Early Retinal Hemorrhage Absorption Rate and Long Term Clinical Outcomes in Branch Retinal Vein Occlusion

Purpose@#We report the relationship between early retinal hemorrhage absorption rate (RHAR) and long-term clinical outcomes associated with branch retinal vein occlusion (BRVO). @*Methods@#This retrospective study included 66 eyes with BRVO. We used a grid as a quantitative measurement unit for measuring the amount of hemorrhage, and calculated the RHAR by measuring variance between sums of the grids. We investigated the relationship of best corrected visual acuity (BCVA), central foveal thickness (CFT), and other long term clinical outcomes with RHAR. @*Results@#The RHAR in BRVO patients measured 16.46 ± 21.48 ∑grid/time (month). Improvement of BCVA (logMAR) was 0.28 ± 0.28 at 12 months, showing statistical significance with the RHAR (p < 0.01). We divided RHAR into two groups by 7.5 ∑ grid/month; slow and fast RHAR groups. Improvement of BCVA (logMAR) was 0.16 ± 0.23 in the slow RHAR group, and 0.38 ± 0.28 in the fast RHAR group, with statistical significance (p = 0.01). Regression of CFT was 133.12 ± 142.93 μm in the slow RHAR group, and 236.62 ± 131.55 μm in the fast RHAR group, with statistical significance (p < 0.01). @*Conclusions@#RHAR may be a prognostic factor during follow-up in BRVO patients.

Early Retinal Hemorrhage Absorption Rate and Long Term Clinical Outcomes in Branch Retinal Vein Occlusion

Purpose@#We report the relationship between early retinal hemorrhage absorption rate (RHAR) and long-term clinical outcomes associated with branch retinal vein occlusion (BRVO). @*Methods@#This retrospective study included 66 eyes with BRVO. We used a grid as a quantitative measurement unit for measuring the amount of hemorrhage, and calculated the RHAR by measuring variance between sums of the grids. We investigated the relationship of best corrected visual acuity (BCVA), central foveal thickness (CFT), and other long term clinical outcomes with RHAR. @*Results@#The RHAR in BRVO patients measured 16.46 ± 21.48 ∑grid/time (month). Improvement of BCVA (logMAR) was 0.28 ± 0.28 at 12 months, showing statistical significance with the RHAR (p < 0.01). We divided RHAR into two groups by 7.5 ∑ grid/month; slow and fast RHAR groups. Improvement of BCVA (logMAR) was 0.16 ± 0.23 in the slow RHAR group, and 0.38 ± 0.28 in the fast RHAR group, with statistical significance (p = 0.01). Regression of CFT was 133.12 ± 142.93 μm in the slow RHAR group, and 236.62 ± 131.55 μm in the fast RHAR group, with statistical significance (p < 0.01). @*Conclusions@#RHAR may be a prognostic factor during follow-up in BRVO patients.

Intraocular Pressure: Intravitreal Preservative-free Triamcinolone Injection in Diabetic Macular Edema and Branch Retinal Vein Occlusion

PURPOSE: To compare the intraocular pressure (IOP) in diabetic macular edema (DME) patients and macular edema associated with branch retinal vein occlusion (BRVO) patients after intravitreal preservative-free Triamcinolone injection.METHODS: This study included 36 patients diagnosed with DME and 44 patients diagnosed with BRVO with macular edema. Both groups were treated with intravitreal preservative-free Triamcinolone (Maqaid®, Wakamoto Pharmaceutical Co., Ltd., Tokyo, Japan) injection, and we compared the IOPs of the two groups determined before injection and at 1, 2, 3, and 6 months after injection. We also compared the IOP elevation ratios and durations, and central foveal thickness (CFT) changes using optical coherence tomography.RESULTS: In both groups, there was no statistical significance in the IOP before injection and at 1, 2, 3, and 6 months after injection. However, the IOP elevation ratio in the DME patients (38.9%) was significantly higher than that in the BRVO patients (15.9%) (p = 0.02). The duration of IOP elevation in the DME patients (1.14 ± 1.85 months) was significantly longer than that in the BRVO patients (0.30 ± 1.20 months) (p = 0.03). When the IOP was not controlled, we used IOP-lowering agents, and two patients in the DME were treated with glaucoma surgery. There was no statistical significance in the CFT before injection and at 1, 2, or 3 months after injection between the two groups (p = 0.72, p = 0.26, p = 0.66, p = 0.34, respectively). However, the CFT after 6 months was 328 ± 103 µm in the DME group and 434 ± 189 µm in the BRVO; this difference was significant (p < 0.01).CONCLUSIONS: Intravitreal injection of preservative-free Triamcinolone was effective in the treatment of both DME patients and macular edema patients associated with BRVO. Furthermore, Triamcinolone was more safely injected in macular edema associated with BRVO patients than in DME patients.

A Report of Two Case of Ocular Toxicity Resulting from Direct or Indirect Bee Venom

PURPOSE: To report a patient stung by a bee, who was diagnosed with sterile endopthalmitis and another patient diagnosed with optic neuritis, with decreasing visual acuity, after refined bee venom injection around the orbital tissue. CASE SUMMARY: A 82-year-old female visited our hospital for decreased visual acuity in the right eye and ocular pain due to a bee sting. The bee sting penetrated the sclera into the vitreous. In the anterior segment, severe cornea edema and anterior chamber cells were seen. Using ultrasonography, inflammation was seen around the intravitreal area. After 3 months, intravitreal inflammation regressed but the patient's visual acuity was light perception negative, and corneal opacity, neovascularization, and phthisis bulbi were detected. A 55-year-old male visited our hospital for ocular pain in the right eye and decreasing visual acuity after refined bee venom injection around the orbital tissue. The best-corrected visual acuity in the right eye was 15/100, there was moderate injection on the conjunctiva. A relative afferent pupillary defect, abnormal color vision test results, and a defect in the visual field test were observed. There was no pain during external ocular movement, and other general blood tests, and a brain MRI were normal. Based on these symptoms, methylprednisolone megatherapy was started for treatment of optic neuritis. After treatment, visual acuity of the right eye was 9/10 and all other clinical optic neuritis symptoms regressed. CONCLUSIONS: Based on these two cases, ocular toxicity from bee venom could result from both direct and indirect courses. Treatment using refined bee venom might be harmful, and caution is recommended in its use.

The Function of the Fellow Eye in Patients with Unilateral Nonarteritic Anterior Ischemic Optic Neuropathy

PURPOSE: To investigate the function of the fellow eye in patients with unilateral nonarteritic anterior ischemic optic neuropathy (NAION). METHODS: From 2009 to March 2018, 18 patients with NAION who underwent bilateral visual field examinations and follow-up visits at least two times were enrolled in this study. Initial visual acuity, final visual acuity, degree of visual field defects, the cup-disc (C/D) ratio of the fellow eye, and the presence or absence of cardiovascular disease was retrospectively analyzed using medical records. RESULTS: The fellow eye mean best-corrected visual acuity was 0.03 ± 0.53 (logMAR) and the mean visual field defect was −4.68 ± 3.65 dB in 18 eyes of patients with unilateral NAION (p = 0.007 and p = 0.001, respectively). The C/D ratios were divided into two groups: > 0.3 and < 0.3. The visual field defect was improved significantly from −4.92 dB to −2.37 dB in the group with optic disc ratios < 0.3 (p = 0.013). When the changes in visual field defects were analyzed according to the presence or absence of cardiovascular disease, the visual field defects were improved from −5.65 dB to −4.49 dB in patients with cardiovascular disease, and improved from −3.69 dB to −1.46 dB in patients without cardiovascular disease (p = 0.025 and p = 0.021, respectively). CONCLUSIONS: In patients with unilateral NAION, reduced function in the fellow eye may appear temporarily, so a visual field examination should be performed in both eyes. The possibility of incipient NAION should be considered in patients with visual field abnormalities in the fellow eye.

A Result of Pneumatic Retinopexy for Pseudophakic Retinal Detachment

PURPOSE: To evaluate the clinical effectiveness of pneumatic retinopexy as a treatment method for pseudophakic retinal detachment. METHODS: A retrospective chart review was conducted of medical records of 38 patients who underwent pneumatic retinopexy using SF6 gas from January 2003 to December 2011 and who were observed during a follow-up period longer than 6 months. Primary and final success rates and final visual acuity were analyzed. Primary success was defined as retinal attachment at the last visit without additional surgery. Final success was defined as retinal reattachment at the last visit regardless of additional surgery. RESULTS: The mean patient age was 58.47 ± 17.00 years. All retinal tears were located in the upper retina (from 8 to 4 o'clock). Preoperative mean visual acuity was 1.17 ± 1.00 log MAR, and postoperative mean visual acuity was 0.42 ± 0.48 log MAR. The primary success rate was 61%, and patients with re-detached retina underwent repeat pneumatic retinopexy or other surgery such as scleral buckling or pars plana vitrectomy. At the final visit, all of the patients demonstrated successful results. CONCLUSIONS: Pneumatic retinopexy does not result in strabismus or refractive error, and the final success rate was 66% in our study. Therefore, pneumatic retinopexy can be considered as an effective management technique for some pseudophakic retinal detachment patients.

Long-term Therapeutic Effect of Intravitreal Bevacizumab (Avastin) on Myopic Choroidal Neovascularization

PURPOSE: To evaluate the long-term therapeutic effects of intravitreal bevacizumab on myopic choroidal neovascularization (CNV). METHODS: Medical records of 6 patients who underwent intravitreal bevacizumab injection for myopic CNV and were followed for more than 2 years, were retrospectively investigated. The best corrected visual acuity was compared at 1,3,12, and 24 months after injection. Two years after the injection, a fluorescein angiography and optical coherence tomography (OCT) were performed to evaluate the central macular thickness and leakage of CNV. RESULTS: The mean best corrected visual acuity was 1.16 +/- 0.43 (logMAR), 0.45 +/- 0.21 (logMAR), 0.29 +/- 0.23 (logMAR), 0.14 +/- 0.11 (logMAR), and 0.11 +/- 0.06 (logMAR) at baseline, 1, 3, 12, and 24 months after injection, respectively. CONCLUSIONS: Intravitreal bevacizumab injection for the treatment of myopic CNV was effective in maintaining postoperative visual acuity for 2 years.

Results of Surgical Treatment for Paralytic Strabismus

PURPOSE: To study the correction effects of standard recession and resection in paralytic strabismus excluding superior oblique palsy. METHODS: Eighteen cases of paralytic strabismus treated by standard recession and resection from March 2005 to October 2007 were retrospectively analyzed. RESULTS: The average angles of deviation before surgery and after surgery were 55 prism diopters (PD) and 12PD, respectively. Adjustable suturing was performed in 12 cases. The diplopia was improved in 14 out of 18 cases (77%) after surgery. Three cases of the -4 grade paralyzed group had a large residual deviation after surgery. The success rate was 78% (14/18) when success was defined as a residual deviation of less than 15PD. Severe ocular motility limitation (-4 grade) group was less affected than other groups. In the below -3 grade paralyzed groups, patients resolved diplopia in the primary eye position, and did not complain of diplopia by incomitance in the secondary eye position. CONCLUSIONS: Standard recession and resection may actively be attempted in below -3 grade paralytic strabismus patients to resolve diplopia in the primary eye position.

Methazolamide-induced Stevens-Johnson Syndrome

PURPOSE: To report three consecutive cases of methazolamide-induced Stevens-Johnson syndrome. CASE SUMMARY: We describe three patients who were all prescribed methazolamide for treatment of ophthalmologic conditions. A 29-year-old man and a 47- year-old woman were prescribed methazolamide (100 mg/day) for the treatment of central serous chorioretinopathy (CSCR). A 66-year-old woman was prescribed methazolamide (100 mg/day) for acute glaucoma of the left eye for approximately two weeks. After taking the methazolamide, three patients were showed the pururitic maculopapular rashes on the whole body and the vesicular eruptions of the oral mucosa and conjunctiva. On the basis of medication histories, characteristic skin lesions and mucosal involvement, we diagnosed all three patients with methazolamide-induced Stevens-Johnson syndrome. All three patients were hospitalized and treated with intravenous steroids and antihistamines. Two of the three cases showed conjunctival pseudomembranes. In two cases, the skin lesions worsened during the first week of treatment, and then resolved without complications over the next two to three weeks. The condition of the 47-year-old female patient deteriorated rapidly to toxic epidermal necrolysis due to sensitivity to sulfa antibiotics. HLA- A24, B59 and Cw1 were detected in all three cases. CONCLUSIONS: In 2008, domestic production of acetazolamide was halted in Korea. Because of this, methazolamide is expected to be prescribed by ophthalmologists more commonly than in previous years. Complete medical histories should be taken before prescribing methazolamide to patients. HLA typing should be conducted whenever possible to screen patients before prescription of methazolamide.

Correlations among Total Symptom Distress, Uncertainty and Quality of Life among Women With Endometriosis / 여성건강간호학회지

PURPOSE: The purpose of this study was to explore the relationships among women's total symptom distress, uncertainty and quality of life in women with endometriosis. METHOD: A total of 121 women who had been diagnosed with endometriosis was given a questionnaire. Data was collected from August 2004 to January 2005. The data was analyzed by frequency, mean, t-test, ANOVA, Pearson correlation coefficient, and multiple linear regression analysis using SPSS WIN 10.0 software. RESULT: The mean score of TSD was 3.23. 'Menstrual cramping' showed the highest score. The mean score of uncertainty, and quality of life of the subject was 56.6, and 38.3 respectively. TSD was significantly related with coffee intake and uncertainty was significantly related with marital status, economic status, alcohol intake, diagnosis after period, and family history. Quality of life was significantly related with age, and dysmenorrhea. There were significant relationships between total symptom distress and uncertainty, and quality of life. There were significant relationship between uncertainty and quality of life. CONCLUSION: Endometriosis symptoms showed a significant relationship with uncertainty and quality of life. This study will help to manage women with endometriosis.

Student's Response to Current Lecture Evaluation Method in One Medical School / 한국의학교육

PURPOSE: The evaluation of a lecture by students is one of the good way to improve a lecture. In one medical school, we started one-year-integrated-lecture curriculum for sophomore. And we evaluated lectures using formal lecture evaluation sheet after completion of each integrated lectures. The results were fed back to lecturers. But lecturers were indifferent to the results. So we performed this study to evaluate the current lecture evaluation method. METHODS: Answering patterns of evaluation sheets were reviewed. 50 students entitled to integrated lectures were given structured questions. 44 of them recovered. And randomly selected 10 students were interviewed. RESULTS: Analysis of evaluation sheets showed that some students checked the items just for fun. More than half of the students answered that they did not check the questions seriously. Reasons why the evaluation of lectures were not going well were; students were not trained to evaluate something; evaluation sheet was not designed to evaluate individual lecturer; listed items were too many in number and inappropriate; some students were suspicious about the impact of evaluation of lectures. In addition to this, it was revealed that students thought the timing of evaluation of lecture was important, too. CONCLUSION: Indifference of lecturers to the results is one form of resistance to the evaluation of lectures by students. To make evaluation of lectures effective, numbers and contents of evaluation items must be selected carefully, students need to be trained, and adequate evaluation timing should be determined with frequent feed backs.

The Experience of the Middle Aged Women's Aging: A Phenomenological Approach(Colaizzi method) / 성인간호학회지

The purpose of this study was about the experience of middle aged women's aging process. The qualitative research method used was the phenomenological approach. This study tried to discover meaning of life and to understand real experiences of their life and to explore the essence of middle aged women's experience of aging. Furthermore, this study tried to establish of concept of middle age women's holistic health and to help of theoretical development to improve the health. The interviewees were 12 members. The data were collected through in-depth interviews with audiotape recording done by the investigators over a period of five months. The data were analyzed Colaizzi method, new data were continuously coded into statements, cored meanings, themes, groups of themes, and categories. The data were separated into 4 categories; body change, feeling the miss, wise coping and planning the future. The group of themes belonging to 4 categories were body change, sexual change; fleeting, tiredness, attachment of the youth; acceptance, a situation as the adult, fill up the hollow feeling, management body; dying peacefully, preparing for the senior age, being ready to pass away.