Characteristics of Unexposed Proliferative Diabetic Retinopathy: An Optical Coherence Tomography Angiography Study

Purpose@#To compare optical coherence tomography angiography (OCTA) findings between severe non-proliferative diabetic retinopathy (NPDR) and unexposed proliferative diabetic retinopathy (PDR), and identify predictive factors. @*Methods@#Patients newly diagnosed with severe NPDR or unexposed PDR between January 2018 and December 2021 were reviewed retrospectively. Unexposed PDR was diagnosed using fluorescein fundus angiography, because new vessels could not be observed in the poster pole or clearly distinguished in the retinal periphery on wide fundus photography. Clinical features at the time of diagnosis, and OCTA measurements (mean vascular density, superficial capillary plexus (SCP) foveal avascular zone (FAZ) area, and mean retinal thickness), were compared between the two groups. Factors that could predict unexposed PDR were investigated using multivariate analysis with a generalized estimating equation. @*Results@#A total of 61 severe NPDR and 23 unexposed PDR eyes were included. The unexposed PDR had significantly larger SCP-FAZ areas (p = 0.031) and lower total and parafoveal mean inner retinal thicknesses (p = 0.014 and p 0.05). Multivariate analysis showed that SCP-FAZ area and parafoveal mean inner retinal thickness were significant predictors of unexposed PDR (p = 0.027 and p = 0.001, respectively). @*Conclusions@#In severe NPDR patients, unexposed PDR may be considered a differential diagnosis when the SCP-FAZ area is large or the parafoveal mean inner retinal thickness is small.

Assessment of Scleral Contour Changes in High Myopia by Optical Coherence Tomography

Purpose@#This study aimed to establish and validate optical coherence tomography (OCT) based diagnostic criteria of high myopia. @*Methods@#This was a cross-sectional study including 100 eyes of high myopia with axial length larger than 26.5 mm and 100 control eyes, which were examined by spectral-domain OCT. Vertical and horizontal OCT of 9 mm scanning across fovea were analyzed. OCT characteristics including mirror artifact, scleral sink due to steep inclination of posterior sclera, scleral visibility, abnormality of outer retinal layer, foveoschisis, and dome-shaped macula were assessed in each group. @*Results@#The mean axial length was 28.65 ± 2.07 mm (range, 26.51–34.59 mm) in high myopia group and 23.79 ± 0.99 mm (range, 21.26–25.94 mm) in control group. Among the OCT characteristics noted at high frequency in the eyes with high myopia, three criteria achieving high sensitivity and specificity were determined: scleral sink over 500 μm, scleral visibility over 100 μm, and dome-shaped macula. Under conditions of presence of any of three criteria in either horizontal or vertical OCT scanning, the diagnostic sensitivity, specificity, positive predictive value, and negative predictive value for high myopia were found to be 95.0%, 98.0%, 98.0%, and 95.1%, respectively. In a new set of OCT images from 50 eyes with high myopia and 50 eyes of nonhigh myopia cases, the OCT-based criteria also proved similar level of diagnostic validity. @*Conclusions@#The OCT-based criteria, which directly addressed posterior scleral contour changes, may lead to an intuitive and accurate diagnosis of high myopia. Also, the criteria may contribute to early detection and monitoring of eyes that cannot be defined as high myopia but can progress. OCT may be useful for monitoring high myopia patients as OCT can detect myopia-associated retinal pathologies as well as scleral contour changes.

Predictors of Dexamethasone Response of Residual Edema by Branch Retinal Vein Occlusion after Bevacizumab Injection

Purpose@#To predict the response to intravitreal dexamethasone (IVD) implant injection in cases where macular edema (ME) caused by branch retinal vein occlusion persists despite intravitreal bevacizumab injection. @*Methods@#Three consecutive (monthly) bevacizumab injections were given to treat ME caused by branched retinal vein occlusion (BRVO) 63 eyes that received additional dexamethasone or bevacizumab injection 1 month later to treat residual ME were retrospectively studied. Each injection group was divided into two subgroups according to ME disappearance status by 6 months after diagnosis. Initial central retinal thickness (CRT), subfoveal choroidal thickness (SFCT), and hyperreflective focus status were compared among the subgroups, as were the changes in these values. @*Results@#At the decision point, the dexamethasone good response subgroups exhibited thicker CRTs and smaller CRT changes than the dexamethasone partial response subgroups (all p < 0.05). The good dexamethasone response subgroup showed smaller SFCT changes, a thicker CRT, and smaller CRT changes than the bevacizumab good response subgroup (all p < 0.05) at the decision point. The cutoff values of the Youden index were 409 μm for the CRT and 62.5 μm for the CRT change (p = 0.002 and p = 0.011, respectively). @*Conclusions@#If ME persists after three bevacizumab injections, IVD more effectively reduces edema if the CRT is thick or if the CRT change is small.

Clinical and Anatomical Outcomes of Arthroscopic Repair of Large Rotator Cuff Tears with Allograft Patch Augmentation: A Prospective, Single-Blinded, Randomized Controlled Trial with a Long-term Follow-up

Background@#Arthroscopic rotator cuff repair using human dermal matrix allograft augmentation has been widely used. We assessed the effect of acellular human dermal matrix augmentation after arthroscopic repair of large rotator cuff tears through a prospective, single-blinded, randomized controlled trial with a long-term follow-up. @*Methods@#Sixty patients with large-sized rotator cuff tears were randomly assigned to two groups. Patients in the control group underwent arthroscopic rotator cuff repair. Allograft patch augmentation was additionally performed in the allograft group. All patients were subdivided into a complete coverage (CC) group or an incomplete coverage (IC) group according to footprint coverage after cuff repair. Constant and American Shoulder and Elbow Surgeons (ASES) scores were assessed preoperatively and at final follow-up. Magnetic resonance imaging was also performed at the same time to evaluate the anatomical results. @*Results@#Forty-three patients were followed up for an average of 5.7 years. Clinical scores (Constant and ASES) increased significantly at the last follow-up in both groups. The increase in ASES score in the allograft group was statistically significantly greater than that in the control group. The degree of Constant score improvement did not differ significantly between the two groups. The retear rate was 9.1% in the allograft group, which was significantly lower than that in the control group (38.1%). In the control group, the CC subgroup had a statistically significantly lower retear rate (16.7%) than did the IC subgroup. There were no retear cases in the CC subgroup of the allograft group. @*Conclusions@#Long-term follow-up of arthroscopic repair of large rotator cuff tears with allograft patch augmentation showed better clinical and anatomical results. Footprint coverage after rotator cuff repair was an important factor affecting the retear rate. If the footprint was not completely covered after rotator cuff repair, allograft patch augmentation may reduce the retear rate.

Analysis of Peripapillary Vessel Density in Ethambutol-induced Optic Neuropathy Using Optical Coherence Tomography Angiography

Purpose@#To investigate the changes in peripapillary and macular vessel density in ethambutol-induced optic neuropathy using optical coherence tomography angiography (OCTA). @*Methods@#The medical records of patients diagnosed with ethambutol-induced optic neuropathy were analyzed retrospectively. Patient age, sex, daily dose (mg/day/kg), treatment duration, best-corrected visual acuity (logMAR), color vision (Ishihara color plate tests), and mean deviation of visual field test were evaluated in non-pathological individuals with age and sex controlled as the normal control group. Peripapillary retinal nerve fiber layer (RNFL) thickness, macular ganglion cell/inner plexiform layer (GC/IPL) thickness, radial peripapillary capillary (RPC) density, and macular superficial capillary plexus (SCP) density were also compared between the patient and control groups. @*Results@#The study included 22 patient eyes and 31 control group eyes. Comparing the OCTA results between the groups, there were no significant differences in peripapillary RNFL thickness, but the temporal RPC density was significantly (p = 0.025) lower in the patient group (48.00 ± 8.23%) than in controls (52.39 ± 5.58%). For macular structures, the mean GC/IPL thickness and whole SCP density were lower in the patients (p = 0.001 and p = 0.008, respectively). In the patients, the changes in peripapillary RNFL thickness and RPC density were significantly positively correlated (r = 0.811, p < 0.001), as were the mean macular GC/IPL thickness and whole SCP density (r = 0.445, p = 0.037). @*Conclusions@#Patients with ethambutol-induced optic neuropathy had significantly lower temporal RPC and macular SCP densities. Ethambutol toxicity may affect not only axonal degeneration but also peripapillary and macular vascular function.

Incidence of arterial steno-occlusive disease and related factors in patients undergoing coronary artery bypass graft surgery / 고신대학교의과대학학술지

Background@#Patients who undergo coronary artery bypass graft (CABG) surgery receive regular physical examinations and medications on an outpatient basis. However, these patients are at risk of developing other vascular diseases, such as postoperative arterial steno-occlusive disease (SOD). This study investigated the incidence of SOD and related factors. @*Methods@#In total, 246 patients who underwent CABG surgery from January 1, 2017 to December 31, 2021 were investigated. The incidence and risk factors of vascular disease were analyzed by dividing the included patients into SOD and non-SOD groups. Laboratory tests, medical history, surgical information, and family history were investigated through an electronic chart review. @*Results@#Data from 193 patients who met the criteria were analyzed. SOD occurred in 19.1% of patients, and the cerebral artery (38%) was the most common artery involved, followed by the peripheral artery (32%), the coronary artery (22%), and the retinal artery (8%). Risk factors for the development of SOD included estimated glomerular filtration rate (eGFR; odds ratio [OR]=0.977, p=0.008), cholesterol (OR=1.020, p=0.001), and patients with diabetes complications (OR=5.077, p=0.010). The 3-year cumulative incidence rate was 21.6%, and the risk factors for cumulative occurrence were a low eGFR, elevated cholesterol, and complications of diabetes. @*Conclusions@#Low eGFR, high cholesterol, and the presence of diabetic complications before CABG surgery may be associated with postoperative vascular disease. In these cases, close monitoring, proper drug administration, and patient warnings may be required.

Autologous Retinal Flap Transplantation of a Refractory Giant Macular Hole with Retinal Detachment

Purpose@#A giant macular hole with retinal detachment occurred in a patient who had undergone several surgical treatments for retinal detachment, macular hole, and complicated cataracts. Here we report a case of successful retinal attachment and macular hole closure for this patient after autologous retinal flap transplantation.Case summary: Recently, an 18-year-old female presented with a newly developed visual field disturbance in her left eye. She had been on medication for severe atopic dermatitis in the past and seven years ago underwent scleral buckling, pars plana vitrectomy, and complicated cataract surgery due to rhegmatogenous retinal detachment of the left eye. Five years ago, extensive internal limiting membrane peeling, intravitreal gas tamponade, and aftercataract removal were performed due to the development of a macular hole with retinal detachment of the left eye. Thereafter, although the retina was reattached, closure of the macular hole was not successful. Recently, a giant macular hole with a retinal detachment was detected in this patient accompanied by symptoms of visual disturbance. Autologous retinal flap transplantation and intravitreal silicone oil tamponade were performed. Two months after the operation, she underwent silicone oil removal. Successful closure of the macular hole and retinal reattachment were confirmed. @*Conclusions@#In a patient with a refractory giant macular hole with retinal detachment, the closure of the hole and retinal reattachment were successfully achieved after retinal flap transplantation, without viscoelastics or perfluorocarbon liquid.

Leukocyte-Poor Platelet-Rich Plasma-Derived Growth Factors Enhance Human Fibroblast Proliferation In Vitro

BACKGROUND: Leukocyte-poor platelet-rich plasma (LP-PRP) from peripheral blood is currently used as a concentrated source of growth factors to stimulate repair at sites of soft tissue injury. Fibroblasts are primary mediators of wound healing. Thus, we aimed to assess the positive effect of LP-PRP on human fibroblast proliferation in vitro. METHODS: LP-PRP was prepared from 49 donors. The fibroblasts were seeded, and at 24 hours after seeding, 1 × 107/10 µL LP-PRP was added once to each well. The cells were harvested 10 times during study period at our planned points, and we examined cell proliferation using the water-soluble tetrazolium salt-1 assay. We collected the supernatants and measured the amount of growth factors such as platelet-derived growth factor (PDGF)-AB/BB, insulin-like growth factor-1 (IGF-1), transforming growth factor-β1 (TGF-β1), and vascular endothelial growth factor (VEGF), which are known to be involved in wound healing processes, by multiplex assay. RESULTS: Human fibroblasts treated with LP-PRP showed a significant increase in proliferation when compared to untreated controls (p < 0.001 at days 4, 6, and 8). Multiplex cytokine assays revealed various secretion patterns. PDGF-AB/BB appeared at early time points and peaked before fibroblast proliferation. IGF-1 and TGF-β1 secretion gradually increased and peaked on days 4 and 6 post-treatment. The early VEGF concentration was lower than the concentration of other growth factors but increased along with cell proliferation. CONCLUSIONS: Platelets in LP-PRP release growth factors such as PDGF, IGF-1, TGF-β1 and VEGF, and these growth factors have a promoting effect for human fibroblast proliferation, one of the important mediators of wound healing. These results suggest that growth factors derived from LP-PRP enhance the proliferation of human fibroblast.

Comparison of shearbond strength between metal and indirect resin according to the different conditionings / 대한치과보철학회지

PURPOSE: The purpose of this study is to investigate the differences in bond strength of four different indirect composites to the gold alloy and Ni-Cr alloy according to type of metal surface treatment after water storage. MATERIALS AND METHODS: Type IV gold alloy and Ni-Cr alloy were used for casting alloy while four types of indirect composite resins (Gradia, Tescera Sinfony and in;joy) were used in this study. Metal specimens were produced by casting and total of 240 specimens (60 specimens per one indirect composite group) were prepared. After bonding indirect composite resin and undergoing 24 hours of polymerization, customized jig was attached to the metal specimen and shear bond strength were measured using universal testing machine. Also, differences in shear bond strength before and after water storage for 240 hours were also measured. RESULTS: In the measurement of shear bond strength according to the metal surface treatments, bead group showed high strength followed by loop and flatting group (P<.05). After being stored in water bath for 240 hours, Gradia showed statistically significant high bond strength compared to other indirect composite resins in all groups (P<.05). CONCLUSION: Shearbond strength was found to be different according to type of metal surface treatment and type of metal used after storage in water. Further studies need to be developed for clinical practices as three are still problems of microleakage, stain or wear.

Antinociceptive Effects of Transcytosed Botulinum Neurotoxin Type A on Trigeminal Nociception in Rats

We examined the effects of peripherally or centrally administered botulinum neurotoxin type A (BoNT-A) on orofacial inflammatory pain to evaluate the antinociceptive effect of BoNT-A and its underlying mechanisms. The experiments were carried out on male Sprague-Dawley rats. Subcutaneous (3 U/kg) or intracisternal (0.3 or 1 U/kg) administration of BoNT-A significantly inhibited the formalin-induced nociceptive response in the second phase. Both subcutaneous (1 or 3 U/kg) and intracisternal (0.3 or 1 U/kg) injection of BoNT-A increased the latency of head withdrawal response in the complete Freund's adjuvant (CFA)-treated rats. Intracisternal administration of N-methyl-D-aspartate (NMDA) evoked nociceptive behavior via the activation of trigeminal neurons, which was attenuated by the subcutaneous or intracisternal injection of BoNT-A. Intracisternal injection of NMDA up-regulated c-Fos expression in the trigeminal neurons of the medullary dorsal horn. Subcutaneous (3 U/kg) or intracisternal (1 U/kg) administration of BoNT-A significantly reduced the number of c-Fos immunoreactive neurons in the NMDA-treated rats. These results suggest that the central antinociceptive effects the peripherally or centrally administered BoNT-A are mediated by transcytosed BoNT-A or direct inhibition of trigeminal neurons. Our data suggest that central targets of BoNT-A might provide a new therapeutic tool for the treatment of orofacial chronic pain conditions.

A Case of Spontaneous Closure of Macular Hole in a Previously Vitrectomized Eye

PURPOSE: To report a case of spontaneous closure of a macular hole in a previously vitrectomized eye. CASE SUMMARY: A 71-year-old female had undergone vitrectomy on the left eye due to a secondary epiretinal membrane with vitreous opacity caused by vasculitis. After the procedure, while the patient was still on medication for the recurrent inflammation of the anterior and posterior segment of the vitreous, a macular hole was found after fundus examinations. Visual acuity of her left eye was 0.125 and ocular coherence tomography (OCT) confirmed a full thickness macular hole with a perifoveal cyst. We recommended vitrectomy, internal limiting membrane peeling, and intravitreal gas injection, but the patient refused further intervention due to her poor general condition. After 2 weeks, resolution of the perifoveal cyst with the macular hole was observed. After 13 weeks, OCT revealed the complete closure of the macular hole with normal foveal depression and the patient regained 0.4 visual acuity. CONCLUSIONS: Spontaneous closure of macular hole is a rare phenomenon in vitrectomized eyes, but a small macular hole with inflammation may close spontaneously without additional intervention. Therefore, observation should be considered rather than hasty surgical intervention. Apparently, the spontaneous closure of a macular hole is due to degenerative processes such as development of macular edema and natural recovery.

Results of Renal Allograft in Recipient with Iliac Endarterectomy / 대한이식학회지

PURPOSE: Pretransplant peripheral vascular examination in renal transplant recipient is not common even though the uremic status is a risk factor of developing atherosclerosis. Since that kind of atherosclerotic stenosis is inadequate for renal artery anastomosis, surgeons should perform certain procedures in that area. Until now, we have no written report about the results of renal transplant recipient who have been done endarterectomy at anastomosing iliac artery. The aim of this paper is to review the results of renal allograft recepient whose anastomosed iliac artery is endarterectomized at the time of transplantation. METHODS: Among 161 living donor renal allografts which were performed between January 1993 through June 1998, 21 allografts needed recipient iliac artery endarterectomy before vascular anastomosis. Their graft survivals, serial changes of blood pressure, serum creatinine level, and ultrasonic measure of renal arterial diameter and peak systolic velocity with their wave patterns were compared between endarterectomy group and non-endarterectomy group (control group). Mean age of endarterectomy group was older than control group (45.4 vs 32.9). Endarterectomy was done at internal iliac artery in 18 patients and both common and external iliac arteries in 3 patients. RESULTS: One and 3 year graft survivals showed higher in endarterectomy group than control group (90.9% vs 82.3%). Uncontrolled hypertension of endarterectomy group was 6.3%, 11.5%, 27.3% in 12, 24, 36 months and that of control group was 18.9%, 23.6%, 25.1%, but there was no statistical significance between groups. Serial changes of serum creatinine level of endarterectomy group was maintained low until the end of 3 years compare to control group (1.2 0.9 mg/ml vs 1.9 1.1). There was no difference between groups in peak systolic velocity and wave pattern proximal and distal to the anastomotic site of renal artery, and also no difference in measured arterial diameter and resistance index. CONCLUSION: Endarterectomy of recipient iliac artery before transplant renal vascular anastomosis show no adverse effect on recipient blood pressure, renal allograft function, graft survival and renal artery restenosis at least up to 3 years after graft.

Sublingual Nitrate-Augmented Redistribution in Thallium-201 Myocardial Perfusion SPECT Compared with Repeated Injection to Detect Viable Myocardium

BACKGROUND: To assess the myocardial perfusion state after myocardial infarction, Tl-201 SPECT (Thallium-201 Single Photon Emission Computed Tomography) with a repeated "booster" injection before the acquisition of delayed redistribution image is more sensitive and more effective than conventional 4 hour redistribution image. However, this protocol has several disadvantages such as patient inconvenience, additional Tl-201 dose and compromised quantitative analysis. In this study, we compared 4 hour nitrate-augmented redistribution protocol with standard 24 hour delayed redistribution protocol with reinjection to evaluate the usefulness of sublingual nitrate to augment myocardial perfusion and the effectiveness of myocardial assessment for each protocol. METHODS: In 20 myocardial infarction patients, stress-redistribution Tl-201 SPECT was performed. Immediately after resting redistribution image was taken, each patient was administered 0.6 mg of nitroglycerin sublingually without additional Tl-201 and nitrate-augmented SPECT was taken after 30 minutes. Each patient then returned the next day and was injected with a booster dose of Tl-201 30 minutes before the delayed redistribution SPECT acquisition. For the analysis of SPECT study, the myocardium was divided into 22 segments, and the perfusion to each segment was scored on a four-point scale by consensus. An overall cardiac perfusion score was derived by summing the perfusion score for each segment. RESULTS: Reduced stress perfusion was identified in 258 segment among total 440 segments: 61 (23.6%) had improved perfusion after rest redistribution; 145 (56.2%) had improved perfusion after nitrate-augmented redistribution; 140 (54.2%) had improved perfusion after 24 hour delayed redistribution after Tl-201 reinjection. The cardiac perfusion score after stress was 38.2+/-13.1. The score increased to 41.5+/-13.1 after rest redistribution. The perfusion score were improved to 46.3+/-10.4 (p< or =0.05 vs. rest redistribution) after nitrate augmentation. The cardiac perfusion score, 46.2+/-10.8, did not improve further after delayed redistribution. CONCLUSION: Tl-201 SPECT with sublingual nitrate-augmented redistribution is as same or better than 24-hour delayed redistribution with reinjection to detect viable myocardium. Therefore, Tl-201 SPECT with sublingual nitrate-augmented redistribution has economic and time sparing advantage over traditional 24 hour delayed redistribution with reinjection.