OBJECTIVE: To estimate the predictive value of initial serum B-hCG and progesterone measurement for pregnancy outcome in IVF-ET. METHODS: Serum B-hCG at 11-12th day after embryo transfer and progesterone at 7th day after oocyte aspiration were measured in 48 successful pregnant IVF-ET cases from July 1993 to June 1997. RESULTS: Of 48 cases, 26 cases (54.2%) successfully carried to sustaining gestation and 22 cases (45.8%) failed to sustain gestation. The estimated initial serum B-hCG levels in the normal sustaining pregnancy group (132.28+ 22.42 mlU/ml) were statistical significantly higher than 29.43+8.08 mIU/ml in the failed sustaining pregnancy group (p<0.001), while the estimated initial serum progesterone levels showed no significant differences (p=0.159). In order to determine the predictive values using the Receiver Operator Curve (ROC), an appropriate cutoff value of 38 mIU/ml for initial serum B-hCG was obtained. In IVF-ET pregnancies, the estimated serum B-hCG levels in cases of chemical abortion in failed sustaining pregnancy were significantly lower compared to the normal sustaining pregnancy group (p<0.001). CONCLUSION: The initial serum B-hCG levels at 11 days after embryo transfer could be used to predict the pregnancy outcome in an IVF program. An initial progesterone level acquired on the 7th day after oocyte retrieval is not a useful indicator to predict pregnancy outcome.
Chorionic Gonadotropin* ; Embryo Transfer* ; Embryonic Structures* ; Female ; Humans* ; Oocyte Retrieval ; Pregnancy ; Pregnancy Outcome* ; Pregnancy* ; Progesterone*

PURPOSE: To determine the incidence (1991~1993) and survival rates (1991~2003) of retinoblastoma in Korea. METHODS: Data of all Korean patients diagnosed with retinoblastoma from 1991-1993 were retrospectively collected by the hospital-based national registry based on notifications from physicians who are able to diagnose retinoblastoma. The incidence rate (1991~1993) was calculated per 100,000 childbirths (dividing the number of retinoblastoma patients by the total number of child-births). The survival rate (1991~2003) was calculated using the Kaplan-Meier method, and the differences were evaluated with the logrank and Wilcoxon tests and Cox's proportional hazards model.In addition, the clinical findings and prognostic factors associated with survival rate were analyzed. RESULTS: There were a total of 108 distinct patients diagnosed with retinoblastoma in the registry. The incidence of retinoblastoma in Koreawas 4.99 per 100,000 childbirths, and the survival rate for 13 years (1991-2003) was 77.8%. The survival rate was significantly lower in the population of bilateral retinoblastomapatients, as compared to unilateral retinoblastoma patients. Optic nerve invasion was found to be an independent variable for the reduction of survival rate, although its effects were not significant. CONCLUSIONS: In the present study, the incidence and survival rates of retinoblastoma in Koreawere presented for the first time. The incidence rate was similar to rates reported from other countries. On the other hand, the survival rate was lower than those in European and the United States. In particularly, the survival rate was significantly lower in patients with bilateral retinoblastoma.
Hand ; Humans ; Incidence ; Korea ; Optic Nerve ; Parturition ; Retinoblastoma ; Retrospective Studies ; Survival Rate ; United States

It is important for the diagnosis of Lambert-Eaton myasthenic syndrome (LEMS) to confirm the incremental response at high-rate stimulation or after brief exercise in the repetitive nerve stimulation (RNS) test. Therefore, it may be difficult to diagnose LEMS if the RNS test is normal initially. We report a patient with LEMS whose diagnosis was delayed due to normal RNS findings. We believe that anti-P/Q-type voltage-gated calcium channel antibody testing is crucial in the diagnosis of LEMS.

PURPOSE: To investigate the relationship between vascular endothelial growth factor (VEGF) and the cancer stem cell-vascular niche complex in human retinoblastoma tissue. METHODS: Six human retinoblastoma specimens primarily enucleated for Reese-Ellsworth classification stage 5a were stained to detect cancer stem cell markers, including ABCG2 for the stem cell marker and MCM2 for the neural stem cell marker, as well as to detect VEGF for the angiogenic cytokine. Using immunofluorescence, the expression of these proteins was analyzed, and their relative locations noted. RESULTS: In non-neoplastic retina of tumor-bearing eyes, ABCG2 and MCM2 were sporadically expressed in the ganglion cell layer and the inner nuclear layer, whereas VEGF was sporadically expressed in inner retina where retinal vessels are abundantly distributed. In the tumor, ABCG2 was strongly expressed out of Wintersteiner rosettes, whereas MCM2 and VEGF were strongly stained in the rosettes. Interestingly, the outer portion of the rosettes was positive for MCM2, and the inner portion of the rosettes was positive for VEGF. CONCLUSIONS: Our data demonstrated that MCM2 and VEGF are strongly expressed in the rosettes of the tumor, which were far from the area of ABCG2-positive cells. Although VEGF might not directly contribute to the cancer stem cell-vascular niche complex, it could play some role in the differentiation of tumor cells to build up the rosettes.
ATP-Binding Cassette Transporters/metabolism ; Biological Markers/*metabolism ; Cell Cycle Proteins/metabolism ; Fluorescent Antibody Technique ; Humans ; Neoplasm Proteins/metabolism ; Nuclear Proteins/metabolism ; Organ Specificity ; Retina/metabolism ; Retinal Neoplasms/*metabolism ; Retinoblastoma/*metabolism ; Stem Cells/*metabolism ; Vascular Endothelial Growth Factor A/*metabolism

PURPOSE: To assess the long-term anatomic and visual outcomes and associated complications of lens-sparing vitrectomy (LSV) in infants with progressive posterior-type tractional retinal detachment (TRD) associated with stage 4A retinopathy of prematurity (ROP). METHODS: In a retrospective case series, the medical records of consecutive patients who presented with progressive posterior-type stage 4A ROP and underwent LSV between 1999 and 2007 were reviewed. Retinal attachment status, visual acuity, and development of postoperative complications were assessed. RESULTS: Eleven eyes of 9 patients were included. The mean follow-up period was 4.6 years. In 8 eyes (73%), plus disease was present at the time of LSV. In 3 eyes (27%), 2 (66%) without plus disease and 1 (13%) with plus disease, the retina remained reattached in the end, while 8 eyes (73%) had TRD on final examination. Two eyes with reattached retinas showed favorable visual acuity. In those eyes with detached retinas, 5 (68%) showed no light perception. When surgery for ROP was unsuccessful, development of cataract, corneal opacity, or glaucoma was common. CONCLUSIONS: The long-term anatomic success rate of LSV for progressive posterior-type stage 4A ROP was low, especially in the presence of plus disease at the time of LSV. Anatomical reattachment is very important for preventing complications and gaining better visual outcomes.
Disease Progression ; Female ; Humans ; Infant ; Infant, Newborn ; Male ; Postoperative Complications/epidemiology ; Retinal Detachment/epidemiology ; Retinopathy of Prematurity/*surgery ; Retrospective Studies ; Treatment Outcome ; Visual Acuity ; Vitrectomy/*methods

Retinopathy of prematurity (ROP) is a major cause of blindness that affects premature infants. With advances in neonatology, ROP is likely to emerge as the most serious problem of vision loss in children even in developed countries; such a situation could be called the third epidemic of ROP. However, controversy and uncertainty still surround favorable outcomes of ROP. For successfully controlling ROP, timely and accurate screening is crucial because early treatment leads to favorable outcomes. Standard guidelines, including ROP classification, have provided satisfactory instructions for the screening and treatment of ROP. To improve the structural and functional outcomes of ROP, optimizing the timing of surgical interventions including cryotherapy, laser-photocoagulation, encircling, and vitrectomy is essential; these interventions can prevent the sequelae of ROP. It is essential for the neonatologist and the ophthalmologist to cooperate exte nsively for the successful treatment of ROP.
Blindness ; Child ; Cryotherapy ; Diterpenes ; Humans ; Infant, Newborn ; Infant, Premature ; Mass Screening ; Neonatology ; Prognosis ; Retinopathy of Prematurity ; Uncertainty ; Vision, Ocular ; Vitrectomy

PURPOSE: To report a case of laser photocoagulation treatment for the patient of Coats' disease accompanying a retinal macrocyst. CASE SUMMARY: A three-year-old boy visited the hospital whose chief complaint was visual acuity decrease of his left eye. Fundus examination showed macular scar, foveal hard exudates and inferior retinal cystic lesion in his left eye. Two months later, examination under anesthesia (EUA) and fluorescein angiography (FAG) was performed. The results revealed inferior retinal macrocyst, nasal avascular retina and telangiectasia around the retinal macrocyst. Laser photocoagulation was performed around the retinal macrocyst and at the nasal avascular retina. One year after the laser photocoagulation, retinal macrocyst did not further progress and the retina was stabilized. CONCLUSIONS: Laser photocoagulation was done around the retinal macrocyst and at the nasal avascular retina of the Coats' disease accompanying a retinal macrocyst and the lesions did not further progress and the retina was stabilized.
Anesthesia ; Cicatrix ; Exudates and Transudates ; Eye ; Fluorescein Angiography ; Humans ; Light Coagulation ; Retina ; Retinaldehyde ; Telangiectasis ; Visual Acuity

PURPOSE: To evaluate clinical characteristics of posterior lenticonus associated with pediatric cataracts and to identify the factors associated with final visual acuities after cataract surgery. METHODS: Thirty-eight patients (46 eyes) who were diagnosed with posterior lenticonus preoperatively or during the operation were involved in this study. We investigated the age at diagnosis, the severity of lens opacity, the pre- and postoperative best corrected visual acuity, and the effectiveness of amblyopia treatment. RESULTS: The mean age at presentation was 39.0+/-37.4 months, and the mean follow-up period was 42.8+/-33.5 months postoperatively. Nine patients (23%) had bilateral posterior lenticonus, and the mean age of bilateral cases was lower (p<0.001) and the lens opacity more severe than those of unilateral cases (P=0.001). Fifteen eyes (32.6%) were surgically identified as having posterior lenticonus during lens aspiration, the mean age of surgically identified cases was lower (p<0.001) and the lens opacity more severe then those of preoperatively diagnosed cases (P=0.014). The age at initial examination was negatively correlated with final visual acuities in log MAR (P=0.04). CONCLUSIONS: Bilateral and surgically identified posterior lenticoni were associated with younger age and more severe lens opacity. The final visual acuities were better in patients with late onsets of lens opacities.
Amblyopia ; Cataract* ; Diagnosis ; Follow-Up Studies ; Humans ; Visual Acuity

PURPOSE: To study the fundus findings in the peripheral retina using examination under general anesthesia in patients showing vitreoretinopathy in the unilateral posterior pole of the eye. METHODS: The records of 27 patients showing vitreoretinopathy in the unilateral posterior pole of the eye were retrospectively reviewed. Analysis of the records for the fundus finding was performed using indirect ophthlamoscopy at the outpatient clinic, fundus findings and results of fluorescein angiography during examination under general anesthesia. RESULTS: The viteroretinopathies in the unilateral posterior poles were retinal vascular and vitreous abnormality including avascular area in seven eyes (16%), retinal dragging in 14 eyes (32%), retinal folding in 21 eyes (48%), and total tractional retinal detachment in two eyes (5%). The final clinical diagnoses were familial exudative vitreoretinopathy in 33 patients, incontinentia pigmenti in four eyes, and idiopathic vitreoretinopathy in seven eyes. Abnormal findings in the peripheral retina of the contralateral eye were observed in 27 eyes (61%) when examined under general anesthesia. Leakage in fluorescein angiography was found in 17 contralateral eyes (39%). The treatment including diode laser photocoagulation and cryotherapy was performed in eyes showing active leakage. CONCLUSIONS: Examination of the bilateral fundus is important in patients showing vitreoretinopathy in the unilateral posterior pole. The examination under anesthesia was helpful for diagnosis, evaluation and treatment in patients showing vitreoretinopathy in the unilateral posterior pole of the eye.
Ambulatory Care Facilities ; Anesthesia ; Anesthesia, General ; Cryotherapy ; Eye ; Fluorescein Angiography ; Humans ; Incontinentia Pigmenti ; Lasers, Semiconductor ; Light Coagulation ; Retina ; Retinal Detachment ; Retinaldehyde ; Retrospective Studies ; Traction

PURPOSE: To report the clinical outcome of children with unilateral high myopic anisometropic amblyopia who were treated with contact lenses (CL). METHODS: Patients who had myopic anisometropia greater than -7 diopters and was treated with contact lenses combined with occlusion therapy during the period between 1998 and 2007 were retrospectively reviewed. Twenty-seven patients who were followed up for more than 1 year after treatment were included in the study. Initial and final best corrected visual acuities (BCVA) were compared and factors which influence the visual outcome were analyzed. RESULTS: A total of 10 out of 27 patients (37%) acquired visual improvement of more than 2 lines. At the final examination, 6 patients (22.2%) had BCVA better than logMAR 0.3 and 10 patients (37.0%) had BCVA better than logMAR 0.7. Medullated nerve fiber and strabismus were the most commonly associated ocular pathologies among the patients. Patients without strabismus or medullated nerve fiber acquired greater visual improvement than patients with these comorbidities. Patients with lower initial refractive error (spherical equivalent) in the amblyopic eye acquired a better final vision. Poor compliance to CL wearing or occlusion therapy adversely affected the final vision. CONCLUSIONS: In the present study of children with unilateral severe myopic anisometropic amblyopia treated with CL combined with occlusion therapy, a third of the patients acquired visual improvement of more than 2 lines. The absence of medullated nerve fiber or strabismus was determined to be a good prognostic factor.
Amblyopia ; Anisometropia ; Child ; Comorbidity ; Compliance ; Contact Lenses ; Eye ; Humans ; Nerve Fibers ; Refractive Errors ; Retrospective Studies ; Strabismus ; Vision, Ocular ; Visual Acuity