Purpose: To report a case of paraneoplastic autoimmune retinopathy in a patient with a history of testicular cancer.Case summary: A 29-year-old man presented with photopsia and floaters. Initial fundus examination revealed no abnormal findings. However, he returned 1 month later with complaints of visual field defects. Fundus examination revealed diffuse white spots in the macula and midperipheral retina and fundus autofluorescence demonstrated hyper-autofluorescence. Optical coherence tomography showed disruption of the ellipsoid zone sparing the fovea. Visual field examination revealed peripheral visual field defects and an electroretinogram showed reduced rod and cone cell responses. Considering his history of testicular cancer, serum paraneoplastic autoantibody panel testing was performed which revealed borderline levels of anti-recoverin antibody leading to a diagnosis of paraneoplastic autoimmune retinopathy. The patient was treated with oral steroids and mycophenolate mofetil for 1 year. However, there was no improvement in the subjective symptoms or ophthalmologic findings. Conclusions This case of paraneoplastic autoimmune retinopathy in a young man with a history of testicular cancer highlights an early clinical presentation of the disease. It is crucial to recognize that the initial clinical presentation of autoimmune retinopathy can be nonspecific.

Purpose: To report a case of paraneoplastic autoimmune retinopathy in a patient with a history of testicular cancer.Case summary: A 29-year-old man presented with photopsia and floaters. Initial fundus examination revealed no abnormal findings. However, he returned 1 month later with complaints of visual field defects. Fundus examination revealed diffuse white spots in the macula and midperipheral retina and fundus autofluorescence demonstrated hyper-autofluorescence. Optical coherence tomography showed disruption of the ellipsoid zone sparing the fovea. Visual field examination revealed peripheral visual field defects and an electroretinogram showed reduced rod and cone cell responses. Considering his history of testicular cancer, serum paraneoplastic autoantibody panel testing was performed which revealed borderline levels of anti-recoverin antibody leading to a diagnosis of paraneoplastic autoimmune retinopathy. The patient was treated with oral steroids and mycophenolate mofetil for 1 year. However, there was no improvement in the subjective symptoms or ophthalmologic findings. Conclusions This case of paraneoplastic autoimmune retinopathy in a young man with a history of testicular cancer highlights an early clinical presentation of the disease. It is crucial to recognize that the initial clinical presentation of autoimmune retinopathy can be nonspecific.

Purpose: To report a case of paraneoplastic autoimmune retinopathy in a patient with a history of testicular cancer.Case summary: A 29-year-old man presented with photopsia and floaters. Initial fundus examination revealed no abnormal findings. However, he returned 1 month later with complaints of visual field defects. Fundus examination revealed diffuse white spots in the macula and midperipheral retina and fundus autofluorescence demonstrated hyper-autofluorescence. Optical coherence tomography showed disruption of the ellipsoid zone sparing the fovea. Visual field examination revealed peripheral visual field defects and an electroretinogram showed reduced rod and cone cell responses. Considering his history of testicular cancer, serum paraneoplastic autoantibody panel testing was performed which revealed borderline levels of anti-recoverin antibody leading to a diagnosis of paraneoplastic autoimmune retinopathy. The patient was treated with oral steroids and mycophenolate mofetil for 1 year. However, there was no improvement in the subjective symptoms or ophthalmologic findings. Conclusions This case of paraneoplastic autoimmune retinopathy in a young man with a history of testicular cancer highlights an early clinical presentation of the disease. It is crucial to recognize that the initial clinical presentation of autoimmune retinopathy can be nonspecific.

Purpose: To assess efficacy, safety, and tolerability of the preservative-free (PF) fixed-dose combination (FC) of tafluprost 0.0015%/timolol 0.5% (PF tafluprost/timolol FC) in treatments-naive patients with primary open-angle glaucoma (POAG). Methods: This was a retrospective, real-world clinical practice setting study that included 107 eyes of 107 subjects with POAG who had never been treated for glaucoma. All subjects were received PF tafluprost/timolol FC once daily. Intraocular pressure (IOP) levels were documented for each eye at the untreated baseline and up to 6 months after the initiation of medical treatment. All adverse events, including ocular and systemic adverse reactions, were recorded. Additionally, the reasons for medication discontinuations were thoroughly documented. Results: A total of 32 POAG patients with high-baseline IOP (>21 mmHg) and 75 with normal-baseline IOP were included in the study. The subjects’ baseline mean age was 62.4 ± 8.7 years (range, 26.0–85.0 years); among them, 42 were female (39.3%). Mean IOP at baseline for all patients was 18.6 ± 4.3 mmHg. The mean IOP at 6 months was 12.6 ± 4.7 mmHg, representing a significant decrease compared to the baseline (–32%, p < 0.001). In POAG patients with high-baseline IOP, mean IOP was significantly lowered from 28.0 ± 5.7 mmHg at baseline to 18.0 ± 5.5 mmHg (–35%, p < 0.001); in patients with normal-baseline IOP, from 14.6 ± 3.4 mmHg at baseline to 10.3 ± 4.1 mmHg (–29%, p < 0.001). PF tafluprost/timolol FC was well-tolerated and safe. After 6 months, 97.2% of all patients remained on therapy. Conclusions In this real-world observational study, once-daily treatment with PF tafluprost/timolol FC demonstrated clinically relevant and statistically significant efficacy, as well as safety and good tolerability, in treatment-naive patients diagnosed with POAG.

Purpose: To compare the safety and consistency of manual capsulorhexis and precision pulse capsulotomy performed using pulsed energy during bilateral cataract surgery and to explore the differences in clinical outcomes. Methods: A total of 101 patients with bilateral cataracts were selected. Precision pulse capsulotomy was performed on one eye and manual continuous curvilinear capsulorhexis on the other. The independent-samples t-test was used to compare the duration of continuous curvilinear capsulorhexis, incisional size and roundness, complications such as radial tears, the cumulative dissipated energy, the visual acuity after surgery, and the corneal epithelial cell count. Results: There was no significant difference in the capsulorhexis time between the pulse energy and manual groups. The extent of capsulorhexis was significantly smaller and the circularity of capsulorhexis was higher in the former group. Complications occurred in two manual capsulorhexis patients but in no pulse energy capsulotomy patient. There was no significant between- group difference in any of postoperative visual acuity, best-corrected visual acuity, or the corneal endothelial cell count. Conclusions During bilateral cataract surgery on the same patients, precision capsulotomy using pulse energy afforded smaller and more circular capsulorhexis and fewer complications than did manual capsulorhexis. However, there was no significant between- group difference in the postoperative clinical outcomes.

Purpose: To compare the effectiveness of warm saline and anti-fog solution for preventing fogging of a non-contact wide-field viewing system during vitrectomy. Methods: Five liters of water at 36°C were placed in a transparent container. The fogging areas of wide-field lenses were microscopically measured. We created three groups: lenses soaked in normal saline at 25°C for 1 minute (control), lenses soaked in normal saline at 50°C for 1 minute (warm saline), and lenses that were wiped with a sponge soaked in anti-fog solution (ULTRASTOP pro med. Solution, Sigmapharm, Vienna, Austria) after prior soaking in normal saline at 25°C for 1 minute (anti-fog). Images of fogged areas were acquired at 10 seconds and 1, 3, and 5 minutes. Extent of fogged areas and central lens invasion were determined. All experiments were repeated 10 times. Results: In the control group, the entire areas were always completely fogged. The average fog coverage values were 4.34 ± 1.28, 6.30 ± 1.38, 56.00 ± 25.01, and 93.81 ± 5.88% at 10 seconds and 1, 3, and 5 minutes in the warm saline group and 4.74 ± 0.57, 7.35 ± 0.96, 10.13 ± 1.09, and 11.74 ± 1.74% in the anti-fog group, respectively. There were significant differences at 3 and 5 minutes (p = 0.029, p = 0.012). Fogging of the central lens was detected in 8 tests after 3 minutes and all 10 tests after 5 minutes in the warm saline group, but no fogging was detected in the anti-fog group. Conclusions Application of an anti-fog solution to a wide-field viewing lens prevents lens fogging during vitrectomy.

Purpose: Investigation of myopic open-angle glaucoma (OAG) prevalence in Northeast Asia by systematic review and meta-analysis. Methods: Systematic PubMed, Embase and Cochrane database searches for Northeast Asian population-based studies published up to 30 November 2020 and reporting on myopia and OAG diagnosis. By random-effect models, pooled OAG prevalence in a myopic population and pooled myopic OAG prevalence in a general population were generated, with 95% confidence intervals (CIs). Results: The meta-analysis encompassed five population-based studies in four countries (12,830 individuals, including 7,723 patients with myopia and 1,112 patients with OAG). In a myopic population, OAG prevalence was 4.10% (95% CI, 3.00–5.70; I2 = 93%); in a general population, myopic OAG prevalence was 1.10% (95% CI, 0.60–1.70; I2 = 94%). A visual examination of funnel plot symmetry raised a suspicion of publication bias. Notwithstanding, Begg and Mazumbar’s adjusted rank correlation test showed no such evidence (p = 0.6242). Conclusions Our systematic review and meta-analysis returned an estimate of OAG prevalence in a myopic Northeast Asian population. Our findings will inform future glaucoma studies as well as public health guidelines for Northeast Asian populations.

Purpose: To analyze 10-year trends in utilization of visual field tests for adult glaucoma or glaucoma-suspect patients using the Korean Health Insurance Review and Assessment data. Methods: Health claims for the years 2010 to 2019, as recorded via Korea’s Health Insurance Review and Assessment service, were accessed. We identified glaucoma patients using the glaucoma diagnostic codes H40 (glaucoma) and H42 (glaucoma in other diseases classified elsewhere). For verification of the glaucoma diagnosis, information on any antiglaucoma medication prescriptions and ocular surgery history also was obtained. Visual field testing data was isolated using procedural codes E6690 (kinetic perimetry) and E6691 (standard automated perimetry [SAP]) performed in tertiary hospitals. Any changes in visual field test utilization were identified using regression trend analysis. Results: From 2010 to 2019, the total number of SAP procedures performed in tertiary hospitals for either glaucoma or glaucoma-suspect patients increased gradually from 93,459 to 216,433. With regard to kinetic perimetry examinations, the total number decreased gradually from 6,364 to 3,792. The yearly average SAP number per patient showed a slight increase, from 1.168 to 1.248 (ß = 0.008, R2 = 0.669, p = 0.004). Meanwhile, the yearly average number of kinetic perimeter examinations per patient showed a significant decrease, from 1.093 to 0.940 (ß = -0.013, R2 = 0.580, p = 0.010). Conclusions Between 2010 and 2019, the yearly average number of SAP procedures performed per glaucoma or glaucoma-suspect patient increased in Korea. Meanwhile, the yearly average number of kinetic perimetry examinations per patient significantly decreased.

Purpose: To investigate adult primary open-angle glaucoma (POAG) patients’ perceived stress levels and to examine the associations with their clinical characteristics. Methods: Sixty-seven POAG patients, excluding those meeting the exclusion criteria (retinal or neurological disease diagnoses) comprised the study population. A validated questionnaire, namely Perceived Stress Scale-10 (PSS-10), was used to assess stress level. Additional data on glaucoma surgery history, medical benefit receipt, comorbidities, and daily antiglaucoma medication number were collected. The clinical characteristics of high (PSS-10 ≥15) and low stress (PSS-10 <15) patients and the risk factors associated with high stress level were subjected to a multivariable logistic regression analysis. Results: The patients were 56.8 ± 12.6 years of age on average, and 29 (43.3%) were female. The mean PSS-10 level was 13.5 ± 5.3 (range, 1–27) for the entire patient group; 31 patients (46.3%) were in the high stress group. In the high stress group relative to the low stress group, best-corrected visual acuity in the better eye was lower (p = 0.044) and the visual field defects, in both eyes, were more severe (better eye, p = 0.005; worse eye, p = 0.026). A logistic regression analysis indicated that severe visual field defect in the better eye (odds ratio, 1.159; 95% confidence interval, 1.016–1.323; p = 0.028) and lower best-corrected visual acuity in the better eye (odds ratio, 4.707; 95% confidence interval, 0.580–6.189; p = 0.072) were both likely to associated with high stress level in patients with POAG. Conclusions These findings suggest an association between severe visual function loss and higher mental stress level in POAG patients. Stress level, therefore, might be an important consideration in POAG patient management.