Ko Eun Kim

Association between choroidal morphology and anti-vascular endothelial growth factor treatment outcome in myopic choroidal neovascularization.

PURPOSEnTo investigate associations between outcome of anti-vascular endothelial growth factor (VEGF) therapy and choroidal morphology in eyes with myopic choroidal neovascularization (CNV).nnnMETHODSnFifty-two eyes of 46 patients with myopic CNV received a single intravitreal anti-VEGF injection, followed by as-needed injections. Baseline choroidal thickness was measured at the fovea and 1.5 and 3 mm nasal, temporal, superior, and inferior to the fovea using enhanced depth imaging optical coherence tomography. Measurements were compared between eyes with and without CNV resolution after a single injection and between those with and without CNV recurrence within 1 year of initial injection. Associations between treatment outcomes and morphologic or clinical factors were assessed using regression analyses.nnnRESULTSnPatients received 1.8 ± 1.3 intravitreal injections during follow-up. Eyes with CNV resolution after a single anti-VEGF injection had a significantly thicker inferior choroid than those without resolution (67.3 ± 32.9 vs. 44.5 ± 17.6 μm, P = 0.002). The subfoveal choroid was thinner in eyes with recurring CNV than in those without recurrence (35.7 ± 23.7 vs. 52.0 ± 20.8 μm, P = 0.029). Associations were found between inferior choroidal thickness and CNV resolution (P = 0.019) and between subfoveal choroidal thickness and 1-year recurrence rates (P = 0.016). Adjusted odds ratios were 9.1 for CNV resolution with an inferior choroidal thickness >49 μm and 5.6 for recurrence within 1 year with a subfoveal choroidal thickness ≤47.5 μm.nnnCONCLUSIONSnA thinner subfoveal/inferior choroid at baseline may indicate poor anatomic outcome after intravitreal anti-VEGF treatment in eyes with myopic CNV.

Optical Coherence Tomography Morphologic Grading of Macular Commotio Retinae and its Association With Anatomic and Visual Outcomes

PURPOSEnTo investigate the morphologic characteristics of macular commotio retinae using spectral-domain optical coherence tomography (SDOCT) and develop a grading system for traumatic photoreceptor damage.nnnDESIGNnRetrospective, observational case series.nnnMETHODSnsetting: Seoul National University Bundang Hospital. patients: Forty-nine patients with macular commotio retinae, examined by SDOCT within 7 days of the initial traumatic event. observations: A 4-step grading system was based on the morphology revealed by SDOCT. Best-corrected visual acuity (BCVA) and structural integrity of the 3 photoreceptor layers (cone outer segment tips [COST], inner/outer segment [IS-OS] junction, external limiting membrane [ELM]) were evaluated at baseline, at 1 month, and at the final visit. Visual and anatomic outcomes at 1 month and at the final visit were compared among subgroups. main outcome measures: The severity of photoreceptor damage as revealed by SDOCT and BCVA.nnnRESULTSnThe following 4 distinct photoreceptor morphologic features were observed: increase in IS-OS junction reflectivity with the disappearance of the thin hyporeflective optical space (n = 8, grade 1), COST defect only (n = 5, grade 2), COST and IS-OS junction defects (n = 16, grade 3), and COST, IS-OS junction, and ELM defects (n = 20, grade 4). Eyes with higher grades at baseline had significantly worse visual (final BCVA, P = .002) and anatomic outcomes (complete photoreceptor recovery, P < .001).nnnCONCLUSIONSnThe number of disrupted photoreceptor layers, as determined using SDOCT images, can be used to grade macular commotio retinae. This system may be useful in documenting the baseline severity of photoreceptor damage and in predicting visual and anatomic outcomes.

The effect of an intravitreal dexamethasone implant for cystoid macular edema in retinitis pigmentosa: a case report and literature review.

Intravitreal injection of a dexamethasone implant was used to treat a 24-year-old patient with retinitis pigmentosa (RP) who developed cystoid macular edema (CME) in both eyes that was refractory to oral acetazolamide and intravitreal bevacizumab treatment. After injection, best corrected visual acuity (BCVA) improved and central macular thickness decreased, but CME recurred in both eyes 6 months later. Although a second intravitreal dexamethasone implant injection resolved the CME and improved the BCVA, CME recurred in both eyes 6 months later. The intravitreal dexamethasone implant may be useful for CME in patients with RP, but its efficacy seems to be limited over time.

Comparison of two different spectral domain optical coherence tomography devices in the detection of localized retinal nerve fiber layer defects

PurposeTo compare the detection of localized retinal nerve fiber layer (RNFL) defects by two different spectral domain optical coherence tomography (SD-OCT) devices.MethodsEyes of 42 normal control subjects and 48 patients with a localized RNFL defect on red-free fundus photographs were imaged by the Cirrus (Carl Zeiss Meditec, Dublin, CA, USA) and 3D OCT (Topcon, Tokyo, Japan) devices. We compared sensitivities, specificities, and area under the receiver operating characteristic curves (AUCs) of circumpapillary RNFL (cpRNFL) thickness and ganglion cell complex (GCC) parameters between the two devices.ResultsThe devices provided different cpRNFL thickness measurements. The highest sensitivities at fixed specificities of 80xa0% (Cirrus: 83.3xa0%; 3D OCT: 77.1xa0%) and 95xa0% (Cirrus: 69.8xa0%; 3D OCT: 68.8xa0%) and the largest AUCs (Cirrus: 0.90; 3D OCT: 0.88) obtained by the cpRNFL parameters of the two devices were similar. Based on the internal normative database, the deviation-from-normal map of the Cirrus OCT device and the 36-segment map of the 3D OCT device had the highest sensitivity (89.6 and 91.7xa0%, respectively). Among the macular GCC parameters of the 3D OCT device, inferior macular RNFL thickness had the highest sensitivity (81.2xa0% at a specificity of 80xa0%) and the largest AUC (0.89).ConclusionsAlthough the two SD-OCT devices have different measurement protocols, they showed similar abilities for the detection of a localized RNFL defect.

Neuroprotective Effects of Human Serum Albumin Nanoparticles Loaded With Brimonidine on Retinal Ganglion Cells in Optic Nerve Crush Model

PURPOSEnWe investigated the neuroprotective effect of human serum albumin nanoparticles (HSA-NPs) and their conjugation with brimonidine (HSA-Br-NPs) on retinal ganglion cells (RGCs) in optic nerve crush (ONC) model.nnnMETHODSnWe fabricated HSA-Br-NPs by ethanol precipitation, including 0.18% brimonidine (Br) and 3.5% human serum albumin (HSA) in HSA-Br-NP solution. We performed ONC and intravitreal injection in Sprague-Dawley rats, which were divided into (1) Normal, (2) balanced salt solution (BSS)-injected ONC, (3) HSA-NP-injected ONC, (4) Br-injected ONC, and (5) HSA-Br-NP-injected ONC groups. Survival of RGC was compared 5 and 14 days after procedures. A cell viability assay evaluated the amyloid-β (Aβ)-associated neuroprotective mechanism of HSA-NP.nnnRESULTSnThe HSA-Br-NPs showed a narrow size distribution (152.8 ± 51.1 nm) and a negatively charged surface (-29.7 ± 7.5 mV), releasing Br for 5 days. The percentages of RGC survival in the HSA-NP (52.6 ± 3.3%), Br (58.0 ± 4.2%), and HSA-Br-NP (63.5 ± 7.1%) groups relative to Normal (100%) were significantly higher than in the BSS group (29.2 ± 3.3%) 5 days after ONC (P < 0.001). However, the HSA-Br-NP (38.1 ± 3.6%) group showed significantly higher RGC density than the BSS (10.3 ± 5.6%, P < 0.001) or Br (18.6 ± 3.9%, P = 0.006) group at 14 days. The HSA-NP injection reduced Aβ deposition in the RGC layer of ONC model, and a cell viability test showed that HSA-NP can inhibit Aβ-induced RGC death.nnnCONCLUSIONSnHuman serum albumin nanoparticles showed neuroprotective potential by inhibiting Aβ deposition, and exerted a sustained therapeutic effect with the combined neuroprotective agent. Our results suggest the potential of HSA-Br-NP as a promising neuroprotective agent.

The usefulness of interferon-gamma release assay for diagnosis of tuberculosis-related uveitis in Korea.

Purpose To evaluate the usefulness of the interferon-gamma release assay (IGRA) for diagnosing tuberculosis (TB)-related uveitis (TRU). Methods Records from 181 patients with ocular signs and symptoms suggestive of TRU and intraocular inflammation of unknown etiology were reviewed. All subjects underwent clinical and laboratory testing, including IGRA, to rule out presence of underlying disease. A diagnosis of presumed TRU was made based on an internists TB diagnosis and a patients response to anti-TB therapy. Sensitivity, specificity, and positive predictive values of IGRA for TRU diagnosis were calculated. Clinical characteristics were compared between patients with positive and negative IGRA results. Results The sensitivity and specificity of IGRA for TRU were 100% and 72.0%, respectively. Mean age, percentage of patients with retinal vasculitis, and the anatomic type of uveitis were significantly different between patients with positive and negative IGRA results (all p ≤ 0.001). Positive IGRA rates and false-positive rates were significantly different between age and anatomic type groups (both p = 0.001). The positive predictive value of the IGRA among patients with intraocular inflammation was high (70%) when all of younger age (≤40 years), posterior uveitis, and retinal vasculitis were present. Conclusions The IGRA is useful for diagnosing TRU in the Korean population, especially when it is used as a screening test. Clinical characteristics, including younger age (≤40 years), posterior uveitis, and retinal vasculitis in IGRA-positive patients, increase the likelihood of the patient having TRU.

Optic disc hemorrhage in glaucoma: pathophysiology and prognostic significance.

Purpose of review This article reviews the recent findings with regard to the pathophysiology and clinical significance of optic disc hemorrhage in glaucoma. Recent findings Even though the pathophysiology of disc hemorrhage has been investigated in depth, its underlying mechanism remains unclear. The key disc hemorrhage mechanisms currently under discussion are mechanical vascular disruption and associated vascular susceptibilities. Recent technical advances in spectral-domain optical coherence tomography have yielded more compelling evidence of mechanical vascular disruption behind the pathogenesis of disc hemorrhage in glaucoma. Studies show that disc hemorrhage is associated with structural and functional glaucoma progression. Furthermore, recent findings suggest that disc hemorrhage can have different significances according to its location, recurrence, and associated underlying mechanism. Summary The underlying mechanism of disc hemorrhage is complex like that of glaucoma. The ongoing controversy respecting the role of disc hemorrhage as a risk factor for glaucoma progression notwithstanding, special attention entailing closer follow-up and/or treatment escalation is recommended for patients with disc hemorrhage. Further studies investigating the unrevealed pathogenesis of disc hemorrhage and its prognostic value in glaucoma are warranted.

Central retinal artery occlusion caused by fat embolism following endoscopic sinus surgery.

Endoscopic sinus surgery (ESS) can lead to a variety of ophthalmic complications. Central retinal arterial occlusion (CRAO) is one such complication, usually due to orbital compartment syndrome. We report a case of CRAO following endoscopic sinus surgery as a result of fat embolism.

Update on the Prevalence, Etiology, Diagnosis, and Monitoring of Normal-Tension Glaucoma.

AbstractGlaucoma is a leading cause of blindness worldwide. Normal-tension glaucoma (NTG) is a type of open-angle glaucoma with intraocular pressure measurements always 21 mm Hg or less. A controversy surrounding NTG is the question of whether it should be regarded as a disease within the spectrum of primary open-angle glaucoma or as a distinctive disease entity. Nonetheless, NTG does have distinctive features compared with primary open-angle glaucoma: intraocular pressure–independent risk factors for development of NTG, characteristic patterns of structural and functional damage, and a unique disease course. This review provides an overview and update on the current issues surrounding the prevalence, etiology, diagnosis, and monitoring of NTG.

Development of Topographic Scoring System for Identifying Glaucoma in Myopic Eyes: A Spectral-Domain OCT Study

PURPOSEnTo develop a new scoring system that uses topographic diagnostic signs of spectral-domain (SD) OCT to enhance glaucoma diagnostic performance for myopic eyes and to validate the systems diagnostic ability.nnnDESIGNnCross-sectional study.nnnPARTICIPANTSnA total of 517 patients (517 eyes; spherical equivalent [SE] <-1.0 diopters [D] or axial length >24.0 mm), including 175 highly myopic eyes (SE <-6.0 D or axial length >26.0 mm), were recruited and divided into 2, training (241 eyes) and validation (276 eyes) test sets.nnnMETHODSnRetinal nerve fiber layer (RNFL) and ganglion cell-inner plexiform layer (GCIPL) topographic signs were selected based on the morphologic patterns of RNFL (size, shape, location, and agreement between deviation and thickness maps) and GCIPL (size, shape, location, color tone, agreement between maps, and step sign) abnormalities indicative of higher likelihood of myopic glaucoma on deviation and thickness maps. The diagnostic score was compiled according to the sensitivity, specificity, and positive likelihood ratio (PLR) of each diagnostic sign using the training set. The area under the receiver operating characteristic curve (AUC) was plotted and compared between the OCT-provided parameters and the scoring system in the validation set.nnnMAIN OUTCOME MEASURESnThe diagnostic performance of a new scoring system as validated by AUC.nnnRESULTSnAmong all of the RNFL and GCIPL parameters, the presence of temporal hemifield asymmetry on the GCIPL thickness map (PLR, 5.98) showed the highest diagnostic ability, followed by location of the RNFL defect (PLR, 5.79) and color tone of the GCIPL defect (PLR, 5.04). The AUC of the topographic scoring system in myopic eyes was 0.979, which was significantly higher than those of the inferior (0.895; P < 0.001) and average (0.894; P < 0.001) RNFL thickness parameters. For highly myopic eyes, the scoring system (AUC, 0.983) also showed a higher diagnostic performance than that of the RNFL and GCIPL thickness parameters (all P < 0.001).nnnCONCLUSIONSnOur scoring system including OCT topographic parameters demonstrated to be beneficial for clinicians to differentiate real glaucomatous damage from myopic healthy eyes. Our results support the value of using multitopographic OCT parameters for detecting glaucoma in myopic eyes.