Treatment Results of Treatment-naïve Neovascular Age-related Macular Degeneration in Patients Over 85 Years of Age

Purpose@#To investigate the characteristics and treatment results of patients aged ≥ 85 years who were diagnosed with treatment-naïve neovascular age-related macular degeneration (nAMD). @*Methods@#The medical records of patients diagnosed with treatment-naïve nAMD who were ≥ 85 years old at the time of diagnosis with at least 12 months follow-up were retrospectively reviewed. The number of intravitreal injections of anti-vascular endothelial growth factor (VEGF) and agents used during the entire period were investigated. Best-corrected visual acuity and optical coherence tomography results before and after treatment were analyzed. Visual acuity of the fellow eye was also collected. @*Results@#A total of 40 eyes of 40 patients with mean age of 87.5 ± 2.4 were included in the study. The mean logarithm of the minimal angle of resolution visual acuity was 0.85 ± 0.57, and the mean of the fellow eye was 0.93 ± 0.99. Compared to before the treatment, there was no significant difference after intravitreal injection in terms of visual acuity. Central retinal thickness showed significant reduction at all time points after treatment. @*Conclusions@#In patients aged ≥ 85 years at the time of diagnosis, intravitreal injections of anti-VEGF prevented deterioration of visual acuity and showed successful anatomical outcomes. Especially, many had poor visual acuity in the fellow eye, suggesting the importance of maintaining visual acuity. Therefore, active treatment is necessary in the elderly.

Clinical analysis of direct medical oversight for the national pilot program of expanding scope of firefighter emergency medical services providers in a Korean metropolitan city

Objective@#The fire department-based emergency medical services (EMS) system and centralized direct medical oversight (DMO) system are well-established in Korea. In 2019, the government launched a national pilot program for expanding the scope of work of EMS providers. This study was undertaken to clinically examine DMO for the ‘specialized EMS squad’ in the Seoul Metropolitan City. @*Methods@#This is a descriptive analysis of the current status of the EMS of the city and DMO. The basic statistics of firefighter EMS providers and the DMO physicians, as well as the number of ambulance runs, were investigated during the study period (July to December 2019). Records of the DMO physicians were also reviewed, to assess intervention of the ‘specialized EMS squad’. @*Results@#Totally, 1,109 patients transferred to hospitals by the ‘specialized EMS squad’ were provided DMO (out-of-hospital cardiac arrest 833, chest pain 229, multiple injured trauma 21, anaphylaxis 17, unplanned out-of-hospital birth 4.; excluding 5 cases of insufficient records). In out-of-hospital cardiac arrest, intravenous epinephrine was implemented by 538 cases (64.6%). Single dose of intravenous epinephrine was used in 218 cases (40.5%), whereas two doses were administered in 163 cases (30.3%). In patients with chest pain, 12-lead electrocardiography was achieved in 226 cases (98.7%). The epinephrine autoinjector (0.3 mg) was applied for 10 cases of anaphylaxis (61.1%). Umbilical cord cutting was executed during 2 births (50%). @*Conclusion@#The national pilot program to expand the scope of firefighter EMS providers was successfully implemented in the Seoul Metropolitan City. Emergency physicians played critical roles for the application. The firefighter EMS providers were able to accomplish advanced life support level practices in the prehospital setting by DMO.

Survey of AREDS2 Formula Intake in Korean Patients with Age-related Macular Degeneration

Purpose@#To investigate the use of second AREDS2 formula in patients with intermediate or advanced age-related macular degeneration. @*Methods@#A prospective survey was conducted between December 2019 and July 2020. The questionnaire consisted of 24 questions on demographics, disease perception, and formula intake. @*Results@#The survey included 100 patients (males, 56%; age [>60 years], 89%). We found that 66%, 84%, and 93% of patients had a good understanding of their disease, had stopped smoking, and were aware of the need for antioxidant supplements; 58% of patients were aware of the supplement they were prescribed, and 63.8% (37% of total) were using the AREDS2 formula. Only 8% of patients had knowledge regarding the supplement ingredients, and 91% consumed the supplement daily. Patients with long disease duration used supplements less frequently (p < 0.05). Older patients and those with a low education level had a limited perception of the disease (p < 0.05). @*Conclusions@#In this prospective survey, some patients consumed supplements other than the AREDS2 formula. Further studies are required to determine ways to increase the use of the AREDS2 formula.

Analysis of Changes in Retinal Photoreceptors Using Optical Coherence Tomography in a Feline Model of Iodoacetic Acid-induced Retinal Degeneration

PURPOSE: We investigated structural changes in the retina by using optical coherence tomography (OCT) in a feline model of retinal degeneration using iodoacetic acid (IAA).METHODS: We examined 22 eyes of 11 felines over 2 years of age. The felines had fasted for 12 hours and were intravenously injected with IAA 20 mg/kg of body weight. OCT (Spectralis OCT) was performed at the point where the ends of the retinal vessels collected in the lateral direction from the optic nerve head and area centralis. Similarly, OCT was performed four times at 1-week intervals following injections, at which point the felines were sacrificed and histologic examinations were performed. Using OCT, the thickness of each layer of the retina was measured.RESULTS: The average body weight of the three male and eight female felines investigated in this study was 1.61 ± 0.19 kg. The mean total retinal thickness of the felines before injection was 221.32 ± 9.82 µm, with a significant decrease in the retinal thickness at 2, 3, and 4 weeks following injections of 186.41 ± 35.42, 174.56 ± 31.94, and 175.35 ± 33.84 µm, respectively (p = 0.028, 0.027, and 0.027, respectively). The thickness of the outer nuclear layer was 57.49 ± 8.03 µm before injection and 29.26 ± 17.87, 25.62 ± 13.88, and 31.60 ± 18.38 µm at 2, 3, and 4 weeks, respectively, after injection (p = 0.028, 0.028, 0.046, respectively).CONCLUSIONS: In a feline model of retinal degeneration using IAA, the total retinal thickness and the thickness of the outer nuclear layer were shown to decrease significantly on OCT.

Analysis of Ocular Complications and Blowout Fracture in Orbital Blunt Trauma

PURPOSE: To help predict the severity of ocular complications in orbital blunt trauma by analyzing clinical features of ocular complications and orbital wall fracture. METHODS: A retrospective survey consisting of 169 eyes of 168 patients with orbital blunt trauma who visited Kosin University Gospel Hospital was performed. The patients' age, gender, height, weight, cause of accident, and ocular complications were investigated. The patients were imaged using computer tomography and divided into two groups according to whether they had orbital wall fracture: the orbital contusion group and the orbital wall fracture group. Variables of orbital wall fracture, including the location, length, width, and area were measured using computer tomography in the orbital wall fracture group. RESULTS: The incidence of ocular complication was 27 of 67 eyes (40.2%) in the orbital wall fracture group and 75 of 102 eyes (73.5%) in the orbital contusion group; ocular complications were found significantly more often in the orbital contusion group than in the orbital wall fracture group (p < 0.001). Among causes of the accident, 'flying object' showed the highest incidence of ocular complication at 40 of 48 eyes (85.1%). In the orbital wall fracture group, there was no significant difference in orbital fracture location, length, width or area between the ocular complication group and the non-ocular complication group. CONCLUSIONS: Ocular complications were found significantly more often in the orbital contusion group than in the orbital wall fracture group, and 'flying object' showed the highest incidence of ocular complication among causes of the accident.

A Case of Branch Retinal Artery Occlusion Associated with Takayasu's Arteritis

PURPOSE: Takayasu's arteritis generally involves the aorta and its main branch. Various ocular manifestations associated with Takayasu's arteritis have been reported, but branch retinal artery occlusion (BRAO) is very rare. We report a case of BRAO associated with Takayasu's arteritis. CASE SUMMARY: 53-year-old female patient visited out emergency room for an inferior visual field defect of the right eye that had presented 2 hours earlier. Visual acuity was 1.0 in both eyes. There were no abnormalities of the anterior segment or pupil reflex. On fundus examination, superior retinal whitening was observed in her right eye. Through ancillary study including optical coherence tomography and fluorescein angiography, she was diagnosed with BRAO and underwent conservative treatments. She had received previous treatment and had been followed-up for Takayasu's arteritis for 20 years. She complained of general weakness, and body temperature was 38.7℃. On blood analysis, erythrocyte sedimentation rate and C-reactive protein were increased compared to previous levels. She was medically treated on the assumption of relapse of Takayasu's arteritis. After 3 months, the retinal whitening in her right eye was resolved, but the visual field defect remained similar to that at the initial visit. CONCLUSIONS: We report this rare case of BRAO associated with Takayasu's arteritis, indicating the need to consider an association between the two diseases.

Comparison of Related Factors between Twins in Which Premature of Retinopathy Developed on One Twin

PURPOSE: To analyze related factors of retinopathy of prematurity by comparing between premature twins in which retinopathy developed on one twin. METHODS: A retrospective survey consisting of 13 premature twins in which retinopathy of prematurity (stage 1 or more) developed on one twin was performed. All twins were born in Kosin University Gospel Hospital. The twins were separated into two groups according to whether they had retinopathy of prematurity: the retinopathy of prematurity (ROP) group and non-ROP group. The twins' gestational age, weight, sex, Apgar score, treatments, blood tests, and neonatal complications were investigated. RESULTS: There were no significant differences between the twins except platelet count and aspartate aminotransferase. Platelet count was 191 (±46) ×10³/µL in the ROP group and 240 (±77) ×10³/µL in the non-ROP group, a significant difference (p = 0.046). Aspartate aminotransferase was 36 (±26.6) IU/L in the ROP group and 22 (±5.9) IU/L in the non-ROP group, a significant difference (p = 0.019). CONCLUSIONS: In conclusion, we found platelet count and aspartate aminotransferase to be significant factors related to development of retinopathy of prematurity. It is thought that these factors should be considered when screening for ROP, although a larger prospective study is be needed before the results can be applied in clinical practice.

Exposure to Diagnostic Radiation in Patients with Inflammatory Bowel Disease: A Single Center Study

BACKGROUND/AIMS: Western studies recently reported that patients with inflammatory bowel disease (IBD) are exposed to diagnostic radiation at potentially harmful levels. There is little research, however, on exposure to diagnostic radiation in patients with IBD in Asian areas. The present study assessed cumulative radiation exposure dose in patients with IBD who were treated at a single-tertiary medical center in Korea and analyzed the factors that increased the exposure dose. METHODS: Retrospective investigation was performed of the medical records of the patients who were followed up for 1 year or more in a period from January 2003 through November 2011 at Kangbuk Samsung Hospital. RESULTS: Included in the study were 202 patients with IBD: 80 (39.6%) had Crohn's disease (CD) and 122 (60.4%) had ulcerative colitis (UC). The mean follow-up period was 4.2+/-2.5 years for CD and 4.3+/-1.4 years for UC. The mean culmulative effective dose (CED) for CD and UC were 39.7 and 11.0 mSv respectively (P<0.001). In CD, factors associated with increased CED were surgery, history of intravenous steroid treatment, and structuring or penetrating disease. CONCLUSIONS: A substantial proportion of IBD patients, especially CD patients, were exposed to significantly harmful amounts of diagnostic radiation, mainly due to computed tomography examination. Efforts should be made to reduced diagnostic medical radiation, especially in patients at risk for increased radiation exposure.

Endoscopy Nurse Participation May Increase the Polyp Detection Rate by Second-Year Fellows during Screening Colonoscopies

BACKGROUND/AIMS: The aim of this study was to assess the effects of endoscopy nurse participation on polyp detection rate (PDR) and adenoma detection rate (ADR) of second-year fellows during screening colonoscopies. METHODS: This was a single-center, prospective, randomized study comparing a fellow alone and a fellow plus an endoscopy nurse as an additional observer during afternoon outpatient screening colonoscopies. The primary end points were PDR and ADR. RESULTS: One hundred ninety-one colonoscopies performed by a fellow alone and 192 colonoscopies performed by a fellow plus an endoscopy nurse were analyzed. The PDR was significantly higher when the nurse was involved (53.1% vs. 41.3%, p or =2 polyps, advanced adenomas, polyp size, polyp location, and polyp shapes between the two groups. There was no difference in the PDR according to the level of experience of the endoscopy nurse. CONCLUSIONS: Endoscopy nurse participation as an additional observer during screening colonoscopy performed by second-year fellow increases the PDR; however, the level of experience of the nurse was not an important factor.

Clinical outcomes of balloon-occluded retrograde transvenous obliteration for the treatment of gastric variceal hemorrhage in Korean patients with liver cirrhosis: a retrospective multicenter study

BACKGROUND/AIMS: This study evaluated the clinical outcomes of balloon-occluded retrograde transvenous obliteration (BRTO) for the treatment of hemorrhage from gastric varices (GV) in Korean patients with liver cirrhosis (LC). METHODS: We retrospectively analyzed data from 183 LC patients who underwent BRTO for GV bleeding in 6 university-based hospitals between January 2001 and December 2010. RESULTS: Of the 183 enrolled patients, 49 patients had Child-Pugh (CP) class A LC, 105 had CP class B, and 30 had CP class C at the time of BRTO. BRTO was successfully performed in 177 patients (96.7%). Procedure-related complications (e.g., pulmonary thromboembolism and renal infarction) occurred in eight patients (4.4%). Among 151 patients who underwent follow-up examinations of GV, 79 patients (52.3%) achieved eradication of GV, and 110 patients (72.8%) exhibited marked shrinkage of the treated GV to grade 0 or I. Meanwhile, new-appearance or aggravation of esophageal varices (EV) occurred in 54 out of 136 patients who underwent follow-up endoscopy (41.2%). During the 36.0+/-29.2 months (mean+/-SD) of follow-up, 39 patients rebled (hemorrhage from GV in 7, EV in 18, nonvariceal origin in 4, and unknown in 10 patients). The estimated 3-year rebleeding-free rate was 74.8%, and multivariate analysis showed that CP class C was associated with rebleeding (odds ratio, 2.404; 95% confidence-interval, 1.013-5.704; P=0.047). CONCLUSIONS: BRTO can be performed safely and effectively for the treatment of GV bleeding. However, aggravation of EV or bleeding from EV is not uncommon after BRTO; thus, periodic endoscopy to follow-up of EV with or without prophylactic treatment might be necessary in LC patients undergoing BRTO.