A Pediatric Lenticular Cyst

Purpose@#We report a lenticular cyst in an 8-year-old boy.Case summary: An 8-year-old boy visited our clinic with reduced visual acuity. On slit lamp examination, an immobile lenticular cyst was evident on the posterior lens capsule of the left eye. There was no other abnormality. He had no history of ocular trauma or surgery. His Snellen best-corrected visual acuities (BCVAs) were 1.0 (-0.50 Dsph 0.50 Dcyl ×180°) in the right eye and 0.3 (+3.25 Dsph 1.00 Dcyl ×180°) in the left. After diagnosis of a primary lenticular cyst and anisometropic amblyopia, the child was prescribed glasses and occlusion therapy (8 hours daily). After 3 months, the BCVA improved to 0.9 in the left eye and was maintained. No change in lenticular cyst size was observed during 8 months of follow-up. @*Conclusions@#Primary lenticular cysts are very rare in children. When the cyst is too small to occlude the visual axis, amblyopia treatment (glasses and occlusion therapy) is preferable to surgery, being both non-invasive and effective.

Clinical and Genetic Risk Factors Associated With the Presence of Lupus Nephritis

Objective@#To elucidate whether clinical features and the weighted genetic risk score (wGRS) were associated with the presence of lupus nephritis (LN). @*Methods@#We retrospectively divided patients with systemic lupus erythematosus (SLE, n=1,078) into biopsy-proven LN (n=507) and non-LN groups (non-LN, n=571). Baseline clinical features, serologic markers, and the wGRS were collected. The wGRS was calculated from 112 non-human leukocyte antigen (non-HLA) loci and HLA-DRβ1 amino acid haplotypes for SLE. Associations among clinical features, wGRS, and the presence of LN were identified. @*Results@#In the multivariate analysis, patients with LN were younger at diagnosis (odds ratio [OR]=0.97, p＜0.001), had more pleuritis (OR=2.44, p＜0.001) and pericarditis (OR=1.62, p=0.029), had a higher detection rate of anti-double stranded deoxyribonucleic acid (anti-dsDNA antibodies, OR=2.22, p＜0.001), anti-Smith antibodies (anti-Sm antibodies, OR=1.70, p=0.002), low level of complement (OR=1.37, p=0.043) and absence of antiphospholipid antibodies (aPL antibodies, OR=1.60, p=0.002), and had higher wGRS (OR=1.16, p=0.012). Mediation analysis suggested that anti-Sm antibodies and low complement could be mediators in the relationship between high wGRS and the presence of LN. @*Conclusion@#Onset age, pleuritis, pericarditis, several serologic markers, and wGRS were associated with the presence of LN. Anti-Sm antibodies and low complement appeared to mediate the indirect relationship between wGRS and the presence of LN.

A Pediatric Lenticular Cyst

Purpose@#We report a lenticular cyst in an 8-year-old boy.Case summary: An 8-year-old boy visited our clinic with reduced visual acuity. On slit lamp examination, an immobile lenticular cyst was evident on the posterior lens capsule of the left eye. There was no other abnormality. He had no history of ocular trauma or surgery. His Snellen best-corrected visual acuities (BCVAs) were 1.0 (-0.50 Dsph 0.50 Dcyl ×180°) in the right eye and 0.3 (+3.25 Dsph 1.00 Dcyl ×180°) in the left. After diagnosis of a primary lenticular cyst and anisometropic amblyopia, the child was prescribed glasses and occlusion therapy (8 hours daily). After 3 months, the BCVA improved to 0.9 in the left eye and was maintained. No change in lenticular cyst size was observed during 8 months of follow-up. @*Conclusions@#Primary lenticular cysts are very rare in children. When the cyst is too small to occlude the visual axis, amblyopia treatment (glasses and occlusion therapy) is preferable to surgery, being both non-invasive and effective.

Clinical and Genetic Risk Factors Associated With the Presence of Lupus Nephritis

Objective@#To elucidate whether clinical features and the weighted genetic risk score (wGRS) were associated with the presence of lupus nephritis (LN). @*Methods@#We retrospectively divided patients with systemic lupus erythematosus (SLE, n=1,078) into biopsy-proven LN (n=507) and non-LN groups (non-LN, n=571). Baseline clinical features, serologic markers, and the wGRS were collected. The wGRS was calculated from 112 non-human leukocyte antigen (non-HLA) loci and HLA-DRβ1 amino acid haplotypes for SLE. Associations among clinical features, wGRS, and the presence of LN were identified. @*Results@#In the multivariate analysis, patients with LN were younger at diagnosis (odds ratio [OR]=0.97, p＜0.001), had more pleuritis (OR=2.44, p＜0.001) and pericarditis (OR=1.62, p=0.029), had a higher detection rate of anti-double stranded deoxyribonucleic acid (anti-dsDNA antibodies, OR=2.22, p＜0.001), anti-Smith antibodies (anti-Sm antibodies, OR=1.70, p=0.002), low level of complement (OR=1.37, p=0.043) and absence of antiphospholipid antibodies (aPL antibodies, OR=1.60, p=0.002), and had higher wGRS (OR=1.16, p=0.012). Mediation analysis suggested that anti-Sm antibodies and low complement could be mediators in the relationship between high wGRS and the presence of LN. @*Conclusion@#Onset age, pleuritis, pericarditis, several serologic markers, and wGRS were associated with the presence of LN. Anti-Sm antibodies and low complement appeared to mediate the indirect relationship between wGRS and the presence of LN.

Changes in Eye Movement Amplitude after Conjunctivo-Limbal Autograft in Patients with Recurrent Pterygium, Ocular Motility Restriction

Purpose@#To investigate changes in eye movement amplitude after conjunctival recession and conjunctivo-limbal autograft for treating recurrent pterygium with ocular motility restriction. @*Methods@#We retrospectively analyzed 18 eyes of 16 patients who had recurrent pterygium with ocular motility restriction, who had received conjuntivo-limbal autografts from January 2011 to December 2019 and who had been followed-up for more than 6 months. We evaluated changes in eye movement amplitude, best corrected visual acuity, uncorrected visual acuity, corneal astigmatism and keratometry, and recurrence and complication rates before and after surgery. @*Results@#The mean age of the patients was 63.9 ± 9.7 years. Eye movement amplitude increased significantly from 5.80 ± 1.70 mm preoperatively to 7.02 ± 1.37 mm postoperatively (p < 0.001). The mean UCVA increased from 0.67 ± 0.46 preoperatively to 0.36 ± 0.35 postoperatively (p < 0.001). The mean corneal astigmatism decreased from 3.51 diopters (D) preoperatively to 1.22 D postoperatively (p = 0.001). According to the power vector analysis, M and B were significantly reduced after the surgery, but the changes in J0 and J45 were not significant. No recurrence of pterygium was observed. @*Conclusions@#Eye movement amplitude for severe recurrent pterygium with symblepharon or ocular motility restriction quantitatively measured the range of ocular movement clinically and was applied to determine the severity of recurrent pterygium and predict the surgical outcome. Conjunctivo-limbal autograft for severe recurrent pterygium is thought to be a safe and effective surgical method because it solves the ocular motility restriction caused by adhesions and has low recurrence rates, although it requires the skilled experience and techniques of the operator and a long operation time.

Infectious Crystalline Keratopathy Caused by Alternaria

PURPOSE: To report a case of infectious crystalline keratopathy caused by Alternaria in the corneal center. CASE SUMMARY: A 66-year-old male visited our clinic with right ocular pain and visual loss after corneal trauma caused by a foreign body hitting his right eye while performing farm work 1 month prior to his visit. The patient had no history of corneal surgery and long-term use of topical corticosteroid. A corneal epithelial defect and whitish snowflake margin infiltration around the corneal stroma were observed in the corneal center, but there was an absence of conjunctival injection and anterior segment inflammation. Cultures and a biopsy of the corneal scrapings revealed Alternaria species fungus. The patient was treated with 1% topical voriconazole and 0.5% moxifloxacin, together with oral voriconazole (400 mg/day). After 2 months of treatment, the disease was completely cured, with a minute corneal opacity. CONCLUSIONS: We successfully treated a rare case of infectious crystalline keratopathy caused by Alternaria, which has not been previously reported in the Republic of Korea.

Adult Idiopathic Renal Fanconi Syndrome: A Case Report

Renal Fanconi syndrome (RFS) is caused by generalized proximal tubular dysfunction and can be divided into hereditary and acquired form. Adult-onset RFS is usually associated with drug toxicity or systemic disorders, and modern molecular genetics may explain the etiology of previous idiopathic cases of RFS. Here, we report the case of a 52-year-old woman with RFS whose etiology could not be identified. She presented with features of phosphaturia, renal glucosuria, aminoaciduria, tubular proteinuria, and proximal renal tubular acidosis. Her family history was unremarkable, and previous medications were nonspecific. Her bone mineral density was compatible with osteoporosis, serum intact parathyroid hormone level was mildly elevated, and 25(OH) vitamin D level was insufficient. Her blood urea nitrogen and serum creatinine levels were 8.4 and 1.19 mg/dL, respectively (estimated glomerular filtration rate, 53 mL/min/1.73 m²). Percutaneous renal biopsy was performed but revealed no specific renal pathology, including mitochondrial morphology. No mutation was detected in EHHADH gene. We propose the possibility of involvement of other genes or molecules in this case of adult RFS.

A Case of Isolated Traumatic Aniridia in a Pseudophakic Eye

PURPOSE: We report a rare case of isolated traumatic aniridia in a pseudophakic eye. CASE SUMMARY: A 69-year-old female came to our emergency department complaining of right eye pain and visual disturbance after trauma due to fall on the stairs. Five years earlier she had undergone an uncomplicated right sutureless phacoemulsification cataract extraction through a 2.2 mm temporal clear corneal incision, followed by insertion of a folding intracapsular intraocular lens. Total iris expulsion occurred through the cataract incision without extension of the wound or disruption of the posterior capsule or intraocular lens. CONCLUSIONS: We report a rare case of isolated traumatic aniridia in a pseudophakic eye, which has not been reported in the Republic of Korea.

The Role of IL-10 in Gastric Spasmolytic Polypeptide-Expressing Metaplasia-Related Carcinogenesis

No abstract available.

A Case of Waardenburg Syndrome Type 4

PURPOSE: To report the first case of Waardenburg syndrome type 4 in Korea. CASE SUMMARY: A 3-year-old boy visited our clinic to have his abnormal right eye iris color checked. The patient had a previous operation Hirschsprung's disease. In addition, his older sister and aunt showed similar ocular findings. A general physical examination, hearing test, and fundus examination were performed. On examination, hypochromic heterochromic iridum, albinism of the posterior pole upon ipsilateral fundus, and dystopia canthorum were found. There was no abnormal finding in the hearing test. CONCLUSIONS: The patient showed hypochromic heterochromic iridum, dystopia canthorum, and albinism of ipsilateral fundus. He also had a family history of Waardenburg syndrome and had surgery associated with congenital megacolon. The patient was diagnosed with Waardenburg syndrome type 4.

Efficacy of the Sutureless Amniotic Membrane Patch for the Treatment of Ocular Surface Disorders

PURPOSE: To evaluate the efficacy of the sutureless amniotic membrane (AM) patch for the treatment of ocular surface disorders. METHODS: A sutureless AM patch using a silicone ring was utilized to treat neurotrophic ulcer, persistent epithelial defect (PED), Shield ulcer, chemical injury and Stevens-Johnson syndrome. Primary outcome was the time to complete corneal and conjunctival epithelialization. Secondary outcome was the number of repeated insertions and complications of the inserted ring. RESULTS: Neurotrophic ulcer was observed in 4 eyes, PED in 2 eyes, Shield ulcer in 1 eye, chemical injury in 4 eyes and Stevens-Johnson syndrome in 4 eyes. The mean (SD) time to complete epithelialization was 13 (7.2) days (6-20 days) in neurotrophic ulcer, 17.5 (7.7) days (12-23) in PED, 5 days in Shield ulcer, 10.6 (6.6) days (3-15) in chemical injury and 13.5 (0.7) days (13-14) in Stevens-Johnson syndrome. There were no protrusion or mechanical trauma of the inserted ring. In 1 case of neurotrophic ulcer and 1 refractory case of chemical injury, repeated insertion was performed due to incomplete healing after dissolution of the AM. In 2 eyes with Stevens-Johnson syndrome, repeated insertion was necessary with heavy accumulation of inflammatory debris on the AM. No symblepharon or fornix contracture was found in chemical injury or Stevens-Johnson syndrome patients. CONCLUSIONS: The sutureless AM patch using a silicone ring was shown to be effective and safe for the treatment of ocular surface disorders. The patch can help surgeons avoid suture-related trauma to the ocular surface during the acute inflammatory period.

The Effectiveness of Mitomycin C on Pterygium Surgery with Amniotic Membrane Transplantation

PURPOSE: To compare postoperative recurrence rates of pterygium surgery with amniotic membrane transplantation with and without mitomycin C. METHODS: A retrospective analysis of 45 eyes of 43 patients who underwent pterygium surgery with amniotic membrane transplantation with a minimum of six months of follow-up. Nineteen eyes underwent mitomycin C application, while the remaining 26 eyes did not. Recurrence rates and complications were evaluated. RESULTS: With a minimum of six months of follow-up, fibrovascular tissue in the excised area not invading the cornea (conjunctival recurrence) was noted in two eyes (10.5%), and fibrovascular tissue invading the cornea (corneal recurrence) was noted in one eye (5.4%) in the amniotic membrane transplantation with mitomycin C group. Conjunctival recurrence was noted in six eyes (23.1%) and corneal recurrence in three eyes (11.5%) in the amniotic membrane transplantation without mitomycin C group. Recurrence rate in the amniotic membrane transplantation with mitomycin C group (15.9%) was significantly lower (p = 0.014) than that in the amniotic membrane transplantation without mitomycin C group (34.6%). Complications included sub-amniotic membrane hemorrhage in two eyes, granuloma in one eye, and wound dehiscence in one eye in each group. There were no specific complications related to usage of mitomycin C. CONCLUSIONS: In pterygium surgery with amniotic membrane transplantation, application of mitomycin C is an effective method to reduce recurrence rates, especially conjunctival recurrences that are related to cosmetic problems. This method may also be helpful to reduce patient discomfort.

Effectiveness of Wide Excision of Subconjucntival Fibrovascular Tissue with Conjunctivo-Limbal Autograft in Pterygium Surgery

PURPOSE: To evaluate the efficacy of wide excision of subconjucntival fibrovascular tissue after conjunctivo-limbal autograft of primary and recurrent pterygium. METHODS: Sixty-five eyes of 59 patients underwent pterygium excision with conjunctivo-limbal autograft. Thirty-six eyes of 33 patients had wide excision of pterygium, 29 eyes of 26 patients did not have wide excision of pterygium. All patients underwent follow-up for more than one year. Complications, recurrence rate, and operation time were evaluated. RESULTS: With a minimum of one year of follow-up, there was no recurrence in either group. Six cases (17%) of subconjunctival fibrosis at the donor site, one case (3%) of subconjunctival neovascularization at the donor site, and one case (3%) of wound gapping at the recipient site were noted in the wide excision group. In the non-wide excision group, there were two cases (7%) of subconjunctival fibrosis at the donor site, one case (3%) of granuloma at the donor site, and one case (3%) of retention cyst at the recipient site. Mean operating time in the non-wide excision group (45.2 +/- 6.9 minutes) was significantly shorter than that in the wide excision group (62.4 +/- 6.2 minutes). CONCLUSIONS: Non-wide excision with conjunctivo-limbal autograft in pterygium surgery can be considered an effective treatment with shorter operating time than the wide excision method. Both of these methods show low recurrence rates and few complications for both primary and recurrent pterygia.

A Case of Acute Idiopathic Bilateral Lower lid Ectropion

Introduction: Ectropion is an eversion of the eyelid due to various causes, and it mainly develops in the lower lid. Usually it shows a slow progression, and it is classified as involutional, cicatricial, paralytic and congenital. Acute idiopathic bilateral lower lid ectropion is very rare; few cases have been reported worldwide, and none have been seen in Korea. CASE SUMMARY: A 79-year-old male patient visited our department with a six-day history of epiphora and lower lid eversion in both eyes. On slit-lamp examination, lower lid ectropion was present in both eyes, and mild corneal punctate epithelial erosion was also observed. Two weeks after conservative treatment, the lower lid eversion disappeared and the lower lid returned to its original position. No changes were observed three months after treatment. We report a case of acute idiopathic bilateral lower lid ectropion with a literature review.

Recurrence Rates of Amniotic Membrane Transplantation, Conjunctival Autograft and Conjunctivolimbal Autograft in Primary Pterygium

PURPOSE: To compare the recurrence rates and complications with amniotic membrane transplantation (fibrin glue group and suture group), conjunctival autograft and conjunctivolimbal autograft in excision of primary pterygium. METHODS: Among 121 eyes of 115 patients with a minimum follow-up period of 12 months, 33 eyes of 31 patients underwent amniotic membrane transplantation with fibrin glue (Group 1) and 29 eyes of 28 patients underwent amniotic membrane transplantation with sutures (Group 2). Twenty-eight eyes of 26 patients underwent conjunctival autograft (Group 3), and 31 eyes of 30 patients underwent conjunctivolimbal autograft (Group 4). Recurrence rates and complications were evaluated retrospectively. RESULTS: With a minimum of 12 months of follow-up, conjunctival recurrence was noted in seven eyes (21.2%) and six eyes (20.7%) in Group 1 and Group 2, respectively. Corneal recurrence occurred in one eye (3.0%) in Group 1 and in three eyes (10.3%) in Group 2 and no conjunctival or corneal recurrence were noted in Group 3 or Group 4. There was a statistically significant difference in conjunctival recurrence rates (p=0.003), but not in corneal recurrence rates (p=0.089) among the four groups. CONCLUSIONS: Although amniotic membrane transplantation preserved the superotemporal conjunctiva and was a technically easy procedure, it had high conjunctival recurrence rates. Conjunctival autograft and conjunctivolimbal autograft are technically demanding and time consuming, but they are more effective in preventing conjunctival recurrence compared with amniotic membrane transplantation.

A Case of Bulbar Conjunctival Schwannoma

PURPOSE: The schwannoma is a tumor originating from Schwann cell proliferation. Schwannoma is a rare disease, making up only 1% of all the tumors that develop in the orbit. Schwannomas usually arise from the choroids or the ciliary body, and occurrence in the conjunctiva is especially rare. Few cases have been reported worldwide, and no cases have been reported in Korea thus far. We report our case along with a literature review. CASE SUMMARY: A 31-year-old male patient visited our department with a history of discomfort of in his right eye for the past 5 years caused by a bulbar conjunctival mass. On ophthalmologic examination, a 5x3x3 mm, elevated, yellowish mass with a smooth surface was observed on the bulbar conjunctiva adjacent to the superonasal limbus near the 2 o'clock area of the right eye. We performed excision and biopsy for diagnosis and treatment of the bulbar conjunctival mass and confirmed the pathologic report for the diagnosis of schwannoma.

Optical Coherence Tomography and Multifocal Electroretinography in a Patient with Choroidal Osteoma

PURPOSE: We present a case of choroidal osteoma and report a pattern of optical coherence tomography and multifocal electroretinography with a literature review. CASE SUMMARY: Using B-scan and CT, we performed OCT and MF-ERG in a patient diagnosed with choroidal osteoma. OCT revealed serous retinal detachment in the macula and a thick, irregular plate-like structure with high reflectivity in the choroidal mass lesion. MF-ERG demonstrated that Trace arrays show suppression of central and peripheral signals, especially in central lesions. Ring averages show reduced amplitudes in all locations, and 3D-topography of the response density shows marked suppression of the central signal and no foveal peak in comparison with the unaffected left eye. CONCLUSIONS: In patients with choroidal osteoma, OCT can reveal thick plate-like high reflectivity with an irregular outer surface, and MF-ERG can predict retinal dysfunction.

Development of Village Health Worker Training Program in Tuguegarao, Phillipines / 農村醫學 地域保健

OBJECTIVES: The purpose of this study was to develop and execute the village heath worker(VHW) training program which based on short term overseas medical volunteer and medical mission. METHODS: Through case studies of previous VHW program and review articles about the state of medical volunteer and medical mission, we developed the VHW training program. Pilot test of the program was carried out in Tugeugarao city, Phillipines on July, 2008. The subject were 32 persons from 15 villages around Tuguegarao city. After training we surveyed regarding the satisfaction of training and the degree of getting knowledge and skills. RESULTS: Through article review, we got the common subjects of previous VHW training program and the limitations of overseas medical volunteer and medical mission. We developed VHW training program aiming to community health promotion through community participation and community change. The main text was "Where There Is No Doctor" of Hesperian Foundation. The program executed through 1 day intensive lecture and practice. The satisfaction of the program was 8.95+/-1.70 on 10 point rating scale. CONCLUSIONS: We strongly expect VHW training program can be available as new model of short overseas medical volunteer as well as medical mission if we could systemize it with the confirming subject before training, management after training and continuous support through connection with the field.

Conjunctivochalasis Surgery: Amniotic Membrane Transplantation with Fibrin Glue

PURPOSE: We evaluated the effect of amniotic membrane transplantation with fibrin glue after redundant conjunctival resection. METHODS: After enchelon-shaped resection of inferior redundant conjunctiva, an amniotic membrane was transplanted using fibrin glue in symptomatic conjunctivochalasis. Conjunctiva was fixed to the episclera with 10-0 nylon. RESULTS: The subjects were 18 eyes of 9 patients (two males=4 eyes, seven females=14 eyes) with an average age of 67.9+/-7.7 years (range: 54-79 years). Mean operation time was 35.6+/-5.6 minutes/eye (range: 30-45 minutes/eye) and mean numbers of sutures were 8+/-0.76 (range: 7-9). The mean follow-up period was 10.4+/-3 months (range: 6-14 months) and the mean time to full epithelization was 14.5+/-3.4 days (range: 11-20 days). At postoperative days 1-2, the lower tear meniscus was reconstructed. There were no recurrences or any postoperative complications observed. CONCLUSIONS: Amniotic membrane transplantation after redundant conjunctival resection in conjunctivochalasis resulted in reconstruction of the lower tear meniscus with stable conjunctival surface and marked improvement of subjective symptoms. Operation time and early postoperative irritation symptoms could be reduced with the use of fibrin glue.

Pterygium Surgery: Wide Excision with Conjunctivo-Limbal Autograft

PURPOSE: To evaluate the efficacy of conjunctivo-limbal autograft after wide excision of primary and recurrent pterygia. METHODS: Twenty-one eyes of 18 patients with primary pterygium and 18 eyes of 18 patients with recurrent pteygium underwent conjunctivo-limbal autograft after wide excision of pterygium. All patients underwent follow-up for more than six months. Recurrence rates and complications were evaluated. RESULTS: With a minimum of six months of follow-up, fibrovascular tissue in the excised area, not invading the cornea, was noted in one eye (5.6%) in the recurrent pterygium group but no further surgical interventions for the cosmetic problem were needed. One eye (4.8%) showed wound dehiscence, three eyes (14.3%) showed subgraft hemorrhage, and one eye (4.8%) showed subconjunctival fibrosis at the donor site in the primary pterygium group, while two eyes (11.1%) showed subgraft hemorrhage, and one eye (5.6%) showed Tenon's Capsule granuloma at the donor site in the recurrent pterygium group. CONCLUSIONS: Conjunctivo-limbal autograft after wide excision of pterygium can be considered an effective treatment with low recurrence rates for both primary and recurrent pterygia.