Clinical Outcomes of Topical Bromfenac Combined with Intravitreal Aflibercept Injection for Exudative Age-related Macular Degeneration

Purpose@#To evaluate the efficacy of topical bromfenac combined with intravitreal aflibercept (IVA) injection in the treatment of exudative age-related macular degeneration over a 2-year period. @*Methods@#We retrospectively studied 43 patients (43 eyes) with exudative age-related macular degeneration. Patients were included if they received IVA injections under an as-needed protocol and had > 2 years of follow-up. Among the 43 eyes, 25 received only IVA (IVA group), whereas 18 received a combination of IVA and topical bromfenac (bromfenac group). The primary outcome measure was the total number of IVA injections administered over 2 years from the initial injection compared between groups. We also compared changes in best-corrected visual acuity (BCVA) and central retinal thickness (CRT) between groups. @*Results@#The bromfenac group received a significantly lower number of IVA injections over 2 years (7.4 ± 1.0), compared with the IVA group (9.0 ± 1.9) (p < 0.01). Both groups showed improvements in BCVA and CRT after 2 years compared with their baseline values. However, changes in BCVA and CRT at 2 years did not significantly differ between groups (p = 0.786 and p = 0.905, respectively). @*Conclusions@#Among patients with exudative age-related macular degeneration, the total number of IVA injections over 2 years was lower in the bromfenac group than in the IVA group. More studies are needed to confirm the efficacy of topical bromfenac in a combined treatment regimen.

One-year Clinical Outcome of Topical Bromfenac in Central Serous Chorioretinopathy

Purpose@#To evaluate the efficacy of topical bromfenac in treating central serous chorioretinopathy (CSC) over a 1-year period. @*Methods@#A retrospective analysis was conducted on 57 patients (57 eyes) with CSC followed for > 1 year. Patients were divided into two groups: those treated with bromfenac eye drops twice daily (29 eyes) and a control group (28 eyes). Best-corrected visual acuity (BCVA), central macular thickness (CMT), and subretinal fluid (SRF) height were measured and compared between the two groups as was the proportion of chronic cases. @*Results@#Significant improvements in CMT and SRF height were noted in both groups over the follow-up period. The bromfenac group demonstrated significantly lower CMT at 6, 9, and 12 months (p = 0.045, 0.042, and 0.023, respectively) and lower SRF height (p = 0.037, 0.048, and 0.046, respectively) compared to the control group. The proportion of chronic cases was significantly lower in the bromfenac group (17.2%) compared to the control group (42.9%, p = 0.035). @*Conclusions@#Topical bromfenac reduced the rate of progression to chronic CSC and showed significant anatomical improvements after 6 months, suggesting its potential as an effective treatment option.

Exudative Retinal Detachment after Pembrolizumab Treatment in Metastatic Cutaneous Melanoma

Purpose@#To report a case of exudative retinal detachment after using pembrolizumab in a patient with metastatic cutaneous melanoma.Case summary: A 67-year-old woman, diagnosed with malignant melanoma of the right thumb and axillary metastasis, presented with bilateral visual disturbance 3 days after adjuvant chemotherapy with pembrolizumab. Her best corrected visual acuity was 0.2 in the right eye and 0.7 in the left, while the intraocular pressure was 14 mmHg in both eyes. Fundus examination showed serous retinal detachment and choroidal detachment in the right eye, as well as a chorioretinal folding in both eyes. Optical coherence tomography showed exudative retinal detachment and choroidal detachment in the right eye, along with choroidal folding in both eyes. The pembrolizumab was stopped immediately, and the patient began treatment with systemic and topical steroids. After 1 month, the visual acuity improved and there was no exudative retinal detachment or choroidal detachment. However, 3 weeks later, exudative retinal detachment recurred in both eyes. The patient started treatment with oral steroids and cyclosporine, which resulted in the resolution of the exudative retinal detachment after 1 month. @*Conclusions@#Exudative retinal detachment may occur as a side effect of pembrolizumab treatment. Therefore, a differential diagnosis and appropriate treatment of ocular side effects are necessary.

Properties of Pleural Mesothelial Cells in Idiopathic Pulmonary Fibrosis and Cryptogenic Organizing Pneumonia

Background@#Profibrotic properties of pleural mesothelial cells may play an important role in the fibrosis activity in idiopathic pulmonary fibrosis (IPF). The purpose of this study was to compare the expression of pleural mesothelial cell markers in IPF and cryptogenic organizing pneumonia (COP), with an assumption that increased expression implies increase in fibrosis. @*Methods@#Twenty IPF lung samples were stained by immunohistochemistry for the pleural mesothelial cell markers: leucine rich repeat neuronal 4 (LRRN4), uroplakin 3B, CCchemokine ligand 18, and laminin-5. Nine COP lung samples were used as controls. A semiquantitative analysis was performed to compare markers expression in IPF and COP. @*Results@#LRRN4 expression was found in epithelial lining cells along the honeycombing and fibroblastic foci in IPF, but not in the fibrotic interstitial lesion and airspace filling fibrous tufts in COP. We found a significant decrease in baseline forced vital capacity when LRRN4 expression was increased in honeycombing epithelial cells and fibroblastic foci. @*Conclusion@#LRRN4 expression patterns in IPF are distinct from those in COP. Our findings suggest that mesothelial cell profibrotic property may be an important player in IPF pathogenesis and may be a clue in the irreversibility of fibrosis in IPF.

Hyperviscosity Syndrome-related Retinopathy in a Patient with Waldenström Macroglobulinemia

Purpose@#We report a case of retinopathy related to bilateral hyperviscosity syndrome in a patient with Waldenström macroglobulinemia.Case summary: A 77-year-old male presented with reduced visual acuities of both eyes 2 months in duration. Fundus examination revealed extensive flame-shaped retinal hemorrhages and venous congestion. Optical coherence tomography (OCT) evidenced macular edema and OCT angiography (OCTA) indicated damage to the superficial and deep capillary plexi of retina and choriocapillaris and dilated large choroidal vessels. We diagnosed central retinal vein occlusion with macular edema and prescribed intravitreal bevacizumab and posterior subtenon triamcinolone injections, however, the edema did not improve. As retinopathy associated with hematological disease was thus suspected, we referred the patient to our department of hematology and oncology for further assessment. He was diagnosed with Waldenström macroglobulinemia. After initiation of chemotherapy, the retinal hemorrhage in and macular edema of both eyes decreased. After six chemotherapy cycles, the retinal hemorrhages resolved and the macular edema improved in both eyes. OCTA revealed that the choroidal vessel dilation also improved. @*Conclusions@#In elderly patients presenting with central retinal vein occlusions and macular edema of both eyes, it is important to assess whether the retinopathy is associated with a hyperviscosity syndrome linked to a hematological disease.

Factors Affecting Intraocular Pressure after Laser Iridotomy in Fellow Eye with Acute Angle Closure Glaucoma

Purpose@#To investigate the factors affecting intraocular pressure (IOP) change after prophylactic laser iridotomy (LI) in the fellow eye with acute angle closure glaucoma. @*Methods@#Twenty-three subjects with acute primary angle closure glaucoma, who had undergone prophylactic LI in the fellow eye were enrolled in this study. IOP was measured before and 1 week after prophylactic LI. Compared with a week after and before the prophylactic LI, eleven eyes with the IOP reduction of 20% or more were classified into A group and twelve eyes with an IOP reduction of 20% or less were classified as B group. Anterior segment parameters were measured using anterior segment swept source optical coherence tomography. @*Results@#The mean age, the best corrected visual acuity, the baseline IOP and the axial length were not significantly different between the two groups (p > 0.05). The IOP after prophylactic LI was significantly different between the two groups (group A 11.36 ± 1.96 mmHg, Group B 13.50 ± 1.83 mmHg; p = 0.013). There was a significant difference in IOP change rate of the two groups (Group A 29.78 ± 11.09%, Group B 9.14 ± 5.91%; p < 0.001). In multiple regression analysis, only the anterior chamber depth was significantly associated with the IOP change rate (p = 0.011). @*Conclusions@#The anterior chamber depth is associated with the change of IOP after prophylactic LI in the fellow eye with acute primary angle closure glaucoma. If the anterior chamber depth is shallow, it is highly likely that the change of IOP is relatively small. Therefore, the anterior chamber depth must be considered in assessing the effectiveness of prophylactic LI.

Factors Affecting Intraocular Pressure after Laser Iridotomy in Fellow Eye with Acute Angle Closure Glaucoma

Purpose@#To investigate the factors affecting intraocular pressure (IOP) change after prophylactic laser iridotomy (LI) in the fellow eye with acute angle closure glaucoma. @*Methods@#Twenty-three subjects with acute primary angle closure glaucoma, who had undergone prophylactic LI in the fellow eye were enrolled in this study. IOP was measured before and 1 week after prophylactic LI. Compared with a week after and before the prophylactic LI, eleven eyes with the IOP reduction of 20% or more were classified into A group and twelve eyes with an IOP reduction of 20% or less were classified as B group. Anterior segment parameters were measured using anterior segment swept source optical coherence tomography. @*Results@#The mean age, the best corrected visual acuity, the baseline IOP and the axial length were not significantly different between the two groups (p > 0.05). The IOP after prophylactic LI was significantly different between the two groups (group A 11.36 ± 1.96 mmHg, Group B 13.50 ± 1.83 mmHg; p = 0.013). There was a significant difference in IOP change rate of the two groups (Group A 29.78 ± 11.09%, Group B 9.14 ± 5.91%; p < 0.001). In multiple regression analysis, only the anterior chamber depth was significantly associated with the IOP change rate (p = 0.011). @*Conclusions@#The anterior chamber depth is associated with the change of IOP after prophylactic LI in the fellow eye with acute primary angle closure glaucoma. If the anterior chamber depth is shallow, it is highly likely that the change of IOP is relatively small. Therefore, the anterior chamber depth must be considered in assessing the effectiveness of prophylactic LI.

Clinical Analysis of Findings for Anterior Segment Optical Coherent Tomography in Recurrent Corneal Erosion Syndrome

PURPOSE@#To evaluate the correlation between abnormal findings seen in anterior segment optical coherent tomography and the recurrence rate in patients with recurrent corneal erosion syndrome.@*METHODS@#Between January 2015 and August 2018, 53 eyes of 52 patients who had been diagnosed with recurrent corneal erosion syndrome were included in the study. Follow-up was performed for 12 months. To confirm the recurrence, we questioned the subjects on their symptoms and performed slit lamp examinations. At the first visit, the second week, and the first month, we performed anterior segment optical coherent tomography to identify pathologic findings for recurrent corneal erosion syndrome.@*RESULTS@#In 12 months, 29 eyes (54.7%) had a recurrence of corneal erosion and 24 eyes (45.3%) had no recurrence. There was no significant difference in age, sex, trauma, diabetes mellitus, or meibomian gland dysfunction between the recurrent and non-recurrent groups. Among the anterior segment optical coherent tomography findings, anterior stromal hyper-reflectivity, undetected epithelial basement membrane, intraepithelial basement membrane, intraepithelial inclusions were not significantly different between the two groups. In the first month, corneal epithelial edema was 82.8% in the recurrent group, but 33.3% in the non-recurrent group. It was significantly different (p = 0.000). Corneal epithelial thickness lowered significantly in the non-recurrent group, but not in the recurrent group in the first month. In other words, epithelial edema improved in the non-recurrent group, whereas epithelial edema did not improve in the recurrent group.@*CONCLUSIONS@#If corneal epithelial edema is not treated in patients with recurrent corneal erosion syndrome, high possibility of a recurrence should be considered.

Anterior Uveitis Caused by Listeria Monocytogenes Infection

PURPOSE: To report a case of anterior uveitis secondary to Listeria monocytogenes infection. CASE SUMMARY: A 57-year-old male presented to our clinic with ocular pain and decreased vision in the right eye for 2 days. The patient had a history of liver transplantation 2 years prior and used immunosuppressive agents. Listeria monocytogenes was identified in blood cultures 1 month before his visit. At presentation, best-corrected visual acuity (BCVA) of the right eye was counting fingers at 20 cm and the intraocular pressure (IOP) was 50 mmHg. Conjunctival hyperemia, corneal edema, keratic precipitates, and cells in the anterior chamber were observed in the right eye. The patient was diagnosed as anterior uveitis in the right eye. Conventional uveitis treatment was initiated but clinical features did not improve and black hypopyon appeared. The possibility of anterior uveitis caused by Listeria monocytogenes infection was considered. An anterior chamber tap and culture were conducted to identify pathogens. Anterior chamber antibiotic injections and systemic antibiotic injections were performed. One week after injection, the BCVA of the right eye improved to 0.4 and the IOP decreased to 14 mmHg. One month after injection, the BCVA of the right eye improved to 1.0 and the IOP decreased to 16 mmHg. No inflammation of the anterior chamber was observed. CONCLUSIONS: When nonspecific uveitis occurs in immunosuppressed patients, cultures and appropriate antibiotics should be considered because of the possibility of infection.

Choroidal Neovascularization in a Patient with Best Disease

PURPOSE: To report a case of choroidal neovascularization in a Best disease patient treated with intravitreal bevacizumab injection and followed up with optical coherence tomography angiography (OCTA). CASE SUMMARY: A 20-year-old female visited our clinic with decreased visual acuity of the left eye for 6 months. On optical coherence tomography (OCT), subretinal fluid and hyperreflective subretinal clumps were observed in the macula of the right eye. Subretinal hemorrhage and subretinal fluid were observed in the left eye. Choroidal neovascularization in the left eye was observed using OCTA, fluorescein angiography, and indocyanine green angiography. A full-field electroretinogram was normal in both eyes, but an electrooculogram revealed that the Arden ratio was 1.564 in the right eye and 1.081 in the left eye. Intravitreal bevacizumab injection was performed in the left eye. At 6 months after the intravitreal injection, the best-corrected visual acuity of the left eye had recovered to 20/20. OCT revealed that subretinal fluid reduced and choroidal neovascularization was stable. After 12 months, visual acuity of the left eye was maintained at 20/20, but OCTA revealed that choroidal neovascularization had increased. CONCLUSIONS: Choroidal neovascularization associated with Best disease can improve by intravitreal bevacizumab injection, and the changes in choroidal neovascularization can be followed using OCTA.

A Clinical Review of Acute Poisonings in Geriatric Patients from Rural Gangwon Province

BACKGROUND: Recently, there has been an increase in acute poisonings in the elderly, which may be associated with attempts at suicide. The purpose of this study was to compare and analyze the clinical aspects and outcomes of acute poisonings in aged individuals with those of younger individuals. METHODS: We performed a retrospective analysis of 207 patients seen in the emergency department (ED) with acute poisoning from January 2009 to December 2010. Two groups were created, >65 years and 65 group and 0.3% in the 65 years than in those <65 years. As motive for suicide, health problem was cited more often in the older group (p=0.000). The older group had fewer interviews with psychiatrists and were more often diagnosed with depressive disorder (p=0.010, p=0.041, respectively). PSS and mortality were higher in the older group (p=0.002, p=0.010, respectively). CONCLUSION: A better understanding for the cause of poisonings and the poisonous substance used in the aged population is needed. And because of the more serious effects of acute poisonings to the elderly patient, they should readily receive regular comprehensive care including psychiatric care.

Comparison of Injuries Related with All-Terrian Vehicles (ATVs) and Motorcycles (MCs)

PURPOSE: All-terrain vehicle (ATV)-related injuries have increased since the introduction of ATVs to Korea. The purpose of this study is to compare patients with ATV-related injuries (PATV) to patients with motorcycle (MC)-related injuries (PMC). METHODS: We retrospectively analyzed the clinical records of PATV and PMC who visited an emergency center in 2008. The cases of PMC were 164, and those of PATV were 52. RESULTS: While PMC are seen evenly in the first half year and the second half year, PATV are seen mainly the first half year (from March to June: 73%). For PMC the most frequent injury mechanism was collision with another vehicle, while for PATV, it was side overturn/roll over. The injury severity score (ISS), the revised trauma score (RTS), the trauma score and the injury severity score (TRISS) were 5.6+/-5.6, 7.7+/-0.7, 5.0+/-2.1 for PMC and 7.1+/-7.5, 7.7+/-1.1, 5.5+/-1.5 for PATV, respectively. The most common injury sites were the lower extremities for PMC and the face for PATV. The rates of admission, surgery and the length of hospital stay were similar between PMC and PATV. CONCLUSION: This study shows that the risk of ATV accidents is similar to that of MC accidents. We recommend that the same safety standards and regulations that are applied to MCs should be used for ATVs. Safe and enjoyable paths have to be sought for drivers of ATVs.