Paracentral Acute Middle Maculopathy after Severe Headache

Purpose@#We report the first case of bilateral paracentral acute middle maculopathy (PAMM) after severe headache in a Korean patient.Case summary: A 43-year-old woman with herniation of a lumbar disk visited the emergency room with a 5-day history of headache and bilateral visual disturbance. She experienced a severe headache, facial fever, and partial visual field defects in both eyes. There were no neurologic symptoms, related acute brain disease or lesions on brain/orbit magnetic resonance imaging.Her best corrected visual acuity was 0.8 (right eye) and 0.5 (left eye), which was lower than. There were no relative afferent pupillary defects, color deficits, or any ocular movement disorder. Her intraocular pressures were normal, but a Humphrey visual field test identified multiple atypical scotomas in both eyes. Ophthalmoscopic examination revealed multiple light gray exudates with unclear margins surrounding the maculas of both eyes. Spectral domain optical coherence tomography (SD-OCT) showed some localized hyper-reflective lesions located in the inner plexiform, inner nuclear, and outer plexiform layers. On optical coherence tomography angiography (OCTA) examination, there was a normal choriocapillaris and a reduction of the inner retinal capillary plexus corresponding to the lesions in the fundus examination. Fluorescent angiography revealed early localized nonperfusion areas and a late leak in the same lesions. In addition, there was delayed filling of the peripheral retina and a late leak. @*Conclusions@#It is important to consider PAMM in patients who show sudden visual loss or visual field defects and SD-OCT and OCTA may assist in the diagnosis.

Optic Nerve Sheath Meningocele with Optic Disc Pit

Purpose@#Optic nerve sheath meningocele is a very rare condition; if the optic nerve is pressed, visual function can deteriorate. We report a patient with optic nerve sheath meningocele treated with optic nerve sheath fenestration.Case summary: We report a 15-month-old male who visited the outpatient clinic due to an orbital tumor in the left eye found by accident. He had no proptosis or relative afferent pupillary defect, and fundus examination revealed a left optic disc pit. On fat-suppressed magnetic resonance imaging (MRI), there was a well-defined 13.5 × 12.7 mm cystic lesion located at the superotemporal aspect of the left optic nerve within the optic nerve sheath. The optic nerve was compressed and displaced inferomedially. Once the diagnosis had been confirmed as optic nerve sheath meningocele, optic nerve sheath fenestration was performed under general anesthesia to relieve optic nerve compression. The compressed left optic disc returned to normal after surgery and the size of the meningocele shrunk to 11.7 × 10.9 mm on MRI. However, it re-expanded to almost the same size as that preoperatively 10 months later. @*Conclusions@#We report a case of optic nerve sheath meningocele with an optic disc pit treated with optic nerve sheath fenestration, which has not been reported previously in the Republic of Korea. Because the effect of optic nerve sheath fenestration could be temporary, it is necessary to conduct regular checkups given the possibility of deterioration of visual function.

Estimated Incidence and Cost Projections of Cataract Surgery in the Republic of Korea

PURPOSE: We sought to predict the future incidence and health expenditures of cataract surgery in the Republic of Korea. METHODS: From 2011 to 2015, National Health Insurance claims data were used to estimate the incidence and prevalence changes of cataract surgery according to demographic characteristics (year, sex, residence, and age). Based on the above results and changes in future population distribution, we estimated the incidence of cataract surgery by 2030. Considering the cost of cataract surgery from 2011 to 2015, we also predicted future health expenditures for cataract surgery. RESULTS: A total of 2,236,107 eyes of 1,591,176 patients underwent cataract surgery from 2011 to 2015. The total number of operated eyes per year increased, from 427,729 to 492,700 (+15%), and the number of patients increased from 306,710 to 346,056 (+12%) from 2011 to 2015. The cost of cataract surgery reimbursed by the National Health Insurance Service (NHIS) increased from 408,307,530,900 won ($360 million) to 449,334,367,080 won ($399 million) (+9%). The future prevalence of cataract surgery was predicted to reach 562,003 in 2030 from 346,056 in 2015. The cost of cataract surgery is expected to increase from 449 billion won ($399 million) in 2015 to 641 billion won ($570 million) in 2030. CONCLUSIONS: Cataract surgery and medical expenses will increase due to social aging. Therefore, we need policies to secure medical resources and expand insurance indications.

Bilateral Rhegmatogenous Retinal Detachments after Systemic Pazopanib Treatment

PURPOSE: A case of bilateral rhegmatogenous retinal detachment is reported after pazopanib treatment of a patient with breast angiosarcoma. CASE SUMMARY: A 53-year-old female presented with bleeding in a right breast mass prior to an emergency room visit. She was diagnosed with metastatic breast angiosarcoma after a breast mass biopsy. She was treated with paclitaxel and radiation therapy. Systemic pazopanib treatment was added to treat lung metastasis. After 3 weeks, she felt sudden floaters in her right eye. In her fundus examination, there was vitreous hemorrhage, but no retinal detachment was noted. Five weeks later, she visited the clinic for a bilateral temporal visual field defect. A fundus examination showed bilateral retinal detachments with superonasal retinal tears. Both the patient and her family did not want surgery for her systemic condition because of her terminal cancer. CONCLUSIONS: Retinal detachment has been reported as a rare complication after systemic pazopanib treatment, but there has been no previous report in the Republic of Korea, therefore this is the first case of bilateral retinal detachments after systemic pazopanib treatment.

Prospective Memory Loss and Related White Matter Changes in Patients with Amnestic Mild Cognitive Impairment

BACKGROUND AND PURPOSE: Prospective memory (PM) has a known relationship with frontal function, and PM decline has been observed in amnestic mild cognitive impairment (aMCI). Cerebral small vessel disease, as evidenced by white matter hyperintensities (WMHs), is linked to frontal dysfunction. This study was undertaken to evaluate the relationship between PM decline and WMHs in patients with aMCI. METHODS: Of 74 enrollees with aMCI, 69 completed this prospective study. We compared total scores and sub-scores of the Prospective and Retrospective Memory Questionnaire (PRMQ) administered at baseline and 3 months later, stratifying patients by degree of WMHs. RESULTS: A significant decline was seen in PRMQ total scores and PM scores at the 3-month mark in patients with moderate (vs. mild) degrees of WMHs (−2.8±7.2 vs. 0.2±7.1; p=0.032). In addition, patients with moderate (vs. mild) degrees of deep WMHs (DWMHs) showed greater PM decline, whereas PM loss in patients with mild, moderate, or severe degrees of periventricular WMHs (PVWMHs) did not differ significantly. CONCLUSIONS: Findings of this study indicate that the burden of WMHs is consistently implicated in PM deterioration experienced by patients with aMCI, and signifies greater PM decline, especially in instances of extensive DWMHs. Greater attention to the change of PM is therefore needed in aMCI patients with WMHs.

1alpha,25-Dihydroxyvitamin D3 Protects Dopaminergic Neurons in Rodent Models of Parkinson's Disease through Inhibition of Microglial Activation

BACKGROUND: Recent studies have demonstrated the molecular basis of the immunomodulatory and anti-inflammatory activities of 1,25-dihydroxyvitamin D3(1,25-(OH)2D3). This hormone improves behavioral deficits and normalizes the nigral dopamine levels in animal models of Parkinson's disease (PD). METHODS: We studied whether the administration of 1,25-(OH)2D3 would protect against 6-hydroxydopa (6-OHDA)- and 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP)-induced neuronal injury, and its potential regulatory effect on microglia activation. RESULTS: We found that 1,25-(OH)2D3 pretreatment significantly decreased 6-OHDA- and MPTP-induced dopaminergic neuronal loss in the substantia nigra pars compacta by preventing the activation of microglia. This observed neuroprotective effect in MPTP-treated mice that were given 1,25-(OH)2D3 may be attributable to inhibition of proinflammatory cytokine expression. CONCLUSION: These results suggest that 1,25-(OH)2D3 is a potentially valuable neuroprotective agent; it may therefore be considered for the treatment of pathologic conditions of the central nervous system, such as PD, where inflammation-induced neurodegeneration occurs.

The Prevalence of Risk Factors for Vascular Disease in Parkinson's Disease; Comparison with Normal Controls and Disease Controls

Background: Data on the relationship between Parkinson's disease (PD) and stroke have been conflicting, some studies showing a reduced risk of stroke during life because of low prevalence of vascular risk factors, and others indicating an increased risk of strokerelated death. The objective of this study is to determine the frequency of vascular risk factors in PD in relation to an unaffected control group and ischemic stroke patient group. Methods: We performed a case-control study on 206 consecutive PD patients, 207 ischemic strokes patients (served as "Disease" controls) and 138 age and sex matched normal subjects (served as controls), calculating multivariate risk estimates (odd ratio) for a series of established risk factors for vascular disease. Results: We found that (1) cigarette smoking (smoker, 0.078, CI=0.034-0.178; ex-smoker, 0.031, CI=0.011-0.088), and diabetes mellitus (0.340, CI=0.169-0.682) were significant less frequent in PD patients than controls, (2) cigarette smoking (smoker, 0.230, CI= 0.094-0.561; ex-smoker, 0.132, CI=0.050-0.348), hypertension (0.283, CI=0.175-0.459), diabetes mellitus (0.257, CI=0.136-0.486), previous stroke (0.063, CI=0.020-0.191), heart disease (0.344, CI=0.176-0.673) than ischemic stroke patients, respectively. Conclusion: We found the significant negative association of a series of vascular factors with PD, indicating a protective effect of PD against ischemic stroke.