Woo Jin Jeung

Clinical features of infectious endophthalmitis in South Korea: a five-year multicenter study.

BackgroundTo investigate clinical features of infectious endophthalmitis over five years in a South Korean population.MethodsMedical records of consecutive patients diagnosed with infectious endophthalmitis at eight institutions located in Gyeongsangnam-do and Pusan city between January 1, 2004 and July 31, 2010 were reviewed.ResultsA total of 197 patients were diagnosed and treated. An average of 30.0 infectious endophthalmitis per year was developed. The annual incidence rate of postoperative endophthalmitis during 2006 ~ 2009 was 0.037%. The ratios of male to female and right to left were 50.2%: 49.8 % and 54.8%: 43.2%, respectively. Eighth decade and spring were the peak age (36.6%) and season (32.0%) to develop the infectious endophthalmitis. The most common past history in systemic disease was hypertension (40.4%), followed by diabetes (23.4%). Cataract operation (60.4%) was the most common cause, among which most of them was uneventful phacoemulsification (95.9%). Corneal laceration (51.6%) and liver abscess (42.9%) were the most common causes of traumatic and endogenous endophthalmitis, respectively. The percentages of patients with initial and final visual acuity less than counting fingers were 62.6% and 35.2%, respectively. Treatment with vitrectomy with or without intravitreal antibiotics injection was administered to 72.6% of patients, while 17.3% received intravitreal antibiotics only.ConclusionsOur study revealed that the development of infectious endophthalmitis was related with seasonal variation and increased during our study period. Pars plana vitrectomy was preferred for the treatment of infectious endophthalmitis in South Korea.

Clinical Effects of Conjunctiva-Müller Muscle Resection in Anophthalmic Ptosis

Purpose To evaluate the clinical effects of conjunctiva-Müller muscle resection through conjunctival incision in anophthalmic patients with mild ptosis. Methods Conjunctiva-Müller muscle resection was performed by one surgeon in 8 patients (8 eyes) who had received evisceration or enucleation and responded to 10% phenylephrine solution to correct ptosis. The average age of the patients was 35.87±13.4 years. Ptosis was seen from 1 to 34 months after evisceration or enucleation. The preoperative MRD 1 was -2 to 0.5 mm (average : -0.25±1.10 mm) and the difference of MRD 1 between before and after 10% phenylephrine use was 2.56±0.98 mm. The Müller muscle was resected 7.5 to 9 mm through conjunctival incision during surgery to match the MRD 1 of sound eye. Mean follow-up period after the operation was 2 to 16 months (average : 8.1 months). Results Postoperatively, the MRD 1 increased by 1.81±0.88 mm on the average, corresponding to the improvement in lid elevation after the use of 10% phenylephrine performed before resection. Surgery was successful in most patients, and postoperative difference in MRD 1 was less than 1 mm from the sound eye. No special postoperative complication was observed. Conclusions Conjunctiva-Müller muscle resection is one of the effective methods of correcting mild ptosis in anophthalmic patients.

The effect of a temperature-sensitive poloxamer-alginate-CaCl2 mixture after strabismus surgery in a rabbit model

PURPOSE To determine the efficacy of a temperature-sensitive poloxamer-alginate mixture in reducing adhesions after strabismus surgery in a rabbit model. METHODS The superior rectus muscle was recessed in each of 36 eyes from 18 rabbits. One randomly assigned eye in each rabbit was treated with a poloxamer-alginate mixture (PA group); the other eye was treated with a subconjunctival injection of saline (control group). The adhesions between the superior rectus muscle, sclera, and conjunctiva were clinically evaluated by a masked observer at 1 day, 1 week, and 4 weeks after surgery. Inflammation was analyzed by hematoxylin and eosin staining and anti-CD11b staining. Late fibrosis was assessed by the Masson trichrome and α-smooth muscle actin staining. Adhesion, inflammation, and fibrosis were graded on a scale of 0-4. RESULTS There was no significant between-group difference in the degree of adhesion at 1 day and 4 weeks after surgery. However, the degree of adhesion in the PA group was lower than that in the control group at postoperative week 1 (P < 0.05). Acute inflammation was similar between the groups (P > 0.05). At postoperative week 4, inflammatory cell infiltration was reduced in the PA group (P = 0.046). A significant between-group difference in late fibrosis at postoperative week 4 was observed through the Masson trichrome (P = 0.024) and α-smooth muscle actin staining (P = 0.025). CONCLUSIONS The poloxamer-alginate mixture significantly decreased adhesion after strabismus surgery in a rabbit model. Additional studies are warranted to evaluate the use of this mixture in preventing postoperative adhesions.

The study of anatomic relationship between the müller muscle and the tarsus in asian upper eyelid.

Purpose: This study was performed to clarify the detailed anatomic relationship between the insertion of Müller muscle and the tarsus in Asian upper eyelids. Materials and Methods: Eight upper eyelids of 4 formalin-fixed Asian cadavers (4 males; age range, 48–69 years; mean age, 60.2 years) were examined. Three perpendicular dissected sections with a 2-mm thickness were obtained from each eyelid. One section was obtained from the midline, and another 2 sections were obtained, each 3-mm from the lateral and medial ends of the tarsus, respectively. Samples were stained with hematoxylin-eosin, Masson trichrome, and antismooth muscle actin antibody and examined microscopically. Results: Müller muscle did not insert directly in the tarsus. However, its muscle tissues were tapered to the superior margin of the tarsus, and the space between the Müller muscle and the tarsus was bridged by fibrous connective tissue strands. Meanwhile, according to a result that measured distance between the Müller muscle insertion and the tarsus, the insertion of Müller muscle was positioned closer in the tarsus at the midline section than at the lateral or medial sections. Conclusions: This study suggests that the Müller muscle is broadly distributed around the superior border of the tarsus as tapered, aggregated smooth muscle bundles without direct insertion on the superior border of the tarsus, despite a few limitation.

Subretinal tenecteplase injection in a submacular hemorrhage from polypoidal choroidal vasculopathy: a case report.

PURPOSE The purpose of this report was to describe a case with a thick submacular hemorrhage (SMH) resulting from polypoidal choroidal vasculopathy that was successfully treated with a subretinal tenecteplase injection. METHODS A retrospective case report. RESULTS A 63-year-old man with acute SMH secondary to polypoidal choroidal vasculopathy underwent a partial posterior vitrectomy, a subretinal tenecteplase (100 μg/0.1 mL) injection with air/fluid exchange, and an intravitreal injection of bevacizumab (2.5 mg/0.1 mL). His preoperative corrected visual acuity was 20/30, but the SMH threatened the fovea. The SMH was displaced inferiorly and absorbed completely at 1 month postoperative. His visual acuity decreased to 20/40 1 week postoperative but recovered to 20/20 2 months after surgery. The electroretinogram showed no distinct elongation of implicit time and slightly decreased amplitude of a-wave and b-wave at 3 months postoperative; optical coherence tomography presented disruption of the inner segment/outer segment line at the onset of SMH but recovered completely at 3 months postoperative. CONCLUSION Subretinal tenecteplase was found to have sufficient hemolytic function and no retinal toxicity and could represent a feasible treatment option for the management of SMH.

Acute Disseminated Encephalomyelitis Without Optic Neuritis Followed by Optic Neuritis in a Child Due to the Sudden Cessation of Steroid Therapy

Abstract Acute disseminated encephalitis (ADEM) is an autoimmune demyelinating disorder of the central nervous system that usually occurs in children after viral infection or vaccination. It is not uncommon for ADEM to be accompanied by optic neuritis. However, ADEM followed by optic neuritis is a rare. We report the case of a 6-year-old girl who initially presented with ADEM (without optic neuritis) due to a live measles, mumps, and rubella vaccine and was treated with intravenous high-dose corticosteroids. After steroid therapy, she recovered neurologically and was not prescribed any medication, including an oral steroid taper, for use after discharge. Three weeks later, she developed unilateral optic neuritis and was again treated with steroid therapy. This is a rare case of ADEM without optic neuritis in a child, followed by optic neuritis due to the sudden cessation of steroid therapy. Further studies and follow-ups are needed to determine whether ADEM followed by optic neuritis can be considered a specific clinical form of this disorder.

An experimental study of rabbit conjunctival epithelial toxicity using co-treatment with Mitomycin-C and a histone deacetylase inhibitor

This study was conducted to evaluate cytotoxicity due to co-treatment with low-dose Mitomycin-C (MMC) and the histone deacetylase inhibitor, suberoylanilide hydroxamic acid (SAHA) for glaucoma filtration surgery. In this study, the effect of co-treatment with MMC and SAHA to induce apoptosis in cultured conjunctival epithelial cells (CEs) in rabbit was investigated. The cytotoxic potential following co-treatment with MMC and SAHA in CEs via assay for reactive oxygen species (ROS) and lactate dehydrogenase (LDH) was also examined. Co-treatment with MMC and SAHA did not induce apoptosis in CEs. In addition, co-treatment with MMC and SAHA caused no significant alteration of ROS and LDH levels in CEs. This study therefore shows that low-dose MMC could still be used as an antimetabolite in co-treatment with SAHA to effectively inhibit fibrosis of Tenon’s capsule fibroblasts (TCFs) following glaucoma filtration surgery, while minimizing cytotoxicity in CEs.

Comparison of the most common isolates of postoperative endophthalmitis in South Korea; Enterococcus species vs coagulase-negative staphylococci

BackgroundTo compare the related factors or manifestations of the two most common isolates of post-operative endophthalmitis, which were Enterococcus spp. and coagulase-negative staphylococci (CNS) in South Korea.MethodsMedical records were reviewed for cases of post-operative endophthalmitis caused by Enterococcus spp. and CNS at eight institutions between January 2004 and July 2010. Various factors including age, sex, residence, systemic diseases, smoking and drinking history, and best corrected visual acuity, and length of time between causative intraocular surgery and symptom development were compared between the two groups.ResultsThe total number of post-operative endophthalmitis cases was 128 and in 116 cases, microbiological culture tests from the aqueous humor or vitreous were performed. Among these cases, 67 (57.8%) were culture proven. Among these 67 cases, 19 (28.4%) were caused by Enterococcus spp., 14 (20.9%) were caused by Staphylococcus epidermidis endophthalmitis, and 5 (7.5%) were caused by other CNS spp. Age, sex, causative procedure, past medical history, social history, and laterality were not different in the two groups. Mean initial and final visual acuity were significantly worse in the Enterococcus spp. endophthalmitis group than in the CNS group (p = 0.049, 0.042, respectively). Length of time between the causative procedure and symptom development was significantly shorter in cases of Enterococcus spp. endophthalmitis (p = 0.004).ConclusionsEnterococcus spp. induce more severe and rapid-onset postoperative endophthalmitis than CNS. Infectious endophthalmitis developed within 2 days after cataract operation could be caused by Enterococcus spp. and have chance to be poor prognosis in South Korea.