Emotional and cognitive changes in chronic kidney disease

Chronic kidney disease (CKD) leads to cognitive impairment and emotional changes. However, the precise mechanism underlying the crosstalk between the kidneys and the nervous system is not fully understood. Inflammation and cerebrovascular disease can influence the development of depression in CKD. CKD is one of the strongest risk factors for cognitive impairment. Moreover, cognitive impairment occurs in CKD as patients experience the dysregulation of several brain functional domains due to damage caused to multiple cortical regions and to subcortical modulatory neurons. The differences in structural brain changes between CKD and non-CKD dementia may be attributable to the different mechanisms that occur in CKD. The kidney and brain have similar anatomical vascular systems, which may be susceptible to traditional risk factors. Vascular factors are assumed to be involved in the development of cognitive impairment in patients with CKD. Vascular injury induces white matter lesions, silent infarction, and microbleeds. Uremic toxins may also be directly related to cognitive impairment in CKD. Many uremic toxins, such as indoxyl sulfate, are likely to have an impact on the central nervous system. Further studies are required to identify therapeutic targets to prevent changes in the brain in patients with CKD.

Analysis of Clinical Characteristics by Gender in Children and Adolescents with Intentional Poisoning at Emergency Department

PURPOSE: The aim of this study is to investigate the difference between male and female in some clinically meaningful aspects and to prevent intentional poisoning in children and adolescents. METHODS: Retrograde medical records review of patients who visited the emergency department of two secondary hospitals for drug ingestion from March 2010 through March 2013 was performed. Unintentional ingestion or ingestion by others was excluded. RESULTS: A total of 138 cases were reported, male 25.4% (n=35), female 74.6% (n=103). The reason for poisoning was intentional in 132 cases (95.7%) and misuse in six cases (4.3%). In female patients, non-prescription drugs was the most common cause of intentional poisoning (68.9%). Male patients tend to use life substances for intentional poisoning more frequently (20.0%) than female (3.9%). Seven male patients and 12 female patients had previous psychiatric history and 34.3% of male and 41.7% of female were consulted to the psychiatric department. CONCLUSION: Female adolescents are more likely to ingest drugs intentionally for suicide attempt than males of comparable ages. The drugs they ingested were, in many cases, obtained with ease from the drug store nearby and, remarkably, most of the drugs they obtained in that way were acetaminophen-containing. This suggests that some guidelines or control in the pharmacy that restrict children or adolescents from obtaining potentially or possibly life-threatening drugs might be necessary. In addition, education regarding drugs is thought to be necessary in school for teenagers as they tend to misuse them with incorrect acknowledgement.

Changing Trends in Surgery for Retinal Detachment in Korea

PURPOSE: To analyze trends in rhegmatogenous retinal detachment (RRD) surgery among the members of the Korean Retina Society from 2001 to 2013. METHODS: In 2013, surveys were conducted by email and post to investigate the current practice patterns regarding RRD treatment. Questions included how surgeons would manage six cases of hypothetical RRD. Results were compared to those reported in 2001. RESULTS: A total of 133 members (60.7%) in 2013 and 46 members(79.3%) in 2001 responded to the survey. Preference for pneumatic retinopexy has decreased in uncomplicated primary RRD (p = 0.004). More respondents in 2013 selected vitrectomy as the primary procedure when mild vitreous hemorrhage (p = 0.001), myopia (p = 0.044) and history of successful scleral buckling on the fellow eye (p = 0.044) were added to the primary scenario. Vitrectomy was over twice as popular in cases of pseudophakic, macula-off RRD with posterior capsular opacity (p = 0.001). CONCLUSIONS: For RRD with myopia, pseudophakia and media opacity, surgical interventions over the last decade have drastically shifted from scleral buckling and pneumatic retinopexy to vitrectomy.

Estrogen Antagonist and Development of Macular Hole

To describe the clinical and optical coherence tomography (OCT) features of a macular hole (MH) or its precursor lesion in patients treated with systemic antiestrogen agents. We reviewed the medical history of the patient, ophthalmic examination, and both fundus and OCT findings. Three female patients receiving antiestrogen therapy sought treatment for visual disturbance. All of the patients showed foveal cystic changes with outer retinal defect upon OCT. Visual improvement was achieved through surgery for the treatment of MH in two patients. Antiestrogen therapy may result in MH or its precursor lesion, in addition to perifoveal refractile deposits. OCT examination would be helpful for early detection in such cases.

Factors Affecting the Ocular Response Analyzer Parameters in Normal Korean

PURPOSE: To identify the normal range of factors which can be measured with Ocular Response Analyzer (ORA, Reichert Inc., Depew, NY, USA) in normal Korean, and to analyze factors affecting ORA by measuring intraocular pressure (IOP) of noncontact tonometer (NCT) and central corneal thickness (CCT). METHODS: Three hundred and one normal Korean subjects who did not have specific ophthalmological diseases and surgeries in the past were recruited for this study. Corneal hysteresis (CH), corneal response factor (CRF), corneal-compensated IOP (IOPcc), and Goldmann correlated IOP (IOPg) were measured using ORA. In addition, IOP of NCT and CCT were measured and the results and factors analyzed. RESULTS: The mean CH measured among normal Korean subjects in this study was 10.70 mmHg. The mean CRF was 10.40 mmHg. CH and CRF were significantly higher in the juvenile group. IOPcc and IOPg as measures of IOP using the ORA had significant correlation with IOP of NCT. In particular, IOPcc appeared to be independent of CCT. CONCLUSIONS: CH and CRF were different according to age, indicating a difference in biomechanical properties of the cornea. In particular, IOPcc is more important as it is independent of corneal thickness and should be compensated in general measurements of IOP reflecting biomechanical properties.

Two Cases of Topiramate-induced Acute Myopia

PURPOSE: We describe 2 cases of bilateral acute myopia associated with topiramate, a drug that has recently been prescribed for epilepsy or weight reduction. CASE SUMMARY: A 24-year-old woman and a 25-year-old woman, both previously devoid of ocular problems, visited our hospital with blurry vision after taking topiramate for weight reduction. A thorough medical history review and ocular examinations, including a slit lamp examination, were performed. CONCLUSIONS: Slit-lamp examinations revealed forward displacement of the lens-iris diaphragm, which resulted in myopia and anterior chamber shallowing. Discontinuation of topiramate and the administration of cycloplegic agents successfully resolved the symptoms.

Preferences for Treatment Modalities of Simple Rhegmatogenous Tetinal Detachment in Korea

PURPOSE: The purpose of this survey is to assess the current practice patterns of vitreoretinal surgeons in Korea regarding the repair of uncomplicated rhegmatogenous retinal detachments. METHODS: Preferences of vitreoretinal surgeons regarding the repair of rhegmatogenous retinal detachments were obtained via electrical mail or mail survey of members of The Korean Retina Society. They were asked which treatment would they prefer for a hypothetical retinal detachment. RESULTS: The majority of respondents selected a scleral buckling procedure for a primary rhegmatogenous retinal detachment with superior retinal break. As the details of the hypothetical detachments became more complicated with myopia, vitreous hemorrhage, or lattice degeneration and additional tear with a positive family history, the respondents selected a scleral buckling procedure with greater frequency. No correlation was identified surgeon's practice career and preferences of procedures. If there were partially precluded fundus detail in pseudophakic retinal detachment, about 50% of respondents selected vitrectomy with or without scleral buckling combined. CONCLUSIONS: From this survey, we found that most members of The Korean Retina Society prefer scleral buckling for repair of primary rhegmatogenous retinal detachments. About a third of members selected pneumoretinopexy for primary procedure. Vitrectomy was considered frequently in the cases with vitreous hemorrhage or with pseudophakia.

The Experimental study of Injections of Cultured Fibroblasts into the Rabbit Vitreous

The major cause of failure of retinal detachment surgery is proliferative vitreoretinopathy(PVR). This disorder is characterized by the formation of the contractile cellular membrane on both surfaces of retina and within the vitreous cavity. These cellular membranes contract and thereby cause traction retinal detachment. The pathogenesis of this disorder is not fully understood. The authors developed a consistent model of proliferative vitreoretinopathy in the rabbit by partially digesting the post. Vitreous with repeated injection and aspiration of 1 IU of hyaluronidase before injection of 250,000 homologous dermal fibroblasts. All experimental rabbit eyes had vitreous opacity and hyperemia of the optic disc head. The progression of PVR was rapid and moderately severe. On day 1, 13 of 15 eyes(87%) had vitreous strand formation alone(Grade 1 PVR). One day 3, all 15 eyes(100%) had vitreous strand formation. We have developed a model of proliferative vitreoretinopathy in the rabbit. After intravitreal autotransplantation of tissue cultured homologous skin fibroblasts, we observed high rate of vitreous strand formation in the vitreous cavity. This experimental model will be useful for studying the pathogenesis of proliferative vitreoretinopathy and evaluating potential treatment for its prevention.

A Prospective Study of Intraocular Candidiasis

Intraocular fungal infection, especially due to candida infection, has become an increasingly important cause of nosocomial infectio. Despite increasing awareness of this complication of candidemia, serious visual impairment due to candida infection remains as a problem. For the determine the frequency of intraocular candidasis and evaluation of risk factor, patients with candidemia were evaluated with indirect ophthalmoscopic examination within ninety six hours ater blood culture. Intraocular candidiasis were found in thirty three Percent of patient with candidemia. Candida chorioretiritis were found in five (27%) patients, candida endophthalmitis was found in one (5%) patients. The candida chorioretinitis was not progressed to candida endophthalmitis in one patients. That patient with candida endophthalmitis was treated with intravitreal amphotericin B injection, pars plana vitrectomy. Among the six intraocular candidiasis patients, five patients got cnadidiasis after long term antibiotics therapy for flame burn injury and one after anticancer therapy combined with intravenous hyperalimentation. The risk factors for the development of intraocular candidiasis can be long-term antibiotic therapy, parenteral hyperalimentation, use of indwelling catheter, or use of immunosupressive drugs in our cases.

A Case of Aicardi Syndrome

Aicardi syndrome is a congenital multiorgan disorder which is characterized by agenesis of the corpus callosum, chorioretinal ""lacunae"" (often associated with retinal colobomas and microphthalmia), vertebral anomalies, a characteristic seizure disorder, and mental retardation. We present a case of Aicardi syndrome with cleft lip and palate.

A Case of Post. Scleritis Associated with Ciliochoroidal Detachment and Ant. Uveitis in Background Diabetic Retinopathy Patient

Posterior scleritis is an uncommon disease. Its clinical manifestations may include pain. reduced visual acuity, cellular infiltration in the aqueous and vitreous humor, serous retinal detachment, chorioretinal lesions, and disc or macular edema. The diagnosis of posterior scleritis is often difficult due to its rarity and the diversity of symptoms. However, ultrasography and computed tomography are noninvasive methods for diagnosis of posterior scleritis. We treated posterior scleritis associated with ciliochoroidal detachment and anterior uveitis with sclerotomy, drainage of ciliochoroidal fluid in a background diabetic retinopathy patient.