Behcet's disease (BD) involves multisystem vasculitis of unknown origin. Ocular manifestations of BD mostly include bilateral panuveitis and retinal vasculitis, which are very challenging to treat. Interferon alfa-2a (IFN) has been recently introduced for treating refractory Behcet uveitis, mainly in Germany and Turkey. Nonetheless, there is so far no consensus about the ideal treatment regimen of IFN for Behcet uveitis. We report our experience of IFN treatment in five Korean BD patients with refractory uveitis. All patients complained of oral ulcers; one patient had a positive pathergy test and 2 showed the presence of HLA-B51. Immunosuppressive agents used prior to IFN treatment included cyclosporine and methotrexate. The IFN treatment was commenced with a dose of 6-9 MIU/day for 7 days, adjusted according to individual ocular manifestations, tapered down to 3 MIU three times in a week, and then discontinued. All patients showed positive response to IFN treatment; 50% of them showed complete response without additional major ocular inflammation during the follow-up period. Other BD symptoms also improved after IFN treatment in most cases. After treatment, the relapse rate and the required dose of oral corticosteroid were decreased in most cases, showing a significant steroid-sparing effect. However, the visual acuity was not improved in most cases due to irreversible macular sequelae. Despite the small sample size of this study, we suggest that, in Korean patients, IFN is an effective treatment modality for BD uveitis as was observed in German and Turkish patients.
Adult ; Behcet Syndrome/complications/diagnosis/*drug therapy ; Chronic Disease ; Cyclosporine/therapeutic use ; Female ; Humans ; Immunosuppressive Agents/administration & dosage ; Interferon-alpha/*therapeutic use ; Male ; Recombinant Proteins/therapeutic use ; Recurrence ; Remission Induction ; Treatment Outcome ; Turkey ; Uveitis/diagnosis/*drug therapy/etiology ; Visual Acuity

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PURPOSE: The diagnosis-related group (DRG) system has been adapted to reduce overall medical costs by grouping and classifying relatively homogenous patients based on similar resource consumption patterns in the treatment. However, despite its wide range of disease manifestation from early inflammation to severe peritonitis, acute appendicitis is included in the DRG system. Responding to a need to assess the DRG system for patients diagnosed with appendicitis, this study evaluates the efficacy of the current DRG system applied to a broad spectrum of the patients with appendicitis undergoing laparoscopic appendectomy. METHODS: A retrospective review was conducted of the patients who underwent laparoscopic appendectomy. Based on the DRG codes' classification, the patients were analyzed for the amount of DRG reimbursement and the total in-patient cost in relation to the time sequence of the disease onset. Statistical analysis was performed to find factors correlated with the DRG reimbursement and total in-patient cost. RESULTS: Findings indicate that, as the symptom duration becomes prolonged, the CRP level and the use of peritoneal drainage increased. Patients with a symptom duration greater than 24 hours required approximately 5 days of hospital stay, 0.5 day longer in the length of hospital stay than that of patients with less than 12 hours of the onset time. As expected, the amount of DRG reimbursement and the total in-patient cost accumulated as the symptom duration increased. CONCLUSION: The current DRG reimbursement system for the patients undergoing laparoscopic appendectomy recompenses a broad spectrum of patients diagnosed with appendicitis effectively.
Appendectomy* ; Appendicitis ; Classification ; Diagnosis-Related Groups* ; Drainage ; Humans ; Inflammation ; Korea ; Laparoscopy ; Length of Stay ; Peritonitis ; Retrospective Studies ; Severity of Illness Index

Purpose: To investigate the clinical results of vitrectomy alone as the primary treatment for rhegmatogenous retinal detachment (RD) in patients with atopic dermatitis (AD). Methods: The medical records of patients with AD treated for rhegmatogenous retinal detachment (RD) were retrospectively reviewed. We investigated the characteristics of retinal breaks and detachments, applied surgical methods, and results. Results: Twenty eyes of 14 patients with AD who presented with rhegmatogenous RD and treated by vitrectomy were included in this analysis. Sixteen eyes (80%) were treated with vitrectomy, either alone or in combination with cataract surgery, and the retina was successfully attached to 94% of the eyes. There were four cases in which vitrectomy was combined with encircling. Reoperation was needed in half of the eyes that received vitrectomy with encircling, which presented nearly total detachment, severe proliferative vitreoretinopathy, and pseudophakia. Conclusions Vitrectomy alone, in combination with cataract surgery, may be sufficient to treat rhegmatogenous RD in patients with AD. Additional encircling or buckling should still be considered in complicated cases.

We performed a retrospective cohort study including people diagnosed with diabetes from 2006 to 2015 according to the Korean National Health Insurance Service-National Sample Cohort database, to analyze the changes in the prevalence, screening rate, and treatment patterns for diabetic retinopathy (DR) over 10 years. The proportion of people who underwent fundus screening for DR steadily increased over the past decade. The prevalence of DR increased from 13.4% in 2006 to 15.9% in 2015, while that of proliferative DR steadily decreased from 1.29% in 2006 to 1.16% in 2015. The proportion of patients undergoing retinal photocoagulation constantly decreased. The prevalence of DR increased over the past decade, while its severity seemed to have improved, with a decreased rate of proliferative DR and retinal photocoagulation. A higher proportion of patients underwent ophthalmic screening using fundus examination, but still less than 30% of patients with diabetes underwent comprehensive examination in 2015.

We performed a retrospective cohort study including people diagnosed with diabetes from 2006 to 2015 according to the Korean National Health Insurance Service-National Sample Cohort database, to analyze the changes in the prevalence, screening rate, and treatment patterns for diabetic retinopathy (DR) over 10 years. The proportion of people who underwent fundus screening for DR steadily increased over the past decade. The prevalence of DR increased from 13.4% in 2006 to 15.9% in 2015, while that of proliferative DR steadily decreased from 1.29% in 2006 to 1.16% in 2015. The proportion of patients undergoing retinal photocoagulation constantly decreased. The prevalence of DR increased over the past decade, while its severity seemed to have improved, with a decreased rate of proliferative DR and retinal photocoagulation. A higher proportion of patients underwent ophthalmic screening using fundus examination, but still less than 30% of patients with diabetes underwent comprehensive examination in 2015.

PURPOSE: We report a case of branch retinal artery occlusion (BRAO) in a healthy pregnant woman. METHODS: A 29-year-old pregnant woman presented with decreased vision in her left eye. She had a pale retina with macular edema consistent with BRAO. An extensive workup was performed to determine an etiologic factor. All test results were within normal limits except for her factor VIII activity. Her visual acuity improved from finger counting to 20/30 over 2 months without any treatment. RESULTS: This case suggests that BRAO can occur in healthy patients without any systemic or ocular disorders. CONCLUSIONS: BRAO can occur in healthy patients without any systemic or ocular disorders, despite an extensile evaluation.
Adult ; Factor VIII/analysis ; Female ; Humans ; Macular Edema/etiology ; Pregnancy ; *Pregnancy Complications, Hematologic ; Retinal Artery Occlusion/*etiology ; Vision Disorders/etiology

PURPOSE: We report a case of branch retinal artery occlusion (BRAO) in a healthy pregnant woman. METHODS: A 29-year-old pregnant woman presented with decreased vision in her left eye. She had a pale retina with macular edema consistent with BRAO. An extensive workup was performed to determine an etiologic factor. All test results were within normal limits except for her factor VIII activity. Her visual acuity improved from finger counting to 20/30 over 2 months without any treatment. RESULTS: This case suggests that BRAO can occur in healthy patients without any systemic or ocular disorders. CONCLUSIONS: BRAO can occur in healthy patients without any systemic or ocular disorders, despite an extensile evaluation.
Adult ; Factor VIII/analysis ; Female ; Humans ; Macular Edema/etiology ; Pregnancy ; *Pregnancy Complications, Hematologic ; Retinal Artery Occlusion/*etiology ; Vision Disorders/etiology

PURPOSE: To analyze stereoacuity in patients with strabismus using various stereotests. METHODS: Stereoacuity was assessed in children who were diagnosed with intermittent exotropia or refractive accommodative esotropia using the Titmus stereotest, TNO stereotest, and the Lang II stereotest. Patients with amblyopia or previous ocular surgery were excluded. RESULTS: Ninety-four patients with intermittent exotropia and 36 patients with refractive accommodative esotropia were included; the mean age was 7.2 years. The mean stereoacuity in intermittent exotropia was 143.1+/-207.9 seconds of arc with the Titmus stereotest, 130.2+/-103.7 seconds of arc with the TNO stereotest, and 200.0+/-0.0 seconds of arc with the Lang II stereotest. The mean stereoacuity in refractive accommodative esotropia was 430.3+/-288.6 seconds of arc, 232.5+/-90.0 seconds of arc, and 230.0+/-97.9 seconds of arc, respectively. The absence of stereoacuity was more frequent in patients with refractive accommodative esotropia than in patients with intermittent exotropia, and both groups of patients showed the largest proportion of absent stereopsis with the TNO stereotest. No factor was significant for stereopsis in patients with intermittent exotropia and patients with refractive accommodative esotropia. CONCLUSIONS: Stereoacuity showed various seconds of arc according to the type of stereotest in the same patient. Patients with refractive accommodative esotropia showed lower stereoacuity in all stereotests than patients with intermittent exotropia. TNO stereotests are sensitive enough to detect the absence of stereopsis in patients with strabismus.
Amblyopia ; Child ; Depth Perception ; Esotropia ; Exotropia ; Humans ; Strabismus

PURPOSE: To analyze ocular manifestations of herpes zoster ophthalmicus and evaluate risk factors and complications affecting visual acuity. METHODS: Ocular, cutaneous, and systemic findings were analyzed retrospectively from the medical records of 81 patients, admitted between 1994 and 2007, to the dermatology department of our hospital for the management of herpes zoster ophthalmicus. RESULTS: Herpes zoster ophthalmicus was manifested as eyelid eruption (93%), conjunctivitis (80%), keratitis (67%), iridocyclitis (36%), secondary glaucoma (20%), or extraocular muscle palsy (1%). Some patients had accompanying systemic illnesses, including malignancy, hepatitis, diabetes mellitus, chronic obstructive pulmonary disease, tuberculosis, and cerebrovascular disease. Patients with decreased vision during the follow-up period were statistically more likely to have presented with keratitis (p=0.032). However, 86% of these patients recovered vision over a 6-month period. CONCLUSIONS: Patients presenting with keratitis upon initial evaluation are at risk for decreased vision and require appropriate ophthalmic evaluation and management.
Conjunctivitis ; Dermatology ; Diabetes Mellitus ; Eyelids ; Follow-Up Studies ; Glaucoma ; Hepatitis ; Herpes Zoster ; Herpes Zoster Ophthalmicus ; Humans ; Iridocyclitis ; Keratitis ; Medical Records ; Muscles ; Paralysis ; Pulmonary Disease, Chronic Obstructive ; Retrospective Studies ; Risk Factors ; Tuberculosis ; Vision, Ocular ; Visual Acuity