Korean Journal of Ophthalmology : KJO最新文献

{"title":"Choroidal osteoma: Spontaneous Resolution of Subretinal Detachment Unresponsive to Anti-VEGF Agent and multimodal imaging.","authors":"Hyuk Jun Lee, Se Joon Woo","doi":"10.3341/kjo.2022.0113","DOIUrl":"https://doi.org/10.3341/kjo.2022.0113","url":null,"abstract":"Dear Editor, Choroidal osteoma (CO) is a rare benign ossifying choroidal tumor that typically affects young female patients [1]. While there is no standard treatment for CO, patients with complications, such as choroidal neovascularization (CNV) and serous retinal detachment (SRD), require treatment [2]. Several reports have discussed the role of antivascular endothelial growth factor (anti-VEGF) agents in the treatment of SRD with or without CNV, associated with CO [2,3]. We describe the spontaneous resolution of SRD in a patient with CO, that was unresponsive to intravitreal anti-VEGF treatment. The patient provided informed consent for publication of the research details and clinical images. A healthy 9-year-old female patient presented with blurred vision in the left eye. The best-corrected visual acuity (BCVA) was 20 / 25 in the left eye. Funduscopic examination of the left eye revealed a juxtafoveal yellow-orange subretinal lesion with distinct borders (Fig. 1A). Fundus f luorescein angiography (FFA) revealed an early patchy hyperf luorescent choroidal filling pattern, dye staining in the area of retinal pigment epithelium (RPE) decompensation overlying the CO, pooling hyperfluorescence in the late phase, and no evidence of CNV (Fig. 1B, 1C). En face optical coherence tomography (OCT) showed the tumor border (Fig 1D, 1E). OCT angiography demonstrated the paucivascular tumor at the level of choroid, and absence of CNV (Fig. 1F). OCT showed SRD, a disrupted photoreceptor layer, and a hyperreflective mass posterior to the RPE (Fig. 1G). Therefore, the patient was diagnosed with CO with subretinal fluid in the absence of CNV. To resolve the SRD, an intravitreal injection of bevacizumab (1.25 mg/0.05 mL, Avastin, Genentech) was administered to her left eye. One month after bevacizumab treatment, her BCVA decreased to 20 / 100, and OCT showed an increased SRD and intraretinal fluid (Fig. 1H). Because the lesion was unresponsive to bevacizumab, the patient was closely monitored without additional treatment. After 4 months, the SRD decreased spontaneously, leading to an improved BCVA of 20 / 50. After 1 year, complete resolution of SRD and intraretinal fluid was confirmed on OCT (Fig. 1I). However, disruption of the photoreceptor layer was detected, and the final BCVA remained unchanged at 20 / 50. SRD, associated with CO, frequently occurs in the absence of CNV. It possibly resulted from multiple pinpoint RPE leakages over the osteoma noted on FFA [4]. Alternatively, the gradual atrophy of the RPE and Bruch’s membrane likely decreased the capacity of the RPE to remove subretinal fluid from the disrupted outer blood-retinal barrier [3]. While it has been established to treat SRD with CNV, the significance of anti-VEGF in treating SRD without CNV remains controversial. Song et al. [3] reported that 83% of patients with CO and SRD did not present with signs of CNV. Following bevacizumab treatment, all patients showed a substantial decrease in SRD bas","PeriodicalId":17883,"journal":{"name":"Korean Journal of Ophthalmology : KJO","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10755346","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Successful Femtosecond Laser-assisted Cataract Surgery for a Cataract with Persistent Pupillary Membrane: A Case Report.","authors":"Jin Yeong Kim, Ikhyun Jun, Tae-Im Kim, Kyoung Yul Seo","doi":"10.3341/kjo.2022.0046","DOIUrl":"https://doi.org/10.3341/kjo.2022.0046","url":null,"abstract":"Dear Editor, The persistent pupillary membrane (PPM) is a remnant of the tunica vasculosa lentis, which provides blood supply for fetal crystalline lens development. During normal fetal development, the tunica vasculosa lentis undergoes involution and disappears between the 8th and 9th gestational months. The PPM develops due to incomplete atrophy of the fetal pupillary membrane [1]. Rarely, if a thick PPM covers the visual axis, administration of topical atropine or surgical intervention is required to prevent the progression of amblyopia and improve visual acuity [1]. Previous studies have reported on the surgical excision of a remnant membrane with cataract surgery or neodymium-doped yttrium aluminum garnet (Nd-YAG) laser lysis of the PPM before phacoemulsification [2,3]. Femtosecond laser-assisted cataract surgery (FLACS), which includes three main steps (corneal arcuate incision, anterior capsulotomy, and lens fragmentation), is an advanced technology that increases the accuracy and reduces the complications compared to conventional cataract surgery [4]. The advantages of FLACS include astigmatism correction, increased stability of the implanted intraocular lens with reproducibility and accuracy of capsulotomy, and reduced use of ultrasound [4]. Capsulotomy performed using the femtosecond laser can excise the PPM, reduce the risk of intraoperative bleeding, and help ensure visibility of the surgical field [5]. Here, we report a case in which a cataract in an eye with a PPM was treated by FLACS. Written informed consent for publication of this case and clinical images was obtained from the patient. A 61-year-old female patient presented to the ophthalmology department of Severance Hospital with bilateral decreased visual acuity and visual discomfort. She had diabetes mellitus but had no history of ocular trauma or operation and no familial ocular disease. Her preoperative corrected distant visual acuity (CDVA) was 0.3 (decimal) with autorefraction -3.00 diopters (D) -1.50 D × 138° in the right eye and 0.7 (decimal) with +2.25 D -0.75 D × 84° in the left eye. The intraocular pressure was 17 and 18mmHg in the right and left eyes, respectively, using a noncontact tonometer. On slit-lamp examination, we observed cataracts with nuclear opacity grade 3 by Lens Opacities Classification System III classification in her both eyes and PPM in her right eye. The pupillary threads were superotemporally connected to the other parts of the iris and attached to the anterior lens capsule (Fig. 1A). Although the PPM did not completely cover the pupil, it was suspected to adversely affect her visual acuity with the cataract in the right eye. The patient was scheduled to undergo FLACS in both eyes, with an interval of 1 week between the left and right eye. We used a LenSx femtosecond laser system (Alcon, Aliso Viejo, CA, USA). Most of the PPM strands were disconnected during the anterior capsulotomy step using the femtosecond laser (Fig. 1B, 1C). However, anteri","PeriodicalId":17883,"journal":{"name":"Korean Journal of Ophthalmology : KJO","volume":" ","pages":"474-475"},"PeriodicalIF":0.0,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/e3/37/kjo-2022-0046.PMC9582498.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33513681","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Characteristics and Long-term Outcomes in Diabetic Macular Edema Patients: With or without Additional Injection Following Ranibizumab Loading.","authors":"Kyungwoo Yoon,&nbsp;Eung Suk Kim,&nbsp;Seung-Young Yu,&nbsp;Kiyoung Kim","doi":"10.3341/kjo.2022.0086","DOIUrl":"https://doi.org/10.3341/kjo.2022.0086","url":null,"abstract":"<p><strong>Purpose: </strong>To investigate the baseline characteristics in patients with diabetic macular edema (DME) during 7 years according to the need for additional treatments after intravitreal ranibizumab (RBZ) loading injections.</p><p><strong>Methods: </strong>The medical records of 32 patients treated with intravitreal RBZ loading for DME during 7 years were reviewed. After three-consecutive monthly RBZ injections, additional treatment was decided according to the patient's response to RBZ loading. Based on whether the patients received treatment with or without additional injections, including intravitreal antivascular endothelial factor or steroid injection, they were divided into the \"no add (NA)\" or \"add\" groups, respectively. The baseline best-corrected visual acuity (BCVA), macular volume (MV), central subfoveal thickness, and other clinical factors were analyzed, and their 7-year changes were compared between the two groups.</p><p><strong>Results: </strong>The BCVA of the NA group was better than that of the add group at 2, 3, 5, and 7 years (year 2, 3, and 5; p < 0.01, respectively). Baseline MV was significantly smaller in the NA group than in the add group (10.72 ± 0.88 μm vs. 11.98 ± 1.64 μm, p = 0.008). The DME duration before treatment in the NA group was significantly shorter than in the add group (1.03 ± 0.98 years vs. 1.91 ± 1.33 years, p = 0.042). The proportion of patients with serous retinal detachment or cystic macular edema was significantly lower in the NA group than in the add group (35.3% vs. 73.3%, p = 0.042). The NA group had smaller MV until 2 years than the add group (year 1, p = 0.002; year 2, p = 0.006).</p><p><strong>Conclusions: </strong>The DME patients without additional treatments during 7 years after the initial loading treatment had shorter duration of DME and diffuse retinal thickening morphologic type with lower MV at baseline, and better long-term visual prognosis.</p>","PeriodicalId":17883,"journal":{"name":"Korean Journal of Ophthalmology : KJO","volume":" ","pages":"398-406"},"PeriodicalIF":0.0,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/e0/d3/kjo-2022-0086.PMC9582492.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40627625","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Correlation of Peripapillary and Juxtapapillary Choroidal Thickness in Healthy Subjects.","authors":"Dong Hwan Son,&nbsp;Jinho Lee,&nbsp;Jeong-Ah Kim","doi":"10.3341/kjo.2022.0050","DOIUrl":"https://doi.org/10.3341/kjo.2022.0050","url":null,"abstract":"Purpose To evaluate the correlation between the two methods of measuring the choroidal thickness around the optic nerve head (ONH). Methods We conducted a cross-sectional study. Sixty-two eyes of 62 healthy subjects were included. Using spectral domain optical coherence tomography, a peripapillary circle scan (diameter of 3.5 mm) and 24 radial B-scan images centered on the Bruch’s membrane opening (BMO) were obtained. Peripapillary choroidal thickness (PPCT) and juxtapapillary choroidal thickness (JPCT) were measured using circle and radial B-scan images, respectively. Correlation and agreements between values measured by two methods were analyzed. Factors associated with PPCT and JPCT, and the difference between the values measured by the two methods were evaluated. Results A total of 62 eyes of 62 healthy subjects were enrolled. Average PPCT and JPCT were 165.2 ± 50.1 and 139.7 ± 39.2 μm, respectively. The linear regression analysis showed a strong correlation between both measurements (PPCT vs. JPCT, r2 = 0.900, p < 0.001). PPCT and JPCT measurements showed good agreement in global and all six sectors (intraclass correlation coefficients >0.900). Bland-Altman plot showed good agreement between the two methods with a systematic deviation of 17.9 μm and a 95% limits of agreement (±1.96 standard deviation) of −9.6 to 60.5. In multivariate regression analysis, BMO area (β = −11.87, p = 0.002) was the only factor significantly correlated with the difference between PPCT and JPCT, which showed a negative correlation. The difference between PPCT and JPCT measurements (PPCT - JPCT) showed a divergent tendency with decreasing BMO area size. Conclusions The two measures of choroidal thickness around the ONH were well correlated. However, the peripapillary choroid was generally thicker than the juxtapapillary choroid, especially in eyes with small BMO area.","PeriodicalId":17883,"journal":{"name":"Korean Journal of Ophthalmology : KJO","volume":"36 5","pages":"379-389"},"PeriodicalIF":0.0,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/1f/b0/kjo-2022-0050.PMC9582501.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9345020","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Multiple Evanescent White Dot Syndrome with Submacular Fluid in Dome-shaped Macula Following COVID-19 Vaccination: A Case Report.","authors":"Hyo Jin Seong,&nbsp;Christopher Seungkyu Lee","doi":"10.3341/kjo.2022.0077","DOIUrl":"https://doi.org/10.3341/kjo.2022.0077","url":null,"abstract":"Dear Editor, Multiple evanescent white dot syndrome (MEWDS) is a unilateral inf lammatory chorioretinopathy characterized by multiple small white dots scattered at the posterior pole. It is a benign and self-limiting condition that usually occurs in healthy young women [1]. There is an ongoing global pandemic of coronavirus disease 2019 (COVID-19), which is caused by severe acute respiratory syndrome coronavirus 2. Herein we report a case of MEWDS as an ocular adverse effect after BNT162b2 messenger RNA (mRNA) COVID-19 vaccination (Pfizer Inc., Philadelphia, PA, USA). The patient provided written informed consent for the publication of the research details and clinical images. A 33-year-old healthy female patient visited a local clinic with a 1-day history of a steadily enlarging dark spot over her right central vision and metamorphopsia in the right eye. Notably, she had received her second dose of the BNT162b2 vaccine 6 days before symptom onset. In the right eye, fundus examination revealed multiple gray-white lesions at the posterior pole and nasal and temporal periphery, and optical coherence tomography (OCT) revealed a dome-shaped macula (DSM) with subretinal fluid and interruption of the ellipsoid zone (Fig. 1A, 1B). Two weeks later, the patient was referred to Severance Hospital. She revealed that the dark spot become slightly lighter 4 to 5 days after onset, but the metamorphopsia remained. The best-corrected visual acuity was 20 / 40 with spherical equivalents -10.12 diopter in the right eye. Fundus examination revealed regression of the small gray-white hyperautofluorescent lesions at the posterior pole and nasal and temporal periphery (Fig. 1C, 1D). OCT revealed a few vitreous cells, hyperreflective subfoveal material without fluid, and ellipsoid zone disruption (Fig. 1E). Early-phase f luorescein angiography revealed multiple hyperf luorescent dots in a wreath-like pattern, while late-phase indocyanine green angiography revealed hypofluorescent dots in areas corresponding to the autofluorescent fundus lesions (Fig. 1F, 1G). The 30-2 Humphrey visual field test (Humphrey, San Leandro, CA, USA) showed enlargement of the blind spot (Fig. 1H). Choroidal neovascularization was not evident on OCT angiography (Fig. 1I). With the diagnosis of MEWDS, she was prescribed 15 mg of oral prednisone per day, which was tapered over 2 weeks. Additionally, she was administered intravitreal bevacizumab (Avastin, 1.25 mg/0.05 mL; Genentech, South San Francisco, CA, USA) in hopes of hastening her recovery. Ten weeks later, her symptoms improved with increased visual acuity to 20 / 50. The fundus lesions resolved further, but subfoveal hyperreflective material was still observed on OCT (Fig. 1J, 1K). Recent case studies have shown that MEWDS can occur or recur within a month of COVID-19 vaccination [1,2]. The cause of MEWDS is unknown; both infectious and immune-mediated origins have been proposed. The presence of antecedent f lu-like symptoms in approxima","PeriodicalId":17883,"journal":{"name":"Korean Journal of Ophthalmology : KJO","volume":" ","pages":"471-473"},"PeriodicalIF":0.0,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/e6/7f/kjo-2022-0077.PMC9582493.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40627626","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perceived Stress Levels and Associated Factors in Adult Patients with Primary Open-angle Glaucoma: A Prospective Survey Study.","authors":"Man Ji,&nbsp;Jin-Soo Kim,&nbsp;Sung Uk Baek,&nbsp;Young Kook Kim,&nbsp;Ki Tae Nam,&nbsp;Jong Young Lee,&nbsp;Hye Jin Lee,&nbsp;Jinho Jeong,&nbsp;Ahnul Ha","doi":"10.3341/kjo.2022.0049","DOIUrl":"https://doi.org/10.3341/kjo.2022.0049","url":null,"abstract":"<p><strong>Purpose: </strong>To investigate adult primary open-angle glaucoma (POAG) patients' perceived stress levels and to examine the associations with their clinical characteristics.</p><p><strong>Methods: </strong>Sixty-seven POAG patients, excluding those meeting the exclusion criteria (retinal or neurological disease diagnoses) comprised the study population. A validated questionnaire, namely Perceived Stress Scale-10 (PSS-10), was used to assess stress level. Additional data on glaucoma surgery history, medical benefit receipt, comorbidities, and daily antiglaucoma medication number were collected. The clinical characteristics of high (PSS-10 ≥15) and low stress (PSS-10 <15) patients and the risk factors associated with high stress level were subjected to a multivariable logistic regression analysis.</p><p><strong>Results: </strong>The patients were 56.8 ± 12.6 years of age on average, and 29 (43.3%) were female. The mean PSS-10 level was 13.5 ± 5.3 (range, 1-27) for the entire patient group; 31 patients (46.3%) were in the high stress group. In the high stress group relative to the low stress group, best-corrected visual acuity in the better eye was lower (p = 0.044) and the visual field defects, in both eyes, were more severe (better eye, p = 0.005; worse eye, p = 0.026). A logistic regression analysis indicated that severe visual field defect in the better eye (odds ratio, 1.159; 95% confidence interval, 1.016-1.323; p = 0.028) and lower best-corrected visual acuity in the better eye (odds ratio, 4.707; 95% confidence interval, 0.580-6.189; p = 0.072) were both likely to associated with high stress level in patients with POAG.</p><p><strong>Conclusions: </strong>These findings suggest an association between severe visual function loss and higher mental stress level in POAG patients. Stress level, therefore, might be an important consideration in POAG patient management.</p>","PeriodicalId":17883,"journal":{"name":"Korean Journal of Ophthalmology : KJO","volume":" ","pages":"443-451"},"PeriodicalIF":0.0,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/55/17/kjo-2022-0049.PMC9582494.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40643318","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Incidence of Acute Endophthalmitis after Intravitreal Antivascular Endothelial Growth Factor Injection in Age-related Macular Degeneration.","authors":"Hyo Jin Seong,&nbsp;Young Min Park,&nbsp;Jiwon Kim,&nbsp;Kang Ju Son,&nbsp;Eun Jee Chung","doi":"10.3341/kjo.2022.0088","DOIUrl":"https://doi.org/10.3341/kjo.2022.0088","url":null,"abstract":"<p><strong>Purpose: </strong>Antivascular endothelial growth factor (anti-VEGF) agents are routinely intravitreously injected to treat neovascular age-related macular degeneration (AMD). Postoperative endophthalmitis, a side effect after intravitreal anti-VEGF injection, has been reported to have a low incidence but may threaten vision. In this study, we aimed to analyze the incidence of acute endophthalmitis after intravitreal anti-VEGF injection and associated risk factors in patients with neovascular AMD in South Korea.</p><p><strong>Methods: </strong>Using the health claims data recorded in the Korean National Health Insurance System database, we identified newly developed neovascular AMD cases from 2010 through 2019. Acute endophthalmitis was defined as a case of invasive treatment for accompanying symptoms. All statistical analyses were performed with a significance level p < 0.05. To find risk factors, we used univariate and multivariable Poisson regression.</p><p><strong>Results: </strong>The overall incidence of acute endophthalmitis was 0.019% (p = 0.21) during the 10-year period: 0.025% for aflibercept injection and 0.014% for ranibizumab injection. The incidence was higher in metropolitan city residents than in Seoul (incidence rate ratio [IRR], 1.96; 95% confidence interval [CI], 1.02-3.79; p = 0.04) and was higher for aflibercept injections than for ranibizumab injections (IRR, 1.82; 95% CI, 1.17-2.82; p = 0.01). However, in multivariate analysis, only aflibercept injections showed a significant effect on the incidence of acute endophthalmitis (IRR, 1.80; 95% CI, 1.16-2.79; p = 0.01).</p><p><strong>Conclusions: </strong>The incidence of acute endophthalmitis after intravitreal anti-VEGF injections was generally low, and aflibercept was revealed as a significant risk factor.</p>","PeriodicalId":17883,"journal":{"name":"Korean Journal of Ophthalmology : KJO","volume":" ","pages":"435-442"},"PeriodicalIF":0.0,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/fb/ae/kjo-2022-0088.PMC9582495.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40627624","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Rare Case of Upper Eyelid Langerhans Cell Histiocytosis.","authors":"Hee Kyung Ryu,&nbsp;Ju Mi Kim,&nbsp;Won-Kyung Cho,&nbsp;Jung Uee Lee","doi":"10.3341/kjo.2022.0075","DOIUrl":"https://doi.org/10.3341/kjo.2022.0075","url":null,"abstract":"Dear Editor, Langerhans cell histiocytosis (LCH) is a rare systemic disorder characterized by clonal proliferation of histiocytes, rarer in adults than in children [1]. It can affect any organ, more frequently bones, skin, and pituitary gland [2]; however, ocular presentation of LCH has been scarcely reported. In this article, we report a rare case of eyelid LCH in an Asian adult. Informed consent for publication of the research details and clinical images was obtained from the patient. A 58-year-old Korean female patient presented with the left upper eyelid mass that gradually enlarged over a few years. She had no underlying disease. She had no history of cosmetic autologous fat transplantation or facial filler injection. Her best-corrected visual acuity was 20 / 25 in the right eye and 20 / 20 in the left eye. Intraocular pressure was in the normal range at both eyes and anterior segment was otherwise normal. Round, elevated, soft, and movable mass right beneath the skin was at the medial side of left upper eyelid (Fig. 1A, 1B). She did not have any pain or tenderness around the mass. We planned anterior orbitotomy for excisional biopsy, and the mass was excised completely from adjacent tissue (Fig. 1C, 1D). There was no postoperative complication. The gross specimen was a size of 3 mm (Fig. 1C, 1D). Microscopic photo reveals atypical histiocytic cells which contain eosinophilic cytoplasm and convoluted nuclei with groove (Fig. 1E). Immunohistochemical stain shows the histiocytic cells reactive to CD1a and anti-S100 protein (Fig. 1F, 1G). She was diagnosed as LCH based on the immunohistochemistry results and referred to oncology department for thorough evaluation to find other LCH lesions. Laboratory tests including complete blood count, blood chemistry, coagulation studies and thyroid function test, urine analysis, high resolution computed tomography and positron emission tomography were done. Since there was no other organ involvement found, treatment has been completed with the surgery and there has been no recurrence or other organ involvement in the 1-year follow-up period. In LCH patients, wide range of symptoms can appear depending on the organ involved, and it makes the diagnosis of LCH easily missed [2]. LCH is categorized as single-system or multisystem LCH depending on the number of organ involvement [3]. Symptoms can range from skin rash, simple mass, bony lesion with or without pain, diabetes to fatal problems, such as dyspnea or neurological problems [2]. Diagnosis of LCH is based on microscopic examination and at least one of the following immunological staining: langerin (CD207) positivity, CD1a positivity, and Birbeck granules on electronic microscopy [2]. S100 protein is the optional immunohistochemical study, because CD1a and langerin stain is more specific [4]. Once the diagnosis of LCH is confirmed, involvement of other organs should be evaluated [2]. The laboratory tests to be performed include a complete blood count, bloo","PeriodicalId":17883,"journal":{"name":"Korean Journal of Ophthalmology : KJO","volume":" ","pages":"466-467"},"PeriodicalIF":0.0,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/7c/43/kjo-2022-0075.PMC9582497.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40627627","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Immediate Vitrectomy for Acute Endophthalmitis in Patients with a Visual Acuity of Hand Motion or Better.","authors":"Jaemin Kim,&nbsp;Hyoung Seok Kim,&nbsp;Su Jin Yoo,&nbsp;Moon Jung Choi,&nbsp;Youngju Lew,&nbsp;Jong Woo Kim,&nbsp;Han Joo Cho","doi":"10.3341/kjo.2022.0014","DOIUrl":"https://doi.org/10.3341/kjo.2022.0014","url":null,"abstract":"<p><strong>Purpose: </strong>To determine the efficacy of immediate pars plana vitrectomy as the primary treatment for acute endophthalmitis in patients with a visual acuity (VA) of hand motion (HM) or better.</p><p><strong>Methods: </strong>A total of 149 patients who were referred to a single center for acute endophthalmitis after cataract surgery over the 13-year study period were retrospectively analyzed. Only patients presenting with a VA of at least HM were included. Patients were initially treated with either primary vitrectomy or intravitreal antibiotic injection alone, and their visual outcomes and reintervention rates after initial treatment were compared.</p><p><strong>Results: </strong>There was no significant difference in the proportion of good (final VA ≥20 / 40) and poor (VA ≤ counting finger) visual outcomes between the groups. However, subgroup analysis of patients with a VA of HM (92 eyes) showed that the incidence of reintervention (14 of 72 eyes [19.4%] vs. 9 of 20 eyes [45.0%]) and poor visual outcomes (10 of 72 eyes [13.9%] vs. 8 of 20 eyes [40.0%]) were lower after prompt vitrectomy than after intravitreal antibiotic injection alone (p = 0.019 and p = 0.022, respectively). For those with a VA of at least counting finger, no significant difference was observed between the groups.</p><p><strong>Conclusions: </strong>For patients with endophthalmitis presenting with a VA of HM, performing a prompt vitrectomy reduced the incidence of reintervention and poor visual outcomes than the administration of intravitreal antibiotics alone. Our results suggest that primary vitrectomy for patients with endophthalmitis presenting with a VA of HM could be more beneficial than intravitreal antibiotic injection alone.</p>","PeriodicalId":17883,"journal":{"name":"Korean Journal of Ophthalmology : KJO","volume":" ","pages":"390-397"},"PeriodicalIF":0.0,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/ba/65/kjo-2022-0014.PMC9582504.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40643321","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Infectious Keratitis in Patients with Ocular Sjögren's Syndrome.","authors":"So Yeon Kim,&nbsp;Seong Hwan Kim,&nbsp;Chang Ho Yoon,&nbsp;Mee Kum Kim,&nbsp;Joo Youn Oh","doi":"10.3341/kjo.2022.0064","DOIUrl":"https://doi.org/10.3341/kjo.2022.0064","url":null,"abstract":"<p><strong>Purpose: </strong>To investigate the incidence, characteristics, risk factors, and treatment outcomes for infectious keratitis in patients with ocular Sjögren's syndrome (SS).</p><p><strong>Methods: </strong>We performed a retrospective chart review of patients who had been followed up for ocular SS in Seoul National University Hospital from 2010 to 2020 and identified cases where infectious keratitis developed. The incidence, demographical and clinical characteristics, risk factors, microbiological profiles, and treatment outcome were investigated, some of which were compared with infectious keratitis cases in the non-SS group.</p><p><strong>Results: </strong>Out of 929 patients with ocular SS, infectious keratitis occurred in 18 eyes (1.94%). All 18 patients were female in the ocular SS group, while 48 out of 100 infectious keratitis patients (48%) were female in the non-SS group (p < 0.01). The mean age at diagnosis of infectious keratitis was 66.1 years in the ocular SS group, which was not different from the non-SS group (57.2 years, p = 0.12). Of risk factors analyzed, the use of therapeutic contact lens was more frequently used in the ocular SS patients, compared to the non-SS patients (67% vs. 11%, p < 0.01). Culture-positivity rate was 50% in the ocular SS group. All culture-proven cases were bacterial infection, one of which was bacterial-fungal coinfection. Infection resolved in all eyes after the mean 29 days of medical treatment, except one that additionally required penetrating keratoplasty with vitrectomy. The visual acuity improved in 15 eyes (83%) after resolution. Infectious keratitis recurred in three patients (17%) during the mean 55.7 months of follow-up.</p><p><strong>Conclusions: </strong>The incidence of infectious keratitis was 1.94% in patients with ocular SS. Most were bacterial infections and resolved by medical treatment. Therapeutic and visual outcomes were favorable, but recurrence occurred in 17%.</p>","PeriodicalId":17883,"journal":{"name":"Korean Journal of Ophthalmology : KJO","volume":" ","pages":"407-412"},"PeriodicalIF":0.0,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/2e/ee/kjo-2022-0064.PMC9582502.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40643315","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}