Jaeryung Oh

Comparison Of Choroidal Thickness Among Patients With Healthy Eyes, Early Age-related Maculopathy, Neovascular Age-related Macular Degeneration, Central Serous Chorioretinopathy, And Polypoidal Choroidal Vasculopathy

Purpose: To compare choroidal thicknesses among eyes with early age-related maculopathy (ARM), neovascular age-related macular degeneration, polypoidal choroidal vasculopathy, and central serous chorioretinopathy. Methods: Patients with age-related maculopathy (37 eyes), neovascular age-related macular degeneration (24 eyes), polypoidal choroidal vasculopathy (12 eyes), and central serous chorioretinopathy (31 eyes) underwent spectral-domain optical coherence tomography evaluations using a choroid scanning protocol. A horizontal linear section comprising 50 averaged scans was obtained of each macula. The choroidal thickness was measured from the outer border of the retinal pigment epithelium to the inner scleral border. Twenty-nine subjects with healthy eyes served as a control group. Analysis of covariance tests were performed to evaluate the effects of various diagnoses on choroidal thickness after removal of variance (covariates = gender, age, and refractive error). Results: Among the different covariates, age was associated with choroidal thickness (fovea: F = 12.067, P = 0.001). After controlling for age differences, the choroid was thicker in polypoidal choroidal vasculopathy (319.92 ± 68.66 μm) and central serous chorioretinopathy (367.81 ± 105.56 μm) patients than in controls (241.97 ± 66.37 μm) and age-related maculopathy patients (186.62 ± 64.02 μm). However, there were no significant differences in mean choroidal thickness between neovascular age-related macular degeneration (226.46 ± 102.87 μm) and any of the other diagnoses. Conclusion: The choroid was thicker in eyes with polypoidal choroidal vasculopathy or central serous chorioretinopathy than in control or age-related maculopathy groups.

Inflammatory and Angiogenic Factors in the Aqueous Humor and the Relationship to Diabetic Retinopathy

Purpose: To determine the relationship between the aqueous concentrations of inflammatory and angiogenic factors and the severity of diabetic retinopathy and diabetic macular edema. Methods: Aqueous samples were obtained from 50 eyes of diabetic patients and 28 eyes of nondiabetic subjects. The aqueous levels of inflammatory factors, including IL-1β, TNF-α, MCP-1, IP-10, IL-8, IL-6, and VEGF were measured with multiplex bead array assays. The aqueous levels of cytokines were investigated according to the severity of diabetic retinopathy and diabetic macular edema measured by optical coherence tomography. Results: The aqueous levels of MCP-1, IP-10, IL-8, and VEGF were higher in eyes of diabetic patients than in eyes of nondiabetic subjects. The aqueous levels of MCP-1 and IP-10 were elevated in eyes with severe NPDR and PDR compared to eyes with less severe DR and eyes of nondiabetic subjects. There was a trend toward elevated IL-8 levels in eyes with severe NPDR compared to eyes of nondiabetic subjects. The aqueous levels of VEGF were markedly elevated in eyes with PDR that had not received PRP compared to eyes with severe NPDR. Eyes with PDR that had received PRP treatment showed higher MCP-1 and IP-10 levels than eyes with PDR that had not received PRP treatment. The aqueous levels of IL-6 were positively correlated with TMV and CSMT in eyes with DR. Conclusions: Elevation of MCP-1, IP-10, and IL-8 levels in eyes with severe NPDR suggests that inflammatory change precedes the development of neovascularization in PDR. The positive correlation between the aqueous levels of IL-6 and macular thickness indicates that IL-6 may play a central role in the development of diabetic macular edema.

A survey of satisfaction in anophthalmic patients wearing ocular prosthesis

PurposeThe purpose of this study was to evaluate patient satisfaction with ocular prosthesis after evisceration or enucleation and to determine which variables were correlated to their satisfaction in order to find out how to increase patient satisfaction.MethodsA satisfaction questionnaire was given to consecutive anophthalmic patients who visited Korea University Hospital from March 2002 through August 2002. Many kinds of variables such as age, gender, type of implant, pegging, and postoperative ocular symptoms that might influence patient satisfaction were evaluated by correlation analysis and multivariate analysis to find the determinants of patient satisfaction.ResultsThe overall rate of satisfaction with ocular prosthesis was 71.8%. The variables significantly correlated to patient satisfaction were economic status, other peoples response, and insertion of motility coupling post or motility peg.ConclusionPatient satisfaction with ocular prosthesis was relatively high. Successful peg insertion to improve the prosthesis movement may be one way for surgeons to increase patient satisfaction.

Retinal Pigment Epithelial Tear After Half Fluence PDT for Serous Pigment Epithelial Detachment in Central Serous Chorioretinopathy

Retinal pigment epithelial tears may occur after photodynamic therapy (PDT) in various diseases. The authors report a case of a retinal pigment epithelial tear after half light intensity (300 mW/cm2) PDT in a large serous pigment epithelial detachment associated with chronic atypical central serous chorioretinopathy. A 52-year-old woman with a large serous pigment epithelial detachment associated with chronic atypical central serous chorioretinopathy in the left eye received her first PDT treatment using verteporfin with a spot size of 6,640 microm, a duration of 83 seconds, and half (300 mW/cm2) of the standard 600 mW/cm2 light intensity, where the delivered PDT light dose was only 25 J/cm2. Two weeks later, visual acuity improved to 20/30. However, a large crescent-shaped retinal pigment epithelial tear was found during fundus examination. Even 50% reduced light fluence PDT can produce a retinal pigment epithelial tear in pigment epithelial detachment associated with chronic atypical central serous chorioretinopathy.

Complete Regression of Choroidal Metastasis Secondary to Non-Small-Cell Lung Cancer with Intravitreal Bevacizumab and Oral Erlotinib Combination Therapy

Purpose: To report a case of a complete regression of choroidal metastasis secondary to non-small-cell lung cancer (NSCLC). Methods: Retrospective case review of a female patient treated with intravitreal bevacizumab and oral erlotinib combination therapy for choroidal metastases secondary to NSCLC. Best corrected visual acuity (BCVA), fluorescein angiography (FA), optical coherence tomography (OCT), and B-scan ultrasonography were compared during the 4-month treatment period. Results: Four weeks after the third injection of bevacizumab (2.5 mg), the BCVA had improved to 20/40 from 20/200 and the 2 subretinal masses had completely disappeared. FA demonstrated only a retinal pigment epithelial (RPE) window defect with minimal to no leakage. In the B-scan ultrasonography and OCT, no further mass-like lesion was detected. The retina and RPE layer were flattened. Conclusion: Combining intravitreal bevacizumab and oral erlotinib could be another treatment option for patients with choroidal metastasis of NSCLC.

Correlations among various functional and morphological tests in resolved central serous chorioretinopathy.

Aims To find the explanatory parameters for best corrected visual acuity (BCVA) and microperimetry (MP) in resolved central serous chorioretinopathy. Methods Thirty-three eyes from 33 patients were analysed retrospectively. BCVA and MP were correlated with parameters from various functional and morphological tests. The mean MP sensitivities at fovea 2° and 4°, retinal thickness and degree of defect at the photoreceptor inner and outer segment junction (IS/OS) of the spectral domain-optical coherent tomography image, normalised coefficient of variation of grey scale at the fovea in the short wavelength and near infrared fundus autofluorescence image, P1 amplitude and latency, and N1 amplitude and latency of multifocal electroretinography at ring 1 (R1) were measured. Spearman correlations and multiple linear regression analysis were used for analysis of correlation between functional and morphological characteristics. Results The mean BCVA was 0.19±0.23 (logarithm of the minimum angle of resolution (logMAR)). The mean MP at 2° was 12.79±4.47 dB. BCVA correlated with MP at 2° (ρ=−0.491, p=0.004) and had a significant association with the IS/OS defect and centre point thickness (CPT) (BCVA=0.413+0.314×IS/OS defect–0.002×CPT; p<0.001, R=0.739, R2=0.546). Retinal sensitivity measured by MP at the fovea (2°) had a significant association with the IS/OS defect and N1 latency at R1 (MP at 2°=19.350–9.116×IS/OS defect –0.324×N1 latency at R1; p<0.001, R=0.804, R2=0.647). Conclusions The visual function of eyes with resolved central serous chorioretinopathy was suboptimal and was better explained when various parameters showing retinal status were combined and interpreted together.

Near-infrared and short-wavelength autofluorescence in resolved central serous chorioretinopathy: association with outer retinal layer abnormalities.

PURPOSE To evaluate the correlation between changes in fundus autofluorescence (AF) measured using 2 different sources (near-infrared fundus autofluorescence from melanin and short-wavelength fundus autofluorescence from lipofuscin) with changes in spectral-domain optical coherence tomography (SD OCT) and fluorescein angiography in resolved central serous chorioretinopathy (CSC). DESIGN Retrospective, observational case study. METHODS A total of 91 eyes from 86 patients with a history of resolved CSC and abnormal AF imaging findings were included. In addition to AF, patients were assessed by means of SD OCT and fluorescein angiography. Outer retinal layer alterations in OCT images and abnormalities in fluorescein angiography were analyzed and correlated with the corresponding AF data. RESULTS All eyes with abnormal near-infrared AF showed a hyperfluorescent angiography window defect in the corresponding area. There was a significant association between the OCT and short-wavelength AF findings. An abnormal short-wavelength AF signal was significantly associated with loss of the ellipsoid portion of the inner segments (EPIS, previously known as the junction between the inner and outer segments of the photoreceptors) on SD OCT (χ(2) test; P < .0001). Near-infrared AF could not predict the status of EPIS without the short-wavelength AF image. CONCLUSIONS Outer retinal layer changes in OCT images can be predicted by analyzing both short-wavelength AF and near-infrared AF images. Abnormal changes in the short-wavelength AF image were predictive of EPIS damage.

Simplified method to measure the peripapillary choroidal thickness using three-dimensional optical coherence tomography.

Purpose To evaluate a simplified method to measure peripapillary choroidal thickness using commercially available, three-dimensional optical coherence tomography (3D-OCT). Methods 3D-OCT images of normal eyes were consecutively obtained from the 3D-OCT database of Korea University Medical Center On the peripapillary images for retinal nerve fiber layer (RNFL) analysis, choroidal thickness was measured by adjusting the segmentation line for the retinal pigment epithelium to the chorioscleral junction using the modification tool built into the 3D-OCT image viewer program. Variations of choroidal thickness at 12 sectors of the peripapillary area were evaluated. Results We were able to measure the peripapillary choroidal thickness in 40 eyes of our 40 participants, who had a mean age of 41.2 years (range, 15 to 84 years). Choroidal thickness measurements had strong inter-observer correlation at each sector (r = 0.901 to 0.991, p < 0.001). The mean choroidal thickness was 191 ± 62 µm. Choroidal thickness was greatest at the temporal quadrant (mean ± SD, 210 ± 78 µm), followed by the superior (202 ± 66 µm), nasal (187 ± 64 µm), and inferior quadrants (152 ± 59 µm). Conclusions The measurement of choroidal thickness on peripapillary circle scan images for RNFL analysis using the 3D-OCT viewing program was highly reliable and efficient.

Risk Factors of Iris Posterior Synechia Formation after Phacovitrectomy with Three-Piece Acrylic IOL or Single-Piece Acrylic IOL

Aims: To identify the risk factors of posterior iris synechia formation after phacovitrectomy with posterior chamber single-piece acrylic intraocular lens (IOL; Acrysof® SA60AT) or 3-piece acrylic IOL (Acrysof® MA60BM) implantation. Methods: We selected 153 eyes of 153 patients treated by phacovitrectomy between March 2000 and August 2006 and retrospectively reviewed the relationship between iris posterior synechiae and various factors, such as IOL type, tamponade, preoperative iris posterior synechiae, major indications for surgery, axial length and preoperative anterior chamber (AC) depth. Results: IOL type (p = 0.0447), C3F8 gas tamponades (p = 0.0074), preoperative iris posterior synechiae (p = 0.0001) and postoperative AC fibrin deposition (p = 0.0303) were significantly associated with postoperative iris posterior synechiae by multiple logistic regression analysis. The odds ratio (OR) for single-piece IOL versus 3-piece IOL was 2.658 (95% confidence interval, CI: 1.010–6.993), the OR for C3F8 gas versus balanced salt solution was 4.051 (95% CI: 1.455–11.281), for the presence of preoperative iris posterior synechiae 12.868 (95% CI: 3.511–47.165), and the OR for postoperative AC fibrin deposition was 6.012 (95% CI: 1.186–30.468). Conclusion: Preoperative iris posterior synechiae, C3F8 gas tamponade, postoperative AC fibrin deposition and the single-piece IOL could increase the rates of iris posterior synechiae after phacovitrectomy.

Long-term Visual Outcome of Arteriovenous Adventitial Sheathotomy on Branch Retinal Vein Occlusion Induced Macular Edema

Purpose To evaluate long-term visual outcome of arteriovenous adventitial sheathotomy in BRVO-induced macular edema. Methods The visual outcomes of 8 patients following vitrectomy with arteriovenous adventitial sheathotomy for BVO-induced macular edema (surgery group) were retrospectively evaluated. The three year post-operative visual acuity of the surgery group was compared with that of the conservatively managed controls. Results All patients were followed for a minimum of 36 months. Mean BCVA (logMAR) in the surgery group changed from 1.10± 0.34 to 1.19±0.70 and to 0.80±0.36 at 12 and 36 months, respectively (p=0.959 at 12 months, p=0.018 at 36 months). In the control group, visual acuity improved from 1.15±0.43 to 0.43±0.44 and to 0.43±0.39 at 12 and 36 months, respectively (p=0.015 at 12 months, at p=0.003 at 36 months). A strong trend toward better visual acuity at 12 months and final examination was observed for controls. (surgery vs. control group, p=0.052 at 12 months, p=0.066 at 36 months). Conclusions Considering the favorable natural course of BVO and the unproven effect of reperfusion on macular edema, surgical efficacy of arteriovenous adventitial sheathotomy requires further evaluation.