Results of office-based fluid-air exchange for postvitrectomy hemorrhage in diabetic retinopathy.

PURPOSE: This study aimed to evaluate the efficacy and clinical outcomes of a one-way fluid-air exchange procedure for the treatment of postvitrectomy diabetic vitreous hemorrhage in patients with proliferative diabetic retinopathy. METHODS: This retrospective study included 233 patients with proliferative diabetic retinopathy, who underwent vitrectomy. A one-way fluid-air exchange procedure was performed in 24 eyes of 24 (10.30%) patients with persistent vitreous cavity rebleeding after the operation. Preprocedural and postprocedural best-corrected visual acuity values were achieved. Complications occurring during and after the procedure were analyzed. RESULTS: Significant visual improvement was observed 1 month after the one-way fluid-air exchange procedure (2.62 ± 0.60 LogMAR at baseline vs. 0.85 ± 0.94 LogMAR at postprocedure, p<0.0001). Moreover, 19 (79.17%) eyes needed the procedure once, and 5 (20.83%) eyed had the procedure more than twice. In 3 (12.50%) eyes, reoperation was eventually required because of persistent rebleeding despite several fluid-air exchanges. No complication was observed during the follow-up. CONCLUSIONS: The one-way fluid-air exchange procedure can be an excellent alternative to re-vitrectomy for patients with proliferative diabetic retinopathy suffering from postvitrectomy diabetic vitreous hemorrhage by removing the hemorrhagic contents directly and achieving fast recovery of visual function without apparent complications.

PSORIASIS INCREASES RETINAL VEIN OCCLUSION RISK IN DIABETIC PATIENTS: A Nationwide Population-Based Study.

PURPOSE: The objective of this research was to explore how psoriasis is linked to the occurrence of retinal vein occlusion (RVO) in diabetic population. METHODS: This was a retrospective, nationwide, population-based cohort study that examined medical records from January 2009 to December 2012. The study focused on patients ≥20 years of age who had been diagnosed with Type 2 diabetes mellitus (DM). The authors compared the incidence rate of RVO between a group of patients with psoriasis and a group of patients without psoriasis until December 2018 in all subjects. RESULTS: Of the 2,745,689 Type 2 DM patients, 23,725 patients were classified in the psoriasis group and the rest of the 2,547,121 individuals in the control group. A total of 497 RVO cases occurred in the psoriasis group (3.14/1,000 person-years) and 42,388 RVO cases in the control group (2.44/1,000 person-years). According to multivariable Cox proportional hazard models, individuals with psoriasis had a significantly greater risk of developing RVO compared with control subjects (hazard ratio: 1.216, 95% confidence interval: 1.11-1.33) after adjustments for covariates. CONCLUSION: This study demonstrated that psoriasis was an independent risk factor for developing RVO in DM patients. Therefore, physicians need to be vigilant for the occurrence of RVO in DM patients who also have psoriasis.

Results of office-based fluid-air exchange for postvitrectomy hemorrhage in diabetic retinopathy

ABSTRACT Purpose: This study aimed to evaluate the efficacy and clinical outcomes of a one-way fluid-air exchange procedure for the treatment of postvitrectomy diabetic vitreous hemorrhage in patients with proliferative diabetic retinopathy. Methods: This retrospective study included 233 patients with proliferative diabetic retinopathy, who underwent vitrectomy. A one-way fluid-air exchange procedure was performed in 24 eyes of 24 (10.30%) patients with persistent vitreous cavity rebleeding after the operation. Preprocedural and postprocedural best-corrected visual acuity values were achieved. Complications occurring during and after the procedure were analyzed. Results: Significant visual improvement was observed 1 month after the one-way fluid-air exchange procedure (2.62 ± 0.60 LogMAR at baseline vs. 0.85 ± 0.94 LogMAR at postprocedure, p<0.0001). Moreover, 19 (79.17%) eyes needed the procedure once, and 5 (20.83%) eyed had the procedure more than twice. In 3 (12.50%) eyes, reoperation was eventually required because of persistent rebleeding despite several fluid-air exchanges. No complication was observed during the follow-up. Conclusions: The one-way fluid-air exchange procedure can be an excellent alternative to re-vitrectomy for patients with proliferative diabetic retinopathy suffering from postvitrectomy diabetic vitreous hemorrhage by removing the hemorrhagic contents directly and achieving fast recovery of visual function without apparent complications.

Fluctuation of Intraocular Pressure and Vascular Factors Are Associated With the Development of Epiretinal Membrane in Glaucoma.

PURPOSE: To identify factors associated with the development of epiretinal membranes (ERM) in glaucoma patients. DESIGN: Multicenter, propensity-score matched, case-control study. METHODS: One hundred ninety-two eyes of 192 patients with glaucoma from the Catholic Medical Center Glaucoma Suspect Cohort Study were analyzed. We identified 64 eyes who developed ERM from the cohort, and 128 eyes without ERM were selected by propensity score matching (1:2) according to baseline age and mean deviation (MD) of the visual field (VF). Demographic, systemic, and ocular characteristics were determined at baseline. Intraocular pressure (IOP) was measured, including baseline, mean IOP, and IOP fluctuation. Early-stage ERM, defined as translucent membrane with no underlying retinal distortion, was detected by fundus photography and optical coherence tomography. Central VF progression was considered when new VF defets developed in one either or both hemifields or when there was an increase of 3 or more abnormal points within 12 points of central 10° fixation. Autonomic nervous system status was evaluated by heart rate variability. RESULTS: Patients who developed ERM were more frequently receiving medication for systemic hypertension and had higher systolic blood pressure, greater IOP fluctuation, more frequent disc hemorrhage (DH), worse VF MD, and a higher rate of central VF progression than patients without ERM. Additionally, patients with early glaucoma who developed ERM had higher rate of autonomic imbalance while patients with moderate-to-advanced glaucoma who developed ERM had greater baseline and peak IOP and worse MD of the last follow-up VF (MD < 6.0 dB). Older age (P = .048), medication for systemic hypertension (P < .001), IOP fluctuation (P < .001), presence of DH (P < .001), and worse last MD of VF (P = .033) were significantly associated with ERM in Cox proportional hazard analysis. CONCLUSIONS: Early stage of ERMs in glaucomatous eyes are significantly associated with glaucoma progression, medication of systemic hypertension, presence of DH, and IOP fluctuation. These suggest that glaucoma patients who develop early stage of ERMs should be carefully monitored in terms of IOP fluctuation, vascular factors, and glaucoma progression.

Treatment of Various Ocular Manifestation of Systemic Lupus Erythematosus with Therapeutic Plasma Exchange.

The goal of this study is to describe a rare case of acute systemic lupus erythematosus (SLE) ocular involvement, followed by a rapid deterioration of the overall condition, and to then describe its successful treatment with therapeutic plasma exchange (TPE). In our case, a 21-year-old female, previously diagnosed with SLE, presented with a bilateral decreased vision for one week. Fundus examination and optical coherence tomography revealed subretinal fluid accumulation in both eyes and severe disc swelling with diffuse subretinal hemorrhages and perimacular whitening in the left eye. Despite systemic high-dose steroid therapy, the patient became worse, but immunosuppressive treatment was postponed due to fever and elevated serum leukocytes with the chance of systemic infection. She had undergone therapeutic plasma exchange (TPE) and was successfully treated. Preceding SLE ocular manifestation can be an indicator of the exacerbation of SLE, and TPE can be a treatment option for such progression.

Impact of cardiovascular comorbidity on increased neutrophil-lymphocyte ratio in pseudoexfoliation syndrome.

BACKGROUND: The purpose of this study was to compare neutrophil-to-lymphocyte ratios (NLRs) of patients with pseudoexfoliation syndrome (PEX) according to the presence of cardiovascular disease (CVD) with those without CVD as controls. METHODS: A total of 197 participants (97 patients with PEX and 100 participants without PEX regarded as the control group) were included in this retrospective study. The PEX group was divided into 2 subgroups, PEX with CVD (group 1) and PEX without CVD (group 2). NLRs were then compared to those of the control group. RESULTS: The incidence of CVD was significantly (P = .015) higher in the PEX group than in the control group. NLR was significantly higher in the group 1 and group 2 compared with that of the control group (P = .048 and P = .002, respectively). In the PEX group, group 1 showed higher NLR than group 2 (P = .023). CONCLUSION: Although the PEX group showed a higher incidence of CVD, the NLR was higher in the PEX group regardless of cardiovascular comorbidity than that in the control group.

Predicting Visual Field Progression by Optical Coherence Tomography Angiography and Pattern Electroretinography in Glaucoma.

PRCIS: Reduced P50-N95 amplitude on pattern electroretinography (PERG) and the presence of microvasculature dropout (MvD) on optical coherence tomography angiography (OCT-A) at baseline were significant factors associated with visual field (VF) progression in predominantly normal tension glaucoma (NTG) patients. OBJECTIVE: We investigated the baseline demographics and ocular characteristics that predict future progression in glaucoma patients, including PERG and OCT-A parameters. METHODS: One Hundred forty eyes with open angle glaucoma that were prospectively enrolled and followed up for at least 3 years, and underwent at least 5 serial VF tests were included. Baseline PERG was performed, and N35, P50, and N95 latencies and amplitudes were obtained. Superficial vessel density at the macula and complete loss of microvasculature within the deep retinal layer of the parapapillary region (MvD) were evaluated from baseline OCT-A images. Eyes with a glaucomatous VF defect in either both hemifields within 24 points of a central 10 degrees of fixation, and with no VF abnormality in the nasal periphery outside 10 degrees of fixation, were considered to have isolated central scotoma. During follow-up, detected disc hemorrhage (DH) was recorded. Parameters associated with VF progression were determined using linear regression analysis of the mean deviation (MD) values, in combination with an event-based analysis using the Glaucoma Progression Analysis (GPA) software from the Humphrey Field Analyzer. "Likely progression" using GPA was considered to have glaucoma progression. RESULTS: Of the 140 eyes, 107 (76.4%) were NTG and 57 (40.7%) exhibited glaucoma progression as defined by Humphrey VF GPA. The MD slopes were -0.43±1.11 dB/y in the progressors and 0.59±1.27 dB/y in the nonprogressors ( P <0.001). Glaucoma patients with progression showed frequent MvD on OCT-A, isolated central scotoma, frequent DH, and reduced baseline P50-N95 amplitude compared with patients without progression. Age at diagnosis ( P =0.038) and baseline P50-N95 amplitude ( P =0.019) showed significant associations with the MD slope. The presence of MvD on OCT-A ( P <0.001) and baseline P50-N95 amplitude ( P =0.037) were significantly associated with VF progression on GPA. CONCLUSIONS: The presence of MvD and retinal ganglion cell dysfunction by PERG at baseline, DH or central scotoma were significant factors associated with VF progression in predominantly NTG patients. These patients should be monitored more closely.

Association of Polymorphisms at the SIX1/SIX6 Locus With Normal Tension Glaucoma in a Korean Population.

PRCIS: We demonstrated that SIX1/SIX6 locus polymorphism (rs10483727 and rs33912345) was significantly associated with a genetic susceptibility to NTG in a Korean population. More studies are needed to investigate whether the SIX1/SIX6 locus is associated with NTG among various ethnic populations. PURPOSE: Several previous studies have reported that the relevance of the SIX1/SIX6 locus to open angle glaucoma (OAG) in various ethnic populations. However, definitions of OAG patients were different among those studies. The relevance of the SIX1/SIX6 locus to normal tension glaucoma (NTG) in a Korean population remains uncertain. Therefore, the purpose of this study was to investigate the relationship of the SIX1/SIX6 locus with NTG in a Korean cohort. METHOD: Patients with NTG and ethnically matched healthy controls were recruited from eye clinics in Korea (210 cases and 117 controls). Four polymorphisms (rs33912345, rs12436579, rs2179970, and rs10483727) of the SIX1/SIX6 locus were genotyped for 327 subjects using a TaqMan single nucleotide polymorphism genotyping assay. RESULTS: The rs33912345 polymorphism was significantly correlated with NTG in the recessive model [odds ratio (OR): 0.265; 95% confidence interval (CI): 0.078-0.898, P =0.033], but not in the allelic and dominant models (both P >0.05). The SNP rs10483727 was significantly associated with NTG in the allelic model (OR: 0.674; 95% CI: 0.464-0.979, P =0.038) and the recessive model (OR: 0.187; 95% CI: 0.058-0.602, P =0.005). Genetic association analysis of SNP rs12436579 and rs2179970 revealed no significant difference in genotype distribution between NTG cases and controls in the allelic, dominant, or recessive models (all P >0.05). CONCLUSION: The current study found that SIX1-SIX6 locus rs10483727 and rs33912345 polymorphisms were significantly associated with NTG risk in the Korean population.

Assessment for Macular Thickness after Uncomplicated Phacoemulsification Using Optical Coherence Tomography.

PURPOSE: Macular edema including cystoid macular edema is one of the main causes of unfavorable visual outcomes after cataract surgery. The macular thickness and the occurrence of macular edema after uncomplicated cataract surgery was evaluated using optical coherence tomography (OCT) in this study. METHODS: Macular map images were taken by OCT before surgery and at 1 week, 1 month, and 2 months postsurgery. The subjects were classified into two groups (group 1, patients with no macular edema; group 2, patients with macular edema). Group 2 was defined as increase in central macular thickness (CMT) by 30% compared with that before surgery. The risk factors for macular edema were evaluated. Group 2 was divided into two subgroups: subclinical macular edema (group 2A) and cystoid macular edema (group 2B) and they were assessed in terms of the clinical course of best-corrected visual acuity and CMT. RESULTS: A total of 376 patients were enrolled in this study, of which 36 (9.57%, group 2) showed macular edema measured by OCT after the surgery. Univariate analysis for group 1 and 2 revealed that intracameral injection of epinephrine during phacoemulsification was associated with the development of macular edema. In group 2, five patients (1.33%) developed cystoid macular edema. Statistically significant differences in the clinical course of CMT were observed at 2 months (201.2 ± 23.1, 250.0 ± 29.8, and 371.0 ± 160.3 in group 1, group 2A, and group 2B, respectively; p < 0.001) and 1 month postoperatively (198.5 ± 23.6, 237.8 ± 40.9, and 314.0 ± 104.5 in group 1, group 2A, and group 2B, respectively; p < 0.001). Group 2B required additional treatment and eventually achieved best-corrected visual acuity of >0.2 with CMT in the normal range. CONCLUSIONS: The intracameral injection of epinephrine may cause macular edema after uncomplicated cataract surgery. Examination of CMT using OCT is recommended for the early detection of macular edema.

Inflammatory cytokines and retinal nonperfusion area in quiescent proliferative diabetic retinopathy.

PURPOSE: We sought to investigate the association between inflammatory cytokine levels and retinal capillary nonperfusion area in eyes with quiescent proliferative diabetic retinopathy (PDR). METHODS: Samples of aqueous humor were collected from 67 eyes (n = 42 patients) with treatment-naïve PDR. Levels of interleukin (IL)-10, IL-1ß, IL-6, IL-8, monocyte chemoattractant protein 1 (MCP-1), and tumor necrosis factor-α (TNF-α) were obtained using multiplex bead assay. Areas of capillary nonperfusion at the posterior pole and peripheral retina were measured via ultra-widefield fluorescein angiography and correlated with cytokine levels. RESULTS: The levels of IL-10, IL-6, IL-8, MCP-1, and TNF-α were positively correlated with the nonperfusion area of the peripheral retina (r = 0.298, 0.401, 0.265, 0.435, and 0.393; all P ≤ 0.030). There were positive correlations between IL and 10, IL-6, IL-8, MCP-1, and TNF-α (all R ≥ 0.247; all P ≤ 0.043). IL-1ß did not show a significant correlation with the nonperfusion area (P = 0.972 for posterior pole and 0.392 for periphery) but was positively correlated with TNF-α (r = 0.334; P = 0.006). CONCLUSIONS: An increased level of inflammation was observed in PDR eyes with larger nonperfusion areas, which suggests inflammation as a possible target for suppressing PDR progression associated with nonperfusion.

Lack of association between SIX1/SIX6 locus polymorphisms and pseudoexfoliation syndrome in a population from the Republic of Korea.

Previous studies have reported the association of the SIX1/SIX6 locus with open-angle glaucoma in various ethnic populations. However, the relevance of the SIX1/SIX6 locus to pseudoexfoliation syndrome (XFS) appears uncertain at present. Thus, we investigated the relationship between polymorphisms in the SIX1/SIX6 locus and XFS in a Korean XFS cohort. A total of 246 participants comprising 167 unrelated Korean patients with XFS and 79 ethnically matched control subjects were recruited. Four polymorphisms of the SIX1/SIX6 locus (rs33912345, rs12436579, rs2179970, and rs10483727) were genotyped using a TaqMan® allelic discrimination assay. Genotypic and allelic associations were analyzed using logistic regression. The minor allele frequency (MAF) of rs33912345 was found to be 0.287 and 0.247 in the XFS cases and controls, respectively, and the MAF of rs12436579 was found to be 0.383 and 0.361 in the XFS cases and control subjects, respectively. The MAF of rs2179970 was found to be 0.090 and 0.095 in the XFS cases and control subjects, respectively, and the MAF of rs10483727 was found to be 0.293 and 0.253 in the XFS cases and control subjects, respectively. Genetic association analysis of 4 SIX1/SIX6 locus single nucleotide polymorphisms (SNPs) revealed no significant difference in genotype distribution between the XFS cases and control subjects in the allelic, dominant, or recessive models (all, P > .05). The current study suggested that SIX1/SIX6 locus polymorphisms (rs33912345, rs12436579, rs2179970, and rs10483727) may not be associated with a genetic susceptibility to XFS in a Korean cohort.

Natural history of incomplete retinal pigment epithelial and outer retinal atrophy in age-related macular degeneration.

OBJECTIVE: To assess the time course and risk factors for conversion of incomplete retinal pigment epithelium and outer retina atrophy (iRORA) to complete retinal pigment epithelium and outer retina atrophy (cRORA) in eyes with non-neovascular intermediate age-related macular degeneration (iAMD), using optical coherence tomography (OCT) analysis. DESIGN: Retrospective survival study. PARTICIPANTS: Tracked structural Spectralis OCT (Heidelberg Engineering, Heidelberg, Germany) volume datasets from 2 retinal specialists at the University of California-Los Angeles were retrospectively screened to identify consecutive participants with non-neovascular iAMD without signs of atrophy or macular neovascularization in either eye at baseline. METHODS: In the first stage of selection, 321 consecutive iAMD eyes were screened for onset of iRORA. Eyes that developed iRORA within the first 24 months were followed for an additional 24 months to assess the rate of conversion to cRORA. A Kaplan-Meier survival curve was formulated to illustrate the conversion from iRORA to cRORA. RESULTS: Among 321 baseline participants with iAMD, 87 incident iRORA lesions (50 eyes, 42 participants) were included in the conversion analysis. Eighty-one iRORA lesions (93.1%) converted to cRORA within 24 months (median 14 months). Multivariate binary logistic regression analysis indicated that intraretinal hyperreflective foci and extrafoveal iRORA location at baseline were associated with a faster rate of progression to cRORA (model R2 = 0.816, p < 0.05). CONCLUSIONS: The majority of incident iRORA lesions progress to cRORA within a 24-month period. These findings may be of value in the design of early intervention trials for risk stratification and prognostication but need to be validated with a prospective analysis.

Ultra-Widefield Fluorescein Angiography Findings in Patients with Macular Edema Following Cataract Surgery.

Purpose: To evaluate the ultra-widefield fluorescein angiography (UWFA) findings in patients with macular edema (ME) following cataract surgery.Methods: Thirty-three eyes from patients who showed greater than a 30% increase in the central subfield thickness following cataract surgery were included. UWFA scored according to a system suggested by the Angiography Scoring for Uveitis Working Group (ASUWG). Factors associated with a high ASUWG score were evaluated.Results: Thirty-three (100.0%) of the 33 eyes showed abnormal UWFA findings, including optic disc staining (81.8%), capillary leakage (100.0%), pinpoint leakage (84.8%), peripheral retinal vascular leakage (24.2%) and retinal staining (6.1%). Multiple regression analysis reveals that following adjustment for other factors, younger age was independently associated with a higher ASUWG score (R2 = 0.476, p = .001).Conclusions: Patients with ME following cataract surgery show generalized inner and outer blood-retinal barrier breakage. Particular attention is required during cataract surgery in young patients.

Non-neovascular age-related macular degeneration with subretinal fluid.

PURPOSE: To evaluate the various patterns of subretinal fluid (SRF) in eyes with age-related macular degeneration (AMD) in the absence of macular neovascularisation (MNV) and to assess the long-term outcomes in these eyes. METHODS: This retrospective study included only eyes with non-neovascular AMD and associated SRF. Eyes with evidence of MNV were excluded. Spectral-domain optical coherence tomography (SD-OCT) was obtained at baseline and at follow-up, and qualitative and quantitative SD-OCT analysis of macular drusen including drusenoid pigment epithelial detachment (PED) and associated SRF was performed to determine anatomic outcomes. RESULTS: Forty-five eyes (45 patients) were included in this analysis. Mean duration of follow-up was 49.7±36.7 months. SRF exhibited three different morphologies: crest of fluid over the apex of the drusenoid PED, pocket of fluid at the angle of a large druse or in the crypt of confluent drusen or drape of low-lying fluid over confluent drusen. Twenty-seven (60%) of the 45 eyes with fluid displayed collapse of the associated druse or drusenoid PED and 24 (53%) of the 45 eyes developed evidence of complete or incomplete retinal pigment epithelial and outer retinal atrophy. CONCLUSION: Non-neovascular AMD with SRF is an important clinical entity to recognise to avoid unnecessary anti-vascular endothelial growth factor therapy. Clinicians should be aware that SRF can be associated with drusen or drusenoid PED in the absence of MNV and may be the result of retinal pigment epithelial (RPE) decompensation and RPE pump failure.

Lack of correlation between S1 RNA binding domain 1 SNP rs3213787/rs11884064 and normal-tension glaucoma in a population from the Republic of Korea.

Previous studies have reported the association of the S1 RNA binding domain 1 (SRBD1) gene with open-angle glaucoma in various ethnic populations. However, in those studies, the definition of the patients differed, as did the results. Therefore, the relevance of the SRBD1 gene to normal tension glaucoma (NTG) appears uncertain at present. Thus, we investigated the relationship between the SRBD1 gene and NTG in a Korean NTG cohort.In total, 159 unrelated Korean patients with NTG and 103 Korean control subjects were recruited. Thus, a total of 262 participants were analyzed for SRBD1 (rs3213787 and rs11884064) gene polymorphisms.The minor allele frequency of rs3213787 was found to be 0.13 and 0.19 in NTG cases and controls, respectively. The genetic association analysis of SNP rs3213787 revealed no significant difference in genotype distribution between NTG cases and controls in allelic (odds ratio [OR] = 0.634, P = .063), dominant (OR = 0.589, P = .066) or recessive models (OR = 0.639, P = .7716). The minor allele frequency of rs11884064 was found to be 0.24 and 0.25 in NTG cases and controls, respectively. For rs11884064, no significant difference in genotype distribution was observed between NTG cases and controls in allelic (OR = 0.938, P = .755), dominant (OR = 0.927, P = .798) or recessive models (OR = 0.920, P = 1.000).The current study suggested that SRBD1 gene polymorphisms (rs3213787 and rs11884064) may not be associated with genetic susceptibility to NTG in a Korean cohort.

Relationship Between Nerve Fiber Layer Hemorrhages and Outcomes in Central Retinal Vein Occlusion.

Purpose: To evaluate the depth and pattern of retinal hemorrhage in acute central retinal vein occlusion (CRVO) and to correlate these with visual and anatomic outcomes. Methods: Retinal hemorrhages were evaluated with color fundus photography and fluorescein angiography at baseline and follow-up. Snellen visual acuity (VA), central foveal thickness (CFT), extent of retinal ischemia, and development of neovascularization were analyzed. Results: 108 eyes from 108 patients were evaluated. Mean age was 63.6 ± 16.1 years with a predilection for the right eye (73.1%). Average follow-up was 17.2 ± 19.2 months. Mean VA at baseline was 20/126 and 20/80 at final follow-up. Baseline (P = 0.005) and final VA (P = 0.02) in eyes with perivascular nerve fiber layer (NFL) hemorrhages were significantly worse than in eyes with deep hemorrhages alone. Baseline CFT was greater in the group with perivascular hemorrhages (826 ± 394 µm) compared to the group with deep hemorrhages alone (455 ± 273 µm, P < 0.001). The 10 disc areas of retinal ischemia was more common in patients with perivascular (80.0%) and peripapillary (31.3%) versus deep hemorrhages alone (16.1%, P < 0.001). Neovascularization of the iris was more common, although this differrence was not significant, in the groups with peripapillary (14.3%) and perivascular (2.0%) NFL versus deep hemorrhages alone (0.0%). Conclusions: NFL retinal hemorrhages at baseline correlate with more severe forms of CRVO, with greater macular edema, poorer visual outcomes, and greater risk of ischemia and neovascularization. This may be related to the organization of the retinal capillary plexus. The depth and pattern of distribution of retinal hemorrhages in CRVO may provide an easily identifiable early biomarker of CRVO prognosis.

Elevated M2 Macrophage Markers in Epiretinal Membranes With Ectopic Inner Foveal Layers.

Purpose: To analyze the differences in the vitreous cytokine profiles in epiretinal membrane eyes with and without an ectopic inner foveal layer (EIFL). Methods: Sixty eyes with epiretinal membrane (32 eyes without EIFL and 28 eyes with EIFL) were included. The vitreous samples were collected during surgery for epiretinal membrane. The cytokine levels of the vitreous were measured using a multiplex bead analysis. Results: The mean logMAR visual acuity was worse (0.42 vs. 0.37; P = 0.331) and the central foveal thickness was higher in the EIFL group (496.9 µm vs. 434.2 µm; P = 0.007) than they were in the group without EIFL. The mean EIFL thickness was 164.1 ± 67.7 µm in the EIFL group. On multiplex analysis of the vitreous cytokines, the levels of CD163 (21529 pg/dL vs. 10877 pg/dL; P = 0.002) and macrophage colony-stimulating factor (206 pg/dL vs. 159 pg/dL, P = 0.004) were significantly higher in the EIFL group than they were in the group without EIFL. Conclusions: Eyes with EIFL had increased vitreous levels of M2 macrophage markers. The activation of glial cell proliferation by M2 macrophages may contribute to EIFL formation.

Lack of Correlation between ASB10 and Normal-tension Glaucoma in a Population from the Republic of Korea.

Purpose: Ankyrin repeats and suppressor of cytokine signaling box-containing protein 10 (ASB10) was identified as a novel gene for glaucoma. Since then, there have been reports on the association of ASB10 with glaucoma in various ethnic populations. In these studies, patients with different glaucoma types were included. Thus, we investigated the relationship between ASB10 and NTG in a Korean cohort.Methods: Whole-exome sequencing was performed to identify the ASB10 variants in one patient with a strong NTG family history. A total of 263 participants, comprising 157 NTG patients and 106 control subjects, were analyzed for ASB10 gene single nucleotide polymorphisms (SNPs).Results: Nine variants of the ASB10 gene were identified using whole-exome sequencing analysis, including four exonic SNPs. Of the exonic variants, three were known polymorphisms (rs3800791, rs2253592, and rs77615410), and one was newly reported (rs552803353). A nonsynonymous variant, rs552803353 was predicted as functionally damaging using PolyPhen-2. The exonic SNPs were compared against gene sequences of the control group in the NTG cohort. However, the minor allele frequency (MAF) of rs552803353 was found to be 0.029 and 0.038 in NTG cases and control subjects, respectively. The MAF of rs3800791 was found to be 0.096 and 0.118 in NTG cases and control subjects, respectively, and the MAF of rs77615410 was found to be 0.220 and 0.245 in NTG cases and control subjects, respectively, which were higher than those reported by previous studies. Genetic association analysis of four ASB10 SNPs revealed no significant difference in genotype distribution between NTG cases and control subjects in allelic, dominant, or recessive models (all, P > .05).Conclusions: The present study indicated that the MAFs of ASB10 gene polymorphisms showed a large difference among various ethnic groups, and that ASB10 gene polymorphisms may not be associated with genetic susceptibility to NTG in a Korean cohort.

Association of HK2 and NCK2 with normal-tension glaucoma in a population from the Republic of Korea.

BACKGROUND: Previous studies have reported the association of HK2 and NCK2 genes with normal-tension glaucoma (NTG) in Japan, but there has been no follow-up study in other countries, so the relevance of these genes to NTG appears uncertain at present. Thus, we investigated the relationship between the HK2 and NCK2 genes and NTG in a Korean NTG cohort. METHODS: In total, 154 unrelated Korean patients with NTG and 101 normal Korean controls were recruited. Thus, a total of 255 participants were analyzed for NCK2 (rs2033008) and HK2 (rs678350) gene polymorphisms. RESULTS: The minor allele frequency (MAF) of rs678350 was significantly higher in NTG patients (MAF = 0.32) than in controls (MAF = 0.23) (OR, 1.586; 95% CI, 1.058 to 2.375; P = 0.028). This trend was more significant in the dominant model (OR, 1.908; 95% CI, 1.144 to 3.180; P = 0.015). When we performed logistic regression analysis to adjust for age, both the allelic and dominant models were still statistically significant. No significant difference was observed in rs2033008 allele or genotype frequencies between the NTG patients and control subjects. CONCLUSIONS: The current study suggested that HK2 gene polymorphism may contribute to the genetic susceptibility to NTG.