Comparison of Intravitreal Bevacizumab and Ranibizumab Injections in Aggressive and Type 1 Retinopathy of Prematurity

Purpose@#To investigate the differences in treatment effects between primary intravitreal bevacizumab injections and ranibizumab injections in type 1 retinopathy of prematurity (ROP) and aggressive ROP. @*Methods@#We retrospectively analyzed the medical records of 61 eyes from 32 premature infants who underwent primary intravitreal anti-vascular endothelial growth factor (VEGF) injections for ROP. P atients with type 1 or aggressive ROP were divided into two groups: the intravitreal bevacizumab injection group and the ranibizumab injection group. We analyzed the period until plus disease disappeared after the first injection, reactivation, additional treatment, and the primary treatment success rate (cases in which retinal vessels formed to the periphery without additional treatment after the first injection). @*Results@#In the type 1 ROP group, the primary treatment success rates for 16 patients (30 eyes) in the bevacizumab injection group and 6 patients (12 eyes) in the ranibizumab injection group were 100.0% and 91.7%, respectively. In the aggressive ROP group, the primary treatment success rates for 5 patients (9 eyes) in the bevacizumab injection group and 5 patients (10 eyes) in the ranibizumab injection group were 55.6% and 60.0%, respectively. In both type 1 and aggressive ROP, there were no significant differences in the period until plus disease disappeared after the first injection, reactivation rate, or additional treatment rate depending on the type of anti-VEGF. @*Conclusions@#Bevacizumab and ranibizumab demonstrated similar efficacy in type 1 ROP and aggressive ROP. However, because aggressive ROP required additional treatment more frequently regardless of the type of anti-VEGF used, close follow-up after the primary injection is essential.

Effective End-to-End Deep Learning Process in Medical Imaging Using Independent Task Learning:Application for Diagnosis of Maxillary Sinusitis

Purpose@#This study aimed to propose an effective end-to-end process in medical imaging using an independent task learning (ITL) algorithm and to evaluate its performance in maxillary sinusitis applications. @*Materials and Methods@#For the internal dataset, 2122 Waters’ view X-ray images, which included 1376 normal and 746 sinusitis images, were divided into training (n=1824) and test (n=298) datasets. For external validation, 700 images, including 379 normal and 321 sinusitis images, from three different institutions were evaluated. To develop the automatic diagnosis system algorithm, four processing steps were performed: 1) preprocessing for ITL, 2) facial patch detection, 3) maxillary sinusitis detection, and 4) a localization report with the sinusitis detector. @*Results@#The accuracy of facial patch detection, which was the first step in the end-to-end algorithm, was 100%, 100%, 99.5%, and 97.5% for the internal set and external validation sets #1, #2, and #3, respectively. The accuracy and area under the receiver operating characteristic curve (AUC) of maxillary sinusitis detection were 88.93% (0.89), 91.67% (0.90), 90.45% (0.86), and 85.13% (0.85) for the internal set and external validation sets #1, #2, and #3, respectively. The accuracy and AUC of the fully automatic sinusitis diagnosis system, including site localization, were 79.87% (0.80), 84.67% (0.82), 83.92% (0.82), and 73.85% (0.74) for the internal set and external validation sets #1, #2, and #3, respectively. @*Conclusion@#ITL application for maxillary sinusitis showed reasonable performance in internal and external validation tests, compared with applications used in previous studies.

Sinonasal Rhabdomyosarcoma Metastasis in Bilateral Multiple Extraocular Muscles:A Case Report and Brief Literature Review

Isolated metastasis in the extraocular muscle (EOM) is uncommon, while metastases in bilateral multiple EOMs is even rarer. Rhabdomyosarcoma (RMS) is a rare soft-tissue malignancy that usually occurs in the pediatric population and is one of the primary malignancies of isolated EOM metastasis. Here, we present a case of sinonasal RMS metastasis to multiple bilateral EOMs along with a brief review of 10 previously reported cases of RMS metastasis in EOMs.

Effects of an Empowerment Program for Patients with Schizophrenia / 정신간호학회지

PURPOSE: The aim of this study was to evaluate a ‘patient empowerment program for schizophrenia (PEPS)’ to improve problem solving ability, quality of life, and mental health literacy for hospitalized patients with schizophrenia. METHODS: The study was a non-equivalent control group non-synchronized design. Study participants were recruited from a psychiatric hospital in Republic of Korea. Of 56 participants, 20 were assigned to the experimental group and 36 to the control group. Data were collected from September, 2017 to January, 2018. Data analyses included chi-squared or Fisher's exact tests, t-tests, and repeated measure ANOVA with SPSS/WIN 21.0 program. RESULTS: After participating PEPS, the experimental group showed a significant increase in quality of life and mental health literacy compared to the control group. However, there were no significant differences in problem solving ability between the two groups. CONCLUSION: Findings show that patients with schizophrenia receive benefits from PEPS in terms of quality of life and mental health literacy. However, further research is necessary to develop clinical strategies to improve their problem solving abilities.

Qualitative Analysis of Tele-healthcare Systems based on the Diffusion of Innovation Model

PURPOSE: The purpose of this study is to explore factors which influence adoption, implementation and continued use of tele-healthcare systems. METHODS: Qualitative research was conducted by in-depth interviews with 17 professionals from various fields of organizations involved in developing and implementing tele-healthcare systems. Data were analysed thematically, using a conceptual model of diffusion of innovations. RESULTS: The system users were reacted positively to the 3 attributes out of 9 which decided the adoption of innovation. In addition, it is required to redesign the tele-health care system simpler and easier so that the system users can access to the system much more easily regardless of space and time limitations. From the design stage on an individual level, it is necessary to conduct detailed needs analysis and listen to users who are at the center of innovation diffusion. On an organizational level, it is necessary to actively prepare for possible problems during system implementation, educate the users and build communication channels continuously. CONCLUSION: This study has identified the factors affecting the innovation of tele-health care systems and contributed to the understanding of the operation of tele-health care systems by the diffusion of innovation theory in community health posts.

Community-onset Necrotizing Fasciitis Caused by Extended-spectrum Beta-lactamase-producing Eshcerichia coli / 대한내과학회지

Necrotizing fasciitis (NF) is an uncommon but fatal infectious disorder that rapidly destroys connective tissue, causing extensive necrosis, severe sepsis, multiple organ failure, and death. NF is more common in patients with comorbid medical conditions. Most NF is caused by bacteria extending from localized skin infections, or remote bacteremia. Escherichia coli (E. coli) has been isolated from polymicrobial NF, but is rarely causative of monomicrobial NF. In addition, NF attributable to community-onset, extended- spectrum beta-lactamase (ESBL)-producing E. coli has not been described previously. As ESBL-producing E. coli are becoming significant pathogens of community-acquired infections worldwide, we report an exceptional case of community-onset NF attributable to monomicrobial ESBL-producing E. coli in a patient with liver cirrhosis.

Corrigendum: Qualitative Analysis of Tele-healthcare Systems based on the Diffusion of Innovation Model

This erratum is being published to correct the co-authors errors.

Anatomical Characteristics of End-stage Exudative Age-related Macular Degeneration Refractory to Intravitreal Anti-vascular Endothelial Growth Factor Injection

PURPOSE: To analyze the anatomical characteristics on spectral-domain optical coherence tomography (SD-OCT) of patients who are legally blind (less than 20/1,000) due to end-stage exudative age-related macular degeneration (AMD) that does not require intravitreal anti-vascular endothelial growth factor (anti-VEGF) injection. METHODS: After anti-VEGF injections (active group), 120 eyes of 103 exudative AMD patients experienced visual acuity improved by at least 2 lines or improvement on SD-OCT. In addition, 55 eyes of 54 end-stage exudative AMD patients who did not respond to treatment or who were legally blind due to foveal scar at the first visit (end-stage group) were evaluated retrospectively. Changes in retinal structures of the 2 groups were analyzed by SD-OCT at the last visit. RESULTS: The mean age of the end-stage group was about 5 years older than the active group. During the follow-up period, subretinal hemorrhage, intraretinal hemorrhage and retinal pigment epithelium tear occurred more frequently in the end-stage group than in the active group (p < 0.05). Intra-retinal fluids and subretinal fluids were more frequently administered in the active group than in the end-stage group, and thick subretinal hyper-reflective materials (SRHRM), fibrovascular pigment epithelial detachment (PED) and extensive inner segment/outer segment (IS/OS) line disruption were observed in all eyes of the end-stage group. The size and thickness of PED, foveal thickness and SRHRM thickness were significantly larger in the end-stage group than in the active group (p < 0.05). Disciform retinal scars were eventually formed in most of the end-stage group. CONCLUSIONS: In end-stage exudative AMD, the presence of retinal hemorrhage and retinal pigment epithelium tear during follow-up, or the findings of thick SRHRM, fibrovascular PED, and extensive IS/OS line disruption on SD-OCT suggest weak expected effect of intravitreal anti-VEGF injection, which can act as a reference for determining the timing of treatment termination.

Anatomical Characteristics of End-stage Exudative Age-related Macular Degeneration Refractory to Intravitreal Anti-vascular Endothelial Growth Factor Injection

PURPOSE: To analyze the anatomical characteristics on spectral-domain optical coherence tomography (SD-OCT) of patients who are legally blind (less than 20/1,000) due to end-stage exudative age-related macular degeneration (AMD) that does not require intravitreal anti-vascular endothelial growth factor (anti-VEGF) injection. METHODS: After anti-VEGF injections (active group), 120 eyes of 103 exudative AMD patients experienced visual acuity improved by at least 2 lines or improvement on SD-OCT. In addition, 55 eyes of 54 end-stage exudative AMD patients who did not respond to treatment or who were legally blind due to foveal scar at the first visit (end-stage group) were evaluated retrospectively. Changes in retinal structures of the 2 groups were analyzed by SD-OCT at the last visit. RESULTS: The mean age of the end-stage group was about 5 years older than the active group. During the follow-up period, subretinal hemorrhage, intraretinal hemorrhage and retinal pigment epithelium tear occurred more frequently in the end-stage group than in the active group (p < 0.05). Intra-retinal fluids and subretinal fluids were more frequently administered in the active group than in the end-stage group, and thick subretinal hyper-reflective materials (SRHRM), fibrovascular pigment epithelial detachment (PED) and extensive inner segment/outer segment (IS/OS) line disruption were observed in all eyes of the end-stage group. The size and thickness of PED, foveal thickness and SRHRM thickness were significantly larger in the end-stage group than in the active group (p < 0.05). Disciform retinal scars were eventually formed in most of the end-stage group. CONCLUSIONS: In end-stage exudative AMD, the presence of retinal hemorrhage and retinal pigment epithelium tear during follow-up, or the findings of thick SRHRM, fibrovascular PED, and extensive IS/OS line disruption on SD-OCT suggest weak expected effect of intravitreal anti-VEGF injection, which can act as a reference for determining the timing of treatment termination.

Recovery Course of Macular Structure after Macular Hole Surgery: Using a Spectral Domain Optical Coherence Tomography Image

PURPOSE: To analyze the recovery course of foveal microstructures and evaluate the important structures for visual improvement after vitrectomy for full thickness macular hole (MH) using optical coherence tomography (OCT). METHODS: We retrospectively reviewed the medical records of 34 cases with idiopathic macular hole. We investigated the healing process of foveal microstructures and visual acuity pre- and post-operatively at 1, 3, 6, 12 months after surgery. We evaluated the integrity of four factors by OCT image: existence of MH (Hole, H(1,3,6,12)), recovery of outer nuclear layer (ONL, O(1,3,6,12)), recovery of external limiting membrane (ELM, E(1,3,6,12)), and recovery of inner segment-outer segment (IS/OS) line of the photoreceptor (Photoreceptor, P(1,3,6,12)). We compared the recovery course and visual acuity of the four groups based on postoperative 12 months. RESULTS: The mean observed period was 1.85 ± 2.59 months at recovery of ONL, 3.78 ± 3.83 months at recovery of ONL and ELM, and 7.40 ± 3.56 months at recovery of ONL, ELM and IS/OS line. At postoperative 12 months, the best corrected visual acuity (BCVA) of Groups E and P were better than that of Groups H and O (p < 0.05). Except for group H, all groups had improved BCVA at postoperative 12 months compared to preoperative BCVA (p < 0.05). CONCLUSIONS: Recovery sequences of foveal microstructures were ONL, ELM and IS/OS line after vitrectomy for idiopathic MH. The most important structures for visual acuity were restorations of both ELM and IS/OS line.

Outer Retinal Layers Alterations in Chronic Central Serous Chorioretinopathy: Spectral Domain-OCT and Fundus Autofluorescence Findings

PURPOSE: To document alteration of the outer retinal layers and fundus autofluorescence (FAF) change in eyes with chronic central serous chorioretinopathy (CSCR). METHODS: Seventeen eyes of fifteen patients diagnosed with chronic CSCR from January 2014 to March 2015 with at least 6 months of follow-up and no history of surgery were enrolled in this study. Morphologic alterations in the retinal pigment epithelium (RPE), the photoreceptor inner segment/outer segment (IS/OS) junction layer, and the outer retina were evaluated by Spectral domain optical coherence tomography (SD-OCT). The FAF images were obtained via Heidelberg Retina Angiogram using a view mode of 30° and were described using distribution patterns of retinal autofluorescence compared to background autofluorescence. After tomographic alignment of the FAF intensities with the OCT findings, we analyzed and assessed the alteration of the outer retinal layers and the characteristics of retinal autofluorescence. RESULTS: RPE detachment lesions in SD-OCT showed little or no change in autofluorescence pattern. Five of seven eyes with RPE humps in SD-OCT showed hyper-fluorescence in FAF. All of the eyes with defects or changes of the reflective line representing the IS/OS junction in SD-OCT correlated with hyper-fluorescence in FAF. Seven of nine eyes with persistent subretinal detachment (SRD) showed specific ring-shaped hyper-fluorescence in FAF matching up with the border of the SRD, and five eyes with photoreceptor OS elongation within SRD showed a granular type of hyper-fluorescence within the ring-shaped hyper-fluorescence in FAF. CONCLUSIONS: In chronic CSCR, we found that RPE humps, the lesion IS/OS junction defect, the border of SRD, photoreceptor OS elongation in SD-OCT correlate with hyper-fluorescence lesions in FAF. The areas of the autofluorescence changes in the FAF images are associated with the extent of change in the RPE and outer retina.

A Case of Ocular Decompression Retinopathy Mimicking Central Retinal Vein Occlusion

No abstract available.

Short-Term Comparison of Surgical Results between One-Haptic and Two-Haptics Transscleral Fixation of Intraocular Lens

PURPOSE: To compare the short-term clinical outcomes of transscleral fixation intraocular lens (IOL) with two haptics or one haptic. METHODS: We retrospectively reviewed the medical records of 26 patients with transscleral fixation of IOL (11 with one-haptic fixation, 15 with two-haptic fixation) except in patients whose visual acuity is not expected to improve due to retinal problems or ocular trauma. We analyzed the manifest refraction, visual acuity, refractive error preoperatively and postoperatively, preoperative IOL decentration, operating time, and postoperative complications. RESULTS: When comparing the two groups preoperatively, the mean lens decentration in the one-haptic group was 2.73 ± 2.88 mm and 4.59 ± 2.18 mm in the two-haptics group. The decentration in the two-haptic group was greater than in the one-haptic group, but not significantly. Visual acuity and refractive power were not significantly different between the groups. The mean operation time (minutes) was 65.00 ± 22.69 and 93.66 ± 29.54 in the one-haptic and two-haptic groups, respectively. The operation time in the one-haptic group was significantly shorter than in the two-haptic group (p = 0.020). When comparing visual acuity preoperatively and postoperatively, both groups showed significant improvement (p < 0.01). However, refractive error and postoperative IOL decentration were similar between the groups. CONCLUSIONS: The short-term surgical results of transscleral fixation using the two surgical techniques were not different; one-haptic transscleral fixation was preferred due to shorter operation time and lower patient discomfort.

Development of Audio-visual Aids of Death Education for Hospice Patients and Their Families / 한국호스피스완화의료학회지

PURPOSE: Patients and their caretakers need to understand various problems and requirements in the dying process so that they may prepare for death for the rest of their remaining life. Accordingly, a systematic audio-visual resource was developed to educate hospice patients and their families at the palliative care ward about the process of dying. METHODS: For the development of an audio-visual resource, a initial education material was produced in the form of simple and accessible Power Point handouts based on literature study. Then, the program was completed through five rounds of a process, including expert advice, revision, update and evaluation. RESULTS: The final version of the program was filmed with cooperation of the medical literature information division. Using the program, patients and families were educated through five phases over three sessions for a total 26 minutes and 34 seconds. CONCLUSION: The significance of this study lies in the fact that it was conducted after the establishment of the palliative care ward, which made it easier for nurses provide the education. It is expected that the program may be used by hospice specialists as well as nurses as an education resource for hospice patients and their families.

A Case of Nishida Muscle Transposition Procedure for Abducens Palsy

PURPOSE: Herein we report a successful Nishida muscle transposition procedure (modified Jensen procedure) with right medial rectus recession for treating a right abducens palsy patient. CASE SUMMARY: A 63-year-old male presented with a 30-year history of esotropia due to traumatic abducens palsy in his right eye. At initial examination, right eye visual acuity was 0.9 and intraocular pressure was 11 mm Hg. Ocular movement of the right eye was restricted in the lateral direction and prism cover-uncover test revealed 75 prism diopter right esotropia. For 2 years, the patient was treated as normal tension glaucoma and used his right eye as the dominant eye by turning his head due to glaucomatous field defect in the left eye. We performed 8.0 mm medial rectus recession and Nishida muscle transposition procedure in the right eye and inserted a suture through the temporal margin of each vertical rectus muscle. One week after surgery, the right eye maintained relatively straight alignment and prism cover-uncover test showed 20 prism diopter residual esotropia in the left eye. CONCLUSIONS: The Nishida muscle transposition is a simple procedure and prevents postoperative risk of anterior segment ischemia without the occurrence of tenotomy and muscle splitting. We report a successful Nishida muscle transposition procedure in a patient with chronic abducens palsy.

Characteristics of Polypoidal Choroidal Vasculopathy Associated with Subretinal Hemorrhage

PURPOSE: To evaluate the clinical features and risk factors of hemorrhagic complications in polypoidal choroidal vasculopathy (PCV) using spectral domain-optical coherence tomography (SD-OCT) and indocyanine green angiography (ICGA). METHODS: We respectively reviewed the data from 43 patients (45 eyes) diagnosed with PCV who received ICGA between January 2010 and October 2013. The patients were divided into 2 groups: 16 patients (17 eyes) with subretinal hemorrhage (subretinal hemorrhagic PCV group) and 27 patients (28 eyes) without subretinal hemorrhage (control group). Based on the ICGA and SD-OCT findings, the number, morphology, location, size of polyps, pigment epithelial detachment (PED), and serous retinal detachment (SRD) were measured and compared between the 2 groups. We also analyzed systemic diseases and history of antithrombotic agents associated with subretinal hemorrhage in PCV. RESULTS: The size of polyps measured by ICGA was significantly different between the 2 groups (p = 0.006). As the size of polyps increased, the size of subretinal hemorrhage, height of PED, base diameter and height of SRD increased (p 0.05). CONCLUSIONS: The patients in the subretinal hemorrhagic PCV group had larger-sized polyps than the patients in the control group. This result suggests that eyes with larger-sized polyps are at risk for hemorrhagic complications and require more careful follow-up and observation in PCV treatment-naive patients.

Characteristics of Polypoidal Choroidal Vasculopathy Associated with Subretinal Hemorrhage

PURPOSE: To evaluate the clinical features and risk factors of hemorrhagic complications in polypoidal choroidal vasculopathy (PCV) using spectral domain-optical coherence tomography (SD-OCT) and indocyanine green angiography (ICGA). METHODS: We respectively reviewed the data from 43 patients (45 eyes) diagnosed with PCV who received ICGA between January 2010 and October 2013. The patients were divided into 2 groups: 16 patients (17 eyes) with subretinal hemorrhage (subretinal hemorrhagic PCV group) and 27 patients (28 eyes) without subretinal hemorrhage (control group). Based on the ICGA and SD-OCT findings, the number, morphology, location, size of polyps, pigment epithelial detachment (PED), and serous retinal detachment (SRD) were measured and compared between the 2 groups. We also analyzed systemic diseases and history of antithrombotic agents associated with subretinal hemorrhage in PCV. RESULTS: The size of polyps measured by ICGA was significantly different between the 2 groups (p = 0.006). As the size of polyps increased, the size of subretinal hemorrhage, height of PED, base diameter and height of SRD increased (p 0.05). CONCLUSIONS: The patients in the subretinal hemorrhagic PCV group had larger-sized polyps than the patients in the control group. This result suggests that eyes with larger-sized polyps are at risk for hemorrhagic complications and require more careful follow-up and observation in PCV treatment-naive patients.

An adult asymptomatic pulmonary artery sling / 영남의대학술지

A pulmonary artery sling is a very rare congenital abnormality in which the left pulmonary artery rises from the posterior surface of the right pulmonary artery and then passes between the trachea and the esophagus, causing tracheal compression. It is associated with tracheo-bronchial abnormalities (50%) and cardiovascular abnormalities (30%). It may produce respiratory symptoms through the airway compression of the abnormal left pulmonary artery and congenital abnormalities associated with it. Because most (90%) pulmonary artery sling patients present symptoms during infancy, their condition is often diagnosed in the first year of life. However, a pulmonary artery sling is occasionally found in adults. It is usually asymptomatic and found incidentally. This is a very rare case of an asymptomatic pulmonary artery sling in an adult. A 38-year-old man presented symptoms of mild exertional dyspnea. His spiral computed tomography showed a pulmonary artery sling. He was discharged without specific treatment because his symptoms improved without specific treatment and might not have been associated with a pulmonary artery sling. We report an adult case of an asymptomatic pulmonary artery sling diagnosed via spiral computed tomography, accompanied by a literature review.

Choroid in Myopic Choroidal Neovascularization Measured Using SD-OCT

PURPOSE: Using the spectral domain optical coherence tomography (SD-OCT), we studied the difference in the choroidal morphology between the choroidal neovascularization (CNV) area and the area surrounding CNV. METHODS: This retrospective study consisted of 19 patients with myopic CNV lesion in eye; fellow eyes were used as controls. All eyes were analyzed by measuring the choroidal thickness and large choroidal vessel size using SD-OCT. Eyes with CNV were divided into groups; the neovascular lesion was defined as group 1, the surrounding area as group 2. Subfovea of the fellow eye was defined as group 3. RESULTS: The choroidal thickness was 80.00 +/- 68.31 in group 1, 63.44 +/- 67.75 in group 2 and 71.11 +/- 65.69 microm in group 3. There was a significant difference between group 1 and group 2 (p = 0.038). There were no significant differences between group 1 and 3 or between group 2 and 3 (p = 0.365, p = 0.314). The large choroidal vessel size was 57.47 +/- 39.78 in group 1, 40.45 +/- 34.69 in group 2 and 45.63 +/- 37.00 microm in group 3. There was a significant difference between group 1 and group 2 (p = 0.025). There were no significant differences between group 1 and 3 or between group 2 and 3 (p = 0.123, p = 0.325). CONCLUSIONS: Choroidal thickness and large choroidal vessel size at the center of the CNV were greater than in the area surrounding CNV. The results suggest that although the CNVs were due to a thinned choroid caused by severe choroidal ischemia, the development of CNV requires maintenance of choriocapillaris and large choroid vessels.

Post-Hepatitic Aplastic Anemia Associated with Hepatitis A Virus

Hepatitis-associated aplastic anemia is a rare disease, but can be fatal if it is diagnosed late or untreated. Despite the previous case report of severe aplastic anemia following hepatitis, hepatitis A virus (HAV)-associated aplastic anemia is very rare, and a case with bone marrow transplantation (BMT) has not been reported in the literature. Here, we report the case of a 13-year-old boy, who developed severe aplastic anemia after full recovery of acute HAV infection, and eventually received BMT for aplastic anemia following HAV infection. It is a very rare case and the first case that recovered after BMT. The aim of this case report is to highlight the potential of progression to aplastic anemia after acute HAV infection and the importance of suspicion when pancytopenia is developed.