Machine Learning-based Auto-merge Program for Nine-directional Ocular Photography

Purpose@#This study introduces a new machine learning-based auto-merge program (HydraVersion) that automatically combines multiple ocular photographs into single nine-directional ocular photographs. We compared the accuracy and time required to generate ocular photographs between HydraVersion and PowerPoint. @*Methods@#This was a retrospective study of 2,524 sets of 250 nine-directional ocular photographs (134 patients) between March 2016 and June 2022. The test dataset comprised 74 sets of 728 photographs (38 patients). We measured the time taken to generate nine-directional ocular photographs using HydraVersion and PowerPoint, and compared their accuracy. @*Results@#HydraVersion correctly combined 71 (95.95%) of the 74 sets of nine-directional ocular photographs. The average working time for HydraVersion and PowerPoint was 2.40 ± 0.43 and 255.9 ± 26.7 seconds, respectively; HydraVersion was significantly faster than PowerPoint (p < 0.001). @*Conclusions@#Strabismus and neuro-ophthalmology centers are often unable to combine and store photographs, except those of clinically significant cases, because of a lack of time and manpower. This study demonstrated that HydraVersion may facilitate treatment and research because it can quickly and conveniently generate nine-directional ocular photographs.

Long-term Outcome of Anterior Chamber Parameters after Laser Iridotomy and Iridoplasty in Primary Angle Closure Glaucoma

Purpose@#To investigate the long-term outcomes of anterior chamber angle parameters in patients with primary angle closure glaucoma (PACG) after peripheral laser iridotomy (LI) combined with iridoplasty (PI) using a dual Scheimpflug analyzer. @*Methods@#This retrospective study included 32 eyes in 32 patients diagnosed with PACG who underwent LI plus PI. Patients with an acute angle closure crisis were excluded. Dual Scheimpflug analyzer images were acquired before and 1 week after LI plus PI, and yearly afterwards. Anterior chamber depth (ACD) and volume (ACV), mean anterior chamber angle (ACA), and intraocular pressure (IOP) were also measured. @*Results@#The mean follow-up was 32.28 ± 13.34 months. Baseline demographics were age 63 ± 7.9 years, 62.5% female, IOP 15.48 ± 4.79 mmHg, ACD 2.09 ± 0.19 mm, and visual field mean deviation -7.97 ± 8.49 dB. ACD increased from baseline to 2.15 ± 0.32 mm, but it was not significant (p = 0.136). ACV increased significantly from 78.32 ± 11.49 mm at baseline to 83.04 ± 11.16 mm at the last visit after LI (p = 0.011). The mean ACA increased significantly from 26.86 ± 2.53° at baseline to 28.82 ± 4.64° at the last visit (p = 0.022). IOP decreased significantly from baseline to 13.06 ± 2.21 mmHg at the last visit (p = 0.001). @*Conclusions@#The ACA parameters improved after LI combined with PI in patients with PACG and remained so on long-term follow-up. IOP was also significantly reduced for more than 2.5 years after LI plus PI.

Repeatability of Bruch’s Membrane Opening-minimum Rim Width in Age-related Macular Degeneration and Diabetic Macular Edema

Purpose@#To evaluate the repeatability of retinal nerve fiber layer (RNFL) thickness and Bruch’s membrane opening-minimum rim width (BMO-MRW) measurements by spectral-domain optical coherence tomography (SD-OCT) in wet age-related macular degeneration (wAMD) and diabetic macular edema (DME). @*Methods@#This was a prospective study. The RNFL thickness and BMO-MRW parameters for each sector and global average were measured twice by SD-OCT. Repeatability was evaluated using the intraclass correlation coefficient (ICC) and coefficient of variation (CV). If the optic disc membrane was confirmed, it was analyzed by dividing it into three groups based on severity. @*Results@#A total of 99 eyes (48 with wAMD, 51 with DME) were included in the analysis. The ICCs of the global RNFL thickness and global BMO-MRW measurements were 0.996 and 0.997, respectively, in wAMD and 0.994 and 0.996, respectively, in DME eyes. The CV values of global RNFL thickness and BMO-MRW were 0.60% and 0.73%, respectively, in wAMD eyes and 1.10% and 1.21%, respectively, in DME eyes. The disc membrane on the optic nerve head significantly affected global BMO-MRW repeatability (B = 0.814, p < 0.001). @*Conclusions@#Both RNFL thickness and BMO-MRW measurements showed good repeatability in eyes with wAMD and DME. The severity of the optic disc membrane significantly affected the repeatability of BMO-MRW measurements in eyes with wAMD and DME. Therefore, physicians should examine the BMO-MRW in eyes with severe optic disc membrane.

Fundus Albipunctatus Diagnosed in a 9-year-old Female

PURPOSE: We report a case of fundus albipunctatus discovered in a young patient. CASE SUMMARY: A 7.6-year-old female showed numerous small whitish-yellow flecks in the perimacular area and retinal periphery. Dark adapted 0.01 electroretinography (ERG) and dark adapted 3.0 ERG were profoundly reduced. At 26 months after the first visit, the best-corrected visual acuities were 1.0 right eye and 0.9 left eye. There were no pigmented lesions, atrophic lesions, or vascular abnormalities in the retina. Humphrey and Goldmann visual field tests were performed, but neither of the tests revealed any scotomas or other visual field defect. The number and size of characteristic numerous small whitish-yellow retinal flecks seemed almost unchanged. In spectral domain-optical coherence tomography (SD-OCT), the subretinal hyper-reflective lesions spanned the retinal pigment epithelium and the external limiting membrane. ERG showed improved dark adapted responses (dark adapted 0.01 ERG and dark adapted 3.0 ERG) after prolonged dark adaptation (2.5 hours). No family member showed any abnormal findings. CONCLUSIONS: Fundus albipunctatus is a rare disease in Koreans. We report a case diagnosed using fundus photography, SD-OCT, visual field tests, and ERG after prolonged dark adaptation (2.5 hours).

Long-term Follow-up Results of Patients with Welding-arc Maculopathy Assessed Using Spectral Domain Optical Coherence Tomography

PURPOSE@#We present four cases of welding arc maculopathy as observed using spectral-domain optical coherence tomography (SD-OCT).CASE SUMMARY: Four patients, who performed welding without wearing protective eye gear, presented to the hospital due to poor visual acuity. The mean visual acuity of the patients was 0.6. Fundus photographs of the four patients revealed a yellowish retinal scar at the fovea. SD-OCT images of the four patients showed photoreceptor inner segment/outer segment junction (IS/OS junction) disruption and retinal pigment epithelium injury. We diagnosed the patients with welding arc maculopathy, and three of them were treated with oral steroids or antioxidants. The IS/OS junctions were restored in two patients, who had short welding arc exposures. The disrupted IS/OS junction recovered partially in one of the other two patients, who had a longer duration of exposure, and the IS/OS junction disruption remained in another patient.@*CONCLUSIONS@#We report four cases of welding arc maculopathy caused by welding light exposure evaluated using SD-OCT and treated with oral steroids and antioxidants.

Influence of Sodium Hyaluronate Concentration on Corneal Aberrations in Soft Contact Lens Wearers

PURPOSE: This study aimed to evaluate the influence of varying concentrations of sodium hyaluronate (SH) eye drops on corneal aberrations in normal individuals wearing silicone hydrogel contact lenses. METHODS: Normal individuals wearing silicone hydrogel contact lenses were enrolled in this study. Subjects were classified into two groups depending on the concentration of the preservative-free SH used (group 1, 0.1% SH; group 2, 0.3% SH). All subjects were asked to blink five times after instillation of the SH eye drop and before the Galilei measurements. Corneal aberrations were measured over the contact lenses before and after SH eye drop instillation. Visual acuity (VA) over the contact lenses was also measured both before instillation of the SH eye drop and after the subjects completed the five blinks. RESULTS: There was no change in VA after SH instillation in group 1; however, group 2′s VA significantly deteriorated after SH instillation. Changes in VA after SH instillation compared to baseline were significantly higher in group 2 than in group 1. Similarly, the increase in corneal aberrations after SH instillation was significant in group 2 but not significant in group 1. Among the significantly increased corneal aberration parameters, defocus was the main type in group 2. Changes in corneal aberrations after SH instillation compared to baseline were significantly higher in group 2 than in group 1. CONCLUSIONS: A 0.3%-concentration of SH increases corneal aberration and decreases VA in soft contact lens wearers. Defocus is the main type of aberration that increased in the 0.3% SH instillation group.

A Case of Acute Macular Neuroretinopathy in a Young Male

PURPOSE: We report a rare case of unilateral acute macular neuroretinoapthy in a young male. CASE SUMMARY: A 35-year-old male presented with a 2-day history of paracentral scotoma. He had suffered for 2 days from a flu-like illness, and his best corrected visual acuity was 20/20 OD and 20/20 OS. Pupillary reflex was normal and no relative afferent pupillary defects were not found. Ocular movement test was normal and pain on ocular movement was not noticed. Ophthalmoscopic examination of the left eye revealed multiple exudates lining the nasal macula toward the fovea. A Humphrey visual field study identified small paracentral scotoma. Spectral domain optical coherence tomography (SD-OCT, Heidelberg Engineering, Heidelberg, Germany) of the lesions showed a hyper-reflective lesion located in the outer plexiform layer and inflammatory cell infiltration. Fluorescent angiography was normal in the macula but showed late leak at the disc. The multifocal electroretinogram (mfERG) showed decreased foveal P1 amplitude in the left eye. The patient was diagnosed with acute macular neuroretinopathy and was treated with 60 mg of prednisolone. His subjective symptoms were improved, the paracentral scotoma disappeared, and the lesions appeared different upon SD-OCT; specifically, the hyper-reflective lesion disappeared and the outer plexiform layer showed thinning. CONCLUSIONS: Acute macular neuroretinopathy is a rare disease, and we report a case using SD-OCT and mfERG.

Ocular Side Effects Induced by 0.25% Alcaftadine Ophthalmic Solution

PURPOSE: To report a case series of patients experiencing side effects of 0.25% alcaftadine eye drops and to analyze the possible reasons for the side effects. CASE SUMMARY: Medical records of 90 patients who had a history of alcaftadine eye drop use were retrospectively analyzed. Eight out of the 90 patients (8.9%) showed ocular side effects that required discontinuation of the alcaftadine eye drops. All eight cases of alcaftadine side effects showed palpebral and bulbar conjunctival injection, watery discharge, and lid swelling. During additional history collection, all patients with alcaftadine side effects confessed of overuse (more than twice/day) of the eye drops. Anticipation for fast symptom relief was the main reason for the alcaftadine overuse. In all side effect cases, patients were asked to stop alcaftadine eye drops and use preservative-free artificial tears and steroid eye drops. After discontinuation of 0.25% alcaftadine eye drops, regression of palpebral and bulbar conjunctival injection and lid swelling was observed. CONCLUSIONS: Overuse of 0.25% alcaftadine eye drops can induce ocular surface toxicity possibly due to toxicity of drug itself. The possible side effects of overuse of 0.25% alcaftadine eye drops should be fully explained to all patients before use.

Novel c.300_301delinsT Mutation in PITX2 in a Korean Family with Axenfeld-Rieger Syndrome

Axenfeld-Rieger syndrome (ARS) is characterized by anomalies of the anterior segment of the eye and systemic abnormalities. Mutations in the FOXC1 and PITX2 genes are underlying causes of ARS, but there has been few reports on genetically confirmed ARS in Korea. We identified a novel PITX2 mutation (c.300_301delinsT) in 2 Korean patients from a family with ARS. We expand the spectrum of PITX2 mutations and, to the best of our knowledge, this is the first confirmed family of PITX2-related ARS in Korea.

Cataracts among Adults Aged 30 to 49 Years: A 10-Year Study from 1995 to 2004 in Korea

PURPOSE: To investigate the long-term characteristics of cataracts among adults aged 30 to 49 years in Korean over a span of 10 years. METHODS: Subjects between the ages of 30 to 49 years who underwent cataract surgery at St. Mary's Hospital from 1995 to 2004 (n = 976) were included. Patients with a history of ocular trauma, uveitis, other ocular or systemic diseases, and congenital cataracts were excluded. Additional information including type of lens opacity, urban/rural region, and pre- and postoperative visual acuities were analyzed. Lens opacity grading was conducted using Lens Opacity Classification System III. The Cochran-Armitage proportion trend test was used to analyze vision changes with the passage of time. RESULTS: Among the patients who had undergone cataract surgeries, 8.8% (976 / 11,111) met the inclusion criteria. The mean age was 41.7 +/- 5.45 years. Gender breakdown of the patient population included 79.0% male and 21.0% female. In terms of home environment, 60.9% were from an urban region and 39.1% from a rural region. Opacity type included anterior polar (AP), posterior subcapsular (PSC), AP and PSC, cortical, and nuclear in 35.7%, 35.1%, 7.0%, 6.0%, and 5.4% of patients, respectively. At a 2-month postoperative follow-up appointment, 92.7% of patients showed a best-corrected visual acuity of more than 20 / 40. CONCLUSIONS: Predominance of AP and PSC opacities as well as male patients was observed in this study population.

Assessment of the Vision-Specific Quality of Life Using Binocular Esterman Visual Field in Glaucoma Patients

PURPOSE: To investigate the correlation of binocular visual field (VF) with vision-specific quality of life in glaucoma patients. METHODS: Sixty patients who were diagnosed as open-angle glaucoma were recruited for the present study. The patients had at least moderate VF defect in 1 eye. VF testing was performed using the unilateral Humphrey Field Analyzer (HFA) and binocular Esterman VF test which was divided into 6 clusters: upper and lower center 10', upper and lower center 30', and upper and lower periphery. The 25-item National Eye Institute Visual Function Questionnaire (VFQ) was used to evaluate patients' vision-specific quality of life. We analyzed the correlation between the efficiency score of each cluster from binocular Esterman VF test, mean deviation of HFA, and the scores of VFQ (Spearman correlation). RESULTS: The correlation between the composition score of VFQ and total score of binocular Esterman visual field test was significant. The highest correlation was observed in the lower periphery cluster (all p 0.05). CONCLUSIONS: Binocular Esterman VF test is an easy and effective way to evaluate the vision-specific quality of life in glaucoma patients.

Vision-Correction Effect of RGP Contact Lens in Patients With Corneal Opacity Following Repaired Corneal Perforations

PURPOSE: To investigate the effect of rigid gas permeable (RGP) contact lenses in patients with corneal scar and opacity following repair of corneal perforations. METHODS: A total of 10 eyes from 10 patients undergoing repair of corneal perforating injuries and fitted with RGP contact lenses were examined in the present study. The mean postoperative 3-month visual acuities, refraction, corneal topography, keratometry, best corrected visual acuities with spectacles and RGP lenses at an average of postoperative 3 months were evaluated. RESULTS: Eight eyes had corneal opacities at the central and 2 eyes at the peripheral portion. Four patients had previous cataract surgery or cataract surgery with intraocular lens insertion due to traumatic cataract. The mean postoperative 3-month LogMAR visual acuity was 1.14 +/- 0.53. Corneal topography showed irregular astigmatism in all patients and the mean keratometric astigmatism was 4.03 +/- 4.06 diopters. The mean best corrected LogMAR visual acuities with spectacles was 0.91 +/- 0.64 and with the RGP contact lens was 0.25 +/- 0.35. A comparative analysis of improvement in visual acuity with the RGP contact lens over spectacle correction was found to be statistically significant (p = 0.005). Patients wore the lenses for more than 6 hours daily for the mean follow-up period (12.10 +/- 7.80 months). CONCLUSIONS: In patients with corneal scar and opacity following repair of corneal perforations, RGP contact lens fitting should be considered first before surgical corrections such as keratoplasty.

Short-Term Effect of Intravitreal Bevacizumab Injection for Choroidal Neovascularization Associated With Degenerative Myopia

PURPOSE: To investigate the short-term effect of intravitreal bevacizumab injection for choroidal neovascularization associated with degenerative myopia. METHODS: In 15 eyes of 15 patients, one or two consecutive intravitreal bevacizumab injections were given. The best-corrected visual acuity (BCVA) and fundus examination were evaluated at baseline and monthly thereafter. Fluorescence angiography (FA) was performed at baseline, 1 month and 3 months after treatment. When the angiographic leakage persisted 1 month after the first injection, a second injection was administered. RESULTS: The mean follow-up period was 9.7 months. The mean logarithm of the minimum angle of resolution (LogMAR) BCVA was 0.81+/-0.44 at baseline, 0.64+/-0.41 at 3 months (p=0.005), and 0.60+/-0.41 (p=0.001) at the final examination. Five eyes received a single injection, while the other ten eyes had two consecutive injections. Three months after the first injection, 14 eyes (93.3%) had no angiographic leakage, and 1 eye (6.7%) showed a decrease in leakage. The mean lines of visual improvement at 3 months and at the final examination were 1.7 and 2.1 lines, respectively. No case of vision loss was observed throughout the follow-up period. CONCLUSIONS: One or two consecutive intravitreal bevacizumab injections had favorable short-term effects on visual acuity stabilization and the regression of choroidal neovascularization associated with neovascular degenerative myopia.

Congenital Optic Disc Coloboma Associated With Right Seventh and Eighth Cranial Nerve Palsy

PURPOSE: To report a case of bilateral congenital optic disc coloboma associated with the right seventh and eighth cranial nerve palsy. CASE SUMMARY: A female neonate with right facial palsy (seventh cranial nerve palsy) and right earlobe hypoplasia was referred for examination for retinopathy of prematurity (ROP). Bilateral optic disc coloboma and peripapillary choroidal defect was detected on the fundus examination and the anterior segment examination revealed no specific findings. On the otolaryngologic examination, laryngomalacia and floppy epiglottis were observed and left otitis media and mastoiditis were noted on the temporal bone computed tomography (CT). On the auditory brain stem response (ABR), right electro-potential was not detected and right cochlear nerve palsy (eighth cranial nerve palsy) was diagnosed. Further chromosomal analysis and brain magnetic resonance imaging (MRI) revealed no abnormal findings. However, on echocardiography, an atrial septal defect was detected and on upper gastrointestinal series, gastroesophageal reflux disease (GERD) was diagnosed. CONCLUSIONS: Congenital optic disc coloboma is frequently accompanied by other congenital deformities or abnormalities, and therefore, systemic examinations and tests to detect associated findings are required.

A Case of Acromegaly First Diagnosed in Pregnancy / 대한내분비학회지

Pregnancy in acromegaly is very rare. Amenorrhea and infertility are common manifestations in acromegaly. The pregnancy may be influenced by acromegaly in many ways and pregnancy itself may influence the course of a pituitary tumor. We report of a case of pregnancy in a woman who was diagnosed with acromegaly during the course of pregnancy. Her pregnancy was uneventful and she delivered a healthy baby at 38 weeks by cesarean section. No treatment was undertaken during the pregnancy and transsphenoidal surgery was performed after the delivery.

A Case of Left Ventricular-Right Atrial Shunt

Left ventricular-right atrial shunt is a relatively uncommon defect, which permits as communication between the left ventricle and right atrium. This paper is fifth case report in our country. This patient was noted to have congenital heart disease in two years old. The pathology of this lesion was classified into four types by Perry. The type C is compatible with this case. The first successful surgical correction was made by Kirby in 1957. The pathology of this lesion was classified into four types by Perry. The type C is compatible with this case. The first successful surgical correction was made by Kirby in 1957. In 12 years old boy, we have experienced a case of left ventricular-right atrial shunt. In selective left ventricular angiocardiography, we found opacification to right atrium and main pulmonary artery simultaneously, and also opacified right ventricle later. Operation was performed during cardiopulmonary bypass. We opened right atrium and found out a defect just below the annulus of the tricuspid valve. The defect measuring 6mm in diameter communicate the left ventricle with right atrium through a segment of the septal leaflet fused to the margins of the septal defect. In the tricuspid valve, a cleft, 4mm in length and a isolated perforation(2mm in diameter) were found in the septal leaflet. Associated cardiac anomaly was a non-functioning patent foramen ovale. The recovery was uneventful and discharged healthily on fourteenth day after operation.

A Case of Lung Metastasis of Testicular Yolk Sac Tumor

No abstract available.

Two Cases of Right Congenital Diaphragmatic Anomaly

Congenital diaphragmatic anomaly is a rare congenital malformation and is found more frequently on the left side than right side. We had experienced two cases of comgenital diaphragmatic anomaly on the right side. One case was 8 months old male with congenital Bochdalek hernia and the other case was 17 months old female with congenital eventration of the diaphagm. The diagnosis was established by physical examination, chest X-ray, upper G-I series and other special studies. A brief review of the related literature was also presented.