Sei Yeul Oh

Analysis of spectral-domain optical coherence tomography in preterm children: retinal layer thickness and choroidal thickness profiles.

PURPOSE To compare retinal layer thickness and choroidal thickness profiles in preterm and full-term children using spectral-domain optical coherence tomography (SD-OCT). METHODS We performed horizontal and vertical SD-OCT crosshair scans through the fovea with and without an enhanced depth technique in 31 premature and 30 full-term children. Retinal layer and choroidal thicknesses were measured at various locations including the fovea and 1.0 and 3.0 mm nasal, temporal, superior, and inferior to the fovea. After adjusting for age and the childs axial length, we compared retinal layer and choroidal thicknesses at the measurement points. RESULTS Total retinal thickness and outer nuclear layer (ONL) thickness at the foveal center in preterm children (256.00 ± 30.71 μm, 141.87 ± 28.75 μm, respectively) were larger than those in full-term children (217.57 ± 10.64 μm, 101.22 ± 10.90 μm, respectively, P < 0.001). Gestational age at birth was inversely correlated with both total retinal and ONL thicknesses (P < 0.001). Choroidal thickness 3.0 mm temporal to the fovea in preterm children (283.75 ± 60.47 μm) was significantly less than that in full-term children (339.89 ± 90.32, P = 0.010). Retinopathy of prematurity staging showed a marginal inverse correlation with choroidal thickness 3.0 mm temporal to the fovea (P = 0.053). Visual acuity in preterm children was not correlated with retinal thickness or choroidal thickness. CONCLUSIONS Our SD-OCT data demonstrated an increased total retinal thickness and ONL thickness at the foveal center and decreased choroidal thickness 3.0 mm temporal to the fovea in preterm children. Further studies are needed to better understand the association between these structural changes and visual functions in preterm children.

Choroidal Thickness In Healthy Children

Purpose: To evaluate the choroidal thickness profiles of healthy children using enhanced depth imaging optical coherence tomography. Methods: Horizontal and vertical enhanced depth imaging optical coherence tomography crosshair scans through the fovea were obtained from 48 healthy children. Choroidal thickness was measured at the fovea, 1 mm and 3 mm nasal, temporal, superior, and inferior to the fovea, and comparisons of choroidal thickness at different measurement points were performed. Results: The mean subfoveal choroidal thickness was 348.4 ± 82.5 &mgr;m and the thickness at 1 mm nasal, temporal, superior, and inferior to the fovea was 306.1 ± 86.3, 352.0 ± 84.8, 349.9 ± 83.8, and 343.8 ± 86.8 &mgr;m, respectively. The thickness at 3 mm nasal, temporal, superior, and inferior to the fovea was 190.1 ± 63.9, 339.2 ± 89.8, 330.7 ± 82.1, and 309.9 ± 78.4 &mgr;m, respectively. Subfoveal choroidal thickness was negatively correlated with age. Conclusion: The data, obtained using enhanced depth imaging optical coherence tomography, provide the choroidal thickness profile of healthy children. The characteristic choroidal thickness profile in children suggests a redistribution process of choroidal tissue with aging.

Analysis of spectral-domain optical coherence tomography measurements in amblyopia: a pilot study

Background/aims To compare the thickness of each retinal layer of amblyopic and fellow eyes in patients with unilateral amblyopia. Methods Horizontal and vertical spectral-domain optical coherence tomography scans through the fovea were obtained for 20 patients with unilateral amblyopia. The thickness of each retinal layer in the amblyopic eyes was measured at the foveal centre, inner macular locations (a mean of 490 μm and 500 μm superior, inferior, nasal and temporal to the foveal centre) and outer macular locations (a mean of 1490 μm and 1500 μm superior, inferior, nasal and temporal to the foveal centre) and compared with corresponding locations in the fellow eyes. Results In amblyopic eyes, there was significant thinning of the ganglion cell layer plus inner plexiform layer at all four nasal and temporal macular locations and at the outer superior and inferior locations. Other retinal layers, including the nerve fibre layer, inner nuclear layer, outer plexiform layer and outer nuclear layer, demonstrated significant differences in thickness at several macular locations. Conclusions These data, obtained using spectral-domain optical coherence tomography, reveal differences between amblyopic and fellow eyes in the thickness of some retinal layers, including a notable difference in the ganglion cell layer plus inner plexiform layer.

Analysis of spectral domain optical coherence tomography measurements in optic neuritis: differences in neuromyelitis optica, multiple sclerosis, isolated optic neuritis and normal healthy controls.

Purpose:  To compare the retinal layer thickness of eyes with optic neuritis (ON) and that of control eyes and ON eyes with and without neuromyelitis optica (NMO) or multiple sclerosis (MS).

Reproducibility of horizontal extraocular muscle insertion distance in anterior segment optical coherence tomography and the effect of head position

PURPOSE To investigate the reproducibility of horizontal extraocular muscle insertion distance measurements in anterior segment optical coherence tomography (AS-OCT) and to evaluate the effect of eye position on the measurement. METHODS The right eyes of 30 healthy young subjects underwent AS-OCT. Varying eye positions were used and the muscle insertion distance was measured by two independent examiners who each measured the insertion distance twice. The measurement was performed for the lateral rectus and medial rectus muscles with the eye rotated 40°, 50°, and 60° to the midline of the instrument. Reproducibility was evaluated with the intraclass correlation coefficient (ICC) and Bland-Altman plot. RESULTS The lateral rectus insertion distance was smallest with 50° rotation and the medial rectus insertion distance did not show a consistent pattern in regards to gaze position. The differences in insertion distance between different eye positions were not statistically significant for both muscles. The inter- and intraexaminer ICC reproducibility values were excellent for both lateral and medial rectus insertion distance measurements. CONCLUSIONS Inter- and intraexaminer reproducibility were excellent for lateral and medial rectus muscle insertion distance measurements using AS-OCT. The measurements tended to be smallest with the 50° position in lateral rectus measurement; however, medial rectus measurements were variable.

An Optical Coherence Tomography-Based Analysis of Choroidal Morphologic Features and Choroidal Vascular Diameter in Children and Adults

PURPOSE To analyze choroidal sub-layers and vascular diameter in children, and to compare these choroidal features with those of adults. DESIGN Retrospective observational study. METHODS This study included 96 eyes from 48 healthy children and 54 eyes from 27 healthy adults. The subfoveal choroidal thickness, large choroidal vessel layer thickness, medium choroidal vessel layer-choriocapillaris layer thickness, and large choroidal vessel diameter were estimated. The ratio of thickness of the large choroidal vessel layer to total choroidal thickness was calculated. The association between subfoveal choroidal thickness and large choroidal vessel layer, as well as ratio of thickness of the large choroidal vessel layer to total choroidal thickness, was analyzed. Furthermore, the ratio and choroidal vascular diameter were compared between children and adults. RESULTS The mean age was 6.7 ± 1.9 years and 30.7 ± 4.3 years in children and in adults, respectively. In children, the mean ratio was 0.71 ± 0.08 and the mean choroidal vascular diameter was 103.1 ± 16.0 μm. In adults, the values were 0.73 ± 0.08 and 122.5 ± 20.7 μm, respectively. The subfoveal choroidal thickness in children was significantly associated with the ratio (P < .001), whereas the association was not significant in adults (P = .173). The choroidal vascular diameter was significantly greater in adults than in children (P < .001). However, the ratio was not different between the 2 groups (P = .391). CONCLUSIONS Choroidal morphologic features are generally comparable between children and adults. Some differences between the 2 groups may reflect changes in choroidal morphology associated with aging.

Long-Term Changes in Refractive Error in Children With Myopic Tilted Optic Disc Compared to Children Without Tilted Optic Disc

PURPOSE To compare changes in the spherical equivalent (SE) refractive error between children with and without myopic tilted optic disc. METHODS Changes in SE refractive error were compared between a group of 88 children with -1.5 diopters or more of myopia with myopic tilted disc and a group of 108 age- and initial SE refractive error-matched children without tilted disc. Factors that significantly influenced changes in SE refractive error were analyzed using mixed models. RESULTS Patients in the myopic tilted disc group were followed for 5.3 ± 3.1 years, on average, and patients in the nontilted disc group were followed for an average of 5.3 ± 2.3 years. An overall tendency toward myopic progression during the follow-up period was noted in both groups. According to univariate analysis, patients with a poorer baseline best-corrected visual acuity (BCVA) and tilted discs tended to have greater myopia over time (P < 0.001 and P = 0.009, respectively). Myopic progression in the tilted disc group was significantly greater than that in the nontilted disc group (P < 0.001) after adjusting for sex and initial BCVA. CONCLUSIONS Patients with myopic disc tilt showed greater myopic progression over time. These data suggest that myopic disc tilt represents a prognostic factor for further myopic progression, but it is unclear whether the disc tilt directly affects the progression rate of myopia or is a noncontributory consequence of other underlying mechanisms. The temporal relationship between the onset of the disc tilt and the myopic progression should be further studied using a prospective design.

Bilateral ischemic optic neuropathy in a patient using tacrolimus (FK506) after liver transplantation.

The relationship between various kinds of optic neuropathy and drugs including amiodarone, ethambutol, linezolid, sildenafil, and interferon is reported in the literature (1). Tacrolimus (FK506, Prograf; Fujisawa USA, Inc., Deerfield, IL)-induced optic neuropathy was reported in three case reports; however, the mechanism of neurotoxicity is unclear (2–4). We report a case of bilateral ischemic optic neuropathy in the patient using tacrolimus and suggest the mechanism of tacrolimus neurotoxicity. A 54-year-old male patient was referred with a 10-day history of painless decreased vision in the left eye. The patient had liver cirrhosis associated with hepatitis B virus infection and had undergone liver transplantation 6 months before. The patient did not have any vascular risk factors. At the presentation, he was receiving mycophenolate 250 mg two times per day, prednisolone 2 mg four times per day, and tacrolimus 2.5 mg two times per day orally to maintain immunosuppression for 5 months. The best corrected visual acuity at the first examination was 20/20 OD and 20/400 OS. Relative afferent pupillary defect was noted in the left eye. The anterior segment and the fundus examination were normal. Cecocentral scotoma with an inferior predilection was revealed in Goldmann visual field (GVF) test, and delayed P100 latency was revealed in visual-evoked potential in the left eye. Laboratory study results including coagulation test were normal, whereas the results of blood studies for cytomegalovirus and mycobacteria were negative. At this time, tacrolimus and mycophenolate plasmatic levels were 6.2 and 1.3 mg/L, respectively. Brain magnetic resonance imaging was normal. Initially, we suspected an idiopathic ischemic optic neuropathy and planned regular follow-up. Three months later, his visual acuity of the right eye was also decreased to counting fingers and relative afferent pupillary defect was noted in the left eye. Visual acuity was counting fingers OS. Fundus examination was normal in the right eye; however, temporal pallor of optic disc was noted in the left eye (Fig. 1A). GVF test revealed cecocentral scotoma with an inferior predilection in both the eyes. Fluorescein angiography (FA) demonstrated no fluorescence filling in the optic disc in both the eyes, from the early phase to the late phase (Fig. 1B). We suspected ischemic optic neuropathy associated with tacrolimus and recommended to the general surgery department to discontinue tacrolimus medication. At this time, there was a mild increase in liver enzymes, and chronic rejection was suspected. Tacrolimus was immediately discontinued, instead cyclosporine was started for immunosuppression. Two weeks later, visual acuity had improved to 20/60 in the right eye but was still limited to counting fingers in the left eye. One month after discontinuing the medication, visual acuity was improved to 20/50 OD and stationary OS. GVF test revealed improved visual field in the right eye and stationary in the left eye, but FA revealed no fluorescence filling in the optic disc in both the eyes. At this time, cyclosporine plasmatic level was 100.9 ng/mL. Optic neuropathy associated with tacrolimus has been reported in three literatures (2– 4). Two cases were bilateral (2, 4) and the other case was not clear in bilaterality, because the left eye was already blind secondary to retinopathy (3). There was an improvement in the visual acuity after discontinuing tacrolimus in two patients (2, 3). Optic disc edema was demonstrated in one patient (2). In these previous reports, mechanism of the optic neuropathy was unclear and suggested to be ischemia or direct neurotoxic effect and corroboraFIGURE 1. (A) Optic disc photograph at presentation of the right and the left eye shows normal appearance in the right eye and temporal pallor in the left eye. (B) Late-phase fluorescein angiography of the right and the left eye when the visual acuity in the right eye was decreased. There was no fluorescence filling in the optic disc in both eyes.

Nasopharyngeal carcinoma presenting with rapidly progressive severe binocular optic neuropathy and periocular pain in a young man.

A 27-year-old man presented with rapid and severe visual loss in both eyes, together with pain behind the eyes. Visual acuities were light perception in both eyes. Pupillary constriction to light was minimal, and ophthalmoscopy results were normal. For a presumptive diagnosis of retrobulbar optic neuritis, he was treated with intravenous corticosteroids, and vision improved transiently. But vision later worsened to no light perception, and MRI revealed bilateral optic nerve enhancement with dural enhancement and thickening in the anterior skull base, sella, and retroclival areas, findings initially interpreted as inflammatory. Nasopharyngoscopy disclosed a soft tissue lesion filling the apex of the nasopharynx and the posterior portion of the ethmoid sinus with associated sinusitis. Biopsy demonstrated a moderately differentiated squamous cell carcinoma believed to have originated in the nasopharynx. This is the first case of bilateral severe optic neuropathy in nasopharyngeal carcinoma invading the skull base. It is reported to emphasize that rapidly progressive severe bilateral optic neuropathy in a young patient with periocular pain need not be caused by inflammation.

The Association Between Menarche and Myopia: Findings From the Korean National Health and Nutrition Examination, 2008–2012

PURPOSE The purpose of this study was to analyze the relationship between age at menarche and myopia in Korean adult females. METHODS A total of 8398 women of at least 19 years of age, who participated in the Korean National Health and Nutrition Examination Survey from 2008 to 2012, underwent a refractive examination using an autorefractor. The association between age at menarche and the severity of myopia was evaluated using a four-level multinomial logistic regression analysis. RESULTS The prevalence of myopia was 61.77% (95% confidence interval [CI], 60.46-63.08), including 40.02% with low, 15.46% with moderate, and 6.29% with high myopia. The mean age at menarche was 14.09 ± 0.03 years. Age at menarche was inversely associated with the severity of myopia. In fully adjusted models, older age at menarche decreased the risk of moderate myopia (odds ratio [OR], 0.93; 95% CI, 0.86-0.99; P = 0.0261), and high myopia (OR, 0.85; 95% CI, 0.77-0.95; P = 0.0012). CONCLUSIONS Later age at menarche is associated with a decreased risk of moderate and high myopia. The effects of female sex hormones on ocular structures and growth spurts may mediate this relationship between age at menarche and myopia.