Introduction Rapid globalization has produced a growing demand for the chronic care management of overseas populations living in medically underserved areas. This study investigated the utilization pattern of telehealth counselling among overseas Koreans with high blood pressure, and evaluated the relationships between mobile self-monitoring application and blood pressure reduction. Methods A global chronic management programme consisting of lifestyle modification and self-monitoring blood pressure was launched to provide a telehealth counselling service for Koreans with high blood pressure living in Vietnam from August 2016 to December 2017. During the first telehealth session, doctors educated patients on lifestyle modifications using a mobile self-monitoring application and checked the change of blood pressure in a follow-up telehealth visit. We examined utilization patterns and compared the blood pressure change among the mobile self-monitoring group versus the control group using Wilcoxon signed rank tests. Results A total of 234 patients with systolic blood pressure of more than 130 mmHg or diastolic blood pressure of more than 80 mmHg were registered, installed the mobile app and were provided with automated blood pressure devices with the telehealth counselling service by Korean doctors. A follow-up telehealth counselling session was provided at three months. Only 15% (36/234) received two or more telehealth counselling sessions. Significant differences were found in the mean change of systolic blood pressure at three months in the monitoring group and the non-monitoring group (-16.0 vs. -5.7, p = 0.008). Discussion In this unique telehealth study, a mobile self-monitoring application was associated with significantly reducing systolic blood pressure levels in three months. Encouraging patients via a mobile application that includes a self-monitoring function might have the potential for self-managing chronic diseases, especially in resource-limited environments.

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Purpose To evaluate the changes in esodeviation after inferior oblique (IO) recession in patients with refractive accommodative esotropia and IO overaction. Methods Graded IO recession was performed in 68 patients who were diagnosed with refractive accommodative esotropia with IO overaction. The patients were followed for at least 3 months after surgery and the angle of esodeviation with correction was evaluated at distance and near at each follow-up evaluation. The patients were divided into two groups: patients who underwent unilateral IO recession (UIO-Rec) and patients who underwent bilateral IO recession (BIO-Rec). The change in esodeviation after surgery was compared between the two groups. Results A total of 68 patients were enrolled in this study, with 38 patients in the UIO-Rec group and 30 in the BIO-Rec group. In the UIO-Rec group, there was no statistically significant difference in esodeviation before and after surgery. In the BIO-Rec group, esodeviation at distance increased significantly 1 day postoperatively ( p = 0.033). However, esodeviation returned to the preoperative value one week after surgery ( p = 0.665). Changes in esodeviation at distance were significantly greater in the BIO-Rec group than in the UIO-Rec group one day after surgery ( p = 0.044). Conclusions Bilateral IO-weakening surgery induced a transient increase in esodeviation in patients with refractive accommodative esotropia. However, we found no evidence that well-controlled esotropia with corrected hyperopia became decompensated after IO-weakening surgery, as induced esodeviation was minor and temporary.

We evaluated changes in ocular axial length (AL), anterior chamber depth (ACD), and intraocular pressure (IOP) after strabismus surgery by comparing the operated and fellow eyes in patients undergoing unilateral strabismus surgery. This was a prospective study including patients who underwent unilateral strabismus surgery for exotropia alone or exotropia with unilateral superior oblique palsy. The AL and ACD using IOLMaster biometer and the IOP using non-contact tonometry were measured 1 day prior to surgery and 1 week, 1 month, and 3 months postoperatively. Fourteen female and 22 male patients (mean age: 8.2 years) were included in the study. In the operated eye, the mean AL increased significantly from 23.99 mm preoperatively to 24.08 mm 1 week postoperatively ( P < .001), and although the mean ACD decreased in this time, the decrease was not statistically significant. The mean IOP of the operated eye increased from 17.08 mmHg preoperatively to 20.31 mmHg at 1 week postoperatively ( P = .01), as did the IOP of the fellow eye ( P = .03). However, the AL and IOP of the operated eyes decreased by 1 month postoperatively. There were no significant differences in the AL, ACD, and IOP between operated and fellow eyes by 3 months postoperatively. Strabismus surgery caused significant AL elongation in the operated eye and IOP elevation in both the operated and fellow eyes immediately after surgery. However, both ocular changes were transient. The AL, ACD, and IOP did not exhibit any significant differences between operated and fellow eyes 3 months postoperatively.

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Purpose: To investigate changes in ocular excyclotorsion in patients with inferior oblique overaction (IOOA) according to amount of correction by graded inferior oblique recession and to compare the amount of excyclotorsion between primary IOOA and secondary IOOA. Methods: This study included 54 eyes of 54 patients who were diagnosed with unilateral IOOA and underwent graded inferior oblique recession. Fundus photographs were taken pre-and postoperatively. The sum of angles of torsion of both eyes was used to analyze changes in excyclotorsion. The angle of excyclotorsion was analyzed using the ImageJ program. Results: Eighteen eyes were grade 2, 24 eyes were grade 3 and 12 eyes were grade 4. Preoperative angle of excyclotorsion was 16.23 ± 5.96˚ for the patients with grade 2 eyes, 18.83 ± 5.76˚ for the patients with grade 3 eyes and 29.00 ± 10.23˚ for the patients with grade 4 eyes. Therefore, as the degree of IOOA increased, the amount of excyclotorsion became larger. There was no statistical significance between grade 2 and grade 3 (p = 0.467), however, there was a statistically significant difference between grade 3 and grade 4 (p < 0.001). Postoperative angle of excyclotorsion was significantly decreased in each group (grade 2: p = 0.020, grade 3: p < 0.001, grade 4: p = 0.041). The amount of surgical recession of inferior oblique muscle showed a positive correlation with a decrease in the angle of excyclotorsion, but was not statistically significant. The amount of excyclotorsion and the decrease of excyclotorsion after surgery were larger in secondary IOOA than in primary IOOA, but were not statistically significant (p = 0.260). Conclusions: As the preoperative degree of IOOA increased, the amount of correction of excyclotorsion became larger but there is no statistical significance. Correction of IOOA and excylclotorsion is expected after graded inferior oblique recession. J Korean Ophthalmol Soc 2016;57 (8)