Analyses of Foveal Avascular Zone in Patients with General Blunt Ocular Trauma Using Optical Coherence Tomography Angiography

Purpose@#To investigate the effect of blunt ocular trauma (BOT) on foveal circulation, and in particular the foveal avascular zone (FAZ), using optical coherence tomography angiography (OCTA). @*Methods@#This retrospective study consisted of 96 eyes (48 traumatized eyes and 48 nontraumatized eyes) from 48 subjects with BOT. We analyzed the FAZ area of deep capillary plexus (DCP) and superficial capillary plexus (SCP) immediately after BOT and at 2 weeks after BOT. We also evaluated the FAZ area of DCP and SCP in patients with and without blowout fracture (BOF). @*Results@#There were no significant differences in FAZ area between traumatized and nontraumatized eyes at DCP and SCP in the initial test. In traumatized eyes, the FAZ area at SCP was significantly reduced on follow-up when compared to initial test (p = 0.01). In case of eyes with BOF, there was no significant differences in FAZ area between traumatized and nontraumatized eyes at DCP and SCP on initial test. No significant difference of FAZ area was found on follow-up relative to the initial test, whether in the DCP or SCP. In case of eyes without BOF, there was no significant differences of FAZ area between traumatized and nontraumatized eyes at DCP and SCP in initial test. Also, no significant difference of FAZ area at DCP was found on follow-up test compared to initial test. However, the FAZ area at SCP was significantly reduced in follow-up test compared with that in the initial test (p = 0.04). @*Conclusions@#Temporary microvascular ischemia occurs in the SCP of patients after BOT. Patients should be warned of transient ischemic changes that may occur after trauma. OCTA can provide useful information regarding the subacute changes in the FAZ at SCP after BOT, even without evident findings of structural damage on fundus examination.

Analysis of Aqueous Humor Cytokines in Exudative Age-related Macular Degeneration and Diabetic Macular Edema

Purpose@#To investigate the cytokine concentrations of aqueous humor in patients with exudative age-related macular degeneration (AMD) and diabetic macular edema (DME). @*Methods@#Fifty-seven subjects were included in the exudative AMD, DME and control groups, each group has 19 patients. Aqueous levels of cytokines epidermal growth factor (EGF), vascular endothelial growth factor-C (VEGF-C), monocyte chemoattractant protein-1 (MCP-1), hepatocyte growth factor (HGF), interleukin (IL)-3, IL-8, IL-6, IL-12p40, intercellular adhesion molecule 1 (ICAM-1) were investigated in each groups. Kruskal-Wallis test and Mann-Whitney U test were performed to compare cytokine concentrations. @*Results@#Aqueous levels of EGF, VEGF-C, MCP-1, HGF, IL-3, IL-8 were significantly higher in exudative AMD group than control group (p = < 0.0001, < 0.0001, 0.004, 0.015, < 0.0001, 0.014) and EGF, VEGF-C, IL-3, IL-8 were significantly higher in DME group than control group (p = < 0.0001, < 0.0001, < 0.0001, 0.005). In the comparison between the exudative AMD and DME groups, EGF was significantly higher in the exudative AMD group (p = 0.001). @*Conclusions@#Various cytokines were increased in patients with exudative AMD and DME. In particular, EGF showed a higher level in exudative AMD than in DME.

Correlation between Topographic Progression of Geographic Atrophy and Visual Acuity Changes

Purpose@#To analyze topographic progression of geographic atrophy with different concentric circles centered on the fovea in correlation with decrease of visual acuity. @*Methods@#We retrospectively analyzed 36 eyes of 26 patients diagnosed with geographic atrophy and followed at least 1 year. One millimeter circular area at the foveal center were defined as zone 1, and doughnut shape areas from between 1 and 2 mm to between 5 and 6 mm were defined as zone 2 to 6. Then, changes of geographic atrophy area in each zone were measured with semi-automatic software. Correlation analysis and regression analysis were performed to determine the relationship between changes in visual acuity and atrophic area in each zone. @*Results@#Mean age was 76.9 years and follow-up period were 3.38 years. The mean atrophic area increased from 8.09 to 16.34 mm2 and visual acuity decreased from 0.39 to 0.69 on logarithm of the minimal angle of resolution. Mean change of total geographic atrophy area was not significantly correlated with visual acuity decrease. While geographic atrophy progression within zone 1, 2, and 3 showed significant causal relationship with decrease of visual acuity (all, p < 0.05). @*Conclusions@#In contrast to the total geographic atrophy area, progression of geographic atrophy in parafoveal area was significantly correlated with decrease of visual acuity.

Massive Retinal Hemorrhage during Epiretinal Membrane Peeling in Patient with Iron Deficiency Anemia

Purpose@#To report a case of massive retinal hemorrhage during epiretinal membrane (ERM) peeling in a patient with iron deficiency anemia (IDA).Case summary: A 59-year-old female presented with gradually decreasing visual acuity and dysmorphopsia in the right eye for several months. She had a history of chronic IDA due to subtotal gastrectomy from gastric cancer 20 years prior. The patient was diagnosed as having macular ERM and underwent vitrectomy. During ERM peeling with intraocular forceps, we found a massive retinal hemorrhage which was presumed to have originated from the superotemporal branched retinal artery. After hemostasis, the operation was completed without critical complications. However, 2 months after surgery, the patient presented with decreased visual acuity once again. In fundus examination, diffuse macular tractional ERM was evident in the proximity of the previous intraoperative hemorrhage site. The patient underwent tractional membrane and internal limiting membrane removal surgery. The patient is currently undergoing follow-up without complications to date following the second surgery. @*Conclusions@#Our case study describes a patient having experienced massive retinal hemorrhage presumably having originated from a superotemporal branched retinal artery during ERM peeling. We speculate that the endothelial cells of retinal vessels are more vulnerable than normal in patients with severe chronic IDA.

Massive Retinal Hemorrhage during Epiretinal Membrane Peeling in Patient with Iron Deficiency Anemia

Purpose@#To report a case of massive retinal hemorrhage during epiretinal membrane (ERM) peeling in a patient with iron deficiency anemia (IDA).Case summary: A 59-year-old female presented with gradually decreasing visual acuity and dysmorphopsia in the right eye for several months. She had a history of chronic IDA due to subtotal gastrectomy from gastric cancer 20 years prior. The patient was diagnosed as having macular ERM and underwent vitrectomy. During ERM peeling with intraocular forceps, we found a massive retinal hemorrhage which was presumed to have originated from the superotemporal branched retinal artery. After hemostasis, the operation was completed without critical complications. However, 2 months after surgery, the patient presented with decreased visual acuity once again. In fundus examination, diffuse macular tractional ERM was evident in the proximity of the previous intraoperative hemorrhage site. The patient underwent tractional membrane and internal limiting membrane removal surgery. The patient is currently undergoing follow-up without complications to date following the second surgery. @*Conclusions@#Our case study describes a patient having experienced massive retinal hemorrhage presumably having originated from a superotemporal branched retinal artery during ERM peeling. We speculate that the endothelial cells of retinal vessels are more vulnerable than normal in patients with severe chronic IDA.

Influence of Atlantoaxial Fusion on Sagittal Alignment of the Occipitocervical and Subaxial spines in Os Odontoideum with Atlantoaxial Instability

STUDY DESIGN: Retrospective case analysis. PURPOSE: We hypothesized that larger the C1–C2 fusion angle, greater the severity of the sagittal malalignment of C0–C1 and C2–C7. OVERVIEW OF LITERATURE: In our experience, instances of sagittal malalignment occur at C0–C1 and C2–C7 following atlantoaxial fusion in patients with Os odontoideum (OO). METHODS: We assessed 21 patients who achieved solid atlantoaxial fusion for reducible atlantoaxial instability secondary to OO. The mean patient age at the time of the operation was 42.8 years, and the mean follow-up duration was 4.9 years. Radiographic parameters were preoperatively measured and at the final follow-up. The patients were divided into two groups (A and B) depending on the C1–C2 fusion angle. In group A (n=11), the C1–C2 fusion angle was ≥22°, whereas in group B, it was <22°. The differences in the radiographic parameters of the two groups were evaluated. RESULTS: At the final follow-up, the C1–C2 angle was increased. However, this increase was not statistically significant (18° vs. 22°, p=0.924). The C0–C1 angle (10° vs. 5°, p<0.05) and C2–C7 angle (22° vs. 13°, p<0.05) significantly decreased. The final C1–C2 angle was negatively correlated with the final C0–C1 and C2–C7 angles. The final C0–C1 angle (4° vs. 6°, p<0.05) and C2–C7 angle (8° vs. 20°, p<0.05) were smaller in group A than in group B. After atlantoaxial fusion, the C0–C1 range of motion (ROM; 17° vs. 9°, p<0.05) and the C2–C7 ROM (39° vs. 31°, p<0.05) were significantly decreased. CONCLUSIONS: We found a negative association between the sagittal alignment of C0–C1 and C2–C7 after atlantoaxial fusion and the C1–C2 fusion angle along with decreased ROM. Therefore, overcorrection of C1–C2 kyphosis should be avoided to maintain good physiologic cervical sagittal alignment.

Delayed Onset Purtscher's Retinopathy with Serous Retinal Detachment after Trauma in a Retinitis Pigmentosa

PURPOSE: To report a case of Purtscher's retinopathy accompanied by serous retinal detachment in a patient with retinitis pigmentosa (RP) who was referred to us for treatment of post-traumatic visual discomfort. CASE SUMMARY: A 36-year-old man with history of RP was referred to us with the chief complaint of bilateral visual discomfort after chest injury from a traffic accident. His corrected visual acuity was 0.3 and 0.6 in the right and left eyes, respectively. Fundus examination revealed findings characteristic of RP in both eyes, along with a lesion in the right eye, which was suspected to be a serous elevation of the macula, as well as suspected exudates near the optic nerves. Optical coherence tomography indicated serous retinal detachment in the right eye, and fluorescein angiography findings were characteristic of RP. Seven days later, the amount of cotton-wool exudate in the right eye had increased and was more distinct than at the initial examination, and retinal hemorrhage was observed. Based on the medical history and specific fundus findings, the patient was diagnosed with Purtscher's retinopathy. One month later, the serous retinal detachment in the right eye had improved, but the vision loss and total anopsia in the right eye persisted. CONCLUSIONS: The concomitant occurrence of RP and Purtscher's retinopathy is very rare. Moreover, the presence of accompanying serous retinal detachment and delayed onset of typical clinical symptoms are not present in typical Purtscher's retinopathy.

An Unusual Case of Endogenous Klebsiella Pneumonia Endophthalmitis

PURPOSE: To report an unusual case of endogenous endophthalmitis in a patient with Klebsiella pneumoniae primary liver abscess. CASE SUMMARY: A-54-year-old man with diabetes mellitus and liver abscess was referred to us for consultation of visual loss in his left eye for 2 days. On the first examination, the patient's left visual acuity was hand motion and the left intraocular pressure was 13 mmHg. Vitreous opacity and inflammatory membrane were detected with increased echogenicity using ultrasonography. Vitectomy and intravitreous antibiotic injection were performed under the impression of endogenous endophthalmitis caused by liver abscess on the day of the first visit. Culture revealed Klebsiella pneumoniae from blood and liver abscess. After vitrectomy, the patient showed improvement. However, on the 20th and 40th postoperative days, the patient complained of blurred vision, and inflammation and hypopyon were observed in the anterior chamber. An intracameral antibiotic injection and anterior chamber washing were performed. The patient has not complained of any other symptoms to date. CONCLUSIONS: In this patient with endophthalmitis, inflammation and hypopyon in the anterior chamber were evident three times after vitrectomy. Ultimately, the inflammation was effectively controlled by intracameral antibiotic injection and anterior chamber washes.

Clinical Features of Compound Nevus

PURPOSE: To evaluate the clinical features of compound nevus. METHODS: A retrospective chart review of the medical records for 32 eyes of 32 patients who were clinically diagnosed as having a compound nevus from February 2011 to February 2017 was performed. RESULTS: The average follow-up period was 21.38 (range, 6–70) months for the 32 patients (9 males and 32 females), and the average age was 21 (range, 7–41) years old. The development or detection of a nevus varied between patients. There were no associated symptoms except for one patient who experienced foreign body sensation. An increase in size was noted in 5 cases (15%). The most common location in the conjunctiva was bulbar in 30 cases (93.8%), and the most common quadrant was temporal in 21 cases (65.6%) followed by nasal conjunctiva in 11 cases (34.4%). The most common locations of anterior margin and posterior margin were on the limbus (56%) and bulbar conjunctiva (92%), respectively. The mean horizontal length was 2.59 ± 1.9 mm and the mean vertical length was 2.62 ± 2.1 mm. All horizontal and vertical lengths were within 5 mm. An elevated nevus was observed in 25 cases (78.1%), and 18 cases (56.3%) had cystic lesions. The color of the nevi were largely brown (26 cases, 81.3%), and 29 cases (90.6%) had feeder vessels. Excisional biopsy and histologic exam were performed in 22 cases (68.8%). The purpose of the treatment was mostly cosmetic (20 cases, 93.8%) or for differential diagnosis with malignant melanoma (2 cases, 6.3%). In the surgery group, no one showed recurrence or any significant complications. CONCLUSIONS: A conjunctival compound nevus is a benign conjunctival mass and can be found in all age groups. Compound nevus can be diagnosed with clinical features, and complete excision with histological exam is an appropriate treatment to differentiate from malignant melanoma.

Analysis of the Retinal Nerve Fiber Layer Thickness in Alzheimer Disease and Mild Cognitive Impairment

PURPOSE: To compare the retinal nerve fiber layer (RNFL) as well as the macula volume and thickness in the eyes of age-matched healthy controls with no cognitive disabilities with those of elderly people with mild cognitive impairment (MCI) or Alzheimer disease (AD). We used optical coherence tomography (OCT) to determine the effectiveness of the above quantities for early diagnosis of MCI or AD. METHODS: Ninety eyes were considered in this study, split between 30 normal eyes, 30 eyes from patients with MCI, and 30eyes from patients with AD. All subjects underwent ophthalmologic and cognitive examinations, and measurements of the RNFL thickness as well as macular volume and thickness were taken for all patients using OCT. RESULTS: The mean RNFL thickness upon OCT was significantly thinner in the AD group than in the MCI group (p = 0.01). The RNFL was thinner in the superior quadrant in patients with AD when compared to the healthy controls (p = 0.03). The RNFL thicknesses in the inferior, nasal, and temporal quadrants did not differ significantly between the groups. Measurements in the 12 clock-hour zones revealed that zone 11 had a significantly thinner RNFL in the AD group as compared with the healthy control group (p = 0.02). In zone 2, the MCI group had a significantly thinner RNFL than the AD group (p = 0.03). CONCLUSIONS: Our OCT findings revealed a neuroanatomic difference in the RNFL thickness among the three groups, i.e., the AD, MCI, and healthy control groups. This suggests that a change in average RNFL thickness could be a meaningful index for diagnosing early AD.

Analysis of Myopic Progression in Childhood Using the Korea National Health and Nutrition Examination Survey

PURPOSE: To investigate the degree, distribution, and change in refractive error in the pediatric population 5 to 20 years of age. METHODS: We collected data from 7,695 subjects aged 5 to 20 years who participated in the Korean National Health and Nutrition Examination Survey from 2008 to 2012. Non-cycloplegic refractive error was measured using an autorefractor. Mean spherical equivalent calculated from the measured refractive error data in both eyes was used. The subjects were categorized into mild, moderate, or high refractive abnormality or emmetropia according to the degree of refractive error. The degree and distribution of refractive error in all subjects and age-matched subjects were analyzed. The change in refractive error was analyzed according to age. RESULTS: Mean refractive error of the study subjects was -1.82 diopters. As subject age increased, myopia increased from +0.04 diopters at 5 years of age to -2.88 diopters at 20 years of age. Myopia was observed in 66.2% of subjects and accounted for only 18.5% of the 5-year-old subjects, but increased to 84.3% in the 20-year-old subjects. The rate among all study subjects was -0.19 diopters per year. The greatest myopic progression rate (-0.46 diopters per year) among all age groups was in subjects 7 to 9 years of age. Myopic progression continued until 16 years of age. CONCLUSIONS: The ratio of pediatric myopia subjects between 5 and 20 years of age was high in Korea. The rate of myopic progression was the fastest in subjects 7 to 9 years of age. After 16 years of age, myopic change paused.

To Report a Case of Tamoxifen-induced Retinopathy Diagnosed Using Spectral Domain Optical Coherence Tomography

PURPOSE: To report a case of tamoxifen-induced retinopathy diagnosed using spectral domain optical coherence tomography (SD-OCT). CASE SUMMARY: A 44-year-old female presented with metamorphopsia in the left eye and binocular vision loss which started 5 months prior. She had no record of external trauma, diabetes or high blood pressure; however, she had been taking 21.9 g tamoxifen (20 mg/day) since October 2012 after a surgery of her left breast due to cancer. On the initial visit, fundus photography showed crystalline dot-like deposits in both parafoveae. Additionally, fluorescence angiography revealed a small leakage around the macular area. Optical coherence tomography (OCT) was obtained to differentiate from other diseases because fundus photography showed crystalline retinopathy. The OCT revealed a normal right eye but the left macula had a microcystic lesion. Based on the diagnosis of tamoxifen-induced retinopathy, the patient stopped taking tamoxifen. Three months after discontinuation of tamoxifen, fundus photography showed slightly decreased crystalline deposits in the parafoveal area and visual acuity of the right eye was slightly improved. However, SD-OCT showed a slightly aggravated disruption of the outer retina in both eyes. CONCLUSIONS: Although retinopathy caused by treatment with tamoxifen occurs infrequently, to prevent complications and irreversible damage, patients who take tamoxifen for medical purposes need to undergo a regular ophthalmologic examination.

A Case of Acute Bilateral Solar Retinopathy Diagnosed with Spectral Domain Optical Coherence Tomography

PURPOSE: To report a case of acute bilateral solar retinopathy diagnosed using spectral domain optical coherence tomography (SD-OCT). CASE SUMMARY: A 74-year-old female patient consulted for amblyopia and metamorphopsia at a local hospital. On the patient's first visit, there were no abnormal findings based on slit lamp microscope. Additional examinations were conducted since the patient complained of metamorphopsia with visual acuity and corrected vision. Fundus photography and SD-OCT examination showed symmetrical lesions near the bilateral macula. Several evaluations of the patient's medical history confirmed that the patient was exposed directly to the sun for 30 minutes. One month after the first visit, visual acuity improved but metamorphopsia remained unchanged. Lesion status could not be confirmed by fundus photography. There was no abnormal finding on fluorescence angiography. SD-OCT examination still showed bilateral symmetric disruption of the outer retina but with no significant interval change. CONCLUSIONS: In the present case, the patient with bilateral intraocular lenses who complained of acute binocular amblyopia was diagnosed accurately through SD-OCT tests for bilateral symmetric disruption on the outer retina and repetitive evaluations of patient's medical history.

A Case of Bilateral Diabetic Papillopathy Related to Rapid Hemoglobin A1c Decrease in Type I Diabetes Mellitus

PURPOSE: To report a case of bilateral diabetic papillopathy related to rapid hemoglobin A1c (HbA1c) decrease in a type I diabetic patient. CASE SUMMARY: A 39-year-old female who was diagnosed with type I diabetes mellitus for the first time at this hospital was presented to our clinic for evaluation of diabetic retinopathy. There were no subjective symptoms, including blurred vision or visual defect. Her best corrected visual acuity in both eyes was 1.0, but her fundus resembled mild nonproliferative diabetic retinopathy. When diagnosed with type I diabetes mellitus, her HbA1c was 15.3%. She used insulin to control her blood glucose and her HbA1c reached 7.3% two months after controlling the blood glucose. Three months after her diabetic diagnosis, there were no differences in subjective symptoms and best corrected visual acuity. Fundus examination showed optic disc swelling in both eyes. To evaluate for the etiology of optic disc swelling, we did the examinations of the optic disc, fundus, and brain magnetic resonance imaging. No specific signs were observed. We diagnosed diabetic papillopathy and observed the patient without any treatments. Her optic disc swelling showed gradual improvement. CONCLUSIONS: This case shows that the rapid HbA1c decrease in type I diabetes mellitus is related to the occurrence of bilateral diabetic papillopathy. This supports previous studies that estimated that the rapid HbA1c decrease in type I diabetes mellitus in response to insulin treatment is one of the risk factors for bilateral diabetic papillopathy.

Analysis of Aqueous Humor Cytokines in Diabetic Retinopathy

PURPOSE: To investigate the relationship between the concentration of aqueous humor cytokines and the severity of diabetic retinopathy. METHODS: Thirty-six subjects were included in the control, non-proliferative diabetic retinopathy (NPDR), and proliferative diabetic retinopathy (PDR) groups, each group has 12 patients. Aqueous levels of cytokines (interleukin (IL)-1alpha, IL-1beta, IL-2, IL-4, IL-6, IL-8, IL-10, vascular endothelial growth factor (VEGF), monocyte chemoattractant protein (MCP)-1, interferon (IFN)-gamma, tumor necrosis factor (TNF)-alpha) were investigated according to the severity of diabetic retinopathy. RESULTS: When the control group was compared with the PDR and NPDR groups, aqueous levels of IL-6 were significantly higher in PDR patients than in those of both the control and NPDR groups (p = 0.016 and p = 0.003, respectively). The aqueous levels of VEGF were significantly higher in the eyes of PDR patients than in those of the control group (p = 0.003). There were no statistically significant differences between the 3 groups with regard to other cytokines. CONCLUSIONS: Aqueous levels of IL-6 and VEGF were higher in the eyes of PDR patients than in those of healthy controls.

Analysis of Aqueous Humor Cytokines in Diabetic Retinopathy

PURPOSE: To investigate the relationship between the concentration of aqueous humor cytokines and the severity of diabetic retinopathy. METHODS: Thirty-six subjects were included in the control, non-proliferative diabetic retinopathy (NPDR), and proliferative diabetic retinopathy (PDR) groups, each group has 12 patients. Aqueous levels of cytokines (interleukin (IL)-1alpha, IL-1beta, IL-2, IL-4, IL-6, IL-8, IL-10, vascular endothelial growth factor (VEGF), monocyte chemoattractant protein (MCP)-1, interferon (IFN)-gamma, tumor necrosis factor (TNF)-alpha) were investigated according to the severity of diabetic retinopathy. RESULTS: When the control group was compared with the PDR and NPDR groups, aqueous levels of IL-6 were significantly higher in PDR patients than in those of both the control and NPDR groups (p = 0.016 and p = 0.003, respectively). The aqueous levels of VEGF were significantly higher in the eyes of PDR patients than in those of the control group (p = 0.003). There were no statistically significant differences between the 3 groups with regard to other cytokines. CONCLUSIONS: Aqueous levels of IL-6 and VEGF were higher in the eyes of PDR patients than in those of healthy controls.

The Relationship among Refractive Power, Axial Length and Choroidal Thickness Measured by SD-OCT in Myopia

PURPOSE: To measure choroidal thickness in healthy myopic eyes and to evaluate the relationship among choroidal thickness and refractive power and axial length. METHODS: Eighty healthy myopic eyes were evaluated in the present study. The refractive power was measured using an automatic refractor and the axial length using A-scan. The subjects were divided into two groups based on refractive power (> or =-6.0 D and or =25 mm and <25 mm). The choroidal thickness was measured using spectral domain (SD) optical coherence tomography (3-dimensional [3D] OCT-2000, Software Version 6.01; Topcon Corp., Tokyo, Japan), and the statistical relationship between the two groups was analyzed. RESULTS: A statistically significant difference was found in choroidal thickness according to refractive power and axial length between the two groups (p < 0.001 and p < 0.05, respectively). CONCLUSIONS: Refractive power and axial length had a significant relation to choroidal thickness measured by OCT. When excluding eyes with pathologic myopia, high myopia in healthy eyes may cause choroidal thinning.

A Case of Needleless Jet Injector Induced Bilateral Chorioretinal Injury

PURPOSE: To report a case of bilateral chorioretinal injury by needleless jet injector misuse. CASE SUMMARY: In a dermatology department, the patient was diagnosed as having total alopecia and was scheduled to be injected on her eyelash by needleless jet injector for treatment but inexpert doctor injected on the eyelid, not eyelash, by mistake. She then suddenly complained of blurred vision and a floater just after that procedure and was referred to the ophthalmology department. Bilateral vitreous hemorrhage and preretinal hemorrhage were seen during indirect ophthalmoscopic examination and bilateral prophylactic argon laser photocoagulation was done around the suspicious tear site. Then bilateral vitreous hemorrhage and preretinal hemorrhage were absorbed and we found a partial retinal rupture lesion and choroidal rupture lesion in the right eye and a retinal injury lesion in the lefteye. Therefore we observed the lesions of both eyes continuously without further treatment. Her clinical symptoms improved. CONCLUSIONS: Needleless jet injector has many advantages, especially less pain and injury than a normal needle injector and is usually used in clinic as preoperative local anesthesia and steroid injection in many medical fields. In this case, the needleless injector was accidentally misused inducing both direct and indirect choroidal rupture and retinal injury. In general, while a needleless jet injector is used in ophthalmology department, we have to use it with the greatest care.

A case of diastasis of the symphysis pubis accompanying gait disturbance developed before labor pain / 대한산부인과학회지

We experienced a case of diastasis of the symphysis pubis accompanying severe pubic pain and serious gait disturbance, which was developed at 34 weeks gestation before labor pain in 36-year-old primiparous woman, who has experienced previous cesarean section at her first pregnancy due to pelvic pain before onset of labor, so we report a case with a review of the literature.

Clinical Significance of Abdominal Deep Subcutaneous Adipose Tissue in the Obese: Associations with Cardiovascular and Risk Factors

BACKGROUND: It is well known that the metabolic syndrome is associated with visceral adipose tissue (VAT), but several recent studies showed stronger association between the subcutaneous adipose tissue (SAT) and insulin resistance. The purpose of this study was to investigate the clinical significance of deep SAT as a cardiovascular and a metabolic risk factor. METHODS: A cross-sectional survey was conducted among fifty-one subjects (21 men and 30 women) who visited an obesity clinic in Yeungnam University Hospital. We performed cross-sectional abdominal CT, and undertook the novel approach of partitioning SAT into the plane superficial to the fascia within SAT (Superficial SAT) and within subcutaneous adipose tissue (deep SAT), as well as the measurement of VAT. Percent body fat was measured by bioimpedance analysis (Inbody 2.0, Biospace). Fasting blood samples were analyzed for total cholesterol, HDL-cholesterol, TG, LDL-cholesterol, FFA, insulin, uric acid and glucose. Resting blood pressure was measured. RESULTS: After adjustment for age, sex, smoking, alchol and exercise, deep SAT was proved to be significantly and positively correlated with fasting insulin, FFA, and uric acid (P<0.05). VAT was significantly correlated with unfavorable levels of FFA, insulin, HDL-cholesterol, TG and diastolic blood pressure (P<0.05). In stepwise multiple regression analysis, deep SAT was shown to be the most powerful of the adiposity measures for explaining the variance in fasting insulin and uric acid levels (r2=0.196 and 0.225, respectively; both P<0.001; including superficial SAT, deep SAT, VAT). CONCLUSION: Our results suggest that the association exists between deep SAT and fasting insulin, a finding which provides further support to the observation that deep SAT may be involved in insulin sensitivity.