Changes in Aqueous Concentrations of Various Cytokines after Intravitreal Bevacizumab Injection for Chronic Central Serous Chorioretinopathy

Purpose@#This study aimed to investigate changes in cytokine levels after intravitreal bevacizumab injection in patients with chronic central serous chorioretinopathy (CSC). @*Methods@#In a prospective interventional trial, 12 eyes from 12 patients with chronic CSC and six eyes from six patients who underwent cataract surgery were included as controls. Patients diagnosed as with CSC received a single intravitreal injection of bevacizumab (1.25 mg/0.05 mL). Aqueous humor samples were collected from the patients and controls. Best-corrected visual acuity and foveal thickness were evaluated, and aqueous samples were obtained before and 4 weeks after injection. The aqueous concentrations of interleukin (IL)-6, IL-8, interferon-induced protein (IP)-10, monocyte chemotactic protein (MCP)-1, platelet-derived growth factor (PDGF)-AA, and vascular endothelial growth factor (VEGF) were measured using a multiplex bead assay. @*Results@#After injection, the foveal thickness decreased significantly from 328.08 μm (range, 210–477 μm) to 283.91 μm (range, 168–356 μm; p = 0.048), but the best-corrected visual acuity was not significantly different (p = 0.066). The aqueous levels of IL-8 increased significantly from 3.3 pg/mL (range, 1.5–8.3 pg/mL) to 4.7 pg/mL (range, 2.2–11.6 pg/mL) at 4 weeks after the injection (p = 0.046). The aqueous levels of VEGF decreased significantly from 31.4 pg/mL (range, 17.0–53.3 pg/mL) to 15.2 pg/mL (range, 7.7–21.5 pg/mL; p < 0.01). No significant changes in levels of IL-6 (p = 0.455), IP-10 (p = 0.055), MCP-1 (p = 0.076), and PDGF-AA (p = 0.339) were noted 4 weeks after injection. @*Conclusions@#In this study we found intravitreal bevacizumab injection decreased VEGF and increased IL-8 in the eyes of patients with chronic CSC. This study suggests the possibility that the pathogenesis of CSC may be related to abnormal circulation of the choroidal blood vessels through VEGF and IL-8 cytokine level changes.

Changes in the Effects of Bilateral Lateral Rectus Muscle Recession According to Preoperative Angle Deviation

PURPOSE: To investigate how the effect of bilateral rectus muscle recession changed by analyzing the effect/dose ratio of surgery according to the preoperative angle deviation.METHODS: We retrospectively studied the medical records of patients from January 2007 to March 2014 who underwent bilateral lateral rectus muscle recession and who visited our hospital for at least 2 years after surgery. We classified the patients into two groups: the preoperative large angle deviation group (35 prism diopters [PD] or more) and the small angle deviation group (20 PD or less). We observed exodrift patterns by measuring distant and near angle deviation according to the preoperative and postoperative times. The effect/dose ratio of recession was calculated at each visit. Surgical success was defined as an alignment between 10 PD of exodeviation and 5 PD of esodeviation, both at distance and at near.RESULTS: Among 165 patients, 84 patients were in the large angle deviation group and 81 patients were in the small angle deviation group. Preoperative angle deviation of the large angle deviation group was 39.34 ± 5.13 PD (range: 35–55 PD) and the small angle deviation group was 19.49 ± 1.62 PD (range: 18-20 PD) (p < 0.001). At postoperative 1 day, the alignments of eyes of the two groups were −8.32 ± 9.31 PD and −13.11 ± 6.94 PD; p < 0.001, respectively. At the date of the final follow-up, the alignments of eyes of the two groups were 4.63 ± 8.94 PD and 1.22 ± 8.01 PD; p = 0.011, respectively, and the effect/dose ratios were 2.25 ± 0.62 PD/mm and 1.94 ± 0.78 PD/mm, respectively, which meant that the effect of correction for the large angle deviation group was larger than that of the small angle deviation group (p = 0.005). Both groups showed postoperative exodrift patterns and similar success rates (75.0% and 80.2%, respectively), which showed no significant difference (p = 0.268).CONCLUSIONS: The small angle deviation group showed a larger effect of correction and high exodrift pattern at the postoperative initial time and the large angle deviation group showed a smaller effect of correction and low exodrift pattern at the postoperative initial time. The preoperative angles of deviation and the operative success rates were not related.

Clinical Manifestations and Computed Tomography Findings of Trapdoor Type Medial Orbital Wall Blowout Fracture

PURPOSE: To report the clinical manifestations and computed tomography (CT) findings of patients with a trapdoor type medial orbital wall blowout fracture.METHODS: From March 2009 to October 2016, the clinical records and computed tomography findings of patients who underwent surgical treatment for a trapdoor type medial orbital wall blowout fracture were retrospectively analyzed.RESULTS: A total of eight patients (six males and two females) were enrolled with a combined mean age of 14.4 years. Clinical manifestations were eyeball movement limitation (abduction and adduction) and ocular motility pain (eight patients, 100%), diplopia (seven patients, 87.5%), and nausea and vomiting (four patients, 50%). On CT, the distance from the orbital apex to the fracture site was an average of 22.0 mm and occurred in the middle position of the entire wall. Two patients had missed rectus completely dislocated into the ethmoid sinus through the fracture gap and six patients had definite involvement in the fracture gap and edema of the medial rectus muscle. The medial rectus muscle cross-sectional area was 47.7 mm² which was edematous compared to the contralateral eye (40.1 mm²). Orbital wall reconstruction was performed an average of 4.1 days after the injury. In all patients with oculocardiac reflex-like nausea and vomiting immediately improved after surgery. Six out of eight patients who had eyeball movement limitations (abduction and adduction) preoperatively showed adduction limitation after surgery. The eyeball movement limitation and diplopia disappeared 11.7 days and 46.7 days after surgery, respectively.CONCLUSIONS: Patients with trapdoor type medial wall blowout fracture showed characteristic computed tomographic findings and clinical manifestations such as eyeball movement limitation, ocular motility pain, diplopia, and oculocardiac reflex. An understanding of clinical findings and quick surgical treatment are therefore required. The type of eyeball movement limitation was abduction and adduction limitation preoperatively and adduction limitation postoperatively.

Changes in Types of Recurrent Intermittent Exotropia after Surgical Correction of Basic Type Intermittent Exotropia

PURPOSE: To report the surgical outcomes and changes in types of recurrent exotropia after surgical correction of basic type intermittent exotropia. METHODS: We retrospectively analyzed the medical records of 91 patients who underwent reoperations for recurrent exotropia after primary surgical correction, and who visited our hospital for a period of at least one year after the reoperation. When distant deviation was >30 prism diopters (PD), we defined convergence insufficiency type (CI type) if the difference of the deviation angle was >10 PD and basic type exotropia if the difference was 33% of the distant deviation angle. RESULTS: The types of recurrent exotropia were similar to those of the preoperative condition in 68 patients (74.7%), and newly emergent CI type was observed in 23 patients (25.3%). With regard to the incidence of CI type, bilateral lateral rectus recession was more common than unilateral lateral rectus recession after primary surgery and medial rectus resection and unilateral lateral rectus recession, but the difference was not significant (p = 0.615). Recurrent CI type exotropia was observed 6 months after primary surgery (p 0.05). There was no significant difference in the success of reoperations between the two groups (p > 0.05). CONCLUSIONS: The types of recurrent exotropia after surgical correction of primary basic type intermittent exotropia differed from those of preoperative exotropia, which was not related to various factors before surgery. Recurrent exotropia was successfully treated by appropriately selected reoperations, regardless of the type of exotropia.

Longitudinal Evaluation of Retinal Structure in Patients with Traumatic Optic Neuropathy Using Optical Coherence Tomography

PURPOSE: We used optical coherence tomography (OCT) for longitudinal evaluation of structural changes in the peripapillary retinal nerve fiber layer (RNFL), the macular ganglion cell-inner plexiform layer (GC-IPL), and the macula in patients with traumatic optic neuropathy. METHODS: From May 2012 to April 2015, the medical records of 20 patients with monocular traumatic optic neuropathy who were followed up for over 6 months were retrospectively analyzed. Best-corrected visual acuity was checked and Cirrus high-definition optical coherence tomography (HD-OCT) was used to measure the thicknesses of the peripapillary RNFL, macular GC-IPL, and macula of both eyes at the first visit (within 4 weeks after trauma), at 10 and 24 weeks after trauma, and at the final visits. The differences over time in the parameters of the traumatic and fellow eyes were analyzed. RESULTS: The final best-corrected visual acuities of the traumatic and fellow eyes differed significantly from those at the first visit (p = 0.007). The average thicknesses of the peripapillary RNFL, the macular GC-IPL, and the macula differed significantly between the traumatic and fellow eyes commencing 10 weeks after trauma (p < 0.001, p = 0.002, p = 0.003, respectively). CONCLUSIONS: Significant changes in visual acuity preceded structural changes in the retina. Objective assessment of retinal structural changes using OCT yields helpful information on the clinical course of patients with traumatic optic neuropathy.

A Case of Spontaneous Corneal Perforation Combined with Primary Pterygium

PURPOSE: We report a case of spontaneous corneal perforation combined with primary pterygium. CASE SUMMARY: A 66-year-old male presented with a foreign body sensation in his right eye. He had no systemic or ocular inflammatory diseases. He had undergone penetrating keratoplasty following amniotic membrane transplantation for corneal perforation at 1 day after pterygium excision in his left eye. The uncorrected visual acuity (UCVA) and intraocular pressure (IOP) in his right eye were 0.8 and 2 mmHg, respectively. Active leakage of an aqueous humor on the head of the pterygium was found on slit lamp examination. With the impression of spontaneous corneal perforation combined with primary pterygium, emergent amniotic membrane transplantation was performed. Diffuse corneal thinning around the 2 mm-sized perforation site was found 3mm away from the limbus in the 5 o'clock after removing the pterygium. The perforation site was covered with amniotic membrane after applying fibrin glue. UCVA and IOP in his right eye were 1.0 and 9 mmHg, respectively, at postoperative 6 months. No definite recurrence of pterygium or additional corneal perforation was found. CONCLUSIONS: Spontaneous corneal perforation may be related to primary pterygium.

Outdoor Air Pollution and Pterygium in Korea

We investigated relationships between outdoor air pollution and pterygium in Korean adults. This study includes 23,276 adults in population-based cross-sectional data using the Korea National Health and Nutrition Examination Survey 2008–2011. Pterygium was assessed using slit lamp biomicroscopy. Air pollution data (humidity, particulate matter with aerodynamic diameter less than 10 μm [PM₁₀], ozone [O₃], nitrogen dioxide [NO₂], and sulfur dioxide levels [SO₂]) for 2 years preceding the ocular examinations were acquired. Associations of multiple air pollutants with pterygium or pterygium recurrence after surgery were examined using multivariate logistic models, after adjusting for several covariates. Distributed lag models were additionally used for estimating cumulative effects of air pollution on pterygium. None of air pollution factors was significantly associated with pterygium or pterygium recurrence (each P > 0.05). Distributed lag models also showed that air pollution factors were not associated with pterygium or pterygium recurrence in 0-to-2 year lags (each P > 0.05). However, primary pterygium showed a weak association with PM₁₀ after adjusting for covariates (odds ratio [OR] 1.23; [per 5 μg/m³ PM₁₀ increase]; P = 0.023). Aging, male sex, and greater sun exposure were associated with pterygium, while higher education level and myopia were negatively associated with pterygium (each P ≤ 0.001). Male sex and myopia were negatively associated with pterygium recurrence (each P < 0.05). In conclusion, exposure to higher PM10 levels was associated with primary pterygium, although this study observed no significant association between air pollution and overall pterygium or pterygium recurrence in Korean adults.

Endoscopic Ultrasonography-Guided Ethanol Injection for a Pancreatic Neuroendocrine Tumor with Multiple Endocrine Neoplasia Type 1 / 대한췌담도학회지

Multiple endocrine neoplasia type 1 (MEN1) is a rare inherited disorder caused by mutations in the MEN1 gene on chromosome 1. Clinical diagnostic criteria for MEN1 include the presence of two or more endocrine tumors such as pituitary, parathyroid, and pancreatic islet tumors. Treatment is needed for tumors accompanied by symptoms or having malignant potential. Malignant neuroendocrine tumors (NETs) are the major cause of MEN1-related death, and pancreatic NETs account for 30-80% of MEN1 cases. Surgery is the mainstay curative treatment, and endoscopic intervention is a treatment option when patients are poor candidates for surgery. A 33-year old female patient with MEN1 was treated via endoscopic ultrasonography-guided ethanol injection for a pancreatic NET.

Endoscopic Ultrasonography-Guided Ethanol Injection for a Pancreatic Neuroendocrine Tumor with Multiple Endocrine Neoplasia Type 1 / 대한췌담도학회지

Multiple endocrine neoplasia type 1 (MEN1) is a rare inherited disorder caused by mutations in the MEN1 gene on chromosome 1. Clinical diagnostic criteria for MEN1 include the presence of two or more endocrine tumors such as pituitary, parathyroid, and pancreatic islet tumors. Treatment is needed for tumors accompanied by symptoms or having malignant potential. Malignant neuroendocrine tumors (NETs) are the major cause of MEN1-related death, and pancreatic NETs account for 30-80% of MEN1 cases. Surgery is the mainstay curative treatment, and endoscopic intervention is a treatment option when patients are poor candidates for surgery. A 33-year old female patient with MEN1 was treated via endoscopic ultrasonography-guided ethanol injection for a pancreatic NET.

Development of Estimation Methods of Skin Oxidation and Evaluation of Anti-Oxidative Effects of Genistein in Topical Formulations

The objective of the present study was to establish the method of measurement of hydrogen peroxide and to estimate the anti-oxidative effect of genistein in the skin. UVB induced skin oxidation and anti-oxidative effect of genistein formulations were evaluated by determining levels of hydrogen peroxide. The mechanism involved in the determination of hydrogen peroxide is based on a color reaction between ferric ion (Fe3+) and xylenol orange, often called FOX assay and subsequent monitoring of absorbance values of the reactant at 540 nm. The reaction was to some extent pH-dependent and detection sensitivity was greatest at pH 1.75. Genistein liposomal gel demonstrated better anti-oxidative effect with regard to lowering hydrogen peroxide levels elevated by UVB irradiation compared to genistein-suspended gel. A linear relationship has been observed between anti-oxidative effect of genistein and drug deposition in the skin tissue. Genistein liposomal gel resulting in the localization of the drug in the deeper skin led to improved anti-oxidative effect compared to genistein gel. The suggested method for evaluation of oxidation of the skin can be used as a tool to screen effective anti-oxidative agents and their delivery systems acting on the skin.

A case of rhabdomyolysis developed in patient with thyroid storm / 대한내과학회지

Rhabdomyolysis is defined as skeletal muscle injury with release of muscle cell constituents into the plasma. Trauma and drugs are important causes of rhabdomyolysis and not rarely it is associated with metabolic disorders such as diabetic coma, severe electrolyte disturbances and myxedema coma. There are a few reports about rhabdomyolysis developed in patient with thyroid storm. which is defined as a sudden, life threatening exacerbation of thyrotoxicosis. In this report, we described the case of thyroid storm complicated by rhabdomyolysis.

A Case of Acute Cholestatic Hepatitis Caused By the Seeds of Psoralea-corylifolia / 대한간학회지

The potential hepatotoxicity of herbal remedies is usually ignored in daily life. One such compound, Boh-Gol-Zhee (in Chinese, Bu Ku Zi), appeared to be the cause for acute cholestatic hepatic injury in the following case. Psoralea corylifolia is known to contain a sufficient amount of phyto-estrogen. Some alternative medicine therapists claim that Psoralea corylifolia is effective for the treatment of osteoporosis. So far, at least 35 chemical components in the fruits of Psoralea corylifolia have been identified. High concentrations of phyto-estrogen, such as genistein, have been found in the leaves of Psoralea corylifolia. Phyto-estrogen has structural similarity to estrogen and exhibits beneficial effects on osteoporosis under estrogen-deficient conditions. The authors observed a case of acute cholestatic hepatitis in a post-menopausal woman caused by seeds of Psoralea corylifolia in amounts over 10 times the usual dose. Other possible causes of liver injury were excluded by laboratory tests and imaging studies. After discontinuation of this remedy, elevated liver enzyme and total bilirubin rapidly returned to normal. Liver biopsy showed zone 3 necrosis, degenerating cells, cholestasis and infiltrations with inflammatory cells. This case stresses the need to warn the potential hepatotoxicity of Psoralea corylifolia seeds, especially in a large dose.

A Case Report of Metanephric Adenoma Diagnosed by Needle Biopsy / 대한신장학회잡지

Metanephric adenoma is a very rare benign renal tumor; only 100 well-documented cases have been reported to date. Metanephric adenoma occurs at all ages, most commonly in the fifth and sixth decades. There is a 2 : 1 female preponderance. They appear to be benign tumors with no malignant potential, and their chief importance is related to the fact that they are most often misinterpreted as renal cell carcinoma or Wilms' tumor. Its light microscopic features are very characteristic, and imunohistochemical and electron microscopic studies are not critical to the diagnosis. We have experienced a case of renal tumor in a 44-year-old female patient diagnosed by ultrasonography-guided needle biopsy which showed small, tightly packed acini or tubular and papillary structures. The patient underwent right nephrectomy. We report metanephric adenoma diagnosed by ultrasonography-guided needle biopsy, which is a very rare and unique case.

A Case of Intrathyroidal Parathyroid Adenoma Diagnosed by Fine-Needle Aspiration / 대한내분비학회지

Fine-needle aspiration can be successfully utilized in the preoperative localization of abnormal parathyroid tissue. Fine-needle aspirate immunostaining for parathyroid hormone (PTH) or chromogranin and thyroglobulin (Tg) with measurement of PTH and Tg levels in the needle washings (FNAB-PTH and FNAB-Tg) can differentiate an enlarged parathyroid tissue from other cervical masses, such as thyroid nodules and lymph nodes. Parathyroid mass can be successfully aspirated by guidance of ultrasonography or computed tomography. Thyroid nodules are the most frequent cause of reduced accuracy of the imaging studies, such as ultrasonography, computer-assisted tomography and scintigraphy. We report on a case of unsuspected intrathyroidal parathyroid adenoma coexisted with thyroid follicular adenoma presenting two thyroid nodules. After biochemical diagnosis of hyperparathyroidism, we could not localize the parathyroid lesion specifically with any imaging method. Through fine-needle aspiration of two thyroid nodules, we performed the immunostaining for chromogranin and thyroglobulin and the measurement of PTH and thyroglobulin levels in the aspirated materials. The results confirmed the right nodule to be thyroid lesion and the left nodule to be parathyroid lesion preoperatively.

A Case of Sparganosis in Renal Allograft Recipient / 대한이식학회지

Human sparganosis is a rare parasitic disease infected by plerocercoid larva (sparganum) of Spirometra species. It was usually diagnosed accidentally. In this article, we report a 44-year-old woman reanl allofraft recipient on cyclosporine and prednisolone as the immunosuppressive agents. She presented an enlarging subcutaneous nodule in the left thigh for 20 days, which was excised in the belief that it was a seroma. Characteristic sparganum lava accompanied by granulomatous inflammation and cyst formation in the subcutaneous tissue were discovered under microscopic examination of the excised tissue. However, the infectious source was not clear.