A 74-year-old man presented with pain and progressively worsening vision from 20 days ago in the left eye. His ophthalmological history was significant for cataract extraction, scleromalacia, and three surgeries for pterygium removal in the left eye. Slit-lamp examination was remarkable for a 4.5×4.0 mm sized epithelial defect, with corneal stromal infiltration and melting and a surrounding feathery margin. Corneal scraping was performed, and culture of specimen demonstrated mold that grew on Sabouraud dextrose agar. The isolate was finally identified as Corynespora cassiicola based on DNA sequencing analysis of internal transcribed spacer (ITS) with maximum identity of 100%. The patient was treated successfully with intracameral amphotericin B injection and topical voriconazole and amphotericin B. To the best of our knowledge, this is the first reported case of mycotic keratitis caused by a plant pathogen, Corynespora cassiicola, in Korea.

Purpose: We evaluated the use of three criteria to determine the need for additional treatment of cystic thyroid nodules after their recurrence following ethanol ablation (EA). Methods: In total, 154 patients (male:female=30:124; mean age, 53.4 years; range, 23 to 79 years) with 154 thyroid nodules (49 cystic and 105 predominantly cystic nodules) who presented between January 2014 and August 2017 were enrolled. All patients underwent follow-up ultrasonography (US) 1 month after EA, and were divided into therapeutic success and failure groups. Therapeutic success was defined as the absence of any residual fluid or sufficient volume reduction (≥50%) with improvement of nodule-related symptoms. The therapeutic failure was defined according to three previously suggested criteria for recommending additional treatment: nodules with ≥1 mL of remnant fluid (criterion 1), volume reduction <50% (criterion 2), and demonstration of a solid component with vascularity (criterion 3). Results: Thyroid nodules treated by EA showed significant volume reduction (18.4±21.6 mL to 4.2±6.5 mL [1-month follow-up] to 1.9±3.3 mL [final follow-up], P<0.001) and improvement in clinical problems. Therapeutic failure were 26 patients according to criteria 1, 14 patients according to criteria 2, and 35 patients according to criteria 3. Additional treatment was unnecessary in 81.3%, 70.0%, and 77.8% of patients deemed to need it according to criteria 1, 2, and 3, respectively. Conclusion The choice to perform additional treatment after EA should be made according to a combination of clinical problems and US features. Understanding this concept will be useful in planning further treatment following US-guided EA.

PURPOSE: In the present study, a case of IgG4-related ophthalmic disease which met the 2015 IgG4-related ophthalmic disease diagnostic criteria is reported and literature review performed. CASE SUMMARY: A 51-year-old female presented with both upper eyelid swelling, redness, and a palpable mass. Eye movements were normal and exophthalmos was not observed. Facial computed tomography showed both lacrimal gland hypertrophy. The patient underwent left anterior orbitotomy with incisional biopsy. Immunostained biopsy showed the ratio of IgG4+ to IgG+ cells was 50% and the mean number of IgG4-positive plasma cells was approximately 150 per high-power field. Hematological examination showed elevated serum IgG4 concentrations of 6,930 mg/dL, however, other organs were not involved. The patient satisfied the diagnostic criteria for IgG4-related ophthalmic disease. The patient was given an oral steroid and immunosuppressant and the symptoms improved. CONCLUSIONS: IgG4-related ophthalmic disease is currently receiving increased attention. The authors of the present study report a case of IgG4-related ophthalmic disease which met the 2015 IgG4-related ophthalmic disease diagnostic criteria.
Biopsy ; Exophthalmos ; Eye Movements ; Eyelids ; Female ; Humans ; Hypertrophy ; Immunoglobulin G ; Lacrimal Apparatus ; Middle Aged ; Plasma Cells

PURPOSE: Superior oblique myokymia is intermittent spontaneous contractions of the superior oblique muscle presenting as rapid and small-amplitude intorsions and depressions of the eye. The authors report a case of superior oblique myokymia that was objectively and quantitatively diagnosed with slit lamp examination and video-oculography and completely resolved with medical treatment. CASE SUMMARY: A 44-year-old woman presented with a seven-year history of intermittent oscillopsia which continued for few seconds. She had no history of head trauma or systemic ocular disease, and the anterior segment and fundus examination were unremarkable. Right eye intorsion lasting for a few seconds as detected by slit lamp examination. Eye movements were recorded using video-oculography, which showed a torsional nystagmus of 5 to 10 degrees with 2 to 5 vertical components in the right eye. Based on these findings, the patient was diagnosed with superior oblique myokymia. The patient was prescribed topical timolol ophthalmic solution, one drop twice per day, but the symptoms persisted. Timolol ophthalmic solution was stopped and replaced with carbamazepine, 200 mg twice a day, which resolved her symptoms. CONCLUSIONS: Slit lamp examination and video-oculography can be used as objective and quantitative diagnostic tools in order to confirmed a diagnosis and lead to proper treatment.
Adult ; Carbamazepine ; Craniocerebral Trauma ; Depression ; Diagnosis* ; Eye Movements ; Female ; Humans ; Slit Lamp ; Timolol ; Trochlear Nerve Diseases*

PURPOSE: To analyze the Paecilomyces keratitis cases in Korea and compare cases from foreign literature. METHODS: The records of 3 patients diagnosed with Paecilomyces keratitis at our hospital and other reported cases in Korea were evaluated to examine the predisposing factors, clinical aspects, antifungal therapy, therapeutic surgery, and visual outcome and compared with previously reported foreign cases. RESULTS: In Korea, 1 patient was female, 4 patients were male and had predisposing factors including prior corneal trauma or surgery, except 1 spontaneous occurrence. All 5 eyes of 5 patients had poor initial visual acuity, less than finger count, and deep corneal infiltration. The patients were treated with multiple topical and systemic antifungal treatments such as intracameral or intrastromal voriconazole injections and required evisceration and penetrating keratoplasty. However, the final outcomes were unsatisfactory. Previously reported cases from foreign literature also had predisposing factors such as corneal surgery, trauma, and soft contact lens use. They were resistant to antifungal therapy and eventually led to surgeries such as penetrating keratoplasty and the final outcomes were poor. CONCLUSIONS: Frequently, Paecilomyces keratitis has direct risk factors and is resistant to many topical and systemic antifungal agents. In the majority of cases, therapeutic surgery was required and the final visual outcomes were poor. When Paecilomyces keratitis is suspected, we suggest aggressive therapy including intracameral and intravitreal injections of voriconazole in the initial treatment.
Antifungal Agents ; Causality ; Contact Lenses, Hydrophilic ; Corneal Ulcer ; Female ; Fingers ; Humans ; Intravitreal Injections ; Keratitis* ; Keratoplasty, Penetrating ; Korea* ; Male ; Paecilomyces* ; Risk Factors ; Visual Acuity

PURPOSE: To evaluate the effect of oral spironolactone for non-resolving chronic central serous chorioretinopathy after intravitreal bevacizumab injection.METHODS: Seventeen eyes of 17 patients with non-resolving chronic central serous chorioretinopathy after intravitreal bevacizumab injection from September 2017 to December 2018 were treated with oral spironolactone for 6 months, and changes in central macular thickness, subretinal fluid height, and best-corrected visual acuity (BCVA) were analyzed retrospectively.RESULTS: The central macular thickness decreased from 309.94 ± 105.20 µm at baseline to 259.76 ± 81.83 µm at 3 months, and 243.11 ± 61.98 µm at 6 months, which were both statistically significant (Wilcoxon signed-rank test, p = 0.016 and p = 0.001, respectively). The subretinal fluid height decreased from 138.05 ± 95.69 µm at baseline to 70.88 ± 83.13 µm at 3 months, and 54.00 ± 56.25 µm at 6 months, which were both statistically significant (Wilcoxon signed-rank test, p = 0.002 and p = 0.000, respectively). The BCVA (LogMAR) changed from 0.30 ± 0.38 at baseline to 0.35 ± 0.43 at 1 month, 0.29 ± 0.43 at 3 months, and 0.26 ± 0.40 at 6 months. The results at 6 months were statistically significant (Wilcoxon signed-rank test, p = 0.033). There were no side effects in patients treated with oral spironolactone.CONCLUSIONS: In chronic central serous chorioretinopathy, treatment with oral spironolactone significantly reduced the central macular thickness, subretinal fluid height, and the BCVA, without side effects.

PURPOSE: The purpose of this study was to investigate the effect of bilateral medial rectus muscle resection on the treatment of recurrent intermittent exotropia. METHODS: A retrospective chart analysis was conducted for 25 patients who underwent bilateral medial rectus resection for recurrent exotropia over 20 prism diopters (PD) between January 2009 and August 2015. The medial rectus was resected from 4.0 to 6.5 mm by 0.5 mm according to the deviation angle. The postoperative angle of deviation was checked at 1 day, 1 week, 3 months, 6 months, and 1 year postoperatively to investigate the amount of corrected deviation per resected muscle. RESULTS: The average preoperative deviation angle was 27.20 ± 5.02 PD exodeviation and the mean resection was 5.10 ± 0.79 mm of the medial rectus. The postoperative angle deviation was 10.68 ± 5.50 PD esodeviation at 1 day. The incidence of esodeviation tended to decrease over time. At 1 year, the postoperative angle deviation was 1.16 ± 7.54 PD esodeviation. The overcorrection rate was 84% at 1 day postoperatively but decreased to 24% at 1 year with a success rate of 68%. The corrected deviation angle per millimeter was 7.53 ± 1.22, 7.75 ± 2.16, 6.27 ± 1.74, 5.50 ± 1.54, and 5.56 ± 1.58 PD/mm at 1 day, 1 week, 3 months, 6 months, and 1 year after surgery, respectively. The dose effect per millimeter decreased over time. The corrected deviated angle per millimeter remained constant regardless of the amount of medial rectus muscle resection at 1 year postoperatively(p=0.939). CONCLUSIONS: Bilateral medial rectus resection for recurrent exotropia over 20 PD tended to overcorrect at first; however, after 1 year, the mean angle of deviation was 1.16 ± 7.54 PD esodeviation. Bilateral medial rectus resection is an effective surgical method for the treatment of recurrent exotropia over 20 PD.
Esotropia ; Exotropia ; Humans ; Incidence ; Methods ; Retrospective Studies

Objective: Thyroidectomy bed lesions frequently show suspicious ultrasound (US) features after thyroid surgery. Fine-needle aspiration (FNA) may not provide definitive pathological information about the lesions. Although core-needle biopsy (CNB) has excellent diagnostic performance in characterizing suspicious thyroid nodules, no published studies have evaluated the performance of CNB specifically for thyroidectomy bed lesions. Therefore, we aimed to evaluate the diagnostic performance and safety of CNB for characterizing thyroidectomy bed lesions. Materials and Methods: A total of 124 thyroidectomy bed lesions in 113 patients (79 female and 34 male; age, 23–85 years) who underwent US-guided CNB between December 2008 and December 2020 were included. We reviewed the US imaging features of the target lesions and the histories of previous biopsies. The pathologic results, diagnostic performance for malignancy, and complications of CNB were analyzed. Results: All samples (100%) obtained by CNB were adequate for pathological analysis. Pathological analysis revealed inconclusive results in two lesions (1.6%). According to the reference standard, 50 lesions were ultimately malignant (40.3%), and 72 were benign (58.1%), excluding the two inconclusive lesions. The performance of CNB for diagnosing malignant thyroidectomy bed lesions in the 122 lesions had a sensitivity of 98.0% (49/50), a specificity of 100% (72/72), positive predictive value of 100% (49/49), and negative predictive value of 98.6% (72/73). Eleven lesions were referred for CNB after prior inconclusive FNA results in thyroidectomy bed lesions, for all of which CNB yielded correct conclusive pathologic diagnoses. According to the pathological analysis of CNB, there were various benign lesions (58.9%, 73/124) besides recurrence, including benign postoperative lesions other than suture granuloma (32.3%, 40/124), suture granuloma (15.3%, 19/124), remnant thyroid tissue (5.6%, 7/124), parathyroid lesions (4%, 5/124), and abscesses (1.6%, 2/124). No major or minor complications were associated with the CNB procedure. Conclusion US-guided CNB is accurate and safe for characterizing thyroidectomy bed lesions.

Objective: Preoperative differentiation between inverted papilloma (IP) and its malignant transformation to squamous cell carcinoma (IP-SCC) is critical for patient management. We aimed to determine the diagnostic accuracy of conventional imaging features and histogram parameters obtained from whole tumor apparent diffusion coefficient (ADC) values to predict IP-SCC in patients with IP, using decision tree analysis. Materials and Methods: In this retrospective study, we analyzed data generated from the records of 180 consecutive patients with histopathologically diagnosed IP or IP-SCC who underwent head and neck magnetic resonance imaging, including diffusion-weighted imaging and 62 patients were included in the study. To obtain whole tumor ADC values, the region of interest was placed to cover the entire volume of the tumor. Classification and regression tree analyses were performed to determine the most significant predictors of IP-SCC among multiple covariates. The final tree was selected by cross-validation pruning based on minimal error. Results: Of 62 patients with IP, 21 (34%) had IP-SCC. The decision tree analysis revealed that the loss of convoluted cerebriform pattern and the 20th percentile cutoff of ADC were the most significant predictors of IP-SCC. With these decision trees, the sensitivity, specificity, accuracy, and C-statistics were 86% (18 out of 21; 95% confidence interval [CI], 65–95%), 100% (41 out of 41; 95% CI, 91–100%), 95% (59 out of 61; 95% CI, 87–98%), and 0.966 (95% CI, 0.912–1.000), respectively. Conclusion Decision tree analysis using conventional imaging features and histogram analysis of whole volume ADC could predict IP-SCC in patients with IP with high diagnostic accuracy.