PurposeTo investigate the effects of transplantation of a circumferentially-trephined autologous oral mucosal graft using a vacuum trephine on ocular surface reconstruction in patients with limbal stem cell deficiency.MethodsPatients with a limbal stem cell deficiency who underwent transplantation of autologous oral mucosal graft performed by a particular surgeon in Seoul National University Hospital were included. The medical records of these five patients were retrospectively reviewed. The lower labial mucosal graft inside the inferior lip was trephined to a depth of 250 µm using a donor vacuum trephine with a 9-mm diameter. Outside markings were made using a 14-mm intraoperative keratometer. The oral mucosal graft was dissected under a microscope using a Beaver mini-blade as either a ring or a crescent-shaped strip with a 5-mm width. The mucosal graft was transplanted onto the limbus in the limbal-deficient eye. Best-corrected visual acuity and corneal status were measured during the follow-up period.ResultsFour patients were diagnosed with Stevens-Johnson syndrome and one was diagnosed with atopy-associated immune keratitis. The mean follow-up period was 10.4 ± 2.9 months. After 4 months, visual acuity improved in all patients, and the mean improvement in logarithm of the minimum angle of resolution visual acuity was 0.526 ± 0.470 (range, 0.15 to 1.10). Corneal surface erosion and neovascularization decreased in four patients, and stromal opacity decreased in two patients. The engraftments maintained ocular surface stabilization in four of the five patients at the last follow-up.ConclusionsTransplantation of circumferential autologous oral mucosal grafts may be effective for the treatment of limbal stem cell deficiency.

PurposeIn partially accommodative esotropia (PAET), prism glasses can correct small angles of residual esotropia but the long-term effect of prismatic correction alone without surgery has not been reported. We aimed to investigate the long-term outcome of prism glasses after full hypermetropic correction for PAET.MethodsThis retrospective, case-control study was performed for children aged 10 years or younger with a residual esotropia of ≤ 20 prism diopters (PD) after full hypermetropic correction who were fitted with prism glasses and followed-up for 3 years or more. Clinical characteristics and the angle of esodeviation were obtained at each follow-up examination. Successful motor outcome after 3 years of prismatic correction was determined if the residual angle of esotropia after full hypermetropic correction was ≤ 10PD. Patients who eventually weaned off prism glasses were noted.ResultsAmong 124 patients, 30.6% achieved success and 7.3% weaned off prism glasses after 3 years of prism-wear. Smaller amount of latent esodeviation (P = 0.001) revealed by prism adaptation and good fusional response at near with the Worth 4-dot test were significant prognostic factors of success by multivariate analysis (P = 0.033). After 3 years of wearing prism glasses, the rate of improvement in stereoacuity was higher in the Success group (60.5% vs 27.9%) (P = 0.001), however, there was no significant difference between the prism-weaned group and prism-wearing group within the Success group (P>0.05).ConclusionPrism glasses for small angle PAET can be a treatment option in patients who have a small angle of latent esodeviation revealed by prism adaptation and good sensory fusion at near. Otherwise, early surgery may be advisable as the majority of patients showed suboptimal outcome even after long-term prism-wear.

Clustered occurrences of ankylosing spondylitis (AS) in family have been noticed. We evaluated patients with AS confirmed by the modified New York criteria for familial history of AS (one or more first to third degree relatives). The clinical characteristics and the recurrence risks (number of AS patients/number of familial members) of the familial AS compared to sporadic AS were investigated. Out of a total of 204 AS patients, 38 patients (18.6%) reported that they had a familial history of AS. The recurrence risks in the familial AS patients for first, second and third degree family members were 14.5%, 5.2%, and 4.4% respectively. Erythrocyte sedimentation rate (ESR) (22.6±22.2 vs 35.4±34.4, P=0.029) and C-reactive protein (CRP) (1.24±1.7 vs 2.43±3.3, P=0.003) at diagnosis, body mass index (21.9±2.7 vs 23.7±3.3, P=0.002) and frequency of oligoarthritis (13.2% vs 33.7%, P=0.021) were significantly lower in the familial form. The presence of HLA-B27 (97.4% vs 83.1%, P=0.044) was significantly higher in familial AS. In conclusion, Korean familial AS patients show a lower frequency of oligoarthritis, lower BMI, lower ESR and CRP at diagnosis and higher presence of HLA-B27.Graphical Abstract

Background: We report a case of different types of maculopathy in eyes after a high-voltage electrical shock injury. Case Report: A 43-year-old male suffered high-voltage electrical injury through his left arm. He underwent cataract surgery in both eyes 3 months after the injury, but there was no vision improvement. Ocular examination, including spectral domain optical coherence tomography, revealed diffuse retinal atrophy in the left eye which did not change until the final visit. In the right eye, an impending macular hole was observed but regressed spontaneously 9 months after the injury, and the visual acuity improved to 20/32 at the final visit. Conclusion: Two different types of maculopathy can occur in each eye after high-voltage electrical shock injury, and this might be due to asymmetric pathogenesis of the eyes according to the proximity to the route of electrical current.

Purpose To evaluate long‐term results of photodynamic therapy (PDT) as a rescue treatment in patients with type 1 neovascularization refractory to intravitreal anti‐vascular endothelial growth factor (VEGF). Methods Patients who underwent reduced‐fluence PDT for refractory type 1 neovascularization, which showed persistent subretinal and/or intraretinal fluid after three or more consecutive anti‐VEGF treatments, and were followed up for ≥24 months were reviewed. Results Seventy‐eight eyes of 78 patients were included, and 37 (47%) were classified as polypoidal choroidal vasculopathy (PCV). The mean number of anti‐VEGF injections before rescue PDT was 8.5 ± 5.4, and the mean follow‐up period after rescue PDT was 74.0 ± 29.4 months. At 3 months after rescue PDT, exudation completely resolved in 55 (71%) patients and vision significantly improved (p = 0.021). Resolution of exudation was associated with choroidal vascular hyperpermeability [odds ratio (OR), 3.82; p = 0.031] and lower maximal height of pigment epithelial detachment (OR, 0.69; p = 0.018). In these patients, exudation recurred in 49 (89%) after mean period of 13.5 months. Vision significantly worsened at 24 months after rescue PDT, and thereafter, and the vision decrease was more prominent in patients with PCV. Rescue PDT could be repeated for recurrent or persistent exudation without increasing the risk of complications. Conclusion In patients with type 1 neovascularization refractory to anti‐VEGF, reduced‐fluence PDT is an effective and safe rescue treatment. Therapeutic efficacy wore off during long‐term follow‐up, but rescue PDT may be repeated safely.

It has been known that retinal vein occlusion (RVO) is associated with chronic kidney disease, especially end-stage renal disease (ESRD). However, little is known about the effect of kidney transplantation (KT) on RVO incidence in ESRD patients. This study aimed to compare the incidence of RVO in KT recipients (n = 10,498), matched ESRD patients (n = 10,498), and healthy controls (HCs, n = 10,498), using a long-term population-based cohort. The incidence of RVO was 2.74, 5.68, and 1.02 per 1000 patient-years, for the KT group, the ESRD group, and the HCs group, respectively. Adjusted hazard ratios for RVO development compared to the HCs group, were 1.53 and 3.21, in the KT group and the ESRD group, respectively. In the KT group, multivariable regression analysis indicated that an age over 50, a Charlson Comorbidity Index score over 4, and a history of desensitization therapy were associated with an increased risk of RVO. In summary, KT recipients have a lower risk for development of RVO than ESRD patients treated with dialysis. However, the risk is still higher compared to healthy people who have normal kidney functions.

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Purpose To evaluate the impact of posterior staphyloma identified using ultra‐widefield fundus imaging on the long‐term progression of myopic maculopathy in highly myopic patients. Methods In this observational cohort study, highly myopic patients who were followed up for at least 5 years using ultra‐widefield fundus imaging were analysed for fundus abnormalities and the progression of myopic maculopathy based on the International Meta‐analysis of Pathologic Myopia classification. Results This study included 390 eyes (210 patients) with the mean follow‐up period of 69.2 ± 7.5 months (range, 60–88). Posterior staphyloma was identified in 198 eyes (50.8%) in the baseline ultra‐widefield fundus images. The border of staphyloma was not identified within 50° view circle corresponding to conventional fundus photography in 42 eyes (21.2%) with staphyloma, most of that were wide macular type. Progression of myopic maculopathy during follow‐up was observed in 202 eyes (51.8%), and eyes with staphyloma were more likely to show progression compared to those without (142/198 [71.7%] versus 60/192 [31.3%]; p < 0.001). In multivariable regression analysis, the presence of posterior staphyloma was an independent risk factor for the progression of myopic maculopathy (p = 0.005). One or more peripheral retinal lesions were observed in 302 eyes (77.4%) and 321 eyes (82.3%) in the baseline and final ultra‐widefield fundus images, respectively. Conclusion Posterior staphyloma was associated with the long‐term progression of myopic maculopathy. With a wider field of view, ultra‐widefield fundus imaging is useful for identifying the posterior staphyloma and monitoring the progression of myopic maculopathy in highly myopic patients.