Analysis of Retinal Vascular Calibers with Cardiovascular Risk Factors

PURPOSE: To analyze the association between retinal vascular caliber and cardiovascular risk factors including smoking, blood pressure, diabetes and age. METHODS: This study included 60 Korean male participants 40-69 years of age. The retinal vessel caliber was measured using computer-assisted fundus photography. Four vessels coursing through the area of one half disc diameter from the optic disc margin were measured. Additionally, we analyzed the association between the retinal vessel caliber and risk factors including smoking, diabetes, hypertension and age. RESULTS: Smoking was not significantly associated with retinal vessel calibers. The diabetes group showed larger average retinal vessel calibers than normal group, but veins were significantly wider (p < 0.05). The average retinal vessel caliber was wider and inferior vein and artery were significantly larger in the hypertension group (p < 0.05). Although the retinal vessel caliber increased with age, significance was observed only in the superior artery (p < 0.05). CONCLUSIONS: In our study, retinal vessel caliber was easily measured using a semi-automatic computer program. This method should prove useful in further studies examining the correlation among retinal vessel caliber variations in many localized ophthalmologic disorder.

A Study for Effective Gaze Fixation Induction Methods in PC-Based Visual Field Testing

PURPOSE: The present study explored novel methods in visual field tests that actively induce the gaze of the examinee to the fixation target in the center vision and compared their effectiveness. METHODS: Four gaze induction methods (dot-on, dot-off, number-on, and number-off) were prepared by combining 2 types of fixation targets (dot and number) and 2 conditions of sound presence (on and off). The gaze induction methods were implemented to a PC-based visual field testing system and the 24-2 visual field testing protocol was administered to 14 participants without glaucoma. The performance of the gaze induction method was evaluated in terms of fixation error rate, target detection rate, and subjective satisfaction (7-point scale, 1 for least satisfied and 7 for most satisfied). RESULTS: The fixation error rates of dot-on (5.7%) and number-on (6.4%) were relatively lower than the other methods; the target detection rates of the induction methods were very high (95-96%) without significant differences, and the subjective satisfaction levels of dot-on (5.7) and number-on (5.4) were significantly higher than the other methods. CONCLUSIONS: In the present study we determined number-on as the preferred effective gaze induction method compared to the conventional dot-off method when fixation error rates and subjective satisfaction were considered.

Risk Factors for the Progression of Intima-Media Thickness of Carotid Arteries: A 2-Year Follow-Up Study in Patients with Newly Diagnosed Type 2 Diabetes

BACKGROUND: Intima-media thickness (IMT) of the carotid arteries is known to have a positive correlation with the risk of cardiovascular disease. This study was designed to identify risk factors affecting the progression of carotid IMT in patients with type 2 diabetes mellitus (T2DM). METHODS: Patients with newly diagnosed T2DM with carotid IMT measurements were enrolled, and their clinical data and carotid IMT results at baseline and 2 years later were compared. RESULTS: Of the 171 patients, 67.2% of males and 50.8% of females had abnormal baseline IMT of the left common carotid artery. At baseline, systolic blood pressure, body mass index and smoking in male participants, and fasting plasma glucose and glycated hemoglobin levels in females were significantly higher in patients with abnormal IMT than in those with normal IMT. Low density lipoprotein cholesterol (LDL-C) levels in males and high density lipoprotein cholesterol (HDL-C) levels in females at the 2-year follow-up were significantly different between the nonprogression and the progression groups. Reduction of the United Kingdom Prospective Diabetes Study (UKPDS) 10-year coronary heart disease (CHD) risk score after 2 years was generally higher in the nonprogression group than the progression group. CONCLUSION: LDL-C levels in males and HDL-C levels in females at the 2-year follow-up were significantly different between participants with and without progression of carotid IMT. Furthermore, a reduction in the UKPDS 10-year CHD risk score appeared to delay the advancement of atherosclerosis. Therefore, the importance of establishing the therapeutic goal of lipid profiles should be emphasized to prevent the progression of carotid IMT in newly diagnosed T2DM patients.

Risk Factors for the Progression of Intima-Media Thickness of Carotid Arteries: A 2-Year Follow-Up Study in Patients with Newly Diagnosed Type 2 Diabetes

BACKGROUND: Intima-media thickness (IMT) of the carotid arteries is known to have a positive correlation with the risk of cardiovascular disease. This study was designed to identify risk factors affecting the progression of carotid IMT in patients with type 2 diabetes mellitus (T2DM). METHODS: Patients with newly diagnosed T2DM with carotid IMT measurements were enrolled, and their clinical data and carotid IMT results at baseline and 2 years later were compared. RESULTS: Of the 171 patients, 67.2% of males and 50.8% of females had abnormal baseline IMT of the left common carotid artery. At baseline, systolic blood pressure, body mass index and smoking in male participants, and fasting plasma glucose and glycated hemoglobin levels in females were significantly higher in patients with abnormal IMT than in those with normal IMT. Low density lipoprotein cholesterol (LDL-C) levels in males and high density lipoprotein cholesterol (HDL-C) levels in females at the 2-year follow-up were significantly different between the nonprogression and the progression groups. Reduction of the United Kingdom Prospective Diabetes Study (UKPDS) 10-year coronary heart disease (CHD) risk score after 2 years was generally higher in the nonprogression group than the progression group. CONCLUSION: LDL-C levels in males and HDL-C levels in females at the 2-year follow-up were significantly different between participants with and without progression of carotid IMT. Furthermore, a reduction in the UKPDS 10-year CHD risk score appeared to delay the advancement of atherosclerosis. Therefore, the importance of establishing the therapeutic goal of lipid profiles should be emphasized to prevent the progression of carotid IMT in newly diagnosed T2DM patients.

Intakes of Antioxidant Nutrients and Carotenoids according to Lens Turbidity Level among Adults Visiting Cataract Clinic / 대한지역사회영양학회지

This study examined intakes of nutrients, carotenoids and polyphenols according to lens turbidity levels among adults visiting a cataract clinic. A total of 102 males and females aged 40 years or higher agreed to participate in the study, and a face-to-face survey interview was conducted to obtain information on general characteristics, health behaviors, and dietary intakes of each participant. The dietary data were collected by a food frequency questionnaire which was previously validated in a Korean population. In addition to essential nutrients, intakes of a total of 10 carotenoids and polyphenols were calculated based on the tables of food functional composition developed by National Academy of Agricultural Science. The subjects were divided into 3 groups according to turbidity levels ( or = 16 and < 25, < or = 25), and health behaviors and dietary intakes were compared among the turbidity groups. Data showed seemingly higher energy intake and lower dietary antioxidant (i.e., vitamin A, beta-carotene, lutein, zeazanthin, lycopene, cryptozanthin) intakes in the highest turbidity group. However, no statistically significant findings were found in all the comparative analysis on characteristics of health behavior and intakes of nutrients, carotenoids and polyphenols. The current study findings should be cautiously interpreted in consideration of several limitations including a cross-sectional study design, a small sample size, uneven sample size distribution across turbidity groups, and limited generalizability due to using a convenience sample. Therefore we cannot conclude that the risk of cataract is unrelated with dietary antioxidant intakes based solely on the results of this study.

Taurine ameliorates hyperglycemia and dyslipidemia by reducing insulin resistance and leptin level in Otsuka Long-Evans Tokushima fatty (OLETF) rats with long-term diabetes

This study aimed to determine whether taurine supplementation improves metabolic disturbances and diabetic complications in an animal model for type 2 diabetes. We investigated whether taurine has therapeutic effects on glucose metabolism, lipid metabolism, and diabetic complications in Otsuka Long-Evans Tokushima fatty (OLETF) rats with long-term duration of diabetes. Fourteen 50-week-old OLETF rats with chronic diabetes were fed a diet supplemented with taurine (2%) or a non-supplemented control diet for 12 weeks. Taurine reduced blood glucose levels over 12 weeks, and improved OGTT outcomes at 6 weeks after taurine supplementation, in OLETF rats. Taurine significantly reduced insulin resistance but did not improve beta-cell function or islet mass. After 12 weeks, taurine significantly decreased serum levels of lipids such as triglyceride, cholesterol, high density lipoprotein cholesterol, and low density lipoprotein cholesterol. Taurine significantly reduced serum leptin, but not adiponectin levels. However, taurine had no therapeutic effect on damaged tissues. Taurine ameliorated hyperglycemia and dyslipidemia, at least in part, by improving insulin sensitivity and leptin modulation in OLETF rats with long-term diabetes. Additional study is needed to investigate whether taurine has the same beneficial effects in human diabetic patients.

Inhibition of NF-kappaB prevents high glucose-induced proliferation and plasminogen activator inhibitor-1 expression in vascular smooth muscle cells

Recent epidemiologic studies clearly showed that early intensive glucose control has a legacy effect for preventing diabetic macrovascular complications. However, the cellular and molecular processes by which high glucose leads to macrovascular complications are poorly understood. Vascular smooth muscle cell (VSMC) dysfunction due to high glucose is a characteristic of diabetic vascular complications. Activation of nuclear factor-kappaB (NF-kappaB) may play a key role in the regulation of inflammation and proliferation of VSMCs. We examined whether VSMC proliferation and plasminogen activator inhibitor-1 (PAI-1) expression induced by high glucose were mediated by NF-kappaB activation. Also, we determined whether selective inhibition of NF-kappaB would inhibit proliferation and PAI-1 expression in VSMCs. VSMCs of the aorta of male SD rats were treated with various concentrations of glucose (5.6, 11.1, 16.7, and 22.2 mM) with or without an inhibitor of NF-kappaB or expression of a recombinant adenovirus vector encoding an IkappaB-alpha mutant (Ad-IkappaBalphaM). VSMC proliferation was examined using an MTT assay. PAI-1 expression was assayed by real-time PCR and PAI-1 protein in the media was measured by ELISA. NF-kappaB activation was determined by immunohistochemical staining, NF-kappaB reporter assay, and immunoblotting. We found that glucose stimulated VSMC proliferation and PAI-1 expression in a dose-dependent manner up to 22.2 mM. High glucose (22.2 mM) alone induced an increase in NF-kappaB activity. Treatment with inhibitors of NF-kappaB such as MG132, PDTC or expression of Ad-IkappaB-alphaM in VSMCs prevented VSMC proliferation and PAI-1 expression induced by high glucose. In conclusion, inhibition of NF-kappaB activity prevented high glucose-induced VSMC proliferation and PAI-1 expression.

Artifacts in Retinal Nerve Fiber Layer Analysis Using Optical Coherence Tomography

PURPOSE: To investigate the frequency and characteristics of artifacts which can cause errors in retinal nerve fiber layer nalysis using optical coherence tomography (OCT). METHODS: The frequency, characteristics and retinal lesions responsible for the artifact were analyzed for 179 patients (338 eyes) by OCT. All images were categorized into two groups according to the presence of artifacts and then, the differences between the two groups were analyzed by t-test and cross-tabulation analysis in terms of age, refractive error, peripapillary atrophic areas, and type of glaucoma. RESULTS: The male to female ratio was 1.37:1, average age was 47.6+/-15.7 years and average degree of refraction was -1.78+/-0.23 diopter. Artifacts were noted in 64 eyes (18.9%), and were present in the temporal quadrant in 12 eyes (18.8%), superior quadrant in 51 eyes (79.7%), nasal quadrant in 19 eyes (87.5%), and inferior quadrant in 8 eyes (48.4%). The average angle of the artifact was 138 degrees. Although retinal lesion, age, and glaucoma type were not significantly different between the two groups, peripapillary atrophy and myopia were significantly more common in the group with the artifact. CONCLUSIONS: When analyzing retinal nerve fiber layer by OCT, artifacts should be considered, especially in cases of peripapillary atrophy and myopia.

A Case of Iridocorneal Endothelial Syndrome with Pigmentary Glaucoma

PURPOSE: To report a case of iridocorneal endothelial syndrome with pigmentary glaucoma. METHODS: We encountered a 44-year-old unilateral glaucoma patient who complained of intermittently decreased visual acuity in the right eye. For differential diagnosis, we carried out ophthalmic and systemic examination. RESULTS: Binocular corrected visual acuity was 1.0. His intraocular pressure, measured using a Goldmann applanation tonometer, was 50 mm Hg in the right eye and 18mm Hg in the left. Upon examination of the right eye, we found pigments with a Krukenberg's spindle appearance on the corneal endothelium, peripheral anterior synechia extending beyond Schwalbe's line, trabecular hyperpigmentation, endothelial pleomorphism, polymegathism, cell loss, dark area within the cells, a light central spot and light peripheral zone, retinal nerve fiber layer defects, and visual field defects, which together led to the diagnosis of iridocorneal endothelial syndrome with pigmentary glaucoma. We observed progressed glaucomatous injury upon examination of the disc stereo photograph, retinal nerve fiber layer photograph, and visual field test, even though we used topical IOP reducers. Eventually, we performed a trabeculectomy in the right eye. CONCLUSIONS: We experienced a case of iridocorneal endothelial syndrome with unilateral pigmentary glaucoma. The glaucoma was not well-controlled with topical IOP reducers. The glaucoma was then treated by a trabeculectomy. We report this case with a review of the literature.

A Case of Anterior uveitis Following Influenza Vaccination

PURPOSE: To report one case of anterior uveitis following influenza vaccination in immunecompromised patient. METHODS: A 63-year-old woman with anterior uveitis following influenza vaccination 9 days after ovarian cancer chemotherapy was examined systematically and treated with 1% prednisolone eyedrop and dexamethasone subconjunctival injection. RESULTS: At the first visit, the corrected vision and intraocular pressure were 0.3 and 23 mmHg in both eyes. And, corneal edema and inflammatory cells in anterior chamber and vitreous were found, but there was no abnormal finding in fundus photography, fluorescein angiography and systemic evaluation. Although the response to steroid treatment was slow, she got better ophthalmologically and no problem in follow checkup 6 months later. CONCLUSIONS: We report a case of anterior uveitis following influenza vaccination in an immunocompromised patient after chemotheraphy and recommend to be cautious in influenza vaccination in the suspicious case of immunecompromized state.

Microbiologic Study of Imported Donor Corneas and Preserved Solutions

PURPOSE: To evaluate the prevalence of contamination of imported donor corneas and their preserved solutions, and to characterize the spectrum of contaminating microorganisms. METHODS: Thirty-seven imported donor corneas and their preserved solutions imported between December 2003 and June 2005 were included in this study. RESULTS: Five imported donor corneas (13.5%) had positive bacterial cultures, and none had positive fungal or mycobacterial cultures. On the other hand, the preserved solutions did not have positive bacterial, fungal, or mycobacterial cultures. One of the 5 imported donor corneas with positive bacterial culture had a mixed bacterial culture. There were 3 isolates of Staphylococcus epidermidis, 1 isolate of Streptococcus viridans, 1 isolate of Enterobacter cloacae, and 1 isolate of Pseudomonas aeruginosa. CONCLUSIONS: The prevalence of contamination of imported donor corneas is low; however, there is a risk of postkeratoplasty infection by contaminated donor corneas. Thus, careful management should be practiced during and after corneal transplant operations.

Correlation between Retinal Nerve Fiber Layer Thickness and Visual Field in Normal Tension Glaucoma

PURPOSE: This study was performed to evaluate the validity of optical coherence tomography 3000 (OCT3) in the diagnosis of normal tension glaucoma (NTG). METHODS: One-hundred and eighty eyes with NTG or glaucomatous optic disc changes by direct ophthalmoscope and 51 normal eyes were included. Mean deviation (MD) and pattern standard deviation (PSD) were acquired by the Humphrey visual field analyzer. Mean retinal nerve fiber layer (RNFL) thickness was measured by OCT3. We analyzed the relationships between MD and mean RNFL thickness, PSD, and mean RNFL thickness. We also analyzed differences in the change of mean RNFL thickness according to the change of visual field defect progression. RESULTS: MD and PSD were proportional to the mean RNFL thickness, using the Pearson correlation coefficient: 0.418 (p=0.001) and -0.397 (p=0.002), respectively. There was a significant decrease in the mean RNFL thickness according to the visual field defect severity. Particular, the RNFL thickness of the superior and inferior quadrants were significantly decreased in the severe visual field defect groups. The difference between the mean RNFL thicknesses in pre-perimetric glaucoma between the normal eye and early glaucoma groups was not statistically significant. CONCLUSIONS: The mean RNFL thickness measured by OCT3 could be considered as valid parameter for the diagnosis of NTG. For early diagnosis of glaucoma, however, visual field test must be considered with OCT3.

The Neuroprotective Effect of Intravitreally Injected CNTF on Rat Retinal Ganglion Cell in Optic Nerve Crush Injury Model

PURPOSE: To make an optic nerve crush injury model and to investigate the neuroprotective effect of intravitreally injected ciliary neurotrophic factor (CNTF) on rat retinal ganglion cells (RGCs) in the model. METHODS: The optic nerves of 12 Sprague-Dawley rats were crushed at 3 mm posterior to the eyeball for 1 minute using aneurysm clip (110 g). Two micrograms of CNTF in 2 micro liter of vehicle was injected intravitreally in one group (n=6) and 2 micro liter of PBS was injected in the control group (n=6) at 4, 7, and 10 days after the optic nerve injury. After 2 weeks, the retrograde labeling of the RGCs was done by the dextran tetramethylrhodamine. Twenty-four hours after the labeling, the retina was wholly mounted and the labeled RGCs were counted under the fluorescence microscope. RESULTS: The death of RGCs in this model began at 1 week and continued for 3 weeks. The number of labeled RGCs in CNTF-injected group (510+/-139/mm2) were significantly higher than that in control group (345+/-87/mm2)(p<0.05). CONCLUSIONS: The optic nerve crush injury model was established by use of aneurysm clip. In this model, the intravitreally injected CNTF had a neuroprotective effect on the rat RGCs.

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.

The Neuroprotective Effect of Ginexin on Rat Retinal Ganglion Cell in Optic Nerve Crush Injury Model

PURPOSE: To investigate the neuroprotective effect of Ginexin (Ginkgo biloba extract) on rat retinal ganglion cell in the optic nerve crush injury model. METHODS: From 1 week before the optic nerve injury, Ginexin 100 mg/kg/day (100 mg group), 200 mg/kg/day (200 mg group) or carboxymethylcellulose as a control group (CMC group) was administrated orally 4 weeks in Spraque-Dawley rats. At 3 weeks after the optic nerve injury, the RGCs were counted and the concentration of intravitreal glutamate was measured. RESULTS: The RGC density of CMC group (103+/-22 cells/mm2) was significantly lower than that of 100 mg group (182+/-39 cells/mm2) and 200 mg group (201+/-63 cells/mm2). There was no difference between the 100 mg group and 200 mg group. The concentration of invtravitreal glutamate did not significantly differ among normal, CMC group, 100 mg group and 200 mg group. CONCLUSIONS: Ginexin increased the survival of the retinal ganglion cell in rat optic nerve crush injury model, but, did not influence on the concentration of intravitreal glutamate.

Seven cases of normal-tension glaucoma with temporal visual field defect only

PURPOSE: To investigate the clinical features of 7 cases (8 eyes) of normal-tension glaucoma with the temporal visual defect only. METHODS: Patient's age, gender, systemic disease, refractive error, intraocular pressure, stereo disc photograph, nerve fiber layer photograph and visual field were analyzed. RESULTS: Age was 32+/-5 years, male:female ratio was 2:5 and 6 eyes were unilateral. Refractive error was -8.80+/-3.80 D, intraocular pressure was 16.0+/-1.90 mmHg and cup:disc ratio was 0.66+/-0.09 (horizontal) X 0.58+/-0.10 (vertical). There was disc hemorrhage in 1 eye, nasal cup in 1 eye, beta-type peripapillary atrophy in 2 eyes and undermining of nasal cup edge in 5 eyes. Pattern of temporal visual field defect, corresponding to the retinal nerve fiber layer defect were horizontal in 1 eye, cecopetal in one eye and cecofugal in 6 eyes. CONCLUSIONS: It is recommend to carefully evaluate nerve fiber layer in the young, high myopic patients showing undermining of nasal cup edge.

Experimental Retinal Pigment Epithelium Transplantation using the RPE Sheet

To make the human RPE sheet for the ideal RPE transplantation and to compare growth rate and morphology between the fetal RPE cells of different obsteric age (17, 24, 34 wks)and the adult RPE cells (24 yrs). The RPE sheet was made as follows : (1)the use of dispase for separation of RPE sheet from the choroid and culture dish; (2)cell culture and cryopreservation, (3)skin biopsy punch for adequate size of RPE sheet. The transplantation methods were:the transplantation of RPE sheet into the subretinal space of rabbit was performed by micropipet system after vitrectomy. The growth rate and the morphology between fetal RPE cells and adult RPE cells were compared by light microscope and electron microscope (scanning &transmission). The RPE sheet was made successfully by use of dispase, skin biopsy punch and the cryopreservation and transplanted effectively with micropipet system. There were significant differences not in morphology, but in growth rate (population doubling time: 28.9 (17 wks), 29.1 (24 wks), 30.2 (34 wks), 35.4 hours (24 yrs).p<0.05)between fetal and adult RPE cells. The human RPE sheet can be made and transplanted into rabbit successfully and timely. And fetal RPE cells may be more ideal than adult RPE cells for the RPE transplantation with respect to the higher cell growth rate.

A Case of Lymphangiomas(So-called Combined Venous Lymphatic Malformation) Resulting in Orbital Abscess

Orbital lymphangiomas are benign vascular hamartomas that may be found in the conjunctiva, the eyelids, the orbit, or elsewhere in the head and neck region. Deep lymphangiomatous lesions are classically characterized by acute onset of a fulminant proptosis resulting from spontaneous hemorrhage within the orbit. Complete surgical excision is often difficult because of the infiltrative nature of the tumor.We report one case of lymphangiomas considered to be associated with cavernous hemangioma which could not be removed completely by several surgical excisions and was exenterated because of orbital abscess of unknown origin and septic condition.

The Ocular Complications in Children with Renal Disease Receiving Steroid Therapy

We included 46 children with renal disease who received systemic corticosteroid therapy in our study and examined the correlation between the corticosteroid use and ocular complications. The average age of patients was 9 +/-4 years and the male: female ratio was 17:6. Cases for corticosteroid treatment were nephrotic syndrome in 16, Henoch-Sch ''onlein purpura in 9, MPGN in 9, Ig A nephropathy in 8,and others in 3. The mean duration of corticosteroid therapy was 11 months(1~77), and the mean total dose at the time of examination was 16,259 mg (2,250~61,292). The incidence of cataract formation was 47.8% and all had posterior subcapsular type. The severity of cataract was grade I in 12, grade II in 8,grade III in 1, and grade IV in 1 according to the Crews' classification.The incidence of intraocular pressure above 18 mmHg was 75%, compared to 18 mmHg (2SD) in normal control. There was no significant relation between the total dose of corticosteroid and the cataract formation, the severity of cataract,and the incidence of increased IOP. Also, there was no relation between the duration of therapy and them. In conclusion, We found that the ocular complications in children do not relate with the dose of corticosteroid and the duration of therapy and may be closely related to the individual susceptibility. It is essential to examine the eye carefully and follow up regularly those children who receive the corticosteroid therapy.