Effect of fronto-orbital advancement on astigmatism in patients with anterior plagiocephaly

The purpose of this study was to determine the effect of unilateral fronto-orbital advancement (FOA) or bilateral FOA on ocular aspects of plagiocephaly. A retrospective review of ocular findings in 16 patients with plagiocephaly was performed. Patients were divided into 2 groups: 12 patients who underwent bilateral FOA (bFOA) and 4 patients who underwent unilateral FOA (uFOA), and ocular findings were compared. One-half of patients showed strabismus in both groups, and all had exotropia. Hypertropia was found only on the same side of the plagiocephaly in 17% of the bFOA group and 25% of the uFOA group. One-third of the patients in the bFOA group and one-half of patients in the uFOA group had oblique muscle dysfunction. In terms of astigmatism, the degree of with-the-rule astigmatism on the contralateral side was larger in the bFOA group compared to the uFOA group (p = 0.030). The degree of with-the-rule astigmatism was larger on the contralateral side than the ipsilateral side (p = 0.005) in the bFOA group. Patients with abnormalities in ductions/versions had larger astigmatism on the contralateral side than those without abnormalities in ductions/versions. In conclusion, bilateral FOA could induce unwanted outcomes of larger astigmatism on the contralateral side. Astigmatism should be carefully evaluated after bilateral FOA.

Age-related differences in ocular biometry in adult Korean population

Background

To evaluate the relationship between age, axial length (AL), anterior chamber depth (ACD) and corneal steepness (K) in patients with cataract.

Methods

In this retrospective study, medical records of 800 patients (800 eyes) who were diagnosed with cataract and received preoperative ophthalmologic examination were reviewed. Data including age, gender and ocular biometric data including AL, ACD and K were collected and analyzed using univariate and multivariate analyses.

Results

Univariate analysis showed increased age has significant correlation with shorter AL (P < 0.001), shallower ACD (P < 0.001) and steeper K (P < 0.001). K value has a negative correlation with AL (P < 0.001). In multivariate analysis, increasing age has a significant association with shorter AL (P < 0.001) and ACD (P < 0.001), although the association between age and K was not significant (P = 0.398). Negative correlation between AL and K remained significant in multivariate analysis (P < 0.001).

Conclusion

In patients with cataract, older age had significant association with shorter AL and ACD. AL and K had negative correlation.

Who may benefit from robotic gastrectomy?: A subgroup analysis of multicenter prospective comparative study data on robotic versus laparoscopic gastrectomy

AIMS

Robotic gastrectomy for gastric cancer has been proven to be a feasible and safe minimally invasive procedure. However, our previous multicenter prospective study indicated that robotic gastrectomy is not superior to laparoscopic gastrectomy. This study aimed to identify which subgroups of patients would benefit from robotic gastrectomy rather than from conventional laparoscopic gastrectomy.

METHODS

A prospective multicenter comparative study comparing laparoscopic and robotic gastrectomy was previously conducted. We divided the patients into subgroups according to obesity, type of gastrectomy performed, and extent of lymph node dissection. Surgical outcomes were compared between the robotic and laparoscopic groups in each subgroup.

RESULTS

A total of 434 patients were enrolled into the robotic (n = 223) and laparoscopic (n = 211) surgery groups. According to obesity and gastrectomy type, there was no difference in the estimated blood loss (EBL), number of retrieved lymph nodes, complication rate, open conversion rate, and the length of hospital stay between the robotic and laparoscopic groups. According to the extent of lymph node dissection, the robotic group showed a significantly lower EBL than did the laparoscopic group after D2 dissection (P = 0.021), while there was no difference in EBL in patients that did not undergo D2 dissection (P = 0.365).

CONCLUSION

Patients with gastric cancer undergoing D2 lymph node dissection can benefit from less blood loss when a robotic surgery system is used.

Pupil-occluding organized hyphema anterior to the intraocular lens treated by neodymium: yttrium-aluminum-garnet laser: a case report

We report, to our best knowledge, the first case of treatment of pupil-occluding postoperative organized hyphema anterior to the intraocular lens (IOL) using neodymium: yttrium-aluminum-garnet (Nd:YAG) laser. A 78-year-old Asian female underwent uneventful cataract operation. She had been taking aspirin, which she discontinued 1 week before surgery. Iris prolapse occurred at the end of the surgery, which led to intracameral bleeding. Two weeks later, her best-corrected visual acuity was hand motion. Although hyphema had decreased, pupil-occluding organized hematoma had formed anterior to the IOL. The blood clot anterior to the IOL was removed using Nd:YAG laser. One week later, although the hematoma anterior to the IOL resolved, endocapsular hematoma was observed, which was dispersed with Nd:YAG laser posterior capsulotomy. Two weeks later, her best-corrected visual acuity improved to 20/60. There was no complication associated with Nd:YAG laser. In conclusion, pupil-occluding organized hyphema anterior to the IOL can occur as a complication of cataract surgery, in which Nd:YAG laser can be a useful treatment option.

Efficacy of automated computer-aided diagnosis of retinal nerve fibre layer defects in healthcare screening

BACKGROUND/AIMS

To evaluate the efficacy of a new automatic computer-aided detection (CAD) system for mass screening of retinal nerve fibre layer (RNFL) defects in a large population using fundus photographs.

METHODS

Among the fundus photographs of 1200 consecutive subjects who visited a healthcare centre, a total of 2270 photographs appropriate for analysis were tested. The photographs were first reviewed by two expert ophthalmologists for detection of RNFL defects (gold standard manual detection). The images were then analysed using an automatic CAD system for detecting RNFL defects in various cases of glaucomatous and non-glaucomatous optic neuropathy. A free-response receiver operating characteristics curve was generated to evaluate the validity of the CAD system. The results of the automatic detection were compared with those of manual detection, and sensitivity and specificity of the CAD system were calculated.

RESULTS

In manual detection of 2270 photographs, 41 RNFL defects from 36 photographs (1.6%) were detected, and no RNFL defects were found in 2234 photographs (98.4%). The sensitivity of the CAD system for detecting RNFL defects was 90.2% (37/41 RNFL defects) and the specificity was 72.5% (1620/2234 photographs with no RNFL defects) at a false-positive rate of 0.36 per image.

CONCLUSIONS

The new CAD system successfully detected RNFL defects during mass screening of fundus photographs in a large population who visited a healthcare centre. The proposed algorithm can be useful for clinicians in screening RNFL defects in healthcare centres. The false-positive rate is still unsatisfactory, although improved compared with the previous study. Further studies are needed to enhance the speed and specificity of image analysis using the CAD system.

Comparison of Long-term Surgical Outcomes Between Unilateral Recession and Unilateral Recession-Resection in Small-Angle Exotropia

PURPOSE

To compare the surgical outcomes of unilateral lateral rectus recession-medial rectus resection (RR) and unilateral lateral rectus recession (ULR) for intermittent exotropia of ≤20 prism diopters (PD).

DESIGN

Retrospective, nonrandomized clinical study.

METHODS

A total of 130 children with intermittent exotropia of ≤20 PD who underwent unilateral RR or ULR of 10 mm were included. Patients were observed for at least 2 years. Success rates, cumulative probabilities of success, and factors related to recurrence and overcorrection were evaluated.

RESULTS

The mean follow-up duration after surgery was 3.1 ± 1.0 years in the RR group and 3.6 ± 1.6 years in the ULR group. In the RR group, 38 of 61 patients (62%) had ocular alignment within 10 PD of exophoria/tropia and 5 PD of esophoria/tropia; 18 patients (30%) had recurrence, and 5 (8%) had overcorrection. In the ULR group, 26 of 69 patients (38%) had successful alignment, 41 patients (59%) had recurrence, and 2 patients (3%) were overcorrected. At 6 months after surgery, the success rate was significantly higher in the ULR group (RR 61%; ULR 78%, P = .039), but it became comparable after 2 years (RR 60%; ULR 52%, P = .370). At the final examination after a mean duration of 3 years, the recurrence rates were lower in the RR group (30% vs 59%, P = .001), and the overcorrection rates were comparable (8% vs 3%, P = .252).

CONCLUSION

Unilateral RR resulted in more successful alignment and lower recurrence compared to ULR for the treatment of small-angle intermittent exotropia of ≤20 PD.

Serum preadipocyte factor 1 concentrations and risk of developing diabetes: a nested case-control study

AIM

To determine whether preadipocyte factor 1 could be a predictive marker for the development of diabetes in people without diabetes at baseline.

METHODS

We conducted a population-based, nested case-control study of individuals who progressed to diabetes (n = 43) or prediabetes (n = 345) and control participants matched on age, sex and fasting plasma glucose concentration, who maintained normal glucose tolerance (n = 389) during a 4-year follow-up using data from the Chungju Metabolic disease Cohort Study. Circulating levels of preadipocyte factor 1 were measured using an enzyme-linked immunosorbent assay.

RESULTS

Baseline serum preadipocyte factor 1 levels showed a stepwise decrease across the glucose tolerance status groups at follow-up (normal glucose tolerance: 10.02 ± 3.02 ng/ml; prediabetes: 9.48 ± 3.35 ng/ml; diabetes: 8.66 ± 3.29 ng/ml; P for trend, 0.0151). Individuals whose fasting plasma glucose level had increased or whose homeostasis model assessment of β-cell function had decreased at follow-up showed significantly lower levels of preadipocyte factor 1 compared with their control group counterparts. After adjusting for age, BMI, fasting plasma glucose, serum insulin levels, systolic blood pressure and triglycerides, the incidence of diabetes was nearly threefold higher in the lowest vs. the upper three quartiles of circulating preadipocyte factor 1 (relative risk 2.794; 95% CI 1.188-6.571; P = 0.0185). Notably, these findings were significant in women but not in men.

CONCLUSIONS

Levels of circulating preadipocyte factor 1 may be a useful biomarker for identifying women at high risk of developing diabetes.

Comparison of the Pattern of Retinal Ganglion Cell Damage Between Patients With Compressive and Glaucomatous Optic Neuropathies

PURPOSE

To compare the patterns of retinal ganglion cell (RGC) damage in the macular and peripapillary areas in compressive optic neuropathy (CON) and glaucomatous optic neuropathy (GON) using spectral-domain optical coherence tomography (SD-OCT), and to determine the usefulness of SD-OCT macular and peripapillary analysis in discriminating between CON and GON.

METHODS

Sixty-three eyes with CON, 68 eyes with GON, and 73 healthy control eyes were included. Spectral-domain OCT scanning of the circumpapillary and macular area was performed to measure the global and six-sector thicknesses of the circumpapillary retinal nerve fiber layer (cpRNFL), and the macular retinal nerve fiber layer (mRNFL) and macular ganglion cell layer (mGCL) thicknesses in the nine macular subfields as defined by the Early Treatment Diabetic Retinopathy Study (ETDRS).

RESULTS

Compared to the healthy eyes, the mRNFL was significantly thinner in six ETDRS subfields (inner and outer subfields of superior, nasal, and inferior areas) in CON, but in only two subfields (outer-inferior and outer-temporal subfields) in GON. The mGCL was thinner in all nine subfields in CON, but in only four subfields (inner and outer subfields of inferior and temporal areas) in GON. The temporal cpRNFL was significantly thinner in CON but was not involved in GON. The macular parameters performed better than cpRNFL parameters in discriminating between the CON and GON.

CONCLUSIONS

Distinct differences in the patterns of RGC damage in the macular and peripapillary areas were found between CON and GON. Evaluation of the macular RGC damage may be a useful adjunct for distinguishing CON from GON when optic disc and visual field examinations are inconclusive.

Long-Term Surgical Outcomes of Augmented Bilateral Lateral Rectus Recession in Children With Intermittent Exotropia

PURPOSE

To compare the long-term surgical outcomes of augmented bilateral lateral rectus (LR) recession with original surgery.

DESIGN

Retrospective, nonrandomized clinical study.

METHODS

A total of 447 children with ≤35 prism diopters (PD) of basic and divergence excess-type intermittent exotropia, who underwent original bilateral LR recession based on the largest angle measured at distance and near, or augmentation surgery with the surgical dosage augmented by 1.0-1.5 mm more than the original formula were included. Patients were observed for at least 2 years. Success rates, cumulative probabilities of success, factors related to recurrence, and overcorrection were evaluated.

RESULTS

At a mean follow-up of 4.0 years, 48 of 101 patients (48%) undergoing original surgery maintained successful alignment within 10 PD of exophoria/tropia and 5 PD of esophoria/tropia; 49 (49%) had recurrence, and 3 (3%) had overcorrection. After augmented surgery, 203 of 346 patients (59%) were successfully aligned, 129 (37%) had recurrence, and 14 (4%) had overcorrection. Augmented surgery showed higher long-term successful alignment rates (P= .047) and lower recurrence rates compared to original surgery (P = .042) and the overcorrection rate was similar between the 2 groups (P= .774). Patients with divergence excess type showed higher cumulative success rates compared to that of the basic type (P = .010) after augmented surgery.

CONCLUSION

Augmented bilateral LR recession resulted in more successful alignment and lower recurrence without higher overcorrection compared to the original surgery for the children with intermittent exotropia. Augmentation of the original table should be considered when planning bilateral LR recession, especially in patients with divergence excess-type exotropia.

Preserved visual function with an orbital invasion of pituitary adenoma

Pituitary adenomas rarely extend to the orbit through the optic foramen and superior orbital fissure. Compressive optic neuropathy could be caused by orbital invasion of the mass showing variable visual prognosis. We are reporting a patient with intact visual acuity after 3 years of a profound orbital invasion of pituitary adenoma.

CHARGE syndrome with oculomotor nerve palsy

CHARGE syndrome is a congenital disorder characterized by coloboma, heart defects, atresia of the choanae, retarded growth, genital hypoplasia, ear anomalies, and/or hearing loss. We report the case of a 2-year-old boy with CHARGE syndrome who presented with left exotropia and elevation deficit since infancy. He had patent ductus arteriosus, small testicles, growth retardation, auricular deformity, left semicircular canal aplasia, and a de novo nonsense mutation (p.Ser705X) of the CHD7 gene. He had a left exotropia of 40 prism diopters, marked limitation of upgaze and mild limitation of downgaze and adduction in the left eye. On upgaze, his left eye adducted but did not elevate. The pupils of both eyes were round and isocoric. Fundus examination revealed optic disk and choroidal colobomas. CHARGE syndrome with oculomotor nerve palsy has not been reported previously.

Transient cortical visual impairment after video-assisted thoracic surgery: a case report

Background

Visual loss associated with thoracic surgery has been reported mostly after coronary angiography or bypass surgery. The position of video-assisted thoracic surgery (VATS) is usually lateral, thus not compressive to the globe. Visual loss after VATS has not been reported. Herein we report a patient without any cardiovascular risk factors who experienced transient cortical blindness after an uneventful VATS.

Case presentation

A 40-year-old man noticed a visual loss at the recovery room after VATS. He showed normal pupillary reflex, normal optic disc appearance, and homonymous hemianopia respecting the vertical meridian, thus was typical for cortical visual impairment.

Conclusions

Transient cortical visual impairment could be encountered after an uneventful VATS in a patient without any cardiovascular risk factors.

Predictive Factors Affecting Long-Term Outcome of Unilateral Lateral Rectus Recession

Background

There are few long-term outcome reports of unilateral lateral rectus (LR) recession for exotropia including a large number of subjects. Previous reports on unilateral LR recession commonly show extremely low rates of initial overcorrection and large exodrifts after surgery suggesting that the surgical dose may be increased. However, little is known of the long-term outcome of a large unilateral LR recession for exotropia.

Objectives

To determine long-term outcomes and predictive factors of recurrence after a large unilateral LR recession in patients with exotropia.

Data Extraction

Retrospective analysis was performed on 92 patients aged 3 to 17 years who underwent 10 mm unilateral LR recession for exotropia of ≤ 25 prism diopters (Δ) with prism and alternate cover testing and were followed up for more than 2 years after surgery. Final success rates within 10Δ of exophoria/tropia and 5Δ of esophoria/tropia at distance in the primary position, improvement in stereopsis and the predictive factors for recurrence were evaluated.

Results

At 24 months after surgery, 54% of patients had ocular alignment meeting the defined criteria of success, 45% had recurrence and 1% had overcorrection. After a mean follow-up of 39 months, 36% showed success, 63% showed recurrence and 1% resulted in overcorrection. The average time of recurrence was 23.4±14.7 months (range, 1–60 months) and the rate of recurrence per person-year was 23% after unilateral LR recession. Predictive factors of recurrence were a larger preoperative near angle of deviation (>16Δ) and larger initial postoperative exodeviation (>5Δ) at distance.

Conclusions

Long-term outcome of unilateral LR recession for exotropia showed low success rates with high recurrence, thus should be reserved for patients with a small preoperative near angle of exodeviation.

Delayed unilateral abducens nerve palsy following contralateral post-traumatic epidural hematoma

A 26-year-old Asian woman presented with diplopia occurring at 1 week after conservative treatment for left temporal bone fracture and left temporo-occipital epidural hematoma (EDH). At presentation, right abducens nerve palsy was observed with esotropia and abduction limitation in the right eye. Six weeks later, the abducens nerve palsy fully recovered with complete absorption of the EDH.

Association between information provision and decisional conflict in cancer patients

BACKGROUND

In this study, we aimed to identify demographic and clinical variables that correlate with perceived information provision among cancer patients and determine the association of information provision with decisional conflict (DC).

PATIENTS AND METHODS

We enrolled a total of 625 patients with cancer from two Korean hospitals in 2012. We used the European Organization for Research and Treatment of Cancer (EORTC) quality-of-life questionnaire (QLQ-INFO26) to assess patients' perception of the information received from their doctors and the Decisional Conflict Scale (DCS) to assess DC. To identify predictive sociodemographic and clinical variables for adequate information provision, backward selective logistic regression analyses were conducted. In addition, adjusted multivariate logistic regression analyses were carried out to identify clinically meaningful differences of perceived level of information subscales associated with high DC.

RESULTS

More than half of patients with cancer showed insufficient satisfaction with medical information about disease (56%), treatment (73%), other services (83%), and global score (80%). In multiple logistic regression analyses, lower income and education, female, unmarried status, type of cancer with good prognosis, and early stage of treatment process were associated with patients' perception of inadequate information provision. In addition, Information about the medical tests with high DCS values clarity [adjusted odds ratio (aOR), 0.54; 95% confidence interval (CI) 0.30-0.97] and support (aOR, 0.53; 95% CI 0.33-0.85) showed negative significance. For inadequate information perception about treatments and other services, all 5 DCS scales (uncertainty, informed, values clarity, support, and effective decision) were negatively related. Global score of inadequate information provision also showed negative association with high DCS effective decision (aOR, 0.43; 95% CI 0.26-0.71) and DCS uncertainty (aOR, 0.46; 95% CI 0.27-0.77).

CONCLUSION

This study found that inadequate levels of perceived information correlated with several demographic and clinical characteristics. In addition, sufficient perceived information levels may be related to low levels of DC.

Glasses-free randot stereotest

We proposed a glasses-free randot stereotest using a multiview display system. We designed a four-view parallax barrier system and proposed the use of a random-dot multigram as a set of view images for the glasses-free randot stereotest. The glasses-free randot stereotest can be used to verify the effect of glasses in a stereopsis experience. Furthermore, the proposed system is convertible between two-view and four-view structures so that the motion parallax effect could be verified within the system. We discussed the design principles and the method used to generate images in detail and implemented a glasses-free randot stereotest system with a liquid crystal display panel and a customized parallax barrier. We also developed graphical user interfaces and a method for their calibration for practical usage. We performed experiments with five adult subjects with normal vision. The experimental results show that the proposed system provides a stereopsis experience to the subjects and is consistent with the glasses-type randot stereotest and the Frisby–Davis test. The implemented system is free from monocular cues and provides binocular disparity only. The crosstalk of the system is about 6.42% for four-view and 4.17% for two-view, the time required for one measurement is less than 20 s, and the minimum angular disparity that the system can provide is about 23 arc sec.

A novel criterion for identifying metabolically obese but normal weight individuals using the product of triglycerides and glucose

OBJECTIVES

Metabolically obese but normal weight (MONW) individuals constitute a subgroup of normal weight individuals that display impaired insulin sensitivity with a higher risk of developing diabetes, cardiovascular disease and mortality. We aimed to propose a novel criterion for defining MONW by examining the usefulness and the cutoff value of the TyG index, a product of the levels of triglycerides and glucose, in identifying MONW individuals. In addition, the performance of this criterion in predicting the future incidence of diabetes was assessed.

SUBJECTS/METHODS

A total of 7541 non-diabetic, normal weight (body mass index ⩾18.5 and <25 kg m(-)(2)) subjects were selected from the Korea National Health and Nutrition Examination Survey conducted in 2009-2010. Another 3185 participants with follow-up studies were selected from a prospective community-based cohort study. The TyG index was calculated as ln(fasting triglycerides (mg dl(-1)) × fasting glucose (mg dl(-1))/2).

RESULTS

The levels of the TyG index paralleled the prevalence of metabolic syndrome and its components. The cutoff value of the TyG index that reflected MONW based on the receiver operating characteristics analysis was 8.82 for men and 8.73 for women, with the area under the curve values being 0.855 and 0.868, respectively. The sensitivity and the specificity were 84.2 and 77.6% in men and 69.1 and 89.4% in women, respectively. Individuals designated as MONW, who have a normal weight and TyG levels higher than cutoff, displayed a metabolically unhealthy phenotype and an approximately twofold higher risk of developing diabetes compared with metabolically healthy normal weight subjects.

CONCLUSIONS

We propose a simple diagnostic criterion of MONW, which might be used to discriminate subjects with a higher risk of metabolic diseases.