Macular Buckling Surgery Using a Novel L-shaped Buckle for Patients with Myopic Tractional Maculopathy

Purpose@#To describe the clinical characteristics and surgical outcomes of patients with myopic tractional maculopathy (MTM) who underwent macular buckling (MB) surgery using a novel L-shaped buckle. @*Methods@#A titanium stent, a style 507 sponge, and a silicone sleeve were used to create an L-shaped macular buckle. The titanium stent was bent through 90° over the last third. The sponge was cut to about 1 cm in length and placed on the extremity. The remaining part of the stent was then covered with a 2-cm-long silicone sleeve; the total buckle length was 3 cm. The buckle was implanted supero-temporally to allow access to the macular region. Intraoperative optical coherence tomography (Zeiss Rescan 700, Carl Zeiss, Jena, Germany) was performed to ensure that the buckle was appropriately positioned. @*Results@#Three patients with MTM underwent MB surgery under general anesthesia. In all patients, the foveae lay at the greatest distances possible from the posterior staphyloma. Given the location of the posterior staphyloma and the posterior scleral expansion, anteroposterior traction was evident in every patient. After surgery, although the extent varied, all patients exhibited reduced anteroposterior traction, evidenced by decreased retinoschisis, staphyloma flattening, and smaller macular holes. In one case, vitrectomy was added to release epiretinal membrane-induced tangential traction. No patient reported any significant ocular complication after surgery. @*Conclusions@#MB using an L-shaped buckle, safely and efficiently relieves anteroposterior traction and improves the macular anatomy in patients with MTM.

Non-alcoholic Fatty Liver Disease and COVID-19 Susceptibility and Outcomes: a Korean Nationwide Cohort

Background@#Evidence for the association between underlying non-alcoholic fatty liver disease (NAFLD), the risk of testing severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) positive, and the clinical consequences of coronavirus disease 2019 (COVID-19) is controversial and scarce. We aimed to investigate the association between the presence of NAFLD and the risk of SARS-CoV-2 infectivity and COVID-19-related outcomes. @*Methods@#We used the population-based, nationwide cohort in South Korea linked with the general health examination records between January 1, 2018 and July 30, 2020. Data for 212,768 adults older than 20 years who underwent SARS-CoV-2 testing from January 1 to May 30, 2020, were obtained. The presence of NAFLDs was defined using three definitions, namely hepatic steatosis index (HSI), fatty liver index (FLI), and claims-based definition. The outcomes were SARS-CoV-2 test positive, COVID-19 severe illness, and related death. @*Results@#Among 74,244 adults who completed the general health examination, there were 2,251 (3.0%) who were SARS-CoV-2 positive, 438 (0.6%) with severe COVID-19 illness, and 45 (0.06%) COVID-19-related deaths. After exposure-driven propensity score matching, patients with pre-existing HSI-NAFLD, FLI-NAFLD, or claims-based NAFLD had an 11–23% increased risk of SARS-CoV-2 infection (HSI-NAFLD 95% confidence interval [CI], 1–28%; FLI-NAFLD 95% CI, 2–27%; and claims-based NAFLD 95% CI, 2–31%) and a 35–41% increased risk of severe COVID-19 illness (HSI-NAFLD 95% CI, 8–83%; FLI-NAFLD 95% CI, 5–71%; and claims-based NAFLD 95% CI, 1–92%). These associations are more evident as liver fibrosis advanced (based on the BARD scoring system). Similar patterns were observed in several sensitivity analyses including the full-unmatched cohort. @*Conclusion@#Patients with pre-existing NAFLDs have a higher likelihood of testing SARSCoV-2 positive and severe COVID-19 illness; this association was more evident in patients with NAFLD with advanced fibrosis. Our results suggest that extra attention should be given to the management of patients with NAFLD during the COVID-19 pandemic.

Association of the GSTM1 and GSTT1 Genes with Diabetic Retinopathy in the Korean Population

PURPOSE: To investigate the correlation between Glutathione-S-transferase (GST) genes and diabetic retinopathy (DR) in patients with type 2 diabetes mellitus (DM). METHODS: In this case-control study, 131 patients who were diagnosed with DR, 105 diabetic patients who did not have DR, and 45 nondiabetic controls were examined from January 2013 to November 2015. To analyze deletion of the GSTT1 and GSTM1 genes, polymerase chain reactions of DNA in a buffy coat from peripheral blood were performed via electrophoresis. RESULTS: There were no statistically significant differences in age, sex, or spherical equivalent between the 236 type 2 diabetic patients and the 45 normal controls (p > 0.05). In both univariate and multivariate analyses, the duration of type 2 DR was longer (p = 0.004, p = 0.013), and HbA1c was higher (p = 0.004, p = 0.007) in the DR group than in the non-DR group. Presence of a GSTM1 deletion is associated with a lower frequency of DR (p = 0.017, p = 0.012). CONCLUSIONS: Deletion of the GSTT1 gene is not associated with an increased risk of DR, whereas GSTM1 deletion is associated with a lower risk of DR in patients with type 2 DM in the Korean population. Additional studies with larger sample sizes and different types of GST genes are needed to confirm this study.

Analysis of Clinical Features and Prognostic Factors of Ocular Surface Squamous Neoplasia

PURPOSE: To analyze the clinical features and prognostic factors of ocular surface squamous neoplasia (OSSN). METHODS: A total of 31 eyes of 31 patients with suspected OSSN who were treated with excision and biopsy were retrospectively reviewed. Clinical features such as patient symptoms, invasion type, morphologic feature and size of lesion were analyzed. All patients were treated with simple excision or mitomycin C combination therapy. Factors affecting recurrence were evaluated. RESULTS: The most common symptom, invasion type, morphological feature, lesion size and histological diagnosis were foreign body sensation (38.7%), combined conjunctiva and cornea type (71.0%), gelatinous type (74.2%), 5 - 10 mm in largest diameter (45.2%) and intraepithelial neoplasia (51.6%), respectively. Age, sex, morphological features, lesion size and histological diagnosis had no effect on recurrence. Mitomycin C combination therapy was significantly associated with decreased recurrence compared to simple excision (p < 0.05). CONCLUSIONS: In OSSN, intraepithelial neoplasia was the most common subtype. Mitomycin C combination therapy was effective in decreasing recurrence.

Clinical Analysis of Primary Conjunctival Malignant Lymphoma

PURPOSE: To investigate clinical outcomes, response to treatment, and the related factors of recurrence and complication, following treatment of primary conjunctival malignant lymphoma. METHODS: The medical records of 39 patients diagnosed with primary conjunctival malignant lymphoma between January 2005 and June 2013 were retrospectively reviewed. RESULTS: The mean age of patients was 51.1 years old. The most common presenting symptom was hyperemia (33.3%). The most common anatomical location of the mass was the fornix (38.5%) and 25.6% patients had bilateral involvement. Histopathologically, mucosa-associated lymphoid tissue (MALT) lymphoma (92.3%) was the most common subtype. Every patient underwent radiotherapy (92.3%) or chemotherapy (7.7%) after surgical excision and had 100% complete remission. Local or systemic recurrence was observed in 15.4% of patients after treatment (mean 8.0 +/- 3.3 months), but was completely remitted after additional radiation or chemotherapy. International prognostic index and location of tumor were significantly related factors for predicting tumor recurrence (p < 0.01, p = 0.02, respectively). Dry eye disease (DED) was the most common ocular complication (44.4%) after radiotherapy. Total radiation dosage and location of tumor were significantly associated factors for developing DED after radiotherapy (both p = 0.04). CONCLUSIONS: Most conjunctival malignant lymphomas were low grade malignant MALT lymphomas that responded well to treatment but recurrence of tumor and development of DED after radiotherapy were common, therefore predicting and preparing these lymphomas is important.

A Case of Chronic Osteomyelitis of the Orbit

PURPOSE: To report a case of chronic osteomyelitis of the orbit. CASE SUMMARY: A 61-year-old woman visited the ophthalmology clinic with a 3-month history of right periorbital swelling and pain. She had a history of ondontitis treated with oral antibiotics three months previously. A hard, tender, swollen mass was palpated near the right lower eyelid extending to the floor of the right orbit. Otherwise, there were no other clinically-specific ocular signs. Orbital computed tomography and bone scan findings suggested right periorbital soft tissue inflammation with underlying osteomyelitis of maxillar and zygomatic bones involving the inferior and lateral orbital walls. The patient was admitted and treated with broad spectrum systemic antibiotics. After 7 days, periorbital soft tissue swelling and pain were improved, but the size of the hard mass was unchanged. Seven days after admission, incision and drainage of the periorbital hard mass near the lower eyelid and debridement of the necrotic and pyogenic tissue were performed. Histologic examination showed chronic granulomatous inflammation and bony necrosis of the mass. The patient was discharged after receiving systemic antibiotics for 7 more days. At the 6-month follow-up, no recurrence or abnormal findings in the right periorbital region were observed. CONCLUSIONS: Chronic orbital osteomyelitis should be treated with combined systemic antibiotics and surgical intervention.