Short-term Efficacy and Safety of Ranibizumab for Neovascular Age-related Macular Degeneration in the Real World: A Post-marketing Surveillance Study

PURPOSE: To investigate the short-term efficacy and safety of ranibizumab in the routine clinical setting in patients with neovascular age-related macular degeneration and to analyze the associated factors for visual outcome. METHODS: This was a post-hoc analysis of a ranibizumab regulatory post-marketing surveillance study in which 4,136 patients were enrolled and followed for 12 weeks. Change in best-corrected visual acuity (BCVA), size of choroidal neovascularization, and the presence of hemorrhage and exudate were analyzed and the association between BCVA change and baseline characteristics were investigated. Data on ocular and systemic adverse events were collected. RESULTS: Mean BCVA improved significantly and mean BCVA change was the logarithm of the minimal angle of resolution 0.13 ± 0.01 (p < 0.001). A lower baseline BCVA and younger age were significant predictive factors for visual improvement or maintenance (≥0 lines). For greater visual acuity gain (≥3 lines), no treatment history, lower baseline BCVA, younger age, and classic-type choroidal neovascularization were significant predictive factors. No new safety signals were found. CONCLUSIONS: In this study, conducted in real-world clinical practice with a large number of neovascular age-related macular degeneration patients, visual and anatomical outcomes improved significantly after three monthly ranibizumab treatments. Treatment-naive patients had a higher chance of greater visual gain (≥3 lines) than non-naive patients.

Stress Fracture of the Proximal Clavicle after Parallel Bars Exercise in a Young Male / 대한정형외과학회잡지

Although acute traumatic fractures of the clavicle are relatively common, stress fractures of the proximal clavicle are extremely rare. Stress fractures of the clavicle have often been reported after a radical neck dissection or radiation but rarely occur during excessive repetitive exercise in professional athletes. The authors report a case of a stress fracture of the proximal clavicle during exercise in a young man with no specific preceding factors, which has not been reported in the Korean literature.

Intraoperative Graft Isometry in Anatomic Single-Bundle Anterior Cruciate Ligament Reconstruction

PURPOSE: Little is known about the isometry of anatomic single-bundle anterior cruciate ligament (ACL) tunnel positions in vivo although it is closely related to graft tension throughout the range of motion. The purpose of this study was to evaluate intraoperative graft isometry in anatomic single-bundle ACL reconstruction in vivo. MATERIALS AND METHODS: Graft length changes were assessed before bio-screw fixation in the tibial tunnel by pulling the graft with tensions of 20 lbs and 30 lbs in full extension at flexion angles of 30°, 60°, 90°, and 120°. RESULTS: At the flexion angle of 30°, 20 lbs and 30 lbs of tension showed −0.4 mm and −0.6 mm length changes, respectively. The greater the flexion angle of the knee, the shorter the graft length in the joint. At the flexion angles of 90° and 120°, there was significant difference in the graft length change between 20 lbs and 30 lbs of tension. CONCLUSIONS: Anatomic single-bundle ACL reconstruction was non-isometric. The graft length was the longest in full extension. The tension of graft became loose in flexion. At the flexion angles of 90° and 120°, there was significant difference in the graft length change between 20 lbs and 30 lbs of tension.

Acute Isolated Tear of Gluteus Medius in Young Male / 대한고관절학회지

The hip rotator cuff tear usually develops in the middle-aged through gradual degenerative changes, similar to rotator cuff tears in the shoulder. An acute tear in the hip abductor by a traumatic event in young ages is very uncommon. The authors experienced an unusual case of an acute traumatic tear isolated to the gluteus medius in a young male; thus, we report the treatment results in this rare case with a review of the literature.

Humeral Shaft Fracture Sustained during Arm Wrestling in Young Males / 대한스포츠의학회지

Humeral shaft fracture sustaining arm wrestling is rare, but occurs intermittently. We treated 15 cases of humeral shaft spiral fractures occurred during arm wrestling for fun since 2007. Average age was 22.47±2.69 years, average body mass index was 22.67±2.06 kg/m2. There was no prominent tendency for the fractures to occur at a certain phase of the match. Fractured level and length of each case were measured in the plain radiographs and compared with those of previous reports. Eight cases (53.3%) had an associating medial butterfly fragment, and the time taken until the fracture occurred was longer than that of simple spiral fracture (15.62±9.03 seconds vs. 7.85±2.67 seconds, p=0.048). Fractures were distributed mid to distal one third of humerus, the length of fracture was 7.93±2.69 cm and involved 25.43%±8.24% of humeral length. All cases except one treated surgically using plate and screws and returned their full activities within postoperative 3 months. Although arm wrestling is a simple and joyful sport, participants should be aware of the risks of injury during arm wrestling, especially for the amateur players.

The Changes of Macular Microvasculature and Related Systemic Parameters in Diabetic Patients without Diabetic Retinopathy

PURPOSE: To investigate the systemic parameters related to changes in the retinal microvasculature using optical coherence tomography angiography (OCTA) in diabetic patients without diabetic retinopathy. METHODS: We retrospectively reviewed the medical records of diabetic patients without diabetic retinopathy. All patients showed normal fundus on dilated fundus examinations. OCTA (DRI OCT Triton, Topcon Corporation, Tokyo, Japan) was performed on a 3 × 3 mm area centered at the fovea. The foveal avascular zone (FAZ) area and vascular density (VD) of the superficial and deep capillary plexus (SCP/DCP) were measured. Multiple regression analysis was conducted to evaluate the relationship between microvascular indexes on OCTA and systemic parameters including sex, age, duration of diabetes mellitus (DM), hemoglobin A1c (HbA1c), total cholesterol, presence of hypertension (HTN) and systolic and diastolic blood pressure (SBP/DBP). RESULTS: A total of 35 eyes of 35 patients were included in this study. The mean age was 55.7 ± 11.6 years, the mean duration of DM was 52.4 ± 88.7 months and the mean HbA1c was 8.8 ± 2.3%. The FAZ area of the DCP increased significantly as the HbA1c level increased (p 0.05). No systemic parameters exhibited significant relationships with VD in either the SCP or the DCP (p > 0.05). CONCLUSIONS: The FAZ area of the DCP detected via OCTA increased as the level of HbA1c increased, although the patients did not show diabetic retinopathy on dilated fundus examinations. Therefore, clinicians should consider this when screening diabetic patients for diabetic retinopathy.

A Case of CMV Endotheliitis Treated with Intravitreal Ganciclovir Injection

We report a case of CMV corneal endotheliitis that was treated with intravitreal ganciclovir injection. A 56-year-old man who has suffered from uveitis was referred to our clinic due to corneal endothelial abnormality. Slit lamp examination showed a localized sectoral corneal edema and linear keratic precipitates along the boundary of edema. In spite of treatment with oral steroid and acyclovir, the disease progressed and two new coin-like lesions were developed. After topical ganciclovir and intavitreal injection of ganciclovir, the corneal lesions disappeared.

A Case of CMV Endotheliitis Treated with Intravitreal Ganciclovir Injection

We report a case of CMV corneal endotheliitis that was treated with intravitreal ganciclovir injection. A 56-year-old man who has suffered from uveitis was referred to our clinic due to corneal endothelial abnormality. Slit lamp examination showed a localized sectoral corneal edema and linear keratic precipitates along the boundary of edema. In spite of treatment with oral steroid and acyclovir, the disease progressed and two new coin-like lesions were developed. After topical ganciclovir and intavitreal injection of ganciclovir, the corneal lesions disappeared.

Comparison of Choroidal Thickness in Eyes with Central Serous Chorioretinopathy, Asymptomatic Fellow Eyes and Normal Eyes

PURPOSE: To compare the choroidal thickness in central serous chorioretiopathy (CSC) patients and normal controls using spectral domain optical coherence tomography (SD-OCT). METHODS: The authors compared the choroidal thickness in eyes with CSC, fellow eyes and in normal eyes. In addition, the authors attempted to determine any correlation between choroidal thickness and other factors such as age, height of serous retinal detachment, and spherical equivalent. Choroidal thickness was measured using a perpendicular line from the outer margin of the subfoveal retinal pigment epithelium to the inner surface of the sclera. RESULTS: Twenty-five eyes of 25 CSC patients, 17 fellow eyes and 29 age-matched normal eyes were examined and categorized as group 1, group 2 and group 3, respectively. Subfoveal choroidal thickness was 370.64 +/- 58.06 microm in group 1, 301.85 +/- 47.83 microm in group 2, and 261.84 +/- 48.22 microm in group 3. The choroidal thickness in group 1 was significantly greater than those in group 2 and group 3, and the choroidal thickness in group 2 was significantly greater than that in group 3 (p = 0.001, p < 0.001, p = 0.004, respectively), where the choroidal thickness showed a negative correlation with age (p = 0.015). CONCLUSIONS: The choroidal thickness was greater in eyes with CSC and in their fellow eyes compared to that in normal eyes. The results suggest that CSC may be caused by choroidal vascular hyperpermeability and increased hydrostatic pressure in the choroid.

Acyclovir-induced Acute Renal Failure in a Patient With Suspected Acute Retinal Necrosis Syndrome

PURPOSE: To report a case of acyclovir-induced acute renal failure (ARF) suspected as acute retinal necrosis syndrome. CASE SUMMARY: The authors report a 55-year-old male patient who presented with left eye visual disturbance due to suspected acute retinal necrosis syndrome. Non-oliguric ARF developed after the infusion of intravenous acyclovir (850 mg every 8 hours). The patient did not show any uremic symptoms or signs. The crystal was not discovered in the urine. After stopping the acyclovir infusion and hydration, acyclovir-induced ARF was reversed. CONCLUSIONS: Although possessing critical nephrotoxicity, acyclovir is a useful antiviral drug. Therefore, when using acyclovir, the importance of hydration and preventing acyclovir-induced ARF should be considered.