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Purpose@#To investigate the incidence and clinical course of acute endophthalmitis after idiopathic epiretinal membrane (iERM) surgery employing microincision vitrectomy (MIVS). @*Methods@#We retrospectively reviewed the medical records of eyes with acute endophthalmitis developing after iERM surgery via 23- or 25-gauge MIVS from 2011 to 2021. The incidence, culture-positive rate (and responsible bacteria), final visual acuity (VA), and factors affecting poor visual outcomes were assessed. @*Results@#Acute endophthalmitis developed in 20 of the 12,921 eyes (0.15%) after MIVS. Of these, 14 of 3,180 eyes treated via iERM (0.44%, one per 227 procedures) developed endophthalmitis; the incidence ratio (iERM versus non-iERM) was 7.1 (p < 0.001, 95% confidence interval [CI] = 2.6-22.7). At least one sclerotomy remained unsutured in all eyes after iERM surgery. Thirteen eyes (92.9%) were given intravitreal antibiotic injections after emergency vitrectomy, and one eye was treated with intravitreal antibiotic injection alone. Staphylococcus epidermidis was cultured from four eyes (28.6%); three strains were methicillin-resistant. All final VAs were not better than the initial VAs; the average VA decreased from 20/42 to 20/259 (p < 0.001). Six eyes (42.9%) attained legal blindness status (final VA < 20/200); Macular invasion was a unique risk factor for such blindness (p = 0.020, odds ratio = 35.0, 95% CI = 1.7-703.0). @*Conclusions@#Acute endophthalmitis developing after iERM surgery with MIVS was more common than such endophthalmitis after other retinal surgery. Approximately 40% of the former patients became legally blind, and the risk was higher in eyes with macular involvement of endophthalmitis.
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Purpose@#To report successful graft reattachment using atropine after Descemet’s membrane stripping automated endothelial keratoplasty (DSAEK) in iris deformity.Case summary: A 76-year-old male was referred for decreased visual acuity due to bullous keratopathy in his right eye. He had previously undergone several eye surgeries, including vitrectomy and intraocular lens fixation, because of retinal detachment, which caused the iris deformity. DSAEK was performed, but the graft detached because of an air bubble in the posterior chamber. Atropine was used to move the air into the anterior chamber. The graft was attached the next day, and maintained during 3 months of follow-up. @*Conclusions@#Atropine is an effective treatment option for cases with air bubble migration to the posterior chamber, leading to graft detachment after DSAEK in iris deformity.
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Purpose@#To report four cases of toxic anterior segment syndrome after cataract surgery under intracameral 0.5% lidocaine anesthesia.Case summary: Four patients had a decrease in visual acuity within 3 days of undergoing cataract surgery. There was evidence of anterior chamber inflammation with corneal edema and opacity. Toxic anterior segment syndrome was diagnosed on the basis of negative microbial cultures and clinical features. Three patients were treated with systemic and topical steroids, and one was treated with topical steroids only. Three months postoperatively, three patients had good visual acuity without inflammation or corneal edema. However, one patient, who did not receive systemic steroids, exhibited persistent corneal edema and required endothelial keratoplasty. @*Conclusions@#Toxic anterior segment syndrome is a surgical complication that requires immediate treatment. Systemic steroids can be helpful with topical steroids. Clinicians should ensure that measures are taken to avoid contamination of surgical procedure with toxic substances to prevent toxic anterior segment syndrome.
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Purpose@#To analyze the effect of office-based probing in different age groups of children with congenital nasolacrimal duct obstruction. @*Methods@#A retrospective study was conducted in 146 children (200 eyes) diagnosed with congenital nasolacrimal duct obstruction who underwent office-based probing. The children were classified into four groups at the time of probing: group A ( 6 months but 12 months but 20 months but < 48 months). Age at the time of the procedure, gender, laterality, follow-up period, clinical symptoms, and the number of probings were investigated. Success rates were compared among the four groups in terms of sex, age, laterality, and the number of probings. @*Results@#The success rate of the first probing was 160/200 eyes (80.0%). The success rates were 87.5% in group A, 85.7% in group B, 77.6% in group C, and 76.7% in group D. No significant difference in the success rate was observed according to age (p = 0.550). The second probing was performed in 40 eyes. The success rates were 100% in group A, 87.5% in group B, 70.6% in group C, and 35.7% in group D. A significant difference in the success rate was observed according to age (p = 0.048). The success rate of the second probing was 25/40 eyes (62.5%). No significant difference in laterality was observed among the four groups (p = 0.291). @*Conclusions@#No significant difference in the success rate of first nasolacrimal duct probing was detected, but a significant difference in the success rate of the second probing was detected according to age in children < 4 years of age.
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Purpose@#To investigate characteristics of optical coherence tomography angiography (OCTA) findings in chronic inactive branch retinal vein occlusion (BRVO) with quantitative analysis. @*Methods@#The medical records of 48 eyes diagnosed with unilateral ischemic acute BRVO, and without recurrence for 6 months after the acute treatment, were reviewed retrospectively. We manually segmented the abnormal vessels of the superficial and deep capillary plexus (SCP-AV and DCP-AV, respectively) and vascular congestion of DCP (DCP-VC) from 6 × 6 mm2 macular OCTA images and automatically calculated the area, vessel density, and average retinal thickness of each corresponding region. Correlations were analyzed between the OCTA parameters of the segmentation area and the baseline characteristics. @*Results@#The DCP-AV area was always wider than that of the SCP-AV (p < 0.001), with a transitional zone (TZ) between the two areas. About two-thirds of the DCP-VC area was distributed in the TZ. The vessel density of the DCP-VC was higher than that of the normal capillary plexus (all, p < 0.001). The average retinal thickness of the DCP-VC was greater than those of SCP-AV and DCP-AV areas (all, p < 0.001), but not different from the normal capillary plexus. The greater the extent of the DCP-VC distribution under the SCP-AV, the fewer the number of injections required to reach stabilization (r = -0.314, p = 0.030). @*Conclusions@#DCP-VC in chronic inactive BRVO was mainly distributed in the TZ with high vessel density. DCP-VC seems to provide a drainage pathway with minimal resistance against elevated intravenous pressure, which may sustain the anatomical stability of chronic BRVO.
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Purpose@#To analyze the effect of office-based probing in different age groups of children with congenital nasolacrimal duct obstruction. @*Methods@#A retrospective study was conducted in 146 children (200 eyes) diagnosed with congenital nasolacrimal duct obstruction who underwent office-based probing. The children were classified into four groups at the time of probing: group A ( 6 months but 12 months but 20 months but < 48 months). Age at the time of the procedure, gender, laterality, follow-up period, clinical symptoms, and the number of probings were investigated. Success rates were compared among the four groups in terms of sex, age, laterality, and the number of probings. @*Results@#The success rate of the first probing was 160/200 eyes (80.0%). The success rates were 87.5% in group A, 85.7% in group B, 77.6% in group C, and 76.7% in group D. No significant difference in the success rate was observed according to age (p = 0.550). The second probing was performed in 40 eyes. The success rates were 100% in group A, 87.5% in group B, 70.6% in group C, and 35.7% in group D. A significant difference in the success rate was observed according to age (p = 0.048). The success rate of the second probing was 25/40 eyes (62.5%). No significant difference in laterality was observed among the four groups (p = 0.291). @*Conclusions@#No significant difference in the success rate of first nasolacrimal duct probing was detected, but a significant difference in the success rate of the second probing was detected according to age in children < 4 years of age.
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Purpose@#To investigate characteristics of optical coherence tomography angiography (OCTA) findings in chronic inactive branch retinal vein occlusion (BRVO) with quantitative analysis. @*Methods@#The medical records of 48 eyes diagnosed with unilateral ischemic acute BRVO, and without recurrence for 6 months after the acute treatment, were reviewed retrospectively. We manually segmented the abnormal vessels of the superficial and deep capillary plexus (SCP-AV and DCP-AV, respectively) and vascular congestion of DCP (DCP-VC) from 6 × 6 mm2 macular OCTA images and automatically calculated the area, vessel density, and average retinal thickness of each corresponding region. Correlations were analyzed between the OCTA parameters of the segmentation area and the baseline characteristics. @*Results@#The DCP-AV area was always wider than that of the SCP-AV (p < 0.001), with a transitional zone (TZ) between the two areas. About two-thirds of the DCP-VC area was distributed in the TZ. The vessel density of the DCP-VC was higher than that of the normal capillary plexus (all, p < 0.001). The average retinal thickness of the DCP-VC was greater than those of SCP-AV and DCP-AV areas (all, p < 0.001), but not different from the normal capillary plexus. The greater the extent of the DCP-VC distribution under the SCP-AV, the fewer the number of injections required to reach stabilization (r = -0.314, p = 0.030). @*Conclusions@#DCP-VC in chronic inactive BRVO was mainly distributed in the TZ with high vessel density. DCP-VC seems to provide a drainage pathway with minimal resistance against elevated intravenous pressure, which may sustain the anatomical stability of chronic BRVO.
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Purpose@#To report well-attached cornea after secondary Descemet’s membrane stripping automated endothelial keratoplasty (DSAEK) without removing the previous graft.Case summary: A 72-year-old man was referred for decreased visual acuity due to bullous keratopathy in the right eye. He had a history of cataract surgery and trabeculectomy in both eyes and primary DSAEK in the right eye 2 years ago. A new DSAEK graft was superimposed onto the previous grafted posterior stroma due to difficulties with primary graft removal. The patient was laid in supine position for 6 hours to facilitate graft attachment. Grafted cornea remained clear and well-attached for 3 months postoperatively. @*Conclusions@#When previous grafts were difficult to remove completely, new graft could be superimposed onto the previously grafted posterior stroma.
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Purpose@#To evaluate peripapillary and macular vessel density changes in glaucoma patients after lowering intraocular pressure (IOP) by trabeculectomy, using optical coherence tomography (OCT) angiography. @*Methods@#A retrospective study was conducted on 20 glaucomatous eyes that underwent trabeculectomy. Preoperative and postoperative IOP, peripapillary retinal nerve fiber layer (RNFL) thickness, macular ganglion cell-inner plexiform layer thickness, peripapillary and macular vessel density measured by OCT, and OCT angiography were analyzed by the Wilcoxon signed-rank test. A regression analysis was performed to identify the factors influencing the change in vessel density. @*Results@#The mean IOP was 31.0 ± 11.80 mmHg prior to surgery, 11.47 ± 4.52 mmHg at 1 month (p < 0.001), and 11.52 ± 3.34 mmHg at 6 months (p < 0.001). Peripapillary RNFL thickness (p = 0.002) increased significantly 6 months postoperatively. Peripapillary vessel density increased significantly 6 months after surgery (p = 0.007) and the magnitude of the reversal of peripapillary vessel density was significantly associated with a greater reduction in IOP (p < 0.001), and the lower preoperative peripapillary vessel density value (p = 0.003) and change in peripapillary vessel density increased significantly. The improvement in peripapillary RNFL thickness was associated with a greater reduction in the IOP (p = 0.011). @*Conclusions@#Measuring peripapillary vessel density using OCT angiography was useful to identify the reversible changes in optic nerve damage caused by reducing IOP after trabeculectomy.
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Purpose@#To report two rare cases of cortical blindness resulting from posterior cerebral artery (PCA) occlusion after laminectomy and laparoscopic gastrectomy under general anesthesia.Case summary: (Case 1) A 65-year-old man presented with visual loss after a bone graft and total laminectomy for spinal stenosis under general anesthesia. His best-corrected visual acuity (BCVA) was hand motion in both eyes. The pupillary light reflex was normal, and a relative afferent pupillary defect (RAPD) was not observed. Slit-lamp microscopy and fundus examination were normal. Using brain computed tomography, magnetic resonance imaging (MRI), and angiography, a PCA infarction was detected. His left 2b PCA was reperfused after intra-arterial thrombolysis. However. he still had left homonymous hemianopia and right homonymous superior quadrantanopia. (Case 2) A 64-year-old man was referred for visual loss in the recovery room after laparoscopic distal gastrectomy under general anesthesia. His BCVA was finger counting for the right eye and hand motion for the left eye. His pupillary light reflex was normal. A RAPD was not observed. Slit-lamp microscopy and a fundus examination were normal. Using a brain MRI and angiography, PCA infarctions were detected. Echocardiography showed an atherosclerotic change with a mobile plaque. Anticoagulation therapy was started, but he still had left homonymous hemianopia and right homonymous inferior quadrantanopia. @*Conclusions@#Cortical blindness caused by non-ophthalmological surgery under general anesthesia is known for severe complications and poor prognoses. Therefore, it is crucial to identify patients with high risks of complications to prevent ophthalmic complications resulting in visual losses before surgery.
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Pneumonia caused by Mycoplasma pneumoniae is manifested as a mild and self-limited. However, several overwhelming cases have been reported. Recently, we experienced a case of M. pneumoniae pneumonia that progressed into ARDS in a 68-year old man who was admitted because of fever and erythema multiforme on whole body. On admission, serum cold agglutinins and anti-mycoplasma Ab were negative. Lobar consolidation was visible at initial chest X-ray. But, bilateral infiltration was noted at follow-up chest X-ray and his condition was aggravated to ARDS. Anti-mycoplasma Ab was elevated up to 1:640. He was treated with roxithromycin, prednisolone and mechanical ventilator in ICU for 2 weeks. And after this, his clinical condition was recovered completely.
Subject(s)
Aged , Humans , Agglutinins , Erythema Multiforme , Fever , Follow-Up Studies , Mycoplasma pneumoniae , Mycoplasma , Pneumonia , Pneumonia, Mycoplasma , Prednisolone , Respiratory Distress Syndrome , Roxithromycin , Thorax , Ventilators, MechanicalABSTRACT
Macroamylasemia is a condition of persistent, elevated serum amylase activity with no apparent clinical symptoms of a pancreatic disorder. In Korea, however, no such case has been reported to date. We report a case of a 17-year-old female diagnosed with macroamylasemia and acute appendicitis. One day earlier, she developed epigastric and right lower quadrant abdominal pain. She was characterized by high level of serum amylase, but normal lipase. Amylase isoenzyme analysis demonstrated increased fraction of salivary type and follow-up amylase level was persistently increased. Immunofixation disclosed the macroamylase binding with an immunoglobulin, consisting of IgA and kappa chain. The patient was treated by appendectomy, and the abdominal pain subsided.
Subject(s)
Female , Humans , Adolescent , Amylases/blood , Appendectomy , Appendicitis/enzymology , Appendicitis/blood , Immunoglobulin A/blood , Immunoglobulin kappa-Chains/blood , Isoenzymes/blood , Protein BindingABSTRACT
BACKGROUND: In-line intravenous filters have been used in intravenous administration sets of fluid to retain bacteria and bacterial endotoxin. We evaluated the effects of intravenous filters on Staphylococcus epidermidis, Pseudomonas aeruginosa, Candida and bacterial endotoxin retention. METHODS: S. epidermidis, C. albicans, P. aeruginosa and endotoxin were injected into each 10 bags of amino acid solution. After incubation for 24 and 72 hours, aspirates of 0.1 mL from 30 bags, with filtration and without filtration, were inoculated into culture media. The effluent from bags containing endotoxin was tested by limulus amebocyte lysate test. RESULTS: When effluents were filtered before culture, those from each 10 bags containing P. aeruginosa, C. albicans and endotoxin were sterile; also there was only one positive bacterial culture among 10 effluents from bags containing S. epidermidis. But by contrast all effluents without filtration showed positive cultures and endotoxin detection. CONCLUSION: This result showed that inline intravenous filters were useful device to remove bacteria, Candida, and bacterial endotoxin.
Subject(s)
Administration, Intravenous , Bacteria , Candida , Culture Media , Filtration , Horseshoe Crabs , Pseudomonas aeruginosa , Staphylococcus epidermidisABSTRACT
Hemobilia is defined as a hemorrhage in the biliary tract and is most commonly associated with accidental or iatrogenic trauma. A case is herein reported of hemobilia developed in a hepatic artery aneurysm after biliary stenting was performed in patient with cholangiocarcinoma. A 63-year-old man was admitted with melena and had history of cholangiocarcinoma with an intraductal biliary stent. A hepatic artery angiography revealed two pseudoaneurysms at the common hepatic artery and right hepatic artery. Transarterial embolization with gelfoam was successfully received and hemobilia was not developed later.
Subject(s)
Humans , Middle Aged , Aneurysm , Aneurysm, False , Angiography , Biliary Tract , Cholangiocarcinoma , Gelatin Sponge, Absorbable , Hemobilia , Hemorrhage , Hepatic Artery , Melena , StentsABSTRACT
Nosocomial Legionnaires' disease has often been documented to occur in immunocompromised patients and to be severe, potentially fatal, pneumonia. We report a case of fatal nosocomial Legionnaires' disease developed shortly after steroid pulse therapy. A 39-year old woman with systemic lupus erythematosus was admitted via emergency room due to generalized edema and gross hematuria. Under the diagnosis of lupus nephritis, she was given intravenous steroid pulse therapy for 3 days and then maintained with oral prednisolone. On the 7th day of admission the patient's conditions got worse with progression to acute renal failure and respiratory difficulty. On the 10th day of admission when she was started on hemodialysis, chestradiograph showed newly developed multifocal mass-like consolidations on both lung fields. In spite of empirical therapy with roxithromycin and rifampin, the consolidations were aggravated and rapidly extended to both whole lung fields. On the 15th day of admission she was mechanically ventilated due to respiratory failure, but died of hypoxia and shock on the 19th day. Later, a legionella species was isolated from the tracheal aspirates and identified as L. pneumophila serogroup 1. We also detected L. pneumophila from the tracheal aspirates by duplex PCR which amplified both 5S rRNA and mip genes of L. pneumophila.