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.

Background: Atopic dermatitis (AD) is a chronic relapsing inflammatory skin disease.Although murine studies have demonstrated that type 2 innate lymphoid cells (ILCs) mediate type 2 skin inflammation, their role in skin fibrosis in AD remains unclear. This study investigated whether type 2 ILCs are involved in skin fibrosis using an AD-like murine model. Methods: C57BL/6 mice were treated epicutaneously with Aspergillus fumigatus (Af) for 5 consecutive days per week for 5 weeks to induce skin fibrosis. Mature lymphocyte deficient Rag1−/− mice were also used to investigate the role of type 2 ILCs in skin fibrosis. Results: The clinical score and transepidermal water loss (TEWL) were significantly higher in the AD group than in the control group. The AD group also showed significantly increased epidermal and dermal thicknesses and significantly higher numbers of eosinophils, neutrophils, mast cells, and lymphocytes in the lesional skin than the control group. The lesional skin of the AD group showed increased stain of collagen and significantly higher levels of collagen than the control group (10.4 ± 2.2 µg/mg vs. 1.6 ± 0.1 µg/mg, P < 0.05). The AD group showed significantly higher populations of type 2 ILCs in the lesional skin compared to the control group (0.08 ± 0.01% vs. 0.03 ± 0.01%, P < 0.05). These findings were also similar with the AD group of Rag1−/− mice compared to their control group. Depletion of type 2 ILCs with anti-CD90.2 monoclonal antibodies significantly improved clinical symptom score, TEWL, and infiltration of inflammatory cells, and significantly decreased levels of collagen were observed in the AD group of Rag1−/− mice (1.6 ± 0.0 μg/mg vs. 4.5 ± 0.3 μg/mg, P < 0.001). Conclusion In the Af-induced AD-like murine model, type 2 ILCs were elevated, with increased levels of collagen. Additionally, removal of type 2 ILCs resulted in decreased collagen levels and improved AD-like pathological findings. These findings suggest that type 2 ILCs play a role in the mechanism of skin fibrosis in AD.

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.

Background and Objectives: This study aimed to investigate the association between cardiovascular events and 2 different levels of elevated on-treatment diastolic blood pressures (DBP) in the presence of achieved systolic blood pressure targets (SBP). Methods: A nation-wide population-based cohort study comprised 237,592 patients with hypertension treated. The primary endpoint was a composite of cardiovascular death, myocardial infarction, and stroke. Elevated DBP was defined according to the Seventh Report of Joint National Committee (JNC7; SBP <140 mmHg, DBP ≥90 mmHg) or to the 2017 American College of Cardiology/American Heart Association (ACC/AHA) definitions (SBP <130 mmHg, DBP ≥80 mmHg). Results: During a median follow-up of 9 years, elevated on-treatment DBP by the JNC7 definition was associated with an increased risk of the occurrence of primary endpoint compared with achieved both SBP and DBP (adjusted hazard ratio [aHR], 1.14; 95% confidence interval [CI], 1.05–1.24) but not in those by the 2017 ACC/AHA definition. Elevated ontreatment DBP by the JNC7 definition was associated with a higher risk of cardiovascular mortality (aHR, 1.42; 95% CI, 1.18–1.70) and stroke (aHR, 1.19; 95% CI, 1.08–1.30). Elevated on-treatment DBP by the 2017 ACC/AHA definition was only associated with stroke (aHR, 1.10;95% CI, 1.04–1.16). Similar results were seen in the propensity-score-matched cohort. Conclusion Elevated on-treatment DBP by the JNC7 definition was associated a high risk of major cardiovascular events, while elevated DBP by the 2017 ACC/AHA definition was only associated with a higher risk of stroke. The result of study can provide evidence of DBP targets in subjects who achieved SBP targets.

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.