Seasonal variation in acute post-cataract surgery endophthalmitis incidences in South Korea.

PURPOSE: Previous studies have reported conflicting results on the influence of seasons on post-cataract surgery endophthalmitis incidences. This study aimed to investigate the seasonality associated with the incidence of postoperative endophthalmitis, and to evaluate its association with climate variables in South Korea. SETTING: South Korea. DESIGN: Retrospective cohort study. METHODS: The postoperative endophthalmitis incidences were identified using the Health Insurance Review and Assessment Service claim data from July 2014 to June 2017. The monthly climate data were obtained from the Korea Meteorological Administration. The incidences of endophthalmitis were analyzed by the month of the year, and by the season. The association between postoperative endophthalmitis and the climatic variables, including mean temperature, relative humidity, precipitation, and hours of sunshine, was investigated. RESULTS: The incidences were the highest in July, and they were the most prevalent during the summer months, although fewer cataract surgeries were performed in the summer months than during the rest of the year. The postoperative endophthalmitis incidences tended to increase with increasing relative humidity and increasing precipitation. CONCLUSIONS: The incidences of post-cataract surgery endophthalmitis peaked during the hot and humid months. Understanding the seasonal and climatic influences on postoperative infection might help in risk stratification and outcome improvisation after the cataract surgery is performed.

Comparison of Solar Radiation and Myopia Occurrence in South Korean Children.

PURPOSE: To investigate the association between regional solar radiation and myopia occurrence in South Korean children. MATERIALS AND METHODS: A population-based cross-sectional study using data of 1218 children aged 7-9 years from the Korea National Health and Nutritional Examination Survey was conducted from January 1, 2008, to December 31, 2012. Myopia prevalence and the mean spherical equivalent were estimated; myopia was defined as spherical equivalent refraction <-1.5 D. Data regarding solar radiation and sunshine duration were collected from 21 national monitoring stations in South Korea. Multiple logistic regression analyses and multiple linear regression analyses were used to evaluate the associations. However, the most important covariate, the time spent outdoors, was not measured and could not be used. RESULTS: In the entire cohort of 1218 participants, solar radiation and sunshine duration were significantly associated with the mean spherical equivalent (P=0.001 and P=0.014, B = 0.088 and B = 0.069, respectively) and solar radiation was significantly associated with myopia prevalence (P=0.008). And, a negative but not statistically significant association between sunshine duration and myopia prevalence was observed (P=0.064, respectively). CONCLUSIONS: Solar radiation and sunshine duration are associated with the mean spherical equivalent and myopia prevalence in South Korean children.

Endophthalmitis after Cataract Surgery in Korea: A Nationwide Study Evaluating Incidence and Risk Factors in a Korean Population.

PURPOSE: To assess the nationwide rate of acute postoperative endophthalmitis (APE) after cataract extraction in Korea and to evaluate potential risk factors thereof. MATERIALS AND METHODS: Nationwide insurance claims data from July 2014 to June 2017 were reviewed. All patients with phacoemulsification or extracapsular/intracapsular cataract extraction were included. Exclusion criteria were combined glaucoma surgery or total vitrectomy or when the patient had a history of intraocular foreign body. RESULTS: In total, 1505103 cases (982203 patients) were included. APE developed in 953 cases (938 patients) with an overall incidence of 0.063%. After adjusting for possible confounding factors, male sex [odds ratio (OR) 1.42; 95% confidence interval (CI) 1.25-1.61; p<0.001], primary clinical setting, operations performed in non-major cities, usage of sutures (OR 2.82; 95% CI 2.13-3.74; p<0.001), anterior vitrectomy (OR 8.71; 95% CI 6.71-11.32; p<0.001), aphakic cataract surgery (OR 1.52; 95% CI 1.03-2.22; p=0.033), hypertension (OR 1.40; 95% CI 1.18-1.66; p<0.001), diabetes (OR 1.59; 95% CI 1.31-1.93; p<0.001), and chronic renal failure (OR 1.28; 95% CI 1.01-1.62; p=0.039) were found to be related to APE development. CONCLUSION: The incidence of APE after cataract extraction was consistent with reports from other studies. Additional research is needed to determine the relationship of newly found risk factors, such as hypertension, primary clinical setting, chronic renal failure, and usage of suturing, with APE development.

Refractive change caused silicone oil adhesion to the intraocular lens following Nd:YAG posterior capsulotomy.

A 32-year-old female who had undergone the silicone oil removal procedure presented with visual disturbance in her left eye. Several months previous, she had cataract surgery in a private clinic, and a month later she had a Nd:YAG laser procedure for posterior capsulotomy. The slit-lamp examination revealed silicone oil droplets that had adhered to the intraocular lens where the posterior capsulotomy was performed. She had experienced high myopia as a manifestation of the resulting refractive changes. We replaced the previous intraocular lens with a new acrylic intraocular lens with resulting improvement to her vision. Here we report the case of a female patient with a history of silicone oil removal surgery where the resulting silicone bubbles had not been removed thoroughly and remained in the vitreous cavity. These bubbles subsequently adhered to the intraocular lens following YAG laser posterior capsulotomy, resulting in refractive changes. We recommend that implanting a silicone intraocular lens in anyone with a history of the silicone oil removal procedure or who has a possible history of silicone oil use should be avoided.

The Comparison of outcomes between lateral rectus muscles re-recession and medial rectus muscles resection in recurrent exotropia.

PURPOSE: To compare the surgical outcomes between bilateral lateral rectus muscles (BLR) re-recession and bilateral medial rectus muscles (BMR) resection in recurrent exotropia. METHODS: The medical records of patients with recurrent exotropia who underwent surgery for intermittent exotropia during the 6 years from January 2001 to December 2006 and followed up for more than 6 months were reviewed retrospectively. RESULTS: In group A, BLR recessions was performed at the first surgery and BLR re-recession was performed at the second surgery. In group B, BLR recession was performed at the first surgery and BMR resection at the second surgery. Success rates at the last follow-up after the second operation were 81.9% in Group A and 83.3% in Group B, showing no statistical difference between the two groups. In group A, no significant underaction of the BLR was noted. Success rates were not statistically different between the 2 mm re-recessed subgroup and 3 mm re-recessed subgroup. CONCLUSIONS: The results support the notion that BLR re-recession successfully corrects recurrent exotropia without producing significant limitation of abduction.

Vertical rectus muscles transposition in large exotropia with medial rectus muscle transection following endoscopic sinus surgery.

PURPOSE: To evaluate the effect of transposition procedures on the vertical rectus muscle (VRM) in the patients who underwent a medial rectus muscle (MR) transection after endoscopic sinus surgery (ESS). METHODS: In 4 patients with exotropia (XT) and a lack of adduction after ESS, orbital CT or MRI revealed a complete transection of the midportion of the MR. Full-tendon VRM transposition was performed within 3 months after injury (early surgery) in 2 patients with 40 delta XT. Two patients with 70 delta and 85 delta XT underwent an X-type augmented Hümmelsheim procedure, which involved pulling each half-tendon and crossing it through the undersurface of the severed MR to the other end of the MR insertion, concurrently with an ipsilateral lateral rectus (LR) recession 11 months and 36 months after ESS, respectively. The adduction deficits were divided into -1 through to -8. The patients were followed up for more than than 1.5 years. RESULTS: Postoperatively, 3 patients showed orthophoria and no diplopia in the primary position. The adduction deficits improved to -3.5 or -4. One patient who underwent an X-type augmented Hümmelsheim procedure showed a residual XT of 25 delta. CONCLUSIONS: VRM transposition is effective in correcting a large XT secondary to a MR transection after ESS. When a longstanding large-angle XT with severe contracture of the ipsilateral LR and massive scarring of the adjacent tissues is present, the X-type augmented Hümmelsheim procedure coupled with an ipsilateral LR recession had an augmenting effect.

The clinical course of consecutive esotropia after surgical correction.

PURPOSE: To investigate the clinical course in patients who underwent surgical correction of consecutive esotropia. METHODS: The medical records of 13 patients who underwent surgical correction of consecutive esotropia were reviewed retrospectively. The authors investigated the deviation and surgical method at the time of exotropia surgery. During the follow up period, the authors also studied incidence of amblyopia development, the effect of occlusion therapy, surgical methods for consecutive esotropia, and postoperative change of deviation. RESULTS: The average exodeviation was 27.1 prism diopter (PD). Bilateral lateral rectus muscle recession was performed in all patients. In all patients, alternate occlusion was tried from 2 weeks after development of consecutive esotropia. However, there was no effect on 7 patients. None of the patients developed amblyopia. Surgery for consecutive esotropia was performed on the average 15.3 months after exotropia surgery. The average esodeviation was 21.1PD. Medial rectus muscle recession was performed in 10 patients and lateral rectus muscle advancement in 3 patients. The average deviation of the subject group immediately after surgery was 1.2PD esodeviation, 0.9PD esodeviation one month after surgery, 2.4PD exodeviation 6 months after surgery, and 4.7PD exodeviation at the last follow up, and it showed a tendency to progress to exodeviation as the follow up period increased. Ten patients (76.9%) showed deviation within 8PD at the last follow up. CONCLUSIONS: The success rate of surgical correction for consecutive esotropia was a favorable outcome. But, careful decisions of the surgical method and amount is needed because the conversion of exodeviation during long-term follow-up is possible.

Conjunctival expansion using a subtenon's silicone implant in New Zealand white rabbits.

PURPOSE: In the field of ophthalmology, the conjunctival autograft is a useful therapeutic material in many cases, but the small size of the autograft is a disadvantage. Therefore, we evaluated the feasibility of taking an expanded sample of conjunctival tissue using a subtenon's silicone implant. MATERIALS AND METHODS: We included a total of nine rabbits; eight rabbits were operative cases, and one was a control. A portion of conjunctival tissue from the control rabbit, which did not undergo surgery, was dissected and examined to determine whether it was histologically different from the experimental group. The surgical procedure was performed on eight rabbits via a subtenon's insertion of a silicone sponge in the left superior-temporal portion; after surgery, we dropped antibiotics into the eyes. We sacrificed a pair of rabbits every three days (on days 3, 6, 9, and 12) after surgery, removed the expanded conjunctival tissues with the silicone sponge implants, and measured their sizes. RESULTS: The mean size of the expanded conjunctival tissues was 194.4 mm2. On the third day, we were able to harvest a 223.56 mm2 section of conjunctival tissue, which was the most expanded sample of tissue in the study. On the twelfth day, we removed a 160.38 mm2 section of conjunctival tissue, which was the least expanded sample of tissue. Statistically, there were no significant differences in the mean dimensions of the expanded conjunctival tissues for each time period. Microscopic examinations showed no histological differences between the expanded conjunctival tissues and the normal conjunctival tissues. CONCLUSION: The results reveal that this procedure is a useful method to expand the conjunctiva for grafting and transplantation.

Calcium mobilization by activation of M(3)/M(5) muscarinic receptors in the human retinoblastoma.

Activation of muscarinic acetylcholine receptors (mAChR) is one of the most important signal transduction pathways in the human body. In this study, we investigated the role of mAChR activation in relation to its subtypes in human retinoblastoma cell-lines (WERI-Rb-1) using Ca(2+) measurement, real-time PCR, and Western Blot techniques. Acetylcholine (ACh) produced prominent [Ca(2+)](i) transients in a repeated manner in WERI-Rb-1 cells. The maximal amplitude of the [Ca(2+)](i) transient was almost completely suppressed by 97.3 +/- 0.8% after atropine (1 microM) pretreatment. Similar suppressions were noted after pretreatments with thapsigargin (1 microM), an ER Ca(2+)-ATPase (SERCA) inhibitor, whereas the ACh-induced [Ca(2+)](i) transient was not affected even in the absence of extracellular calcium. U-73122 (1 microM), a PLC inhibitor, and xestospongin C (2 microM), an IP(3)-receptor antagonist, elicited 11.5 +/- 2.9% and 17.8 +/- 1.9% suppressions, respectively. The 50% inhibitory concentration of (IC(50)) values for blockade of a 100 microM ACh response by pirenzepine and 4-DAMP were 315.8 and 9.1 nM, respectively. Moreover, both M(3) and M(5) mAChRs were prominent in quantitative real-time-PCR. Taken together, the M(3)/M(5) subtypes appear to be the major contributor, leading to intracellular calcium mobilization from the internal store via an IP(3)-dependent pathway in the undifferentiated retinoblastoma cells.

Valsalva retinopathy associated with fiberoptic gastroenteroscopy.

CASE REPORT: A 45-year-old woman presented with a sudden loss of vision in her left eye, which occurred while she was having a routine upper fiberoptic gastroenteroscopy. According to the gastrointestinal specialist, the patient had performed multiple sustained Valsalva maneuvers during the procedure. Funduscopy showed a preretinal hemorrhage with a half disc diameter in the fovea of the left eye. COMMENTS: A diagnosis of Valsalva retinopathy was made on the basis of history and fundus finding. The hemorrhage resolved within 2 months without any sequelae. To our knowledge, this is the first report of the occurrence of Valsalva retinopathy following a routine upper fiberoptic gastroenteroscopy.

A case of photic retinal injury associated with exposure to plasma arc welding.

PURPOSE: To report of photic retinopathy induced by plasma arc welding, and the OCT (optical coherence tomography) results of damaged retinal lesions. METHODS: We describe a case report of a 37-year-old male, working in the steel industry, who presented with central scotoma in both eyes. RESULTS: On his first visit, one day after performing plasma arc welding with protective gear at work, his best corrected vision was 0.7 for both eyes. Ophthalmic examination of the fundus showed a round yellow lesion with an approximate size of 300 micrometers superonasal to the fovea of both eyes. On his next visit, one month later, his vision had recovered to 1.0, his symptoms had improved, and the ophthalmoscopic examination of the fundus revealed that the round yellow spots had disappeared from both eyes. CONCLUSIONS: To our knowledge, this is the first report of photic retinopathy induced by plasma arc welding, and the OCT (optical coherence tomography) results of damaged retinal lesions have not previously been reported. For these reasons, we report this case.

Transcaruncular approach to blowout fractures of the medial orbital wall.

Transcutaneous and transconjunctival approaches are still frequently used to repair orbital wall fractures. However, medial orbital wall fracture remains a challenging area for plastic surgeons due to technical difficulties and postoperative scars. The transcaruncular approach is described and we present our experience with this approach to access the medial orbital wall in 10 patients with blowout fracture in the medial orbital region. All patients were corrected satisfactorily without cutaneous scar. The transcaruncular approach is a useful technique to repair medial orbital wall fractures.

Juvenile xanthogranuloma as an isolated corneoscleral limbal mass: a case report.

A case of a juvenile xanthogranuloma of the corneoscleral limbus was encountered in a 5-year-old oriental boy, who presented with a 5-month history of a lump in the right eye. The lesion extended from the inferior limbus. This yellow-orange mass was vascular and firmly fixed to the underlying tissue. The lesion was diagnosed preoperatively as an atypical dermolipoma and an uneventful excisional biopsy was performed. The pathologic diagnosis showed the characteristic picture of a juvenile xanthogranuloma with numerous Touton giant cells. Dermoid and lipodermoid tumors, as a corneoscleral limbal mass, are the most frequently encountered in childhood. A juvenile xanthogranuloma is a rare and usually benign skin disease with an unknown cause, which occurs in infants and young children. However, it can occur also as a corneoscleral limbal mass in young children.

Development of parafoveal exudates and serous retinal detachment in a pregnant woman with tuberous sclerosis.

The authors describe an unusual case of a serous detachment of the fovea and decreased vision with parafoveal exudates with subsequent spontaneous resolution and return of central vision in a pregnant patient with tuberous sclerosis. To our knowledge, this is the first report of an ocular change during gestation in a patient with tuberous sclerosis.