Joon Mo Kim

Ginkgo biloba Extract and Bilberry Anthocyanins Improve Visual Function in Patients with Normal Tension Glaucoma

Ginkgo biloba extract (GBE) and anthocyanins are considered beneficial for various vascular diseases. This study was performed to evaluate the effect of GBE and anthocyanins on visual function in patients with normal tension glaucoma (NTG) based on the vascular theory of mechanisms of glaucomatous optic nerve damage. Retrospective analysis was carried out by a chart review of 332 subjects (209 men and 123 women) who were treated with anthocyanins (n=132), GBE (n=103), or no medication (control, n=97). Humphrey Visual Field (HVF) test, logarithm of the minimal angle of resolution best-corrected visual acuity (logMAR BCVA), intraocular pressure, blood pressure, and fasting blood glucose were determined before and after treatment. Complete ocular and systemic examinations were performed. The mean follow-up duration was 23.82±9.84 (range, 12-59) months; the mean anthocyanin treatment duration was 24.32±10.43 (range, 6-53) months, and the mean GBE treatment duration was 23.81±10.36 months (range, 6-59) months. After anthocyanin treatment, the mean BCVA for all eyes improved from 0.16 (±0.34) to 0.11 (±0.18) logMAR units (P=.008), and HVF mean deviation improved from -6.44 (±7.05) to -5.34 (±6.42) (P=.001). After GBE treatment, HVF mean deviation improved from -5.25 (±6.13) to -4.31 (±5.60) (P=.002). A generalized linear model demonstrated that the final BCVA was not affected by demographic differences among the groups. These results suggest that anthocyanins and GBE may be helpful in improving visual function in some individuals with NTG.

Investigation of the association between Helicobacter pylori infection and normal tension glaucoma.

PURPOSE To investigate whether Helicobacter pylori infection is associated with normal tension glaucoma (NTG). METHODS One hundred consecutive NTG patients (group 1) from an outpatient glaucoma clinic were enrolled. Medical records of the 88 control participants (control 1) of the outpatient clinic, and 104 NTG patients (group 2) and 1116 healthy controls (control 2) (1220 subjects in total) from a primary health care center were reviewed retrospectively to compare the results. Serum samples from all subjects were analyzed for the presence of H. pylori-specific immunoglobulin G antibodies using ELISA. The distributions of serologic H. pylori test results of the NTG patients and control subjects were compared, and possible associations between clinical phenotypes and positive serologic results were assessed. Bilaterality of NTG patients was also analyzed. RESULTS NTG patients had significantly more positive serologic results than did the healthy controls. There were significant differences between group 1 and control 1 patients (P = 0.020; odds ratio [OR], 2.05), group 1 and control 2 patients (P = 0.016; OR, 1.73), and group 2 and control 2 patients (P = 0.008; OR, 1.83). However, no significant association was found between clinical characteristics and a positive serologic result for H. pylori in NTG patients. CONCLUSIONS This study suggests that H. pylori infection may be associated with an increased risk for NTG. H. pylori may play a role in the development or progression of NTG as a secondary aggravating factor because of the coexistence of other main causes or it may be the primary cause.

Optic Disc Hemorrhage May Be Associated with Retinal Nerve Fiber Loss in Otherwise Normal Eyes

PURPOSE To evaluate quantitatively the structural damage of the peripapillary retinal nerve fiber layer (RNFL) in eyes with disc hemorrhage (DH). DESIGN Prospective cross-sectional study. PARTICIPANTS Seventy patients with DH (70 eyes; mean age +/- standard deviation, 60.0+/-11.8 years) and 100 healthy control subjects (100 eyes; mean age +/- standard deviation, 57.7+/-8.0 years) were enrolled from the Glaucoma Clinic of Seoul National University Hospital. METHODS Normal eyes without DH (group 1: normal control group) served as controls. Eyes with DH were divided into the following groups: (1) eyes with a DH, accompanied by no visible RNFL defect according to red-free fundus photography and normal visual fields (group 2: DH only group); (2) eyes with a DH and a localized RNFL defect in the same quadrant, accompanied by normal visual fields (group 3: DH-preperimetric group); and (3) eyes with a DH and a localized RNFL defect in the same quadrant, accompanied by glaucomatous visual field defect in the corresponding hemifield location (group 4: DH-perimetric group). Optical coherence tomography (OCT)-measured RNFL thicknesses were compared. MAIN OUTCOME MEASURES Average and segmental (4 quadrants and 12 clock-hours) OCT-measured RNFL thicknesses. RESULTS The number of eyes in groups 1, 2, 3, and 4 was 100, 25, 22, and 23 eyes, respectively. The OCT-measured RNFL thickness was significantly different among the 4 groups in average RNFL thickness and in inferior, superior, and nasal quadrants (P<0.01, 1-way analysis of variance). On post hoc analysis, the eyes of groups 2 and 3 showed thinner average RNFL thickness than those of group 1, and the average RNFL thickness of group 4 was significantly lower than that of groups 2 and 3 (P<0.001, 1-way analysis of variance and Tukeys test). The OCT-measured RNFL thickness revealed a topographic relationship with the DH location. CONCLUSIONS Significant RNFL loss was already present in the DH only eyes with apparently normal RNFL configuration by red-free fundus photography, indicating that preperimetric changes of the RNFL are already present. These results suggest that OCT has the potential to detect subclinical or preperimetric RNFL loss in the eyes with DH. FINANCIAL DISCLOSURE(S) The authors have no proprietary or commercial interest in any of the materials discussed in this article.

Microbial contamination of multiply used preservative-free artificial tears packed in reclosable containers

Background/aims: To evaluate microbial contamination of multiply used preservative-free artificial tears packed in reclosable containers after daily use. Methods: Subjects were provided with preservative-free artificial tears (Groups 1 and 2) and artificial tears containing a preservative (Group 3). After administration three times or more per 10 h, bottles were collected, and any remaining fluid in the bottles was cultured. A risk factor analysis for microbial contamination was performed by the use of univariate and multivariate analysis. Results: A total of 242 eye-drop bottles were evaluated. Five (2.0%) of the 242 bottles had bacterial contamination. In group 1, four (3.9%) of 102 bottles were contaminated, and identified bacteria were all coagulase-negative Staphylococcus. In group 2, one (1.0%) of 105 bottles was contaminated, and it was a Gram-negative Acinetobacter species. No bottles from group 3 showed any contamination. Based on multivariate analysis, advanced age and fingertip touch were statistically significant risk factors for microbial contamination (p<0.05). Conclusion: Preservative-free artificial tears in reclosable containers are at risk of contamination in a daily and multiple use setting, especially in patients with a poor administering technique, which is associated with fingertip touch and advanced age.

Relation between Axial Length and Ocular Parameters

Purpose: To investigate the relation between axial length (AL) and ocular parameters. Methods: Measurements of ocular biometric parameters were performed with an optical biometer, pachymeter, optical coherence tomography, and an automatic refractometer. AL, refractive error (RE), central corneal thickness, anterior chamber depth (ACD), corneal curvature (CC), white-to-white distance (WWD), and retinal nerve fiber layer (RNFL) thickness were measured. AL was evaluated in relation to ocular parameters. The Pearson correlation coefficient (r) was used to statistically evaluate each scattergram. Results: With elongation of the AL, the mean RE (r = –0.790, p < 0.001), CC (r = –0.444, p < 0.001), and RNFL thickness (r = –0.306, p < 0.001) all decreased, while the mean ACD (r = 0.506, p < 0.001) and WWD (r = 0.279, p < 0.001) increased. Conclusions: In shorter eyes, there was a tendency toward hyperopia, a steeper cornea, and a thicker RNFL, and in longer eyes toward myopia, a flatter cornea, and a thinner RNFL.

The Association between Retinal Vessel Diameter and Retinal Nerve Fiber Layer Thickness in Asymmetric Normal Tension Glaucoma Patients

PURPOSE The aim of this study was to evaluate the associations between retinal vessel diameter and retinal nerve fiber layer (RNFL) thickness in patients with normal tension glaucoma (NTG). METHODS This study included 67 untreated patients with asymmetric NTG, with no evidence of glaucoma in the contralateral eyes, and 48 age- and sex-matched normal control subjects. We included patients from 20 to 70 years of age who had no history of hypertension, diabetes, or other vascular diseases. All subjects underwent detailed eye examinations that included red-free photography, stereoscopic optic disc photography, automated perimetry, and measurement of RNFL thickness with optical coherence tomography. We compared RNFL thicknesses, temporal retinal arteriolar diameters (TRAD), and temporal retinal venular diameters (between quadrants with and without RNFL defects) with computer-assisted imaging software. RESULTS The mean diameter of the temporal retinal vessels in the quadrants with RNFL defects were significantly smaller in patients with NTG than in those with quadrants without RNFL defects (P < 0.001) and in control subjects (P < 0.001). TRADs were correlated with RNFL defects and RNFL thicknesses (P < 0.05) in binary logistic regression analysis and in multiple linear regression analysis (P < 0.001). There were no statistically significant differences between vessel diameters in control subjects and those in nondefective quadrants of the affected NTG eyes or the unaffected eyes of patients with NTG. CONCLUSIONS Our results show that narrower retinal vessels are found in areas of RNFL defects. Considering previous reports and our analysis, this is likely due to the decreased demand for retinal blood flow in damaged areas of the retina.

The effect of cataract surgery on diurnal intraocular pressure fluctuation.

PurposeWe examined prospectively the effects of cataract surgery on diurnal intraocular pressure (IOP) fluctuation in patients without glaucoma. Materials and MethodsWe evaluated 42 eyes from 42 patients without glaucoma that underwent clear corneal phacoemulsification and intraocular lens implantation by the same surgeon without complications. The diurnal IOP was measured using a Goldmann applanation tonometer the day before surgery and at least 4 weeks after surgery. The diurnal IOP was measured from 9 AM to 11 PM every 2 hours by the same clinician. ResultsThe mean age of the 14 men and 28 women was 69.7±7.6 (SD) years. The mean preoperative IOP was 12.2±2.5 mm Hg. Postoperatively, the mean IOP was 10.7±2.1 mm Hg. The maximum IOP was significantly decreased from the mean preoperative level of 13.7±2.7 mm Hg to 12.3±2.7 mm Hg at follow-up. The minimum IOP was also significantly decreased from 10.9±2.7 mm Hg to 9.7±2.1 mm Hg. Cataract surgery reduced IOP significantly at all measurement time points (P<0.05). However, there was no significant difference in the range of IOP before (2.8±1.3 mm Hg) and after (2.7±1.5 mm Hg) surgery (P=0.498). ConclusionsWe found a significant decrease in IOP after cataract surgery in nonglaucoma patients. However, change of diurnal IOP fluctuation after surgery was not statistically different. These results can be used as baseline data for diurnal IOP fluctuation studies in glaucoma patients after cataract surgery.

Effect of signal strength on reproducibility of circumpapillary retinal nerve fiber layer thickness measurement and its classification by spectral-domain optical coherence tomography

PurposeTo assess the effect of signal strength (SS) on the reproducibility of circumpapillary retinal nerve fiber layer (cpRNFL) thickness measurement (measurement agreement) and its color-coded classification (classification agreement) by Cirrus spectral-domain optical coherence tomography (OCT).MethodsSeven hundred and eighty-nine participants, consecutively enrolled from December 2009 to August 2010, underwent two repeated Cirrus OCT scans to measure cpRNFL thickness (optic disc cube 200 × 200). Intraclass correlation (ICC) and linear-weighted kappa coefficient (κ) were calculated as indicators for cpRNFL measurement and classification agreement. The difference in cpRNFL thickness measurements between repeated OCT scans (inter-scan measurement difference) was correlated with mean SS, SS change or difference between repeated OCT scans (inter-scan SS difference), and average cpRNFL thickness.ResultsMean SS was negatively correlated with inter-scan SS difference and was positively correlated with the inter-scan measurement difference. Repeated scans with SS change (inter-scan SS difference = 1 or 2) showed larger variability than scans without SS change (inter-scan SS difference = 0) in total average cpRNFL and all quadrant maps except for the nasal quadrant. Multivariate analysis revealed that inter-scan measurement differences increased in subjects with thinner cpRNFL thicknesses and in scans with lower mean SS and higher inter-scan SS differences. Measurement agreement (ICC) in groups with larger inter-scan SS differences (=2) was lower than those with smaller inter-scan SS differences (=0 or 1) in their average cpRNFL and inferior quadrant maps. Classification agreement (κ) in groups with larger inter-scan SS differences (=2) was lower than those with smaller inter-scan SS differences (=0 or 1) in their average cpRNFL and quadrant maps (superior and inferior quadrant) although statistically not significant.ConclusionsSpecial attention should be paid when comparing the cpRNFL thickness measurement and color-coded classification of 2 or more Cirrus OCT scans as the agreements may be susceptible to SS differences.

Simple Surgical Approach with High-Frequency Radio-Wave Electrosurgery for Conjunctivochalasis

OBJECTIVE To introduce a new simple surgical approach with high-frequency radio-wave electrosurgery to reduce conjunctivochalasis (CCh). DESIGN Prospective, noncomparative, interventional case series analysis. PARTICIPANTS Twelve patients (20 eyes) with CCh were recruited from the outpatient service of the Department of Ophthalmology, Kangbuk Samsung Hospital, Seoul, Korea. METHODS On the inferior bulbar conjunctiva, subconjunctival coagulation was performed with a fine-needle electrode using a high-frequency radio-wave electrosurgical unit (Ellman Surgitron; Ellman International, Inc., Hewlett, NY) in coagulation mode. MAIN OUTCOME MEASURES Conjunctivochalasis grade; epiphora and dry eye symptoms (the Ocular Surface Disease Index [OSDI]; Allergan Inc., Irvine, CA, holds the copyright); and intraoperative and postoperative complications. RESULTS Eighteen eyes (90%) recovered a smooth, wet, and noninflamed conjunctival surface within 1 month and remained stable for a follow-up period of 3 months. At 3 months postoperatively, 18 eyes (90%) had grade 0 CCh. There was a statistically significant decrease of the OSDI score at 3 months postoperatively (P < 0.001). CONCLUSIONS A surgical approach with high-frequency radio-wave electrosurgery produced a significant reduction in CCh and an improvement in symptoms. Radio-wave surgical techniques represent a favorable alternative to surgical treatment of CCh. FINANCIAL DISCLOSURE(S) The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Changes in corneal endothelial cell density in patients with normal-tension glaucoma

PurposeTo study the changes in corneal endothelial cell density in eyes with normal-tension glaucoma compared with those in controls.MethodsA total of 227 subjects in three groups, one each of normal-tension glaucoma and primary open-angle glaucoma patients and one of normal controls, were studied from January 2008 to July 2008 in the Ophthalmology Department of Kangbuk Samsung Hospital. The glaucoma (normal-tension glaucoma and primary open-angle glaucoma) patients included monocular and binocular glaucoma patients. Corneal endothelial cells were examined using a noncontact specular microscope.ResultsThe mean endothelial cell densities in the three groups were as follows: normal-tension glaucoma group, 2696.7 ± 303.9 cell/mm2; primary open-angle glaucoma group, 2370.5 ± 392.3 cell/mm2; and normal group, 2723.6 ± 300.6 cell/mm2. The endothelial cell count was not significantly different between normal-tension glaucoma and normal groups (P = 1.000). Primary open-angle glaucoma patients had significantly lower endothelial cell counts (P < 0.001) than the normal group. The endothelial cell count was also significantly lower in eyes with primary open-angle glaucoma than in normal-tension glaucoma eyes (P < 0.001).ConclusionsThere was a significant decrease in corneal endothelial cell density in eyes with primary open-angle glaucoma, but not in eyes with normal-tension glaucoma. Elevated intraocular pressure likely affected the decrease of corneal endothelial cell density in eyes with glaucoma.