FUNDUS AUTOFLUORESCENCE PATTERNS IN CENTRAL SEROUS CHORIORETINOPATHY.

PURPOSE: To investigate the patterns of fundus autofluorescence (FAF) abnormalities in patients with central serous chorioretinopathy (CSC). METHODS: This cross-sectional observational study included 126 eyes of 118 patients who were diagnosed with central serous chorioretinopathy from December 2006 to April 2012 at Kyung Hee University Hospital, Seoul, Korea. Fundus autofluorescence patterns were analyzed with spectral domain optical coherence tomography and visual acuity. RESULTS: Fundus autofluorescence patterns were grouped as blocked (38.9%), mottled (8.7%), hyper (31.0%), hyper/hypo (13.5%), or descending tract (8.0%). The duration of symptoms was 7.8 (±20.4), 28.3 (±31.8), 42.5 (±69.1), 163.8 (±183.5), and 174.5 (±162.3) days in the blocked, mottled, hyper, descending tract, and hyper/hypo groups, respectively (P < 0.001). The blocked FAF group had the best visual acuity (P = 0.011). The intact ellipsoid zone on the spectral domain optical coherence tomography was mostly found in the blocked FAF group (P < 0.001), and the disrupted ellipsoid zone was commonly exhibited in the hyper/hypo and descending tract groups. Disrupted external limiting membrane line on the spectral domain optical coherence tomography was seen in two patients of the descending tract group only. CONCLUSION: The FAF abnormalities in central serous chorioretinopathy show multiple patterns and are related with the chronicity and visual acuity. Fundus autofluorescence patterns in central serous chorioretinopathy are helpful when considering the timing of treatment and predicting the disease status.

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

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

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

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

Association of IOP with Systemic Factors in a Korean Cohort.

PURPOSE: To assess the relationship of intraocular pressure (IOP) to age, sex, and other demographic and health characteristics in a Korean cohort. METHODS: This retrospective cross-sectional study included subjects (n = 155,198) without glaucoma. All participants underwent health screening at the Kangbuk Samsung Hospital from August 2012 to July 2013. Anthropometric measurements, systemic health characteristics, and ocular examination including noncontact tonometry were performed on all participants. Additionally, sociodemographic and behavioral questionnaires were obtained. The systemic variables were analyzed by multiple regression analysis to identify their relationship with IOP. RESULTS: The mean IOP tended to be highest in subjects in their 50s and lowest in subjects in their 20s and 60s for both Korean men and women. This pattern remained the same after adjusting for several demographic and health characteristics. The mean IOP for men was significantly higher than that for women (p < 0.001), but the difference between sexes decreased with increasing age. In the univariate analysis, almost all systemic factors showed a positive association with IOP except for high-density lipoprotein cholesterol. By multiple regression analysis, IOP was positively associated with sex (male), current smoking status, systolic blood pressure, fasting plasma glucose, body mass index, total cholesterol, and high-density lipoprotein (p ≤ 0.001). CONCLUSIONS: In a Korean cohort, the mean IOP was highest in subjects in their 50s. The mean IOP for men was significantly higher than that for women. Several systemic factors were significantly correlated with IOP.

Disc hemorrhages and their risk factors in an urban South Korean population.

PURPOSE: The aim of this study was to estimate the prevalence of disc hemorrhage (DH) and evaluate its related risk factors in an urban South Korean population. METHODS: This retrospective cross-sectional study included subjects who underwent health screening at the Health Screening Center of Kangbuk Samsung Hospital from August 2012 to July 2013. All fundus photographs were first reviewed by two ophthalmologists and then by two glaucoma specialists and one retina specialist to determine the presence of DHs. In addition to fundus photographs, each participant completed systemic examination as well as sociodemographic and behavioral questionnaires. RESULTS: Fundus photographs were available for 164,029/168,044 (97.61%) subjects 20 years and older. The prevalence of DH was 226/164,029 (0.14%; 95% confidence interval, 0.12 to 0.16) per subject. A large proportion (61.5%) of eyes with DH had localized wedge-shaped retinal nerve fiber layer defects indicative of glaucoma. There was also a slight increase in DH prevalence with age, but no other statistically significant associations were found. CONCLUSIONS: The prevalence of DH was 0.14% in urban South Korean subjects 20 years and older. Older age and the presence of glaucomatous retinal nerve fiber layer defects were associated with higher prevalence of DH. These findings suggest that the presence of a DH in an eye implies a high likelihood of glaucoma, although its absence does not indicate that glaucoma is absent.

Effect of axial length on diurnal IOP in cataract patients without glaucoma.

PURPOSE: To evaluate the effect of ocular biometrics on intraocular pressure (IOP) and diurnal IOP fluctuation in nonglaucomatous subjects. METHODS: We examined 115 subjects from May to December 2007 in Kangbuk Samsung Hospital, Seoul, Korea. Intraocular pressure was measured with a Goldmann applanation tonometer in habitual positions every 2 hours from 9 am to 11 pm. Ocular biometric values including central corneal thickness, central corneal power, axial length, anterior chamber depth, and lens thickness were measured using an ultrasound biometer and keratometer and the refractive state was determined. RESULTS: Two hundred fourteen eyes of 115 patients were included in this study; the mean (±SD) IOP of all eyes was 12.33 (±2.55) mmHg. The mean (±SD) diurnal IOP fluctuation was 2.72 (±1.43) mmHg. Central corneal thickness was positively correlated with the mean IOP (Pearson correlation, r = 0.217, p = 0.002); however, there was no relationship between central corneal thickness and the diurnal IOP fluctuation. Axial length was not related to the mean IOP (Pearson correlation, r = 0.049, p = 0.476) and the diurnal IOP fluctuation (Pearson correlation, r = 0.058, p = 0.395). The mean IOP or diurnal IOP fluctuation was not related to any of the following values: central corneal power, anterior chamber depth, refractive error, lens thickness, or vitreous chamber depth. CONCLUSIONS: Central corneal thickness is significantly related to the IOP but may not affect diurnal IOP fluctuation. The axial length was not associated with IOP profiles in this study. Our results can contribute to a broader understanding of the effects of ocular biomechanical properties on the IOP profile.

Elemental analysis of sunflower cataract in Wilson's disease: a study using scanning transmission electron microscopy and energy dispersive spectroscopy.

Signature ophthalmic characteristics of Wilson's disease (WD) are regarded as diagnostically important manifestations of the disease. Previous studies have proved the common occurrence of copper accumulation in the liver of patients with WD. However, in the case of sunflower cataracts, one of the rare diagnostic signs of WD, no study has demonstrated copper accumulation in the lens capsules of sunflower cataracts in WD patients. To investigate the nanostructure and elemental composition of sunflower cataracts in WD, transmission electron microscopy (TEM) was done on the capsulorhexised anterior lens capsule of sunflower cataracts in WD in order to evaluate anatomical variation and elemental changes. We utilized energy dispersive X-ray spectroscopy (EDS) to investigate the elemental composition of the lens capsule using both point and mapping spectroscopy. Quantitative analysis was performed for relative comparison of the elements. TEM showed the presence of granular deposits of varying size (20-350 nm), appearing mainly in the posterior one third of the anterior capsule. The deposits appeared in linear patterns with scattered dots. There were no electron-dense particles in the epithelial cell layer of the lens. Copper and sulfur peaks were consistently revealed in electron-dense granular deposits. In contrast, copper and sulfur peaks were absent in other tissues, including granule-free lens capsules and epithelial tissue. Most copper was exclusively located in clusters of electron-dense particles, and the copper distribution overlapped with sulfur on mapping spectroscopy. Quantitative analysis presented inconsistent ratios of copper to sulfur in each electron-dense granule. The mean ratio of copper to sulfur was about 3.25 (with a range of 2.39-3.78). This is the first elemental analysis of single electron particles in sunflower cataracts using EDS in the ophthalmic area. Sunflower cataracts with WD are assumed to be the result of accumulation of heterogeneous compounds composed of several materials, including copper, sulfur, and/or copper-binding proteins. Linear patterns of copper and sulfur deposition were detected in various sizes and composition ratios with these elements in cases of WD.

A patient with branch retinal vein occlusion accompanied by superior ophthalmic vein thrombosis due to severe superior ophthalmic vein enlargement in a patient with graves ophthalmopathy.

We report a patient with branch retinal vein occlusion (BRVO) accompanied by superior ophthalmic vein (SOV) thrombosis resulting from severe SOV enlargement in a patient with Graves ophthalmopathy (GO). A 78-year-old woman diagnosed with BRVO presented with reduced vision. She had a more than 20-year history of unilateral GO. Fluorescein angiography and spectralis optical coherence tomography revealed BRVO with cystoid macular edema. Approximately 5 months later, she complained of advanced left proptosis. A computed tomography scan at that time revealed dilated SOV with high internal attenuation due to SOV thrombosis of the left orbit. Because of the uncertain onset of SOV thrombosis and minimal signs of acute orbital congestion, we prescribed prophylactic daily aspirin to improve blood flow rather than a heparin-based treatment. In addition, she was treated with lubricants for exposure keratopathy and a dorzolamide/timolol eyedrops to prevent increases in intraocular pressure. This is the first clinical report of BRVO accompanied by SOV thrombosis due to SOV enlargement in chronic severe GO. It should be recognized that SOV thrombosis can lead to an increase in proptosis even in chronic GO.

Changes in ocular biometrics following cycloplegic refraction in strabismic and amblyopic children.

This study was aimed to analyze ocular biometric changes following cycloplegia in pediatric patients with strabismus and amblyopia. Cycloplegia is routinely used to measure refractive error accurately by paralyzing accommodation. However, effects on axial length (AL), anterior chamber depth (ACD), keratometry (Km), and white-to-white distance (WTW) are not well studied in this population. This retrospective study examined 797 patients (1566 eyes) undergoing cycloplegic refraction at a Samsung Kangbuk hospital pediatric ophthalmology clinic from 2010 to 2023. Ocular biometry was measured before and after instilling 1% cyclopentolate and 0.5% phenylephrine/0.5% tropicamide. Patients were categorized by strabismus diagnosis, age, refractive error and amblyopia status. Differences in AL, ACD, Km, WTW, and refractive error pre- and post-cycloplegia were analyzed using paired t tests. ACD (3.44 ±â€…0.33 vs 3.58 ±â€…0.29 mm, P < .05) and WTW (12.09 ±â€…0.42 vs 12.30 ±â€…0.60 mm, P < .05) increased significantly after cycloplegia in all groups except other strabismus subgroup (Cs) in both parameters and youngest subgroup (G1) in ACD. Refractive error demonstrated a hyperopic shift from -0.48 ±â€…3.00 D to -0.06 ±â€…3.32 D (P < .05) in overall and a myopic shift from -6.97 ±â€…4.27 to -8.10 ±â€…2.26 in high myopia (HM). Also, AL and Km did not change significantly. In conclusion, cycloplegia impacts ocular biometrics in children with strabismus and amblyopia, significantly increasing ACD and WTW. Refractive error shifts hyperopically in esotropia subgroup (ET) and myopically in high myopia subgroup (HM), eldest subgroup (G3) relating more to anterior segment changes than AL/Km. Understanding cycloplegic effects on biometry is important for optimizing refractive correction in these patients.

Comparison of contamination rates between preserved and preservative-free fluoroquinolone eyedrops.

BACKGROUND: To evaluate the antimicrobial effectiveness of preservative-free fluoroquinolone products compared with benzalkonium chloride containing fluoroquinolones using the challenge test provided by the United States Pharmacopeia (USP) and the in-use test. METHODS: 1. Challenge test: to compare the growth of microorganisms between different fluoroquinolone preparations, four test organisms, including Staphylococcus aureus, Pseudomonas aeruginosa, Candida albicans, and Aspergillus niger were chosen among five microorganisms listed by USP 2004. The inoculated products were sampled for microbial survivors at days 7, 14, and 28 following initial inoculation at room temperature. The number of surviving organisms were calculated as a Log10 reduction from the original inocula. 2. In-use test: a total of 100 bottles were collected after instillation of preservative-free fluoroquinolone eyedrops in volunteer patients after 1 week of use. The remaining fluid and tips of the bottles were cultured. Colonies on the plates were counted at the end of the incubation period. All microorganisms were identified by Gram staining and biochemical assays. RESULTS: 1. Challenge test: preservative-free gatifloxacin and levofloxacin demonstrated a lower log reduction against A. niger than preserved fluoroquinolones and preservative-free moxifloxacin at all time points. 2. In-use test: There was no contamination identified on plates inoculated by preservative-free quinolone bottles after 1 week of use in this study. CONCLUSIONS: Physicians should be aware of the lower antifungal preservative effectiveness of some preservative-free fluoroquinolone preparations than preserved ones.

Comparison of localized retinal nerve fiber layer defects in highly myopic, myopic, and non-myopic patients with normal-tension glaucoma: a retrospective cross-sectional study.

BACKGROUND: The purpose of this study was to evaluate the relationship between patterns of localized retinal nerve fiber layer (RNFL) defects and the degree of myopia in patients with normal-tension glaucoma (NTG). METHODS: We retrospectively reviewed medical records of patients with high myopia (42 eyes; spherical equivalent [SE] < -6.0 diopters [D]), low to moderate myopia (93 eyes; SE -6.0D ~ and -0.5D), and emmetropia (65 eyes; SE -0.5D ~ +0.5D), all of which were diagnosed as having NTG with localized RNFL defects. On RNFL photographs, the proximity of the RNFL defect to the center of the fovea (angle I) and the sum of the angular width of the defects (angle II) were determined. The patterns of localized RNFL defects were then compared with respect to differences in angles I and II. RESULTS: Angle I was significantly smaller in the high myopia group than in the low to moderate myopia group (p = 0.028) and the emmetropia group (p = 0.044), while angle II was significantly larger in the high myopia group compared with the low to moderate myopia group and the emmetropia group (p < 0.001, p = 0.007). CONCLUSIONS: Among subjects with NTG, localized RNFL defects are wider and closer to the fovea in eyes with high myopia than those with low to moderate myopia or emmetropia.

The Relationship between Transcranial Doppler Ultrasonography and Visual Field Test Results in Glaucoma and Glaucoma Suspect Patients.

PURPOSE: To evaluate the relationships between parameters of transcranial ultrasonography and results of visual field tests in patients with open angle glaucoma or suspected of having glaucoma. METHODS: This retrospective study was based on data from medical records of patients who visited the Department of Ophthalmology in Kangbuk Samsung Hospital from January 1, 2016, to October 17, 2019, and underwent transcranial Doppler ultrasonography as part of a routine health examination. Ophthalmic data were visual acuity, intraocular pressure, optical coherence tomography, and Humphrey visual field test results. Retinal nerve fiber layer defect was confirmed by a glaucoma specialist. Patients' ophthalmic data, such as average ganglion cell layer thickness, visual field index, pattern standard deviation, and mean deviation, were divided into quartiles. Each ophthalmic artery parameter from transcranial Doppler ultrasonography was compared between quartiles. RESULTS: A total of 162 patients were reviewed. There was no difference in Doppler ophthalmic artery (OA) parameters between patients with or without retinal nerve fiber layer defect. None of the quartile groups of average ganglion cell layer thickness showed significant difference in any OA parameters. Patients in the low-visual field index quartile showed significant low peak systolic velocities of OAs when adjusted for age, sex, and presence of diabetes mellitus or hypertension (p = 0.016). A higher pattern standard deviation showed lower peak systolic velocity (p = 0.046). There was no significant tendency between any other OA parameter and mean deviation value. CONCLUSIONS: Our study suggests that hemodynamic parameters of ophthalmic arteries might be associated with visual field status of patients. Further large-population studies are needed in order to better understand the relationship between visual function and ocular blood flow.

Rate of Retinal Nerve Fiber Layer Thinning in Glaucomatous Eyes With Optic Disc and Parapapillary Deep-Layer Microvasculature Loss.

PRCIS: Microvasculature dropout in the parapapillary choroidal layer was a more important biomarker of glaucomatous nerve fiber layer thinning when it presented with deep-layer microvasculature of the optic disc rather than when it presents by itself. PURPOSE: To characterize open angle glaucoma eyes with optic nerve head deep-layer microvasculature dropout (MvD-D) and parapapillary choroidal layer microvasculature dropout (MvD-P) and compare their retinal nerve fiber layer (RNFL) thinning rate. MATERIAL AND METHODS: This study included 122 open angle glaucoma eyes that underwent ≥5 serial spectral-domain optical coherence tomography scans during a mean follow-up of 5.4 years. Swept-source optical coherence tomography angiography was used to evaluate MvD-P and MvD-D. Subjects were classified into 3 groups according to the presence of MvD-P and MvD-D: (1) no dropout (n=37); (2) solely MvD-P (n=40), and (3) both MvD-P and MvD-D (n=45). The RNFL thinning rate was compared among the 3 groups, and the associated factors were assessed by Cox proportional hazard analysis. RESULTS: RNFL thinning rates were highest in the group with both MvD-P and MvD-D, followed by the group with solely MvD-P and finally by the no dropout group (-0.24 vs. -0.65 vs. -1.20 µm/y, P <0.001). Thinner central corneal thickness [hazard ratio (HR)0.990, P =0.003], presence of disc hemorrhage (HR=1.802, P =0.035), and coexistence of MvD-P and MvD-D (HR=2.941, P <0.001) were the factors associated with RNFL thinning. CONCLUSIONS: The coexistence of MvD-P and MvD-D was associated with faster RNFL thinning than MvD-P alone or no dropout, which suggested that observing the optic disc deep microvasculature along with parapapillary choroidal layer using Swept-source optical coherence tomography angiography may be clinically relevant in monitoring glaucoma progression.

Association Between Optic Disc Perfusion Determined by Swept-Source Optical Coherence Tomography Angiography and Visual Field Progression in Glaucoma.

PRCIS: Reduced optic disc vessel density determined by swept-source optical coherence tomography angiography (SS-OCTA) was associated with visual field (VF) deterioration in glaucomatous eyes, which suggested that this parameter can be a potential biomarker that correlates well with functional deterioration. PURPOSE: The purpose of this study was to identify the association between optic disc perfusion evaluated by SS-OCTA and VF progression in primary open angle glaucoma (POAG) eyes. METHODS: A total of 266 POAG eyes of 266 patients (5.4 y of mean follow-up) were included. Optic nerve head SS-OCTA was performed to evaluate the optic disc vessel density (dVD), parapapillary choroidal vessel density (pcVD), choroidal microvascular dropout (cMvD), and optic disc microvascular dropout (dMvD). VF progression was defined using Early Manifest Glaucoma Trial criteria. Factors associated with VF worsening were assessed by Cox proportional hazard analysis. RESULTS: Eighty (30.1%) out of the 266 POAG eyes showed VF progression. The progression group showed a significantly higher proportion of disc hemorrhage, cMvD, and dMvD but lower dVD and pcVD than the stable group (all P <0.05). Considering the strong association between the parameters [dMvD vs. dVD ( r = -0.757, P =0.010], cMvD vs. pcVD ( r = -0.745, P =0.012), dMvD vs. cMvD ( r = 0.802, P <0.001], dVD vs. pcVD ( r = 0.862, P <0.001), CMvD vs. dVD ( r = -0.698, P =0.031), and dMvD vs. pcVD ( r = -0.688, P =0.034)], 6 models with different combinations of covariates compensating for multicollinearity were developed. Younger age, presence of disc hemorrhage, and lower dVD were consistently associated with progression in all models that included these parameters. CONCLUSIONS: Optic disc perfusion, represented as dVD, may be a useful biomarker that correlates well with functional deterioration in POAG eyes.

Reduced intradisc vessel density is associated with optic disc hemorrhage in eyes with primary open-angle glaucoma.

We sought to investigate the association between optic nerve head (ONH)/choroidal microvasculature perfusion and optic disc hemorrhage (ODH) in eyes with primary open-angle glaucoma (POAG) using swept-source optical coherence tomography angiography (SS-OCTA). A total of 266 POAG eyes (59 with a single instance of ODH, 40 with a history of recurrent ODH, and 167 eyes without ODH) with a mean follow-up of 5.4 years were included. Intradisc vessel density (VD), parapapillary choroidal VD, optic disc microvascular dropout (MvD), and choroidal microvascular dropout (CMvD), were evaluated on a 3 × 3 mm SS-OCTA image of ONH and compared between eyes with and without ODH. Recurrent ODH was defined as occurrence 1 year after first ODH detection during the total follow-up period. Logistic regression analyses were performed to investigate factors associated with ODH. The prevalence of CMvD, optic disc MvD, and ß-parapapillary atrophy were not different among the no ODH, single ODH, and recurrent ODH groups. Eyes with ODH had lower intradisc VDs than those without ODH (P = 0.021), but no difference was found in intradisc VDs between the single and recurrent ODH groups (P = 0.977). Better VF MD at baseline (odds ratio [OR], 1.150; 95% confidence interval [CI], 1.055-1.254; P = 0.002) and lower intradisc VD (OR, 0.863; 95% CI, 0.812-0.918; P < 0.001) were associated with ODH occurrence. Among POAG eyes, those with ODH had lower intradisc VDs than those without ODH. POAG eyes in an earlier disease stage or those with lower intradisc VDs should be monitored for the possibility of ODH occurrence.

Increased expression of oxyproteins in the optic nerve head of an in vivo model of optic nerve ischemia.

BACKGROUND: To investigate the effects of microvascular compromise on the expression of oxidative proteins in the optic nerve head. METHODS: Endothelin-1 (0.1 µg/day) was delivered to the perineural region of the anterior optic nerve by osmotically driven minipumps for two, four, and eight weeks in ten rabbits, respectively. As a control, a balanced salt solution was delivered for two and eight weeks in five rabbits, respectively. Expression of oxyproteins in the cornea, vitreous, retina, and optic nerve head for each time period was determined using the OxyBlot protein oxidation detection kit. Retina was stained with H&E and TUNEL for histological examination. RESULTS: There was a significant increase in the expression of oxyproteins in the optic nerve head after two weeks of endothelin-1 administration (p < 0.001, Mann Whitney U test). In contrast, there was no expression of oxyproteins in the cornea, retina, or vitreous. The number of cells in the retinal ganglion cell layer, inner nuclear layer, and outer nuclear layer decreased remarkably with time in the endothelin-1-treated group. Furthermore, the inner and outer nuclear layers, as well as the inner and outer plexiform layers, became thinner over time. CONCLUSIONS: Administration of endothelin-1 to the microvasculature of the optic nerve leads to increased expression of oxyproteins in the optic nerve head and loss of retinal ganglion cells.

Changes in intraocular pressure after pharmacologic pupil dilation.

BACKGROUND: Intraocular pressure (IOP) may vary according to the change of ocular conditions. In this study, we want to assess the effect and mechanism of pupil dilation on IOP in normal subjects. METHODS: We prospectively evaluated 32 eyes of 32 patients (age; 61.7±8.2 years) with normal open angles under diurnal IOP. IOP was measured every two hours from 9 AM to 11 PM for one day to establish baseline values and was measured again for one day to assess the differences after dilation. To induce dilation, we administered 2.5% phenylephrine and 1% tropicamide every 5 minutes from 8:30 AM to 8:45 AM and for every two hours from 11 AM to 9 PM to keep the pupil dilated. Diurnal IOP, biometry, Visante OCT, and laser flare photometry were measured before and after dilation. RESULTS: We observed a significant increase in IOP after dilation, 1.85±2.01 mmHg (p=0.002). IOP elevation remained significant until about four hours after dilation. Thereafter, IOP decreased slowly and eventually reached pre-dilation level (p>0.05). Flare values decreased, and the anterior chamber angle became wider after mydriasis. CONCLUSIONS: Dilation of the pupil significantly and incidentally elevated IOP in normal subjects. Further related studies are warranted to characterize the mechanism of the increased IOP after dilation.

Thermal Injury Induces Small Heat Shock Protein in the Optic Nerve Head In Vivo.

PURPOSE: To investigate the induction pattern of various heat shock protein (HSP) in the optic nerve head after thermal stress using transpupillary thermotherapy and to determine the dose-response relationship of thermal stress on the induction of various HSP. METHODS: The 810-nm diode laser with 50-µm spot size was aimed to the center of optic nerve head of right eye of Norway brown rats. First, the various exposure powers (100, 120, 140 mW) were used with the same exposure duration, 60 seconds, to investigate power dosing effect. Second, the various exposure durations (1, 2, 3, and 5 minutes) were applied under constant 100 mW laser power to investigate time dosing effect. Left eyes were served as controls. To quantify HSP expression, enucleation was performed at 24 hours after transpupillary thermotherapy. HSP 27 and αB-crystallin inductions in optic nerve head were examined with Western blot. RESULTS: All type of HSP was observed in normal state. After thermal injury, the expression of HSP 27 were increased, and the αB-crystallin were decreased. CONCLUSIONS: Induction pattern of each HSP in the optic nerve head were different after thermal injury. Some HSPs were induced or exhausted. Further research is needed on the characteristic functions and induction conditions of each HSP.

Efficacy and safety of newly developed preservative-free latanoprost 0.005% eye drops versus preserved latanoprost 0.005% in open angle glaucoma and ocular hypertension: 12-week results of a randomized, multicenter, controlled phase III trial.

AIM: To evaluate the therapeutic efficacy, safety and tolerability of newly developed preservative-free (PF) latanoprost generic [TJO-002] and compare it with benzalkonium chloride (BAK)-preserved latanoprost [Xalatan®] in patients with primary open angle glaucoma (POAG) and ocular hypertension (OHT). METHODS: Included patients were aged ≥19y with POAG/OHT. After a washout period, patients with IOP 21-35 mm Hg at 9 a.m. were enrolled. After a full ophthalmic and glaucoma examination, 144 patients with POAG and OHT participated in this study. Subjects were randomly assigned either PF latanoprost (74 eyes) or BAK-preserved latanoprost (70 eyes). All subjects were examined at 4, 8, and 12wk after first administration. At each follow-up visit, IOP was measured at 9 a.m. and 5 p.m. and compliance was assessed. Throughout the study, all adverse events were recorded and monitored by the masked investigators who measured IOP. RESULTS: Both groups showed a statistically significant decrease of average diurnal IOP at 12wk compared to baseline (-7.21±3.10 mm Hg in the PF latanoprost group and -7.02±3.17 mm Hg in the BAK latanoprost group, both P<0.0001). There was no statistically significant diurnal IOP variation between the groups. In terms of tolerability, pruritus, burning/stinging, and sticky eye sensation, severity was significantly lower in the PF latanoprost group than in the BAK latanoprost group (P<0.05). CONCLUSION: PF latanoprost has at least similar efficacy in terms of IOP reduction and better tolerability compared with BAK latanoprost.

Comparison of the Intraocular Pressure-Lowering Effect and Safety of Preservative-Free And Preservative-Containing Brimonidine/Timolol Fixed-Combination Ophthalmic Solutions in Patients with Open-Angle Glaucoma.

Purpose: To compare the therapeutic efficacy and safety of newly developed preservative-free (PF) brimonidine/timolol fixed-combination (BTFC) ophthalmic solutions and a preservative-containing (PC) BTFC ophthalmic solution in patients with open-angle glaucoma.Methods: This study was conducted as a multicenter, randomized, open-label, parallel-group clinical trial to evaluate the efficacy and safety of PF BTFC as compared with PC BTFC in adult patients (aged ≥ 19 years) with open-angle glaucoma (OAG) and ocular hypertension (OHT). A total of the 106 patients were enrolled, with 53 patients each randomized to the two treatment groups and included in the analysis of the safety set (SS).After a washout period, patients with an IOP below 35 mmHg at 9 a.m. were enrolled. After a full ophthalmic and glaucoma examination, a total of 106 OAG and OHT patients were randomized to the PF group or PC group.All subjects were examined 4 and 12 weeks after first administration. At each follow-up visit, IOP was measured at 9 a.m. and 11 a.m. and the efficacy, safety, and compliance were evaluated. Throughout the study, all adverse events were recorded and monitored by the investigators.Results The mean IOP changes from baseline to 12 weeks at 11:00 a.m. were -3.45 ± 2.53 mmHg in the PF group and -3.65 ± 2.76 mmHg in the PC group (p < .0001 for both). The difference in mean IOP change between the two groups was 0.20 ± 2.65 mmHg, which was not significantly different. The proportion of patients with IOP reductions of ≥ 15% and ≥ 20% and IOP at all-time points in the PF group were not significantly different when compared with in the PC group. There were no specific differences between the two groups regarding the incidence of adverse events.Conclusions PF BTFC ophthalmic solution shows a similar efficacy and safety profile to that of PC BTFC.