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Purpose To evaluate and compare the morphologic characteristics of buried optic disc drusen (ODD) and optic disc edema (ODE) by using en face optical coherence tomography (OCT) and OCT angiography (OCTA). Design Retrospective, cross-sectional study. Methods We reviewed the medical records of 61 patients (92 eyes) with buried ODD, 45 patients (62 eyes) with ODE, and 42 normal-appearing fellow eyes examined at 1 referral center between November 1, 2017 and April 30, 2019. Characteristic en face OCT and OCTA findings of buried ODD compared to those of ODE and normal optic discs were investigated. Results On en face OCT, all buried ODD were visualized as hyperreflective kidney-shaped masses well demarcated from the optic nerve axons, whereas ODE was visualized as ill-defined boundaries confluent with the retinal nerve fibers. On OCTA, 25.0% of the eyes with buried ODD showed a C-shaped vessel density decrease in the nasal radial peripapillary capillary layer, while 40.3% of the eyes with ODE had nonspecific focal vessel density decrease around the optic nerve head. Larger ODD were significantly associated with a vessel density decrease on OCTA (P = .009). The disc diameter positively correlated with the ODD area (r = 0.245; P = .018) and negatively correlated with the ODD height (r = −0.237; P = .023). Conclusions En face OCT showed the characteristic features of buried ODD compared to those of ODE or normal optic discs. The demarcation of buried ODD from the optic nerve axons on en face OCT and the poor vascular perfusion of buried ODD on OCTA suggest that buried ODD are materials deposited around the optic disc rather than the herniated optic nerve axon fibers.

To evaluate the morphologic characteristics of optic nerve head drusen.Retrospective case series.setting: Institutional (Seoul National University Bundang Hospital). patients: Sixty-one patients with optic nerve head drusen. observation procedure: Visible and buried optic nerve head drusen were identified using funduscopy, whereas homogenous and nonhomogenous optic nerve head drusen were identified using spectral-domain optical coherence tomography images. Buried optic nerve head drusen were classified according to the size. main outcome measures: Classification of optic nerve head drusen.Of 99 eyes in 61 patients, optic nerve head drusen were buried in 95 eyes and visible in 4 eyes. The patients with visible optic nerve head drusen were older on average than those with buried optic nerve head drusen (53.3 ± 8.6 years vs 13.5 ± 7.1 years; P.001) and exhibited larger disc diameters (1643 ± 265 μm vs 1287 ± 185 μm; P = .016). All 4 eyes with visible optic nerve head drusen exhibited hyperreflective borders, which were not found in patients with buried optic nerve head drusen. Of 95 eyes with buried optic nerve head drusen, 64 eyes (67%) showed homogenous internal reflectivity, whereas 31 eyes (33%) showed nonhomogenous reflectivity with lobulations. Large optic nerve head drusen were associated with a small optic disc diameter, nonhomogenous internal reflectivity, a partial highly reflective border, intraretinal cysts, and increased temporal retinal nerve fiber layer thickness.Optic nerve head drusen have a diverse spectrum of spectral-domain optical coherence tomography findings associated with patient age and disc size.

Objective To evaluate the recurrence rate after upper eyelid epiblepharon repair in patients with Down syndrome. Design Retrospective, observational study. Methods Total of 578 Korean children (21 with Down syndrome patients, 557 with non-Down syndrome patients), who had undergone epiblepharon repair and were followed up for more than 2 months, were included in this study. The recurrence rate was compared between two groups at 2, 6 months after surgery. Recurrence was defined as the re-appearance of cilia touching to cornea. The recurrence rate was also analyzed according to whether patients had undergone concomitant z-medial epicanthoplasty or not. Results Lower eyelid epiblepharon repair was performed on 22 eyelids of Down syndrome patients, and 1072 eyelids of non-Down syndrome patients. At 3 months after surgery, the recurrence rate was not significantly different between two groups ( P = 1.00). Upper eyelid epiblepharon was repaired on 40 eyelids of Down syndrome patients, and 204 eyelids in non-Down syndrome patients. At 2 and 6 months after surgery, the recurrence rate was significantly higher in Down syndrome patients (27.5% and 29.4%) than non-Down syndrome patients (3.4% and 4.6%) ( P = 0.000, P = 0.004, respectively). The recurrence rate of upper eyelid epiblepharon repair was not affected in both groups whether Z-epicanthoplasty was combined or not ( P = 1.00 in both groups). Conclusions In Down syndrome patients, the recurrence rate after upper eyelid epiblepharon repair was higher than non-Down syndrome patients. The effect of combined Z-medial epicanthoplasty was limited in both groups.

The ability to acquire and use several languages selectively is a unique and essential human capacity. Here we investigate the fundamental question of how multiple languages are represented in a human brain. We applied functional magnetic resonance imaging (fMRI) to determine the spatial relationship between native and second languages in the human cortex, and show that within the frontal-lobe language-sensitive regions (Broca's area)1,2,3, second languages acquired in adulthood (‘late’ bilingual subjects) are spatially separated from native languages. However, when acquired during the early language acquisition stage of development (‘early’ bilingual subjects), native and second languages tend to be represented in common frontal cortical areas. In both late and early bilingual subjects, the temporal-lobe language-sensitive regions (Wernicke's area)1,2,3 also show effectively little or no separation of activity based on the age of language acquisition. This discovery of language-specific regions in Broca's area advances our understanding of the cortical representation that underlies multiple language functions.