Hee Jung Kwon

Choroidal thickness in Behcet's uveitis: an enhanced depth imaging-optical coherence tomography and its association with angiographic changes.

PURPOSE To evaluate the change in subfoveal choroidal thickness between active and quiescent phases of Behcets posterior uveitis and compare this with the healthy population using enhanced depth imaging optical coherence tomography (EDI-OCT). METHODS Thirty eyes from 30 patients with Behcets posterior uveitis (mean age, 47.03 ± 11.01 years) were retrospectively enrolled in the study. Their subfoveal choroidal thickness was measured using EDI-OCT in the active and quiescent phases of Behcets uveitis, and compared with the age, sex, and spherical equivalent-matched healthy population. Changes in retinal vascular leakage on fluorescein angiography (FA) were correlated with the changes in subfoveal choroidal thickness. RESULTS Mean subfoveal choroidal thickness in the acute phase of Behcets uveitis was significantly greater than that in the quiescent phase (398.77 ± 155.59 μm versus 356.72 ± 141.09 μm; P = 0.004). Subfoveal choroidal thickness in the quiescent phase was also significantly greater than that of the healthy population (259.96 ± 65.16 μm; P < 0.0001). There was a statistically significant association between the change in subfoveal choroidal thickness and the change in vascular leakage revealed by FA (ρ = 0.381, P = 0.046). Subfoveal choroidal thickness in the uninvolved fellow eyes of patients with unilateral Behcets uveitis was also evaluated and it was significantly greater than that of the healthy population (n = 13 eyes; P = 0.001) CONCLUSIONS: This study found choroidal thickening during the active phase of Behcets posterior uveitis. Subfoveal choroidal thickness during the quiescent phase was also significantly greater than in normal eyes. The degree of reduction in choroidal thickening was significantly correlated with improvement in retinal vascular leakage as revealed by FA.

Treatment of serous macular detachment associated with circumscribed choroidal hemangioma.

PURPOSE To evaluate the effects of transpupillary thermotherapy and intravitreal bevacizumab injection on serous macular detachment and cystoid macular edema (CME) associated with circumscribed choroidal hemangioma. DESIGN Retrospective, interventional case series. METHODS We reviewed the records of 12 patients with circumscribed choroidal hemangioma treated with transpupillary thermotherapy and/or intravitreal injection of bevacizumab. We assessed changes in best-corrected visual acuity (BCVA), central foveal thickness by optical coherence tomography, and resolution of serous macular detachment and CME. RESULTS Six of 8 patients treated with transpupillary thermotherapy showed complete resolution of serous macular detachment and CME and the median minimal angle of resolution (logMAR) BCVA improved from 0.85 to 0.35 (P = .026). Among these 6 patients, 1 had no recurrence for 86 months and 5 had sustained resolution of serous macular detachment for a mean duration of 32.8 months before recurrence. Among the 9 patients treated with bevacizumab (including 5 patients who had transpupillary thermotherapy as a primary treatment), 5 showed resolution of serous macular detachment and the median logMAR BCVA improved from 0.7 to 0.5 (P = .042). Among these 5 patients, 3 had sustained resolution for a mean duration of 5.7 months and 2 showed recurrent serous macular detachment after 3 and 12 months. CONCLUSION Transpupillary thermotherapy and intravitreal bevacizumab appear effective in the management of symptomatic circumscribed choroidal hemangioma, although recurrence of serous macular detachment and CME developed after long-term follow-up of transpupillary thermotherapy, and the duration of treatment effectiveness appears to be short with bevacizumab.

Prognosis of choroidal melanoma and the result of ruthenium brachytherapy combined with transpupillary thermotherapy in Korean patients

Background/aims To evaluate the clinical features and prognosis of choroidal melanoma in Korean patients and the results of treatment with ruthenium (Ru) 106 plaque brachytherapy. Methods The medical charts of 111 patients diagnosed with choroidal melanoma who underwent Ru brachytherapy with trans-pupillary thermotherapy or local resection (61 patients) or who underwent other treatments (26 primary enucleations, 22 γ-knife radiotherapies and two lamellar sclerouvectomies) were reviewed retrospectively. Results The mean largest basal diameter (LBD) was 11.4±3.2 mm and the mean apical height was 7.8±2.9 mm. Compared with the collaborative ocular melanoma study, mean tumour height was skewed toward higher values (6.2 vs 4.8 in medium tumours, p<0.0001; 10.9 vs 9.5 mm in large tumours, p=0.034) and the LBD in large tumours was skewed toward smaller values (13.6 vs 17.3, p<0.0001). The estimated 5-year metastasis-free rate was 73.9% and the disease-specific survival rate was 84.6%. For the 61 patients that were treated with Ru brachytherapy, the 5-year metastasis-free and disease-specific survival rates were 79.0% and 87.7%, respectively, and the 5-year incidence of enucleation was 25.4%. The mean tumour regression at 6, 12 and 18 months after brachytherapy was 80.2%, 73.1% and 69.2%, respectively. Conclusions Choroidal melanomas in Korean patients tend to grow vertically with a relatively large apical height and a small LBD. The prognosis of choroidal melanomas overall as well as prognosis after Ru brachytherapy were similar to those seen in previous studies with Caucasian patients. The enucleation rate after brachytherapy seems to be higher in Korean patients, for which a greater initial tumour height seems to be partly responsible.

Correlation between Fluorescein Angiographic Findings and Visual Acuity in Behçet Retinal Vasculitis

Purpose To identify significant fluorescein angiographic (FA) characteristics associated with visual acuity (VA) in Behçet retinal vasculitis. Materials and Methods Retrospective review of 86 eyes of 48 patients (age: 35.6±10.2 years) with Behçet retinal vasculitis were performed. VA and FA findings as well as correlation between them were assessed. Results The mean initial VA of eyes with posterior pole-involved vasculitis (63 eyes; 73.3%) was significantly worse than that of those with peripheral vasculitis (23 eye; 26.7%) (logarithm of the minimum angle of resolution VA: 0.554±0.572 vs. 0.078±0.148; p<0.0001). Subgroup analysis revealed a more severe and diffuse pattern of vascular leakage in posterior pole-involved vasculitis compared to peripheral vasculitis (p<0.0001). Retinal vascular leakage (β=0.345; p<0.0001), optic disc hyperfluorescence (β=0.147; p=0.032), and macular leakage (β=0.107; p=0.047) were significantly associated with worse initial VA. During the follow up (mean: 33.3±17.9 months), the change of leakage showed no significant correlation with change of VA in posterior pole-involved vasculitis (τ=0.199, p=0.092). Conclusion Posterior pole involvement, the degree of retinal vascular leakage, optic disc hyperfluorescence, and macular leakage are significantly associated with VA in Behçet retinal vasculitis.

Repeatability and Agreement of Swept Source and Spectral Domain Optical Coherence Tomography Evaluations of Thickness Sectors in Normal Eyes.

Purpose of the Study: The purpose of the study was to evaluate the clinical efficacy of swept-source optical coherence tomography (SS-OCT), we compared the intradevice repeatability of thickness measurements obtained using SS-OCT to that of measurements obtained using spectral domain OCT (SD-OCT), and assessed the interdevice agreement of thickness measurements. Materials and Methods: This cross-sectional prospective study involved 3 consecutive measurements of peripapillary retinal nerve fiber layer (PP-RNFL) and ganglion cell-inner plexiform layer thickness in healthy subjects, using 2 different OCT systems. Intraclass correlation coefficients (ICCs) and coefficients of variability were calculated and compared for repeatability and agreement between study groups. Intradevice ICCs for each OCT system were compared, and Bland-Altman plots were used to evaluate their agreement. Results: Fifty-eight eyes from 58 healthy subjects (25 men and 33 women) were analyzed. SS-OCT images yielded larger PP-RNFL thickness values than SD-OCT images in every sector examined. In contrast, SD-OCT images yielded larger macular ganglion cell-inner plexiform layer thickness values than SS-OCT images. For SS-OCT, intradevice ICCs were ≥0.9 for all sectors. However, for SD-OCT, the 3 PP-RNFL measurement sectors had correlation coefficients <0.9. Interdevice ICCs varied more and were lower than intradevice values, because thickness measurement values differed between the OCT devices. Conclusions: Measurements differed between systems even for the same subject. SS-OCT had an intradevice repeatability similar to that of SD-OCT. These findings support the clinical application of SS-OCT.

Frequency, Type and Cause of Artifacts in Swept-Source and Cirrus HD Optical Coherence Tomography in Cases of Glaucoma and Suspected Glaucoma

ABSTRACT Purpose: To evaluate and compare the frequency, type and cause of imaging artifacts incurred when using swept-source optical coherence tomography (SS OCT) and Cirrus HD OCT in the same patients on the same day. Materials and methods: From left eye OCT results of 72 patients, disc area and macular area data could be compared between the two types of OCT. For each scan, the final printout report and source data were examined. For comparison between the two types of OCT, only source image data were used because of differences in the final printout report format. Results: There were no significant differences in the artifact frequencies between the two groups in either area (disc area: 35.9% of SS OCT, 42.2% of Cirrus OCT, p = 0.523; Macular area: 24.2% of SS OCT, 22.7% of Cirrus OCT, p = 1.00). The overall results of artifact comparison between the two types of OCTs also showed no significant differences. Boundary misidentification was the most common type of artifact observed, and ocular pathology was the most common cause of artifact in both types of OCTs. Among ocular pathologies, the epiretinal membrane (ERM) was the most common cause of OCT artifact production in both types of OCTs. Conclusions: There was no significant difference in the frequency, type and cause of artifacts between SS OCT and Cirrus HD OCT. Artifacts in OCT can influence the interpretation of OCT results. In particular, ERM around the optic disc could contribute to OCT artifacts and should be considered in glaucoma diagnosis or during patient follow-up using OCT.

Surgically induced astigmatism following trabeculectomy

PurposeSurgically induced astigmatism (SIA) has attracted much interest in recent times because changes in corneal astigmatism can lead to decreased uncorrected visual acuity and patient discomfort. This study aimed to evaluate SIA and to identify factors correlated therewith after trabeculectomy.MethodsWe retrospectively reviewed medical charts of patients who were treated with trabeculectomy at 120° meridian (superotemporal area on right eye and superonasal area on left eye) by the same surgeon. Preoperative keratometric data were compared with data collected from 2 months to 12 months postoperatively. SIA was evaluated using Naeser’s polar value analysis.ResultsUsing Naeser’s method, ΔKP(120) was calculated as 0.7 ± 0.7 (0.82@104°), which indicates a with-the-rule change. After surgery, the combined mean polar values changed significantly (Hotelling T2 = 22.47; p < 0.001). Multivariate analysis of variance indicated that postoperative intraocular pressure and location of surgery were independent factors that were significantly associated with SIA (p = 0.002 and 0.03, respectively).ConclusionsTrabeculectomy at the 120° meridian was not astigmatically neutral. In addition, the SIA after trabeculectomy appears to be greater in eyes with low postoperative intraocular pressure and a superonasal surgical wound rather than a superotemporal wound.

Choroidal Thickness in Behcet's Uveitis: An Enhanced Depth Imaging-Optical Coherence Tomography and Its Association With Angiographic ChangesChoroidal Thickness in Behcet's Uveitis

PURPOSE To evaluate the change in subfoveal choroidal thickness between active and quiescent phases of Behcets posterior uveitis and compare this with the healthy population using enhanced depth imaging optical coherence tomography (EDI-OCT). METHODS Thirty eyes from 30 patients with Behcets posterior uveitis (mean age, 47.03 ± 11.01 years) were retrospectively enrolled in the study. Their subfoveal choroidal thickness was measured using EDI-OCT in the active and quiescent phases of Behcets uveitis, and compared with the age, sex, and spherical equivalent-matched healthy population. Changes in retinal vascular leakage on fluorescein angiography (FA) were correlated with the changes in subfoveal choroidal thickness. RESULTS Mean subfoveal choroidal thickness in the acute phase of Behcets uveitis was significantly greater than that in the quiescent phase (398.77 ± 155.59 μm versus 356.72 ± 141.09 μm; P = 0.004). Subfoveal choroidal thickness in the quiescent phase was also significantly greater than that of the healthy population (259.96 ± 65.16 μm; P < 0.0001). There was a statistically significant association between the change in subfoveal choroidal thickness and the change in vascular leakage revealed by FA (ρ = 0.381, P = 0.046). Subfoveal choroidal thickness in the uninvolved fellow eyes of patients with unilateral Behcets uveitis was also evaluated and it was significantly greater than that of the healthy population (n = 13 eyes; P = 0.001) CONCLUSIONS: This study found choroidal thickening during the active phase of Behcets posterior uveitis. Subfoveal choroidal thickness during the quiescent phase was also significantly greater than in normal eyes. The degree of reduction in choroidal thickening was significantly correlated with improvement in retinal vascular leakage as revealed by FA.