Preprocedural determination of an occlusion pathomechanism in endovascular treatment of acute stroke: a machine learning-based decision.

OBJECTIVE: To evaluate whether an occlusion pathomechanism can be accurately determined by common preprocedural findings through a machine learning-based prediction model (ML-PM). METHODS: A total of 476 patients with acute stroke who underwent endovascular treatment were retrospectively included to derive an ML-PM. For external validation, 152 patients from another tertiary stroke center were additionally included. An ML algorithm was trained to classify an occlusion pathomechanism into embolic or intracranial atherosclerosis. Various common preprocedural findings were entered into the model. Model performance was evaluated based on accuracy and area under the receiver operating characteristic curve (AUC). For practical utility, a decision flowchart was devised from an ML-PM with a few key preprocedural findings. Accuracy of the decision flowchart was validated internally and externally. RESULTS: An ML-PM could determine an occlusion pathomechanism with an accuracy of 96.9% (AUC=0.95). In the model, CT angiography-determined occlusion type, atrial fibrillation, hyperdense artery sign, and occlusion location were top-ranked contributors. With these four findings only, an ML-PM had an accuracy of 93.8% (AUC=0.92). With a decision flowchart, an occlusion pathomechanism could be determined with an accuracy of 91.2% for the study cohort and 94.7% for the external validation cohort. The decision flowchart was more accurate than single preprocedural findings for determining an occlusion pathomechanism. CONCLUSIONS: An ML-PM could accurately determine an occlusion pathomechanism with common preprocedural findings. A decision flowchart consisting of the four most influential findings was clinically applicable and superior to single common preprocedural findings for determining an occlusion pathomechanism.

Coincidental Nasopharyngeal Carcinoma and Ventral Foramen Magnum Meningioma: Case Report and Review of the Literature.

Multiple primary tumors at adjacent site are rare. We report a rare case of coincidentally found nasopharyngeal cancer and ventral foramen magnum meningioma. The 68-year-old male patient presented with a year history of ataxia. Radiological examination revealed lesions in the nasopharyngeal space and ventral foramen magnum. A needle aspiration biopsy for nasopharyngeal space and surgical removal for foramen magnum lesion were performed. The pathological diagnoses were nasopharyngeal cancer and meningioma, respectively. The concomitant occurrence of these two tumors is very rare and there is no known association between these two tumors. We report a case of ventral foramen magnum meningioma simultaneously present with nasopharyngeal carcinoma.

Hyperattenuations on flat-panel computed tomography after successful recanalization of mechanical thrombectomy for anterior circulation occlusion.

BACKGROUND: To evaluate intraparenchymal hyperattenuation (IPH) on flat-panel computed tomography (FPCT) findings and their clinical usefulness for predicting prognosis after successful mechanical thrombectomy (MT) for acute occlusion of anterior circulation. METHODS: A retrospective review was conducted for 158 consecutive patients undergoing mechanical thrombectomy during the last six years. After excluding those with posterior circulation occlusion or incomplete recanalization and those without FPCT, 82 patients were finally included. Immediate post-procedural IPH on FPCT was categorized into four patterns (none, striatal, cortical, or combined pattern). Follow-up magnetic resonance images or CT scans after 48 hours from MT were analyzed according to FPCT findings. The existence of hemorrhagic transformation, intracerebral hemorrhage, and brain swelling was evaluated. Functional clinical outcomes were accessed with post-procedural 3-month modified Rankin scales (mRS). RESULTS: Of 82 patients, 34 patients were found to have IPH (16 with a striatal pattern, 8 with a cortical pattern, and 10 with a combined pattern). Hemorrhagic complication (P<0.001), brain swelling (P<0.001), and poor mRS scores (P=0.042) showed significant differences according to IPH patterns. Multivariate logistic regression analysis revealed that the presence of a striatal pattern (OR: 13.26, P<0.001), cortical pattern (OR: 11.61, P=0.009), and combined pattern (OR: 45.34, P<0.001) independently predicted hemorrhagic complications. The location of the occlusion (OR: 4.13, P=0.034), cortical pattern (OR: 5.94, P=0.039), and combined pattern (OR: 39.85, P=0.001) predicted brain swelling. Age (OR: 1.07, P=0.006) and the presence of a combined pattern (OR: 10.58, P=0.046) predicted poor clinical outcomes. CONCLUSIONS: FPCT is a rapid and effective tool for a prompt follow-up just after MT to predict prognosis. Those with striatal patterns showed relatively good clinical outcomes despite significant hemorrhage. Cortical IPH patterns independently predicted a high rate of post-procedural hemorrhage or brain swelling. Combined pattern is a strong predictor for both radiologic and poor clinical outcomes.

The increased amount of coffee consumption lowers the incidence of fatty liver disease in Korean men.

BACKGROUND AND AIMS: Coffee is known to have a beneficial effect on various liver diseases. The aim of this retrospective longitudinal study was to investigate an association between the amount of coffee consumption and the incidence of fatty liver disease in Korean adults. METHODS AND RESULTS: Data from a total of 91,436 male and female subjects with the mean follow-up period of 2.8 years were analyzed. The incidence of fatty liver was not associated with the amount of coffee consumption at baseline, but it was associated with the change in the amount of coffee consumption at the follow-up period. Multiple linear regression analyses showed that hazard ratios for incidence of fatty liver disease were significantly low in "increase" group comparing with "no change" group in fully adjusted model. When a subgroup analysis by gender was conducted, similar significant results were observed in male subjects, but not in females. CONCLUSIONS: The increment in the amount of coffee consumption is associated with the lower incidence of fatty liver in Korean men and suggests that increasing the coffee consumption may have a protective effect on fatty liver.

Comparison of Embolic Protection with Proximal and Distal Protection Devices: Periprocedural Complications, Clinical Outcomes, and Cerebral Embolic Lesions on Diffusion-Weighted Magnetic Resonance Imaging.

OBJECTIVE: Two main types of embolic protection devices have been used during carotid artery stenting (CAS): distal protection devices (DPDs) and proximal protection devices (PPDs). We compared the complications, clinical outcomes, and new ischemic lesions on diffusion-weighted magnetic resonance imaging (DWI) studies between patients who had undergone CAS using a DPD or PPD. METHODS: We performed a retrospective review of the data from patients who had undergone CAS from March 2010 to January 2016. The periprocedural and 30-day adverse events and new ischemic lesions on DWI studies after CAS were evaluated. RESULTS: CAS was performed in 103 patients (DPD, n = 60; PPD, n = 43). The number of patients with new ischemic lesions was greater in the DPD than in the PPD group (78% vs. 56%; P = 0.014). Most lesions (>90%) were tiny (≤3 mm), and the average number of new tiny lesions per patient was significantly greater in the DPD than in the PPD group (mean, 9.6 vs. 4.0; P = 0.008). No significant differences in the periprocedural or 30-day adverse rates were noted between the 2 groups. Intolerance during the procedure occurred in 5 patients (12%) in the PPD group, 4 of whom had poor collateral circulation. CONCLUSIONS: The number of new ischemic lesions per patient and the incidence of ischemic lesions found on DWI were significantly greater in the DPD than in the PPD group. The lack of differences in the periprocedural and 30-day adverse rates between the 2 groups suggests that cerebral microemboli might not be associated with the clinical outcomes. For patients with poor collateral status, DPDs should be used preferentially to avoid the neurologic compromise associated with PPDs.

Associations Among Pregnancy, Parturition, and Open-angle Glaucoma: Korea National Health and Nutrition Examination Survey 2010 to 2011.

PURPOSE: The purpose of this study was to investigate the association between factors associated with parturition and open-angle glaucoma (OAG) in Korean females. METHODS: A population-based, cross-sectional survey was performed from the Korean National Health and Nutrition Examination Survey from 2010 to 2011 and enrolled postmenopausal female participants (n=1798). We obtained information on demographics, comorbidities, and health-related behaviors and performed comprehensive ophthalmic examinations. Multivariate regression analysis was used to assess the correlation between pregnancy and delivery and the prevalence of OAG in all enrolled subjects. RESULTS: The prevalence of OAG among study participants was 6.42%. There was a significant difference in the number of deliveries and age at first delivery between the OAG group and the nonglaucoma group. In multiple linear regression models adjusted for age, hypertension, and intraocular pressure only pregnancy 1 was associated with higher risk of OAG compared with pregnancy 2 (P=0.023). Subjects who had 3 or 4 deliveries were at higher risk of OAG compared with subjects with 2 deliveries (P=0.027). An age at first delivery of 16 to 20 years or 21 to 23 years was associated with increased OAG risk compared with the reference group (P<0.05). CONCLUSIONS: A history of three or more deliveries and an age at first delivery younger than 23 years were associated with increased risk of OAG. These results suggest that changes or events during the period from pregnancy to delivery affect the development of glaucoma.

Association Between Optic Disc Hemorrhage and Renal Function in South Korea.

PURPOSE: The purpose of this article is to investigate the relationship between renal function and disc hemorrhage (DH). MATERIALS AND METHODS: This retrospective cross-sectional survey was conducted at Kangbuk Samsung Hospital Health Screening Center between August 2012 and July 2013, and a total of 168,044 participants at least 20 years of age who voluntarily visited the health screening center for systemic and ophthalmologic examinations, including fundus photography, were enrolled. All subjects underwent a physical examination and provided samples for laboratory analysis. Digital fundus photographs of both eyes were taken and reviewed. Estimated glomerular filtration rate (eGFR) was calculated from serum creatinine concentration using the Modification of Diet in Renal Disease (MDRD) formula and Cockcroft-Gault (CG) formula. Subjects were stratified by eGFR into quartiles. RESULTS: Among participants, 220 (0.1%) showed DH, and 2376 (1.6%) showed glaucomatous retinal nerve fiber layer defects. The DH group showed higher creatinine and lower eGFR than the non-DH group. A significant trend was observed among higher creatinine, decreased eGFR as obtained by the MDRD and CG formulas, and the prevalence of DH (P for trend ≤0.003, logistic regression analysis). A multiple logistic regression model adjusted for age, sex, hypertension, diabetes, and hyperlipidemia showed that the lowest eGFR quartiles estimated by MDRD and CG were significantly associated with DH compared with the highest eGFR quartile (adjusted odds ratio, 1.96; 95% confidence interval, 1.22-3.14 by CG, 1.86; 95% confidence interval, 1.17-2.96 by MDRD). CONCLUSION: Renal function impairment was independently associated with a higher prevalence of DH in a South Korean population.

Inflammation in the Prediction of Type 2 Diabetes and Hypertension in Healthy Adults.

BACKGROUND: While inflammation is associated with obesity and insulin resistance, their inter-relationships in the development of type 2 diabetes or hypertension are not clear. AIM OF THE STUDY: To evaluate inflammatory markers in prediction of type 2 diabetes and hypertension. METHODS: The study population of this retrospective cohort study consisted of individuals who participated in a comprehensive health screening program with measurement of white blood cell count and C-reactive protein from 2002-2010 (N = 96,606) in nondiabetic and normotensive Koreans. Median follow up time were 3.7 years for incident type 2 diabetes and 3.3 years for hypertension. Multivariate Cox proportional hazards models were performed to assess risk for type 2 diabetes or hypertension by white blood cell or C-reactive protein quartiles with adjustment of various possible confounding factors including insulin resistance. RESULTS: During the follow-up period, 1448 (1.5%) developed type 2 diabetes and 10,405 (10.8%) developed hypertension. Among men, comparison of adjusted hazard ratios (HR) for incident type 2 diabetes in the highest versus lowest white blood cell or C-reactive protein quartiles were 1.48 [95% confidence interval (CI), 1.20-1.83] and 1.30 (95% CI, 1.07-1.57), respectively. Among women, white blood cell but not C-reactive protein was significantly associated with type 2 diabetes [HR 1.79 (95% CI 1.24-2.57)]. White blood cell and C-reactive protein quartiles were also modestly associated with incident hypertension in both sexes. CONCLUSIONS: Although white blood cell and C-reactive protein are associated with adiposity and insulin resistance, these inflammatory markers also independently predict type 2 diabetes and/or hypertension.

Cerebral Arterial Stenosis in Patients with Spontaneous Intracerebral Hemorrhage.

OBJECTIVE: Spontaneous intracerebral hemorrhage (ICH) and ischemic stroke share common vascular risk factors such as aging and hypertension. Previous studies suggested that the rate of recurrent ICH and ischemic stroke might be similar after ICH. Presence of cerebral arterial stenosis is a potential risk factor for future ischemic stroke. This study investigated the prevalence and factors associated with cerebral arterial stenosis in Korean patients with spontaneous ICH. METHODS: A total of 167 patients with spontaneous ICH were enrolled. Intracranial arterial stenosis (ICAS) and extracranial arterial stenosis (ECAS) were assessed by computed tomography angiography. Presence of ICAS was defined if patients had arterial stenosis in at least one intracranial artery. ECAS was assessed in the extracranial carotid artery. More than 50% luminal stenosis was defined as presence of stenosis. Prevalence and factors associated with presence of ICAS and cerebral arterial stenosis (presence of ICAS and/or ECAS) were investigated by multivariable logistic regression analysis. RESULTS: Thirty-two (19.2%) patients had ICAS, 7.2% had ECAS, and 39 (23.4%) patients had any cerebral arterial stenosis. Frequency of ICAS and ECAS did not differ among ganglionic ICH, lobar ICH, and brainstem ICH. Age was higher in patients with ICAS (67.6±11.8 vs. 58.9±13.6 years p=0.004) and cerebral arterial stenosis (67.9±11.6 vs. 59.3±13.5 years, p<0.001) compared to those without stenosis. Patients with ICAS were older, more frequently had diabetes, had a higher serum glucose level, and had a lower hemoglobin level than those without ICAS. Patients with cerebral arterial stenosis were older, had diabetes and lower hemoglobin level, which was consistent with findings in patients with ICAS. However, patients with cerebral arterial stenosis showed higher prevalence of hypertension and decreased kidney function compared to those without cerebral arterial stenosis. Multivariable logistic regression analyses showed that aging and presence of diabetes independently predicted the presence of ICAS, and aging, diabetes, and hypertension were independently associated with presence of cerebral arterial stenosis. CONCLUSION: 19.2% of patients with spontaneous ICH had ICAS, but the prevalence of ECAS was relatively lower (7.2%) compared with ICAS. Aging and diabetes were independent factors for the presence of ICAS, whereas aging, hypertension, and diabetes were factors for the cerebral arterial stenosis.

The Effects of Urinary Albumin and Hypertension on All-Cause and Cardiovascular Disease Mortality in Korea.

BACKGROUND: Urinary albumin levels and hypertension (HTN) are independently associated with an increased risk of all-cause mortality. The effect of albuminuria on mortality in the absence or presence of HTN is uncertain. This study aimed to evaluate the effect of albuminuria and HTN on all-cause and cardiovascular disease (CVD) mortality. METHODS: Mortality outcomes for 32,653 Koreans enrolled in a health screening including measurements of the urinary albumin/creatinine ratio (UACR) at baseline and median follow-up of 5.13 years. Receiver operating characteristic curve analyses were performed in UACR and the cut-point was 5.42 mg/g. The participants for UACR at the cut-point of 5.42 µg/mg were categorized into UACR < 5.42 or UACR ≥ 5.42. HTN status was categorized as No HTN or HTN (defined as the absence or presence HTN). RESULTS: The median (interquartile) baseline UACRs were higher in those who died than in survivors. Subjects with a UACR ≥ 5.42 mg/g without or with HTN showed a similar increased risk for all-cause mortality and CVD mortality, even after adjusting for known CVD risk factors compared to those with no HTN/UACR < 5.42 (reference), (all-cause mortality; hazard ratio [HR] 1.48; 95% confidence interval [CI] 1.02-2.15: HR 1.47; 95% CI 0.94-2.32, respectively), (CVD mortality; HR 5.75; 95% CI 1.54-21.47: HR 5.87; 95% CI 1.36-25.29). CONCLUSIONS: The presence of urinary albumin and HTN is a significant determinant of CVD and death. Urinary albumin might be more attributable to CVD and all-cause mortality than HTN.

Relationship between anthropometric parameters and open angle glaucoma: The Korea National Health and Nutrition Examination Survey.

AIMS: To evaluate the relationships between open-angle glaucoma (OAG) and various anthropometric measurements. DESIGN: Korea National Health and Nutrition Examination Survey (KNHANES), a population-based cross-sectional study using a complex, stratified, multistage, probability-cluster survey. METHODS: A total of 5,255 participants including 247 glaucoma patients, aged ≥ 19 years were included from the KNHANES V database. Glaucoma diagnosis was based on International Society of Geographical and Epidemiological Ophthalmology criteria. Various anthropometric data regarding obesity were analyzed including body mass index (BMI), total body fat mass, total body muscle mass (lean body mass, non-bone lean body mass, and appendicular skeletal muscle (ASM) mass), and waist circumference (WC). The differences in OAG prevalence with respect to anthropometric parameter quartiles were examined. RESULTS: In males, the multivariate general linear model adjusted for age, alcohol, smoking, exercise, systemic hypertension, diabetes, and intraocular pressure (IOP) showed the quartiles for the anthropometric parameters BMI, fat mass/weight ratio and fat mass/muscle mass ratio were negatively associated with OAG. However, muscle mass parameter/BMI ratio was significantly positively associated with OAG (P for trend<0.05). In females, height and fat mass/BMI showed a significant relationship with the risk of OAG. (P value<0.05). CONCLUSIONS: In the present study, high fat mass was associated with low OAG risk. Body composition seemed to affect the prevalence of OAG, but further evaluation is needed.

Glaucomatous Optic Nerve Changes and Thyroid Dysfunction in an Urban South Korean Population.

Purpose. This study was performed to evaluate the relationship between intraocular pressure (IOP) and glaucomatous optic nerve change and thyroid factors in Korean population. Materials and Methods. The study included subjects who underwent health screening in Kangbuk Samsung Hospital. Detailed history taking and systemic and ocular examination including fundus photography were performed for all participants. All fundus photographs were divided into two groups based on disc and RNFL appearance: nonglaucoma and glaucoma group. Subjects were also divided into quartiles of each thyroid function parameter, and the relationship with IOP and glaucoma were analysed. Results. In univariate analysis, free T4, T3, and TSH in normal subjects and T3 in thyroid disease group were associated with the IOP. After adjusting for age and sex, the IOP tended to slightly decrease according to the level of the quartile of free T4 and T3 in normal subjects. In terms of glaucoma, on multivariate analysis, it did not show a significant correlation with any thyroid function tests. Conclusions. In normal subjects, the IOP tended to be decreased according to the level of free T4 and T3 but the amounts were clinically insignificant. Thyroid factors are not an independent risk factor for the development of glaucoma.

The association between dietary cholesterol intake and subclinical atherosclerosis in Korean adults: The Kangbuk Samsung Health Study.

BACKGROUND: The Scientific Report of the Dietary Guidelines Advisory Committee (2015) concluded that restriction of dietary cholesterol is unnecessary in most adults for the prevention of cardiovascular disease. OBJECTIVE: We aimed to assess the risk for subclinical atherosclerosis according to coronary artery calcium score (CACS), based on dietary cholesterol intake in apparently healthy Korean adults. METHODS: This was a cross-sectional study performed in 30,068 participants (mean age 40.8 years; 84.5% men) in a health screening program in Korea. The data were collected from 2001 to 2013 and analyzed in 2015. Total energy intake and dietary cholesterol intake were assessed with a food frequency questionnaire. The participants were stratified according to quartile of dietary cholesterol intake. CACS was measured by multi-detector computed tomography. Lipid profiles were measured, and the participants were divided into 6 groups according to low-density lipoprotein cholesterol (LDL-C) level: <70, 70 to 99, 100 to 129, 130 to 159, 160 to 189, and ≥190 mg/dL. RESULTS: The presence of coronary artery calcification was defined as CACS>0. Dietary cholesterol intake did not correlate with mean value of serum LDL-C level. For both genders, the odds ratio for coronary artery calcification was not significantly greater with greater amounts of dietary cholesterol (as assessed by quartile). The risk for coronary artery calcification was not higher in subjects with LDL-C 70-129 mg/dL compared with those with LDL-C < 70 mg/dL; however, the risk was significantly greater in subjects with LDL-C ≥ 130 mg/dL compared with those with LDL-C < 70 mg/dL. CONCLUSIONS: Dietary cholesterol intake did not have an association with LDL-C level or with risk for coronary artery calcification in apparently healthy Korean adults. The results have to be translated with consideration of limitation of population-based studies.

Specific Location of Disc Hemorrhage is Linked to Nerve Fiber Layer Defects.

PURPOSE: To investigate the relationship between retinal nerve fiber layer (RNFL) defects and the quadrant and proximal location of disc hemorrhages (DHs) in a large population examined for health screening. METHODS: A total of 168,044 subjects older than 20 years underwent a single screening ophthalmic examination with color fundus photography as part of a comprehensive health screening program. The presence and location of DHs and RNFL defects were assessed. The DH locations were defined according to the quadrant location (inferotemporal, superotemporal, inferonasal, or superonasal) and the most proximal end of DHs relative to the disc center (cup base, cup margin, disc rim, or extrapapillary region). Using these two location descriptors as independent variables, a logistic regression analysis was conducted to explore the effects of DH location on RNFL defects. RESULTS: Two hundred twenty-six eyes had DH and 120 (53.1%) of them had RNFL defects. After adjusting for proximal location, DHs located in the inferotemporal quadrant accompanied RFNL defects 12 times more frequently than those in the superonasal quadrant (odds ratio [OR], 11.81; P = .004). Conversely, after adjusting for quadrant location, the ORs for an associated RNFL defect were 3.73 (P < .001), 16.54 (P < .001), and 8.91 (P = .002) for DHs with the proximal end at the disc rim, cup margin, and cup base, respectively. CONCLUSIONS: Among the four quadrants and four proximal locations, DHs were identified most frequently in the inferotemporal quadrant and outside the disc, respectively. Some DH locations, such as the inferotemporal quadrant and the cup margin, were associated with RNFL defects, whereas others were not.

Relationship between Plasma Homocysteine Level and Glaucomatous Retinal Nerve Fiber Layer Defect.

AIMS: To investigate the association between plasma homocysteine levels and glaucomatous retinal nerve fiber layer (RNFL) defect in South Korean population. MATERIALS AND METHODS: This retrospective cross-sectional study included subjects who underwent screening at Kangbuk Samsung Hospital Health Screening Center between August 2012 and July 2013. Subjects underwent physical examination and provided samples for laboratory analysis of homocysteine. Subjects were divided equally into four quartiles (Qs) based on plasma homocysteine level. Digital fundus photographs of both eyes were obtained. Determination of glaucomatous disc appearance was based on criteria set forth by the International Society of Geographical and Epidemiological Ophthalmology and based on the appearance of the RNFL and optic disc. Multivariate logistic regression models were used to define elevated glaucoma risk with P < 0.2 on univariate analysis. RESULTS: A total of 78,049 subjects were included; 76,093 subjects were male, and 1956 subjects were female. When analyzed by gender, the mean homocysteine level in the male group with glaucomatous RNFL defects (11.05 ± 3.80 µmol/L) was higher than those without RNFL defects (10.81 ± 4.12 µmol/L (P = 0.000, χ2 test). Upon multifactorial logistic regression analysis adjusted for age, gender, creatinine, diabetes mellitus, hypertension, and hyperlipidemia, glaucomatous RNFL defects had a significant correlation with plasma homocysteine level. Based on the Q2 level, the odds ratio (OR) of Q3 was 1.267, while the OR of Q4 was 1.285 (95% CI = 1.067-1.505, 1.081-1.529, respectively, P for trend = 0.001). CONCLUSION: Our results suggest that homocysteine level is associated with the presence of glaucomatous RNFL defects.

Relationships Between Anthropometric Measurements and Intraocular Pressure: The Korea National Health and Nutrition Examination Survey.

PURPOSE: To evaluate the relationship between intraocular pressure (IOP) and various anthropometric measures. DESIGN: A population-based cross-sectional study. METHODS: A total of 5008 participants, 2080 men and 2928 women ≥19 years of age were included from the Korea National Health and Nutrition Examination Survey V database, focusing on the years 2010 and 2011. We selected IOP in the right eye of a normal healthy population as the outcome variable of our study. We analyzed the relationship between IOP and anthropometric parameters using dual-energy X-ray absorptiometry by sex. Lean body mass was calculated as total body mass minus fat mass. We used general linear models and logistic regression analysis to evaluate risk factors of high IOP. Our main outcome measure was correlation between anthropometric data and IOP. RESULTS: In multivariate general linear models, greater body mass index (BMI) and waist circumference were correlated with higher IOP for both men (BMI, ß = 0.053, P = .026; waist circumference, ß = 0.016, P = .067) and women (BMI, ß = 0.074, P < .001; waist circumference, ß = 0.028, P < .001). Greater fat mass (ß = 0.027, P = .037) and fat mass/lean body mass (ß = 1.170, P = .06) were correlated with higher IOP, while greater lean body mass/weight (ß = -3.188, P = .025), lean body mass/BMI (ß = -1.379, P = .002), appendicular skeletal muscle mass/BMI (ß = -2.270, P = .022), and bone mineral content/BMI (ß = -11.653, P = .031) were correlated with lower IOP in women, but not in men (P > .10). CONCLUSIONS: In healthy women, greater fat mass was associated with higher IOP, and greater muscle mass was associated with lower IOP after adjusting for weight and BMI. Fat and muscle influenced IOP in women independently.

The Relationship between Vitamin D and Glaucoma: A Kangbuk Samsung Health Study.

PURPOSE: To investigate the relationship between vitamin D and glaucoma. METHODS: This retrospective, cross-sectional study included subjects who underwent a health screening at the Health Screening Center of Kangbuk Samsung Hospital from August 2012 to July 2013. All fundus photographs were reviewed by ophthalmologists. The ophthalmologists determined if an eye was glaucomatous based on the criteria set forth by the International Society of Geographical and Epidemiological Ophthalmology and by the appearance of the retinal nerve fiber layer and optic disc. If the subjects previously underwent an ophthalmologic examination, they were enrolled based on the documented history. In addition to fundus photographs, each participant underwent a systemic examination including blood sampling and sociodemographic and behavioral questionnaires. The subjects were divided into five groups according to serum 25-hydroxyvitamin D (25(OH)D) level. Multivariate logistic regression models were constructed to assess possible associations between elevated glaucoma risk and systemic factors with a p < 0.2 on univariate analysis. RESULTS: Of the 169,208 subjects older than 20 years, 123,331 were eligible for the study. There was no difference in the prevalence of glaucoma according to quintile of serum 25(OH)D level based on sex (p = 0.412 for males, p = 0.169 for females). According to the multivariable-adjusted logistic analysis, the odds ratio of glaucoma for the fourth quintile was significantly lower than that of the first quintile in females (odds ratio, 0.713; 95% confidence interval, 0.520 to 0.979). CONCLUSIONS: Lower 25(OH)D level was significantly associated with an elevated risk of glaucoma in females compared with higher 25(OH)D level. Further evaluation is needed to investigate the relationship between glaucoma and vitamin D.

Association between Renal Function and Open-Angle Glaucoma: The Korea National Health and Nutrition Examination Survey 2010-2011.

PURPOSE: To investigate the relationship between renal function and primary open-angle glaucoma (POAG) in a South Korean population. DESIGN: A population-based, cross-sectional survey using a multistage, stratified, probability-clustered sampling method from the Korean National Health and Nutrition Examination Survey (KNHANES). PARTICIPANTS: A total of 5971 participants at least 40 years of age were selected from the KNHANES between 2010 and 2011. METHODS: A standardized protocol was used to interview every participant and perform comprehensive ophthalmic examinations. Glaucoma was diagnosed according to criteria from the International Society of Geographical and Epidemiological Ophthalmology. The estimated glomerular filtration rate (eGFR) was calculated from serum creatinine concentrations using the Cockcroft-Gault formula, as follows: eGFR = (140 - age) × mass (kg) × (0.85 for female subjects)/(72 × serum creatinine (mg/dl). The presence of proteinuria also was assessed. Subjects were stratified by eGFR into the following groups: ≥90, 60-90, 45-59, and <45 ml/min/1.73 m(2). MAIN OUTCOME MEASURES: Renal function and POAG. RESULTS: The overall prevalence of POAG was 5.5%. The prevalence of low eGFR (<60 ml/min/1.73 m(2)) was 9.5%, and the prevalence of eGFR <45 ml/min/1.73 m(2) was 2.0%. Multiple linear regression models were adjusted for age, sex, and other confounding factors (high-density lipoprotein level, blood glucose concentration, blood pressure, and intraocular pressure). These models revealed a positive correlation between the presence of POAG and low eGFR (odds ratio [OR], 2.88; 95% confidence interval [CI], 1.44-5.76). No association was found between proteinuria and POAG (adjusted for age, sex, and other confounding factors; OR, 0.96; 95% CI, 0.29-3.17). CONCLUSIONS: This population-based study of South Korean adults showed that low eGFR levels are independently associated with POAG.

Rapid Visual Deterioration Caused by Posterior Fossa Arachnoid Cyst.

Posterior fossa is a site next to the middle fossa where arachnoid cyst frequently occurs. Generally, most arachnoid cysts are asymptomatic and are found incidentally in most cases. Although arachnoid cysts are benign and asymptomatic lesions, patients with posterior fossa arachnoid cysts often complain of headaches, gait disturbance, and ataxia due to the local mass effects on the cerebellum. We observed a patient with a posterior fossa arachnoid cyst who had visual symptoms and a headache, but did not have gait disturbance and ataxia. We recommended an emergency operation for decompression, but the patient refused for personal reasons. After 7 days, the patient revisited our hospital in a state of near-blindness. We suspected that the arachnoid cyst induced the hydrocephalus and thereby the enlarged third ventricle directly compressed optic nerves. Compressed optic nerves were rapidly aggravated during the critical seven days; consequently, the patient's vision was damaged despite the operation. Considering the results of our case, it is important to keep in mind that the aggravation of symptoms cannot be predicted; therefore, symptomatic arachnoid cysts should be treated without undue delay.