Background and Objectives: This study aimed to evaluate the factors that influence deep sleep restoration in patients with obstructive sleep apnea (OSA) following positive airway pressure (PAP) therapy. Methods: In total, 363 patients diagnosed with OSA who received PAP therapy over at least 3 months were enrolled in the study. Polysomnographic parameters, anatomical characteristics, and subjective sleep-related parameters were evaluated according to the presence of daytime sleepiness and morning headache before and after 3 months of PAP treatment. Results: Age was significantly different according to whether excessive daytime sleepiness (EDS) was alleviated (average: 49.35 years) or persisted (average: 52.82 years) (p=0.001). Age was also significantly associated with morning headache (p=0.037). Body mass index (BMI) was higher in the alleviated EDS group (28.70 kg/m2) than in the persistent EDS group (27.13 kg/m2; p=0.002). The apnea-hypopnea index (AHI) was correlated with the EDS outcome (p=0.011). The group with alleviated EDS had a longer mandibular plane to hyoid distance (MPH) than the group with persistent EDS (17.95 mm vs. 15.38 mm; p<0.001). However, BMI, AHI, and MPH showed no significant associations with morning headache. Epworth Sleepiness Scale scores were higher in the alleviated EDS and alleviated morning headache groups (EDS: p<0.001, morning headache: p=0.001). Self-Efficacy Measure for Sleep Apnea (SEMSA) values differed significantly between the EDS groups (p<0.001), but not between the morning headache groups (p=0.122). After 3 months of PAP therapy, the MPH was negatively correlated with EDS in univariate (odds ratio [OR]=0.921, p<0.001) and multivariate analyses (OR=0.937, p=0.028). The SEMSA score was also negatively correlated with EDS in univariate (OR=0.961, p<0.001) and multivariate (OR=0.973, p=0.019) analyses. Conclusion Age, polysomnographic metrics, and anatomical considerations were important for sleep quality-associated daytime symptoms. In addition, anatomical characteristics and the patient’s self-efficacy were significantly associated with the effect of PAP treatment on sleep quality.

Purpose: This study aimed to investigate changes in cytokine levels after intravitreal bevacizumab injection in patients with chronic central serous chorioretinopathy (CSC). Methods: In a prospective interventional trial, 12 eyes from 12 patients with chronic CSC and six eyes from six patients who underwent cataract surgery were included as controls. Patients diagnosed as with CSC received a single intravitreal injection of bevacizumab (1.25 mg/0.05 mL). Aqueous humor samples were collected from the patients and controls. Best-corrected visual acuity and foveal thickness were evaluated, and aqueous samples were obtained before and 4 weeks after injection. The aqueous concentrations of interleukin (IL)-6, IL-8, interferon-induced protein (IP)-10, monocyte chemotactic protein (MCP)-1, platelet-derived growth factor (PDGF)-AA, and vascular endothelial growth factor (VEGF) were measured using a multiplex bead assay. Results: After injection, the foveal thickness decreased significantly from 328.08 μm (range, 210–477 μm) to 283.91 μm (range, 168–356 μm; p = 0.048), but the best-corrected visual acuity was not significantly different (p = 0.066). The aqueous levels of IL-8 increased significantly from 3.3 pg/mL (range, 1.5–8.3 pg/mL) to 4.7 pg/mL (range, 2.2–11.6 pg/mL) at 4 weeks after the injection (p = 0.046). The aqueous levels of VEGF decreased significantly from 31.4 pg/mL (range, 17.0–53.3 pg/mL) to 15.2 pg/mL (range, 7.7–21.5 pg/mL; p < 0.01). No significant changes in levels of IL-6 (p = 0.455), IP-10 (p = 0.055), MCP-1 (p = 0.076), and PDGF-AA (p = 0.339) were noted 4 weeks after injection. Conclusions In this study we found intravitreal bevacizumab injection decreased VEGF and increased IL-8 in the eyes of patients with chronic CSC. This study suggests the possibility that the pathogenesis of CSC may be related to abnormal circulation of the choroidal blood vessels through VEGF and IL-8 cytokine level changes.

African tick-bite fever (ATBF), caused by Rickettsia africae, is the second most frequent cause of fever after malaria in travelers returning from Southern Africa. As the Korean outbound travelers are increasing every year, tick-borne rickettsial diseases as a cause of febrile illness are likely to increase. We describe a febrile Korean returning traveler who showed two eschars after visiting the rural field in Manzini, Swaziland. We performed nested polymerase chain reaction using the eschar and diagnosed the patient with ATBF. He was treated with oral doxycycline for 7 days, and recovered without any complications. We believe that the present case is the first ATBF case diagnosed in a Korean traveler.

Purpose: To confirm that the phaco chop method using an illuminated chopper (iChopper; Oculight, Seongnam, Korea) can reduce cataract surgery complications, and that even beginners can safely and effectively perform phaco chop. Methods: We retrospectively analyzed the medical records of the first 30 phaco chop cases using illuminated chopper of four cataract surgeons. Four ophthalmologists had a variety of empirical backgrounds, from those who have experienced more than 10,000 cataract surgery, to beginners who have experienced 20 cataract surgery. Results: Of the total 120 eyes, two eyes (1.67%) had posterior capsule rupture. The chopping method was changed from phaco chop to stop and chop in three eyes (2.5%) including one eye with brown cataract with pseudoexofoliation syndrome and two eyes with nuclear opacity grade ≥5. Conclusions The rates of posterior capsule rupture of phaco chop using an illuminated chopper were very low in four surgeons with various experiences and who became proficient shortly in phaco chop.

Purpose: To minimize ultrasound power use and surgical phaco time in illuminated chop cataract surgery. Methods: The charts of patients who underwent senile cataract surgery by a single surgeon were reviewed retrospectively. A conventional intracameral endoilluminator was used in a Stop & Chop group (n = 45), while an illuminated chopper was used in an illuminated chop (I-Chop) group (n = 71). EFX, a unitless value that roughly correlates with ultrasound energy during phacoemulsification, surgical phaco time, and changes in endothelial cell count were compared between the two groups and the ratio of zero phacoemulsification in the I-Chop group was evaluated. Results: EFX of the Stop & Chop and I-Chop groups was 18.08 ± 16.15 and 0.82 ± 3.53, respectively (p = 0.001), while the surgical phaco time was 185.08 ± 41.42 and 162.04 ± 49.65 seconds (p = 0.01). However, the endothelial loss did not differ in the two groups (7.03 ± 7.89 vs. 7.13 ± 9.47%, p = 0.76). In the I-Chop group, 56 (86%) eyes had zero phaco energy and patients with EFX >1 (n = 6) had more severe nuclear sclerosis grading (2.90 ± 0.71 vs. 4.5 ± 1.0; p = 0.001). Conclusions The I-Chop group had lower EFX and shorter surgical phaco time than the Stop & Chop group. Illuminated chop using an illuminated chopper is one way to attain minimal phacoemulsification.

Purpose: This study analyzed the effects of non-damaging retinal laser therapy (NRT) in patients with chronic central serous chorioretinopathy. Methods: A retrospective study was conducted on patients with chronic central serous chorioretinopathy who were undergoing follow-up with NRT from November 2016 to February 2018. NRT was performed in patients who underwent intravitreal anti-vascular endothelial growth factor (anti-VEGF) injection at least two times with no improvement in visual acuity and a reduced amount of subretinal fluid. Before and after treatment, logMAR best-corrected visual acuity (BCVA) evaluation and subretinal fluid (SRF) according to thickness measurements of the macula determined from optical coherence tomography imagery were performed over a period of at least 6 months. Results: Eighteen eyes of 18 patients (11 male and 7 female) with chronic central serous retinopathy were treated with NRT. The mean age of patients was 54.6 ± 13.19 years old and the mean duration of follow-up was 9.75 ± 3.20 months. The central macular thickness decreased from 375 to 246 nm (p < 0.001) and BCVA improved from 0.48 to 0.40 (p = 0.028). SRF completely resolved in 55.56% of the patients after NRT. Conclusions In patients with chronic central serous chorioretinopathy, which did not improve even after intravitreal anti-VEGF injection, NRT is a relatively safe and effective treatment.

Purpose: To report a rare case of bilateral optic nerve sheath meningocele diagnosed in a patient with exophthalmos.Case summary: A 33-year-old male visited our clinic with bilateral exophthalmos for 6 months. The patient had been diagnosed with hypertension 3 years previously; however, the condition had been poorly controlled. He also had a history of treatment associated with retinal vein occlusion, macular edema, and papilledema 2 years earlier. There was no limitation in his ocular movement. A Hertel exophthalmometry test showed bilateral exophthalmos of 20 mm in both eyes. Visual field tests showed an inferior arcuate visual field defect in the right eye and a superotemporal peripheral field defect in the left eye. In orbital magnetic resonance imagery, cerebrospinal fluid space widening along the optic nerve and flattening of the bilateral posterior pole of the eye were evident. The patient was diagnosed with optic nerve sheath meningocele. Conclusions Optic nerve sheath meningocele should be considered as a differential diagnosis of exophthalmos patients. Because it is a disease that can affect visual function in a manner similar to that of a visual field defect, rapid diagnosis through imaging study and thorough regular follow-up examinations are essential.

Purpose: To report a rare case of bilateral optic nerve sheath meningocele diagnosed in a patient with exophthalmos.Case summary: A 33-year-old male visited our clinic with bilateral exophthalmos for 6 months. The patient had been diagnosed with hypertension 3 years previously; however, the condition had been poorly controlled. He also had a history of treatment associated with retinal vein occlusion, macular edema, and papilledema 2 years earlier. There was no limitation in his ocular movement. A Hertel exophthalmometry test showed bilateral exophthalmos of 20 mm in both eyes. Visual field tests showed an inferior arcuate visual field defect in the right eye and a superotemporal peripheral field defect in the left eye. In orbital magnetic resonance imagery, cerebrospinal fluid space widening along the optic nerve and flattening of the bilateral posterior pole of the eye were evident. The patient was diagnosed with optic nerve sheath meningocele. Conclusions Optic nerve sheath meningocele should be considered as a differential diagnosis of exophthalmos patients. Because it is a disease that can affect visual function in a manner similar to that of a visual field defect, rapid diagnosis through imaging study and thorough regular follow-up examinations are essential.

PURPOSE: We compared the posterior capsule rupture (PCR) rate between microscope versus intracameral illumination in phacoemulsification surgery performed by novice ophthalmologists. METHODS: We conducted a retrospective chart review of 300 eyes of 211 patients who underwent phacoemulsification by novice ophthalmologists from March 2012 to October 2017. Novice ophthalmologists (n = 6) were divided into those using microscope illumination (n = 4) and intracameral illumination users (n = 2). The first 50 cataract surgery cases of each novice ophthalmologist were reviewed. The results using a phacoemulsification machine and microscopy were the same. The intraoperative complications and learning curve in each case were evaluated. RESULTS: Phacoemulsifications performed by novice ophthalmologists showed a statistically significant difference in PCR rate between the microscope illumination (19.0%, 38/200) and intracameral illumination (4.0%, 4/100) groups (p = 0.001). The incidence of PCR was reduced to 22%, 18%, 16%, 12%, and 8% per 10 cases in the microscope group, while it was 15% in the first 10 cases and 0% in 50 cases thereafter in the intracameral illumination group. CONCLUSIONS: Novice surgeons had a lower PCR rate during cataract surgery using intracameral illumination than using microscope illumination. Both groups showed a tendency for the PCR to decrease with increasing surgical cases, but the intracameral illumination group showed a shorter learning curve.
Cataract ; Humans ; Incidence ; Intraoperative Complications ; Learning Curve ; Lighting ; Microscopy ; Phacoemulsification ; Polymerase Chain Reaction ; Retrospective Studies ; Rupture ; Surgeons

Post-menopausal osteoporosis (PMO) is a major global human health concern. Owing to the need for therapeutic drugs without side effects, natural extracts containing various polyphenolic compounds that may exert estrogenic effects have been studied in depth. Rhus verniciflua Stokes (RVS), which has been used as a traditional herbal medicine for centuries in Korea, was recently revealed to exert estrogenic effects attributable to its bioactive ingredients sulfuretin and butein, which have strong estrogen receptor–binding affinities. In this study, the protective potential of RVS in PMO was evaluated by using an experimental animal model of PMO, which was established by ovariectomy (OVX) of female Sprague Dawley rats. The oral administration of RVS at 20 mg/kg or 100 mg/kg for 8 weeks markedly protected against OVX-induced atrophy of the uterine tube and reversed the elevation in the ratio of serum receptor activator of nuclear factor-κB ligand to osteoprotegerin, which is a marker of disease severity. In addition, RVS inhibited OVX-induced tibia bone loss, activated osteogenic activity, and suppressed osteoclastic activity in the tibial epiphyseal plate, a region of bone remodeling. Collectively, these factors indicated that the oral intake of RVS might be beneficial for the prevention of PMO.
Administration, Oral ; Atrophy ; Bone Remodeling ; Estrogens ; Fallopian Tubes ; Female ; Growth Plate ; Herbal Medicine ; Humans ; Korea ; Models, Animal ; Models, Theoretical* ; Osteoclasts ; Osteoporosis, Postmenopausal* ; Osteoprotegerin ; Ovariectomy ; Rats, Sprague-Dawley ; Rhus* ; Tibia