Human Vitreous Proteomes in Idiopathic Macular Hole

PURPOSE: To investigate the vitreous proteomic profiles of macular hole (MH) patients compared to donor eyes and epiretinal membrane (ERM) patients. METHODS: Ten donor eyes, 25 MH patients (15 MH without posterior vitreous detachment (PVD) and 10 MH with PVD), 10 ERM patients and 4 patients with vitreomacular traction syndrome (VMTS) were enrolled in the present study. The undiluted vitreous samples were obtained from all eyes. Proteins were identified using the micro-RPLC/MS/MS technique and using mass spectrometric data analysis from the IPI database. Proteins were searched for the function, subcellular location and tissue specificity using the Uniprot database. RESULTS: The mean vitreous protein concentrations were the highest (p < 0.01) in MH patients without PVD. There were no qualitative changes according to the age of donor eyes. However, the authors newly-identified 12 proteins (i.e. vasorin) in donor eyes. Ten out of 136 proteins (7.3%) (i.e. retinoschisin) were exclusively detected in the MH samples. S100A8 was exclusively detected in eyes without PVD, whereas CD59 was exclusively detected in eyes with PVD. CONCLUSIONS: The results suggest there is a small difference in the vitreous proteomic profiles in MH patients compared to donor eyes or ERM patients, and that the expression of vitreous proteins is closely associated with the presence of PVD.

The Results of Nation-Wide Registry of Age-related Macular Degeneration in Korea

PURPOSE: To evaluate the incidence and clinical features of age-related macular degeneration (AMD) in Korea. METHODS: Web-based (www.armd-nova.or.kr) registration was conducted for AMD patients aged 50 or more who were newly diagnosed by retinal specialists in Korea from August 20, 2005 to August 20, 2006. Patient data including ophthalmologic examination, fundus photography, fluorescein angiogram and/or indocyanin green angiogram (ICG), past medical history, behavioral habit, combined systemic diseases were up-loaded. RESULTS: Among finally enrolled 1,141 newly diagnosed AMD patients, 690 patients (60.5%) were male and 451 patients (39.5%) were female. The average age of AMD patients was 69.7+/-8.0. Early AMD was observed in 190 patients and 951 patients had late AMD. Classic choroidal neovascular membrane (CNVM) was observed in 18.6% of exudative AMD patients and 63.4 % had occult CNVM. Subfoveal CNVM was observed in 80.4% of the patients with CNVM. Among the 580 exudative AMD eyes that performed indocyanin green angiography (ICG), 184 eyes (31.7%) had polypoidal choroidal vasculopathy (PCV) and 36 eyes (6.2%) showed retinal angiomatous proliferation (RAP). Age, male gender, smoking, diabetes and hypertension significantly increased the risk of the AMD among Koreans. CONCLUSIONS: Because of the low rate of participation by retinal specialists, definite incidence of AMD was not obtainable. However, the estimated 1-year AMD incidence in the Pusan area of Korea is at least 0.4%. In contrast to Western people, 31.7% of exudative AMD cases were revealed to be PCV and 6.2% were revealed to be RAP. This discrepancy between ethnic groups should be considered in the diagnosis and treatment modality selection of Korean AMD patients.

Tuberculous Uveitis in a Hemodialysis Patient / 대한신장학회지

Tuberculous uveitis is a rare manifestation of tuberculosis infection. Although early diagnosis is important to saving the sight of patients, it is difficult. In dialysis patient, the diagnosis of tuberculosis is often delayed because of non-specific symptoms and extrapulmonary involvements. We report a case involving a 37-year-old man receiving hemodialysis who was presented with persistent fever and left- sided blurred vision. At ophthalmic examination, active papillitis, vitritis, and peripapillary retinal detachment were observed. Neck computed tomography showed multiple necrotic lymphadenopathies (LAPs) in right lateral neck, which was proven as tuberculous lymphadenitis on histological examination. After anti-tuberculosis therapy, fever was subsided and LAPs were improved. Visual acuity was also improved.

Clinical Results between Scleral Buckling and Vitrectomy in Pseudophakic Retinal Detachment with Intact Posterior Capsule

PURPOSE: To compare the clinical outcomes between scleral buckling and vitrectomy in the primary management of pseudophakic retinal detachment with an intact posterior capsule. METHODS: The medical records of 63 eyes that underwent scleral buckling (36 eyes) or vitrectomy (27 eyes) as a primary operation of uncomplicated pseudophakic retinal detachment with intact posterior capsules with a follow-up of more than one year were retrospectively reviewed from 2000 to 2005. We compared the clinical outcomes using anatomical and functional success rates at postoperative one year. Anatomical success was defined by a reattachment rate and functional success was measured by a change of more than 0.3 logMAR. RESULTS: Anatomical success rates were 86% in the scleral buckling and 82% in the vitrectomy, respectively (p=0.837). Functional success rates were 81% in the scleral buckling and 70% in the vitrectomy, respectively (p=0.065). There were no significant differences of anatomical and functional success rates according to each surgical procedure. CONCLUSIONS: Either scleral buckling or vitrectomy may be chosen as a primary operation in the management of pseudophakic retinal detachment with intact posterior capsule.

Clinical Evaluation of Patients with Nonproliferative Diabetic Retinopathy Following Medication of Anthocyanoside: Multicenter Study

PURPOSE: To prospectively investigate the change of clinical manifestations after 1 year of administration of anthocyanoside (Tagen-F(R)) to patients with NPDR-associated macular edema. METHODS: One hundred seventy-five eyes in 88 patients were enrolled in this study, at 5 centers, from March, 2005 to October, 2005. Patients took 3 capsules of Vaccinium myrtillus extract (170 mg/capsule, Tagen-F(R), Kukje pharmaceutical) per day. The primary endpoints were corrected visual acuity and contrast sensitivity which were checked at 2 months following the beginning of treatment [East 1]. The secondary endpoints were the number of hard exudates, microaneurysms, leaking points and the changes of foveal thickness. These were examined at the beginning of, 6 months after, and 12 months after treatment. RESULTS: Corrected visual acuity showed no significant changes during 12 months. Contrast sensitivity improved gradually, especially in 12, 16 cycles per degree [East 2]. There was no statistically significant changes in the numbers of hard exudates, microaneurysms, and leaking points. Foveal thickness measured by OCT was maintained and there was no aggravation of macular edema. CONCLUSIONS: There was marked improvement of contrast sensitivity in patients with NPDR after 1 year of administration of anthocyanoside (Tagen-F(R)), and it might contribute to the quality of vision and the satisfaction of patients. Visual acuity and macular edema were maintained without aggravation.

PAX2 Gene Assay in a Family of Ocular Coloboma with Bilateral Renal Hypoplasia / 대한신장학회지

We report one family with bilateral renal hypoplasia and ocular coloboma in two consecutive generations. Ophthalmological examination revealed optic disc coloboma and decreased visual acuity. Fragments spanning exon 1-12 of the PAX2 gene were amplified from genomic DNA using PCR primers. The PCR products were purified and directly sequenced. No definite mutation was detected in the PAX2 genes in these patients, but two coding region single nucleotide polymorphisms were identified. This result suggests that the optic disc coloboma with bilateral renal hypoplasia might be genetically heterogenous or other genes could be responsible.

The Changes of Aqueous Vasopermeability Factors After Intravitreal Triamcinolone Injection for Branch Retinal Vein Occlusion

PURPOSE: To investigate the changes of aqueous vascular endothelial growth factor (VEGF) and interleukin (IL)-6 in patients with acute macular edema secondary to recent-onset branch retinal vein occlusion (BRVO) after a single intravitreal injection of triamcinolone acetonide (IVTA) METHODS: Aqueous and plasma levels of VEGF and IL-6 were measured by ELISA in ten controls and thirty patients at the time of IVTA and 3 months afterward. We compared the aqueous levels of VEGF and IL-6 and the clinical course between responders and non-responders. RESULTS: The aqueous levels of VEGF and IL-6 were significantly higher in non-responders than in responders at baseline measurements (495+/-259 pg/ml vs. 223+/-110 pg/ml, P<.001; 36+/-32 pg/ml vs. 16+/-19 pg/ml, P=.037, respectively). The aqueous levels of VEGF were still higher in non-responders (303+/-75 pg/ml) 3 months after IVTA, while the aqueous levels of VEGF in responders returned to normal (77+/-23 pg/ml, P<.001). The aqueous levels of IL-6 normalized in all patients 3 months after IVTA. In non-responders, central foveal thickness was significantly higher, and foveal ischemia and a wide non-perfused area were more common. CONCLUSIONS: Non-IL6-dependent VEGF may contribute to persistent or recurrent ischemic macular edema associated with BRVO after IVTA.

Photodynamic Therapy for Choroidal Neovascularization Secondary to Age-Related Macular Degeneration

PURPOSE: To investigate the effects of repeated photodynamic therapy (PDT) for subfoveal choroidal neovascularization secondary to age-related macular degeneration (AMD) in Korean patients. METHODS: Clinical data of patients who were treated with repeated (3 times or more) PDT for subfoveal choroidal neovascularization secondary to AMD and followed up for more than 6 months were collected from 17 hospitals around the country. Visual outcomes at 12 and 24 months, follow-up were compared between subtypes of choroidal neovascularization. The factors related to final visual prognosis and PDT-related adverse effects were evaluated. RESULTS: 244 patients (244 eyes) were recruited (male: 60%, age: 67.7+/-9.1 years). The portion of patients with predominantly classic, minimally classic, and occult without classic choroidal neovascularization was 57%, 13%, and 24%, respectively and that of patients with visual improvements or less than moderate visual loss at 24 months follow-up were 28%, 38%, 30% and 47%, 56%, and 65%, respectively. Baseline visual acuity and age were significantly related to the final visual prognosis (p<0.05). PDT-related adverse events developed in 15 (6.1%) patients, but most were mild and transient. CONCLUSIONS: Repeated PDT for subfoveal choroidal neovascularization secondary to AMD has effects comparable to those of previous prospective, controlled trials without any significant safety concerns in Korea.

Early versus Late Intravitreal Triamcinolone Acetonide for Macular Edema associated with Branch Retinal Vein Occlusion

PURPOSE: To compare the effect of early versus late intravitreal injection of triamcinolone in patients with macular edema due to branch retinal vein occlusion (BRVO). METHODS: Twenty eyes of 20 patients with macular edema from BRVO, including 10 with duration after onset of 3 months, were treated using a single intravitreal triamcinolone injection (4 mg/0.1 ml). Best-corrected visual acuity and foveal thickness by optical coherence tomography were measured 1, 3, and 6 months post-injection. RESULTS: In patients that received treatment after a disease duration of 3 months, improvements in visual acuity and foveal thickness, though apparent at 1 month, were not maintained at 3 and 6 months post-triamcinolone. CONCLUSIONS: Intravitreal triamcinolone is more effective in patients with BRVO who are treated earlier.

Isolated Cilioretinal Artery Occlusion in Pseudoexfoliation Syndrome: A Case Report

PURPOSE: To report a case of isolated cilioretinal artery occlusion associated with pseudoexfoliation syndrome. METHODS: A 66-year-old female presented with acute vision loss of the right eye. Three months prior, she had been diagnosed as having pseudoexfoliation glaucoma of both eyes, and the intraocular pressure of both eyes had been well-controlled with topical medication. RESULTS: The presenting visual acuity in her right eye was 20/100. Fundus examinations showed sectoral retinal whitening on superior macula. Fluorescein angiography revealed delayed filling of the cilioretinal artery, consistent with cilioretinal artery occlusion. No significant findings were identified by carotid doppler examination or echocardiography. After 8 weeks, retinal changes were completely resolved with improvement of her right vision to 20/25. CONCLUSIONS: Isolated cilioretinal artery occlusion may develop as an intraocular manifestation of pseudoexfoliation syndrome.

Phenotypic Characteristics of CD8(bright) T Cells in Behcet's Uveitis

PURPOSE: To determine the phenotypic characteristics of peripheral CD8(bright) T cells. METHODS: Forty patients with Behcet's disease (BD) with uveitis (active: 20; inactive: 20) and 20 healthy controls were recruited in this study. Phenotypic analysis of fresh PBMCs was performed using anti-CD8 mAb and anti-CD56 mAb in conjunction with a three- or four-color immunofluorescence tests for the expression levels of the following molecules: CD11b, CD27, CD45RA, CD45RO, CD62L, CD94, NKG2D, and HLA-DR. RESULTS: CD27 and CD62L were down-regulated on peripheral CD8(bright) T cells in patients with active Behcet's uveitis in contrast to the up-regulation of CD11b and HLA-DR. These phenotypic natures were remarkable in the CD56+ subsets. CD45RA(dim)CD45RO- phenotypes were expanded in peripheral CD8(bright)CD56+ T cells according to the disease activity. Interestingly, in active Behcet's uveitis, CD94 was up-regulated on peripheral CD8(bright)CD56+ T cells in BD in contrast to the down-regulation of NKG2D compared with the normal controls. CONCLUSIONS: CD8(bright)CD56+ T cells are characterized by activated effector phenotypes with functional NK receptors and they may play immunopathogenic roles in Behcet's uveitis.

Changes of Natural Killer T Cells in Behcet's Uveitis

PURPOSE: To determine the phenotypic and functional changes of circulating CD56+ T cells in ocular Behcet's disease (BD) according to the intraocular inflammatory activity METHODS: Forty patients with BD were divided into two groups according to the inflammatory activity (active; 20, inactive; 20). Twenty patients with acute anterior uveitis and 20 healthy subjects were used as controls. Populations of T lymphocytes subsets in the peripheral blood were determined by flow cytometric analysis, using monoclonal antibodies for CD3, CD4, CD8, CD56, pan alpha beta TCR, pan gamma delta TCR, and V alpha24. The frequencies of intracellular cytokine (IFN-gamma and IL-4) were measured in circulating T cells. RESULTS: CD56 expression was significantly upregulated on CD3+ T cells in active BD compared with those of inactive BD which showed similar data as acute anterior uveitis and healthy subjects (p<0.05). This upregulated expression of CD56 was prominent in CD8(high) T and gamma delta T subsets. The frequencies of IFN-gamma production on circulating T cells were increased in active BD while the frequencies of IL-4 producing cells were decreased, and these trends were prominent in the subsets of CD56+ T cells. CONCLUSIONS: Circulating T cells with CD56 expression are phenotypically and functionally upregulated according to the inflammatory activity of BD. This suggests that CD56+ T cells may play a pathogenic role in maintenance of ocular inflammation in BD.

Natural History and Visual Prognosis of Idiopathic Choroidal Neovascularization

PURPOSE: To examine long-term natural history and visual prognosis of idiopathic subfoveal or juxtafoveal choroidal neovascularization (CNV). METHODS: A retrospective review of fourteen eyes diagnosed as idiopathic CNV at Seoul National University Hospital was done. Patients under 40 years old whose follow-up period of more than 36 months without treatments were included. Best corrected visual acuity (BCVA) with biomicroscopic and fluorescein angiographic examinations was measured at the initial and final visit. Clinical factors correlated with final visual acuity were analyzed. RESULTS: Mean age was 34 years ranged from 20 to 40 years and male to female ratio was 4 to 10. Patients were followed for a median of 45 months (range, 36-60 months). On initial examinations, BCVA in 14 eyes was over 0.15 with eight eyes under 0.5 and with six eyes over 0.6. Subfoveal CNV were in 12 eyes and juxtafoveal were in 2. All had the size smaller than 1DD (disc diameter). On the final visit, BCVA in 14 eyes was over 0.2 with three eyes under 0.5 and 11 eyes more than 0.6. Five eyes (36%) retained visual acuity and 8 eyes (57%) improved more than two lines. BCVA in one eye deteriorated two lines. In 6 eyes (42%), CNV was found to be regressed after the follow-up period. Initial visual acuity was significantly correlated with final visual acuity (p=0.013, Pearson correlation test). CONCLUSIONS: Idiopathic CNV has favorable visual prognosis and a tendency of spontaneous involution.

Correlation Between Disc Hemorrhage and Peripapillary Atrophy in Glaucoma Patients with Unilateral Disc Hemorrhage

PURPOSE: To investigate the correlation of peripapillary atrophy with disc hemorrhage in glaucoma patients with a unilateral disc hemorrhage METHODS: A retrospective review was performed on the medical records of 36 glaucoma patients (7 with primary open-angle glaucoma and 29 with normal-tension glaucoma) with a unilateral disc hemorrhage during a mean follow-up period of 25 months. Topographic measurements were performed with Heidelberg Retina Tomograph (HRT) within three months of detection of a disc hemorrhage. The parameters of zone beta of peripapillary atrophy were analyzed by the atrophy zone analysis program and compared with the fellow eyes. RESULTS: The area, angular and radial extent of zone beta, and ratio of zone beta area to disc area were significantly greater in the hemorrhagic eyes than in the contralateral eyes. The difference of refractive error, intraocular pressure, MD and CPSD of visual fields was not found to be significant between both eyes. CONCLUSIONS: The area and extent of peripapillary atrophy was significantly greater in the eyes with disc hemorrhage compared to the contralateral control eyes. This study suggested quantitatively that the peripapillary atrophy is associated closely with disc hemorrhage in glaucoma patients.

Efficacy of Occlusion Therapy in Amblyopia Patients Older than 9 Years of Age

PURPOSE: To evaluate the efficacy of occlusion therapy in amblyopia patients older than 9 years of age. METHODS: A retrospective study on 16 amblyopes older than 9 years was performed to evaluate initial best-corrected visual acuity, final best-corrected visual acuity, the type of amblyopia, and compliance. RESULTS: The average age at initiation of amblyopia therapy was 10.5 years and the average follow-up 24 months. Anisometropia was present in 11 patients, strabismus in 2, and both anisometropia and strabismus in 3 patients. The initial visual acuity was 0.2 or less in three, 0.3 to 0.5 in seven, 0.6 to 0.7 in six patients. The refractive errors of amblyopic eye were myopic in seven, hyperopic in seven and astigmatism in two patients. The amount of anisometropia was 2.56 diopters. Strabismus was exotropia in 5 patients. Initial therapy consisted of optical correction for the amblyopic eye and full-time occlusion for the nonamblyopic eye in 14, and part-time occlusion in two patients. Maintenance therapy of part-time occlusion with a patch in 11 patients and with Min's glasses in 3 patients followed improvement of visual acuity. Fifteen out of 16 patients improved their visual acuity over 3 lines of visual acuity and one remaining patient showed poor compliance. Final visual acuities were 0.7 or better in 14 patients, and 0.5 and 0.4 in each remained patient. CONCLUSIONS: Given compliance, occlusion therapy for anisometropic and strabismic amblyopia can be successful even if started after 9 years of age.