Purpose: To investigate the incidence and clinical course of acute endophthalmitis after idiopathic epiretinal membrane (iERM) surgery employing microincision vitrectomy (MIVS). Methods: We retrospectively reviewed the medical records of eyes with acute endophthalmitis developing after iERM surgery via 23- or 25-gauge MIVS from 2011 to 2021. The incidence, culture-positive rate (and responsible bacteria), final visual acuity (VA), and factors affecting poor visual outcomes were assessed. Results: Acute endophthalmitis developed in 20 of the 12,921 eyes (0.15%) after MIVS. Of these, 14 of 3,180 eyes treated via iERM (0.44%, one per 227 procedures) developed endophthalmitis; the incidence ratio (iERM versus non-iERM) was 7.1 (p < 0.001, 95% confidence interval [CI] = 2.6-22.7). At least one sclerotomy remained unsutured in all eyes after iERM surgery. Thirteen eyes (92.9%) were given intravitreal antibiotic injections after emergency vitrectomy, and one eye was treated with intravitreal antibiotic injection alone. Staphylococcus epidermidis was cultured from four eyes (28.6%); three strains were methicillin-resistant. All final VAs were not better than the initial VAs; the average VA decreased from 20/42 to 20/259 (p < 0.001). Six eyes (42.9%) attained legal blindness status (final VA < 20/200); Macular invasion was a unique risk factor for such blindness (p = 0.020, odds ratio = 35.0, 95% CI = 1.7-703.0). Conclusions Acute endophthalmitis developing after iERM surgery with MIVS was more common than such endophthalmitis after other retinal surgery. Approximately 40% of the former patients became legally blind, and the risk was higher in eyes with macular involvement of endophthalmitis.

Objectives: This study compares the labeling information on the sizes of interdental brushes marketed in Korea to their actual sizes. Moreover, it analyzes the relationship between the size of the passage hole diameter (PHD), brush diameter, stem diameter, and stem length. Methods: Among the commercially available interdental brushes in Korea, 171 interdental brushes, 3 in each size, were collected from 9 companies. The labels of the collected interdental brushes were researched, and the PHD was measured and compared. The correlation between the passage hole diameter, brush diameter, stem diameter, and stem length was analyzed. Multiple regression analysis was performed to verify the effect of brush diameter, stem diameter, and stem length on the determination of the PHD. Results: The sizes of the interdental brushes were expressed using the ISO labeling or the Small, Medium, Large (S, M, L) labeling and indicated in units of 0.1. The concordance rate of the measured PHD and named PHD was 39.7%. The measured brush diameter, stem diameter, and stem length increased as the interdental brush size increased. There was a significant correlation (P<0.01) between PHD, brush diameter, stem diameter, and stem length. The order of variables with the most to least significant influence on PHD was stem diameter (β=0.528), brush diameter (β=0.404), and stem length (β=0.074). Conclusions This study shows that the label and actual size of interdental brushes did not match, and the concordance rate between the measured and labeled PHDs was low. Therefore, the interdental brush size labels among manufacturers should be standardized. Moreover, these manufacturers must provide the correct size information for the interdental brushes.

Objectives: This study aimed to develop a method for objectively evaluating toothpaste abrasivity, enabling a direct comparison between different toothpastes. Methods: Nine commercially available toothpaste variants were selected, and 8 mm thick acrylic specimens were allocated to each toothpaste treatment group (n=7). A control group without toothpaste was also included. Specimens and toothbrushes were mounted on the V8 Cross brushing machine, and toothpaste (0.05-0.1 g) was applied for 20 strokes under a 200 g load and 1 Hz speed. The surface wear was measured at an absorbance of 600 nm in a UV-Vis spectrophotometer. Specimens were then photographed with a polarized light microscope, and the gray value of the worn brushed part was obtained through image analysis using Image J software. A one-way ANOVA followed by Bonferroni’s post-hoc test was employed for analyzing absorbance and gray value differences among the toothpaste groups. The correlation between absorbance and gray value was assessed using Pearson’s correlation analysis. Results: Significant differences were noted in absorbance and gray values across the toothpaste groups (P<0.05), and a strong correlation was observed between the absorbance and the values from the images analyzed (r=0.948, P<0.001). The wear rankings based on absorbance and image analysis values were mostly the same. Conclusions This study introduces a direct and objective method for evaluating toothpaste abrasion, offering users objective information on different toothpaste types.

Purpose: To investigate the changes in intraocular cytokines after ranibizumab treatment in patients with polypoidal choroidal vasculopathy (PCV). Methods: This multicenter, prospective study enrolled patients with PCV treated with three monthly ranibizumab followed by a pro re nata regimen for 24 weeks. Best corrected visual acuity, slit lamp examination, fundus photography, and optical coherence tomography were performed every 4 weeks. Aqueous humor was collected to measure intraocular cytokines at baseline, week 8, and the time of recurrence or week 20. The association of changes in intraocular cytokines with visual acuity, central macular thickness, central choroidal thickness, area of abnormal vessels, and polyp closure was assessed. Results: This study included 25 eyes. The mean patient age was 70.3 ± 6.1 years. The vascular endothelial growth factor (VEGF) concentration decreased at week 8, but only interferon (IFN)-γ, tissue inhibitors of matrix metalloproteinases (TIMP)-2, and monocyte chemoattractant protein (MCP)-2 decreased at the time of recurrence. The recurrence interval was positively associated with the baseline epithelial-neutrophil activating peptide (ENA)-78, interleukin (IL)-17, leptin, and transforming growth factor-β1, and baseline central macular thickness was positively correlated with the baseline fibroblast growth factor-4 and IL-10. Thick central choroidal thickness was associated with a low basic fibroblast growth factor and high IFN-γ at baseline. The MCP-3 and Tie-2 levels decreased in two eyes with polyp closure. Conclusions Ranibizumab significantly reduced intraocular VEGF concentrations and consequently improved PCV. However, the cytokines IFN-γ, TIMP-2, and MCP-2, rather than VEGF, were associated with PCV recurrence. Further studies of intraocular cytokines involved in neovascularization in PCV are needed.

Purpose: To report a case of extensive syphilitic punctate inner retinitis (SPIR) triggering bilateral macular ischemia after intravitreal triamcinolone injections, and the multimodal retinal imaging findings.Case summary: A 69-year-old male patient with nonproliferative diabetic retinopathy was transferred to our hospital because of bilateral visual deterioration (to counting fingers) after the first intravitreal triamcinolone injection. Fundus examination revealed numerous yellow punctate precipitates in the superficial retinae, retinal arteriolitis, and vitritis. The punctate lesions and surrounding retinal regions showed decreased vascular density on optical coherence tomography angiography, and focal hypofluorescence on fluorescein angiography. The patient was positive for all of the Venereal Disease Research Laboratory test, the fluorescent treponemal antibody-absorption test, and Treponema pallidum hemagglutination; we diagnosed bilateral SPIR. After treatment with aqueous crystalline penicillin solutions (24 million units per day for 14 days), the punctate lesions reduced but arteriolitis progressed to obliterative vasculitis. After 6 months, the bilateral SPIR and vitritis resolved, and the bilateral visual acuity improved to 20/100. However, inner retinal and macular ischemia persisted because of capillary nonperfusion attributable to obliterative vasculitis. Conclusions Extensive SPIR can develop after an initial intravitreal steroid injection; the inner retinal ischemia and visual loss may persist after treatment because obliterative vasculitis develops. Therefore, patients scheduled for intravitreal steroid injections should be screened for syphilis infection.

Purpose: To describe the development of multiple retinal hemorrhages after uncomplicated macular hole (MH) surgery, and to determine the associated factors. Methods: The medical records of 163 patients (167 eyes) diagnosed with idiopathic MHs and who underwent surgery at Pusan National University Hospital between March 2016 and July 2018 were retrospectively reviewed. The development of retinal hemorrhages was evaluated using ultra-widefield fundus photographs. Multiple retinal hemorrhages were defined as three or more dot or blot hemorrhages that had not been observed before and during the surgery. The patients were divided into two groups according to the presence of multiple retinal hemorrhages. The variable parameters were compared between the two groups to find the risk factors. The associated factors were evaluated further for the independent factor using multiple logistic regression analysis. Results: Multiple retinal hemorrhages were observed in 31 eyes (18.6%) after MH surgery. The associated factors were the surgical induction of posterior vitreous detachment (PVD) (p = 0.003), use of the internal limiting membrane flap technique (p = 0.028), and staining with Brilliant Blue G (BBG) (p = 0.003). Retinal hemorrhages were exclusively observed in eyes in which BBG was used. Surgical PVD induction was the only independent risk factor (odds ratio, 13.099; p = 0.013). No statistically significant differences were observed between the two groups in the postoperative visual outcomes and MH closure rate. Additionally, patients who underwent surgery for idiopathic epiretinal membrane during the study period were reviewed to validate the above findings. Multiple retinal hemorrhages were noted in only one case (0.4%) in which BBG was used after surgical induction of PVD. Conclusions Multiple retinal hemorrhages after MH surgery appear to be related to the intravitreal use of BBG in eyes that sustained mechanical damage because of surgical induction of PVD; however, they did not affect surgical outcomes.

Purpose: To describe the development of multiple retinal hemorrhages after uncomplicated macular hole (MH) surgery, and to determine the associated factors. Methods: The medical records of 163 patients (167 eyes) diagnosed with idiopathic MHs and who underwent surgery at Pusan National University Hospital between March 2016 and July 2018 were retrospectively reviewed. The development of retinal hemorrhages was evaluated using ultra-widefield fundus photographs. Multiple retinal hemorrhages were defined as three or more dot or blot hemorrhages that had not been observed before and during the surgery. The patients were divided into two groups according to the presence of multiple retinal hemorrhages. The variable parameters were compared between the two groups to find the risk factors. The associated factors were evaluated further for the independent factor using multiple logistic regression analysis. Results: Multiple retinal hemorrhages were observed in 31 eyes (18.6%) after MH surgery. The associated factors were the surgical induction of posterior vitreous detachment (PVD) (p = 0.003), use of the internal limiting membrane flap technique (p = 0.028), and staining with Brilliant Blue G (BBG) (p = 0.003). Retinal hemorrhages were exclusively observed in eyes in which BBG was used. Surgical PVD induction was the only independent risk factor (odds ratio, 13.099; p = 0.013). No statistically significant differences were observed between the two groups in the postoperative visual outcomes and MH closure rate. Additionally, patients who underwent surgery for idiopathic epiretinal membrane during the study period were reviewed to validate the above findings. Multiple retinal hemorrhages were noted in only one case (0.4%) in which BBG was used after surgical induction of PVD. Conclusions Multiple retinal hemorrhages after MH surgery appear to be related to the intravitreal use of BBG in eyes that sustained mechanical damage because of surgical induction of PVD; however, they did not affect surgical outcomes.

Purpose: To report a case of preretinal pigmentary proliferation on the fovea after scleral buckling for rhegmatogenous retinaldetachment.Case summary: A 49-year-old female visited out clinic complaining of a visual field defect in the right eye for 5 days. Thebest-corrected visual acuity (BCVA) was 0.8 in her right eye. Fundus examination of the right eye revealed an upper rhegmatogenousretinal detachment without macular involvement and retinal breaks were found at 11 o’clock and 11’ 30” direction. She underwentscleral buckling, subretinal fluid drainage, and cryoretinopexy under general anesthesia. At postoperative day 4, thesubretinal fluid was reduced, but the BCVA decreased to 0.2. The fovea was covered with a brownish pigmentary clump and preretinalhyperreflective proliferative tissue was observed on the fovea by optical coherence tomography. Oral steroid was administeredand a decrease of pigmentary proliferation was observed at 2 weeks after surgery. At 3 months postoperatively, thepigmentary proliferation had almost disappeared and the BCVA recovered to 0.8. Conclusions Pigmentary proliferation on the fovea may be observed in patients treated with scleral buckling for rhegmatogenousretinal detachment, so careful observation is needed to differentiate this process from other proliferative diseases.

Objectives: The water fluoridation program in Hapcheon township area has been implemented since 2000. This study aimed to evaluate the caries-preventive effect of water fluoridation on permanent teeth after implementation of an 18-year community water fluoridation program in a suburban area. Methods: A survey was conducted in 2018 with 359 subjects, aged 8, 10, and 12 years, residing in the Hapcheon township area. In this prospective cohort study, the data on caries prevalence obtained from 671 subjects, aged 8, 10, and 12 years, in 2000, when the community water fluoridation program was initiated in the township, were used as a cohort to evaluate the caries-preventive effect after 18 years. The caries-preventive effect of community water fluoridation on permanent teeth was estimated by comparison of the adjusted DMFT scores between the program and the control group, and between the pre- and post-program data after 18 years. The confounding factor, mean number of fissure-sealed teeth, was adjusted to estimate the caries-preventive effect of fluoridation on permanent teeth. Results: Based on the results of the surveys conducted in Hapcheon-eup in 2000 and 2018, the mean number of fissure-sealed permanent teeth was 2.24 in 2000 and 1.38 in 2018. The mean DMFT scores of subjects aged 8, 10, and 12 years in 2018, adjusted for fissure-sealed permanent teeth in the fluoridated area, were significantly lower than those reported by the 2018 Korea National Children’s Oral Health Survey. In addition, the mean values of the adjusted DMFT scores of subjects aged 8, 10, and 12 years in 2018, after the 18-year fluoridation program, were significantly lower than those reported in 2000, the year the fluoridation program was initiated. Conclusions Community water fluoridation has a high caries-reducing effect; thus, the reintroduction of water fluoridation program is desirable to prevent dental caries.

Objectives: The purpose of this study was to investigate the risk factors related to periodontal health in middle school and high school adolescents. Methods: This study was conducted using data from the Sixth Korean National Health and Nutrition Examination Survey (KNHANES, 2013-2015). Among the 22,948 participants in the Sixth KNHANES, 1,222 participants (aged 12-18 years) who completed the systemic and oral health examinations and questionnaires were included in this study. Independent variables related to demographic socioeconomic status and oral health-related behaviors were the following: age, gender, household income, frequency of daily toothbrushing, smoking, alcohol drinking, annual dental visit, and periodontal treatment. The dependent variables were the prevalence of gingival bleeding or calculus and the number of sextants with gingival bleeding or calculus. Results: Among the total participants, 34.1% were diagnosed with prevalence of gingival bleeding or calculus, and periodontal health was found to be at its worst at 17 years of age (41.6% of participants). Moreover, household income, alcohol drinking, annual dental visits, and frequency of daily toothbrushing were related to prevalence and the number of sextants with gingival bleeding or calculus. The adjusted odds ratio (aOR) for prevalence of gingival bleeding or calculus by alcohol consumption, toothbrushing less than twice per day, and number of DMFT were 5.00 (95% CI: 2.24-11.18), 2.21 (95% CI: 1.21-4.04), and 1.09 (95% CI: 1.02-1.17), respectively. Conclusions To prevent periodontal disease among adolescents, it is necessary to improve oral health-related behavior and its associated factors and continuous oral health education.