Clinical Benefits of Amniotic Membrane Contact Lens

Purpose@#To investigate the clinical efficacy of MS-Amnion amniotic membrane contact lenses. @*Methods@#MS-Amnion amniotic membrane contact lenses were placed for 1 week in patients with severe superficial punctate keratitis or corneal epithelial defects that did not respond to medical treatment. Eighteen eyes followed-up for ≥3 months were evaluated in terms of the best-corrected visual acuity, tear break-up time, and corneal sensation and opacity before and after application of the MS-Amnion amniotic membrane contact lens. The success and recurrence rates, and complications during follow-up, were recorded. @*Results@#Out of 18 eyes, 15 (83.3%) healed within 2 weeks without any treatment other than the amniotic membrane; three eyes (16.7%) were unresponsive, and thus underwent temporary amniotic membrane transplantation. Recurrence developed in three eyes (20%). The amniotic membrane contact lens dropped out in five eyes (27.8%) and folded over in two (11.1%). The mean best-corrected visual acuity improved from 0.89 to 0.27 logarithm of the minimal angle of resolution after 3 months, while the mean corneal opacity decreased from 0.38 to 0.11 after 3 months; the changes were statistically significant. The tear break-up time and corneal sensation also improved, but they were not statistically significant. We encountered no significant complications. @*Conclusions@#The MS-Amnion amniotic membrane contact lenses can heal the amniotic membrane and do not require suturing when applied in the outpatient clinic. This may be beneficial for patients with intractable ocular surface disorders.

Long-term Outcome of Surgical Treatment with Various Reinforcement Material Grafts on Scleromalacia

Purpose@#To investigate the long-term efficacy and stability of the use of various reinforcement material grafts on scleromalacia. @*Methods@#This retrospective study was conducted on scleromalacia patients who underwent surgical treatment with reinforcement material grafts from January 2012 to March 2019. The choice of amniotic membrane, Tenon’s capsule, acellular sclera, or collagen matrix implanted in the area of scleromalacia was made based on disease severity. Amniotic membrane transplantation with a pedicular rotatory inferior conjunctival flap was performed to prevent having a bare sclera. The patient demographics, cause of scleromalacia, best-corrected visual acuity (BCVA), recurrence rate, postoperative complications, and restoration appearance were evaluated. @*Results@#A total of 58 patients (58 eyes) were enrolled in this study. The mean age of patients was 65.7 ± 9.6 years, and 32 patients (55.2%) were women. The mean follow-up period was 28.1 ± 17.3 months. The most common cause of scleromalacia was pterygium operation (53 patients, 91.4%). The reinforcement materials were mainly amniotic membrane (31 patients, 53.4%) and acellular sclera (15 patients, 25.7%). There was no recurrence of scleromalacia or structural instability during the follow-up period. The preoperative and postoperative mean BCVA values were 0.24 ± 0.24 and 0.21 ± 0.23 logMAR, respectively. Wound dehiscence (three patients, 5.2%) and conjunctival cyst (three patients, 5.2%) occurred with the highest frequency. @*Conclusions@#The use of the appropriate reinforcement material graft according to the severity of scleromalacia and amniotic membrane transplantation using a pedicular rotatory inferior conjunctival flap to prevent a bare sclera can be effective for treating scleromalacia, without long-term recurrence.

Surgical Outcome of Minimal Resection with Full Thickness Rotating Suture Technique for Lower Lid Epiblepharon

PURPOSE: To introduce the minimal skin and orbicularis oculi muscle resection with the full thickness rotating suture technique for lower lid epiblepharon and to assess its surgical outcome. METHODS: A retrospective review of medical records was performed on lower lid epiblepharon patients who were followed for more than 6 months after surgical correction performed between January 2004 and December 2015. All surgeries were performed by one surgeon using minimal skin and orbicularis oculi muscle resection and the full thickness rotating suture technique for lower lid epiblepharon correction. RESULTS: A total of 943 lower lid epiblepharon patients (403 male, 540 female) were included in the analysis. The mean patient age was 6.7 ± 2.4 years, and the mean postoperative follow-up was 12.9 ± 7.2 months. Eyelid shape and function were well maintained in 904 patients (95.9%), with no recurrence during follow-up. Among the recurrent cases (39 patients [4.1%]), 19 patients (2%) underwent a second correction surgery. CONCLUSIONS: Minimal skin and orbicularis oculi muscle resection with the full thickness rotating suture technique for lower lid epiblepharon showed good surgical outcome with few complications and high success rate.

Scleral Lens Application for Preventing Corneal Edema During Vitrectomy

PURPOSE: To analyze the effect of scleral lens application for preventing corneal edema during vitrectomy on postoperative corneal status using anterior segment OCT (RTVue 100, Optovue, Fremont, CA, USA). METHODS: The medical records of 42 eyes (42 patients) who underwent total vitrectomy with no appreciable corneal disease between November 2014 and June 2015 were retrospectively reviewed. Evaluations were performed at 1 day, 1 week, and 1 month after total vitrectomy. Corneal status was noted at every follow-up visit using anterior segment OCT. An analysis was performed to define the changes in corneal status in association with scleral lens application during the surgery. RESULTS: 18 of 42 eyes were treated with a scleral lens during total vitrectomy. The corneal thickness increased after vitrectomy in all cases. The mean corneal thickness increment was 23.9 ± 9.7 µm in the scleral lens group and 43.0 ± 19.5 µm in the non-scleral lens group at 1 day after vitrectomy (p < 0.001). At 1 week after vitrectomy, the mean corneal thickness increment was 8.1 ± 7.2 µm in the scleral lens group and 32.3 ± 19.2 µm in the non-scleral lens group (p < 0.001). The difference in superficial punctate keratitis grade between the two groups was not statistically significant. CONCLUSION: Scleral lens application during vitrectomy seems to prevent postoperative corneal edema. More cases and a longer period of study is needed to draw definitive conclusions.

Comparison of Orbital Anatomy in Korean and Caucasian Patients Using Computed Tomography

PURPOSE: In this study we analyzed and compared the orbital anatomy in Korean and Caucasian subjects using computed tomography (CT) measurements. METHODS: Two observers performed a cross-sectional, retrospective analysis of 44 CT scans of subjects (22 Koreans, 22 Caucasians) with no appreciable orbital or globe disease. Ten length measurements and 3 angle measurements of various orbital aspects were obtained. Analysis was performed to determine if changes in these parameters were associated with race. RESULTS: Anterior medial interorbital length was 24.05 +/- 2.00 mm in Korean and 21.96 +/- 1.96 mm in Caucasian subjects. Anterior vertical orbital length was 34.19 +/- 1.67 mm in Korean and 35.03 +/- 1.18 mm in Caucasian subjects. The anterior medial interorbital length and anterior vertical orbital length (p < 0.05) were significantly different. Interorbital angle was 47.69degrees +/- 1.49degrees in Korean and 46.15degrees +/- 2.19degrees in Caucasian subjects; the difference was statistically significant (p < 0.05). CONCLUSIONS: Compared with Caucasians, the orbit of Korean subjects has a narrower orbital opening and longer interorbital distance. The present study regarding the anatomy of Korean and Caucasian orbits will assist physicians with the evaluation and treatment of orbital diseases.

Obstetric and Neonatal Outcomes of the Teenage Pregnancy

PURPOSE: In recent years, Korea has showed a steady increase in the frequency of teenage births, while the overall birth rate has declined. As the teenage birth is known as a high risk pregnancy itself, we examined perinatal complications of teenage mothers and whose neonates in aspects of medical problem, and social status and support. METHODS: We examined the perinatal characteristics of teenage mothers and whose babies, who were hospitalized at Korea University Ansan Hospital from January 2004 to July 2009 using medical records retrospectively. Twenty-seven teenage mothers and their 28 babies were enrolled in this study. RESULTS: Teenage mothers were all unmarried and showed high rates of preterm labor, maternal anemia, and unexpected delivery. Among them, 11 (40.7%) were from families that were separated. Eleven mothers (40.7%) did not have any antenatal care. There were high rates of prematurity and low birth weight (60.7% and 64.3%, respectively). The complication included: respiratory distress syndrome, patent ductus arteriosus and necrotizing enterocolitis. Fourteen babies (51.9%) were not going to be brought up by their biological parents. CONCLUSION: Teenage pregnancy had high rates of preterm labor and associated complications, often caused by the lack of proper antenatal care. Babies from unmarried mothers were likely to be adopted and this could be a social burden. Therefore, to reduce unplanned teenage pregnancy and births, sex education and social supports should be provided to all teenagers.

Perinatal Complications of Mothers and Neonates Resulting from Inadequate Prenatal Care / 대한주산의학회잡지

OBJECTIVE: With improvement in the social and economic states of Korea, most of the pregnancies have been appropriately examined but there are a few mothers and newborns who have not received proper prenatal care. The aim of this study was to investigate obstetrical and neonatal complications resulting from inadequate prenatal care. METHODS: The medical records of 107 neonates who had received prenatal care lesser than 3 visits and admitted to the neonatal intensive care units of Korea University Ansan Hospital from January 2004 to December 2009 were retrospectively reviewed. Obstetrical complications, neonatal gestational age, birth weight, neonatal complications were analyzed. We compared neonatal complications of the inadequate prenatal care group and those of the adequate prenatal care group lesser than 34 weeks' gestational age neonates. RESULTS: In obstetrical complications, there were twenty women with anemia, fifteen cases with premature rupture of membranes, and fourteen chorioamnionitis. In neonatal complications, there were forth-four premature infants, and forty-four low birth weight infants. Respiratory distress syndrome, small for gestational age, severe intraventricular hemorrhage were more common in the inadequate prenatal care group than the adequate prenatal care group. Thirty-seven infants (34.5%) were sent to the adoption agency. Fifty infants (46.6%) received medical expense support by the social service. CONCLUSIONS: Obstetrical and neonatal complications and social burden were increasing when the pregnancies had not received adequate prenatal care. To reduce perinatal complications of mothers and neonates in low socioeconomic classes, practical nation's policies and social supports for adequate prenatal care should be provided.

A case of Mullerian cyst of the uterine cervix / 대한산부인과학회지

Uterine Mullerian cyst is extremely rare and the diagnosis is made by histological analysis. We report a case of a huge cyst which was initially regarded as ovary cyst or cystic degeneration of uterine myoma in 46-year-old woman. She was admitted due to tender palpable lower abdominal mass and total abdominal hysterectomy was performed. Histologically, the cyst was lined by unilayer (unilocular) ciliated columnar epithelial cells. Immunostains for PAS and mucicarmine showed negative results.

Isolation and characterization of mesenchymal stem cells from human amnion and decidua / 대한산부인과학회지

OBJECTIVES: The purpose of this study is to isolate a population of multipotent cells from human amnion and decidua, respectively. METHODS: Human placentas (gestational age, 30~42 weeks) were obtained after vaginal or cesarean deliveries. Amnions and deciduas were divided mechanically. The collected cells from the amnion and decidua were cultured. Cultured cells were immunophenotypically characterized. The adipogenic, osteogenic and neurogenic differentiation capacities were tested, and their growth kinetics were analyzed. RESULTS: We successfully isolated MSCs from both the amnion and decidua. The phenotype of MSCs cultured from different fetal and maternal parts of the placenta was comparable. The growth kinetics of MSCs derived from amnions and deciduas were similar. Isolated MSCs were differentiated into various cell lines such as adipogenic, osteogenic, myogenic and neurogenic cells. CONCLUSIONS: The human amnion and decidua could be an excellent source of MSC because they are easily obtainable after delivery and showed a higher expansion capacity than that of MSCs from adult bone marrow.

A Phase II Study of Genexol(R) (paclitaxel) in Metastatic Breast Cancer / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: Paclitaxel is a very effective agent in the treatment of breast cancer. Samyang Corporation has developed its own process to produce paclitaxel in a large volume using plant cell culture technology. To evaluate the efficacy and safety of Genexol(R) in patients with metastatic breast cancer who have failed to respond to standard therapy, we performed a prospective, multi- center phase II clinical trial. MATERIALS AND METHODS: Patients with metastatic breast cancer were included in this study. Enrollees were required to have histologically confirmed breast cancer with bidimensionally measurable metastatic disease. Genexol(R) was administered at 175 mg/m2 as a 3-hour intravenous infusion every 3 weeks. All patients were premedicated with hydrocortisone, pheniramine maleate, and H2 blocker 30 minutes prior to paclitaxel. We planned to administer at least 4 courses of paclitaxel unless there was disease progression or unacceptable toxicity and to continue treatment up to a total of 6 courses in cases of objective response following 4 courses. RESULTS: The median duration of follow-up was 8.9 (2.07~13.7) months. Forty-five patients were registered and 43 were eligible. The performance status of patients was ECOG 0~1 in 39 patients (90.7%) and 2 in 4 (9.3%). The location of metastases at the start of the study were the lung (15 patients), liver (8 patients), lymph nodes (22 patients), and other (7 patients). Among the 40 evaluable patients, 15 patients obtained partial responses (PRs) (37.5%, 95% CI: 22.5~52.5%). The median duration of response was 11.67 (4.1~11.7) months and the median time to progression was 7.73 (2.8~11.7) months. The median survival time was not reached at 13.7 months, and the overall survival rate at 13.7 months was 70.1%. The hematologic toxicity was primarily neutropenia with grade 3 or 4 in 10 patients (23.3%). The grade 3 or 4 non-hematologic toxicities included alopecia (17, 39.5%), myalgia (2, 4.7%), neuropathy (2, 4.7%), and pruritus (1, 2.3%). Mild hypersensitivity reaction was observed in 2 patients, although it did not cause withdrawal of the test drug. CONCLUSION: The results suggest that the Genexol injection is an effective anticancer formulation for the treatment of metastatic breast cancer and toxicity is acceptable.