Dementia incidence and population-attributable fraction for dementia risk factors in Republic of Korea: a 12-year longitudinal follow-up study of a national cohort.

Background: We aimed to investigate the incidence of dementia by age and year as well as the population-attributable fractions (PAFs) for known dementia risk factors in Republic of Korea. Methods: A 12-year, nationwide, population-based, retrospective cohort study was conducted. We used customized health information from the National Health Insurance Service (NHIS) data from 2002 to 2017. We analyzed age- and sex-adjusted incidence rates and PAF of dementia for each risk factor such as depression, diabetes, hemorrhagic stroke, ischemic stroke, hypertension, osteoporosis and physical inactivity using Levin's formula. Results: Of the 794,448 subjects in the dementia-free cohort, 49,524 (6.2%) developed dementia. Dementia incidence showed annual growth from 1.56 per 1,000 person-years in 2006 to 6.94 per 1,000 person-years in 2017. Of all dementia cases, 34,544 subjects (69.8%) were female and 2,479 subjects (5.0%) were early onset dementia. AD dementia accounted for 66.5% of the total dementia incidence. Considering relative risk and prevalence, physical inactivity attributed the greatest to dementia (PAF, 8.1%), followed by diabetes (PAF, 4.2%), and hypertension (PAF, 2.9%). Altogether, the significant risk factors increased the risk of dementia by 18.0% (overall PAF). Conclusion: We provided the incidence of dementia and PAFs for dementia risk factors in Republic of Korea using a 12-year, nationwide cohort. Encouraging lifestyle modifications and more aggressive control of risk factors may effectively prevent dementia.

Deep learning-based classification system of bacterial keratitis and fungal keratitis using anterior segment images.

Introduction: Infectious keratitis is a vision threatening disease. Bacterial and fungal keratitis are often confused in the early stages, so right diagnosis and optimized treatment for causative organisms is crucial. Antibacterial and antifungal medications are completely different, and the prognosis for fungal keratitis is even much worse. Since the identification of microorganisms takes a long time, empirical treatment must be started according to the appearance of the lesion before an accurate diagnosis. Thus, we developed an automated deep learning (DL) based diagnostic system of bacterial and fungal keratitis based on the anterior segment photographs using two proposed modules, Lesion Guiding Module (LGM) and Mask Adjusting Module (MAM). Methods: We used 684 anterior segment photographs from 107 patients confirmed as bacterial or fungal keratitis by corneal scraping culture. Both broad- and slit-beam images were included in the analysis. We set baseline classifier as ResNet-50. The LGM was designed to learn the location information of lesions annotated by ophthalmologists and the slit-beam MAM was applied to extract the correct feature points from two different images (broad- and slit-beam) during the training phase. Our algorithm was then externally validated using 98 images from Google image search and ophthalmology textbooks. Results: A total of 594 images from 88 patients were used for training, and 90 images from 19 patients were used for test. Compared to the diagnostic accuracy of baseline network ResNet-50, the proposed method with LGM and MAM showed significantly higher accuracy (81.1 vs. 87.8%). We further observed that the model achieved significant improvement on diagnostic performance using open-source dataset (64.2 vs. 71.4%). LGM and MAM module showed positive effect on an ablation study. Discussion: This study demonstrated that the potential of a novel DL based diagnostic algorithm for bacterial and fungal keratitis using two types of anterior segment photographs. The proposed network containing LGM and slit-beam MAM is robust in improving the diagnostic accuracy and overcoming the limitations of small training data and multi type of images.

Transcutaneous Electrical Stimulation for the Prevention of Dry Eye Disease after Photorefractive Keratectomy: Randomized Controlled Trial.

Objective: To evaluate the efficacy and safety of transcutaneous electrical stimulation (TES) for the prevention of dry eye after photorefractive keratectomy (PRK). Design: Prospective, single-center, single-blinded, parallel group, placebo-controlled, randomized clinical trial. Participants: Between February 2020 and October 2020, patients at the Samsung Medical Center scheduled to undergo PRK to correct myopia were screened and enrolled. Methods: The participants in the TES group were instructed to use the electrical stimulation device (Nu Eyne 01, Nu Eyne Co) at the periocular region after the operation, whereas those in the control group were to use the sham device. Dry eye symptoms were evaluated preoperatively and postoperatively at weeks 1, 4, and 12 using the Ocular Surface Disease Index (OSDI) questionnaire, the 5-Item Dry Eye Questionnaire (DEQ-5), and the Standard Patient Evaluation for Eye Dryness II (SPEED II) questionnaire. Dry eye signs were assessed using tear break-up time (TBUT), total corneal fluorescein staining (tCFS), and total conjunctival staining score according to the National Eye Institute/Industry scale. The pain intensity was evaluated using a visual analog scale. Main Outcome Measures: Primary outcomes were OSDI and TBUT. Results: Twenty-four patients were enrolled and completed follow-up until the end of the study (12 patients in the TES group, 12 patients in the control group). Refractive outcomes and visual acuity were not different between the groups. No serious adverse event was reported with regard to device use. No significant difference in OSDI and SPEED II questionnaires and the DEQ-5 was observed between the groups in the 12th week after surgery. The TBUT scores 12 weeks after the surgery were 9.28 ± 6.90 seconds in the TES group and 5.98 ± 2.55 seconds in the control group with significant difference (P = 0.042). The tCFS and total conjunctival staining score were significantly lower in the TES group than in the control group at postoperative 4 weeks. Pain intensity at the first week was significantly lower in the TES group than in the control group by 65% (P = 0.011). Conclusion: The application of TES is safe and effective in improving dry eye disease after PRK. Financial Disclosures: The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Association Between Retinopathy of Prematurity in Very-Low-Birth-Weight Infants and Neurodevelopmental Impairment.

PURPOSE: To evaluate the impact of retinopathy of prematurity (ROP) severity and the treatment of very-low-birth-weight infants (VLBWIs) on neurodevelopmental impairment in early childhood. DESIGN: Prospective cohort study. METHOD: This was a prospective cohort study. The data were obtained from the Korean Neonatal Network (KNN), a nationwide registry for VLBWIs. Infants who were born from 2013 to 2015 and underwent ROP evaluation at birth and neurodevelopmental examinations at corrected ages of 18 to 24 months were included in the study. Infants with a history of meningitis or severe congenital anomalies were excluded. The VLBWI patients were grouped into no ROP, no treatment-requiring ROP (non-TR-ROP), and treatment-requiring ROP (TR-ROP) groups. Neurodevelopmental impairment was defined as participants who had at least 1 developmental problem according to the Bayley Scales of Infant and Toddler Development-2nd Edition (Bayley-II; <70), Bayley Scales of Infant and Toddler Development-3rd Edition (Bayley-III; <70), and Korean Developmental Screening Test (K-DST) tests (below -1 SD), and the Korean Ages and Stages Questionnaire (K-ASQ) (below the threshold) and Gross Motor Function Classification System (GMFCS; at level 2 or above). Multivariable logistic regression analysis was performed to evaluate the association between ROP and neurodevelopmental impairment. RESULT: Among 3132 infants, 1093 (34.9%) had ROP. Among the ROP infants, 644 were not treated for ROP (non-TR-ROP group) and 449 received ROP treatments (TR-ROP group). The patients in the TR-ROP group had an increased risk of developing neurodevelopmental problems compared to those in the no ROP group (odds ratio [OR] = 1.72, 95% CI = 1.33-2.21). The TR-ROP group had a higher risk of all 3 types of neurodevelopmental problems: mental (OR = 1.62, 95% CI = 1.25-2.09), social (OR = 1.62, 95% CI = 1.12-2.09), and motor (OR = 1.69, 95% CI = 1.31-2.18). The risk of neurodevelopmental problems in patients treated with laser therapy did not differ from that in patients treated with anti-vascular endothelial growth factor (anti-VEGF) therapy (OR = 1.17, 95% CI = 0.73-1.88). CONCLUSION: ROP was independently associated with neurodevelopmental impairment in early childhood. The type of ROP treatment (anti-VEGF or laser treatment) did not affect neurodevelopmental impairment in patients in the TR-ROP group.

Decreased visual acuity is related to thinner cortex in cognitively normal adults: cross-sectional, single-center cohort study.

BACKGROUND: Decreased visual acuity (VA) is reported to be a risk factor for dementia. However, the association between VA and cortical thickness has not been established. We investigated the association between VA and cortical thickness in cognitively normal adults. METHOD: We conducted a cross-sectional, single-center cohort study with cognitively normal adults (aged ≥ 45) who received medical screening examinations at the Health Promotion Center at Samsung Medical Center. Subjects were categorized as bad (VA ≤ 20/40), fair (20/40 < VA ≤ 20/25), and good (VA > 20/25) VA group by using corrected VA in the Snellen system. Using 3D volumetric brain MRI, cortical thickness was calculated using the Euclidean distance between the linked vertices of the inner and outer surfaces. We analyzed the association between VA and cortical thickness after controlling for age, sex, hypertension, diabetes, dyslipidemia, intracranial volume, and education level. RESULTS: A total of 2756 subjects were analyzed in this study. Compared to the good VA group, the bad VA group showed overall thinner cortex (p = 0.015), especially in the parietal (p = 0.018) and occipital (p = 0.011) lobes. Topographical color maps of vertex-wise analysis also showed that the bad VA group showed a thinner cortex in the parieto-temporo-occipital area. These results were more robust in younger adults (aged 45 to 65) as decreased VA was associated with thinner cortex in more widespread regions in the parieto-temporo-occipital area. CONCLUSION: Our results suggest that a thinner cortex in the visual processing area of the brain is related to decreased visual stimuli.

Relationships among visual acuity, risk of acute myocardial infarction, and stroke: a nationwide cohort study in south korea.

PURPOSE: Visual impairment (VI) is highly prevalent in the elderly and is associated with functional decline. Previous research demonstrated an association between VI and cardiovascular events, but investigations have yet to be conducted in general population samples. We evaluated the relationship between visual acuity (VA) and development of cardiovascular diseases (CVD) in a nationwide Korean population. METHODS: This is a nationwide retrospective cohort study. We used the National Health Information Database of the National Health Insurance Service of Korea to identify subjects who participated in the National Health Insurance Service health screening program in 2012. We monitored 5,941,761 subjects for the development of cardiovascular diseases for a period of 5 years. RESULTS: After adjustments for age, sex, and other covariates, with subjects having a visual acuity better than 20/20 as the reference group, the adjusted hazard ratios (HRs) and 95% confidential intervals (CI) for acute myocardial infarction and stroke were visual acuity between 20/20 and 20/60, 1.073 (95% CI 1.053, 1.094) and 1.151 (95% CI 1.132, 1.171), respectively; for visual acuity between 20/60 and 20/200, 1.236 (95% CI 1.197, 1.277), and 1.336 (95% CI 1.302, 1.371), respectively; and for visual acuity worse than 20/200, 1.325 (95% CI 1.285, 1.366) and 1.383 (95% CI 1.349, 1.418), respectively. CONCLUSION: Subjects with lower VA had higher risks of acute myocardial infarction and stroke. These results suggest that low VA is an independent risk factor for CVD.

Reproductive risk factors of pterygium in postmenopausal women: a nationwide study in the Republic of Korea.

This study is to elucidate the associations between female reproductive factors and pterygium. A total of 1,339,969 postmenopausal women in a retrospective cohort of Korean National Health Insurance Service data on ages 40 and above in 2009 was included. Cox proportional hazards regression was conducted to assess the hazard ratio (HR) for pterygium according to reproductive factors. Late menarche, early menopause, short reproductive period, increasing parity (≥ 2 children), breastfeeding (≥ 6 months), and no use of hormone replacement therapy (HRT) or oral contraceptive (OC) were significantly associated with risk of pterygium. In multivariate analysis, the HR for pterygium was 1.764 (95% confidence interval [CI], 1.529-2.035) for menarche age ≥ 17 years (reference: menarche age < 12 years). The HR of menopause age ≥ 55 years was 0.782 (95% CI, 0.724-0.845) (reference: menopause age < 40 years). The HR of parity ≥ 2 was 1.261 (95% CI, 1.148-1.385) (reference: nulliparity). The HR of breastfeeding ≥ 1 year was 1.663 (95% CI, 1.564-1.768) (reference: no breastfeeding). The HRs of HRT and OC use for any length of time were lower than those for the non-user groups (reference). Reproductive factors that increase estrogen exposure have protective effects against pterygium in females.

Effects of Lipiflow Treatment Prior to Cataract Surgery: A Prospective, Randomized, Controlled Study.

To investigate the effects of preoperative Lipiflow (Johnson & Johnson, Jacksonville, FL, USA) treatment before cataract surgery on meibomian gland dysfunction (MGD) and dry eye induced by surgery. DESIGN: Prospective, randomized controlled study. METHODS: This study comprised 124 eyes of 124 patients with planned surgery for senile cataract. Participants were randomly allocated into control and Lipiflow groups based on administration of Lipiflow treatment 3 weeks before cataract surgery. For meibomian gland (MG) evaluation, MG atrophy, degree of gland expressibility, and quality of gland secretions were examined at the baseline visit and 1 and 3 months postoperatively. Ocular surface parameters of tear film break-up time, Oxford corneal staining score, and tear film lipid layer thickness were measured at each visit. Ocular Surface Disease Index and Dry Eye Questionnaire were also assessed. RESULTS: The control group exhibited a significant decrease in MG expressibility, worsened meibum quality, decreased lipid layer thickness, and worsened corneal staining after cataract surgery. Also, dry eye symptom showed significant worsening. Conversely, the Lipiflow group showed significantly improved MG patency and meibum quality, increased tear film break-up time, and reduced corneal staining, and presented improved subjective outcomes reported on both Ocular Surface Disease Index and Dry Eye Questionnaire. The improvement of each parameter in the Lipiflow group showed a linear correlation with baseline MGD grade. In addition, patients without baseline MGD showed less worsening or improvement of MGD and dry eye induced by surgery, with preoperative Lipiflow treatment. CONCLUSIONS: Preoperative Lipiflow treatment conducted before cataract surgery may be a safe and effective intervention for relieving MGD and dry eye induced by surgery. It might be recommended not only for the patients with preoperative MGD but also for those without baseline MGD, to prevent the development of MGD and dry eye induced by ocular surgeries.

Evaluation of tear osmolarity measured by I-Pen osmolarity system in patients with dry eye.

This retrospective comparative study was to evaluate tear osmolarity measured by I-Pen osmolarity system (I-MED Pharma Inc, Dollard-des-Ormeaux, Quebec, Canada) in healthy subjects without dry eye disease (DED) and patients with DED, and its association with other ocular surface parameters. This study comprised 65 eyes of 65 patients. The ocular surface parameters including tear osmolarity with I-Pen osmometer of the patients who visited the refractive surgery center of Samsung Medical Center between January 1, 2020 and May 31, 2020 were retrospectively collected. The subjects were divided as asymptomatic normal group and symptomatic dry eye group. The distribution of tear osmolarity and its association with other ocular surface parameters were evaluated. Total thirty-two patients (32 eyes) were included in the control group, and 33 patients (33 eyes) were included in the DED group. Tear osmolarity was significantly higher in the DED group. Tear osmolarity was negatively correlated with tear break-up time, and the Schirmer test, and was positively correlated with Ocular Surface Disease Index symptom score. The cut-off value of 318 mOsm/L showed a sensitivity of 90.9% and specificity of 90.6% for diagnosing DED. The I-Pen osmometer can be considered suitable for use in the clinical setting, with good performance in DED diagnosis.

Effects of the re-esterified triglyceride (rTG) form of omega-3 supplements on dry eye following cataract surgery.

BACKGROUND/AIMS: To evaluate the clinical outcomes of the systemic re-esterified triglyceride (rTG) form of omega-3 fatty acids in patients with dry eye symptoms after cataract surgery. METHODS: This prospective comparative cohort study comprised 66 patients complaining of new-onset non-specific typical dry eye 1 month after uncomplicated cataract surgery. Subjects were randomly allocated into control and omega-3 groups based on administration of the systemic rTG form of omega-3 fatty acids for 2 months, in addition to use of artificial teardrop. Ocular surface parameters (Schirmer's test, tear break-up time, corneal staining score and matrix metalloproteinase-9 (MMP-9)) and subjective questionnaire results (Ocular Surface Disease Index (OSDI)) and Dry Eye Questionnaire [DEQ]) for dry eye were evaluated before and after omega-3 supplementation. RESULTS: Two months after omega-3 supplementation, the Oxford score was lower in the omega-3 group than in the control group. There was an improvement of subjective symptom scores of OSDI and DEQ in the omega-3 group (both p<0.05). The ratio of increasing MMP-9 level in the omega-3 group was lower than that in the control group (p=0.027). CONCLUSION: The rTG form of omega-3 supplementation might be related to reduction of ocular surface inflammation rather than secretion of tears, and it might be effective for non-specific typical dry eye after uncomplicated cataract surgery. TRIAL REGISTRATION NUMBER: NCT04411615.

Clinical manifestations of cuticular drusen in Korean patients.

Cuticular drusen show some similarities to and differences from soft drusen in age-related macular degeneration (AMD) and might thus be a unique AMD subtype. Previous studies on cuticular drusen were performed mainly in white ethnic groups, but AMD shows ethnic differences. We investigated clinical manifestations of cuticular drusen in Korean patients to evaluate possible ethnic differences. Clinical records of Korean patients with cuticular drusen were retrospectively reviewed. Fundus distribution pattern, imaging features, and presence of large drusen, drusenoid pigment epithelial detachment (PED), and macular complications, including geographic atrophy (GA), choroidal neovascularization (CNV), and acquired vitelliform lesion (AVL), were assessed via multimodal imaging in 162 eyes with cuticular drusen (n = 81 patients; 67 females; mean age: 66.6 ± 9.1 years). Diffuse distribution was found in 61.7% and peripapillary involvement in 75.3% of eyes. Large drusen, drusenoid PED, GA, CNV, and AVL were observed in 59.3%, 26.5%, 18.5%, 3.7%, and 1.2% of eyes, respectively. The macular complication prevalence was similar between patients ≤ 60 and those > 60 years old. In Korean patients, cuticular drusen were less frequently associated with macular complications than in white patients, and the proportion of macular complications differed significantly, with AVL representing an uncommon complication.

Visual Acuity and Development of Parkinson's Disease: A Nationwide Cohort Study.

BACKGROUND: Visual dysfunction in Parkinson's disease (PD) is well known from previous reports, but the association of visual deficits with PD development has not yet been studied. The aim of this research was to evaluate the association of visual acuity with the risk of PD occurrence using a nationwide cohort in South Korea. METHODS: Among the population participating in the National Health Insurance Service, which is mandatory for all South Koreans, 6,055,113 individuals who had taken part in health screening programs between January 1, 2009, and December 31, 2012, were included in the cohort and followed until December 31, 2017. The hazard ratio was calculated for groups with high and low visual acuity using multivariate adjusted Cox regression analysis. RESULTS: A total of 22,872 subjects (0.38%) were diagnosed as having PD within the study period. Groups with low visual acuity showed a higher incidence of PD compared with groups with good visual acuity. Compared with the reference group (visual acuity better than 20/20), the adjusted hazard ratios and 95% confidence intervals (CIs) was 1.315 (95% CI, 1.261-1.371) for the group with visual acuity between 20/20 and 20/60, 1.357 (95% CI, 1.277-1.442) for the group with visual acuity between 20/60 and 10/100, and 1.267 (95% CI, 1.193-1.343) for the group with visual acuity less than 10/100. CONCLUSIONS: Low visual acuity was associated with the development of PD. This suggests that visual dysfunction is one of the premotor symptoms for PD development. © 2020 International Parkinson and Movement Disorder Society.

Refractive corneal inlay for presbyopia in emmetropic patients in Asia: 6-month clinical outcomes.

BACKGROUND: To evaluate the 6-month clinical outcomes of Flexivue Microlens refractive corneal inlay in emmetropic patients in Asia for the surgical compensation of presbyopia. METHODS: In this retrospective study, corneal inlay implantation was done using a femtosecond laser. The follow-up period was 6 months. Near/intermediate/distant visual acuities, refraction, keratometry, defocus curve, wavefront aberrations, contrast sensitivity, Scheimpflug corneal scanning, endothelial cell density, dry eye test, confocal microscopy scanning, and patient questionnaires were evaluated. RESULTS: The inlay implantation was performed in 21 eyes from June 2015 to April 2017. 6 months after surgery, the uncorrected near visual acuity of the operated eyes increased significantly from 0.55 ± 0.22 logMAR preoperatively to 0.25 ± 0.15 logMAR (p < 0.05) but mean bilateral uncorrected distant visual acuity did not change significantly (p = 0.90). Total higher-order aberration and spherical aberration increased, and the contrast sensitivity of the operated eyes decreased. Endothelial cell density and central corneal thickness did not change from preoperative values. Patient satisfaction for near vision was increased 6 months after implantation, and 50.0% of patients were independent of near spectacles. Explantation was done in 2 cases. CONCLUSION: The Flexivue Microlens refractive corneal inlay was effective for improving near visual acuity at 6 months follow-up But proportion of spectacle independency and patient satisfaction were lower in this Korean population than in previous reports. Further study with a longer follow-up period is needed.

Measurable Range of Subfoveal Choroidal Thickness With Conventional Spectral Domain Optical Coherence Tomography.

PURPOSE: We investigate the measurable range of subfoveal choroidal thickness (SFCT) with conventional spectral domain optical coherence tomography (SD-OCT) in normal healthy eyes. METHODS: All subjects underwent an SD-OCT horizontal line scan centered at the fovea with standard and enhanced depth imaging (EDI) techniques. Two independent observers manually measured SFCT on standard and EDI-OCT images, if two choroidal borders were identified. The rate of successful measurement with standard OCT was evaluated. Inter- and intraclass correlation coefficients and Bland-Altman plots were used for analysis. RESULTS: OCT images of 724 normal healthy eyes from 374 subjects were evaluated. Although the inner choroidal border was identified on all OCT images, the outer choroidal border was identified on 378 of 724 (52.2%) conventional OCT images. Mean SFCT of all study eyes measured by EDI-OCT images was 292.6 ± 94.0. The number of successful measurements with conventional OCT was 100%, 87.5%, 48.1%, 33.0%, and 0%, in the SFCT ranges of <241, 241-280, 281-320, 321-360, and >360 µm, respectively. The accumulated rate of successful measurement with conventional OCT was 100%, 96.4%, and 82.2% in the SFCT ranges of ≤240, ≤280, and ≤320 µm, respectively. Two protocols showed good inter-correlation of SFCT, when SFCT were measurable in both scans. CONCLUSIONS: SFCT can be measured by conventional OCT in eyes with thin choroid, and the measured value shows high agreement with those measured by EDI-OCT. In such eyes, conventional OCT can be used potentially to evaluate the retina and choroid. TRANSLATIONAL RELEVANCE: In eyes with a thin choroid, conventional OCT can be used potentially to evaluate the retina and choroid with high agreement with EDI-OCT.

Gamma Knife Radiosurgery for Cancer Metastasized to the Ocular Choroid.

OBJECTIVE: Choroidal metastases (CMs) are the most common intraocular tumor. Management is mainly radiation therapy with goals of pain control and visual improvement. However, many radiation-related complications are reported. Since gamma knife radiosurgery (GKS) for CM was first reported in 1995, few cases have been reported. We report 7 cases of CMs treated with GKS. METHODS: From April 2011 to November 2014, 7 patients with CM underwent GKS. Their median age at treatment was 64 years (range, 51-71 years). Four males and three females were treated. Lung cancer was the most common primary pathology, followed by renal cell carcinoma and stomach cancer. Four patients had multiple cerebral lesions and were treated simultaneously for choroidal lesions. The median marginal dose of 20 Gy (range, 15-25 Gy) was administered at the 50% isodose line. RESULTS: Median follow-up period after GKS was 8 months (range, 2-38.3 months). Four patients expired due to underlying malignancy progression. Except for two patients who were not followed with magnetic resonance image after GKS, all patients showed size reduction in the treated lesions, but a new choroidal lesion appeared in one patient and one recurred. Six of seven patients reported subjectively improved visual symptoms. Visual acuity improved in 2 patients, and 2 were stable upon objective examination. One patient showed no improvement in visual acuity, but ocular pain was relieved; another patient showed improved vision and tumor remission, but visual deterioration recurred. CONCLUSION: GKS was shown to be safe and effective and should be considered for CM treatment.

Delayed Absorption of Subretinal Fluid after Retinal Reattachment Surgery and Associated Choroidal Features.

PURPOSE: The aim of this study was to investigate the incidence and associated clinical factors of delayed absorption of subretinal fluid (SRF) after surgery for rhegmatogenous retinal detachment. METHODS: This study involved 36 eyes of 36 consecutive patients who underwent successful surgery for rhegmatogenous retinal detachment. A complete ophthalmologic evaluation, including clinical fundus examination, optical coherence tomography, and indocyanine green angiography, was conducted before and after surgery. Delayed absorption was defined as the presence of residual concave SRF or an SRF bleb at 6 months after surgery. Clinical factors and choroidal features on indocyanine green angiography were compared according to the presence and absence of delayed absorption. RESULTS: Eighteen of 36 eyes (50%) showed delayed absorption. Macular involvement and worse preoperative visual acuity were significantly related to the presence of delayed absorption (p = 0.001 and p = 0.034, respectively). On indocyanine green angiography, preoperative choroidal vascular hyperpermeability was noted in 70% of eyes with delayed absorption and in 14% of eyes without it (p = 0.010). CONCLUSIONS: Delayed absorption of SRF after retinal reattachment surgery was not rare, with a 50% of incidence in this study. Macula-off status was significantly related to the incidence of delayed SRF absorption, and choroidal features such as choroidal vascular hyperpermeability might be responsible in part, possibly through the resultant exudative property of choroid.

The Incidence and Risk Factors of Lens-iris Diaphragm Retropulsion Syndrome during Phacoemulsification.

PURPOSE: In the present study, the incidence and risk factors of lens-iris diaphragm retropulsion syndrome (LIDRS) were evaluated. METHODS: Patients who underwent cataract surgery using phacoemulsification between June 2014 and December 2014 were included in the study. The preoperative ocular biometric and intraoperative surgical parameters were examined. The incidence of LIDRS and various risk factors were analyzed using an independent t-test, Pearson's chi-square test, and univariable and multivariable logistic regression analyses. RESULTS: Among 124 eyes of 124 patients, 100 (80.6%) had no LIDRS and 24 (19.4%) had LIDRS. LIDRS occurred in 13 of 31 vitrectomized eyes (41.9%) and 11 of 93 non-vitrectomized eyes (11.8%). Based on univariable analysis, age (odds ratio [OR], 0.920; p = 0.001), vitrectomized eye (OR, 5.038; p = 0.001), spherical equivalent (OR, 0.778; p < 0.001), axial length (OR, 1.716; p < 0.001), anterior chamber depth (OR, 3.328; p = 0.037), and 3.0 mm vs. 2.2 mm incision size (OR, 4.964; p = 0.001) were statistically significant risk factors associated with the development of LIDRS. Conditional multivariable logistic regression showed that vitrectomized eye (OR, 3.865; 95% confidence interval [CI], 1.201 to 12.436; p = 0.023), long axial length (OR, 1.709; 95% CI, 1.264 to 2.310; p = 0.001), and 3.0 vs. 2.2 mm incision size (OR, 3.571; 95% CI, 1.120 to 11.393; p = 0.031) were significant independent risk factors associated with LIDRS. CONCLUSIONS: LIDRS is a relatively common occurrence and was found to be associated with vitrectomized eye, long axial length, and larger incision size. Evaluating risk factors prior to cataract surgery can help reduce associated morbidity.

Optic Disc Characteristics and Visual Field Progression in Normal Tension Glaucoma Patients With Tilted Optic Discs.

PURPOSE OF THE STUDY: The purpose of the study was to evaluate the optic disc characteristics associated with visual field (VF) progression in normal tension glaucoma (NTG) eyes with tilted optic discs. METHODS: Sixty-six eyes of 66 NTG patients with tilted optic disc were included in this cross-sectional study, who were examined by at least 5 Humphrey 30-2 VFs. Glaucomatous VF progression was evaluated using pointwise linear regression. Optic nerve heads were scanned with enhanced-depth imaging optical coherence tomography (EDI-OCT), and evaluated for the focal lamina cribrosa (LC) defects and LC thicknesses. Optic disc torsion degrees and tilt ratios were measured from disc photographs. Logistic regression analyses were used to identify the risk factors for VF progression and focal LC defects. RESULTS: Multivariate analysis showed that VF progression was associated with the presence of focal LC defects and greater number of VFs. The eyes with focal LC defects were associated with greater torsion degree and tilt ratio in multivariate analysis. The VF mean deviation slopes and localized VF progression rates in eyes with focal LC defects were greater than those without defects. CONCLUSIONS: The greater optic disc tilt and torsion in NTG eyes with tilted optic disc were associated with focal LC defects, but not with VF progression. The focal LC defects were associated with VF progression. This study suggests that the focal LC defects in NTG patients with tilted optic disc may be an independent risk factor for glaucomatous VF progression, and the development of focal LC defects could be influenced by optic disc torsion or tilt.