Purpose: We investigated the effects of upper eyelid surgery on corneal higher-order aberrations and astigmatism. Methods: We enrolled 38 patients (66 eyes) who underwent blepharoplasty and 48 (81 eyes) who underwent levator resection. The marginal reflex distance1 (MRD1), corneal astigmatism, and corneal higher-order aberrations were measured preoperatively, and at 6 months postoperatively, and the two groups were compared. Results: Corneal astigmatism decreased significantly in the ptosis repair group (p < 0.001) but there was no significant change in the axis of astigmatism. Preoperative third-order and coma-like aberrations were significantly more common in the ptosis repair group than in the other group (p = 0.027 and p = 0.044, respectively); both decreased significantly after the operation (p = 0.030 and p = 0.006, respectively). The decrease in MRD1 and changes in the two aberrations showed a significantly stronger negative correlation in the ptosis repair group than in the other group (b = -0.186; p < 0.001 and b = -0.159; p < 0.001, respectively). Conclusions For patients with both cataract and ptosis, it is best to perform levator resection surgery before cataract surgery, because corneal higher-order aberrations and astigmatism are improved by levator resection. In turn, this reduces postoperative refractive error and improve vision quality.

Background: Atopic dermatitis (AD) is a heterogeneous disease with different age of onset, disease course, clinical symptoms, severity, and risk of comorbidity. The characteristics of children with AD also vary by age or country. However, little is known about the clinical characteristics of AD in Korean school-aged children and adolescents. Furthermore, there are few studies on phenotypic differences according to onset age. This study aimed to explore the clinical characteristics and phenotypes according to onset age and severity of AD in children and adolescents in Korea. Methods: AD patients aged 6–18 years who presented to 18 hospitals nationwide were surveyed.The patients were examined for disease severity by pediatric allergy specialists, and data on history of other allergic diseases, familial allergy history, onset age, trigger factors, lesion sites,treatment history and quality of life were collected. The results of the patient’s allergy test were also analyzed. The patients were classified into infancy-onset (< 2 years of age), preschoolonset (2–5 years of age), and childhood-onset (≥ 6 years of age) groups. Study population was analyzed for clinical features according to onset-age groups and severity groups. Results: A total of 258 patients with a mean age of 10.62 ± 3.18 years were included in the study. Infancy-onset group accounted for about 60% of all patients and presented significantly more other allergic diseases, such as allergic rhinitis and asthma (P = 0.002 and P = 0.001, respectively). Food allergy symptoms and diagnoses were highly relevant to both earlier onset and more severe group. Inhalant allergen sensitization was significantly associated with both infancy-onset group and severe group (P = 0.012 and P = 0.024, respectively). A family history of food allergies was significantly associated with infancyonset group (P = 0.036). Severe group was significantly associated with a family history of AD, especially a paternal history of AD (P = 0.048 and P = 0.004, respectively). Facial (periorbital, ear, and cheek) lesions, periauricular fissures, hand/foot eczema, and xerosis were associated with infancy-onset group. The earlier the onset of AD, the poorer the quality of life (P = 0.038). Systemic immunosuppressants were used in only 9.6% of the patients in the severe group. Conclusion This study analyzed the clinical features of AD in Korean children and adolescents through a multicenter nationwide study and demonstrated the phenotypic differences according to onset age and severity. Considering the findings that the early-onset group is more severe and accompanied by more systemic allergic diseases, early management should be emphasized in young children and infants.

BACKGROUND: Although secondary cervicothoracic scoliosis frequently occurs in patients with congenital muscular torticollis (CMT), the relationship between scoliosis and CMT has not been evaluated. This study aims to evaluate the effects of surgical release of sternocleidomastoid (SCM) muscle on secondary cervicothoracic scoliosis in patients with CMT and determine factors affecting the improvement of scoliosis after surgical release of SCM muscle. METHODS: Eighty-seven of the 106 patients, confirmed as having secondary cervicothoracic scoliosis with CMT with a minimum 1-year follow-up, were included in this study. Preoperative and last follow-up radiologic outcomes were assessed for the cervicomandibular angle (CMA), Cobb angle of the cervicothoracic scoliosis, and direction of convexity in the scoliosis curve. Patients were divided into two groups to assess the improvement of Cobb angle according to residual growth potential; age ≤ 15 years and > 15 years. The improvement of Cobb angle after surgical release was compared in the two groups. Correlation analysis and multivariable regression analysis were performed to determine the factors affecting the improvement of scoliosis. RESULTS: All the radiologic parameters, such as the Cobb angle and CMA, improved significantly after surgical release (p < 0.001). The improvement of Cobb angle was significantly higher in age ≤ 15 years than in age > 15 years (p < 0.001). The improvement of Cobb angle was significantly correlated with age (r = −0.474, p < 0.001) and the preoperative Cobb angle (r = 0.221, p = 0.036). In multivariable regression analysis, age and preoperative Cobb angle were shown to be predisposing factors affecting the improvement of scoliosis. CONCLUSIONS: The results showed that SCM release can be a beneficial treatment for secondary cervicothoracic scoliosis. The improvement of scoliosis was greater when the SCM release was performed before the patient reached the end of growth.
Causality ; Follow-Up Studies ; Humans ; Scoliosis ; Torticollis

PURPOSE: Although anaphylaxis is recognized as an important, life-threatening condition, data are limited regarding its triggers in different age groups. We aimed to identify anaphylaxis triggers by age in Korean children. METHODS: We performed a retrospective review of medical records for children diagnosed with anaphylaxis between 2009 and 2013 in 23 secondary or tertiary hospitals in South Korea. RESULTS: A total of 991 cases (mean age=5.89±5.24) were reported, with 63.9% involving patients younger than 6 years of age and 66% involving male children. Food was the most common anaphylaxis trigger (74.7%), followed by drugs and radiocontrast media (10.7%), idiopathic factors (9.2%), and exercise (3.6%). The most common food allergen was milk (28.4%), followed by egg white (13.6%), walnut (8.0%), wheat (7.2%), buckwheat (6.5%), and peanut (6.2%). Milk and seafood were the most common anaphylaxis triggers in young and older children, respectively. Drug-triggered anaphylaxis was observed more frequently with increasing age, with antibiotics (34.9%) and nonsteroidal anti-inflammatory drugs (17.9%) being the most common causes. CONCLUSIONS: The most common anaphylaxis trigger in Korean children was food. Data on these triggers show that their relative frequency may vary by age.
Anaphylaxis* ; Anti-Bacterial Agents ; Arachis ; Child* ; Contrast Media ; Egg White ; Epidemiology ; Fagopyrum ; Humans ; Juglans ; Korea ; Male ; Medical Records ; Milk ; Retrospective Studies* ; Seafood ; Tertiary Care Centers ; Triticum

PURPOSE: To investigate the clinical features and compliance of cosmetic contact lens (CL)-related complications compared with soft CL-related complications. METHODS: We performed a retrospective chart review of 97 patients (194 eyes) regarded as having CL-related complications at the outpatient clinic. The portion of complications, gender, age, and chief complaints at the initial visit were analyzed, as was compliance to cosmetic and soft CL-related guidelines for use. RESULTS: A total of 97 patients (49 patients with cosmetic CL-related complications and 43 patients with soft CL-related complications) were evaluated. The mean age of the subjects using cosmetic CL was 19.8 years (14-31 years), and all the patients were female. The chief complaints at the initial visit included ocular pain, injection, blurred vision, dryness, itching and foreign body sensation. The main complications included corneal erosion, sterile corneal infiltrate, allergic disease, neovascularization, corneal ulcer and dry eye syndrome. No statistical difference was found regarding chief complaints or complications. The proportion of patients lost to follow-up was 47% in cosmetic CL-related and 20% in soft CL-related complications, a significant difference (p = 0.015). CONCLUSIONS: Because young females are the most common CL patients and do not always fully comply with the guidelines for use, ophthalmologists need to warn these patients about the risk of serious complications.
Ambulatory Care Facilities ; Compliance* ; Contact Lenses, Hydrophilic ; Corneal Neovascularization ; Dry Eye Syndromes ; Female ; Foreign Bodies ; Humans ; Lost to Follow-Up ; Pruritus ; Retrospective Studies ; Sensation ; Ulcer

PURPOSE: To report a case of acute endophthalmitis after a dexamethasone (Ozurdex(R)) intravitreal implant for macular edema (ME) secondary to branch retinal vein occlusion (BRVO). CASE SUMMARY: A 63-year-old male patient presented with decreased vision in the right eye due to ME secondary to BRVO. The patient was treated with an intravitreal bevacizumab injection, but ME did not improve. Two months after the injection, dexamethasone (Ozurdex(R)) intravitreal implantation was performed. Four days after the implantation, the patient visited our clinic complaining of severe visual disturbance. Slight conjunctival injection was observed and inflammatory cells and hypopyon were found in the anterior chamber. Fundus was not visible due to vitreous opacity. The patient was presumed to have acute endophthalmitis. Vitrectomy, intravitreal antibiotics injection, dexamethasone implant removal and phacoemulsification were performed. After treatment, the patient's fundus markedly improved, the inflammatory response was controlled and coagulase negative staphylococcus was detected from vitreous culture. CONCLUSIONS: In cases of intravitreal dexamethasone implant associated with acute endophthalmitis, careful examination for diagnosis of endophthalmitis is recommended because the patient may not present with severe ocular pain and injection due to anti-inflammatory effect of corticosteroid.
Anterior Chamber ; Anti-Bacterial Agents ; Coagulase ; Dexamethasone* ; Diagnosis ; Endophthalmitis* ; Humans ; Intravitreal Injections ; Macular Edema ; Male ; Middle Aged ; Phacoemulsification ; Retinal Vein Occlusion ; Staphylococcus ; Vitrectomy ; Bevacizumab

PURPOSE: To report a rare case of thrombocytopenia after intravitreal bevacizumab injection (IVBI) in a patient with macular edema secondary to branch retinal vein occlusion (BRVO). CASE SUMMARY: A 52-year-old female presented to our clinic with complaints of visual disturbance in her right eye for 2 months. She was receiving hemodialysis therapy 3 times a week for 4 years due to chronic renal failure. Unilateral macular edema secondary to BRVO was observed on fundus examination and was confirmed with optical coherence tomography (OCT). The first IVBI was performed, and an additional injection was given 4 weeks later. Four weeks after the second injection, thrombocytopenia was present. The patient was followed up in our clinic without IVBI for 8 weeks and the platelet count recovered. Thrombocytopenia was reconfirmed after 2 additional monthly injections. After she revisited our clinic without IVBI for 8 weeks, the platelet count recovered without any treatment. CONCLUSIONS: When a patient presents with thrombocytopenia after IVBI with macular edema in BRVO, thrombocytopenia due to IVBI should be considered as a possible diagnosis.
Antibodies, Monoclonal, Humanized ; Diagnosis ; Female ; Humans ; Kidney Failure, Chronic ; Macular Edema* ; Middle Aged ; Platelet Count ; Renal Dialysis ; Retinal Vein Occlusion* ; Retinal Vein* ; Retinaldehyde* ; Thrombocytopenia* ; Tomography, Optical Coherence ; Bevacizumab

We report a case of CTX-M-55-type extended-spectrum beta-lactamase (ESBL)-producing Shigella sonnei infection in a 27-year-old Korean woman who had traveled to China. The patient was admitted to the hospital due to abdominal pain, watery diarrhea, and fever (39.3degrees C). S. sonnei was isolated from her stool specimens, and the pathogen was found to be resistant to cefotaxime due to CTX-M-55-type ESBL. Insertion sequence (IS)Ecp1 was found upstream of the blaCTX-M-55 gene. The blaCTX-M-55 gene was transferred from the S. sonnei isolate to an Escherichia coli J53 recipient by conjugation. Pulsed-field gel electrophoresis and Southern blotting revealed that the blaCTX-M-55 gene was located on a plasmid of approximately 130 kb.
Adult ; Anti-Bacterial Agents/pharmacology ; Asian Continental Ancestry Group ; Cefotaxime/pharmacology ; China ; Drug Resistance, Bacterial/drug effects ; Dysentery, Bacillary/diagnosis/*microbiology ; Electrophoresis, Gel, Pulsed-Field ; Escherichia coli/metabolism ; Feces/microbiology ; Female ; Humans ; Plasmids/chemistry/genetics ; Republic of Korea ; Shigella sonnei/enzymology/*isolation & purification ; Travel ; beta-Lactamases/genetics/*metabolism

Oral food challenge is a definitive diagnostic test for immediate and occasionally delayed adverse reaction to foods. The gold standard for diagnosing food allergy is still the double-blind, placebo-controlled food challenge, but it is time-consuming, expensive and troublesome for physician and patients. Open oral food challenge controlled by trained personnel is useful and sufficient methods when concern of bias is low. We aimed to provide a practical guideline for oral food challenge in children for the diagnosis of suspected food allergy or the evaluation of food tolerance. We considered reasons, types, indications, contraindications, risks, benefits, detailed methods, practical performance, interpretations of test results, and treatments for the adverse reactions of oral food challenge.
Bias (Epidemiology) ; Child ; Diagnostic Tests, Routine ; Food Hypersensitivity ; Humans

BACKGROUND AND OBJECTIVES: The purpose of this study was to evaluate the impact of open-mouth breathing on the upper airway anatomy of patients with sleep-disordered breathing (SDB) based on polysomnography. MATERIALS AND METHODS: A total of 114 subjects (101 males and 13 females) with a mean age of 42.7 years and a mean body mass index (kg/m2) of 26.2 were enrolled in this study. All subjects were divided into four groups (simple snoring, mild obstructive sleep apnea syndrome[OSAS], moderate OSAS and severeOSAS) according to the apnea-hypopnea index. Lateral cephalometric radiograms (retropalatal, retroglossal, and hypopharyngeal distance, and pharyngeal length) were taken with the mouth closed and open. RESULTS: The lateral cephalometric variables were compared between the mouth closed and open positions, and it was found that the retropalatal and retroglossal distances and pharyngeal length were significantly changed in all groups. However, the hypopharyngeal distance did not change significantly in any of the groups. CONCLUSION: Open-mouth breathing significantly reduces the retropalatal and retroglossal distance and lengthens the pharynx in patients with SDB. Since these anatomical changes may worsen SDB or decrease positive airway pressure treatment compliance, ENT doctors should attempt to convert SDB patients from open-mouth breathing to nasal breathing.
Body Mass Index ; Cephalometry ; Compliance ; Humans ; Male ; Mouth ; Mouth Breathing ; Pharynx ; Respiration ; Sleep Apnea Syndromes ; Sleep Apnea, Obstructive ; Snoring