Publications by authors named "Young Suk Yu"

184 Publications

Change in the eye position under general anesthesia in children with intermittent exotropia.

J AAPOS 2021 02 1;25(1):5.e1-5.e7. Epub 2021 Mar 1.

Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea; Department of Ophthalmology, Seoul National University Hospital, Seoul, Korea. Electronic address:

Purpose: To evaluate the eye position in subjects with intermittent exotropia and normal subjects under general anesthesia (GA) using the strabismus photo analyzer.

Methods: This retrospective case-control study included 78 subjects with intermittent exotropia and 25 normal control subjects who underwent epiblepharon surgery. Eye position under GA was assessed using the strabismus photo analyzer, based on eye models generated from corneal lights and limbus in pre- and post-anesthesia images. Eye positions under GA in the control and intermittent exotropia groups were compared. Preoperative angle of deviation was also compared with amount of change in eye position under GA in the intermittent exotropia group.

Results: Eye position under GA was more divergent in subjects with intermittent exotropia than in controls (P = 0.008). The amount of change in eye position under GA was correlated with the preoperative angle of deviation (r = 0.47; P < 0.001). In small preoperative exodeviations, the change in eye position was primarily more divergent, whereas in large exodeviations, a convergent tendency-less exotropic compared with the preoperative angle of exodeviation-was observed.

Conclusions: In subjects with small preoperative exodeviations, there was a tendency for eye position to become more divergent after GA; in those with large exodeviations, there was less exotropia after GA.
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http://dx.doi.org/10.1016/j.jaapos.2020.09.008DOI Listing
February 2021

Development of New Solitary Retinoblastoma Tumors during and after Chemotherapy.

Korean J Ophthalmol 2021 02 2;35(1):73-79. Epub 2021 Feb 2.

Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea.

Purpose: To review the occurrence of new solitary tumors during and after intravenous chemotherapy against retinoblastoma.

Methods: From 115 eyes of 78 patients with a diagnosis of intraocular retinoblastoma who underwent intravenous chemotherapy and focal treatment without prior treatment, patient demographics, age at diagnosis, laterality, classification (Reese-Ellsworth and International Classification of Retinoblastoma), and treatment options were recorded. In addition, the occurrence of small tumors during and after chemotherapy was documented with a detailed review of medical records and fundus photographs.

Results: Of a total of 115 eyes of 78 consecutive patients, new solitary tumors were observed in 50 eyes (50 / 115, 43%) of 40 patients (40 / 78, 51%). Multinominal logistic regression analyses showed that age at diagnosis (before 1 year) and vitreal seeding at diagnosis were linked to the development of isolated and miliary tumors, respectively. Kaplan-Meier analyses demonstrated that all small tumors developed with 20 months from the start of chemotherapy. Twenty-eight eyes (28 / 34, 82%) were salvaged with additional focal treatment in 34 eyes with isolated tumors.

Conclusions: Small tumors were observed during and after chemotherapy against retinoblastoma in patients who underwent intravenous chemotherapy and focal treatment. It is necessary to promptly identify and address small tumors for the preservation of eyeball and vision.
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http://dx.doi.org/10.3341/kjo.2020.0115DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7904413PMC
February 2021

Pontin arginine methylation by CARM1 is crucial for epigenetic regulation of autophagy.

Nat Commun 2020 12 8;11(1):6297. Epub 2020 Dec 8.

Creative Research Initiatives Center for Epigenetic Code and Diseases, Department of Biological Sciences, Seoul National University, Seoul, 08826, South Korea.

Autophagy is a catabolic process through which cytoplasmic components are degraded and recycled in response to various stresses including starvation. Recently, transcriptional and epigenetic regulations of autophagy have emerged as essential mechanisms for maintaining homeostasis. Here, we identify that coactivator-associated arginine methyltransferase 1 (CARM1) methylates Pontin chromatin-remodeling factor under glucose starvation, and methylated Pontin binds Forkhead Box O 3a (FOXO3a). Genome-wide analyses and biochemical studies reveal that methylated Pontin functions as a platform for recruiting Tip60 histone acetyltransferase with increased H4 acetylation and subsequent activation of autophagy genes regulated by FOXO3a. Surprisingly, CARM1-Pontin-FOXO3a signaling axis can work in the distal regions and activate autophagy genes through enhancer activation. Together, our findings provide a signaling axis of CARM1-Pontin-FOXO3a and further expand the role of CARM1 in nuclear regulation of autophagy.
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http://dx.doi.org/10.1038/s41467-020-20080-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7722926PMC
December 2020

Spontaneous regression of congenital corneal opacity.

Graefes Arch Clin Exp Ophthalmol 2020 Feb 25;258(2):359-366. Epub 2019 Nov 25.

Department of Ophthalmology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea.

Purpose: To determine the incidence of spontaneous regression of congenital corneal opacity (CCO) and identify clinical factors associated with the regression.

Methods: Medical records and anterior segment photographs were reviewed of 57 eyes in 35 patients with CCO that were not related to congenital glaucoma, tumors, infection, trauma, or metabolic disorders and were followed up without corneal transplantation for longer than one year at Seoul National University Hospital. Spontaneous regression of corneal opacity was defined as a decrease in corneal opacity significant enough for visual axis clearance. Data on demographics, systemic, and ocular characteristics were collected and compared between patients who had spontaneous regression of CCO and those who did not.

Results: Spontaneous regression of corneal opacity developed in 32 eyes (22 patients, 56.1%) out of 57 CCO eyes (35 patients) at the mean 8.2 ± 5.4 months of age (the median 6.7 months). Absence of combined ocular anomalies such as iris anomaly, lens opacity, and peripheral corneal vascularization was significantly associated with the regression of opacity.

Conclusions: Corneal opacity can spontaneously regress in 56.1% of eyes with CCO during the first year of life. Careful follow-up with amblyopia management can be one of treatment options for CCO.
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http://dx.doi.org/10.1007/s00417-019-04526-5DOI Listing
February 2020

Postnatal ophthalmological characteristics in patients with congenital cataract diagnosed by fetal ultrasonography.

J Matern Fetal Neonatal Med 2019 Nov 18:1-7. Epub 2019 Nov 18.

Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Republic of Korea.

To evaluate the findings of postnatal ophthalmological examinations in patients diagnosed with cataracts by prenatal fetal sonography. We retrospectively identified patients diagnosed with fetal cataract without other ocular abnormalities using antenatal ultrasound. We analyzed data including the patients' family history, the presence of metabolic or systemic disease-associated cataracts, gestational age at diagnosis, fetal sonography reports, and the results of postnatal ophthalmological examinations. In total, eight patients were diagnosed with cataracts by prenatal fetal ultrasonography, and all these patients showed mild to severe degrees of cataract after birth. Patients showed hyperechoic opacity of the lens in the available images. The mean gestational age at diagnosis was 26 ± 3 weeks (range, 22-28 weeks), and three patients (37.5%) had a family history of congenital cataract. All patients, except one patient who had patent ductus arteriosus, showed no systemic abnormalities associated with cataracts on postnatal evaluation. Six (75.0%) were diagnosed with bilateral cataracts after birth, and of these, two patients had been diagnosed with unilateral left cataract prenatally. Postnatal ophthalmological examination revealed that all patients showed opacities involving the nucleus of the lens and three patients (37.5%) had associated abnormalities of microcornea or microphthalmia, which were not diagnosed antenatally. In all our subjects, the lens opacities on prenatal fetal sonography were diagnosed postnatally as cataracts involving the nucleus. A careful postnatal examination is essential to detect the presence of associated ocular abnormalities such as microcornea and/or microphthalmia and cataract in the contralateral eye in patients with congenital cataract.
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http://dx.doi.org/10.1080/14767058.2019.1685963DOI Listing
November 2019

Factors Associated with the Prognosis after Operation in Children with Recurrent Intermittent Exotropia.

J Korean Med Sci 2019 Oct 7;34(38):e252. Epub 2019 Oct 7.

Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea.

Background: To describe factors affecting the prognosis after operation for recurrent intermittent exotropia (X[T]) in children.

Methods: Clinical records of 50 patients who underwent operation for recurrent X(T) by a single surgeon were reviewed. The age at diagnosis of X(T), and first and second operations, deviation angle at distance and near, surgical method, concurrent vertical strabismus, stereoacuity, and Worth's Four Dot (W4D) examination before reoperation were analyzed, along with the postoperative deviation angle. A successful surgical outcome was defined as orthophoria, esodeviation ≤ 5 prism diopters, or exodeviation ≤ 10 prism diopters at distance.

Results: Among the 50 recurrent exotropes who underwent surgery and were followed up for more than 1 year postoperatively, 13 showed recurrent exotropia and 1 showed consecutive esotropia. The mean age at reoperation was 8.49 ± 2.19 years, and the mean duration of postoperative follow-up was 27.78 ± 12.02 months. Good near fusion before reoperation was a significant factor in the success of surgery ( = 0.006). Smaller postoperative deviation angle measured immediately and 2 months after surgery were related to smaller final deviation angle ( = 0.027 and = 0.022, respectively).

Conclusion: Peripheral suppression lowers the success rate of operation for recurrent X(T) in children. Overcorrection rather than orthotropia should be the target of immediate postoperative deviation angle. Peripheral suppression status and immediate and 2-month postoperative deviation angle may be important clues for predicting the final result of operation for recurrent X(T).
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http://dx.doi.org/10.3346/jkms.2019.34.e252DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6776833PMC
October 2019

RORα is crucial for attenuated inflammatory response to maintain intestinal homeostasis.

Proc Natl Acad Sci U S A 2019 10 30;116(42):21140-21149. Epub 2019 Sep 30.

Creative Research Initiatives Center for Epigenetic Code and Diseases, School of Biological Sciences, Seoul National University, 08826 Seoul, South Korea;

Retinoic acid-related orphan receptor α (RORα) functions as a transcription factor for various biological processes, including circadian rhythm, cancer, and metabolism. Here, we generate intestinal epithelial cell (IEC)-specific RORα-deficient (RORα) mice and find that RORα is crucial for maintaining intestinal homeostasis by attenuating nuclear factor κB (NF-κB) transcriptional activity. RORα mice exhibit excessive intestinal inflammation and highly activated inflammatory responses in the dextran sulfate sodium (DSS) mouse colitis model. Transcriptome analysis reveals that deletion of RORα leads to up-regulation of NF-κB target genes in IECs. Chromatin immunoprecipitation analysis reveals corecruitment of RORα and histone deacetylase 3 (HDAC3) on NF-κB target promoters and subsequent dismissal of CREB binding protein (CBP) and bromodomain-containing protein 4 (BRD4) for transcriptional repression. Together, we demonstrate that RORα/HDAC3-mediated attenuation of NF-κB signaling controls the balance of inflammatory responses, and therapeutic strategies targeting this epigenetic regulation could be beneficial to the treatment of chronic inflammatory diseases, including inflammatory bowel disease (IBD).
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http://dx.doi.org/10.1073/pnas.1907595116DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6800319PMC
October 2019

Incidence and Risk Factors for Glaucoma Development After Bilateral Congenital Cataract Surgery in Microphthalmic Eyes.

Am J Ophthalmol 2019 12 23;208:265-272. Epub 2019 Aug 23.

Department of Ophthalmology, Seoul National University College of Medicine, Seoul, South Korea; Department of Ophthalmology, Seoul National University Hospital, Seoul, South Korea. Electronic address:

Purpose: To evaluate the long-term incidence and risk of glaucoma after bilateral congenital cataract surgery in microphthalmic eyes.

Design: Retrospective, observational case series.

Methods: Subjects: Children with microphthalmic eyes who had undergone surgery for bilateral congenital cataract within 6 months of birth and been followed up for at least 5 years.

Procedures: Review of medical records at our institution.

Main Outcome Measures: Probability of an eye's developing glaucoma after bilateral congenital cataract surgery and associated risk factors.

Results: Thirty-eight eyes of 19 children with bilateral congenital cataract were included. The mean age at surgery was 3.2 ± 1.7 months, and the mean follow-up duration was 7.79 ± 2.61 years. After cataract surgery, 11 eyes (29.0%) developed glaucoma at the age of 4.0 ± 1.4 years. Three of these eyes underwent Ahmed glaucoma valve implantation surgery. The probability of an eye's developing glaucoma was estimated to be 32.0% by 10 years after surgery. In a multivariate analysis, axial length was significantly associated with glaucoma development (odds ratio = 0.364, P = .025). Age at the time of cataract surgery, corneal diameter, and aphakia did not affect the risk of glaucoma (P > .10). Eyes without glaucoma had a better final visual outcome than those with glaucoma (0.75 ± 0.60 and 1.47 ± 1.10 logMAR, respectively, P = .049).

Conclusions: The long-term cumulative risk of postoperative glaucoma development was 32.0% by 10 years after bilateral congenital cataract surgery. Because the risk of developing glaucoma persists for several years after surgery, careful monitoring and control of intraocular pressure is needed to preserve vision in such patients.
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http://dx.doi.org/10.1016/j.ajo.2019.08.005DOI Listing
December 2019

Reply.

Am J Ophthalmol 2019 06 20;202:152-153. Epub 2019 Apr 20.

Seoul, Republic of Korea.

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http://dx.doi.org/10.1016/j.ajo.2019.02.018DOI Listing
June 2019

Development of a patient-derived xenograft model of glioblastoma via intravitreal injection in mice.

Exp Mol Med 2019 04 16;51(4):1-9. Epub 2019 Apr 16.

Department of Neurosurgery, Seoul National University Hospital, Seoul, 03080, Republic of Korea.

Currently, the two primary patient-derived xenograft (PDX) models of glioblastoma are established through intracranial or subcutaneous injection. In this study, a novel PDX model of glioblastoma was developed via intravitreal injection to facilitate tumor formation in a brain-mimicking microenvironment with improved visibility and fast development. Glioblastoma cells were prepared from the primary and recurrent tumor tissues of a 39-year-old female patient. To demonstrate the feasibility of intracranial tumor formation, U-87 MG and patient-derived glioblastoma cells were injected into the brain parenchyma of Balb/c nude mice. Unlike the U-87 MG cells, the patient-derived glioblastoma cells failed to form intracranial tumors until 6 weeks after tumor cell injection. In contrast, the patient-derived cells effectively formed intraocular tumors, progressing from plaques at 2 weeks to masses at 4 weeks after intravitreal injection. The in vivo tumors exhibited the same immunopositivity for human mitochondria, GFAP, vimentin, and nestin as the original tumors in the patient. Furthermore, cells isolated from the in vivo tumors also demonstrated morphology similar to that of their parental cells and immunopositivity for the same markers. Overall, a novel PDX model of glioblastoma was established via the intravitreal injection of tumor cells. This model will be an essential tool to investigate and develop novel therapeutic alternatives for the treatment of glioblastoma.
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http://dx.doi.org/10.1038/s12276-019-0241-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6467997PMC
April 2019

Long-term outcomes of bilateral lateral rectus recession versus unilateral lateral rectus recession-medial rectus plication in children with basic type intermittent exotropia.

Eye (Lond) 2019 09 3;33(9):1402-1410. Epub 2019 Apr 3.

Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Republic of Korea.

Purpose: To compare the long-term surgical outcomes between bilateral lateral rectus recession (BLR) and unilateral lateral rectus recession-medial rectus plication (RP) in intermittent exotropia.

Methods: Children who underwent BLR or RP for basic type intermittent exotropia between 2015 and 2016 with a minimum follow-up period of 2 years were retrospectively reviewed. Surgical outcomes were classified based on postoperative angle of deviation as follows: success (esodeviation ≤ 5 prism diopters [PD] to exodeviation ≤ 10 PD), and failure (overcorrection [esodeviation > 5 PD] and undercorrection or recurrence [exodeviation > 10 PD]).

Results: Of 144 patients, 90 underwent BLR and 54 underwent RP. The angle of exodeviation of the RP group steadily increased over time after the surgery. The BLR group showed an earlier exodrift and a more stable course compared to the RP group. Kaplan-Meier survival analysis showed a better survival in the BLR group, with final success rates of 48.9% in the BLR group and 25.9% in the RP group after a mean follow-up of 2.2 years. Patients with a successful outcome had greater esodeviation at 1 week postoperatively (at distance 7.6 PD in the BLR group, 11.4 in the RP group).

Conclusions: Surgical outcomes were better in the BLR group than in the RP group. The RP group showed higher rates of recurrence of exodeviation, while the BLR group presented a more stable course. Establishing more esodeviation at postoperative week 1 in the RP group compared to the BLR group would be required to achieve successful results.
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http://dx.doi.org/10.1038/s41433-019-0422-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7002523PMC
September 2019

Progressive Intrascleral Epithelial Cyst With Intracorneal Extension.

J Pediatr Ophthalmol Strabismus 2019 Mar 25;56:e20-e23. Epub 2019 Mar 25.

The authors report a case of primary sclerolimbal cyst with corneal extension in a 3-year-old boy. The cyst enlarged and dissected into the cornea over time. Surgical excision with tectonic allograft was performed. Preoperative, intraoperative, and postoperative anterior segment findings were shown, and results from histologic and cytologic assays were presented. [J Pediatr Ophthalmol Strabismus. 2019;56:e20-e23.].
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http://dx.doi.org/10.3928/01913913-20190213-02DOI Listing
March 2019

Long-term surgical outcomes of patients with consecutive exotropia.

Graefes Arch Clin Exp Ophthalmol 2019 May 13;257(5):1037-1044. Epub 2019 Mar 13.

Department of Ophthalmology, Seoul National University College of Medicine, 101 Daehak-Ro, Jongno-Gu, Seoul, 110-744, South Korea.

Purpose: To evaluate the long-term surgical outcome of patients with consecutive exotropia.

Methods: Patients who underwent surgery for the treatment of consecutive exotropia between January 2008 and July 2016 with a minimum follow-up period of 2 years were retrospectively reviewed. Surgical outcomes were classified based on postoperative angle of deviation at 2 years as follows: success (esodeviation ≤ 5 prism diopters [PD] to exodeviation ≤ 10 PD), and recurrence [exodeviation > 10 PD]). Postoperative angles of deviation at 1 week, 1 month, 6 months, 1 year, and 2 years and at the final follow-up were investigated.

Results: A total of 37 patients (28 in the success group and 9 in the recurrence group) were included. Surgical success rate at 2 years was 75.7%, and reoperation rate was 10.8% during a mean follow-up period of 42.4 ± 18.3 months after consecutive exotropia surgery. After surgery, exodrift occurred mostly during 1-month follow-up in both groups, and those with no exodrift within 1 month presented a higher surgical success. Thereafter, patients in the success group showed a more stable course during follow-up than those in the recurrence group. Stereopsis was an important factor associated with surgical outcome.

Conclusions: Exodrift occurs mostly within 1 month after surgery for consecutive exotropia. Targeting initial overcorrection and establishing esodeviation at postoperative month 1 is important to achieve successful results.
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http://dx.doi.org/10.1007/s00417-019-04293-3DOI Listing
May 2019

Relation between preoperative hyperopia and surgical outcome in infantile esotropia.

Int J Ophthalmol 2018 18;11(12):1963-1967. Epub 2018 Dec 18.

Department of Ophthalmology, Seoul National University College of Medicine, Seoul 110-744, South Korea.

Aim: To evaluate the relation between preoperative hyperopia and surgical outcomes of infantile esotropia in patients younger than 24 months of age.

Methods: Medical records of patients who underwent bilateral medial rectus muscle recession for infantile esotropia between November 1, 2002 and December 1, 2011 were retrospectively reviewed. Patients were divided into two groups according to the degree of preoperative hyperopia. Group I had less than +3.0 diopter (D) of hyperopia and group II had between +3.0 and +5.0 D of hyperopia. Postoperative alignments were evaluated 1wk, 3, 6mo, and 1y after surgery. Following the 1-year postoperative visit, patients were monitored yearly. Relationships between preoperative factors including hyperopia and postoperative outcomes were evaluated.

Results: Forty-six patients were included, with 33 patients in group I and 13 patients in group II. The preoperative mean refractive error was +0.88 D in group I and +3.45 D in group II. Surgical outcomes were not significantly different between groups at any postoperative time point examined. Cumulative probability of surgical success, prevalence of inferior oblique overaction, dissociated vertical deviation, and re-operation rate were not significantly different between groups.

Conclusion: Preoperative moderate hyperopia (less than +5.0 D) did not affect the surgical outcome of infantile esotropia. Therefore, the surgical correction of esotropia should be considered when the angle of esodeviation is unchanged following hyperopia correction, even in children with moderate hyperopia.
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http://dx.doi.org/10.18240/ijo.2018.12.15DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6288546PMC
December 2018

A comparison of surgical outcomes between pre-and full-term patients with exotropia.

PLoS One 2018 7;13(12):e0208848. Epub 2018 Dec 7.

Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea.

Purpose: To compare the surgical outcomes between pre- and full-term patients with exotropia and to examine the factors associated with surgical outcomes.

Methods: This retrospective study included 48 pre- and 432 full-term patients with basic-type exotropia who underwent unilateral or bilateral lateral rectus muscle (ULR or BLR) recession. Preoperative characteristics and surgical outcomes were compared between the pre- and full-term infants. Additionally, factors affecting the surgical outcomes were evaluated in all patients.

Results: The preoperative characteristics were significantly different between the pre- and full-term groups in terms of neurodevelopmental disabilities (p = 0.020). There were no significant differences between the pre- and full-term groups in terms of the success, overcorrection, and recurrence rates after the mean follow-up period of 34.6 ± 13.9 months (p = 0.697). The major cause of surgical failure was recurrence in both groups. Pre-term birth was not a risk factor for overcorrection and recurrence. However, regardless of the pre- or full-term birth status, the presence of neurodevelopmental disabilities significantly affected final overcorrection (p = 0.004).

Conclusions: Pre-term patients with exotropia showed similar surgical outcomes to full-term controls. The presence of neurodevelopmental disabilities was a risk factor for final overcorrection.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0208848PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6286133PMC
May 2019

Long-Term Outcome of Nd:YAG Laser Posterior Capsulotomy in Children: Procedural Strategies and Visual Outcome.

Am J Ophthalmol 2019 01 27;197:121-127. Epub 2018 Sep 27.

Department of Ophthalmology, Seoul National University College of Medicine, Seoul, South Korea; Laboratory of Ocular Regenerative Medicine and Immunology, Seoul Artificial Eye Center, Seoul National University Hospital Biomedical Research Institute, Seoul, South Korea; Department of Ophthalmology, Seoul National University Hospital Healthcare System Gangnam Center, Seoul, South Korea. Electronic address:

Purpose: To evaluate the long-term outcome of neodymium:yttrium-aluminum-garnet (Nd:YAG) laser posterior capsulotomy after cataract surgery in children.

Design: Retrospective case series.

Methods: Electronic medical records of pediatric patients who underwent Nd:YAG laser posterior capsulotomy between January 1, 2008, and October 31, 2012, and followed up for more than 5 years were reviewed.

Results: Thirty-one eyes of 25 patients were included. Only compliant patients assessed during slit-lamp examination and anterior segment photography underwent laser treatment. The mean age at the time of initial laser treatment was 9.04 ± 3.51 years (minimum 56 months), and the mean interval between cataract surgery and initial laser treatment was 28.1 ± 22.1 months. Posterior capsular openings were successfully made in 26 (83.9%) eyes with a single attempt and in 3 (9.7%) eyes with a second attempt. Overall success rate was 93.5%. The logMAR best-corrected visual acuity was significantly improved from 0.61 ± 0.36 to 0.19 ± 0.25 at 1 month posttreatment (P < .0001) and well maintained, at least for 5 years of follow-up, without serious complications. The recurrence of posterior capsular opacity was observed in 7 (24.1%) eyes, which was successfully managed by repeated laser procedure or surgical capsulectomy.

Conclusions: By selecting compliant patients and repeated attempts, Nd:YAG laser posterior capsulotomy can be successfully performed in a pediatric population without serious complications. Laser treatment is also a good option for managing recurred posterior capsular opacity. Restored visual acuity can be maintained for at least 5 years.
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http://dx.doi.org/10.1016/j.ajo.2018.09.022DOI Listing
January 2019

Clinical features and outcome of corneal opacity associated with congenital glaucoma.

BMC Ophthalmol 2018 Aug 2;18(1):190. Epub 2018 Aug 2.

Laboratory of Ocular Regenerative Medicine and Immunology, Seoul Artificial Eye Center, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea.

Background: To investigate the clinical features of corneal opacity and the surgical outcome of penetrating keratoplasty (PK) in eyes with congenital glaucoma.

Methods: A retrospective review was made of the records from 320 eyes of 193 patients who were diagnosed with congenital glaucoma between January 1981 and January 2016. Anterior segment photographs at disease presentation were examined for the presence and severity of corneal opacity. Data on patient demographics, intraocular pressure (IOP), ocular and systemic comorbidities, ocular surgery and its outcome were collected.

Results: Overall, corneal opacification was observed in 248 of 320 eyes (77.5%). Out of 248 eyes with corneal opacification, 53 eyes had Haab striae alone, and 195 eyes presented with either nebulomacular corneal opacity (128 eyes, iris details visible through opacity) or leukomatous corneal opacity (67 eyes, iris details invisible through opacity). In 12 eyes with severe leukomatous corneal opacity, PK was performed at the mean age of 18.6 months (range 4-57 months). The grafts failed in 6 eyes (50%) due to endothelial rejection (4 eyes) or graft infection (2 eyes) during the mean 80.6 months of follow-up (range 15-228 months). The median survival time was 36 months. The graft failure was significantly associated with smaller corneal diameter at the time of surgery, but not with the age, IOP, combined aniridia, simultaneous glaucoma or lens surgery.

Conclusion: Congenital glaucoma was combined with corneal opacity in 77.5%. The corneal transplant survival was 50% in eyes with congenital glaucoma and total corneal opacity.
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http://dx.doi.org/10.1186/s12886-018-0865-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6090947PMC
August 2018

Long-term Outcomes After Same Amount of Bilateral Rectus Muscle Recession for Intermittent Exotropia With the Same Angle of Deviation.

J Pediatr Ophthalmol Strabismus 2018 Sep 19;55(5):319-325. Epub 2018 Jun 19.

Purpose: To evaluate long-term outcomes of homogenous bilateral rectus recession in patients with the same preoperative angle of deviation in intermittent exotropia and investigate factors associated with surgical outcomes.

Methods: In this retrospective review, patients with the same preoperative angle of deviation who underwent bilateral 6-mm lateral rectus recession between January 2008 and January 2014 were observed for 2 or more years. Patients were classified into two groups based on deviation angle: success (orthophoria or exodeviation < 10 prism diopters [PD]) or recurrence (exodeviation ≥ 10 PD). Preoperative and postoperative ophthalmologic factors were compared between groups.

Results: The success and recurrence groups contained 50 and 49 patients, respectively. Preoperative maximum angle of deviation was 29.0 ± 1.8 PD at distance in the success group and 28.9 ± 1.8 PD in the recurrence group. Deviation at the 2-year follow-up was 3.7 ± 3.7 and 18.3 ± 5.3 PD in the success and recurrence groups, respectively (P < .001). Preoperative factors were not significantly different between groups except for presence of lateral incomitance; success group patients presented more lateral incomitance (P = .035). The success group also presented more esodeviation just after the operation and showed a more stable course during follow-up. Surgical outcomes of patients with 10 PD or more of esodeviation 1 week postoperatively were significantly more favorable than patients with less than 10 PD of esodeviation (P = .027, log-rank test).

Conclusions: Presence of lateral incomitance and early postoperative overcorrection were significantly associated with favorable surgical outcome and should be considered when planning intermittent exotropia surgery. [J Pediatr Ophthalmol Strabismus. 2018;55(5):319-325.].
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http://dx.doi.org/10.3928/01913913-20180329-02DOI Listing
September 2018

Outcomes of Proton Beam Radiation Therapy for Retinoblastoma With Vitreous Seeds.

J Pediatr Hematol Oncol 2018 11;40(8):569-573

Department of Ophthalmology, Seoul National University College of Medicine.

Vitreous seeds are the most challenging aspect in the management of retinoblastoma. We report the outcomes of treatment with proton beam radiation therapy (PBRT) for retinoblastoma with vitreous seeds in naive or previously treated eyes. In this retrospective case series, we analyzed data of 4 retinoblastoma patients with vitreous seeds who received PBRT at the Proton Therapy Center, National Cancer Center in Korea between June 2007 and August 2017. All 4 eyes treated by PBRT were classified as group D according to the International Classification of Retinoblastoma (ICRB) criteria, and the vitreous seeds, as class 3 (clouds). The tumor and vitreous seeds regressed in 2 eyes, and globe salvage was achieved in these 2 eyes (50%). The post-PBRT ophthalmologic follow-up time of these 2 preserved eyes was 12 and 50 months, respectively. Visual acuity measurements of the successfully treated patients were 20/40 and 20/600. No radiation-associated malignancies were noted. In conclusion, PBRT successfully treated vitreous seeds classified as clouds in half of the cases, and successfully treated patients who retained useful vision. Therefore, PBRT might be a viable treatment option for vitreous seeds in patients with retinoblastoma.
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http://dx.doi.org/10.1097/MPH.0000000000001176DOI Listing
November 2018

Effects on Periocular Tissues after Proton Beam Radiation Therapy for Intraocular Tumors.

J Korean Med Sci 2018 Apr 16;33(16):e120. Epub 2018 Apr 16.

Department of Ophthalmology, College of Medicine, Seoul National University, Seoul, Korea.

Background: To present our experience on orbital and periorbital tissue changes after proton beam radiation therapy (PBRT) in patients with intraocular tumors, apart from treatment outcomes and disease control.

Methods: Medical records of 6 patients with intraocular tumors who had been treated with PBRT and referred to oculoplasty clinics of two medical centers (Seoul National University Hospital and Seoul Metropolitan Government-Seoul National University Boramae Medical Center) from October 2007 to September 2014 were retrospectively reviewed. The types of adverse effects associated with PBRT, their management, and progression were analyzed. In anophthalmic patients who eventually underwent enucleation after PBRT due to disease progression, orbital volume (OV) was assessed from magnetic resonance (MR) images using the Pinnacle3 program.

Results: Among the six patients with PBRT history, three had uveal melanoma, and three children had retinoblastoma. Two eyes were treated with PBRT only, while the other four eyes ultimately underwent enucleation. Two eyes with PBRT only suffered from radiation dermatitis and intractable epiphora due to canaliculitis or punctal obstruction. All four anophthalmic patients showed severe enophthalmic features with periorbital hollowness. OV analysis showed that the difference between both orbits was less than 0.1 cm before enucleation, but increased to more than 2 cm³ after enucleation.

Conclusion: PBRT for intraocular tumors can induce various orbital and periorbital tissue changes. More specifically, when enucleation is performed after PBRT due to disease progression, significant enophthalmos and OV decrease can develop and can cause poor facial cosmesis as treatment sequelae.
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http://dx.doi.org/10.3346/jkms.2018.33.e120DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5897156PMC
April 2018

Predictability of formulae for intraocular lens power calculation according to the age of implantation in paediatric cataract.

Br J Ophthalmol 2019 01 31;103(1):106-111. Epub 2018 Mar 31.

Department of Ophthalmology, Seoul National University Hospital, Seoul, South Korea

Aims: To analyse the predictability of diverse intraocular lens (IOL) power calculation formulae in paediatric patients with congenital cataract.

Methods: The medical records of patients who underwent cataract surgery and posterior chamber IOL implantation (in-the-bag) for congenital cataract before 17 years of age were reviewed retrospectively. Target refractions calculated by Sanders-Retzlaff-Kraff (SRK)/II, SRK/T and Hoffer-Q formulae were compared with the actual refraction. Patients were subgroup according to the age at IOL implantation (age group 0-24 months, 25-60 months, 61-120 months, 121-203 months), and we compared mean prediction error (PE) and mean absolute error (AE) for each formula. Corrected AE was obtained by linear regression analysis.

Results: Totally 481 eyes were included in the final analysis. Both SRK/II and SRK/T yielded the lowest mean AE in the age group 0-24 months and SRK/II yielded the lowest mean AE in the age group 25-60 months. For every formula, the mean PE was positive during the first five years of age, which converged to zero according to age as IOL implantation increases. The tendency for immediate postoperative overcorrection in younger patients (<6 years) could be improved by corrected formulae based on the linear regression equation.

Conclusions: Patients with congenital cataract who underwent IOL implantation within 5 years of age showed higher AE than the older ones did. Among the three formulae evaluated, SRK/II consistently provided the best predictive result in these patients. For patients aged >10 years, all three formulae showed favourable predictive abilities.
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http://dx.doi.org/10.1136/bjophthalmol-2017-311706DOI Listing
January 2019

Long-term Lens Complications Following Removal of Persistent Pupillary Membrane.

Korean J Ophthalmol 2018 04 19;32(2):103-107. Epub 2018 Mar 19.

Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea.

Purpose: We evaluated the long-term surgical outcome and lens complications in children with persistent pupillary membrane following removal using vitreous scissors.

Methods: Patients diagnosed with persistent pupillary membrane who received surgical treatment from 1987 to 2012 were retrospectively reviewed. The removal was performed using vitreous scissors after instillation of miotics. The minimum follow-up period after surgery was four years. Factors of age, sex, visual acuity, refractive errors, and complications during or after surgery were evaluated.

Results: A total of 32 eyes of 26 patients were included. The mean age at the initial visit was 22.6 ± 34.7 (range, 0.9 to 141.2) months, and the mean age at surgery was 43.7 ± 36.0 (range, 1.0 to 142.5) months. There were no intraoperative complications using vitreous scissors, and all lesions were completely removed. After a mean follow-up period of 6.5 ± 3.3 (range, 4.0 to 14.8) years, the best corrected visual acuity at the final visit was 0.6 ± 0.9 logarithm of the minimum angle of resolution, and two eyes (6.3%) presented with lens opacity during follow-up.

Conclusions: In children with persistent pupillary membrane, there were no intraoperative complications, and only two patients presented with lens change during the long-term postoperative follow-up period. Surgical removal should be considered a safe and effective treatment for patients with visually significant persistent pupillary membrane.
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http://dx.doi.org/10.3341/kjo.2017.0069DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5906394PMC
April 2018

Comparison of the characteristics of patients with intermittent exotropia according to response to diagnostic monocular occlusion.

Jpn J Ophthalmol 2018 Mar 30;62(2):243-248. Epub 2018 Jan 30.

Department of Ophthalmology, Seoul National University College of Medicine, 101 Daehak-Ro, Jongno-Gu, Seoul, 110-744, Korea.

Purpose: To compare the characteristics of intermittent exotropia patients according to their response to the diagnostic monocular occlusion test.

Study Design: Retrospective study.

Methods: A retrospective review was performed of 141 patients with intermittent exotropia who had taken a monocular occlusion test before surgery. We classified the patients into 3 groups based on the response to monocular occlusion. The increase group was defined as those patients having an increase in deviation of ≥ 5 prism diopters (PD) after monocular occlusion as compared with the maximum measured angle. The decrease group was defined as those patients having a decrease in deviation of ≥ 5 PD. Otherwise, patients were classified as having no change. The patients' characteristics were compared among the groups.

Results: At distance fixation, 9 patients (6.5%) were classified as increase, 92 patients (66.7%) as no change, and 37 patients (26.8%) as decrease after monocular occlusion. At near fixation, 50 patients (35.5%) were classified as increase, 65 patients (46.1%) as no change, and 26 patients (18.4%) as decrease. At distance fixation, no significant differences were found between the parameters of the patients in the increase group and those of the patients in the other 2 groups. In patients with a small maximum angle of exodeviation at near fixation and with few visits, the deviation at near fixation significantly increased after diagnostic occlusion.

Conclusion: Fifty-two patients (36.8%) showed an increase of ≥ 5 PD during distance or near fixation after monocular occlusion. In patients with a small maximum angle at near fixation and with few visits, it would be beneficial to perform the monocular occlusion test before surgery to reveal the maximal deviation angle, regardless of exotropia type.
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http://dx.doi.org/10.1007/s10384-018-0567-8DOI Listing
March 2018

Relationship between Pericytes and Endothelial Cells in Retinal Neovascularization: A Histological and Immunofluorescent Study of Retinal Angiogenesis.

Korean J Ophthalmol 2018 02 25;32(1):70-76. Epub 2018 Jan 25.

Department of Ophthalmology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.

Purpose: To evaluate the relationship between pericytes and endothelial cells in retinal neovascularization through histological and immunofluorescent studies.

Methods: C57BL/6J mice were exposed to hyperoxia from postnatal day (P) 7 to P12 and were returned to room air at P12 to induce a model of oxygen-induced retinopathy (OIR). The cross sections of enucleated eyes were processed with hematoxylin and eosin. Immunofluorescent staining of pericytes, endothelial cells, and N-cadherin was performed. Microfluidic devices were fabricated out of polydimethylsiloxane using soft lithography and replica molding. Human retinal microvascular endothelial cells, human brain microvascular endothelial cells, human umbilical vein endothelial cells and human placenta pericyte were mixed and co-cultured.

Results: Unlike the three-layered vascular plexus found in retinal angiogenesis of a normal mouse, angiogenesis in the OIR model is identified by the neovascular tuft extending into the vitreous. Neovascular tufts and the three-layered vascular plexus were both covered with pericytes in the OIR model. In this pathologic vascularization, N-cadherin, known to be crucial intercellular adhesion molecule, was also present. Further evaluation using the microfluidic in vitro model, successfully developed a microvascular network of endothelial cells covered with pericytes, mimicking normal retinal angiogenesis within 6 days.

Conclusions: Pericytes covering endothelial cells were observed not only in vasculature of normal retina but also pathologic neovascularization of OIR mouse at P17. Factors involved in the endothelial cell-pericyte interaction can be evaluated as an attractive novel treatment target. These future studies can be performed using microfluidic systems, which can shorten the study time and provide three-dimensional structural evaluation.
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http://dx.doi.org/10.3341/kjo.2016.0115DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5801093PMC
February 2018

Fluorescein Angiographic Abnormalities in the Contralateral Eye with Normal Fundus in Children with Unilateral Coats' Disease.

Korean J Ophthalmol 2018 02 25;32(1):65-69. Epub 2018 Jan 25.

Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea.

Purpose: We report the detection of peripheral retinal vascular abnormalities in the fellow eye with normal fundus in children with unilateral Coats' disease.

Methods: The clinical records of patients diagnosed with Coats' disease were retrospectively reviewed. We recorded the subjects' characteristics and obtained fundus photography and fluorescein angiography (FA) images. The main outcome measure was peripheral vascular abnormalities in the contralateral eye with normal fundus in children with unilateral Coats' disease, observed with FA.

Results: Out of 47 patients with Coats' disease, two (4.3%) were diagnosed with clinically bilateral Coats' disease. Of the 45 patients with presumed unilateral Coats' disease, four (8.9%) had bilateral abnormal peripheral vasculature in FA. The mean age of these four patients was 6.4 ± 5.4 years (range, 1 to 14 years), and three patients were male (75%). All four had peripheral retinal nonperfusion, and two (50%) received laser photocoagulation due to peripheral leakage with telangiectatic vessels.

Conclusions: Coats' disease may more often be a bilateral disease with asymmetry than previously thought. Patients with Coats' disease should undergo careful examination of the fellow eye with FA in order to detect and treat vascular abnormalities that are not visible clinically.
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http://dx.doi.org/10.3341/kjo.2016.0092DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5801092PMC
February 2018

RORα2 requires LSD1 to enhance tumor progression in breast cancer.

Sci Rep 2017 09 20;7(1):11994. Epub 2017 Sep 20.

Creative Research Initiatives Center for Chromatin Dynamics, School of Biological Sciences, Seoul National University, Seoul, 151-742, South Korea.

Retinoic acid-related orphan receptor α (RORα) regulates diverse physiological processes, including inflammatory responses, lipid metabolism, circadian rhythm, and cancer biology. RORα has four different isoforms which have distinct N-terminal domains but share identical DNA binding domain and ligand binding domain in human. However, lack of specific antibody against each RORα isoform makes biochemical studies on each RORα isoform remain unclear. Here, we generate RORα2-specific antibody and characterize the role of RORα2 in promoting tumor progression in breast cancer. RORα2 requires lysine specific demethylase 1 (LSD1/KDM1A) as a coactivator for transcriptional activation of RORα2 target genes, exemplified by CTNND1. Intriguingly, RORα2 and LSD1 protein levels are dramatically elevated in human breast cancer specimens compared to normal counterparts. Taken together, our studies indicate that LSD1-mediated RORα2 transcriptional activity is important to promote tumor cell migration in human breast cancer as well as breast cancer cell lines. Therefore, our data establish that suppression of LSD1-mediated RORα2 transcriptional activity may be potent therapeutic strategy to attenuate tumor cell migration in human breast cancer.
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http://dx.doi.org/10.1038/s41598-017-12344-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5607251PMC
September 2017

Chronological Changes in Tip Cells during Sprouting Angiogenesis of Development of the Retinal Vasculature in Newborn Mice.

Curr Eye Res 2017 11 19;42(11):1511-1517. Epub 2017 Sep 19.

a Fight against Angiogenesis-Related Blindness (FARB) Laboratory, Clinical Research Institute , Seoul National University Hospital , Seoul , South Korea.

Purpose: To investigate a sequential chronological change in tip cells during the development of the retinal vasculature in newborn mice.

Materials And Methods: Newborn C57BL/6 mice were used for this study. To elucidate the patterns in the developing retinal vasculature, histology, and immunohistochemistry-antiplatelet endothelial cell adhesion molecule-1, anticollagen type IV, isolectin IB-were performed on sections of mouse retina on postnatal days (P)-4, -8, and -12. Staining patterns of isolectin IB-stained arterial and venous tip cells were compared in retinal wholemounts, in which the numbers and characteristics of tip cells were compared between arteries and veins on P-4, -6, and -8. In addition, vascular densities and branching patterns were compared between arterial and venous vascular forefront areas.

Results: Tip cells in the superficial vascular plexus were observed until P-8. The number of tip cells was highest on P-6, decreasing dramatically from P-6 to P-8 (P-4, 165.2 ± 10.1, n = 17; P-6, 183.8 ± 19.4, n = 15; P8, 21.4 ± 6.4, n = 15) (p < 0.05, respectively, t-test). There was a greater number of tip cells in veins versus arteries on P-4 and P-6 (P-4, 91.0 ± 9.2 veins versus 74.2 ± 10.4 arteries; P-6, 104.0 ± 10.2 veins versus 79.8 ± 11.3 arteries) (p < 0.05, respectively). Arterial tip cells had thinner and longer sprouts compared with venous tip cells (basal thickness: 15.7 ± 8.7 veins versus 9.9 ± 3.5 μm arteries) (length, 20.3 ± 9.1 veins versus 37.1 ± 13.2 μm arteries on P-4) (p < 0.05, respectively). Vessel areas and densities of vascular branch points were significantly higher around veins compared to arteries (vessel areas: 58.9 ± 1.2% veins versus 40.8 ± 1.9% arteries; vascular branch points, 1371.9 ± 136.7/mm veins versus 1046.7 ± 175.5/mm arteries) (p < 0.05, respectively).

Conclusion: The number of tip cells increased to a greater extent in the superficial vascular plexus of veins versus arteries until P-6. Consequently, there are more vessel areas and vascular branch points near retinal veins versus arteries. Arterial tip cells are longer and thinner than the shorter and thicker venous tip cells.
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http://dx.doi.org/10.1080/02713683.2017.1347691DOI Listing
November 2017

RORα controls hepatic lipid homeostasis via negative regulation of PPARγ transcriptional network.

Nat Commun 2017 07 31;8(1):162. Epub 2017 Jul 31.

Department of Biological Sciences, Creative Research Initiatives Center for Chromatin Dynamics, Seoul National University, Seoul, 08826, South Korea.

The retinoic acid receptor-related orphan receptor-α (RORα) is an important regulator of various biological processes, including cerebellum development, circadian rhythm and cancer. Here, we show that hepatic RORα controls lipid homeostasis by negatively regulating transcriptional activity of peroxisome proliferators-activated receptor-γ (PPARγ) that mediates hepatic lipid metabolism. Liver-specific Rorα-deficient mice develop hepatic steatosis, obesity and insulin resistance when challenged with a high-fat diet (HFD). Global transcriptome analysis reveals that liver-specific deletion of Rorα leads to the dysregulation of PPARγ signaling and increases hepatic glucose and lipid metabolism. RORα specifically binds and recruits histone deacetylase 3 (HDAC3) to PPARγ target promoters for the transcriptional repression of PPARγ. PPARγ antagonism restores metabolic homeostasis in HFD-fed liver-specific Rorα deficient mice. Our data indicate that RORα has a pivotal role in the regulation of hepatic lipid homeostasis. Therapeutic strategies designed to modulate RORα activity may be beneficial for the treatment of metabolic disorders.Hepatic steatosis development may result from dysregulation of lipid metabolism, which is finely tuned by several transcription factors including the PPAR family. Here Kim et al. show that the nuclear receptor RORα inhibits PPARγ-mediated transcriptional activity by interacting with HDAC3 and competing for the promoters of lipogenic genes.
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http://dx.doi.org/10.1038/s41467-017-00215-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5534431PMC
July 2017

Effect of 4-Month Intermittent Atropine Penalization in Amblyopic Children for Whom Patch Therapy Had Failed.

J Pediatr Ophthalmol Strabismus 2017 Nov 5;54(6):375-380. Epub 2017 Jul 5.

Purpose: To evaluate the effect of 4-month intermittent atropine penalization in children with amblyopia for whom patch therapy had failed and to analyze the factors associated with treatment success.

Methods: This retrospective observational study included participants who visited the hospital between January 1, 2011, and December 31, 2015. Forty-one children with amblyopia for whom patch therapy had failed were included and their medical records were analyzed retrospectively. They were treated with 1% atropine eye drops in the sound eye twice per week for 4 months. Treatment success was defined as a best corrected visual acuity (BCVA) improvement of two lines in the amblyopic eye. Age, cause of amblyopia, pretreatment BCVA at the start of atropine penalization in the amblyopic eye, age at the start of eyeglass prescription, age at the start of patch therapy, duration, compliance with and total amount of patch therapy, type of refraction, type of strabismus, and cause of failure of patch therapy were analyzed and compared between two groups: the failure and success groups.

Results: Twenty of 41 patients (48.8%) showed treatment success. The mean age was 5.59 ± 1.52 years and the mean BCVA of the amblyopic eye was 0.40 ± 0.20 logarithm of the minimum angle of resolution (logMAR). Younger age and poor pretreatment BCVA at the start of atropine penalization in the amblyopic eye were the factors associated with treatment success.

Conclusions: Intermittent atropine penalization for 4 months can improve BCVA in children with amblyopia for whom patch therapy has failed. Atropine penalization can be especially effective in younger children and those with poor BCVA at the start of atropine penalization in the amblyopic eye. [J Pediatr Ophthalmol Strabismus. 2017;54(6):375-380.].
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http://dx.doi.org/10.3928/01913913-20170329-02DOI Listing
November 2017

Clinical characteristics of sibling patients with comitant strabismus.

Int J Ophthalmol 2017 18;10(5):772-775. Epub 2017 May 18.

Department of Ophthalmology, Seoul National University College of Medicine, Seoul 110-744, Korea.

Aim: To investigate the clinical characteristics of sibling patients with comitant strabismus.

Methods: Sibling patients who were diagnosed with comitant strabismus from January 2005 to December 2014 were retrospectively reviewed. Factors including age, sex, types of strabismus, refractive errors, angle of deviation, and coexistence of other strabismus were analyzed.

Results: A total of 62 patients (31 pairs of siblings) were included. Of these, 26 pairs had intermittent exotropia, 3 had accommodative esotropia, and 2 had infantile esotropia. There were no pairs with different subtypes of strabismus. The age at first visit was 3.7±2.6y and the mean follow-up period was 30.5±24.1mo. In siblings with intermittent exotropia, there was no difference in age of onset, age at operation, or refractive errors between the first and second-born children. The 20 (77%) pairs of siblings with exotropia showed more than 80% concordance of maximum angle of deviation during follow-up. In the 9 pairs in which both siblings had an operation, the final angle of deviation after the operation was 8.2±8.1 prism diopters (PD) in first-born children and 8.6±6.5 PD in second-born children.

Conclusion: The subtypes of strabismus are the same in all pairs of siblings and clinical characteristics of strabismus are similar between the first and second-born children. This similarity could be an indicator for the diagnosis of second-born children. Further prospective study including a larger number of sibling patients is needed.
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http://dx.doi.org/10.18240/ijo.2017.05.19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5437467PMC
May 2017