OBJECTIVE: The purpose of the present study was to investigate cardiovascular autonomic dysfunction in patients with Parkinson's disease (PD) with mild to severe stages of motor symptoms and to compare cardiovascular autonomic dysfunction between drug-naïve and dopaminergic drug-treated groups. METHODS: This study included 188 PD patients and 25 age-matched healthy controls who underwent head-up tilt-testing, 24-h ambulatory blood pressure (BP) monitoring and 24-h Holter monitoring. Autonomic function test results were evaluated among groups categorized by motor symptom severities (mild vs. moderate vs. severe) and treatment (drug-naïve or dopaminergic drug treatment). RESULTS: Orthostatic hypotension and supine hypertension were more frequent in patients with PD than in healthy controls. The frequencies of orthostatic hypotension, supine hypertension, nocturnal hypertension and non-dipping were not different among groups. Additionally, no significant differences were detected in supine BP, orthostatic BP change, nighttime BP, nocturnal BP dipping, or heart rate variabilities among groups. CONCLUSIONS: Cardiovascular autonomic dysfunction is not confined to moderate to severe PD patients, and starts early in the course of the disease in a high proportion of PD patients. In addition, dopaminergic drug treatments do not affect cardiovascular autonomic function.
Blood Pressure ; Electrocardiography, Ambulatory ; Heart Rate ; Humans ; Hypertension ; Hypotension, Orthostatic ; Parkinson Disease*

PURPOSE: To evaluate preferences and trends in the management of diabetic retinopathy in Korea and Japan. METHODS: An Internet survey comprised of 49 questions was sent to the members of Korean Retina Society (KRS) and Japanese Society of Ophthalmic Diabetology (JSOD). The survey was conducted during the period between June 2012 and July 2012. RESULTS: Ninety-one of 210 members of the KRS (43%) and 120 of 754 members of the JSOD (16%) participated in the survey. For diffuse diabetic macular edema, 'intravitreal injection of anti-vascular endothelial growth factor (anti-VEGF) followed by focal laser treatment' was the most preferred treatment in Korea (48%), while 'sub-tenon steroid injection followed by focal laser treatment' was the most common procedure in Japan (33%). Vitrectomy was the second most common procedure in Japan (18%). In contrast, none of the KRS members preferred vitrectomy in this situation. For refractory diabetic macular edema, however, vitrectomy with or without the use of anti-VEGF was chosen in 75% of the KRS members. In Japan, vitrectomy without the use of intravitreal injection of anti-VEGF or steroid was relatively more preferred. Small-gauge (G) vitrectomy using either a 23 G or 25 G needle was popular in both countries (90% in Korea, 64% in Japan). CONCLUSIONS: Although the trends in diagnostic and surgical environments were similar in Korea and Japan, the preferred treatment approaches for diabetic macular edema were different. Sub-tenon steroid injection and vitrectomy were preferred in Japan, while anti-VEGF injection was most commonly employed in Korea.
Asian Continental Ancestry Group ; Diabetic Retinopathy* ; Endothelial Growth Factors ; Humans ; Internet ; Intravitreal Injections ; Japan* ; Korea* ; Macular Edema ; Needles ; Retina ; Vitrectomy

PURPOSE: To evaluate various types and; characteristics of non-retinal lesions associated with ultra-wide field scanning laser ophthalmoscope images. METHODS: This retrospective study included 139 eyes of 139 patients with non-retinal lesions observed on color images obtained using Optomap 200Tx (Optos PLC, Dunfermline, Scotland, UK). The non-retinal lesion is a hyperreflective or hyporeflective shadow due to anterior segment of the eye or vitreous except the retina. Types and characteristics of red laser separation, green laser separation and autofluorescence images of non-retinal lesions were evaluated. RESULTS: All non-retinal lesions in images were categorized into 2 groups according to the location of non-retinal lesions. The anterior non-retinal lesions group included corneal opacity, cataract and posterior capsular opacity. The posterior non-retinal lesions group included asteroid hyalosis, posterior vitreous detachment, vitreous opacity and vitreous hemorrhage. Anterior non-retinal lesions were more often hyporeflective in red and green laser separation images (p < 0.001). Posterior non-retinal lesions were more often hyperreflective in green laser separation images and hyporeflective in red laser separation images (p < 0.001). CONCLUSIONS: Ultra-wide field scanning laser ophthalmoscope images can frequently have various shadows from anterior or posterior lesions of the eye. These shadows show a difference in reflectivity depending on their origins. To understand the difference helps in the interpretation of the fundus images.
Cataract ; Corneal Opacity ; Humans ; Ophthalmoscopes* ; Retina ; Retrospective Studies ; Scotland ; Vitreous Detachment ; Vitreous Hemorrhage

BACKGROUND AND PURPOSE: Altered blood pressure (BP) and heart rate variations (HRVs) have been reported in Alzheimer's disease (AD). However, it is unclear how these two manifestations are associated with AD. Therefore, the objective of this study was to investigate BP and heart rate variability in AD compared to that in normal controls, patients with subjective memory impairment (SMI), and patients with mild cognitive impairment (MCI). METHODS: Case-control comparisons were made among AD (n=37), MCI (n=24), SMI (n=17), and controls (n=25). All patients underwent clinical and neuropsychological assessments with 24-h ambulatory BP and Holter monitoring. RESULTS: Patients with AD had higher pulse pressures than those in other groups. In addition, AD patients experienced blunted nocturnal BP dipping associated with declining cognitive status. AD patients also had larger ranges of HRV in parasympathetic domains compared to other groups, especially at night. CONCLUSIONS: Our results suggest that diurnal sympathetic and parasympathetic cardiac variability were significantly disturbed in mild cholinesterase-naive AD patients. This may be an indirect sign of disturbed integrity to the sleep-wake cycle in mild AD.
Alzheimer Disease* ; Blood Pressure* ; Case-Control Studies ; Electrocardiography, Ambulatory ; Heart Rate* ; Heart* ; Humans ; Memory ; Mild Cognitive Impairment

BACKGROUND: Genetic alterations have been identified in melanomas according to different levels of sun exposure. Whereas the conventional morphology-based classification provides a clue for tumor growth and prognosis, the new classification by genetic alterations offers a basis for targeted therapy. OBJECTIVE: The purpose of this study is to demonstrate the biological behavior of melanoma subtypes and compare the two classifications in the Korean population. METHODS: A retrospective chart review was performed on patients found to have malignant melanoma in Severance Hospital from 2005 to 2012. Age, sex, location of the tumor, histologic subtype, tumor depth, ulceration, lymph node invasion, visceral organ metastasis, and overall survival were evaluated. RESULTS: Of the 206 cases, the most common type was acral melanoma (n=94, 45.6%), followed by nonchronic sun damage-induced melanoma (n=43, 20.9%), and mucosal melanoma (n=40, 19.4%). Twenty-one patients (10.2%) had the chronic sun-damaged type, whereas eight patients (3.9%) had tumors of unknown primary origin. Lentigo maligna melanoma was newly classified as the chronic sun-damaged type, and acral lentiginous melanoma as the acral type. More than half of the superficial spreading melanomas were newly grouped as nonchronic sun-damaged melanomas, whereas nodular melanoma was rather evenly distributed. CONCLUSION: The distribution of melanomas was largely similar in both the morphology-based and sun exposure-based classifications, and in both classifications, mucosal melanoma had the worst 5-year survival owing to its tumor thickness and advanced stage at the time of diagnosis.
Classification ; Diagnosis ; Humans ; Hutchinson's Melanotic Freckle ; Lymph Nodes ; Melanoma* ; Neoplasm Metastasis ; Prognosis ; Retrospective Studies ; Solar System ; Ulcer

PURPOSE: To compare ocular fatigue, non-ocular symptoms, and ocular surface changes, such as tear break-up time (BUT) and ocular surface temperature, after watching 2-dimensional (2D) and 3-dimensional (3D) images. METHODS: Fourteen volunteers were enrolled in the present study. Subjects watched 2D as well as 3D images and answered questions regarding ocular fatigue and general symptoms such as headache. Before and after watching images, the spherical equivalent, degree of conjunctival injection, tear BUT, and ocular surface temperature were measured and the amount of change was analyzed. While watching images, subjects answered questions regarding ocular fatigue and the time when they began to feel definitive symptoms. RESULTS: Watching 3D images induced a greater degree of ocular fatigue, headache, and decreasing concentration than watching 2D images (p = 0.038, 0.003, and 0.045, respectively). While watching images, 3D images induced a greater degree of ocular fatigue than 2D images and caused subjects to feel earlier ocular fatigue (3D: 54.86 min, 2D: 78.57 min, p = 0.002). Spherical equivalents became more myopic after watching 3D images. CONCLUSIONS: After watching 3D images, a greater degree of ocular fatigue, headache, and decreasing concentration was induced and a shorter time to feel definitive ocular fatigue was observed than after watching 2D images. In addition, spherical equivalents changed myopically after watching 3D images.
Fatigue ; Headache

PURPOSE: To report a case of secondary macular hole formed after phacoemulsification in a vitrectomized eye which was treated with macular hole surgery. CASE SUMMARY: A 53-year-old man with a history of pars plana vitrectomy developed a cataract in his left eye. Uncomplicated cataract surgery involving phacoemulsification with posterior chamber intraocular lens implantation was performed. At his routine 3-month post-operative visit, he reported metamorphopsia. Fundus examinations and optical coherence tomography revealed a cystoid macular edema and a full thickness macular hole. He underwent repair of the macular hole including internal limiting membrane peeling and gas injection. Three months later, post-operative examinations showed anatomical closure of the macular hole. CONCLUSIONS: When performing cataract surgery, even in a previously vitrectomized eye, clinicians should be aware of the possibility of cystoid macular edema. A thorough pre- and post-operative assessment, including fundus examinations and optical coherence tomography must be carefully performed in order to detect a macular hole associated with cystoid macular edema. And prompt treatment is required when a macular hole is detected.
Cataract ; Eye ; Humans ; Lens Implantation, Intraocular ; Macular Edema ; Membranes ; Middle Aged ; Phacoemulsification ; Retinal Perforations ; Tomography, Optical Coherence ; Vision Disorders ; Vitrectomy

PURPOSE: To report a case of secondary macular hole formed after phacoemulsification in a vitrectomized eye which was treated with macular hole surgery. CASE SUMMARY: A 53-year-old man with a history of pars plana vitrectomy developed a cataract in his left eye. Uncomplicated cataract surgery involving phacoemulsification with posterior chamber intraocular lens implantation was performed. At his routine 3-month post-operative visit, he reported metamorphopsia. Fundus examinations and optical coherence tomography revealed a cystoid macular edema and a full thickness macular hole. He underwent repair of the macular hole including internal limiting membrane peeling and gas injection. Three months later, post-operative examinations showed anatomical closure of the macular hole. CONCLUSIONS: When performing cataract surgery, even in a previously vitrectomized eye, clinicians should be aware of the possibility of cystoid macular edema. A thorough pre- and post-operative assessment, including fundus examinations and optical coherence tomography must be carefully performed in order to detect a macular hole associated with cystoid macular edema. And prompt treatment is required when a macular hole is detected.
Cataract ; Eye ; Humans ; Lens Implantation, Intraocular ; Macular Edema ; Membranes ; Middle Aged ; Phacoemulsification ; Retinal Perforations ; Tomography, Optical Coherence ; Vision Disorders ; Vitrectomy

The prevalence of group B streptococcus (GBS) among pregnant women and disease burdens in neonates and adults are increasing in Korea. Colonizing isolates, collected by screening pregnant women (n=196), and clinical isolates collected from clinical patients throughout Korea (n=234), were serotyped and screened for antibiotic resistance. Serotype III (29.8%) and V (27.7%) predominated, followed by Ia (17.0%). Antibiotic resistance was higher among clinical than colonizing isolates for erythromycin (35.1% and 26.9%; P=0.10) and for clindamycin (49.4% and 42.1%; P=0.17). erm(B) occurred in 91.9% of erythromycin resistant isolates, and 84.0% of isolates resistant to clindamycin. Only five isolates (4.2%) resistant to erythromycin were susceptible to clindamycin; by contrast, and unique to Korea, 34% of isolates resistant to clindamycin were erythromycin susceptible. Among these 60 erythromycin-susceptible & clindamycin-resistant isolates, 88% was serotype III, and lnu(B) was found in 89% of strains. Four fifths of the serotype V isolates were resistant to both erythromycin and clindamycin. Further characterization of the genetic assembly of these resistance conferring genes, erm(B) and lnu(B), will be useful to establish the clonal lineages of multiple resistance genes carrying strains.

PURPOSE: To develop methods for the objective measurement of ocular fatigue. METHODS: Fifteen patients were enrolled in the present study. Subjects performed visual tasks on a computer for one hour. A survey of ocular fatigue was conducted with a questionnaire. Tear break-up time, blinking rate, ocular protection index, conjunctival injection, maximal blinking interval, temperature of the ocular surface, and visual evoked potential were evaluated before and immediately after the task. Surface electromyography of the orbicularis oculi muscle was performed before and during the task. RESULTS: The survey showed increases in subjective ocular fatigue in all subjects. Tear break-up time, ocular protection index and maximal blinking interval decreased, while temperature of the ocular surface increased after the task. Conjunctival injection showed a tendency to increase. Electromyography, and visual evoked potential did not change significantly. CONCLUSIONS: In the present study, tear break-up time, ocular protection index, maximal blinking interval, and temperature of the ocular surface changed as ocular fatigue increased. Therefore, these measures can be objectively used for the evaluation of ocular fatigue.
Asthenopia ; Blinking ; Electromyography ; Evoked Potentials, Visual ; Fatigue ; Humans ; Muscles ; Surveys and Questionnaires