A pair of 19-year-old female identical twins was referred to our hospital with progressive visual loss. They exhibited bilateral chorioretinal atrophy involving the midperiphery on fundoscopy and fluorescein angiography. Bilateral visual field constriction was noted on dynamic Goldmann perimetry, and a markedly impaired response was observed on both photopic and scotopic electroretinograms. Cystoid macular edema was identified in both eyes on optical coherence tomography. Plasma levels of ornithine were elevated. Based on these observations, the patients were diagnosed with gyrate atrophy of the choroid and retina. The clinical diagnosis was confirmed by mutation analysis of the ornithine-delta-aminotransferase (OAT) gene. Patients were treated with a pyridoxine supplement (300 mg/day) and an arginine-restricted diet to lower plasma levels of ornithine, which were successfully reduced without progression of chorioretinal atrophy for 15 months. Our report describes the first case of gyrate atrophy in the Korean population diagnosed by OAT gene analysis and treated with vitamin B6 dietary supplementation.
DNA/*analysis ; DNA Mutational Analysis ; Diagnosis, Differential ; Electroretinography ; Female ; Fluorescein Angiography ; Fundus Oculi ; Gyrate Atrophy/*diagnosis/enzymology/genetics ; Humans ; *Mutation ; Ornithine-Oxo-Acid Transaminase/*genetics/metabolism ; Tomography, Optical Coherence ; Visual Acuity ; Young Adult

PURPOSE: To evaluation the accuracy of the IOL power calculation formulae measured by IOL Master(R) and applanation ultrasonography for the Tecnis ZCB00 IOL. METHODS: We performed a retrospective study of 170 eyes in 121 patients who underwent cataract surgery in our hospital with AMO Tecnis ZCB00 IOL.s. The SRK/T formula was used to predict the patient's implanted IOL power. Differences in the predicted refractive errors between IOL Master(R) and ultrasonography were analyzed and factors attributed to the differences were also analyzed. Three months after cataract surgery, mean numeric error and mean absolute error were analyzed. RESULTS: SRK/II and SRK/T formulas calculated using ultrasonography showed differences compared to the same formulas calculated using IOL Master(R), in which hyperopic shift was also demonstrated. No definite factor was attributed to the differences between the 2 methods. Although the 3 formulas of IOL Master(R) showed no significant difference in refractive errors, the SRK/T formula calculated using IOL Master(R) showed the least mean absolute and numeric errors. CONCLUSIONS: IOL Master(R) is considered more suitable when determining proper AMO Tecnis ZCB00 IOL power in cataract surgery. The hyperopic shift should be considered when calculating the IOL power using only ultrasonography.
Cataract ; Ultrasonography* ; Humans ; Lenses, Intraocular* ; Refractive Errors ; Retrospective Studies ; Ultrasonography

PURPOSE: In the present study, the incidence and risk factors of lens-iris diaphragm retropulsion syndrome (LIDRS) were evaluated. METHODS: Patients who underwent cataract surgery using phacoemulsification between June 2014 and December 2014 were included in the study. The preoperative ocular biometric and intraoperative surgical parameters were examined. The incidence of LIDRS and various risk factors were analyzed using an independent t-test, Pearson's chi-square test, and univariable and multivariable logistic regression analyses. RESULTS: Among 124 eyes of 124 patients, 100 (80.6%) had no LIDRS and 24 (19.4%) had LIDRS. LIDRS occurred in 13 of 31 vitrectomized eyes (41.9%) and 11 of 93 non-vitrectomized eyes (11.8%). Based on univariable analysis, age (odds ratio [OR], 0.920; p = 0.001), vitrectomized eye (OR, 5.038; p = 0.001), spherical equivalent (OR, 0.778; p < 0.001), axial length (OR, 1.716; p < 0.001), anterior chamber depth (OR, 3.328; p = 0.037), and 3.0 mm vs. 2.2 mm incision size (OR, 4.964; p = 0.001) were statistically significant risk factors associated with the development of LIDRS. Conditional multivariable logistic regression showed that vitrectomized eye (OR, 3.865; 95% confidence interval [CI], 1.201 to 12.436; p = 0.023), long axial length (OR, 1.709; 95% CI, 1.264 to 2.310; p = 0.001), and 3.0 vs. 2.2 mm incision size (OR, 3.571; 95% CI, 1.120 to 11.393; p = 0.031) were significant independent risk factors associated with LIDRS. CONCLUSIONS: LIDRS is a relatively common occurrence and was found to be associated with vitrectomized eye, long axial length, and larger incision size. Evaluating risk factors prior to cataract surgery can help reduce associated morbidity.
Anterior Chamber ; Cataract ; Diaphragm* ; Humans ; Incidence* ; Iris ; Logistic Models ; Phacoemulsification* ; Risk Factors*

PURPOSE: To manage a critically ill patient effectively, an emergency physician must make an accurate assessment of the patient's hemodynamic status. Although the hemodynamic status can be accurately measured through the use of a pulmonary artery catheter, this device has significant limitations in the emergency department. Instead, the most commonly used method of measuring cardiac output (CO) in the emergency department is transthoracic echocardiography (TTE). However, TTE has been reported to underestimate the CO. Impedance cardiography (ICG) is an established and accurate technique for noninvasive determination of hemodynamic parameters. Thus, this study aimed to assess the agreement between CO measurements made by using TTE and ICG. METHODS: In 20 healthy volunteers, the hemodynamic parameters (stroke volume and CO) obtained by TTE were compared with the parameters derived from simultaneous measurements by ICG. RESULTS: The mean stroke volumes and COs were 63.9+/-11.6 ml and 4.1+/-0.7 L/min, respectively, by TTE, and 77.2+/-10.2 ml and 5.0+/-0.6 L/min by ICG. The correlation coefficients for stroke volume and CO between TTE and ICG were 0.77 and 0.64. The mean difference in stroke volume between TTE and ICG was -13.3+/-6.4 ml (-19.5+/-10.5 %), and the mean difference in CO was -0.88+/-0.48 L/min (-20.1+/-11.6 %). CONCLUSION: In healthy volunteers, the comparison between TTE and ICG showed a good correlation for stroke volume and CO. However, the mean differences in stroke volume and CO between TTE and ICG were -19.5+/-10.5 % and -20.1+/-11.6 %, respectively.
Cardiac Output* ; Cardiography, Impedance ; Catheters ; Critical Illness ; Echocardiography* ; Emergencies ; Emergency Service, Hospital ; Healthy Volunteers ; Hemodynamics ; Humans ; Male* ; Pulmonary Artery ; Stroke Volume ; Volunteers*

PURPOSE: To report the predisposing factors and surgical outcomes of intraocular lens dislocation (IOL) after phacoemulsification. METHODS: We performed a retrospective study of 131 eyes in 120 patients who were diagnosed with IOL dislocation after phacoemulsification between January 2008 and December 2013. The main outcomes are possible predisposing factors, characteristics of IOL dislocation, and outcomes of rectification surgery, including visual acuity (VA), and refractive status before and at 3 months after surgery. RESULTS: The main conditions associated with IOL dislocation were as follows: status after vitrectomy (27.5%), long axial length (9.2%), neodymium-doped yttrium aluminium garnet (Nd:YAG) posterior capsulotomy (8.4%), uveitis (6.1%), trauma (5.3%), mature cataract (3.8%), and pseudoexfoliation (2.3%). Mean uncorrected VA improved significantly after rectification surgery (p = 0.00), and best-corrected VA also improved significantly (p = 0.01). Mean value of spherical equivalent tended to decrease, although the decrease was not significant (p = 0.07). Whereas astigmatism showed a significant increase (p = 0.01). 6 eyes (4.6%) were associated with recurrence of IOL dislocation. CONCLUSIONS: Possible major predisposing factors for IOL dislocation are status after vitrectomy, long axial length, Nd:YAG posterior capsulotomy, uveitis, and trauma. The surgical outcome and improvement of postoperative visual acuity were satisfactory.
Astigmatism ; Cataract ; Causality* ; Dislocations* ; Humans ; Lenses, Intraocular* ; Phacoemulsification* ; Posterior Capsulotomy ; Recurrence ; Retrospective Studies ; Uveitis ; Visual Acuity ; Vitrectomy ; Yttrium

BACKGROUND: QT dispersion(QTD : QTmax-QTmin) or JT dispersion(JTD:JTmax-JT-min)in 12 leads ECG has been known to reflect regional variations in ventricular repolarization and has been reported to bel one of the marker of regional myocardial ischemia. To evaluate the significance of QTD or JTD of exercise ECG in diagnosis of coronary artery disease, we studied 106 patients(mean age, 56.9 years old, male 63) who were referred for the evaluation of chest pain on exertion. METHOD: Treadmill exercise stress test with modified Bruce protocol and coronary angiography were performed in 106 patients with chest pain on exertion. ST-segment depression by >1.0 mm 0.08 second after J-point during or after exercise in exercise test and >50% stanosis of epicardial artery in coronary angiogram were defined as positive. Of 106 patients, 41 had positive exercise ECG and positive coronary angiogram(true positive, TP), 20 had positive exercise ECG and negative coronary angiogram(false positive, FT), 20 had negative exercise ECG and positive coronary angiogram(faalse negative, FN), and 23 had negative exercise ECG and negative coronary angiogram(true negative, Tn). QT and JT interval in 12 leads were measured at baseline and peakexercise and were corrected for heart rate using Bazett's formula. QTD and JTD were measured by calculation the difference between the maximum QT and mininum QT and that between maximum JT and minumum JT. RESULTS: QTD at baseline for TP(72.8ms)was prolonged compared to Tn(52.2ms,P<0.01), but was not different from that for FT(70.2 ms). At peak exercise, QTD for TP(81.3 msec) was significantly prolonged(p<0.01), while QTD for FP(71.2 msec) was not different from that for TN(56.8 msec). JTD at baseline(78.4 msec) and at peak exercise(88.2 msec) for TP were significantly prolonged compared to those for TN(55.2msec and 55.1msec p<0.01,p<0.01, respectively), but those for FP were not porlonged(77.0msec and 79.0msec, respectively). QTD and JTD at peak exercise were more markedly prolonged in patients with sever stenosis of coronary artery(p=0.053 and p<0.05, repectively) and multivessels diseases(p<0.01, 0<0.05) than those with less severe disease and single vessel disease. Patients with left anterior descending artery lesion had greater QTD and JTD at peak exercise than those with other vessels lesion(p<0.01). In addition to standard criteria with ST segment displacement in exercise EGC, inclusion of exercise induced QTD of more than 60msec increased the sensitivity of exercise ECG from 66.7% to 83.3%, and JTD of more than 70msec increased the specificity from 52% to 76.0%. CONCLUSION: Measurement of QT dispersion and JT dispersion of exercise ECG may be useful method to identify the severity of coronary artery disease and to improve diagnostic accuracy of exercise ECG in coronary artery disease.
Arteries ; Chest Pain ; Constriction, Pathologic ; Coronary Angiography ; Coronary Artery Disease ; Depression ; Diagnosis ; Electrocardiography* ; Exercise Test ; Heart Rate ; Humans ; Male ; Myocardial Ischemia ; Sensitivity and Specificity

PURPOSE: The present study assessed the influence of overnight orthokeratology (ortho-k) on the myopic progression in Korean children and analyzed factors affecting myopic progression. METHODS: The ortho-k group was comprised of 31 patients satisfying the inclusion criteria for ortho-k. In the ortho-k group, spherical equivalent refractive error (SER) was measured at baseline, and after 2 weeks, 6 and 12 months. The control group was comprised of 31 patients who were matched according to age, gender, and baseline SER of the ortho-k subjects. RESULTS: In the ortho-k group, the mean +/- SD changes in SER from 2 weeks to 6 months, 6 to 12 months, and 2 weeks to 12 months were -0.17 +/- 0.50 D, -0.04 +/- 0.76 D, and -0.21 +/- 0.78 D, respectively. In the control group, the changes in SER from baseline to 6 months, 6 to 12 months, and baseline to 12 months were -0.38 +/- 0.42 D, -0.44 +/- 0.38 D, and -0.82 +/- 0.68 D, respectively. Significant differences were found between changes in SER from 6 to 12 months and from baseline to 12 months (p < 0.05). In the ortho-k group, relationships between the changes of SER for 1 year and the numeric values of baseline measurements were analyzed. When comparing the results between the group of SER change > or = -0.5 D with the group of SER change < -0.5 D, numeric values of white-to-white diameters of the 2 groups were different, and a significant correlation was found between the range of SER change and the white-to-white diameter (Pearson's r = -0.471, p = 0.008). CONCLUSIONS: Ortho-k is effective for slowing myopic progression. The smaller the white-to-white diameter, the slower the myopic progression could be.
Child ; Humans ; Refractive Errors

PURPOSE: With many advantages, Electronic Medical Record (EMR) systems have been adopted by numerous edical institutions. However, medical personnel, the direct users of the system, have a negative opinion of it. Especially, medical personnel at the emergency department, in which the most rapid services are required, have a more negative opinion. We performed this study to improve the system from the view points of time factors, which are the most unsatisfactory to medical personnel. METHODS: We compared the time consumed for making patients' medical records before and after the adoption of EMR system in Asan Medical Center. A questionnaire regarding contentment and the presumptive time consumption of the EMR were answered by emergency medical personnel. RESULTS: The actual time consumed for the written and the electronic records was the same. However, from the survey, the time consumed on the electronic recording system was perceived to be longer by medical personnel. 46.7% of the doctors and 53.8% of the nurses answered that EMR was convenient, and 59.3% of them agreed to continue using the system. CONCLUSION: If the EMR system is developed for user convenience, it can also be useful in emergency care as well. Therefore, emergency medical personnel must participate in the initial period of EMR system development.
Chungcheongnam-do ; Electronic Health Records* ; Emergencies* ; Emergency Medical Services* ; Emergency Service, Hospital ; Medical Records ; Surveys and Questionnaires ; Time Factors

PURPOSE: To evaluate the relations between progression of glaucoma in visual field and peripapillary area change in normal tension glaucoma (NTG). METHODS: We respectively evaluated 66 patients (66 eyes) with normal tension glaucoma; these patients were classified as progressive glaucoma group and non-progressive glaucoma group by visual field test. Interobserver and intraobserver agreement was evaluated for qualitative assessment. Zone beta change was measured by Image J (National Institute of Health, Bethesda, USA) by two methods. One method used paired t-test and the other method used CV (correlation of variation) to define significant progression of zone beta. RESULTS: 46 patients (46 eyes) were classified as progressive glaucoma and 20 patients (20 eyes) were classified as non-progressive glaucoma. There was no statistically significant different change of zone beta between two groups and there were no changes of zone beta over coefficient of variation (CV). CONCLUSIONS: The measurement of change of zone beta seems to be of no use in recognition of progression in normal tension glaucoma.
Atrophy ; Glaucoma ; Humans ; Low Tension Glaucoma ; Visual Field Tests ; Visual Fields

PURPOSE: To evaluate the effect and prognostic factors of automated thermodynamic treatment (thermal compression therapy device [KCL 1100®]) for Meibomian gland dysfunction (MGD). METHODS: Patients (48 eyes of 24 subjects) with MGD were recruited for a prospective clinical trial. Patients received 15-minute treatments twice a day using the KCL 1100®. Severity of dry eye symptoms were evaluated using the Standard Patient Evaluation for Eye Dryness (SPEED) and Ocular Surface Disease Index (OSDI), and severity of Meibomian gland function was evaluated using the Meibomian gland expressibility (MGE), Meibomian gland secretion (MGS) score and lipid layer thickness measured by LipiView®. To evaluate ocular surface, we measured tear break-up time (BUT) and fluorescein corneal staining score (Oxford scale). Data were presented for baseline and at 2 weeks and 1 month post-treatment. RESULTS: Dry eye symptom (SPEED, OSDI), Meibomian gland function (MGE, MGS), and ocular surface index (BUT, Oxford scale) of patients were significantly improved from baseline to 2 weeks (p < 0.05) and 1 month post-treatment (p < 0.05). In addition, patients with more severe dry eye symptom and Meibomian gland index at baseline examination achieved improvement in mild to moderate MGD (p < 0.05). Improvement of Meibomian gland function (MGE) was associated with improvement of ocular surface index (BUT, Oxford scale) (p < 0.05), but not with improvement of dry eye symptom (SPEED, OSDI) (p > 0.05). There were no significant adverse events during the treatment. CONCLUSIONS: KCL 1100® automated thermodynamic treatment is an effective and safe treatment for MGD. Additionally, KCL 1100® is more effective in patients with moderate dry eye symptom and MGD.
Fluorescein ; Humans ; Meibomian Glands* ; Prospective Studies ; Tears ; Thermodynamics*