Correlation between Endophthalmitis and Stroke Development in Ankylosing Spondylitis Patients: A Population-Based Cohort Study.

BACKGROUND: This cohort study aimed to research the correlation between endophthalmitis and stroke development in ankylosing spondylitis (AS) patients by reviewing National Health Insurance Research Database (NHIRD) data. METHODS: This study obtained data from the NHIRD over a sixteen-year period. The primary outcome was stroke development. We used Fisher's exact test and Pearson's chi-squared test to analyze the variables. We investigated the risk factors for disease development using Cox regression analyses. We compared the cumulative incidence of stroke using Kaplan-Meier analysis. RESULTS: The study cohort included 549 patients with AS and endophthalmitis, while the comparison cohort included 2196 patients with AS but without endophthalmitis. The stroke development was increased in the study cohort (adjusted hazard ratio, 1.873; p ≤ 0.001). The total stroke development in the study cohort and the comparison cohort was 1724.44 per 100,000 person-years and 1085.11 per 100,000 person-years, respectively (adjusted hazard ratio, 1.873; 95% confidence interval, 1.776-2.022; p < 0.001). Our study cohort showed an increased stroke rate. CONCLUSIONS: Our studies showed that endophthalmitis increases the risk of stroke in AS patients and endophthalmitis is an independent risk factor for stroke in AS patients. Nonetheless, advanced studies that thoroughly investigate the correlation between endophthalmitis and stroke in AS patients are needed to validate our findings.

Optic neuropathy caused by orbital Kimura disease: A rare case report.

RATIONALE: Kimura disease (KD) is a rare, chronic inflammatory disease characterized by painless subcutaneous nodules predominantly located in the head and neck regions. Orbital KD, which intrudes into the intraconal space and results in compressive optic neuropathy, is rare and has not been previously reported. PATIENT CONCERNS: A 68-year-old man presented with blurred vision and progressive proptosis in the left eye that had been present for 2 years. DIAGNOSIS: Magnetic resonance imaging of the brain revealed soft tissue lesions with contrast enhancement and restricted diffusion involving the bilateral eyelids, orbits, and intraconal region; those on the left side were more prominent than those on the right side. The lesion encased the left optic nerve. Laboratory test results revealed elevated serum immunoglobulin E level and peripheral eosinophilia. An orbital mass biopsy demonstrated hyperplastic lymphoid follicles with germinal centers in the subcutaneous area and abundant mononuclear and binuclear eosinophils infiltrating the interfollicular area. A pathological diagnosis of KD was made based on the blood test results. INTERVENTIONS: Orbital decompression and debulking surgery of the orbital tumor in the left eye were performed to treat the compressive optic neuropathy. OUTCOMES: After systemic oral steroid and immunosuppressive agent therapies, the patient's visual acuity in the left eye improved, and the KD activity was stable. CONCLUSIONS: We present a rare case of orbital KD-associated optic neuropathy, wherein early diagnosis and treatment preserved the patient's vision. This complication should be considered in patients with a history of compressive optic neuropathy during the differential diagnosis.

Relationship between Using Fibrate and Open-Angle Glaucoma in Hyperlipidemic Patients: A Population-Based Cohort Study.

BACKGROUND: This study aimed to investigate the associated risk between using fibrate and open-angle glaucoma (OAG) in hyperlipidemic patients from the National Health Insurance Research Database (NHIRD). METHODS: We collected data over a 16-year period from the NHIRD, and used the Fisher's exact test and Pearson chi-square test to analyze variables. Adjusted hazard ratios (aHR) were used to examine the risk factors for disease development. We applied Kaplan-Meier analysis to compare the cumulative incidence of OAG. RESULTS: A total of 10,011 patients using fibrate were enrolled in the study cohort, and 40,044 patients not using fibrate were enrolled in the control cohort. The incidence of OAG was lower in the study cohort than in the control cohort (aHR = 0.624, p = 0.007). The overall incidence of OAG was 463.02 per 100,000 person-years in the study cohort and 573.65 per 100,000 person-years in the control cohort. We used the Kaplan-Meier method to calculate the cumulative risk of developing OAG. The results revealed that after using fibrate for over seven years, the study cohort had a greatly lower rate of developing OAG than the control cohort (log-rank test p = 0.050). CONCLUSIONS: Our studies showed that using fibrate for over seven years may lead to a lower risk of OAG in patients with hyperlipidemia. Nevertheless, further prospective studies that comprehensively investigate the relationship between using fibrate and OAG are needed.

Rare Orbital Metastasis Originating from Ampullary Adenocarcinoma.

BACKGROUND: Orbital metastasis from ampullary carcinoma is rare, with no previously reported cases. CASE PRESENTATION: We report the case of a 60-year-old man who complained of a right-sided headache, blurred vision, progressive proptosis, ptosis, and right eye pain for 3 months. His past medical history included an ampullary adenocarcinoma stage IIIA treated via the Whipple procedure and adjuvant chemoradiotherapy 1 year ago. However, he was lost to follow-up. Computed tomography of the orbit showed a soft tissue lesion in the right orbital fossa measuring 3.3 × 2 × 2 cm. An orbital mass biopsy demonstrated an intestinal-type adenocarcinoma that tested positive for cytokeratins 7 and 20 and CDX2 on immunohistochemical staining. The pathologic diagnosis was metastatic adenocarcinoma from the ampulla of Vater. Despite oncological treatment, the patient's illness progressed. He received palliative treatment and died 1 month later. CONCLUSIONS: We presented a rare case of orbital metastasis from ampullary adenocarcinoma. This should be considered in the differential diagnosis of patients with a history of ampullary adenocarcinoma who present with symptoms referring to the relevant locations.

Ocular Decompression Retinopathy after Anterior Chamber Paracentesis for Neovascular Glaucoma.

Ocular decompression retinopathy (ODR) is a rare complication associated with intraocular pressure (IOP)-lowering interventions. We report a case of neovascular glaucoma in the left eye with marked IOP elevation (33 mmHg in the left eye). The IOP in the left eye did not improve despite medical treatment. Paracentesis of the left eye was then performed, and the IOP in the left eye decreased to 9 mmHg. One day after the procedure, several intraretinal hemorrhages, Roth spots, and subhyaloid hemorrhages appeared in the fundus of the left eye. Left eye retinopathy was likely ODR because of the rapid decline in IOP.

The extracts of Astragalus membranaceus enhance chemosensitivity and reduce tumor indoleamine 2, 3-dioxygenase expression.

Astragalus membranaceus has been shown to possess anti-inflammation and antitumor properties. Several studies have indicated that extracts of Astragalus membranaceus (PG2) have growth inhibitory effects on tumor. However, the effect of PG2 on enhancing the chemotherapy, modulating tumor immune escape and their mechanism of action is unknown and need further investigation. Connexin (Cx) 43 is ubiquitous in cells and involved in facilitating the passage of chemotherapeutic drugs to bystander tumor cells. The indoleamine 2, 3-dioxygenase (IDO) depletes tryptophan, reduces the active T cell number and destroys immune surveillance. Herein, we provide evidence that the treatment of PG2 induced Cx43 expression, decreases IDO expression and enhances the distribution of chemotherapeutic drug. However, the effects of combination therapy (PG2 plus cisplatin) in animal models significantly retarded tumor growth and prolonged the survival. We believe that the information provided in this study may aid in the design of future therapy of PG2, suggest suitable combinations with chemotherapies.