Case of cryptococcal choroiditis in adult with T-cell leukemia/lymphoma.

A rare case of 70-year-old woman with adult T-cell leukemia/lymphoma who developed multifocal choroiditis from a dissemination of Cryptococcus neoformans is reported. Ophthalmologic examination revealed multiple yellowish choroidal lesions in the posterior pole of both eyes. Sequential optical coherence tomographic images disclosed the involvement of the choroid and the consecutive changes in its architecture during the course of treatment. The recognition of these ocular manifestations may be important for the rapid diagnosis of C. nerformans-disseminated diseases. Rapid diagnosis and prompt therapy with intravitreal injection as well as systemic fosfluconazole and liposomal amphotericin B led to clinical improvement of intraocular cryptococcosis.

Case of adult-onset neuronal intranuclear hyaline inclusion disease with negative electroretinogram.

PURPOSE: To report the findings in a 72-year-old man with neuronal intranuclear hyaline inclusion disease (NIHID) with the negative-type electroretinogram (ERG) and without night blindness. METHODS: Standard ophthalmological examinations including the medical history, measurements of the best-corrected visual acuity and intraocular pressures, slit-lamp biomicroscopy, ophthalmoscopy, spectral-domain optical coherence tomography, fundus autofluorescence, and perimetry were performed. In addition, neurological and electrophysiological examinations were performed. RESULTS: NIHID was confirmed by skin biopsy. The ophthalmologic examinations revealed sluggish pupillary reflexes without visual disturbances and retinal abnormalities. The amplitudes of the dark-adapted 0.01 ERG was absent, and light-adapted 3 ERG and light-adapted 30 Hz flicker ERG were reduced in amplitude and delayed in implicit time. The rod system was more severely affected than the cone system, indicating that NIHID is classified as one of rod-cone dysfunction syndrome. The dark-adapted 3 ERG consisted of a markedly reduced b-wave with larger a-wave (negative ERG), but the amplitude of a-wave was smaller than normal. CONCLUSIONS: Since the ophthalmoscopical findings and the subjective visual functions may be essentially normal, the characteristic ERG abnormalities can be an important findings in adult-onset NIHID without night blindness.

Uveitis induced by programmed cell death protein 1 inhibitor therapy with nivolumab in metastatic melanoma patient.

Nivolumab, a new immune checkpoint inhibitor, binds to programmed cell death-protein 1 receptors on T cell, blockades binding of its ligands, and augments the immunologic reaction against tumor cells. Augmented immune response, however, may lead to immune-related adverse events. Herein we describe a rare case of bilateral anterior uveitis induced by nivolumab treatment for metastatic melanoma. A 54-year-old woman presented with mild conjunctival redness and blurred vision two months after initiating nivolumab treatment. Ophthalmological examination revealed bilateral non-granulomatous anterior uveitis. The flare values in the anterior chamber were monitored as an objective inflammatory index during nivolumab therapy and clinical time course was reported in this paper.

Study of ocular candidiasis during nine-year period.

BACKGROUND: To determine the clinical features, fungal profiles, treatment outcomes, and factors that are significantly associated with the visual outcomes of eyes with endogenous fungal endophthalmitis (EFE). MATERIAL AND METHODS: The medical records of 17 eyes of 9 patients diagnosed with EFE during January 2005 to December 2013 were reviewed. The collected data included patient characteristics, visual acuities (VAs), length between appearance of the first sign of infection and the first ophthalmic examinations, fungal profiles, and treatment regimen. The main outcome measure was the VA. Statistical analyses were done to detect the factors significantly associated with the visual prognosis. RESULTS: The median age at presentation was 67 years. Seven patients had Candida albicans, and 2 had Candida tropicalis. Eight patients received intravenous fosfluconazole, 4 systemic micafungin, 4 oral itraconazole, and 2 intravenous voriconazole. The minimum inhibitory concentrations of fluconazole against Candida albicans isolated from 5 patients ranged from 0.25 to 1.0 µg/mL. A final VA of ≥20/200 was achieved in 69.2% of the eyes. Multiple regression analysis (r(2) = 0.695) detected both initial logMAR (the Logarithm of the minimum angle of resolution) VA (P = 0.0067) and longer length between onset of symptoms and the first ophthalmic examinations (P = 0.0491) as significant worsen factors for final logMAR VA. CONCLUSIONS: Early ophthalmic consultation, better initial visual acuity, and use of effective systemic antifungal treatment might lead to relatively good visual outcomes in EFE.

Short-term treatment effects of the quad-helix appliance on dentofacial morphology of hyperdivergent patients.

OBJECTIVES: The purpose of this study was to evaluate the effects of shor-term expansion treatment using the quad-helix appliance on dentofacial morphology in orthodontic patients presenting with a hyperdivergent facial pattern. METHODS: The treatment group consisted of 40 patients with a hyperdivergent facial pattern, who were treated for maxillary incisor crowding with a quad-helix appliance during the mixed dentition period. Lateral cephalograms taken at the start (TO) and end (TI) of the treatment were obtained as a course of care. A similar number of patients, who possessed the same type of facial pattern and who remained untreated, were assigned to a control group. Two consecutive lateral cephalograms of each untreated patient were taken at the same time points as TO and T1. All cephalograms were traced, analysed and compared between the two groups. RESULTS: The treatment changes as a result of the quad-helix appliance were expressed in an upward rotation of the mandible [2.34°] and distal tipping and impeded mesial movement of the maxillary first molars. Significant differences were evident between the treatment and control groups. CONCLUSION: Quad-helix appliance treatment can be appropriate for significantly decreasing the mandibular plane angle in hyperdivergent patients presenting with moderate maxillary incisor crowding and a positive overjet and overbite.

Clinical and Genetic Features of Tubulointerstitial Nephritis and Uveitis Syndrome with Long-Term Follow-Up.

PURPOSE: To investigate the clinical manifestations, prognosis, and HLA-type of tubulointerstitial nephritis and uveitis syndrome (TINU) with long-term follow-up. METHODS: Clinical data of five patients with TINU were retrospectively reviewed. RESULTS: The mean age was 15.8 years. The mean follow-up periods were 54.0 months. The initial subjective symptoms were bulbar injection (100%), ocular pain (80%), and blurred vision (60%). The medical department that the patients visited first was ophthalmology in 4 (80%) cases. Urinalysis showed the characteristic increase of the ß2 microglobulin in all (100%) patients. Uveitis and nephritis were diagnosed within 1 week from each other. Although two showed recurrences, the topical and systemic steroid treatment with mean duration of 14.1 months brought the resolution of nephritis and uveitis in all patients. Recurrence-free periods ranged from 12 to 71 months. The final visual outcome was 20/20 or better in all cases. HLA-DR4 or the allele of DRB1∗04 was present in all (100%) patients. CONCLUSIONS: TINU should be considered in the differential diagnosis in young patients with uveitis of unknown origin and renal dysfunction. Urinary ß2 microglobulin level and HLA typing may help in the diagnosis of TINU. The prognosis for patients with TINU is generally good with steroid treatment.

Prognostic values of blood pH and lactate levels in patients resuscitated from out-of-hospital cardiac arrest.

AIM: Early prediction of prognosis after out-of-hospital cardiac arrest (OHCA) remains difficult. High blood lactate or low pH levels may be associated with poor prognosis in OHCA patients, but these associations remain controversial. We compared blood lactate and pH levels in OHCA patients transferred to our hospital to measure their prognostic performance. METHODS: We investigated the associations between blood lactate and pH levels on admission and neurological outcomes in 372 OHCA patients who had a return of spontaneous circulation. RESULTS: Of the 372 OHCA patients, 31 had a favorable neurological outcome. Blood lactate levels were lower in patients with a favorable outcome than in those with an unfavorable outcome, but this difference did not reach statistical significance (82 ± 49 vs. 96 ± 41 mg/dL). However, pH levels were significantly higher in patients with a favorable outcome than in those with an unfavorable outcome (7.26 ± 0.16 vs. 6.93 ± 0.19, P < 0.001). The relative cumulative frequency distribution curve analysis showed the optimal cut-off points of lactate and pH to be approximately 80 mg/dL and 7.05, respectively. Sensitivity and specificity to predict a favorable outcome were 61% and 64% for lactate <80 mg/dL and 84% and 80% for pH >7.05, respectively. Areas under receiver-operating characteristic curves were significantly larger for pH than for lactate levels (P < 0.001). In multivariate analysis, pH >7.05 was an independent predictor for a favorable outcome. CONCLUSION: After OHCA, patients with a favorable outcome had lower lactate and higher pH levels than those with an unfavorable outcome, but pH level was a much better predictor for neurological outcome than lactate levels.

Nanocomposite Phosphor Consisting of CaI2:Eu2+ Single Nanocrystals Embedded in Crystalline SiO2.

High luminescence efficiency is obtained in halide- and chalcogenide-based phosphors, but they are impractical because of their poor chemical durability. Here we report a halide-based nanocomposite phosphor with excellent luminescence efficiency and sufficient durability for practical use. Our approach was to disperse luminescent single nanocrystals of CaI2:Eu2+ in a chemically stable, translucent crystalline SiO2 matrix. Using this approach, we successfully prepared a nanocomposite phosphor by means of self-organization through a simple solid-state reaction. Single nanocrystals of 6H polytype (thr notation) CaI2:Eu2+ with diameters of about 50 nm could be generated not only in a SiO2 amorphous powder but also in a SiO2 glass plate. The nanocomposite phosphor formed upon solidification of molten CaI2 left behind in the crystalline SiO2 that formed from the amorphous SiO2 under the influence of a CaI2 flux effect. The resulting nanocomposite phosphor emitted brilliant blue luminescence with an internal quantum efficiency up to 98% upon 407 nm violet excitation. We used cathodoluminescence microscopy, scanning transmission electron microscopy, and Rietveld refinement of the X-ray diffraction patterns to confirm that the blue luminescence was generated only by the CaI2:Eu2+ single nanocrystals. The phosphor was chemically durable because the luminescence sites were embedded in the crystalline SiO2 matrix. The phosphor is suitable for use in near-ultraviolet light-emitting diodes. The concept for this nanocomposite phosphor can be expected to be effective for improvements in the practicality of poorly durable materials such as halides and chalcogenides.