Ji Won Jung

Changes in subfoveal choroidal thickness and choroidal extravascular density by spectral domain optical coherence tomography after haemodialysis: a pilot study

Aims To examine the changes in the subfoveal choroidal thickness (SFCT) and choroidal density using spectral domain optical coherence tomography (SD-OCT) before and after haemodialysis (HD). Methods 28 eyes of 19 patients with chronic renal failure (CRF) undergoing HD were included. Ophthalmologic examinations including SD-OCT were performed 1 h before and after HD. The SFCT was measured manually using Image J software, and the relationships between the change in SFCT and in the systemic parameters after HD were evaluated. The changes in choroidal extravascular density of the OCT image after HD were evaluated by comparing brightness value obtained with Adobe Photoshop software. Results The mean SFCT of all eyes increased significantly from 276.94±58.73 µm to 288.29±65.57 µm (p=0.003). In the univariate generalised estimating equation (GEE), the SFCT increased significantly after HD (p=0.006). After adjusting for age, gender and other significant factors in univariate analysis, the SFCT increased significantly after HD (p=0.032). The decrease in systolic blood pressure (SBP) was associated with the increase in SFCT (p=0.013). The choroidal extravascular density of OCT image increased after HD (p<0.001) and the mean change was 12.35±9.72. Conclusions In the SD-OCT image, the SFCT became thicker and the choroidal extravascular density increased after HD in patients with CRF. The decrease in SBP after HD was associated with an increase in SFCT. The choroidal autoregulatory control of ocular hemodynamic change and shifting of fluid and molecules between the blood and choroidal interstitium might be involved in the mechanism of these choroidal changes.

Long-term Result of Maintenance Treatment With Tacrolimus Ointment in Chronic Ocular Graft-Versus-Host Disease

PURPOSE To investigate the efficacy and safety of long-term maintenance treatment with tacrolimus ointment in chronic ocular graft-vs-host disease (GVHD) with ocular surface inflammation. DESIGN A retrospective interventional consecutive case series. METHOD Long-term maintenance treatment (≥6 months) with topical 0.02% tacrolimus ointment was applied to patients with chronic ocular GVHD with ocular surface inflammation (at least grade 2 inflammatory score). We evaluated the inflammatory score, steroid score and steroid use period of total duration, and numbers of inflammatory aggravations before and after tacrolimus treatment. The clinical outcomes were assessed by symptom score, ocular surface staining, Schirmer I test, tear break-up time (TBUT), and classification of chronic GVHD conjunctivitis at the initial and final examinations. RESULTS Thirteen patients (24 eyes) were treated with tacrolimus ointment for up to 20 months (average 12.2 months). The ocular surface inflammatory score decreased from 2.8 to 0.6 (P = .001) within 2-8 weeks after starting tacrolimus ointment treatment. The numbers of inflammatory aggravation and the need for steroid treatment also decreased after initiating tacrolimus treatment. At the final follow-up, all patients reported improvement in clinical outcomes, compared to initial findings. Except for blurred vision or mild burning sensation, there were no reported side effects. CONCLUSION Considering the chronic course of GVHD, long-term maintenance treatment with tacrolimus ointment could be useful and safe to locally treat ocular surface inflammation in chronic ocular GVHD.

Tear Cytokines as Biomarkers for Chronic Graft-versus-Host Disease.

We investigated the tear cytokine profiles in patients who underwent stem cell transplantation (SCT) and attempted to evaluate whether tear cytokines are associated with the presence of systemic chronic graft-versus-host disease (GVHD), regardless of ocular GVHD status. We also tested tear cytokines as biomarkers for chronic ocular GVHD severity. Forty-four patients who underwent SCT were enrolled and their diagnosis of chronic GVHD was confirmed. Ocular surface parameters and tear cytokine profiles were evaluated and the correlations between concentrations of cytokines and ocular surface parameters or several chronic ocular GVHD severity scales were evaluated. Tear interleukin (IL)-2, IL-10, IL-17α, interferon (IFN)-γ, IL-6, and tumor necrosis factor (TNF)-α were elevated in patients with chronic systemic GVHD compared with patients without chronic systemic GVHD. Receiver-operating characteristic curve analysis revealed that area under the curve (AUC) values for tear IL-10 (AUC = .795), IL-17α (AUC = .821), IL-6 (AUC = .912), and TNF-α (AUC = .910) were significantly correlated with the presence of chronic GVHD (all P < .001). Tear IL-10, IL-6, and TNF-α showed a stronger correlation with ocular surface parameters than other cytokines and these cytokines also correlated with several chronic ocular GVHD severity scales (all P < .05). Our data suggest the tear cytokines are useful biomarkers for the diagnosis of chronic GVHD after SCT and chronic ocular GVHD severity.

Analysis of Factors Associated With the Tear Film Lipid Layer Thickness in Normal Eyes and Patients With Dry Eye Syndrome

PURPOSE To determine the effects of clinical variables, including age, sex, history of refractive or cataract surgery, contact lens use, and ocular surface and meibomian gland parameters on the lipid layer thickness (LLT) in normal subjects and patients with dry eye syndrome (DES). METHODS A total of 64 normal subjects and 326 patients with DES were enrolled, and they underwent measurements of LLT with a LipiView interferometer and tear meniscus height using optical coherence tomography, tear film break-up time (TBUT) determination, ocular surface staining, Schirmers test, examination of the lid margins and meibomian glands, and assessment using the Ocular Surface Disease Index (OSDI). RESULTS In normal subjects, the median (range) LLT was 67 (33-100) nm, and age was the only factor that was significantly associated with LLT (β = 0.678, P = 0.028). In patients with DES, the median (range) LLT was 84 (20-100) nm, and 79.0% of the participants fulfilled the diagnostic criteria for meibomian gland dysfunction (MGD). In a multivariate analysis, increased age and female sex were significantly related to increased LLT (β = 0.282, P = 0.005 and β = 11.493, P < 0.001), and hypersecretory MGD and lid margin inflammation were independently associated with increased LLT (β = 11.299, P = 0.001 and β = 12.747, P = 0.001). CONCLUSIONS Lipid layer thickness measurements using a new interferometer are significantly affected by demographic factors such as age, sex, ocular surgical history, and MGD type. Therefore, all of these factors must be considered in the diagnosis of ocular surface diseases.

The Effects of Two Non-Steroidal Anti-Inflammatory Drugs, Bromfenac 0.1% and Ketorolac 0.45%, on Cataract Surgery

Purpose To compare the additive effects of two types of non-steroidal anti-inflammatory drugs (NSAIDs), bromfenac 0.1% or ketorolac 0.45%, relative to topical steroid alone in cataract surgery. Materials and Methods A total 91 subjects scheduled to undergo cataract operation were randomized into three groups: Group 1, pre/postoperative bromfenac 0.1%; Group 2, pre/postoperative preservative-free ketorolac 0.45%; and Group 3, postoperative steroid only, as a control. Outcome measures included intraoperative change in pupil size, postoperative anterior chamber inflammation control, change in macular thickness and volume, and ocular surface status after operation. Results Both NSAID groups had smaller intraoperative pupil diameter changes compared to the control group (p<0.05). There was significantly less ocular inflammation 1 week and 1 month postoperatively in both NSAID groups than the control group. The changes in central foveal subfield thickness measured before the operation and at postoperative 1 month were 4.30±4.25, 4.87±6.03, and 12.47±12.24 µm in groups 1 to 3, respectively. In the control group, macular thickness and volume increased more in patients with diabetes mellitus (DM), compared to those without DM. In contrast, in both NSAID groups, NSAIDs significantly reduced macular changes in subgroups of patients with or without DM. Although three ocular surface parameters were worse in group 1 than in group 2, these differences were not significant. Conclusion Adding preoperative and postoperative bromfenac 0.1% or ketorolac 0.45% to topical steroid can reduce intraoperative miosis, postoperative inflammation, and macular changes more effectively than postoperative steroid alone.

Clinical Outcomes Following Implantation of Diffractive Multifocal Intraocular Lenses With Varying Add Powers

PURPOSE To compare clinical outcomes after implantation of TECNIS diffractive multifocal intraocular lenses (IOLs) with different add powers. DESIGN Prospective, comparative, interventional case series. METHODS Subjects underwent cataract extraction and diffractive multifocal IOL implant. Subjects had an additional add power of +2.75 diopters (D) (Group 1, 23 eyes), +3.25 D (Group 2, 21 eyes), or +4.00 D (Group 3, 21 eyes). Evaluations were performed 1 and 3 months following cataract surgery, including measurement of monocular uncorrected distance visual acuity (UDVA), refractive error (manifest refraction [MR]), and monocular uncorrected near visual acuity (UNVA) at 33, 40, and 50 cm. At 3 months, internal aberrations and contrast sensitivity were evaluated and subjects completed a questionnaire on outcomes satisfaction, visual symptoms, and spectacle use. RESULTS Sixty-five eyes (43 subjects) were included. After surgery, no significant differences between groups were observed in UDVA and MR values. UNVA at 33 cm was best in Group 3 (1 month: P = .032; 3 months: P = .031). Three months after surgery, UNVA was best in Group 1 at 50 cm (P = .017). No significant differences in internal aberration and contrast sensitivity were observed between groups and surgical satisfaction was worst in Group 3 (P = .001). A total of 87.0%, 85.7%, and 76.9% had spectacle independence in Groups 1, 2, and 3, respectively (P = .080). CONCLUSIONS TECNIS diffractive multifocal IOLs with lower add powers provide good vision over longer working distances and excellent distant vision. Subjects with lower add power had greater satisfaction, more spectacle independence, and fewer visual symptoms than those with +4.00 D add.

Assessment of the Tear Meniscus by Strip Meniscometry and Keratograph in Patients With Dry Eye Disease According to the Presence of Meibomian Gland Dysfunction.

PURPOSE We aimed to compare the tear meniscus measurements using strip meniscometry (SM) and Keratograph5M (K5M) between 3 subtypes of dry eye disease patient groups, classified according to the presence of meibomian gland dysfunction (MGD), and normal subjects. METHODS We enrolled 145 eyes from 145 subjects and measured the tear meniscus using SM and K5M, tear film breakup time, ocular surface staining, and ocular surface disease index; the Schirmer test; and examined lid margins and meibomian glands. Correlation of tear meniscus parameters with other parameters and efficacy of the 2 measurements were evaluated. RESULTS The SM and K5M results were significantly lower in the non-Sjögren syndrome aqueous-deficient dry eye (non-SS ADDE) with and without MGD groups than in the MGD-only group and normal subjects. The SM or K5M results correlated with each other and with other ocular surface parameters. The area under the curve (AUC) of the SM and K5M results was 0.637 (P = 0.012) and 0.610 (P = 0.042), respectively. Except for the MGD group, the AUC of the SM and K5M results were 0.721 (P < 0.001) and 0.694 (P = 0.001), respectively. The AUC of SM and K5M were 0.947 (P < 0.001) and 0.784 (P = 0.002), differentiating non-SS ADDE-only patients from those with normal eyes. CONCLUSIONS Tear meniscus measurements using SM and K5M can compensate for detection of aqueous-deficient components of dry eye. These results should be interpreted according to the presence or absence of MGD.PURPOSE We aimed to compare the tear meniscus measurements using strip meniscometry (SM) and Keratograph5M (K5M) between 3 subtypes of dry eye disease patient groups, classified according to the presence of meibomian gland dysfunction (MGD), and normal subjects. METHODS We enrolled 145 eyes from 145 subjects and measured the tear meniscus using SM and K5M, tear film breakup time, ocular surface staining, and ocular surface disease index; the Schirmer test; and examined lid margins and meibomian glands. Correlation of tear meniscus parameters with other parameters and efficacy of the 2 measurements were evaluated. RESULTS The SM and K5M results were significantly lower in the non-Sjögren syndrome aqueous-deficient dry eye (non-SS ADDE) with and without MGD groups than in the MGD-only group and normal subjects. The SM or K5M results correlated with each other and with other ocular surface parameters. The area under the curve (AUC) of the SM and K5M results was 0.637 (P = 0.012) and 0.610 (P = 0.042), respectively. Except for the MGD group, the AUC of the SM and K5M results were 0.721 (P < 0.001) and 0.694 (P = 0.001), respectively. The AUC of SM and K5M were 0.947 (P < 0.001) and 0.784 (P = 0.002), differentiating non-SS ADDE-only patients from those with normal eyes. CONCLUSIONS Tear meniscus measurements using SM and K5M can compensate for detection of aqueous-deficient components of dry eye. These results should be interpreted according to the presence or absence of MGD.

Evaluation of pigment location in tinted soft contact lenses

PURPOSE The purpose of this study was to investigate efficient methods to evaluate the pigment layer location of tinted soft contact lenses and to assess various lens products on the market using those methods. METHODS Two types of tinted soft contact lenses with known pigment location embedded or back surface were manufactured and examined. Light microscopy (LM), focused ion beam milling and scanning electron microscopy (FIB-SEM), and Fourier-domain optical coherence tomography (FD-OCT) were used to examine the pigment layer. Lens surface roughness was also measured using atomic force microscopy. In the second part of the experiment, pigment location and surface roughness of a clear lens (Lens A) and eight commercially-available tinted soft contact lenses (Lens B-I) were evaluated using FIB-SEM and FD-OCT. RESULTS Pigment location could be reliably determined with FIB-SEM and FD-OCT. With LM, 40% of the lens sections were broken or deformed during slide preparation. The pigment particles in Lens B were buried below the front surface and there were no significant differences of roughness between the front and back surfaces. However, all tinted lenses with surface pigment had significant difference of roughness between front and back surfaces at the pigmented area. CONCLUSION The FIB-SEM and FD-OCT could reliably locate the pigment layer of tinted soft contact lenses. In addition, lens surface roughness was influenced by pigment layer location.

Effect of the pigment-free optical zone diameter of decorative tinted soft contact lenses on visual function

Aims We investigated changes in visual function after wearing decorative tinted soft contact lenses with different pigment-free optical zone diameters. Methods A prospective study was performed in 30 eyes of 30 healthy volunteers. Best-corrected visual acuity (BCVA), ocular higher-order aberrations (HOAs), modulation transfer function (MTF), Strehl ratio and contrast sensitivity were evaluated after wearing clear lens and tinted lenses with different pigment-free optical zone diameters (4, 5 and 6 mm). Results BCVA decreased from 0.00 logMAR after wearing a clear lens to 0.04±0.04 logMAR after wearing 4 mm optical zone lens (p<0.001). As the optical zone diameter decreased, ocular aberrations were induced. Total HOAs, coma aberration and secondary astigmatism showed significant difference between clear lens and 5 or 4 mm optical zone lenses (p<0.050). Spherical aberration and trefoil showed significant difference between clear lens and 4 mm optical zone lens (p<0.050). The results for Strehl ratio revealed poorer optical quality for both 5 and 4 mm optical zone lens (both p=0.002). The entire ocular MTF was significantly different, corresponding to the decreased optical zone diameter. The HOAs showed a correlation with the blocked pupil covered by the tinted part (r=0.435, p<0.001). In photopic and mesopic conditions, the contrast sensitivity decreased significantly with the reduced pigment-free optical zone diameters. Conclusion Decorative tinted contact lenses significantly increased ocular aberrations and decreased optical quality and contrast sensitivity, as the pigment-free optical zone diameter decreased. Therefore, consumers of tinted lenses should be informed about the possible disturbance in visual function. Trial registration number NCT02537275.

Lattice corneal dystrophy type IIIA with hyaline component from a novel A620P mutation and distinct surgical treatments.

Purpose: The aim of this study was to report a lattice corneal dystrophy (LCD) family with a novel mutation of A620P in the TGFBI gene, its long-term treatment, follow-up data, and related pathologic findings. Methods: A total of 28 family members were clinically examined, and blood samples or buccal epithelial cells were taken for DNA analysis. All exons from the entire TGFBI gene coding region were analyzed for mutations in 3 affected members. Exon 14 was amplified in other family members and in 100 normal Korean persons as control. Corneal tissues from 1 affected family member were examined using light and electron microscopy. Results: Clinical examination revealed relatively late-onset LCD with asymmetric progression and recurrent corneal erosion. The affected family members have been treated with penetrating keratoplasty, deep lamellar keratoplasty, and phototherapeutic keratectomy for up to 19 years. Screening of the TGFBI gene revealed a novel A620P mutation, which was found in all affected members. The amyloid origin of deposits was confirmed by Congo red and was also partially stained with Masson trichrome. Although there were no electron-dense bodies as in granular dystrophy, transmission electron microscopy demonstrated that the stromal deposits were not homogenous and contained a variety of constituents with different electron densities. Conclusions: We present the characteristics and surgical treatment of corneas with a novel A620P mutation in TGFBI showing LCD type IIIA with hyaline component.