Reattachment of Graft Using Atropine after Descemet Stripping Automated Endothelial Keratoplasty in Iris Deformity

Purpose@#To report successful graft reattachment using atropine after Descemet’s membrane stripping automated endothelial keratoplasty (DSAEK) in iris deformity.Case summary: A 76-year-old male was referred for decreased visual acuity due to bullous keratopathy in his right eye. He had previously undergone several eye surgeries, including vitrectomy and intraocular lens fixation, because of retinal detachment, which caused the iris deformity. DSAEK was performed, but the graft detached because of an air bubble in the posterior chamber. Atropine was used to move the air into the anterior chamber. The graft was attached the next day, and maintained during 3 months of follow-up. @*Conclusions@#Atropine is an effective treatment option for cases with air bubble migration to the posterior chamber, leading to graft detachment after DSAEK in iris deformity.

Associations of Physical Activity and Sitting Time with Serum Vitamin D Status in Korean Adults: Results from the 2014 Korea National Health and Nutrition Examination Survey

Background@#Recent evidence has reported the relationships between 25-hydroxyvitamin D (25[OH]D) insufficiency and chronic diseases. This study examined the association of physical activity and sitting time with vitamin D status. @*Methods@#This study analyzed the data of 1,598 adults aged ≥19 who participated in the 2014 Korea National Health and Nutrition Examination Survey. Vitamin D insufficiency was defined as a serum 25(OH)D level of ≤20 ng/mL. The odds ratios and 95% confidence intervals of vitamin D insufficiency according to physical activity and sitting time were calculated using a multivariable logistic regression analysis. @*Results@#The mean levels of serum 25(OH)D were 16.5 ng/mL in males and 15.2 ng/mL in females, respectively and was significantly higher in the participants with sitting times of <5 hours/day than those with sitting times of ≥5 hours/day. After adjusting for confounding variables, sitting time of <5 hours/day was associated with decreased odds of vitamin D insufficiency as compared with sitting time of ≥5 hours/day in the total participants and females. In addition, the odds ratio for vitamin D insufficiency was significantly lower in the group with sitting times of <5 hours/ day than in the group with sitting times of ≥5 hours/day even among people with low physical activity in the total participants and females. @*Conclusion@#Serum 25(OH)D level was insufficient in the Korean adults and shorter sitting time was related to lower odds ratio of vitamin D insufficiency. Our findings suggest that sitting time is an independent factor of serum vitamin D status.

Anti-staphylococcal Effect of a Nephrite-containing Contact Lens Storage Case

Purpose@#To compare the anti-staphylococcal effect of nephrite-containing contact lens (CL) storage cases and conventional CLstorage cases.Method: The degree of proliferation and adhesion of Staphylococcus aureus (S. aureus) on first- to third-generation silicone hydrogelcontact lenses (SHCLs) was analyzed through comparison of 5% nephrite-containing CL storage cases and conventionalCL storage cases. The degree of adhesion of S. aureus to the CL was also compared between 1% or 5% nephrite solution andmultipurpose solution (MPS).Result: Nephrite-containing CL storage cases showed a significant inhibitory effect on S. aureus proliferation (p = 0.004) and significantlyreduced the number of adherent S. aureus on all first- to third generation SHCLs compared with conventional CL storagecases (p = 0.026, p = 0.043, and p = 0.001, respectively). The anti-staphylococcal effect of 1% and 5% nephrite solutionswas not significantly better than that of MPS. @*Conclusions@#Nephrite shows potential as a next-generation substance for reducing infectious keratitis caused by S. aureuswhen added to CL storage cases.

Arteritic Anterior Ischemic Optic Neuropathy Associated with Giant-Cell Arteritis in Korean Patients: A Retrospective Single-Center Analysis and Review of the Literature

BACKGROUND AND PURPOSE: The aim of this study is to report the relative incidence of arteritic anterior ischemic optic neuropathy (AAION) associated with giant-cell arteritis (GCA) in a single-center and evaluate the clinical features of AAION in Korean patients. METHODS: The medical records of patients with presumed AION who visited our hospital from January 2013 to August 2018 were examined retrospectively. The patients were divided into two groups: AAION associated with GCA, and non AION (NAION). We additionally reviewed the literature and identified all cases of AAION in Korean and Caucasian patients. We evaluated the clinical data including the initial and final best-corrected visual acuities, fundus photographs, visual field tests, fluorescein angiography, and contrast-enhanced MRI, and compared the data with those for Caucasian patients in the literature. RESULTS: Of the 142 patients with presumed AION, 3 (2.1%) were diagnosed with AAION and 139 (97.9%) were diagnosed with NAION. Seven Korean patients with AAION associated with GCA were identified in our data and the literature review. We found no difference in any clinical features other than laterality: four of the seven Korean patients had bilateral involvement. Moreover, the optic nerve sheath was enhanced in two of our Korean patients. CONCLUSIONS: AAION associated with GCA is a very rare condition compared to NAION in Korea. However, GCA should be considered in all cases of ischemic optic neuropathy because AAION is associated with poor visual outcome, and sometimes presents bilaterally.

Clinical Outcomes of Patients Implanted with Bifocal and Extended Depth of Focus Intraocular Lenses

PURPOSE: To compare the postoperative clinical outcomes after cataract surgery with implantation of bifocal intraocular lenses (IOLs) and extended depth of focus (EDOF) IOLs. METHODS: A total of 60 patients were divided into three groups, and each group included 20 patients of 40 eyes: group A with a +3.25 D bifocal IOL in both eyes, group B with an EDOF IOL in both eyes, and group C with a +3.25 D bifocal in one eye and an EDOF IOL in the other eye. We retrospectively reviewed the patients' medical charts to analyze their binocular uncorrected visual acuities (UCVAs; distant, intermediate, and near) and refraction at postoperative 3 months. RESULTS: The binocular distant UCVAs were 0.04 ± 0.01, 0.05 ± 0.02, and 0.04 ± 0.01 in groups A, B, and C, respectively, and there were no differences between the groups (p > 0.05). The intermediate UCVAs were 0.16 ± 0.01, 0.10 ± 0.01, and 0.10 ± 0.01, respectively, and group A was the lowest (A–B, p = 0.031; A–C, p = 0.018; B–C, p = 1.000). The near UCVAs were 0.05 ± 0.01, 0.24 ± 0.01, and 0.13 ± 0.01, respectively, and there were significant differences between the groups (A–B, p < 0.001, A–C: p = 0.009; B–C, p = 0.003). CONCLUSIONS: There were no significant differences among the three groups in binocular distant UCVA, and groups B and C showed better intermediate UCVAs than group A. Near UCVA was ranked in the order of groups A, C, B.

The Short-Term Effect of Prostaglandin Analog Monotherapy on Corneal Biomechanical Properties in Normal Tension Glaucoma Patients

PURPOSE: To evaluate the effects of short-term prostaglandin analogues treatment on the corneal biomechanics of patients with normal tension glaucoma. METHODS: This study included 52 eyes of 52 patients who were diagnosed with normal tension glaucoma. All patients were divided into two groups; one group (27 eyes) received tafluprost while the other group (25 eyes) received travoprost. Intraocular pressure, Biomechanical properties were measured by using goldmann applanation tonometer, ocular response analyzer before treatment and at 8-week after treatment. RESULTS: The mean decrease in intraocular pressure, Goldmann-correlated IOP (IOPg), corneal-compensated intraocular pressure by using Goldmann applanation tonometer, and Ocular response analyzer were statistically significant in total patients, tafluprost, and travoprost group after using prostaglandin analogues (p < 0.001, p < 0.001, p < 0.001, respectively). Corneal hysteresis showed no statistical differences after treatment in total, tafluprost and travoprost group but corneal resistance factor (CRF) showed statistically significant decrease after using prostaglandin analogues in total, tafluprost, and travoprost group (p < 0.001, p = 0.025, p < 0.001). Upon multivariate analysis, the higher initial IOPg and the lower initial CRF checked, the variation of CRF (CRF in baseline – CRF at 8 weeks) got higher (β = 0.134, p = 0.017). CONCLUSIONS: It is needed to carefully monitor and evaluate the effects of prostaglandin analogues on intraocular pressure associated with initial intraocular pressure and the changes of CRF after prostaglandin treatment in normal tension glaucoma patients. CRF is sensitive factor to short-term changes of intraocular pressure after prostaglandin analogues treatment, and it is required to consider the properties of CRF when we evaluate between progression of glaucoma and corneal biomechanical properties.

Effect of Inferior Oblique Weakening Procedures Combined with Surgery for Intermittent Exotropia

PURPOSE: To investigate whether combining inferior oblique weakening procedures with bilateral lateral rectus recession as a surgical approach to intermittent exotropia enhances postoperative horizontal angle of deviation over bilateral lateral rectus recession alone. METHODS: Patients were allocated to one of two surgical groups: a bilateral lateral rectus recession group (Group 1) or a bilateral lateral rectus recession with bilateral inferior oblique weakening group (Group 2). Group differences in the angle of distance deviation were evaluated preoperatively and at 3- and 12-months postoperatively. RESULTS: There were no significant differences in preoperative factors or angles of deviation between Group 1 (n = 98) and Group 2 (n = 77); no significant intergroup difference in the angle of deviation was observed at any postoperative time point (p > 0.05). CONCLUSIONS: Combined inferior oblique weakening procedures did not significantly influence the horizontal angle of deviation after surgery for intermittent exotropia. Accordingly, there is no need to revise the surgical amount of lateral rectus recession.

A case report of a surgical guide fabricated via intraoral scanning-based implant planning and wax-based rapid prototyping / 대한치과보철학회지

With the recent progress of digital technology, the computer guided surgery utilizing a guide template in the placement of implant has been actively performed, and the method employing the intraoral scanner at the implant prosthesis introduced. Fabrication method of the guide template can be largely classified into design-related rapid prototyping (RP) system and vector milling system, and each of the method has its own weakness in the clinical application despite of excellent accuracy. Thus, in this case study, a working model was fabricated by the wax RP technology using images acquired by CBCT and an intraoral scanner, and the metal bushing was picked up with orthodontic resin cast upon the wax model. Using this method, a surgical guide template was fabricated and used in surgery. From this, we could obtain a satisfactory outcome clinically in the implant placement and the fabrication of the final prostheses and thus report this case herein.

Discriminating Between Normal and Glaucomatous Eyes Using the Modified ISNT Rule

PURPOSE: To evaluate the diagnostic ability of the modified ISNT rule (disc rim thickness of the smaller of inferior and superior > the larger of nasal and temporal) for normal and glaucomatous eyes compared to the classic ISNT rule (disc rim thickness of inferior > superior > nasal > temporal). METHODS: Color stereo optic disc photographs of 113 normal subjects and 108 open angle glaucoma patients with early and moderate stage were morphometrically evaluated. The classic ISNT rule and the modified ISNT rule were assessed by masked evaluation of disc photographs at the 3, 6, 9 and 12 o'clock positions. RESULTS: Among normal subjects, 58 of 113 eyes (51.3%) were normal and in open angle glaucoma patients, 104 of 108 eyes (96.3%) were abnormal with the classic ISNT rule. Among normal subjects, 98 of 113 eyes (94.2%) were normal and in open angle glaucoma patients, 102 of 108 eyes (94.4%) were abnormal with the modified ISNT rule. The modified ISNT rule was more accurate than the classic ISNT rule in terms of Cohen's Kappa analysis used for discriminating between normal and glaucomatous eyes. CONCLUSIONS: The modified ISNT rule is useful for differentiating between normal and glaucomatous optic nerves and easily applied in clinical practice.

Clinical Outcomes of the Surgical Management with Dislocated Posterior Chamber Intraocular Lens

PURPOSE: To evaluate the clinical outcomes of the surgical treatment in patients with dislocation of an intraocular lens (IOL). METHODS: The present study investigated the postoperative naked visual acuity, corrected visual acuity, astigmatism, and postoperative complications in patients with a minimum follow-up of 1 month after the surgical treatment of a dislocated posterior chamber IOL. RESULTS: The study included 48 eyes of 48 patients (32 males and 16 females) with an age ranging from 33 to 76 years with a mean of 56.7 years at initial visit. The mean time interval from cataract extraction and IOL implantation to dislocation of IOL was 4.9 years. The IOL was exchanged in 13 eyes and was repositioned in 35 eyes. The IOL was repositioned without tying in 11 eyes, by scleral fixation with tying inside the eye in 10 eyes, and by scleral fixation with tying outside the eyeball in 14 eyes. The mean naked visual acuity improved from 1.21 +/- 0.70 to 0.70 +/- 0.48 (p = 0.001) and the best corrected visual acuity improved significantly from 0.82 +/- 0.68 to 0.35 +/- 0.30 (p = 0.002). Among the repositioned IOLs managed by IOL repositioning using scleral fixation with tying inside the eye, 4 eyes re-dislocated. These eyes were re-treated for a second time with IOL repositioning and scleral fixation with tying outside the eye. CONCLUSIONS: Surgical management of dislocated IOLs resulted in significant improvement of visual acuity. Scleral fixation with tying inside the eye had a high risk of re-dislocation because of the difficulty in tightly securing the knot.

A Case of Nonarteritic Anterior Ischemic Optic Neuropathy Following Acute Angle-Closure Glaucoma

PURPOSE: Nonarteritic anterior ischemic optic neuropathy (NAION) is believed to result from inadequate blood supply to the posterior ciliary arteries. To date, NAION in a patient with acute angle-closure glaucoma (AACG) has been reported in only two studies in the English literature. Thus, the authors report a case of NAION following AACG in a Korean patient. CASE SUMMARY: A 59-year-old woman presented with a three-day history of acute ocular pain and decreased vision in her right eye; visual acuity was hand movement and the intraocular pressure (IOP) was 66 mm Hg in the right eye. Slit-lamp examination of the patient's right eye revealed diffuse corneal edema, shallow anterior chamber, and mid-dilated pupil. Gonioscopy revealed a grade 0 angle in the right eye, and a relative afferent pupillary defect was noted. Fundus photography showed disc hemorrhage and swelling of the optic disc. Fluorescein angiography demonstrated hyperfluorescence of the optic disc due to leakage. Visual evoked potential of the right eye at the initial visit showed a decreased amplitude of P100 compared with that of the left eye. A diagnosis of NAION following AACG was made. Laser iridotomy was successfully performed to the right eye. Two months later, IOP decreased from 66 to 21 mm Hg. However, visual acuity remained as hand movement and fundus examination revealed a pale optic disc. CONCLUSIONS: NAION following AACG may be attributed to an acute IOP rise with resultant perfusion pressure decrease in the vessels which supply the optic nerve. The result obtained from the patient in the present study indicates that evaluation for NAION should be considered in AACG cases.

Effect of Mitomycin C, Dexamethasone, and Cyclosporine A 0.05% on the Proliferation of Human Corneal Keratocytes

PURPOSE: To investigate the biologic effect of mitomycin C, dexamethasone and cyclosporine A 0.05% on cultured human keratocytes in vitro. METHODS: Human corneal keratocytes were exposed to a concentration of mitomycin C (0.05%), dexamethasone (0.05%) and cyclosporine A (0.05%) for a period of 3, 5, and 10 minutes. MTT-based colorimetric assay was performed to assess the metabolic activity of cellular proliferation and the concentration of type I procollagen COOH-terminal peptide (PIP) and laminin were measured. Cell damage was determined by using the lactate dehydrogenase (LDH) assay. Apoptotic response was evaluated utilizing flow cytometric analysis with Annexin V and propiodium iodide. RESULTS: The inhibitory effect of cellular proliferation and cytotoxicity in cultured human keratocytes showed a time-dependent response in all drugs. The production of PIP and laminin showed a time-dependent response in cultured cells. Apoptosis was observed in flow cytometry after being treated with mitomycin C, dexamethasone and cyclosporine A. Cyclosporin A resulted in less apoptosis of keratocytes than mitomycin C and dexamethasone. CONCLUSIONS: The apoptotic response of mitomycin C, dexamethasone and cyclosporine A is associated with the inhibitory effect of human corneal keratocyte proliferation. To decrease corneal opacity, mitomycin C and dexamethasone were more effective than cyclosporine A in the present study. Additionally, a high concentration of cyclosporine A greater than 0.05% is necessary to lower corneal opacity.

The Inhibitory Effect of Myopic and Astigmatic Progression by Orthokeratology Lens

PURPOSE: To investigate the clinical effects of orthokeratology lens wear on inhibition of the progression of Korean myopia and astigmatism. METHODS: The authors reviewed out-patient records of 144 eyes of 74 patients wearing orthokeratology lenses. The cycloplegic refraction and keratometry before and after wearing the lens were compared. The 190 eyes wearing spectacles were included into the control group. We evaluated the relationship between orthokeratology lens wear and control group according to age, initial myopia, initial astigmatism, myopic progression, astigmatic progression and duration of orthokeratology lens wearing. RESULTS: The mean cycloplegic refractive error of spherical equivalent was -3.36 +/- 1.96 diopters (D) in the patients wearing orthokeratology lenses, the mean astigmatism was -0.86 +/- 0.72 D, and the mean wearing period was 3.41 +/- 1.5 years. The mean myopic progression was 0.25 +/- 0.31 D in lens wearing, and 0.62 +/- 0.39 D in glasses wearing, respectively. There were statistically significant differences between lens and glasses wearing group (t-test, p 0.01). CONCLUSIONS: The orthokeratology lens was found to be effective in suppression of the progression of Korean myopia and astigmatism, compared with the glasses.

A Case of an Orbital Myxoma

PURPOSE: Orbital myxoma is an extremely rare tumor. To date, only a few cases have been reported in the literature. The present study reports a case of an orbital myxoma and demonstrates the clinical and histological features. CASE SUMMARY: A 37-year-old woman presented with a painless movable mass in the orbital margin of the left eye. Computed tomography of the orbit revealed a sharply outlined solid mass, and an excisional biopsy was performed. The excised specimen consisted of a 17x9x10 mm3 brownish mass of scattered spindle cells and small vascular spaces in a fibromyxoid background. Immunohistochemically, the tumor cells were not immunoreactive for SMA, S-100 protein or CD34. Histopathologic examination revealed the tumor to be a myxoma. There was no mass lesion in computed tomography of the orbit, and no recurrence or complications were found one month after removal. CONCLUSIONS: When a patient presents with a painless and movable mass in the orbital area, orbital myxoma should be considered as a possible diagnosis. The orbital myxoma with bone invasion should be completely removed to prevent the lesion from recurring.

The Immunohistochemical Study of bcl-2 and p53 Expression of Pilomatricoma / 대한피부과학회지

BACKGROUND: The pathogenesis of pilomatricoma is unknown. Several reports have suggested that apoptosis may play a role in the pathogenesis of pilomatricoma. As the bcl-2 and p53 are well-known regulators of apoptosis, a disturbance in either bcl-2 or p53 could compromise a proper apoptotic response and relate to the development of the tumor. OBJECTIVE: The purpose of this study was to evaluate the expression of bcl-2 and p53 proteins in pilomatricoma. METHODS: Paraffin blocks of 14 cases of pilomatricoma were stained immunohistochemically by using anti-bcl-2 and anti-p53 antibodies. RESULTS: 1. Histologically, SCs were found in all 14 pilomatricomas, while BCs and TCs were found each in 9 tumors. 2. All the SCs found in 14 tumors and all the TCs found in 9 tumors were unstained for both bcl-2 and p53. 3. The expression of bcl-2 in 9 tumors was variable. Basal BCs showed reactivity from negativity(-) to strong positivity(+++) and suprabasal BCs showed reativity from negativity(-) to moderately strong(++) positivity. Both basal BCs and suprabasal BCs showed negativity for bcl-2 in 3 tumors and similar positive staining in 1 tumor, while basal BCs showed stonger positivity than suprabasal BCs in 5 tumors. 4. The expression of p53 in 9 tumors was also variable. Both basal BCs and suprabasal BCs showed reactivity from negativity(-) to moderately strong positivity(++). Both basal BCs and suprabasal BCs showed negativity for p53 in 1 tumor and similar positive staining in 6 tumors, while suprabasal BCs showed stronger positivity than basal BCs in 2 tumors. CONCLUSION: The above immunohistochemical findings showed that the expression of bcl-2 and p53 was variable and suggest that both bcl-2 and p53 have a limited role in the control of apoptosis in pilomatricoma.

A Case of Median Raphe Cyst / 대한피부과학회지

Median raphe cyst is a relatively uncommon lesion occurring in the midline male perineum, especially ventral aspect of penis. It is an embryologic developmental anomaliy of the male genitalia. Histologically, the lining cells are usually pseudostratified columnar epithelium, but can be stratified squamous epithelium and sometimes mucous glands and ciliated cells can be observed within the cyst wall. Herein, we report a case of median raphe cyst in the midline of the scrotum of a 2-year-old boy.

A Case of Median Raphe Cyst / 대한피부과학회지

Median raphe cyst is a relatively uncommon lesion occurring in the midline male perineum, especially ventral aspect of penis. It is an embryologic developmental anomaliy of the male genitalia. Histologically, the lining cells are usually pseudostratified columnar epithelium, but can be stratified squamous epithelium and sometimes mucous glands and ciliated cells can be observed within the cyst wall. Herein, we report a case of median raphe cyst in the midline of the scrotum of a 2-year-old boy.

A Case of Pearly Penile Papules / 대한피부과학회지

Pearly penile papules are small, smooth, dome-shaped, grayish to skin-colored papules, that are arranged in one or several rows. These are commonly located circumferentially on the corona and sulcus of the glans penis. A 36-year-old male patient had had asymptomatic numerous pearly smooth 1 * 1mm -sized dome-shaped papules for several months. A Histopathological examination revealed an increased number of fibroblasts on the papillary dermis, vascular proliferation and a mild lymphocytic infiltration. We diagnosed the condition as pearly penile papules. No treatment other than reassurance was given. We report, herein, a case of pearly penile papules.

A Case of Pseudoxanthoma Elasticum Clinically Mimicking Cutis Laxa / 대한피부과학회지

Pseudoxanthoma elasticum is a rare, heritable, systemic disease of connective tissue characterized by degeneration of elastic fiber and mainly affects the skin, eye and blood vessels. We report a case of pseudoxanthoma elasticum mimicking cutis laxa. She had a generalized laxity of the skin for about 30 years. There were similar skin lesions in her sister. No other systemic involvement was found. Histopathologic examination revealed clumping, fragmentation and calcification of elastic fibers in the dermis.