Seong Woo Kim

Comparison Of Choroidal Thickness Among Patients With Healthy Eyes, Early Age-related Maculopathy, Neovascular Age-related Macular Degeneration, Central Serous Chorioretinopathy, And Polypoidal Choroidal Vasculopathy

Purpose: To compare choroidal thicknesses among eyes with early age-related maculopathy (ARM), neovascular age-related macular degeneration, polypoidal choroidal vasculopathy, and central serous chorioretinopathy. Methods: Patients with age-related maculopathy (37 eyes), neovascular age-related macular degeneration (24 eyes), polypoidal choroidal vasculopathy (12 eyes), and central serous chorioretinopathy (31 eyes) underwent spectral-domain optical coherence tomography evaluations using a choroid scanning protocol. A horizontal linear section comprising 50 averaged scans was obtained of each macula. The choroidal thickness was measured from the outer border of the retinal pigment epithelium to the inner scleral border. Twenty-nine subjects with healthy eyes served as a control group. Analysis of covariance tests were performed to evaluate the effects of various diagnoses on choroidal thickness after removal of variance (covariates = gender, age, and refractive error). Results: Among the different covariates, age was associated with choroidal thickness (fovea: F = 12.067, P = 0.001). After controlling for age differences, the choroid was thicker in polypoidal choroidal vasculopathy (319.92 ± 68.66 μm) and central serous chorioretinopathy (367.81 ± 105.56 μm) patients than in controls (241.97 ± 66.37 μm) and age-related maculopathy patients (186.62 ± 64.02 μm). However, there were no significant differences in mean choroidal thickness between neovascular age-related macular degeneration (226.46 ± 102.87 μm) and any of the other diagnoses. Conclusion: The choroid was thicker in eyes with polypoidal choroidal vasculopathy or central serous chorioretinopathy than in control or age-related maculopathy groups.

Inflammatory and Angiogenic Factors in the Aqueous Humor and the Relationship to Diabetic Retinopathy

Purpose: To determine the relationship between the aqueous concentrations of inflammatory and angiogenic factors and the severity of diabetic retinopathy and diabetic macular edema. Methods: Aqueous samples were obtained from 50 eyes of diabetic patients and 28 eyes of nondiabetic subjects. The aqueous levels of inflammatory factors, including IL-1β, TNF-α, MCP-1, IP-10, IL-8, IL-6, and VEGF were measured with multiplex bead array assays. The aqueous levels of cytokines were investigated according to the severity of diabetic retinopathy and diabetic macular edema measured by optical coherence tomography. Results: The aqueous levels of MCP-1, IP-10, IL-8, and VEGF were higher in eyes of diabetic patients than in eyes of nondiabetic subjects. The aqueous levels of MCP-1 and IP-10 were elevated in eyes with severe NPDR and PDR compared to eyes with less severe DR and eyes of nondiabetic subjects. There was a trend toward elevated IL-8 levels in eyes with severe NPDR compared to eyes of nondiabetic subjects. The aqueous levels of VEGF were markedly elevated in eyes with PDR that had not received PRP compared to eyes with severe NPDR. Eyes with PDR that had received PRP treatment showed higher MCP-1 and IP-10 levels than eyes with PDR that had not received PRP treatment. The aqueous levels of IL-6 were positively correlated with TMV and CSMT in eyes with DR. Conclusions: Elevation of MCP-1, IP-10, and IL-8 levels in eyes with severe NPDR suggests that inflammatory change precedes the development of neovascularization in PDR. The positive correlation between the aqueous levels of IL-6 and macular thickness indicates that IL-6 may play a central role in the development of diabetic macular edema.

Retinal vessel diameter, retinal nerve fiber layer thickness, and intraocular pressure in Korean patients with normal-tension glaucoma

PURPOSE To investigate the retinal vessel diameter and evaluate the relationship of the retinal nerve fiber layer (RNFL) thickness with retinal vessel diameter and intraocular pressure (IOP) in patients with normal-tension glaucoma (NTG). DESIGN A prospective, cross-sectional study. METHODS This study included 60 previously untreated patients with NTG (60 eyes) and 45 age- and sex-matched healthy controls (45 eyes) that had no history of systemic vascular disease at a single institution. The diameters of the central retinal arteries and veins were measured on retinal photographs. The central retinal arteriolar equivalent (CRAE) and central retinal venular equivalent (CRVE) were calculated using the revised Parr-Hubbard formula. The RNFL thickness was measured using Stratus optical coherence tomography. RESULTS The mean central retinal arteriolar (P = .000) and venular (P = .000) diameters were significantly smaller in the eyes with NTG than in the normal eyes. Multivariate linear regression analysis demonstrated a significant positive correlation between the RNFL thickness and CRAE (P = .014), and a negative correlation between the RNFL thickness and IOP (P = .005) in the eyes with NTG. However, there was no significant correlation between the RNFL thickness and the independent variables in the control group (P = .112). CONCLUSION The patients with NTG had smaller diameters of the central retinal vessels than the normal subjects. Both IOP and CRAE were significantly associated with RNFL thickness in the patients with NTG. Our results suggest that narrower retinal vessels and higher IOP may be related to the thinning of the RNFL in patients with NTG.

Retinal Pigment Epithelial Tear After Half Fluence PDT for Serous Pigment Epithelial Detachment in Central Serous Chorioretinopathy

Retinal pigment epithelial tears may occur after photodynamic therapy (PDT) in various diseases. The authors report a case of a retinal pigment epithelial tear after half light intensity (300 mW/cm2) PDT in a large serous pigment epithelial detachment associated with chronic atypical central serous chorioretinopathy. A 52-year-old woman with a large serous pigment epithelial detachment associated with chronic atypical central serous chorioretinopathy in the left eye received her first PDT treatment using verteporfin with a spot size of 6,640 microm, a duration of 83 seconds, and half (300 mW/cm2) of the standard 600 mW/cm2 light intensity, where the delivered PDT light dose was only 25 J/cm2. Two weeks later, visual acuity improved to 20/30. However, a large crescent-shaped retinal pigment epithelial tear was found during fundus examination. Even 50% reduced light fluence PDT can produce a retinal pigment epithelial tear in pigment epithelial detachment associated with chronic atypical central serous chorioretinopathy.

Complete Regression of Choroidal Metastasis Secondary to Non-Small-Cell Lung Cancer with Intravitreal Bevacizumab and Oral Erlotinib Combination Therapy

Purpose: To report a case of a complete regression of choroidal metastasis secondary to non-small-cell lung cancer (NSCLC). Methods: Retrospective case review of a female patient treated with intravitreal bevacizumab and oral erlotinib combination therapy for choroidal metastases secondary to NSCLC. Best corrected visual acuity (BCVA), fluorescein angiography (FA), optical coherence tomography (OCT), and B-scan ultrasonography were compared during the 4-month treatment period. Results: Four weeks after the third injection of bevacizumab (2.5 mg), the BCVA had improved to 20/40 from 20/200 and the 2 subretinal masses had completely disappeared. FA demonstrated only a retinal pigment epithelial (RPE) window defect with minimal to no leakage. In the B-scan ultrasonography and OCT, no further mass-like lesion was detected. The retina and RPE layer were flattened. Conclusion: Combining intravitreal bevacizumab and oral erlotinib could be another treatment option for patients with choroidal metastasis of NSCLC.

Polyamine-depletion induces p27Kip1 and enhances dexamethasone-induced G1 arrest and apoptosis in human T lymphoblastic leukemia cells

Glucocorticoid-induced apoptosis is preceded by G1 arrest and supposed to be up-regulated by polyamine-depletion, which also induces G1, arrest. In CEM leukemia cells, dexamethasone showed an antileukemic effect by inducing G1 arrest and apoptosis. DFMO, which depleted cellular polyamines by inhibiting ornithine decarboxylase, induced G1 arrest but without apoptosis, though it enhanced dexamethasone-induced G1 arrest and apoptosis. The G1 arrest was associated with hypophosphorylation of pRb. Dexamethasone inhibited the increase of mutated p53 expression but had little effect on p2Wafl/Cip1 expression. The p27Kip1, level was increased by dexamethasone or and DFMO in line with the kinetics of G1 arrest. Therefore, the up-regulation of dexamethasone-induced apoptosis by polyamine-depletion may be associated with additive down-regulation of G1 progression via the p27Kip1-pRb pathtway.

Correlations among various functional and morphological tests in resolved central serous chorioretinopathy.

Aims To find the explanatory parameters for best corrected visual acuity (BCVA) and microperimetry (MP) in resolved central serous chorioretinopathy. Methods Thirty-three eyes from 33 patients were analysed retrospectively. BCVA and MP were correlated with parameters from various functional and morphological tests. The mean MP sensitivities at fovea 2° and 4°, retinal thickness and degree of defect at the photoreceptor inner and outer segment junction (IS/OS) of the spectral domain-optical coherent tomography image, normalised coefficient of variation of grey scale at the fovea in the short wavelength and near infrared fundus autofluorescence image, P1 amplitude and latency, and N1 amplitude and latency of multifocal electroretinography at ring 1 (R1) were measured. Spearman correlations and multiple linear regression analysis were used for analysis of correlation between functional and morphological characteristics. Results The mean BCVA was 0.19±0.23 (logarithm of the minimum angle of resolution (logMAR)). The mean MP at 2° was 12.79±4.47 dB. BCVA correlated with MP at 2° (ρ=−0.491, p=0.004) and had a significant association with the IS/OS defect and centre point thickness (CPT) (BCVA=0.413+0.314×IS/OS defect–0.002×CPT; p<0.001, R=0.739, R2=0.546). Retinal sensitivity measured by MP at the fovea (2°) had a significant association with the IS/OS defect and N1 latency at R1 (MP at 2°=19.350–9.116×IS/OS defect –0.324×N1 latency at R1; p<0.001, R=0.804, R2=0.647). Conclusions The visual function of eyes with resolved central serous chorioretinopathy was suboptimal and was better explained when various parameters showing retinal status were combined and interpreted together.

Systemic Factors Associated with Central Serous Chorioretinopathy in Koreans

Purpose To investigate systemic factors associated with central serous chorioretinopathy (CSC). Methods We retrospectively reviewed the medical records of 113 Korean patients who were diagnosed with CSC and who underwent history taking with a specialized questionnaire for CSC. They were matched for age and gender at a ratio of 1 : 3 to 339 normal controls. Normal controls were consecutively selected from a database at the Health Promotion Center. General characteristics and medical histories were compared between the two groups. The statistical analyses used included independent t-test, Mann-Whitney test, Fishers exact test, and multivariate logistic regression analysis. Results There were 90 men and 23 women in the CSC group, and the male-female ratio for both groups was 3.9 : 1. The mean age of the patients was 45.6 years. In multivariate analysis, hypertension (odds ratio [OR], 2.327; 95% confidence interval [CI], 1.349-4.013), use of medicinal plants (OR, 2.198; 95% CI, 1.193-4.049), sleep disturbances (OR, 1.732; 95% CI, 1.096-2.739), and snoring (OR, 1.727; 95% CI, 1.058-2.820) were strongly associated with CSC. Conclusions Hypertension, sleep disturbance, snoring, and medicinal plant use were identified as factors associated with CSC. Expanded history taking, including systemic factors and culture-specific behavior related to stress or fatigue such as use of medicinal plants, will be helpful in identifying Korean patients at an increased risk for CSC.

Near-infrared and short-wavelength autofluorescence in resolved central serous chorioretinopathy: association with outer retinal layer abnormalities.

PURPOSE To evaluate the correlation between changes in fundus autofluorescence (AF) measured using 2 different sources (near-infrared fundus autofluorescence from melanin and short-wavelength fundus autofluorescence from lipofuscin) with changes in spectral-domain optical coherence tomography (SD OCT) and fluorescein angiography in resolved central serous chorioretinopathy (CSC). DESIGN Retrospective, observational case study. METHODS A total of 91 eyes from 86 patients with a history of resolved CSC and abnormal AF imaging findings were included. In addition to AF, patients were assessed by means of SD OCT and fluorescein angiography. Outer retinal layer alterations in OCT images and abnormalities in fluorescein angiography were analyzed and correlated with the corresponding AF data. RESULTS All eyes with abnormal near-infrared AF showed a hyperfluorescent angiography window defect in the corresponding area. There was a significant association between the OCT and short-wavelength AF findings. An abnormal short-wavelength AF signal was significantly associated with loss of the ellipsoid portion of the inner segments (EPIS, previously known as the junction between the inner and outer segments of the photoreceptors) on SD OCT (χ(2) test; P < .0001). Near-infrared AF could not predict the status of EPIS without the short-wavelength AF image. CONCLUSIONS Outer retinal layer changes in OCT images can be predicted by analyzing both short-wavelength AF and near-infrared AF images. Abnormal changes in the short-wavelength AF image were predictive of EPIS damage.

Simplified method to measure the peripapillary choroidal thickness using three-dimensional optical coherence tomography.

Purpose To evaluate a simplified method to measure peripapillary choroidal thickness using commercially available, three-dimensional optical coherence tomography (3D-OCT). Methods 3D-OCT images of normal eyes were consecutively obtained from the 3D-OCT database of Korea University Medical Center On the peripapillary images for retinal nerve fiber layer (RNFL) analysis, choroidal thickness was measured by adjusting the segmentation line for the retinal pigment epithelium to the chorioscleral junction using the modification tool built into the 3D-OCT image viewer program. Variations of choroidal thickness at 12 sectors of the peripapillary area were evaluated. Results We were able to measure the peripapillary choroidal thickness in 40 eyes of our 40 participants, who had a mean age of 41.2 years (range, 15 to 84 years). Choroidal thickness measurements had strong inter-observer correlation at each sector (r = 0.901 to 0.991, p < 0.001). The mean choroidal thickness was 191 ± 62 µm. Choroidal thickness was greatest at the temporal quadrant (mean ± SD, 210 ± 78 µm), followed by the superior (202 ± 66 µm), nasal (187 ± 64 µm), and inferior quadrants (152 ± 59 µm). Conclusions The measurement of choroidal thickness on peripapillary circle scan images for RNFL analysis using the 3D-OCT viewing program was highly reliable and efficient.