A Case of Asymmetrical Vogt-Koyanagi-Harada Disease in a Patient with Ota Nevus Following Laser Treatment

Purpose@#To report a case of Vogt-Koyanagi-Harada (VKH) disease exhibiting asymmetric symptoms, predominantly in the affected eye, aside from the bilateral findings noted in indocyanine green angiography (ICG) in a patient who had undergone treatment for nevus of Ota.Case summary: A 33-year-old male presented with decreased visual acuity, ocular pain in the right eye, and a 3-week history of headache. The patient had undergone two laser treatments at 1-month intervals to address a nevus of Ota on the upper and lower eyelids and the maxillary area of the right side. He had no notable medical history. Fundus examination and optical coherence tomography indicated multiple serous retinal detachments. ICG displayed multiple hyperfluorescent spots in both eyes. Given these findings, the patient was diagnosed with VKH disease, predominantly affecting the right eye. Human leukocyte antigen (HLA) testing revealed the presence of the HLA-DRB1*09 and HLA-DQB1*03 (DQ8) alleles. The patient initially received high-dose intravenous steroid therapy, later transitioning to oral steroids. After a month of treatment, the serous retinal detachments had resolved and his vision improved. No signs of recurrence were evident during a 6-month follow-up. @*Conclusions@#VKH disease can manifest asymmetrically, especially in the eye affected after laser treatment for nevus of Ota. Despite potential monocular presentation, it is crucial to assess for binocular involvement through comprehensive examinations.

Changes in Intraocular Pressure and Anterior Chamber Parameters Following Cataract Surgery, Vitrectomy, and Combined Surgery

Purpose@#The aim of this study is to investigate changes in intraocular pressure (IOP) and anterior-segment parameters before and after cataract surgery, vitrectomy, and combined surgery. @*Methods@#The records of patients who had undergone cataract surgery (cataract group), vitrectomy (vitrectomy group), or combined cataract surgery and vitrectomy (combined group) at our hospital were retrospectively examined. The vitrectomy group consisted of pseudophakic eyes. IOP and anterior-segment measurements, including anterior chamber depth (ACD), angle opening distance (AOD), trabecular-iris angle (TIA), and trabecular-iris space area (TISA), were measured using swept-source anterior-segment optical coherence tomography before and 6 months after surgery in 41, 15, and 40 eyes, respectively. @*Results@#In the cataract and combined groups, there was a decrease in IOP (cataract group: from 15.8 to 13.4 mmHg, p 0.649, p <0.001), and postoperative IOP reduction in the cataract and combined groups (r = 0.377, p = 0.018 and r = 0.559, p = 0.001, respectively). @*Conclusions@#Compared to the vitrectomy group, the cataract and combined groups showed reduced postoperative IOP and increased AOD, TISA, and TIA. In these two groups, patients with shallower preoperative ACDs showed greater changes in IOP after surgery. Changes in IOP after surgery are thought to be related to changes in the anterior segment caused by the removal of the crystalline lens.

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.

Surgical Treatment of a Large Choroidal Melanoma

Purpose@#We report successful eyeball-preserving management of a patient with a large choroidal melanoma. We combined partial lamellar sclerouvectomy (PLSU) with ruthenium (Ru)-106 plaque brachytherapy.Case summary: A 48-year-old woman with a history of asthma visited our clinic with a chief complaint of gradual loss of vision at the nasal side of her right eye (best-corrected visual acuity 0.6). Fundus examination revealed a mushroom-shaped, dark choroidal mass 17.1 mm (basal diameter) × 14.2 mm (apical height). There was no evidence of distant metastasis. To remove the tumor while preserving the eyeball, we combined PLSU and simultaneous Ru-106 plaque brachytherapy with the patient under hypotensive general anesthesia. At 6 weeks postoperatively, trans pars plana vitrectomy with silicone oil injection was performed to remove the vitreous hemorrhage and treat the retinal detachment. Intravitreal bevacizumab (Avastin, Genentech Inc., San Francisco, CA, USA) (0.05 mL, 1.25 mg) was injected every 2 months to prevent the development of radiation retinopathy. No residual tumor, recurrence, or distant metastasis was noted during follow-up of 2 years. The patient was stable with no ocular complications at her last visit (2 years postoperatively). @*Conclusions@#Contrary to what we expected and despite the surgical difficulties, PLSU combined with Ru-106 plaque brachytherapy is a useful eyeball-preserving strategy even when encountering a very large choroidal melanoma (diameter > 16 mm and apical height > 10 mm). Such a melanoma was previously believed to be treatable only via enucleation.

Correlation Between Executive Function and Walk While Crossing Over an Obstacle Under Different Gait Phases

Background@#and Purpose: Dual walking task such as crossing over an obstacle may serve as an excellent tool for predicting early cognitive decline. Thus, this study aimed to investigate correlation between walking while crossing over an obstacle and executive functions under different gait phases to validate the use of walking with an obstacle for predicting early cognitive decline. @*Methods@#A cross-sectional study was conducted on 48 elderly individuals from 2 day-care centers and 3 welfare-centers in Seoul and Gyeonggi, Korea. Executive function tests (Trail Making Test, Stroop test) and dual walking tests (gait speed, cadence, stance time, gait cycle time) were performed and compared using partial correlation analysis. @*Results@#There were significant correlations between executive function and most of the gait variables (stance time, cadence, and gait cycle time) (p<0.05) when crossing over an obstacle while walking. Especially, stance time exhibited significant correlations with most executive functions (p<0.05). @*Conclusions@#When evaluating executive function during walking with an obstacle, postobstacle-crossing phase and stance time need to be observed.

Knowledge and management of food allergy by parents of preschool children who experience food allergies / 한국영양학회지

Purpose@#This study investigates the necessary educational materials from the perspective of caregivers managing food allergies of preschoolers. @*Methods@#An online survey enrolled 400 caregivers of preschoolers with food allergies. The study was conducted in July 2022, and data were analyzed using the IBM SPSS Statistics 25. @*Results@#The caregivers of preschoolers with food allergies showed low food allergy knowledge. The highest percentage of incorrect answers were for items related to the cause (74.2%) and response (65.2%) to food allergies. Moreover, categorizing the levels of knowledge as high, medium, and low, we found that caregivers with younger children exhibited a better understanding of food allergies. Approximately 56.9% of subjects in the high class were caregivers with preschoolers under three years, whereas caregivers with preschoolers over four years comprised 43.2% of the high-class subjects. Regarding food allergy treatment, four questions measured how well the caregivers tended to the children. With higher levels of knowledge, caregivers were more likely to read nutrient information and check for food allergens. The caregivers of preschoolers who were clinically diagnosed with food allergies demonstrated a higher percentage of using separate ingredients and cooking utensils. @*Conclusion@#This study shows how the caregivers’ knowledge levels are critical in managing and treating food allergies among preschoolers. With caregivers’ lower knowledge of food allergies and preschoolers younger than four years, self-diagnosis of food allergies and existing food allergies were not managed efficiently. Hence, customized education for caregivers is essential to improve their knowledge level regarding limiting foods that may cause allergies, reading food labels, and using ingredients and cooking utensils separately.

Intraocular Cytokine Changes in Patients with Polypoidal Choroidal Vasculopathy Treated with Ranibizumab

Purpose@#To investigate the changes in intraocular cytokines after ranibizumab treatment in patients with polypoidal choroidal vasculopathy (PCV). @*Methods@#This multicenter, prospective study enrolled patients with PCV treated with three monthly ranibizumab followed by a pro re nata regimen for 24 weeks. Best corrected visual acuity, slit lamp examination, fundus photography, and optical coherence tomography were performed every 4 weeks. Aqueous humor was collected to measure intraocular cytokines at baseline, week 8, and the time of recurrence or week 20. The association of changes in intraocular cytokines with visual acuity, central macular thickness, central choroidal thickness, area of abnormal vessels, and polyp closure was assessed. @*Results@#This study included 25 eyes. The mean patient age was 70.3 ± 6.1 years. The vascular endothelial growth factor (VEGF) concentration decreased at week 8, but only interferon (IFN)-γ, tissue inhibitors of matrix metalloproteinases (TIMP)-2, and monocyte chemoattractant protein (MCP)-2 decreased at the time of recurrence. The recurrence interval was positively associated with the baseline epithelial-neutrophil activating peptide (ENA)-78, interleukin (IL)-17, leptin, and transforming growth factor-β1, and baseline central macular thickness was positively correlated with the baseline fibroblast growth factor-4 and IL-10. Thick central choroidal thickness was associated with a low basic fibroblast growth factor and high IFN-γ at baseline. The MCP-3 and Tie-2 levels decreased in two eyes with polyp closure. @*Conclusions@#Ranibizumab significantly reduced intraocular VEGF concentrations and consequently improved PCV. However, the cytokines IFN-γ, TIMP-2, and MCP-2, rather than VEGF, were associated with PCV recurrence. Further studies of intraocular cytokines involved in neovascularization in PCV are needed.

Discovery of dipeptidyl peptidase-4 inhibitor specific biomarker in non-alcoholic fatty liver disease mouse models using modified basket trial

Background/Aims@#We aimed to define an optimal target population and drug-specific biomarkers that may predict dipeptidyl peptidase (DPP)-4 inhibitor responses in non-alcoholic fatty liver disease (NAFLD). @*Methods@#An exploration study (study I) was performed using three different NAFLD models (basket study design; high-fat diet [HFD], methionine choline-deficient diet [MCD], and high-cholesterol Western diet [WD] models). RNA transcriptome analysis was performed on pre-studied liver tissues to identify biomarkers that could predict the response to DPP-4 inhibitors. In the validation study (study II), the HFD-induced NAFLD model was divided into high and low hepatic insulin-like growth factor binding protein 1 (Igfbp-1) groups based on the pre-study liver biopsy. @*Results@#DPP-4 inhibitor attenuated the NAFLD activity score and fibrosis stage in the HFD model but not in the WD and MCD models. The overall response rate was 19% across the modified basket NAFLD trial and 42%, 25%, and 0% in the HFD, WD, and MCD models. Hepatic Igfbp-1 expression was higher in the responder group than in the non-responder group in pre-study biopsy samples. In contrast, hepatic Igfbp-1 expression was lower in the responder group than in the non-responder group in the end-study biopsy samples. DPP-4 inhibitor response rates were 83% and 17% in the baseline hepatic high Igfbp-1 and low Igfbp-1 groups, respectively. Hepatic messenger RNA Igfbp-1 expression was positively correlated with serum IGFBP-1 levels. @*Conclusions@#The DPP-4 inhibitor response was higher in the HFD phenotype and pre-treatment levels of hepatic or serum IGFBP-1 were high.

Effects of a Self-Growing Program Based on the Ecological System Theory for Parenting Stress and Posttraumatic Growth of Middle-aged Women with Adolescent Children / 정신간호학회지

Purpose@#The purpose of this study was to evaluate the effects of a self-growing program (SGP) based on the Ecological System Theory on parenting stress and posttraumatic growth of middle-aged women with adolescent children. @*Methods@#A quasi-experimental study with a nonequivalent control group and a pretest-posttest design was used. Participants were 82 middle-aged women, living in two cities, with adolescent children who had experienced parenting stress from July 2019 to October 2019. The experimental group (n=40) received 10 SGP sessions for 5 weeks. Data were analyzed using the SPSS 21.0 program for descriptive statistics, repeated measures ANOVA, Independent t-test, Friedman test, and Mann-Whitney U test. @*Results@#The SGP was effective against parenting stress (F=240.49, p<.001) and posttraumatic growth (x2=70.96, p<.001) of middle-aged women with adolescent children. @*Conclusion@#The findings revealed that the SGP can be an effective intervention to reduce parenting stress and increase the self-growth of middle-aged women. Therefore, the SGP could be a nursing intervention to support the self-growth of middle-aged women who experience adolescent parenting stress during a developmental crisis.

Investigation of Tear Lipid Layer Patterns According to Blinking Among Dry Eye Patients

Purpose@#To investigate tear lipid layer patterns according to blinking using an interferometer for dry eye patients. @*Methods@#We retrospectively reviewed the medical records of 132 patients who underwent dry eye disease-related evaluation, including LipiView®, between August 2018 and January 2020. Data including past history, slit-lamp examination, tear film break-up time, Schirmer, Oxford score grading, lipid layer thickness (LLT), number of blinks, and tear lipid layer patterns according to blinking were collected. We subdivided dry eye as meibomian gland dysfunction (MGD), aqueous deficiency dry eye (ADDE), and combined ADDE/MGD (Combine); we also classified the tear lipid layer patterns as uphill, flat, downhill, and mix. @*Results@#The numbers of patients in each tear lipid film pattern were as follows; uphill 45, flat 16, downhill 53, and mix 18. The statistically significant clinical characteristics among the four patterns were Oxford score (p = 0.001), LLT (p = 0.019), number of blinks (p = 0.001), number of partial blinks (p = 0.013), and the partial/total blinks ratio (p = 0.001). The most common pattern for MGD was downhill 44.7%; for Combine, downhill 40.7% and uphill 35.8%; and for ADDE, uphill 38.5%. @*Conclusions@#The tear lipid layer graph patterns according to blinking using LipiView® were associated with the number of blinks, the partial/total blink ratio, and LLT.

Atypical Retinal Hemorrhages after Vitrectomy for Idiopathic Macular Hole: Possible Toxicity of Brilliant Blue G

Purpose@#To describe the development of multiple retinal hemorrhages after uncomplicated macular hole (MH) surgery, and to determine the associated factors. @*Methods@#The medical records of 163 patients (167 eyes) diagnosed with idiopathic MHs and who underwent surgery at Pusan National University Hospital between March 2016 and July 2018 were retrospectively reviewed. The development of retinal hemorrhages was evaluated using ultra-widefield fundus photographs. Multiple retinal hemorrhages were defined as three or more dot or blot hemorrhages that had not been observed before and during the surgery. The patients were divided into two groups according to the presence of multiple retinal hemorrhages. The variable parameters were compared between the two groups to find the risk factors. The associated factors were evaluated further for the independent factor using multiple logistic regression analysis. @*Results@#Multiple retinal hemorrhages were observed in 31 eyes (18.6%) after MH surgery. The associated factors were the surgical induction of posterior vitreous detachment (PVD) (p = 0.003), use of the internal limiting membrane flap technique (p = 0.028), and staining with Brilliant Blue G (BBG) (p = 0.003). Retinal hemorrhages were exclusively observed in eyes in which BBG was used. Surgical PVD induction was the only independent risk factor (odds ratio, 13.099; p = 0.013). No statistically significant differences were observed between the two groups in the postoperative visual outcomes and MH closure rate. Additionally, patients who underwent surgery for idiopathic epiretinal membrane during the study period were reviewed to validate the above findings. Multiple retinal hemorrhages were noted in only one case (0.4%) in which BBG was used after surgical induction of PVD. @*Conclusions@#Multiple retinal hemorrhages after MH surgery appear to be related to the intravitreal use of BBG in eyes that sustained mechanical damage because of surgical induction of PVD; however, they did not affect surgical outcomes.

Optimal Hypoxic Preconditioning of Human Embryonic Stem Cell-Derived Mesenchymal Stem Cells (hES-MSCs) and Their Characteristics

Background and Objectives@#Hypoxia is frequently used to enhance stem cell function. However, the optimal level of hypoxia for growth and function of human embryonic stem cell-derived mesenchymal stem cells (hES-MSCs) is yet to be determined. The purpose of this study was to find the optimal level of hypoxia for hES-MSCs and characteristics of hES-MSCs cultured under these optimal hypoxic conditions. @*Methods@#and Results: Cell viability and changes in the morphology of hES-MSCs were determined through cell proliferation and CCK-8 assay. The hES-MSCs were preconditioned under various hypoxic conditions (0.5∼5% O2 and 24∼72 h). The expression of cytokines in each culture condition was compared using cytokine array analysis. The morphology of hES-MSCs did not change under various hypoxic culture conditions. hES-MSCs viability after 48 h incubation in 2% O2condition was higher than that in normoxic condition. HIF1α expression was increased up to six folds after 48 h of hypoxic preconditioning. HIF1α expression in hES-MSCs peaked after 48 h of incubation in 1% O2 condition. The expressions of PDGF-BB, IGFBP-6, VEGF-A, and angiogenin were increased after hES-MSCs were incubated for 48 h in 2% O2 condition. @*Conclusions@#The hES-MSCs viability and expressions of PDGF-BB, IGFBP-6, VEGF-A, and angiogenin increased after 48 h incubation in 2% O2 condition.

Two Cases of Ocular Manifestations in Patients with Microdeletion of the Chromosome 7 Long Arm

Purpose@#We report ocular manifestations in two patients with 7q microdeletion. Case summary: (Case 1) A 62-day-old male infant was admitted to the ophthalmology outpatient department for ocular examination after being diagnosed with microdeletion of chromosome seven (7q36.2q36.3 deletion) in DNA microarray comparative genomic hybridization (DNA microarray CGH) and fluorescence in situ hybridization (FISH) tests. Fundus examination showed optic disc hypoplasia in both eyes and retinopathy of prematurity, accompanied by retinal hemorrhage in his right eye. Around the age of 24 months, the patient was diagnosed with intermittent exotropia with anisometropia and was prescribed spectacles. (Case 2) A 3-year-old male infant was referred to the ophthalmology clinic to evaluate poor fixation, which was found during rehabilitation therapy for cerebral palsy and developmental delay. Fundus examination showed an increased cup/disc ratio bilaterally. A flash visual evoked potential test indicated a decrease in amplitude in his right eye. Intermittent exotropia of forty prism diopters was observed. DNA microarray CGH and FISH tests performed at another hospital revealed microdeletion of chromosome seven (7q35 microdeletion) and CNTNAP2 gene loss. @*Conclusions@#When genetic anomalies associated with ocular development are identified, it is necessary to detect the ophthalmic abnormalities early and provide the appropriate treatment to allow for the development of normal visual function.

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.

Characteristics of Optical Coherence Tomography Angiography Findings in Chronic Inactive Branch Retinal Vein Occlusion

Purpose@#To investigate characteristics of optical coherence tomography angiography (OCTA) findings in chronic inactive branch retinal vein occlusion (BRVO) with quantitative analysis. @*Methods@#The medical records of 48 eyes diagnosed with unilateral ischemic acute BRVO, and without recurrence for 6 months after the acute treatment, were reviewed retrospectively. We manually segmented the abnormal vessels of the superficial and deep capillary plexus (SCP-AV and DCP-AV, respectively) and vascular congestion of DCP (DCP-VC) from 6 × 6 mm2 macular OCTA images and automatically calculated the area, vessel density, and average retinal thickness of each corresponding region. Correlations were analyzed between the OCTA parameters of the segmentation area and the baseline characteristics. @*Results@#The DCP-AV area was always wider than that of the SCP-AV (p < 0.001), with a transitional zone (TZ) between the two areas. About two-thirds of the DCP-VC area was distributed in the TZ. The vessel density of the DCP-VC was higher than that of the normal capillary plexus (all, p < 0.001). The average retinal thickness of the DCP-VC was greater than those of SCP-AV and DCP-AV areas (all, p < 0.001), but not different from the normal capillary plexus. The greater the extent of the DCP-VC distribution under the SCP-AV, the fewer the number of injections required to reach stabilization (r = -0.314, p = 0.030). @*Conclusions@#DCP-VC in chronic inactive BRVO was mainly distributed in the TZ with high vessel density. DCP-VC seems to provide a drainage pathway with minimal resistance against elevated intravenous pressure, which may sustain the anatomical stability of chronic BRVO.

Atypical Retinal Hemorrhages after Vitrectomy for Idiopathic Macular Hole: Possible Toxicity of Brilliant Blue G

Purpose@#To describe the development of multiple retinal hemorrhages after uncomplicated macular hole (MH) surgery, and to determine the associated factors. @*Methods@#The medical records of 163 patients (167 eyes) diagnosed with idiopathic MHs and who underwent surgery at Pusan National University Hospital between March 2016 and July 2018 were retrospectively reviewed. The development of retinal hemorrhages was evaluated using ultra-widefield fundus photographs. Multiple retinal hemorrhages were defined as three or more dot or blot hemorrhages that had not been observed before and during the surgery. The patients were divided into two groups according to the presence of multiple retinal hemorrhages. The variable parameters were compared between the two groups to find the risk factors. The associated factors were evaluated further for the independent factor using multiple logistic regression analysis. @*Results@#Multiple retinal hemorrhages were observed in 31 eyes (18.6%) after MH surgery. The associated factors were the surgical induction of posterior vitreous detachment (PVD) (p = 0.003), use of the internal limiting membrane flap technique (p = 0.028), and staining with Brilliant Blue G (BBG) (p = 0.003). Retinal hemorrhages were exclusively observed in eyes in which BBG was used. Surgical PVD induction was the only independent risk factor (odds ratio, 13.099; p = 0.013). No statistically significant differences were observed between the two groups in the postoperative visual outcomes and MH closure rate. Additionally, patients who underwent surgery for idiopathic epiretinal membrane during the study period were reviewed to validate the above findings. Multiple retinal hemorrhages were noted in only one case (0.4%) in which BBG was used after surgical induction of PVD. @*Conclusions@#Multiple retinal hemorrhages after MH surgery appear to be related to the intravitreal use of BBG in eyes that sustained mechanical damage because of surgical induction of PVD; however, they did not affect surgical outcomes.

Optimal Hypoxic Preconditioning of Human Embryonic Stem Cell-Derived Mesenchymal Stem Cells (hES-MSCs) and Their Characteristics

Background and Objectives@#Hypoxia is frequently used to enhance stem cell function. However, the optimal level of hypoxia for growth and function of human embryonic stem cell-derived mesenchymal stem cells (hES-MSCs) is yet to be determined. The purpose of this study was to find the optimal level of hypoxia for hES-MSCs and characteristics of hES-MSCs cultured under these optimal hypoxic conditions. @*Methods@#and Results: Cell viability and changes in the morphology of hES-MSCs were determined through cell proliferation and CCK-8 assay. The hES-MSCs were preconditioned under various hypoxic conditions (0.5∼5% O2 and 24∼72 h). The expression of cytokines in each culture condition was compared using cytokine array analysis. The morphology of hES-MSCs did not change under various hypoxic culture conditions. hES-MSCs viability after 48 h incubation in 2% O2condition was higher than that in normoxic condition. HIF1α expression was increased up to six folds after 48 h of hypoxic preconditioning. HIF1α expression in hES-MSCs peaked after 48 h of incubation in 1% O2 condition. The expressions of PDGF-BB, IGFBP-6, VEGF-A, and angiogenin were increased after hES-MSCs were incubated for 48 h in 2% O2 condition. @*Conclusions@#The hES-MSCs viability and expressions of PDGF-BB, IGFBP-6, VEGF-A, and angiogenin increased after 48 h incubation in 2% O2 condition.

Two Cases of Ocular Manifestations in Patients with Microdeletion of the Chromosome 7 Long Arm

Purpose@#We report ocular manifestations in two patients with 7q microdeletion. Case summary: (Case 1) A 62-day-old male infant was admitted to the ophthalmology outpatient department for ocular examination after being diagnosed with microdeletion of chromosome seven (7q36.2q36.3 deletion) in DNA microarray comparative genomic hybridization (DNA microarray CGH) and fluorescence in situ hybridization (FISH) tests. Fundus examination showed optic disc hypoplasia in both eyes and retinopathy of prematurity, accompanied by retinal hemorrhage in his right eye. Around the age of 24 months, the patient was diagnosed with intermittent exotropia with anisometropia and was prescribed spectacles. (Case 2) A 3-year-old male infant was referred to the ophthalmology clinic to evaluate poor fixation, which was found during rehabilitation therapy for cerebral palsy and developmental delay. Fundus examination showed an increased cup/disc ratio bilaterally. A flash visual evoked potential test indicated a decrease in amplitude in his right eye. Intermittent exotropia of forty prism diopters was observed. DNA microarray CGH and FISH tests performed at another hospital revealed microdeletion of chromosome seven (7q35 microdeletion) and CNTNAP2 gene loss. @*Conclusions@#When genetic anomalies associated with ocular development are identified, it is necessary to detect the ophthalmic abnormalities early and provide the appropriate treatment to allow for the development of normal visual function.

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.

Characteristics of Optical Coherence Tomography Angiography Findings in Chronic Inactive Branch Retinal Vein Occlusion

Purpose@#To investigate characteristics of optical coherence tomography angiography (OCTA) findings in chronic inactive branch retinal vein occlusion (BRVO) with quantitative analysis. @*Methods@#The medical records of 48 eyes diagnosed with unilateral ischemic acute BRVO, and without recurrence for 6 months after the acute treatment, were reviewed retrospectively. We manually segmented the abnormal vessels of the superficial and deep capillary plexus (SCP-AV and DCP-AV, respectively) and vascular congestion of DCP (DCP-VC) from 6 × 6 mm2 macular OCTA images and automatically calculated the area, vessel density, and average retinal thickness of each corresponding region. Correlations were analyzed between the OCTA parameters of the segmentation area and the baseline characteristics. @*Results@#The DCP-AV area was always wider than that of the SCP-AV (p < 0.001), with a transitional zone (TZ) between the two areas. About two-thirds of the DCP-VC area was distributed in the TZ. The vessel density of the DCP-VC was higher than that of the normal capillary plexus (all, p < 0.001). The average retinal thickness of the DCP-VC was greater than those of SCP-AV and DCP-AV areas (all, p < 0.001), but not different from the normal capillary plexus. The greater the extent of the DCP-VC distribution under the SCP-AV, the fewer the number of injections required to reach stabilization (r = -0.314, p = 0.030). @*Conclusions@#DCP-VC in chronic inactive BRVO was mainly distributed in the TZ with high vessel density. DCP-VC seems to provide a drainage pathway with minimal resistance against elevated intravenous pressure, which may sustain the anatomical stability of chronic BRVO.