Correlation between bilateral lateral rectus muscle recession and myopic progression in children with intermittent exotropia

Although several studies have reported about the relationship between the surgical correction of intermittent exotropia and myopic progression, it remains unclear, unlike the relationship between esotropia and hyperopia. Thus, this retrospective case control study evaluated the impact of bilateral lateral rectus recession in intermittent exotropia on myopic progression. This study included 388 patients with intermittent exotropia. The refractive errors and degree of exodeviation at each follow up period were analyzed. The rate of myopic progression was −0.46 ± 0.62 diopter (D)/year in patients who underwent surgery and −0.58 ± 0.78 D/year in patients who did not, with no significant difference between them (p = 0.254). Patients who had recurrences of more than 10 prism diopters were compared with patients who did not have. The rate of myopic progression was −0.57 ± 0.72 D/year in the recurrent group and −0.44 ± 0.61 D/year in the non-recurrent group, with no significant difference between them (p = 0.237). Patients with fast myopic progression had more recurrence than patients with slow progression (p = 0.042). Moreover, recurrence had a positive correlation with fast myopic progression (OR = 2.537, p = 0.021). Conclusively, the surgical correction of intermittent exotropia did not influence myopic progression. © 2023, The Author(s).ope

Therapeutic Efficacy of Intravitreal Dexamethasone Implant in Korean Patients with Non-infectious Uveitis

Purpose To evaluate the therapeutic efficacy and safety of intravitreal dexamethasone implant in non-infectious uveitis (divided into anterior, intermediate, posterior, and panuveitis types). Methods The medical records of patients who received intravitreal dexamethasone implants between June 2013 and January 2018 at a tertiary referral hospital were analyzed retrospectively. Results A total of 38 eyes of 36 patients were included. All patients were diagnosed with non-infectious uveitis and received intravitreal dexamethasone implants. The mean age was 55.6 years, and 18 (50.0%) patients were male. In total, 6 (15.8%) eyes were diagnosed with anterior uveitis, 5 (13.2%) with intermediate uveitis, 16 (42.1%) with posterior uveitis, and 11 (28.9%) with panuveitis. Patients with all types of uveitis showed significant improvement in clinical outcomes after intravitreal dexamethasone implant. Three eyes showed increased intraocular pressure, while four showed cataract progression and thus received cataract extraction after injection. Seventeen (44.7%) eyes relapsed an average of 1.18 ± 0.39 times and received additional treatments. Conclusions Non-infectious uveitis patients showed significant improvement in clinical outcomes after intravitreal dexamethasone implant injection. However, care is required during injection due to the risk of recurrence, as well as side effects such as increased intraocular pressure and cataract progression.ope

Long-term therapeutic effects of partial splenic embolization on secondary hypersplenism

Background: Liver cirrhosis causes secondary hypersplenism and thrombocytopenia is clinically troublesome. Splenectomy (SPL) was thought to be the curative management for correcting thrombocytopenia. However, decompensated liver function prevents any surgical approach due to high morbidity and mortality. Hence, partial splenic embolization (PSE) has been introduced, which is a less invasive procedure. The purpose of this study was to assess the long-term therapeutic effects of PSE and to compare them with those of SPL. Methods: This study was performed retrospectively in patients who underwent PSE or SPL from Jan. 1999 to Dec. 2003. The patients either had symptoms of bleeding or they needed to correct their thrombocytopenia for further treatment of associated diseases. The therapeutic effects were evaluated, and the complications were assessed. Results: Forty and 35 patients were enrolled in the PSE and SPL groups, respectively. WBC, platelet and hemoglobin counts were all significantly increased at the 2 year follow-up in both groups. Child-Pugh score significantly decreased in the PSE group from 6.5 before treatment to 5.5 after treatment (p=0.004). Minor complications were easily controlled with supportive care, and major complications very rarely occurred in both groups. Conclusions: PSE and SPL both proved to be effective measures with few serious complications for treating pancytopenia in patients with liver cirrhosis. Considering the improved liver function (the prothrombin time) and the Child-Pugh score after PSE, it may be more reasonable to initially recommend PSE for the patients with liver cirrhosis and secondary hypersplenism.ope

Therapeutic Efficacy of Spironolactone for Central Serous Chorioretinopathy

Purpose: To evaluate the therapeutic effects and safety of oral spironolactone (SPRL) in patients with central serous chorioretinopathy (CSC). Materials and methods: The medical records and imaging data of patients diagnosed with CSC and treated with SPRL were retrospectively reviewed. Central macular thickness (CMT), subretinal fluid (SRF) height, subfoveal choroidal thickness (SFCT), and best-corrected visual acuity (BCVA) at baseline, at 1, 3, and 6 months, and at the last visit after the treatment were analyzed. Results: In total, 103 patients with 107 eyes were included. The mean age of the patients was 51.5±9.3 years, and 77 (72.0%) were male. The mean follow-up duration was 48.6±40.2 weeks. The mean duration of oral SPRL therapy was 15.5±13.4 weeks. CMT, SRF height, and SFCT improved significantly at 1, 3, and 6 months after SPRL therapy and at the last follow-up. BCVA, however, showed no significant change at any time point. The rate of complete resolution of SRF at 1 month was higher in those with chronic CSC than in those with acute CSC (21.1% vs. 6.0%, respectively). Recurrence occurred in 14 (13.1%) eyes after the complete resolution of SRF. Older age (p=0.001), a greater number of previous intravitreal bevacizumab injections (p=0.006), and poor initial visual acuity (p=0.048) were associated with recurrence. No permanent adverse effects were observed. Conclusion: Oral SPRL showed therapeutic benefits in patients with CSC in terms of SRF resolution, but relatively frequent recurrence was observed, especially in older patients.ope

Short-term Effect and Safety of a Single Intravitreal Brolucizumab in Refractory Neovascular Age-related Macular Degeneration

Purpose: To assess effect of brolucizumab in Korean patients, and also analyze incidence of intraocular inflammation (IOI) rate, clinical features, treatment and prognosis. Methods: We reviewed EMR chart of history of brolucizumab injection patients retrospectively in Severance Hospital. Total 101 eyes of 92 patients were included. Patients consist of 80 wet age-related macular degeneration (wAMD) and 21 polypoidal choroidal vasculopathy (PCV). Demographic data, best corrected visual acuity (BCVA), anatomical features as central macular thickness, subretinal fluid (SRF), intraretinal fluid (IRF), height of pigment epithelium detachment (PED) through optical coherence tomography, incidence of IOI and their clinical feature, treatment, prognosis were assessed. Results: BCVA and subfoveal choroidal thickness of patients showed no statistical significancy. Central macular thickness, IRF and PED height showed statistically significant effect in 1 month after injection. SRF was improved significantly during 2 months of follow up. In subgroup analysis of PCV group, BCVA, subfoveal choroidal thickness, IRF showed no statistical significance. Central macular thickness and SRF showed improvement throughout 2 months. PED height showed 1 month of statistically significant effectiveness. There were six cases (5.9%) of IOI in total 101 eyes of brolucizumab injection cases. One case (0.99%) among IOI patients showed non-occlusive vasculitis. There was no case of occlusive vasculitis in our study. All cases were resolved after steroid treatment, topical or combination of topical and subtenon injection. Conclusions: Intravitreal injection of brolucizumab in Korean wAMD patients and PCV subgroups refractory to other anti-VEGF showed effectiveness in central macular thickness, IRF, SRF, and PED height. Incidence of IOI was 5.9% and no case of severe visual acuity deterioration. All IOI cases were resolved after topical or subtenon triamcinolone injection.ope

Discovery of susceptible gene by GWAS and prognostic biomarker by analysis of clinical data in Korean Crohn's disease

의학과/박사크론병은 아직까지 이 질병의 원인이 정확히 밝혀지지 않은 만성 난치성 염증성 장질환 중 하나이다. 전 위장관 침범이 가능하나 주로는 소장말단부위 회장과 대장에 궤양성 병변을 유발하며 상당수의 환자가 장의 협착, 농양, 천공, 누공 등 치명적 합병증으로 진행될 수 있으며, 수술적 치료가 필요한 경우도 있다. 염증성 장질환의 발생률 및 유병률은 지역적으로 큰 차이를 보이고 있으나, 최근 우리나라의 역학조사 결과에 의하면 발생률 및 유병률이 증가추세에 있다. 크론병은 궤양성 대장염과 함께 유전적, 환경적, 환자의 면역 시스템 등 복합적인 원인에 의해 발생하는 것으로 생각되어 왔으나, 최근 서구에서 진행된 연구에 따르면 가족 내에 발병률이 높고, 이란성보다는 일란성 쌍생아에서 보다 유병률이 높으며, 다양한 인종간 유병률의 차이를 보이고 있어 유전적 소인이 병인에 관여하는 것으로 생각된다. 한국인의 크론병의 임상양상에서 누적 수술률이 서구에 비해 약간 적은 경향을 보이나, 질병 침범부위에서 소장과 대장을 함께 침범하거나 항문주위 질환을 동반하는 경우가 더 흔하며, 다른 약제에 의한 반응률은 서구와 별차이가 없으나 azathioprine에 의한 골수 억제 부작용의 빈도는 매우 높게 관찰되고 있다. 한편, 과거 서구에서 단일염기다형성(SNP)으로 알려진 NOD2와 ATG16L1은 우리나라 크론병 환자에서는 감수성 유전자가 아닌 것으로 밝혀져, 한국인의 크론병 환자와 관련된 감수성 유전자를 찾기 위해 유전체 전장 연관성 분석(genome-wide association study, GWAS)을 하게 되었다. 본 연구의 목적은 국내 최초로 크론병 환자군을 대상으로 유전체 전장 연관성 분석 연구를 수행함으로 한국인의 크론병 발병 및 임상경과에 영향을 미치는 감수성 유전자를 규명하고자 하였다. 세브란스병원 임상연구윤리심의 위원회로부터 연구윤리심의를 받은 염증성 장질환 코호트 샘플 1200여개 중 크론병 환자 277명과 이에 대응하는 한국인 247명의 혈액샘플을 이용하여 분석하였다. 유전체 전장 연관성 분석 결과 TNFSF15 유전자가 한국인의 크론병에서 가장 감수성 있는 유전자로 나타났다.또한, 질환 표현형과의 연관 분석 결과 회장 말단의 병변과 연관성이 높을 것으로 생각되는 유전자는 DAB1, 대장을 침범한 경우와 연관성이 있는 유전자는 DACH1, 크론병으로 진단 후 조기입원과 연관될 것으로 생각되는 유전자는 NUCB2, 그리고 azathioprine이나 생물학제제를 사용하게 되는 환자와 연관성이 있는 유전자로 GRM8이 가능성이 있을 것으로 생각되며, 이 부분에 대해서는 추가 연구가 필요할 것으로 생각된다.ope

Clinical outcome of Crohn's disease.

의학과/석사[한글]크론병은 입으로부터 항문까지 소화관 전체에 병변을 일으키며, 질병 행태로는 점막층, 점막하층, 근육층 및 장막의 전층을 침범할 수 있는 전형적인 만성, 반복성 재연의 경과를 보이는 질환이다./ 이 질환은 발생시기가 10~20대로 인생에 있어서 학업이나 사회생활에서 활동이 왕성한 시기에 발병하며, 급성기에서 회복된 후에도 완전관해가 되지않고 만성질환으로 이환되는 비율이 높고, 다양한 임상양상을 나타내는 질환으로 서구에서는 그동안 많은 연구가 되었으나, 아직까지 우리나라에서는 증례보고나 단편적인 분석 정도만 보고되었다./ 이에 저자는 최근에 발표된 비엔나 분류법을 이용하여 크론병의 임상경과를 살펴보고, 비엔나 분류법의 임상적 유용성을 알아보고자 하였다. /1998년 발표된 비엔나 분류법은 크론병을 진단 당시의 나이에 따라 40세 미만(A1)과 40세 이상(A2)으로 나누고, 병변의 해부학적 위치에 따라 회장말단에 국한된 경우(L1), 대장만 침범한 경우(L2), 회장말단과 대장을 침범한 경우(L3), 회장말단보다 상부를 침범한 경우(L4)로 구분하고, 질병 행태에 따라 염증형(B1), 협착형(B2), 누공형(B3)으로 분류하는 방법이다./ 1990년 6월부터 2000년 6월까지 연세대학교 세브란스 병원에서 처음으로 크론병으로 진단된 후 24개월 이상 추적관찰이 가능하였던 72명의 환자를 대상으로 다음과 같은 방법을 이용하여 분석하였다. / 진단당시의 임상증상, 누적 수술률, 스테로이드 및 면역억제제 투약시기를 조사하였다. 매달 Harvey-Bradshaw 지수를 조사하여 일년 중 가장 높은 점수로 질병의 활성도를 평가하였다. 그리고 연간질병부담지수를 이용하여 환자가 겪는 질병의 부담정도를 분석하였다. 비엔나 분류법에 따라 환자를 나누어 보고 각 아군의 임상경과를 비교하였다. 또한 시간의 경과에 따른 질병 행태의 변화를 조사하였다. / 연간질병부담지수는 환자가 질병으로 인하여 겪는 괴로운 정도를 평가한 것으로 부담의 정도와 발현기간이 모두 중요하므로, 임상적 질병의 중증도를 월별로 평가하여 관해 상태이면 0점, 경증이면 1점, 중등증이면 2점, 중증이면 3점으로 하고 1년 간의 합으로 정의하였다./ 다음은 이번 연구조사에서 나타난 환자의 임상양상과 비엔나 분류법을 이용한 임상경과 분석결과이다.//1. 대상 환자는 총 72명으로 남자 40명, 여자 32명이었으며 크론병 진단 당시의 평균 나이는 27.9세였다. /2. 증상이 처음 발생한 후 크론병으로 진단될 때까지의 기간은 평균 16.9개월이었으며 현재까지 추적기간은 51.3개월이었다./3. 비엔나 분류법에 따라서 볼 때 진단당시 나이가 40세 미만이 64명(88.9%), 40세 이상이 8명(11.1%)이었으며, 회장말단에 국한된 경우가 14명(19.5%), 대장만 침범한 경우가 10명(13.9%), 회장말단과 대장을 침범한 경우가 33명(45.8%), 회장말단보다 상부를 침범한 경우가 15명(20.8%)이었다. 질병 행태별로는 염증형이 34명(47.2%), 협착형이 21명(29.2%), 누공형이 17명(23.6%)이었다./4. 연간최고질병활성도와 연간질병부담지수의 시간에 따른 변화를 Paired T-test로 비교해본 결과 진단 다음해에는 통계적으로 유의하게 감소하였으며 이후에는 큰 변화가 없었다. /5. 질병 행태 변화를 Kaplan-Meier 방법을 이용하여 분석한 결과 진단 후 협착형이나 누공형으로 진행하지 않고 염증형을 보이는 경우는 2년 후와 5년 후 각각 42.7%와 39.7%였고, 누공형으로 될 확률은 2년 후와 5년 후가 각각 33.3%와 36.3%였다./6. 진단 후 모든 환자에서 설파살라진 또는 메살라진을 투약하였으며, 스테로이드는 진단당시부터 사용된 경우가 19명(26%), 임상경과 중 한 번이상 증상조절을 위해 사용된 경우가 43명(59.7%)이었으며, azathioprine이 사용된 환자는 18명(25.0%)이었다./7. 누적수술률은 1년에 18.4%, 5년에 34.2%였다./8. 스테로이드 누적투여율은 1년에 48.6%, 5년에 64.8%였다./9. 비엔나 분류법에 따른 각 아군의 임상경과를 비교한 결과 진단당시 나이가 40세 이상인 군(A2)에서 연간최고질병활성도, 연간질병부담지수, 누적수술률, 스테로이드 및 면역억제제 누적투여율이 40세 미만인 군(A1)보다 통계적으로 유의하게 낮았다./10. 위치에 따른 분류에서는 연간최고질병활성도, 연간질병부담지수, 면역억제제 누적투여율에 있어 각 아군간에 유의한 차이를 보이지 않았다. 그러나, 대장만 침범한 경우(L2)가 다른 아군보다 누적수술률이 유의하게 낮은 반면, 스테로이드 누적투여율은 회장말단보다 상부를 침범한 경우(L4)와 함께 회장말단에 국한된 군(L1)이나 회장말단과 대장을 함께 침범한 군(L3)보다 통계적으로 유의하게 높았다./11. 질병 행태에 따른 분류에서는 누공형인 군(B3)의 연간최고질병활성도, 연간질병부담지수, 누적수술률, 스테로이드 누적투여율이 염증형(B1)이나 협착형(B2)보다 통계적으로 유의하게 높았다. // 진단당시의 나이 및 병변의 위치에 따른 아군의 비율은 외국에서 발표된 비엔나 분류에 따른 아군의 비율과 유사하였으며, 질병 행태별로 볼 때 진단당시에는 누공형이나 협착형의 환자가 다소 많았으나 시간이 지나면서 누공형의 경우 증가속도가 완만하게 증가하고, 협착형은 감소하여 그 비율은 외국에서 보고된 아군별 비율과 가까워지는 경향을 보였다. 연간최고질병활성도 및 연간질병부담지수를 비엔나 분류법에 따라 나눈 각 아군에 적용시켜 비교해본 결과 진단당시 나이가 40세 이상인 경우 임상경과가 양호한 반면 질병 행태에서 누공형의 경우 임상경과가 좋지 않았다. 누적수술률, 스테로이드 누적투여율도 비엔나 분류법에 따른 아군을 비교해 보면 시간에 따른 증가추세가 외국에서 보고된 것과 큰 차이가 없었다. 따라서 비엔나 분류법은 크론병의 임상경과를 예측하는데 도움이 되는 것으로 나타났다. [영문]Crohn''s disease is a heterogeneous entity that can affect any part of digestive tract from the mouth to the anus. Due to behavior of this disease, mucosa, submucosa, muscle and serosa can be affected while clinical course shows various cycles of remissions and relapses. Most of the period when patient is diagnosed with Crohn''s disease lies between second to third decades which is very important period in their life in terms of academic training and social activity. The disease does not completely resolve even after correction of severe complication. Up until now, there are only a few case reports or incomprehensive analysis in Korea compared to that in western country. In this research, we analyze various clinical features and courses of Crohn’s disease according to the Vienna classification and evaluate the clinical implication of the Vienna classification. The Vienna classification that was proposed in 1998, defined a classification for Crohn''s disease based on age at diagnosis [below 40 years (A1), equal to or above 40 years (A2)], location of disease [terminal ileum (L1), colon (L2), ileocolon (L3), upper gastrointestinal tract (L4)], and disease behavior [nonstricturing and nonpenetrating (B1), structuring (B2), penetrating (B3)]. In this study, data were gathered from a review of charts of 72 patients who were initially diagnosed as Crohn''s disease at Yonsei University Severance Hospital from June 1990 to June 2000 and regularly followed up at least 24 months. This research also analyzed the severity and duration of clinical symptoms, the number of surgery, and prescription of steroids or immunosuppressive drugs. The degree of disease activity was measured by Harvey-Bradshaw index every month. Annual disease burden index describes symptomatic period and severity when the symptom was most severe during last follow up year. This research classified the patient groups according to the Vienna classification, compared clinical courses among groups, and investigated the evolution of disease behavior across time. Followings are clinical features and clinical courses according to the Vienna classification. 1.Among 72 patients, 40 patients were male and 32 patients were female and the average of patient’s age was 27.9 years at diagnosis. 2.The time taken to diagnose Crohn’s disease from the onset of symptoms was 16.9 months and the average follow up period was 51.3 months. 3.According to the Vienna classification, the percentage of less than 40 years of age was 88.9% (64 patients) and the percentage of the age more than 40 years was 11% (8 patients). By disease location, Disease was located in the ileum terminal (L1) in 14 patients (19.5%), in the colon (L2) in 10 patients (13.9%), in ileocolon (L3) in 33 patients (45.8%), and in upper gastrointestinal tract (L4) in 15 patients (20.8%). By disease behavior, the percentage of nonstricturing nonpenetrating type (B1) was 47.2% (34 patients), structuring type (B2) was 29.2% (21 patients), and penetrating type (B3) was 23.6% (17 patients). 4.The results of Paired t-test on annual maximal disease activity index and annual disease burden index showed that the index decreased a year after initial diagnosis with statistical significance and there was no further prominent change. 5.As a result of analysis on disease behavior using Kaplan-Meier methods, the proportion of nonstricturing and nonpenetrating type without developing to structuring or penetrating respectively was 42.7% and 39.7% after 1 and 5 years from diagnosis, respectively. The proportion of penetrating type was 33.3% and 63.7% respectively after 1 and 5 years. 6.Sulfasalazines or Mesalazines were prescribed to all the patients at diagnosis, the cases in which steroids were used from the initial diagnosis in 19 patients (26%), while 43 patients were prescribed by steroid more than one time during follow-up period in order to lessen symptom. Azathioprines were used in 18 patients (25.0%) for relieving symptom. 7.The cumulative probability of the first surgery was 18.4% over a year and 34.2% over 5 years after diagnosis. 8.The cumulative probability of first treatment with steroids or with immunosuppressive drugs was 48.6% over a year and 64.8% over 5 years after diagnosis. 9.As a result of clinical courses analysis according to the Vienna classification, the age at diagnosis equal to or above 40 years (A2) was relatively lower than below 40 years (A1) in terms of annual maximal disease activity index, annual disease burden index, and the cumulative probability of the first surgery and treatment with steroids or with immunosuppressive drugs. 10.There was no statistically significant difference in lesions location in terms of annual maximal disease activity index, annual disease burden index, and the cumulative probability of treatment with immunosuppressive drugs. However, the colonic disease (L2) showed statistically significantly lower frequency of accumulated surgery and higher frequency of steroid medication than other subgroups. 11.By disease behavior, penetrating type (B3) showed higher tendency in annual maximal disease activity index, annual disease burden index, the cumulative probability of the first surgery and treatment with steroids than the other types (B1, B2). This research found out a similar pattern in 72 samples as that of foreign patients in terms of age and location of disease at diagnosis according to the Vienna classification. By disease behavior, it also turned out that the ratio among subgroups was approaching to reported ratio of foreign cases during follow-up period, even though the ratio of structuring and penetrating type at the initial diagnosis was higher than that of foreign cases. Clinical course in the patients of age at diagnosis was equal to or above 40 years (A2) showed a higher probability of remaining remission, however patients with intestinal penetrating disease (B3) were frequently submitted to abdominal surgery. The composition ratio between each subgroup, as defined by the Vienna classification, showed a similar increasing trend over time as the reported foreign cases in terms of the cumulative probability of the first surgery and treatment with steroids. Vienna classification was useful to predict clinical course of Crohn’s disease.ope

A modified, simple technique for internal limiting membrane free flap transplantation in macular hole surgery: the Peel-PFCL-Peel technique

ope

Pachydrusen, choroidal vascular hyperpermeability, and punctate hyperfluorescent spots

Purpose: To investigate the relationship between pachydrusen and features of choroidal vascular hyperpermeability (CVH) and punctate hyperfluorescent spots (PHS) on serial imaging in patients with polypoidal choroidal vasculopathy (PCV) or pachychoroid neovasculopathy (PNV). Methods: Patients diagnosed between January 2007 and June 2016 at 2 high-volume, tertiary hospitals were retrospectively reviewed with serial multimodal imaging assessment. The primary outcome was the association between drusen subtypes (hard/soft drusen, subretinal drusenoid droplets, or pachydrusen) with CVH and PHS, previously described in central serous chorioretinopathy. Results: Among the 105 eyes (105 patients; mean age, 67.0 years), 87 (82.9%) were diagnosed with PCV and 18 (17.1%) with PNV. Pachydrusen was the most frequently identified subtype (54 eyes, 51.4%). CVH (72.2% vs 41.4%, P = 0.021) and PHS (72.2% vs 44.8%, P = 0.041) were observed with greater frequency in PNV eyes. Significant correlations were found between CVH and PHS (phi coefficient φ 0.30, P = 0.003), and PHS with pachydrusen (φ 0.20, P = 0.040). Over a mean follow-up of 74.8 months, new drusen co-localizing to PHS were noted in 22 (21.0%) eyes (φ 0.54, P < 0.001). Conclusion: We observed a trend of pachydrusen appearing in conjunction with PHS in PCV or PNV. Frequent localization of new drusen to these choroidal lesions was observed over long-term follow-up. PHS may be a form of late-staining "forme fruste" drusen, possibly associated with micro-ischemic changes to the choriocapillaris.restrictio

Clinical significance of anti-Saccharomyces cerevisiae antibody (ASCA) in Korean patients with Crohn's disease and its relationship to the disease clinical course

BACKGROUNDS/AIMS: The implications of anti-Saccharomyces cerevisiae antibody for the diagnosis and the clinical course of Crohn's disease have been reported in Western countries, but rarely in Korea with its very different environmental and genetic backgrounds. We aimed to evaluate whether anti-S. cerevisiae antibody expression is associated with diagnostic findings, stratified Vienna classification phenotypes, disease activity and clinical course in Korean patients with Crohn's disease. MATERIALS/METHODS: One hundred and fifteen patients with Crohn's disease, diagnosed and treated between 1990 and 2004 at Severance Hospital, Yonsei University and followed for at least 2 years, were included in this study. Anti-S. cerevisiae antibody was detected by an indirect immunofluorescence assay using EUROIMMUN kits. Information collected during treatment included demography, Vienna classification phenotype, clinical manifestation, laboratory tests, treatment modality and surgery rate. Disease activity was measured monthly using the Harvey-Bradshaw index. RESULTS: The anti-S. cerevisiae antibody prevalence was 38.3% in Crohn's disease patients. There was no difference in anti-S. cerevisiae antibody expression between genders. The mean age at diagnosis was younger for the anti-S. cerevisiae antibody positive group than the negative group (25.3 years versus 29.7 years, p<0.05). Clinical manifestations and laboratory tests at diagnosis did not differ between the groups. The anti-S. cerevisiae antibody positive group had increased fibrostenosis (B2) and penetration (B3) compared to negative group, as determined by the Vienna classification (75.0% versus 53.5%, p<0.05). Anti-S. cerevisiae antibody positive patients were admitted to the hospital more frequently than anti-S. cerevisiae antibody negative patients (p<0.05). The yearly cumulative Harvey-Bradshaw index score was higher in the anti-S. cerevisiae antibody positive group than in the negative group during the follow-up period (p<0.05). In addition, steroid (72.7% versus 52.1%, p<0.05) and immunosuppressive (45.5% versus 23.9%, p<0.05) treatments were more frequently given to the anti-S. cerevisiae antibody positive group. CONCLUSIONS: Our data demonstrate that anti-S. cerevisiae antibody positive Crohn's disease patients had a more severe clinical course and thus often required more aggressive medical treatment.ope