Avascular necrosis (AVN) is a rare disease occurring in the capitate of the wrist which is the third most common site of AVN among carpal bones. There are few reports on the MRI findings of AVN in the capitate bone. Besides, there is a paucity of reports showing the benefits of imaging for the choice of the treatment modality. We report two rare cases of capitate AVN requiring surgery.

Purpose: To compare differences between the original criteria for diagnosis of ocular sarcoidosis (OS) (first International Workshop for OS [IWOS] 2009) and the revised criteria (sixth IWOS 2017), and their clinical usefulness when assessing OS in Korean patients. Methods: We analyzed patients with suspected OS who visited our tertiary referral ophthalmological and pulmonary clinic from 2007 to 2018. We diagnosed patients using both sets of criteria. Blood test and biopsy data (collected by physicians) and slit-lamp, fundus, and fluorescein angiography data (collected by ophthalmologists) were reviewed. Results: Thirty-four patients were diagnosed using both criteria. Of 32 patients who underwent biopsies, 31 had OS (96.87%). Using either set of criteria, 31 patients were diagnosed with definite OS and two with presumed OS. One patient diagnosed with possible OS using the previous criteria was diagnosed with presumed OS using the revised criteria. The new criteria add the lysozyme level, the CD4/CD8 ratio, and positron emission tomography imaging data to the old criteria and add the descriptors “presumed OS” and “probable OS”. There is no need to use the revised criteria in Korea; the biopsy and imaging data are adequately diagnostic. Conclusions IWOS revised the OS diagnostic criteria by adding new parameters. However, this was unnecessary for Korea, where the biopsy and imaging data are adequately diagnostic.

Purpose: To compare differences between the original criteria for diagnosis of ocular sarcoidosis (OS) (first International Workshop for OS [IWOS] 2009) and the revised criteria (sixth IWOS 2017), and their clinical usefulness when assessing OS in Korean patients. Methods: We analyzed patients with suspected OS who visited our tertiary referral ophthalmological and pulmonary clinic from 2007 to 2018. We diagnosed patients using both sets of criteria. Blood test and biopsy data (collected by physicians) and slit-lamp, fundus, and fluorescein angiography data (collected by ophthalmologists) were reviewed. Results: Thirty-four patients were diagnosed using both criteria. Of 32 patients who underwent biopsies, 31 had OS (96.87%). Using either set of criteria, 31 patients were diagnosed with definite OS and two with presumed OS. One patient diagnosed with possible OS using the previous criteria was diagnosed with presumed OS using the revised criteria. The new criteria add the lysozyme level, the CD4/CD8 ratio, and positron emission tomography imaging data to the old criteria and add the descriptors “presumed OS” and “probable OS”. There is no need to use the revised criteria in Korea; the biopsy and imaging data are adequately diagnostic. Conclusions IWOS revised the OS diagnostic criteria by adding new parameters. However, this was unnecessary for Korea, where the biopsy and imaging data are adequately diagnostic.

Purpose: To evaluate the effectiveness and safety of treating choroidal melanoma and cancer that has metastasized to the choroid with gamma knife radiosurgery (GKR). Methods: We performed a retrospective chart review that included 10 eyes of eight patients with a diagnosis of choroidal tumors who underwent GKR between January 2016 and February 2019 and who had at least one month follow-up visit. Results: The mean patient age was 57.9 ± 14.6 years (range, 32-83 years). The choroidal tumor group included six choroidal metastases and four choroidal melanomas. The mean follow-up period after GKR was 7.0 ± 4.3 months (range, 2-13 months). The mean cumulative marginal dose was 25.36 ± 7.35 Gy (range, 16-45 Gy). Pre- and postoperative magnetic resonance imaging revealed a reduction in tumor volume in eight of the 10 eyes and five of them presented with improved visual symptoms. One patient showed increased tumor volume; however, a new choroidal lesion was not observed. Another patient showed no reduction in tumor size; however, the pain had worsened, and the eye was enucleated. The mean maximum tumor diameter decreased from 1.60 ± 0.37 cm before to 1.22 ± 0.47 cm after GKR (p = 0.004), and the mean minimum diameter decreased from 0.62 ± 0.27 cm before to 0.38 ± 0.35 cm after GKR (p = 0.031). No radiation-induced optic neuropathy, retinopathy, or cataracts was observed in any of the cases during the follow-up period. Conclusions GKR was shown to be safe for choroidal lesions identified in orbital magnetic resonance imaging with a reduction in the size of choroidal tumors and eyeball preservation expected with this treatment approach.

Purpose: To evaluate the effectiveness and safety of treating choroidal melanoma and cancer that has metastasized to the choroid with gamma knife radiosurgery (GKR). Methods: We performed a retrospective chart review that included 10 eyes of eight patients with a diagnosis of choroidal tumors who underwent GKR between January 2016 and February 2019 and who had at least one month follow-up visit. Results: The mean patient age was 57.9 ± 14.6 years (range, 32-83 years). The choroidal tumor group included six choroidal metastases and four choroidal melanomas. The mean follow-up period after GKR was 7.0 ± 4.3 months (range, 2-13 months). The mean cumulative marginal dose was 25.36 ± 7.35 Gy (range, 16-45 Gy). Pre- and postoperative magnetic resonance imaging revealed a reduction in tumor volume in eight of the 10 eyes and five of them presented with improved visual symptoms. One patient showed increased tumor volume; however, a new choroidal lesion was not observed. Another patient showed no reduction in tumor size; however, the pain had worsened, and the eye was enucleated. The mean maximum tumor diameter decreased from 1.60 ± 0.37 cm before to 1.22 ± 0.47 cm after GKR (p = 0.004), and the mean minimum diameter decreased from 0.62 ± 0.27 cm before to 0.38 ± 0.35 cm after GKR (p = 0.031). No radiation-induced optic neuropathy, retinopathy, or cataracts was observed in any of the cases during the follow-up period. Conclusions GKR was shown to be safe for choroidal lesions identified in orbital magnetic resonance imaging with a reduction in the size of choroidal tumors and eyeball preservation expected with this treatment approach.

Purpose: To investigate macular microvasculature changes using optical coherence tomography angiography (OCTA) and analyze their correlation with the structural parameters in highly myopic eyes. Methods: We measured the area of the foveal avascular zone (FAZ) and the parafoveal vessel density in the superficial and deep retinal plexuses using OCTA. The magnification effect of the FAZ area was corrected using Bennett's formula. Retinal thickness measured at each corresponding area of the OCTA parameters, subfoveal choroidal thickness, and ocular characteristics were reviewed, and the relationships between the microvasculature measurements and the ocular structural characteristics were explored. Results: Fifty-two eyes with high myopia and 52 normal sex- and age-matched controls were included in the analysis. The FAZ area was significantly larger in the myopic eyes (p = 0.023). The superficial parafoveal vascular density was significantly decreased (p= 0.007) in the myopic eyes compared with the normal eyes, whereas there was no significant difference in the deep parafoveal vascular density (p = 0.226). Regarding the retinal thickness, only the parafoveal inner retinal thickness was significantly smaller in the myopic eyes than in the normal eyes (p = 0.023). The FAZ and subfoveal choroidal thickness were significantly correlated with the axial length, and the parafoveal inner retinal thickness was significantly correlated with the superficial parafoveal vascular density (all p < 0.05). Conclusions The FAZ was enlarged and the parafoveal vascular density was reduced in the highly myopic eyes. The decrease was prominent in the superficial capillary plexuses and well-correlated with the retinal thickness profiles. The macular microvascular network alteration may be attributed to the ocular axial elongation that occurs with myopia.

Purpose: We aimed to study the clinical characteristics and long-term prognoses of retinoblastoma according to the age at diagnosis. Methods: A retrospective chart review of non-screened patients newly diagnosed with retinoblastoma between January 2007 and February 2018. Results: Among the 20 patients analyzed, 11 were diagnosed at an age younger than 1 year (group 1) and nine at 1 year or older (group 2). The mean lag times until diagnosis were 1.0 ± 0.4 and 5.0 ± 2.1 months for groups 1 and 2, respectively (p = 0.056). The mean follow-up durations were 49.4 ± 12.7 and 58.3 ± 8.8 months, respectively (p = 0.412). Group 1 had a significantly higher proportion of bilateral retinoblastoma than did group 2 (72.7% vs. 11.1%, p = 0.010). Four of five patients (80.0%) with germline RB1 mutations were diagnosed with retinoblastoma at age 3 months or younger. The eyes of patients in group 2 had significantly higher International Intraocular Retinoblastoma Classification stages than did those of patients in group 1 (p for trend = 0.010). The proportion of eyes with optic nerve invasion and those that had undergone enucleation were significantly higher in group 2 (p = 0.033 and 0.046, respectively). Survival did not differ according to the age at diagnosis. Conclusions Early onset retinoblastoma does not seem to indicate poor ocular or survival prognosis in Korean children with retinoblastoma.

Atrial fibrillation (AF) is the most common arrhythmia associated with the risk of morbidity and mortality in clinical patients. AF is considered as an arrhythmia type that develops and progresses through close connection with cardiac structural arrhythmogenic substrates. Since the introduction of catheter ablation-mediated electrical isolation of arrhythmogenic substrates, cardiac imaging indicates improved treatment outcome and prognosis with appropriate candidate selection, ablation catheter guidance, and post-ablation follow-up. Currently, cardiac computed tomography (CCT) and cardiovascular magnetic resonance (CMR) imaging are essential in the case management of AF at both pre-and post-procedural stages of catheter ablation. In this review, we discuss the roles and technical considerations of CCT and CMR imaging in the management of patients with AF undergoing catheter ablation.
Arrhythmias, Cardiac ; Atrial Fibrillation ; Case Management ; Catheter Ablation ; Catheters ; Follow-Up Studies ; Humans ; Magnetic Resonance Imaging ; Mortality ; Prognosis ; Treatment Outcome

PURPOSE: We assessed the visual and anatomical outcomes, and the safety profile of long-term intravitreal anti-vascular endothelial growth factor (VEGF) injections (aflibercept, ranibizumab, and bevacizumab) given to treat neovascular age-related macular degeneration (NAMD). METHODS: We analyzed medical records collected over 7 years of treatment-naive NAMD patients who received outpatient clinic-based intravitreal anti-VEGF injections. All were treated employing either “treat-and-extend” or “as needed” protocols at the discretion of the retinal specialist. The number of injections, adverse events associated with injection, and measures of visual acuity (VA), central foveal thickness (CFT), and intraocular pressure (IOP) were recorded. RESULTS: Overall, we assessed 196 eyes of 196 patients (average age 68.6 ± 9.6 years; 77 females). Patients received an average of 17.3 ± 13.5 injections over 78.0 ± 16.5 months of clinical follow-up. The initial mean VA (logMAR) was 0.75 ± 0.58 and the CFT was 349.7 ± 152.6 µm. Both parameters exhibited maximal improvements at the 6-month visit (p < 0.05). However, the clinical outcomes worsened over the 7-year clinical course; the best-corrected visual acuity (BCVA) was 0.91 ± 0.78 and the CFT was 284.5 ± 105.8 µm at 7 years. The BCVA at 7 years was significantly correlated with the initial BCVA. IOP-related events increased 11-fold and anterior chamber reactions increased 3-fold over the years, but no significant complications such as endophthalmitis were recorded. CONCLUSIONS: The use of intravitreal anti-VEGF agents was associated with initial visual improvements over 6 months but did not prevent the worsening of NAMD over 5 years. The BCVA at the initial visit was a strong predictor of the final BCVA. A more intensive injection schedule might improve long-term outcomes.
Anterior Chamber ; Appointments and Schedules ; Choroidal Neovascularization ; Endophthalmitis ; Endothelial Growth Factors ; Follow-Up Studies ; Humans ; Intraocular Pressure ; Macular Degeneration ; Medical Records ; Outpatients ; Ranibizumab ; Retinaldehyde ; Specialization ; Visual Acuity

BACKGROUND: The present study describes our 10-year experience with uveoretinal adverse events that manifest because of chemotherapy. METHODS: A retrospective chart review was performed for all patients who presented to the ophthalmologic department while undergoing systemic chemotherapy between July 2005 and June 2015. RESULTS: A total of 55 patients (mean age, 51.2 years, 38 women [69.1%]) suspected of having uveoretinal disease owing to the use of chemotherapeutic agents alone were enrolled. Breast cancer was the predominant disease (36.4%); noninfectious anterior uveitis (21.8%) was the most common condition. Bilateral involvement was observed in 16 patients (29.1%). Although cisplatin (21.8%) was the most commonly used drug, daunorubicin, cytarabine, tamoxifen, toremifene, and imatinib were also frequently used. The median duration until ophthalmologic diagnosis was 208.5 days (range, 19–5,945 days). The proportion of patients with final visual acuity (VA) < 20/40 Snellen VA (0.5 decimal VA) was 32.7%. However, no relationship was observed between final VA < 20/40 and age, sex, therapeutic agents, and metastasis. CONCLUSION: Uveoretinal complications were mostly mild to moderate and exhibited a favorable response to conservative therapy. A considerable number of patients exhibited significant irreversible loss of vision after cessation of the causative chemotherapeutic agent. Ophthalmological monitoring is required during chemotherapy.
Antineoplastic Agents ; Breast Neoplasms ; Cisplatin ; Cytarabine ; Daunorubicin ; Diagnosis ; Drug Therapy ; Drug-Related Side Effects and Adverse Reactions ; Female ; Humans ; Imatinib Mesylate ; Molecular Targeted Therapy ; Neoplasm Metastasis ; Retrospective Studies ; Tamoxifen ; Toremifene ; Uveitis ; Uveitis, Anterior ; Visual Acuity