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BACKGROUND Rosai–Dorfman disease (RDD) is a rare histiocytic proliferation of unknown etiology commonly found in children and adolescents. The common manifestation of RDD is massive and painless bilateral cervical lymphadenopathy with extranodal disease. While extranodal involvement in RDD is common, the spleen is an infrequent site of disease. CASE SUMMARY We report a 10-mo-old female infant with RDD presenting multiple splenic masses without cervical lymphadenopathy. She had fever, and blood tests showed leukocytosis, anemia, and elevated erythrocyte sedimentation rate and C-reactive protein. Ultrasound, computed tomography, and magnetic resonance images demonstrated multiple splenic masses. Despite antibiotic therapy, her symptoms were not relived. She underwent diagnostic splenectomy and was discharged with recovery. CONCLUSION In pediatric patients with refractory infectious symptoms or hematological abnormalities, clinicians should suspect RDD, even in patients without significant lymphadenopathy.

PRECIS The development of beta-zone peripapillary atrophy (β-PPA) and focal lamina cribrosa defect (FLD) was significantly associated with decreased peripapillary optical coherence tomography angiography (OCTA) vessel parameters in young myopic eyes. PURPOSE The purpose of this study was to investigate whether β-PPA and FLD affect peripapillary vessel density (VD) or perfusion density (PD) from OCTA in young myopic eyes. MATERIALS AND METHODS In a cross-sectional study, 330 eyes of 165 healthy volunteers with myopia were involved. Eyes underwent OCTA to measure peripapillary PD and VD. Eyes were grouped according to the presence of β-PPA or FLD: eyes without β-PPA or FLD (group A), eyes with β-PPA but without FLD (group B), and eyes with both β-PPA and FLD (group C). PD and VD were compared among 3 groups, and linear mixed-effect regression model was used to investigate the determinants of PD. RESULTS β-PPA was found in 219 eyes (66.4%), and FLD was detected in 27 eyes (8.2%). The average VD and PD were greatest in group A (19.13±2.04 mm-1 and 0.375±0.038), followed by group B (18.34±2.26 mm-1 and 0.363±0.042) and group C (16.71±2.81 mm-1 and 0.330±0.052) (P

BackgroundTo investigate the longitudinal change of localised retinal nerve fibre layer (RNFL) defects associated with change of ß-zone parapapillary atrophy (PPA) in primary open-angle glaucoma (POAG) eyes.MethodsPOAG patients with a localised RNFL defect and ß-zone PPA who had undergone disc/RNFL photography at 1-year intervals for 10 years or longer were enrolled. The topographic parameters of ß-zone PPA (area, maximal radial extent and angular extent around disc) were measured. Progression of RNFL defect was defined as widening of defect and/or appearance of new defect. The factors associated with progression of RNFL defect were assessed by OR using multivariable logistic regression.ResultsA total of 209 patients (209 eyes) with POAG were included (mean: 54 years old). Over the course of 11.5±2.3-year follow-up period, progression of RNFL defect was detected in 114 eyes (54.5%). Enlargement of PPA parameters (area and angular extent) was significantly more common in patients with RNFL defect progression than in eyes without progression (all pConclusionsProgression of RNFL defect is associated with increment of angular extent of PPA in POAG eyes.

Glaucoma shares common risk factors with chronic kidney disease (CKD) but previous cross-sectional studies have demonstrated discrepancies in the risk of glaucoma in CKD patients. This study enrolled kidney transplantation recipients (KTRs) (n = 10,955), end stage renal disease (ESRD) patients (n = 10,955) and healthy controls (n = 10,955) from National Health Insurance Service database of the Republic of Korea. A Cox proportional hazard regression model was used to calculate the hazard ratios (HR) for primary open-angle glaucoma (POAG) and primary angle-closure glaucoma (PACG) incidences. The incidence of POAG was higher in ESRD patients (3.36/1,000 person-years, P P P = 0.07) or KTRs (P = 0.08) when adjusted for the confounding factors. The incidence of PACG was significantly higher in ESRD patients (0.41/1,000 person-years) than in healthy controls (0.14/1,000 person-years, P = 0.008). The PACG incidence was significantly lower in KTRs than in ESRD patients (HR = 0.35, P = 0.015). In conclusion, this nationwide cohort study demonstrated that kidney transplantation can reduce the risk of PACG but not POAG in ESRD patients.

BACKGROUND The infusion of triolein emulsion (TE) induced increased vascular permeability and a negligible and temporary decrease in liver function without specific histopathological damage. AIM To assess changes in doxorubicin concentration according to the percentage of TE infused via a hepatic artery to study the vascular permeability in the rabbit liver. METHODS Thirty-nine healthy rabbits were divided into five groups according to the concentration of emulsified triolein infused into the hepatic arteries: Group 0, saline infusion (control group, n = 5); group 1, 0.3% TE (n = 13); group 2, 0.6% TE (n = 6); group 3, 0.9% TE (n = 8); and group 4, 1.5% TE (n = 6). Doxorubicin (2.4 mg/kg) was infused immediately after TE injection via the hepatic arteries. After 2 h, the livers were harvested, and doxorubicin concentrations were calculated fluorometrically. The doxorubicin concentrations were compared between TE groups and the control group, and the optimal concentrations within the TE groups were calculated. Statistical analysis was performed using the nonparametric Mann-Whitney U test and Kruskal–Wallis test. P < 0.05 were considered statistically significant. RESULTS In the liver, doxorubicin concentrations were 2.06, 2.07, 2.16 and 1.66 times higher in groups 1 through 4, respectively, and significantly higher in the TE groups than in the control group (all P < 0.05). However, there were no significant differences in the mean doxorubicin concentrations between the four TE groups (P = 0.642). In the lungs, the mean doxorubicin concentrations were not significantly different between the control and TE groups (P > 0.05). CONCLUSION TE infusion into the hepatic arteries significantly increased the doxorubicin concentration approximately twofold but was not different between the TE groups. These findings suggest that TE infusion might be a useful adjuvant treatment of liver cancers.

Purpose To investigate 24-hour nyctohemeral intraocular pressure (IOP)-related patterns with contact lens sensors (CLSs) in eyes with primary open-angle glaucoma (POAG) with normal baseline IOP (i.e., normal-tension glaucoma [NTG]) and healthy controls. Design Prospective, case-control study. Participants Thirty eyes of 30 patients with NTG, who had had a wash-out period for their IOP-lowering treatment, and 20 eyes of 20 healthy volunteer subjects. Methods Patients and subjects were hospitalized for the purposes of 24-hour CLS (SENSIMED Triggerfish; Sensimed AG, Lausanne, Switzerland) measurement. The IOP-related patterns during wake and sleep times over the course of the 24 hours were compared between the 2 groups. The 24-hour ambulatory blood pressure and posture were monitored simultaneously. A generalized linear model was used to find the factors associated with NTG. Main Outcome Measures The IOP-related patterns, including mean and standard deviation (SD) of measurements, amplitude of cosine-fit curve, acrophase (signal peak), and bathyphase (signal trough) values (millivolt equivalents [mVEq]). Results The SDs of the 24-hour CLS measurements were significantly greater in NTG eyes than in healthy controls (112.51±26.90 vs. 85.18±29.61 mVEq, P = 0.002). The amplitudes of cosine-fit curve (141.88±39.96 vs. 106.08±41.49 mVEq, P = 0.004) and acrophase values (277.74±129.80 vs. 190.58±127.88 mVEq, P = 0.024), mostly measured during nocturnal period, were significantly greater in NTG eyes than in healthy controls. The NTG subjects slept longer in the lateral decubitus posture than the healthy controls (199.1±137.8 vs. 113.2±86.2 minutes, P = 0.009). In the multivariable generalized linear model, the greater amplitude of cosine-fit curve (β = 0.218, P = 0.012) and greater time of decubitus posture during sleep (β = 0.180, P = 0.004) were found to be significantly associated with NTG. Conclusions Continuous monitoring of 24-hour IOP-related values with CLS can be useful for assessment of glaucoma risk, especially for patients with NTG whose IOP appears to be in the normal range. Fluctuation of 24-hour IOP-related values and posture during sleep time might be associated with NTG.

To compare the accuracy of glaucomatous defects and diagnostic power for primary open-angle glaucoma (POAG) between swept-source optical coherence tomography (SS-OCT) and spectral-domain OCT (SD-OCT) in myopic eyes.Prospective, case-control study.A total of 150 myopic POAG eyes and 100 healthy myopic eyes underwent SD-OCT and SS-OCT in random order on the same day. The locations of glaucomatous defects on SD-OCT thickness and deviation maps and SS-OCT wide-field thickness (thickness surfaces) and SuperPixel maps were rated, and the maps' accuracies were compared. The area under receiver operating characteristic (AUROC) of the peripapillary retinal nerve fiber layer (RNFL) and the macular parameters (GCL++: equivalent to ganglion cell-inner plexiform layer [GCIPL] + RNFL; GCL+: equivalent to GCIPL) from each of the devices for myopic POAG were calculated and compared.The wide-field RNFL thickness (thickness surface) map showed the best accuracy for glaucomatous defects in the inferotemporal (96.4%) and superotemporal (92.4%) regions. The RNFL/GCL++/GCL+ wide-field thickness (thickness surface) map showed better accuracy for glaucomatous defects in both the superotemporal and inferotemporal regions than with the SD-OCT thickness map (all P values.05). The average GCL++ (87.6%) and GCL+ (87.5%) thicknesses showed significantly greater AUROC for myopic POAG than GCIPL thickness from SD-OCT (83.8%, all P values.05).In myopic eyes, the SS-OCT wide-field map exhibited better accuracy for glaucomatous defect and greater diagnostic power for POAG than SD-OCT outcomes. This result might have been due to SS-OCT's wider scan and measurement area.

Background/AimsTo evaluate the association between strabismus and primary open-angle glaucoma (POAG) in a representative Korean population.MethodsA total of 11 114 participants aged 20 years or older in the Korea National Health and Nutrition Examination Survey database for the years 2010 through 2011 were reviewed. A standardised protocol was used to interview every participant and to perform comprehensive ophthalmic examinations. Glaucoma diagnosis was based on fundus photography and frequency-doubling technology perimetry results, according to the International Society of Geographical and Epidemiological Ophthalmology criteria. Ocular alignment was evaluated using the alternate prism and cover test, and clinically significant horizontal strabismus was defined as exodeviation of ≥15 prism dioptres (PD) and esodeviation of ≥10 PD. Univariate and multivariate regression analyses were used to evaluate the potential risk factors for POAG.ResultsIn the Korean population, subjects with clinically significant esodeviation had a much higher prevalence of POAG (12.32%) than those without clinically significant esodeviation (3.14%, p=0.016). After adjusting for age and intraocular pressure, clinically significant esodeviation was independently associated with POAG (OR 7.61, p=0.002).ConclusionEsodeviation was independently associated with POAG in the Korean population. This could be the result of, at least in part, ocular-adduction-induced greater strain on the temporal optic nerve head and peripapillary tissues, which makes eyes with esodeviation more vulnerable to POAG.

Purpose To investigate the difference in longitudinal change of s-zone parapapillary atrophy (PPA) between eyes with primary open-angle glaucoma (POAG) and normal eyes. Design Longitudinal, observation study. Participants A total of 153 eyes with POAG and 105 normal eyes. Methods Participants were followed for 10 years or more, with disc photography performed every year. The topographic parameters of s-zone PPA (area, maximal radial extent, angular extent around disc) were measured. The factors associated with the enlargement of s-zone PPA parameters were assessed by odds ratio (OR) using multivariable logistic regression. Main Outcome Measures Enlargement of s-zone PPA parameters and associated factors. Results Over the course of the average 11.6±1.3-year follow-up period, enlargement of β-zone PPA was detected in 66.7% of POAG eyes and in 26.7% of normal eyes. Increment of all PPA parameters was significantly more common in cases of POAG than in normal eyes (all P Conclusions The pattern of s-zone PPA change differed between POAG and normal eyes during a follow-up of 10 years or more. The enlargement of PPA occurred more frequently in POAG than in normal eyes. The widening of radial extent was associated with older age and glaucoma, whereas the increment of angular extent was associated with glaucomatous damage.

BackgroundTo investigate the relationship between estimated mean ocular perfusion pressure (MOPP) and peripapillary perfusion density (PD) or vessel density (VD) as measured by spectral-domain optical coherence tomography angiography (OCTA) in young healthy eyes.Methods132 healthy participants (264 eyes) under 45 years of age underwent optic disc OCTA scan sized 3×3 mm to acquire PD and VD in the superficial vascular complex (SVC). Optic nerve head (ONH) parameters including retinal nerve fibre layer (RNFL) thickness, rim area and disc area were measured. MOPP was estimated from systemic blood pressure and intraocular pressure (IOP). A linear mixed model was used to find the systemic and ocular factors associated with PD and VD.ResultsThe average age of the subjects was 25.8±6.5 years. PD and VD showed a significant correlation with RNFL thickness (r=0.224, p0.05).ConclusionPD and VD in the SVC were significantly associated with ONH parameters while showing no association with estimated MOPP. OCTA-derived VD may not represent perfusion pressure, but is rather more dependent on peripapillary structure.

Background/Aims To investigate whether the association of long-term intraocular pressure (IOP) fluctuation with the rate of progression of normal-tension glaucoma (NTG) differs between myopia and non-myopia. Methods The medical records of 65 myopic NTG (axial length (AL) > 24.0 mm) and 64 non-myopic NTG eyes (AL Results The average follow-up period was 8.3 years. Twenty-two (22) non-myopic eyes (34.4%) and 27 myopic eyes (41.5%) showed NTG progression (p=0.511). The interaction of myopia with IOP fluctuation was a significant factor regarding both MD and VFI slope (p=0.002, 0.024, respectively); stratified analyses suggested that the risk effect of IOP fluctuation was significant only in myopic NTG in terms of both MD (β= −1.27, p=0.003) and VFI slope (β=−2.32, p=0.011). Conclusion Long-term IOP fluctuation was significantly related to faster visual field progression in myopic NTG eyes, compared with non-myopic NTG eyes.

Unicondylar femoral fractures are uncommon injuries, known to occur primarily in young people, with high energy trauma. However, according to our experiences, unicondylar femoral fractures in geriatric patients generally involved the medial femoral condyle, unlike previously reported. In addition, the fractures of medial femoral condyle (FMFC) showed a characteristic fracture pattern. To date, there has been no published article focusing on the FMFC in geriatric patients. Thus, the aim of this study was to determine the characteristics of FMFC in geriatric patients and to present their outcomes. We retrospectively reviewed the medical records of 13 patients over age of 65 who underwent surgery for FMFC (AO-OTA 33B2). Of the 13, 10 patients were treated with Tomofix medial distal femoral plate (MDF) (Synthes GmbH, Switzerland) and additional screws fixation; the other three were treated with screw fixation and cast application. The mean age of patients was 76.8 years, and 10 patients were females. The fracture was due to low-energy trauma in all of the cases. Eight patients had medial knee osteoarthritis, and 2 patients were on osteoporosis treatment. A characteristic fracture pattern was observed. The fracture line extended from the lateral aspect of the intercondylar notch to the posteromedial column of the distal femur, with a characteristic medial beak. All fractures belonged to AO classification 33B2.1; there were no cases of AO classification 33B2.2 or 33B2.3. The postoperative joint function was graded according to the Kolmert functional criteria: ten cases were excellent, one case was good, one case was fair, and one case was poor. FMFC caused by low-energy trauma in geriatric patients tend to have a characteristic pattern. We believe that anatomic reduction and firm fixation with Tomofix MDF plate and cannulated screw for low-energy trauma FMFC in geriatric patients would yield good outcomes.

BackgroundTo investigate the thinning rate of three-dimensional neuroretinal rim thickness (3D-NRT) in glaucoma eyes with optic disc haemorrhage (DH) and its relationship to retinal nerve fibre layer thickness (RNFLT) progression.MethodsNinety-five (95) eyes of 95 glaucoma patients with initial DH in the inferotemporal (n=69) and superotemporal (n=26) regions and 48 eyes of 48 glaucoma patients without DH were retrospectively reviewed. The rates of change for 3D-NRT and RNFLT were compared by linear mixed-effect model. For the direct comparison between 3D-NRT and RNFLT, dynamic-range-based normalised coefficient was used. The effect of DH frequency on the rates of thinning of 3D-NRT and RNFLT was evaluated.ResultsDuring a mean 7-year follow-up, the rates of thinning of 3D-NRT (–5.69±4.88 µm/year) and RNFLT (–2.03±2.03 µm/year) at 7 o’clock were faster than those at other locations (all pConclusionDH eyes are associated with the progression of both 3D-NRT and RNFLT, especially in the inferotemporal region. DH eyes show a relatively faster thinning rate of average RNFLT than 3D-NRT. The frequency of DH can affect the progression of 3D-NRT as well as RNFLT.

Purpose To evaluate the potential of the temporal raphe sign on the macular ganglion cell–inner plexiform layer (mGCIPL) thickness map for discriminating glaucomatous from nonglaucomatous optic neuropathy (NGON) in eyes with mGCIPL thinning. Design Cross-sectional study. Participants A total of 175 eyes of 175 patients with mGCIPL thinning on Cirrus (Carl Zeiss Meditec, Dublin, CA) high-definition OCT were retrospectively included. Glaucoma specialists and neuro-ophthalmology specialists evaluated the patients’ medical records for diagnosis of glaucomatous optic neuropathy (GON) or NGON. Finally, by consensus, 67 eyes with GON and 73 eyes with NGON were enrolled. Methods A positive temporal raphe sign was declared in patients in whom there was a straight line longer than one-half of the length between the inner and outer annulus in the temporal elliptical area of the mGCIPL thickness map. Decision tree analysis was performed to formulate a diagnostic model. Main Outcome Measures Area under receiver operating characteristic curve (AUC) with sensitivity and specificity. Results The temporal raphe sign was observed in 61 of 67 GON eyes (91.0%), but in only 21 of 73 NGON eyes (28.8%) (P Conclusions In clinical practice, determining whether the temporal raphe sign appears on OCT macular scans can be a useful tool for discrimination of glaucomatous from nonglaucomatous mGCIPL thinning.

Background/AimsTo investigate the topographic relationship between macular superficial microvessel density (SMD) and macular ganglion cell-inner plexiform layer (GCIPL) thickness in eyes with glaucoma-suspect (GS) and early normal-tension glaucoma (NTG).MethodsA total of 86 eyes of 86 patients with early NTG (standard automated perimetry mean deviation >−5.5 decibels) and a total of 25 eyes of 25 patients with GS were retrospectively reviewed. All of the subjects underwent optical coherence tomography (OCT) and OCT angiography (OCTA) scan. On the OCTA scan images, macular SMD was analysed by customised software.ResultsIn GS and patients with early NTG, macular GCIPL thickness showed significant correlations with macular SMD in the superotemporal (ST), inferotemporal (IT) and inferoinferior (II) sectors (r=0.191, 0.373 and 0.346 for ST, IT and II sector, respectively). Additionally, circumpapillary retinal nerve fibre layer (RNFL) thickness and macular SMD showed significant correlations between the ST sector of the macula and the 1, 9 clock-hour peripapillary regions and between the IT and II sectors of the macula and the 6, 7, 8 clock-hour peripapillary regions. The IT sector macular SMD showed fair diagnostic power (area under the receiver operating characteristic curve [AUROC] = 0.758) and showed high diagnostic power when combined with IT sector macular GCIPL thickness (AUROC=0.954).ConclusionsSectoral macular SMD showed topographic correlations with macular GCIPL thickness and circumpapillary RNFL thickness in patients with GS and early-stage NTG. Macular SMD analysis is potentially useful in the clinical evaluation of early glaucoma.

Intraocular pressure (IOP), the pressure within the eyeball, is a function mainly of the production and elimination of aqueous humour. Balanced IOP helps to maintain the eyeball contour, allowing proper refraction of light in the anterior segment of the eye. Increases in IOP can cause injury to the ocular structure, typically the optic nerve head and retinal ganglion cells. IOP increase, additionally, is a risk factor for glaucoma progression. However, it is not unusual that glaucoma worsens despite well-managed IOP; indeed, glaucoma can develop and progress even within the normal IOP range. IOP measured once during daytime office hours might not provide sufficient information for effective glaucoma management. In fact, IOP is not a fixed value but rather changes over time: it fluctuates with the intrinsic circadian rhythm and can also change in various lifestyle-related situations (eg, with body posture, during exercise, while holding breath and according to dietary habits). It is therefore worth exploring the various factors that can affect IOP and glaucoma risk. In this review, the various exogenous influences on IOP in the literature are investigated.

Rho-associated coiled-coil kinase (ROCK) signaling can affect glaucoma risk by regulating trabecular meshwork outflow. We investigated the effect of ROCK gene polymorphism on the risks of primary open-angle glaucoma (POAG) and POAG-related phenotypes including intraocular pressure (IOP) in a Korean population. A total of 24 single-nucleotide polymorphisms (SNPs) from ROCK1 and ROCK2 were selected and genotyped for 363 POAG patients and 213 healthy controls. Among the 363 POAG patients, 282 were normal-tension glaucoma (NTG, baseline IOP ≤ 21 mmHg) and 81 were high-tension glaucoma (HTG, baseline IOP &gt, 21 mmHg). The SNPs rs288979, rs1006881, rs35996865, rs10083915, and rs11873284 in ROCK1 (tagged to each other, r2 = 1) were nominally associated with risk of HTG (OR = 0.52, p = 0.045). However, there were no SNPs that were significantly associated with the risk of NTG. In the genotype-phenotype correlation analysis, the SNPs rs2230773 and rs3771106 in ROCK2 were significantly correlated with central corneal thickness (CCT)-adjusted IOP (p = 0.024) and axial length (AXL, p = 0.024), respectively. The present data implicated the role of ROCK in POAG development, and as such, can serve as a good reference for upcoming Rho/ROCK-pathway-related studies on POAG.

Purpose To investigate the change of border tissue configuration during axial elongation in childhood. Methods Fifty-four subjects (108 eyes; age range, 29.3-132.5 months) who had undergone a series of swept-source optical coherence tomography scans at intervals of 6 months or longer were classified into stable axial length (AXL) eyes (n = 55; AXL change of ≤0.36 mm) and elongating AXL eyes (n = 53; AXL change of >0.36 mm). The angle between the Bruch's membrane opening (BMO) reference plane and the border tissue of Elschnig was defined as the border tissue angle (BTA). The border tissue angle, BMO distance (BMOD) and minimum rim width (MRW) were measured in the temporal and nasal regions. Results During 15.6 ± 7.2 months of follow-up, the AXL significantly increased from 22.8 ± 1.3 mm to 23.3 ± 1.4 mm (P < 0.001). Changes of border tissue angle and AXL showed a significant correlation only in the temporal region of elongating AXL eyes (r = -0.409; P = 0.002), but not in stable AXL eyes. Both BMOD and nasal MRW significantly increased from 1482.5 ± 153.0 to 1506.1 ± 154.6 µm and from 310.6 ± 83.2 to 324.6 ± 95.6 µm, respectively (all Ps < 0.001). The changes of BMOD and nasal MRW showed a significant positive correlation with changes of AXL in elongating AXL eyes but not in stable AXL eyes. Conclusions During the axial elongation in childhood, temporal border tissue configuration change, BMO enlargement, and nasal peripapillary tissue elevation showed a significant correlation with changes in the AXL.

Multiple prominent hypointense vessels on susceptibility-weighted image (SWI) have been found in the ischemic territory of patients with acute ischemic stroke. SWI is suitable for venous imaging.To evaluate the conditions of prominent hypointense vessel (PHV) in hyperacute and acute cerebral infarctions using susceptibility-weighted image (SWI).Magnetic resonance images, including SWI, of 284 patients with acute infarction were evaluated. Based on lesion size, the infarction was classified as a small ( 3 cm) or a large ( 3 cm) infarction. Stage of infarction was classified as hyperacute ( 6 h) or acute ( 6 h, 1 week) on the basis of the onset of stroke. The site of infarction was categorised as a deep grey matter or a mixed (cortical and/or deep grey matter) infarction. The venous structures were analysed qualitatively for the calibre difference between ipsilateral and contralateral hemispheres. We quantitatively analysed the relationship between the size of areas with PHV on SWI and the abnormalities on MR angiography, apparent diffusion coefficient value, and signal intensity on T2WI in the 271 patients.PHV over the infarction site was observed in 54.1% (137/253) of the large infarctions, and 19.3% (6/31) of the small infarctions on SWI. PHV was demonstrated in 63.1% (118/187) of mixed infarctions and 25.8% (25/97) of deep grey matter infarctions, and 59.2% (58/98) in hyperacute and 45.7% (85/186) of acute infarctions. The presence of PHV was statistically significant in the size and region of cerebral infarction (p 0.05), and was not significant in the stage of infarction (p = 0.137). Quantitative analysis revealed significant differences in the MRA abnormalities and ADC values in the PHV ( +) group (p 0.05) and no significant difference in the T2WI SI ratio in the PHV ( +) group (p = 0.086), compared with PHV (-) group.PHV on SWI was more prominent at the portions with the large and mixed infarctions. PHV was observed both in hyperacute and acute infarction.

Introduction: Although collagen is widely used in various forms as a functional ingredient in skin care products, the effect of oral supplementation of collagen tripeptides (CTPs) on human skin is unclear. Moreover, the majority of the positive outcomes of CTP reported so far have not considered the effect of weather conditions. Therefore, we tested the effect of CTP and adjusting for climate change on skin properties in middle-aged women.Materials and Methods: A randomized controlled trial was conducted with 84 women between 40 and 60 years of age. Participants were randomized to receive placebo or 1,000 mg CTP daily for 12 weeks. CTP was prepared from the skin of Nile Tilapia by the digestion method using collagenase from non-pathogenic bacteria of the genus Bacillus. Skin hydration, wrinkling, and elasticity were assessed at baseline and after 6 and 12 weeks with adjustments for temperature, humidity, and ultraviolet A exposure during the evaluation time using weather data from the regional meteorological office.Results: Of the 82 participants, 74 completed the trial without adverse effects. Compared with the control group, trans-epidermal water loss was reduced more in the CTP group after 12 weeks (P < 0.05). At 12 weeks, even after adjustment for humidity, temperature, and UVA in the region, the difference of the two groups in TEWL remained statistically significant (adjusted for humidity and temperature, P = 0.024; adjusted for UVA, P = 0.032; adjusted for temperature, high temperature, and ultraviolet A, P = 0.031). In terms of skin hydration, more improvement was evident in the CTP group than in the control group. In the subgroup analysis, subjects under 50 years of age showed a significant improvement in total score and moisture in the subjective skin improvement questionnaire after taking CTP for 12 weeks. Application of CTP was well-tolerated, and no notable adverse effect was reported from both groups.Discussion: Our findings suggest that oral ingestion of CTP from the Skin of Nile Tilapia (Oreochromis niloticus) is well-tolerated and helps reduce water loss in in middle-aged women.Clinical Trial Registration:www.clinicaltrials.gov/, Identifier: NCT03505684.

Glaucoma is one of the leading causes of blindness. It is a progressive disease with differing rates of progression among individuals. Since the severity of the disease at presentation is a major risk factor for glaucoma blindness, early diagnosis and detection of progression is critical to prevention of blindness due to glaucoma. This chapter provides an overview on the utility of optical coherence tomography (OCT) imaging for early detection of glaucomatous structural damage and progression, with relevant clinical cases. The OCT devices enable not only thickness measurement of each retinal layer but also topographical analysis of glaucomatous damage based on deviation and/or thickness maps. Clinicians can use built-in Guided Progression Analysis (GPA) software to detect structural change and estimate the rate of progression. This chapter offers the latest knowledge along with practical tips for interpreting OCT printouts for early diagnosis and monitoring of glaucomatous damage.

RATIONALE Acute necrotizing encephalopathy (ANE) is a specific type of encephalopathy usually followed by febrile infection. It has an aggressive clinical course; however, it usually does not recur after recovery in cases of spontaneous ANE. Nevertheless, there are several studies reporting recurrences in familial ANE with RAN-binding protein 2 (RANBP2) mutation. There are few cases of familial ANE with RANBP2 mutation in Asian populations. PATIENTS CONCERNS A 21-month-old Korean boy who was previously healthy, presented with seizure following parainfluenza - a virus and bocavirus infection, followed by 2 recurrent seizure episodes and encephalitis after febrile respiratory illnesses. Meanwhile, his 3-year-old sister had focal brain lesions on neuroimaging studies when evaluated for head trauma. The siblings also had an older brother who presented status epilepticus after febrile respiratory illness at the age of 10 months old. DIAGNOSIS Brain magnetic resonance imaging was performed to evaluate the seizure and neurologic symptoms. Imaging findings showed variable spectrum - from non-specific diffuse white matter injury pattern to typical "tricolor pattern" of the ANE on diffusion-weighted images. The other 2 siblings showed focal lesions in both external capsules and severe diffuse brain edema. Genetic tests identified a heterozygous missense mutation in the RANBP2 [c.1754C>T (p.Thr585Met)] in 2 siblings and their mother. INTERVENTIONS Patients were treated conservatively with anticonvulsive agents, intravascular immunoglobulin, and steroids. OUTCOMES Among the 3 siblings, 2 male siblings died from familial ANE, whereas the female sibling was asymptomatic. LESSONS These cases highlight the radiological aspects of familial ANE with incomplete penetrance of the RANBP2 gene in 3 family members, showing variable involvements of the brain and natural history on magnetic resonance images. Radiologists should be aware of the typical and atypical imaging findings of familial ANE for prompt management of affected patients.

The present study investigated the effect of aldehyde dehydrogenase2 (ALDH2) rs671 polymorphism and alcohol consumption on the severity of primary open-angle glaucoma (POAG). The questionnaire for alcohol consumption pattern and targeted genotyping for ALDH2 rs671 polymorphism was performed from 445 Korean POAG patients. Retinal nerve fiber layer (RNFL) and ganglion cell-inner plexiform layer (GCIPL) thicknesses were measured and compared according to alcohol consumption and ALDH2 rs671 genotype. Heavy drinking group eyes had thinner RNFL thickness than did abstinence group eyes (65.0 ± 10.9 vs. 70.9 ± 11.5 µm, P = 0.023). Both mild (65.8 ± 9.6 µm) and heavy (63.8 ± 8.4 µm) drinking group eyes had significantly thinner macular GCIPL thickness than did abstinence group eyes (68.1 ± 8.2 µm, P = 0.003). However, ALDH2 rs671 polymorphism did not show any significant association with RNFL or GCIPL thickness. Alcohol consumption was significantly associated with GCIPL thinning (β = –0.446, P = 0.035) after adjustment for multiple confounding factors. As excessive alcohol consumption was significantly associated with thinner GCIPL thickness while ALDH2 polymorphism had no significant effect on RNFL or GCIPL thickness, glaucoma patients should avoid excessive alcohol consumption regardless of ALDH2 polymorphism.

Objective The efficacy of preoperative embolization for hypervascular metastatic spine disease (MSD) such as renal cell and thyroid cancers has been reported. However, the debate on the efficacy of preoperative embolization for non-hypervascular MSD still remains unsettled. The purpose of this study is to determine whether preoperative embolization for non-hypervascular MSD decreases perioperative blood loss. Methods A total of 79 patients (36 cases of preoperative embolization and 43 cases of non-embolization) who underwent surgery for metastatic spine lesions were included. Representative hypervascular tumors such as renal cell and thyroid cancers were excluded. Intraoperative and perioperative estimated blood losses (EBL), total number of transfusion and calibrated EBL were recorded in the embolization and non-embolization groups. The differences in EBL were also compared along with the type of surgery. In addition, the incidence of Adamkiewicz artery and complications of embolization were assessed. Results The average age of 50 males and 29 females was 57.6±13.5 years. Lung (30), hepatocellular (14), gastrointestinal (nine) and others (26) were the primary cancers. The demographic data was not significantly different between the embolization and the non-embolization groups. There were no significant differences in intraoperative EBL, perioperative EBL, total transfusion and calibrated EBL between two groups. However, intraoperative EBL and total transfusion in patients with preoperative embolization were significantly lower than in non-embolization in the corpectomy group (1645.5 vs. 892.6 mL, p=0.017 for intraoperative EBL and 6.1 vs. 3.9, p=0.018 for number of transfusion). In addition, the presence of Adamkiewicz artery at the index level was noted in two patients. Disruption of this major feeder artery resulted in significant changes in intraoperative neuromonitoring. Conclusion Preoperative embolization for non-hypervascular MSD did not reduce perioperative blood loss. However, the embolization significantly reduced intraoperative bleeding and total transfusion in corpectomy group. Moreover, the procedure provided insights into the anatomy of tumor and spinal cord vasculature.

Purpose To compare the macular interdigitation zone (IZ) of normal eyes with eyes showing different normal-tension glaucoma (NTG) stages. Methods Forty-two normal eyes (age, 56 ± 5.4 years), 45 pre-perimetric eyes (age, 59 ± 6.9 years), 51 mild-to-moderate glaucoma eyes (age, 58 ± 7.2 years; mean deviation [MD], -5.5 ± 3.0 dB), and 50 severe glaucoma eyes (age, 59 ± 6.9 years; MD, -15.1 ± 5.4 dB) were enrolled. All of the subjects underwent high-resolution spectral-domain optical coherence tomography (SD-OCT) to obtain 19 horizontal and 19 vertical macular B-scans 9 mm in length. The en face image of the scan area was divided into 589 rectangular boxes (side length of 375 µm). The IZ locations were marked on the corresponding image boxes. The IZ area was then quantified according to the number of boxes showing IZs among the 589 total boxes. Results The IZ area in the severe glaucoma eyes was significantly smaller than in the mild-to-moderate glaucoma eyes (28.99 ± 7.88 mm2 vs. 40.79 ± 7.46 mm2; P < 0.001), was smaller in the mild-to-moderate glaucoma eyes than in the pre-perimetric glaucoma eyes (40.79 ± 7.46 mm2 vs. 49.92 ± 8.10 mm2; P < 0.001), and was smaller still in the pre-perimetric glaucoma eyes than in the normal eyes (49.92 ± 8.10 mm2 vs. 56.85 ± 7.94 mm2; P < 0.001). In the 146 NTG eyes, a statistically significant correlation was found between IZ area and MD (r = 0.64; P < 0.001). Conclusions SD-OCT revealed a reduction in IZ area in NTG eyes, and the extent of the reduction was positively associated with glaucoma severity. These findings suggest, though tentatively, that changes in the outer retinal layer can occur in the course of glaucoma progression.

We investigated the expression of molecules in peripheral blood mononuclear cells (PBMCs) and plasma of patients with acute primary angle closure (APAC).Peripheral blood was collected from patients with APAC (n = 10) and age-matched controls (n = 5). The gene transcription profile was analyzed in PBMCs using microarrays and validated by real-time reverse transcription polymerase chain reaction (RT-PCR). The levels of secreted proteins were evaluated in plasma by ELISA.347 gene transcripts were up-regulated by 2-fold or more, and 696 transcripts down-regulated 2-fold or more in PBMCs from patients compared to controls. The most highly up-regulated gene was thrombospondin-1 (TSP-1, 8.66-fold increase), and the most down-regulated gene was prostaglandin-endoperoxide synthase 2 (PTGS2, 9.09-fold decrease). Real-time RT-PCR assay confirmed the increase of TSP-1 and the decrease of PTGS2 in PBMCs of patients. ELISA revealed that the levels of TSP-1 and active transforming growth factor (TGF)-β1 that is activated by TSP-1 were elevated in plasma of patients, while the level of prostaglandin E2 (PGE2) that is converted by PTGS2 was reduced. The plasma level of TSP-1 was positively correlated with that of active TGF-β1.Our data suggest that the molecular network including TSP-1, TGF-β1, and PGE2 might be involved in the pathogenesis of APAC and PACG.

Primary open-angle glaucoma (POAG) can develop even within normal ranges of intraocular pressure, and this type of glaucoma (so-called ‘normal-tension glaucoma [NTG]’) is highly prevalent in East Asia including Korea and Japan. We conducted exome chip analysis to identify low-frequency and rare variants associated with POAG from the primary cohort (309 POAG patients and 5,400 control, all Koreans). For replication, Korean (310 POAG patients and 5,612 controls) and Japanese (565 POAG patients and 1,104 controls) cohorts were further investigated by targeted genotyping. SNP rs116121322 in LRRC27 showed nominally significant association with POAG in the discovery cohort (OR = 29.85, P = 2E–06). This SNP was validated in the Korean replication cohort but only in the NTG subgroups (OR = 9.86, P = 0.007). Japanese replication cohort did not show significant association with POAG (P .00.44). However, the meta-analysis in the entire cohort revealed significant association of rs116121322 with POAG (ORcombined = 10.28, Pcombined = 1.4E–07). The LRRC27 protein expression was confirmed from human trabecular meshwork cells. For gene-based testing, METTL20 showed a significant association in POAG (Pcombined = 0.002) and in the subgroup of NTG (Pcombined = 0.02), whereas ZNF677 were significantly associated with only in the subgroup of high-tension glaucoma (Pcombined = 1.5E–06). Our findings may provide further genetic backgrounds into the pathogenesis of POAG, especially for the patients who have lower baseline intraocular pressures.

The macula contains more than 50% of the retinal ganglion cells, which typically are damaged in the eyes undergoing glaucomatous change [1–3]. The macular structure is characterized by less variation among individuals and is relatively less affected by ocular or systemic demographic factors than is the peripapillary retinal nerve fiber layer (RNFL) [4–7]. In addition, the rapid development of optical coherence tomography (OCT) technology has enabled accurate measurement of each layer of the retina, making the macular region very important to the diagnosis and monitoring of glaucoma [8].

Based on biomechanical theory, lamina cribrosa (LC) displacement, the key component of progressive glaucomatous change, is presumed to be dependent on intraocular pressure (IOP) as well as tissue stiffness of LC. In the performance of the Valsalva maneuver, both IOP and cerebrospinal fluid pressure can increase. The present study investigated the age-dependent variation of LC displacement during the standardized Valsalva maneuver in healthy subjects. Sixty-three (63) eyes (age range: 20–76 years) were prospectively underwent IOP measurement and Cirrus HD-OCT optic disc scans before and during the standardized Valsalva maneuver. During the standardized Valsalva maneuver, the IOP significantly increased from 13.2 ± 2.9 mmHg to 18.6 ± 5.2 mmHg (P P = 0.009), a smaller increase of IOP during the Valsalva maneuver (P = 0.002), and greater baseline maximal LC depth (P = 0.013) were associated with more anterior displacement of the LC during the standardized Valsalva maneuver. Taken together, age as well as translaminar pressure dynamics seems to play a crucial role in LC biomechanics.

Purpose To investigate the natural clinical course of more than 5 years and the risk factors of progression in patients with pre-perimetric open angle glaucoma (OAG) of “young age of onset (under age 40)” without treatment. Design Retrospective observational case series. Methods Optic disc photography, red-free retinal nerve fiber layer (RNFL) photography, optical coherence tomography, and visual field (VF) examinations were performed every 6 months. Glaucoma progression was defined as structural or functional deterioration. A linear mixed-effects model was used to estimate the rate of structural and functional changes. Kaplan-Meier survival analysis and log-rank testing were used to compare survival experiences, and Cox proportional hazards modeling was performed to identify risk factors for glaucoma progression. Results Of the 98 eyes of 98 patients (mean age, 30.6 years old), glaucoma progression was detected in 42 eyes (42.9%). The rate of average RNFL thickness thinning was −0.46 ± 0.50 μm/y, and the mean deviation (MD) change was −0.03 ± 0.13 dB/y. The glaucoma progression probability at 5 years was 39% by structural criteria and 5% by functional criteria. Older age at diagnosis (P = .004), presence of temporal raphe sign (horizontal straight line on macular ganglion cell-inner plexiform layer thickness map) (P = .011), lamina pore visibility (P = .034), and greater pattern standard deviation (P = .005) were significant factors for glaucoma progression. Conclusions In untreated pre-perimetric OAG patients with a “young age of onset” condition, the estimated MD slope for the disease course of more than 5 years was −0.03 dB/y, and the average RNFL thinning rate was −0.46 μm/y. The predictors for progression were structural parameters of temporal raphe sign, lamina pore visibility, and functional parameter of pattern standard deviation.

Background/AimsTo investigate the associations between the morphological characteristics of beta-zone parapapillary atrophy (β-zone PPA) and subsequent visual field (VF) progression in eyes with primary open-angle glaucoma (POAG).MethodsOne hundred and twenty-one POAG eyes with β-zone PPA along with 48 normal eyes with β-zone PPA were included. β-zone PPA area was calculated based on the PPA pixel area/optic-disc pixel area ratio and the optical coherence tomography (OCT)-measured disc area. β-zone PPA margin irregularity was quantified as a function of both area (A) and perimeter (P, calculated as 1/(4πA/P²)). VF progression was defined using standard automated perimetry’s guided progression analysis software.ResultsOf the 121 POAG eyes, 49 (40.5%) showed VF progression during the 10.1±1.9 years of follow-up. The baseline β-zone PPA area was similar among the three groups (Progressors, Non-progressors and Controls, p=0.995). However, the β-zone PPA irregularity index was significantly higher in the Progressors (pConclusionsIn POAG eyes, baseline β-zone PPA margin regularity was significantly associated with subsequent VF progression. Irregular margin of β-zone PPA might be the mark of vulnerability in the parapapillary area to further glaucomatous damage.

We developed a hybrid deep learning model (HDLM) algorithm that quantitatively predicts macular ganglion cell-inner plexiform layer (mGCIPL) thickness from red-free retinal nerve fiber layer photographs (RNFLPs). A total of 789 pairs of RNFLPs and spectral domain-optical coherence tomography (SD-OCT) scans for 431 eyes of 259 participants (183 eyes of 114 healthy controls, 68 eyes of 46 glaucoma suspects, and 180 eyes of 99 glaucoma patients) were enrolled. An HDLM was built by combining a pre-trained deep learning network and support vector machine. The correlation coefficient and mean absolute error (MAE) between the predicted and measured mGCIPL thicknesses were calculated. The measured (OCT-based) and predicted (HDLM-based) average mGCIPL thicknesses were 73.96 ± 8.81 µm and 73.92 ± 7.36 µm, respectively (P = 0.844). The predicted mGCIPL thickness showed a strong correlation and good agreement with the measured mGCIPL thickness (Correlation coefficient r = 0.739; P r = 0.713; P P = 0.378 and 0.724, respectively). The trained HDLM algorithm showed a great capability for mGCIPL thickness prediction from RNFLPs.

PURPOSE: To investigate the association between the laminar dot sign (LDS) and the deep optic nerve head (ONH) structure in eyes with primary-open-angle glaucoma (POAG). METHODS: Eighty-four eyes of 84 patients with POAG were prospectively included. All of the patients underwent stereo optic disc photography (SDP), red-free retinal nerve fibre layer (RNFL) photography, SS-OCT, and standard automated perimetry. By evaluating the SDP, patients were classified into laminar dot sign (LDS) and non-LDS groups. The deep structure of the ONH including the anterior prelaminar depth (APLD) and prelaminar tissue thickness (PTT) were quantitated using SS-OCT. Progression was assessed by structural or functional deterioration during the average 4.3 ± 1.2 years of follow-up. RESULTS: The LDS group had deeper APLD (405.47 ± 107.55 vs. 302.45 ± 149.51, P

A dysvascular digit is defined as a threatened circulatory condition of a digit caused owing to multiple reasons, such as medical illness or trauma. A dysvascular digit always needs surgical manipulation of the vessel in trauma cases. The revascularization of the digit is a priority in such conditions, after which reconstruction of the defect is performed. In this article, the authors present and discuss the venous free flap, thenar free flap, toe plantar free flap, free style perforator flap, hypothenar free flap, and anconeus muscle free flap.

Purpose To investigate the relationship between intereye visual field defect (VFD) asymmetry and subsequent VF progression in primary open-angle glaucoma (POAG). Methods Moderate-stage patients with POAG (226 eyes of 113 patients) with a single hemifield defect were followed for 8.7 years. Participants were categorized into three groups by initial VF pattern: (1) unilateral VFD, (2) bilateral VFD within same hemifield (superior–superior, inferior–inferior), (3) bilateral VFD within opposite hemifield (superior–inferior). The mean deviation (MD) difference between the intereye was defined as the intereye MD asymmetry index (iMAI). Intereye visual-sensitivity difference within the same hemifield was calculated as the intereye hemifield visual-sensitivity asymmetry index. Functional progression was detected by Glaucoma Progression Analysis. The overall rate of MD change and the association between new indices were evaluated by linear regression. A Kaplan-Meier survival analysis was performed and the factors associated with glaucoma progression were evaluated by Cox proportional hazard modeling. Results Unilateral VFD eyes and bilateral VFD eyes within opposite VF hemifield showed significant progression and faster rate of MD change compared with bilateral VFD eyes within same VF hemifield (71.1% vs. 45.9% vs. 21.1% [P = 0.001]; –1.27 dB/y vs. −0.64 dB/y vs. −0.32 dB/y [P = 0.001]). Unilateral VFD eyes showed the fastest time to VF progression compared with other groups (P = 0.002). A faster rate of MD change was associated with greater intereye MD asymmetry index (P = 0.001) and greater intereye hemifield visual-sensitivity asymmetric index (P = 0.031), which were significant risk factors for glaucoma progression (all P < 0.001). Conclusions Among POAG eyes with comparable hemifield VFDs, eyes without a corresponding hemifield defect in the fellow eye showed faster rates of progression compared with those with a corresponding hemifield defect.

Several recent studies showed the optimal contrast enhancement with a low-concentration and iso-osmolar contrast media in both adult and pediatric patients. However, low contrast media concentrations are not routinely used due to concerns of suboptimal enhancement of cardiac structures and small vessels. To evaluate the feasibility of using iso-osmolar contrast media containing a low iodine dose for CT cardiac angiography at 80 kilovolts (kVp) in neonates and infants. The iodixanol 270 group consisted of 79 CT scans and the iopromide 370 group of 62 CT scans in patients ≤1 year old. Objective measurement of the contrast enhancement was analyzed and contrast-to-noise ratios of the ascending aorta and left ventricle were calculated. Regarding subjective measurement, a four-point scale system was devised to evaluate degrees of contrast enhancement, image noise, motion artifact and overall image quality of each image set. Reader performance for correctly differentiating iodixanol 270 and iopromide 370 by visual assessment was evaluated. Group objective and subjective measurements were nonsignificantly different. Overall sensitivity, specificity and diagnostic accuracy for correctly differentiating iodixanol 270 and iopromide 370 by visual assessment were 42.8%, 59%, and 50%, respectively. The application of iodixanol 270 achieved optimal enhancement for performing pediatric cardiac CT angiography at 80 kVp in neonates and infants. Objective measurements of contrast enhancement and subjective image quality assessments were not statistically different in the iodixanol 270 and iopromide 370 groups.

Objective This study was designed to investigate the long-term results using the technique of canal wall up mastoidectomy and reconstruction of the posterior canal wall using bone pâte and auricular cartilage in the treatment of chronic otitis media with cholesteatoma. Materials and methods A retrospective review was performed on 42 patients who underwent canal wall up mastoidectomy and posterior canal wall reconstruction at a single institution between November 2005 and November 2012. Results Of the 42 patients, postoperative tympanic membranes were normal in 38 (90.5%), perforated in 1 (2.4%), and retracted in 3 (7.1%). Mean preoperative and postoperative values of the air-bone gap (ABG) were 29.4±12.8 and 23.4±11.7 dB, respectively, which represented a significant average improvement. For patients with ossiculoplasty (n=24), the mean preoperative and postoperative ABG values were 34.7±6.0 and 27.5±8.0 dB, respectively, which also represented a significant average improvement. Thirty-one (73.8%) of the patients were followed up without any complication, but 5 had otorrhea (11.9%), 4 had dizziness (9.5%), and 2 had facial palsy (4.8%). Conclusion A canal wall up mastoidectomy with reconstruction of the posterior canal wall using auricular cartilage and bone pâte provides successful preservation of the anatomic structure and a significant improvement in hearing without the long-term disadvantages of a canal wall down mastoidectomy.

Objectives. Antioxidative enzyme efficiency changes in some organs with age. However, no study has been conducted on age-related antioxidant enzyme changes in tongue. In the present study, the authors investigated the activities of four antioxidative enzymes and their protein expressions in the tongues of young and old Fischer 344 rats. Methods. Age-dependent changes in the enzyme activities of total superoxide dismutase (SOD), Mn-SOD, Cu/Zn-SOD, catalase (CAT), and glutathione peroxidase (GPx) were determined using chemical kits, and the protein expressions levels of these enzymes by Western blotting. The study was conducted using rats aged 7 months (the young group, n=8) and 22 months (the old group, n=8). Results. Total SOD, Cu/Zn-SOD, and GPx activities in the tongues of old rats were lower than in young rats, and similarly, corresponding protein expressions were downregulated in old rats. On the other hand, although the protein expressions of Mn-SOD and CAT were lower in old rats, their enzyme activities were not. Conclusion. The results of this study provide a possible mechanism for the tongue aging process, as in old Fischer 344 rats the antioxidant defense system was diminished with respect to enzyme activity levels and protein abundances.

PurposeTo investigate whether mass glaucoma screening relative to opportunistic case finding at a primary eye clinic is helpful for early detection of glaucoma.MethodsSubjects referred by glaucoma screening (by non-contact tonometry and non-mydriatic fundus photography; group A, n = 220) and from a primary eye clinic (group B, n = 327) were retrospectively recruited. The positive predictive value (PPV) for glaucoma and the rate of glaucoma awareness were compared. Also, for the newly diagnosed glaucoma ('definite glaucoma') patients, the demographics and structural and functional severities of glaucoma were compared.ResultsThe PPV for definite glaucoma was 25.5% for group A and 52.4% for group B. The rate of false-positive for 'glaucoma referral to tertiary hospital' was significantly higher for group A than for group B (38.6 vs. 18.3%, P < 0.001). Among the definite-glaucoma patients (group A: n = 56; group B: n = 182), the proportion of glaucoma awareness was significantly higher in group B (69.2%) than in group A (8.9%, P < 0.001). The mean deviation (MD) of visual field (VF) was significantly higher in group A than in group B (-3.08 ± 3.99 vs. -6.70 ± 7.29 dB, Padjusted = 0.040), and the inferior and inferotemporal ganglion cell-inner plexiform layer (GCIPL) thicknesses tended to be greater in group A than in group B, with marginal significance (Padjusted < 0.10).ConclusionsGlaucoma screening can be helpful for early detection of glaucoma. However, improvement of the screening strategy is needed in order to enhance its specificity for glaucoma.

The authors report a case of primary sclerolimbal cyst with corneal extension in a 3-year-old boy. The cyst enlarged and dissected into the cornea over time. Surgical excision with tectonic allograft was performed. Preoperative, intraoperative, and postoperative anterior segment findings were shown, and results from histologic and cytologic assays were presented. [ J Pediatr Ophthalmol Strabismus . 2019;56:e20–e23.]

Purpose To compare the diagnostic accuracy of three-dimensional neuroretinal rim (3D-NRR) and peripapillary retinal nerve fiber layer (RNFL) thickness for differentiation of myopic glaucoma from myopia. Methods Healthy myopic individuals (n = 193 eyes) and age-matched myopic glaucoma patients (n = 61 eyes) were enrolled. A 200 × 200-optic disc cube scan was performed with Cirrus HD-OCT. The rates of false-positive errors were compared between RNFL and 3D-NRR thickness measurements. The diagnostic accuracies of RNFL and 3D-NRR thickness for myopic glaucoma were compared by calculating the areas under receiver operating characteristic (AUROC) curves and the partial area under the curve (pAUC) for sensitivity ≥90%. Results The overall false-positive rate was significantly greater for RNFL thickness (26.9%) than for 3D-NRR thickness (2.1%, P < 0.001). False-positive RNFL-thickness errors were prevalent in the nasal peripapillary region. The 3D-NRR thickness relative to RNFL revealed a greater AUROC from the 12 to 6 o'clock and 9 o'clock sectors. Again, comparing 3D-NRR with RNFL thickness, the pAUC for sensitivity ≥90% was greater in the nasal quadrant, 12, 3, 4, and 5 o'clock sectors. Also, the sensitivity and specificity, based on the internal normative database, were greater for 3D-NRR than for RNFL thickness. Conclusions 3D-NRR thickness measurement reduced the false-positive rate for glaucoma diagnosis and demonstrated better accuracy for glaucoma detection in myopic eyes. Measurement of 3D-NRR can be complementary to RNFL thickness measurement for differentiation of myopic glaucoma from myopia.

Background Volar plate avulsion fracture of the proximal interphalangeal (PIP) joint is one of the most common hand injuries. In this study, we divided patients into two groups: patients with pure volar plate avulsion fracture, and patients with volar plate avulsion fracture concomitant with collateral ligament rupture. The purpose of this study was to compare long-term surgical outcomes between the two groups. As a secondary measure, the Mitek bone anchoring and polydioxanone (PDS) bone suturing techniques were compared. Methods A single-institutional retrospective review of the surgical treatment of volar plate avulsion fracture was performed. The cases were divided into those with pure volar plate avulsion fracture (group A, n=15) and those with volar plate avulsion fracture concomitant with collateral ligament rupture (group B, n=15). Both groups underwent volar plate reattachment using Mitek bone anchoring or PDS bone suturing followed by 2 weeks of immobilization in a dorsal protective splint. Results The average range of motion of the PIP joint and extension lag were significantly more favorable in group A (P Conclusions Overall, the surgical outcomes of volar plate reattachment were successful irrespective of whether the collateral ligaments were torn. However, greater extension lag was observed in cases of collateral ligament injury.

Background This study aims to validate the performance and biocompatibility of an implantable inductive-type sensor for continuous monitoring of intraocular pressure (IOP) Methods The sensor is composed of a top layer integrated with an inductor and capacitor circuit, and a bottom layer integrated with ferrite. With IOP change, the sensor's bottom layer is mechanically deflected, which changes the distance between the bottom-layer ferrite and top-layer inductor, resulting in an alteration of inductance magnitude and the resonant frequency (RF). In-vitro measurement was conducted via air pressurization in a sealing jig (n = 3). Subsequently, the sensor was implanted into the anterior chamber of a rabbit eye. In-vivo measurement was performed while the IOP was elevated by infusion of balanced salt solution (BSS, 6 μL/min). Smaller-sized sensors later were implanted into two rabbit eyes, which were microscopically examined at 2, 4 and 8 weeks post-implantation. The eyes were then immediately enucleated for histological examination. Results The in-vitro measurement showed a significant RF shift as pressure in the jig was increased from 0 mmHg to 60 mmHg (average initial frequency: 10.86 MHz, average shift: 403 kHz). The in-vivo measurement also showed an RF decrease, from 12.80 MHz to 12.67 MHz, as the pressure was increased from 10 mmHg to 20 mmHg. Microscopic in-vivo evaluations and histological exams, performed at intervals up to 8 weeks post-implantation, showed no evidence of significant inflammation or deformity of the ocular-tissue structures. Conclusions The implantable inductive-type IOP sensor demonstrated wireless pressure-sensing ability and favourable biocompatibility in the rabbit eye.

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PURPOSE To evaluate the rate of progressive macular ganglion cell-inner plexiform layer (GCIPL) thinning in patients with open-angle glaucoma (OAG) who had been treated with intravitreal antivascular endothelial growth factor (VEGF) injection for wet age-related macular degeneration (AMD). METHODS This study was a retrospective modified case control study with fellow eye comparison. We enrolled bilateral OAG patients who had been treated with repeated anti-VEGF injections for unilateral wet AMD and followed-up on for a minimum of 24 months by Cirrus high-definition optical coherence tomography. The rate of macular GCIPL thinning was determined by linear regression of serial optical coherence tomography GCIPL thickness measurements over time. We compared the rate of macular GCIPL thinning between anti-VEGF-treated eyes and fellow untreated dry AMD eyes. RESULTS This study involved 32 OAG eyes of 16 subjects. The total follow-up period was 58.4±25.5 (24 to 98) months, and the mean number of anti-VEGF injections was 10.6±10.4 (3 to 40). The eyes with repeated anti-VEGF treatment differed significantly from their fellow eyes in the rate of GCIPL thinning (-2.95±3.58 vs. -0.77±0.95 µm/y, P=0.015). Also, multivariable regression analyses showed that anti-VEGF injection was significantly associated with the rate of GCIPL thinning (P=0.025). CONCLUSIONS In subjects with bilateral OAG, the rate of GCIPL thinning is significantly faster in eyes treated with anti-VEGF injection for wet AMD than in untreated dry AMD fellow eyes. This finding suggests that in glaucomatous eyes, VEGF inhibition could play a role, at least in part, in progressive change of inner retinal layers.

The lamina cribrosa (LC) is a multilayered, collagenous, sieve-like structure at the deep optic nerve head, and is presumed to be the primary site of axonal injury. According to biomechanical theory, intraocular pressure-induced posterior deformation of the LC causes blockage of axonal transport and alters the ocular blood flow, so that the axons of the retinal ganglion cells lead to apoptosis, which results in glaucomatous optic disc change. Although most of the research on the LC to date has been limited to experimental animal or histologic studies, the recent advances in optical coherence tomography devices and image processing techniques have made possible the visualization of the LC structure in vivo. LC deformation in glaucoma typically has been evaluated in terms of its position from a structural reference plane (LC depth), entire curvature or shape, thickness, or localized structural change (focal LC defects or LC pore change). In this review, we highlight the methods of assessing LC deformation from in vivo optical coherence tomography scans, and we discuss the clinical implications of the recent investigations of the in vivo structure of LC in glaucoma.

Purpose To investigate the prevalence of vitreopapillary traction (VPT) and its effect on peripapillary structure and visual function in eyes with idiopathic epiretinal membrane (ERM). Design Observational, comparative study. Participants Patients with idiopathic ERM (n = 116 eyes) and controls with similar age (n = 62 eyes). Methods Spectral domain optical coherence tomography (SD-OCT) axial optic disc scans were evaluated to identify VPT in eyes with idiopathic ERM. Based on VPT presence/absence, eyes were categorized as ERM with VPT (ERM +VPT , n = 52 eyes) or ERM without VPT (ERM −VPT , n = 64 eyes). Optic nerve head (ONH) parameters, average and sectoral retinal nerve fiber layer (RNFL) thickness, and central macular thickness (CMT) were compared between groups. Best-corrected visual acuity (BCVA) and visual field (VF) (automated Humphrey central 30-2 perimetry) mean deviation (MD) and pattern standard deviation (PSD) were compared between groups. Main Outcome Measures The ONH parameters, peripapillary RNFL thickness, BCVA, VF MD, and PSD. Results Fifty-two of 116 eyes (44.8%) with idiopathic ERM had VPT. The ERM +VPT group had larger rim area, smaller average and vertical cup-to-disc ratios, and smaller cup volume than ERM −VPT and normal groups (all P P = 0.006). Average and temporal RNFL thickness was higher in ERM +VPT (98.64±9.33 μm and 93.90±23.42 μm) than in normal eyes (94.02±8.45 μm and 66.42±12.71 μm). No significant difference in BCVA was found between ERM −VPT and ERM +VPT eyes, but MD was lower in ERM +VPT than in ERM −VPT (−3.91±3.68 dB vs. −2.18±2.42 dB; P = 0.005). Additionally, PSD was greater in ERM +VPT . Multivariate logistic regression analysis revealed that age (odds ratio [OR], 1.190; P = 0.014) and increased CMT (OR, 1.013; P = 0.005) were associated with vision loss, whereas VPT presence was associated with VF defects (OR, 6.290; P = 0.024). Conclusions Vitreopapillary traction was observed in >40% of eyes with idiopathic ERM, as confirmed by SD-OCT imaging. Vitreopapillary traction with idiopathic ERM was associated with altered optic disc architecture, increased average and temporal RNFL thickness, and VF defects.

To investigate whether the rate of retinal nerve fiber layer (RNFL) thinning differs according to the microstructure of β-zone parapapillary atrophy (PPA) as evaluated by spectral-domain (SD) optical coherence tomography (OCT) in primary open-angle glaucoma (POAG).Prospective, observational, comparative study.A total of 195 eyes with POAG that had been evaluated by serial SD-OCT RNFL thickness measurements for ≥ 2 years.On the basis of the extent of Bruch's membrane (BM) within the β-zone PPA (area without retinal pigment epithelium [RPE]), as shown in the infrared fundus images, PPA was divided into PPA+BM (PPA with intact BM) and PPA-BM (PPA devoid of BM). Eyes were categorized into group A (having PPA+BM only, n=64), group B (having both PPA+BM and PPA-BM, n=58), group C (having PPA-BM only, n=32), and group D (without β-zone PPA, n=41). The rate of progressive OCT RNFL thinning was determined by linear regression and compared between groups. Factors influencing the rate of RNFL thinning were evaluated, including age, sex, follow-up duration, history of filtering surgery, baseline RNFL thickness, baseline intraocular pressure (IOP), mean IOP and IOP fluctuation during follow-up, PPA types, baseline PPA width, PPA width increase, axial length (AXL), central corneal thickness, and visual field mean deviation (MD).Rate of thinning of OCT RNFL thicknesses over time.Patients in groups B and C were significantly younger and more myopic, and had a greater AXL, than those in groups A and D (all P0.001). The rate of global RNFL thinning was significantly faster in group A (-1.66 ± 2.94 μm/year) than in the other groups (group B, -0.87 ± 1.28 μm/year; group C, 0.20 ± 1.86 μm/year; group D, -0.28 ± 1.74 μm/year; P = 0.001). Multivariate regression showed a significant association of shorter follow-up period (P = 0.016), greater baseline global RNFL thickness (P = 0.035), type of β-zone PPA (group A, P = 0.023), and greater baseline PPA+BM width (P = 0.034) with a faster rate of RNFL thinning.The rate of RNFL thinning differed according to the microstructure of β-zone PPA. It was faster for eyes with β-zone PPA with intact BM than for eyes without β-zone PPA or with β-zone PPA devoid of BM.