Publications by authors named "Se Joon Woo"

265 Publications

Infectious endophthalmitis after scleral fixation of an intraocular lens.

Retina 2021 Mar 24. Epub 2021 Mar 24.

Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Borame Hospital, Seoul, Korea Department of Ophthalmology, Kim's Eye Hospital, Konyang University College of Medicine, Seoul, Korea Department of Ophthalmology, College of Medicine, Kosin University, Gospel Hospital, Busan, Korea Department of Ophthalmology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.

Purpose: To determine the mechanism of infection, clinical features, and risk factors of endophthalmitis after scleral fixation of an intraocular lens (IOL).

Methods: We included fifteen patients with infectious endophthalmitis after scleral fixation of an IOL between April 2004 and December 2017, as well as four patients found through a literature search. Thus, a total of nineteen patients were analyzed.

Results: Among nineteen eyes, infectious endophthalmitis developed at a mean of 23 months (range: 1day-10 years) after scleral fixation surgery. Nine eyes (47.4%) had early-onset endophthalmitis (≤6 weeks), and ten eyes (52.6%) had delayed-onset endophthalmitis (>6 weeks). Eleven eyes (57.9%) had presumed microbial influx due to suture exposure. Those with delayed-onset endophthalmitis showed a higher rate of suture-related infection (80.0% vs. 33.3%) and culture of gram-negative bacteria (70.0% vs. 12.5%) than did those with early-onset endophthalmitis.

Conclusion: Infectious endophthalmitis can develop late after scleral fixation of an IOL, usually related to the exposed sutures, and the visual prognosis is poor. Eyes that have sutured scleral fixation should be monitored regularly, and preventive measures should be performed if an exposed suture is found.
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http://dx.doi.org/10.1097/IAE.0000000000003176DOI Listing
March 2021

Genotype and Long-term Clinical Course of Bietti Crystalline Dystrophy in Korean and Japanese Patients.

Ophthalmol Retina 2021 Feb 23. Epub 2021 Feb 23.

Department of Ophthalmology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.

Purpose: To investigate the genotype and long-term clinical phenotype of patients with Bietti crystalline dystrophy (BCD) in Korea and Japan.

Design: Retrospective case series.

Participants: We analyzed 62 patients with clinical features of BCD who harbor pathogenic biallelic CYP4V2 variants in their homozygote or compound heterozygote.

Methods: Data were collected from patient charts, including age, best-corrected visual acuity (BCVA), Goldmann perimetry results, fundus photography, OCT findings, fundus autofluorescence results, and electroretinography findings. We compared the clinical course of the patients with homozygous c.802-8_810de117insGC [exon7del], the most common mutation in the East Asian population, with those of the patients with other genotypes.

Main Outcome Measures: Best-corrected visual acuity, visual field (VF), and their changes during follow-up.

Results: The mean age at the first visit was 55.2 years, with a mean follow-up of 7.1 years. The mean BCVAs at the first and last visits were 0.28 logarithm of the minimum angle of resolution (logMAR) and 0.89 logMAR, respectively. In genetic testing, c.802-8_810de117insGC was detected in 86 of 124 alleles of the patients, and 36 patients were homozygous for this mutation. The age, BCVA, VF area, central foveal thickness, and abnormal hypoautofluorescent area at either the first or last visit were not different between the exon7del homozygotes and the others. The mean BCVA changes per year were 0.089 logMAR in the exon7del homozygotes and 0.089 logMAR in the others. An age- and gender-adjusted linear regression analysis showed no association between the exon7del homozygote status and the rate of vision loss. Characteristic crystalline deposits in the posterior pole were generally observed in younger patients and disappeared over time along with progressive retinochoroidal atrophy.

Conclusions: Patients with BCD and a homozygote for c.802-8_810de117insGC accounted for more than 50% of this cohort of Korean and Japanese patients, and the clinical effect of this deleterious variant was not severe in the spectrum of CYP4V2 retinopathy.
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http://dx.doi.org/10.1016/j.oret.2021.02.009DOI Listing
February 2021

Long-Term Outcomes of Ophthalmic and Retinal Artery Occlusion After Cosmetic Facial Filler Injection.

Aesthet Surg J 2021 Feb 22. Epub 2021 Feb 22.

Department of Ophthalmology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea.

Background: Ophthalmic artery occlusion (OAO) and retinal artery occlusion (RAO) after facial filler injection have become increasingly significant due to the increment of cosmetic injection procedures for aesthetic purposes.

Objectives: To analyze the long-term visual outcomes and complications of cosmetic facial filler related OAO and RAO.

Methods: This single center, retrospective case series included 17 eyes of 16 filler related OAO or RAO patients with a follow-up period of one year or longer. Main outcome measures were best-corrected visual acuity (BCVA) and long-term complications.

Results: The mean age at diagnosis was 31.7 ± 9.7 years and all patients were female. The mean follow-up period was 5.4 ± 2.4 years. The mean BCVA was 2.34 and 2.41 logMAR at the initial and last visits, respectively, which indicates sustained long-term visual decrement. Ocular complications included retinal atrophy and degeneration (100.0%), optic atrophy and profound visual impairment (82.4%), strabismus (80.0%), retinal fibrous membrane (68.8%), posterior synechiae (35.3%), neovascularization (29.4%), iris atrophy and cataract (23.5%), corneal opacity and phthisis bulbi (17.6%), visual field defect and iris defect (11.8%), ophthalmoplegia (7.7%), and pupillary block (5.9%). Extra-ocular complications of brain infarction and depression were found in 25.0%, while skin necrosis was found in 13.3% of patients.

Conclusions: Facial filler related OAO or RAO resulted in long-term poor visual outcome, and most of the patients experienced irreversible visual impairment with no light perception despite various treatments. Various long-term ocular and extra-ocular complications were observed, which should be monitored for a long-term follow-up period. Our findings suggest that prevention should be stressed more than treatment.
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http://dx.doi.org/10.1093/asj/sjab099DOI Listing
February 2021

Assessment of Trends in the Incidence Rates of Central Retinal Artery Occlusion in Korea From 2002 to 2015.

JAMA Ophthalmol 2021 Feb 11. Epub 2021 Feb 11.

Department of Ophthalmology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea.

Importance: Central retinal artery occlusion (CRAO) is associated with and shares common risk factors with cardiovascular diseases. Over the past several decades, the incidence rates of stroke and ischemic heart disease have substantially decreased in high-income industrialized countries. However, little is known regarding current trends in CRAO incidence rates.

Objective: To estimate trends in the incidence rates of CRAO in Korea.

Design, Setting, And Participants: This nationwide population-based cohort study was designed on September 7, 2017, and used data from the Korean National Health Insurance Service from January 1, 2002, to December 31, 2015. Individuals with incident CRAO between 2002 and 2015 were identified using the CRAO diagnostic code (H34.1) from the International Classification of Diseases, Tenth Revision. Unadjusted CRAO incidence rates were calculated using the number of CRAO cases identified and the corresponding midyear population, which was obtained from resident registration data. Standardized incidence rates were calculated based on the 2015 census population, and weighted mean annual incidence rates with 95% CIs were computed based on the Poisson distribution. To identify trends in incidence rates, joinpoint regression analysis was performed using standardized incidence rates, and annual percentage changes (APCs) were calculated across the 12-year study period. Data were analyzed from May 1, 2019, to April 30, 2020.

Main Outcomes And Measures: Temporal trends in CRAO incidence rates (measured as cases per 100 000 person-years) and age-standardized APCs in CRAO incidence rates using joinpoint and birth cohort analyses.

Results: Among 50 million residents of Korea, 9892 individuals (5884 men [59.5%]) with incident CRAO between 2002 and 2015 were identified. The mean age of Korean individuals diagnosed with CRAO was 62.4 years (range, 0-97 years); among men and women, the mean age was 61.5 years (range, 0-96 years) and 63.6 years (range, 0-97 years), respectively. The mean standardized incidence rate of CRAO was 2.00 cases per 100 000 person-years (95% CI, 1.97-2.04 cases per 100 000 person-years) among the entire population, 2.43 cases per 100 000 person-years (95% CI, 2.37-2.49 cases per 100 000 person-years) among men, and 1.61 cases per 100 000 person-years (95% CI, 1.57-1.66 cases per 100 000 person-years) among women. The highest incidence rate (9.85 cases per 100 000 person-years; 95% CI, 9.10-10.60 cases per 100 000 person-years) was observed among those aged 80 to 84 years (13.74 cases per 100 000 person-years [95% CI, 12.16-15.32 cases per 100 000 person-years] for men and 8.04 cases per 100 000 person-years [95% CI, 7.21-8.86 cases per 100 000 person-years] for women). The incidence rate in the overall study population decreased over time (APC, -3.46%; 95% CI, -4.3% to -2.6%), and this decreasing trend was more evident in women (APC, -4.56%; 95% CI, -5.7% to -3.4%) than in men (APC, -2.90%; 95% CI, -3.9% to -1.9%). The decrease in the incidence rate was more evident among participants younger than 65 years (APC, -6.80%; 95% CI, -8.3% to -5.2%) than among those 65 years and older (APC, -0.57%; 95% CI, -1.5% to -0.4%). Among participants born after 1930, a decrease in the CRAO incidence rate over time was observed in every age group, while the same decreasing trend was not present among those born before 1930.

Conclusions And Relevance: This study found that the CRAO incidence rate has been decreasing among residents of Korea, especially among women, individuals younger than 65 years, and individuals born after 1930. This observed decrease may be associated with the development of a national health care system and the general improvement in chronic disease management.
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http://dx.doi.org/10.1001/jamaophthalmol.2020.6860DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7879389PMC
February 2021

Ocular Drug Delivery to the Retina: Current Innovations and Future Perspectives.

Pharmaceutics 2021 Jan 15;13(1). Epub 2021 Jan 15.

Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam 13620, Korea.

Treatment options for retinal diseases, such as neovascular age-related macular degeneration, diabetic retinopathy, and retinal vascular disorders, have markedly expanded following the development of anti-vascular endothelial growth factor intravitreal injection methods. However, because intravitreal treatment requires monthly or bimonthly repeat injections to achieve optimal efficacy, recent investigations have focused on extended drug delivery systems to lengthen the treatment intervals in the long term. Dose escalation and increasing molecular weight of drugs, intravitreal implants and nanoparticles, hydrogels, combined systems, and port delivery systems are presently under preclinical and clinical investigations. In addition, less invasive techniques rather than intravitreal administration routes, such as topical, subconjunctival, suprachoroidal, subretinal, and trans-scleral, have been evaluated to reduce the treatment burden. Despite the latest advancements in the field of ophthalmic pharmacology, enhancing drug efficacy with high ocular bioavailability while avoiding systemic and local adverse effects is quite challenging. Consequently, despite the performance of numerous in vitro studies, only a few techniques have translated to clinical trials. This review discusses the recent developments in ocular drug delivery to the retina, the pharmacokinetics of intravitreal drugs, efforts to extend drug efficacy in the intraocular space, minimally invasive techniques for drug delivery to the retina, and future perspectives in this field.
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http://dx.doi.org/10.3390/pharmaceutics13010108DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7830424PMC
January 2021

Cerebral magnetic resonance imaging of coincidental infarction and small vessel disease in retinal artery occlusion.

Sci Rep 2021 Jan 13;11(1):864. Epub 2021 Jan 13.

Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 173-82 Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, South Korea.

There are several reports in the literature on the association between non-arteritic retinal artery occlusion (NA-RAO) and acute ischemic stroke. We investigated the burden of small vessel disease (SVD) and cerebral coincident infarction observed on cerebral magnetic resonance imaging (MRI) in patients with newly diagnosed NA-RAO. In this retrospective, observational, case-series study, consecutive patients with NA-RAO who underwent cerebral MRI within one month of diagnosis between September 2003 and October 2018 were included. The classification of NA-RAO was based on ophthalmologic and systemic examinations. We also investigated the co-incident infarction and burden of underlying SVD, which were categorized as white matter hyperintensity lesion (WMH), cerebral microbleeds (CMB), and silent lacunar infarction (SLI). Among the 272 patients enrolled in the study, 18% presented co-incident infarction and 73% had SVD, which included WMH (70%), CMB (14%), and SLI (30%). Co-incident infarction, WMH, and SLI significantly increased with age: co-incident infarction was observed in 8% of young (< 50 years) patients and 30% of old (≥ 70 years) patients. The embolic etiology of RAO (large artery atherosclerosis, cardioembolism, and undetermined etiology) was significantly associated with the prevalence of SVD (82%: 70%: 64%, P = 0.002) and co-incident infarction (30%: 19%: 8%; P = 0.009). Therefore, high co-incidence of acute cerebral infarction and underlying SVD burden warrant careful neurologic examination and appropriate brain imaging, followed by management of NA-RAO. Urgent brain imaging is particularly pertinent in elderly patients with NA-RAO.
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http://dx.doi.org/10.1038/s41598-020-80014-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7806736PMC
January 2021

Phacovitrectomy versus lens-sparing vitrectomy for rhegmatogenous retinal detachment repair according to the surgical experience.

Retina 2020 Dec 28;Publish Ahead of Print. Epub 2020 Dec 28.

Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea.

Purpose: To compare the efficacy and safety between lens-sparing vitrectomy and phacovitrectomy for primary rhegmatogenous retinal detachment (RRD) treatment according to surgical experience.

Methods: We retrospectively reviewed the medical records of 193 patients with primary RRD who underwent either lens-sparing vitrectomy(n=111) or phacovitrectomy(n=82). Patients were operated by two experienced surgeons or eight vitreoretinal fellows and had a minimum follow-up of 6 months. Anatomical success rate, postoperative complications, functional outcomes were compared.

Results: Primary anatomical success rate was 92.8% (103/111) for lens-sparing vitrectomy and 91.5% (75/82) for phacovitrectomy (P=0.733). The fellows had lower success rate after phacovitrectomy compared with the experts, but not statistically significant (85% [34/40] vs. 97.6% [41/42], P=0.054). During phacovitrectomy, one zonulysis case in the experts group and four posterior capsular rupture cases in the fellows group were noted. Cystoid macular edema was found only after phacovitrectomy (12.2% [10/82]), and epiretinal membrane occurred more after phacovitrectomy than after lens-sparing vitrectomy (28% [23/82] vs. 8.1% [9/111], P<0.001). There was no difference in the occurrence of cystoid macular edema and epiretinal membrane after phacovitrectomy between two surgeon groups (P=0.514, 0.701, respectively).

Conclusions: Combined phacoemulsification and vitrectomy has no additional benefit in improving the surgical outcome of primary RRD management. Considering the intra-and postoperative complications and the relatively low success rate, phacovitrectomy may not be a desirable option in inexperienced surgeons.
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http://dx.doi.org/10.1097/IAE.0000000000003090DOI Listing
December 2020

Clinical features of RBC-coated IOL after breakthrough vitreous hemorrhage secondary to neovascular age-related macular degeneration.

J Cataract Refract Surg 2020 Dec 9. Epub 2020 Dec 9.

Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.

Purpose: To investigate the incidence and clinical features of red blood cell (RBC)-coated intraocular lens (IOL) in breakthrough vitreous hemorrhage (VH) with subretinal hemorrhage (SRH) secondary to neovascular age-related macular degeneration (nAMD).

Setting: Seoul National University Bundang Hospital, Seongnam, Korea.

Design: Retrospective cohort analysis.

Methods: A total of 30 patients diagnosed as breakthrough VH with SRH in nAMD who underwent pars plana vitrectomy (PPV) were included in this study. Demographics and clinical characteristics of the subjects, visual acuities, and SRH sizes measured as optic disc diameters (DD) were analyzed. The correlation analysis between SRH size and absorption duration of RBC-coated IOL were performed.

Results: RBC-coated IOLs were observed in 11 patients (37%). Appearance of RBC-coated IOLs was noted after postoperative 1 month, and mean duration of SRH absorption was 8.6±2.6 months. SRH sizes were significantly different between eyes with RBC-coated IOL and clear IOL (62.8±20.7 vs 27.4±14.2, P < 0.001). There was definite correlation between SRH size and absorption duration of RBC-coated IOL (correlation coefficient 0.899, P < 0.001, R2 = 0.831). There were no significant differences according to age, sex, laterality, underlying medical conditions, preoperative lens status, history of anti-VEGF treatment, and visual acuities. The degenerated RBC on the surface of IOL was confirmed by electron- and light-microscopy.

Conclusions: RBC-coated IOL could develop after vitrectomy surgery for breakthrough VH with massive SRH secondary to nAMD and it can be confused with IOL opacification. As it spontaneously disappears gradually, observation without IOL removal is warranted.
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http://dx.doi.org/10.1097/j.jcrs.0000000000000549DOI Listing
December 2020

Clinical Characteristics of Uveitis in Patients with Psoriasis in Korea: A Retrospective Multicenter Case Series.

Korean J Ophthalmol 2021 02 11;35(1):64-72. Epub 2020 Dec 11.

Department of Ophthalmology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.

Purpose: To describe the clinical characteristics and treatment outcomes of uveitis in patients with psoriasis in Korea.

Methods: The medical records of 20 patients (27 eyes) with psoriatic uveitis in two tertiary hospitals were retrospectively reviewed. We analyzed data about patient demographics, uveitis types, laterality, onset of disease, human leukocyte antigen (HLA) types, intraocular pressure, visual acuity, comorbidities, and medical treatments and outcomes for uveitis and psoriasis.

Results: The cohort comprised 11 males and nine females (age of onset, 50.1 ± 13.2 years) and the mean follow-up period was 3.9 ± 4.0 years. Types of uveitis included anterior (85%), intermediate (10%), and panuveitis (5%). A total of 13 (65%) cases presented with unilateral involvement and 12 out of 18 patients (66.7%) were positive for HLA-B27. The average intraocular pressure of affected eyes was 11.6 ± 3.6 at the first visit and 13.8 ± 3.6 mmHg at the final visit. The average logarithm of the minimum angle of resolution visual acuity of affected eyes at the initial examination was 0.16 ± 0.52 and 0.27 ± 0.71 at the last examination. Most common comorbidity (13 patients, 65%) was psoriatic arthritis (PsA). All cases underwent topical corticosteroid treatment; however, 11 (55%) required systemic corticosteroid and immunosuppressants for the treatment of uveitis. Notable deterioration in visual outcome was found in two cases (10%) due to severe intraocular inflammation and its complications (uveitic glaucoma and bullous keratopathy). Recurrent uveitis was observed in 57.9% of patients. Patients with PsA tended to have higher positive rate of HLA-B27 (83.3%). However, there was no significant correlation between visual prognosis and location of psoriatic uveitis, presence of PsA, and HLA-B27 positivity.

Conclusions: Psoriatic uveitis in Koreans usually presents with anterior uveitis with unilateral involvement. PsA was the most common comorbidity. In majority of patients, visual outcomes are satisfactory with appropriate topical or systemic immunosuppressive treatment.
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http://dx.doi.org/10.3341/kjo.2020.0131DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7904410PMC
February 2021

Intravitreal Bevacizumab for the Treatment of Choroidal Neovascularization after Eyeball Perforation during Retrobulbar Anesthesia.

Korean J Ophthalmol 2021 02 11;35(1):91-93. Epub 2020 Dec 11.

Department of Ophthalmology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.

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http://dx.doi.org/10.3341/kjo.2020.0133DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7904412PMC
February 2021

A Case of Bilateral Iris Involvement of Lymphoma Successfully Managed with Intravitreal Methotrexate Injection.

Korean J Ophthalmol 2020 12 3;34(6):498-499. Epub 2020 Dec 3.

Department of Ophthalmology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.

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http://dx.doi.org/10.3341/kjo.2020.0053DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7738225PMC
December 2020

Massive submacular haemorrhage in polypoidal choroidal vasculopathy versus typical neovascular age-related macular degeneration.

Acta Ophthalmol 2020 Dec 2. Epub 2020 Dec 2.

Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea.

Purpose: To investigate the incidence rate of massive submacular haemorrhage (SMH) and risk factors in polypoidal choroidal vasculopathy (PCV) and typical neovascular age-related macular degeneration (tnAMD).

Methods: A total of 465 patients who were diagnosed with either PCV (n = 245) or tnAMD (n = 220) from 2003 to 2014 were enrolled. Cumulative incidence of massive SMH in PCV and that in tnAMD were compared. Risk factors of massive SMH were also analysed.

Results: Massive SMH occurred in 32 patients (13.1%) with PCV and 9 patients (4.1%) with tnAMD. Incidence rates of massive SMH 5 and 10 years after the first visit were 11.1% and 29.9% in PCV and 4.3% and 9.9% in tnAMD, respectively. Incidence rates of massive SMH in PCV were significantly higher than those in tnAMD (hazard ratio [HR], 2.66; p = 0.007). Cox regression analysis revealed that mean number of photodynamic therapies (PDTs) per year (HR, 4.24; p < 0.001), cluster type of polypoidal lesion (HR, 3.42; p = 0.003) in PCV, and mean number of anti-VEGF injections per year (HR, 1.58; p < 0.001) in tnAMD were significantly associated with risk of massive SMH. For patients with severe vision loss, proportion of incident massive SMH was significantly higher in PCV (29.5%) than in tnAMD (6.9%, p < 0.001).

Conclusion: The incidence rate of massive SMH in eyes with PCV was about three times higher than that in eyes with tnAMD. Treatment methods that can reduce the incidence of massive SMH should be considered, especially for eyes with PCV.
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http://dx.doi.org/10.1111/aos.14676DOI Listing
December 2020

Ten-Year Progression From Intermediate to Exudative Age-Related Macular Degeneration and Risk Factors: Bundang AMD Cohort Study Report 1.

Am J Ophthalmol 2021 Apr 3;224:228-237. Epub 2020 Dec 3.

Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea. Electronic address:

Purpose: This study investigated the 10-year incidence of progression from intermediate to exudative age-related macular degeneration (AMD) and identified genetic and environmental factors influencing that progression in the Korean population.

Design: Retrospective, observational cohort study.

Methods: In total, 632 eyes of 418 patients (age: ≥50 years) with intermediate AMD were enrolled. The incidence of exudative AMD was assessed from color fundus photographs and optical coherence tomography images obtained at baseline and during annual visits. Data regarding lifestyle variables and dietary habits were acquired through comprehensive questionnaires. Genotyping data concerning 3 single nucleotide polymorphisms (SNPs), rs800292 and rs1061170 in the CFH gene and rs10490924 in ARMS2 were also analyzed. The cumulative incidence of exudative changes was estimated using Kaplan-Meier analysis. Associated influential factors were evaluated using univariate and multivariate Cox regression models.

Results: The mean follow-up period was 3.99 ± 2.85 years. The cumulative incidence of progression to exudative AMD was 5.6%, 14.8%, and 28.4% at 2, 5, and 10 years, respectively. Multivariate Cox analysis showed that age (hazard ratio [HR]: 1.041; P = .0393), family history of AMD (HR: 3.175; P = .0184), and pre-existing exudative AMD in the fellow eye (HR: 3.186; P = 5.31 × 10) were positively associated with exudative changes. Regular intake of green tea (HR: 0.632; P = .0475) was associated with a decrease in exudative changes. The ARMS2 SNP rs10490924 (HR: 1.482; P = .0185) showed a significant association with AMD progression.

Conclusions: The annual progression rate from intermediate to exudative AMD in the Korean population is approximately 2.8%, which is comparable with that for whites. Intake of green tea may be a modifiable protective factor against exudative changes.
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http://dx.doi.org/10.1016/j.ajo.2020.11.012DOI Listing
April 2021

Ocular surface complications of local anticancer drugs for treatment of ocular tumors.

Ocul Surf 2021 01 22;19:16-30. Epub 2020 Nov 22.

Department of Ophthalmology, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03080, South Korea; Laboratory of Ocular Regenerative Medicine and Immunology, Biomedical Research Institute, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, South Korea. Electronic address:

Local chemotherapy is increasingly used, either in combination with surgery or as monotherapy, for management of ocular tumors. Yet many of the local chemotherapeutic agents used for ocular tumors are cytotoxic drugs that are frequently associated with toxicities in normal ocular tissues. Understanding and managing these side effects are important because they affect treatment tolerability, outcome and quality of vision. Herein, we review local anticancer drugs administered for the treatment of ocular tumors, with an emphasis on their toxicities to the ocular surface, adnexa and lacrimal drainage system. We provide the underlying mechanisms and management strategies for the ocular side effects. Recent innovations in anticancer immunotherapy and ocular drug delivery systems also are discussed as new potential therapeutic modalities for alleviation of side effects.
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http://dx.doi.org/10.1016/j.jtos.2020.11.006DOI Listing
January 2021

Efficacy and Safety of a Proposed Ranibizumab Biosimilar Product vs a Reference Ranibizumab Product for Patients With Neovascular Age-Related Macular Degeneration: A Randomized Clinical Trial.

JAMA Ophthalmol 2021 01;139(1):68-76

Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland.

Importance: Neovascular age-related macular degeneration is the leading cause of blindness in individuals 50 years or older. The availability of a ranibizumab biosimilar product (SB11) may facilitate access to an effective alternative to this treatment.

Objective: To demonstrate equivalence of efficacy, similar safety, and similar immunogenicity of SB11 compared with the reference ranibizumab.

Design, Setting, And Participants: This randomized, double-masked, parallel-group phase 3 equivalence study was conducted in 75 centers in 9 countries from March 14, 2018, to December 9, 2019, among 705 participants 50 years or older with neovascular age-related macular degeneration with active subfoveal choroidal neovascularization lesions. Analysis was performed on an intent-to-treat basis.

Interventions: Intravitreous injection of SB11 or ranibizumab, 0.5 mg, every 4 weeks through week 48.

Main Outcomes And Measures: Preplanned interim analysis after all participants completed the week 24 assessment of primary efficacy end points at week 8 for change from baseline in best-corrected visual acuity (BCVA) and week 4 for central subfield thickness (CST), with predefined equivalence margins for adjusted treatment differences of -3 letters to 3 letters for BCVA and -36 μm to 36 μm for CST.

Results: Baseline and disease characteristics among 705 randomized participants (403 women [57.2%]; mean [SD] age, 74.1 [8.5] years) were comparable between treatment groups (SB11, 351; ranibizumab, 354). Least-squares mean (SE) changes in BCVA from baseline at week 8 were 6.2 (0.5) letters in the SB11 group vs 7.0 (0.5) letters in the ranibizumab group, with an adjusted treatment difference of -0.8 letter (90% CI, -1.8 to 0.2 letters). Least-squares mean (SE) changes in CST from baseline at week 4 were -108 (5) μm in the SB11 group vs -100 (5) μm in the ranibizumab group, with an adjusted treatment difference of -8 μm (95% CI, -19 to 3 μm). Incidences of treatment-emergent adverse events (231 of 350 [66.0%] vs 237 of 354 [66.9%]), including serious treatment-emergent adverse events (44 of 350 [12.6%] vs 44 of 354 [12.4%]) and treatment-emergent adverse events leading to study drug discontinuation (8 of 350 [2.3%] vs 5 of 354 [1.4%]), were similar in the SB11 and ranibizumab groups. Immunogenicity was low, with a cumulative incidence of antidrug antibodies up to week 24 of 3.0% (10 of 330) in the SB11 group and 3.1% (10 of 327) in the ranibizumab group.

Conclusions And Relevance: These findings of equivalent efficacy and similar safety and immunogenicity profiles compared with ranibizumab support the use of SB11 for patients with neovascular age-related macular degeneration.

Trial Registration: ClinicalTrials.gov Identifier: NCT03150589.
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http://dx.doi.org/10.1001/jamaophthalmol.2020.5053DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7677876PMC
January 2021

Preclinical Efficacy and Safety of VEGF-Grab, a Novel Anti-VEGF Drug, and Its Comparison to Aflibercept.

Invest Ophthalmol Vis Sci 2020 Nov;61(13):22

Department of Ophthalmology, Seoul National University Bundang Hospital, Seongnam, Korea.

Purpose: VEGF-Grab is a novel anti-vascular endothelial growth factor (VEGF) candidate drug with higher affinity to both VEGF and placental growth factor (PlGF) compared to aflibercept. We investigated the preclinical efficacy of VEGF-Grab for ophthalmic therapy and compared it to that of aflibercept.

Methods: The in vitro anti-VEGF efficacy of VEGF-Grab was determined using VEGF-induced cell proliferation/migration and tube formation assays. The in vivo antiangiogenic efficacy of intravitreal injection of either VEGF-Grab or aflibercept was evaluated using murine models of ocular angiogenesis: mouse oxygen-induced retinopathy (OIR) and rat laser-induced choroidal neovascularization (CNV). The in vivo retinal toxicity in the mouse eye resulting from the injection of either drug was evaluated with light and electron microscopy.

Results: VEGF-Grab showed greater inhibition of VEGF-induced cell proliferation/migration than aflibercept, but it showed comparable inhibition of tube formation in vitro. In the in vivo OIR model, VEGF-Grab showed a comparable suppression of retinal neovascularization compared to aflibercept. Additionally, VEGF-Grab showed an efficacy similar to that of aflibercept in terms of CNV inhibition in the laser-induced CNV model. Histology and transmission electron microscopy showed no significant signs of toxicity in the mouse retina at 7 and 30 days following the intravitreal injection of VEGF-Grab or aflibercept.

Conclusions: Compared to aflibercept, VEGF-Grab presented comparable in vivo antiangiogenic efficacy and superior in vitro anti-VEGF activity. The retinal safety profiles were comparable for the two drugs. Considering its known higher binding affinity to VEGF and PlGF compared to aflibercept, VEGF-Grab could be a potential candidate drug for neovascular retinal diseases and an alternative to aflibercept.
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http://dx.doi.org/10.1167/iovs.61.13.22DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7671872PMC
November 2020

Ophthalmic Manifestations and Genetics of the Polyglutamine Autosomal Dominant Spinocerebellar Ataxias: A Review.

Front Neurosci 2020 21;14:892. Epub 2020 Aug 21.

Department of Ophthalmology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, South Korea.

Spinocerebellar ataxia (SCA) is a part of the cerebellar neurodegenerative disease group that is diverse in genetics and phenotypes. It usually shows autosomal dominant inheritance. SCAs, always together with the cerebellar degeneration, may exhibit clinical deficits in brainstem or eye, especially retina or optic nerve. Interestingly, autosomal dominant SCAs share a common genetic mechanism; the length of the glutamine chain is abnormally expanded due to the increase in the cytosine-adenine-guanine (CAG) repeats of the disease causing gene. Studies have suggested that the mutant ataxin induces alteration of protein conformation and abnormal aggregation resulting in nuclear inclusions, and causes cellular loss of photoreceptors through a toxic effect. As a result, these pathologic changes induce a downregulation of genes involved in the phototransduction, development, and differentiation of photoreceptors such as , one of the photoreceptor transcription factors. However, the exact mechanism of neuronal degeneration by mutant ataxin restricted to only certain type of neuronal cell including cerebellar Purkinje neurons and photoreceptor is still unclear. The most common SCAs are types 1, 2, 3, 6, 7, and 17 which contain about 80% of autosomal dominant SCA cases. Various aspects of eye movement abnormalities are evident depending on the degree of cerebellar and brainstem degeneration in SCAs. In addition, certain types of SCAs such as SCA7 are characterized by both cerebellar ataxia and visual loss mainly due to retinal degeneration. The severity of the retinopathy can vary from occult macular photoreceptor disruption to extensive retinal atrophy and is correlated with the number of CAG repeats. The value of using optical coherence tomography in conjunction with electrodiagnostic and genetic testing is emphasized as the combination of these tests can provide critical information regarding the etiology, morphological evaluation, and functional significances. Therefore, ophthalmologists need to recognize and differentiate SCAs in order to properly diagnose and evaluate the disease. In this review, we have described and discussed SCAs showing ophthalmic abnormalities with particular attention to their ophthalmic features, neurodegenerative mechanisms, genetics, and future perspectives.
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http://dx.doi.org/10.3389/fnins.2020.00892DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7472957PMC
August 2020

Intraocular Distribution and Kinetics of Intravitreally Injected Antibodies and Nanoparticles in Rabbit Eyes.

Transl Vis Sci Technol 2020 05 20;9(6):20. Epub 2020 May 20.

Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.

Purpose: To investigate the intraocular distribution and kinetics of antibodies and nanoparticles in the experimental model.

Methods: Antibodies (whole IgG 149kDa, antigen-binding fragments 48.39 kDa) and four kinds of nondegradable nanoparticles (25, 50, 200, and 250 nm) were intravitreally injected in the right eye of New Zealand white rabbits. The average optical density and concentration were used to measure intraocular distribution and kinetics.

Results: After intravitreal injection, antibodies were distributed throughout the vitreous humor and eliminated gradually into anterior and posterior routes. Fluorescence intensity decreased 1 day after injection and was not detected 25 days after injection. The nondegradable nanoparticles migrated posteriorly to the retina 7 days after injection onward and anteriorly to the aqueous humor from 1 hour to 1 day after injection. The fluorescence intensity of the nanoparticles was relatively stable in the vitreous humor, compared to antibodies. Nanoparticles accumulated on the internal limiting membrane of the retina with no penetration into deeper retinal tissue, whereas the smaller size 25 nm nanoparticles passed across the ciliary body and moved into choroid, retina, and suprachoroidal space. A gradual decrease of nanoparticles by their sizes in the vitreous after 30 days after injection was described as the percentage ratio: 61.1% (25 nm), 69.1% (50 nm), 78.6% (200nm), and 85.3% (250 nm).

Conclusions: Our study revealed the in vivo intraocular distribution and kinetics of antibodies and nanoparticles with diverse sizes and the result might help to develop newer intraocular drugs and drug delivery systems to treat retinal diseases.

Translational Relevance: These experimental results can be valuable data for human research.
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http://dx.doi.org/10.1167/tvst.9.6.20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7409074PMC
May 2020

Intraocular Pharmacokinetics of 10-fold Intravitreal Ranibizumab Injection Dose in Rabbits.

Transl Vis Sci Technol 2020 03 9;9(4). Epub 2020 Mar 9.

Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.

Purpose: To investigate intraocular pharmacokinetics of 10-fold dose of intravitreally injected ranibizumab compared with the conventional dose in an experimental model.

Methods: Ranibizumab 30 µL at 10 mg/mL (conventional) and 100 mg/mL (10-fold) doses was injected separately into each eye of 28 rabbits. Ranibizumab concentrations in the aqueous humor, vitreous, and retina were estimated at each time period after injection, using enzyme-linked immunosorbent assay. The pharmacokinetic properties of ranibizumab were determined using a one-compartment model in all three ocular tissues. The time-concentration profile and predictive trends were plotted to determine drug efficacy in the retina.

Results: Maximum concentrations after conventional and 10-fold dosing were observed in the retina at 1 and 4 days after injection, respectively. The half-life of ranibizumab after conventional and 10-fold dosing did not differ in the anterior chamber and vitreous, whereas the half-life was prolonged approximately twice with the 10-fold dose in the retina (36.74 h vs. 76.85 h) and serum (91.93 h vs. 179.01 h). Similarly, the estimated time for ranibizumab concentration in the retina over 27 ng/mL (minimum effective concentration of ranibizumab) was prolonged approximately twice with the 10-fold dose (1315 h [55 days] vs. 2393 h [100 days]). No adverse effects were observed in either group.

Conclusions: The retinal half-life and concentration of ranibizumab in rabbit eyes were increased approximately twice after a 10-fold dose compared with the conventional dose. This finding indicates a possibility to lengthen the injection interval to improve the efficacy of ranibizumab in human eyes.

Translational Relevance: Our results highlight the potential for clinical application of a high-dose (10-fold) of anti-VEGF agents to prolong the intravitreal injection intervals, simultaneously improving the drug efficacy.
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http://dx.doi.org/10.1167/tvst.9.4.7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7396190PMC
March 2020

In vivo imaging of the hyaloid vascular regression and retinal and choroidal vascular development in rat eyes using optical coherence tomography angiography.

Sci Rep 2020 07 30;10(1):12901. Epub 2020 Jul 30.

Department of Mechanical Enginnereing, Korea Advanced Institute of Science and Technology (KAIST), 291 Daehak-ro, Yuseong-gu, Daejeon, 34141, Republic of Korea.

This study investigates the hyaloid vascular regression and its relationship to the retinal and choroidal vascular developments using optical coherence tomography angiography (OCTA). Normal and oxygen-induced retinopathy (OIR) rat eyes at postnatal day 15, 18, 21, and 24 were longitudinally imaged using OCTA. At each day, two consecutive imaging for visualizing the hyaloid vasculature and the retinal and choroidal vasculatures were conducted. The hyaloid vessel volume and the retinal and choroidal vessel densities were measured. The hyaloid vessel volumes gradually decreased during the regression, although the OIR eyes exhibited large vessel volumes at all time points. A spatial relationship between persistent hyaloid vasculature and retardation of underlying retinal vascular development was observed in the OIR eyes. Furthermore, anti-vascular endothelial growth factor (VEGF) was administered intravitreally to additional OIR eyes to observe its effect on the vascular regression and development. The VEGF injection to OIR eyes showed reduced persistent hyaloid vessels in the injected eyes as well as in the non-injected fellow eyes. This study presents longitudinal imaging of intraocular vasculatures in the developing eye and shows the utility of OCTA that can be widely used in studies of vascular development and regression and preclinical evaluation of new anti-angiogenic drugs.
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http://dx.doi.org/10.1038/s41598-020-69765-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7393149PMC
July 2020

Spatial Functional Characteristics of East Asian Patients With Occult Macular Dystrophy (Miyake Disease); EAOMD Report No. 2.

Am J Ophthalmol 2021 01 21;221:169-180. Epub 2020 Jul 21.

Laboratory of Visual Physiology, Division of Vision Research, National Institute of Sensory Organs, National Hospital Organization Tokyo Medical Center, Tokyo, Japan; Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan; UCL Institute of Ophthalmology, London, United Kingdom; Moorfields Eye Hospital, London, United Kingdom. Electronic address:

Purpose: To describe the functional phenotypic features of East Asian patients with RP1L1-associated occult macular dystrophy (ie, Miyake disease).

Design: An international multicenter retrospective cohort study.

Methods: Twenty-eight participants (53 eyes) with Miyake disease were enrolled at 3 centers (in Japan, China, and South Korea). Ophthalmologic examinations including spectral-domain optical coherence tomography (SDOCT) and multifocal electroretinogram (mfERG) were performed. Patients were classified into 3 functional groups based on mfERG: Group 1, paracentral dysfunction with relatively preserved central/peripheral function; Group 2, homogeneous central dysfunction with preserved peripheral function; and Group 3, widespread dysfunction over the recorded area. Three functional phenotypes were compared in clinical parameters and SDOCT morphologic classification (severe phenotype, blurred/flat ellipsoid zone and absence of the interdigitation zone; mild phenotype, preserved ellipsoid zone).

Results: There were 8 eyes in Group 1, 40 eyes in Group 2, and 5 eyes in Group 3. The patients in Group 1 showed significantly later onset (P = .005) and shorter disease duration (P = .002), compared with those in Group 2. All 8 eyes in Group 1 showed the mild morphologic phenotype, while 43 of 45 eyes in Groups 2 and 3 presented the severe phenotype, which identified a significant association between the functional grouping and the morphologic classification (P < .001).

Conclusions: A spectrum of functional phenotypes of Miyake disease was first documented with identification of 3 functional subtypes. Patients with paracentral dysfunction had the mildest phenotype, and those with homogeneous central or widespread dysfunction showed overlapping clinical findings with severe photoreceptor changes, suggesting various extents of visual impairment.
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http://dx.doi.org/10.1016/j.ajo.2020.07.025DOI Listing
January 2021

Single-Haptic Dislocation of Retropupillary Iris-Claw Intraocular Lens: Outcomes of Reenclavation.

Ophthalmic Surg Lasers Imaging Retina 2020 07;51(7):384-390

Background And Objective: To report the clinical feature of dislocated retropupillary iris-claw aphakic intraocular lens (IOL) and outcomes of reenclavation.

Patients And Methods: In this multicenter, retrospective case series, 225 eyes of 225 patients underwent retropupillary fixation of iris-claw aphakic IOL and the cases with haptic dislocation were reviewed.

Results: Single haptic dislocation was observed in 22 of 225 eyes (9.8%) after 89 ± 77 days (range: 5 days to 277 days) postoperatively, and resolution was achieved through reenclavation without any intraoperative complications in all patients. Iris atrophy in 13 eyes (59%) and history of face washing at the time of dislocation in five patients (23%) were noted. Reenclavation did not cause statistically significant change in best-corrected visual acuity (P = .315), spherical equivalent (P = .660), or endothelial cell count (P = .182) compared to those after the primary surgery.

Conclusion: Single-haptic dislocation of retropupillary iris-claw aphakic IOL is not a rare complication and can be safely and effectively corrected by reenclavation. [Ophthalmic Surg Lasers Imaging Retina. 2020;51:384-390.].
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http://dx.doi.org/10.3928/23258160-20200702-03DOI Listing
July 2020

Correlation of electroretinography components with visual function and prognosis of central retinal artery occlusion.

Sci Rep 2020 07 22;10(1):12146. Epub 2020 Jul 22.

Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 173-82 Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, South Korea.

We investigated the full-field electroretinographic (ERG) parameters with visual function and prognosis in central retinal artery occlusion (CRAO), according to its severity. 110 affected eyes of CRAO patients were enrolled and compared with fellow uninvolved eyes (N = 110) and normal control eyes (N = 30). B/A ratio and photopic negative response amplitude (PhNR) resulted in statistically significant differences among the CRAO subgroups according to the severity of retinal ischemia. Amplitudes of PhNR indicating ganglion cell function showed a more marked decline in mild to severe ischemia than those of the B-wave. In terms of visual function and outcome, baseline visual acuity and visual field defects were correlated with B/A ratio only (both, P < .001), whereas improvements in visual acuity and visual field were correlated with B-wave amplitude in dark-adapted 3.0 (P = .004 and .006), B/A ratio (P = .023 and .008), and PhNR amplitude (P < .001 and .004). These three ERG parameters were found to be credible predictive factors of visual prognosis. In conclusion, B-wave amplitude in dark-adapted 3.0, B/A ratio, and PhNR amplitude changes in eyes with CRAO are associated with baseline features related to the severity of retinal ischemia, and these are correlated with visual function and prognosis.
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http://dx.doi.org/10.1038/s41598-020-68957-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7376222PMC
July 2020

Subtenon retrobulbar hyaluronidase injection for ophthalmic artery occlusion following facial filler injection.

Int J Ophthalmol 2020 18;13(7):1170-1172. Epub 2020 Jul 18.

Department of Ophthalmology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam 13620, Republic of Korea.

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http://dx.doi.org/10.18240/ijo.2020.07.25DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7321939PMC
July 2020

RECURRENCE OF IDIOPATHIC EPIRETINAL MEMBRANE AND ITS PREDISPOSING FACTORS: An Optical Coherence Tomography Study.

Retina 2021 Mar;41(3):516-524

Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea; and.

Purpose: To evaluate the incidence and clinical course of recurrent epiretinal membrane (ERM) after ERM surgery and to identify predisposing optical coherence tomography (OCT) findings for the recurrence.

Methods: Postoperative ERM recurrence, defined as reappearance of the membrane after its removal or regrowth of the remnant membrane, was investigated in 301 eyes with idiopathic ERM followed up for more than 6 months after macular surgery by fundus photographs and spectral-domain OCT. The incidences of recurrent ERM and its associated clinical characteristics were assessed. Preceding OCT findings in the area subsequently showing recurrent ERM were evaluated at early postoperative periods.

Results: Among the 301 eyes that underwent ERM peeling, 119 (39.5%) and 86 (28.6%) showed ERM recurrence on OCT images and biomicroscopic examination/fundus photographs, respectively, during the follow-up period (average: 18.1 months). Neighboring remnant membrane and hyperreflective dots on the retinal surface at 1 week after the surgery and postoperative inner retinal wrinkling persisting for ≥1 month were predisposing OCT findings for ERM recurrence, with an odds ratio of 6.48 (95% confidence interval, 3.51-12.0), 3.48 (95% confidence interval, 1.81-6.70), and 6.11 (95% confidence interval, 3.30-11.3), respectively (all P < 0.001).

Conclusion: Incidence of ERM recurrence varies depending on the definition used for the recurrence. Optical coherence tomography examination may be useful for the prediction and sensitive detection of recurrent ERM.
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http://dx.doi.org/10.1097/IAE.0000000000002868DOI Listing
March 2021

Twelve-year incidence of retinal vein occlusion and its trend in Korea.

Graefes Arch Clin Exp Ophthalmol 2020 Oct 26;258(10):2095-2104. Epub 2020 Jun 26.

Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 173-82 Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, South Korea.

Purpose: To estimate the 12-year incidence and trends of clinically diagnosed retinal vein occlusion (RVO) in Korea.

Methods: This is a nationwide population-based retrospective study using the Korean national health claims database from 2002 to 2015. The study consisted of the entire Korean population based on the 2015 Census of Population. We identified patients with incident RVO in 2004-2015. We estimated the crude incidence rates and age- and sex-standardized incidence rates in each 12-year study period. To determine the trend, we also performed joinpoint regression analyses.

Results: We identified 240,495 incident RVO cases. The average incidence rate was 48.09 (95% confidence interval [CI], 47.92-48.27). Women showed a 1.24 times higher incidence rate (53.18 [95% CI, 52.92-53.44]) compared with men (42.78 [95% CI, 42.55-43.02]), while, among patients aged less than 50 years and those aged 80 years or over, men showed higher incidence rates than did women. The highest incidence of 193.56 (95% CI, 191.06-196.06) was observed in the age group of 75 to 79 years. The joinpoint analysis showed an increasing trend of RVO incidence among patients at the age of 70 years and older (annual percentage change, 2.1; 95% CI, 0.2-4.0; p < 0.01).

Conclusion: RVO is a disease of the elderly that peaks in the late 70s and occurs more in women than in men. In Korea, RVO incidence increased from 2004 to 2015 among the population aged 70 years or older, while among those aged less than 70 years, no trend was observed in RVO incidence rates.
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http://dx.doi.org/10.1007/s00417-020-04811-8DOI Listing
October 2020

Use of OCT Retinal Thickness Deviation Map for Hydroxychloroquine Retinopathy Screening.

Ophthalmology 2021 01 16;128(1):110-119. Epub 2020 Jun 16.

Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Hanyang University College of Medicine, Seoul, Republic of Korea.

Purpose: To investigate the use of a retinal thickness deviation map generated from swept-source (SS) OCT images for hydroxychloroquine retinopathy screening.

Design: Retrospective cohort study.

Participants: This study included 1192 Korean patients with a history of hydroxychloroquine treatment: 881 patients (1723 eyes) in the discovery set and 311 patients (591 eyes) in the validation set. Patients were screened for retinal toxicity using SS OCT, fundus autofluorescence, and standard automated perimetry.

Methods: According to the 2016 American Academy of Ophthalmology guidelines, hydroxychloroquine retinopathy was diagnosed by the presence of abnormalities on ≥1 objective structural tests alongside corresponding visual field defects. The 12 × 9-mm macular volume SS OCT scan was performed, and the retinal thickness deviation map was generated automatically using the built-in software. On this map, yellow (retinal thickness, <5% of the normative level) or red (<1% of the normative level) pixels were defined as abnormal. Abnormal findings were evaluated, and diagnostic criteria were developed based on the discovery set data; criteria were validated using the validation set data.

Main Outcome Measures: The rate and patterns of abnormalities on the retinal thickness deviation map and sensitivity and specificity of the diagnostic criteria.

Results: The retinal thickness deviation map showed the following abnormal patterns in eyes with hydroxychloroquine retinopathy: pericentral (36.0%) or parafoveal (6.1%) ring, mixed-ring (34.2%), central island (13.2%), and whole macular thinning (10.5%). The criterion of ≥5 contiguous red pixels showing 1 of the 5 characteristic patterns in both eyes yielded the greatest diagnostic performance (sensitivity and specificity of 98.2% and 89.1% and of 100% and 87.5% in the discovery and validation set data, respectively). Moreover, the area of abnormal pixels on the map was correlated significantly with the mean deviation (P < 0.001) and pattern standard deviation (P < 0.001) on the Humphrey 30-2 test in eyes with hydroxychloroquine retinopathy.

Conclusions: The retinal thickness deviation map may facilitate the objective evaluation of hydroxychloroquine retinopathy because it does not require subjective, morphologic evaluation of the outer retinal layers. The map has the potential to enhance hydroxychloroquine retinopathy screening when used in conjunction with conventional screening methods.
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http://dx.doi.org/10.1016/j.ophtha.2020.06.021DOI Listing
January 2021

Normal to supernormal 30-Hz flicker ERGs predict visual function and prognosis in central retinal artery occlusion.

Doc Ophthalmol 2020 12 6;141(3):279-292. Epub 2020 Jun 6.

Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 173-82 Gumi-ro, Bundang-gu, Seongnam-Si, Gyeonggi-do, 13620, South Korea.

Purpose: To determine whether normal to supernormal 30-Hz flicker ERGs are associated with visual function and prognosis in patients with central retinal artery occlusion (CRAO).

Methods: A total of 133 patients diagnosed with unilateral acute non-arteritic CRAO by examination with electroretinography (ERG) were examined. Thirty-hertz flicker ERG amplitudes were analyzed according to the severity of CRAO, and their correlation with visual function and prognosis was assessed. All patients were categorized into one of three groups according to the flicker ERG amplitude ratios between affected and fellow eyes: ≥ 110%, supernormal; 90-110%, normal; and < 90%, subnormal.

Results: Thirty-hertz flicker ERG parameters differed significantly according to the severity of retinal ischemia, i.e., between incomplete versus complete CRAO: mean amplitude (55.89 ± 24.38 > 45.41 ± 23.47 μV, P = 0.029), amplitude ratio (76.1 ± 23.1% > 58.7 ± 25.7%, P < 0.001), and proportion of normal to supernormal flicker ERGs (30.5% > 12.4%, P < .001). One-month and final follow-up visual function and prognosis were better in the normal to supernormal flicker ERGs: 1 month BCVA (1.55 ± 0.65 > 2.05 ± 0.61 logMAR, P < .001), final BCVA (1.32 ± 0.79 > 1.97 ± 0.68 logMAR, P < .001), 1-month VA improvement (- 0.50 ± 0.47 > - 0.10 ± 0.29 logMAR, P < .001), and final VA improvement (- 0.74 ± 0.61 > - 0.18 ± 0.37 logMAR, P < .001).

Conclusions: Normal to supernormal 30-Hz flicker ERG changes in eyes with CRAO are associated with the milder severity of retinal ischemia and showed better visual function and outcome than the subnormal ERG group.
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http://dx.doi.org/10.1007/s10633-020-09775-yDOI Listing
December 2020