Impact of Social Distancing and Personal Hygiene on the Prevalence of Epidemic Keratoconjunctivitis during the COVID-19 Pandemic

Purpose@#To analyze the change in the weekly incidence of epidemic keratoconjunctivitis (EKC) per 1,000 outpatients during the coronavirus disease 2019 (COVID-19) pandemic by comparing the mean weekly proportion of EKC of 2020 with that from 2016 to 2019. @*Methods@#Using data from the Korea Disease Control and Prevention Agency for 2016-2020, we analyzed the weekly proportion of EKC per 1,000 outpatients. The data were also analyzed according to age, semester and vacation periods, region, and social distancing stages. For the Daegu data, we also analyzed the effects of social distancing in an area. @*Results@#The mean weekly proportion of EKC per 1,000 outpatients in 2020 was lower than in previous years for all ages (2016-2019 19.77 ± 7.17‰, 2020 7.28 ± 2.97‰; p < 0.001). During the semester, the mean difference between 2016-2019 and 2020 was significant, particularly for preschool children. In Daegu, the weekly proportion of EKC per 1,000 outpatients during the extra 12-18 weeks of social distancing was significantly lower (2016-2019, 18.78 ± 6.61‰; 2020, 8.94 ± 2.92‰; p < 0.001). @*Conclusions@#The public health interventions implemented during the COVID-19 outbreak not only reduced the prevalence of COVID-19 but also reduced the prevalence of EKC. Therefore, maintaining hygiene principles and standard precautions may help prevent EKC.

Clinical Characteristics of the Eye with Fuch’s Corneal Endothelial Dystrophy after Descemet Stripping Only

Purpose@#To report the effect of removal of a central descemet membrane on the endothelial function, morphology, and clinical symptoms of eyes with Fuch’s endothelial dystrophy. @*Methods@#From August 2019 to January 2021, patients with Fuch’s endothelial dystrophy, i.e., with confluent, central corneal guttae and cataracts that required surgery, underwent phacoemulsification, intraocular lens implantation, and central descemet membrane stripping. To evaluate the effect of descemet stripping only (DSO), visual acuity and intraocular pressure were measured, and corneal pachymetry, slit-lamp and specular microscopy, and anterior segment optical coherence tomography performed, before surgery and at 1, 7, and 30 days and 3 and 6 months after surgery. @*Results@#Seven patients (10 eyes) were included. Visual acuity improved from 1.01 ± 0.40 logarithm of the minimum angle of resolution (logMAR) preoperatively to 0.33 ± 0.22 logMAR 6 months after surgery (p = 0.008). The mean central corneal thickness decreased from 578.50 ± 36.88 μm preoperatively to 568.50 ± 48.61 μm 6 months after surgery; the difference was not significant (p = 0.507). The endothelial cell count increased significantly from 663.80 ± 356.40/mm2 preoperatively to 1,082.00 ± 274.46/mm2 6 months after surgery (p = 0.043). @*Conclusions@#DSO can serve as a useful alternative when corneal transplantation is not possible in patients with Fuch’s endothelial dystrophy, but treatment efficacy and safety require further evaluation.

Results after Less Invasive Locking Plating in Intra-Articular Fractures of the Distal Femur

PURPOSE: The purpose of this study was to determine the clinical outcomes after a less invasive locking plating technique in intra-articular fractures of the distal femur. MATERIALS AND METHODS: This was a retrospective 19 case series of patients with distal femoral intraarticular fractures treated with a less invasive locking plating technique in a single center (Dankook University Hospital) from June 2010 to April 2016. Nineteen patients (11 males and 8 females) with a mean age of 55.9 years were enrolled. The functional outcomes were evaluated using the visual analogue scale (VAS), range of knee joint motion (flexion & extension), and Knee Society score. The radiology outcomes were evaluated with parameters measured in a plain radiograph (deviation angle of alignment axis on coronal and sagittal plane, mechanical lateral distal femur angle). RESULTS: The mean follow-up period was 26.4 months (range, 12–72 months) and the mean duration to union was 15.94 weeks (range, 11–28 weeks). The mean VAS was 1.36 (range, 0–8) and the range of motion of the knee joint was extension 4.73° (range, 0°–30°) and flexion 107.36° (range, 60°–135°). The mean Knee Society score was 85.47 (range, 47–100). The mean deviation angle of the coronal alignment axis was 4.07° (range, 1.3°–8.8°), the mean deviation angle of the sagittal alignment axis was 3.23° (range, 0.7°–7.0°), and the mechanical lateral femoral angle was 87.75° (range, 82.8°–95.5°). Six patients had traumatic osteoarthritis at the final follow-up. CONCLUSION: The purpose of this study was to evaluate the clinical and radiologic outcomes of intraarticular fractures of the distal femur in patients who underwent an anatomical reduction through an open reduction, and converted to an extra-articular fracture with rigid internal fixation. The results were relatively satisfactory.

Choroidal Neovascularization in a Patient with Best Disease

PURPOSE: To report a case of choroidal neovascularization in a Best disease patient treated with intravitreal bevacizumab injection and followed up with optical coherence tomography angiography (OCTA). CASE SUMMARY: A 20-year-old female visited our clinic with decreased visual acuity of the left eye for 6 months. On optical coherence tomography (OCT), subretinal fluid and hyperreflective subretinal clumps were observed in the macula of the right eye. Subretinal hemorrhage and subretinal fluid were observed in the left eye. Choroidal neovascularization in the left eye was observed using OCTA, fluorescein angiography, and indocyanine green angiography. A full-field electroretinogram was normal in both eyes, but an electrooculogram revealed that the Arden ratio was 1.564 in the right eye and 1.081 in the left eye. Intravitreal bevacizumab injection was performed in the left eye. At 6 months after the intravitreal injection, the best-corrected visual acuity of the left eye had recovered to 20/20. OCT revealed that subretinal fluid reduced and choroidal neovascularization was stable. After 12 months, visual acuity of the left eye was maintained at 20/20, but OCTA revealed that choroidal neovascularization had increased. CONCLUSIONS: Choroidal neovascularization associated with Best disease can improve by intravitreal bevacizumab injection, and the changes in choroidal neovascularization can be followed using OCTA.

Anterior Uveitis Caused by Listeria Monocytogenes Infection

PURPOSE: To report a case of anterior uveitis secondary to Listeria monocytogenes infection. CASE SUMMARY: A 57-year-old male presented to our clinic with ocular pain and decreased vision in the right eye for 2 days. The patient had a history of liver transplantation 2 years prior and used immunosuppressive agents. Listeria monocytogenes was identified in blood cultures 1 month before his visit. At presentation, best-corrected visual acuity (BCVA) of the right eye was counting fingers at 20 cm and the intraocular pressure (IOP) was 50 mmHg. Conjunctival hyperemia, corneal edema, keratic precipitates, and cells in the anterior chamber were observed in the right eye. The patient was diagnosed as anterior uveitis in the right eye. Conventional uveitis treatment was initiated but clinical features did not improve and black hypopyon appeared. The possibility of anterior uveitis caused by Listeria monocytogenes infection was considered. An anterior chamber tap and culture were conducted to identify pathogens. Anterior chamber antibiotic injections and systemic antibiotic injections were performed. One week after injection, the BCVA of the right eye improved to 0.4 and the IOP decreased to 14 mmHg. One month after injection, the BCVA of the right eye improved to 1.0 and the IOP decreased to 16 mmHg. No inflammation of the anterior chamber was observed. CONCLUSIONS: When nonspecific uveitis occurs in immunosuppressed patients, cultures and appropriate antibiotics should be considered because of the possibility of infection.

Effects of Platelet-rich Plasma on Ocular Surface in Patients with Dry Eye Syndrome: Clinico-experimental Analysis

PURPOSE@#To evaluate the effect of platelet rich plasma (PRP) on ocular surface damage caused by hyperosmotic conditions using retrospective clinical and experimental analyses.@*METHODS@#Eighty eyes of moderate dry eye syndrome patients who had no responses using conventional treatments were included in the study. Before and 1, 3, and 6 months after the use of autologous PRP, the visual acuity, intraocular pressure, tear break-up time (TBUT), ocular staining score (OSS), and ocular surface disease index (OSDI) were compared. The changes in inflammatory factors of ocular surface cells were analyzed using a corneo-limbal epithelial cell culture and a hyperosmotic stress experimental model.@*RESULTS@#Using retrospective clinical analyses, in 64 eyes (80%) after the use of autologous PRP, the symptom scores and symptoms were significantly reduced in the OSDI questionnaire when compared with the symptom scores and symptoms before treatment. The TBUT and OSS, which were objective indicators showed a significant increase of TBUT and significant decrease of OSS in 68 eyes (85%) and 72 eyes (90%), respectively. The expression of inflammatory factors such as interleukin-1, tumor necrosis factor-α, metalloproteinase (MMP)-1, and MMP-3 decreased in corneo-limbal epithelial cells under hyperosmotic conditions when PRP was added.@*CONCLUSIONS@#The use of autologous PRP showed significant improvement before and after treatment in the TBUT, OSS, symptom scores and symptoms, and OSDI. In addition, anti-inflammatory effects were demonstrated in hyperosmotic models simulating dry eye syndrome. Therefore, autologous PRP could be used effectively for the treatment of moderate dry eye syndrome.

Toxic Optic Neuropathy Caused by Chlorfenapyr Poisoning

PURPOSE: To report a case of toxic optic neuropathy caused by chlorfenapyr ingestion accompanied by central nervous system involvement. CASE SUMMARY: A 44-year-old female visited our clinic complaining of reduced visual acuity in both eyes for 7 days. She had ingested a mouthful of chlorfenapyr for a suicide attempt 2 weeks prior to the visit. Gastric lavage was performed immediately after ingestion at the other hospital. Her best-corrected visual acuity was finger count 30 cm in the right eye and hand motion in the left eye. Both pupils were dilated by 5.0 mm and the response to light was sluggish in both eyes. A relative afferent pupillary defect was detected in her left eye. Funduscopy revealed optic disc swelling in both eyes. Magnetic resonance imaging of the brain showed a symmetric hyper-intense signal in the white matter tract including the internal capsule, corpus callosum, middle cerebellar peduncle, and brainstem. The patient was diagnosed with toxic optic neuropathy induced by chlorfenapyr ingestion, and underwent high-dose intravenous corticosteroid pulse therapy. Three days later, the best-corrected visual acuity was no light perception in both eyes. Three months later, optic atrophy was observed in both eyes. Optical coherence tomography revealed a reduction in the thicknesses of the retinal nerve fiber layer and ganglion cell and inner plexiform layer in the macular area. CONCLUSIONS: Ingestion of even a small amount of chlorfenapyr can cause severe optic nerve damage through the latent period, despite prompt lavage and high-dose steroid treatment.

Sacral Stress Fracture Developing after Lumbosacral Fusion in a Patient with Spondylolisthesis: A Case Report / 대한척추외과학회지

STUDY DESIGN: Case report OBJECTIVES: To report a case of sacral stress fracture that developed after lumbosacral fusion. SUMMARY OF LITERATURE REVIEW: Sacral stress fractures rarely develop after lumbosacral fusion, and osteoporosis, female sex, being over 60 years old, and long segment fusion are known risk factors. MATERIALS AND METHODS: A 66-year-old woman with spondylolisthesis at L5 on S1 underwent posterior lumbar interbody fusion and posterior instrumentation. A sacral stress fracture was found 4 weeks after the first operation, and we performed posterior reduction and posterior instrumentation with S2 alar screws. RESULTS: The patient was free from symptoms and no further displacement was found at 3 months after the last operation. CONCLUSIONS: Sacral stress fracture after lumbosacral fusion can be treated with posterior reduction and posterior instrumentation with S2 alar screws.

Sacral Stress Fracture Developing after Lumbosacral Fusion in a Patient with Spondylolisthesis: A Case Report

OBJECTIVES@#To report a case of sacral stress fracture that developed after lumbosacral fusion.SUMMARY OF LITERATURE REVIEW: Sacral stress fractures rarely develop after lumbosacral fusion, and osteoporosis, female sex, being over 60 years old, and long segment fusion are known risk factors.@*MATERIALS AND METHODS@#A 66-year-old woman with spondylolisthesis at L5 on S1 underwent posterior lumbar interbody fusion and posterior instrumentation. A sacral stress fracture was found 4 weeks after the first operation, and we performed posterior reduction and posterior instrumentation with S2 alar screws.@*RESULTS@#The patient was free from symptoms and no further displacement was found at 3 months after the last operation.@*CONCLUSIONS@#Sacral stress fracture after lumbosacral fusion can be treated with posterior reduction and posterior instrumentation with S2 alar screws.

Analysis on the Calculated Dose in the Lung Radiation Surgery Planning Using TomoTherpay / 의학물리

The applicability and feasibility of TomoTherapy in the lung radiation surgery was analyzed by comparison of the calculated dose distribution in TomoTherapy planning with the results of conventional IMRS (intensity modulated radiation surgery) using LINAC (linear accelerator). The acquired CT (computed tomograph) images of total 10 patients whose tumors' motion were less than 5 mm were used in the radiation surgery planning and the same prescribed dose and the same dose constraints were used between TomoTherapy and LINAC. The results of TomoTherapy planning fulfilled the dose requirement in GTV (gross tumor volume) and OAR (organ at risk) in the same with the conventional IMRS using LINAC. TomoTherapy was superior in the view point of low dose in the normal lung tissue and conventional LINAC was superior in the dose homogeneity in GTV. The calculated time for treatment beam delivery was long more than two times in TomoTherapy compared with the conventional LINAC. Based on the results in this study, TomoTherapy can be evaluated as an effective way of lung radiation surgery for the patients whose tumor motion is little when the optimal planning is produced considering patient's condition and suitability of dose distribution.

Analysis on the Effect of Field Width in the Delineation of Planning Target Volume for TomoTherapy / 의학물리

The Hi-Art system for TomoTherapy allows only three (1.0 cm, 2.5 cm, 5.0 cm) field widths and this can produce different dose distribution around the end of PTV (Planning target volume) in the direction of jaw movement. In this study, we investigated the effect of field width on the dose difference around the PTV using DQA (Delivery quality assurance) phantom and real clinical patient cases. In the analysis with DQA phantom, the calculated dose and irradiated films showed that the more dose was widely spreaded out in the end region of PTV as increase of field width. The 2.5 cm field width showed a 1.6 cm wider dose profile and the 5.0 cm field width showed a 4.2 cm wider dose profile compared with the 1.0 cm field width in the region of 50% of maximum dose. The analysis with four patient cases also showed the similar results with the DQA phantom which means that more dose was irradiated around the superior and inferior end of PTV as an increase of field width. The 5.0 cm field width produced the remarkable high dose distribution around the end region of PTV and we could evaluate the effect quantitatively with the calculation of DVH (Dose volume histogram) of the virtual PTVs which were delineated around the end of PTV in the direction of jaw variation. From these results, we could verify that the margin for PTV in the direction of table movement should be reduced compared with the conventional margin for PTV when the large field such as 5.0 cm was used in TomoTherapy.

Analysis on the Decrease of Planning Target Volume in the Case of Lung Radiation Surgery with the Application of Respiratory Gated Radiotherpy Method / 의학물리

The application of a respiratory gated radiotherpy method to the lung radiation surgery was evaluated compared with the conventional method in which the whole tumor motion range is considered in the delineation of PTV (Planning target volume). The four dimensional CT simulation images were acquired for the five NSCLC (Non-small cell lung cancer) patients for radiation surgery. The respiratory gated plan was prepared with the 50% phase CT images and the conventional method was planned based on the ITV (Internal target volume) which include all the target volumes created in each phase CT images within a whole respiratory period. The DVH (Dose volume histogram) of OAR (Organ at risk) which calculated in each method was compared for the evaluation of the plan properness. The relative decrease of OARs' DVH were verified in the application of respiratory gated method. The average decrease rate were 16.88+/-9.97% in the bronchus, 34.13+/-19.15% in the spinal cord, 28.42+/-18.49% in the chest wall and 32.48+/-16.66% in the lung. Based on these results, we can verified the applicability and the effectiveness of the respiratory gated method in the lung radiation surgery.