Purpose: We report on three patients who received 0.625% povidone-iodine (PVI) intravitreal injections to treat endophthalmitis that did not respond to conventional antibiotic treatment or were inoperable.Case summary: Case 1 was a 42-year-old female with suspected left-eye endophthalmitis that developed after anterior chamber irrigation to treat silicone oil emulsification. A 0.625% PVI intravitreal injection reduced inflammation of the anterior chamber and the vitreous. Case 2 was an 84-year-old male who was blind in the left eye due to glaucoma. He was diagnosed with endogenous endophthalmitis on the basis of the anterior chamber hypopyon and vitreous inflammation. After 0.625% PVI intravitreal injection, the endophthalmitis resolved without any recurrence. Case 3 was a 49-year-old female with suspected endogenous left-eye endophthalmitis attributable to a liver abscess. Despite intravitreal antibiotic injections, the inflammation worsened. A 0.625% PVI intravitreal injection improved both the anterior chamber and vitreous inflammation. Conclusions Intravitreal 0.625% PVI injection is a useful option when a patient with endophthalmitis is likely to not recover full vision, when surgery cannot be performed, and when there is no response to empirical antibiotics.

Purpose: To evaluate the efficacy of topical bromfenac combined with intravitreal aflibercept (IVA) injection in the treatment of exudative age-related macular degeneration over a 2-year period. Methods: We retrospectively studied 43 patients (43 eyes) with exudative age-related macular degeneration. Patients were included if they received IVA injections under an as-needed protocol and had > 2 years of follow-up. Among the 43 eyes, 25 received only IVA (IVA group), whereas 18 received a combination of IVA and topical bromfenac (bromfenac group). The primary outcome measure was the total number of IVA injections administered over 2 years from the initial injection compared between groups. We also compared changes in best-corrected visual acuity (BCVA) and central retinal thickness (CRT) between groups. Results: The bromfenac group received a significantly lower number of IVA injections over 2 years (7.4 ± 1.0), compared with the IVA group (9.0 ± 1.9) (p < 0.01). Both groups showed improvements in BCVA and CRT after 2 years compared with their baseline values. However, changes in BCVA and CRT at 2 years did not significantly differ between groups (p = 0.786 and p = 0.905, respectively). Conclusions Among patients with exudative age-related macular degeneration, the total number of IVA injections over 2 years was lower in the bromfenac group than in the IVA group. More studies are needed to confirm the efficacy of topical bromfenac in a combined treatment regimen.

Purpose: To evaluate the efficacy of topical bromfenac in treating central serous chorioretinopathy (CSC) over a 1-year period. Methods: A retrospective analysis was conducted on 57 patients (57 eyes) with CSC followed for > 1 year. Patients were divided into two groups: those treated with bromfenac eye drops twice daily (29 eyes) and a control group (28 eyes). Best-corrected visual acuity (BCVA), central macular thickness (CMT), and subretinal fluid (SRF) height were measured and compared between the two groups as was the proportion of chronic cases. Results: Significant improvements in CMT and SRF height were noted in both groups over the follow-up period. The bromfenac group demonstrated significantly lower CMT at 6, 9, and 12 months (p = 0.045, 0.042, and 0.023, respectively) and lower SRF height (p = 0.037, 0.048, and 0.046, respectively) compared to the control group. The proportion of chronic cases was significantly lower in the bromfenac group (17.2%) compared to the control group (42.9%, p = 0.035). Conclusions Topical bromfenac reduced the rate of progression to chronic CSC and showed significant anatomical improvements after 6 months, suggesting its potential as an effective treatment option.

Purpose: To report a case of exudative retinal detachment after using pembrolizumab in a patient with metastatic cutaneous melanoma.Case summary: A 67-year-old woman, diagnosed with malignant melanoma of the right thumb and axillary metastasis, presented with bilateral visual disturbance 3 days after adjuvant chemotherapy with pembrolizumab. Her best corrected visual acuity was 0.2 in the right eye and 0.7 in the left, while the intraocular pressure was 14 mmHg in both eyes. Fundus examination showed serous retinal detachment and choroidal detachment in the right eye, as well as a chorioretinal folding in both eyes. Optical coherence tomography showed exudative retinal detachment and choroidal detachment in the right eye, along with choroidal folding in both eyes. The pembrolizumab was stopped immediately, and the patient began treatment with systemic and topical steroids. After 1 month, the visual acuity improved and there was no exudative retinal detachment or choroidal detachment. However, 3 weeks later, exudative retinal detachment recurred in both eyes. The patient started treatment with oral steroids and cyclosporine, which resulted in the resolution of the exudative retinal detachment after 1 month. Conclusions Exudative retinal detachment may occur as a side effect of pembrolizumab treatment. Therefore, a differential diagnosis and appropriate treatment of ocular side effects are necessary.

Purpose: We report a case of retinopathy related to bilateral hyperviscosity syndrome in a patient with Waldenström macroglobulinemia.Case summary: A 77-year-old male presented with reduced visual acuities of both eyes 2 months in duration. Fundus examination revealed extensive flame-shaped retinal hemorrhages and venous congestion. Optical coherence tomography (OCT) evidenced macular edema and OCT angiography (OCTA) indicated damage to the superficial and deep capillary plexi of retina and choriocapillaris and dilated large choroidal vessels. We diagnosed central retinal vein occlusion with macular edema and prescribed intravitreal bevacizumab and posterior subtenon triamcinolone injections, however, the edema did not improve. As retinopathy associated with hematological disease was thus suspected, we referred the patient to our department of hematology and oncology for further assessment. He was diagnosed with Waldenström macroglobulinemia. After initiation of chemotherapy, the retinal hemorrhage in and macular edema of both eyes decreased. After six chemotherapy cycles, the retinal hemorrhages resolved and the macular edema improved in both eyes. OCTA revealed that the choroidal vessel dilation also improved. Conclusions In elderly patients presenting with central retinal vein occlusions and macular edema of both eyes, it is important to assess whether the retinopathy is associated with a hyperviscosity syndrome linked to a hematological disease.

Point-of-care ultrasound (POCUS) is a useful tool that is widely used in the emergency and intensive care areas. In Korea, insurance coverage of ultrasound examination has been gradually expanding in accordance with measures to enhance Korean National Insurance Coverage since 2017 to 2021, and which will continue until 2021. Full coverage of health insurance for POCUS in the emergency and critical care areas was implemented in July 2019. The National Health Insurance Act classified POCUS as a single or multiple-targeted ultrasound examination (STU vs. MTU). STU scans are conducted of one organ at a time, while MTU includes scanning of multiple organs simultaneously to determine each clinical situation. POCUS can be performed even if a diagnostic ultrasound examination is conducted, based on the physician's decision. However, the Health Insurance Review and Assessment Service plans to monitor the prescription status of whether the POCUS and diagnostic ultrasound examinations are prescribed simultaneously and repeatedly. Additionally, MTU is allowed only in cases of trauma, cardiac arrest, shock, chest pain, and dyspnea and should be performed by a qualified physician. Although physicians should scan all parts of the chest, heart, and abdomen when they prescribe MTU, they are not required to record all findings in the medical record. Therefore, appropriate prescription, application, and recording of POCUS are needed to enhance the quality of patient care and avoid unnecessary cut of medical budget spending. The present article provides background and clinical guidance for POCUS based on the implementation of full health insurance coverage for POCUS that began in July 2019 in Korea.
Abdomen ; Budgets ; Chest Pain ; Critical Care ; Dyspnea ; Emergencies ; Heart ; Heart Arrest ; Insurance Coverage ; Insurance ; Insurance, Health ; Korea ; Medical Records ; National Health Programs ; Patient Care ; Point-of-Care Systems ; Prescriptions ; Shock ; Thorax ; Ultrasonography

Point-of-care ultrasound (POCUS) is a useful tool that is widely used in the emergency and intensive care areas. In Korea, insurance coverage of ultrasound examination has been gradually expanding in accordance with measures to enhance Korean National Insurance Coverage since 2017 to 2021, and which will continue until 2021. Full coverage of health insurance for POCUS in the emergency and critical care areas was implemented in July 2019. The National Health Insurance Act classified POCUS as a single or multiple-targeted ultrasound examination (STU vs. MTU). STU scans are conducted of one organ at a time, while MTU includes scanning of multiple organs simultaneously to determine each clinical situation. POCUS can be performed even if a diagnostic ultrasound examination is conducted, based on the physician's decision. However, the Health Insurance Review and Assessment Service plans to monitor the prescription status of whether the POCUS and diagnostic ultrasound examinations are prescribed simultaneously and repeatedly. Additionally, MTU is allowed only in cases of trauma, cardiac arrest, shock, chest pain, and dyspnea and should be performed by a qualified physician. Although physicians should scan all parts of the chest, heart, and abdomen when they prescribe MTU, they are not required to record all findings in the medical record. Therefore, appropriate prescription, application, and recording of POCUS are needed to enhance the quality of patient care and avoid unnecessary cut of medical budget spending. The present article provides background and clinical guidance for POCUS based on the implementation of full health insurance coverage for POCUS that began in July 2019 in Korea.

PURPOSE: To report transient corneal edema after phacoemulsification as a predictive factor for the development of pseudophakic cystoid macular edema (PCME). METHODS: A total of 150 eyes from 150 patients (59 men and 91 women; mean age, 68.0 ± 10.15 years) were analyzed using spectral domain optical coherence tomography 1 week and 5 weeks after routine phacoemulsification cataract surgery. Transient corneal edema detected 1 week after surgery was analyzed to reveal any significant relationship with the development of PCME 5 weeks after surgery. RESULTS: Transient corneal edema developed in 17 (11.3%) of 150 eyes 1 week after surgery. A history of diabetes mellitus was significantly associated with development of transient corneal edema (odds ratio [OR], 4.04; 95% confidence interval [CI], 1.41 to 11.54; p = 0.011). Both diabetes mellitus and transient corneal edema were significantly associated with PCME development 5 weeks after surgery (OR, 4.58; 95% CI, 1.56 to 13.43; p = 0.007; and OR, 6.71; CI, 2.05 to 21.95; p = 0.003, respectively). In the 8 eyes with both diabetes mellitus and transient corneal edema, 4 (50%) developed PCME 5 weeks after surgery. CONCLUSIONS: Transient corneal edema detected 1 week after routine cataract surgery is a predictive factor for development of PCME. Close postoperative observation and intervention is recommended in patients with transient corneal edema.
Adult ; Aged ; Aged, 80 and over ; Cornea/*pathology ; Corneal Edema/*diagnosis/etiology ; Female ; Fluorescein Angiography ; Follow-Up Studies ; Fundus Oculi ; Glucosinolates ; Humans ; Macular Edema/diagnosis/*etiology ; Male ; Middle Aged ; *Phacoemulsification ; Pseudophakia/*complications/diagnosis ; Retrospective Studies ; Tomography, Optical Coherence

PURPOSE: The purpose of this study was to verify objectively whether abdominal ultrasonography performed by emergency physicians (EP) in emergency departments (ED) immediately after history taking and physical examination could give effective diagnostic information and to check the feasibility and usefulness of the COUCH method. METHODS: From May 1, 2005 to September 30, 2005 we recruited 368 patients who complained of abdominal pain in the ED. Senior level emergency physicians (EP) conducted history taking and physical examinations, following which they were asked for their suspected diagnosis and their level of confidence (from maximum 5 to minimum 1) regarding each diagnosis. The same EP then performed abdominal ultrasonography (US), using the COUCH method and were again asked for their suspected diagnosis and level of confidence. We compared the suspected diagnoses and levels of confidence before and after abdominal US by using the t-test. RESULTS: A total of 106 patients (55 male, 51 female, average age 35.46+/-18.11 years) were enrolled. The number of patients with a suspected diagnosis of after history taking and physical examination only (2.43+/-0.5) was significantly greater than after abdominal US (1.34+/-0.5) (p<0.01). The level of confidences of suspected diagnosis of after history taking and physical examination only (3.43+/-1.14), by contrast, was less than after abdominal US (4.40+/-1.22) (p<0.01). Each year of postgraduate residents could have the same results after US. CONCLUSION: We found that abdominal ultrasonography could give EP more informations for pronouncing a correct diagnosis for patients with abdominal pain in the ED, and the COUCH method could lead the EP to get better training for ultrasonography and to diagnose more rapidly and accurately.
Abdominal Pain ; Diagnosis, Differential ; Emergencies ; Female ; Humans ; Male ; Physical Examination

BACKGROUND AND OBJECTIVES: Making the noninvasive diagnosis of coronary artery disease in patients with a permanent pacemaker is difficult because of the inability to interpret electrocardiograms and the low specificity of perfusion scintigraphy. We evaluated the diagnostic accuracy of noninvasive pacemaker stress echocardiography (PASE) as a screening test for coronary artery disease in patients with atypical angina and a permanent pacemaker. SUBJECTS AND METHODS: This a prospective study, and transthoracic stress-pacing echocardiography was performed on 15 patients (9 men and 6 women; age, mean age: 71.1+/-11.0 years) with atypical angina and a permanent pacemaker. All the patients underwent noninvasive pacemaker-stress echocardiography by external programming (pacing the heart rate up to 150 beats per minute). Coronary angiography was performed on the 8 patients with positive PASE results. Significant coronary artery disease was defined as > or =70% stenosis in at least one major coronary artery. RESULTS: The echocardiographic images were interpretable for all the patients. No significant side effects were observed. The left ventricular systolic function was preserved in all the patients (left ventricular ejection fraction; 63.5+/-8%). Only 5 (62.5%) of 8 patients showed significant coronary artery disease, as documented by coronary angiography. CONCLUSION: Noninvasive PASE is a simple, rapid, safe and diagnostically efficient test for detecting coronary artery disease in patients with atypical angina and a permanent pacemaker. Larger studies are necessary to validate our findings.
Constriction, Pathologic ; Coronary Angiography ; Coronary Artery Disease ; Coronary Stenosis ; Coronary Vessels ; Echocardiography ; Echocardiography, Stress ; Electrocardiography ; Heart Rate ; Humans ; Male ; Mass Screening ; Pacemaker, Artificial ; Perfusion Imaging ; Prospective Studies ; Sensitivity and Specificity