Clinical features of anaphylaxis and risk factors of severe anaphylaxis in the emergency department

Objective@#This study investigates the triggers and clinical features of anaphylaxis, and determines the risk factors associated with severe anaphylaxis. @*Methods@#This is a retrospective observational study spanning a duration of 2 years (2020-2021) using the electronic data of patients diagnosed with anaphylaxis in the university-affiliated emergency center. Severe anaphylaxis was defined as refractory anaphylaxis requiring ≥3 times epinephrine administration and/or continuous epinephrine infusion. Baseline and clinical characteristics were compared between the severe and the non-severe anaphylaxis groups. Binary logistic regression analysis was performed to reveal independent risk factors associated with severe anaphylaxis. @*Results@#The median age of study patients was determined to be 53.0 years (range, 37.5-65.0 years). Fifty-eight patients (58.0%) were male. Drugs were found to be the most common trigger. In clinical manifestations, cutaneous manifestation was the most common. Severe anaphylaxis occurred in 19 patients (19.0%). Latent time was shorter in the severe anaphylaxis group-10.0 minutes (5.0-20.0) vs. 30.0 minutes (10.0-60.0), P<0.001. Drug as a trigger (68.4% vs. 39.5%, P=0.023), hypotension (57.9% vs. 9.9%, P<0.001), cardiovascular manifestation (84.2% vs. 40.7%, P=0.001), and hyperlactatemia (73.7% vs. 46.9%, P=0.036) were more frequently observed in the severe anaphylaxis group. Shorter latent time, drug as a trigger, and presence of hypotension were independent risk factors for severe anaphylaxis. @*Conclusion@#Anaphylaxis patients with shorter latent time, diagnosed with drugs as a trigger, and presenting with hypotension, must be subjected to careful monitoring and early active treatment.

Comparison of Indocyanine Green Angiography and Optical Coherence Tomography Angiography for Polypoidal Choroidal Vasculopathy

Purpose@#To assess the diagnostic value of optical coherence tomography angiography (OCTA), and the factors affecting the diagnosis of polypoidal choroidal vasculopathy (PCV) by OCTA and indocyanine green angiography (ICGA). @*Methods@#The numbers and area of polyps, and the presence and area of a branched vascular network (BVN) as revealed by ICGA and OCTA, were retrospectively analyzed in 43 patients with active PCV. The patients were divided into two groups according to whether the number of polyps matched between the two methods: group 1, equal number of polyps revealed by ICGA and OCTA; group 2, different number of polyps revealed by ICGA and OCTA. @*Results@#In 43 PCV patients, the total number of polyps was 1.47 ± 0.83 in ICGA and 1.07 ± 0.91 in OCTA (p < 0.001), and the polyp area was 0.27 ± 0.42 mm2 in ICGA and 0.17 ± 0.15 mm2 in OCTA (p = 0.023). BVN was found in 33 eyes (76.7%) by ICGA and 29 eyes (67.4%) by OCTA (p < 0.001). The BVN area was 3.61 ± 2.59 mm2 in ICGA and 2.74 ± 2.76 mm2 in OCTA (p = 0.002). Central retinal thickness and central choroidal thickness were significantly greater in group 2 than group 1 (p < 0.001, respectively). Subretinal fluid (SRF) (p = 0.009) and subretinal hemorrhage (SRH) (p = 0.005) were significantly more prevalent in group 2 than group 1. Polyp height (p = 0.022) and diameter (p = 0.042) were significantly greater in group 2 than group 1. @*Conclusions@#OCTA is a supplementary diagnostic technique for detecting PCV. The presence of SRF and SHR, and large polyp height and diameter, were associated with the polyp detection rate of OCTA for PCV.

The Normative Retinal and Choroidal Thicknesses of the Rabbit as Revealed by Spectral Domain Optical Coherence Tomography

Purpose@#We used spectral domain optical coherence tomography (SD-OCT) to assess the retinal and choroidal thicknesses of the rabbit, a commonly used animal model of ophthalmic disease. We report normative datasets. @*Methods@#Semi-automated measurements were made on 15 normal right eyes of New Zealand white rabbits. Total retinal, inner retinal layer, outer retinal layer, choroidal, ganglion cell layer, ganglion cell complex, inner nuclear layer, and outer nuclear layer thicknesses were measured at fixed distances (0, 1, 2, 3, 4, and 5 mm) below the optic nerve head. @*Results@#Total retinal layer (Pearson’s correlation coefficient [CC] = -0.778, p < 0.05), inner retinal layer (CC = -0.710, p < 0.05), outer retinal layer (CC = -0.495, p < 0.05), ganglion cell complex (CC = -0.292, p < 0.05), ganglion cell layer (CC = -0.284, p < 0.05), and outer nuclear layer thicknesses (CC = -0.760, p < 0.05) decreased with the distance from the optic nerve head. Inner nuclear layer thickness correlated negatively with the distance from the optic nerve head, but the correlation coefficient was low (CC = -0.263, p < 0.05). Choroidal thickness increased with the distance from the optic nerve head (CC = 0.511, p < 0.05). @*Conclusions@#Rabbit retinal thicknesses were measured and analyzed by the distance from the optic nerve head. The datasets will serve as standards when using rabbits.

Comparison of Indocyanine Green Angiography and Optical Coherence Tomography Angiography for Polypoidal Choroidal Vasculopathy

Purpose@#To assess the diagnostic value of optical coherence tomography angiography (OCTA), and the factors affecting the diagnosis of polypoidal choroidal vasculopathy (PCV) by OCTA and indocyanine green angiography (ICGA). @*Methods@#The numbers and area of polyps, and the presence and area of a branched vascular network (BVN) as revealed by ICGA and OCTA, were retrospectively analyzed in 43 patients with active PCV. The patients were divided into two groups according to whether the number of polyps matched between the two methods: group 1, equal number of polyps revealed by ICGA and OCTA; group 2, different number of polyps revealed by ICGA and OCTA. @*Results@#In 43 PCV patients, the total number of polyps was 1.47 ± 0.83 in ICGA and 1.07 ± 0.91 in OCTA (p < 0.001), and the polyp area was 0.27 ± 0.42 mm2 in ICGA and 0.17 ± 0.15 mm2 in OCTA (p = 0.023). BVN was found in 33 eyes (76.7%) by ICGA and 29 eyes (67.4%) by OCTA (p < 0.001). The BVN area was 3.61 ± 2.59 mm2 in ICGA and 2.74 ± 2.76 mm2 in OCTA (p = 0.002). Central retinal thickness and central choroidal thickness were significantly greater in group 2 than group 1 (p < 0.001, respectively). Subretinal fluid (SRF) (p = 0.009) and subretinal hemorrhage (SRH) (p = 0.005) were significantly more prevalent in group 2 than group 1. Polyp height (p = 0.022) and diameter (p = 0.042) were significantly greater in group 2 than group 1. @*Conclusions@#OCTA is a supplementary diagnostic technique for detecting PCV. The presence of SRF and SHR, and large polyp height and diameter, were associated with the polyp detection rate of OCTA for PCV.

The Normative Retinal and Choroidal Thicknesses of the Rabbit as Revealed by Spectral Domain Optical Coherence Tomography

Purpose@#We used spectral domain optical coherence tomography (SD-OCT) to assess the retinal and choroidal thicknesses of the rabbit, a commonly used animal model of ophthalmic disease. We report normative datasets. @*Methods@#Semi-automated measurements were made on 15 normal right eyes of New Zealand white rabbits. Total retinal, inner retinal layer, outer retinal layer, choroidal, ganglion cell layer, ganglion cell complex, inner nuclear layer, and outer nuclear layer thicknesses were measured at fixed distances (0, 1, 2, 3, 4, and 5 mm) below the optic nerve head. @*Results@#Total retinal layer (Pearson’s correlation coefficient [CC] = -0.778, p < 0.05), inner retinal layer (CC = -0.710, p < 0.05), outer retinal layer (CC = -0.495, p < 0.05), ganglion cell complex (CC = -0.292, p < 0.05), ganglion cell layer (CC = -0.284, p < 0.05), and outer nuclear layer thicknesses (CC = -0.760, p < 0.05) decreased with the distance from the optic nerve head. Inner nuclear layer thickness correlated negatively with the distance from the optic nerve head, but the correlation coefficient was low (CC = -0.263, p < 0.05). Choroidal thickness increased with the distance from the optic nerve head (CC = 0.511, p < 0.05). @*Conclusions@#Rabbit retinal thicknesses were measured and analyzed by the distance from the optic nerve head. The datasets will serve as standards when using rabbits.

Does Diabetes Increase the Risk of Contracting COVID-19? A Population-Based Study in Korea

Background@#This study aimed to determine the infection risk of coronavirus disease 2019 (COVID-19) in patients with diabetes (according to treatment method). @*Methods@#Claimed subjects to the Korean National Health Insurance claims database diagnosed with COVID-19 were included. Ten thousand sixty-nine patients with COVID-19 between January 28 and April 5, 2020, were included. Stratified random sampling of 1:5 was used to select the control group of COVID-19 patients. In total 50,587 subjects were selected as the control group. After deleting the missing values, 60,656 subjects were included. @*Results@#Adjusted odds ratio (OR) indicated that diabetic insulin users had a higher risk of COVID-19 than subjects without diabetes (OR, 1.25; 95% confidence interval [CI], 1.03 to 1.53; P=0.0278). In the subgroup analysis, infection risk was higher among diabetes male insulin users (OR, 1.42; 95% CI, 1.07 to 1.89), those between 40 and 59 years (OR, 1.66; 95% CI, 1.13 to 2.44). The infection risk was higher in diabetic insulin users with 2 to 4 years of morbidity (OR, 1.744; 95% CI, 1.003 to 3.044). @*Conclusion@#Some diabetic patients with certain conditions would be associated with a higher risk of acquiring COVID-19, highlighting their need for special attention. Efforts are warranted to ensure that diabetic patients have minimal exposure to the virus. It is important to establish proactive care and screening tests for diabetic patients suspected with COVID-19 for timely disease diagnosis and management.

Feasibility of Robot-Assisted Gait Training with an End-Effector Type Device for Various Neurologic Disorders

Robots are being used to assist the recovery of walking ability for patients with neurologic disorders. This study aimed to evaluate the feasibility and functional improvement of training with robot-assisted gait training (RAGT) using the Morning Walk®, an end-effector type robot using footplates and saddle seat support. A total of 189 individuals (65.1% men, 34.9% women; mean age, 53.2 years; age range: 5–87 years) with brain lesions, spinal cord injuries, Parkinson's disease, peripheral neuropathies, and pediatric patients were involved in this retrospectively registered clinical trial. Each participant performed 30 minutes of RAGT, five times a week, for a total of 24 sessions. Failure was defined as an inability to complete all 24 sessions, and the reasons for discontinuation were analyzed. Parameters of Medical Research Council scales and Functional Ambulation Categories were analyzed before and after RAGT training. Among the 189 patients, 22 (11.6%) failed to complete the RAGT. The reasons included decreased cooperation, musculoskeletal pain, saddle seat discomfort, excessive body-weight support, joint spasticity or restricted joint motion, urinary incontinence from an indwelling urinary catheter, and fatigue. Comparison between the pre- and post-training motor and ambulatory functions showed significant improvement. The result of the study indicates that the Morning Walk® is feasible and safe and useful for functional improvement in patients with various neurologic disordersTRIAL REGISTRATION: Clinical Research Information Service Identifier: KCT0003627

Does Diabetes Increase the Risk of Contracting COVID-19? A Population-Based Study in Korea

Background@#This study aimed to determine the infection risk of coronavirus disease 2019 (COVID-19) in patients with diabetes (according to treatment method). @*Methods@#Claimed subjects to the Korean National Health Insurance claims database diagnosed with COVID-19 were included. Ten thousand sixty-nine patients with COVID-19 between January 28 and April 5, 2020, were included. Stratified random sampling of 1:5 was used to select the control group of COVID-19 patients. In total 50,587 subjects were selected as the control group. After deleting the missing values, 60,656 subjects were included. @*Results@#Adjusted odds ratio (OR) indicated that diabetic insulin users had a higher risk of COVID-19 than subjects without diabetes (OR, 1.25; 95% confidence interval [CI], 1.03 to 1.53; P=0.0278). In the subgroup analysis, infection risk was higher among diabetes male insulin users (OR, 1.42; 95% CI, 1.07 to 1.89), those between 40 and 59 years (OR, 1.66; 95% CI, 1.13 to 2.44). The infection risk was higher in diabetic insulin users with 2 to 4 years of morbidity (OR, 1.744; 95% CI, 1.003 to 3.044). @*Conclusion@#Some diabetic patients with certain conditions would be associated with a higher risk of acquiring COVID-19, highlighting their need for special attention. Efforts are warranted to ensure that diabetic patients have minimal exposure to the virus. It is important to establish proactive care and screening tests for diabetic patients suspected with COVID-19 for timely disease diagnosis and management.

Feasibility of Robot-Assisted Gait Training with an End-Effector Type Device for Various Neurologic Disorders

Robots are being used to assist the recovery of walking ability for patients with neurologic disorders. This study aimed to evaluate the feasibility and functional improvement of training with robot-assisted gait training (RAGT) using the Morning Walk®, an end-effector type robot using footplates and saddle seat support. A total of 189 individuals (65.1% men, 34.9% women; mean age, 53.2 years; age range: 5–87 years) with brain lesions, spinal cord injuries, Parkinson's disease, peripheral neuropathies, and pediatric patients were involved in this retrospectively registered clinical trial. Each participant performed 30 minutes of RAGT, five times a week, for a total of 24 sessions. Failure was defined as an inability to complete all 24 sessions, and the reasons for discontinuation were analyzed. Parameters of Medical Research Council scales and Functional Ambulation Categories were analyzed before and after RAGT training. Among the 189 patients, 22 (11.6%) failed to complete the RAGT. The reasons included decreased cooperation, musculoskeletal pain, saddle seat discomfort, excessive body-weight support, joint spasticity or restricted joint motion, urinary incontinence from an indwelling urinary catheter, and fatigue. Comparison between the pre- and post-training motor and ambulatory functions showed significant improvement. The result of the study indicates that the Morning Walk® is feasible and safe and useful for functional improvement in patients with various neurologic disordersTRIAL REGISTRATION: Clinical Research Information Service Identifier: KCT0003627

Feasibility of Robot-Assisted Gait Training with an End-Effector Type Device for Various Neurologic Disorders

Robots are being used to assist the recovery of walking ability for patients with neurologic disorders. This study aimed to evaluate the feasibility and functional improvement of training with robot-assisted gait training (RAGT) using the Morning Walk®, an end-effector type robot using footplates and saddle seat support. A total of 189 individuals (65.1% men, 34.9% women; mean age, 53.2 years; age range: 5–87 years) with brain lesions, spinal cord injuries, Parkinson's disease, peripheral neuropathies, and pediatric patients were involved in this retrospectively registered clinical trial. Each participant performed 30 minutes of RAGT, five times a week, for a total of 24 sessions. Failure was defined as an inability to complete all 24 sessions, and the reasons for discontinuation were analyzed. Parameters of Medical Research Council scales and Functional Ambulation Categories were analyzed before and after RAGT training. Among the 189 patients, 22 (11.6%) failed to complete the RAGT. The reasons included decreased cooperation, musculoskeletal pain, saddle seat discomfort, excessive body-weight support, joint spasticity or restricted joint motion, urinary incontinence from an indwelling urinary catheter, and fatigue. Comparison between the pre- and post-training motor and ambulatory functions showed significant improvement. The result of the study indicates that the Morning Walk® is feasible and safe and useful for functional improvement in patients with various neurologic disordersTRIAL REGISTRATION: Clinical Research Information Service Identifier: KCT0003627

Clinical Usefulness of the Korean Developmental Screening Test (K-DST) for Developmental Delays

OBJECTIVE: To evaluate the clinical usefulness of the Korean Developmental Screening Test (K-DST) via comparison with Korean Ages and Stages Questionnaire (K-ASQ) for the diagnosis of developmental delay in pediatric patients. METHODS: The K-DST and K-ASQ were used to screen pediatric patients who visited the hospital for evaluation and diagnosis of delayed development. Korean Bayley Scales of Infant Development-II (K-BSID-II) or Korean Wechsler Preschool and Primary Scale of Intelligence III (K-WPPSI-III) were used for the standardized assessment. Moreover, the final clinical diagnosis was confirmed by three expert physicians (rehabilitation doctor, psychiatrist, and neurologist). The sensitivity and specificity of each screening tool for the final diagnosis were investigated and correlated with standardized assessments. RESULTS: A total of 145 pediatric consultations were conducted, which included 123 developmental disorders (40 autism spectrum disorders, 46 global developmental delay/intellectual disability, and 37 developmental language disorders) and another 22 that were not associated with any such disorders. The sensitivity and specificity of K-DST based on the final clinical diagnosis were 82.9% and 90.9%, respectively, which were not significantly different from that of K-ASQ (83.7% and 77.3%). Both K-DST and K-ASQ showed good correlation with K-BSID-II and K-WPPSI-III. No significant difference was found between the K-DST and K-ASQ measures. CONCLUSION: K-DST is an excellent screening tool and is expected to replace K-ASQ with high validity.

Comparison of Posterior Capsule Rupture Rate during Phacoemulsification by Novice Ophthalmologists: Microscope vs. Intracameral Illumination

PURPOSE: We compared the posterior capsule rupture (PCR) rate between microscope versus intracameral illumination in phacoemulsification surgery performed by novice ophthalmologists. METHODS: We conducted a retrospective chart review of 300 eyes of 211 patients who underwent phacoemulsification by novice ophthalmologists from March 2012 to October 2017. Novice ophthalmologists (n = 6) were divided into those using microscope illumination (n = 4) and intracameral illumination users (n = 2). The first 50 cataract surgery cases of each novice ophthalmologist were reviewed. The results using a phacoemulsification machine and microscopy were the same. The intraoperative complications and learning curve in each case were evaluated. RESULTS: Phacoemulsifications performed by novice ophthalmologists showed a statistically significant difference in PCR rate between the microscope illumination (19.0%, 38/200) and intracameral illumination (4.0%, 4/100) groups (p = 0.001). The incidence of PCR was reduced to 22%, 18%, 16%, 12%, and 8% per 10 cases in the microscope group, while it was 15% in the first 10 cases and 0% in 50 cases thereafter in the intracameral illumination group. CONCLUSIONS: Novice surgeons had a lower PCR rate during cataract surgery using intracameral illumination than using microscope illumination. Both groups showed a tendency for the PCR to decrease with increasing surgical cases, but the intracameral illumination group showed a shorter learning curve.

Development of a Post-vitrectomy Injection of N-methyl-N-nitrosourea as a Localized Retinal Degeneration Rabbit Model

Since genetic models for retinal degeneration (RD) in animals larger than rodents have not been firmly established to date, we sought in the present study to develop a new rabbit model of drug-induced RD. First, intravitreal injection of N-methyl-N-nitrosourea (MNU) without vitrectomy in rabbits was performed with different doses. One month after injection, morphological changes in the retinas were identified with ultra-wide-field color fundus photography (FP) and fundus autofluorescence (AF) imaging as well as spectral-domain optical coherence tomography (OCT). Notably, the degree of RD was not consistently correlated with MNU dose. Then, to check the effects of vitrectomy on MNU-induced RD, the intravitreal injection of MNU after vitrectomy in rabbits was also performed with different doses. In OCT, while there were no significant changes in the retinas for injections up to 0.1 mg (i.e., sham, 0.05 mg, and 0.1 mg), outer retinal atrophy and retinal atrophy of the whole layer were observed with MNU injections of 0.3 mg and 0.5 mg, respectively. With this outcome, 0.2 mg MNU was chosen to be injected into rabbit eyes (n=10) at two weeks after vitrectomy for further study. Six weeks after injection, morphological identification with FP, AF, OCT, and histology clearly showed localized outer RD - clearly bordered non-degenerated and degenerated outer retinal area - in all rabbits. We suggest our post-vitrectomy MNU-induced RD rabbit model could be used as an interim animal model for visual prosthetics before the transition to larger animal models.

Incidence of Cerebral Palsy in Korea and the Effect of Socioeconomic Status: A Population-Based Nationwide Study

PURPOSE: Cerebral palsy (CP) is a neurodevelopmental disorder that causes serious disability. Prematurity and low birth weight (LBW) are known to be the strongest risk factors of CP. While socioeconomic status (SES) has been found to influence the occurrence of CP, prematurity, and LBW, no studies have investigated this effect in Korea. The aim of this study was to evaluate the incidence of CP, prematurity, and LBW in Korea, as well as the effect of SES thereon. MATERIALS AND METHODS: Data were obtained from the National Health Information Database from 2007 to 2013; persons with a history of CP, prematurity, and LBW were investigated by year. SES was defined in accordance with income quintiles, birth regions, and coverage classification. RESULTS: The incidence of CP decreased over the last five years, despite increased rates of prematurity and LBW. CP incidence was significantly lower in affluent groups than in the most deprived group, although this difference disappeared after controlling for confounders. The incidence of CP was significantly higher in medical aid beneficiaries, even after controlling for confounders. CONCLUSION: CP incidence in Korea has decreased over the last five years, despite an increase in high-risk deliveries. Income level had no effect in CP incidence. These results may aid CP management and prevention policies.

Segmental Motor Paresis Presenting with Abdominal Wall Pseudohernia due to Herpes Zoster: Case Report

Herpes zoster is characterized by vesicular eruption and rash of the skin in the affected dermatomes. Sensory symptoms such as pain and hypesthesia are often accompanied in patients with herpes zoster. While motor paralysis is uncommon, abdominal paralysis can result in rare complications such as abdominal wall pseudohernia. In the present report, we discuss the case of a 62 year-old man who presented with abdominal wall protrusion after herpes zoster infection involving the right T10-T12 dermatomes. Magnetic resonance imaging findings were not specifically correlated with abdominal wall protrusion. Needle electromyography revealed abnormal spontaneous activity in the right paraspinal muscles at the T10-T12 levels, rectus abdominis, and external oblique muscles. Dermatomal somatosensory evoked potentials (SEPs) exhibited prolonged latency in the right T10 and T12 dermatomes. These findings suggest that herpes zoster infection can affect both motor and sensory nerves.

A Case of Retinal Vessel Occlusion Caused by Bartonella Infection

No abstract available.

Cost of Rehabilitation Treatment of Patients With Cerebral Palsy in Korea

OBJECTIVE: To investigate rehabilitation treatment cost of patients with cerebral palsy (CP) according to age. METHODS: We analyzed the cost of rehabilitation treatment from 2007 to 2013 for patients diagnosed with CP by sourcing data from the National Health Information Database. RESULTS: While the number of recently born children requiring rehabilitation treatment has decreased, the number of patients requiring this treatment in other age groups has gradually increased. In addition, annual physical therapy, occupational therapy, hydrotherapy, and botulinum toxin injection treatment costs per person have increased. On the other hand, the number of orthopedic surgeries and selective dorsal rhizotomy performed has decreased. CONCLUSION: This study investigated trends in the cost of treatment for patients with CP. This study can be used as a basis to provide treatment support for patients with CP.

Disability Registration State of Children With Cerebral Palsy in Korea

OBJECTIVE: To investigate the disability registration state of children with cerebral palsy (CP) in Korea. METHODS: Based on the National Health Information Database, the disability registration state was examined for brain lesion disability and other possible complicated disabilities accompanying brain disorder in children diagnosed with CP aged up to 5 years old who were born between 2002 and 2008. RESULTS: Of children diagnosed with CP, 73.1% were registered as having brain lesion disability for the first time before they turned 2 years old. The younger the children, the more likely they will have 1st and 2nd degree disability. However, when the age of children is increased, such likelihood is decreased. The percentage of children registered as having overlapping disabilities was 7%–20%. CONCLUSION: It is important to establish a more accurate standard to rate disability and provide national support systems for children with CP with various severities and multiple disabilities. By reorganizing the current disability registration system for pediatric brain lesions, the system could serve as a classification standard to provide medical and social welfare services.

Current Situation of Assistive Devices and Appliances Provision for Persons with Cerebral Palsy in Korea / 보건행정학회지

BACKGROUND: The aim of this study was to investigate the current state of the assistive devices and appliances provision system for cerebral palsy patients registered with brain disability. METHODS: From 2003 to 2013, we analyzed the records of cerebral palsy patients who had assistive devices and appliances provisioned at least once in their lives based on National Health Information Database. Patients with cerebral palsy were divided into three groups: infants and toddlers, school age and adolescence, and adults. RESULTS: Data on short leg plastic orthoses, ankle joint orthoses, and wheelchair were mainly analyzed. The types of ankle joint orthoses divided into three categories: limited, 90° limited, and Klenzac. Limited ankle joint orthoses was most frequently supported of the three in all age groups. Powered wheelchair and scooter were most supported to adult patients. When the re-supply duration was evaluated, the duration was suitable to the duration on guideline of regulation of re-supplement according to the related laws in adult patients but not in infants/toddlers and school age/adolescence as the actual re-supplement duration was much shorter than the reference value. CONCLUSION: This study confirmed the pattern of assistive devices and appliances supply differed depending on the age of cerebral palsy patients.

Long-term Changes of Endothelial Cell Density after Pars Plana Vitrectomy with Fragmentation

PURPOSE: To evaluate the long-term changes in cornea endothelial cell density (ECD) after pars plana vitrectomy (PPV) with fragmentation. METHODS: Twenty patients (20 eyes) who underwent PPV with fragmentation and who were followed up for 2 years were enrolled in this retrospective study. The cornea ECD, coefficient of variation (CV), and hexagonality (HA) were calculated using a specular microscopy at 1, 3, 6, 12 months, and 2 years after surgery. RESULTS: The preoperative mean ECD was 1,782 ± 623 cells/mm², and the postoperative mean ECD did not significantly change at 1, 3, 6, and 12 months. Additionally, there were no significant changes in CV or HA. At 2 years after surgery, the mean ECD was 1,722 ± 532 cells/mm², the mean CV was 35.50 ± 3.03%, and the mean HA was 53.00 ± 4.91%. There were no significant changes in ECD, CV, or HA preoperatively and postoperatively at 1, 3, 6, and 12 months. CONCLUSIONS: In this study, the mean ECD did not significantly decrease after PPV with fragmentation at 2 years after surgery. A PPV with fragmentation was an appropriate surgical procedure for patients with low cornea endothelial cell density.