Ocular Surface Reconstruction Using Circumferentially-trephined Autologous Oral Mucosal Graft Transplantation in Limbal Stem Cell Deficiency

PURPOSE: To investigate the effects of transplantation of a circumferentially-trephined autologous oral mucosal graft using a vacuum trephine on ocular surface reconstruction in patients with limbal stem cell deficiency. METHODS: Patients with a limbal stem cell deficiency who underwent transplantation of autologous oral mucosal graft performed by a particular surgeon in Seoul National University Hospital were included. The medical records of these five patients were retrospectively reviewed. The lower labial mucosal graft inside the inferior lip was trephined to a depth of 250 µm using a donor vacuum trephine with a 9-mm diameter. Outside markings were made using a 14-mm intraoperative keratometer. The oral mucosal graft was dissected under a microscope using a Beaver mini-blade as either a ring or a crescent-shaped strip with a 5-mm width. The mucosal graft was transplanted onto the limbus in the limbal-deficient eye. Best-corrected visual acuity and corneal status were measured during the follow-up period. RESULTS: Four patients were diagnosed with Stevens-Johnson syndrome and one was diagnosed with atopy-associated immune keratitis. The mean follow-up period was 10.4 ± 2.9 months. After 4 months, visual acuity improved in all patients, and the mean improvement in logarithm of the minimum angle of resolution visual acuity was 0.526 ± 0.470 (range, 0.15 to 1.10). Corneal surface erosion and neovascularization decreased in four patients, and stromal opacity decreased in two patients. The engraftments maintained ocular surface stabilization in four of the five patients at the last follow-up. CONCLUSIONS: Transplantation of circumferential autologous oral mucosal grafts may be effective for the treatment of limbal stem cell deficiency.

Trifocal versus Bifocal Diffractive Intraocular Lens Implantation after Cataract Surgery or Refractive Lens Exchange: a Meta-analysis

BACKGROUND: We compared the efficacy between trifocal and bifocal diffractive intraocular lens (IOL) implantation. METHODS: Through PubMed, MEDLINE, EMBASE, and CENTRAL, we searched potentially relevant articles published from 1990 to 2018. Defocus curves, visual acuities (VAs) were measured as primary outcomes. Spectacle dependence, postoperative refraction, contrast sensitivity (CS), glare, and higher-order aberrations (HOAs) were measured as secondary outcomes. Effects were pooled using random-effects method. RESULTS: We included 11 clinical trials, with a total of 787 eyes (395 subjects). The trifocal IOL group showed better binocular distance VA corrected with defocus levels of −0.5, −1.0, −1.5, and −2.5 diopter than the bifocal IOL group (All P ≤ 0.004). The trifocal IOL group showed better monocular uncorrected distance and intermediate VAs (mean difference [MD], −0.04 logarithm of the minimum angle of resolution [logMAR]; 95% confidence interval [CI], −0.07, −0.01; P = 0.006 and MD, −0.07 logMAR; 95% CI, −0.13, −0.01; P = 0.03, respectively). Postoperative refraction, glare, CS, and HOAs were not significantly different from each other. CONCLUSION: The overall findings indicate that trifocal diffractive IOL implantation is better than the bifocal diffractive IOL in intermediate VA, and provides similar or better in distance and near VAs without any major deterioration in the visual quality.

Improving the Toric Intraocular Lens Calculation by Considering Posterior Corneal Astigmatism and Surgically-induced Corneal Astigmatism

PURPOSE: To investigate the effect of surgically induced corneal astigmatism (SICA) and total corneal astigmatism (TCA) estimation on the anterior corneal astigmatism (ACA)-based toric intraocular lens (IOL) calculation. METHODS: Data from preoperative and postoperative corneal astigmatism, postoperative visual acuities, and refractive outcomes were collected. The incision was superior in with the rule anterior corneal astigmatism (WTRA) eyes and temporal in against the rule anterior corneal astigmatism eyes. The following five methods of calculating the toric IOL were compared: (1) ACA only and estimated SICA; (2) ACA with a fixed posterior corneal astigmatism (PCA) and estimated SICA; (3) ACA with a fixed PCA value and actual SICA; (4) and (5) TCA derived from the regression equations of ACA and actual SICA. The residual astigmatism was simulated. The Alpins method was used to analyze the astigmatism. RESULTS: Sixty eyes from 46 patients were enrolled. Thirty eyes had WTRA and the other thirty had against the rule anterior corneal astigmatism. The vector and arithmetic means of the difference vector decreased when the information regarding the actual SICA and PCA was added to the calculation (from 0.59 diopters [D] @ 87.5° to 0.15 D @ 48.5°, and from 0.95 ± 0.53 to 0.71 ± 0.63 D, respectively; p < 0.001). The mean difference vector across the whole sample was lowest using model 5. The correction index was significantly closest to 1.0 in the WTRA group. CONCLUSIONS: Researchers may improve the accuracy of post-implantation predictions by calculating toric IOL using exact SICA and TCA, with consideration of the PCA derived from the regression equation of ACA.

Distribution of Interleukin-22–secreting Immune Cells in Conjunctival Associated Lymphoid Tissue

PURPOSE: Interleukin (IL)-22 is a cytokine involved in epithelial cell regeneration. Currently, no research studies have analyzed the distribution of the three distinct IL-22–secreting cell populations in human or mouse conjunctiva. This study investigated the distribution of the three main populations of IL-22–secreting immune cells, αβ Th cells, γδ T cells, or innate cells (innate lymphoid cells [ILCs] or natural killer cells), in conjunctival associated lymphoid tissues (CALTs) in human and mouse models. METHODS: We collected discarded cadaveric bulbar conjunctival tissue specimens after preservation of the corneo-limbal tissue for keratoplasty from four enucleated eyes of the domestic donor. The bulbar conjunctiva tissue, including the cornea from normal (n = 27) or abraded (n = 4) B6 mice, were excised and pooled in RPMI 1640 media. After the lymphoid cells were gated in forward and side scattering, the αβ Th cells, γδ T cells, or innate lymphoid cells were positively or negatively gated using anti-CD3, anti-γδ TCR, and anti–IL-22 antibodies, with a FACSCanto flow cytometer. RESULTS: In normal human conjunctiva, the percentage and number of cells were highest in αβ Th cells, followed by γδ T cells and CD3–γδ TCR – IL-22+ innate cells (presumed ILCs, pILCs) (Kruskal-Wallis test, p = 0.012). In normal mice keratoconjunctiva, the percentage and total number were highest in γδ T cells, followed by αβ Th cells and pILCs (Kruskal-Wallis test, p = 0.0004); in corneal abraded mice, the population of αβ Th cells and pILCs tended to increase. CONCLUSIONS: This study suggests that three distinctive populations of IL-22–secreting immune cells are present in CALTs of both humans and mice, and the proportions of IL-22+αβ Th cells, γδ T cells, and pILCs in CALTs in humans might be differently distributed from those in normal mice.

Effect of Hydroxychloroquine Treatment on Dry Eyes in Subjects with Primary Sjögren's Syndrome: a Double-Blind Randomized Control Study

The effect of hydroxychloroquine (HCQ) on dry eye has not been fully determined. This study aimed to compare the 12-week efficacy of HCQ medication with that of a placebo in the management of dry eye in primary Sjögren's syndrome (pSS). A double-blind, randomized control study was conducted in 39 pSS subjects from May 2011 through August 2013. pSS was diagnosed based on the classification criteria of the American-European Consensus Group. Subjects received 300 mg of HCQ or placebo once daily for 12 weeks and were evaluated at baseline, 6, and 12 weeks, with a re-visit at 16 weeks after drug discontinuance. The fluorescein staining score, Schirmer test score, tear film break-up time (TBUT), and ocular surface disease index (OSDI) were measured, and tears and blood were collected for ESR, IL-6, IL-17, B-cell activating factor (BAFF), and Th17 cell analysis. Color testing was performed and the fundus was examined to monitor HCQ complications. Twenty-six subjects completed the follow-up. The fluorescein staining score and Schirmer test score did not differ significantly. The OSDI improved with medication in the HCQ group but was not significantly different between the groups. TBUT, serum IL-6, ESR, serum and tear BAFF, and the proportion of Th17 cells did not change in either group. HCQ at 300 mg daily for 12 weeks has no apparent clinical benefit for dry eye and systemic inflammation in pSS (ClinicalTrials.gov. NCT01601028).

The Relationship of Caffeine Intake with Depression, Anxiety, Stress, and Sleep in Korean Adolescents / 가정의학회지

BACKGROUND: In various studies in adults, caffeine may increase wakefulness and relieve pain, but caffeine overdose can cause many adverse serious effects on health. Caffeine intake has recently been increasing in adolescents. In spite of importance of caffeine effects on Korean adolescents, there are lack of scientific and systematic studies. The purpose of our study was to identify the relationship between caffeine consumption and effects on adolescents. METHODS: We performed study on 234 middle school students at one middle school in Daegu using a self-report questionnaire. We divided students to quartiles according to amount of caffeine intake. We used Beck Depression Inventory (BDI) to evaluate the degree of depression and Beck Anxiety Inventory (BAI) to evaluate the degree of anxiety. We also used Insomnia Severity Scale (ISI) to evaluate the degree of insomnia and Global Assessment of Recent Stress (GARS) to evaluate the stress in students. We used logistic regression analysis to identify the relationship between caffeine consumption and effects. RESULTS: Higher caffeine intake was associated with higher weight, height, lower academic achievement, and higher score in BDI, BAI, ISI, and GARS (P for trend <0.005). Higher caffeine intake quartile was associated with greater odds of having significant depression (BDI ≥10, P for trend=0.011), and insomnia (ISI ≥8, P for trend=0.015) after adjustment for factors that can affect the psychological status. CONCLUSION: We found that caffeine intake is associated weight, height, academic achievement, and higher score in BDI, BAI, ISI, and GARS. Caffeine intake was positively associated with the severity of depression and the severity of insomnia among adolescents in Korean.

Clinical Efficacy of Topical Voriconazole as Treatment in Culture-Positive Fungal Keratitis

PURPOSE: To evaluate the efficacy of topical voriconazole in treatment of culture-positive fungal keratitis. METHODS: Twenty-two cases of culture-positive fungal keratitis treated with topical anti-fungal drugs from October 2004 to December 2010 were evaluated and medical records were reviewed. Patients were divided into 3 groups according to the method of topical antifungal treatment; the first group (V, n = 6) received voriconazole monotherapy, the second group (V+, n = 10) received topical voriconazole and amphotericin B combined therapy, and the third group (A, n = 6) received amphotericin B monotherapy. RESULTS: The treatment success rate between the 3 groups was not significantly different. The epithelial defect healing time of group V was shorter than group V+. Treatment failure risk factors included Fusarium spp. infection and the presence of hypopyon. Eight eyes received topical voriconazole maintenance therapy for 66 days and there were no corneal erosions or epithelial defects. CONCLUSIONS: In fungal keratitis, topical voriconazole is as effective as other standard treatments and provides a faster healing time in the corneal epithelium than other standard treatments. However, voriconazole should be used with caution and therapeutic surgery should be considered in Fusarium spp. infections.

A Case of Vesiculobullous Darier' Disease / 대한피부과학회지

Vesiculobullous Darier's disease is a rare variant of Darier's disease which is characterized by vesicles and bullae, usually distributed on the sun-exposed areas of the body. Blistering may be percipitated by factors such as high humidity, ultraviolet radiation, etretinate treatment, surgery or physical stress. Widespread vesiculation or bullous lesions are unusual in the absence of cutaneous bacterial or viral infections. Herein, we report an unusual case of vesiculobullous Darier's disease which developed on the scalp in a 25-year-old man.

A Case of Hailey-Hailey Disease Improved with Topical Tacrolimus Ointment / 대한피부과학회지

A 45-year-old woman presented with a six-month history of Hailey-Hailey disease, which was recalcitrant to many dermatologic therapies including systemic antibiotics, dapsone, and topical corticosteroids. We precribed tacrolimus (0.1%) ointment for application to the lesions twice a day and examined weekly for the efficacy; the lesions were much improved after 6 weeks of treatment.

A Case of Verrucous Malignant Melanoma / 대한피부과학회지

Verrucous malignant melanoma is a rare variant of melanoma, characterized by a hyperkeratotic verrucous surface, a rather uniform color, and a moderately irregular outline. Histologically, discrepancy exists between tumor thickness according to Breslow and Clark's level due to the marked epidermal hyperplasia. Herein, we report an unusual case of verrucous malignant melanoma which developed on the right leg in a 32-year-old man.

Two Cases of Sclerotic Fibroma / 대한피부과학회지

Sclerotic fibroma is an uncommom fibrotic neoplasm that can occur as solitary lesions in otherwise healthy individuals. Multiple sclerotic fibromas of the skin are considered a cutaneous marker of multiple hamartoma syndrome or Cowden's disease. Sclerotic fibroma was first described by Weary et al. in the tongue of a patient with Cowden's disease in 1972. Rapini and Golitz described the sporadic occurrence of histologically identical tumors, and they suggested the names `hypocellular fibroma' and `sclerotic fibromas of the skin' for these lesions in 1990. The characteristics of sclerotic fibromas include hypocellularity and stromal sclerosis with eosinophilic, hyalinized collagen bundles in a parallel or whorled arrangement. We report two cases of solitary sclerotic fibroma of the skin not associated with Cowden's disease.

Clinical Patterns of Cutaneous Lesions on the Legs in Patients with Cutaneous Polyarteritis Nodosa / 대한피부과학회지

BACKGROUND: Cutaneous manifestations of vasculitis can be seen as pleomorphic lesions; purpura, erythema, nodule, bulla, ulcer and so on. In cases of polyarteritis nodosa (PAN), cutaneous presentations of small artery pathology may be seen in about one fourth among those patients with systemic form of PAN, and in all cases of cutaneous form subset. OBJECTIVE: To examine the pattern or morphology of cutaneous lesions found in the skin (especially on the lower legs) among Korean patients with cutaneous form of PAN. Patients AND METHODS: Eight patients with diagnosis-confirmed cases of cutaneous PAN were examined regarding the patterns of cutaneous lesions, as well as possible local symptoms, distributions, duration, and any positive findings in laboratory examinations and systemic review. RESULTS: Clinical patterns of cutaneous lesions observed in the lesional areas among those 8 patients were mottled or atypical reticular erythema (5 cases), subcutaneous nodules (3 cases), scattered erythematous patch (3 cases), ecchymotic erythematous patch (3 cases) and superficial ulcer (1 case). Tenderness was detected at the nodular lesions; predilection site were shin and calf areas; a few laboratory abnormalities and systemic symptoms were found regardless of the duration of skin lesions. CONCLUSION: Common clinical patterns of cutaneous lesion recognized with 8 patients of cutaneous PAN were mottled/atypical reticular erythemas, subcutaneous nodules, erythematous/ecchymotic patches, and these in all cases were seen at the lower legs. In patients with each different clinical presentation, there were no relevancies between the duration and severity of the disease.

Carbonic anhydrase II immunostaining in the cerebellum of postnatal mice / 대한해부학회지

The carbonic anhydrase II (CA-II) is specifically expressed in oligodendrocytes, the cells responsible for myelination in the central nervous system. However no direct evidence on relationship between myelin formation and CA-II immunoreactivity has been described. The aims of these studies are to investigate the relationship between CA-II and myelination during cerebellar development of mouse. Myelin staining was found on postnatal (P) 14, and its intensity increased in proportion to developmental age. CA-II positive oligodendrocytes were observed in the white matter of cerebellum on P 14 day. CA-II positive oligoden-drocytes also occured in the granular layer and Purkinje cell layers in the later stage of dvelopment. The parallel development in the CA-II expression and myelination during development suggests that CA-II in oligoendrocyte play a role to myelination.