In Taek Kim

Aqueous Levels of Angiopoietin-like 4 and Semaphorin 3E Correlate with Nonperfusion Area and Macular Volume in Diabetic Retinopathy

OBJECTIVE To investigate the aqueous levels of angiopoietin-like 4 (ANGPTL4), semaphorin 3E (Sema3E), and vascular endothelial growth factor (VEGF) in patients with diabetic retinopathy and to ascertain their association with diabetic retinopathy phenotypes. DESIGN Prospective, nonrandomized, comparative case series. PARTICIPANTS Of all 104 consecutive patients (104 eyes) who had intravitreal anti-VEGF injections from April 2012 through April 2013 for diabetic macular edema (DME), 51 had severe nonproliferative diabetic retinopathy (NPDR) and 53 had proliferative diabetic retinopathy (PDR). The controls were 54 consecutive nondiabetic patients who had undergone cataract surgery (54 eyes) during the same period. METHODS The ANGPTL4, Sema3E, and VEGF levels in aqueous humor samples obtained before intravitreal injections were measured by enzyme-linked immunosorbent assay. Capillary nonperfusion area (NPA) was calculated from encircled angiography using the 7 standard field images described in the Early Treatment Diabetic Retinopathy Study protocol. Total macular volume (TMV) was measured by spectral-domain optical coherence tomography. MAIN OUTCOME MEASURES Aqueous ANGPTL4, Sema3E, and VEGF levels in severe NPDR, PDR, and control groups and their correlations with each other, NPA, and TMV. RESULTS The severe NPDR and PDR groups had higher aqueous levels of ANGPTL4 and VEGF than the control group (all P < 0.001). The PDR group had higher ANGPTL4 and VEGF levels than the severe NPDR group (both P < 0.001). The aqueous ANGPTL4 levels of all diabetic retinopathy patients correlated positively with NPA (r = 0.820, P = 0.003) and TMV (r = 0.824, P < 0.001). The control group had higher aqueous Sema3E levels than the NPDR and PDR groups (both P < 0.001). Aqueous Sema3E levels correlated negatively with VEGF levels in all subjects (r = -0.57, P = 0.025). CONCLUSIONS The ANGPTL4 may be a candidate target in DME treatment and a biomarker of ischemic-induced retinopathy, including diabetic retinopathy.

One-year follow-up of macular ganglion cell layer and peripapillary retinal nerve fibre layer thickness changes after panretinal photocoagulation

Background/aims To assess the changes of ganglion cell–inner plexiform layer (GCIPL) thickness, retinal nerve fibre layer (RNFL) thickness, and central subfield thickness (CST) after panretinal photocoagulation (PRP) in diabetic retinopathy for 1 year. Methods This prospective, interventional case series study examined 35 patients (35 eyes) undergoing PRP, who were diagnosed with severe non-proliferative diabetic retinopathy to non-high-risk proliferative diabetic retinopathy without macular oedema. Macular GCIPL thickness, CST, and peripapillary RNFL thickness were measured by spectral-domain optical coherence tomography at baseline, and then at 1, 3, 6, 9 and 12 months after PRP. Results Macular GCIPL and peripapillary RNFL (average and all sections) thickness at each follow-up increased significantly from the baseline (p<0.001, respectively). The average, superior and inferior RNFL thickness at 12 months after PRP decreased significantly compared to the 1-month post-PRP (p=0.007, p=0.028 and p=0.025). The average GCIPL and temporal RNFL thickness showed a significant correlation at each follow-up (p<0.001, respectively). CST at each follow-up increased significantly from the baseline (p<0.001, respectively). Conclusions The macular GCIPL and peripapillary RNFL thickness increased throughout the 1-year post-PRP. Furthermore, the macular GCIPL and temporal RNFL thickness showed a significant correlation throughout the 1 year of follow-up.

Two-year results of AcrySof toric intraocular lens implantation in patients with combined microincision vitrectomy surgery and phacoemulsification.

Aim To evaluate the effects and stability of AcrySof toric intraocular lens (IOL) implantation in patients who had combined microincision vitrectomy surgery (MIVS) and phacoemulsification for vitreoretinal diseases and cataract with corneal astigmatism. Methods A retrospective comparative study with 20 patients (20 eyes) who had combined 23-gauge MIVS and phacoemulsification with regular corneal astigmatism (>1.00 dioptres) was done. 10 eyes had toric IOL and 10 eyes had non-toric IOL implantation. The main outcome measures were uncorrected visual acuity (UCVA), refractive cylinder and toric IOL axis rotation at postoperative months 1, 6, 12, 18 and 24. Results The mean UCVA of toric IOL was better than non-toric IOL at each postoperative period (p=0.019, 0.001, 0.007, 0.004 and 0.001, respectively). The mean absolute residual refractive cylinder of toric IOL was less than non-toric IOL at each postoperative period (p=0.001, <0.001, <0.001, <0.001 and <0.001, respectively). At month 24, the mean toric IOL axis rotation was 3.3±2.1°, which was within 5° in 80% and within 10° in 100%. Conclusions Toric IOL implantation could be an effective method of correcting corneal astigmatism in patients who have vitreoretinal diseases and cataract. The toric IOL showed good rotational stability, even in vitrectomised eyes for 24 months.

ANGIOPOIETIN-LIKE 4 CORRELATES WITH RESPONSE TO INTRAVITREAL RANIBIZUMAB INJECTIONS IN NEOVASCULAR AGE-RELATED MACULAR DEGENERATION.

Purpose: To investigate whether the aqueous angiopoietin-like 4 (ANGPTL4) level correlates with clinical features in neovascular age-related macular degeneration (AMD). Methods: The control and study groups consisted of all consecutive patients who received senile cataract surgery or intravitreal ranibizumab injection for treatment-naïve neovascular AMD, respectively. The AMD group received 3 monthly ranibizumab injections followed by monthly pro re nata for at least 12 months. Aqueous ANGPTL4 and vascular endothelial growth factor (VEGF) were measured at baseline and 4 weeks after the first injection. In the AMD group, best-corrected visual acuity, lesion area by fluorescein angiography, and central subfield thickness were measured at baseline and at 12 months. Results: The AMD group (30 eyes) had higher baseline aqueous ANGPTL4 and VEGF levels than those of the control group (32 eyes) (both P < 0.001). Four weeks after the first injection, VEGF in the patients with AMD had dropped significantly (P < 0.001). Baseline ANGPTL4 correlated with the lesion area at baseline and at 12 months (P < 0.05, respectively), and also correlated with the frequency of anti-VEGF injections during 12 months (P = 0.008). Conclusion: Aqueous ANGPTL4 levels correlated with the lesion area and anti-VEGF treatment frequency. Angiopoietin-like 4 may be a potential diagnostic and/or therapeutic biomarker in the neovascular AMD.

VARIATION OF 24-HOUR INTRAOCULAR PRESSURE IN SILICONE OIL-FILLED EYES.

Purpose: To evaluate the variation of 24-hour intraocular pressure (IOP) in silicone oil (SO)–filled eyes. Methods: Prospective, nonrandomized comparative case series of 42 eyes of 21 patients, each with an SO-filled eye after vitrectomy. The fellow eyes served as controls. Each subject slept the usual 8 hours, and IOPs were measured at 4-hour intervals over 24 hours, twice before sleep (5:30 and 9:30 PM), twice during sleep (1:30 and 5:30 AM), and twice after sleep (9.30 AM and 1:30 PM). Intraocular pressure was measured in the sitting position using a Goldmann applanation tonometer. The SO-filled eyes and fellow eyes were compared with respect to diurnal-to-nocturnal and nocturnal-to-diurnal IOP changes. Results: At all 6 time points, SO-filled eyes had higher mean IOPs than fellow eyes (all P < 0.05). For both groups, mean nocturnal IOP was higher than mean diurnal IOP (both P < 0.001). Changes in diurnal-to-nocturnal IOP and nocturnal-to-diurnal IOP between SO-filled eyes and fellow eyes did not differ significantly (P > 0.05, respectively). The peak IOP occurred in the nocturnal period for all fellow eyes and for 94.7% of SO-filled eyes. Conclusion: The IOP of SO-filled eyes varied over a 24-hour period, peaking largely in the nocturnal period, as observed for the IOP of fellow eyes.

Aqueous Angiopoietin-Like 4 Levels Correlate With Nonperfusion Area and Macular Edema in Branch Retinal Vein Occlusion.

PURPOSE To investigate whether macular edema (ME) due to branch retinal vein occlusion (BRVO) associates with retinal overexpression of angiopoietin-like 4 (ANGPTL4). The aqueous ANGPTL4 and vascular endothelial growth factor (VEGF) levels in patients with ME due to BRVO were measured, and the relationships between ANGPTL4 levels and the degree of retinal ischemia and edema were determined. METHODS The study and control groups consisted of all consecutive patients who were scheduled to undergo intravitreal bevacizumab injection for treatment-naïve BRVO with ME and senile cataract surgery, respectively. The study group was divided into the major BRVO and macular BRVO subgroups on the basis of the involved retinal area. The aqueous ANGPTL4 and VEGF levels were measured by enzyme-linked immunosorbent assay. In the patients with BRVO, capillary nonperfusion area by fluorescein angiography and central subfield macular thickness (CSMT) and total macular volume (TMV) by spectral-domain optical coherence tomography were determined. RESULTS Patients with ME due to BRVO (50 eyes) had higher aqueous ANGPTL4 and VEGF levels than the controls (61 eyes) (both P < 0.001). The major BRVO had higher ANGPTL4 and VEGF levels than the macular BRVO (both P < 0.001). The aqueous ANGPTL4 levels of all BRVO patients correlated positively with nonperfusion area (r = 0.901, P < 0.001), CSMT (r = 0.574, P < 0.001), and TMV (r = 0.453, P = 0.001), even after adjustment for VEGF levels. CONCLUSIONS The aqueous ANGPTL4 levels correlated significantly with phenotypes of BRVO with ME. This suggests that ANGPTL4 may be a candidate biomarker and treatment target in ischemia-induced retinopathies, including BRVO.

Association of Plasma Semaphorin 3A With Phenotypes of Diabetic Retinopathy and Nephropathy

PURPOSE To investigate whether diabetic retinopathy phenotypes and albuminuria are associated with the overexpression of plasma semaphorin 3A (Sema3A). METHODS The study group with severe nonproliferative diabetic retinopathy (NPDR) or proliferative diabetic retinopathy (PDR), the diabetes without diabetic retinopathy group, and the control group without diabetes consisted of all consecutive patients who were scheduled to undergo intravitreal bevacizumab injection for treatment-naïve diabetic macular edema (DME) and senile cataract surgery, respectively. In all subjects, the plasma Sema3A levels before intravitreal bevacizumab injections or cataract surgery were measured by enzyme-linked immunosorbent assay. In the patients with DME, the capillary nonperfusion area (measured by fluorescein angiography), total macular volume (measured by spectral-domain optical coherence tomography), and the urine albumin-to-creatinine ratio were determined. RESULTS Severe NPDR (57 eyes) and PDR groups (51 eyes) both had significantly higher Sema3A levels than the control (58 eyes) and diabetes without diabetic retinopathy groups (54 eyes) (P < 0.001). Moreover, the PDR group had higher Sema3A levels than the severe NPDR group (P < 0.001). Plasma Sema3A levels correlated positively with the retinal nonperfusion area size (r = 0.844, P = 0.004), total macular volume (r = 0.765, P = 0.005), and the urine albumin-to-creatinine ratio (r = 0.752, P < 0.001). When DME patients were divided into normo-, micro-, and macroalbuminuria groups, the macroalbuminuria group had significantly higher plasma Sema3A levels than the microalbuminuria group or the normoalbuminuria group (P = 0.002 and P < 0.001, respectively). CONCLUSIONS The plasma Sema3A levels correlated significantly with the phenotypes of diabetic retinopathy and albuminuria. This suggests that Sema3A may be a potential biomarker for diabetic retinopathy and nephropathy.

Comparative study of corneal wetting agents during 25-gauge microincision vitrectomy surgery under a noncontact wide-angle viewing system.

BACKGROUND AND OBJECTIVE To compare the effects of corneal wetting agents during 25-gauge microincision vitrectomy surgery (MIVS) under a binocular indirect ophthalmic microscope system. MATERIALS AND METHODS This prospective, randomized, comparative study included 45 eyes undergoing 25-gauge MIVS. The randomly assigned corneal wetting agents were balanced salt solution, ProVisc, and DisCoVisc. The main outcome measures were the frequency of applications, the duration of each application, and the corneal surface status including corneal fluorescein staining score postoperatively. RESULTS The mean frequency of applications was higher for balanced salt solution (13.6 ± 4.3) than ProVisc (2.7 ± 1.0) or DisCoVisc (1.7 ± 0.5) (P < .001). The duration of each application was longer for DisCoVisc (29.8 ± 6.0 minutes) than balanced salt solution (3.7 ± 1.1 minutes) or ProVisc (17.6 ± 3.6 minutes) (P < .001). The fluorescein staining score was higher for balanced salt solution until 7 days postoperatively (P < .001). CONCLUSION ProVisc and DisCoVisc could be more effective corneal wetting agents than balanced salt solution by minimizing the frequency of intraoperative application and postoperative corneal injury.