Dong Yoon Kim

Clinical Patterns of Uveitis in Tertiary Ophthalmology Centers in Seoul, South Korea

ABSTRACT Purpose: To identify the characteristics and causes of uveitis in Seoul, South Korea. Methods: We performed a retrospective medical record review of 602 patients diagnosed with uveitis at seven tertiary ophthalmology centers between January and December 2013. Results: The most common type of uveitis was anterior uveitis (n = 281), followed by posterior uveitis (n = 152), panuveitis (n = 126), and intermediate uveitis (n = 43). Among patients with an identified cause (n = 252), 149 and 103 had non-infectious and infectious uveitis, respectively, and ankylosing spondylitis (n = 53), Behcet disease (n = 43), and endophthalmitis (n = 25) were common identified causes of uveitis. Conclusions: Anterior uveitis was the most common type of uveitis, and the incidence of infectious uveitis was relatively high in Seoul. Ankylosing spondylitis and Behcet disease were the most common systemic diseases causing uveitis in this sample.

Association Between Hyperreflective Dots on Spectral-Domain Optical Coherence Tomography in Macular Edema and Response to Treatment

Purpose To investigate the association between hyperreflective dots (HRDs) on spectral-domain optical coherence tomography (SD-OCT) and response to intravitreal bevacizumab (IVB) or dexamethasone injection in eyes with diabetic macular edema (DME) or macular edema due to retinal vein occlusion (RVO). Methods A retrospective review was conducted involving patients with DME or macular edema due to RVO. Patients with treatment-naïve macular edema were initially treated with three consecutive IVB injections and classified based on the treatment response to bevacizumab. After three consecutive IVB injections, bevacizumab nonresponders were treated using dexamethasone implants and reclassified based on the treatment response. The best-corrected visual acuity, number of HRDs, and outer plexiform layer (OPL) disruptions were analyzed according to the treatment response. Results Eighty-two eyes with DME and 68 eyes with RVO were included in this study. Thirty-six (43.9%) eyes with DME and 22 (32.4%) eyes with RVO were bevacizumab nonresponders. The number of baseline HRDs in bevacizumab nonresponders (16.06 ± 6.60 in DME, 14.23 ± 4.09 in RVO) was significantly greater than that in responders (11.26 ± 3.64, P < 0.001 in DME, 11.17 ± 4.83, P = 0.013 in RVO), and it did not decrease after IVB injections. Unlike the response to bevacizumab, eyes that responded to dexamethasone implant but not to IVB had significantly more HRDs (19.56 ± 6.75) than eyes that did not respond (11.50 ± 3.78, P = 0.006). The OPL disruption rate was significantly higher in bevacizumab nonresponders than in responders (P < 0.001 in DME and P = 0.001 in RVO). Conclusions In patients with DME or macular edema due to RVO, the number of HRDs on SD-OCT may be a predictive indicator of the response to IVB injection or dexamethasone implant. In bevacizumab responders, the number of HRDs on SD-OCT was small. In contrast, more HRDs, which might reflect increased inflammation in the retina, were observed in dexamethasone responders. Therefore, dexamethasone implants might be more effective in DME or RVO eyes with multiple HRDs and OPL disruption on SD-OCT.

Mineralocorticoid Receptor Antagonist Treatment for Steroid-Induced Central Serous Chorioretinopathy Patients with Continuous Systemic Steroid Treatment

Purpose To investigate the effectiveness of mineralocorticoid receptor (MR) antagonist in patients with steroid-induced central serous chorioretinopathy (CSC). Methods A retrospective review was conducted of steroid-induced CSC patients who were treated with the MR antagonist spironolactone 50 mg once per day for at least 1 month. The primary outcome measure was complete resolution rate of subretinal fluid (SRF) after spironolactone treatment. Secondary outcomes included central subfield thickness (CST), subfoveal choroidal thickness (SFCT), and best-corrected visual acuity (BCVA) changes after spironolactone treatment. Results Seventeen eyes from 15 patients were included in this study. Conditions warranting chronic systemic steroid use were myasthenia gravis (6/15, 40%), glomerulonephritis (5/15, 33.3%), and organ transplantation (4/15, 26.7%). Mean symptom duration of CSC was 4.00 ± 3.04 months. After spironolactone treatment, 14 eyes (82.4%) showed complete resolution of SRF (P < 0.001) without discontinuation of systemic steroid. CST and BCVA were significantly improved after spironolactone treatment. SFCT was significantly decreased after spironolactone treatment. No patients experienced electrolyte imbalance after spironolactone treatment. Conclusion MR antagonist treatment may be a therapeutic option for steroid-induced CSC patients. This treatment modality may be especially beneficial for steroid-induced CSC patients who cannot discontinue steroid medication due to systemic conditions.

Effect of Gravity Acceleration on Choroidal and Retinal Nerve Fiber Layer Thickness: A Swept-Source Optical Coherence Tomography Study

Purpose The purpose of this study was to evaluate the effect of gravity acceleration on choroidal and retinal nerve fiber layer (RNFL) thickness using swept-source optical coherence tomography (SS-OCT). Methods Thirteen healthy volunteers who planned to participate in human centrifuge training as part of the flight surgeon selection process enrolled this study. During centrifuge training, gravity was gradually increased up to six times that of sea level. All subjects underwent complete ophthalmologic examination and three-dimensional wide-scanning SS-OCT imaging (DRI OCT-1 Atlantis; Topcon, Tokyo, Japan). Imaging was performed before (baseline), immediately after, and 15, 30, and 60 minutes after centrifuge training. Changes in choroidal thickness, choroidal volume, retinal thickness, and RNFL thickness after centrifuge training were analyzed. Results Mean choroidal thickness significantly and transiently decreased immediately (258.19 ± 73.54 μm, P < 0.001), 15 minutes (258.54 ± 75.12 μm, P = 0.001), and 30 minutes (254.31 ± 66.92, P = 0.001) after human centrifuge training, relative to baseline (273.35 ± 80.80 μm). However, the decreased choroidal thickness returned to baseline levels 1 hour after centrifuge training (270.12 ± 71.69 μm, P = 0.437). Mean retinal thickness and RNFL thickness were not significantly affected by human centrifuge training. In participants who suffered from gravity-force induced loss of consciousness (G-LOC) during training, the amount of the choroidal thickness decrease was larger than in participants who did not experience G-LOC. However, because of the small sample size, the difference, although large, was not statistically significant. Conclusions Choroidal thickness and volume significantly and transiently decreased after human centrifuge training, which might reflect that choroidal perfusion was transiently decreased during human centrifuge training. Considering choroidal thickness decreased after human centrifuge training, long-term exposure to a high gravity environment may lead to ischemic injury to ocular structures.