Publications by authors named "Mi Sun Sung"

51 Publications

Posture-induced Changes in Intraocular Pressure After Trabeculectomy in Patients with Primary Open-angle Glaucoma.

J Glaucoma 2021 Jul 9. Epub 2021 Jul 9.

Department of Ophthalmology, Chonnam National University Medical School and Hospital, Gwangju, Republic of Korea.

Prcis: Trabeculectomy can effectively reduce posture-induced changes in intraocular pressure in patients with primary open-angle glaucoma.

Purpose: To investigate posture-induced changes in intraocular pressure (IOP) after trabeculectomy in patients with medically uncontrolled primary open-angle glaucoma (POAG).

Design: Prospective, consecutive study.

Methods: Thirty-seven eyes of 37 patients with POAG were included. IOP was measured before trabeculectomy and 1 month, 2 months, 3 months, and 6 months postoperatively with patients in the sitting position, supine position, and lateral decubitus position (LDP) sequentially using iCare IC200® rebound tonometry. In the LDP, the eye scheduled for trabeculectomy was in the dependent position, the contralateral unoperated eye was a control eye. The central corneal thickness (CCT), axial length (AL), and anterior chamber depth (ACD) were measured using partial coherence interferometry.

Results: In the sitting, supine, and LDP, the IOP was significantly reduced at every time point during the follow-up. Although the posture-induced changes in IOP persisted during the follow-up, the range of IOP changes in the sitting and supine positions, sitting and LDP, and the supine and LDP were significantly reduced after than before trabeculectomy. The CCT did not change significantly after trabeculectomy.

Conclusions: Trabeculectomy can effectively reduce posture-induced changes in IOP in patients with POAG.
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http://dx.doi.org/10.1097/IJG.0000000000001911DOI Listing
July 2021

Clinical features of advanced glaucoma with optic nerve head prelaminar schisis Prelaminar schisis in advanced glaucoma.

Am J Ophthalmol 2021 Jun 18. Epub 2021 Jun 18.

Department of Ophthalmology and Research Institute of Medical Sciences, Chonnam National University Medical School and Hospital, Gwangju, South Korea. Electronic address:

Purpose: To investigate the clinical characteristics of optic nerve head (ONH) prelaminar schisis in eyes with advanced glaucoma.

Design: Cross-sectional study.

Methods: One hundred sixteen eyes with advanced glaucoma (30-2 MD < -12 dB) were included. ONH prelaminar schisis was identified using the spectral-domain optical coherence tomography independently by 2 evaluators and only eyes that reached to consensus for the presence of ONH prelaminar schisis were included. Bruch's membrane opening-minimum rim width (BMO-MRW), thickness and depth of lamina cribrosa (LC), peripapillary retinal nerve fiber layer (RNFL) thickness, macular thickness (total, RNFL, ganglion cell layer, inner plexiform layer), and peripapillary and subfoveal choroidal thickness were additionally obtained. Clinical characteristics were compared between the two groups based on the presence of ONH prelaminar schisis.

Results: ONH prelaminar schisis was identified in 48 of 116 eyes. Multivariate logistic regression analysis revealed that short axial length, thin and deep LC, and thick macula were associated with the presence of ONH prelaminar schisis. When the structure-function relationships were determined, macular structural parameters tended to have a better relationship with functional parameters than the BMO-MRW and peripapillary RNFL thickness parameters in eyes with ONH prelaminar schisis.

Conclusions: The ONH prelaminar schisis was associated with thin and deep LC, short axial length, and generally thick macula. In patients with this features, the macular measurements rather than peripapillary or ONH measurements, better predict the functional status of the eye. Our findings may have significant clinical implications for management of advanced glaucoma eyes with and without ONH prelaminar schisis.
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http://dx.doi.org/10.1016/j.ajo.2021.06.007DOI Listing
June 2021

Clinical Evaluation of Unilateral Open-Angle Glaucoma: A Two-Year Follow-Up Study.

Chonnam Med J 2021 May 24;57(2):144-151. Epub 2021 May 24.

Department of Ophthalmology, Chonnam National University Hospital, Gwangju, Korea.

To evaluate the clinical characteristics of unilateral open-angle glaucoma, patients diagnosed with unilateral open-angle glaucoma from January 2017 to October 2018 were divided into primary open-angle glaucoma and normal-tension glaucoma groups according to the type of glaucoma diagnosed. The glaucoma and the contralateral eyes were compared, and the contralateral eye was analyzed for conversion to glaucoma and its risk factors were assessed during the 2-year follow-up period. Among 99 patients, 36 were diagnosed with primary open-angle glaucoma and 63 with normal-tension glaucoma. When comparing the glaucoma eye with the contralateral eye, the visual field mean deviation value (all p<0.001), peripapillary retinal nerve fiber layer thickness (all p<0.001), macular ganglion cell layer-inner plexiform layer thickness (p<0.001, p=0.003), and optic nerve cup-disc ratio (p=0.005, p<0.001) were significantly different in both the primary open-angle glaucoma and normal-tension glaucoma groups. In normal-tension glaucoma, peripapillary retinal nerve fiber layer thickness was significantly thinner in the glaucoma conversion group than in the glaucoma non-conversion group (p=0.008). It was significantly associated with glaucoma conversion (odds ratio=0.97, p=0.023). In conclusion, in patients with unilateral open-angle glaucoma, the contralateral eye may develop glaucoma. In particular, if the peripapillary retinal nerve fiber layer thickness is decreased in normal-tension glaucoma, the possibility of glaucoma conversion is high; hence, careful examination is required.
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http://dx.doi.org/10.4068/cmj.2021.57.2.144DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8167448PMC
May 2021

Long-term outcomes of prediction error after combined phacoemulsification and trabeculectomy in glaucoma patients.

BMC Ophthalmol 2021 Jan 26;21(1):60. Epub 2021 Jan 26.

Department of Ophthalmology, Chonnam National University Medical School and Hospital, 42 Jebong-ro, Dong-gu, Gwangju, 61469, South Korea.

Background: To investigate long-term outcomes of prediction error after phacotrabeculectomy and to determine risk factors that may cause unstable prediction error after phacotrabeculectomy in glaucoma patients.

Methods: A total 120 eyes of 120 patients who had underwent uncomplicated phacotrabeculectomy (combined group) or phacoemulsification (phaco-only group) were included. Best-corrected visual acuity (BCVA), intraocular pressure (IOP) were measured before and after surgery, and anterior segment parameters including anterior chamber depth (ACD), lens vault (LV), and anterior vault (AV) measured using anterior-segment optical coherence tomography were compared between the two groups. The mean absolute error (MAE) at 3, 6, 12, and 24 months postoperatively were compared. Risk factors associated with unstable prediction error (MAE ≥ 0.5) were investigated in the combined group.

Results: In both groups, BCVA was improved and IOP was decreased significantly. MAE at 3, 6, 12, 24 months postoperatively were not significantly different between two groups. The risk factors for unstable prediction error after 12 months of phacotrabeculectomy were old age and LV. Whereas, the only factor predicting unstable prediction error after 24 months of phacotrabeculectomy was LV. The cut-off value of LV for predicting unstable refractive error analyzed by the ROC curve was 0.855 mm.

Conclusions: Phacotrabeculectomy may be an effective treatment with stable long-term outcomes of prediction error similar to phacoemulsification in patients with glaucoma. However, elderly patients or patients with large LV may be predisposed to unstable prediction error after phacotrabeculectomy.
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http://dx.doi.org/10.1186/s12886-021-01824-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7839202PMC
January 2021

Neurotrophic Keratopathy after Micropulse Transscleral Cyclophotocoagulation in a Glaucoma Patient.

Korean J Ophthalmol 2021 02 11;35(1):97-98. Epub 2020 Dec 11.

Department of Ophthalmology, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea.

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http://dx.doi.org/10.3341/kjo.2020.0103DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7904407PMC
February 2021

Intravitreal Injection of Liposomes Loaded with a Histone Deacetylase Inhibitor Promotes Retinal Ganglion Cell Survival in a Mouse Model of Optic Nerve Crush.

Int J Mol Sci 2020 Dec 6;21(23). Epub 2020 Dec 6.

Department of Ophthalmology, Chonnam National University Medical School and Hospital, Gwangju 61469, Korea.

Various neuroprotective agents have been studied for the treatment of retinal ganglion cell (RGC) diseases, but issues concerning the side effects of systemically administered drugs and the short retention time of intravitreally injected drugs limit their clinical applications. The current study aimed to evaluate the neuroprotective effects of intravitreally injected trichostatin A (TSA)-loaded liposomes in a mouse model of optic nerve crush (ONC) and determine whether TSA-loaded liposomes have therapeutic potential in RGC diseases. The histone deacetylase inhibitor, TSA, was incorporated into polyethylene glycolylated liposomes. C57BL/6J mice were treated with an intravitreal injection of TSA-loaded liposomes and liposomes loaded with a lipophilic fluorescent dye for tracking, immediately after ONC injury. The expression of macroglial and microglial cell markers (glial fibrillary acidic protein and ionized calcium binding adaptor molecule-1), RGC survival, and apoptosis were assessed. We found that the liposomes reached the inner retina. Their fluorescence was detected for up to 10 days after the intravitreal injection, with peak intensity at 3 days postinjection. Intravitreally administered TSA-loaded liposomes significantly decreased reactive gliosis and RGC apoptosis and increased RGC survival in a mouse model of ONC. Our results suggest that TSA-loaded liposomes may help in the treatment of various RGC diseases.
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http://dx.doi.org/10.3390/ijms21239297DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7730870PMC
December 2020

Anterior scleral thickness in myopic eyes and its association with ocular parameters.

Ophthalmic Res 2020 Oct 20. Epub 2020 Oct 20.

Purpose: This study was designed to determine whether the anterior scleral thickness is affected by axial elongation and to investigate the association between anterior scleral thickness and various ocular parameters in myopic eyes.

Methods: This cross-sectional study included 79 healthy myopic participants. Anterior scleral thickness was measured in eight meridians (superior-nasal [SN], superior [S], superior-temporal [ST], temporal [T], inferior-temporal [IT], inferior [I], inferior-nasal [IN], and nasal [N]) using anterior segment optical coherence tomography. Bruch's membrane opening (BMO) area, width of β-parapapillary atrophy with and without Bruch's membrane (PPA+BM and PPA-BM), and the global peripapillary and subfoveal choroidal thickness (CT) were additionally measured. Age- and sex-adjusted partial correlation analysis and linear regression analysis were performed to examine the effects of axial length and various ocular parameters on anterior scleral thickness in myopic eyes.

Results: The mean age of the included participants was 27.03 ± 2.70 years. Overall, the anterior scleral thickness varied topographically according to the meridians and distance from the scleral spur. In the partial correlation analysis controlled for the effect of age and sex, increasing axial length was related to anterior scleral thinning at several measurement points along the T, I, and N meridians. Among the several ocular parameters, multivariate linear regression analysis with age, sex, and axial length as covariates revealed that central corneal thickness, intraocular pressure, and BMO area were significantly associated with anterior scleral thickness.

Conclusion: In conclusion, there was a close relationship between the anterior scleral thickness and several ocular parameters in myopic eyes. These features should be taken into consideration when managing myopia, and our results might have important implications for understanding the pathogenesis of scleral changes during axial elongation.
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http://dx.doi.org/10.1159/000512396DOI Listing
October 2020

The protective effect of 3% diquafosol on meibomian gland morphology in glaucoma patients treated with prostaglandin analogs: a 12-month follow-up study.

BMC Ophthalmol 2020 Jul 10;20(1):277. Epub 2020 Jul 10.

Department of Ophthalmology and Research Institute of Medical Sciences, Chonnam National University Medical School and Hospital, 42 Jebong-ro, Dong-Gu, Gwangju, 61469, South Korea.

Background: To determine if 3% diquafosol (DQS) can preserve the meibomian gland morphology in glaucoma patients treated with prostaglandin analogs (PGA) for a 12-month follow-up period.

Methods: This study included 84 eyes of 46 normal tension glaucoma (NTG) patients who were treated with either preservative-containing PGA (PC-PGA; 16 patients, 28 eyes), preservative-free PGA (PF-PGA; 21 patients, 39 eyes), or a combination of PC-PGA and 3% DQS (PC-PGA + DQS; 9 patients, 17 eyes). The meibography of the upper eyelid was acquired using Keratograph® 5 M at baseline and at each follow-up (1, 3, 6, 9, and 12 months). Meibomian gland loss (MGL) was quantitatively analyzed by using ImageJ software.

Results: In the PC-PGA group, MGL increased significantly from baseline to month 9 and month 12, whereas no significant changes were observed in the PF-PGA and PC-PGA + DQS groups during the entire 12 months. All groups showed similar MGL at each follow-up time from baseline to six months. However, MGL in the PC-PGA group was significantly higher than those in the PF-PGA and PC-PGA + DQS groups at the 9 and 12 months.

Conclusions: Combining 3% DQS with PC-PGA was as effective as PF-PGA in preserving the meibomian gland morphology for at least 12 months. Our results suggest that 3% DQS may be a promising strategy for managing glaucoma patients with a high risk of developing meibomian gland dysfunction due to preservative-containing topical medications.
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http://dx.doi.org/10.1186/s12886-020-01550-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7350718PMC
July 2020

Parapapillary atrophy and changes in the optic nerve head and posterior pole in high myopia.

Sci Rep 2020 03 12;10(1):4607. Epub 2020 Mar 12.

Department of Ophthalmology and Research Institute of Medical Sciences, Chonnam National University Medical School and Hospital, Gwangju, South Korea.

We investigated the relationship between microstructure of β-parapapillary atrophy (β-PPA) and morphologic features of optic nerve head (ONH) and posterior pole in highly myopic eyes. Eighty-nine highly myopic eyes were included in this study. Bruch's membrane opening (BMO) area, lamina cribrosa (LC) thickness, anterior laminar depth, peripapillary and subfoveal choroidal thickness (CT), macular Bruch's membrane (BM) length, and width of β-PPA with and without Bruch's membrane (PPA and PPA) were evaluated. The mean age and axial length of the included subjects were 26.88 ± 2.44 years and 27.03 ± 0.88 mm, respectively. The width of PPA was larger with increasing BMO area (P = 0.001), whereas the BMO area was not associated with the width of PPA. The large PPA was significantly related to a thinner LC (P = 0.003), deeper anterior lamina surface (P < 0.001), longer macular BM length (P = 0.008), and thinner temporal peripapillary CT (P = 0.034). We found that the morphologic features of the ONH and posterior pole in highly myopic eyes were different based on the microstructure of β-PPA. Whether these features are linked to the development of glaucoma in myopic eyes should be investigated in future studies.
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http://dx.doi.org/10.1038/s41598-020-61485-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7067880PMC
March 2020

Association of macular thickness with parapapillary atrophy in myopic eyes.

BMC Ophthalmol 2020 Mar 6;20(1):93. Epub 2020 Mar 6.

Department of Ophthalmology and Research Institute of Medical Sciences, Chonnam National University Medical School and Hospital, 42 Jebong-ro, Dong-gu, Gwangju, 61469, South Korea.

Background: To investigate whether macular structure could be affected by axial elongation and to determine the association between macular intraretinal thickness and the microstructure of β-zone parapapillary atrophy (PPA) in myopic eyes.

Methods: The study recruited 113 healthy myopic subjects (113 eyes). Images of the macula, subfoveal choroid, and optic nerve head were acquired using spectral-domain optical coherence tomography (SD-OCT). An automatic segmentation algorithm was used to segment the macular images into 7 intraretinal layers. PPA widths with and without Bruch's membrane (PPA and PPA, respectively) were evaluated. Linear regression analysis was performed to evaluate the association between macular intraretinal thickness and axial length and the microstructure of PPA.

Results: An increase in axial length was associated with a decrease in whole macular thickness of the peripheral region and an increase in whole macular thickness of the central region. Thickness alterations of the macular intraretinal layers were most apparent in the peripheral region. A significant correlation was found between PPA width and macular intraretinal layer thickness, whereas no significant correlation was found between PPA width and macular intraretinal layer thickness. Moreover, both PPA and PPA widths significantly correlated with subfoveal choroidal thickness.

Conclusions: Macular intraretinal layer thickness may be affected by PPA width. These findings indicate that the microstructure of PPA should be considered when evaluating the macula in patient with myopia and glaucoma.
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http://dx.doi.org/10.1186/s12886-020-01362-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7060613PMC
March 2020

Bruch's membrane opening enlargement and its implication on the myopic optic nerve head.

Sci Rep 2019 12 20;9(1):19564. Epub 2019 Dec 20.

Department of Ophthalmology and Research Institute of Medical Sciences, Chonnam National University Medical School and Hospital, Gwangju, South Korea.

We examined the association between Bruch's membrane opening (BMO) area and various ocular parameters and investigated the implication of BMO enlargement on the myopic optic nerve head. One hundred eighty-five myopic eyes were included in this cross-sectional study. Among the included eyes, 53 having axial lengths between 26 and 27 mm were further analyzed to investigate the association between BMO area and various ocular parameters. BMO area, BMO-minimum rim width (BMO-MRW), peripapillary choroidal thickness (pCT), width of β-parapapillary atrophy with and without Bruch's membrane (PPA and PPA), and presence of lamina cribrosa (LC) defect were evaluated. We found that BMO area tended to increase with increasing axial length, but varied among the highly myopic eyes even though they had similar degrees of myopia. In the subgroup analysis of eyes with axial lengths between 26 and 27 mm, BMO area was highly variable and it significantly correlated with PPA width and temporal-inferior, nasal-inferior, and nasal BMO-MRW and pCT. LC defects were more common in myopic eyes with enlarged BMO. A multivariate regression model revealed that higher intraocular pressure, enlarged BMO, and thinner BMO-MRW were associated with LC defects in highly myopic eyes. These findings should be considered when evaluating myopic eyes.
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http://dx.doi.org/10.1038/s41598-019-55926-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6925273PMC
December 2019

Neuroprotective Effect of Brazilian Green Propolis on Retinal Ganglion Cells in Ischemic Mouse Retina.

Curr Eye Res 2020 08 27;45(8):955-964. Epub 2019 Dec 27.

Department of Ophthalmology and Research Institute of Medical Sciences, Chonnam National University Medical School and Hospital , Gwangju, South Korea.

Purpose: The current study was undertaken to investigate whether Brazilian green propolis (BGP) can increase the viability of retinal ganglion cells (RGCs) in ischemic mouse retina, and examined the possible mechanisms underlying this neuroprotection.

Materials And Methods: C57BL/6J mice were subjected to constant elevation of intraocular pressure for 60 min to establish retinal ischemia-reperfusion injury. Mice then received saline or BGP (200 mg/kg) intraperitoneally once daily until sacrifice. The expression of hypoxia-inducing factor (HIF)-1α and glial fibrillary acidic protein (GFAP) and the level of histone acetylation were assessed at 1, 3, and 7 days after injury. The expression of Bax, Bcl-2, p53, NF-κB, Nrf2, and HO-1 were also analyzed at 3 days after injury. The neuroprotective effect of BGP treatment on RGC survival was evaluated using Brn3a immunohistochemical staining.

Results: The expression of HIF-1α and GFAP was increased and the level of histone acetylation decreased in saline-treated ischemic retinas within 7 days. BGP treatment effectively attenuated the elevated expression of HIF-1α, GFAP, Bax, NF-κB and p53. The expression of Bcl-2, Nrf2, HO-1 and the level of histone acetylation increased by BGP treatment, resulting in a significant difference between BGP-treated and saline-treated retinas. Immunohistochemical staining for Brn3a also revealed that BGP treatment protected against RGC loss in ischemic retina.

Conclusions: Our results suggest that BGP has a neuroprotective effect on RGCs through the upregulation of histone acetylation, downregulation of apoptotic stimuli, and suppression of NF-κB mediated inflammatory pathway in ischemic retina. These findings suggest that BGP is a potential neuroprotective agent against RGC loss under oxidative stress.
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http://dx.doi.org/10.1080/02713683.2019.1705493DOI Listing
August 2020

HDAC2 Regulates Glial Cell Activation in Ischemic Mouse Retina.

Int J Mol Sci 2019 Oct 17;20(20). Epub 2019 Oct 17.

Department of Ophthalmology, Chonnam National University Medical School and Hospital, Gwangju 61469, Korea.

The current study was undertaken to investigate whether histone deacetylases (HDACs) can modulate the viability of retinal ganglion cells (RGCs) and the activity of glial cells in a mouse model of retinal ischemia-reperfusion (IR) injury. C57BL/6J mice were subjected to constant elevation of intraocular pressure for 60 min to induce retinal IR injury. Expression of macroglial and microglial cell markers (GFAP and Iba1), hypoxia inducing factor (HIF)-1α, and histone acetylation was analyzed after IR injury. To investigate the role of HDACs in the activation of glial cells, overexpression of HDAC1 and HDAC2 isoforms was performed. To determine the effect of HDAC inhibition on RGC survival, trichostatin-A (TSA, 2.5 mg/kg) was injected intraperitoneally. After IR injury, retinal GFAP, Iba1, and HIF-1α were upregulated. Conversely, retinal histone acetylation was downregulated. Notably, adenoviral-induced overexpression of HDAC2 enhanced glial activation following IR injury, whereas overexpression of HDAC1 did not significantly affect glial activation. TSA treatment significantly increased RGC survival after IR injury. Our results suggest that increased activity of HDAC2 is closely related to glial activation in a mouse model of retinal IR injury and inhibition of HDACs by TSA showed neuroprotective potential in retinas with IR injuries.
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http://dx.doi.org/10.3390/ijms20205159DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6829428PMC
October 2019

Effects of Preservative on the Meibomian Gland in Glaucoma Patients Treated with Prostaglandin Analogues.

Chonnam Med J 2019 Sep 24;55(3):156-162. Epub 2019 Sep 24.

Department of Ophthalmology, Chonnam National University Hospital, Gwangju, Korea.

This study compared the effect of preservative-containing (PC) and preservative-free (PF) prostaglandin analogue (PGA) formulations on the ocular surface, especially on the meibomian gland (MG) in patients with open-angle glaucoma (OAG). This is a retrospective study of treatment-naïve patients with OAG (n=80) and healthy controls (n=40). OAG patients were randomized into groups using either PC-PGA or PF-PGA for 12 months. All participants underwent ocular surface and MG examinations including their meibum score, meiboscore, and lid margin abnormality score (LAS). Eighty OAG patients were randomized into two groups (n=42 in PC, n=38 in PF). All PGA and control groups showed similar ocular surface and MG parameters at the baseline. Both PC- and PF-PGA groups showed increased meibum scores, meiboscores, and LASs at 12 months compared to the baseline (all p<0.05). At the 12-months visit, PC-PGA group showed severe OSDI, shorter TBUT, greater OSS, and worse MG parameters than those of the other two groups (all p<0.05). In addition, PF-PGA group showed worse meiboscores, meibum scores, and severe OSS scores than those of the control group (all p<0.05). Both PC and PF formulations can cause damage to the MG in patients using PGA. However, PC formulations induced more ocular discomfort, poorer ocular surface, and more severe MG loss compared to PF formulations. Therefore, it would be advisable to use PF formulations in patients with a preexisting or concomitant ocular surface disease or MGD.
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http://dx.doi.org/10.4068/cmj.2019.55.3.156DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6769241PMC
September 2019

Trends in the characteristics of acute primary angle closure in Korea over the past 10-years.

PLoS One 2019 9;14(10):e0223527. Epub 2019 Oct 9.

Department of Ophthalmology and Research Institute of Medical Sciences, Chonnam National University Medical School and Hospital, Gwangju, South Korea.

Purpose: To investigate the changes in the demographic, clinical, and biometric characteristics of APAC patients in South Korea during the last decade.

Methods: Medical records of patients with APAC who visit the emergency department or the glaucoma clinic of Chonnam National University Hospital, a tertiary referral center in Gwangju, South Korea in 2007 and 2017 were analyzed. Demographics, clinical characteristics, and treatment modality were compared between the APAC patients in 2007 and 2017.

Results: The number of patients with APAC increased from 54 in 2007 to 68 in 2017. Female patients in their 60s were most common in both groups and there was no significant difference in IOP, cataract grade, gonioscopic grading, PAS, or optic nerve damage between the two groups at baseline visit (all P > 0.05). However, APAC eyes in 2017 had a shallower ACD (1.74 ± 0.28 mm vs 1.87 ± 0.35 mm; P = 0.024) and greater LV (1.05 ± 0.26 mm vs 0.93 ± 0.19 mm; P = 0.001) than those of APAC eyes in 2007. During one year follow-up, 25 patients (51.02%) received LPI only, and 18 patients (36.73%) required LE, and 6 patients (12.24%) required phacotrabeculectomy or sequential LE and trabeculectomy. However, in 2017, LPI alone was sufficient in 23 patients (38.33%), 29 patients (48.33%) required further LE, and 8 patients (13.33%) required phacotrabeculectomy or sequential LE and trabeculectomy for the treatment of APAC (P = 0.015).

Conclusions: Compared to older cases of APAC, recent cases received LE more frequently, which suggests an increasing trend of LE as a treatment option for APAC. In addition, recent cases had a greater LV and shallower ACD than older cases and these biometric differences may be one of the reasons for increasing rate of LE in this study.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0223527PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6785132PMC
March 2020

Structure-function Relationship in Advanced Glaucoma After Reaching the RNFL Floor.

J Glaucoma 2019 11;28(11):1006-1011

Department of Ophthalmology and Research Institute of Medical Sciences, Chonnam National University Medical School and Hospital, Gwangju, South Korea.

PRéCIS:: Although the circumpapillary retinal nerve fiber layer (cpRNFL) reached the measurement floor, the nasal macular region is important for assessing central visual function in advanced glaucoma.

Purpose: To investigate the relationship between the central visual field (VF) and macular parameters obtained from spectral-domain optical coherence tomography (SD-OCT) in patients with advanced glaucoma that reached the cpRNFL thickness measurement floor and to determine whether the structural changes measured by SD-OCT are useful for estimating the functional status in these patients.

Methods: A total of 68 eyes from 68 patients with advanced glaucoma were included. Only eyes having an average cpRNFL thickness of ≤57 μm that reached the measurement floor were included. Macular imaging using Cirrus SD-OCT and 10-2 Humphrey VF was performed. The VF mean deviation was converted to a linear scale using unlogged 1/Lambert values. The relationships between the central VF and various macular parameters were determined.

Results: Patients had a mean VF mean deviation of -20.69 dB and an average cpRNFL thickness of 51.76±3.61 μm. Correlations between the VF and all cpRNFL thickness parameters were not significant. However, significant correlations were found between the central VF and superonasal macular ganglion cell-inner plexiform layer thickness (r=0.334; P=0.003), inner nasal macular thickness (r=0.301; P=0.013), and outer nasal macular thickness (r=0.331; P=0.007).

Conclusions: Even after the cpRNFL had reached the measurement floor, several macular parameters showed a statistically significant relationship with functional status in VF. In particular, the assessment of structural changes in the nasal macular region may be important in determining the central VF in advanced glaucoma.
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http://dx.doi.org/10.1097/IJG.0000000000001374DOI Listing
November 2019

Carnosine decreases retinal ganglion cell death in a mouse model of optic nerve crushing.

Neurosci Lett 2019 10 12;711:134431. Epub 2019 Aug 12.

Department of Ophthalmology, Chonnam National University Medical School & Hospital, 42 Jebong-ro, Dong-gu, Gwangju, 61469, South Korea. Electronic address:

Purpose: The objectives of this study were to investigate whether carnosine can increase retinal ganglion cell (RGC) survival in the mouse retina and to determine the possible association between nuclear factor-kappa B (NF-κB) mediated oxidative stress and neuroprotection of RGCs following optic nerve crushing (ONC).

Methods: C57BL/6 J mice underwent ONC and were treated with carnosine (250 mg/kg) or saline intraperitoneally once daily until sacrifice. Peroxisome proliferator activated receptor (PPAR)-γ and glial fibrillary acidic protein (GFAP) expression were assessed at 1, 3, and 7 days after ONC. The effects of carnosine on the expression of PPAR-γ, GFAP, and NF-κB were assessed. To evaluate the effects of carnosine on mitochondrial biogenesis and function, we compared the expression of PPAR gamma coactivator-1α (PGC-1α) and mitochondrial transcription factor A (mtTFA) in retinas from mice that were treated with carnosine or saline at 3 days after ONC. RGC survival was assessed by labeling flat-mounted retinas with Brn3a at 2 weeks after ONC.

Results: The expression levels of PPAR-γ and GFAP were upregulated in saline-treated retinas for 7 days after ONC, with maximal expression at 3 days, and carnosine treatment effectively attenuated this upregulation. In addition, upregulation of NF-κB, PGC-1α and mtTFA expression was also observed in saline-treated retinas after ONC, and this upregulation was blocked by carnosine treatment, resulting in a significant difference between carnosine-treated and saline-treated retinas after ONC. Immunohistochemical staining for Brn3a also showed that carnosine treatment protected against RGC loss after ONC.

Conclusions: Inhibition of NF-κB expression and oxidative stress by carnosine treatment plays a significant role in the prevention of RGC loss after ONC. The results also highlight the potential of carnosine as a neuroprotective agent against RGC loss in optic neuropathy.
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http://dx.doi.org/10.1016/j.neulet.2019.134431DOI Listing
October 2019

Inner retinal thinning as a biomarker for cognitive impairment in de novo Parkinson's disease.

Sci Rep 2019 08 14;9(1):11832. Epub 2019 Aug 14.

Department of Ophthalmology, Chonnam National University Medical School and Hospital, Gwangju, South Korea.

We investigated the association between retinal changes measured using optical coherence tomography (OCT) and diverse clinical grading scales in patients with Parkinson's disease (PD). Seventy-four eyes of 74 patients with de novo PD and 53 eyes of age-matched control subjects were included. The thickness of the peripapillary retinal nerve fiber layer (pRNFL) and macular ganglion cell-inner plexiform layer (mGCIPL) were measured. We analyzed the correlations between the clinical PD grading scales and OCT parameters, and between the OCT parameters and volumetric data in the cerebral cortical and subcortical structures. The area under the receiver operating characteristic curve (AUC) was calculated for diagnosing cognitive impairment in patients with PD. Statistically significant reductions in the thickness of average, temporal, and inferior pRNFL and overall mGCIPL were observed in patients with PD. The Montreal Cognitive Assessment score was significantly associated with mGCIPL thinning. The AUC of the mGCIPL parameters for diagnosing cognitive impairment in patients with PD ranged from 0.651 to 0.760. Moreover, thinning of the mGCIPL was significantly associated with the volumetric parameters of associated brain structures. Our findings highlight the clinical implications of OCT measurements as a potential biomarker for early detection of cognitive impairment in patients with PD.
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http://dx.doi.org/10.1038/s41598-019-48388-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6694167PMC
August 2019

Factors Influencing Visual Field Recovery after Transsphenoidal Resection of a Pituitary Adenoma.

Korean J Ophthalmol 2018 Dec;32(6):488-496

Department of Ophthalmology and Research Institute of Medical Sciences, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea.

Purpose: This study aimed to analyze the factors influencing visual field recovery after transsphenoidal approach-tumor resection (TSA-TR) in pituitary adenoma patients with visual field defects (VFDs).

Methods: We retrospectively evaluated 102 eyes of 102 patients with VFDs induced by pituitary adenomas who underwent TSA-TR between January 2010 and December 2015. All patients had been observed for more than one year. The severity of the VFD in each patient was evaluated using the mean deviation (MD) and pattern standard deviation in the most-affected eye. Clinical and demographic data such as preoperative visual acuity and visual field, age, sex, tumor volume, neurological symptoms at diagnosis, duration of symptoms, patterns of the preoperative VFD, and preoperative central VFD were investigated and analyzed for association with recovery of the visual field.

Results: Recovery from VFDs occurred in 71 (69.6%) eyes after a mean period of 18.36 ± 5.21 months. The recovery group was younger ( = 0.003), had higher preoperative MD values ( = 0.016), and had better preoperative visual acuity ( = 0.03), compared with the non-recovery group. Preoperative central VFD ( = 0.006) and preoperative bilateral VFD ( = 0.016) were significantly less frequent in the recovery group. Multivariate logistic regression revealed that age at diagnosis (odds ratio [OR], 0.962; = 0.022), preoperative MD (OR, 1.069; = 0.046), preoperative central VFD (OR, 0.212; = 0.039), and preoperative bilateral VFD (OR, 0.212; = 0.035) were associated with visual field recovery after TSA-TR.

Conclusions: Younger age, higher preoperative MD, and the preoperative abscence of central VFD or bilateral VFD were favorable factors influencing visual field recovery after TSA-TR in patients with pituitary adenomas. An understanding of the associated clinical factors may help predict visual outcomes after TSA-TR in pituitary adenoma patients with VFDs.
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http://dx.doi.org/10.3341/kjo.2017.0094DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6288018PMC
December 2018

Assessment of superficial retinal microvascular density in healthy myopia.

Int Ophthalmol 2019 Aug 3;39(8):1861-1870. Epub 2018 Sep 3.

Department of Ophthalmology and Research Institute of Medical Sciences, Chonnam National University Medical School and Hospital, 42 Jebong-ro, Dong-gu, Gwangju, 61469, South Korea.

Purpose: To evaluate retinal microvasculature in healthy myopia and investigate the correlation between microvascular density and ocular factors.

Methods: A total of 174 eyes from 174 healthy Korean subjects were included. The eyes were divided into four groups according to refraction: emmetropia [21 eyes, - 1.00 D ≤ mean spherical equivalent (MSE) < + 0.75 D], mild myopia (32 eyes, - 3.00 D ≤ MSE < - 1.00 D), moderate myopia (76 eyes, - 6.00 D ≤ MSE < - 3.00 D), and high myopia (45 eyes, MSE < - 6.00 D). Images of retinal vasculature in parapapillary and parafoveal area were obtained using optical coherence tomography angiography. Superficial retinal microvascular density was measured for correlation analysis with ocular parameters.

Results: High myopia was found to have a lower superficial parapapillary microvascular density compared with the other groups in total parapapillary area, and in sectors of nasal and inferonasal (all p ≤ 0.001). The superficial parapapillary microvascular density showed a negative correlation with axial length (AL) and intraocular pressure (IOP) (β = - 0.479, p = 0.008 and β = - 0.160, p = 0.048, respectively), and a positive correlation with parapapillary retinal nerve fiber layer (RNFL) thickness (β = 0.140, p < 0.001). However, there was no significant difference in superficial parafoveal microvascular density among all groups (p > 0.05).

Conclusions: This study reveals that superficial parapapillary microvascular density is lower in high myopia and has correlation with AL, IOP, and parapapillary RNFL thickness. It also indicates that superficial parafoveal microvascular density tends to be unaffected by healthy myopia. These retinal microvascular alterations may facilitate understanding the pathogenesis of glaucomatous optic nerve damage in high myopia.
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http://dx.doi.org/10.1007/s10792-018-1014-zDOI Listing
August 2019

Trichostatin A Ameliorates Conjunctival Fibrosis in a Rat Trabeculectomy Model.

Invest Ophthalmol Vis Sci 2018 06;59(7):3115-3123

Department of Ophthalmology and Research Institute of Medical Sciences, Chonnam National University Medical School and Hospital, Gwangju, South Korea.

Purpose: To investigate whether histone deacetylase (HDAC) activity is associated with postoperative scarring and to evaluate the effect of HDAC inhibition by topical trichostatin A (TSA) on conjunctival fibrosis after trabeculectomy in a rat model.

Methods: Trabeculectomy was performed on the left eye of Sprague-Dawley rats. In the first experiment, adenoviruses HDAC 1, HDAC 2, and green fluorescent protein were added to the subconjunctival space during trabeculectomy. Expression of α-smooth muscle actin (α-SMA) was evaluated. In the second experiment, rats undergoing trabeculectomy were randomized into control, vehicle control, steroid, 500 nmol/L TSA, and 1 μmol/L TSA groups. On postoperative day 14, bleb vascularity, toxic effect of topical TSA on corneal epithelium, expression of α-SMA, transforming growth factor (TGF)-β1, and phosphorylated-Smad2/3 and the infiltration of CD45+ cells were determined. Masson's trichrome staining and immunofluorescence staining for α-SMA and CD45 were also performed.

Results: Overexpression of HDAC1 contributed to accelerated conjunctival fibrosis after trabeculectomy. HDAC inhibition by topical administration of 1 μmol/L TSA significantly decreased bleb vascularity, leukocyte infiltration, and expression of α-SMA and TGF-β1 in the conjunctiva. Its effectiveness on conjunctival fibrosis was comparable to that of topical steroid. Masson's trichrome staining showed decreased collagen deposition in the bleb tissues of steroid and 1 μmol/L TSA treatment groups. Topical TSA did not have any toxic effect on the corneal epithelium.

Conclusions: HDAC activity is involved in postoperative conjunctival fibrosis. HDAC inhibition by topical administration of TSA eye drops is a safe and effective therapeutic modality to modulate wound healing after trabeculectomy.
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http://dx.doi.org/10.1167/iovs.18-23826DOI Listing
June 2018

Microstructure of Parapapillary Atrophy Is Associated With Parapapillary Microvasculature in Myopic Eyes.

Am J Ophthalmol 2018 08 30;192:157-168. Epub 2018 May 30.

Department of Ophthalmology and Research Institute of Medical Sciences, Chonnam National University Medical School and Hospital, Gwangju, South Korea; Center for Creative Biomedical Scientists, Chonnam National University, Gwangju, South Korea. Electronic address:

Purpose: To evaluate the clinical characteristics of beta-parapapillary atrophy (β-PPA) in myopic eyes and determine whether the microstructure of β-PPA is associated with parapapillary microvasculature by using optical coherence tomography (OCT) angiography.

Design: Cross-sectional study.

Methods: This study included 80 subjects with myopia with β-PPA. Spherical equivalent (SE) refractive error, axial length, horizontal tilt angle, and the width of β-PPA were evaluated. The microstructure of β-PPA and subfoveal choroidal thickness were evaluated using enhanced-depth imaging OCT and eyes were classified into 3 groups based on the presence of Bruch membrane (BM): a PPA-only group, a PPA and PPA group, and a PPA-only group. Superficial and deep parapapillary vessel density was measured using OCT angiography. Clinical characteristics were compared among the groups and linear regression analysis was performed to explore the relationship between the parapapillary microvasculature and microstructure of β-PPA.

Results: The mean axial length and SE refractive error of the participants were 26.47 ± 1.17 mm and -6.28 ± 2.71 diopters, respectively. The PPA-only group had a more inferiorly rotated optic disc (P = .025), larger β-PPA (P < .001), and lower superficial and deep parapapillary vessel density (both P < .001) compared with those of the PPA-only group. Multivariate linear regression analysis showed that the average PPA width on horizontal scans was significantly associated with superficial and deep parapapillary vessel density (P = .034 and P = .003, respectively).

Conclusions: Significant differences were observed in the microvasculature according to the microstructure of β-PPA. PPA width was closely correlated with superficial and deep parapapillary vessel density. Longitudinal studies are needed to elucidate the role of β-PPA in the development and progression of glaucoma in myopic eyes.
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http://dx.doi.org/10.1016/j.ajo.2018.05.022DOI Listing
August 2018

Association Between Optic Nerve Head Deformation and Retinal Microvasculature in High Myopia.

Am J Ophthalmol 2018 04 6;188:81-90. Epub 2018 Feb 6.

Department of Ophthalmology and Research Institute of Medical Sciences, Chonnam National University Medical School and Hospital, Gwangju, South Korea; Center for Creative Biomedical Scientists, Chonnam National University, Gwangju, South Korea. Electronic address:

Purpose: To evaluate the retinal microvasculature of peripapillary and macular regions in highly myopic eyes and investigate the association between the vascular parameters and optic nerve head (ONH) deformation.

Design: Cross-sectional study.

Methods: Seventy-one subjects with highly myopic eyes and 26 subjects with emmetropic eyes were included. Horizontal B-scan images of the ONH were obtained using optical coherence tomography (OCT) and horizontal tilt angles were measured. Integrated automated algorithms in the Avanti OCT angiography were used to quantify the peripapillary vessel density and area of the foveal avascular zone (FAZ) at the level of superficial and deep vascular networks. Association between horizontal disc tilt and the vascular parameters was evaluated.

Results: The mean axial length and horizontal tilt angle were 26.73 ± 0.63 mm and 9.77 ± 3.00 degrees in the highly myopic group and 23.46 ± 0.55 mm and 5.95 ± 3.48 degrees in the emmetropic group, respectively. Highly myopic eyes exhibited significantly lower average peripapillary vessel density (P = .010) and larger superficial and deep FAZs (P = .001 and P < .001, respectively) compared with emmetropic eyes. Linear regression analyses showed that horizontal tilt angle significantly correlated the average peripapillary vessel density (P = .037) and the areas of superficial (P < .001) and deep (P < .001) FAZs.

Conclusions: The retinal microvasculature was significantly different in highly myopic eyes according to the degree of horizontal optic disc tilt. In addition to peripapillary vessel density, FAZ can be affected by the degree of optic disc tilt.
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http://dx.doi.org/10.1016/j.ajo.2018.01.033DOI Listing
April 2018

Association between meibomian gland dysfunction and compliance of topical prostaglandin analogs in patients with normal tension glaucoma.

PLoS One 2018 31;13(1):e0191398. Epub 2018 Jan 31.

Department of Ophthalmology, Chonnam National University Medical School and Hospital, Gwangju, South Korea.

Purpose: The aim of this study was to investigate the association between tear film and meibomian gland parameters in patients with normal tension glaucoma (NTG), who underwent topical prostaglandin analog (PGA) monotherapy, and medication compliance.

Methods: Ocular surface disease index (OSDI), Schirmer's test, tear film break-up time (TBUT), keratoepitheliopathy (KEP) score with fluorescein, and meibomian gland parameters were assessed in 45 eyes of 45 patients with NTG (NTG group), who received topical PGA monotherapy for more than 1 year. The results were compared to those of 40 eyes of 40 normal subjects (control group). Medication compliance was assessed by an 8-item Morisky Medication Adherence Scale (MMAS-8). Multiple logistic regression analysis was used to identify the factors associated with medication compliance.

Results: There was a significant difference in OSDI (P = 0.043), Schirmer's test (P < 0.001), TBUT (P < 0.001), KEP score (P = 0.015) and all meibomian gland parameters (all P < 0.001) between two groups. When the NTG group was divided into compliant and non-compliant groups based on the scores of MMAS-8, 30 (75%) patients were classified into the compliant group. Multiple logistic regression analysis revealed that the lid margin score (OR, 0.256; 95% CI, 0.072-0.908, P = 0.035), meibum score (OR, 0.144; 95% CI, 0.023-0.915, P = 0.04), and meibo score (OR, 0.344; 95% CI, 0.140-0.845, P = 0.02) were significant factors associated with compliance in patients with NTG. The meibomian gland parameters showed a negative correlation with medication compliance (all P < 0.005).

Conclusions: Malfunction of the meibomian glands can be an important clinical finding associated with compliance of PGA monotherapy in patients with NTG.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0191398PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5791996PMC
February 2018

Association of Interleukin-1 gene clusters polymorphisms with primary open-angle glaucoma: a meta-analysis.

BMC Ophthalmol 2017 Nov 28;17(1):218. Epub 2017 Nov 28.

Department of Ophthalmology, Chonnam National University Medical School and Hospital, 42 Jebongro, Gwang-ju, 61469, Republic of Korea.

Background: Previous studies have associated the Interleukin-1 (IL-1) gene clusters polymorphisms with the risk of primary open-angle glaucoma (POAG). However, the results were not consistent. Here, we performed a meta-analysis to evaluate the role of IL-1 gene clusters polymorphisms in POAG susceptibility.

Methods: PubMed, EMBASE and Cochrane Library (up to July 15, 2017) were searched by two independent investigators. All case-control studies investigating the association between single-nucleotide polymorphisms (SNPs) of IL-1 gene clusters and POAG risk were included. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated for quantifying the strength of association that has been involved in at least two studies.

Results: Five studies on IL-1β rs16944 (c. -511C > T) (1053 cases and 986 controls), 4 studies on IL-1α rs1800587 (c. -889C > T) (822 cases and 714 controls), and 4 studies on IL-1β rs1143634 (c. +3953C > T) (798 cases and 730 controls) were included. The results suggest that all three SNPs were not associated with POAG risk. Stratification analyses indicated that the rs1143634 has a suggestive associated with high tension glaucoma (HTG) under dominant (P = 0.03), heterozygote (P = 0.04) and allelic models (P = 0.02), however, the weak association was nullified after Bonferroni adjustments for multiple tests.

Conclusions: Based on current meta-analysis, we indicated that there is lack of association between the three SNPs of IL-1 and POAG. However, this conclusion should be interpreted with caution and further well designed studies with large sample-size are required to validate the conclusion as low statistical powers.
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http://dx.doi.org/10.1186/s12886-017-0616-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5704439PMC
November 2017

Clinical features of superficial and deep peripapillary microvascular density in healthy myopic eyes.

PLoS One 2017 26;12(10):e0187160. Epub 2017 Oct 26.

Department of Ophthalmology and Research Institute of Medical Sciences, Chonnam National University Medical School and Hospital, Gwangju, South Korea.

Purpose: To evaluate the clinical features of peripapillary microvasculature in myopic eyes and investigate the association between the superficial and deep peripapillary microvascular density and the myopic optic disc characteristics.

Materials And Methods: This cross-sectional study included one hundred and fifty healthy myopic eyes with β-peripapillary atrophy (β-PPA). Ovality index, degree of optic disc rotation, and the area of β-PPA were measured. Superficial and deep peripapillary microvascular density was measured using optical coherence tomography angiography. Logistic regression analysis was performed to look for the factors associated with peripapillary microvascular reduction.

Results: The mean superficial peripapillary microvascular density was 62.14 ± 5.47%; 33 (22.0%) participants were found to have decreased microvascular density. Increased axial length (p < 0.001) and decreased average peripapillary retinal nerve fiber layer thickness (p = 0.027) were associated with the superficial peripapillary microvascular reduction. The mean deep peripapillary microvascular density was 73.76 ± 4.02%; 26 (17.33%) participants were found to have decreased microvascular density. Larger ovality index (p = 0.028) and more inferiorly rotated optic disc (p = 0.021) were associated with the deep peripapillary microvascular reduction.

Conclusions: Axial elongation was significantly associated with microvascular reduction in the superficial peripapillary retina, whereas it was not associated with deep peripapillary microvascular reduction. The deep peripapillary microvascular density was independently associated with myopic optic disc characteristics such as ovality index and optic disc rotation.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0187160PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5658175PMC
November 2017

Efficacy and Safety of Intracameral Bevacizumab for Treatment of Neovascular Glaucoma.

Korean J Ophthalmol 2017 Dec 20;31(6):538-547. Epub 2017 Oct 20.

Department of Ophthalmology and Research Institute of Medical Sciences, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea.

Purpose: To evaluate the long-term efficacy and safety of intracameral bevacizumab in patients with neovascular glaucoma.

Methods: This retrospective study included 26 eyes of 26 neovascular glaucoma patients who received intracameral bevacizumab injection between January 2013 and May 2015, and were followed-up for at least 1 year. All patients were treated with topical and/or systemic intraocular pressure (IOP)-lowering medications, intracameral bevacizumab, and panretinal photocoagulation (PRP). The main outcome measures were changes in visual acuity, IOP, and neovascularization of the iris (NVI) and the anterior chamber angle (NVA). To assess the safety of intracameral bevacizumab, corneal endothelial changes were also determined using specular microscopy. Patients whose IOP was uncontrolled received IOP-lowering surgery. Clinical factors associated with IOP-lowering surgery were also investigated.

Results: In all patients, intracameral bevacizumab resulted in a rapid and marked reduction of IOP, NVI, and NVA within 1 week. At 12 months after initial injection, 19 of 26 eyes (73%) underwent IOP-lowering surgery. The average interval between initial injection and surgical treatment was 33.6 ± 26.9 days. Baseline IOP (p = 0.018), NVA grade (p = 0.029), and incomplete PRP (p = 0.005) were identified as predictive factors for IOP-lowering surgery. During the follow-up period, there were no statistically significant corneal endothelial changes after intracameral bevacizumab injection.

Conclusions: During 1 year of follow-up after intracameral bevacizumab, the procedure was found to be safe for the corneal endothelium. However, the IOP-lowering effect was transient, and 73% of patients eventually required IOP-lowering surgery. Predictive factors for IOP-lowering surgery were high baseline IOP and NVA grade, and incomplete PRP.
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http://dx.doi.org/10.3341/kjo.2017.0017DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5726989PMC
December 2017

Clinical Features of Ocular Ischemic Syndrome and Risk Factors for Neovascular Glaucoma.

Korean J Ophthalmol 2017 Aug 26;31(4):343-350. Epub 2017 Jun 26.

Department of Ophthalmology and Research Institute of Medical Sciences, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea.

Purpose: We aimed to examine the clinical features and prognosis of ocular ischemic syndrome and to investigate the risk factors for the development of neovascular glaucoma (NVG).

Methods: The medical records from 25 patients (25 eyes) who were diagnosed with ocular ischemic syndrome were retrospectively analyzed. We recorded the length of time between symptom onset and diagnosis, visual acuity, intraocular pressure, clinical findings of the anterior and posterior segments of the eye, fluorescein angiography, systemic diseases, smoking history, and the extent of any ipsilateral carotid artery stenosis. The risk factors for NVG in patients with ocular ischemic syndrome were investigated.

Results: The mean age was 67.9 ± 12.5 years, and 21 men and 4 women were included in this study. At initial examination, the mean logarithm of the minimum angle of resolution (logMAR) was 2.02 ± 1.26, and the mean intraocular pressure was 21.0 ± 10.3 mmHg. Among 25 eyes of the 25 patients, NVG occurred in 17 eyes after a mean period of 12.6 ± 14.0 months. The length of time between symptom onset and diagnosis (p = 0.025) and the extent of ipsilateral carotid artery stenosis (p = 0.032) were identified as significant risk factors for NVG. At the final follow-up, the mean logMAR visual acuity was 3.13 ± 1.24, showing a poor prognosis regardless of whether NVG occurred.

Conclusions: Overall, the prognosis for ocular ischemic syndrome is very poor. The risk of NVG increases with the length of time between symptom onset and diagnosis, as well as with the severity of ipsilateral carotid artery stenosis.
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http://dx.doi.org/10.3341/kjo.2016.0067DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5540990PMC
August 2017

Anterior segment configuration as a predictive factor for refractive outcome after cataract surgery in patients with glaucoma.

BMC Ophthalmol 2016 Oct 18;16(1):179. Epub 2016 Oct 18.

Department of Ophthalmology and Research Institute of Medical Sciences, Chonnam National University Medical School and Hospital, 42 Jebong-ro, Dong-gu, Gwangju, 61469, Republic of Korea.

Background: To compare refractive outcomes after cataract surgery between patients with closed-angle and open-angle glaucoma and evaluate the influence of preoperative factors on refractive outcomes in patients with glaucoma.

Methods: Patients diagnosed with glaucoma and who underwent uncomplicated cataract surgery were enrolled in this retrospective observational study. We collected data including age, history of prior laser peripheral iridotomy and trabeculectomy, type of glaucoma, manifest refraction, intraocular pressure, axial length, and various anterior segment parameters using anterior-segment optical coherence tomography. Factors associated with unsatisfactory refractive outcome at postoperative 6 month were evaluated.

Results: A total of 143 eyes (143 subjects) were included. Of these, 49 and 94 had closed-angle and open-angle glaucoma, respectively. At postoperative-6 month evaluation, the mean absolute error (MAE) predicted by the SRK-II and SRK-T formulae was 0.67 ± 0.61 and 0.81 ± 0.66 diopters (D), respectively. The overall predictability of achieving within ± 1.0 D of target was 76.92 % and 72.73 %, respectively. At a cutoff value of 1.0 D for MAE, there was no statistical significant difference in refractive outcome between the closed-angle and open-angle glaucoma groups. Logistic regression modeling showed that large lens vault (LV) was a significant predictor of unsatisfactory refractive outcome after cataract surgery in patients with glaucoma.

Conclusions: When considering cataract surgery in patients with glaucoma, surgeons should recognize that the refractive outcomes may be unsatisfactory in eyes with large LV.
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http://dx.doi.org/10.1186/s12886-016-0359-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5070221PMC
October 2016

Analysis of Clinical Factors Associated with Retinal Morphological Changes in Patients with Primary Sjögren's Syndrome.

PLoS One 2016 21;11(6):e0157995. Epub 2016 Jun 21.

Department of Ophthalmology, Chonnam National University Medical School and Hospital, Gwangju, Republic of Korea.

Purpose: To investigate clinical factors associated with abnormal retinal morphologies in patients with primary Sjögren's syndrome (pSS).

Methods: One-hundred-thirty patients with pSS who underwent immunoserological tests, minor salivary gland biopsies, and optical coherence tomography examinations were retrospectively analyzed. Risk factors for abnormally reduced peripapillary retinal nerve fiber layer (pRNFL) and macular ganglion cell-inner plexiform layer (mGCIPL) thicknesses were evaluated, as well as the correlation between clinical factors and pRNFL and mGCIPL thicknesses.

Results: Anti-Sjögren's syndrome type B (SSB) antibody positivity (P = 0.048) was identified as a risk factor associated with abnormally reduced pRNFL thickness, and anti-SSB positivity (P = 0.005) and erythrocyte sedimentation rate (ESR) level (P = 0.031) were identified as risk factors associated with an abnormally reduced mGCIPL thickness as revealed by multivariate logistic regression analysis. There was a significant negative correlation between anti-SSB antibody levels and the thickness of pRNFL and mGCIPL. The thicknesses of pRNFL and mGCIPL were significantly reduced in anti-SSB-positive eyes when compared to anti-SSB-negative eyes (P < 0.05). However, histopathologic grading was not associated with the pRNFL and mGCIPL thicknesses.

Conclusion: Anti-SSB antibody positivity and ESR levels may be useful for predicting an abnormally reduced pRNFL or mGCIPL thickness in patients with pSS. Our results may provide clinical evidence to substantiate the association between aberrant autoimmunity and inner retinal changes in patients with pSS.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0157995PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4915668PMC
July 2017