Correlation between Macular GCIPL Thickness and Visual Acuity after Resolution of Diabetic Macular Edema

PURPOSE: To evaluate the peripapillary retinal nerve fiber layer (pRNFL) thickness and macular ganglion cell-inner plexiform layer (mGCIPL) thickness in eyes with resolved diabetic macular edema (DME). METHODS: Twenty eyes of diabetic retinopathy patients with resolved DME (DME group) after treatment, and 20 eyes of diabetic retinopathy patients without DME (no-DME group) were included in this study. The pRNFL thickness, mGCIPL thickness and central macular thickness (CMT) were measured using spectral-domain optical coherence tomography (SD-OCT). Analyses were performed to determine the correlation between the different thicknesses and the visual function. RESULTS: No significant difference in mean CMT was observed between the DME and no-DME groups. Average pRNFL thickness in the DME group was thicker than in the no-DME group (p = 0.003). Average mGCIPL thickness in the DME group was thinner than in the no-DME group (p = 0.030). Final visual acuity was significantly correlated with average mGCIPL thickness and minimum mGCIPL thickness, but not pRNFL thickness and CMT in the DME group. CONCLUSIONS: mGCIPL thickness decreased in the DME group compared with the no-DME group and was correlated with the visual acuity. These results suggested that inner retinal injury in patients with DME might lead to poor visual outcome after treatment.

Intraocular Foreign Body of a Vitreous Cutter Tip Fragment

PURPOSE: To report a case of intraocular foreign body of a vitreous cutter tip fragment. CASE SUMMARY: A 60-year-old women was referred by her ophthalmologist with a two-day history of visual disturbance in her right eye. She had undergone pars plana vitrectomy, barrier laser and C3F8 gas injection due to pseudophakic rhegmatogenous retinal detachment in our retinal service center four months previously. Slit-lamp biomicroscopy of her right eye showed cornea stromal edema with Descemet membrane folding. Gonioscopic examination revealed a metallic foreign body in the direction of the 6-o'clock anterior chamber angle. Anterior chamber irrigation with successful removal of the metallic foreign body using intraocular foreign body forceps was performed. The removed intraocular foreign body was a vitrectomy cutter tip fragment 20 gauge in size and 3 mm in length. After surgery, the corneal stromal edema disappeared and her visual acuity in the right eye recovered. CONCLUSIONS: Intraoperative breakage of vitreous cutter tips can occur and cause toxic ocular tissue reaction. Care should be taken against vitreous cutter tip breakage during vitrectomy.

Effect of Triamcinolone on Angiogenesis-related Factors of Cultured Retinal Pigment Epithelial Cells

PURPOSE: To examine the effects of triamcinolone on angiogenesis related factors in cultured human retinal pigment epithelial cells. METHODS: Human retinal pigment epithelial cells were exposed to triamcinolone, cultured in a hypoxic environment, and expression and production of VEGF and PEDF were subsequently tested by RT-PCR and Western blot. Angiogenesis was measured via a tube formation assay using ECV 304 cells and with a migration assay using human dermal microvascular endothelial cells. RESULTS: Expression and production of VEGF and PEDF were tested by RT-PCR and Western blot, respectively. VEGF abundance was reduced while that of PEDF was unchanged in triamcinolone exposed retinal pigment epithelial cells cultured in hypoxic environment compared with cells with no treatment in hypoxic environment (p<0.05). Tube formation and cell migration were reduced by triamcinolone (p<0.05). CONCLUSIONS: These results suggest that triamcinolone affects the secretion of angiogenesis-related factors and suppresses neovascularization.

Various Treatments Using Invaluable Donor Cornea

PURPOSE: To report cases of transplanting a donor's 2 corneas to 5 patients suffering from several corneal diseases. CASE SUMMARY: Two corneas were donated from a 66-year-old donor, who suffered from brain damage due to asphyxia, one hour after being pronounced dead by doctors. Two penetrating keratoplasties and 3 partial lamellar keratoplasties were performed for patients with corneal opacity, corneal ulcer and corneal perforation. After the procedure all grafts were stable. CONCLUSIONS: Under the present circumstances of decreasing donations of corneas after death and the increasing demand for keratoplasty in Korea, the mutual cooperation among hospitals to treat more than one patient using one donated cornea is a method the authors believe can alleviate this situation.

A Case of Acinetobacter Baumannii Keratitis After Contact Lens Wearing

PURPOSE: To report a case of Acinetobacter baumannii keratitis in a soft contact lens wearer. To our knowledge, such a case has not been previously reported in South Korea. CASE SUMMARY: A 17-year-old boy who had worn soft contact lens for 4 months came to our hospital complaining of severe ocular pain, glare, and visual disturbance in his left eye for 2 days prior to admission. On slit-lamp examination, a round 2.5x4.5 mm lesion with epithelial defects and diffuse edema was noted. Numerous keratic precipitates and hypopyon on the dependent position were also noted. Specimens from corneal scraping, the contact lens itself, and the storage case with lens cleanser solution were evaluated by bacteriology examination. The patient was treated with topical 0.5% Moxifloxacin. A few days later, Acinetobacter baumannii was isolated in a bacterial culture from a corneal specimen. The patient's clinical features improved steadily with topical 0.5% Moxifloxacin therapy. Complete epithelialization with resolution of the corneal edema and inflammatory infiltrations of the left eye was achieved after 5 days of topical Moxifloxacin therapy. CONCLUSIONS: Along with a literature review, we report a case of successfully treated Acinetobacter baumannii keratitis in a soft contact lens wearer.

A Case of Purtscher's Retinopathy Responsive to High-dose Steroid Therapy

PURPOSE: To report a case of high dose steroid-responsive Purtscher's retinopathy which was developed after operation for diaphragmatic laceration sustained in motorcycle accident. CASE SUMMARY: A 68-year-old man came to our hospital with complaining of decreased visual acuity in the right eye after diaphragmatic laceration operation. Best corrected visual acuity was 0.1 in the right eye. Anterior segment was nonspecific. However, afferent pupillary defect was observed. Superficial intraretinal hemorrhage, numerous cotton-wool spots, peripapillary hemorrhage, and macular edema were detected on fundus examination. Fluorescein angiography revealed capillary nonperfusion and fluorescein filling defect due to retinal hemorrhage in arteriovenous phase and fluorescein leakage from the macula and capillary nonperfusion area in the late venous phase. Accordingly, Purtscher's retinopathy was diagnosed and the patient was observed without specific treatment. After 2 weeks of observation, symptoms and fundus findings were not changed. High-dose steroid therapy was begun with injection of one gram of methylprednisone for three days, switched to oral prednisolone, and then slowly tapered in period of 3 weeks. 7 days after the treatment, visual acuity was improved to 0.2 in the right eye but afferent pupillary defect was still observed. Cotton-wool spots slightly decreased, peripapillary hemorrhage was absorbed but macular edema was remained. 14 days after the treatment, visual acuity greatly improved to 0.63 and afferent pupillary defect was not observed. Cotton-wool spots and macular edema were decreased but fluoroscein leakage from capillary nonperfusion area was remained. CONCLUSIONS: In the case of Purtscher's retinopathy, high-dose steroid therapy can be a useful management method for the improvement of visual acuity and other symptoms.

Measurement of Replicative Senescence in Long Term Cultured Human Keratinocytes / 대한해부학회지

The keratinocyte culture has been used for the reconstruction of artificial skin or as in vitro skin model. For these purpose, keratinocytes should be cultured for long time (usually 10 cumulative population doublings) and it is important to evaluate the state of replicative senescence or cell senescence during this time. This study was undertaken to investigate senescence associated beta-galactosidase (SA-beta-gal) activity for the senescent cell and keratin 19 immunohistochemistry for the skin stem cell in keratinocytes on ten times serial subculture (referred to 10 cumulative population doublings). Keratinocytes were isolated from foreskin of a 2 day old child, and cultured in KSFM and then in DMEM/F-12. In both keratinocytes cultured in KSFM and DMEM/F-12, lysosomal beta-galactosidase activity, which is detected at pH 4.0, was present in all cells regardless of their replicative age. In contrast, SA-beta-gal activity, which is detected at pH 6.0, was present in a few cells (from 0.1% to 3%) during whole subcultures. These data suggest that most of keratinocytes did not undergo replicative senescence in this culture. Furthermore, in keratin 19 skin stem cell staining, a lot of keratinocytes (13.8%) showed strong positive reaction on the 10th subculture. Together with the results of beta-galactosidase activity, the persistence of high proportion of keratin 19 positive skin stem cells implies further increment of keratinocyte populations by continued subcultures.

The Study of Sexual Dysfunction in Patients with End Stage Renal Disease / 대한신장학회잡지

Sexual dysfunction is a common problem in patients with end stage renal disease. The pathogenesis of this problem is complex, and includes psychological factors, vascular, and neurological disorders, drug therapy, uremic intoxication and hormonal disturbances. However, we don't have any valid report because pathogenesis and physiologic significance is not proved clearly. With the questionnaire that we provided to our patients, we evaluated the sexual dysfunction in patients with end stage renal disease, and we treated our patient with antidepressants for males and estrogen for females. The results are as follows: 1) Sixty patients among 70 answered the sexual question. Among these, 46 patients (76%) complained of sexual dysfunction, 75% of male patients and 58% of female patients complained of impotence and mensturation disturbance, respectively. Especially, female patients complained of loss of libido as a whole. Also they said that they never tried to do anything to recover their sexual dysfunction. 2) After starting dialysis, 57% of patients showed decrease in coital frequency than before. 58% of patients showed no significant change in subjective sezual symptoms after dialysis. 18% of patients showed significant change in sexual function after anemia treatment. 3) Eighty-eight percents of males and one hundred percents of females treated with antidepressants and estrogen, respectively showed no effect. Finally, we found that sexual dysfunction is a common problem in chronic renal failure, but they never try to recover their conditions. Our therapeutic approach was not effective, but dialysis in CRF patient must be used for lifting the value of life, not by way of life extension. In addition we can make more effective treatment through objective study and psychological examination.

Unusual Endoscopic Retrograde Cholangiographic Finding in a Case of Xanthogranulomatous Cholecystitis / 대한소화기내시경학회지

Xanthogranulomatous cholecystitis is a rare form of chronic gallbladder inflammation that is characterized by a severe proliferative fibrosis and has rarely been described in the radiologic literature. Like xanthogranulomatous pyelonephritis, it is an entirely benign but unusual expression of a reactive process and may be confused with a malignant neoplasm. Histologically, foamy histiocytes, multinucleated giant cells, other inflammatory cells, fibrous reaction with spindle cells, cholesterol cleft and noncaseating granuloma were found. Treatment of this benign inflammatory condition requires cholecystectomy to remove the focus of inflammation, control subsequent infection and relieve symptoms A case of xanthogranulomatous cholecystitis mimiking carcinoma of the gallbladder on abdominal USG, abdominal CT, and ERCP examination is presented with brief review of the literature.

A Case of Acute Pancreatitis due to Impaction of Ascaris lumbricoides into the Pancreatic Duct / 대한소화기내시경학회지

Acute pancreatitis due to impaction of Ascaris lumbricoides into the pancreatic duct is very rare. Authors hnve experienced one case of pancreatic ascariasis. Patient was a 62-year-old female with epigastric pain. Abdominal USG and endoscopic retrograde cholangiopancreatography showed characteristic finding of pancreatic ascariasis. Ascaris was removed with palypectomy snare and acute pancreatitis was resolved completely.

Superficial Spreading Stomach Cancer: Report of One Case / 대한소화기내시경학회지

Superficial spreading stomach cancer, as first described by Stout in 1942, is superficially spreading cancer confined to mucosa and submucosa, and measuring up to 10 cm in diameter. Clinical manifestation is peptic ulcer like symptom with a long duration, and a gross appearance is characterized by reddening, irregular and slight nodular thickening of the involved mucosa. We should be careful to differentiate chronic atrophie gastritis or multiple superficial gastric erosions from superficial spreading stomach cancer. It is classified to a subtype of early gastric cancer type Ilc(IIc'') and the prognosis is as good as early gastric cancer. A 60-yearold woman was admitted to our hospital because of epigastric pain for 2 years. She was confirmed to have superficial spreading stomach cancer by gastroduodenoscopy, endoseopic ultrasonography, and operation. We report a case of superficial spreading stomach cancer with a review of relevant literatures.

A Case of Biliary Mucinous Cystadenocarcinoma / 대한소화기내시경학회지

Biliary cystadenoma and cystadenocarcinoma are rare tumors which have a good prognosis after complete surgical removal. Correct pre-operative diagnosis depends on the imaging characteristics of the tumors. Computed tomography, Ultrasono-graphy, angiography and cholangiogram are useful diagnostic procedure in biliary cystic tumor but definite diagnosis cannot be made without histologic diagnosis. Before the surgery, cholangioscopy is necessary for deciding operation field. The prognosis of the biliary cystic tumor seems to be much better than that of other solid hepatic tumors. If there is no evidence of metastasis, complete resection of these tumors is, therefore, necessary for these possibly curable disease. Recently, we experienced a 60-year-old woman complained of jaundice and generalized itching sensation, which was diagnosed as biliary mucinous cystadenocarcinoma. We decided operation field by cholangioscopy, and performed left hepatic lobectomy and T-tube choledochojejunostomy. So, we report this case with a review of relevant literature.