Purpose: We corrected the axial lengths of the macular and peripapillary significance maps using software embedded in a commercial spectral domain optical coherence tomography (SD-OCT) package. We evaluated the accuracy of glaucoma diagnosis in patients with high myopia, and the clinical implications. Methods: Seventy eyes of 70 highly myopic patients with or without normal-tension glaucoma were retrospectively reviewed. The sensitivities and specificities of the color-coded significance maps were calculated using 1% (red) or 5% (yellow) as the abnormality criteria, and the values compared before and after axial length corrections performed using embedded SD-OCT software. Results: At the 1% level of the normative database, we found no significant difference in specificity or sensitivity. At the 5% level, the increase in specificity was significant only for the inferotemporal sectors of the macular significance map. The specificity of the inferotemporal sector of the inner scan circle increased from 61.9 to 78.6% (p = 0.016) and that of the outer scan circle from 69 to 83.8% (p = 0.031). The specificities of the entire chart, the superior sector of the superior/inferior chart, and the 12-clockwise map increased significantly from 54.8 to 78.6% (p = 0.002), 59.5 to 76.2% (p = 0.039), and 59.5 to 76.2% (p = 0.002) respectively. Conclusions Clinicians should note that axial length correction of significance maps reduces the false-positive glaucoma diagnostic rates in highly myopic eyes. Correction of significance maps using embedded software may thus aid clinicians in the diagnosis of glaucoma in high myopic eyes.

Purpose: To evaluate endothelial damage after cataract surgery in eyes affected by an angle-closure attack (ACA) and compare it to that in the unaffected fellow eyes (FEs) of patients with ACA and normal eyes (NEs). Methods: The medical data of eyes affected by ACA, FEs (with no history of acute glaucoma attack), and NEs of patients who underwent cataract surgery with simultaneous intraocular lens implantation were retrospectively reviewed. Endothelial cell density (ECD) and central corneal thickness (CCT) measured before surgery and at 1 week, 1 month, and 3 months after surgery were analyzed, and the percentages of loss in ECD and increase in CCT of the three groups were compared. Results: The study enrolled 140 eyes from 100 patients (50 eyes in the ACA group, 40 eyes in the FE group, and 50 eyes in the NE group). The mean ECD was significantly lower in the ACA group than in the other groups (p < 0.001). However, the percentage of ECD reduction was not significantly greater in the ACA group than in the other groups (p > 0.05). None of the eyes developed corneal edema at 3 months postoperatively. Moreover, the CCTs of the three groups were similar throughout the follow-up period (p > 0.05). Conclusions Phacoemulsification was not associated with greater endothelial cell loss in the ACA group than in the NE and FE groups. This finding shows that ACA history may not contribute to the exacerbation of corneal endothelial damage in cataract surgery.

Purpose: To evaluate endothelial damage after cataract surgery in eyes affected by an angle-closure attack (ACA) and compare it to that in the unaffected fellow eyes (FEs) of patients with ACA and normal eyes (NEs). Methods: The medical data of eyes affected by ACA, FEs (with no history of acute glaucoma attack), and NEs of patients who underwent cataract surgery with simultaneous intraocular lens implantation were retrospectively reviewed. Endothelial cell density (ECD) and central corneal thickness (CCT) measured before surgery and at 1 week, 1 month, and 3 months after surgery were analyzed, and the percentages of loss in ECD and increase in CCT of the three groups were compared. Results: The study enrolled 140 eyes from 100 patients (50 eyes in the ACA group, 40 eyes in the FE group, and 50 eyes in the NE group). The mean ECD was significantly lower in the ACA group than in the other groups (p < 0.001). However, the percentage of ECD reduction was not significantly greater in the ACA group than in the other groups (p > 0.05). None of the eyes developed corneal edema at 3 months postoperatively. Moreover, the CCTs of the three groups were similar throughout the follow-up period (p > 0.05). Conclusions Phacoemulsification was not associated with greater endothelial cell loss in the ACA group than in the NE and FE groups. This finding shows that ACA history may not contribute to the exacerbation of corneal endothelial damage in cataract surgery.

Purpose: To compare early changes in the macular retinal nerve fiber layer (mRNFL) and ganglion cell-inner plexiform layer (mGCIPL) thicknesses according to the severity of initial optic disc edema in optic neuritis patients using swept-source optical coherence tomography (SS-OCT). Methods: We retrospectively reviewed 18 eyes of patients diagnosed with naïve optic neuritis along with optic disc edema who underwent SS-OCT. The central thickness of the optic nerve head and the peripapillary retinal thickness were measured at the initial visit. To quantitate the degree of initial optic disc edema, we calculated the difference of each measurement between the affected eye and the normal fellow eye. The mRNFL and mGCIPL thicknesses were measured at the initial visit and at the 1 month follow-up. The association between changes in mRNFL and mGCIPL thicknesses at the 1 month follow-up and the severity of initial optic disc edema were evaluated. Results: In the affected eye, the mGCIPL thickness was reduced at 1 month. The central thickness of the optic nerve head at the initial visit correlated with the reduction in the temporal mGCIPL at 1 month (R = 0.648, p = 0.045). Furthermore, thicker nasal peripapillary retinal thickness at the initial visit correlated with a reduction in nasal (R = 0.659, p = 0.038) and temporal (R = 0.774, p = 0.009) mGCIPL at 1 month. Thicker temporal peripapillary retinal thickness at the initial visit correlated with reduction in the nasal (R = 0.646, p = 0.044) and temporal (R = 0.760, p = 0.011) mGCIPL at 1 month. Conclusions In optic neuritis patients with optic disc edema, severe optic disc edema, evaluated by peripapillary retinal thickness and central thickness of the optic nerve at the initial visit was associated with a reduced temporal mGCIPL thickness at 1 month. This study suggested that initially severe optic disc edema in optic neuritis patients can predict a rapid decline in the mGCIPL.

A 33-year-old woman visited the emergency department presenting with fever and dyspnea. She was pregnant with gestational age of 31 weeks and 6 days. She had dysuria for 7 days, and fever and dyspnea for 1 day. The vital signs were as follows: blood pressure 110/70 mmHg, heart rate 118 beats/minute, respiratory rate 28/minute, body temperature 38.7℃, and oxygen saturation by pulse oximetry 84% during inhalation of 5 liters of oxygen by nasal prongs. Crackles were heard over both lung fields. There were no signs of uterine contractions. Chest X-ray and chest computed tomography scan showed multiple consolidations and air bronchograms in both lungs. According to urinalysis, there was pyuria and microscopic hematuria. She was diagnosed with community-acquired pneumonia and urinary tract infection (UTI) that progressed to severe sepsis and acute respiratory failure. We found extended-spectrum beta-lactamase producing Escherichia coli in the blood culture and methicillin-resistant Staphylococcus aureus in the sputum culture. The patient was transferred to the intensive care unit with administration of antibiotics and supplementation of high-flow oxygen. On hospital day 2, hypoxemia was aggravated. She underwent endotracheal intubation and mechanical ventilation. After 3 hours, fetal distress was suspected. Under 100% fraction of inspired oxygen, her oxygen partial pressure was 87 mmHg in the arterial blood. She developed acute kidney injury and thrombocytopenia. We diagnosed her with multi-organ failure due to severe sepsis. After an emergent cesarean section, pneumonia, UTI, and other organ failures gradually recovered. The patient and baby were discharged soon thereafter.
Acute Kidney Injury ; Adult ; Anoxia ; Anti-Bacterial Agents ; beta-Lactamases ; Blood Pressure ; Body Temperature ; Cesarean Section ; Dyspnea ; Dysuria ; Emergency Service, Hospital ; Escherichia coli ; Female ; Fetal Distress ; Fever ; Gestational Age ; Heart Rate ; Hematuria ; Humans ; Inhalation ; Intensive Care Units ; Intubation, Intratracheal ; Lung ; Methicillin-Resistant Staphylococcus aureus ; Oximetry ; Oxygen ; Partial Pressure ; Pneumonia ; Pregnancy Complications, Infectious ; Pregnancy ; Pyuria ; Respiration, Artificial ; Respiratory Insufficiency ; Respiratory Rate ; Respiratory Sounds ; Sepsis ; Sputum ; Thorax ; Thrombocytopenia ; Urinalysis ; Urinary Tract Infections ; Uterine Contraction ; Vital Signs

A 33-year-old woman visited the emergency department presenting with fever and dyspnea. She was pregnant with gestational age of 31 weeks and 6 days. She had dysuria for 7 days, and fever and dyspnea for 1 day. The vital signs were as follows: blood pressure 110/70 mmHg, heart rate 118 beats/minute, respiratory rate 28/minute, body temperature 38.7℃, and oxygen saturation by pulse oximetry 84% during inhalation of 5 liters of oxygen by nasal prongs. Crackles were heard over both lung fields. There were no signs of uterine contractions. Chest X-ray and chest computed tomography scan showed multiple consolidations and air bronchograms in both lungs. According to urinalysis, there was pyuria and microscopic hematuria. She was diagnosed with community-acquired pneumonia and urinary tract infection (UTI) that progressed to severe sepsis and acute respiratory failure. We found extended-spectrum beta-lactamase producing Escherichia coli in the blood culture and methicillin-resistant Staphylococcus aureus in the sputum culture. The patient was transferred to the intensive care unit with administration of antibiotics and supplementation of high-flow oxygen. On hospital day 2, hypoxemia was aggravated. She underwent endotracheal intubation and mechanical ventilation. After 3 hours, fetal distress was suspected. Under 100% fraction of inspired oxygen, her oxygen partial pressure was 87 mmHg in the arterial blood. She developed acute kidney injury and thrombocytopenia. We diagnosed her with multi-organ failure due to severe sepsis. After an emergent cesarean section, pneumonia, UTI, and other organ failures gradually recovered. The patient and baby were discharged soon thereafter.

A dog with a history of diarrhea and dyschezia exhibited an oval-shaped, soft-tissue opacity mass in the abdomen on radiographs. CT examination revealed a large fluid-filled structure displacing the urinary bladder, prostate, and colon. The mass had continuity with the prostate; therefore, it was tentatively diagnosed as a paraprostatic cyst. Cytologic examination was performed and the mass was considered a non-inflammatory cyst. However, after surgery, histopathologic examination revealed a necrotic, inflamed cystic lipoma. This case shows that unusual intra-abdominal lipomas may have a cystic appearance.
Abdomen ; Animals ; Colon ; Constipation ; Diagnostic Imaging ; Diarrhea ; Dogs ; Lipoma* ; Prostate ; Urinary Bladder

PURPOSE: To evaluate the effect of intravitreal injection on the corneal endothelium according to the injected drug. METHODS: The present study included 118 eyes of 113 patients who received intravitreal injection. Before each injection and 1 month after the injection, specular microscopy was performed to evaluate the corneal endothelial changes and central corneal thickness. We classified the patients according to the injected drug (bevacizumab 21 eyes, ranibizumab 20 eyes, aflibercept 47 eyes, dexamathasone implant 30 eyes), phakic or pseudophakic eyes, single or multiple injections and analyzed them retrospectively. RESULTS: The mean corneal endothelial cell density was 2,693.2 ± 298.2 cells/mm² before injection and 2,686.8 ± 288.7 cells/mm² 1 month after injection, and there was no statistically significant difference (p = 0.731). According to the kind of drug, the mean corneal endothelial cell density and central corneal thickness were not significantly different before and 1 month after injection in any of the 4 groups. CONCLUSIONS: There were no significant changes in corneal endothelium before and 1 month after intravitreal injection of the various drugs.
Endothelial Cells ; Endothelium, Corneal* ; Humans ; Intravitreal Injections* ; Microscopy ; Ranibizumab ; Retrospective Studies

PURPOSE: This study was conducted to investigate the depressive symptoms and quality of life (QOL) in patients with age-related macular degeneration (AMD) using data obtained from the Korea National Health and Nutritional Examination Survey V-2 (KNHANES V-2) conducted in 2011. METHODS: This was a population-based, cross-sectional study that selected 329 participants from the fifth KNHANES (2011) who were diagnosed with AMD by an ophthalmologist based on fundus photography. The prevalence of depressive symptoms and the health-related QOL (using EuroQol indices) in this cohort were also estimated. Factors associated with depressive symptoms, including socioeconomic status, QOL indices, and associated chronic diseases, were investigated using multivariate regression models. RESULTS: Depressive symptoms were observed more frequently in AMD patients than in non-AMD controls (p = 0.013). Among the total 329 AMD participants, 65 (19.8%) had depressive symptoms. There were 16 males (24.6%) and 49 females (75.4%). Upon multivariate analysis, significant factors found to be associated with depressive symptoms were female gender (odds ratio [OR], 2.082; 95% confidence interval [CI], 1.001 to 4.330), being in the “dependent” group for activities of daily living (OR, 4.638; 95% CI, 2.061 to 10.435), and having “some problems” in the “anxiety-depression” dimension of the EQ-5D (OR, 7.704; 95% CI, 1.890 to 31.408). CONCLUSIONS: Female gender and being dependent on others for activities of daily living increased the association of depressive symptoms in this cohort of AMD participants. Screening for depressive symptoms in East Asian AMD patients with these characteristics should be an important component of their care.
Activities of Daily Living ; Asian Continental Ancestry Group ; Chronic Disease ; Cohort Studies ; Cross-Sectional Studies ; Depression* ; Female ; Humans ; Korea* ; Macular Degeneration* ; Male ; Mass Screening ; Multivariate Analysis ; Nutrition Surveys* ; Photography ; Prevalence ; Quality of Life* ; Social Class