A 50-year-old female was referred to our clinic with visual disturbance, hyphema and increased intraocular pressure (IOP) in her right eye 7 days after experiencing blunt trauma in that eye. She had undergone uncomplicated laser in situ keratomileusis (LASIK) on both eyes 10 years earlier. At initial examination, the best corrected visual acuity (BCVA) in her right eye was counting fingers at 2 feet with no correction. Central Goldmann applanation tonometry (GAT) showed an IOP of 7 mm Hg. Peripheral digital tonometry showed the IOPs in her right eye superiorly, nasally, temporally, and inferiorly were 36 mm Hg, 35 mm Hg, 34.5 mm Hg and 36.5 mm Hg, respectively. Slit-lamp examination showed diffuse epithelial and stromal edema and a blood clot 1 mm in height in the anterior chamber. Spectral domain scanning laser ophthalmoscope/optical coherence tomography (SD-SLO/OCT) images showed a pocket of fluid between the LASIK flap and the underlying stroma. The patient was started on anti-inflammatory agent and IOP lowering agents. After 15 days of treatment, IOP measured with GAT was 10 mm Hg, slit-lamp examination showed that epithelial and stromal edema had disappeared, and OCT showed no fluid between the corneal flap and stroma.
Anterior Chamber ; Edema ; Female ; Fingers ; Foot ; Humans ; Hyphema* ; Intraocular Pressure ; Keratomileusis, Laser In Situ* ; Manometry ; Middle Aged ; Visual Acuity

OBJECTIVE: REM sleep behavior disorder (RBD) is associated with psychiatric symptoms, such as anxiety and alexithymia. However, only a few studies on the relationship between depression and RBD have been published. In this study, we investigated the occurrence of depression and associated factors in patients with RBD. METHODS: In total 94 patients (mean age: 61.9±12.7 years, male: 70.2%) diagnosed as RBD were examined using detailed clinical histories, the Beck Depression Inventory (BDI), the Epworth Sleepiness Scale (ESS), and nocturnal polysomnography (PSG). RESULTS: The mean BDI score of all patients was 12.4±10.3 and 44.7% of RBD patients showed depressed mood (BDI >11 points). Depressed RBD patients were less able to recall enacted dreams than were non-depressed patients (61.9% vs. 86.5%, p=0.008). Logistic regression analysis showed that failure to recall enacted dreams was significantly associated with depression, after controlling for confounding variables including the respiratory disturbance index and a history of psychiatric disorders (odds ratio=0.323, p=0.041). CONCLUSION: In this study, 44.7% of RBD patients were found to suffer from depressed mood. And, depression was found to be associated with reduced ability to recall enacted dreams. We suggest that routine evaluation of depression be performed in RBD patients, particularly when failure to recall enacted dreams is evident. We speculate that such failure may be associated with emotional dysregulation or neurodegeneration.
Affective Symptoms ; Anxiety ; Confounding Factors (Epidemiology) ; Depression ; Dreams* ; Humans ; Logistic Models ; Male ; Polysomnography ; REM Sleep Behavior Disorder* ; Sleep, REM*

Purpose: To investigate the clinical features, risk factors, and treatment outcomes for anterior chamber migration of an intravitreal dexamethasone implant (Ozurdex®; Allergan Inc., Irvine, CA, USA). Methods: We retrospectively reviewed the medical records of patients who were diagnosed with anterior chamber Ozurdex® migration. Prior surgical histories were obtained and comprehensive ophthalmic examinations were conducted for all eyes. Treatment strategies and outcomes were also analyzed. Results: Among 1,276 intravitreal Ozurdex® injections, anterior migration occurred in six eyes of six patients (0.47%). All six eyes were pseudophakic, and they had undergone prior vitrectomies. The vitrectomized pseudophakic eyes, in contrast to the nonvitrectomized pseudophakic eyes, were significantly associated with an increased risk of anterior chamber migration (odds ratio [OR] = 19.2, p = 0.009). Moreover, the vitrectomized eyes with reduced zonular/capsular bag complex integrity, in contrast to the vitrectomized eyes with intact zonular/capsular bag complex integrity, were significantly associated with an increased risk of anterior chamber migration (OR = 50.2, p < 0.001). All six eyes underwent surgical intervention: one eye with a repositioning procedure, and the other five eyes with surgical removal of the implant. Corneal edema was resolved within two months after surgery; however, one patient eventually developed corneal endothelial dysfunction. Conclusions Prior vitrectomy and a defective lens capsule or weak zonules/zonular dehiscence are risk factors for anterior chamber Ozurdex® migration; thus, caution is recommended in these patients. Urgent removal of the implant should be considered when anterior migration of the implant is diagnosed with corneal edema.

Purpose: To investigate the clinical features, risk factors, and treatment outcomes for anterior chamber migration of an intravitreal dexamethasone implant (Ozurdex®; Allergan Inc., Irvine, CA, USA). Methods: We retrospectively reviewed the medical records of patients who were diagnosed with anterior chamber Ozurdex® migration. Prior surgical histories were obtained and comprehensive ophthalmic examinations were conducted for all eyes. Treatment strategies and outcomes were also analyzed. Results: Among 1,276 intravitreal Ozurdex® injections, anterior migration occurred in six eyes of six patients (0.47%). All six eyes were pseudophakic, and they had undergone prior vitrectomies. The vitrectomized pseudophakic eyes, in contrast to the nonvitrectomized pseudophakic eyes, were significantly associated with an increased risk of anterior chamber migration (odds ratio [OR] = 19.2, p = 0.009). Moreover, the vitrectomized eyes with reduced zonular/capsular bag complex integrity, in contrast to the vitrectomized eyes with intact zonular/capsular bag complex integrity, were significantly associated with an increased risk of anterior chamber migration (OR = 50.2, p < 0.001). All six eyes underwent surgical intervention: one eye with a repositioning procedure, and the other five eyes with surgical removal of the implant. Corneal edema was resolved within two months after surgery; however, one patient eventually developed corneal endothelial dysfunction. Conclusions Prior vitrectomy and a defective lens capsule or weak zonules/zonular dehiscence are risk factors for anterior chamber Ozurdex® migration; thus, caution is recommended in these patients. Urgent removal of the implant should be considered when anterior migration of the implant is diagnosed with corneal edema.

Purpose: To report a case of autosomal dominant drusen confirmed by molecular genetic testing and the clinical features and findings of a multimodal diagnostic imaging study.Case summary: A 32-year-old male presented with decreased visual acuity in his right eye from 1 year prior to his first visit. On the first visit, his visual acuities were 0.3 in the right eye and 1.2 in the left eye. A fundus examination showed numerous drusen of various sizes widely distributed on the posterior pole of both eyes, as well as subretinal fibrotic change with pigmentation in the right eye. Optical coherence tomography showed extensive hyperreflective deposits beneath the retinal pigment epithelium in both eyes and small amounts of cystic intraretinal fluid in the right eye. Fluorescein angiography and fundus autofluorescence showed the drusen as multiple hyperfluorescent spots, while indocyanine green angiography indicated hypofluorescence corresponding to the drusen. Genetic sequence analysis revealed a pathogenic variant of the EFEMP1 gene, heterozygous c.1033C>T (p.Arg345Trp), which accords with the diagnosis of autosomal dominant drusen. Intravitreal bevacizumab injection was given in the right eye; however, there was no improvement in the amount of intraretinal fluid nor visual acuity. Conclusions Autosomal dominant drusen is a very rare disease. It is necessary to distinguish it from age-related macular degeneration, as the affected age and clinical features of drusen are different, including the response to anti-vascular endothelial growth factor treatment.

Purpose: This study was conducted to identify the types of perception toward quarantine measures at hospitals or community treatment centers among patients infected with COVID-19. Methods: This study applied Q-methodology. Two hundred and nineteen Q populations were constructed based on related literature and in-depth interviews with 5 adults infected with COVID-19 and who experienced quarantine and hospitalization. Interviews were performed from November 14 to 29, 2020. A total of 45 Q samples were extracted and Q sorting was performed using a 9-point scale for 30 adult subjects who experienced quarantine at hospitals and community treatment centers. The data were analyzed using the PC-QUANL program. Results: The perception of subjects toward quarantine measures was classified into the following six types: ‘passive acceptance’, ‘social stigma perception’, ‘appreciation of daily life through awareness of the realities of illness’, ‘why me?’, ‘fearful perception’, and ‘positive meaning’. Conclusion The perception of quarantine measure among patients with COVID-19 is identified as six types with positive and negative emotional characteristics. This result will contribute to the development of individualized strategies to address psychosocial health problems among patients with infectious diseases.

Purpose: To develop a deep learning model that can predict the axial lengths of eyes using ultra-widefield (UWF) fundus photography. Methods: We retrospectively enrolled patients who visited the ophthalmology clinic at the Seoul National University Hospital between September 2018 and December 2021. Patients with axial length measurements and UWF images taken within 3 months of axial length measurement were included in the study. The dataset was divided into a development set and a test set at an 8:2 ratio while maintaining an equal distribution of axial lengths (stratified splitting with binning). We used transfer learning-based on EfficientNet B3 to develop the model. We evaluated the model’s performance using mean absolute error (MAE), R-squared (R2), and 95% confidence intervals (CIs). We used vanilla gradient saliency maps to illustrate the regions predominantly used by convolutional neural network. Results: In total, 8,657 UWF retinal fundus images from 3,829 patients (mean age, 63.98 ±15.25 years) were included in the study. The deep learning model predicted the axial lengths of the test dataset with MAE and R2 values of 0.744 mm (95% CI, 0.709–0.779 mm) and 0.815 (95% CI, 0.785–0.840), respectively. The model’s accuracy was 73.7%, 95.9%, and 99.2% in prediction, with error margins of ±1.0, ±2.0, and ±3.0 mm, respectively. Conclusions We developed a deep learning-based model for predicting the axial length from UWF images with good performance.

In the article, “A Validation Study of a Multiple Reaction Monitoring-Based Proteomic Assay to Diagnose Breast Cancer” in Volume 22(4), page 579-586 was error in the table. In Table 1, the value of pN0 was incorrectly listed as 29 (56.9) in ‘diagnosed as normal by biomarker’ and corrected to 39 (76.5). The authors apologize for any inconvenience that this may have caused.

OBJECTIVES: The potential association between choline acetyltransferase(CHAT) polymorphism and the risk of mild cognitive impairment(MCI) has not been investigated in Korea. We examined the main effect of CHAT polymorphism and its interaction with apolipoprotein E(APOE) polymorphism in the development of MCI in elderly Korean sample. METHODS: We analyzed CHAT 2384G > A polymorphism and APOE polymorphism among 149 MCI subjects with MCI and 298 normal controls. We tested the association between MCI and CHAT A allele status using a logistic regression model. In addition, we employed generalized multifactor dimensionality reduction(GMDR) to investigate the interaction between CHAT and APOE with regard to the risk of MCI. RESULTS: The CHAT A allele was associated with AD risk(OR = 1.59, 95% CI = 1.02-2.48, p = 0.042). No significant gene-gene interaction between CHAT and APOE was found in GMDR method(testing balanced accuracy = 0.540, p = 0.055). CONCLUSION: The CHAT A allele was associated with MCI risk in the Korean elderly. Its interaction with the APOE epsilon4 allele was not significant with regard to the development of MCI.
Aged ; Alleles ; Apolipoproteins ; Apolipoproteins E ; Choline ; Choline O-Acetyltransferase ; Humans ; Korea ; Logistic Models ; Mild Cognitive Impairment

BACKGROUND: Hemoglobin dilution occurs after acute blood loss, by shifting extravascular blood components into the intravascular space, providing the theoretical possible to calculate amount of blood loss by comparing this difference.Assessing blood loss during the operative procedure is crucial to provide appropriate treatment, however there are few objective standards by which to make this assessment.In this study, we used the hemoglobin dilution method to predict blood loss following an operative procedure. METHODS: During the year 2007, 96 patients who had undergone lumbar spinal fusion surgery were enrolled in this study.On a retrospective basis, we investigated the weight, height, intraoperative blood loss, hemoglobin change, and the amount of transfused erythrocytes by reviewing anesthetic notes from the surgery. On the basis of these data, we calculated estimated blood loss by using Nadler's formula. RESULTS: The majority of study participants were female and average age was 60.1 yrs.We observed 2.3 g/dl decrement of postoperative hemoglobin, and estimated blood volume was 3,599 ml. Estimated blood loss was 853.7 ml, and observed blood loss was 1,070 ml, thus creating 217.1 ml difference.Analysis showed a moderate degree of correlation between observed and estimated values and a correlation coefficient of 0.49. We obtained regression equations of y = 0.828x + 363.5. CONCLUSIONS: Estimated blood loss was underestimated compared to observed values, by 20%, and this discrepancy is was attributed to ethnic differences. To predict a precise estimated blood loss, attempts to make a modified formula targeted to the Korean population are required.
Blood Volume ; Erythrocytes ; Female ; Hemodilution ; Hemoglobins ; Hemorrhage ; Humans ; Retrospective Studies ; Spinal Fusion ; Surgical Procedures, Operative