Soon Cheol Cha

Prevalence of Pseudoexfoliation Syndrome and Associated Factors in South Koreans: The Korean National Health and Nutrition Examination Survey

ABSTRACT Purpose: To investigate the prevalence of pseudoexfoliation syndrome (PXS) and factors associated with PXS in South Koreans by analyzing data from the Korean National Health and Nutrition Examination Survey (KNHANES). Methods: Using the KNHANES database of 2009–2012, 13,223 participants aged 50 years or older were included. Participants underwent standardized interviews and systemic and ocular examinations. Systemic factors analyzed included age, sex, daily length of sun exposure, presence of Raynaud phenomenon or migraine, hypertension, diabetes mellitus, body mass index, serum lipid profile, duration and frequency of smoking, and alcohol consumption. Evaluated ocular factors were refractive error, presence of cataract and glaucoma, intraocular pressure, and peripheral anterior chamber depth. Logistic regression analysis was performed to identify factors associated with the presence of PXS. Results: PXS was found in 16 participants (0.12%). When compared with the non-PXS group, eyes with PXS showed a higher prevalence of cataract (p = 0.020). In logistic regression analysis, age (odds ratio, OR, 1.04, 95% confidence interval, CI, 0.99–1.09; p = 0.016) and the presence of cataract (OR 8.17, 95% CI 1.06–62.84; p = 0.044) were associated with the presence of PXS. Sun exposure for ≥5 hours/day was marginally associated with the presence of PXS (OR 2.76, 95% CI 0.96–7.95; p = 0.060). Conclusion: The prevalence of PXS per 1000 persons was 1.10 in South Koreans aged ≥50 years. Participants with PXS had a higher prevalence of cataract, were older, and were more likely to be exposed to the sun for ≥5 hours/day than participants without PXS.

Recurrent symptomatic intraocular pressure spikes during hemodialysis in a patient with unilateral anterior uveitis

BackgroundThe relationship between intraocular pressure (IOP) changes and hemodialysis has been evaluated for several decades. However, no report on an IOP rise in uveitis patients during hemodialysis has been previously documented. This report describes the case of an uveitis patient with repetitive IOP spikes associated with severe ocular pain during hemodialysis sessions, which resolved after glaucoma filtering surgery.Case presentationA 47-year-old male with diabetes and hypertension had complained of recurrent ocular pain in the left eye during hemodialysis sessions. A slit-lamp examination showed diffuse corneal epithelial edema with several white keratic precipitates and inflammatory cells (Grade 3+) in the anterior chamber of the left eye. No visible neovascularization or synechiae were visible on the iris or angle. Topical glaucoma eye-drops and intravenous mannitol before hemodialysis did not prevent subsequent painful IOP spikes in the left eye. At the end of hemodialysis, IOP averaged ~40 mmHg. After trabeculectomy with mitomycin C in the left eye, his IOP stabilized in the low-teens (range, 10–14 mmHg) and no painful IOP spikes occurred during hemodialysis over the first postoperative year.ConclusionWe present a case of recurrent painful IOP spikes during hemodialysis in a patient with unilateral anterior uveitis unresponsive to conventional medical treatment prior to hemodialysis. To our knowledge, this is the first case report of repetitive symptomatic IOP rise during hemodialysis in an uveitic glaucoma patient. This case highlights the importance of the awareness of the possibility that IOP may rise intolerably during hemodialysis in uveitis patients with a compromised outflow facility.

Immunohistopathologic features of surgically excised overhanging filtering bleb: myofibroblasts after filtration surgery--a case report.

Dear Editor,An overhanging filtering bleb is a late, uncommon complica-tion of trabeculectomy. It expands from the limbus onto thecornea and causes a foreign body sensation, tearing, anddecreased visual acuity [1]. However, there are few reportsofhistopathologicalfindingsofanoverhangingbleb[1–3].Inthis paper, histopathological findings and an immunohisto-chemical study of an overhanging bleb are presented, partic-ularly a case in which a dissecting portion of an overhangingbleb was successfully removed.A 58-year-old male underwent uncomplicatedphacotrabeculectomy with mitomycin C. Seven years later,he visited the authors’ glaucoma clinic due to ocular discom-fortinhislefteye.Henotedseeinga“whitishmaterial”onhisleft eye and an increasing foreign body sensation. A slit-lampexamination showed a thin-walled, avascular, multiloculatedcystic bleb in the superior cornea (Fig. 1a).Despitetheuseofatopicallubricant,theoculardiscomfortwas not relieved. Thus, the authors decided to perform a blebrevision surgery. The corneal portion of the overhanging blebwas bluntly dissected and then removed with cyclodialysisspatula, forceps and scissors. The underlying bleb remainednegative for the Seidel test 1 day after the operation. And itwasstillnegativeafterwards.Until6monthsafterthesurgery,the patient was satisfied with the treatment of his oculardiscomfort and showed stable IOP control without leakage(Fig. 1b). The biopsy specimen consisted of the bleb and thesuperior superficial cornea. A histopathological examinationshowed a multiloculated cystic structure with a flattened cor-neal epithelium, and focal myxoid and hyaline degenerationof the stroma (Fig. 2a). Moreover, the stromal spindle cells(myofibroblasts)werepositiveforvimentinandalpha-smoothmuscle actin (ASMA), and negative for CD34 (immunohis-tochemical stain, Fig. 2b–d).Alargeoverhangingblebmaygraduallyextenddownoverthe cornea, possibly because of the eyelid movement [2].Excision of the excessive bleb near the limbus will not causea bleb leak and will generally not require suturing [1, 2].However,thepathogenesisofanoverhangingblebhadnotbeen fully understood. And there are few reports of blebrevisionsurgeryandhistopathologicexaminations.Tothebestof our knowledge, this is the first report on an immunohisto-chemical stain for myofibroblast in an overhanging filteringbleb. A previously published article suggested a subepithelialdissection component of the bleb into the cornea and thedissectionplaneoverlyingBowman’smembrane[1,2].How-ever, the myofibroblast has not been evaluated in previousstudies [1–3]. The crucial role played by the myofibroblast inwound healing and pathological organ remodeling is well-established. The main mechanism of wound healing bymyofibroblasts is known as tension production throughwound contraction and extracellular matrix production [4].Sometimes they don’t get lost by apoptosis after woundhealing and lead to hypertrophic scar. Myofibroblasts gener-ally show altered responses to cytokine and are characterizedby vimentin-positive stromal cells and the presence of intra-cellular microfilament bundles that contain ASMA, the actinisoform expressed by smooth muscle cells.