Sang Jun Park

The clinical and ocular manifestations of Takayasu arteritis.

Purpose To evaluate the clinical and ocular manifestations of Takayasu arteritis and the fundus fluorescein angiography (FFA) characteristics of Takayasu retinopathy (TR). Patients and Methods Medical records and fundus fluorescein angiograms of 156 eyes of 78 patients with Takayasu arteritis were reviewed. Fundus FA using a wide-field fundus camera (60°) was performed in 19 patients, and conventional angiography or spiral computed tomographic angiography was performed in all 78 patients. Results The series included 67 female and 11 male patients; mean age at time of diagnosis was 26.7 years (range, 4–61 years). Hypertension was found in 44 (56.4%) patients, ischemic cerebrovascular symptoms in 18 (23.1%) patients, and amaurosis fugax in 20 (25.6%) patients. On fundus examination, no retinopathy was found in 87 (55.8%) eyes; hypertensive retinopathy was found in 48 (30.8%) eyes; and TR was found in 21 (13.5%) eyes. Patients with TR had carotid artery or aortic arch involvement, and patients with hypertensive retinopathy had involvement of the descending aorta or renal artery and sparing of the carotids. Best-corrected visual acuity in TR Stage 1 to 3 ranged from 20/15 to 20/30, but in Stage 4, it ranged from 20/200 to hand motions because of secondary ocular complications. On FFA, the arm-to-retina circulation time was prolonged in all 21 eyes with TR (mean, 22.7 ± 8.9 seconds), but only 14 eyes showed delayed arteriovenous filling time, which was mainly found in chronic, moderate to severe TR, Stage 3 or 4. Arteriovenous anastomosis was found in all 12 eyes with Stage 3 and 4 TR. Conclusions Delayed arm-to-retina circulation time is shown in all cases of TR, but delayed arteriovenous filling time is mostly found in moderate and severe TR. During ophthalmic examination, the delay of arteriovenous filling time and formation of arteriovenous anastomosis must be examined carefully to prevent visual deterioration.

Morphologic photoreceptor abnormality in occult macular dystrophy on spectral-domain optical coherence tomography.

PURPOSE. To investigate morphologic photoreceptor layer abnormalities and their correlation with visual function in occult macular dystrophy (OMD), by using spectral-domain optical coherence tomography (SD-OCT). METHODS. This observational case series included 18 eyes of 9 patients with OMD. All patients underwent an ophthalmic evaluation, which included a fundus examination, fluorescein angiography, full-field electroretinography (ERG), multifocal ERG, time-domain optical coherence tomography (TD-OCT), and visual field testing. Morphologic photoreceptor layer abnormalities of the retinal layers were investigated with SD-OCT. The structure-function relationship was investigated regarding visual acuity, symptom duration, and multifocal ERG RESULTS: RESULTS. Best corrected visual acuity ranged from 20/200 to 20/20. Four patients had a symmetric decline of acuity in both eyes (20/200-20/100), and five had unilateral vision impairment (20/200-20/50). TD-OCT showed foveal thinning in all patients, but revealed no other retinal layer abnormality. In 15 eyes of 8 patients, SD-OCT demonstrated a well-defined disruption of the inner segment-outer segment (IS-OS) junction of the photoreceptors and of the Verhoeff membrane (cone outer segment tips). SD-OCT showed that three of five patients with presumed unilateral OMD had bilateral OMD after initial or follow-up examinations. Degrees of abnormality in the photoreceptor layer varied and correlated with visual acuity and symptom duration. CONCLUSIONS. SD-OCT can demonstrate the disruption of photoreceptors in most patients with OMD and the morphologic changes on SD-OCT correlate with visual function and disease progression. These morphologic abnormalities can be an important feature and cause of vision loss in patients with OMD.

Age-Related Macular Degeneration: Prevalence and Risk Factors from Korean National Health and Nutrition Examination Survey, 2008 through 2011

OBJECTIVE To investigate the prevalence and risk factors of age-related macular degeneration (AMD) in the Korean population. DESIGN A cross-sectional study using a complex, stratified, multistage, probability-cluster survey, which can produce nationally representative estimates. PARTICIPANTS Using the database of Korean National Health and Nutrition Examination Survey from 2008 through 2011, 14 352 participants 40 years of age or older with gradable fundus photographs were included. METHODS Age-related macular degeneration was determined by fundus photograph. Prevalences of AMDs were estimated. Risk factor analyses were conducted using logistic regression analyses (LRAs). MAIN OUTCOME MEASURES Prevalence and risk factors of AMD. RESULTS The prevalence of AMD was 6.62% (95% confidence interval [CI], 6.15%-7.09%) in the Korean population: 6.02% (95% CI, 5.56%-6.48%) were early AMD and 0.60% (95% CI, 0.45%-0.75%) were late AMD. The prevalence of early AMD in women (6.73%; 95% CI, 6.11%-7.35%) was higher than that in men (5.25%; 95% CI, 4.61%-5.89%; P<0.001), and the prevalence of late AMD in women (0.37%; 95% CI, 0.22%-0.52%) was lower than that in men (0.85%; 95% CI, 0.59%-1.12%; P<0.001). However, in multiple LRAs both early and late AMD had no association with gender, house income, residence, sun exposure, or systemic comorbidities, including hypertension, diabetes mellitus, and cardiovascular diseases. Early AMD had positive associations with older age groups (P<0.001), lower education (P = 0.027), occupation (P<0.001), anemia (P = 0.027), hepatitis B surface antigen carrier status (P<0.001), not being overweight (body mass index [BMI], P = 0.032; waist circumference, P = 0.041, in separate analyses), and higher serum high-density lipoprotein (HDL) level (P = 0.046), but not with smoking status. Late AMD had positive associations with age groups (P<0.001), current smokers (P = 0.022), and lower BMI (P = 0.037). CONCLUSIONS The results suggest that there are 1.21 million individuals with early AMD and 121 000 individuals with late AMD in Korea. Nonoverweight status and higher HDL levels, generally assumed as positive health indicators, as well as anemia and hepatitis B infection had harmful associations with AMD in our study, implying a possible different pathophysiologic process of AMD in Asians compared with that of white persons.

Nationwide Incidence of Clinically Diagnosed Central Retinal Artery Occlusion in Korea, 2008 to 2011

PURPOSE To define the incidence and demographics of clinically diagnosed central retinal artery occlusion (CRAO) in Korea. DESIGN Nationwide population-based retrospective study using data entered into the Korean national health claims database from 2007 to 2011. PARTICIPANTS Data of the entire Korean population (N = 47,990,761, based on the 2010 census) were analyzed. METHODS We used the national health claims database to identify patients diagnosed with CRAO. Incident cases were those with no claims related to CRAO in 2007 and were included once on the earliest claims related to CRAO in the years 2008 to 2011. Incident cases had a disease-free period before diagnosis of at least 1 to 4 years. The average incidence rate of CRAO was estimated according to the entire Korean population. MAIN OUTCOME MEASURES The person-time incidence rates of clinically diagnosed CRAO in Korea, including the age- and sex-specific incidence rates, were estimated. RESULTS A total of 3464 CRAO cases (59.1% men) were identified. The incidence rate of clinically diagnosed CRAO during the study period was 1.80 per 100,000 person-years (95% confidence interval [CI], 1.74-1.86). The incidence rate among men and women was 2.15 (95% CI, 2.05-2.24) and 1.47 (95% CI, 1.39-1.54) per 100,000 person-years (male-to-female ratio, 1.47), respectively. The age-specific male-to-female ratios were constant between the ages of 30 and 89 years (range, 1.51-2.10 years). The highest incidence of 10.08 (95% CI, 8.80-11.35) per 100,000 person-years was observed in those aged 80 to 84 years (14.65 [95% CI, 11.90-17.40] and 8.00 [95% CI, 6.63-9.37] per 100,000 person-years for men and women aged 80-84 years, respectively). The incidence rate of CRAO increased exponentially with age until the 9th decade of life. CONCLUSIONS To our knowledge, this is the first nationwide epidemiologic study of CRAO in individuals of all ages. The incidence rate of CRAO in Korea increased exponentially with increasing age and was highest among those aged 80 to 84 years. Moreover, the incidence rate in men was 1.47 times higher than that in women.

Risk and Risk Periods for Stroke and Acute Myocardial Infarction in Patients with Central Retinal Artery Occlusion.

PURPOSE To investigate the risk of stroke and acute myocardial infarction (AMI) in patients with incident central retinal artery occlusion (CRAO). DESIGN A self-controlled case series (SCCS) study. PARTICIPANTS Patients with incident CRAO from the entire Korean population of 48 million individuals. METHODS We used the Korean national claim database (2007-2011) for analyses. After identifying patients with incident CRAO, the relative incidence rate ratios (IRRs) for stroke and AMI in risk periods were measured in these patients using a SCCS method. MAIN OUTCOME MEASURES The IRRs of stroke and AMI by risk periods. RESULTS Of 1655 patients with incident CRAO in 2009-2010, 165 had stroke/AMI (ischemic stroke in 139, hemorrhagic stroke in 13, and AMI in 15) in the observation period spanning 365 days before and after the occurrence of CRAO. The IRR of stroke/AMI 1 to 30 days after CRAO occurrence significantly increased (14.0; 95% confidence interval [CI], 8.90-22.00); the IRR peaked during the 1 to 7 days after CRAO occurrence (44.51; 95% CI, 27.07-73.20), and the increased risk was present for the first 30 days. The IRR of stroke/AMI also significantly increased 1 to 30 days (6.82; 95% CI, 4.01-11.60) and 31 to 90 days (2.86; 95% CI, 1.66-4.93) before CRAO occurrence. Subanalysis for only ischemic stroke showed similar, magnified IRRs in the risk periods compared with all events. The IRRs were not significantly different between sexes or age groups (<65 vs. ≥65 years). CONCLUSIONS Patients with incident CRAO are at increased risk of ischemic stroke just after CRAO occurrence, and the risk is particularly increased during the first week immediately after the CRAO occurrence. The results suggest that patients with incident CRAO require immediate neurologic evaluation and preventive treatment to reduce mortality and morbidity.

Five year nationwide incidence of rhegmatogenous retinal detachment requiring surgery in Korea.

Purpose To define the incidence and demographic characteristics of rhegmatogenous retinal detachment (RRD) requiring surgery in Korea. Design Nationwide population-based retrospective study. Methods Patients who underwent surgery for RRD from 2007 to 2011 were retrospectively identified using the diagnostic code for RRD and the surgical codes for retinal detachment surgeries in the national claim database. The average incidence rate of RRD during the 5-year period was estimated using the population data of the 2010 Census in Korea. Results A total of 24,928 surgically treated RRD cases were identified. The average incidence of surgery requiring RRD was 10.39 cases per 100,000 person-years [95% confidence interval (CI), 10.26–10.52). The incidence in men (11.32 cases per 100,000 person-years; 95% CI: 11.13–11.51) was significantly higher than that in women (9.47 cases per 100,000 person-years; 95% CI: 9.29–9.64) (p<0.001). The incidence of surgery requiring RRD showed a bimodal distribution across age groups, with one peak (28.55 cases per 100,000 person-years; 95% CI: 27.46–29.67) representing patients between 65 and 69 years of age and the second peak (approximately 8.5 per 100,000 person-years) representing patients between 20 and 29 years of age. The male-to-female ratio was approximately 1.0 for the peak-incidence age groups, whereas the ratio was higher for the other age groups. Conclusions The incidence of RRD in the Korean population was similar to that reported previously, with the peak incidence being lower than that in the Caucasian population. The age-specific RRD incidence pattern in Korea followed a bimodal distribution.

Prevalence and Incidence of Exudative Age-Related Macular Degeneration in South Korea: A Nationwide Population-Based Study

PURPOSE To determine the prevalence and incidence of exudative age-related macular degeneration (AMD) in South Korea. DESIGN Nationwide population-based retrospective study using data from the Korean national health claims database from 2008 through 2012. PARTICIPANTS Entire South Korean population 40 years of age or older (n = 22,376,510). METHODS We accessed the national health claims database to identify exudative AMD patients using the registration program database for rare intractable diseases, which included ophthalmologist-confirmed exudative AMD, for copayment reduction. MAIN OUTCOME MEASURES Prevalence and incidence rates of exudative AMD. RESULTS During the 5-year study period, 81 513 patients had exudative AMD (48.2% men) and were included in the prevalence estimates. The prevalence in the general population 40 years of age or older was 36.43 (95% confidence interval [CI], 36.18-36.68) per 10,000 people, that in men was 37.01 (95% CI, 36.65-37.38) per 10,000 people, and that in women was 35.90 (95% CI, 35.56-36.24) per 10,000 people. After excluding prevalent cases during the initial 2-year washout period, 20,196 cases were identified with incident exudative AMD during the final 3-year study period (2010-2012). The incidence in the general population 40 years of age or older was 3.02 (95% CI, 2.98-3.06) per 10,000 person-years, that in men was 3.76 (95% CI, 3.69-3.83) per 10,000 person-years, and that in women was 2.34 (95% CI, 2.29-2.39) per 10,000 person-years. The prevalence and incidence increased with advancing age and peaked at approximately 80 years of age. Both the prevalence and incidence were higher in men than in women in all age groups. CONCLUSIONS These detailed estimates of the nationwide, population-based prevalence and incidence of exudative AMD in an Asian population may help to understand the disease pathophysiology and to plan accordingly within the healthcare system.

Partial Recovery after Intraarterial Pharmacomechanical Thrombolysis in Ophthalmic Artery Occlusion following Nasal Autologous Fat Injection

Although autologous fat injection into the face is a widely used procedure in aesthetic surgery, heed must be taken because it may cause severe complications related to inadvertent arterial embolization, including stroke and vision loss. Vision loss may originate from ophthalmic artery occlusion, and no therapeutic options have yet been reported for this condition. Herein, the authors report a case of ophthalmic artery occlusion following nasal autologous fat injection. Partial recovery of choroidal and retinal perfusion, ocular motility, and corneal clarity was achieved after intraarterial pharmacomechanical thrombolysis.

Nationwide Incidence of Clinically Diagnosed Retinal Vein Occlusion in Korea, 2008 through 2011: Preponderance of Women and the Impact of Aging

OBJECTIVE This study aimed at defining the incidence and demographics of clinically diagnosed retinal vein occlusion (RVO) in Korea. DESIGN Nationwide population-based retrospective study using data entered into the Korean national health claims database from 2007 through 2011. PARTICIPANTS Data of the entire population of Korea (n = 47,990,761, based on the 2010 census) were analyzed. METHODS The Korean national health claims database was analyzed to identify patients with RVO. Incident cases included individuals with no RVO claims in 2007, but with RVO claims in the years 2008 through 2011. The incidence rate of RVO was estimated for the entire Korean population. MAIN OUTCOME MEASURES The person-time incidence rates of clinically diagnosed RVO in Korea, including the age- and gender-specific incidence rates, were estimated. RESULTS A total of 92 730 RVO cases (56.4% in women) were identified. The incidence rate of clinically diagnosed RVO during the study period was 48.31 per 100,000 person-years (95% confidence interval [CI], 48.00-48.62). The incidence rate among men and women was 42.40 (95% CI, 41.99-42.81) and 54.14 (95% CI, 53.67-54.60) per 100,000 person-years, respectively (P < 0.001). The highest incidence of 214.92 per 100,000 person-years (95% CI, 211.29-218.56) was observed in the age group of 70 to 74 years (186.62 [95% CI, 181.46-191.78] and 236.25 [95% CI, 231.21-241.29] per 100,000 person-years for men and women aged 70 to 74 years, respectively). The incidence rate of RVO increased as the age of the population increased-more than doubling approximately every 10 years from the second to the seventh decade of life. Retinal vein occlusion occurred more often in men 30 to 54 years of age and in men older than 85 years, but was more common in women 55 to 84 years of age. CONCLUSIONS This study reports the population-based RVO incidence in Korea. The RVO incidence increased exponentially as the age of the population increased, and the RVO incidence in women was 1.28 times higher than that in men.

Five heavy metallic elements and age-related macular degeneration: Korean National Health and Nutrition Examination Survey, 2008-2011.

OBJECTIVE To investigate the association between age-related macular degeneration (AMD) and 5 heavy metallic elements (lead, mercury, cadmium, manganese, and zinc). DESIGN A cross-sectional study using a complex, stratified, multistage, probability cluster survey. PARTICIPANTS Participants of the Korean National Health and Nutrition Examination Survey from 2008 to 2011. METHODS Using a standardized protocol, AMD was determined by fundus photograph grading. Blood concentrations of lead, mercury, cadmium, manganese, and zinc were measured. Associations between AMD and these 5 elements were estimated using logistic regression analyses (LRAs). The distributions of the 5 metallic elements in blood were analyzed, and the same set of LRAs estimating the association between AMD and logarithmic-transformed blood concentrations of the 5 elements were also conducted. MAIN OUTCOME MEASURES Association between AMD and 5 heavy metals. RESULTS Lead was positively associated with both early AMD and late AMD in all LRAs. Mercury and cadmium also had a positive association with late AMD in all LRAs, but not with early AMD. In contrast, manganese and zinc had an inverse association with late AMD in all LRAs. Manganese and zinc were not associated with early AMD. Using logarithmic-transformed blood concentrations for each metallic element, the LRAs showed similar results compared with those of the LRAs using nontransformed blood concentrations, despite the skewed distribution of these metallic elements in the blood. CONCLUSIONS This study suggests that the toxic heavy metals (lead, mercury, and cadmium) may negatively influence late AMD, whereas essential heavy metals (manganese and zinc) may favorably influence late AMD. Lead may widely affect the pathogenesis of both early and late AMD.