Correlation between Severity of Idiopathic Epiretinal Membrane and Irvine-Gass Syndrome.

A higher risk of pseudophakic cystoid macular edema (PCME) has been reported in patients with preoperative idiopathic epiretinal membrane (ERM); however, whether the formation of PCME depends on the grade of ERM has not been well established. We conducted a retrospective case-control study of 87 eyes of 78 patients who were preoperatively diagnosed with idiopathic ERM and had undergone cataract surgery. Patients were divided into two groups: PCME and non-PCME groups. After cataract surgery, the ERM status was graded using the Gass and Govetto classifications. Both the central macular thickness (CMT) and ERM grade increased after surgery, and higher preoperative CMT and ERM grades were found in the PCME group. The association between higher-grade ERM and the development of PCME was significant in the Govetto classification (grade 2, odds ratio (OR): 3.13; grade 3, OR: 3.93; and grade 4, OR: 16.07). The study results indicate that close attention should be given to patients with ERM with the presence of an ectopic inner foveal layer before cataract surgery.

Comparison of the Effectiveness of Intravitreal Bevacizumab Injections with and without Simultaneous Cataract Surgery in Diabetic Patients with Macular Edema.

Intravitreal bevacizumab (IVB), often injected during cataract surgery, is currently the main treatment for diabetic macular edema. This retrospective study aimed to compare the effectiveness of IVB injections alone and during cataract surgery in patients with diabetic macular edema. We examined 43 eyes in 40 patients who underwent cataract surgery with simultaneous IVB injections 3-12 months after IVB injections alone. Best-corrected visual acuity and central subfield macular thickness (CMT) were measured 1-month post-injection. The CMTs of the same eyes with IVB-only first and combined-treatment procedures later were 384 ± 149 vs. 315 ± 109 µm pretreatment (p = 0.0002), and after 1 month, they were 319 ± 102 vs. 419 ± 183 µm (p < 0.0001). In the IVB-only procedure, 56.1% of eyes had CMT < 300 µm 1 month after the injection compared to 32.5% after the combined treatment. Therefore, on average, when IVB was administered during cataract surgery, CMT increased, whereas after IVB injection alone, it effectively decreased. More prospective trials with large sample sizes are needed to evaluate the effectiveness of IVB injection performed simultaneously with cataract surgery.

Prognostic factors in fluid-gas exchange after primary idiopathic macular hole surgery.

PURPOSE: This retrospective study aimed to evaluate the prognostic factors associated with the success of fluid-gas exchange in patients who had undergone failed primary idiopathic macular hole (IMH) surgery. METHODS: In total, 19 eyes of 19 patients with failed IMH surgery who then underwent fluid-gas exchange were included. Of those, 18 eyes had macular hole (MH) closure (successful, 15 eyes; unsuccessful, 3 eyes). Demographics, pre-operative characteristics, and pre-procedural characteristics were assessed. The patients were divided into successful (U or V-type closure) and unsuccessful groups (W-type or unclosed), following fluid-gas exchange. One eye was unclosed after fluid-gas exchange; therefore, this patient underwent additional vitrectomy for MH closure (unsuccessful). RESULTS: The outcomes of the fluid-gas exchange were categorized as unclosed or as U-type, V-type, or W-type closure. None of the patients experienced complications after the procedure. The successful group showed a significantly lower pre-operative and pre-procedural minimum diameter, base diameter, and macular hole volume, and higher pre-operative and pre-procedural macular hole index, hole form factor, and tractional hole index values. Moreover, a better visual prognosis was observed in the successful group. CONCLUSION: These findings suggest that indices predicting favorable results of primary surgery for IMH are useful for predicting the success of fluid-gas exchange in patients with failed primary MH surgery.

Central retinal thickness changes and risk of neovascular glaucoma after intravitreal bevacizumab injection in patients with central retinal vein occlusion.

This retrospective study evaluated changes in the central retinal thickness (CRT) and the risk factors for neovascular glaucoma (NVG) after intravitreal bevacizumab injection under a pro re nata (PRN) regimen for macular oedema in 57 eyes with central retinal vein occlusion (CRVO). The clinical characteristics at the time of NVG diagnosis were assessed, and baseline and final clinical characteristics and mean CRT values at 1-, 3-, and 6-month follow-up evaluations were recorded. The incidence of NVG was 21.1%, with the neovascular group (12 eyes) showing poor baseline and final visual acuity, a higher incidence of baseline ischaemic-type CRVO and subretinal fluid, a higher mean CRT at the 1-month follow-up, and a higher number of intravitreal bevacizumab injections during the 6-month follow-up. Nine eyes with NVG (75%) showed a mean CRT < 300 µm at the time of diagnosis. An ischaemic CRVO and higher CRT at the 1-month follow-up were related to the development of NVG in the multivariate analysis. Thus, NVG development in CRVO patients treated with intravitreal bevacizumab injections was associated with an ischaemic CRVO and elevated CRT at the 1-month follow-up; PRN bevacizumab regimens based on CRT or control of macular oedema did not completely prevent NVG development.

Association of tear matrix metalloproteinase 9 immunoassay with signs and symptoms of dry eye disease: A cross-sectional study using qualitative, semiquantitative, and quantitative strategies.

PURPOSE: This study aimed to analyze the association of tear matrix metalloproteinase 9 (MMP-9) immunoassay with the severity of dry eye (DE) signs and symptoms through qualitative, semiquantitative, and quantitative evaluations of immunoassay band. MATERIALS AND METHODS: This cross-sectional study enrolled 320 eyes of 320 patients. The clinical signs of DE were assessed using the Ocular Surface Disorder Index (OSDI) score, visual analogue scale (VAS), tear breakup time (tBUT), tear volume evaluation by tear meniscometry, and staining scores of the cornea and conjunctiva by the Oxford grading scheme. The tear MMP-9 immunoassay results were interpreted using qualitative (positive or negative), semi-quantitative (reagent band density on a four-point scale: 0 = negative; 1 = weakly positive; 2 = moderately positive; 3 = strongly positive), and quantitative (ratio of reagent band density to control band density) indicators. RESULTS: Positive MMP-9 immunoassay results were significantly related to shorter tBUT, tBUT ≤3 seconds, higher corneal staining score, corneal staining score ≥2, and conjunctival staining score ≥2. The semi-quantitative results of the MMP-9 immunoassay were positively correlated with higher corneal staining score (r = 0.122, p = 0.029) and negatively correlated with tBUT (r = -0.125, p = 0.025). However, in the quantitative analysis, none of the DE signs or symptoms were correlated to the band density of the MMP-9 immunoassay. CONCLUSIONS: The positive MMP-9 immunoassay results were related to the severity of ocular signs of DE. However, using quantitative measures of the MMP-9 immunoassay to assess the clinical severity of DE requires further investigation.

In vitro validation of the tear matrix metalloproteinase 9 in-situ immunoassay.

We aimed to validate a tear MMP-9 in-situ immunoassay (InflammaDry) and to identify factors that could affect results or interpretation. Three factors were examined: sample concentration, volume, and time. Recombinant human (rh) MMP-9 (10 or 20 µl; 0, 12.5, 25, 50, 100, 200, 500, and 1,000 ng/ml) was applied to the kit and the detection limit and assay reproducibility were examined. At a rhMMP-9 volume of 10 µl (≥ 50 ng/ml), all positive results were identified by densitometry at 10 and 20 min; however, after 20 min, more than half of the nine ophthalmologists interpreted a positive result. At a rhMMP-9 volume of 20 µl (≥ 25 ng/ml), ophthalmologists and densitometry identified almost all test lines at 10 and 20 min. At 10 µl, densitometry showed a linear dose-response pattern. At 20 µl, densitometry showed a linear dose-response pattern at concentrations up to 500 ng/ml; however, full saturation was achieved at concentrations ≥ 500 ng/ml. When the same amount of rhMMP-9 was applied, the density result increased significantly upon doubling of the solvent volume (i.e., by adding the same volume of PBS to a sample). InflammaDry showed a high inter- and intra-assay coefficient of variation at 10 min (28.4% and 24.7%, respectively). The results of the MMP-9 in-situ immunoassay varied significantly depending on sample volume. Therefore, when interpreting the results, careful attention must be paid to tear volume.

Characteristics of Ocular Manifestations of Patients with Coronavirus Disease 2019 in Daegu Province, Korea.

BACKGROUND: The coronavirus disease 2019 (COVID-19) has reportedly affected almost 23 million people, with more than 800 thousand deaths globally. There have been a few reports on the ocular manifestations of COVID-19 patients in China but no reports in Korea. The present study aimed to examine ocular manifestations of COVID-19 patients in Korea. METHODS: COVID-19 patients admitted from March 2020 to April 2020 at Keimyung University Dongsan Hospital and Keimyung University Daegu Dongsan Hospital were reviewed retrospectively for ocular manifestations. During the period of hospitalization, ocular symptoms as well as blood test results were noted and analyzed. Patients were then divided into the first-episode and relapsed group and ocular symptoms were analyzed in the groups. RESULTS: A total of 103 patients were included in this study. Among them, 71patients were in the first-episode group and 32 patients in the relapsed group. No significant differences were determined in terms of positivity of ocular symptoms between the first-episode group (12 patients, 16.9%) and the relapsed group (10 patients, 31.3%, P > 0.05). Symptoms of positive upper respiratory infection and lower creatine phosphokinase were determined to be related to positive ocular symptoms. Conjunctival congestion was noted in seven patients. In the subgroup analysis, the conjunctival congestion-positive patients exhibited higher positivity of upper respiratory infection symptoms (100%) as compared with those in the negative group (40%, P = 0.017). CONCLUSION: Positive upper respiratory infection symptoms and lower creatine phosphokinase were determined to be related to ocular symptoms in COVID-19 patients. Among these patients, positive upper respiratory infection symptoms were associated with conjunctival congestion.

Optical coherence tomographic findings of ocular siderosis following intraocular foreign body removal: A case report.

RATIONALE: Ocular siderosis is arrested by the removal of intraocular foreing body (IOFB). The progression of ocular siderosis is very rare and few reports demonstrate the optical coherence tomographic (OCT) findings. PATIENT CONCERNS: A 55-year-old Asian man presented to our clinic with the chief complaint of decreased vision in his left eye for 5 months. On slit lamp examination of the left eye, the corneal stroma had a rust-colored hue, and the retina was not visible due to vitreous opacity. An orbital computed tomography was ordered considering the possibility of left IOFB, which confirmed the presence of a vitreous IOFB. On the next day, he had a continuous curvilinear capsulorrhexis with phacoemulsification and intraocular lens implantation, pars plana vitrectomy, and removal of IOFB in the left eye. Six years later, he revisited our clinic. On slit lamp examination, the corneal haziness had worsened, and the iris showed heterochromia resembling the spokes of a wheel in the left eye. DIAGNOSIS: Ocular siderosis. INTERVENTION: Anterior and posterior segment OCT was performed. OUTCOMES: The anterior segment OCT showed linear hyperreflectivity on the anterior corneal stroma just beneath the Bowman's layer. The posterior segment OCT showed inner retinal degeneration observed at the parafoveal area. LESSONS: Ocular siderosis progression can happen after the removal of IOFB. The swept source OCT might be useful to assess the cornea and retina in ocular siderosis patient with corneal haziness.

Importance of tear volume for positivity of tear matrix metalloproteinase-9 immunoassay.

The tear matrix metalloproteinase-9 (MMP-9) immunoassay (Inflammadry) exhibits variable results in dry eye (DE) patients. We investigated if the tear volume in DE patients affects the results of MMP-9 immunoassay in clinical and in vitro settings. This cross-sectional study enrolled 188 eyes of 188 DE patients. The clinical symptoms and signs of DE were assessed using the Ocular Surface Disease Index and visual analog scale, strip meniscometry, tear break-up time, and tear meniscus height (TMH), area (TMA), and depth (TMD) using swept-source optical coherence tomography and corneal and conjunctival staining scores. For quantitative evaluation, the bands produced by the InflammaDry test were analyzed with ImageJ. DE subjects were grouped according to MMP-9 positivity and TMH. The InflammaDry-positive group showed greater TMH, TMA, and TMD than the MMP-9-negative group (p < 0.05). InflammaDry test band density in the high TMH group was significantly greater than that in the low and normal TMH groups (p < 0.05). InflammaDry test band density correlated positively with TMH, TMA, and TMD (all p < 0.05). InflammaDry test results were influenced by tear volume. Low tear volume in aqueous tear-deficient DE may induce false-negative results, and reflex tearing during the test may induce false-positive results.

Clinical characteristics of branch retinal vein occlusion with increased retinal haemorrhage during treatment for macular oedema.

This study was performed to evaluate clinical characteristics of branch retinal vein occlusion (BRVO) patients with increased retinal haemorrhage during macular oedema (MO) treatment. Patients were divided into increased and non-increased retinal haemorrhage groups. The former group was sub-divided based on the degree of increase: < 50% or ≥ 50%. Baseline characteristics, clinical data, and best vision achieved before and after increased retinal haemorrhage were assessed. Sixty-eight eyes of 68 patients were included. Forty-six eyes were non-increased, 11 eyes experienced < 50% increase in retinal haemorrhage, and 11 eyes had ≥ 50% increase. Ischaemic BRVO was related to increased haemorrhage based on the multivariate analysis. The ≥ 50% increase group exhibited higher baseline central subfield macular thickness (CSMT), poorer baseline best corrected visual acuity (BCVA), and longer mean periods between the final intravitreal injections and the time increased retinal haemorrhages were observed, compared to the < 50% group. The best vision achieved before and after increased haemorrhage was significantly worse in the ≥ 50% group. In conclusion, the ischaemic type of BRVO is related to increased retinal haemorrhage during MO treatment, and a ≥ 50% increase in haemorrhages is associated with higher CSMT and poorer BCVA at baseline, with poor visual gain.

Spontaneous resolution of serous retinal detachment caused by choroidal mass after a first trimester abortion.

Pregnancy-related ocular diseases develop mostly in the third trimester of pregnancy. Here, we describe a case of a pregnant woman with a choroidal mass that caused a serous retinal detachment during the first trimester of pregnancy. The patient's condition resolved spontaneously after an abortion.

In-the-bag dislocation of polyfocal full-optics accommodative intraocular lens: A case report.

Herein, we report a case of in-the-bag dislocation of a WIOL-CF® polyfocal full-optics intraocular lens (IOL), without a history of trauma. A 56-year-old man was referred to our hospital with the chief complaint of sudden-onset visual disturbance in his left eye. He had undergone uneventful phacoemulsification with WIOL-CF® IOL implantation in the left eye at the local clinic 7 years prior. In fundus examination, IOL-capsular bag complex dislocated into the posterior vitreous was observed. We believe this is the first report of in-the-bag dislocation of a WIOL-CF® IOL that has been subluxated or dislocated in a characteristic pattern, not an in-the-bag pattern.

Foveal choroidal neovascularization secondary to accidental laser exposure in a dermatologist: A case report.

RATIONALE: Most laser-induced retinal injuries are caused by accidental laser discharge during the preparation of laser devices without protective goggles, laser injury during the cosmetic procedure in a dermatologist, is very rare, with no prior case reports. PATIENT CONCERNS: A 55-year-old Asian male dermatologist visited our hospital with a 2-week history of visual disturbance in his right eye. He had experienced sudden central scotoma in the right eye while using a Q-switched Nd:YAG laser (1064 nm, 2 J/cm, 6-mm spot size, 750 ps) 2 to 3 cm from the target without proper eye protection. He had applied a glass slide firmly onto the treatment area prior to commencing the procedure. The choroidal neovascularization (CNV) was detected via optical coherence tomography angiography (OCTA) 2 weeks after the laser injury. DIAGNOSIS: Foveal CNV secondary to laser energy reflected from the glass slide. INTERVENTION: Intravitreal bevacizumab (1.25 mg/0.05 mL) injection was performed. OUTCOMES: Regression of CNV was observed. LESSONS: Retinal injury can occur not only by direct laser beam exposure but also by way of a beam reflected from a glass slide. Operators should always use laser safety eyewear during cosmetic procedures involving laser devices, so as to prevent the occurrence of ocular complications. Thorough short-term follow-up with OCTA is recommended for the prompt detection of CNV in cases of retinal laser injury.

Ocular manifestations in a patient with de novo Fabry disease.

Fabry disease (FD) is an X-linked, recessively inherited, rare, progressive, disorder of glycosphingolipid metabolism affecting multiple organs resulting in organ dysfunction. It is rare to find only one FD affected subject with a de novo mutation. Here we report a case of a 41-year-old Asian male diagnosed with de novo FD. Comprehensive ophthalmological evaluation was performed using slit lamp, color fundus photography, optical coherence tomography, fluorescein angiography, and indocyanine green angiography. On slit lamp examination, cornea verticillata and slightly tortuous, and aneurysmal dilatation of inferior bulbar conjunctival vessels were observed. Other imaging modalities showed unremarkable findings. Cornea verticillata and inferior bulbar conjunctival vascular abnormalities may be detected earlier than other ocular abnormalities in de novo FDs like hereditary FDs.

Value of multidetector computed tomography for the radiologic grading of sacroiliitis in ankylosing spondylitis.

The objective of this study is to investigate the value of multidetector computed tomography (MDCT) in the assessment of sacroiliitis in patients with established ankylosing spondylitis (AS). Paired plain radiographs and MDCT images of the 330 sacroiliac (SI) joints in 165 patients with definite or probable ankylosing spondylitis were analyzed for sacroiliitis. Sacroiliitis on plain radiographs were graded on a scale of 0-4 according to the modified New York (NY) criteria. For grading of sacroiliitis by MDCT, modified NY criteria were revised for MDCT application introducing the concept of quantification. The relationship between sacroiliitis grades by plain radiography and MDCT was analyzed by two radiologists, blinded for all clinical data. Of the 330 SI joints assessed, there was agreement between the sacroiliitis grading by plain radiography and MDCT in 73 (22.1 %) SI joints. Sacroiliitis grade by MDCT was higher in 250 (75.8 %) SI joints and lower in 7 (2.1 %) SI joints than that by plain radiography. Using the MDCT, 83.6 % of patients met the modified NY radiologic criteria for the classification of AS, compared with 58.2 % of the patients by plain radiography. Twenty-six percent of the patients, who did not meet the modified NY criteria for the classification of AS by plain radiography, met the criteria by MDCT. Disease durations in patients with grade 2 and grade 3 sacroiliitis were significantly shorter in patients evaluated by MDCT compared with plain radiography. MDCT is a useful imaging method that can be applied to the initial diagnosis of the AS, and by better visualization of SI joint changes, it can be used to predict the progress of the disease.

Prevalence of human papilloma virus infections and cervical cytological abnormalities among Korean women with systemic lupus erythematosus.

We performed a multicenter cross-sectional study of 134 sexually active systemic lupus erythematosus (SLE) patients to investigate the prevalence of and risk factors for high risk human papilloma virus (HPV) infection and cervical cytological abnormalities among Korean women with SLE. In this multicenter cross-sectional study, HPV testing and routine cervical cytologic examination was performed. HPV was typed using a hybrid method or the polymerase chain reaction. Data on 4,595 healthy women were used for comparison. SLE patients had greater prevalence of high-risk HPV infection (24.6% vs. 7.9%, P<0.001, odds ratio 3.8, 95% confidence interval 2.5-5.7) and of abnormal cervical cytology (16.4 vs. 2.8%, P<0.001, OR 4.4, 95% CI 2.5-7.8) compared with controls. SLE itself was identified as independent risk factors for high risk HPV infection among Korean women (OR 3.8, 95% CI 2.5-5.7) along with ≥2 sexual partners (OR 8.5, 95% CI 1.2-61.6), and Pap smear abnormalities (OR 97.3, 95% CI 6.5-1,456.7). High-risk HPV infection and cervical cytological abnormalities were more common among Korean women with SLE than controls. SLE itself may be a risk factor for HPV infection among Korean women, suggesting the importance of close monitoring of HPV infections and abnormal Pap smears in SLE patients.

Clinical and radiographic features of adult-onset ankylosing spondylitis in Korean patients: comparisons between males and females.

The objective of this study was to investigate clinical and radiographic features and gender differences in Korean patients with adult-onset ankylosing spondylitis. Multicenter cross-sectional studies were conducted in the rheumatology clinics of 13 Korean tertiary referral hospitals. All patients had a confirmed diagnosis of ankylosing spondylitis according to the modified New York criteria. Clinical, laboratory, and radiographic features were evaluated and disease activities were assessed using the Bath ankylosing spondylitis disease activity index. Five hundred and five patients were recruited. The male to female ratio was 6.1:1. Average age at symptom onset was 25.4+/-8.9 yr and average disease duration was 9.6+/-6.8 yr. Males manifested symptoms at a significantly earlier age. HLA-B27 was more frequently positive in males. Hips were more commonly affected in males, and knees in females. When spinal mobility was measured using tragus-to-wall distance and the modified Schober's test, females had significantly better results. Radiographic spinal changes, including bamboo spine and syndesmophytes, were more common in males after adjustment of confounding factors. In conclusion, we observed significant gender differences in radiographic spinal involvement as well as other clinical manifestations among Korea patients with adult-onset ankylosing spondylitis. These findings may influence the timing of the diagnosis and the choice of treatment.

Multiple cardiovascular complications in a patient with Behcet's disease.

Arterial and cardiac involvement of Behcet's disease is a rare but life threatening complication. The rupture of an arterial aneurysm might result in sudden death. We report a 54-year-old man with an established diagnosis of Behcet's disease who presented with multiple cardiovascular complications that eventually lead to his death. He presented with extensive venous occlusions, and sequentially developed right ventricular thrombosis with multiple pulmonary thromboembolisms, and a pulmonary artery aneurysm. We report this unusual sequence of cardiovascular complications in a patient with Behcet's disease.

The clinical usefulness of multidetector computed tomography of the sacroiliac joint for evaluating spondyloarthropathies.

BACKGROUND: Due to the low sensitivity of plain radiography, the diagnosis of early stage ankylosing spondylitis (AS) is often difficult since many patients do not meet the radiographic criteria. The objective of our study was to investigate the diagnostic value of performing multidetector computed tomography (MDCT) of the sacroiliac (SI) joint in the evaluation of AS patients. METHODS: Thirty seven patients with definite or probable AS were evaluated. Plain radiography and MDCT imaging of the pelvis were performed for evaluating the SI joints. Two radiologists analyzed the images, and they graded the sacroiliitis on a scale of 0-4 according to the modified NY criteria. The clinical variables we analyzed included the disease duration, the treatment duration, the prescribed drugs, peripheral joint involvement, enthesopathy, the functional limitations and the BASDAI. RESULTS: MDCT detected more bilateral sacroiliitis as compared to the plain radiography (86.5% vs. 75.7%, respectively), and MDCT yielded a higher grade of disease in 32.4% (right SI joint) and 24.3% (left SI joint) of the patients. More patients satisfied the modified NY criteria with using MDCT as compared with that when using the plain radiography (81.1% vs. 54.1%, respectively, p=0.002). CONCLUSIONS: Visualization of the sacroiliac joint by MDCT provided a better diagnosis of AS, and especially during the early stage of the disease.