Hyesun Kim

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.

Clinical and spectral-domain optical coherence tomography findings in patients with focal choroidal excavation.

OBJECTIVE To describe the clinical and spectral-domain optical coherence tomography (SD-OCT) findings in patients with focal choroidal excavation (FCE). DESIGN Retrospective case series. PARTICIPANTS Forty-one eyes of 38 patients with FCE identified in 2 tertiary medical centers in Korea. METHODS Clinical features, SD-OCT findings, and associated macular disorders of FCE were analyzed and detailed. MAIN OUTCOME MEASURES Statistical associations among clinical features, including lesion type, size, and choroidal thickness, and frequency of association with central serous chorioretinopathy (CSC), choroidal neovascularization (CNV), and polypoidal choroidal vasculopathy (PCV). RESULTS Mean patient age was 50.1 years (range, 25-76 years). The mean spherical equivalent of refractive error was -3.7 diopters (range, -10.0 to +1.5 diopters). Three patients (8%) had bilateral lesions, and 1 patient (3%) had 2 distinct lesions in the same eye. The mean FCE width and depth were 757 μm and 107 μm, respectively, with a positive correlation between width and depth (P = 0.003). The mean subfoveal choroidal thickness of FCE eyes was 284 μm, which was not statistically different from that of age-, sex-, and refractive error-matched normal subjects. Choroidal thickness in FCE was less in eyes with hyperreflective choroidal tissue under the excavation that was present in 22 eyes (54%) versus eyes without excavation (128 vs. 190 μm, respectively; P = 0.009). Twelve FCEs (29%) were the nonconforming type, revealing separation between the photoreceptor tips and the retinal pigment epithelium on SD-OCT. Nonconforming FCE was associated with visual symptoms (P < 0.001) and the presence of concurrent CSC (P = 0.001). Ten eyes (24%) were associated with CSC, and 9 eyes (22%) were associated with CNV, including 1 eye with PCV features. One eye with FCE and type 1 CNV developed a new excavation, and the excavated area in 1 eye with PCV enlarged slightly during follow-up. CONCLUSIONS Focal choroidal excavation is a relatively common entity and frequently associated with choroidal diseases, including CSC, CNV, and PCV. Although FCE is classically thought to be a congenital malformation, acquired FCE forms possibly exist.

Therapeutic outcomes of retinal hemangioblastomas.

Purpose: To report the results of treatments and therapeutic complications of retinal hemangioblastomas (RH). Methods: Retrospective consecutive case series. Data from 32 patients (37 eyes) with RH were reviewed for characteristics of RH and treatment outcomes. Results: Among 32 patients, we identified 73 RHs in 37 eyes. At baseline, 24 of 37 eyes (65%) had 20/50 visual acuity or better, 8 eyes (22%) had intermediate vision (20/400—20/50), and 5 eyes (13%) had poor vision (⩽20/400). Seven RHs (9.6%) were located in the juxtapapillary area, and 66 RHs (90.4%) were located in peripheral area. Small RHs (54.8%; <0.5 mm in size) were treated with laser photocoagulation, moderate-sized RHs (24.7%; 0.5–3.0 mm in size) were treated with transpupillary thermotherapy, and large RHs (20.5%; >3.0 mm in size) were treated with a combination of transpupillary thermotherapy and cryotherapy. After treatment, 90% of small RHs regressed, whereas only 67% of large RHs regressed (P = 0.044). Peripheral RHs showed better response to treatment than juxtapapillary RHs (P = 0.010). Treatment-related complications occurred in 5 eyes (14%), and 1-step combination therapy was applied more frequently in the complication group (P = 0.048). Conclusion: Small RHs in peripheral areas may require aggressive treatment because they respond well to treatment. In larger RHs, staged treatment could reduce treatment-related complications. Transpupillary thermotherapy could be an effective method in tumor regression for moderate-to-large–sized RHs showing tumor regression rate of 70%.

Subfoveal choroidal thickness in idiopathic choroidal neovascularization and treatment outcomes after intravitreal bevacizumab therapy.

Purpose: To determine subfoveal choroidal thickness in idiopathic choroidal neovascularization (CNV) and evaluate visual and anatomical outcomes in patients with idiopathic CNV after intravitreal bevacizumab. Methods: Retrospective observation case series. Seventeen eyes of 17 patients with idiopathic CNV were treated with a single intravitreal bevacizumab injection, followed by additional doses based on optical coherence tomography findings, including intraretinal fluid, subretinal fluid, or pigment epithelial detachment. We analyzed best-corrected visual acuity, central subfield thickness, and subfoveal choroidal thickness at presentation and final visit. Seventeen unaffected fellow eyes and 17 healthy eyes constituted the control group for subfoveal choroidal thickness. Results: The subfoveal choroidal thickness was significantly thinner in eyes with idiopathic CNV (237.59 ± 53.84 &mgr;m) than in the unaffected fellow eyes (281.71 ± 59.01 &mgr;m, P = 0.001) or normal control eyes (290.38 ± 58.94 &mgr;m, P = 0.028). Mean logarithm of the minimum angle of resolution best-corrected visual acuity improved from 0.46 initially to 0.26 after treatment (P = 0.024). Mean central subfield thickness decreased from 387.88 ± 97.52 &mgr;m at baseline to 261.41 ± 31.18 &mgr;m after treatment (P < 0.001). Conclusion: Subfoveal choroidal thickness is reduced and may be associated with the pathophysiology of idiopathic CNV. Intravitreal bevacizumab resulted in significant visual and anatomical improvement in patients with idiopathic CNV.

Comparison of the Clinical Manifestations between Acute Vogt-Koyanagi-Harada Disease and Acute Bilateral Central Serous Chorioretinopathy

Purpose To compare clinical, angiographic, and optical coherence tomographic characteristics between eyes with acute Vogt-Koyanagi-Harada (VKH) disease and eyes with acute bilateral central serous chorioretinopathy (CSC), and to demonstrate distinguishing features between the two diseases in confusing cases. Methods The medical records of 35 patients with VKH disease and 25 patients with bilateral CSC were retrospectively reviewed. Characteristics according to slit-lamp biomicroscopy, ophthalmoscopy, fundus photography, fluorescein angiography, indocyanine green angiography, and spectral-domain optical coherence tomography were compared between the two diseases. Results Five of 35 patients (10 of 70 eyes, 14.3%) with VKH disease were initially misdiagnosed as CSC patients, and six of 25 patients (12 of 50 eyes, 24%) with bilateral CSC were initially misdiagnosed as patients with VKH disease. Pigment epithelial detachment in CSC and optic disc hyperemia in VKH disease show the highest positive predictive values of 100% for each disease. Conclusions Optic disc hyperemia in VKH disease and pigment epithelial detachment in bilateral CSC are the most specific clinical manifestations of each disease at initial patient presentation.

Identification of Underlying Causes of Spontaneous Submacular Hemorrhage by Indocyanine Green Angiography

Purpose: To investigate the causes of acute spontaneous submacular hemorrhage with indocyanine green angiography (ICGA). Methods: Retrospective observation case series. A total of 51 eyes from 51 patients with newly developed spontaneous submacular hemorrhage were enrolled. Best-corrected visual acuity (BCVA), fundus photography, fluorescein angiography, spectral domain optical coherence tomography (OCT), and ICGA at baseline were analyzed. The extent of hemorrhage using fundus photography, height of hemorrhage, and central foveal thickness measured by OCT was analyzed to compare the diagnostic and nondiagnostic groups. Results: The mean logarithm of the minimum angle of resolution (logMAR) BCVA at presentation was 1.21 ± 0.74 (Snellen equivalent, 20/324); the mean follow-up period was 23.9 ± 23.9 months. The cause of submacular hemorrhage was diagnosed in 43 of 51 eyes (84.3%) based on ICGA at presentation. The initial diagnoses were correct in 93% of eyes. In 3 cases, the initial diagnosis of age-related macular degeneration (AMD) was changed to polypoidal choroidal vasculopathy (PCV) based on follow-up ICGA. The central foveal thickness was significantly greater in the nondiagnostic group (1,102.4 vs. 666.7 μm, respectively; p = 0.008). The most common cause of submacular hemorrhage was neovascular AMD (52.9%), followed by PCV (37.3%), macroaneurysm (5.9%), and lacquer crack (3.9%). The mean final visual acuity was generally worse in patients with submacular hemorrhage with typical AMD (visual acuity 20/618) or PCV (visual acuity 20/240) compared to that in patients with retinal macroaneurysm (visual acuity 20/100) or lacquer crack (visual acuity 20/72). Conclusions: ICGA at initial presentation helps identify causes of submacular hemorrhage, allowing differential treatment approaches that may improve outcomes and safety.

Medullary Sodium and Urea Gradient of the Dog Kidney in Hypothermia

Summary The kidneys were removed from 11 euthermic and 8 hypothermic (average rectal temp. 25°C) dogs and four slices of the tissue from papilla to cortex were taken from each kidney. The Na, K, and urea concentrations of the slice were then determined in slice extracts. Although urine osmolality was significantly reduced in hypothermia, the papillary Na and urea concentrations at a given urine osmolality were markedly higher in hypothermic kidneys than in euthermic, suggesting that the impairment of renal concentrating ability in hypothermia is partly attributable to a failure of the collecting duct urine to osmotically equilibrate with the surrounding media. On the basis of the latter finding, it is postulated that the action of ADH is less effective in hypothermia.

Punctate Hyperfluorescent Spots Associated With Polypoidal Choroidal Vasculopathy on Indocyanine Green Angiography

BACKGROUND AND OBJECTIVE To evaluate punctate hyperfluorescent spots on indocyanine green angiography (ICGA) in eyes with polypoidal choroidal vasculopathy (PCV). PATIENTS AND METHODS Retrospective observation case series of 88 eyes of 81 patients (63 men and 18 women) analyzing fundus photography, fluorescein angiography, ICGA, and spectral-domain optical coherence tomography (OCT) findings at baseline. RESULTS Seven patients (9%) had bilateral PCV lesions. Mean age was 68.44 ± 5.94 years (range: 45 to 86 years). Macular-type PCV was found in 72 eyes (81.8%), peripapillary-type PCV in 12 eyes (13.6%), and combined-type PCV in four eyes (4.5%). Choroidal vascular hyperpermeability was observed in 38 eyes (43.2%), and punctate hyperfluorescent spots on ICGA in 47 eyes (53.4%). ICGA of unaffected fellow eyes of 74 patients with unilateral PCV revealed choroidal hyperpermeability in 23 eyes (31.1%) and punctate hyperfluorescent spots in 38 eyes (51.4%). Presence of punctate hyperfluorescent spots was significantly associated with choroidal vascular hyperpermeability (P < .001). CONCLUSION Punctate hyperfluorescent spots were frequently observed in eyes with PCV in late-phase ICGA, as previously described in eyes with central serous chorioretinopathy, which may represent leakage from punctate hyperpermeable inner choroid spots or late staining of forme fruste drusen or drusen-like subretinal pigment epithelium deposits associated with choroidal hyperpermeability.

Regional cerebral blood flow changes and performance deficit during a sustained attention task in schizophrenia: 15O-water positron emission tomography

Attention deficit has been reported in both schizophrenia patients and patients with major depressive disorder (MDD). The aim of this study was to elucidate the deficits in sustained attention and associated neural network dysfunctions in schizophrenia patients and MDD patients, and to investigate the difference between the two patient groups.

A Trend Analysis and Strategy for Document Delivery Service in the Changing Digital Information Environment and Copyright Law

The document delivery service has been influenced by the changing digital information environment and the copyright law. This paper proposes the key points for the improved documents delivery service through trend analysis of BL(The Great Britain), NLA(Australia), subito(German speaking countries), JST(Japan), KISTI(Korea) and KERIS(Korea) and copyright law in each country. The purpose of this study is providing with the clues for developing strategies that can satisfy the users` needs in document delivery service for libraries and information centers.