Predictive Factors for Retreatment after Intravitreal Ranibizumab Injection to Treat Type 1 Retinopathy of Prematurity

Purpose@#To investigate predictive factors for retreatment after intravitreal ranibizumab injection as first-line treatment for retinopathy of prematurity (ROP). @*Methods@#The medical records of consecutive infants diagnosed with type 1 ROP from 2013 to 2021 who received 0.2 mg intravitreal ranibizumab as their first treatments were retrospectively reviewed. Only eyes with severe ROP were included. Retreatment was performed if eyes again met the criteria for type 1 ROP or presented with stage 3 ROP and the plus sign. Factors around the time of first injection that predicted retreatment were assessed. @*Results@#Intravitreal ranibizumab was injected into 44 eyes of 44 infants. The mean gestational age (GA) and body weight were 27.8 weeks and 1,046.6 g, respectively. Retreatment was required by 21 eyes (47.7%) at an average of 8.9 weeks after the first injection, thus at 37.2 weeks of mean postmenstrual age. The retreatment group exhibited a lower GA (p = 0.036), lower 1 minute (min) (p = 0.014) and 5 min (p = 0.029) Apgar scores, and more quadrants with plus signs (p = 0.044) before the first injections; they also had a longer period of oxygen requirement (p = 0.001), more loss of the plus sign (p = 0.014), and more ROP involution (p = 0.003) after the first injections. The risk of needing retreatment increased with a lower 1 min Apgar score (p = 0.010, odds ratio [OR] = 2.04) and later disappearance of the plus sign (p = 0.013, OR = 1.44) after the first injection. @*Conclusions@#About half of patients with type 1 ROP may require retreatment 2 months after the first ranibizumab injection. Delayed loss of the plus sign increases the risk of retreatment; careful fundus examination is recommended after the first injection.

Incidence and Clinical Course of Acute Endophthalmitis after Idiopathic Epiretinal Membrane Surgery with Microincision Vitrectomy

Purpose@#To investigate the incidence and clinical course of acute endophthalmitis after idiopathic epiretinal membrane (iERM) surgery employing microincision vitrectomy (MIVS). @*Methods@#We retrospectively reviewed the medical records of eyes with acute endophthalmitis developing after iERM surgery via 23- or 25-gauge MIVS from 2011 to 2021. The incidence, culture-positive rate (and responsible bacteria), final visual acuity (VA), and factors affecting poor visual outcomes were assessed. @*Results@#Acute endophthalmitis developed in 20 of the 12,921 eyes (0.15%) after MIVS. Of these, 14 of 3,180 eyes treated via iERM (0.44%, one per 227 procedures) developed endophthalmitis; the incidence ratio (iERM versus non-iERM) was 7.1 (p < 0.001, 95% confidence interval [CI] = 2.6-22.7). At least one sclerotomy remained unsutured in all eyes after iERM surgery. Thirteen eyes (92.9%) were given intravitreal antibiotic injections after emergency vitrectomy, and one eye was treated with intravitreal antibiotic injection alone. Staphylococcus epidermidis was cultured from four eyes (28.6%); three strains were methicillin-resistant. All final VAs were not better than the initial VAs; the average VA decreased from 20/42 to 20/259 (p < 0.001). Six eyes (42.9%) attained legal blindness status (final VA < 20/200); Macular invasion was a unique risk factor for such blindness (p = 0.020, odds ratio = 35.0, 95% CI = 1.7-703.0). @*Conclusions@#Acute endophthalmitis developing after iERM surgery with MIVS was more common than such endophthalmitis after other retinal surgery. Approximately 40% of the former patients became legally blind, and the risk was higher in eyes with macular involvement of endophthalmitis.

Blockade of PD-L1/PD-1 signaling promotes osteo-/odontogenic differentiation through Ras activation / 国际口腔科学杂志·英文版

The programmed cell death ligand 1 (PD-L1) and its receptor programmed cell death 1 (PD-1) deliver inhibitory signals to regulate immunological tolerance during immune-mediated diseases. However, the role of PD-1 signaling and its blockade effect on human dental pulp stem cells (hDPSCs) differentiation into the osteo-/odontogenic lineage remain unknown. We show here that PD-L1 expression, but not PD-1, is downregulated during osteo-/odontogenic differentiation of hDPSCs. Importantly, PD-L1/PD-1 signaling has been shown to negatively regulate the osteo-/odontogenic differentiation of hDPSCs. Mechanistically, depletion of either PD-L1 or PD-1 expression increased ERK and AKT phosphorylation levels through the upregulation of Ras enzyme activity, which plays a pivotal role during hDPSCs osteo-/odontogenic differentiation. Treatment with nivolumab (a human anti-PD-1 monoclonal antibody), which targets PD-1 to prevent PD-L1 binding, successfully enhanced osteo-/odontogenic differentiation of hDPSCs through enhanced Ras activity-mediated phosphorylation of ERK and AKT. Our findings underscore that downregulation of PD-L1 expression accompanies during osteo-/odontogenic differentiation, and hDPSCs-intrinsic PD-1 signaling inhibits osteo-/odontogenic differentiation. These findings provide a significant basis that PD-1 blockade could be effective immunotherapeutic strategies in hDPSCs-mediated dental pulp regeneration.

Iatrogenic Retinal Breaks in Macular Hole and Epiretinal Membrane Using 25-gauge Vitrectomy

Purpose@#To determine the incidence and characteristics of iatrogenic retinal breaks in patients who underwent 25-gauge vitreous surgery for macular hole and idiopathic epiretinal membrane, with a comparison and analyses of surgical records and preoperative data, including wide-angle fundus imaging and indirect ophthalmoscopic examination findings. @*Methods@#The medical records were analyzed retrospectively for 82 macular hole eyes and 285 epiretinal membranes that underwent vitrectomy at our hospital from January 2016 to December 2019. The number and location of retinal breaks observed in preoperative fundus examination and wide-angle fundus imaging were compared with those indicated in the surgical records. The presence of retinal breaks and retinal lattice degeneration was investigated, and the relationship of each factor with respect to posterior vitreous detachment (PVD) was examined. @*Results@#Of the 367 eyes that underwent vitrectomy, six eyes (1.6%) developed iatrogenic retinal breaks. Thirty-four eyes (9.3%) had retinal breaks before surgery. Retinal break was found in 15 (4.1%) eyes, retinal lattice degeneration was indicated in 32 eyes (8.7%), and PVD occurred in 261 eyes (71.1%). The association of iatrogenic retinal break and PVD was not confirmed. An additional 14 preoperative breaks, not seen in indirect ophthalmoscopic examination, were identified in wide-angle fundus images. @*Conclusions@#It was found that 25-gauge vitrectomy-related iatrogenic retinal breaks occurred at a lower frequency than previously reported for 20-gauge vitrectomy procedures. Wide-angle fundus imaging was able to identify retinal breaks more accurately than conventional research methods.

Iatrogenic Retinal Breaks in Macular Hole and Epiretinal Membrane Using 25-gauge Vitrectomy

Purpose@#To determine the incidence and characteristics of iatrogenic retinal breaks in patients who underwent 25-gauge vitreous surgery for macular hole and idiopathic epiretinal membrane, with a comparison and analyses of surgical records and preoperative data, including wide-angle fundus imaging and indirect ophthalmoscopic examination findings. @*Methods@#The medical records were analyzed retrospectively for 82 macular hole eyes and 285 epiretinal membranes that underwent vitrectomy at our hospital from January 2016 to December 2019. The number and location of retinal breaks observed in preoperative fundus examination and wide-angle fundus imaging were compared with those indicated in the surgical records. The presence of retinal breaks and retinal lattice degeneration was investigated, and the relationship of each factor with respect to posterior vitreous detachment (PVD) was examined. @*Results@#Of the 367 eyes that underwent vitrectomy, six eyes (1.6%) developed iatrogenic retinal breaks. Thirty-four eyes (9.3%) had retinal breaks before surgery. Retinal break was found in 15 (4.1%) eyes, retinal lattice degeneration was indicated in 32 eyes (8.7%), and PVD occurred in 261 eyes (71.1%). The association of iatrogenic retinal break and PVD was not confirmed. An additional 14 preoperative breaks, not seen in indirect ophthalmoscopic examination, were identified in wide-angle fundus images. @*Conclusions@#It was found that 25-gauge vitrectomy-related iatrogenic retinal breaks occurred at a lower frequency than previously reported for 20-gauge vitrectomy procedures. Wide-angle fundus imaging was able to identify retinal breaks more accurately than conventional research methods.

Anti-staphylococcal Effect of a Nephrite-containing Contact Lens Storage Case

Purpose@#To compare the anti-staphylococcal effect of nephrite-containing contact lens (CL) storage cases and conventional CLstorage cases.Method: The degree of proliferation and adhesion of Staphylococcus aureus (S. aureus) on first- to third-generation silicone hydrogelcontact lenses (SHCLs) was analyzed through comparison of 5% nephrite-containing CL storage cases and conventionalCL storage cases. The degree of adhesion of S. aureus to the CL was also compared between 1% or 5% nephrite solution andmultipurpose solution (MPS).Result: Nephrite-containing CL storage cases showed a significant inhibitory effect on S. aureus proliferation (p = 0.004) and significantlyreduced the number of adherent S. aureus on all first- to third generation SHCLs compared with conventional CL storagecases (p = 0.026, p = 0.043, and p = 0.001, respectively). The anti-staphylococcal effect of 1% and 5% nephrite solutionswas not significantly better than that of MPS. @*Conclusions@#Nephrite shows potential as a next-generation substance for reducing infectious keratitis caused by S. aureuswhen added to CL storage cases.

Short-term Outcomes and Prognostic Factors of iStent in the Republic of Korea

Purpose@#To evaluate the intraocular pressure (IOP) reduction, success rate and prognostic factors after trabecular micro-bypassstent implantation in patients with open-angle glaucoma. @*Methods@#We retrospectively reviewed 33 eyes of 33 patients with open-angle glaucoma who were followed-up for more than6 months after trabecular micro-bypass stent implantation. The success of surgery was defined as an IOP ≤ 21 mmHg and anIOP reduction ≥ 20% from baseline, regardless of whether glaucoma medication was used. @*Results@#During the follow-up at 6 months after trabecular micro-bypass stent implantation, the IOP was significantly decreasedfrom 23.70 ± 6.26 mmHg before surgery to 18.03 ± 4.64 mmHg after 6 months, and the glaucoma medication was significantlydecreased from 3.73 ± 0.67 before surgery to 3.43 ± 0.67 after 6 months (p < 0.001 and p = 0.027, respectively). The successrate at 6 months was 33.7 ± 5.5% in patients with only trabecular micro-bypass stent implantation. Using multiple regressionanalyses of the risk factors, age was associated with success rate (odds ratio, 1.076; 95% confidence interval, 0.996-1.164;p = 0.045). @*Conclusions@#In patients in the Republic of Korea, trabecular micro-bypass stent implantation was an effective surgery for IOPreduction, and showed a better surgical success rate in younger patients.

Two Cases of Periorbital Necrotizing Fasciitis in Immunocompromised Patients

Purpose@#To report two cases of periorbital necrotizing fasciitis in immunocompromised patients.Case Summary: (Case 1) A 55-year-old female with a history of diabetes and hepatic liver resection visited our clinic complainingof periorbital edema in her left eye 4 days prior to her visit. The visual acuity of the left eye was no light perception.Erythematous edema of the periorbital area and a black necrotic lesion in the left eye were observed. Periorbital necrotizing fasciitiswas diagnosed and broad-spectrum antibiotics were injected. Urgent debridement was recommended but the patient wentto another hospital and orbital exenteration was performed. K. pneumoniae was isolated in her blood culture. (Case 2) A56-year-old female with a history of ovarian cancer chemotherapy visited our clinic complaining of periorbital pain and skin necrosisin her right eye 3 days prior to her visit. The visual acuity of the right eye could not be measured because of severe lidedema. Periorbital necrotizing fasciitis was diagnosed and antibiotic injection and urgent debridement were performed. P. aeruginosawas isolated in her blood culture. Postoperative infection progression and recurrence were not observed and eyelid reconstructionwas performed. @*Conclusions@#Early detection and treatment of periorbital necrotizing fasciitis is important in immunocompromised patients.Proper antibiotic therapy and necrotic debridement are needed to remove the periorbital inflammation.

A Case of Pigmentary Proliferation on the Fovea after Scleral Buckling forRhegmatogenous Retinal Detachment

Purpose@#To report a case of preretinal pigmentary proliferation on the fovea after scleral buckling for rhegmatogenous retinaldetachment.Case summary: A 49-year-old female visited out clinic complaining of a visual field defect in the right eye for 5 days. Thebest-corrected visual acuity (BCVA) was 0.8 in her right eye. Fundus examination of the right eye revealed an upper rhegmatogenousretinal detachment without macular involvement and retinal breaks were found at 11 o’clock and 11’ 30” direction. She underwentscleral buckling, subretinal fluid drainage, and cryoretinopexy under general anesthesia. At postoperative day 4, thesubretinal fluid was reduced, but the BCVA decreased to 0.2. The fovea was covered with a brownish pigmentary clump and preretinalhyperreflective proliferative tissue was observed on the fovea by optical coherence tomography. Oral steroid was administeredand a decrease of pigmentary proliferation was observed at 2 weeks after surgery. At 3 months postoperatively, thepigmentary proliferation had almost disappeared and the BCVA recovered to 0.8. @*Conclusions@#Pigmentary proliferation on the fovea may be observed in patients treated with scleral buckling for rhegmatogenousretinal detachment, so careful observation is needed to differentiate this process from other proliferative diseases.

Abducens Nerve Palsy in Patient with Intracranial Hypotension After SpineSurgery

Purpose@#We report a case of a patient with sixth cranial nerve palsy due to intracranial hypotension after lumbar disc surgery.Case Summary: A 56-year-old male patient complained of horizontal diplopia one day ago. He underwent disc surgery at L4-5level 1 week ago and developed a severe positional headache postoperatively. On ophthalmologic evaluation, he was found tohave 45 prism diopters esotropia of the left eye in the primary position, and left abduction was limitated and diagnosed as left abducensnerve palsy. Brain magnetic resonance imaging showed diffuse tentorial thickening and enhancement of the pachymeninges.Ultrasonography in the previous surgery site revealed fluid collection and cystic lesion. The intrancranial hypotension due to cerebrospinalfluid leakage was suspected to be the cause of abducens nerve palsy. The intravenous fluid was infused and the subduralblood patch was applied to the wound. The headache improved immediately, but diplopia lasted for about 6 months. @*Conclusions@#Intracranial hypotension due to the cerebrospinal fluid leaks may cause abducens nerve palsy, appropriate treatmentsuch as epidural blood patch should be considered immediately.

Clinical Outcomes of Patients Implanted with Bifocal and Extended Depth of Focus Intraocular Lenses

PURPOSE: To compare the postoperative clinical outcomes after cataract surgery with implantation of bifocal intraocular lenses (IOLs) and extended depth of focus (EDOF) IOLs. METHODS: A total of 60 patients were divided into three groups, and each group included 20 patients of 40 eyes: group A with a +3.25 D bifocal IOL in both eyes, group B with an EDOF IOL in both eyes, and group C with a +3.25 D bifocal in one eye and an EDOF IOL in the other eye. We retrospectively reviewed the patients' medical charts to analyze their binocular uncorrected visual acuities (UCVAs; distant, intermediate, and near) and refraction at postoperative 3 months. RESULTS: The binocular distant UCVAs were 0.04 ± 0.01, 0.05 ± 0.02, and 0.04 ± 0.01 in groups A, B, and C, respectively, and there were no differences between the groups (p > 0.05). The intermediate UCVAs were 0.16 ± 0.01, 0.10 ± 0.01, and 0.10 ± 0.01, respectively, and group A was the lowest (A–B, p = 0.031; A–C, p = 0.018; B–C, p = 1.000). The near UCVAs were 0.05 ± 0.01, 0.24 ± 0.01, and 0.13 ± 0.01, respectively, and there were significant differences between the groups (A–B, p < 0.001, A–C: p = 0.009; B–C, p = 0.003). CONCLUSIONS: There were no significant differences among the three groups in binocular distant UCVA, and groups B and C showed better intermediate UCVAs than group A. Near UCVA was ranked in the order of groups A, C, B.

The Factors that Influence the Clinical Outcomes after Trial without Catheter for Acute Urinary Retention due to Benign Prostatic Hyperplasia: a Multicenter Trial / 대한비뇨기과학회지

PURPOSE: Benign prostatic hyperplasia (BPH) is a common problem that's experienced by aging men, and it can lead to serious outcomes, including acute urinary retention (AUR). We studied the factors that influence the clinical outcomes after trial without catheter (TWOC) for AUR due to BPH. MATERIALS AND METHODS: The medical records of all 455 BPH patients who visited the emergency room for the first time with AUR from March 2001 through February 2005 were retrospectively reviewed. The patients were divided into two groups: the success group (group I) or failure group (group II) that underwent trial without catheter. The patient's characteristics were compared between the two groups using logistic regression analysis and the chi-square test. RESULTS: From the 292 cases of group I and the 163 cases of group II, the multivariate analysis revealed statistically significant differences in the retention volume (p<0.01), the prostate volume (p<0.01) and the previous use of alpha-blockers before AUR (p<0.01). CONCLUSIONS: The prostate volume, retention volume and previous use of alpha-blockers before AUR were thought to influence the clinical outcomes of TWOC for the BPH patients with AUR, and these factors should be considered in future treatment planning.

Effect of Body Mass Index on the Result of the Tension-free Vaginal Tape Procedure in Patients with Stress Urinary Incontinence / 대한비뇨기과학회지

PURPOSE: The aim of the study was to evaluate the clinical outcome, according to the body mass index (BMI), of tension-free vaginal tape (TVT) for the surgical treatment of stress urinary incontinence. MATERIALS AND METHODS: Women were classified as being of normal weight (BMI 20-25), overweight (BMI 26-30) or obese (BMI>30). The patients characteristics and clinical outcomes of the operation were analyzed according to the BMI. RESULTS: There were no significant differences in the patients characteristics, with the exception of the pre-operative posterior urethrovesical angle (PUVA). The subjective cure rate, satisfaction rate and complications of the normal BMI patients did not significantly differ from the women with the high BMI. CONCLUSIONS: The TVT procedure in stress urinary incontinence patient's results in similar subjective cure rates, satisfaction rates and post-operative complications, irrespective of the BMI, which makes it safe for overweight and obese women, and would appear to be an adequate treatment for future use.

Ganglioneuroma Arising from the Retroperitoneal Sympathetic Chains / 대한비뇨기과학회지

A ganglioneuroma is a rare benign tumor that originates in the neural crest, and is found along the path of the sympathetic chain, from the base of the skull to the pelvic cavity. It is characterized histologically by the composition of mature ganglion cells and nerve fibers. Due to the slow growth of the tumor, it may be incidentally found or detected by the pressure effects on adjacent structures. Herein, a case of a ganglioneuroma arising from the retroperitoneal sympathetic chain is reported in a 45-year-old female patient with a review of the literature.