Hyun Sun Jeon

Efficacy and safety of immunosuppressive agents in the treatment of necrotising scleritis: a retrospective, multicentre study in Korea

Aim To investigate the efficacy and safety of cyclophosphamide and other immunosuppressive agents (ISAs) in the treatment of necrotising scleritis. Methods We reviewed the medical records of patients with necrotising scleritis at 11 tertiary care centres in South Korea from 2002 to 2012, treated with ISAs within 3 months of follow-up period. We divided patients into two groups: a group treated with cyclophosphamide (CYC group) and a group treated with other ISAs; azathioprine, ciclosporin, methotrexate and mycophenolate mofetil (OISA group). Main outcome measures evaluated were remission rate, relapse rate, rate of visual loss, steroid-sparing rate, adverse effects and discontinuation of medication due to adverse effects. Results CYC group had a remission in 95.2% of the patients and OISA group had in 96.3%. Remission rate, relapse rate, visual loss rate and steroid-sparing rate were not significantly different between the two groups (all p>0.05). The median duration of steroid use was longer in CYC group than in other OISA group (55 vs 16 days, p=0.09). The incidence of adverse effects in the CYC group was comparable with that of the OISA group (61.9% vs 41.4%, p=0.15). However, the incidence of leucopenia, haemorrhagic cystitis and discontinuation of medication due to adverse effects were much higher in the CYC group (p<0.001, p<0.001, p=0.05, respectively). Conclusion The efficacy of cyclophosphamide in the treatment of necrotising scleritis was comparable with that of other ISAs. However, the rate of discontinuation due to side effects was much higher in the CYC group.

Recovery of Corneal Endothelial Cells from Periphery after Injury.

Background Wound healing of the endothelium occurs through cell enlargement and migration. However, the peripheral corneal endothelium may act as a cell resource for the recovery of corneal endothelium in endothelial injury. Aim To investigate the recovery process of corneal endothelial cells (CECs) from corneal endothelial injury. Methods Three patients with unilateral chemical eye injuries, and 15 rabbit eyes with corneal endothelial chemical injuries were studied. Slit lamp examination, specular microscopy, and ultrasound pachymetry were performed immediately after chemical injury and 1, 3, 6, and 9 months later. The anterior chambers of eyes from New Zealand white rabbits were injected with 0.1 mL of 0.05 N NaOH for 10 min (NaOH group). Corneal edema was evaluated at day 1, 7, and 14. Vital staining was performed using alizarin red and trypan blue. Results Specular microscopy did not reveal any corneal endothelial cells immediately after injury. Corneal edema subsided from the periphery to the center, CEC density increased, and central corneal thickness decreased over time. In the animal study, corneal edema was greater in the NaOH group compared to the control at both day 1 and day 7. At day 1, no CECs were detected at the center and periphery of the corneas in the NaOH group. Two weeks after injury, small, hexagonal CECs were detected in peripheral cornea, while CECs in mid-periphery were large and non-hexagonal. Conclusions CECs migrated from the periphery to the center of the cornea after endothelial injury. The peripheral corneal endothelium may act as a cell resource for the recovery of corneal endothelium.

Chemically injured keratocytes induce cytokine release by human peripheral mononuclear cells

PURPOSE To establish an in vitro model to study the role of keratocytes in corneal chemical burns and to investigate the interaction between chemically injured keratocytes and human peripheral blood mononuclear cells (PBMCs). METHODS Human keratocytes, epithelial cells, and PBMCs were cultured. The PBMC stimulation assay was then performed using cultured human keratocytes, epithelial cells, and NaOH-treated keratocytes. Matrix metalloprotease-9 (MMP-9), transforming growth factor-beta 1 (TGF-β1), and macrophage migration inhibitory factor (MIF) secretion profiles of activated PBMCs stimulated by NaOH-treated keratocytes were determined by ELISA. RESULTS Human keratocytes stimulated PBMC proliferation (p=0.016), and keratocytes treated with various concentrations of NaOH further stimulated PBMC proliferation compared to control cells in a dose-dependent manner (p=0.028 and 0.009). MMP-9 and MIF levels were higher than in the negative controls, while TGF-β1 levels did not differ from those of the negative controls. CONCLUSION Our results suggest that PBMCs are stimulated by chemically injured keratocytes, and produce inflammatory cytokines in response. This may be a major mechanism underlying the process causing corneal chemical burn injuries. This model can be used as an in vitro model for further studies on corneal chemical burns.

Risk Factors for Recurrence After Pterygium Surgery: An Image Analysis Study.

Purpose: To determine the risk factors related to recurrence of pterygium using automated image analysis. Methods: This study included 149 eyes of 149 patients who underwent pterygium excision and limbal–conjunctival autograft. Demographic variables including age and sex were collected. Image analysis was performed using anterior segment photographs taken preoperatively to measure relative length (horizontal length of pterygium invading cornea/horizontal corneal diameter), relative width (width of pterygium invading cornea/vertical corneal diameter), relative area (RA; area of pterygium invading cornea/total corneal area), and vascularity index (VI; degree of vascularity). In all patients, recurrence of pterygium was determined at 1 year after surgery. Association between these factors and recurrence rate was evaluated with univariate and multivariate analyses. Results: Recurrence at 1 year was reported in 18.8% (28/149) of the patients. Univariate analysis showed that relative length (P = 0.001), relative width (P = 0.031), relative area (P = 0.009), and VI (P < 0.001) were significantly associated with increased risk of recurrence, whereas age and sex had no significant association with recurrence. In multivariate analysis, only VI (P < 0.001) had significant correlation with recurrence. Patients with VI ≥30 had significantly higher recurrence rate than those with VI <30 (33.3% vs. 8.1%, P < 0.001). Conclusions: Increased vascularity was associated with a higher risk of recurrence. Quantification of vascularity using automated image analysis might be useful in predicting the risk of recurrence.

Quantification of Astigmatism Induced by Pterygium Using Automated Image Analysis.

Purpose: To determine the factors influencing pterygium-induced astigmatism (PIA) and to develop a prediction model of PIA using these factors. Methods: This cross-sectional study included 97 eyes of 97 patients who underwent a pterygium excision and a limbal conjunctival autograft. Anterior segment photographs were taken preoperatively, and corneal topography was done preoperatively and at 3 months postoperatively. PIA was defined as the vector difference between the topographic astigmatism preoperatively and at 3 months postoperatively. Image analysis was performed using anterior segment photographs to measure the relative length (RL) (horizontal length of pterygium invading the cornea/horizontal corneal diameter), relative width (width of pterygium invading the cornea/vertical corneal diameter), relative area (area of pterygium invading the cornea/total corneal area), and vascularity index (VI) (degree of vascularity). Association between these factors and PIA was evaluated with univariate and multivariate analyses. We also attempted to generate a model for prediction of PIA using these factors. Results: Univariate analysis showed that the RL, relative width, relative area, and VI were significantly associated with PIA (P < 0.001 for all variables, Pearson coefficient (r) = 0.708, 0.555, 0.606, and 0.642, respectively). In multivariate analysis, only the RL (P < 0.001) and VI (P < 0.001) had significant correlation with PIA. A multiple regression model for PIA was generated as follows: PIA = 0.080 × RL (%) + 0.039 × VI – 0.823 (r2 = 0.502, F = 95.71, P < 0.001). Conclusions: Larger lengths and increased vascularity were associated with larger PIA. PIA can be predicted by evaluating the length and vascularity of pterygium involving the cornea.

Assessment of Transepidermal Water Loss From the Ocular Area in Dry Eye Disease

Purpose To investigate transepidermal water loss (TEWL) from the ocular area in dry eye disease (DED) and evaluate the correlation between ocular TEWL and other DED parameters. Methods Transepidermal water loss from the ocular area in 56 eyes with DED and 38 healthy eyes was measured using a Tewameter TM300 that was equipped with custom made goggles (measuring temperature 24°C-26°C and relative humidity 35%-45%). The DED group was classified into two subgroups, aqueous deficient dry eye (ADDE) and evaporative dry eye (EDE). Correlations between ocular TEWL and other DED parameters, such as tear osmolarity, tear break-up time (TBUT), corneal staining, conjunctival staining, Schirmer I test, Ocular Surface Disease Index (OSDI), and Visual Analogue Scale score were evaluated. Results Ocular TEWL was significantly higher in the DED group (63.0 ± 12.2 g/h/m2) than in the control group (54.7 ± 14.2 g/h/m2; P = 0.003). Although there was no significant difference, TEWL was higher in the ADDE subgroup (64.0 ± 10.7 g/h/m2) compared with the EDE subgroup (61.1 ± 14.9 g/h/m2). Tear break-up time, corneal staining score, and OSDI were significantly correlated with ocular TEWL (P < 0.05) in all participants. Ocular TEWL loss was negatively correlated with Schirmer I test value in the DED group. Conclusions Ocular TEWL was significantly higher in DED patients compared with controls, reflecting higher tear evaporation in DED patients. Patients who have shorter Schirmer I test values tend to have higher TEWL values. Not only EDE but also ADDE patients may have increased tear evaporation.

Atopic dermatitis is not a risk factor for keratoconus: A population-based cohort study

Requiring pharmacy compounding of local anesthesia would presumably increase costs and would not necessarily confer any benefit to patient safety. In-office compounding helps ensure cost-effective care for our patients. More studies with larger patient samples and various procedure settings are necessary to further support this conclusion and ensure that in-office compounding does not become prohibited by costly and unnecessary regulation.

Association of Pediatric Atopic Dermatitis and Cataract Development and Surgery

Importance There is a paucity of data addressing the risk of cataract development in pediatric patients with atopic dermatitis (AD). Objective To investigate the association of AD with subsequent cataract development and cataract surgery in a Korean pediatric population. Design, Setting, and Participants This population-based retrospective longitudinal cohort study used nationally representative data from the Korean National Health Insurance Service database from 2002 to 2013. Incident AD cases, consisting of patients younger than 20 years with AD and severe AD and were matched to 4 controls each using propensity score derived from age, sex, residential area, and household income. Main Outcomes and Measures Incidence probabilities of cataract development and cataract surgery between the AD group and controls were compared using Kaplan-Meier methods and log-rank tests. Cox proportional hazard models were fitted for cataract and cataract surgery to determine the risk factors in the matched cohort. Results Of 34 375 patients with incident AD (16 159 girls [47%]; mean [SD] age, 3.47 [4.96] years), there were 3734 severe AD cases (10.9%) with 137 500 matched controls. Development of cataracts was not different between the AD and control groups, (0.216% vs 0.227%; 95% CI, −0.041% to 0.063%; P = .32) or between the severe AD cohort and their controls (0.520% vs 0.276%; 95% CI, −0.073% to 0.561%; P = .06). Cataract surgery was performed more frequently in the AD cohort than in the control group (0.075% vs 0.041%; 95% CI, 0.017%-0.050%; P = .02) and in the severe AD cohort compared with their controls (0.221% vs 0.070%; 95% CI, 0.021%-0.279%; P = .03). Severe AD was associated with both development of cataract (adjusted hazard ratio, 1.94; 95% CI, 1.06-3.58, P = .03) and requirement for cataract surgery (adjusted hazard ratio, 5.48; 95% CI, 1.90-15.79, P = .002). Conclusions and Relevance Absolute risk of cataract was rare, with or without AD, even after 10 years of observation. However, our results suggest that pediatric patients with AD have an increased risk for cataracts requiring surgery and that disease severity may increase the risk for cataract development and cataract surgery.

Effect of Histocompatibility Y Antigen Matching on Graft Survival in Primary Penetrating Keratoplasty

Purpose: To investigate the influence of histocompatibility Y (H-Y) antigen matching on corneal graft survival in primary penetrating keratoplasty (PK). Methods: Medical records of patients who underwent primary PK at Seoul National University Bundang Hospital between June 2005 and October 2015 were retrospectively analyzed. The eyes were classified into 2 groups: H-Y-compatible (115 eyes) and H-Y-incompatible (23 eyes). The H-Y-compatible group included donor/recipient combinations of male/male (57 eyes), female/male (44 eyes), and female/female (14 eyes). The H-Y-incompatible group included the male/female (23 eyes) combination alone. A subgroup analysis of low- and high-risk patients according to preoperative diagnoses was also performed. Survival analysis was conducted using the Kaplan–Meier method; differences between groups were assessed with a log-rank test. Results: A total of 138 eyes from 136 patients (age: 58 ± 18 years) were enrolled. Rejection-free graft survival and graft survival were not significantly different between H-Y-compatible and H-Y-incompatible groups (&khgr;2 = 0.4, P = 0.548; &khgr;2 = 1.9; P = 0.17, respectively). Preoperative diagnoses of high-risk cases included those with corneal perforation or thinning (8.7%) and infectious keratitis (7.2%). Low-risk cases included corneal opacity (50.0%), bullous keratopathy (25.4%), keratoconus (5.8%), and corneal dystrophy (2.9%). In the high-risk group, rejection-free graft survival rate was significantly higher in the H-Y-compatible group (&khgr;2 = 3.9, P = 0.049). Conclusions: H-Y antigen matching does not influence graft rejection and failure in cases of primary PK. However, matching the H-Y antigen could help reduce graft rejection, especially in preoperatively high-risk patients.

Tear Dysfunction Syndrome After Burn

The objective of this study was to evaluate tear dysfunction of burn patients objectively. We retrospectively reviewed medical records of patients who had been examined within 1 week after burn injury. Visual acuity, intraocular pressure, cilia burned state, tear film break-up time (TBUT), and fluorescein corneal staining were evaluated. Sixty-four eyes of 32 patients (man 27, female 5) were included. Mean age was 44.41 ± 12.76 years old. Mean best corrected visual acuity was logMAR 0.04 ± 0.08, mean intraocular pressure was 13.41 ± 3.13 mm Hg, and mean TBUT was 5.48 ± 3.18 seconds. Thirty-four eyes (53.13%) showed burned cilia, 36 eyes (56.25%) showed corneal erosion on fluorescein stating. Intraocular pressure and TBUT were lower in TBSA with burn involved ≥ 10% group than TBSA with burn involved < 10% group (P = .000; P = .058). The percentage of TBSA of burn involved and tear break up time showed statistically significant negative correlations (r = -0.262; P = .037). Many burn patients have discomfort due to tear dysfunction syndrome. Tear dysfunction may be caused by direct injury of eye burn itself and body fluid deficiency. We recommend that when we treat burn patients, we have to pay attention to their symptoms and manage patients eye symptoms properly such as routine artificial tear lubricant treatment.