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PRéCIS:: This observed patient-specific features and treatment-driven conditions that were significantly associated with the impairment of health-related quality of life (HRQOL) among glaucoma patients. The results suggest that more systematic strategies should be implemented to improve an HRQOL.To determine factors contributing to an HRQOL and assess total, direct and indirect, effects that may exist between the determinants using path analysis.Data were derived from previous Korea glaucoma outcomes research. A total of 847 glaucoma outpatients with ≤2 years of eye-drop use were included in the present study. Including factors and their hypothetical pathways to an HRQOL were based on the literature review and consultation with specialists. Age, sex, comorbidities, and education levels were included as underlying conditions and treatment patterns were defined by the number of daily instillations of prescribed eye-drops. Treatment satisfaction and adherence were estimated using a Treatment Satisfaction Questionnaire for Medication, which assessed side-effects, effectiveness, convenience, global satisfaction, and pill count. An HRQOL was assessed by EQ-5D and EQ-visual analogue scale (EQ-VAS).In EQ-5D analysis, male individuals showed total effects (β=0.102, P=0.0026), including both direct (β=0.076, P=0.0095) and indirect effects (β=0.0253, P=0.0020), which were mediated by treatment satisfaction in the side effects and global satisfaction categories. Higher education (β=0.197, P=0.0020) and satisfaction in the side effect (β=0.095, P=0.0076) and global satisfaction (β=0.075, P=0.0414) categories were found to have direct effects on EQ-5D. For EQ-VAS, higher education levels had significant total effects (β=0.153, P=0.0020) accounting for direct effects (β=0.131, P=0.0030) and indirect effects (β=0.0223, P=0.0531) through global satisfaction. In addition, male individuals had indirect effects (β=0.274, P=0.0165), which was indirectly mediated by satisfaction in the global satisfaction category. Comorbidity (β=-0.096, P=0.0090) and satisfaction in the effectiveness (β=0.094, P=0.0302), convenience (β=0.076, P=0.0390), and global satisfaction (β =0.144, P=0.0020) categories showed indirect effect on EQ-VAS.Higher education and better treatment satisfaction had positive effects on HRQOL both in direct and indirect ways whereas comorbidities indirectly showed negative associations with HRQOL.

Purpose To determine the diagnostic value of the ganglion cell-inner plexiform layer (GCIPL) thickness in glaucomatous eyes with superior or inferior visual hemifield defects. Patients and methods Eighty-five patients with glaucoma (42 isolated superior hemifield defects and 43 isolated inferior hemifield defects) and 46 normal subjects were enrolled. All patients underwent Cirrus high-definition optical coherence tomography and standard automated perimetry. The area under the receiver operating characteristic curve (AUC) was calculated to determine the diagnostic ability of the GCIPL and peripapillary retinal nerve fiber layer (pRNFL). Results In the superior hemifield defect glaucoma group, the best parameters for discriminating normal eyes from glaucomatous eyes were the inferotemporal GCIPL thickness (0.942), inferior quadrant RNFL thickness (0.974), and 7 o'clock sector RNFL thickness (0.999). For diagnosing inferior hemifield defect glaucoma, the AUCs of all GCIPL parameters (0.331 to 0.702) were significantly lower than that of the superior quadrant RNFL thickness (0.866, P Conclusions The diagnostic ability of GCIPL parameters was similar to that of the pRNFL parameters in superior hemifield defect glaucoma. However, the diagnostic performance of the GCIPL parameters was significantly inferior to those of the pRNFL parameters in eyes with inferior hemifield defect glaucoma.

To compare the topographic characteristics of myopic and nonmyopic disc hemorrhage (DH) in primary open-angle glaucoma. Patients were assigned to the myopic DH group (spherical equivalent of −1.0 diopters or less) or to the nonmyopic DH group (emmetropia and hyperopia). DH was classified as lamina cribrosa-, cup margin-, disc rim-, or peripapillary-type DH according to its proximal location. The DH types of the two groups were compared using Fisher's exact test. Multivariate logistic regression was used to evaluate the factors associated with myopia. Thirty-four eyes were assigned to the myopic DH group and 42 eyes to the nonmyopic DH group. A significantly higher proportion (32.4 %) of lamina cribrosa-type DH was found in the myopic DH group than in the nonmyopic DH group (4.8 %; P = 0.008). Eyes with lamina cribrosa-type DH were 12.59 times more likely to be myopic than were eyes with peripapillary-type DH (95 % CI: 1.22–129.53; P = 0.033). Lamina cribrosa-type DH was significantly more common in myopic eyes than in nonmyopic eyes. This result suggests that the pathogenesis of DH may differ between myopic DH and nonmyopic DH.

Background/aims This study aimed to investigate treatment patterns and medication adherence of glaucoma. It also identified key factors associated with non-adherence. Methods It was a cross-sectional, observational study. Patients who use eye-drops for ≤2 years were recruited at 15 eye clinics from March to November 2013. Data were collected through self-administered questionnaires and medical chart review. Medication adherence was evaluated using patients’ self-report on pill count and defined as patients’ administering drug for ≥80% of prescribed days. Medication adherence rate was calculated by dividing actual number of administration from total prescribed number of administration for 7 days. Patients whose self-reported prescription was different from total daily doses of physicians9 prescription were considered as non-adherent. Results A total of 1050 patients included, and medication adherence rate was evaluated in 1046 patients whose verification of adherence was available. Of the total, 27.4% were non-adherent, and the medication adherence rates of the total, the adherent, and the non-adherent were 90.6±17.8%, 96.8±5.5% and 56.6±24.7%, respectively. The most commonly used medication was prostaglandin (PGA) alone and the second was combination of two-class (β-blocker and carbonic anhydrase inhibitor (CAI)) and three-class combination of PGA, β-blocker and CAI followed. In multivariate analysis, the risk of non-adherence was 1.466 times greater in males than in females (95% CI 1.106 to 1.943) and 1.328-fold greater as the daily number of administration was increased (95% CI 1.186 to 1.487). Conclusion Approximately, one-third of the patients were non-adherent, and males and increased daily number of administration were associated with non-adherence. It highlights that more systematic treatment strategies should be considered for better medication adherence, leading to effective glaucoma management.

Various methods have been recommended to decide a proper insertion depth of central venous catheter (CVC). The carina is recommended as a useful target level for the CVC tip position. We evaluated the sternal head of a right clavicle and the nipples as anatomic landmarks for determining the optimal depth of CVC in paediatric patients.Ninety children,5 yr, undergoing catheterization through the right internal jugular vein were enrolled. The insertion depth was determined as follows. The insertion point was designated as 'Point I'. The sternal head of the right clavicle was called 'Point A' and the midpoint of the perpendicular line drawn from Point A to the line connecting both nipples was called 'Point B'. The insertion depth of CVC was determined by adding the two distances (from I to A and from A to B) and subtracting 0.5 cm from this. A chest radiography was taken and the distance of the CVC tip from the carina level was measured by the Picture Archiving and Communicating System.The mean distance of the CVC tip from the carina level was 0.1 (1.0) (P=0.293) cm above the carina (95% CI 0.1 cm below the carina-0.3 cm above the carina). There was no specific relationship between the distance of the CVC tip from the carina level and the patients' age, height, and weight.The CVC tip could be placed near the carina by using the external landmarks without any formulae, images, and devices in children in our study.

Background The bispectral index (BIS) has been evaluated as a tool for measuring depth of anaesthesia, but the use of BIS in a paediatric population is still controversial. This study was designed to evaluate the correlation of BIS with end-tidal sevoflurane concentration and age in infants and children. Methods Eighty-one patients undergoing elective urology surgery were allocated into three age groups; 6 months to 2 yr (n=28), 3–7 yr (n=33), and 8–12 yr (n=20). Sevoflurane was administered to achieve steady-state end-tidal sevoflurane concentrations (ETsevo) of 2.0, 3.0, and 4.0%; these were achieved consecutively either from the lowest or from the highest concentration. The BIS (version XP) was monitored continuously. Results In all three groups, BIS decreased significantly when ETsevo increased from 2.0 to 3.0% but there was a paradoxical increase in BIS values when ETsevo increased from 3.0 to 4.0%. The non-linear regression analysis showed a significant correlation between BIS and age at each ETsevo. The younger patients showed the higher BIS values. Conclusions In children aged 6 months to 12 yr, the BIS increased paradoxically as ETsevo increased from 3.0 to 4.0%. BIS values showed a wide variation in the same ETsevo and the age itself was considered to be a factor affecting the BIS values.

Emergence agitation (EA) is more frequent after sevoflurane anesthesia than other inhalational agents but the etiology remains unclear. We investigated whether the EA after sevoflurane anesthesia is related to rapid emergence.Eighty-five patients, aged 1-7 years, undergoing elective urology surgery were studied. After induction, anesthesia was maintained with 2.0-2.5% sevoflurane and 50% N(2)O. BIS was monitored continuously throughout surgery and emergence. At the end of surgery, the children were randomly assigned to one of two groups: group I, immediate cessation of sevoflurane; or group G, gradual decrease of sevoflurane with the rate of 0.1%.min(-1). Emergence agitation score was recorded during recovery.Times from immediate cessation or start of decrease of sevoflurane to BIS 70, 80, 90 and extubation were significantly longer in group G. The incidence of severe agitation (scoreor =3) was not significantly different between group I and group G: which were 35.7% and 32.6%, respectively.Prolonged recovery did not reduce the incidence of EA following sevoflurane anesthesia in children.

Purpose: To evaluate the amount of intraocular pressure (IOP) change in the eye against the pillow in the lateral decubitus position (LDP). Methods: Thirty eyes from 15 healthy volunteers (12 men and three women) aged 29 ± 3 (range 25–37) years participated in this study. Using the rebound tonometer (Icare PRO, Icare Finland Oy, Helsinki, Finland), the IOP of both eyes was checked in sitting, supine, right and left LDPs. In the LDP, the additional IOP measurements were taken with the lower eyeball against the latex pillow. Results: Baseline IOP in the sitting position was 12.7 ± 1.9 mmHg in the right eye and 12.8 ± 2.2 mmHg in the left eye. Ten minutes after shifting from the sitting to the supine position, IOP increased significantly (right eye: +1.4 ± 1.4 mmHg, p = 0.006; left eye: +1.8 ± 1.5 mmHg, p = 0.001). Changing from the supine to the right and left LDP increased significantly the IOP of dependent eye (right eye: +2.3 ± 1.8 mmHg, p = 0.001; left eye: +1.5 ± 1.8 mmHg, p = 0.011). When the dependent eye was compressed against the pillow in the LDP, the IOP of the dependent eyes increased significantly after 10 min (right eye in the right LDP: +4.1 ± 4.9 mmHg, p = 0.011; left eye in the left LDP: +3.4 ± 3.7 mmHg, p = 0.006). Conclusion: The IOP was significantly elevated when the eyeball was against the pillow in the LDP.

Purpose: To evaluate the change of iris-trabecular contact index (ITC index) after cataract surgery in acute angle closure glaucoma. Methods: Twelve patients (17 eyes) who had a history of acute angle closure glaucoma underwent swept source optical coherence tomography before and after cataract surgery. Correlations between lens vault (LV), ITC index and intraocular pressure (IOP), anterior chamber depth (ACD), anterior chamber volume (ACV), and angle parameters were analyzed before and after cataract surgery. Results: IOP (p = 0.007), ACD (p < 0.001), ACV (p < 0.001), angle parameters (p = 0.001), and ITC index (p = 0.012) were improved after cataract surgery. ITC index decreased from 88.42 ± 23.59% to 48.91 ± 35.13% after cataract surgery (p = 0.012). There was no correlation between LV and ACD (p = 0.075), ACV (p = 0.864), angle parameter (p = 0.112-0.707), or ITC index (p = 0.288) before cataract surgery. The correlations between ITC index and IOP (p = 0.021), ACD (p = 0.002), ACV (p < 0.001), and angle parameter (p = 0.001-0.030) were statistically significant before surgery but not statistically significant (p = 0.223/0.206/0.761/ 0.096-0.819) after surgery. Conclusions: ITC index significantly improved after cataract surgery, but part of angle closure was not resolved in some cases of acute angle closure glaucoma. J Korean Ophthalmol Soc 2016;57(9):1400-1406

Background Three-phase bone scintigraphy (TPBS) is an established objective diagnostic method for complex regional pain syndrome (CRPS), but its validity remains controversial. The aims of this study were: (i) to re-evaluate the diagnostic performance of TPBS, and (ii) to suggest new TPBS criteria based on the proposed research criteria for CPRS in Budapest (the 2003 Budapest research criteria). Methods The medical records of 228 consecutive patients, evaluated using the Budapest research criteria, were retrospectively analysed. Of these, 116 patients were included in the present study, and 69 of 116 were diagnosed to have CRPS based on these criteria. The diagnostic performance of TPBS was assessed by determining its sensitivity, specificity, and positive and negative likelihood ratios, and new criteria for TPBS were identified by pattern analysis using the Budapest research criteria. Results The sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio of TPBS for the diagnosis of CRPS according to the Budapest research criteria were 40.0, 76.5, 1.73, and 0.78, respectively. Furthermore, D–D–D, D–D–S, and D–D–I patterns [i.e. according to decreased (D), symmetrical (S), or increased (I) tracer uptake during Phases I, II, and III] of TPBS were found to be positively predictive for CRPS. Conclusions The diagnostic value of a positive TPBS for CRPS is low from the view point of the Budapest research criteria. Our findings suggest that a diagnosis of CRPS using the Budapest research criteria should be considered when decreased patterns of TPBS are observed during Phases I and II.

Purpose: To report a single case of tsutsugamushi disease with anterior uveitis and eschars on the upper eyelid. Case summary: A 56-year-old female patient complained of ocular pain and gradually decreasing visual acuity in her right eye. On physical examination, lymphadenopathy was palpable on the right side of the neck, and eschars were observed on the forehead and upper eyelid. On slit lamp examination, conjunctival injection, episcleral vessel dilations and severe intraocular inflammatory reaction were observed. Fundus examination showed no abnormal findings. A blood test was submitted for analysis, and tsutsugamushi disease was diagnosed. The patient's ocular manifestations responded well to treatment with steroids. After three weeks, the patient showed improvement on ocular examination, and no problems were observed at the six-month follow-up. Conclusions: Although ocular manifestation of tsutusgamushi disease with conjunctivitis and limbitis has previously been reported, ocular manifestation of tsutusgamushi disease with anterior uveitis has not been reported. Anterior uveitis may respond satisfactorily to steroid treatment, along with improvement in systemic conditions.

Purpose: We compared intra-individual visual outcomes and patient satisfaction after implantable contact lens (ICL) and Toric ICL implantation. Methods: Twenty-eight eyes of 14 patients were enrolled in this retrospective study. One eye of each patient was assigned to ICL (ICL Group), and the contralateral eye was allocated to Toric ICL (Toric ICL Group). All patients were examined for visual acuity, refraction, intraocular pressure, slit lamp measurements, and satisfaction one week, one month, two months, and six months postoperatively. Results: Mean spherical equivalents of the two groups were corrected from -7.83D (ICL Group) and -5.55D (Toric ICL Group) to 0.13D and 0.20D, respectively, and the mean refractive cylinders were corrected from 0.92D and 2.60D to 0.42D and 0.27D, respectively, at six months postoperatively. The myopias of these two groups and the astigmatism of the Toric ICL group were effectively corrected. The uncorrected visual acuity (UCVA) of the two groups were 1.02 and 1.05, respectively, at six months postoperatively. The safety index, efficacy index, predictability, and stability were favorable. There were no significant differences between the two groups in terms of postoperative UCVA, intraocular pressure(IOP), vaulting, noticeable complications, or patient satisfaction. Conclusions: The results show ICL implantation is effective treatment for high myopia, and Toric ICL implantation is a viable surgical option for the treatment of compound myopia astigmatism. Selection of proper phakic intraocular lens(IOL) is recommended for correcting astigmatism.

Purpose: To assess the safety and efficacy of intracorneal ring segment (Intacs ring) implantation in managing keratoconus. Methods: This retrospective case series comprised of 11 keratoconic eyes (11 patients) had Intacs ring (Addition Technology, Inc, California, USA) implantation. The main outcome measures were best corrected visual acuity, refraction, keratometry, topography, and pachymetry. Patients were examined before Intacs ring implantation as well as one week, one, three, and six months postoperatively. Results: The mean best corrected visual acuity improved from 0.600.33 logMAR preoperatively to 0.390.23 logMAR six months postoperatively (p >0.05) and the mean corneal thickness, from 432.82 preoperatively to 448.00 at six months (p >0.05). The mean cylinder improved from -5.362.70D preoperatively to -2.501.66D six months postoperatively (p 2.38D to 42.831.72D at six months (p 3.49D preoperatively to -3.663.37D six months postoperatively (p

Purpose: To evaluate the clinical features of subretinal hemorrhage after photodynamic therapy in eyes with exudative age-related macular degeneration. Methods: We retrospectively reviewed data for 267 eyes of 243 patients who had undergone PDT for the treatment of ARMD between January 2005 and December 2006. Best corrected visual acuity, fundus photography, fluorescein angiography, and ICG angiography were performed before and after treatment. We followed up the patients at 1 week, 1 month, and 3 months after treatment and at 3-month intervals thereafter. Results: Postoperative subretinal hemorrhage was seen in 36 (13.4%) of 267 eyes. The pretreatment and post-treatment mean visual acuities were logMAR 0.80 and logMAR 1.05 respectively, representing a decrease of 2.05 lines. On FAG, two eyes were predominantly classic, four eyes were minimally classic, and 30 eyes were occult. The laser irradiation spot size was under 3,000 µm in one case and from 3,000 µm to 5,000 µm in 19 cases and over 5,000 µm in 16 eyes. Conclusions: Subretinal hemorrhage after PDT for ARMD can be a common complication in patients who have been treated for larger irradiation spot sizes and for pigment epithelial detachment (PED), so doctors should be aware of the risk of serious hemorrhagic complications in such situations.