Purpose: To report a case of late opacification of a hydrophilic acrylic monofocal intraocular lens (IOL) with a hydrophobic surface (CT SPHERIS® 204) after a second vitrectomy in a patient with proliferative diabetic retinopathy.Case summary: A 50-year-old male with diabetes presented with decreased visual acuity in the right eye. He had undergone phacoemulsification and IOL (CT SPHERIS® 204) implantation, vitrectomy, endolaser photocoagulation, and intravitreal bevacizumab (Avastin®) injection due to vitreous hemorrhage in the right eye about 43 months prior. Four months after the surgery, presenting with recurrent vitreous hemorrhage and neovascularization of the angle, he underwent partial vitrectomy and intravitreal and intracameral bevacizumab (Avastin®) injection. The best-corrected visual acuity was 0.1 in the right eye when he presented with decreased visual acuity. Slit lamp examination of the right eye showed diffuse whitish granular opacity on the surface of the IOL. The IOL was explanted, together with the capsular bag, and examined using scanning electron microscopy and energy-dispersive X-ray spectroscopy. Conclusions This case is the first to report late opacification of a hydrophilic, acrylic monofocal IOL with a hydrophobic surface, the CT SPHERIS® 204. It is necessary to be cautious in using this type of lens in patients with diabetic retinopathy.

Purpose: To investigate the clinical outcomes of refixation of a dislocated intraocular lens (IOL) and IOL exchange with intrascleral fixation. Methods: We performed a retrospective study of 90 patients (91 eyes) who underwent refixation or exchange of IOLs from January 2014 to April 2019. The patients were divided into an ab externo scleral refixation group (group 1), an intrascleral refixation group (group 2), and an exchange with intrascleral fixation group (group 3). We evaluated the best-corrected visual acuity (BCVA), spherical equivalent, cylindrical power, intraocular pressure, and postoperative complications. Results: The BCVA was 0.10 ± 0.17 (group 1), 0.15 ± 0.29 (group 2), and 0.31 ± 0.52 (group 3) at 6 months after surgery. The BCVA change in group 3 was significantly greater than that in groups 1 and 2 (p = 0.018 and p = 0.046, respectively). The final BCVA was not significantly different among the groups (p = 0.422). The spherical equivalent was -1.26 ± 1.72 diopters (D) (group 1), -1.32 ± 2.09 D (group 2), and -0.17 ± 1.58 D (group 3) at 6 months after surgery, showing that group 1 and group 2 were more myopic than group 3 (p = 0.004 and p = 0.001, respectively). Haptic slippage was the most common complication. Conclusions Refixation of dislocated IOLs and IOL exchange with intrascleral fixation did not differ significantly in terms of the final visual outcomes. Refixation was associated with more myopia and a higher risk of IOL dislocation or haptic slippage than exchange.

Purpose: To report a case of delayed symptoms after intralenticular dexamethasone implant (Ozurdex ® ; Allergan, Irvine, CA, USA).Case summary: A 65-year-old male was referred for myodesopsia and decreased visual acuity. A dexamethasone implant was located in the crystalline lens, and the lens showed mild nucleus opacity. The patient had been treated with multiple intravitreal injections of anti-vascular endothelial growth factor and had received an injection of dexamethasone implant about seven weeks before symptom onset. Based on the symptoms, phacoemulsification was performed and an intraocular lens was placed within the capsular bag. After surgery, symptoms improved. One month after surgery, as cystoid macular edema worsened, the patient was treated with an intravitreal injection of triamcinolone acetonide (MaQaid ® ; Wakamoto Pharmaceutical Co., Ltd., Tokyo, Japan). After intravitreal injection, cystoid macular edema improved. Conclusions Intralenticular injection of the dexamethasone implant is very rare; however, great care should be taken during the procedure. It should be noted that the onset of symptoms by intralenticular dexamethasone implant may not occur immediately following the procedure. Thus, close follow-up is necessary, with the possibility of surgical intervention depending on visual acuity and underlying complications.

Purpose: To report a case of late opacification of a hydrophilic acrylic monofocal intraocular lens (IOL) with a hydrophobic surface (CT SPHERIS® 204) after a second vitrectomy in a patient with proliferative diabetic retinopathy.Case summary: A 50-year-old male with diabetes presented with decreased visual acuity in the right eye. He had undergone phacoemulsification and IOL (CT SPHERIS® 204) implantation, vitrectomy, endolaser photocoagulation, and intravitreal bevacizumab (Avastin®) injection due to vitreous hemorrhage in the right eye about 43 months prior. Four months after the surgery, presenting with recurrent vitreous hemorrhage and neovascularization of the angle, he underwent partial vitrectomy and intravitreal and intracameral bevacizumab (Avastin®) injection. The best-corrected visual acuity was 0.1 in the right eye when he presented with decreased visual acuity. Slit lamp examination of the right eye showed diffuse whitish granular opacity on the surface of the IOL. The IOL was explanted, together with the capsular bag, and examined using scanning electron microscopy and energy-dispersive X-ray spectroscopy. Conclusions This case is the first to report late opacification of a hydrophilic, acrylic monofocal IOL with a hydrophobic surface, the CT SPHERIS® 204. It is necessary to be cautious in using this type of lens in patients with diabetic retinopathy.

Purpose: To analyze the change in the weekly incidence of epidemic keratoconjunctivitis (EKC) per 1,000 outpatients during the coronavirus disease 2019 (COVID-19) pandemic by comparing the mean weekly proportion of EKC of 2020 with that from 2016 to 2019. Methods: Using data from the Korea Disease Control and Prevention Agency for 2016-2020, we analyzed the weekly proportion of EKC per 1,000 outpatients. The data were also analyzed according to age, semester and vacation periods, region, and social distancing stages. For the Daegu data, we also analyzed the effects of social distancing in an area. Results: The mean weekly proportion of EKC per 1,000 outpatients in 2020 was lower than in previous years for all ages (2016-2019 19.77 ± 7.17‰, 2020 7.28 ± 2.97‰; p < 0.001). During the semester, the mean difference between 2016-2019 and 2020 was significant, particularly for preschool children. In Daegu, the weekly proportion of EKC per 1,000 outpatients during the extra 12-18 weeks of social distancing was significantly lower (2016-2019, 18.78 ± 6.61‰; 2020, 8.94 ± 2.92‰; p < 0.001). Conclusions The public health interventions implemented during the COVID-19 outbreak not only reduced the prevalence of COVID-19 but also reduced the prevalence of EKC. Therefore, maintaining hygiene principles and standard precautions may help prevent EKC.

Purpose: To report the effect of removal of a central descemet membrane on the endothelial function, morphology, and clinical symptoms of eyes with Fuch’s endothelial dystrophy. Methods: From August 2019 to January 2021, patients with Fuch’s endothelial dystrophy, i.e., with confluent, central corneal guttae and cataracts that required surgery, underwent phacoemulsification, intraocular lens implantation, and central descemet membrane stripping. To evaluate the effect of descemet stripping only (DSO), visual acuity and intraocular pressure were measured, and corneal pachymetry, slit-lamp and specular microscopy, and anterior segment optical coherence tomography performed, before surgery and at 1, 7, and 30 days and 3 and 6 months after surgery. Results: Seven patients (10 eyes) were included. Visual acuity improved from 1.01 ± 0.40 logarithm of the minimum angle of resolution (logMAR) preoperatively to 0.33 ± 0.22 logMAR 6 months after surgery (p = 0.008). The mean central corneal thickness decreased from 578.50 ± 36.88 μm preoperatively to 568.50 ± 48.61 μm 6 months after surgery; the difference was not significant (p = 0.507). The endothelial cell count increased significantly from 663.80 ± 356.40/mm2 preoperatively to 1,082.00 ± 274.46/mm2 6 months after surgery (p = 0.043). Conclusions DSO can serve as a useful alternative when corneal transplantation is not possible in patients with Fuch’s endothelial dystrophy, but treatment efficacy and safety require further evaluation.

BACKGROUND: Not much is known about the role of gastric microbiota except for Helicobacter pylori in human health and disease. In this study, we aimed to detect human gastric microbiota in both gastric mucosa and gastric juice by barcoded 454-pyrosequencing of the 16S rRNA gene and to compare the results from mucosa and juice. METHODS: Gastric biopsies and stomach juices were collected from 4 subjects who underwent standard endoscopy at Seoul National University Bundang Hospital. Gastric microbiota of antral mucosa, corpus mucosa samples, and gastric fluids were analyzed by barcoded 454-pyrosequencing of the 16S rRNA gene. The analysis focused on bacteria, such as H. pylori and nitrosating or nitrate-reducing bacteria. RESULTS: Gastric fluid samples showed higher diversity compared to that of gastric mucosa samples. The mean of operational taxonomic units was higher in gastric fluid than in gastric mucosa. The samples of gastric fluid and gastric mucosa showed different composition of phyla. The composition of H. pylori and Proteobacteria was higher in mucosa samples compared to gastric fluid samples (H. pylori, 66.5% vs. 3.3%, P = 0.033; Proteobacteria, 75.4% vs. 26.3%, P = 0.041), while Actinobacteria, Bacteroidetes, and Firmicutes were proportioned relatively less in mucosa samples than gastric fluid. However there was no significant difference. (Actinobacteria, 3.5% vs. 20.2%, P = 0.312; Bacteroidetes, 6.0% vs. 14.8%, P = 0.329; Firmicutes, 12.8% vs. 33.4%, P = 0.246). CONCLUSIONS: Even though these samples were small, gastric mucosa could be more effective than gastric fluid in the detection of meaningful gastric microbiota by pyrosequencing.
Actinobacteria ; Bacteria ; Bacteroidetes ; Biopsy ; Endoscopy ; Gastric Juice* ; Gastric Mucosa ; Genes, rRNA ; Helicobacter pylori ; Humans ; Microbiota* ; Mucous Membrane* ; Proteobacteria ; Seoul ; Stomach

This study was performed to evaluate the effects of diabetes on short- and mid-term clinical outcomes in patients with acute myocardial infarction (AMI). Between October 2005 and December 2009, a total of 22,347 patients with AMI from a nationwide registry was analyzed. At the time point of the day 30 after AMI onset, landmark analyses were performed for the development of major adverse cardiovascular events (MACEs), including death, re-infarction and revascularization. In this cohort, 6,131 patients (27.4%) had diabetes. Short-term MACEs, which occurred within 30 days of AMI onset, were observed in 1,364 patients (6.1%). Among the 30-day survivors (n = 21,604), mid-term MACEs, which occurred between 31 and 365 days after AMI onset, were observed in 1,181 patients (5.4%). After adjustment for potential confounders, diabetes was an independent predictor of mid-term MACEs (HR, 1.25; 95% CI, 1.08-1.45; P = 0.002), but not of short-term MACEs (HR: 1.16; 95% CI: 0.93-1.44; P = 0.167). Diabetes is a poor prognostic factor for mid-term clinical outcomes but not for short-term outcomes in AMI patients. Careful monitoring and intensive care should be considered in diabetic patients, especially following the acute stage of AMI.
Acute Disease ; Aged ; Cardiovascular Diseases/etiology ; Cohort Studies ; Diabetes Mellitus, Type 2/complications/*diagnosis ; Diagnosis, Differential ; Female ; Humans ; Incidence ; Male ; Middle Aged ; Myocardial Infarction/*diagnosis/epidemiology/mortality ; Prognosis ; Proportional Hazards Models ; Registries ; Survival Analysis ; Time Factors

BACKGROUND AND OBJECTIVES: Acute myocardial infarction (AMI) occurring in patients at a young age (40 years or younger) is an uncommon condition and is characterized by multiple cardiovascular risk factors. We analyzed the risk factors of young-aged Korean AMI patients (age of 40 years or younger) and other AMI patients, who were registered in the Korea Acute Myocardial Infarction Registry (KAMIR) for one year. SUBJECTS AND METHODS: In 2006, 8,565 patients (mean age 64.4+/-12.7 years; 5,591 males) were registered in the KAMIR. The patients were divided into two groups: Group I (younger patients < or =40 years; n=261; mean age 35.9+/-4.5 years; 245 males) and Group II (older patients >40 years; n=8,304, mean age 65.4+/-11.8 years; 5,330 males). The clinical and angiographic characteristics and major adverse cardiac events (MACE) were compared for the two groups of patients. RESULTS: The baseline clinical characteristics of gender, age, risk factors (hypertension, smoking, diabetes, familial history) and body weight were different between the two groups (p<0.001). The baseline echocardiographic and laboratory findings of the initial ejection fraction, and the glomerular filtration rate, level of creatine kinase (CK), level of CK-MB isoenzyme, total cholesterol level, triglyceride level, and N-terminal prohormone brain natriuretic peptide (NT-proBNP) level were different between the two groups (p< or =0.001). According to the use of multiple logistic regression analysis, use of thrombolysis [p=0.009, adjusted hazard ratio (aHR)=9.140, 95% confidence interval (CI): 1.727-48.383], a high blood glucose level (p=0.029, aHR=1.008, 95% CI: 1.001-1.016), a low body mass index (<25 kg/m(2), p=0.031, aHR=6.236, 95% CI: 1.183-32.857), and a high CK-MB level and high Thrombolysis in Myocardial Infarction (TIMI) risk score were independent predictors of MACE at 1 year after an AMI in young age patients. Early clinical outcomes were better in Group I than in Group II patients, but one-, six- and twelve-month MACE were not different between the two groups. CONCLUSION: The independent predictors of MACE at 1 year in young age AMI patients were the use of thrombolysis, a high blood glucose level, a low body mass index, a high CK-MB level and a high TIMI risk score. Patients that have had an acute myocardial infarction at a young age have a better early clinical outcome, but the long-term clinical outcomes were not different compared with older patients, and thus long-term intensive medical therapy will be required, even in young AMI patients.
Age of Onset ; Blood Glucose ; Body Mass Index ; Body Weight ; Cholesterol ; Creatine Kinase ; Glomerular Filtration Rate ; Humans ; Korea ; Logistic Models ; Myocardial Infarction ; Natriuretic Peptide, Brain ; Prognosis ; Risk Factors ; Smoke ; Smoking

PURPOSE: As allergic diseases become common and their socio-economic burden increases, the government needs to develop measures to prevent and manage allergic diseases. Gyeonggi-do Atopy Asthma Education Information Center, funded by the Ministry of Health and Welfare, the Korean Center for Disease Control and Gyeonggi-do, was established in October 2011 to carry out the community-based programs for the patients with allergic diseases in Gyeonggi-do. We investigated the demand on learning, preferred topics and the way of learning about allergic diseases from the public health centers in Gyeonggi-do. METHODS: From March to May 2012, 54 administrators from 45 public health centers in Gyeonggi-do answered about their educational demand and preferred way of learning and having information. RESULTS: A total of 52 administrators (96%) from the public health centers answered that they wanted to participate in the education programs on allergic diseases from Gyeonggi-do Atopy Asthma Education Information Center. Forty eight percent of them had learned about allergic diseases at least once previously by lectures, followed by information brochures and by on-line searching. They wanted to learn about an overview of atopic eczema and how to care it, followed by overviews of asthma and allergic rhinitis. They preferred small group seminars with about 10 participants for learning and wanted to have video clips of lectures, followed by booklets for educational materials. CONCLUSION: This research on the educational demand from the public health centers will be useful in planning the future community-based allergy programs and enhancing communication with the administrators in Gyeonggi-do.
Administrative Personnel ; Asthma ; Centers for Disease Control and Prevention (U.S.) ; Dermatitis, Atopic ; Financial Management ; Humans ; Hypersensitivity ; Information Centers ; Learning ; Lectures ; Pamphlets ; Public Health ; Rhinitis ; Rhinitis, Allergic, Perennial