Diagnostic Ability of Macular Ganglion Cell Layer Measurements in Glaucoma Using Swept Source Optical Coherence Tomography

PURPOSE: To evaluate diagnostic ability of macular ganglion cell complex (mGCC), macular ganglion cell inner plexiform layer (mGCIPL) measurements in glaucoma using swept source deep range imaging optical coherence tomography (DRI OCT-1, Topcon Co., Tokyo, Japan). METHODS: From August of 2014 to July of 2015, 109 eyes of 109 subjects were assessed for the average thickness and sectional thickness of both mGCC and mGCIPL to determine whether there exists any significant difference among advanced stage glaucoma group, early stage glaucoma group and normal group in Swept source OCT. Comparisons were also made between the above measurements and circumpapillary retinal nerve fiber layer (cpRNFL) thickness measurements in their diagnostic accuracy, sensitivity, and specificity. RESULTS: The diagnostic ability of mGCC based-mean thickness value (area under the curve [AUC] = 0.78/0.99) in detecting early stage glaucoma group as well as advanced stage group was not significantly different from that of cpRNFL thickness measurement. However, there was a significant difference in thickness between mGCIPL (AUC = 0.70) and cpRNFL in early stage glaucoma groups (p = 0.018). The sensitivities and specificities of mGCC were 0.95/0.97, and those of mGCIPL were 0.92/0.97, respectively. CONCLUSIONS: The two swept source OCT based methods measuring retinal ganglion cell layer thickness appeared to have a good diagnostic accuracy, high sensitivity and specificity in detecting glaucomatous eyes. Nevertheless, of the two methods, mGCC thickness measurement was more efficient in detecting early glaucomatous changes.

Spontaneous Separation of Idiopathic Epiretinal Membrane in an Elderly Patient

PURPOSE: To report a case of spontaneous separation of idiopathic epiretinal membrane in an elderly patient. CASE SUMMARY: A 61-year-old male presented with decreased visual acuity in the right eye. He was diagnosed with idiopathic epiretinal membrane (ERM) in the right eye and posterior vitreous detachment (PVD) in both eyes. The patient underwent pars plana vitrectomy and ERM removal in the right eye. At postoperative 1 year, his vision in the right eye had improved, but idiopathic ERM developed in the left eye and visual acuity in the left eye decreased. Three years later, the ERM in the left eye resolved spontaneously and his vision increased. CONCLUSIONS: Herein we present a rare case of spontaneous separation of idiopathic ERM associated with a pre-existing PVD in an elderly patient and reviewed the available literatures regarding the possible mechanisms for the spontaneous separation of ERM in the presence of a pre-existing PVD.

ON and OFF Responses of the Electroretinogram in Patients with Glaucoma

PURPOSE: To investigate whether there is a difference in ON- and OFF-responses of the photopic electroretinogram (ERG) in glaucomatous eyes. METHODS: Photopic ERG and optical coherence tomography were performed in 15 normal, 13 glaucoma suspect, and 22 glaucoma subjects. Amplitudes and implicit times for a, b, d, i, photopic negative response (PhNR), and retinal nerve fiber layer thickness were compared among the three groups. RESULTS: The PhNROFF amplitude (microV) was 19.05 +/- 11.41 in the glaucoma group, 14.24 +/- 10.37 in the glaucoma suspect group, and 2.69 +/- 12.16 in the normal group, demonstrating a significant difference among the three groups (p < 0.01). The PhNRON amplitude (microV) was 20.15 +/- 13.99 in the glaucoma group, 31.49 +/- 17.09 in the glaucoma suspect group, and 37.59 +/- 9.53 in the normal group, a significant difference (p < 0.01). However, there was no significant difference between the three groups. The ON-OFF response PhNR amplitude was correlated with retinal nerve fiber thickness (r = 0.481, r = -0.480, respectively), and areas under the receiver operating characteristic curve were 0.782, and 0.718, respectively. CONCLUSIONS: There is a potential role for the ON-OFF response PhNR in early detection of glaucomatous damage.

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.

Effect of Refractive Error on the Multifocal Electroretinogram

PURPOSE: To evaluate the influence of refractive blur on the results of mfERG. METHODS: mfERG was performed on 10 healthy volunteers with a refractive error within +/- 1 diopter. The central 30 degrees of the ocular fundus were stimulated by an array of 103 hexagonal elements, for four minutes, using VERISTM. To change the refractive status, 6-cm diameter corrective lens, of -6, -4, -2, plano, +2, +4, and +6 diopters, were placed in front of the eyes, and the examination distance adjusted to compensate retinal image size changes due to corrective lens. The mfERG responses were grouped by 6 concentric rings, and then averaged. For each ring, the latencies and amplitudes of the N1, P1 and N2 were analyzed. The 6 rings were divided into the central (ring 1, 2) and peripheral (ring 3~6) retina, and the latencies and amplitudes of the N1, P1 and N2 were then also analyzed. RESULTS: Refractive blur can affect the results of the mfERG. Latency delay was more common at the peripheral than central retina, but had no statistically significant correlations with the refractive power increase. CONCLUSIONS: When the viewing distance was adjusted to create a constant retinal image size, the influence of refractive blur may cause some changes in the mfERG results. Therefore, when evaluating the results of an mfERG, the effects of the refractive error should be borne in mind.

A Study of Prediction of Postoperative Visual Acuity using Simple Electroretinogram Before Cataract Extraction

PURPOSE: To evaluate the usefulness of the electroretinogram using EMS (Electrophysiology Modular System; TMS, Luneberg, Germany), a simpler method compared with standard ERG as a preoperative evaluation of cataract. METHOD: Forty-six eyes of 25 patients who had undergone cataract surgery were included. Scotopic, photopic and 30 Hz flicker response were examined with EMS. On the basis of fundus finding, the subjects were classified into two groups: Group 1 (cataract with normal fundus) and group 2 (cataract with abnormal fundus). On the basis of lens opacity, group 1 was subclassified into the following three sub-groups: mild, moderate, and severe opacity. We analyzed the differences of the ERG values of these three sub-groups. And also we analyzed the difference of the ERG values of two groups and postoperative visual acuity. RESULTS: In group 1, the ERG responses were generally reduced as the lens opacity increased and the photopic a wave amplitude was significantly reduced especially when the opacity was severe. But there was no significant difference between the lens opacity and the prognosis of postoperative visual acuity. In group 2, scotopic b wave and photopic a, b wave amplitude were significantly reduced and the prognosis of postoperative visual acuity was poor (P>0.05). Conclusion: Our results show that the ERG would be a clinically significant test in evaluating the function of the retina and detecting the retinal lesions, and it can be used in the prediction of the prognosis of postoperative visual acuity. And the EMS shows similar results comparable to the previous reports, so it can be used clinically in more simple manners.

Effect of Beta Blocker on MUC2, MUC5AC Expression of the Cultured Human Conjunctival Cell

PURPOSE: To evaluate the characteristics of MUC2, MUC5AC expression and the effect of beta-blocker on MUC2, MUC5AC expression in cultured human conjunctival cell. METHODS: Human conjunctival cell was cultured. After obtaining the monoclonality of conjunctival cells, secondary culture was done. Cultured conjunctival cell was treated with 0.2 nM timolol. Specimen was collected in 1, 3, 5, 10 days after the confluence of cultured conjunctival cells. To determine the effect of beta blocker, Periodic acid-Schiff (PAS) staining, immunohistochemistry, RT-PCR, and flowcytometry were performed. RESULTS: Goblet cell was found in cultures of conjunctival cell. MUC5AC was detected in RT-PCR, immunohistochemistry, and flowcytometry, but MUC2 was detected only in flowcytometry. Beta blocker didn't have significant effects on expression of MUC2 and MUC5AC in flowcytometry. CONCLUSIONS: MUC2 and MUC5AC were detected in cultured conjunctival cell. Beta blocker may not affect goblet cell. The other factor will be related to goblet cell suppressing the mucin in long standing antiglaucomatous medication.

A Study of Point Mutations of Human Insulin-like Growth Factor / 대한내분비학회지

Background: FSS is a normal variants in Korea, but some of them had defect of noctumal GH pulse i.e. neurosecretory dysfunction. Although Korean children had strikingly got higher final height in the last decade. We are interested in what kinds of differences were existed in FSS group. Previous study showed theres no difference of GH related biochemical markers between normal and FSS group, like IGF-I, IGFBP-3 etc. We analyzed molecular difference in FSS group. Methods: We screened 23 FSS patients and 16 normal controls to IGF-I gene prornoter region with PCR-SSCP (single strand conformation polymorphisrn) method and sequenced 1 FSS patients who had abnormal SSCP band. Results: We found 1 out of 23 patients with abnormal SSCP band (none for 16 controls). Their IGF-I promoter gene were sequenced with modified Maxam-Gilbert method. One subject had 2 point mutations(+8 and +74). Conclusion: We found point mutations of IGF-I promoter in FSS group, This position was regarded as HNF(hepatic nuclear factor)-3 binding sites. We needed more study for the detection of its biological function according io linear growth with in vivo and in vitro study.