1
|
Lee EJ, Han JC, Kang M, Kong DS, Hong SD, Park KA, Kee C. Longitudinal changes in optic disc cupping from the baseline in chiasmal lesion optic neuropathy and glaucoma. Sci Rep 2024; 14:8889. [PMID: 38632299 PMCID: PMC11024126 DOI: 10.1038/s41598-024-59419-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 04/10/2024] [Indexed: 04/19/2024] Open
Abstract
We aimed to investigate the changes in cupping in chiasmal lesion optic neuropathy (chON) compared to baseline optic disc and glaucoma. We used a novel study design to enroll patients who had fundus photographs incidentally taken during routine health check-ups prior to the onset of optic neuropathy. In 31 eyes (21 patients) with chON and 33 eyes (30 patients) with glaucoma, we investigated the change in cup-to-disc (C/D) area from the baseline to overt cupping using flicker analysis. Compared to the baseline, 23 eyes (74.2%) had increased cup size and 3 (9.7%) had vascular configuration changes in the chONgroup; in contrast, all glaucoma eyes exhibited changes in cup size and vascular configuration. The increase in C/D area ratio was significantly smaller in chON (0.04 ± 0.04) compared to glaucoma (0.10 ± 0.04, P < 0.001); the minimum residual neuroretinal rim width showed a more pronounced difference (29.7 ± 8.2% vs 7.1 ± 3.9%, P < 0.001). The changes distributed predominantly towards the nasal direction in chON, contrasting the changes to the arcuate fibers in glaucoma. In conclusion, our results provide the first longitudinal evidence of true pathological cupping in chONcompared to photographically disease-free baseline. The marked difference in the residual minimum rim width reaffirms the importance of rim obliteration in the differential diagnosis between the two diseases.
Collapse
Affiliation(s)
- Eun Jung Lee
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, 06351, Korea
| | - Jong Chul Han
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, 06351, Korea
| | - Mira Kang
- Center for Health Promotion, Digital Innovation Center, Samsung Medical Center, Seoul, Korea
| | - Doo-Sik Kong
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sang Duk Hong
- Department of Otolaryngology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kyung-Ah Park
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, 06351, Korea.
| | - Changwon Kee
- Department of Ophthalmology, Kim's Eye Hospital, Konyang University College of Medicine, Seoul, Korea.
| |
Collapse
|
2
|
Cho HK, Kee C. Longitudinal Rates of Change in Structural Parameters of Optical Coherence Tomography in Primary Angle Closure Glaucoma following Laser Iridotomy along with Peripheral Iridoplasty. J Ophthalmol 2024; 2024:9978354. [PMID: 38445101 PMCID: PMC10914411 DOI: 10.1155/2024/9978354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 01/22/2024] [Accepted: 02/01/2024] [Indexed: 03/07/2024] Open
Abstract
Background This study aimed to investigate longitudinal rates of change (LRCs) of structural parameters from optical coherence tomography (OCT) in patients with primary angle closure glaucoma (PACG) after laser iridotomy (LI) along with laser peripheral iridoplasty (PI). Methods Among 146 patients diagnosed with PACG, thirty-two subjects (32 eyes) who underwent LI plus PI and accomplished more than five times of reliable OCT tests were included in the current retrospective study. Retinal nerve fiber layer (RNFL) and Bruch's membrane opening-minimum rim width (BMO-MRW) were measured by spectral-domain OCT with three month interval. LRCs of global and six Garway-Heath sectors were investigated using the linear mixed-effects model which adjusted BMO area, sex, and age. Imaging of dual Scheimpflug analyzer was performed before and at 1 week after LI with PI and yearly thereafter. Results The mean follow-up period was 32.28 ± 13.34 months with a mean number of 10.18 ± 3.33 OCT images. Baseline characteristics are as follows: age, 63 ± 7.9 years; female, 62.5%; intraocular pressure(IOP), 15.48 ± 4.79 mmHg; anterior chamber depth, 2.09 ± 0.18 mm; and mean deviation, -7.97 ± 8.48 dB. Global LRC of BMO-MRW was 0.86 ± 1.34 μm/yr and RNFL was -0.64 ± 0.22 μm/yr. IOP decreased significantly to 13.06 ± 2.21 mmHg (p=0.001) while anterior chamber volume (p=0.011) and mean anterior chamber angle (p=0.022) increased significantly after LI along with PI compared to the baseline at the final visit. Conclusions LRC of a new parameter, BMO-MRW, and LRC of RNFL were relatively low in patients with PACG, following LI along with PI. After widening of the anterior chamber angle and decrease of IOP due to LI plus PI, PACG might show stable structural prognosis assessed by OCT.
Collapse
Affiliation(s)
- Hyun-Kyung Cho
- Department of Ophthalmology, Gyeongsang National University Changwon Hospital, Gyeongsang National University, School of Medicine, Changwon, Republic of Korea
- Institute of Health Sciences, School of Medicine, Gyeongsang National University, Jinju, Republic of Korea
| | - Changwon Kee
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| |
Collapse
|
3
|
Soya E, N'Djessan JJ, Koffi F, Kouamé S, Gbassi C, Kee C, N'Za A, Konin C. [Vascular age and cardiovascular risk in hypertensive patients followed at the heart institute]. Ann Cardiol Angeiol (Paris) 2024; 73:101678. [PMID: 38070449 DOI: 10.1016/j.ancard.2023.101678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 07/20/2023] [Accepted: 09/26/2023] [Indexed: 01/27/2024]
Abstract
OBJECTIVE To calculate the vascular age of hypertensive patients and assess the risk at 10 years of occurrence of an absolute cardiovascular event in outpatient consultation of the Abidjan Heart Institute. PATIENTS AND METHODOLOGY Cross-sectional study with descriptive and analytical purposes from June 2021 to September 2021, i.e. 4 months in patients at least 30 years of age followed in the outpatient department for arterial hypertension without cardiovascular complications. Data were collected using a questionnaire. We considered the parameters established in the D'Agostino chart for the calculation of vascular age. Each parameter was weighted and the total points obtained corresponded to the vascular age. The cardiovascular risk at 10 years was also obtained from another abacus established by D'Agostino by cross-referencing the total points of each patient with pre-established data. RESULTS Three hundred hypertensive people were included in this study. The calendar average age was 62.0 ± 10 years with extremes of 30 and 95 years. The gender distribution showed female predominance and there was no significant difference in vascular age by sex. The mean vascular age of all patients was 73.4 ± 9.9 years. The mean difference between actual and vascular age was 11.4 years. Dyslipidemia (p = 0.0002), diabetes (p = 0.0004) and unstandardized BP (p = 0.0000) significantly influenced vascular age. There was no significant difference between smokers and non-smokers (p = 0.1349). All men had a greater than 30% risk of having a cardiovascular accident while women before the age of 35 had no risk. Over the age of 60, almost all patients (both men and women) had a greater than 30% risk of having a cardiovascular accident at 10 years. CONCLUSION The calculation of vascular age made it possible to assess arterial aging and calculate the probability at 10 years of occurrence of a cardiovascular event. This study also highlights the importance of cardiovascular risk and vascular age assessment for management adaptation and therapeutic education.
Collapse
Affiliation(s)
- E Soya
- Unités de soins intensifs cardiologiques, Institut de Cardiologie d'Abidjan
| | - J J N'Djessan
- Unités de soins intensifs cardiologiques, Institut de Cardiologie d'Abidjan.
| | - F Koffi
- Service de consultation de médecine, Institut de Cardiologie d'Abidjan
| | - S Kouamé
- Unités de soins intensifs cardiologiques, Institut de Cardiologie d'Abidjan
| | - C Gbassi
- Unités de soins intensifs cardiologiques, Institut de Cardiologie d'Abidjan
| | - C Kee
- Unités de soins intensifs cardiologiques, Institut de Cardiologie d'Abidjan
| | - A N'Za
- Unités de soins intensifs cardiologiques, Institut de Cardiologie d'Abidjan
| | - C Konin
- Unités de soins intensifs cardiologiques, Institut de Cardiologie d'Abidjan
| |
Collapse
|
4
|
Lee EJ, Lee D, Kim MJ, Kim K, Han JC, Kee C. Different glaucoma progression rates by age groups in young myopic glaucoma patients. Sci Rep 2024; 14:2589. [PMID: 38297037 PMCID: PMC10830449 DOI: 10.1038/s41598-024-53133-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 01/29/2024] [Indexed: 02/02/2024] Open
Abstract
We aimed to investigate the age-related glaucoma progression rates in myopic normal tension glaucoma (NTG). In this long-term retrospective cohort (7.2 ± 3.5 years), we grouped patients based on their age at initial presentation: group A (age < 30 years, 60 eyes), group B (30 ≤ age < 40, 66 eyes), and group C (40 ≤ age < 50 years, 63 eyes). We used a linear mixed-effects model to estimate retinal nerve fiber layer (RNFL) defect width enlargement rates. Group A showed a significantly faster rate of RNFL defect progression (3.01 ± 1.74°/year) than those of groups B and C (2.05 ± 1.55°/year and 2.06 ± 1.29°/year, P = 0.004 and 0.002). The difference was more marked when calculated for the first 10 years of follow-up in group A, B, and C (3.95 ± 2.70°/year, 2.39 ± 1.64°/year, and 1.98 ± 1.31°/year), and between the periods of age < 30 years, 30 ≤ age < 40 years, and 40 ≤ age < 50 years within group A. This is the first evidence of rapid glaucoma progression in the young adulthood and stabilization in older age in myopic NTG. Clinicians should consider the potentially aggressive course of glaucoma, especially in younger patients with myopic NTG, in contrast to the general slow progression in adulthood.
Collapse
Affiliation(s)
- Eun Jung Lee
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Dongyoung Lee
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Min-Ji Kim
- Biomedical Statistics Center, Research Institute for Future Medicine, Samsung Medical Center, Seoul, South Korea
| | - Kyunga Kim
- Biomedical Statistics Center, Research Institute for Future Medicine, Samsung Medical Center, Seoul, South Korea
- Department of Ophthalmology, Kim's Eye Hospital, Konyang University College of Medicine, Seoul, South Korea
| | - Jong Chul Han
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Changwon Kee
- Department of Ophthalmology, Kim's Eye Hospital, Konyang University College of Medicine, Seoul, South Korea.
| |
Collapse
|
5
|
Nam Y, Kim J, Kim K, Park KA, Kang M, Cho BH, Oh SY, Kee C, Han J, Lee GI, Kang MC, Lee D, Choi Y, Yun HJ, Park H, Kim J, Cho SJ, Chang DK. Deep learning-based optic disc classification is affected by optic-disc tilt. Sci Rep 2024; 14:498. [PMID: 38177229 PMCID: PMC10767025 DOI: 10.1038/s41598-023-50256-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Accepted: 12/18/2023] [Indexed: 01/06/2024] Open
Abstract
We aimed to determine the effect of optic disc tilt on deep learning-based optic disc classification. A total of 2507 fundus photographs were acquired from 2236 eyes of 1809 subjects (mean age of 46 years; 53% men). Among all photographs, 1010 (40.3%) had tilted optic discs. Image annotation was performed to label pathologic changes of the optic disc (normal, glaucomatous optic disc changes, disc swelling, and disc pallor). Deep learning-based classification modeling was implemented to develop optic-disc appearance classification models with the photographs of all subjects and those with and without tilted optic discs. Regardless of deep learning algorithms, the classification models showed better overall performance when developed based on data from subjects with non-tilted discs (AUC, 0.988 ± 0.002, 0.991 ± 0.003, and 0.986 ± 0.003 for VGG16, VGG19, and DenseNet121, respectively) than when developed based on data with tilted discs (AUC, 0.924 ± 0.046, 0.928 ± 0.017, and 0.935 ± 0.008). In classification of each pathologic change, non-tilted disc models had better sensitivity and specificity than the tilted disc models. The optic disc appearance classification models developed based all-subject data demonstrated lower accuracy in patients with the appearance of tilted discs than in those with non-tilted discs. Our findings suggested the need to identify and adjust for the effect of optic disc tilt on the optic disc classification algorithm in future development.
Collapse
Affiliation(s)
- Youngwoo Nam
- Medical AI Research Center, Institute of Smart Healthcare, Samsung Medical Center, Seoul, Republic of Korea
- Department of Digital Health, SAIHST, Sungkyunkwan University, Seoul, Republic of Korea
| | - Joonhyoung Kim
- Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Kyunga Kim
- Department of Digital Health, SAIHST, Sungkyunkwan University, Seoul, Republic of Korea
- Biomedical Statistics Center, Research Institute for Future Medicine, Samsung Medical Center, Seoul, Republic of Korea
- Department of Data Convergence & Future Medicine, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Kyung-Ah Park
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea.
| | - Mira Kang
- Department of Digital Health, SAIHST, Sungkyunkwan University, Seoul, Republic of Korea.
- Health Promotion Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea.
- Digital Innovation Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
| | - Baek Hwan Cho
- Department of Medical Device Management and Research, SAIHST, Sungkyunkwan University, Seoul, Republic of Korea
- Department of Biomedical Informatics, CHA University School of Medicine, CHA University, Seongam, Republic of Korea
| | - Sei Yeul Oh
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
| | - Changwon Kee
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
| | - Jongchul Han
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
- Department of Medical Device Management and Research, SAIHST, Sungkyunkwan University, Seoul, Republic of Korea
| | - Ga-In Lee
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
| | - Min Chae Kang
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
| | - Dongyoung Lee
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
| | - Yeeun Choi
- Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hee Jee Yun
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
| | - Hansol Park
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
| | - Jiho Kim
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
| | - Soo Jin Cho
- Health Promotion Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
| | - Dong Kyung Chang
- Department of Digital Health, SAIHST, Sungkyunkwan University, Seoul, Republic of Korea
- Division of Gastroenterology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| |
Collapse
|
6
|
Lee EJ, Han JC, Kee C. Ancillary PanoMap OCT shows the progression of glaucomatous papillomacular bundle defect with disc haemorrhage on the fovea-disc axis. Br J Ophthalmol 2023; 107:1630-1637. [PMID: 36002238 DOI: 10.1136/bjo-2021-320642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 07/31/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND/AIMS To identify the spatial relationship between disc haemorrhage (DH) on the fovea-disc axis and retinal nerve fibre layer (RNFL) defect in the papillomacular bundle (PMB) using ancillary PanoMap optical coherence tomography (OCT). METHODS We investigated the presence and progression of spatially corresponding PMB defects in glaucomatous eyes with temporally located DH on the fovea-disc axis (FoDi-DH). We identified PMB defects using ancillary PanoMap OCT with guided progression analysis, in addition to red-free photographs. RESULTS We studied 36 eyes of 35 glaucoma patients with FoDi-DH, pre-existing PMB defects were observed in 18 eyes (50.0%) at the time and location of the initial FoDi-DH occurrence, 14 (38.9%) of which progressed during the follow-up period. New development of PMB defects occurred in 15 (41.7%) of 18 eyes without pre-existing PMB defects. Overall, FoDi-DH was associated with PMB defects in 33 (91.7%) eyes at locations spatially overlapping the PMB defect. Red-free photography and OCT were complementary in detecting PMB defects and progression. Among 47 cases, 20 were concordant, while 10 and 17 were detected only in photography and OCT, respectively. The central visual field defect increased significantly throughout the follow-up period (p=0.006). CONCLUSION Most FoDi-DH cases were related to the presence and progression of glaucomatous PMB defects at locations spatially overlapping the defect. OCT helped clarify changes in PMB defects detected by red-free photograph and the detection of photo-negative PMB defects as well. Similar to inferotemporal and superotemporal-direction DH, temporal DH on the PMB may be an indicator of ongoing RNFL damage that deserves close attention.
Collapse
Affiliation(s)
- Eun Jung Lee
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (the Republic of)
| | - Jong Chul Han
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (the Republic of)
| | - Changwon Kee
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (the Republic of)
| |
Collapse
|
7
|
Lee EJ, Han JC, Kee C. Deep Optic Nerve Head Morphology in Tilted Disc Syndrome and Its Clinical Implication on Visual Damage. Invest Ophthalmol Vis Sci 2023; 64:10. [PMID: 37796490 PMCID: PMC10561776 DOI: 10.1167/iovs.64.13.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 08/22/2023] [Indexed: 10/06/2023] Open
Abstract
Purpose To study deep optic nerve head (ONH) morphology in tilted disc syndrome (TDS) and identify factors associated with retinal nerve fiber layer (RNFL) defect. Methods In patients with TDS, we evaluated the optic disc shape using the Bruch's membrane opening (BMO)-anterior scleral canal opening (ASCO) offset and measured the border tissue (BT) length, depth, and angle in the direction of the tilt, using radial ONH optical coherence tomography (OCT). We compared the parameters between the TDS groups with and without RNFL defects. Results Twenty-one eyes had no glaucomatous RNFL defect, and 38 eyes had a glaucomatous RNFL defect. The group with RNFL defects had a higher baseline IOP, larger tilt axis of BMO-ASCO optic disc margin (76.4° ± 14.5° vs. 87.9° ± 15.4°, P = 0.012), larger BMO-lamina cribrosa insertion (LCI) angle (25.6° ± 9.3° vs. 43.6° ± 15.2°, P < 0.001), and more lamina cribrosa (LC) defects (4.3% vs. 30.6%, P = 0.028) than without RNFL defects. The tilt axis and BMO-LCI angle were significant factors after adjusting for baseline IOP and LC defect. The BMO-LCI angle had excellent diagnostic power for glaucomatous RNFL defect in TDS, similar to the visual field mean deviation. Conclusions OCT-based large deep ONH BT angle and tilt axis were factors associated with the presence of RNFL defects in TDS. The results suggest a mechanism of RNFL defect associated with structural ONH deformation. Further investigations are warranted to understand the role of ONH structures in a general population with and without optic disc tilt.
Collapse
Affiliation(s)
- Eun Jung Lee
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jong Chul Han
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Changwon Kee
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| |
Collapse
|
8
|
Lee EJ, Han JC, Kee C, Park KA, Kong DS, Hong SD. Peripapillary Vascular Density in Compressive Optic Neuropathy and Normal-Tension Glaucoma: A Severity-Controlled Comparison. Invest Ophthalmol Vis Sci 2023; 64:10. [PMID: 37672287 PMCID: PMC10484018 DOI: 10.1167/iovs.64.12.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 08/03/2023] [Indexed: 09/07/2023] Open
Abstract
Purpose To investigate the differences in peripapillary vessel density (VD) between compressive optic neuropathy (CON) and normal-tension glaucoma (NTG). Methods We compared patients with chronic CON and NTG, particularly after strictly controlling the mean extent of macular damage by the area of the ganglion cell-inner plexiform layer (GCIPL) loss in optical coherence tomography (OCT). We compared retinal nerve fiber layer (RNFL) and GCIPL thickness from OCT and peripapillary and macular VD from OCT angiography (OCTA) between the CON and NTG groups. Results From the initial 184 patients with CON and 443 patients with OAG, we included 41 patients with CON (57 eyes) and 64 patients with NTG (75 eyes) with a comparable extent of macular GCIPL thinning. Under similar mean macular involvement, the peripapillary VD was significantly lower in the CON group than in the NTG group after considering the effects of age, spherical equivalent, visual field sensitivity, peripapillary RNFL (pRNFL) thickness, GCIPL thickness, and image quality scores (P < 0.001). Marked loss of VD in the temporal and nasal sectors in CON was notable, attributing to the significantly lower peripapillary VD compared to NTG. Conclusions Patients with CON had a significantly lower peripapillary VD than those with NTG under similar mean degrees of pRNFL thickness and GCIPL damage. Our results reveal the potential utility of OCTA VD besides OCT pRNFL thickness, in relation to different topographic patterns of pRNFL loss, and possible differences in the pathogenesis of microvascular compromise between CON and NTG.
Collapse
Affiliation(s)
- Eun Jung Lee
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jong Chul Han
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Changwon Kee
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kyung-Ah Park
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Doo-Sik Kong
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sang Duk Hong
- Department of Otolaryngology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| |
Collapse
|
9
|
An HJ, Cho HK, Song DH, Kee C. Quantitative analysis of exosomes in the aqueous humor of Korean patients with pseudoexfoliation glaucoma. Sci Rep 2022; 12:12875. [PMID: 35896586 PMCID: PMC9329372 DOI: 10.1038/s41598-022-17063-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 07/20/2022] [Indexed: 11/09/2022] Open
Abstract
We aimed to quantitatively analyze the exosome and its cargo in individual aqueous humor (AH) samples from pseudoexfoliation (PEX) glaucoma patients compared to controls using a novel detection platform. We investigated the size distribution and measured the quantitative exosome particle counts in each AH sample. AH (80–120 µL) was obtained during cataract surgery or glaucoma filtering surgery from 12 Korean subjects (six with PEX glaucoma and six age-matched controls). The mean size of the exosomes was 58.9 ± 18.5 nm measured by a tangential flow filtration system using single-particle interferometric reflectance imaging sensor. Exosome particle count in each CD 63, CD 81, and CD9 spot was significantly greater in PEX glaucoma than in controls in total, CD 63, CD9, syntenin, and scattering(all p < 0.003). The CD63 spot showed a particle count of 8319.1 ± 797.7 in PEX glaucoma patients and 4786.8 ± 1302.1 in controls (p = 1.88E−11). Individual fluorescent capture spot images also revealed denser exosome particles in PEX patients than in controls. Syntenin, indicating exosomal origin, was detected in all AH samples. Exosomes differentially detected in AH suggest the possible role of exosomes in the pathogenesis of PEX glaucoma.
Collapse
Affiliation(s)
- Hyo Jung An
- Department of Pathology, Gyeongsang National University Changwon Hospital, Gyeongsang National University, School of Medicine, Changwon, Republic of Korea.,Institute of Health Sciences, School of Medicine, Gyeongsang National University, Jinju, Republic of Korea
| | - Hyun-Kyung Cho
- Institute of Health Sciences, School of Medicine, Gyeongsang National University, Jinju, Republic of Korea. .,Department of Ophthalmology, Gyeongsang National University Changwon Hospital, Gyeongsang National University, School of Medicine, 11 Samjeongja-ro, Seongsan-gu, Changwon, Gyeongsangnam-do, 51472, Republic of Korea.
| | - Dae Hyun Song
- Department of Pathology, Gyeongsang National University Changwon Hospital, Gyeongsang National University, School of Medicine, Changwon, Republic of Korea.,Institute of Health Sciences, School of Medicine, Gyeongsang National University, Jinju, Republic of Korea
| | - Changwon Kee
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| |
Collapse
|
10
|
Cho HK, Seong H, Kee C, Song DH, Kim SJ, Seo SW, Kang SS. MicroRNA profiles in aqueous humor between pseudoexfoliation glaucoma and normal tension glaucoma patients in a Korean population. Sci Rep 2022; 12:6217. [PMID: 35418653 PMCID: PMC9007941 DOI: 10.1038/s41598-022-09572-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 03/03/2022] [Indexed: 02/06/2023] Open
Abstract
We aimed to obtain microRNA (miRNA) profiles of patients with pseudoexfoliation (PEX) glaucoma or normal-tension glaucoma (NTG) compared to normal controls using individual aqueous humor (AH) samples and investigate the role of miRNAs in the pathogenesis of PEX glaucoma compared to NTG in Korean. AH (80-120 µl) was collected before cataract surgery or trabeculectomy from 26 Korean subjects (eleven with PEX glaucoma, age-matched eight NTG, and seven controls). RNA sequencing was conducted for RNA samples extracted from 26 AH samples. Bioinformatics analysis was performed for targets and related pathways. A total of 334 and 291 discrete miRNAs were detected in AH samples of PEX glaucoma and NTG patients, respectively. Two significantly upregulated miRNAs (hsa-miR-30d-5p and hsa-miR-320a) and ten significantly downregulated miRNAs (hsa-miR-3156-5p, hsa-miR-4458, hsa-miR-6717-5p, hsa-miR-6728-5p, hsa-miR-6834-5p, hsa-miR-6864-5p, hsa-miR-6879-5p, hsa-miR-877-3p, hsa-miR-548e-3p, and hsa-miR-6777-5p) in PEX glaucoma patients compared to control (fold-change > 2, p < 0.05) were found. In NTG patients, ten significantly upregulated and two downregulated miRNAs compared to control were found. Only hsa-miR-6777-5p was commonly downregulated in both PEX glaucoma and NTG patients. Related pathways were proteoglycans in cancer, glioma, and TGF-beta signaling pathway in PEX glaucoma. These differentially expressed miRNAs between PEX glaucoma and NTG samples suggest the possible role of miRNA in the pathogenesis of glaucoma, further implying that pathogenic mechanisms may differ between different types of glaucoma.
Collapse
Affiliation(s)
- Hyun-Kyung Cho
- Department of Ophthalmology, Gyeongsang National University Changwon Hospital, Gyeongsang National University, School of Medicine, 11 Samjeongja-ro, Seongsan-guGyeongsangnam-do, Changwon, 51472, Republic of Korea. .,Institute of Health Sciences, School of Medicine, Gyeongsang National University, Jinju, Republic of Korea.
| | - Hyemin Seong
- Institute of Health Sciences, School of Medicine, Gyeongsang National University, Jinju, Republic of Korea.,Department of Pharmacology and Convergence Medical Science, School of Medicine, Gyeongsang National University, Jinju, Republic of Korea.,Department of Ophthalmology, School of Medicine, Gyeongsang National University Hospital, Gyeongsang National University, Jinju, Republic of Korea
| | - Changwon Kee
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Dae Hyun Song
- Institute of Health Sciences, School of Medicine, Gyeongsang National University, Jinju, Republic of Korea.,Department of Pathology, Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
| | - Seong Jae Kim
- Institute of Health Sciences, School of Medicine, Gyeongsang National University, Jinju, Republic of Korea.,Department of Ophthalmology, School of Medicine, Gyeongsang National University Hospital, Gyeongsang National University, Jinju, Republic of Korea
| | - Seong Wook Seo
- Institute of Health Sciences, School of Medicine, Gyeongsang National University, Jinju, Republic of Korea.,Department of Ophthalmology, School of Medicine, Gyeongsang National University Hospital, Gyeongsang National University, Jinju, Republic of Korea
| | - Sang Soo Kang
- Institute of Health Sciences, School of Medicine, Gyeongsang National University, Jinju, Republic of Korea.,Department of Anatomy and Convergence Medical Science, Gyeongsang National University, Jinju, Republic of Korea
| |
Collapse
|
11
|
Park DY, Noh H, Kee C, Han JC. Topographic Relationships among Deep Optic Nerve Head Parameters in Patients with Primary Open-Angle Glaucoma. J Clin Med 2022; 11:jcm11051320. [PMID: 35268410 PMCID: PMC8910857 DOI: 10.3390/jcm11051320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 02/19/2022] [Accepted: 02/25/2022] [Indexed: 12/04/2022] Open
Abstract
Purpose: To investigate the topographic relationships among the deep optic nerve head (ONH) parameters representing myopic axial elongation or changes in the lamina cribrosa (LC) in patients with primary open-angle glaucoma (POAG). Methods: Among patients with POAG who visited the clinic between January 2015 and March 2017, the following deep ONH parameters were measured using spectral-domain optical coherence tomography (SD-OCT): externally oblique border tissue (EOBT) length, ONH tilt angle, optic canal (OC) obliqueness, and anterior LC insertion depth (ALID). In addition, the angular locations of the maximal value of each parameter were measured. We analyzed the correlations between the parameters, correlations with axial length (AL), and the spatial correspondence with glaucomatous ONH damage. Results: A total of 100 eyes with POAG were included in the analysis. The EOBT length, ONH tilt angle, and OC obliqueness were correlated with each other and with AL, whereas ALID showed less correlation with the other parameters and AL. The angular location where the three AL-related parameters had maximum values was also correlated with the predominant region of the glaucomatous ONH damage, while the angular location of the deepest ALID showed less correlation. Conclusions: Among the deep ONH parameters, the AL-related parameters EOBT length, ONH tilt angle, and OC obliqueness showed strong spatial correspondence with glaucomatous ONH damage, whereas the LC-related parameter ALID was less correlated with both AL and the region with glaucomatous ONH damage. Further studies are needed to determine how these differences affect glaucomatous ONH change.
Collapse
Affiliation(s)
- Do-Young Park
- Department of Ophthalmology, Yeungnam University Hospital, Yeungnam University College of Medicine, Daegu 42415, Korea;
| | - Hoon Noh
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (H.N.); (C.K.)
| | - Changwon Kee
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (H.N.); (C.K.)
| | - Jong-Chul Han
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (H.N.); (C.K.)
- Department of Medical Device, Management and Research, SAIHST, Sungkyunkwan University, Seoul 06355, Korea
- Correspondence:
| |
Collapse
|
12
|
Son KY, Han JC, Kee C. Parapapillary deep-layer microvasculature dropout is only found near the retinal nerve fibre layer defect location in open-angle glaucoma. Acta Ophthalmol 2022; 100:e174-e180. [PMID: 33742532 DOI: 10.1111/aos.14856] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Accepted: 03/02/2021] [Indexed: 12/12/2022]
Abstract
PURPOSE We aimed to investigate the topographic correspondence between deep-layer microvasculature dropout (MvD) and retinal nerve fibre layer (RNFL) defects in eyes with open-angle glaucoma (OAG) using spectral-domain optical coherence tomography (SD-OCT) and optical coherence tomography angiography (OCT-A). METHODS Microvasculature dropout width and location were determined using OCT-A, RNFL thickness, RNFL defect width and location were revealed using SD-OCT. The association between MvD and RNFL widths and that between the location of the MvD and RNFL defects were investigated. In addition, patients with OAG were divided into two groups: the RNFL defect in one hemiretina (RNFLD-HR) group (n = 24 eyes) and the RNFL defects in both hemiretinas (RNFLD-BR) group (n = 25 eyes). The presence, width and location of MvDs were compared between the two groups. RESULTS Forty-nine eyes were included. In 24 RNFLD-HR eyes, all MvDs were found in the inferior area, corresponding with the location of the RNFL defect. Meanwhile, in 25 RNFLD-BR eyes, 18 MvDs (72%) were found in the inferior hemiretina, two (8%) were found in the superior hemiretina, and five (20%) were found in both hemiretinas. In RNFLD-BR eyes, the average RNFL thickness was thinner in a location with MvD than a location without MvD. CONCLUSION Considering that MvD is only observed at the location of the RNFL defect in RNFLD-HR eyes and is usually found in the location of more severe RNFL defects in RNFLD-BR eyes, MvD seems to be a sign that accompanies glaucomatous damage in OAG eyes.
Collapse
Affiliation(s)
- Ki Young Son
- Department of Ophthalmology Samsung Medical Center Sungkyunkwan University School of Medicine Seoul Korea
| | - Jong Chul Han
- Department of Ophthalmology Samsung Medical Center Sungkyunkwan University School of Medicine Seoul Korea
| | - Changwon Kee
- Department of Ophthalmology Samsung Medical Center Sungkyunkwan University School of Medicine Seoul Korea
| |
Collapse
|
13
|
Lee EJ, Kee HJ, Park KA, Han JC, Kee C. Comparative Topographical Analysis of Choroidal Microvascular Dropout Between Glaucoma and Nonarteritic Anterior Ischemic Optic Neuropathy. Invest Ophthalmol Vis Sci 2021; 62:27. [PMID: 34705024 PMCID: PMC8556563 DOI: 10.1167/iovs.62.13.27] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Purpose To identify the presence of choroidal microvascular dropout (MvD) in nonarteritic anterior ischemic optic neuropathy (NAION) eyes and to characterize the topographical distribution for the mechanistic interpretation of MvD development. Methods We performed optical coherence tomography angiography on 47 open-angle glaucoma (OAG) and 19 NAION eyes with β-zone peripapillary atrophy (βPPA). We recorded the presence of MvD and compared between the peripapillary topographical measures of MvD, retinal nerve fiber layer (RNFL) defect, and βPPA in angular width and location. Results MvD was present in both diseases, marginally more frequently in NAION eyes (19/19, 100.0%) than in OAG eyes (38/47, 80.6%, P = 0.050), without a discernable difference in appearance. NAION eyes also showed wider MvD and RNFL defects compared to OAG eyes (both P < 0.001). In topographical measurements, the distribution of MvD showed a strong correspondence to superimposition areas of βPPA and RNFL defects, more distinctly than to RNFL defects (all P < 0.001). The outline of superimposition area also remarkably resembled the MvD area. Conclusions MvD was present in both the OAG and NAION groups. The βPPA-RNFL defect superimposition area topographically and morphologically matched MvD. Further investigations are needed to elucidate the role of RNFL defects in the pathogenesis of MvD and the clinical significance.
Collapse
Affiliation(s)
- Eun Jung Lee
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyun Joo Kee
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kyung-Ah Park
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jong Chul Han
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Changwon Kee
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| |
Collapse
|
14
|
Abstract
Purpose To identify the temporal correlation between the increase in peripapillary retinoschisis (PPRS) and glaucoma progression during PPRS fluctuation. Methods We performed a comparative clinical timeline analysis for PPRS and glaucomatous progression in eyes with PPRS. In particular, the interval between the increase in PPRS extent and glaucoma progression was analyzed. Temporal correlation was defined when the interval was less than one year between glaucoma progression and PPRS increase, including both de novo development and an increase in the amount of retinoschisis on serial optical coherence tomography. Results We included 33 eyes of 30 patients, with an average follow-up period of 7.5 ± 3.0 years and a total of 253 glaucoma examinations. Glaucoma progression was observed in 21 of 33 eyes; 19 (90.5%) of the 21 eyes with glaucoma progression and 29 (74.4%) of the 39 episodes of PPRS increase showed temporal correlation. The de novo development of PPRS during the follow-up period over baseline PPRS was more frequently observed in the glaucoma progression group than in the no-progression group (P = 0.006). Conclusions In glaucomatous eyes with PPRS, the increase in PPRS temporally correlated with glaucoma progression. Possible glaucoma progression may be considered around the time of increase and de novo development of PPRS.
Collapse
Affiliation(s)
- Eun Jung Lee
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyun Joo Kee
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jong Chul Han
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Changwon Kee
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| |
Collapse
|
15
|
Lee EJ, Kee HJ, Han JC, Kee C. Evidence-based understanding of disc hemorrhage in glaucoma. Surv Ophthalmol 2020; 66:412-422. [PMID: 32949554 DOI: 10.1016/j.survophthal.2020.09.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 09/04/2020] [Accepted: 09/09/2020] [Indexed: 12/21/2022]
Abstract
Disc hemorrhage is a characteristic finding that is highly associated with glaucoma development or progression. Consequently, the literature commonly designates disc hemorrhage as a "risk factor" for glaucoma progression; however, the exact cause-and-effect relationship or mechanism remains unclear. In this review, we discuss the emerging evidence that disc hemorrhage is a secondary development that follows glaucomatous damage. As our understanding of disc hemorrhage has progressed in recent decades, we suggest the terminology be changed from "risk factor" to "indicator" of ongoing glaucomatous development or progression for a more accurate description, better indication of the clinical implications and, ultimately, a better guide for future research.
Collapse
Affiliation(s)
- Eun Jung Lee
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyun Joo Kee
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jong Chul Han
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Changwon Kee
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
| |
Collapse
|
16
|
Cho HK, Kee C. Comparison of Rate of Change between Bruch's Membrane Opening Minimum Rim Width and Retinal Nerve Fiber Layer in Eyes Showing Optic Disc Hemorrhage. Am J Ophthalmol 2020; 217:27-37. [PMID: 32283093 DOI: 10.1016/j.ajo.2020.03.051] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 03/27/2020] [Accepted: 03/31/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE To investigate and compare the longitudinal rate of change of Bruch's membrane opening minimum rim width (BMO-MRW) and peripapillary retinal nerve fiber layer (RNFL) thickness in eyes showing optic disc hemorrhage(DH). DESIGN Observational case series. METHODS A total of 82 subjects(82 eyes) showing DH who had undergone more than five reliable spectral-domain optical coherence tomography (OCT) tests were included. BMO-MRW and RNFL were measured with OCT at 3-month intervals. The rates of change in global and each Garway-Heath sector were calculated with a linear mixed-effects model after adjusting for age, sex, and BMO area. RESULTS The mean follow-up period was 21.57 ± 7.88 months with a mean number of 7.88 ± 2.39 OCT tests. Baseline demographics were age (58.37 ± 10.65 y); 46.3% were female; and the mean deviation was -4.41 ± 5.04 dB. The global rate of change in BMO-MRW was -3.507 ± 0.675 μm/y and in -1.404 ± 0.208 μm/y in RNFL. The rate of change was the greatest in the inferotemporal sector, which was -9.141 ± 1.254 μm/y in BMO-MRW and -4.204 ± 0.490 μm/y in the RNFL. The rate of change was significantly greater in BMO-MRW than in the RNFL in all sectors, except for the nasal sector (P < .05). Percentage of reduction was significantly greater in BMO-MRW than in RNFL in the inferotemporal and superotemporal sectors (P < .05). CONCLUSIONS BMO-MRW showed a significantly greater rate of change than RNFL in eyes showing DH, especially in the inferotemporal and superotemporal sectors in percentage of reduction. Thus, it may be more advantageous to detect glaucomatous progression earlier in BMO-MRW than in the RNFL in eyes showing DH that are more likely to progress.
Collapse
Affiliation(s)
- Hyun-Kyung Cho
- Department of Ophthalmology, Gyeongsang National University Changwon Hospital, Gyeongsang National University, School of Medicine, Changwon, Gyeongsangnam-do, Republic of Korea; Institute of Health Sciences, School of Medicine, Gyeongsang National University, Jinju, Republic of Korea.
| | - Changwon Kee
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| |
Collapse
|
17
|
Cho HK, Kee C. Rate of Change in Bruch's Membrane Opening-Minimum Rim Width and Peripapillary RNFL in Early Normal Tension Glaucoma. J Clin Med 2020; 9:jcm9082321. [PMID: 32707745 PMCID: PMC7465929 DOI: 10.3390/jcm9082321] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 06/30/2020] [Accepted: 07/14/2020] [Indexed: 11/16/2022] Open
Abstract
Background: to investigate the rate of change (ROC) of Bruch’s membrane opening minimum rim width (BMO-MRW) and peripapillary retinal nerve fiber layer (RNFL) thickness in early normal tension glaucoma (NTG) patients. Methods: in this longitudinal cohort study, 115 subjects (115 eyes) diagnosed as early NTG (mean deviation > −6.0 dB) and who had completed more than five times of spectral-domain optical coherence tomography (OCT) tests with acceptable quality were included. Measurement of BMO-MRW and RNFL were performed at 3-month intervals by OCT. Linear mixed-effects model was employed to calculate the ROC in global region and six Garway-Heath sectors with adjusting age, sex, and BMO area. Results: Average follow-up was 20.99 ± 6.99 months with OCT number of 7.54 ± 2.12. Baseline intraocular pressure was 14.72 ± 2.70 mmHg and MD was −2.73 ± 2.26 dB. ROC of global BMO-MRW was −2.06 ± 0.65 µm/yr and RNFL was −0.96 ± 0.16 µm/yr (p = 0.098). The most rapid ROC was in inferotemporal sector (BMO-MRW: −3.02 ± 0.88 µm/yr, RNFL: −1.96 ± 0.36 µm/yr) followed by superotemporal sector. Conclusion: The ROC of BMO-MRW, the new parameter along with that of RNFL should be considered in the management of early NTG. BMO-MRW may show visible reduction ROC better than RNFL to detect early progression in early NTG when visual field may not show significant change.
Collapse
Affiliation(s)
- Hyun-kyung Cho
- Department of Ophthalmology, Gyeongsang National University Changwon Hospital, Gyeongsang National University School of Medicine, Changwon 51472, Korea
- lnstitute of Health Sciences, School of Medicine, Gyeongsang National University, Jinju 52727, Korea
- Correspondence: or ; Tel.: +82-55-214-2410; Fax: +82-55-214-3257
| | - Changwon Kee
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea;
| |
Collapse
|
18
|
Kim KE, Kim JM, Song JE, Kee C, Han JC, Hyun SH. Development and Validation of a Deep Learning System for Diagnosing Glaucoma Using Optical Coherence Tomography. J Clin Med 2020; 9:E2167. [PMID: 32659918 PMCID: PMC7408821 DOI: 10.3390/jcm9072167] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 06/28/2020] [Accepted: 07/06/2020] [Indexed: 11/30/2022] Open
Abstract
This study aimed to develop and validate a deep learning system for diagnosing glaucoma using optical coherence tomography (OCT). A training set of 1822 eyes (332 control, 1490 glaucoma) with 7288 OCT images, an internal validation set of 425 eyes (104 control, 321 glaucoma) with 1700 images, and an external validation set of 355 eyes (108 control, 247 glaucoma) with 1420 images were included. Deviation and thickness maps of retinal nerve fiber layer (RNFL) and ganglion cell-inner plexiform layer (GCIPL) analyses were used to develop the deep learning system for glaucoma diagnosis based on the visual geometry group deep convolutional neural network (VGG-19) model. The diagnostic abilities of deep learning models using different OCT maps were evaluated, and the best model was compared with the diagnostic results produced by two glaucoma specialists. The glaucoma-diagnostic ability was highest when the deep learning system used the RNFL thickness map alone (area under the receiver operating characteristic curve (AUROC) 0.987), followed by the RNFL deviation map (AUROC 0.974), the GCIPL thickness map (AUROC 0.966), and the GCIPL deviation map (AUROC 0.903). Among combination sets, use of the RNFL and GCIPL deviation map showed the highest diagnostic ability, showing similar results when tested via an external validation dataset. The inclusion of the axial length did not significantly affect the diagnostic performance of the deep learning system. The location of glaucomatous damage showed generally high level of agreement between the heatmap and the diagnosis of glaucoma specialists, with 90.0% agreement when using the RNFL thickness map and 88.0% when using the GCIPL thickness map. In conclusion, our deep learning system showed high glaucoma-diagnostic abilities using OCT thickness and deviation maps. It also showed detection patterns similar to those of glaucoma specialists, showing promising results for future clinical application as an interpretable computer-aided diagnosis.
Collapse
Affiliation(s)
- Ko Eun Kim
- Department of Ophthalmology, Nowon Eulji Medical Center, Eulji University School of Medicine, Seoul 01830, Korea;
| | - Joon Mo Kim
- Department of Ophthalmology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul 03181, Korea; (J.M.K.); (J.E.S.)
| | - Ji Eun Song
- Department of Ophthalmology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul 03181, Korea; (J.M.K.); (J.E.S.)
| | - Changwon Kee
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea;
| | - Jong Chul Han
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea;
- Institute of Biomedical Artificial Intelligence, SAIHST, Sungkyunkwan University, Seoul 06351, Korea
| | - Seung Hyup Hyun
- Department of Nuclear Medicine, Medical AI Research Lab, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea
| |
Collapse
|
19
|
Lee EJ, Han JC, Park DY, Kee C. Long-term morphologic fundus and optic nerve head pattern of progressive myopia in congenital glaucoma distinguished by age at first surgery. Sci Rep 2020; 10:10041. [PMID: 32572115 PMCID: PMC7308308 DOI: 10.1038/s41598-020-67051-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 04/09/2020] [Indexed: 11/09/2022] Open
Abstract
The purpose of this study was to investigate the preservation of round optic nerve head (ONH) shape in myopic eyes of surgically treated congenital glaucoma patients, with regard to factors associated with intraocular pressure (IOP) elevation-induced peripapillary scleral (PPS) deformation. Using optical coherence tomography (OCT) on the ONH and macula, we identified myopic eyes with round ONH and internally oblique border tissue and those with non-round ONH. We investigated differences in clinical factors between the two groups. We included 51 eyes of 34 patients. Age at first surgery (2.8 vs. 15.2 months, P < 0.001) was significantly different between the two groups. Axial length was also significantly longer (P = 0.004) in the non-round group, but multiple logistic regression analysis revealed age as the only significant factor (P < 0.05) in ONH roundness. Interestingly, the round ONH group also had non-curved fundus morphology and a thick choroid, while the non-round ONH group showed diverse degrees of disc tilt and posterior pole curvature, and a thin choroid. In conclusion, in eyes with congenital glaucoma, age at first surgery, particularly when older than 6 months, was associated with round ONH and emmetropia-like fundus despite high myopia. The findings may indicate two different changes in the posterior sclera and the neural canal in response to the increased IOP.
Collapse
Affiliation(s)
- Eun Jung Lee
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jong Chul Han
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Do Young Park
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Changwon Kee
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
| |
Collapse
|
20
|
Park DY, Cho SY, Jin DK, Kee C. Clinical Characteristics of Autosomal Dominant GJA1 Missense Mutation Linked to Oculodentodigital Dysplasia in a Korean Family. J Glaucoma 2020; 28:357-362. [PMID: 30628995 DOI: 10.1097/ijg.0000000000001190] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE We aimed to present a comprehensive assessment of the ophthalmic characteristics of genetically confirmed oculodentodigital dysplasia (ODDD) in 4 members of a single Korean family across 3 generations. PATIENTS AND METHODS The characteristics of 4 affected ODDD patients were evaluated. Comprehensive ophthalmic and medical examinations were performed in 3 patients including the proband, together with genetic analysis, and retrospective chart review was conducted for an affected ancestor. For genetic analysis, targeted gene panel sequencing was conducted using genomic DNA extracted from peripheral blood. RESULTS All affected individuals in this family showed shared ophthalmic abnormalities of microcornea, microphthalmia, elevated intraocular pressure, and shallow anterior chamber, all of which have been reported as typical ocular features of ODDD. Myopic refractive error despite short axial length and thick cornea were highlighted as new findings of ODDD. Facial abnormalities were common in all affected members, but their fingers were normal. Severity of glaucoma was different among the affected individuals and seemed to depend on elevation of intraocular pressure, which occurred in narrow, but open-angle. Genetic analysis revealed the presence of c.119C>T (p.Ala40Val) in GJA1, which is responsible for ODDD, but not found in the control population. CONCLUSIONS This report describes detailed ocular characteristics in a genetically confirmed ODDD family, including unreported findings of thick cornea and myopic refractive error despite short axial length. The ocular features derived from the A40V mutation in GJA1 showed complete penetrance, suggesting a possible role of Cx43 in regulation of IOP and pathogenesis of glaucoma.
Collapse
Affiliation(s)
| | - Sung Yoon Cho
- Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Dong-Kyu Jin
- Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | | |
Collapse
|
21
|
Lee EJ, Han JC, Park DY, Kee C. A neuroglia-based interpretation of glaucomatous neuroretinal rim thinning in the optic nerve head. Prog Retin Eye Res 2020; 77:100840. [PMID: 31982595 DOI: 10.1016/j.preteyeres.2020.100840] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 01/02/2020] [Accepted: 01/13/2020] [Indexed: 12/14/2022]
Abstract
Neuroretinal rim thinning (NRR) is a characteristic glaucomatous optic disc change. However, the precise mechanism of the rim thinning has not been completely elucidated. This review focuses on the structural role of the glioarchitecture in the formation of the glaucomatous NRR thinning. The NRR is a glia-framed structure, with honeycomb geometry and mechanically reinforced astrocyte processes along the transverse plane. When neural damage selectively involves the neuron and spares the glia, the gross structure of the tissue is preserved. The disorganization and loss of the glioarchitecture are the two hallmarks of optic nerve head (ONH) remodeling in glaucoma that leads to the thinning of NRR tissue upon axonal loss. This is in contrast to most non-glaucomatous optic neuropathies with optic disc pallor where hypertrophy of the glioarchitecture is associated with the seemingly absent optic disc cupping. Arteritic anterior ischemic optic neuropathy is an exception where pan-necrosis of ONH tissue leads to NRR thinning. Milder ischemia indicates selective neuronal loss that spares glia in non-arteritic anterior ischemic optic neuropathy. The biological reason is the heterogeneous glial response determined by the site, type, and severity of the injury. The neuroglial interpretation explains how the cellular changes underlie the clinical findings. Updated understandings on glial responses illustrate the mechanical, microenvironmental, and microglial modulation of activated astrocytes in glaucoma. Findings relevant to the possible mechanism of the astrocyte death in advanced glaucoma are also emerging. Ultimately, a better understanding of glaucomatous glial response may lead to glia-targeting neuroprotection in the future.
Collapse
Affiliation(s)
- Eun Jung Lee
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-gu, Seoul, 06351, South Korea
| | - Jong Chul Han
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-gu, Seoul, 06351, South Korea
| | - Do Young Park
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-gu, Seoul, 06351, South Korea
| | - Changwon Kee
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-gu, Seoul, 06351, South Korea.
| |
Collapse
|
22
|
Han JC, Choi JH, Park DY, Lee EJ, Kee C. Reply to Correspondence. Am J Ophthalmol 2020; 209:213-214. [PMID: 31677767 DOI: 10.1016/j.ajo.2019.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2019] [Accepted: 09/17/2019] [Indexed: 11/17/2022]
|
23
|
Han JC, Han SH, Park DY, Lee EJ, Kee C. Clinical Course and Risk Factors for Visual Field Progression in Normal-Tension Glaucoma With Myopia Without Glaucoma Medications. Am J Ophthalmol 2020; 209:77-87. [PMID: 31493404 DOI: 10.1016/j.ajo.2019.08.023] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 08/19/2019] [Accepted: 08/24/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE To investigate the natural clinical course and the risk factors of visual field (VF) progression in untreated normal-tension glaucoma (NTG) with myopia with a minimum 3-year follow-up. DESIGN Retrospective cohort study. METHODS Kaplan-Meier survival analysis and log-rank test were used to compare survival experiences between the groups. The hazard ratios (HRs) for the associations between potential risk factors and glaucomatous progression were determined using Cox proportional hazards model. RESULTS The average follow-up period for the included 97 patients was 71.1 ± 29.7 months and 32 eyes showed progression during the observation period. In NTG with myopia, Kaplan-Meier survival curve showed progression cases in 10.3% at 36 months and 24.8% at 60 months. When age and disc tilt direction were classified into 2 groups, a higher cumulative probability of progression was observed in those aged ≤50 years than >50 years (P = .001) and in those with disc tilt direction <45 degrees than disc tilt direction ≥45 degrees (P = .002). In Cox proportional hazards model, younger age, presence of disc hemorrhage, and more temporally tilted disc or parapapillary atrophy were associated with progression. CONCLUSIONS NTG with myopia seems to have a slow progression rate even without glaucoma medications. Only 10.3% and 24.8% of patients showed VF progression at 3 years and 5 years of follow-up in untreated NTG with myopia. To predict VF progression in untreated NTG with myopia, it seems that age and disc morphology should be considered.
Collapse
|
24
|
Lee EJ, Han JC, Park DY, Kee C. Difference in Topographic Pattern of Prelaminar and Neuroretinal Rim Thinning Between Nonarteritic Anterior Ischemic Optic Neuropathy and Glaucoma. Invest Ophthalmol Vis Sci 2019; 60:2461-2467. [PMID: 31163088 DOI: 10.1167/iovs.19-26891] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose To compare the local distribution of prelaminar and neuroretinal rim (NRR) thickness between eyes with nonarteritic anterior ischemic optic neuropathy (NAION) and normal tension glaucoma (NTG) using enhanced depth imaging spectral-domain optical coherence tomography (OCT). Methods This cross-sectional study included pairs of NAION and NTG patients, and controls. We measured the central prelaminar thickness; Bruch's membrane opening (BMO)-horizontal (HRW), minimal (MRW), and vertical rim widths (VRW), and vertical/horizontal thicknesses at knee of curve at rising curvature of the cup wall. HV ratio was calculated as BMO-HRW/BMO-VRW. The six thicknesses and their differences were compared. Results We had 12 pairs, with comparable visual field loss and retinal nerve fiber layer (RNFL) thickness between NAION and NTG. Within the optic nerve head (ONH), BMO-MRW, BMO-HRW, horizontal width at the knee of curve, and central prelaminar tissue showed significantly larger values in NAION compared to NTG (P < 0.05). The difference of NRR thickness between NAION and NTG increased in a centripetal manner, being maximum at the knee of curve. The mean HV ratio was 1.63 in NAION, 0.83 in NTG, and 1.06 in controls (P < 0.001). OCT showed disproportionately less altered prelaminar tissue in NAION. Conclusions NAION and NTG showed significantly different distributions of prelaminar and NRR tissue thicknesses despite similar RNFL thicknesses, with the maximal difference being the horizontal cup wall thickness at the knee of curve. Sparing of prelaminar tissue loss characterized the ONH in NAION. OCT might aid in differential diagnosis based on local variation in thinning patterns.
Collapse
Affiliation(s)
- Eun Jung Lee
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jong Chul Han
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Do Young Park
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Changwon Kee
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| |
Collapse
|
25
|
Haroz EE, Ingalls A, Kee C, Goklish N, Neault N, Begay M, Barlow A. Informing Precision Home Visiting: Identifying Meaningful Subgroups of Families Who Benefit Most from Family Spirit. Prev Sci 2019; 20:1244-1254. [PMID: 31432381 PMCID: PMC7082862 DOI: 10.1007/s11121-019-01039-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The Maternal, Infant, and Early Childhood Home Visiting Program was reauthorized February 8, 2018, and invests $2 billion over 5 years to improve mothers' and children's outcomes across the life course. Along with this investment, the home-visiting field is striving for implementation innovations to deliver the greatest impact to the most families at the most efficient cost through a focus on precision home visiting. Consistent with the precision home-visiting approach to identify meaningful subgroups to guide content tailoring, the purpose of this paper is to answer (1) how and to what degree an evidence-based home-visiting model benefits mothers and children with substance use or depression and (2) what baseline characteristics indicate who can benefit most. We completed a secondary data analysis of the most recently completed randomized controlled trial (RCT) of Family Spirit (N = 322), a federally endorsed home-visiting intervention designed for young Native American mothers and their children. We examined how baseline differences in mothers' substance use, depression, and demographic characteristics (household mobility, education, parity, and premature birth) moderated mothers' and children's intervention-related outcomes. Children born to mothers with past substance use histories benefited more from the intervention than children born to abstinent mothers (p < 0.01). Unstable housing, parity, and low educational attainment emerged as moderators of intervention effectiveness. Results from this investigation will serve as a basis for designing and evaluating a precision approach to Family Spirit and may provide lessons for other models to explore tailoring variables for optimal impact and efficiency. Trial Registry: NCT00373750.
Collapse
Affiliation(s)
- E E Haroz
- Center for American Indian Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - A Ingalls
- Center for American Indian Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - C Kee
- Center for American Indian Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - N Goklish
- Center for American Indian Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - N Neault
- Center for American Indian Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - M Begay
- Center for American Indian Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - A Barlow
- Center for American Indian Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| |
Collapse
|
26
|
Cho HK, Kee C. Characteristics of Patients Showing Discrepancy Between Bruch's Membrane Opening-Minimum Rim Width and Peripapillary Retinal Nerve Fiber Layer Thickness. J Clin Med 2019; 8:jcm8091362. [PMID: 31480634 PMCID: PMC6780706 DOI: 10.3390/jcm8091362] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 08/27/2019] [Accepted: 08/28/2019] [Indexed: 11/20/2022] Open
Abstract
Background: To investigate clinical characteristics of patients showing discrepancy between Bruch’s membrane opening minimum rim width (BMO-MRW) and peripapillary retinal nerve fiber layer (RNFL) thickness. Correlation with the visual field (VF) was also inspected. Methods: In this prospective, cross-sectional study, 106 eyes (106 subjects) showing normal BMO-MRW classification but abnormal RNFL classification were included. All patients underwent confocal scanning laser ophthalmoscopy, spectral-domain optical coherence tomography, and standard automated perimetry. Results: Clinical characteristics were as follows: mean age: 52.79 ± 14.75 years; spherical equivalent (SE), −2.52 ± 3.48 diopter (D); SE < −5.0 D, 34 (32.1%) eyes; large disc (>2.43 mm2), 40.6%; small disc (<1.63 mm2), 12.5%; VF index, 96.72 ± 9.58%; mean deviation, −1.74 ± 3.61 dB; β-peripapillary atrophy (PPA), 96.2%; γ-PPA, 75.5%. Majority (86.1%) of these cases demonstrated normal (71.3%) or borderline (14.9%) on VF. Temporal and nasal RNFL showed significant differences among disc size subgroups (all p < 0.05). Nasal RNFL was significantly thicker in a large disc group than other subgroups. Temporal, superotemporal, inferotemporal, inferonasal RNFL, and superior RNFL peak location showed significant differences (all p < 0.05) among SE subgroups. Temporal RNFL was significantly thicker in the high myopia group than other subgroups. Conclusions: Temporalization of RNFL peaks in myopia and nasalization of RNFL peaks in large disc that display abnormal classifications might show normal classification of BMO-MRW. These findings of discrepancy between classifications should be considered in the diagnosis of early glaucoma.
Collapse
Affiliation(s)
- Hyun-Kyung Cho
- Department of Ophthalmology, Gyeongsang National University Changwon Hospital, School of Medicine, Gyeongsang National University, Changwon 51472, Korea.
- lnstitute of Health Sciences, School of Medicine, Gyeongsang National University, Jinju 52727, Korea.
| | - Changwon Kee
- Department of Ophthalmology, Samsung Medical Center, School of Medicine, Sungkyunkwan University, Seoul 06351, Korea
| |
Collapse
|
27
|
Cho HK, Kim S, Lee EJ, Kee C. Neuroprotective Effect of Ginkgo Biloba Extract Against Hypoxic Retinal Ganglion Cell Degeneration In Vitro and In Vivo. J Med Food 2019; 22:771-778. [PMID: 31268403 DOI: 10.1089/jmf.2018.4350] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Hypoxia-induced oxidative stress and disturbed microvascular circulation are both associated with pathogenesis of glaucoma. Ginkgo biloba extract (GBE) has been reported to have positive pharmacological effects on oxidative stress and impaired vascular circulation. This study aimed to investigate the neuroprotective effect of GBE against hypoxic injury to retinal ganglion cells (RGCs) both in vitro and in vivo. The rat RGC line was used, and oxidative stress was induced by hydrogen peroxide (H2O2) in vitro. EGb 761, a standardized GBE, or vehicle was applied to RGCs. Hypoxic optic nerve injury in vivo was induced by clamping the optic nerve of rats with a "microserrefine clip" with an applicator, which was applied without crushing the optic nerve. This method is different from "optic nerve crush model" and does not involve elevation of intraocular pressure, and may serve as a possible normal tension glaucoma animal model. EGb 761 at various concentrations or vehicle was administered intraperitoneally. RGC density was measured to estimate the survival both in vitro and in vivo. The survival of RGCs was significantly (P < .001) higher upon treatment with 1 or 5 μg/mL of EGb 761 compared with vehicle after oxidative stress in vitro. RGC density upon treatment with EGb 761 of 100 mg/kg (1465.6 ± 175 cells/mm2) or 250 mg/kg (1307.6 ± 213 cells/mm2) was significantly higher (P < .01, P < .05, respectively) than that obtained with vehicle (876.3 ± 136 cells/mm2) in vivo. Our results suggest that GBE has neuroprotective effect on RGCs against hypoxic injury both in vitro and in vivo.
Collapse
Affiliation(s)
- Hyun-Kyung Cho
- 1Department of Ophthalmology, Gyeongsang National University Changwon Hospital, Gyeongsang National University, School of Medicine, Changwon, Korea
| | - Sibum Kim
- 2Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Eun Jung Lee
- 2Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Changwon Kee
- 2Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| |
Collapse
|
28
|
Han JC, Choi JH, Park DY, Lee EJ, Kee C. Border Tissue Morphology Is Spatially Associated with Focal Lamina Cribrosa Defect and Deep-Layer Microvasculature Dropout in Open-Angle Glaucoma. Am J Ophthalmol 2019; 203:89-102. [PMID: 30825418 DOI: 10.1016/j.ajo.2019.02.023] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 02/12/2019] [Accepted: 02/13/2019] [Indexed: 10/27/2022]
Abstract
PURPOSE To investigate the topographic relationship among focal lamina cribrosa (LC) defect, microvasculature dropout (MvD) and border tissue morphology in open angle glaucoma (OAG) eyes using spectral-domain (SD) optical coherence tomography (OCT) and OCT angiography. DESIGN Cross-sectional study. METHODS One hundred twenty-six OAG eyes and 97 normal eyes were included. The maximum externally oblique border tissue (EOBT) length was measured by using enhanced depth imaging SD-OCT as well as focal LC defect size. Circumferential MvD width and height ratio were measured using OCT angiography. RESULTS Significant correlations were found among the locations of focal LC defect, MvD and maximum EOBT length. The mean absolute locational difference was 29.1° (95% CI, -47.6 to 105.7) between focal LC defect and MvD, 10.0° (95% CI, -79.4 to 99.4) between focal LC defect and maximum EOBT length, and 10.6° (95% CI, -71.1 to 92.3) between MvD and maximum EOBT length. In multivariate logistic regression analysis, a worse VF defect was significantly associated with the presence of focal LC defects and MvDs (P < .002; P = .002, respectively). MvD circumferential width was associated with glaucoma severity (R = -0.66, P < .001), whereas focal LC defect size and MvD height ratio were associated with maximum EOBT length (R = 0.48, P < .001; R = 0.65, P < .001, respectively) and AL (R = 0.53, P < .001; R = 0.52, P < .001, respectively). CONCLUSIONS There was a topographical correlation among the locations of focal LC defect, MvD and maximum border length. In addition, the presence of focal LC defect and MvD were also strongly associated with glaucoma severity. Thus, it is thought that focal LC defect and MvD may be biomarkers that reflect glaucoma severity especially at the location of maximum border tissue elongation.
Collapse
|
29
|
Lee EJ, Kim SJ, Han JC, Eo DR, Lee MG, Ham DI, Kang SW, Kee C, Lee J, Cha HS, Koh EM. Peripapillary Retinal Nerve Fiber Layer Thicknesses Did Not Change in Long-term Hydroxychloroquine Users. Korean J Ophthalmol 2019; 32:459-469. [PMID: 30549469 PMCID: PMC6288022 DOI: 10.3341/kjo.2018.0004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Accepted: 03/20/2018] [Indexed: 11/23/2022] Open
Abstract
Purpose To evaluate changes in the peripapillary retinal nerve fiber layer (RNFL) thicknesses using spectral-domain optical coherence tomography (SD-OCT) in hydroxychloroquine (HCQ) users. Methods The medical records of HCQ users were retrospectively reviewed. In these HCQ users, an automated perimetry, fundus autofluorescence photography, and SD-OCT with peripapillary RNFL thickness measurements were performed. The peripapillary RNFL thicknesses were compared between the HCQ users and the control groups. The relationships between the RNFL thicknesses and the duration or cumulative dosage of HCQ use were analyzed. Results This study included 77 HCQ users and 20 normal controls. The mean duration of HCQ usage was 63.6 ± 38.4 months, and the cumulative dose of HCQ was 528.1 ± 3.44 g. Six patients developed HCQ retinopathy. Global and six sectoral RNFL thicknesses of the HCQ users did not significantly decrease compared to those of the normal controls. No significant correlation was found between the RNFL thickness and the duration of use or cumulative dose. The eyes of those with HCQ retinopathy had temporal peripapillary RNFL thicknesses significantly greater than that of normal controls. Conclusions The peripapillary RNFL thicknesses did not change in the HCQ users and did not correlate with the duration of HCQ use or cumulative doses of HCQ. RNFL thickness is not a useful biomarker for the early detection of HCQ retinal toxicity.
Collapse
Affiliation(s)
- Eun Jung Lee
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sang Jin Kim
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
| | - Jong Chul Han
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Doo Ri Eo
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Min Gyu Lee
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Don Il Ham
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Se Woong Kang
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Changwon Kee
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jaejoon Lee
- Division of Rheumatology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hoon Suk Cha
- Division of Rheumatology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Eun Mi Koh
- Division of Rheumatology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| |
Collapse
|
30
|
Jung NY, Han JC, Ong YT, Cheung CYL, Chen CP, Wong TY, Kim HJ, Kim YJ, Lee J, Lee JS, Jang YK, Kee C, Lee KH, Kim EJ, Seo SW, Na DL. Retinal microvasculature changes in amyloid-negative subcortical vascular cognitive impairment compared to amyloid-positive Alzheimer's disease. J Neurol Sci 2018; 396:94-101. [PMID: 30447606 DOI: 10.1016/j.jns.2018.10.025] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 10/25/2018] [Accepted: 10/29/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND PURPOSE To investigate small vessel abnormalities in patients with cognitive impairment, we compared retinal microvascular alterations between patients with cognitive impairment related to Alzheimer's disease (ADCI) and those with subcortical vascular cognitive impairment (SVCI). METHODS We prospectively recruited 29 amyloid-positive ADCI patients, 28 amyloid-negative SVCI patients that were confirmed by 11C-PiB-PET scan and 34 individuals with normal cognition (NC). The three groups were compared in terms of retinal vascular variables (retinal fractal dimension, vascular caliber, tortuosity and branching angle) by using a semi-automated, computer-assisted analysis of digital fundus photographs. We also investigated the relationship between retinal variables and white matter hyperintensities (WMH) on MRI. RESULTS Compared to NC individuals, the SVCI patients had smaller total and arteriolar fractal dimensions, whereas there was no significant difference of fractal dimension between ADCI and NC. Other retinal variables did not differ among the three groups. A significant correlation existed between fractal dimension and WMH volume. CONCLUSIONS Retinal microvascular alterations, especially retinal fractal dimension, may be useful markers that reflect cerebral microvascular changes in patients with SVCI as opposed to ADCI, who had no definite difference in retinal variables compared to the NC group.
Collapse
Affiliation(s)
- Na-Yeon Jung
- Department of Neurology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine and Research Institute for Convergence of Biomedical Science and Technology, Yangsan, Republic of Korea; Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea; Neuroscience Center, Samsung Medical Center, Seoul, Republic of Korea
| | - Jong Chul Han
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Yi Ting Ong
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | - Carol Yim-Lui Cheung
- Department of Ophthalmology & Visual Sciences, Chinese University of Hong Kong, Hong Kong
| | | | - Tien Yin Wong
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | - Hee Jin Kim
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea; Neuroscience Center, Samsung Medical Center, Seoul, Republic of Korea
| | - Yeo Jin Kim
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea; Neuroscience Center, Samsung Medical Center, Seoul, Republic of Korea; Department of Neurology, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, Republic of Korea
| | - Juyoun Lee
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea; Neuroscience Center, Samsung Medical Center, Seoul, Republic of Korea; Department of Neurology, Chungnam National University Hospital, Daejeon, Republic of Korea
| | - Jin San Lee
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea; Neuroscience Center, Samsung Medical Center, Seoul, Republic of Korea; Department of Neurology, Kyung Hee University Hospital, Seoul, Republic of Korea
| | - Young Kyoung Jang
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea; Neuroscience Center, Samsung Medical Center, Seoul, Republic of Korea
| | - Changwon Kee
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Kyung Han Lee
- Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Eun-Joo Kim
- Department of Neurology, Pusan National University Hospital, Pusan National University School of Medicine and Medical Research Institute, Busan, Republic of Korea
| | - Sang Won Seo
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea; Neuroscience Center, Samsung Medical Center, Seoul, Republic of Korea
| | - Duk L Na
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea; Neuroscience Center, Samsung Medical Center, Seoul, Republic of Korea.
| |
Collapse
|
31
|
Han JC, Choi JH, Park DY, Lee EJ, Kee C. Deep Optic Nerve Head Morphology Is Associated With Pattern of Glaucomatous Visual Field Defect in Open-Angle Glaucoma. Invest Ophthalmol Vis Sci 2018; 59:3842-3851. [PMID: 30073358 DOI: 10.1167/iovs.18-24588] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose We investigated the relationship between visual field (VF) defect pattern and deep optic nerve head (ONH) morphology in open angle glaucoma (OAG) eyes using spectral-domain optical coherence tomography (SD-OCT). Methods Of 278 OAG eyes, 169 with and 55 without externally oblique border tissue (EOBT) were included in the final analysis. Enhance depth imaging SD-OCT was used to measure the deep ONH parameters, such as EOBT length, ONH tilt angle, and optic canal (OC) obliqueness. The extents and locations of the maximum deep ONH parameters were explored according to VF pattern in OAG eyes. Results OAG eyes with EOBT showed longer axial length (AL; 25.6 vs. 24.4 mm; P < 0.001) and greater superior VF defects (67.5% vs. 49.1%; P = 0.02) compared to OAG eyes without EOBT. Multivariate logistic regression analysis revealed that relatively inferior location of maximum deep ONH parameters was associated with superior hemifield defects dominant in OAG (P < 0.001 in all parameters). In addition, the locations of maximum deep ONH parameters were consistent with dominant VF defect locations in OAG eyes with AL < 24.5 mm. The presence of paracentral scotoma in OAG was associated with worse mean deviation (MD) and relatively inferior location of deep ONH parameters. Conclusions The locations of maximum deep ONH parameters were associated with the location of dominant VF defects and presence of paracentral scotoma in OAG eyes.
Collapse
Affiliation(s)
- Jong Chul Han
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jae Hwan Choi
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Do Young Park
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Eun Jung Lee
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Changwon Kee
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| |
Collapse
|
32
|
Cho HK, Lee MG, Kee C. Association between the Frequency of Optic Disk Hemorrhage and Progression of NTG Related with the Initial Location of RNFL Defect. Ophthalmic Res 2018; 60:152-160. [PMID: 29895036 DOI: 10.1159/000486575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Accepted: 12/30/2017] [Indexed: 11/19/2022]
Abstract
PURPOSE This study aimed to investigate the association of the frequency of optic disk hemorrhage (DH) and progression of normal tension glaucoma (NTG) between each group based on the location of the initial retinal nerve fiber layer (RNFL) defect. METHODS In this retrospective, observational cohort study, 142 NTG patients who underwent more than 5 reliable visual field tests with initial superior hemifield (group 2, n = 51), inferior hemifield (group 1, n = 44), or both hemifield (group 3, n = 47) defects were included. The number of DHs was inspected in serial optic disk photographs by 2 different ophthalmologists. Progression rates, which are the slope of mean thresholds from the 52 points, were calculated using a linear mixed effect model. RESULTS The mean follow-up period was 8.19 ± 3.30 years. DHs related with the initial RNFL defect occurred significantly more frequently in group 2 (35 in inferior hemifield) than in group 1 (6 in superior hemifield) (p = 0.009) or group 3 (6 in inferior hemifield) (p = 0.006). The progression rate in group 2 was significantly faster than in group 1 (p = 0.019) or the superior hemifield of group 3 (p = 0.001). The progression rate of subjects showing recurrent DH was significantly faster than those showing single DH from all groups (-0.5460 vs. -0.2867 dB/year, p = 0.0053). CONCLUSIONS More careful examination and caution are required when NTG patients show recurrent DH in the inferior hemifield related to the initial RNFL defect.
Collapse
Affiliation(s)
- Hyun-Kyung Cho
- Department of Ophthalmology, Gyeongsang National University Changwon Hospital, Gyeongsang National University School of Medicine, Changwon, Republic of Korea
| | - Min Gyu Lee
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Changwon Kee
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| |
Collapse
|
33
|
Park JE, Lee EJ, Ki CS, Kee C. PITX2-related Axenfeld-Rieger Syndrome with a Novel Pathogenic Variant (c.475_476delCT). Ann Lab Med 2018; 38:283-286. [PMID: 29401568 PMCID: PMC5820078 DOI: 10.3343/alm.2018.38.3.283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2017] [Revised: 07/06/2017] [Accepted: 11/29/2017] [Indexed: 11/19/2022] Open
Affiliation(s)
- Jong Eun Park
- Department of Laboratory Medicine and Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Eun Jung Lee
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Chang Seok Ki
- Department of Laboratory Medicine and Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
| | - Changwon Kee
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
| |
Collapse
|
34
|
Lee S, Choi DYD, Lim DH, Chung TY, Han JC, Kee C. Lamina Cribrosa Changes after Laser In Situ Keratomileusis in Myopic Eyes. Korean J Ophthalmol 2018; 32:95-102. [PMID: 29611373 PMCID: PMC5906408 DOI: 10.3341/kjo.2017.0111] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Accepted: 12/28/2017] [Indexed: 11/23/2022] Open
Abstract
PURPOSE To determine deep optic nerve head structure changes after transient intraocular pressure elevation during laser in situ keratomileusis (LASIK) for myopia. METHODS Enhanced depth imaging-optical coherence tomography was performed in each myopic eye that underwent LASIK surgery. Enhanced depth imaging-optical coherence tomography images were created at postoperative 1 day, 1 week, 2 weeks, and 1 month. Lamina cribrosa (LC) thickness, LC depth and prelaminar thickness at the superior, middle and inferior portions of the optic nerve head were measured by two investigators. RESULTS Forty eyes in 40 patients were included in the present study. During follow-up, there were no significant differences in prelaminar thickness or LC depth. The LC demonstrated increased thickness at postoperative 1 day at all three locations (superior, middle, and inferior) (p < 0.001, p < 0.001, p < 0.001, respectively). However, no significant changes were observed at postoperative 1 week, 2 weeks, and 1 month. CONCLUSIONS The LC thickness could increase at 1 day after LASIK surgery. However, the thickness will gradually return to baseline morphology. Temporary intraocular pressure increase during LASIK does not appear to induce irreversible LC thickness changes.
Collapse
Affiliation(s)
- Soomin Lee
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Da Ye Diana Choi
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Dong Hui Lim
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Tae Young Chung
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jong Chul Han
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Changwon Kee
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
| |
Collapse
|
35
|
Suh W, Won HH, Kee C. The Association of Single-Nucleotide Polymorphisms in the MMP-9 Gene with Normal Tension Glaucoma and Primary Open-Angle Glaucoma. Curr Eye Res 2017; 43:534-538. [DOI: 10.1080/02713683.2017.1410177] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Wool Suh
- Department of Ophthalmology, Hallym University Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Gyeonggido, Korea
| | - Hong-Hee Won
- Samsung Advanced Institute for Health Sciences and Technology (SAIHST), Sungkyunkwan University, Samsung Medical Center, Seoul, Korea
| | - Changwon Kee
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| |
Collapse
|
36
|
Han JC, Ko H, Kim SH, Rhee T, Nam SW, Hwang S, Lee GI, Sung J, Song YM, Kee C. Heritability of the morphology of optic nerve head and surrounding structures: The Healthy Twin Study. PLoS One 2017; 12:e0187498. [PMID: 29145429 PMCID: PMC5690586 DOI: 10.1371/journal.pone.0187498] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2017] [Accepted: 10/18/2017] [Indexed: 11/18/2022] Open
Abstract
Background Optic nerve head (ONH) and surrounding structures such as β-zone peripapillary atrophy (PPA) are important structures in glaucomatous pathogenesis. Thus, for understanding genetic components in glaucoma pathogenesis, it is necessary to evaluate the heritability of ONH and surrounding structures. The present study investigated the genetic influences on ONH and surrounding structures such as β-zone PPA and retinal vessels. Methods A total of 1,205 adult twins and their family members (362 monozygotic (MZ) twin subjects (181 pairs), 64 dizygotic (DZ) twin subjects (32 pairs), and 779 singletons from 261 families), were part of the Korean Healthy Twin Study. ONH parameters including the vertical cup-to-disc ratio, the presence, the area and the location of β-zone PPA and the angular location of retinal vein were measured. The genetic influences on the structures were evaluated using variance-component methods. Results The intraclass correlation coefficient (ICC) values of axial length were highest among the parameters. The ICCs of the area and location of PPA were similar to those of vertical cup-to-disc ratio. However, retinal vessel angular locations showed low ICC values even in MZ twins. After age and sex adjustment, for axial length, vertical cup-to-disc ratio, the presence, area and location of PPA, the estimated narrow-sense heritability was 0.85, 0.48, 0.76, 0.50 and 0.65 in the right eye and 0.84, 0.47, 0.72, 0.46 and 0.72 in the left eye, respectively. The estimated narrow-sense heritability of angular location of the superior and inferior vein was 0.17 and 0.12 in the right eye and 0.13 and 0.05 in the left eye, respectively. Conclusions ONH and surrounding structures such as vertical cup-to-disc ratio and the presence, the area and the location of β-zone PPA seemed to be determined by the substantial genetic influence, whereas the venous angular location did not.
Collapse
Affiliation(s)
- Jong Chul Han
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Hyeonyoung Ko
- Department of Family Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Seung Hoon Kim
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Taekkwan Rhee
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Seung Wan Nam
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Sungsoon Hwang
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Ga-In Lee
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Joohon Sung
- Department of Epidemiology, School of Public Health and Institute of Health and Environment, Seoul National University, Seoul, South Korea
| | - Yun-Mi Song
- Department of Family Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
- * E-mail: (CK); (YMS)
| | - Changwon Kee
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
- * E-mail: (CK); (YMS)
| |
Collapse
|
37
|
Cho HK, Kee C, Yang H, Huh HD, Kim SJ, Park YM, Park JM. Comparison of circumferential peripheral angle closure using iridotrabecular contact index after laser iridotomy versus combined laser iridotomy and iridoplasty. Acta Ophthalmol 2017; 95:e539-e547. [PMID: 28556512 DOI: 10.1111/aos.13450] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Accepted: 03/07/2017] [Indexed: 11/27/2022]
Abstract
PURPOSE To compare the quantitative changes of peripheral angle after laser iridotomy (LI) alone (group A) or combined LI and Iridoplasty (group B) using iridotrabecular contact (ITC) index by swept-source anterior segment optical coherence tomography (AS-OCT). METHODS In this prospective comparative observational study, OCT images were obtained before and after the procedure. In each image frame, scleral spur (SS) and the ITC end point (EP) were marked and ITC index was calculated as a percentage of the angle closure from 360°. Age, gender, diagnosis and initial ITC index in Group B were matched with group A. Changes in ITC index, anterior chamber angle parameters, and intraocular pressure (IOP) were inspected. RESULTS Thirty-three eyes (20 patients) with shallow anterior chamber were included in each group. Initial ITC index and initial IOP were not significantly different between the two groups (both p > 0.05). However, ITC index and IOP after the procedure were significantly lower in group B than those in group A (ITC index: 31.3 ± 23.2 in group A, 19.0 ± 21.3 in group B, p = 0.011, IOP: p = 0.004). All anterior chamber angle parameters in group B and all parameters in group A except nasal trabecular-iris angles (TIA) were significantly increased after the laser procedure (all p < 0.05). CONCLUSION In patients with shallow anterior chamber, combined LI and Iridoplasty may open the peripheral angle better than LI alone. Iridoplasty may be able to additionally relieve the peripheral angle closure caused by other mechanisms than pupillary block.
Collapse
Affiliation(s)
- Hyun-kyung Cho
- Department of Ophthalmology; Gyeongsang National University Changwon Hospital; Gyeongsang National University, School of Medicine; Changwon Korea
| | - Changwon Kee
- Department of Ophthalmology; Samsung Medical Center; Sungkyunkwan University School of Medicine; Seoul Korea
| | - Heon Yang
- Department of Ophthalmology; Sungmo Eye Hospital; Busan Korea
| | - Hyoun Do Huh
- Department of Ophthalmology; Gyeongsang National University Changwon Hospital; Gyeongsang National University, School of Medicine; Changwon Korea
| | - Su Jin Kim
- Department of Ophthalmology; Gyeongsang National University Changwon Hospital; Gyeongsang National University, School of Medicine; Changwon Korea
| | - Young Min Park
- Department of Ophthalmology; Gyeongsang National University Changwon Hospital; Gyeongsang National University, School of Medicine; Changwon Korea
| | - Jong Moon Park
- Department of Ophthalmology; Gyeongsang National University Changwon Hospital; Gyeongsang National University, School of Medicine; Changwon Korea
| |
Collapse
|
38
|
Lee EJ, Han JC, Kee C. Intereye comparison of ocular factors in normal tension glaucoma with asymmetric visual field loss in Korean population. PLoS One 2017; 12:e0186236. [PMID: 29040292 PMCID: PMC5645097 DOI: 10.1371/journal.pone.0186236] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Accepted: 09/27/2017] [Indexed: 11/23/2022] Open
Abstract
Purpose To identify ocular parameters corresponding to asymmetric visual field (VF) loss in normal tension glaucoma (NTG) through intereye comparisons. Patients and methods Medical records of NTG patients with asymmetric and symmetric VF losses were retrospectively reviewed. The criterion for asymmetry in VF was 6 dB difference of mean deviation. Refractive error, intraocular pressure (IOP), central corneal thickness, ovality index, and peripapillary atrophy (PPA)/disc area ratio were obtained from each patient. Intereye comparison was performed for asymmetric group, symmetric group, and myopic and nonmyopic asymmetric subgroups. Results We included 155 patients; 110 patients in asymmetric group and 45 patients in symmetric group. In intereye comparison for total asymmetric group, refractive error (P = 0.006), initial IOP (P = 0.001), ovality index (P = 0.008), and PPA (P < 0.001) were significantly asymmetric. For myopic subgroup, refractive error (P = 0.004), ovality index (P = 0.001), and PPA (P = 0.003) were significant factors. For nonmyopic subgroup, initial IOP (P = 0.003) and PPA (P = 0.007) were significant factors. Symmetric group showed no significant difference between the eyes. Multivariate analysis demonstrated that refractive error (P = 0.002) and PPA (P = 0.028) were significant factors in myopic subgroup, and initial IOP (P = 0.022) and PPA (P = 0.002) were significant factors in nonmyopic subgroup. Conclusions In this intereye comparison, the more myopic eye in myopic NTG patient, and the more pressured eye in nonmyopic NTG patient demonstrated more severe VF loss. Myopic and nonmyopic patients may follow different pathophysiologic processes. Discriminative attentions should be paid to NTG patients by subtypes.
Collapse
Affiliation(s)
- Eun Jung Lee
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jong Chul Han
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Changwon Kee
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- * E-mail:
| |
Collapse
|
39
|
Lee EJ, Han JC, Kee C. A novel hypothesis for the pathogenesis of glaucomatous disc hemorrhage. Prog Retin Eye Res 2017; 60:20-43. [DOI: 10.1016/j.preteyeres.2017.08.002] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Revised: 08/08/2017] [Accepted: 08/28/2017] [Indexed: 01/16/2023]
|
40
|
Kim SB, Lee EJ, Han JC, Kee C. Comparison of peripapillary vessel density between preperimetric and perimetric glaucoma evaluated by OCT-angiography. PLoS One 2017; 12:e0184297. [PMID: 28859176 PMCID: PMC5578657 DOI: 10.1371/journal.pone.0184297] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2017] [Accepted: 08/21/2017] [Indexed: 01/02/2023] Open
Abstract
Purpose To determine peripapillary vessel density in eyes with perimetric glaucoma (PG) or preperimetric glaucoma (PPG) compared to normal controls using optical coherence tomography-angiography (OCT-A). Methods We recruited 13 patients with unilateral perimetric normal-tension glaucoma (NTG) and fellow preperimetric NTG showing only inferotemporal retinal nerve fiber layer (RNFL) defect in red-free RNFL photography in both eyes. We also enrolled 9 healthy controls. Using OCT-A, radial peripapillary capillary densities at inferotemporal and superotemporal regions were evaluated. Paired comparison of peripapillary vessel density was performed for PG eye, PPG eye, and normal eye. Results A total of 26 eyes of the 13 patients with unilateral PG and fellow PPG eyes and 18 eyes of 9 normal controls were analyzed. Vessel densities at the whole peripapillary region and inferotemporal region in PG eyes were significantly lower than those in PPG eyes (P = 0.001, P<0.001, respectively). Comparison between PPG and normal eyes showed no significant difference in the whole peripapillary region or the inferotemporal region (P = 0.654, P = 0.174, respectively). There was no significant (P = 0.288) difference in vessel density at superotemporal region among the three types of eyes (PG eye, PPG eye, and normal eye). Conclusion PPG eyes and normal eyes were found to have the similar densities of peripapillary microvasculature at the area with nerve fiber layer defect, whereas in PG eye, there was a significant decrease in vessel density at the area of RNFL thinning. This provides evidence that microvascular compromise in the retina might be a secondary change to nerve fiber layer degeneration in the pathogenesis of NTG.
Collapse
Affiliation(s)
- Si Bum Kim
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Eun Jung Lee
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jong Chul Han
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Changwon Kee
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- * E-mail:
| |
Collapse
|
41
|
Han JC, Lee EJ, Kim SB, Kee C. The Characteristics of Deep Optic Nerve Head Morphology in Myopic Normal Tension Glaucoma. Invest Ophthalmol Vis Sci 2017; 58:2695-2704. [PMID: 28538978 DOI: 10.1167/iovs.17-21791] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose To investigate the relationship between axial length (AL) and deep optic nerve head (ONH) structure and to evaluate the characteristics of deep ONH structures in myopic normal tension glaucoma (NTG). Methods The following parameters were assessed using spectral-domain optical coherence tomography (SD-OCT): externally oblique border tissue (EOBT) length, ONH tilt angle, optic canal (OC) obliqueness, and β-zone peripapillary atrophy (PPA). In addition, the angular location of the maximal value of each parameter and retinal nerve fiber layer (RNFL) defect were measured using infrared and red-free photos. Results A total of 74 myopic NTG eyes and 67 myopic control eyes with a spherical equivalent < -0.5 diopters from 141 subjects were included. AL was correlated with the maximal values of EOBT length, ONH tilt angle, OC obliqueness, and β-zone PPA (P < 0.001, P = 0.003, P < 0.001, and P < 0.001, respectively). Multivariate logistic regression analysis revealed that temporally located maximal values of EOBT length, ONH tilt angle, and OC obliqueness were associated with the presence of myopic NTG (P = 0.014, P = 0.016, and P = 0.030, respectively). In myopic NTGs, RNFL defect locations were consistent with the locations of maximal values of EOBT length, ONH tilt angle, OC obliqueness, and β-zone PPA (P < 0.001, P < 0.001, P < 0.001, and P = 0.003, respectively). Conclusions Temporalized angular locations of deep ONH parameters were associated with the presence of NTG in myopia. In myopic NTGs, the locations of deep ONH parameters were consistent with the locations of RNFL defect.
Collapse
Affiliation(s)
- Jong Chul Han
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Eun Jung Lee
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Si Bum Kim
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Changwon Kee
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| |
Collapse
|
42
|
Cho HK, Ahn D, Kee C. Evaluation of circumferential angle closure using iridotrabecular contact index after laser iridotomy by swept-source optical coherence tomography. Acta Ophthalmol 2017; 95:e190-e196. [PMID: 27520383 DOI: 10.1111/aos.13190] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Accepted: 06/13/2016] [Indexed: 01/09/2023]
Abstract
PURPOSE To investigate the quantitative changes of circumferential angle closure after laser iridotomy (LI) using the iridotrabecular contact (ITC) index by Swept-Source optical coherence tomography (OCT). METHODS In this prospective observational study conducted in a hospital setting, 42 eyes of 36 patients (five males, 31 females) who underwent LI were included. The mean age was 65.00 ± 8.13 years old and the diagnosis included primary angle closure (PAC, 21 eyes), PAC suspect (16 eyes) and PAC glaucoma (five eyes). Optical coherence tomography (OCT) images were obtained pre-LI and at 1 week post-LI. In each image frame, the scleral spur (SS) and the ITC end-point were marked, from which the ITC index was calculated as a percentage of the angle closure across 360°. Measurements inspected before and after LI included: central anterior chamber depth (ACD), anterior chamber volume (ACV), lens vault (LV), nasal and temporal angle opening distance (AOD), angle recess area (ARA), trabecular-iris space area (TISA), trabecular-iris angle (TIA) at 500 μm and 750 μm from the SS and intraocular pressure (IOP). RESULTS The ITC index and IOP decreased significantly after LI from 71.52 ± 26.29 to 35.31 ± 27.19 and from 20.64 ± 12.72 mmHg to 14.02 ± 3.49 mmHg, respectively (p < 0.001 and p < 0.001). Central ACD (1.94 ± 0.31 mm pre-LI) and LV (1.13 ± 0.32 mm pre-LI) did not show a significant change after LI (all p > 0.05), but ACV increased significantly after LI (p < 0.001). Most of the angle parameters except for nasal TIAs increased significantly after LI (all p < 0.05). CONCLUSION The ITC index from patients with shallow anterior chamber angle showed a significant decrease after LI, but part of the angle closure was not relieved after LI. Other mechanisms besides pupillary block may play a role together in causing angle closure.
Collapse
Affiliation(s)
- Hyun-kyung Cho
- Department of Ophthalmology; Gyeongsang National University Changwon Hospital; School of Medicine; Gyeongsang National University; Changwon Korea
| | - Dongsub Ahn
- Department of Ophthalmology; Sungmo Eye Hospital; Busan Korea
| | - Changwon Kee
- Department of Ophthalmology; Samsung Medical Center; Sungkyunkwan University School of Medicine; Seoul Korea
| |
Collapse
|
43
|
Lee EJ, Han JC, Kee C. Nasalised distribution of peripapillary retinal nerve fibre layers in large discs. Br J Ophthalmol 2017; 101:1643-1648. [PMID: 28404668 DOI: 10.1136/bjophthalmol-2016-309436] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Revised: 11/13/2016] [Accepted: 03/09/2017] [Indexed: 11/04/2022]
Abstract
BACKGROUND To describe the distribution pattern of the peripapillary retinal nerve fibre layer (RNFL) and major retinal vessel positions in patients with a large disc. METHODS The medical records of patients with a large disc and those of normal controls were reviewed retrospectively. Comprehensive ophthalmic examinations including Cirrus HD-optical coherence tomography (OCT) and Heidelberg Retinal Tomography III (HRT III) were performed. We divided patients into two groups (large disc group and control group) using an HRT-measured disc size of 2.5 mm2 as a reference point. We extracted RNFL thicknesses at 256 points with OCT, measured major retinal vessel positions and compared them between the two groups. RESULTS In total, 97 eyes of 97 patients were included, with 60 patients in the large disc group and 37 patients in the control group. All patients were free of any glaucomatous change. We observed nasal shifting of the second superior and inferior peaks in the large disc group compared with the controls. The superior major temporal retinal arteries in patients with large disc also showed significant nasal displacement. CONCLUSIONS We could observe nasalisation of the peripapillary RNFL and superior retinal artery in patients with a large disc. As this phenomenon may lead to false positive results in OCT-based RNFL thickness maps, results from our study may help prevent misdiagnosis of glaucoma and improve the sensitivity and specificity of glaucoma detection.
Collapse
Affiliation(s)
- Eun Jung Lee
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jong Chul Han
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Changwon Kee
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| |
Collapse
|
44
|
Han JC, Lee EJ, Kim SH, Kee C. Visual Field Progression Pattern Associated With Optic Disc Tilt Morphology in Myopic Open-Angle Glaucoma. Am J Ophthalmol 2016; 169:33-45. [PMID: 27318077 DOI: 10.1016/j.ajo.2016.06.005] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Revised: 06/02/2016] [Accepted: 06/02/2016] [Indexed: 11/18/2022]
Abstract
PURPOSE To understand the long-term characteristics of visual field (VF) progression in myopic open-angle glaucoma (OAG) according to the morphology of optic disc tilt. DESIGN Retrospective, comparative, longitudinal cohort study. METHODS Myopic OAG eyes were divided into temporally tilted disc and inferiorly tilted disc groups according to optic disc torsional degrees. Kaplan-Meier survival analysis was used to compare the survival rates between nonmyopic OAG, myopic OAG with temporally tilted disc, and myopic OAG with inferiorly tilted disc. The hazard ratio (HRs) for the associations between risk factors and progression were analyzed using Cox proportional hazards modeling. In the inferiorly tilted disc group, subgroups were classified into progression, stationary, and progression-to-stationary groups, and the clinical characteristics of VF progression were compared among the subgroups. RESULTS A total of 82 eyes in 82 nonmyopic OAG patients and 150 eyes in 150 myopic OAG patients were included. Myopic OAG with inferiorly tilted disc showed significantly more baseline and final 1-hemifield-involvement cases compared with myopic OAG with temporally tilted disc (P < .001, P < .001, respectively). The cumulative probability of progression was shown to be faster for myopic OAG with inferiorly tilted disc compared with temporally tilted disc and nonmyopic OAG (P = .002, P = .038, respectively). A larger number of medications (HR = 1.339; P = .004), earlier-stage VF defect (HR = 1.217; P < .001), and inferiorly tilted disc (HR = 2.378; P < .001) were predictive of progression. In the analysis of myopic OAG with inferiorly tilted disc, the progression group had younger age and earlier-stage VF defect at baseline compared with the stationary group (P = .01, P < .001, respectively). CONCLUSIONS It is likely that VF progression in myopic OAG is associated with the morphology of the optic disc tilt. Especially in OAG with inferiorly tilted disc, VF is likely not to progress after terminating VF progression at the region associated with optic disc tilt.
Collapse
Affiliation(s)
- Jong Chul Han
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Eun Jung Lee
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Seung Hoon Kim
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Changwon Kee
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
| |
Collapse
|
45
|
Abstract
Background To evaluate the observed prevalence and the optic nerve head (ONH) characteristics of normal tension glaucoma (NTG)-suspect eyes in branch retinal vein occulusion (BRVO) eyes in Korean population. Methods This was a retrospective observational study. We investigated 445 BRVO eyes that were diagnosed in the retina clinic of Samsung Medical Center between March 2005 and December 2011. The observed prevalence of NTG-suspect in BRVO eyes was evaluated compared to the previous population based study. In addition, NTG-suspect cases in BRVO were divided into three groups based on the characteristics of optic disc morphology. Results In 445 BRVO eyes, 30 eyes were excluded from the present study. In 415 BRVO eyes, 4.3% (18 eyes) (95% confident interval [CI], 2.4–6.3%) were diagnosed with suspect glaucoma and this is not significantly different from the result in the general Korean population (P = 0.09). We classified the NTG-suspect eyes into three groups such as disc rim notching and thinning type (Group 1; 55.6%), optic cup-sited hemorrhage type (Group 2; 16.7%) and disc rim thinning and pallor type (Group 3; 27.8%). NTG-suspect in the fellow eye were only found in group 1 (80%) and group 2 (67%), but not in group 3 (P = 0.01). Conclusions BRVO and glaucoma seem to have no common vascular pathogenesis in consideration of the prevalence of NTG-suspect in BRVO eyes compared to general Korean population.
Collapse
Affiliation(s)
- Jong Chul Han
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Doo Ri Eo
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Taek Kwan Lee
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jong Hoon Shin
- Department of Ophthalmology, Busan National University Hospital, Busan National University School of Medicine, Busan, Republic of Korea
| | - Changwon Kee
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- * E-mail:
| |
Collapse
|
46
|
Park KA, Kim YD, In Woo K, Kee C, Han JC. Optical coherence tomography measurements in compressive optic neuropathy associated with dysthyroid orbitopathy. Graefes Arch Clin Exp Ophthalmol 2016; 254:1617-1624. [DOI: 10.1007/s00417-016-3335-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Revised: 02/28/2016] [Accepted: 03/28/2016] [Indexed: 10/21/2022] Open
|
47
|
Abstract
PURPOSE To demonstrate the clinical characteristics of juvenile-onset open angle glaucoma (JOAG) and to evaluate the prognostic factors for visual field (VF) progression in eyes with JOAG. METHODS The medical records of 125 eyes of 72 patients with JOAG were analyzed retrospectively. At least four reliable VF tests were required to determine the VF progression, and the progression was defined using the modified Anderson criteria. Comparisons in clinical manifestations among groups were performed using independent t-test, and generalized estimating equations were also conducted. RESULTS The mean follow-up duration was 94.4 ± 50.5 months. Patients with JOAG showed a male preponderance (64 %), myopia (-4.99 ± 4.01 diopters) and a severe elevation of intraocular pressure (35.6 ± 10.8 mmHg). Forty-two JOAG patients (58 %) had complained of symptoms associated with vision and pain; however, one-third presented with no definite symptoms. Fifty-seven patients were diagnosed with JOAG in both eyes, and they were significantly older (p = 0.039) and had a greater family history (p = 0.035) than patients with unilateral JOAG. The progression group exhibited a significantly higher intraocular pressure at the last visit (p = 0.023) than the non-progression group. CONCLUSIONS Because patients with considerable JOAG had no definite symptoms, periodic eye examinations are needed. To prevent the VF's progression, JOAG patients may require more careful management of intraocular pressure.
Collapse
Affiliation(s)
- Youngkyo Kwun
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Eun Jung Lee
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jong Chul Han
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Changwon Kee
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| |
Collapse
|
48
|
Affiliation(s)
- Wool Suh
- Department of Ophthalmology; Hallym University Dongtan Sacred Heart Hospital; Hallym University College of Medicine; Hwaseong Korea
| | - Changwon Kee
- Department of Ophthalmology; Samsung Medical Center; Sungkyunkwan University School of Medicine; Seoul Korea
| |
Collapse
|
49
|
Han JC, Cho SH, Sohn DY, Kee C. The Characteristics of Lamina Cribrosa Defects in Myopic Eyes With and Without Open-Angle Glaucoma. ACTA ACUST UNITED AC 2016; 57:486-94. [DOI: 10.1167/iovs.15-17722] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
50
|
Suh W, Won HH, Kee C. The association of single nucleotide polymorphisms in the connective tissue growth factor gene with pseudoexfoliation syndrome/glaucoma. Acta Ophthalmol 2015; 93:e682-3. [PMID: 25847507 DOI: 10.1111/aos.12719] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Wool Suh
- Department of Ophthalmology; Hallym University Dongtan Sacred Heart Hospital; Hwaseong Korea
| | - Hong-Hee Won
- Samsung Biomedical Research Institute; Samsung Medical Center; Seoul Korea
| | - Changwon Kee
- Department of Ophthalmology; Samsung Medical Center; Sungkyunkwan University School of Medicine; Seoul Korea
| |
Collapse
|