Hyun Seung Yang

Elevated plasma pentraxin 3 levels are associated with development and progression of diabetic retinopathy in Korean patients with type 2 diabetes mellitus.

PURPOSE To evaluate the association between elevated levels of plasma pentraxin 3 (PTX3) and the development and/or progression of diabetic retinopathy (DR). METHODS In this case-control study, 92 diabetic patients with DR (group 3), 30 diabetic patients without DR (group 2), and 41 normal subjects (group 1) were enrolled. Log-transformed values of plasma PTX3 and high-sensitivity C-reactive protein (hsCRP) concentrations were measured and used in our analysis. For subgroup analysis, group 3 was divided into four subgroups: mild, moderate, severe nonproliferative, and proliferative DR. RESULTS In our 163 participants, average plasma PTX3 levels were 916.1 ± 532.2, 1093.7 ± 1034.2, and 1817.9 ± 1776.9 pg/mL for groups 1, 2, and 3, respectively. The duration of diabetic mellitus (DM), glycated hemoglobin (HbA1c), log hsCRP, and log PTX3 were significantly different between the three groups (P = 0.008, P < 0.001, P = 0.046, and P < 0.001, respectively). In subgroup analysis, plasma log PTX3 levels increased in correlation with the severity of DR (R = 0.372, P < 0.001). Multivariate logistic analysis showed that the correlation between DR development and duration of DM and log PTX3 values was significant (P = 0.014 and P = 0.025, respectively), whereas correlation with log hsCRP values was not significant in univariate analysis (P = 0.129). The receiver operating characteristic curves of DR development were plotted using log PTX3 and log hsCRP values, and the area under the curves was found to be 0.721 (P = 0.001) and 0.614 (P = 0.087), respectively. CONCLUSIONS Plasma PTX3 is positively associated with DR development and progression, and may be a more accurate predictor of DR development than hsCRP.

Characteristics of spontaneous idiopathic epiretinal membrane separation in spectral domain optical coherence tomography.

Purpose: To investigate the prevalence, characteristics, and visual acuity of spontaneous idiopathic epiretinal membrane (ERM) separations using spectral domain optical coherence tomography. Methods: In a series of 1,248 consecutive eyes with idiopathic ERM, Group I with preexisting posterior vitreous detachment included 1,091 eyes (87.4%) and Group II without preexisting posterior vitreous detachment included 157 eyes (12.6%). Groups IA and IIA included self-resolution cases of ERM from Groups I and II, respectively. Results: The ERM self-separation occurred in 37 eyes (3.0%) for 32.6 ± 11.7 months, with 16 eyes (1.5%) in Group IA and 21 eyes (13.4%) in Group IIA. The mean best-corrected visual acuity (logMAR) improved in Groups IA and IIA by 0.1 (P = 0.013) and 0.06 (P = 0.078), respectively. From tomographic analyses, dominant undulation and retinal nerve fiber layer defects were more frequent in Group IA than Group IIA (P < 0.001 and P = 0.024, respectively). However, the completeness of ERM separation, inner segment/outer segment junction defects, and ERM recurrence were more frequent in Group IIA than Group IA (P = 0.039, P = 0.023 and P = 0.041, respectively). Multivariate analysis for factors related to visual improvement revealed only inner segment/outer segment junction defects as significantly associated (P = 0.025). Conclusion: Different mechanisms underlying the self-resolution of idiopathic ERM lead to distinct tomographic characteristics and may affect the postseparation visual function.

Postoperative restoration of foveal inner retinal configuration in patients with epiretinal membrane and abnormally thick inner retina.

Purpose: To investigate foveal inner retinal layer (IRL) restoration and its relationship with functional visual outcomes after membrane peeling in eyes with idiopathic epiretinal membrane (ERM) with foveal central thick IRL. Methods: Consecutive eyes (n = 57) with a thick foveal IRL that underwent 25-gauge vitrectomy for ERM treatment were included. Complete ophthalmic and spectral domain optical coherence tomography examinations were performed before and 1 year after surgery. Results: Before surgery, mean best-corrected visual acuity (BCVA) was 20/48 (logMAR, 0.38); central foveal thickness, 515.0 ± 90.9 &mgr;m; and central IRL thickness (CIRLT) at the fovea, 167.7 ± 80.1 &mgr;m. One year after ERM peeling, mean BCVA improved to 20/30 (logMAR, 0.18), central foveal thickness to 404.1 ± 96.4 &mgr;m, and CIRLT to 76.8 ± 68.0 &mgr;m. In multivariate analysis, initial BCVA and CIRLT at baseline correlated well with final BCVA and BCVA improvement at 12 months. In comparison with Group B eyes (persistently thick foveal IRL at 12 months), Group A eyes (restored foveal IRL at 12 months) had thinner CIRLT at baseline and showed a significant post-surgical improvement in BCVA and metamorphopsia. Conclusion: In eyes with idiopathic ERM and decreased vision due to abnormally thick IRL in the foveal center, postoperative visual outcomes correlated well with preoperative CIRLT and postoperative restoration of IRL configuration after ERM peeling.

New approach for conjunctivochalasis using an argon green laser.

Purpose: To evaluate the effectiveness of conjunctivoplasty using an argon green laser in symptomatic patients with conjunctivochalasis (CCh). Methods: Twenty-nine eyes of 18 patients with various grades of CCh were included in this study. All the patients, who were refractory to the conventional therapy, were treated using an argon green laser. The ocular symptoms and signs, including the CCh grade, the tear Ocular Surface Disease Index, the breakup time, the Schirmer test, and the abnormal ocular surface findings, were evaluated preoperatively and postoperatively. Results: The mean age of the patients was 69.1 ± 8.4 years. The grade of CCh in 25 eyes (86%) decreased at 6 months after the laser conjunctivoplasty. When the grade reduction rates were calculated, the reduction rates of grades 1, 2, and 3 were 100%, 69%, and 48%, respectively. Most of the patients showed a significant symptomatic improvement, and the Ocular Surface Disease Index scores decreased from 0.41 to 0.22 (P < 0.001). The breakup time increased from 9.1 to 10.2 (P = 0.007), but the Schirmer test results did not show any differences after the surgery (P = 0.257). Conclusions: Conjunctivoplasty using an argon green laser is a simple and effective choice to treat symptomatic patients with CCh, especially in cases of mild-to-moderate grade CCh.

Delayed choroidal and retinal blood flow in polycythaemia vera patients with transient ocular blindness: a preliminary study with fluorescein angiography

Borowitz, M.J., Devidas, M., Hunger, S.P., Bowman, W.P., Carroll, A.J., Carroll, W.L., Linda, S., Martin, P.L., Pullen, D.J., Viswanatha, D., Willman, C.L., Winick, N. & Camitta, B.M. Children’s Oncology Group (2008) Clinical significance of minimal residual disease in childhood acute lymphoblastic leukemia and its relationship to other prognostic factors: a Children’s Oncology Group study. Blood, 111, 5477–5485. Cav e, H., van der Werff ten Bosch, J., Suciu, S., Guidal, C., Waterkeyn, C., Otten, J., Bakkus, M., Thielemans, K., Grandchamp, B. & Vilmer, E. (1998) Clinical significance of minimal residual disease in childhood acute lymphoblastic leukemia. European Organization for Research and Treatment of Cancer–Childhood Leukemia Cooperative Group. The New England Journal of Medicine, 339, 591–598. Conter, V., Bartram, C.R., Valsecchi, M.G., Schrauder, A., Panzer-Gr€ umayer, R., M€ oricke, A., Aric o, M., Zimmermann, M., Mann, G., de Rossi, G., Stanulla, M., Locatelli, F., Basso, G., Niggli, F., Barisone, E., Henze, G., Ludwig, W.-D., Haas, O.A., Cazzaniga, G., Koehler, R., Silvestri, D., Bradtke, J., Parasole, R., Beier, R., van Dongen, J. J. M., Biondi, A. & Schrappe, M. (2010) Molecular response to treatment redefines all prognostic factors in children and adolescents with B-cell precursor acute lymphoblastic leukemia: results in 3184 patients of the AIEOP-BFM ALL 2000 study. Blood, 115, 3206–3214. Coustan-Smith, E., Sancho, J., Hancock, M.L., Boyett, J.M., Behm, F.G., Raimondi, S.C., Sandlund, J.T., Rivera, G.K., Rubnitz, J.E., Ribeiro, R.C., Pui, C.-H. & Campana, D. (2000) Clinical importance of minimal residual disease in childhood acute lymphoblastic leukemia. Blood, 96, 2691–2696. Coustan-Smith, E., Sancho, J., Behm, F.G., Hancock, M.L., Razzouk, B.I., Ribeiro, R.C., Rivera, G.K., Rubnitz, J.E., Sandlund, J.T., Pui, C.-H. & Campana, D. (2002) Prognostic importance of measuring early clearance of leukemic cells by flow cytometry in childhood acute lymphoblastic leukemia. Blood, 100, 52–58. Irving, J., Jesson, J., Virgo, P., Case, M., Minto, L., Eyre, L., Noel, N., Johansson, U., Macey, M., Knotts, L., Helliwell, M., Davies, P., Whitby, L., Barnett, D., Hancock, J., Goulden, N. & Lawson, S. on behalf of the UKALL Flow MRD group and UK MRD steering group (2009) Establishment and validation of a standard protocol for the detection of minimal residual disease in B lineage childhood acute lymphoblastic leukemia by flow cytometry in a multi-center setting. Haematologica, 94, 870–874. Motwani, J., Jesson, J., Sturch, E., Jones, S., Eyre, L., Short, P., Davies, P., Williams, M.D., Darbyshire, P.J., Hill, F.G.H. & Lawson, S. (2009) Predictive value of flow cytometric minimal residual disease analysis in childhood acute lymphoblastic leukaemia at the end of remission induction therapy: results from a single UK centre. British Journal of Haematology, 144, 133–135. Volejnikova, J., Mejstrikova, E., Valova, T., Reznickova, L., Hodonska, L., Mihal, V., Sterba, J., Jabali, Y., Prochazkova, D., Blazek, B., Hak, J., Cerna, Z., Hrusak, O., Stary, J., Trka, J. & Fronkova, E. (2011) Minimal residual disease in peripheral blood at day 15 identifies a subgroup of childhood B-cell precursor acute lymphoblastic leukemia with superior prognosis. Haematologica, 96, 1815–1821.

In vivo validation of the new Tonopen AVIA tonometer using manometers placed in the anterior chamber and the vitreous cavity under various vitreous conditions.

Abstract Purpose: To validate intraocular pressure (IOP) measurements using the new Tonopen AVIA® tonometer by comparing values obtained with those measured by manometers placed in the anterior chamber (AC) and the vitreous cavity (VC). Materials and Methods: Seventy-nine consecutive patients awaiting phacovitrectomy for epiretinal membrane (ERM) or macular hole (MH) (n = 29), vitreous hemorrhage (DMVH) (n = 27) or silicone oil removal (n = 23) were included in this prospective observational study. A clinician masked to patient information performed a complete ophthalmologic examination, including measurements of corneal thickness (CT), AC depth and axial length. Another examiner simultaneously measured conventional IOP using the Tonopen AVIA® (TIOP) and AC and VC IOPs (ACIOP and VCIOP) using two transducers. Results: The mean TIOP, ACIOP and VCIOP were 16.1 ± 3.8, 16.1 ± 4.4 and 15.5 ± 4.6 mmHg, respectively. There was a good agreement between the TIOP and ACIOP; however, the agreement between TIOP and VCIOP was relatively poor in subgroup analysis. VCIOP was significantly higher than TIOP in the ERM and MH group, with a mean difference of 1.0 mmHg (p = 0.042); however, they were significantly lower in the DMVH group, with a mean difference of −0.7 mmHg (p = 0.026) and in the silicone oil group (mean difference, −2.3 mmHg) (p < 0.0001). In multivariate analysis, TIOP correlated significantly only with CT (p < 0.037) and increased by 2.7 mmHg per 100 μm increase in CT. Conclusions: IOP measurements using the Tonopen AVIA® tonometer showed good agreement with ACIOP values, although TIOP measurements were affected by CT. However, the VCIOP values using the transducer may have over- or underestimated IOP relative to TIOP and ACIOP under various vitreous conditions. Further validation of VCIOP using a cannular type of manometer should be considered.

SUBFOVEAL CHOROIDAL THICKNESS CHANGES IN TREATED IDIOPATHIC CENTRAL SEROUS CHORIORETINOPATHY AND THEIR ASSOCIATION WITH RECURRENCE.

Purpose: To analyze the changes in subfoveal choroidal thickness (SFChT) before and after resolution of central serous chorioretinopathy (CSC) and their association with recurrence during follow-up. Methods: Seventy-six eyes with CSC that were completely resolved after treatment with either intravitreal bevacizumab (IVB, 42 eyes) or with half-fluence photodynamic therapy (34 eyes) were included. Best-corrected visual acuity and spectral domain optical coherence tomography were performed at baseline, after complete resolution, and at regular intervals thereafter. Results: Subfoveal choroidal thickness was similar in the IVB-treated and half-fluence photodynamic therapy–treated eyes at baseline, as well as after complete resolution of the CSC. However, recurrence was more frequent in the IVB-treated eyes (19.0% vs. 2.9%, P = 0.037). The reduction of SFChT after CSC resolution was greater in the nonrecurrent eyes than in the recurrent eyes (91.35 ± 46.40 vs. 19.25 ± 16.47 &mgr;m, P < 0.001), and the extent of SFChT reduction was associated with the rate of recurrence of CSC (odds ratio = 0.877, P = 0.019). When CSC recurred, SFChT increased toward the baseline value. Conclusion: Treatment of idiopathic CSC by both IVB and half-fluence photodynamic therapy can reduce SFChT when subretinal fluid is completely resolved. Recurrence is more frequent after IVB and specifically in eyes with a smaller reduction in SFChT after resolution of the CSC.

A case of Purtscher retinopathy associated with stent-assisted coil embolization of a middle cerebral artery aneurysm.

Purpose. This article reports a case of Purtscher retinopathy following therapeutic coil embolization of a middle cerebral artery (MCA) aneurysm. Methods. Case report. Results. A 53-year-old woman with a history of stent-assisted coil embolization in her left MCA unruptured aneurysm presented with a visual disturbance about 3 hours after the procedure. Her left eye vision was 20/40. Fundus examination of the left eye showed an intraretinal hemorrhage and multiple whitish retinal lesions. The spectral-domain optical coherence tomography (OCT) examination showed focal thickness around the whitish lesions and a hemorrhage site. Three weeks later, the retinal whitish lesions decreased but new multiple intraretinal hemorrhages were found near the previous whitish lesions. Fluorescein angiography revealed the obstruction of an arteriole at the posterior pole. After 5 weeks, all lesions in the fundus photography and OCT were almost gone and her left visual acuity was 20/20. Conclusions. A thorough understanding of clinical findings and mechanism of this disorder, including the possibility of direct emboli during coil embolization rather than secondary emboli from the postoperative coil-thrombus complex formed in the aneurysm after the procedure, is therefore necessary to prevent unwanted ocular complications after coil embolization.

Co-Evaluation of Peripapillary RNFL Thickness and Retinal Thickness in Patients with Diabetic Macular Edema: RNFL Misinterpretation and Its Adjustment

We investigated the relationship between the peripapillary retinal nerve fiber layer and peripapillary retinal thickness in patients with diabetic macular edema. Fifty eyes (group I) with non-proliferative diabetic retinopathy and diabetic macular edema receiving intravitreal anti-VEGF injection, and 90 eyes (group II) without diabetic macular edema were included in this case-control study. The peripapillary retinal nerve fiber layer thickness, peripapillary retinal thickness, and a new retinal nerve fiber layer index using a modeled relationship between the two parameters were evaluated with spectral-domain optical coherence tomography, at baseline and at the 6-month follow-up. In group I, the peripapillary retinal nerve fiber layer thickness decreased from 126.4 μm at baseline to 117.6 μm at 6 months (p < 0.001), while the peripapillary retinal thickness decreased from 376.0 μm at baseline to 359.6 μm at 6 months (p < 0.001) after intravitreal anti-VEGF injection. In group II, however, both the parameters remained stable at the 6-month follow-up (100.7 to 102.1 μm and 311.1 to 316.2 μm, respectively, and all p > 0.01). Analysis with the new index to adjust for retinal edema showed no significant change from baseline to 6 months in both groups (p = 0.593 and p = 0.101, respectively). The peripapillary retinal nerve fiber layer thickness is strongly affected by the peripapillary retinal thickness. Therefore, the measured changes in peripapillary retinal nerve fiber layer thickness may not represent the real gain or loss of the retinal nerve fiber layer. Therefore, the new retinal nerve fiber layer index, which corrects for the component of macula edema, could be a better means of assessing the changes of peripapillary retinal nerve fiber layer thickness in patients with diabetic macular edema.

New prophylactic intraoperative septated circumferential barrier laser in macular surgery

OBJECTIVE Despite the availability of minimally invasive intraoperative prophylactic sclerotomy-site laser retinopexy and 360-degree laser retinopexy to reduce the incidence of retinal detachment (RD), RD is still prevalent in macular surgery. We investigated the efficacy and safety of a new prophylactic laser retinopexy method, the intraoperative septated circumferential barrier laser (SCBL), to prevent clinically significant RD during complete phacovitrectomy in macular surgery. DESIGN Retrospective case-control study. PARTICIPANTS Six hundred and eighteen consecutive patients who underwent an uncomplicated phacovitrectomy between 2005 and 2011 to treat an epiretinal membrane (ERM) and macular hole (MH) were included. METHODS Three hundred and forty-four patients received SCBL (group 1), and 274 patients did not receive SCBL (group 2). In the SCBL procedure, 1 or 2 rows of circumferential moderate-intensity burns were placed anteriorly to the equator with a subsequent 5-6 septate laser burns made from the circumferential laser marks to the anterior vitreous base perpendicularly at intervals of about 60 degrees. RESULTS The SBCL procedure took an additional 208 ± 23.1 seconds in the most recent 47 patients. SCBL was associated with a significant reduction of clinically significant RD (from 2.6% in group 2 to 0% in group 1; p = 0.003). Postoperative complications related to SCBL such as anatomical failure in MH, macular edema, and ERM were not significantly different between the 2 groups (p = 0.738, p = 0.743, and p = 0.914, respectively). CONCLUSIONS Prophylactic intraoperative SCBL produces a significant benefit by preventing postoperative RD without significant complications in ERM and MH surgery combined with phacoemulsification.