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Optic Neuritis as First Manifestation of Multiple Sclerosis: A Case Report

2011-12-31T15:00:00Z

Title: Optic Neuritis as First Manifestation of Multiple Sclerosis: A Case Report All Author(s): Hoon Dong Kim; Jai Ho Choi Abstract: Optic neuritis is one of the most important clinical manifestation associated with multiple sclerosis. We experienced a case of retrobulbar optic neuritis as the first manifestation of multiple sclerosis in young man without specific neurologic symptom or sign. A 18-years-old man suffered from loss of vision in the left eye before a week was visited our hospital. He had relative afferent pupillary defect, color blindness, and non-specific visual field defect without optic disc swelling. On the other hand, the patient didn't present any neurologic symptoms including headache, motor weakness, or paresthesia. On T2-weighted images of the brain magnetic resonance imaging (MRI) scan, multiple lesions with high signal density were found on cerebral hemisphere, pons, and medulla. As a result, the patient was diagnosed as multiple sclerosis, and the treatment with high dose steroid was started. We should keep in mind that multiple sclerosis can be revealed as optic neuritis without other neurologic symptom or sign, and meticulous evaluation is needed for the patients with optic neuritis.

Clinical Factors, Treatment Selection, and Outcomes in Postcataract Fungal Endophthalmitis from Contaminated Viscoelastics

2023-12-31T15:00:00Z

Title: Clinical Factors, Treatment Selection, and Outcomes in Postcataract Fungal Endophthalmitis from Contaminated Viscoelastics All Author(s): Jae Hui Kim; Mihyun Choi; Seong-Woo Kim; Kyu Hyung Park; Korean Retina Society Abstract: Purpose: To investigate the factors associated with treatment outcomes of postcataract surgery fungal endophthalmitis outbreaks related to contaminated viscoelastics. Design: Retrospective analysis of clinical data from multiple institutions. Subjects: This study included 228 eyes of 210 patients who were diagnosed with postcataract surgery fungal endophthalmitis related to the use of viscoelastic material (Unial, Unimed Pharmaceutical Inc); they were followed up for 6 months after the diagnosis. Methods: Clinical features and causative species were identified and treatment outcomes were analyzed in patients who underwent 6 months of follow-up. Propensity score matching was conducted to elucidate the impact of vitrectomy timing and intraocular lens (IOL) removal on treatment outcomes. Main outcome measures: Clinical factors and selection of treatment modalities associated with treatment outcomes at 6 months. Results: Baseline visual acuity (P < 0.01), age (P = 0.05), and the presence of corneal edema (P < 0.01) were closely associated with poor best-corrected visual acuity (BCVA) at 6 months. Patients who underwent immediate vitrectomy after diagnosis showed significantly better BCVA at 6 months (mean logarithm of minimum angle of resolution 0.26 ± 0.43 vs. 0.52 ± 0.52, P = 0.03) and greater degree of visual improvement (mean -0.17 ± 0.37 improvement vs. 0.10 ± 0.57 deterioration, P = 0.03) than those who underwent deferred vitrectomy. Patients who underwent IOL removal during vitrectomy required a lower number of intravitreal antifungal agent injections (mean 8.9 ± 9.1 vs. 16.7 ± 12.2, P < 0.01) and showed a lower incidence of repeated vitrectomy (20% vs. 82%, P < 0.01) than in those without IOL removal. Conclusions: In postcataract fungal endophthalmitis, prompt vitrectomy at the time of diagnosis resulted in better treatment outcomes, and IOL removal reduced the treatment burden. Prompt and aggressive surgical intervention should be considered for postcataract fungal endophthalmitis. Financial disclosure(s): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article. Keywords: Fungal endophthalmitis; Fusarium; Intraocular lens removal; Prognostic factor; Vitrectomy.

Massive Subretinal and Vitreous Hemorrhages after Cardiopulmonary Resuscitation in a Patient with Septic Shock Caused by Acute Necrotizing Pancreatitis: Case Report

2024-12-31T15:00:00Z

Title: Massive Subretinal and Vitreous Hemorrhages after Cardiopulmonary Resuscitation in a Patient with Septic Shock Caused by Acute Necrotizing Pancreatitis: Case Report All Author(s): Jae Hee Lee; Chang Hwan Lee; Hoon Dong Kim Abstract: Purpose: Cardiopulmonary resuscitation (CPR) is an emergency procedure that is performed to recover blood circulation through repeated chest compressions. We report a case of massive vitreous and subretinal hemorrhages of both eyes following CPR in a patient with septic shock. Case summary: A 46-year-old man without medical history presented with decreased vision in both eyes. Twenty days prior to presentation, he underwent CPR for cardiac arrest due to sepsis related to acute necrotizing pancreatitis. His initial best-corrected visual acuity (BCVA) was 20/200 in both eyes. Initial fundus photography revealed multiple dot intraretinal hemorrhages with cotton wool spots. Over two days, the retinal hemorrhages increased, and an ischemic sign was observed in both eyes on fundus fluorescein angiography. After three days, massive vitreous hemorrhages developed in both eyes, along with subretinal hemorrhage with retinal detachment (RD) in the right macular area. Laboratory tests revealed a coagulation profile abnormality. The BCVAs deteriorated to hand motion. Immediately, vitrectomy was performed, revealing vitreous hemorrhage and huge subretinal hemorrhages during the surgery. After one month, generalized retinal atrophy was evident in both eyes. Conclusions: This case describes massive vitreous and subretinal hemorrhages with RD following CPR that resulted in a poor visual outcome despite surgical intervention. Multiple factors may have contributed to the severe intraocular hemorrhage, including the physical nature of chest compressions during CPR, the acute pancreatitis with associated sepsis, ischemia due to microvascular damage, neovascularization, and coagulopathy. Therefore, meticulous fundus examination is required in patients undergo CPR and have a suspected coagulation profile abnormality.

An interpretable and interactive deep learning algorithm for a clinically applicable retinal fundus diagnosis system by modelling finding-disease relationship

2022-12-31T15:00:00Z

Title: An interpretable and interactive deep learning algorithm for a clinically applicable retinal fundus diagnosis system by modelling finding-disease relationship All Author(s): Jaemin Son; Joo Young Shin; Seo Taek Kong; Jeonghyuk Park; Gitaek Kwon; Hoon Dong Kim; Kyu Hyung Park; Kyu-Hwan Jung; Sang Jun Park Abstract: The identification of abnormal findings manifested in retinal fundus images and diagnosis of ophthalmic diseases are essential to the management of potentially vision-threatening eye conditions. Recently, deep learning-based computer-aided diagnosis systems (CADs) have demonstrated their potential to reduce reading time and discrepancy amongst readers. However, the obscure reasoning of deep neural networks (DNNs) has been the leading cause to reluctance in its clinical use as CAD systems. Here, we present a novel architectural and algorithmic design of DNNs to comprehensively identify 15 abnormal retinal findings and diagnose 8 major ophthalmic diseases from macula-centered fundus images with the accuracy comparable to experts. We then define a notion of counterfactual attribution ratio (CAR) which luminates the system's diagnostic reasoning, representing how each abnormal finding contributed to its diagnostic prediction. By using CAR, we show that both quantitative and qualitative interpretation and interactive adjustment of the CAD result can be achieved. A comparison of the model's CAR with experts' finding-disease diagnosis correlation confirms that the proposed model identifies the relationship between findings and diseases similarly as ophthalmologists do.