Bum-Joo Cho

Prevalence and Risk Factors of Age-Related Macular Degeneration in Korea: The Korea National Health and Nutrition Examination Survey 2010-2011

PURPOSE To investigate the prevalence and risk factors of age-related macular degeneration (AMD) in the general Korean adult population. METHODS The study involved a nationally representative Korean population from the 2010 to 2011 Korea National Health and Nutrition Examination Survey. A total of 7899 subjects ≥ 40 years old participated in health interviews, physical examinations, and ophthalmologic assessment including fundus photography. RESULTS The overall prevalence of early AMD was estimated at 6.7% (95% confidence interval [CI], 6.1-7.4), and that of late AMD was estimated at 0.7% (95% CI, 0.5-0.9), which included 0.5% prevalence of neovascular AMD and 0.2% prevalence of geographic atrophy. The prevalence rates of early and late AMD among participants aged ≥ 65 years were 16.9% and 1.8%, respectively. Hyperopia was positively associated with the presence of any AMD type (odds ratio [OR], 1.08 for every 1 diopter increase). In multivariate analyses, significant risk factors for the presence of any AMD type were age, serum high-density lipoprotein (HDL) level, serum gamma-glutamyl transferase (GGT) level, and hepatitis B surface antigen (HBsAg) serum positivity (OR, 2.26). The risk factors for late AMD included age, ever-smoking history (OR, 2.18), serum GGT level, and systolic blood pressure. CONCLUSIONS The prevalence of AMD in Korea was similar to the prevalence of pooled Asian and Western populations. Age and serum GGT level were strongly associated with both the presence of any AMD and late AMD. Additionally, serum HDL level, HBsAg serum positivity, ever-smoking history, and systolic blood pressure were identified as risk factors for AMD.

Topographic correlation between β-zone parapapillary atrophy and retinal nerve fiber layer defect.

OBJECTIVE To investigate whether a topographic correlation exists between β-zone parapapillary atrophy (PPA) and retinal nerve fiber layer (RNFL) defect. The location and extent of the β-zone were examined. DESIGN Retrospective, cross-sectional study. PARTICIPANTS One hundred twenty-eight eyes from 128 consecutive patients with primary open-angle glaucoma (POAG) and a single localized RNFL defect were included. METHODS Digital optic disc photographs of the enrolled eyes were reviewed and eyes with β-zone PPA were identified. The topographic parameters of β-zone PPA and RNFL defect were measured on optic disc photographs and digital red-free RNFL photographs. The association between these parameters was examined statistically. MAIN OUTCOME MEASURES Angular location and angular extent of β-zone PPA and RNFL defect, angular location of point of maximum radial extent (PMRE) of β-zone PPA, and β-zone PPA-to-disc area ratio. RESULTS Eighty-two (64.1%) of the 128 eyes with a single localized RNFL defect had β-zone PPA. Patients with β-zone PPA were younger (by 6.6 years) than those without β-zone PPA (P = 0.001). β-Zone PPA was located most commonly inferotemporally (65.9%). The RNFL defect was located in the same hemifield as the β-zone PPA in 76% of eyes and was located in the same hemifield as PMRE in 88% of eyes. The angular location of the RNFL defect showed a linear correlation with those of β-zone PPA (r = 0.390; P<0.001) and PMRE (r = 0.558; P<0.001). The angular extent of RNFL defect was not correlated significantly with that of β-zone PPA (P = 0.106), but it was associated weakly with β-zone PPA-to-disc area ratio (r = 0.197; P = 0.026). The angular extent of the RNFL defect also was correlated with the cup-to-disc ratio (r = 0.322; P<0.001) and the cup-to-disc area ratio (r = 0.337; P = 0.002). CONCLUSIONS In POAG, a localized RNFL defect is correlated spatially with β-zone PPA.

Surgical outcomes according to vitreous management after scleral fixation of posterior chamber intraocular lenses.

Purpose: To investigate the effect of vitreous management on surgical outcomes after scleral fixation of posterior chamber intraocular lenses. Methods: The medical records of 83 eyes from 83 patients, who underwent scleral fixation of posterior chamber intraocular lenses without any preexisting vitreoretinal complication and were followed up for ≥6 months, were reviewed retrospectively. Subjects were divided according to the strategy used for vitreous management into a pars plana vitrectomy (PPV) group (47 eyes) and an anterior vitrectomy (AV) group (36 eyes). Surgical outcomes were compared between the groups. Results: Both groups were comparable regarding demographics, follow-up period, and underlying ocular disease. The degree of visual improvement was similar in both groups (P = 0.911). Postoperatively, each group developed a myopic shift, which was greater in the PPV group than in the AV group (P = 0.040). Intraocular pressure elevations ≥25 mmHg occurred in 50% of eyes in the AV group and in 11% of eyes in the PPV group (P < 0.001). Intraocular lenses dislocated more frequently in the AV group (28%) than in the PPV group (9%; P = 0.036). Intraocular lens capture was more common in the PPV group (23%) than in the AV group (3%; P = 0.010). There was no significant difference in the rate of postoperative vitreoretinal complications. Conclusion: In eyes that received scleral fixation of posterior chamber intraocular lenses, PPV decreased the chances of postoperative intraocular pressure elevation and intraocular lens dislocation but increased the likelihood of intraocular lens capture and the magnitude of postoperative myopic shift.

Epidemiological association between systemic diseases and age-related macular degeneration: the Korea National Health and Nutrition Examination Survey 2008-2011.

PURPOSE We examined the epidemiological association between systemic diseases and age-related macular degeneration (AMD) in the general Korean population. METHODS This cross-sectional study involved nationally representative data obtained from the 2008 to 2011 Korea National Health and Nutrition Examination Surveys. A total of 14,352 subjects aged ≥40 years participated in standardized health interviews regarding physician-diagnosis of several systemic diseases as well as physical examinations, including fundus photography for the evaluation of AMD. RESULTS The overall prevalence rates of early, late, and any AMD were 6.0%, 0.6%, and 6.6%, respectively. In univariate logistic regression analyses adjusted for age and sex as well as smoking in late AMD, any AMD and late AMD were less prevalent among diabetic patients and more prevalent in participants with a history of liver cancer. A history of liver cirrhosis was associated with a higher prevalence of any AMD. In the final multivariate model, the associated factors for any AMD included age (odds ratio [OR], 1.09), the presence of diabetes mellitus (DM; OR, 0.74), and a history of liver cancer (OR, 4.32). Factors associated with late AMD included age (OR, 1.09), ever-smoking history (OR, 2.45), the presence of DM (OR, 0.22), and a history of liver cancer (OR, 12.51). The presence of diabetic retinopathy was associated with a lower prevalence of any AMD (OR, 0.35). CONCLUSIONS When adjusted for confounders, any AMD and late AMD were less prevalent in diabetic patients. In contrast, a history of liver cancer was associated with a higher prevalence of any AMD and late AMD.

Complications of Pathologic Myopia.

Abstract: Pathologic myopia (PM) is one of the leading causes of visual impairment worldwide. The pathophysiology of PM is not fully understood, but the axial elongation of the eye followed by chorioretinal thinning is suggested as a key mechanism. Pathologic myopia may lead to many complications such as chorioretinal atrophy, foveoschisis, choroidal neovascularization, rhegmatogenous retinal detachment, cataract, and glaucoma. Some complications affect visual acuity significantly, showing poor visual prognosis. This article aims to review the types, pathophysiology, treatment, and visual outcome of the complications of PM.

Association between Reproductive Factors and Age-Related Macular Degeneration in Postmenopausal Women: The Korea National Health and Nutrition Examination Survey 2010-2012

Purpose To examine the association between female reproductive factors and age-related macular degeneration (AMD) in postmenopausal women. Design Nationwide population-based cross-sectional study. Methods A nationally representative dataset acquired from the 2010–2012 Korea National Health and Nutrition Examination Survey was analyzed. The dataset involved information for 4,377 postmenopausal women aged ≥50 years with a fundus photograph evaluable for AMD in either eye. All participants were interviewed using standardized questionnaires to determine reproductive factors including menstruation, pregnancy, parity, lactation, and hormonal use. The association between reproductive factors and each type of AMD was investigated. Results The mean age of the study participants was 63.1±0.2 years. Mean ages at menarche and menopause were 16.1±0.0 and 49.2±0.1 years, respectively. The overall prevalence rates of early and late AMD were 11.2% (95% confidence interval [CI], 10.1–12.5) and 0.8% (95% CI, 0.5–1.2), respectively. When adjusted for age, neither smoking nor alcohol use was associated with the presence of any AMD or late AMD. Multivariate logistic regression analysis revealed age (OR, 1.12 per 1 year), duration of lactation (OR, 0.91 per 6 months), and duration of use of oral contraceptive pills (OCP) (OR, 1.10 per 6 months) as associated factors for late AMD. The other variables did not yield a significant correlation with the risk of any AMD or late AMD. Conclusion After controlling for confounders, a longer duration of lactation appeared to protect against the development of late AMD. A longer duration of OCP use was associated with a higher risk of late AMD.

Cosmetic improvement of nevus of Ota by scleral allograft overlay.

OBJECTIVE To report surgical outcome of a new therapeutic technique for nevus of Ota by scleral allograft overlay. DESIGN Noncomparative clinical interventional study. PARTICIPANTS Eight eyes of 7 patients with scleral nevus of Ota. METHODS Patients underwent subconjunctival scleral allograft overlay between September 2005 and June 2007 at Seoul National University Hospital. Preoperative neval extent, postoperative cosmesis, complications, and visual acuity change were evaluated. RESULTS Most of the patients showed satisfying cosmetic improvement. There were no significant complications in a follow-up period of more than 3 years. CONCLUSIONS Scleral allograft overlay is a safe and effective procedure for cosmetic improvement of nevus of Ota.

The Efficacy of Superior Inverted Internal Limiting Membrane Flap Technique for the Treatment of Full-Thickness Macular Hole:

The Efficacy of Superior Inverted Internal Limiting Membrane Flap Technique for the Treatment of Full-Thickness Macular Hole Vitrectomy for macular holes (MHs) has shown a high closure rate and evident vision improvement.1–4 Many studies have shown that the removal of a membrane at the vitreoretinal interface in patients with idiopathic MH produced good functional and anatomical results.4–7 Surgical treatment of MHs aims to relieve vitreofoveal traction because firm foveal vitreous adhesion, anteroposterior vitreomacular traction, and tangential traction are believed to be the main factors in the pathogenesis of MH.2 In 2010, Michalewska et al8 suggested an inverted internal limiting membrane (ILM) flap technique for the treatment of idiopathic large MH. This technique prevented the postoperative flat-open appearance of MHs and improved the functional and anatomical results for MHs with a large diameter (.400 mm).9 However, the spontaneous retroversion of the ILM flap, or even ILM flap loss, occurs in up to 14% to 20% of patients during fluid–air exchange.8,10 Moreover, the patients have to mostly lie face down after the surgery. Recently published studies have introduced a modification of the classic inverted ILM flap technique.11,12 In this procedure, ILM peeling was restricted to the temporal side of the fovea, and the MH was covered with the temporal ILM flap. These studies concluded that the new technique was as effective as the classic inverted ILM flap technique for repairing large MHs. However, the temporal-side ILM flap could be difficult to keep in position because of the vector sum between gravity and the ILM tangential force. Therefore, in the present study, we attempted a novel modification by changing the direction of the ILM flap to the superior side to decrease the need of staying prone after the surgery for patients who had difficulty maintaining this position. We investigated the efficacy and convenience of the superior inverted ILM flap technique for the treatment of large idiopathic fullthickness MH. To our knowledge, this is the first study reporting the surgical outcome of this modified technique.

Horner's Syndrome and Contralateral Abducens Nerve Palsy Associated with Zoster Meningitis

A 55-year-old woman presented with diplopia following painful skin eruptions on the right upper extremity. On presentation, she was found to have 35 prism diopters of esotropia and an abduction limitation in the left eye. Two weeks later, she developed blepharoptosis and anisocoria with a smaller pupil in the right eye, which increased in the darkness. Cerebrospinal fluid analysis showed pleocytosis and a positive result for immunoglobulin G antibody to varicella zoster virus. She was diagnosed to have zoster meningitis with Horners syndrome and contralateral abducens nerve palsy. After intravenous antiviral and steroid treatments, the vesicular eruptions and abducens nerve palsy improved. Horners syndrome and diplopia resolved after six months. Here we present the first report of Horners syndrome and contralateral abducens nerve palsy associated with zoster meningitis.