CLINICAL OUTCOME OF POLYPOIDAL CHOROIDAL VASCULOPATHY/ANEURYSMAL TYPE 1 NEOVASCULARIZATION ACCORDING TO CHOROIDAL VASCULAR MORPHOLOGY.

PURPOSE: To determine the impact of choroidal vascular morphology on clinical outcomes in patients with polypoidal choroidal vasculopathy/aneurysmal Type 1 neovascularization. METHODS: Sixty-six eyes with polypoidal choroidal vasculopathy/aneurysmal Type 1 were included. Eyes were subdivided according to the choroidal vascular morphology of the large vessel layer on optical coherence tomography en face images: focal (n = 39) versus diffuse (n = 27) pachyvessels. All patients were treated with intravitreal ranibizumab pro re nata with or without rescue photodynamic therapy. RESULTS: Best-corrected visual acuity at baseline, 6, and 12 months did not differ between groups (P = 0.394, 0.142, and 0.292). At Month 3, best-corrected visual acuity was worse, and the proportion of eyes with fluid was higher in the focal group (P = 0.016 and 0.024). Among responders, the number of injections during 12-month follow-up was higher in the focal group (P = 0.033). During the total follow-up period, photodynamic therapy was required in 15 eyes (10 focal and 5 diffuse group, P = 0.497). The injection-free period after the photodynamic therapy was shorter in the focal group (P = 0.018). CONCLUSION: The polypoidal choroidal vasculopathy/aneurysmal Type 1 eyes with a diffuse pattern of pachyvessels required fewer injections during 12-month follow-up and showed a longer injection-free period after rescue photodynamic therapy.

Choroidal morphology under pachydrusen.

IMPORTANCE: To reveal choroidal morphological profiles under pachydrusen. BACKGROUND: Drusen in pachychoroid disorders show certain differences from conventional drusen and are recently named as "pachydrusen." This study analysed the specific choroidal morphology under pachydrusen. DESIGN: This study is a cross-sectional case series. PARTICIPANTS: Enrolled were 136 eyes with pachydrusen from 134 patients. METHODS: The presence of pachydrusen in fundus area covered by a 12 × 9 mm2 optical coherence tomography (OCT) image was accessed in eyes with pachychoroid-related diseases or their fellow eyes using colour fundus photography and swept source OCT. Choroidal morphology under the pachydrusen was analysed using OCT B-scans and en face images. MAIN OUTCOME MEASURES: Choroidal thicknesses and topographical correlation between pachydrusen and pachyvessels. RESULTS: A total of 225 pachydrusen in 136 eyes were analysed. The mean number of pachydrusen was 1.65 ± 1.07 per eye. Most pachydrusen were located para- or perifoveally (37 subfoveal, 86 parafoveal and 102 perifoveal). The proportion of Haller's layer to total choroidal thickness was higher at the area of the pachydrusen compared to the subfovea (0.881 ± 0.081 vs 0.765 ± 0.111, P < 0.001). In multimodal image analysis, 90.1% of pachydrusen identified using fundus photography and OCT B-scan were located at the area of a dilated Haller vessel (pachyvessel) seen on en face images. CONCLUSIONS AND RELEVANCE: Choroidal morphology under the pachydrusen showed increased Haller's layer thickness with an attenuated choriocapillaris layer, which is the hallmark of pachychoroid definition. Topographically, their locations correlated with the underlying pachyvessel.

Five-year outcomes of the tension-free vaginal tape procedure for treatment of female stress urinary incontinence.

OBJECTIVES: We evaluated the long-term efficacy and safety of a tension-free vaginal tape (TVT) procedure for the treatment of female stress urinary incontinence (SUI) in a Korean population. METHODS: We included 134 patients (mean age, 52.3+/-9.3 yr) who underwent the TVT procedure for SUI in three institutions and followed for 5 yr (mean, 67.0 mo; range, 60-76 mo) postoperatively. We analysed voiding diaries and complete multichannel urodynamic studies preoperatively as well as cough stress tests, uroflowmetry, and questionnaires postoperatively. RESULTS: The overall 5-yr success rates (cure/improved) were 94.9% (76.9% and 18.0%, respectively), with an 86.6% patient satisfaction rate. Although the success rates between 1 and 5 yr were similar (97.7% vs. 94.9%), the cure rate decreased from 90.1% to 76.9% (p<0.001) at 5 yr. The 5-yr cure rate for mixed urinary incontinence (MUI) was 72.0%, which was not significantly different from pure SUI (78.0%, p>0.05). Maximal flow rate dropped from 25.9+/-10.3ml/s to 20.4+/-8.6ml/s at 1 mo postoperatively and recovered to 24.8+/-8.5ml/s at 5 yr. Complications included bladder perforation in 5 patients (3.7%), tape cutting or release in 11 (8.2%), and persistent suprapubic pain in 3 (2.2%). Urgency and urge incontinence improved in 46.7% and 48.0% of patients, respectively. CONCLUSIONS: TVT was an effective and safe procedure for SUI and MUI with high success rates in the long-term follow-up. It also improved concomitant overactive bladder symptoms and initially reduced postoperative urine flow, which recovered over time.

Seasonal variation of snail population of Parafossarulus manchouricus and larval trematode infection in river Kumho, Kyungpook province, Korea.

Studies were conducted to determine the ecology of the snail, Parafossarulus manchouricus, the seasonal variation of the snail population, and the infestation rates of these snails with the cercariae of digenetic trematodes, in the snail habitat of river Kumho, in Dongchon of Taegu city, in Kyungpook Province, Korea, from 1975 to 1979. The earliest time the snails were found was early in April every year. At that time the water temperature ranged from 13 to 14 degrees C. The population density of snails ranged from 2 to 8 per square meter. The highest population density of snails was encountered in late June and the water temperature was between 24 and 26 degrees C. The snails disappeared in early and mid-November, when the water temperature dropped to 10~13 degrees C. The average snail population in June was 115.9 per square meter in 1975 but in 1976 dropped abruptly to 30.5 and remained at approximately the same level in 1977. It then decreased at considerably lower rates, with the average of 18.7 in 1978 and 14.5 in 1979. The snails collected in the habitat were examined for the presence of cercariae of digenetic trematodes. Of these, four species, Clonorchis sinensis, Cyathocotyle orientalis, Exorchis oviformis, and Loxogenes liberum were found. The most frequently liberated cercaria was L. liberum 43.3 per cent, followed by E. oviformis 6.2 per cent and C. orientalis 1.5 per cent. The least frequently liberated was C. sinensis 0.1 per cent. In the monthly liberation rates for larval trematodes, the higher rates were observed in June, July and August every year, and the cercarial rates for Clonorchis sinensis, Cyathocotyle orientails and Exorchis oviformis demonstrate a fairly consistently fluctuating downward trend over the five-year period, except for Loxogenes liberum. Summarizing the results, this study indicated that the population density of snails in the habitat and the infection of the snail with the cercariae of digenetic trematodes has decreased over the five-year period from 1975 to 1979.

Clonorchis sinensis in Kyungpook Province, Korea: 1. Distribution and demonstration of the cercaria of Clonorchis sinensis from snail, Parafossarulus manchouricus Bourgigant.

Studies were conducted in rivers in Kyungpook Province, Korea from July 1970 to September 1974 to determine the stations where Parafossarulus manchouricus, the intermediate snail host of Clonorchis sinensis, are abundant, and the infection rates of these snails with the cercaria of Clonorchis sinensis. Snail collections were made during four consecutive summers(July to September in each year). Ten snail habitats were found. The population density of the snails per square meter of the river bottom ranged from 25 to 250. The highest population of snails was encountered at the Dong-chon station. Cercaria studies by means of the immersing and crushing technics indicated surprisingly low rate of Clonorchis sinensis infection among the snails examined. The proportion of infected snails in Kyungpook Province was 0.8 per thousand of all snails examined. Results indicated that the Parafossarulus manchouricus exists in limited areas within the rivers under study and the infection of the snail with the cercaria of Clonorchis sinensis is very low.