Jae Pil Shin

Age-Related Macular Degeneration: Prevalence and Risk Factors from Korean National Health and Nutrition Examination Survey, 2008 through 2011

OBJECTIVE To investigate the prevalence and risk factors of age-related macular degeneration (AMD) in the Korean population. DESIGN A cross-sectional study using a complex, stratified, multistage, probability-cluster survey, which can produce nationally representative estimates. PARTICIPANTS Using the database of Korean National Health and Nutrition Examination Survey from 2008 through 2011, 14 352 participants 40 years of age or older with gradable fundus photographs were included. METHODS Age-related macular degeneration was determined by fundus photograph. Prevalences of AMDs were estimated. Risk factor analyses were conducted using logistic regression analyses (LRAs). MAIN OUTCOME MEASURES Prevalence and risk factors of AMD. RESULTS The prevalence of AMD was 6.62% (95% confidence interval [CI], 6.15%-7.09%) in the Korean population: 6.02% (95% CI, 5.56%-6.48%) were early AMD and 0.60% (95% CI, 0.45%-0.75%) were late AMD. The prevalence of early AMD in women (6.73%; 95% CI, 6.11%-7.35%) was higher than that in men (5.25%; 95% CI, 4.61%-5.89%; P<0.001), and the prevalence of late AMD in women (0.37%; 95% CI, 0.22%-0.52%) was lower than that in men (0.85%; 95% CI, 0.59%-1.12%; P<0.001). However, in multiple LRAs both early and late AMD had no association with gender, house income, residence, sun exposure, or systemic comorbidities, including hypertension, diabetes mellitus, and cardiovascular diseases. Early AMD had positive associations with older age groups (P<0.001), lower education (P = 0.027), occupation (P<0.001), anemia (P = 0.027), hepatitis B surface antigen carrier status (P<0.001), not being overweight (body mass index [BMI], P = 0.032; waist circumference, P = 0.041, in separate analyses), and higher serum high-density lipoprotein (HDL) level (P = 0.046), but not with smoking status. Late AMD had positive associations with age groups (P<0.001), current smokers (P = 0.022), and lower BMI (P = 0.037). CONCLUSIONS The results suggest that there are 1.21 million individuals with early AMD and 121 000 individuals with late AMD in Korea. Nonoverweight status and higher HDL levels, generally assumed as positive health indicators, as well as anemia and hepatitis B infection had harmful associations with AMD in our study, implying a possible different pathophysiologic process of AMD in Asians compared with that of white persons.

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.

In Vivo Corneal Endothelial Safety of Intracameral Bevacizumab and Effect in Neovascular Glaucoma Combined With Ahmed Valve Implantation

PurposeTo evaluate the corneal toxicity of intracameral bevacizumab in rabbit eyes and also the effects of intracameral bevacizumab in neovascular glaucoma patients combined with Ahmed glaucoma valve implantation. Materials and MethodsIntracameral bevacizumab (1.25 mg/0.05 mL) was injected into 5 eyes of 5 New Zealand white rabbits. A balanced salt solution (0.05 mL) was injected intracamerally in another 5 rabbits as a control. The corneal thickness, endothelial cell counts, and intraocular pressure were measured before and at 1, 2, and 4 weeks after the intracameral injection of bevacizumab and a balanced salt solution. Scanning electron microscopic examinations were performed at 1 and 4 weeks after injection. In the clinical cases, 6 patients who received an intracameral injection of bevacizumab (1.25 mg) and Ahmed glaucoma valve implantation were enrolled. The visual acuity, intraocular pressure, and regression of iris rubeosis by iris fluorescein angiography were recorded before and at 1 week, 1 month, and 2 months after the intracameral bevacizumab injection and Ahmed glaucoma valve implantation. ResultsNo morphologic and functional changes in the corneal endothelial cells were observed in the rabbit eyes after the intracameral bevacizumab and balanced salt solution injections. Iris rubeosis regression was observed in all eyes within 1 week after the injection. The visual acuity remained stable or improved, and the intraocular pressure was controlled in all eyes throughout the follow-up period. There were no ocular and systemic complications associated with the combined procedure. ConclusionsAn intracameral injection of bevacizumab may be a safe alternative treatment for iris rubeosis in neovascular glaucoma when combined with Ahmed glaucoma valve implantation.

Biodegradable Intrascleral Implant of Triamcinolone Acetonide in Experimental Uveitis

PURPOSE To evaluate the efficacy of a biodegradable intrascleral implant of triamcinolone acetonide (TA) in a rabbit model of experimental uveitis. METHODS A disc-shaped TA implant (1 x 3 mm, containing 6.4 mg of TA), which is made by poly(D,L-lactide) (PLA) and TA, was intrasclerally implanted into eight albino rabbits after a subcutaneous injection of tuberculin antigen. Control animals (n = 8) received sham devices. Uveitis was induced with an intravitreal injection of tuberculin antigen. To induce chronic inflammation, all eyes were reinjected with intravitreal antigen on day 14 and were observed for 1 month. Aqueous protein concentrations and cell counts were determined on days 7, 14, and 28. Inflammation of the anterior chamber (AC) and vitreous opacity were graded clinically and retinal functions were evaluated electroretinographically and histologically. RESULTS Anterior chamber cells, flare, and vitreous opacity scores showed significantly less inflammation in treated eyes than in untreated eyes (P < 0.05). Quantitative analyses of aqueous cell counts and protein concentrations showed significant decreases in treated eyes (P < 0.05). Histopathologic examinations showed less severe inflammation and tissue disorganization in treated eyes. CONCLUSIONS The biodegradable intrascleral TA implant was found to be effective at suppressing the inflammation induced by experimental uveitis in rabbits for at least 4 weeks.

An Overview of Ophthalmologic Survey Methodology in the 2008-2015 Korean National Health and Nutrition Examination Surveys

The Korea National Health and Nutrition Examination Survey (KNHANES) is a national program designed to assess the health and nutritional status of the noninstitutionalized population of South Korea. The KNHANES was initiated in 1998 and has been conducted annually since 2007. Starting in the latter half of 2008, ophthalmologic examinations were included in the survey in order to investigate the prevalence and risk factors of common eye diseases such as visual impairment, refractive errors, strabismus, blepharoptosis, cataract, pterygium, diabetic retinopathy, age-related macular degeneration, glaucoma, dry eye disease, and color vision deficiency. The measurements included in the ophthalmic questionnaire and examination methods were modified in the KNHANES IV, V, and VI. In this article, we provide detailed information about the methodology of the ophthalmic examinations in KNHANES in order to aid in further investigations related to major eye diseases in South Korea.

Dried Human Amniotic Membrane Does Not Alleviate Inflammation and Fibrosis in Experimental Strabismus Surgery

Purpose. The purpose of this study was to evaluate the efficacy of dried human amniotic membrane (AM) in reducing the postoperative inflammatory response and scarring after strabismus surgery. Methods. The inflammatory response at the extraocular muscle reattachment site was analyzed after superior rectus (SR) resection in 12 rabbits. Dried human AM (Ambiodry2) was applied between the resected SR muscle plane and Tenons capsule of the left eyes of rabbits. As a control, the right eyes of rabbits underwent SR resection only. The surgeon randomly ordered which eye gets operated first during the experiment. Two weeks later, enucleation was performed. Six sagittal sections were made for each eye at the insertion of the SR muscle. The grade of postoperative inflammation and the presence of fibrosis were evaluated in histological examinations. Results. There was no statistically significant difference in the intensity of inflammation and fibrous proliferation between the eyes treated with dried human AM after SR resection and those treated with SR resection only. Conclusions. The use of dried human AM was not effective in controlling the postoperative inflammation and scarring in rabbit eyes after extraocular muscle surgery. However, this may be due to the devitalized dry preparation of human AM (Ambiodry2), which may have lost the expected anti-inflammatory and anti-scarring properties, and further studies on humans may be necessary.

Epidemiological association between systemic diseases and age-related macular degeneration: the Korea National Health and Nutrition Examination Survey 2008-2011.

PURPOSE We examined the epidemiological association between systemic diseases and age-related macular degeneration (AMD) in the general Korean population. METHODS This cross-sectional study involved nationally representative data obtained from the 2008 to 2011 Korea National Health and Nutrition Examination Surveys. A total of 14,352 subjects aged ≥40 years participated in standardized health interviews regarding physician-diagnosis of several systemic diseases as well as physical examinations, including fundus photography for the evaluation of AMD. RESULTS The overall prevalence rates of early, late, and any AMD were 6.0%, 0.6%, and 6.6%, respectively. In univariate logistic regression analyses adjusted for age and sex as well as smoking in late AMD, any AMD and late AMD were less prevalent among diabetic patients and more prevalent in participants with a history of liver cancer. A history of liver cirrhosis was associated with a higher prevalence of any AMD. In the final multivariate model, the associated factors for any AMD included age (odds ratio [OR], 1.09), the presence of diabetes mellitus (DM; OR, 0.74), and a history of liver cancer (OR, 4.32). Factors associated with late AMD included age (OR, 1.09), ever-smoking history (OR, 2.45), the presence of DM (OR, 0.22), and a history of liver cancer (OR, 12.51). The presence of diabetic retinopathy was associated with a lower prevalence of any AMD (OR, 0.35). CONCLUSIONS When adjusted for confounders, any AMD and late AMD were less prevalent in diabetic patients. In contrast, a history of liver cancer was associated with a higher prevalence of any AMD and late AMD.

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.

Frosted Branch Angiitis as Ocular Manifestation of Behçet's Disease: Unusual Case Report and Literature Review

We report an unusual case of unilateral frosted branch angiitis associated with Behçets disease, including a review of previously reported cases. A 39-year-old male with history of recurrent oral and genital ulcers presented with visual loss in his left eye. Fundus findings demonstrated occlusive retinal vasculitis resembling acute frosted branch angiitis. Laboratory examinations including viral markers revealed no abnormal findings except positive HLA-B51. The patient was treated with systemic steroid and cyclosporine. Six months after presentation, new oral ulcers and pseudofolliculitis appeared, and he was diagnosed with Behçets disease following rheumatology consultation. During follow-up, there was no change in visual acuity of hand movement, and disc neovascularization developed even after complete panretinal photocoagulation. Ocular manifestations of Behçets disease can present as unilateral frosted branch angiitis, and may consecutively involve in both eyes. Early immunosuppressive treatment is recommended.

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.