Risk Factors of Secondary Glaucoma after Congenital Cataract Surgery in Korean Patients

PURPOSE: To assess the risk of development of secondary glaucoma after congenital cataract surgery using a long-term follow-up study. METHODS: In total, 148 eyes of 91 patients who underwent congenital cataract surgery at our hospital or other hospitals were included in a retrospective chart review. A diagnosis of secondary glaucoma was made if the intraocular pressure (IOP) exceeded 21 mmHg and the corneal diameter, axial length, or the cup-to-disc ratio increased, or surgery was performed to control the IOP. To analyze the clinical features and risk factors of secondary glaucoma, we evaluated the mean age at cataract surgery, binocularity, presence of a nuclear cataract, methods of cataract surgery, presence of an intraocular lens (IOL), duration of diagnosis of secondary glaucoma after cataract surgery, duration of follow-up, recent best-corrected visual acuity, and refractive errors. RESULTS: Thirty-five eyes (23.6%) were diagnosed with secondary glaucoma as a complication of congenital cataract surgery. Of these, 11 eyes (31.4%) were treated with glaucoma surgery a mean of 3.4 times. The mean duration from congenital cataract surgery to diagnosis of glaucoma was 112.2 ± 113.1 months. Patients with aphakia had a higher risk of developing secondary glaucoma compared with patients undergoing primary IOL implantation (p = 0.001). Younger age (<3 months at surgery), a nuclear cataract, and aphakia were risk factors for the development of secondary glaucoma (p = 0.03, p = 0.006, and p < 0.001, respectively), and the risk of developing secondary glaucoma increased with secondary IOL implantation (p = 0.052). CONCLUSIONS: Secondary glaucoma after congenital cataract surgery was more common in patients with secondary IOL implantation, aphakia, a younger age (<3 months), and a nuclear cataract. Patients who underwent congenital cataract surgery had an increased risk for developing secondary glaucoma. Long-term monitoring of the IOP and optic nerve is therefore required for these patients.

A Case of Severe Vaso-Occlusive Retinopathy as the First Manifestation Associated with Systemic Lupus Erythematosus

PURPOSE: To report a case of severe vaso-occlusive retinopathy with significant decrease of bilateral visual acuity as the first manifestation associated with systemic lupus erythematosus (SLE). CASE SUMMARY: A 23-year-old man was referred to our clinic with bilateral visual impairment of hand motion (HH). Fundus examination revealed severe retinal hemorrhage, cotton-wool patch, occlusive retinal vasculitis with vascular engorgement, and diffuse retinal edema in both eyes. Because of a malar rash on both cheeks, generalized edema was observed on initial examination with hypertension, azotemia, anemia, and thrombocytopenia, The patient was diagnosed with SLE, strongly positive to antinuclear antibody (ANA), and received an intravitreal injection of Bevacizumab (Avastin, Genentech Inc., San Francisco, CA, USA) in the left eye in addition to hemodialysis, transfusion, systemic corticosteroid and immunosuppressant treatment due to lupus nephritis. Eighteen months later, the retinal edema, cotton-wool patch and hemorrhage resolved, leaving epiretinal membrane without traction in his left eye and diffuse degeneration of the right eye. Final visual acuity was HM in the right eye and 20/100 in the left eye. CONCLUSIONS: Vaso-occlusive retinopathy in SLE can result in permanent visual impairment. In a patient with a high possibility of SLE retinopathy, a periodic fundus examination and intensive management of systemic disease should be considered.

A Statistical Observation of Non-Penetrating Ocular Injuries

PURPOSE: To investigate the clinical and social characteristics of non-penetrating ocular injuries and use the results for treatment and prevention. METHODS: A retrospective survey was performed on 468 eyes of 421 patients, who visited our clinic due to non-penetrating ocular injuries from January 2010 to December 2010. The incidence of ocular injuries, sex, age, monthly and seasonal distribution, side, cause, influence of alcohol, and change in visual acuity were reviewed statistically. RESULTS: The incidence of non-penetrating ocular injuries was 4.9%. The incidence was more common in males (82.9%), in the 3rd decade of life (23.5%) and in summer (30.8%). Minor injuries (36.1%) were the most common caused by scratches, finger pricks, nails, or small foreign bodies. The second common cause was violence (16.4%), followed by traffic accidents (14.7%). The injuries related to alcohol represented 12.6% of all cases. When considering initial diagnoses, periorbital contusion and corneal abrasion were the most common. The initial visual acuity was less than 20/200 in 9.4% of the eyes and the final acuity after a 6-months of treatment was less than 20/200 in 3.0% of the eyes. CONCLUSIONS: This survey gathered the clinical and social characteristics as well as new insights into non-penetrating ocular injuries which can be used for treatment and prevention.

A Case of Fungal Keratitis after Intracorneal Ring Segment Implantation for Keratoconus

PURPOSE: To report a case of fungal keratitis 3 days after intracorneal ring segment (ICRS) implantation for keratoconus. CASE SUMMARY: A 65-year-old woman was referred to our clinic with refractory infectious keratitis in her left eye 3 days after ICRS insertion for keratoconus. Slit lamp examinations revealed infiltrates around the incision site with cellular reaction in the anterior chamber after the ICRS had been removed. Corneal scrapings were obtained for staining and cultures, and intensive topical antibiotics were administered. Initial microscopy and cultures were negative. Despite the use of intensive topical antibiotics, there was no improvement. Hyphae were isolated from additional corneal scrapings. The patient's symptoms and corneal findings improved following administration of topical amphotericin B and oral itraconazole. CONCLUSIONS: Infectious keratitis after ICRS implantation is an uncommon but sight-threatening complication. Fungal keratitis should also be considered if infectious keratitis after ICRS is unresponsive to antibiotics.

Fluorescein Angiographic Findings of Nonarteritic Anterior Ischemic Optic Neuropathy and Optic Neuritis

PURPOSE: To compare the fluorescein angiographic findings of nonarteritic anterior ischemic optic neuropathy (NA-AION) and optic neuritis. METHODS: The present study included 41 patients (41 eyes), who were diagnosed with NA-AION or optic neuritis and underwent fluorescein angiography in our clinic. The clinical profiles of patients, characteristics of optic disc head and hemorrhage, and visual field findings were analyzed retrospectively. The onset and filling time, perfusion time of retinal artery, optic disc, and peripapillary choroid were evaluated quantitatively. RESULTS: Patients with NA-AION showed statistically significant delay in both the onset time, filling time and perfusion time of the optic disc and peripapillary choroid compared with patients with optic neuritis (p < 0.05). There was no significant difference in the dye leakage of the peripapillary areas between the 2 groups (p = 0.324). CONCLUSIONS: In the present study, the results of fluorescein filling were significantly different between the NA-AION group and the optic neuritis group. The results may help determine the therapeutic plan and to differentiate between the 2 disease entities, especially in cases of overlapping clinical features.

Acute myocardial infarction coincident with gastric ulcer bleeding following herbal medication-induced acute renal failure / 대한내과학회지

Acute renal failure, acute myocardial infarction (AMI), and gastric ulcer bleeding (GUB) are associated with high rates of morbidity and mortality, especially in older patients. The development of each of these conditions can be followed by the development of another; however, it is rare for these three conditions to develop concurrently. Here, we report the case of a 92-year-old man who was admitted because of generalized weakness that developed after the ingestion of nothing but functional foods, including herbal medications containing Glycyrrhiza and Aloe, for ten days. After admission, AMI and GUB developed approximately six hours apart. Conservative treatment was chosen for the bleeding ulcer because of the high procedural risk, and the use of antiplatelet agents and heparinization for treatment of the infarction were stopped. The patient remained hemodynamically stable following the administration of a statin, diuretics, and proton pump inhibitors. A healed scar at the site of the ulcer was confirmed three weeks later; however, postinfarct angina developed after the patient's last endoscopy. Percutaneous coronary intervention was successfully performed with two stents placed in the left anterior descending artery.

A Case of Synchronous Double Primary Cancer of the Penis and Urinary Bladder / Journal of the Korean Cancer Association, 대한암학회지

Multiple primary cancers are the occurrence of more than two cancers of different origin in an individual. Penile cancer is a rare disease, and finding it combined with other cancers is even rarer. A 64-year-old man with a painful penile mass was referred to us from a primary urological clinic. We performed a biopsy of the penile mass and the histology revealed a well-differentiated squamous cell carcinoma. Abdominal computed tomography showed a localized bladder tumor with inguinal lymphadenopathy. The patient underwent a partial penectomy, transurethral resection of the bladder tumor and inguinal lymph node dissection. The histology of the bladder tumor was high-grade papillary carcinoma, and that of the lymph node was squamous cell carcinoma. The penile and bladder tumors were in stage II (T1N1M0) and stage I (T1N0M0), respectively. We successfully treated the patient with adjuvant radiotherapy and systemic chemotherapy.

A Case of Cameron Ulcer Associated with Massive Gastrointestinal Bleeding Treated by Angiographic Embolization

Gastric erosions or ulcers located at or near the level of the neck of a large diaphragmatic hernias are referred to as Cameron ulcers. Cameron ulcers are almost always incidental findings. In some patient, Cameron ulcers cause the dyspepsia, gastroesophageal reflux disease and iron deficiency anemia due to chronic gastrointestinal bleeding or even acute bleeding. We report the case of an acute upper gastrointestinal bleeding due to a Cameron ulcer in a patient with a history of aspirin and NSIADs use, which was successfully treated with angiographic coil embolization.

Two Cases of Rectal Dieulafoy's Lesion with Massive Hematochezia in Elderly Patients

Dieulafoy's lesion is rare cause of massive gastrointestinal bleeding. Dieulafoy's lesion is understood to represent a tiny submucosal defect with fibrinoid necrosis at its base, overlying a large, tortous, thick-walled artery in the muscularis mucosa. Although the original descriptions and early reports were of lesions in the proximal stomach, similar lesions have subsequently been reported in the esophagus, duodenum, jejunum, colon and rectum. Rectal Dieulafoy's lesion is rare but it is one of the causes of massive hematochezia. We report two cases of rectal Dieulafoy's lesion that was successfully treated with endoscopic hemostasis by clipping in the elderly patients.