Differentiation Syndrome with Ocular Manifestations in Acute Promyelocytic Leukemia Patients Treated with All-trans Retinoic Acid

Purpose@#To report a rare case of differentiation syndrome with ocular manifestations in a patient with acute promyelocytic leukemia treated with all-trans retinoic acid (ATRA).Case summary: A 27-year-old female complained of yellowing of vision and decreased visual acuity during an ATRA medication course for acute promyelocytic leukemia. Bilateral diffuse drusen-like lesions were found at the posterior pole along with multiple pigment epithelial detachment on optical coherence tomography (OCT) scans. Fluorescein angiography showed multiple hyperfluorescent lesions with leakage at the late phase corresponding to drusen-like lesions in fundus photography. Indocyanine green angiography revealed multiple hypocyanescent lesions. ATRA treatment was discontinued and replaced with high-dose dexamethasone. Accordingly, the patient experienced a rapid improvement in visual symptoms and the chorioretinal lesions on OCT scans showed marked resolution. @*Conclusions@#Differentiation syndrome-associated chorioretinopathy may occur in patients with acute promyelocytic leukemia treated with ATRA. Because the occurrence of chorioretinopathy may be associated with systemic aggravation of the ATRA syndrome, preemptive treatment with early detection is required.

Differentiation Syndrome with Ocular Manifestations in Acute Promyelocytic Leukemia Patients Treated with All-trans Retinoic Acid

Purpose@#To report a rare case of differentiation syndrome with ocular manifestations in a patient with acute promyelocytic leukemia treated with all-trans retinoic acid (ATRA).Case summary: A 27-year-old female complained of yellowing of vision and decreased visual acuity during an ATRA medication course for acute promyelocytic leukemia. Bilateral diffuse drusen-like lesions were found at the posterior pole along with multiple pigment epithelial detachment on optical coherence tomography (OCT) scans. Fluorescein angiography showed multiple hyperfluorescent lesions with leakage at the late phase corresponding to drusen-like lesions in fundus photography. Indocyanine green angiography revealed multiple hypocyanescent lesions. ATRA treatment was discontinued and replaced with high-dose dexamethasone. Accordingly, the patient experienced a rapid improvement in visual symptoms and the chorioretinal lesions on OCT scans showed marked resolution. @*Conclusions@#Differentiation syndrome-associated chorioretinopathy may occur in patients with acute promyelocytic leukemia treated with ATRA. Because the occurrence of chorioretinopathy may be associated with systemic aggravation of the ATRA syndrome, preemptive treatment with early detection is required.

Diabetic Nephropathy in Type 2 Diabetic Retinopathy Requiring Panretinal Photocoagulation

PURPOSE: To investigate the risk factors of diabetic nephropathy in patients with diabetic retinopathy requiring panretinal photocoagulation (PRP) and the visual prognosis. METHODS: A retrospective review of electronic medical records was conducted at Seoul St. Mary's Hospital, comprising 103 patients with type 2 diabetes mellitus and diabetic retinopathy who underwent PRP from 1996 to 2005. Patients with type 1 diabetes mellitus, non-diabetic renal disease, non-diabetic retinal disease, visually significant ocular disease, high-risk proliferative diabetic retinopathy, and advanced diabetic retinopathy were excluded. The patients were divided into three groups: no nephropathy (group 1, n = 45), microalbuminuria (group 2, n = 16), and advanced nephropathy (group 3, n = 42). Duration of diagnosis of retinopathy and nephropathy, glycosylated hemoglobin, visual acuity, complications, and treatment history were investigated. RESULTS: The mean glycosylated hemoglobin of group 3 (8.4 ± 1.2) was higher than that of group 1 (7.7 ± 1.0) or group 2 (7.7 ± 1.0) (p = 0.04). Mean interval from PRP to diagnosis of nephropathy was 8.8 ± 6.0 years in group 2 and 8.7 ± 4.9 years in group 3. The significant decrease in visual acuity in group 3 (28 eyes, 35.9%) was significantly higher than that in group 1 (15 eyes, 18.1%, p = 0.01) or group 2 (6 eyes, 20.7%, p = 0.03). Only vitreous hemorrhage showed a significantly higher incidence in groups 2 and 3 than in group 1 (p = 0.02). Multivariate regression analysis revealed that female sex and lower glycosylated hemoglobin were significantly associated with a protective effect on development of nephropathy. CONCLUSIONS: In the clinical setting, many patients with PRP-requiring diabetic retinopathy develop nephropathy an average of 8 to 9 years after PRP. Male sex and higher glycosylated hemoglobin could be risk factors of nephropathy.

Scleral Buckling under a Slit-lamp Illumination System with a Contact Wide-angle Viewing Lens Compared with an Indirect Ophthalmoscope

PURPOSE: To investigate the outcomes of scleral buckling surgery performed under a slit-lamp illumination system (Visulux) with a contact wide-angle viewing lens (Mini Quad) in patients with rhegmatogenous retinal detachment (RRD) and to compare these outcomes with those of surgery performed under an indirect ophthalmoscope. METHODS: By retrospective review of electronic medical records, patients with RRD who had undergone scleral buckling surgery were identified. Scleral buckling surgeries were performed with two illumination instruments, a slit-lamp (SL group) and an indirect ophthalmoscope (IO group). Subretinal fluid drainage, cryopexy, and intravitreal gas injection were performed optionally. At 6 months after surgery, anatomical and functional outcomes were evaluated and compared between the two groups. Operation time was also compared between the two groups. RESULTS: Of the 45 total patients (45 eyes), 28 were included in the SL group, and 17 were included in the IO group. In the SL and IO groups, the primary anatomical success rate was 89.3% and 88.2%, respectively (p = 0.92). The logarithm of the minimal angle of resolution change, which reflects improvement in best-corrected visual acuity after surgery, was −0.19 ± 0.38 in the SL group and −0.21 ± 0.63 in the IO group; this difference was not statistically significant (p = 0.91). The mean operation time was significantly shorter in the SL group (78.9 ± 11.8 minutes) than in the IO group (100.0 ± 13.9 minutes, p < 0.001), especially for patients who underwent additional procedures such as subretinal fluid drainage and cryopexy (81.4 ± 12.9 and 103.5 ± 12.3 minutes, respectively, p < 0.001). CONCLUSIONS: Scleral buckling surgery performed under a slit-lamp illumination system yielded a similar anatomical success rate and similar functional improvement in RRD compared with surgery performed under an indirect ophthalmoscope. The slit-lamp system could save time, especially in bullous RRD, which requires additional subretinal fluid drainage.

Laser Iridotomy-Induced Bullous Keratopathy in Korea: Clinical Features and Comparison with Pseudophakic Bullous Keratopathy

PURPOSE: To investigate the clinical features and prevalence of patients with laser iridotomy-induced bullous keratopathy in Korea. METHODS: Using a retrospective study, the patients with laser iridotomy-induced bullous keratopathy who underwent penetrating keratoplasty were selected. We investigated the duration from iridotomy to corneal decompensation, preoperative anterior chamber depth, axial length, keratometry, and survival time of the grafted cornea. The data were compared with the data of patients with pseudophakic bullous keratopathy as controls. RESULTS: Laser iridotomy-induced bullous keratopathy was found in 17 eyes, which represented 2.3% of penetrating keratoplasty cases (727) and 8.5% of bullous keratopathy cases (201), with a mean age of 66.9 years. The laser iridotomy-induced bullous keratopathy group showed a higher female ratio (15 out of 17), shorter mean axial length (22.09 +/- 0.79 mm) and anterior chamber depth (1.91 +/- 0.36 mm) than the control group (15 out of 50, 24.30 +/- 2.54 mm and 3.27 +/- 0.66 mm, respectively) with a statistical significance (p = 0.002, p < 0.001 and p < 0.001, respectively). Mean survival time of the grafted cornea was 39.9 +/- 8.6 months in the group of laser iridotomy-induced bullous keratopathy, which was shorter than the control group (47.8 +/- 3.1 months) without statistical significance (p = 0.47). CONCLUSIONS: In Korea, laser iridotomy-induced bullous keratopathy shows non-negligible prevalence and should be further investigated.

Assessment of Posterior Capsular Opacification of Korean Using Straylight and Glare Sensitivity Meter

PURPOSE: To evaluate posterior capsular opacity (PCO) using straylight and glare sensitivity meter and to compare availability of straylight and glare sensitivity with known methods for PCO evaluation. METHODS: Thirty-six pseudophakic eyes with PCO were selected for this study. Best-corrected visual acuity (BCVA), straylight (C-quant, Oculus GmbH, Wetzlar, Germany) and glare sensitivity (Binoptometer, Oculus GmbH, Wetzlar, Germany) were measured before mydriasis. After mydriasis, PCO images were captured with a slit-lamp and analyzed using the Evaluation of Posterior Capsular Opacification (EPCO) program (EPCO software, University of Heidelberg, Heidelberg, Germany). The same measurements were taken after capsulotomy and compared with pre-capsulotomy data. RESULTS: After capsulotomy, BCVA, EPCO score and straylight were improved with statistical significance (p < 0.05). Cases of PCO with mildly decreased visual acuity showed statistically significantly improved EPCO score and straylight (p < 0.05). Glare sensitivity did not show significant improvement but was statistically significantly correlated with straylight (p = 0.023, Rho = 0.732). CONCLUSIONS: Straylight is an available measurement for evaluation of PCO. Glare sensitivity meter which correlates with straylight can be used as a supportive measurement.

Assessment of Posterior Capsular Opacification of Korean Using Straylight and Glare Sensitivity Meter

PURPOSE: To evaluate posterior capsular opacity (PCO) using straylight and glare sensitivity meter and to compare availability of straylight and glare sensitivity with known methods for PCO evaluation. METHODS: Thirty-six pseudophakic eyes with PCO were selected for this study. Best-corrected visual acuity (BCVA), straylight (C-quant, Oculus GmbH, Wetzlar, Germany) and glare sensitivity (Binoptometer, Oculus GmbH, Wetzlar, Germany) were measured before mydriasis. After mydriasis, PCO images were captured with a slit-lamp and analyzed using the Evaluation of Posterior Capsular Opacification (EPCO) program (EPCO software, University of Heidelberg, Heidelberg, Germany). The same measurements were taken after capsulotomy and compared with pre-capsulotomy data. RESULTS: After capsulotomy, BCVA, EPCO score and straylight were improved with statistical significance (p < 0.05). Cases of PCO with mildly decreased visual acuity showed statistically significantly improved EPCO score and straylight (p < 0.05). Glare sensitivity did not show significant improvement but was statistically significantly correlated with straylight (p = 0.023, Rho = 0.732). CONCLUSIONS: Straylight is an available measurement for evaluation of PCO. Glare sensitivity meter which correlates with straylight can be used as a supportive measurement.

Development of Detection Methods for Cellulolytic Activity of Auricularia auricula-judae

To obtain basic information on the detection of cellulolytic activity in Auricularia auricula-judae, the influences of dye reagent, pH, and temperature were assessed. Chromogenic dye (congo red, phenol red, remazol brilliant blue, and trypan blue) was individually incorporated into a medium containing either carboxymethyl-cellulose, Avicel, or D-cellobiose as a polysaccharide carbon substrate. The other assessments utilized pHs ranging from 4.5 to 8.0 and temperatures from 15~35degrees C. Overall, when A. auricula-judae species were transferred onto media contained Congo red and adjusted pH 7.0 and then incubated at 25degrees C for 5 days, the clear zone indicative of cellulolytic activity was more pronounced.