Current Status and Future Perspectives on Stem Cell-Based Therapies for Parkinson’s Disease

Parkinson’s disease (PD) is the second most common neurodegenerative disorder after Alzheimer’s disease, affecting 1%–2% of the population over the age of 65. As the population ages, it is anticipated that the burden on society will significantly escalate. Although symptom reduction by currently available pharmacological and/or surgical treatments improves the quality of life of many PD patients, there are no treatments that can slow down, halt, or reverse disease progression. Because the loss of a specific cell type, midbrain dopamine neurons in the substantia nigra, is the main cause of motor dysfunction in PD, it is considered a promising target for cell replacement therapy. Indeed, numerous preclinical and clinical studies using fetal cell transplantation have provided proof of concept that cell replacement therapy may be a viable therapeutic approach for PD. However, the use of human fetal cells remains fraught with controversy due to fundamental ethical, practical, and clinical limitations. Groundbreaking work on human pluripotent stem cells (hPSCs), including human embryonic stem cells and human induced pluripotent stem cells, coupled with extensive basic research in the stem cell field offers promising potential for hPSC-based cell replacement to become a realistic treatment regimen for PD once several major issues can be successfully addressed. In this review, we will discuss the prospects and challenges of hPSC-based cell therapy for PD.

Serous Retinal Detachment Following Laser Peripheral Iridotomy for the Angle Closure Secondary to Posterior Scleritis / 계명의대학술지

This study was aimed to report a case of serous retinal detachment following laser peripheral iridotomy (LPI) for the treatment of angle closure secondary to posterior scleritis. A 55-year-old man with bilateral ocular pain, redness, and headache was referred to Keimyung University Dongsan Medical Center. At the initial examination, his visual acuity was 1.0 in the both eyes. The intraocular pressure (IOP) was 25 mmHg in the right eye and 28 mmHg in the left eye. Slit lamp examination showed a shallow anterior chamber, which was found to be Shaffer grade I by gonioscopy. There were no specific findings in the fundus, except a slightly edematous disc margin in both eyes. LPI was performed on both eyes. Fourth day after LPI, the patient complained of a central scotoma and visual disturbance of the left eye, in which the visual acuity had decreased to 0.06. The optical coherence tomography showed serous retinal detachment at the posterior pole. Fluorescein angiography revealed a focal leakage in the superotemporal area, as well as multiple hyperfluorescence lesions. Posterior scleritis of the left eye was diagnosed. Systemic steroid therapy was initiated and the area with the leakage was treated by focal laser photocoagulation. Two weeks later, the serous retinal detachment of the left eye resolved and visual acuity improved to 0.63. Laser peripheral iridotomy can exacerbate serous retinal detachment in patients with posterior scleritis that presented as acute angle closure.

Photodynamic Therapy and Focal Laser Photocoagulation in Chronic Central Serous Chorioretinopathy

PURPOSE: The aim of this study was to compare the treatment efficacy of photodynamic therapy (PDT) and focal laser photocoagulation in chronic central serous chorio retinopathy (CSC). METHODS: A retrospective study in a clinical practice setting including 40 eyes of 40 patients with chronic CSC which were treated with PDT or focal laser photocoagulation were recruited in this study from March 2011 to December 2013. Mean change in best corrected visual acuity (BCVA), presence or absence of resolution of subretinal fluid (SRF) and pigment epithelial detachment (PED), recurrence rate, and complications were analyzed. RESULTS: PDT was performed in 23 eyes of 23 patients and focal laser photocoagulation was performed in 17 eyes of 17 patients, and all patients were followed up for more than six months. Location of leakage point and appearance of leakage showed no statistically significant difference between the two groups. Both groups showed significant improvement in BCVA at one month and six months after the treatment; however, there was no statistically significant difference in BCVA improvement between the two groups. In both groups, SRF and PED were partially or completely resolved. Resolution of SRF was better in the PDT group at one month after the treatment; however, no statistically significant difference in the resolution period was observed between the two groups. None of the patients experienced adverse events in the PDT group, but one patient developed choroidal neovascularization after treatment in the focal laser photocoagulation group. Two patients showed recurrence in the PDT group and needed retreatment. CONCLUSIONS: Both treatments are beneficial in patients with chronic CSC. Focal laser photocoagulation can be a good treatment option in terms of cost-effectiveness and convenience.

Factors Related to Repeatability of Intravitreal Bevacizumab Injections in Branch Retinal Vein Occlusion Macular Edema

PURPOSE: To identify the factors related to repeatability of intravitreal bevacizumab injections in patients with macular edema secondary to branch retinal vein occlusion (BRVO). METHODS: The present study included 26 patients with macular edema secondary to BRVO occurring within 1 month of diagnosis. Initial best corrected visual acuity, type of BRVO according to the involved vein branch, distance between fovea and occlusion vein, central macular thickness, type of macular edema, presence of macula hemorrhage, and presence of capillary nonperfusion were evaluated at the time of diagnosis. The patients received an intravitreal bevacizumab injection at the time of diagnosis and reinjections when macular edema and visual acuity were aggravated. According to the factors considered, the reinjection-free rate which was considered a survival rate was evaluated for 1 year after the first injection. RESULTS: The patients with initial visual acuity lower than log MAR 0.5 showed 52.6% survival rate within 1 year compared with 14.3% of the patients with visual acuity higher than log MAR 0.5 (p < 0.01). The patients with occluded vein closer than a distance of 2.5 disc diameters (DD) from the foveal center had a 57.1% survival rate and the patients with occluded vein farther than a distance of 2.5 DD from the foveal center had a 25.0% survival rate (p = 0.04). Macular BRVO and major BRVO patients had 64.3% and 16.7% survival rates, respectively (p = 0.01). CONCLUSIONS: The patients with BRVO may have less chance of repetitive intravitreal bevacizumab injections due to macular edema when initial visual acuity is lower than log MAR 0.5, occluded vein is closer than 2.5 DD from the foveal center, and macular branch is involved at the initial diagnosis. These factors can be utilized to predict the prognosis of BRVO patients and the probability of repetitive intravitreal bevacizumab injections.

Macular Hole Formation after Vitrectomy: Preventable?

PURPOSE: To evaluate the causes of secondary macular hole after vitrectomy and the possibility of their prevention. METHODS: 27 patients (28 eyes) who experienced macular hole formation after vitrectomy were reviewed retrospectively. Age, sex, operation methods, duration between the vitrectomy and the secondary macular hole surgery and causes of the primary vitrectomy were recorded. Best-corrected visual acuity (BCVA) before and after primary vitrectomy; preoperative and postoperative macular findings with optical coherence tomography and fundus examination; and BCVA before and after macular hole surgery were analyzed. RESULTS: Of the 2945 eyes that had undergone vitrectomy, 28 eyes (0.96%) experienced macular hole formation. As causes of primary vitrectomy, 12 eyes had proliferative diabetic retinopathy, 6 eyes had rhegmatogenous retinal detachment, 2 eyes had branch retinal vein occlusion, 3 eyes had age-related macular degeneration and 5 eyes had trauma such as eyeball rupture or intraocular foreign body. The mean duration between primary vitrectomy and macular hole formation was 20.4 months (4 days-115 months). The estimated causes of macular hole formation included cystoid macular edema (CME) (n = 13), thinning of the macula (n = 6), thickening of internal limiting membrane or recurrence of preretinal membrane (PRM) (n = 7), recurrence of subretinal hemorrhage (n = 1) and macular damage during vitrectomy (n = 2). Final BCVA after macular hole surgery decreased in most cases compared to BCVA before macular hole formation except in 7 eyes (25%). CONCLUSIONS: Close observation of the macula after primary vitrectomy especially in eyes with continuous CME, and recurrent PRM and proper management on them including timely removal of the tangential traction force are necessary for preventing macular hole formation. In addition, surgeons should make efforts not to exert excessive tractional force on the macula to avoid iatrogenic damage during removal of the preretinal membrane.

Clinical Characteristics of Rhegmatogenous Retinal Detachment in Patients under 40 Years of Age

PURPOSE: To investigate the risk factors and the factors affecting surgical and visual outcomes of rhegmatogenous retinal detachment in patients under 40 years of age. METHODS: This retrospective study included 88 patients (96 eyes) diagnosed with rhegmatogenous retinal detachment that were followed up for more than 3 months postoperatively. Patients were categorized into 3 groups according to age. The etiologic risk factors and the primary anatomical and functional success rates were analyzed. Preoperative factors that could affect postoperative visual acuity and primary anatomical outcome, such as subretinal strands and proliferative vitreoretinopathy (grade C or worse), were analyzed. RESULTS: Myopia more severe than -4.0 diopters was the most common predisposing factor in all 3 groups. Anatomical success rates and functional success rates were not significantly different among the groups. Prevalence of macular detachment and proliferative vitreoretinopathy were highest in group 1. The presence of subretinal strands was highest in group 2 and proliferative vitreoretinopathy was highest in group 1. Patients with preoperative subretinal strands showed a lower primary anatomical success rate in group 1 and poor postoperative visual acuity in groups 1 and 2. Patients with proliferative vitreoretinopathy had poor postoperative visual acuity however there was no significant difference in primary anatomical success rate among the groups. CONCLUSIONS: Proliferative vitreoretinopathy did not affect the anatomical success rate but did affect visual outcome in rhegmatogenous retinal detachment in patients under age 40. Subretinal strands contributed to a lower anatomical success rate and poorer visual outcome in such patients that were under age 18.

Clinical Characteristics of Rhegmatogenous Retinal Detachment in Patients under 40 Years of Age

PURPOSE: To investigate the risk factors and the factors affecting surgical and visual outcomes of rhegmatogenous retinal detachment in patients under 40 years of age. METHODS: This retrospective study included 88 patients (96 eyes) diagnosed with rhegmatogenous retinal detachment that were followed up for more than 3 months postoperatively. Patients were categorized into 3 groups according to age. The etiologic risk factors and the primary anatomical and functional success rates were analyzed. Preoperative factors that could affect postoperative visual acuity and primary anatomical outcome, such as subretinal strands and proliferative vitreoretinopathy (grade C or worse), were analyzed. RESULTS: Myopia more severe than -4.0 diopters was the most common predisposing factor in all 3 groups. Anatomical success rates and functional success rates were not significantly different among the groups. Prevalence of macular detachment and proliferative vitreoretinopathy were highest in group 1. The presence of subretinal strands was highest in group 2 and proliferative vitreoretinopathy was highest in group 1. Patients with preoperative subretinal strands showed a lower primary anatomical success rate in group 1 and poor postoperative visual acuity in groups 1 and 2. Patients with proliferative vitreoretinopathy had poor postoperative visual acuity however there was no significant difference in primary anatomical success rate among the groups. CONCLUSIONS: Proliferative vitreoretinopathy did not affect the anatomical success rate but did affect visual outcome in rhegmatogenous retinal detachment in patients under age 40. Subretinal strands contributed to a lower anatomical success rate and poorer visual outcome in such patients that were under age 18.

Gender Differences in Risk Factor and Clinical Outcome in Patients with Ischemic Stroke / 고신대학교의과대학학술지

OBJECTIVE: Gender is an important determinant for risk factors and outcomes of ischemic stroke. The aim of this study was to compare risk factors, and clinical outcomes after ischemic stroke between male and female patients. METHODS: The hospital records of patients with ischemic stroke were reviewed retrospectively. Demographic data, stroke risk factors, clinical severities and outcomes after stroke were collected and compared between male and female patients. Stroke severity and clinical disability after ischemic stroke were evaluated by means of the National Institutes of Health Stroke Scale (NIHSS) and modified Rankin Scale (mRS) respectively. RESULTS: Among 447 patients with ischemic stroke, 195 (43.6%) patients were women. The mean age at ischemic stroke was higher in women than in men (p<0.01). As compared to men, women had a significantly lower prevalence of hyperhomocysteinemia, smoking and drinking (all p<0.01). NIHSS and mRS scores were not different between the 2 genders. CONCLUSIONS: Profiles of risk factors differed between the 2 genders, with men having a higher prevalence of hyperhomocysteinemia, smoking and drinking. There were no gender differences in stroke severity and disability after ischemic stroke.

Relationship between the Morphology of Diabetic Macular Edema and Renal Dysfunction in Diabetes

PURPOSE: To determine the correlation between renal dysfunction and the morphologic changes of macular edema in diabetes. METHODS: The current study included 93 patients with diabetic macular edema based on optical coherence tomography (OCT) who completed systemic condition testing one month before or after the OCT. Based on the OCT findings, patients were divided into the following five groups: group A (diffuse), group B (cystoid), group C (serous), group D (vitreomacular tractional), and group E (a mixed presence of cystoid and serous types). In each group, we performed a retrospective analysis of serum albumin, urine albumin, and serum creatinine. We also analyzed the patients in whom serum albumin was 1.6 mg/dL. Urine albumin was measured in all five groups. In each group, a comparative analysis was performed using Fisher's exact test. RESULTS: The number of patients who were assigned to groups A to E was 15, 46, 6, 3, and 23, respectively. According to a comparison of the patients in whom the serum albumin and serum creatinine were abnormal, there was no significant difference among the five groups. The proportion of patients in whom the urine albumin was abnormal was significantly greater in group C (67%) than in groups A (7%), B (20%), or E (22%). CONCLUSIONS: Serous-type macular edema occurred more frequently than other types of macular edema in patients with albuminuria.

Relationship between the Morphology of Diabetic Macular Edema and Renal Dysfunction in Diabetes

PURPOSE: To determine the correlation between renal dysfunction and the morphologic changes of macular edema in diabetes. METHODS: The current study included 93 patients with diabetic macular edema based on optical coherence tomography (OCT) who completed systemic condition testing one month before or after the OCT. Based on the OCT findings, patients were divided into the following five groups: group A (diffuse), group B (cystoid), group C (serous), group D (vitreomacular tractional), and group E (a mixed presence of cystoid and serous types). In each group, we performed a retrospective analysis of serum albumin, urine albumin, and serum creatinine. We also analyzed the patients in whom serum albumin was 1.6 mg/dL. Urine albumin was measured in all five groups. In each group, a comparative analysis was performed using Fisher's exact test. RESULTS: The number of patients who were assigned to groups A to E was 15, 46, 6, 3, and 23, respectively. According to a comparison of the patients in whom the serum albumin and serum creatinine were abnormal, there was no significant difference among the five groups. The proportion of patients in whom the urine albumin was abnormal was significantly greater in group C (67%) than in groups A (7%), B (20%), or E (22%). CONCLUSIONS: Serous-type macular edema occurred more frequently than other types of macular edema in patients with albuminuria.

Altered expression of norepinephrine transporter and norepinephrine in human placenta cause pre-eclampsia through regulated trophoblast invasion / 대한생식의학회지

OBJECTIVE: We investigated the norepinephrine transporter (NET) expression in normal and pre-eclamptic placentas and analyzed the invasion activity of trophoblastic cells based on norepinephrine (NE)-NET regulation. METHODS: NET and NE expression levels were examined by western blot and enzyme-linked immunosorbent assay, respectively. Trophoblast invasion activity, depending on NE-NET regulation, was determined by NET-small interfering RNA (siRNA) and NET transfection into the human extravillous trophoblast cells with or without NE treatment and invasion rates were analyzed by zymography and an invasion assay. RESULTS: NET mRNA was expressed at a low level in pre-eclamptic placentas compared with normal placentas and NE concentration in maternal plasma increased significantly in pre-eclamptic women compared to normal pregnant women (p<0.05). NET gene upregulation and NE treatment stimulated trophoblast cell invasion up to 2.5-fold (p<0.05) by stimulating matrix metalloproteinase-9 activity via the phosphoinositol-3-kinase/AKT signaling pathway, whereas NET-siRNA with NE treatment reduced invasion rates. CONCLUSION: NET expression is reduced by inadequate regulation of NE levels during placental development. This suggests that a complementary balance between NET and NE regulates trophoblast cell invasion activities during placental development.

Factors Affecting Final Visual Acuity in Infectious Endophthalmitis Following Cataract Surgery

PURPOSE: To evaluate the factors affecting the clinical outcome and final visual acuity in patients with infectious endophthalmitis following cataract surgery. METHODS: In this study, 35 patients who were diagnosed with endophthalmitis following cataract surgery from 2003 to 2012 were retrospectively analyzed. To evaluate factors affecting final visual acuity, the following were investigated: initial visual acuity, presence of diabetes mellitus, onset of endophthalmitis after the cataract surgery, performance of vitrectomy, duration between diagnosis and vitrectomy, presence of culture and results of bacterial cultures, type of corneal incision, presence of suture on corneal incision, presence of posterior capsule rupture, and surgeon's experience in referred cases. RESULTS: Intravitreal antibiotic injection was given in all 35 cases, and vitrectomy was additionally performed in 30 of the cases. Statistically, none of the initially investigated factors affected final visual acuity. Coagulase-negative staphylococci including staphylococcus epidermidis were the most common organisms isolated during the study period. CONCLUSIONS: No single factor investigated significantly affected the final visual acuity in postoperative endophthalmitis following cataract surgery.

Changes in Antipsychotic Drug Usage in the Psychiatric Inpatients at a University Hospital between 1997, 2003-2004 and 2009-2010 / 대한정신약물학회지

OBJECTIVE: Patterns of clinical use of antipsychotics have changed greatly in the past decade. The authors' goal was to examine these patterns in an inpatient unit at a university hospital between 1997, 2003-2004, and 2009-2010. METHODS: We evaluated medication use in inpatients treated with antipsychotic drugs during 2009-2010 (n=379) and compared the results with inpatients treated with antipsychotics in 2003-2004 (n=379) and inpatients treated with antipsychotics in 1997 (n=165). RESULTS: The distribution of psychiatric diagnoses in 2009-2010 was different from that in 2003-2004 and 1997. The proportion of patients with schizophrenia spectrum disorders was higher in 2009-2010 (p=0.013, p<0.001). An atypical agent was prescribed for 98.7% (n=374) of patients in 2009-2010. This represents a significant proportional increase over both 2003-2004 (93.7%, n=355; p<0.001) and 1997 (57.6%, n=95; p<0.001). In 2009-2010 the number of patients receiving prescriptions of two or more antipsychotics in combination was 16.1% (n=61), which represents a significant proportional increase over 2003-2004 (9.0%, n=34; p=0.007) and 1997 (4.8%, n=8; p=0.001). CONCLUSION: The present study demonstrates that atypical antipsychotic medications have replaced typical antipsychotic medications. Polypharmacy increased markedly despite limited empirical evidence of cost-risk-benefit relationships.

Intravitreal Bevacizumab Injection for Choroidal Neovascularization Secondary to Laser Photocoagulation for Central Serous Chorioretinopathy

PURPOSE: To report a case of intravitreal bevacizumab injection for choroidal neovascularization following direct laser photocoagulation for central serous chorioretinopathy. CASE SUMMARY: A 44-year-old male patient with an 8-month history of metamorphopsia in his left eye visited our clinic and was diagnosed with central serous chorioretinopathy after performing refraction, fundus examination, fluorescein angiography (FAG) and optical coherence tomography (OCT). After 1 month, laser photocoagulation of the leaking point observed on the FAG was performed. After 8 weeks following laser photocoagulation, visual acuity was reduced to 0.4, subretinal hemorrhage accompanied by choroidal neovascularization was observed on FAG and OCT, and an intravitreal bevacizumab injection was administered. After 4 weeks following the injection, macular edema and subretinal hemorrhage decreased, visual acuity increased to 1.0 and was maintained properly. However, after 2 years, the central serous chorioretinopathy recurred and after 3 months, healed spontaneously. CONCLUSIONS: Intravitreal bevacizumab injection is a safe and effective treatment for secondary choroidal neovascularization occurring after direct laser photocoagulation for central serous chorioretinopathy. In addition, a single treatment can maintain the patient's status with no recurrence of choroidal neovascularization over a long-term period.

A Case of Hydrophilic Acrylic Intraocular Lens Opacification in a Patient with Proliferative Diabetic Retinopathy

PURPOSE: To report a case of hydrophilic acrylic intraocular lens (IOL) opacification in a patient who underwent vitrectomy and cataract surgery for the treatment of diabetic retinopathy. CASE SUMMARY: A 54-year-old female complained of blurred vision for 15 months after having combined vitrectomy and phacoemulsification with IOL (Rayner(R) Superflex(R) 620H) implantation for the treatment of high-risk proliferative diabetic retinopathy. On slit-lamp examination, IOL opacification was evident. IOL exchange was performed and the explanted IOL analyzed. Scanning electron microscopy (SEM) revealed the presence of translucent granular deposits on the anterior subsurface of the IOL. Energy dispersive X-ray spectroscopy (EDS) demonstrated calcium and phosphate deposition within the IOL optic.

A Case of Idiopathic Central Serous Chorioretinopathy in a 12-year-old Male Treated with Bevacizumab

A 12-year-old male presented with a chief complaint of a 1-month-history of decreased visual acuity in his right eye. The patient had no past history of steroid use or other systemic diseases. On fundus examination, which included fluorescent angiography (FAG) and optical coherence tomography (OCT), the patient was diagnosed with idiopathic central chorioretinopathy, whose clinical course was monitored without any specific treatments. At the time of admission, the best-corrected visual acuity was 0.5 in the right eye and 1.0 in the left eye. On fundoscopy, a serous detachment of 1 disc diameter in size was observed in the posterior pole. According to the FAG and the OCT, serous neurosensory detachment was present. After two months of monitoring the clinical course, the best corrected visual acuity in the right eye was 0.8, and there was improvement of neurosensory retinal detachment. However, OCT detected recurrence after five months, and the corrected visual acuity was decreased to 0.6. Bevacizumab was then injected into the vitreous cavity. Complete resolution of the subretinal fluid resulted eight months later, and the corrected visual acuity improved to 1.0.

Changes of Medication Usage in Inpatients of Major Depressive Disorder: One University Hospital among Year 2001, 2006 and 2010 / 대한정신약물학회지

OBJECTIVE: Prescription patterns have changed rapidly due to development of new drugs, results of new researches, and increment of clinician's experience. The goal of this study was to examine and compare the trend of prescription patterns for major depressive disorder at a university hospital among year 2001, 2006, and 2010. METHODS: We reviewed the medication usage of inpatients with major depressive disorder in 2001, 2006 and 2010, including antidepressants used as first choice, switching, and combination, and various augmentation agents. And we investigated the time to switching and combination of antidepressant in 2001, 2006 and 2010. RESULTS: The antidepressants used as first line drug were selective serotonin reuptake inhibitor (SSRI) (49.7%), mirtazapine (24.5%), and tricyclic antidepressant (TCA) (4.9%) in 2001, and SSRI (49.4%), mirtazapine (25.6%) and serotonin-norepinephrine reuptake inhibitor (SNRI) (20.2%) in 2006, SSRI (42.7%), mirtazapine (19.5%) and SNRI (18.3%) in 2010 in frequency order. The antidepressants used as switching drug were TCA (33.3%), mirtazapine (25.0%), and nefazodone (16.7%) in 2001, SSRI (35.0%), mirtazapine (35.0%), and SNRI (20.0%) in 2006, and SSRI (50.0%), SNRI (30.0%) and mirtazapine (20.0%) in 2010. As combination treatment, SSRI and TCA combination was used mostly by far in 2001 (51.1%), but in 2006 and 2010, various combination were used. In 2010 year, SNRI and mirtazapine, SSRI and TCA, SSRI and mirtazapine (42.1%, 21.1%, 15.8%, respectively) combination treatment were used in frequency order. The use of typical antipsychotics as augmentation agent decreased and the use of atypical antipsychotics increased significantly in 2010. Most frequently used atypical antipsychotic was quetiapine in 2010. The use of thyroid hormone was significantly decreased after 2006, but the use of mood stabilizer was increased between 2001 and 2010 (p=0.001). CONCLUSION: The results of the present study suggested that there were lots of change in prescription patterns for major depressive disorder between 2001 and 2010. Especially, these changes could be seen in use of various antidepressants, increment in use of atypical antipsychotics and lamotrigine. It can reflect not only the current progress of psychopharmacology and clinical experience, but also the clinical complexity of treatment of depression.

A Case of Postoperative Endophthalmitis by Extended-spectrum Beta-lactamase-producing Escherichia coli

A 75-year-old female was transferred to our clinic three days after uneventful phacoemulsification with intraocular lens (IOL) implantation in the right eye that had been carried out at a local clinic. Under the diagnosis of postoperative endophthalmitis, the patient underwent pars plans vitrectomy, IOL explantation, silicone oil tamponade, and intravitreal antibiotic injection. Even after the procedure, the patient's condition was further aggravated, and extended-spectrum beta-lactamase-producing Escherichia coli were identified on bacterial identification test. Although meropenem was applied locally and systemically, the patient had no-light perception visual acuity.

A Case of Subconjunctival Foreign Body Migration after Collagen-Containing Filler Injection

PURPOSE: To report a case of subconjunctival foreign body migration in both eyes after collagen-containing filler injection. CASE SUMMARY: A 51-year-old female, who had been treated with collagen-containing filler in her eyelid, nose, and forehead for cosmetic complaints four months earlier, presented to our clinic with decreased visual acuity and foreign body sensation in both eyes. Slit lamp examination revealed moderate nucleosclerosis and subcapsular opacity in her crystalline lens, in addition to scattered subconjunctival foreign body infiltration in both eyes. Cataract extraction with posterior chamber lens implantation was performed, and the subconjunctival foreign body was also partially removed. Biopsy of the remaining foreign body was performed, and examination revealed foreign material and multivacuolated cells in the conjunctiva. CONCLUSIONS: Clinicians and patients should be aware of the risk of migration of collagen-containing filler inject at or near the eyelid, to the eyeball, including the conjunctiva.

A Case of Endophthalmitis Treated with Surgical Removal of the Inflammatory Plaque on Corneal Endothelium

PURPOSE: To report a case of endophthalmitis treated with surgical removal of the inflammatory endothelial plaque. CASE SUMMARY: A 61-year-old male was transferred to our clinic due to corneal laceration of the left eye. An emergency operation for the lacerated cornea was performed. After the operation, the patient had no specific symptoms for 8 months but then visited our clinic with sudden decreased visual acuity. On slit lamp examination, the patient had some chamber reactions. Anterior chamber reactions exacerbated after 2 months and the best corrected visual acuity was decreased from 1.0 to 0.08. An inflammatory corneal endothelial plaque and endothelial precipitates had developed. The posterior segment was not visualized due to the severe anterior chamber inflammatory reaction. No growth was observed on bacterial or fungal cultures. However, administration of eye drops and oral voriconazole were initiated based on a clinical impression suspicious of fungal infection. Despite the treatment, the infection did not respond. Voriconazole was then directly injected into the vitreous and anterior chamber. Although the patient's best corrected visual acuity slightly improved, the inflammatory reactions of the anterior chamber and vitreous did not. The inflammatory endothelial plaque on the patient's cornea was then surgically removed and the best corrected visual acuity improved to 1.0. Mycelium was detected on the KOH smear of the endothelial plaque. There were no further inflammatory reactions in the anterior chamber or vitreous after surgical removal of the endothelial plaque.