Jong Hyun Oh

Biometric Characteristics of Eyes With Central Serous Chorioretinopathy

PURPOSE To investigate the biometric characteristics of eyes with idiopathic central serous chorioretinopathy (CSC). METHODS Medical records of 52 consecutive patients with unilateral CSC were reviewed. Central serous chorioretinopathy was diagnosed using spectral-domain optical coherence tomography (SD-OCT) and fluorescein angiography. Data collected for comparison with fellow eyes were refractive error, biometric measurements using partial coherence interferometry, and SD-OCT parameters. RESULTS Mean time from subjective symptom onset to initial visit was 8.3 ± 12.29 weeks. Mean axial length (AL) was shorter in CSC eyes than in fellow eyes by 0.24 ± 0.379 mm (P < 0.001), and mean anterior chamber depth (ACD) was shallower in CSC eyes than in fellow eyes by 0.03 ± 0.088 mm (P = 0.021). Central serous chorioretinopathy eyes also had thicker subfoveal choroidal thickness (CT) than fellow eyes by 34.0 ± 45.93 μm (P < 0.001). Differences in spherical equivalents between CSC and fellow eyes correlated with AL differences (r = -0.690, P < 0.001) and CT differences (r = 0.473, P = 0.001). On multiple linear regression analysis, the differences in ACD between CSC and fellow eyes were significantly correlated with AL differences (P = 0.032) and symptom duration (P = 0.019). CONCLUSIONS Biometric characteristics such as AL and ACD were different between eyes with CSC and fellow eyes. Variations in biometry, which correlated with CT differences, might be related to differences in refractive errors between eyes.

Evaluation of the pentacam ray tracing method for the measurement of central corneal power after myopic photorefractive keratectomy

Purpose: The study evaluated the ray tracing method [total corneal refractive power (TCRP)] in a Pentacam apparatus (Oculus, Wetzlar, Germany) for postoperative keratometry measurement after myopic photorefractive keratectomy (PRK). Methods: Manifest refraction (MR) and Pentacam analyses were performed preoperatively and at 6 months postoperatively after the PRK (STAR S4 IR CustomVue; Abbott Medical Optics/Visx) in 49 right eyes from 49 patients (age, 25.42 ± 3.51 years). Postoperative corneal power was calculated using the clinical history method (CHM) and compared with postoperatively measured simulated keratometry (simK), true net power (TNP) at 3 mm, and pupil-centered TCRP at the center, 1, 3, and 4 mm (TCRP0, TCRP1, TCRP3, and TCRP4). Vertex-distance-adjusted refractive change (delta-MR) at the corneal plane was also compared with various keratometric changes (delta-K). Results: Postoperative TCRP0, TCRP1, TCRP3, and TCRP4 showed no significant difference compared with that of the CHM. Postoperative simK was significantly higher than that of the CHM, whereas the TNP was significantly lower compared with that of the CHM. The delta-Ks measured by simK, TNP, and TCRPs were significantly smaller than delta-MR, and delta-TCRP4 showed the least difference [mean ± SD, 0.28 ± 0.55 diopters (D)] with delta-MR. The 95% limit of agreement between delta-MR and delta-TCRP4 was −0.85 to 1.31 D. The difference between delta-TCRP4 and delta-MR was <0.5 D in 55.1% and <1.0 D in 87.8% of the eyes studied. Conclusions: Although postoperative TCRPs showed no significant difference with CHM, delta-MR was still underestimated after myopic PRK.

Systemic Comorbidities of Dry Eye Syndrome: The Korean National Health and Nutrition Examination Survey V, 2010 to 2012.

Purpose: To identify systemic comorbidities in patients with dry eye syndrome in South Korea. Methods: From 2010 to 2012, 17,364 participants aged 20 or older were randomly included in the nationwide Korean National Health and Nutrition Examination Survey V. The prevalence of dry eye syndrome and demographics of these patients were investigated. We performed conditional logistic regression analyses based on age, sex, residential area, education level, occupation type, and household income level to obtain the odds ratio for each systemic comorbidity among subjects with and without dry eye syndrome. Results: The prevalence of dry eye syndrome in this study was 10.4%. Age [adjusted odds ratio (AOR): 1.02], female gender (AOR: 3.01), and indoor occupation (AOR: 1.30) were associated with a higher prevalence of dry eye syndrome and found to be less prevalent in those residing in rural areas (AOR: 0.73) and with lower education levels (AOR: 0.66–0.99). With regard to systemic comorbidities, dyslipidemia (AOR: 1.63), degenerative arthritis (AOR: 1.56), rheumatoid arthritis (AOR: 1.44), thyroid disease (AOR: 1.79), and renal failure (AOR: 2.56) were associated with a significantly higher prevalence of dry eye syndrome. Conclusions: We found that patients with dry eye syndrome have a higher prevalence of several systemic comorbidities. A more comprehensive therapeutic approach considering the effect of systemic medication may be necessary in these patients.

Characteristics of cystoid spaces in type 2 idiopathic macular telangiectasia on spectral domain optical coherence tomography images.

Purpose: To investigate the morphologic and topographic characteristics of intraretinal cystoid spaces in eyes with Type 2 idiopathic macular telangiectasia (MacTel 2). Methods: Using B-scan and en face images of eyes with MacTel 2 taken from a spectral domain optical coherence tomography database, the circularities and mean gray values of the cystoid spaces were measured to determine their boundaries and reflectivity. The characteristics of cystoid spaces in MacTel 2 eyes were compared with those in eyes with Type 1 idiopathic macular telangiectasia (MacTel 1), retinal vein occlusion, and diabetic macular edema, which are caused by vascular leakage. The cystoid spaces of en face optical coherence tomography images were matched with fluorescein angiographic images. Results: The circularity of the cystoid spaces in B-scan and en face optical coherence tomography images of 16 eyes with MacTel 2 was lower than that of eyes with MacTel 1 (P = 0.004 and P = 0.003, respectively), retinal vein occlusion (P < 0.001 and P < 0.001, respectively), and diabetic macular edema (P < 0.001 and P < 0.001, respectively). The mean gray value ratio of the cystoid spaces of eyes with MacTel 2 was lower than that of eyes with MacTel 1 (P = 0.002) and diabetic macular edema (P < 0.001). In eyes with MacTel 2, the cystoid spaces were located in the foveal center or parafoveal area. Conclusion: Characteristics of cystoid spaces of eyes with MacTel 2 were different from those in eyes with MacTel 1, retinal vein occlusion, and diabetic macular edema. The irregular boundaries and low reflectivity of the cystoid spaces in MacTel 2 may represent the degenerative origin of the disease.

Effects of Ginkgo biloba Extract on Cultured Human Retinal Pigment Epithelial Cells under Chemical Hypoxia

Abstract Purpose: To investigate the effects of Ginkgo biloba extract (GBE) on expression of hypoxia-inducible factor (HIF)-1α and vascular endothelial growth factor (VEGF) in retinal pigment epithelial (RPE) cells under chemical hypoxia. Materials and Methods: RPE cells (ARPE-19) were cultured in either untreated media (control group), media treated with 200 μM cobalt chloride (hypoxia group) or media treated with both 200 μM cobalt chloride and 100 μg/ml GBE (hypoxia + GBE group) for various amounts of time. HIF-1α and VEGF expression were compared between groups. HIF-1α and VEGF messenger RNA (mRNA) were quantified using real-time polymerase chain reaction (PCR). HIF-1α of extracted nuclei and VEGF of the media were quantified using enzyme-linked immunosorbent assay (ELISA). The expression of HIF-1α was also assessed with Western blot and immunocytochemistry. Results: HIF-1α mRNA, VEGF mRNA, HIF-1α and VEGF levels were higher in the hypoxia group compared with the control group; however, real-time PCR revealed decreased expression of HIF-1α mRNA and VEGF mRNA in the hypoxia + GBE group compared with the hypoxia group. In the ELISA, the HIF-1α and VEGF protein concentrations also decreased with GBE treatment. Western blot and immunostaining showed that the intensity of HIF-1α signals in the hypoxia + GBE group was lower than that of the hypoxia group. Conclusion: GBE reduced HIF-1α and VEGF expression in RPE cells cultured under chemical hypoxia in vitro.

Predicting Ocular Residual Astigmatism Using Corneal and Refractive Parameters: A Myopic Eye Study

Abstract Purpose: To investigate the nature of ocular residual astigmatism (ORA) in myopic patients and to identify indicators to predict a patient’s ORA from corneal and ocular refractive data. Methods: In total, 356 myopic eyes from 178 patients (M:F = 41:137) were examined using a Scheimpflug keratometer (Pentacam) and a wavefront analyzer (WaveScan). Vertex distance-adjusted total ocular astigmatism and corneal astigmatism [anterior corneal power (ACP) and true net power (TNP)] were used to calculate ORA, respectively. A power vector system (J0 and J45) was adopted for the astigmatism analysis. Results: The mean age of the study eyes was 27.6 ± 5.0 years, and mean refractive spherical equivalent, sphere and cylinder was −4.94 ± 1.90 diopter, −4.42 ± 1.87 diopter, and −1.05 ± 0.82, respectively. Corneal astigmatism measured by TNP was more representative of total ocular astigmatism than ACP (p < 0.001). Both the J0 and J45 components of ORA showed significant negative correlation with corneal astigmatism measured by ACP and TNP (p < 0.001). ORA (J0 and J45) was negatively correlated with total ocular spherical equivalent and positively correlated with total ocular astigmatism. Conclusions: We verified the general compensatory effect of corneal astigmatism by internal optics in myopic patients. TNP was closer to refractive astigmatism than ACP was. Total ocular spherical equivalent and total ocular astigmatism showed significant correlation with ORA. Therefore these can be possible indicators to predict ORA.

Transient Corneal Edema is a Predictive Factor for Pseudophakic Cystoid Macular Edema after Uncomplicated Cataract Surgery

Purpose To report transient corneal edema after phacoemulsification as a predictive factor for the development of pseudophakic cystoid macular edema (PCME). Methods A total of 150 eyes from 150 patients (59 men and 91 women; mean age, 68.0 ± 10.15 years) were analyzed using spectral domain optical coherence tomography 1 week and 5 weeks after routine phacoemulsification cataract surgery. Transient corneal edema detected 1 week after surgery was analyzed to reveal any significant relationship with the development of PCME 5 weeks after surgery. Results Transient corneal edema developed in 17 (11.3%) of 150 eyes 1 week after surgery. A history of diabetes mellitus was significantly associated with development of transient corneal edema (odds ratio [OR], 4.04; 95% confidence interval [CI], 1.41 to 11.54; p = 0.011). Both diabetes mellitus and transient corneal edema were significantly associated with PCME development 5 weeks after surgery (OR, 4.58; 95% CI, 1.56 to 13.43; p = 0.007; and OR, 6.71; CI, 2.05 to 21.95; p = 0.003, respectively). In the 8 eyes with both diabetes mellitus and transient corneal edema, 4 (50%) developed PCME 5 weeks after surgery. Conclusions Transient corneal edema detected 1 week after routine cataract surgery is a predictive factor for development of PCME. Close postoperative observation and intervention is recommended in patients with transient corneal edema.

Demographic Features of Idiopathic Macular Telangiectasia in Korean Patients

Purpose To investigate the clinical and demographic features of idiopathic macular telangiectasia (MacTel) in Korean patients since the introduction of spectral domain optical coherence tomography (SD-OCT). Methods We reviewed medical records of patients who were diagnosed with MacTel from 2009 to 2013. All patients underwent fluorescein angiography and SD-OCT and were classified as type 1 or type 2 according to the classification system proposed by Yannuzzi. Results Over a period of 5 years, 4 (18.2%) patients were diagnosed with type 1 MacTel and 18 (81.8%) patients were diagnosed with type 2 MacTel. All patients with type1 MacTel were male, and their mean age was 51 ± 8.6 years. Among patients with type 2 MacTel, 3 (16.7%) were male, 15 (83.3%) were female, and the mean age was 60 ± 13.6 years. Whereas all type 1 MacTel patients had either metamorphopsia or mild scotoma, of the 18 patients with type 2 MacTel, only 4 (22.2%) had those symptoms, 10 (55.6%) complained of only mild visual impairment, and the other 4 (22.2%) had no symptoms. Intraretinal cystoid spaces were observed in 26 (72.2%) of 36 eyes with type 2 MacTel by SD-OCT. These cystoid spaces had irregular boundaries and did not correspond to angiographic leakages. Conclusions Type 2 MacTel was most common in the present study. The wider availability of SD-OCT may have contributed to the diagnosis of type 2 MacTel. Type 2 MacTel may be more prevalent than type 1 in Koreans, which corresponds to the results of Western countries.

Moment of cyst eruption captured by optical coherence tomography in diabetic macular edema.

G1 suggested that the structural changes that occur when the inner wall of a large cystoid space in cystoid macular edema ruptures lead to formation of a lamellar macular hole (LMH). In addition to the traction associated with the epiretinal membrane or the posterior hyaloid membrane, increased internal pressure within the cystoid space has been suggested as a contributing factor in LMH formation. Directly observing a rupturing cyst would be helpful in understanding the pathogenesis of LMH formation. A 52-year-old woman received 3 sub-Tenon’s injections of triamcinolone acetonide and 8 intravitreal injections of bevacizumab in her left eye for treatment of diabetic cystoid macular edema. Despite these procedures, cystoid macular edema did not resolve completely; her best-corrected visual acuity was 20/50, and central subfield retinal thickness was 431 mm (Figure 1, A and B). One month after the ninth intravitreal injection of bevacizumab, intraretinal fluid eruption into the vitreous cavity through an inner wall defect in the cystoid space was noted on optical coherence tomography (Figure 1C; see Video, Supplemental Digital Content 1, http://links.lww.com/IAE/A320). Lamellar macular hole was found on optical coherence tomography examination the next month (Figure 1D). Fig. 1. Fundus photograph and optical coherence tomography (OCT) images of diabetic cystoid macular edema in the left eye. A and B. A large cystoid space is noted at the fovea. C. One month after intravitreal injection of bevacizumab, intraretinal fluid eruption into the vitreous cavity through an inner wall defect of the cystoid space is noted in a B-scan OCT image. The volume of the cyst was approximately 0.18 mm3. Cystic material with high reflectivity was passing through approximately 0.05 mm2 of the orifice. The height of the eruption column reached 355 mm. D. The next month, a lamellar macular hole was found at the same location.

Retinal nerve fiber layer configuration in eyes with Epiretinal membrane

Purpose To characterize configurations of the optic nerve head (ONH) and peripapillary retinal nerve fiber layer (RNFL) eyes with epiretinal membrane (ERM). Methods We reviewed medical records of consecutive patients with ERM who were examined between September 2012 and August 2013. Patients were categorized based on the severity of ERM on fundus imaging; patients with ERM but without retinal distortion were in group 1, and patients with ERM and retinal distortion were in group 2. Optic nerve head and RNFL parameters measured by spectral domain optical coherence tomography were assessed and compared between eyes with ERM and normal fellow eyes. Results There were no significant differences in ONH and RNFL parameters between ERM eyes and normal fellow eyes in group 1 (n = 12). In group 2 (n = 33), cup volume was smaller (p = 0.020), temporal quadrant RNFL thickness was greater by 18.8 ± 16.6 &mgr;m (p < 0.001), and RNFL peak angle was smaller by 18.7 ± 25.3 degrees in ERM eyes compared with fellow eyes (p = 0.001). In the 15 patients in group 2 who underwent ERM removal, temporal quadrant RNFL thickness decreased and the RNFL peak angle increased after the surgery (p = 0.008 and p = 0.001, respectively). Conclusions The configurations of the ONH and peripapillary RNFL in eyes with ERM were different from those in fellow eyes. The characteristic configurations of RNFL such as small peak angle and temporal quadrant thickening may be considered when evaluating parameters as measured by spectral domain optical coherence tomography.