Su Young Kim

Evaluation of socioeconomic status as a risk factor of pterygium using the Korean National Health and Nutrition Examination Survey 2010 to 2011: A STROBE-compliant article

Abstract Pterygium is a common conjunctival disorder. The socioeconomic risk factors of pterygium have not been systematically evaluated in Korea. The study investigated risk factors of pterygium considering socioeconomic status. Participants were 9839 adults aged 19 to 74 years, who underwent ophthalmic slit-lamp examinations as part of the Korean National Health and Nutrition Examination Survey 2010 to 2011. Pterygium was diagnosed as a growth of fibrovascular tissue over the cornea. The socioeconomic risk factors were analyzed in association with the presence of pterygium. Multiple logistic regression analysis was used to evaluate the odds ratios for differences in socioeconomic status. The presence of pterygium was associated with diabetes mellitus, hypertension, metabolic syndrome, and sun exposure time (>5 h/d). The blood level of 25-hydroxyvitamin D was higher in the pterygium group than in the control group, but both groups were deficient in 25-hydroxyvitamin D compared with the normal reference level. Pterygium was almost 3 times as frequent among persons who worked outdoors, such as skilled agricultural, forestry, and fishery workers, than among those who worked indoors (odds ratio 3.061, 95% confidence interval 1.946–4.813). Low educational status and longer working hours were also significantly associated with pterygium. This study used a nationwide population-based survey conducted by the Korean Centers for Disease Control and Prevention to reveal that pterygium is associated with low socioeconomic status. Efforts should be made to reduce the risk of pterygium by changing modifiable risk factors, especially among people with low socioeconomic status.

Macular hole formation, spontaneous closure, and reopening in severe hypertensive chorioretinopathy

Macular hole is rarely reported in severe hypertensive chorioretinopathy, and spontaneous closure of a macular hole is uncommon. We report a case of reopening after spontaneous closure of a full‐thickness macular hole in a patient with severe hypertensive chorioretinopathy.

A comparison of the Plusoptix S09 with an autorefractometer of noncycloplegics and cycloplegics in children.

AbstractThe aim of the study is to compare outcome measures of refractive error obtained using the Plusoptix S09 photorefractor and an autorefractometer of noncycloplegics and cycloplegics in children.We reviewed the medical records of 40 patients (77 eyes) who were classified using 2 methods. The patients were first assigned to 2 groups consisting of 11 eyes with ≥+3.0 D and 66 eyes with <+3.0 D, and then to 2 groups of 12 and 65 eyes with cycloplegic and noncycloplegic refraction of spherical powers ≥+2.0 D and <+2.0 D, respectively. We compared the outcome measures of refractive error using the Plusoptix S09 photorefractor and an autorefractometer of noncycloplegics and cycloplegics.There was no statistically significant difference between the Plusoptix S09 photorefractor and cycloplegic autorefractometer in the spherical power and spherical equivalent. In contrast, there was a statistically significant difference between the Plusoptix S09 photorefractor and noncycloplegic autorefractometer (P < 0.001). There was a statistically significant difference between the spherical equivalent of the Plusoptix S09 photorefractor and cycloplegic autorefractometer in children with hyperopia ≥+3.0D and with cycloplegic and noncycloplegic refraction of spherical power ≥+2.0 D. We also found a significant difference between the outcomes of the Plusoptix S09 photorefractor and cycloplegic autorefractometer in the spherical power and spherical equivalent for children with hyperopia ≥+3.0 D.The refractive error of the Plusoptix S09 photorefractor was similar to that of the cycloplegic autorefractometer, in contrast to the noncycloplegic autorefractometer. However, the Plusoptix S09 photorefractor is an inaccurate tool to estimate the refractive errors of children with moderate hyperopia.

Effectiveness of Toric Orthokeratology in the Treatment of Patients with Combined Myopia and Astigmatism

Purpose The purpose of this multi-institute, single-group clinical trial was to evaluate the effectiveness and safety of toric orthokeratology lenses for the treatment of patients with combined myopia and astigmatism. Methods A total of 44 patients were included in this clinical trial. The patients ranged in age from 7 to 49 years, with myopia of -0.75 to -6.0 diopters (D) and astigmatism of 1.25 to 4.0 D. After excluding 21 subjects, 23 subjects (39 eyes) were analyzed after toric orthokeratology lens use. The subjects underwent ophthalmologic examination after 1 day and 1, 2, 3, and 4 weeks of wearing overnight toric orthokeratology lenses. Results A total of 19 subjects (31 eyes) completed the trial after five subjects (eight eyes) dropped out. In the patients who completed the study by wearing lenses for 4 weeks, the myopic refractive error decreased significantly by 2.60 ± 2.21 D (p < 0.001), from -3.65 ± 1.62 to -1.05 ± 1.64 D. The astigmatic refractive error were also significantly decreased by 0.63 ± 0.98 D (p = 0.001), from 2.07 ± 0.83 to 1.44 ± 0.99 D. The mean uncorrected and corrected visual acuities before wearing the lenses were 2.14 ± 0.80 logarithm of the logMAR (logMAR) and 0.05 ± 0.13 logMAR, respectively, which changed to 0.12 ± 0.30 logarithm of the logMAR (p < 0.001) and 0.01 ± 0.04 logMAR (p = 0.156) after 4 weeks. No serious adverse reactions were reported during the clinical trial. Conclusions Our results suggest that toric orthokeratology is an effective and safe treatment for correcting visual acuity in patients with combined myopia and astigmatism.

Sudden bilateral vision loss as the sole manifestation of posterior reversible encephalopathy syndrome from acute uremia: Clinical case report

Rationale: Posterior reversible encephalopathy syndrome (PRES) is a cliniconeuroradiological entity associated with vasogenic edema. Symptoms may include headache, seizures, altered mental status, and visual impairment. Patients with PRES generally present with neurological deficits. Patient concerns: Here, we report an unusual case of a 42-year-old man who presented with sudden bilateral vision loss without any other neurologic symptoms. Diagnoses: He was diagnosed with PRES secondary to acute uremia. Interventions and outcomes: Our patient experienced a dramatic improvement in visual acuity, blood chemistry values, and magnetic resonance imaging findings following repeated hemodialysis. Lessons: Sudden bilateral vision loss may be the sole manifestation of PRES, particularly in patient with risk factors for PRES. Awareness of this variation of the clinical symptoms of PRES is important to facilitate its recognition.

Late emergence of macular sparing in a stroke patient: Clinical Case Report

Rationale: Occlusive cerebrovascular disease is the most common cause of homonymous hemianopia (HH) with macular sparing. Patient concerns: A 61-year-old man came to our ophthalmology clinic complaining of right-side hemianopia. Ophthalmic examination, visual field (VF) examination, and brain magnetic resonance imaging (MRI) were performed. Diagnoses: He had right HH without macular sparing on the initial VF test. And brain MRI 6 days after the visual symptoms began revealed a left occipital infarction. Interventions and Outcomes: Thirty-seven days after the onset, his follow-up 24-2 VF examination showed HH with bilateral macular sparing, which was not apparent in the initial VF examination. About 4 months after the stroke, his central 10-2 VF examination also showed HH with bilateral macular sparing. Lessons: We report a case of HH with a dramatic improvement in central vision several days after an occipital infarction. To our knowledge, this is the first case to show macular sparing developing after several days.

Biometric and refractive changes in a patient with persistent traumatic hypotony

nervous system (CNS) caused by JC virus, a human DNA polyomavirus. About 90% of adults are seropositive for this ubiquitous virus. However, PML affects almost exclusively patients with impaired cell-mediated immunity. In the last decades, PML has gained importance due to acquired immune deficiency syndrome (AIDS) and the increased use of immunosuppressive drugs, especially monoclonal antibodies. B-CLL itself predisposes to PML in absence of a specific immunosuppressive agent. The underlying conditions in this patient were his background of long B-CLL history in synopsis with multiple immunosuppressive treatments, most notably fludarabine and rituximab, which had caused impaired function and very low counts of B and T cells. Absolute confirmation of PML requires brain biopsy with demonstration of JC viral particles in the nuclei of oligodendrocytes. However, authorities regard appropriate clinical and radiologic features coupled with demonstration of JC viral DNA sufficient for PML diagnosis. Overall, apart from combined antiretroviral therapy in AIDS patients, treatment options are scarce and prognosis is extremely poor. PML manifests as focal neurologic deficits, rapidly progressing over weeks to months. Some of the common clinical features include motor weakness, cognitive deficits, dysphasia and incoordination. Vision loss is seen in up to 50% of PML cases and ranges from very mild to cortical blindness, depending on the extent of occipital lobe involvement. Visual symptoms without associated neurologic signs are infrequent. This patient initially presented with a 3-month history of moderate bilateral vision loss as the sole clinical manifestation of bilateral occipital lobe demyelination. It took several weeks for other neurological symptoms to appear, even though the initial MRI showed scattered white matter lesions outside the occipital lobes. Unexplained visual loss in immunosuppressed patients should thus call attention to CNS complications and necessitates neuroimaging, even in the absence of other focal neurologic deficits.

Degeneration of Axenfeld nerve loop: a clinicopathologic case report ☆

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