Kyung Hoon Seo

Diurnal variation in choroidal thickness in relation to sex, axial length, and baseline choroidal thickness in healthy Korean subjects.

Purpose: To investigate diurnal variations in choroidal thickness (CT) in relation to various factors in healthy Korean subjects using spectral-domain optical coherence tomography. Methods: A prospective study was conducted on 100 healthy volunteers who each underwent measurements of CT in the same subfoveal area using an enhanced depth imaging technique with spectral-domain optical coherence tomography at 8 AM, 11 AM, 2 PM, and 5 PM. Possible correlations between the diurnal variation of CT and other factors, such as sex, axial length (AL), baseline CT (8 AM), blood pressure, and intraocular pressure, were evaluated. Results: One hundred volunteers with a mean age of 30.1 years were scanned. A significant pattern of diurnal variation was observed, with a mean CT of 278.28 ± 91.78 &mgr;m at 8 AM, 271.57 ± 89.08 &mgr;m at 11 AM, 266.39 ± 86.18 &mgr;m at 2 PM, and 264.92 ± 87.10 &mgr;m at 5 PM in a right eye. Right eye and left eye had a similar trend of diurnal cycle. Based on sex, AL, and baseline CT, the pattern of diurnal variation was greater and the amplitude significantly was greater in men, AL ⩽ 24 mm and baseline CT ≥ 300 &mgr;m (men vs. women: P = 0.048, AL ⩽ 24 mm vs. AL > 24 mm: P = 0.036, baseline CT ≥ 300 &mgr;m vs. baseline CT < 200 &mgr;m: P = 0.002, baseline CT ≥ 300 &mgr;m vs. 200 &mgr;m ⩽ baseline CT < 300 &mgr;m: P = 0.008). There were no significant correlations between the diurnal variation of CT and systolic blood pressure, diastolic blood pressure, or intraocular pressure. Conclusion: In men as well as in those with a shorter AL and thick baseline CT, a greater pattern of diurnal variation with significantly greater amplitude was observed.

VISUAL AND MORPHOLOGIC OUTCOMES OF INTRAVITREAL RANIBIZUMAB FOR DIABETIC MACULAR EDEMA BASED ON OPTICAL COHERENCE TOMOGRAPHY PATTERNS.

Purpose: To evaluate the visual and morphologic outcomes of intravitreal ranibizumab (IVR) in eyes with diabetic macular edema (DME) based on the morphologic pattern on optical coherence tomography. Methods: A prospective and consecutive series of 55 eyes with DME was classified according to OCT features: diffuse retinal thickening (DRT), cystoid macular edema (CME), and serous retinal detachment (SRD). Patients received three consecutive monthly injections of IVR and as needed thereafter. The primary outcome was the number of treatments undertaken by DME type over 12 months. Best-corrected visual acuity, retinal thickness, and microstructural changes were also evaluated. Results: The eyes were classified as DRT (n = 23), CME (16), or SRD (16). The mean number of injections over 12 months was significantly different among the groups: DRT (3.69), CME (5.33), and SRD (5.09; P = 0.028). Best-corrected visual acuity of SRD (20/60) was significantly worse than that of the other types (DRT = 20/38; CME = 20/43; P = 0.015) after 12 months. Conclusion: Vision gains and retinal anatomy improvement were maintained in all three types during the first year of IVR administration. Especially, DRT maintained a good response to ranibizumab in a fewer number of injections. Disruption of the photoreceptor integrity at the baseline was correlated with poorer visual outcome and occurred more frequently in SRD.

TOPOGRAPHIC CHANGES IN MACULAR GANGLION CELL-INNER PLEXIFORM LAYER THICKNESS AFTER VITRECTOMY WITH INDOCYANINE GREEN-GUIDED INTERNAL LIMITING MEMBRANE PEELING FOR IDIOPATHIC MACULAR HOLE.

Purpose: To evaluate the topographic changes in macular ganglion cell–inner plexiform layer (GCIPL) thickness after vitrectomy with indocyanine green–guided internal limiting membrane (ILM) peeling in eyes with idiopathic macular hole. Methods: This is a retrospective analysis of 58 consecutive eyes with surgically closed macular hole after vitrectomy with indocyanine green–guided ILM peeling. Further, 31 eyes that had undergone vitrectomy without ILM peeling were used as the control group. The macular GCIPL thickness was measured with spectral domain optical coherence tomography before vitrectomy and at 1 month and 6 months after vitrectomy. Results: The preoperative mean GCIPL thickness was 78.79 &mgr;m and mean thickness at 1 month and 6 months after surgery significantly reduced progressively to 70.93 &mgr;m and 67.64 &mgr;m (P < 0.001 and P < 0.001, respectively). The postoperative mean GCIPL thickness was significantly lower than that of the group without ILM peeling at 1 month and 6 months postoperatively (P < 0.001, P < 0.001, respectively). The GCIPL thickness in the temporal area was significantly lower than in the nasal area at 1 month and 6 months postoperatively (P < 0.001, P < 0.001, respectively). Conclusion: A reduction of the macular GCIPL thickness was observed after vitrectomy with indocyanine green–guided ILM peeling for idiopathic macular hole, especially in the temporal area.

Change of retinal pigment epithelial atrophy after anti-vascular endothelial growth factor treatment in exudative age-related macular degeneration.

Purpose: The study aimed to investigate the quantitative changes of retinal pigment epithelial (RPE) atrophy during a 24-month follow-up period of anti-vascular endothelial growth factor (VEGF) for exudative age-related macular degeneration (AMD). Materials and Methods: This is a retrospective study. Sixty-five eyes of 62 consecutive patients with naοve exudative AMD who had received treatment with anti-VEGF therapy and followed for more 24 months were enrolled. All patients received three initial monthly injections of anti-VEGF (ranibizumab or bevacizumab), followed by pro re nata or treat-and-extend protocol. Color fundus image, optical coherence tomography, and fundus autofluorescence were evaluated for RPE atrophy. Multiple regression analysis was performed to investigate the predictive factors found during univariate analysis to identify an association with increased RPE atrophic areas. Results: The mean number of anti-VEGF treatments was 9.18. RPE atrophic area was 1.293 ± 1.298 mm 2 at baseline and enlarged to 2.394 ± 1.940 mm 2 after 24 months, which differed significantly (P = 0.001). Multiple regression analysis revealed that larger areas of RPE atrophy at month 4 and larger numbers of anti-VEGF treatments were associated with increased RPE atrophic areas. Conclusions: RPE atrophy progresses in eyes with exudative AMD during anti-VEGF treatment. Larger areas of RPE atrophy at month 4 and larger numbers of anti-VEGF injections were associated with an increased risk of progression of RPE atrophy the following treatment. These findings may be useful to clinicians using intravitreal anti-VEGF for the treatment of exudative AMD, both for selecting an appropriate treatment plan and for predicting the progression of RPE atrophy.

Repeatability and Reproducibility of Spectral-Domain Optical Coherence Tomography Measurements of Retinal Thickness in Rats.

ABSTRACT Purpose: To evaluate the in vivo repeatability and reproducibility of spectral-domain optical coherence tomography (SD-OCT) measurements of total retinal thickness (TRT) and retinal nerve fiber layer (RNFL) thickness in rats.Methods: Retinal thickness was measured using an RNFL circular scan with AutoRescan and TruTracking modes in 20 eyes of Long-Evans Tokushima Otsuka rats. Three RNFL circular scan images were acquired with a brief rest between measurements to evaluate intra-session repeatability. Three additional RNFL circular scans were acquired 1 day later to evaluate intersession repeatability. Two experienced examiners independently measured TRT using automatic alignment and RNFL thickness using manual alignment according to the same procedure to evaluate inter-examiner reproducibility 1 week later. The correlation of measurements by OCT and histology was determined.Results: For TRT, the intra-session and inter-session intraclass correlation coefficient (ICC) with SD-OCT was between 0.85 and 0.93. The coefficient of variance (CV) ranged from 3.9% to 4.8%. For RNFL thickness, intra-session, and inter-session ICC with SD-OCT were between 0.61 and 0.91. The inter-examiner ICC was 0.74 for TRT and 0.70 for RNFL. The CV was 4.4% for TRT and 6.0% for RNFL. OCT and histologically determined TRT and RNFL thicknesses were significantly positively related based on Pearson’s correlation coefficient (TRT, r = 0.781, p < 0.001; RNFL, r = 0.517, p = 0.019).Conclusions: TRT and RNFL thickness measurements using SD-OCT in rats had high intra-session and inter-session repeatability and inter-examiner reproducibility in vivo. This method will facilitate longitudinal studies to follow disease processes over time and to evaluate therapeutic effects after experimental intervention.

Clinical Patterns of Uveitis in Tertiary Ophthalmology Centers in Seoul, South Korea

ABSTRACT Purpose: To identify the characteristics and causes of uveitis in Seoul, South Korea. Methods: We performed a retrospective medical record review of 602 patients diagnosed with uveitis at seven tertiary ophthalmology centers between January and December 2013. Results: The most common type of uveitis was anterior uveitis (n = 281), followed by posterior uveitis (n = 152), panuveitis (n = 126), and intermediate uveitis (n = 43). Among patients with an identified cause (n = 252), 149 and 103 had non-infectious and infectious uveitis, respectively, and ankylosing spondylitis (n = 53), Behcet disease (n = 43), and endophthalmitis (n = 25) were common identified causes of uveitis. Conclusions: Anterior uveitis was the most common type of uveitis, and the incidence of infectious uveitis was relatively high in Seoul. Ankylosing spondylitis and Behcet disease were the most common systemic diseases causing uveitis in this sample.