She developed pulmonary edema during the procedure. Coiling failed so neurosurgeon performed aneurysmal clipping under general anesthesia. The massive intraarterial infusion and flushing with heparinized saline may have triggered the pulmonary edema. We monitored diuresis and hemodynamics following surgery, as a high degree of vigilance, including monitoring of arterial blood gas and electrolyte evaluation, of patients undergoing prolonged endovascular embolization and receiving many intra-arterial fluids may help recovery.

A Case of the Type I Thanatophoric Dysplasia Diagnosed in the 2nd Trimester / 대한산부인과학회지

Skeletal dysplasias, a heterogenous group of bone growth disorders including thanatophoric dysplasia can be detected by routine prenatal ultrasound examination. As it is difficult to make a specific diagnosis, prediction of prognosis is of importance for obstetric management. In order to specify diagnosis, radiological, pathological and molecular genetic examination are often required. Our report describes a case of the type I thanatophoric dysplasia diagnosed specifically and terminated in the 2nd trimester.

A Case of Progressive Supranuclear Palsy with Schizophrenic Symptoms / 신경정신의학

We have experienced a rare case of progressive supranuclear palsy with hallucination and delusion. The common manifestations of progressive supranuclear palsy are gait disturbance, mental change and sign of vertical ophthamoplegia but no efficacious therapy has been known. Neuropsychiatric symptom clusters include cognitive impairment, affective and behavioral changes, sleep disturbance, and psychotic symptoms. Though schizophrenia-like psychosis has been reported but this is certainly rare. Addressing a case of progressive supranuclear palsy, in whom parkisonian symptoms appeared with concurrent psychotic symptoms, we emphasize accurate diagnosis.