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Background The prevalence of cataracts is steadily increasing among the middle-aged and elderly worldwide. We hypothesized that adults aged > 50 years with age-related cataracts (ARCs) have an association with metabolic syndrome (MS) and its components, and MS has interactions with different dietary patterns and lifestyles that affect ARC risk. We examined the hypothesis using the Korean Genome and Epidemiology Study (KoGES; a large-scale hospital-based cohort study), which collected data between 2004–2013. Methods Participants ≥ 50 years old were classified as cases (1,972 ARC patients) and controls (38,290 healthy controls) based on a diagnosis of cataract by a physician. MS and its components were defined using WHO definitions for Asians. Dietary consumption was evaluated using a validated semi-quantitative food frequency questionnaire (SQFFQ), which contained 106 foods, and dietary patterns were analyzed by principal component analysis. After adjusting for potential covariates, logistic regression was used to investigate associations between MS and its components and between dietary patterns and a positive cataract history. Results ARC had a positive association with MS after 1.32-fold adjusting for age, sex, residence area, body mass index, and energy intake. Plasma glucose and HbA1c concentrations exhibited an increased ARC risk in the participants with MS by 1.50- and 1.92-fold and without MS by 1.35 and 1.88-fold, respectively. Serum high-density lipoprotein (HDL) concentrations were negatively associated with ARC risk only in the MS patients, but not without MS. However, blood pressure, abdominal obesity, and serum triglyceride concentrations did not associate with ARC risk regardless of MS. High intake of a Korean-balanced diet (KBD) containing fermented food exhibited a negative association with ARC risk (OR = 0.81) only in the MS group. The fat and coffee intake had a negative association with ARC only in the non-MS group. Current- and former-smokers were positively associated with ARC risk. Conclusion Persons who have hyperglycemia and low-HDL-cholesterolemia had increased susceptibility of ARC prevalence. A KBD with a proper amount of fat (≥ 15%) is recommended, and smoking should be prohibited., Graphical Abstract

ObjectiveTo examine healthcare resource utilisation (HRU) and direct medical costs for patients with diabetic macular oedema (DME) treated with antivascular endothelial growth factor (anti-VEGF) in Korea by comparing with those for (1) patients with diabetes mellitus (DM) without retinopathy and (2) patients with neovascular age-related macular degeneration (nAMD) treated with anti-VEGF.DesignRetrospective cohort study.SettingThe Korean National Health Insurance (NHI) database from 1 January 2014 to 31 December 2016.ParticipantsWe identified 1398 patients older than 30 years of age who received anti-VEGF treatment for DME in 2015 after excluding patients who had a diagnosis of nAMD in 2015 and any cancer in the preceding year.Main outcome measuresOne-year healthcare resource use and direct medical costs of patients with DME treated with anti-VEGF.ResultsIn total, 1398 patients with DME receiving anti-VEGF, 12 813 patients with DM without retinopathy and 12 222 patients with nAMD receiving anti-VEGF were identified. Hospital admissions and outpatient visits were highest in patients with DME, while the number of licensed anti-VEGF injections in those with DME was about half that of those with nAMD (2.1 vs 3.9 per patient per year). Mean 1-year medical costs were also higher in patients with DME (US$6723) than in those with DM without retinopathy (US$2687) and nAMD (US$4980). In a multivariable analysis with matched cohorts, DME was associated with 66% higher medical costs for comorbid diseases (adjusted OR (aOR), 1.66; 95% CI 1.45 to 1.90) and 50% lower anti-VEGF injections (aOR, 0.50; 95% CI 0.46 to 0.54) compared with nAMD.ConclusionsThe overall HRU and economic burden for DME treated with anti-VEGF were higher than for DM without retinopathy or for nAMD treated with anti-VEGF. Meanwhile, the lower number of licensed anti-VEGF injections compared with nAMD may reflect a potential lack of ophthalmological treatment for DME supported by the NHI in Korea.

Age-related cataract (ARC) development is associated with loss of crystalline lens transparency related to interactions between genetic and environmental factors. We hypothesized that polygenetic risk scores (PRS) of the selected genetic variants among the ARC-related genes might reveal significant genetic impacts on ARC risk, and the PRS might have gene&ndash, gene and gene&ndash, lifestyle interactions. We examined the hypothesis in 1972 and 39,095 subjects aged &ge, 50 years with and without ARC, respectively, in a large-scale hospital-based cohort study conducted from 2004 to 2013. Single nucleotide polymorphisms (SNPs) of the genes related to ARC risk were identified, and polygenetic risk scores (PRS) were generated based on the results of a generalized multifactor dimensionality reduction analysis. Lifestyle interactions with PRS were evaluated. The PRS derived from the best model included the following six SNPs related to crystallin metabolism: ULK4_rs1417380362, CRYAB_rs2070894, ACCN1_rs55785344, SSTR2_rs879419608, PTN_rs322348, and ICA1_rs200053781. The risk of ARC in the high-PRS group was 2.47-fold higher than in the low-PRS group after adjusting for confounders. Age, blood pressure, and glycemia interacted with PRS to influence the risk of ARC: the incidence of ARC was much higher in the elderly (&ge, 65 years) and individuals with hypertension or hyperglycemia. The impact of PRS on ARC risk was greatest in middle-aged individuals with hypertension or hyperglycemia. Na, coffee, and a Western-style diet intake also interacted with PRS to influence ARC risk. ARC risk was higher in the high-PRS group than in the low-PRS group, and high Na intake, Western-style diet, and low coffee intake elevated its risk. In conclusion, ARC risk had a positive association with PRS related to crystallin metabolism. The genetic impact was greatest among those with high Na intake or hypertension. These results can be applied to precision nutrition interventions to prevent ARC.

Glaucoma, a leading cause of blindness, has multifactorial causes, including environmental and genetic factors. We evaluated genetic risk factors of glaucoma with gene-gene interaction and explored modifications of genetic risk with gene-lifestyles interaction in adults &gt, 40 years. The present study included 377 subjects with glaucoma and 47,820 subjects without glaucoma in a large-scale hospital-based cohort study from 2004 to 2013. The presence of glaucoma was evaluated by a diagnostic questionnaire evaluated by a doctor. The genome-wide association study was performed to identify genetic variants associated with glaucoma risk. Food intake was assessed using a semiquantitative food frequency questionnaire. We performed generalized multifactor dimensionality reduction analysis to construct polygenetic-risk score (PRS) and explored gene &times, nutrient interaction. PRS of the best model included LIM-domain binding protein-2 (LDB2) rs3763969, cyclin-dependent kinase inhibitor 2B (CDKN2B) rs523096, ABO rs2073823, phosphodiesterase-3A (PDE3A) rs12314390, and cadherin 13 (CDH13) rs12449180. Glaucoma risk in the high-PRS group was 3.02 times that in the low-PRS group after adjusting for confounding variables. For those with low serum glucose levels (&lt, 126 mg/dL), but not for those with high serum glucose levels, glaucoma risk in the high-PRS group was 3.16 times that in the low-PRS group. In those with high carbohydrate intakes (&ge, 70%), but not in those with low carbohydrate intakes, glaucoma risk was 3.74 times higher in the high-PRS group than in the low-PRS group. The glaucoma risk was 3.87 times higher in the high-PRS group than in the low-PRS group only in a low balanced diet intake. In conclusion, glaucoma risk increased by three-fold in adults with a high PRS, and it can be reduced by good control of serum glucose concentrations and blood pressure (BP) with a balanced diet intake. These results can be applied to precision nutrition to reduce glaucoma risk.

This study provides a population-based report on eyelid skin cancer epidemiology showing trends in its incidence and survival in South Korea.For this population-based epidemiological study, nationwide cancer incidence data were obtained from the Korea Central Cancer Registry, covering the entire population. Age-standardised incidence rates (ASRs) and annual per cent changes (APCs) were calculated according to sex, histological types, stage, and date of diagnosis. The 5-year relative survival rates (RSRs) were estimated for patients diagnosed between 1993 and 2016.The ASR increased from 0.27 per 100,000 population in 1999 to 0.61 in 2016, with an APC of 4.94%. The most common histopathological type was basal cell carcinoma (BCC), accounting for 67.5% of all eyelid skin cancers during 1999-2016, followed by sebaceous gland carcinoma (SGC, 10.7%), and squamous cell carcinoma (SCC, 10.6%). The number of localised cancer diagnoses tended to increase, compared to that of distant cancer. The 5-year RSR was nearly 100% when considering all eyelid skin cancers together. When considering them separately, the 5-year RSR of BCC was nearly 100% throughout, whereas for SGC and SCC, it gradually increased from 94.2% and 87.7% (1993-1995), respectively, to nearly 100% (2011-2016) for both. Melanoma had the lowest survival, although its survival has increased markedly since 1993.Nationwide data used in this study showed an increase in incidence and survival rates of eyelid skin cancers in Korea. BCC was the most predominant type, and its proportion among all eyelid skin cancer cases has increased.

This study was performed to investigate the association between oral health and sleep duration in South Korean subjects using 2010-2015 data from the Korean National Health and Nutrition Examination Survey (KNHANES).Cross-sectional data on 35,599 adults over the age of 19 years who completed KNHANES were analyzed. All participants reported subjective oral health status and their daily average sleep duration using a self-reported questionnaire. Sleep duration and oral health status were divided into 3 categories: ≤5, 6-8, ≥9 h/day and good, fair, poor, respectively.The overall prevalence of poor oral health status was 43.8%. Univariate analysis demonstrated that poor oral health status was significantly associated with age, smoking, alcohol, diabetes, education, income, depression, marital status, and sleep duration. After adjusting for covariates (age, sex, diabetes mellitus, hypertension, obesity, smoking, income, education, marital status), sleep durations of ≤5 hours (OR = 1.42; 95% CI, 1.26-1.60) and ≥9 hours (OR = 1.21; 95% CI, 1.04-1.40) were significantly associated with poor oral health, compared to a sleep duration of 6-8 hours. Short or long sleep duration was more likely to have an impact on the development of poor oral health status in men than in women. A significant relationship between sleep duration and oral health status was found in participants younger than 60 years.This is the first report that both short and long sleep durations are significantly associated with the development of poor oral health status. The effect of short or long sleep duration on poor oral health was more significant in younger subjects and in men.

BackgroundHerpes simplex virus type 1 (HSV-1) is causative for hypertensive anterior uveitis. Trabecular meshwork (TM) cells, which are the key cells regulating intraocular pressure (IOP), is considered to be the site of inflammation. We explored the profiles of genes expressed in human TM primary cells upon HSV-1 infection.MethodsHuman TM cells were infected with HSV-1 and total RNA was isolated. The global transcriptional gene network analyses were performed in mock-infected and HSV-1 infected TM cells. Using ingenuity pathway analysis, we determined the key biological networks upon HSV-1 infection. The results of microarray analyses were validated using quantitative PCR.ResultsTM cells had a high susceptibility to HSV-1 infection. HSV-1 induced transcriptional suppression of many components related to fibrosis in TM cells. The top biological network related to the genes which were significantly altered upon HSV-1 infection was organismal injury and abnormalities involving TGF-β1 and PDGF-BB. The results of PCR analyses for selected molecules were found to be in good agreement with the microarray data. HSV-1-infected TM cells showed an 80-fold increase in the expression of PDGF-BB, which was further increased by treatment with TGF-β1. HSV-1 also induced a 4-fold increase in the expression of the monocyte chemoattractant protein (MCP)-1, the downstream molecules of PDGF-BB.ConclusionsIn human TM cells, HSV-1 induced transcriptional suppression of many components related to fibrosis and enhanced expression of both PDGF-BB and MCP-1. Our study may provide a novel mechanism for the pathogenesis of HSV-1 infection in TM cells.

We aimed to evaluate the anatomical and functional outcomes of pars-plana vitrectomy (PPV) with or without autologous platelet concentrate (APC) injection in patients with recurrent macular holes (MHs), large MHs, or MHs with high myopia. This multicenter, prospective, interventional randomized controlled trial was conducted from March 2017 to April 2020. Participants were randomly allocated to a PPV group or a PPV+APC group. All participants underwent standard 25-gauge PPV, and eyes in the PPV+APC group underwent PPV with intravitreal APC injection before air-gas exchange. A total of 117 patients were enrolled (PPV group: n = 59, PPV+APC group: n = 58). Hole closure was achieved in 47 participants (79.7%) in the PPV group and 52 participants (89.7%) in the PPV+APC group. There were no between-group differences in the anatomical closure rate or functional outcomes including best-corrected visual acuity, metamorphopsia, pattern-reversal visual evoked potential, or Visual Function Questionnaire-25 score. The use of APC injection does not improve the anatomical and functional outcomes of surgery for large MHs, recurrent MHs, or MHs with high myopia. The adjunctive use of APC can be considered in selected cases because it is not inferior to conventional MH surgery, is relatively simple to perform, and is not affected by the surgeon’s skill.

Lipoprotein(a) [Lp(a)] has mainly been considered to be a predictor of the incidence of cardiovascular disease. In addition, previous studies have shown potential linkage between Lp(a) and diabetic microvascular complications.We investigated the incidence and risk factors for the development of diabetic retinopathy (DR) in patients with type 2 diabetes.A total of 787 patients with type 2 diabetes without DR were consecutively enrolled and followed up prospectively. Retinopathy evaluation was annually performed by ophthalmologists. The main outcome was new onset of DR.The median follow-up time was 11.1 years. Patients in the DR group had a longer duration of diabetes (P.001), higher baseline HbA1c (P.001), higher albuminuria level (P = .033), and higher level of Lp(a) (P = .005). After adjusting for sex, age, diabetes duration, presence of hypertension, renal function, LDL cholesterol, mean HbA1c, and medications, the development of DR was significantly associated with the serum Lp(a) level (HR 1.57, 95% confidence interval [1.11-2.24]; P = .012, comparing the 4th vs 1st quartile of Lp(a)). The patient group with the highest quartile range of Lp(a) and mean HbA1c levels ≥7.0% had an HR of 5.09 (95% confidence interval [2.63-9.84]; P.001) for developing DR compared with patients with lower levels of both factors.In this prospective cohort study, we demonstrated that the DR was independently associated with the serum Lp(a) level in patients with type 2 diabetes.

Background The characteristics of the optic nerve head (ONH) in open angle glaucoma (OAG) patients with diabetes have not been reported. This study aimed to characterize the ONH structures and glaucomatous damage in diabetic OAG patients, using age-matched non-diabetic OAG patients and control subjects. Methods The locations of visual field defects of OAG patients were classified and the prelaminar thickness and lamina cribrosa depth were measured in 64 OAG patients with type 2 diabetes (OAG+DM), 68 OAG patients without diabetes (OAG-DM), and 36 controls. All participants were scanned by spectral domain-optical coherence tomography. The anterior prelaminar depth and lamina cribrosa depth were measured at the center of the reference line (the Bruch's membrane opening plane). The prelaminar tissue thickness was obtained by subtracting the anterior prelaminar depth from the anterior lamina cribrosa depth. Results The visual field defects in the OAG+DM group were more commonly found in the inferior hemifield (P = 0.010), and tended to involve the central visual field compared to the OAG-DM group (P = 0.044). In the comparison of ONH parameters, the prelaminar thickness was highest in the OAG+DM group, followed by the control subjects and the OAG-DM group (P = 0.035). Post-hoc testing showed that prelaminar thickness was significantly greater in the OAG+DM group than in the OAG-DM group (P = 0.033). The lamina cribrosa depth was deepest in the OAG+DM group, followed by the OAG-DM group and the control subjects (P = 0.006). Conclusions Diabetic and non-diabetic OAG patients exhibit different characteristics of glaucoma, particularly increased prelaminar thickening in diabetics.

Purpose To determine the relationship between the sighting eye choice and functional and structural asymmetries in open-angle glaucoma (OAG). Methods Two hundred patients with bilateral OAG underwent dominant eye testing using a hole-in-a-card test. The paired eyes were divided into worse and better eyes according to the mean deviation (MD) of visual field (VF) results. Based on the results, patients whose sighting eyes corresponded to eyes with a better VF were designated as group 1, and those whose sighting eyes corresponded to eyes with a worse VF as group 2. Results The sighting eye corresponded predominantly to eyes with better VFs (P < 0.001). The MD of the worse eye was significantly lower (P = 0.008), and the intereye difference in MD was significantly larger in group 1 than in group 2 (P < 0.001). In a comparison of regional VF threshold values and corresponding retinal nerve fiber layer thickness (RNFLT), the superior and inferior VF threshold values were consistently more deteriorated in the nonsighting worse eyes in group 1 (P = 0.009 and 0.003), compared with the sighting worse eyes in group 2, whereas the corresponding RNFLT was not significantly different between the groups. Multiple linear regression analysis showed that the sighting eye choice (P = 0.047), higher vertical cup-to disc ratio (P = 0.042), older age (P = 0.044), thinner average RNFLT (P = 0.007), and average ganglion cell-inner plexiform layer thickness of worse eyes (P < 0.001) were significantly associated with the MD of the worse eyes. Conclusions The sighting eye choice was associated with functional asymmetry between eyes with glaucoma. The functional deterioration was evident in nonsighting eyes with worse VFs.

In this study, we explored the presence and elevation of glucose-regulated protein 78 (GRP78) in aqueous humor of patients with diabetic macular edema (DME). After comparing DME patients with the controls, we analyzed GRP78 and vascular endothelial growth factor (VEGF) levels in DME patients. We examined factors associated with GRP78 levels in DME patients. GRP78 was detected in aqueous humor with elevated levels in DME patients. Stepwise backward regression analysis showed that GRP78 levels were associated with the VEGF levels and the duration of diabetes (P

Objectives Although determining the quality of life among glaucoma patients has important clinical and public health implications, the utility value of glaucoma patients has not yet been determined in Korea. Methods The Korean National Health and Nutrition Examination Survey database was used to identify 833 glaucoma patients based on ophthalmologic examinations. The adjusted mean utility values, calculated by EuroQol-5D (EQ-5D-3L), of glaucoma patients according to patient demographics and measures of glaucoma severity were determined using multivariate linear regression analysis. Results The mean utility value of glaucoma patients was 0.8968. Patients aged 70 years or more had significantly lower utility value (0.86, p value 0.005) compared to those aged less than 50 years (0.96). Patients within the lowest quartile of income had a utility value of 0.87, compared to a utility value of 0.96 for those within the highest quartile (p value 0.001). Patients who were not married had lower utility value (0.87) compared to married patients (0.93). Patients within the lowest quartile of worse eye frequency doubling technology (FDT) score had lower utility value (0.88) compared to those within the highest quartile (0.94). Finally, bilateral vision loss patients had significantly lower utility value (0.83, p value 0.013) compared to patients without vision loss (0.92). Conclusion The present study assessed utility values of Korean glaucoma patients. The quality of life determined by EQ-5D-3L in Korean glaucoma patients was higher compared to those in other countries. Patient demographics as well as measures of disease severity were important factors in determining the quality of life within glaucoma patients.

Background: We evaluated the protective effect of ALS-L1023, an extract of Melissa officinalis L. (Labiatae; lemon balm) against oxidative stress-induced apoptosis in human retinal pigment epithelial cells (ARPE-19 cells). Methods: ARPE-19 cells were incubated with ALS-L1023 for 24 h and then treated with hydrogen peroxide (H2O2). Oxidative stress-induced apoptosis and intracellular generation of reactive oxygen species (ROS) were assessed by flow cytometry. Caspase-3/7 activation and cleaved poly ADP-ribose polymerase (PARP) were measured to investigate the protective role of ALS-L1023 against apoptosis. The protective effect of ALS-L1023 against oxidative stress through activation of the phosphatidylinositol 3-kinase/protein kinase B (PI3K/Akt) was evaluated by Western blot analysis. Results: ALS-L1023 clearly reduced H2O2-induced cell apoptosis and intracellular production of ROS. H2O2-induced oxidative stress increased caspase-3/7 activity and apoptotic PARP cleavage, which were significantly inhibited by ALS-L1023. Activation of the PI3K/Akt pathway was associated with the protective effect of ALS-L1023 on ARPE-19 cells. Conclusions: ALS-L1023 protected human RPE cells against oxidative damage. This suggests that ALS-L1023 has therapeutic potential for the prevention of dry age-related macular degeneration.

Background The effect of ALS-L1023, an extract of Melissa officinalis L. (Labiatae; lemon balm) leaves, on experimental choroidal neovascularization (CNV) in mice was evaluated. Methods C57BL/6 mice were given either vehicle or ALS-L1023 daily via oral gavage for 3 weeks (days 0–21). CNV was induced by rupturing Bruch's membrane using laser photocoagulation (day 7). Two weeks after laser injury (day 21), the CNV lesions were evaluated by an examination of choroidal flat mounts using fluorescein-labelled dextran, immunofluorescence staining with isolectin B4 and fluorescence angiography. The effects of ALS-L1023 on endothelial cell tube formation and the expression of phosphorylated extracellular signal-regulated kinase 1/2 were evaluated using human umbilical vein endothelial cells. Results The extent of CNV was reduced by ALS-L1023. Mice treated with 100 and 200 mg/kg/day of the material exhibited 44.3 and 68.1% reductions in the extent of CNV lesions, respectively, compared to the vehicle group (P

Purpose To investigate associations between serum 25-hydroxyvitamin D levels and age-related cataracts. Setting Department of Ophthalmology, College of Medicine, Catholic University of Korea, South Korea. Design Observational cross-sectional study. Methods Participants aged 40 years or older in the fourth (2008 to 2009) and fifth (2010 to 2012) Korea National Health and Nutrition Examination Survey (KNHANES) had evaluation of their serum 25-hydroxyvitamin D levels and ophthalmic slitlamp examinations to identify cataract. An age-related cataract was defined as the presence of a cortical, nuclear, anterior subcapsular, posterior subcapsular, or mixed cataract or a history of cataract surgery. Results The study evaluated eyes of 18 804 patients. The mean levels of serum 25-hydroxyvitamin D were 20.0 ng/mL in men and 17.5 ng/mL in women. In men, but not in women, the odds ratio (OR) for age-related cataracts decreased statistically significantly when the serum 25-hydroxyvitamin D levels were in the highest quintile than when they were in the lowest quintile (OR, 0.76; 95% confidence interval, 0.59-0.99) after adjusting for potentially confounding factors including age, sex, smoking status, diabetes, hypertension, and sunlight exposure. However, trend analysis did not show a significant declining trend in the cataract risk associated with higher serum 25-hydroxyvitamin D quintiles (P = .084). In women, serum 25-hydroxyvitamin D levels were not associated with age-related cataracts. Conclusions The age-related cataract risk decreased in men with higher serum 25-hydroxyvitamin D levels than in those with lower serum 25-hydroxyvitamin D levels after adjusting for potential confounding factors. In light of previous research indicating an antioxidative effect of vitamin D, the connection between vitamin D and age-related cataract warrants further study. Financial Disclosure Neither author has a financial or proprietary interest in any material or method mentioned.

Purposes To investigate the association between sleep duration and myopia. Methods This population-based, cross-sectional study using a nationwide, systemic, stratified, multistage, clustered sampling method included a total of 3625 subjects aged 12–19 years who participated in the Korean National Health and Nutrition Examination Survey 2008–2012. All participants underwent ophthalmic examination and a standardized interview including average sleep duration (hr/day), education, physical activity and economic status (annual household income). Refractive error was measured by autorefraction without cycloplegia. Myopia and high myopia were defined as ≤−0.50 dioptres (D) and ≤−6.0 D, respectively. Sleep durations were classified into 5 categories: 9 hr. Results The overall prevalence of myopia and high myopia were 77.8% and 9.4%, respectively, and the overall sleep duration was 7.1 hr/day. The refractive error increased by 0.10 D per 1 hr increase in sleep after adjusting for potential confounders including sex, age, height, education level, economic status and physical activity. The adjusted odds ratio (OR) for refractive error was 0.90 (95% confidence interval [CI], 0.83–0.97) per 1 hr increase in sleep. The adjusted OR for myopia was decreased in those with >9 hr of sleep (OR, 0.59; 95% CI, 0.38–0.93; p for trend = 0.006) than in those with

There are concerns about arterial thromboembolic event after intravitreal injection of bevacizumab or ranibizumab. Motivated by the fact that D-dimer was a sensitive biomarker for thromboembolism, we evaluated serum D-dimer levels in patients with age-related macular degeneration (AMD) after intravitreal injection of bevacizumab and ranibizumab.In this prospective, nonrandomized, uncontrolled study, 122 patients (122 eyes) with AMD were enrolled. Sixty-two eyes received intravitreal injections of bevacizumab and 60 eyes received intravitreal injections of ranibizumab monthly for 3 months. Serum D-dimer levels were measured in patients before intravitreal injection and 1 day, 1 week, 1 month, and 3 months thereafter.Serum D-dimer levels were not significantly altered following injection of either bevacizumab or ranibizumab. Subgroup analysis for patients at risk for thromboembolic events revealed that serum D-dimer levels showed no significant change after injection of ranibizumab. However, D-dimer levels significantly increased at 1 day (P=0.041) and 1 week (P=0.022) after injection of bevacizumab.Serum D-dimer levels were not changed after injection with either bevacizumab or ranibizumab. In subgroup analysis, bevacizumab injection in patients at risk of thromboembolism increased serum D-dimer levels.

To investigate the clinical characteristics and treatment results of adult patients with ocular toxocariasis.A total of 54 consecutive patients who were clinically and serologically diagnosed with ocular toxocariasis were retrospectively reviewed.Among patients, 66.7 and 77.3% showed increases in eosinophil cationic protein (ECP) and total Ig E in serum, respectively. Four eyes (7.2%) initially presented as neuroretinitis with subsequent motile retinal lesion. The recurrence rates in the combination treatment group with albendazole and corticosteroids were significantly lower than those in the steroid-alone group during the mean follow-up of 27.6 months (p = 0.001).The adjunctive test of serum total IgE level may be helpful for the diagnosis of ocular toxocariasis. Ocular toxocariasis should be considered in the differential diagnosis of unilateral neuroretinitis with subsequent motile retinal lesion. Combined treatment with albendazole and corticosteroids appeared to be effective for reducing the recurrence of intraocular inflammation.

We hypothesized that the ocular dominance associated with brain asymmetry would influence macular structure. We assessed the structural asymmetry of the macula by ocular dominance.A total of 144 patients with no ophthalmic abnormalities were examined. After classifying eyes as dominant or non-dominant using the hole-in-a-card test, the macular ganglion cell inner plexiform layer and the macular thickness were measured in both groups using spectral domain optical coherence tomography, and we sought associations between ocular dominance and retinal thickness.Ocular dominance was more frequently found in right eyes than in left eyes (68.75% vs 31.25%, respectively; p0.001). Using conditioned logistic regression, the right eye and the temporal-to-nasal retinal thickness ratio of the macular ganglion cell inner plexiform layer were selected as a final model for the determination of ocular dominance (p0.001, p = 0.013 respectively).Macular vertical asymmetry was associated with ocular dominance. The macular structure and ocular dominance associated with visual cortex lateralization have functional and structural relationships.

To evaluate the prevalence and risk factors of neovascular glaucoma (NVG) after vitrectomy in patients with vitreous hemorrhage associated with proliferative diabetic retinopathy (PDR). This retrospective, noncomparative, observational study included 127 eyes of 127 patients with PDR who received vitrectomy with a follow-up period of at least 6 months. The prevalence of NVG and associated risk factors were assessed including sex, age, previous panretinal photocoagulation, baseline intraocular pressure, combined phacovitrectomy, and pretreatment with intravitreal bevacizumab (IVB) before vitrectomy for the treatment of vitreous hemorrhage. NVG developed in 15 (11.8%) of 127 patients. Of the 15 eyes with NVG, 11 cases (73.3%) postoperatively developed NVG within 6 months. Postoperative NVG was associated with preoperative IVB treatment (odds ratio, 4.43; P = 0.019). The prevalence of NVG after vitrectomy was 11.8%, and an associated risk factor for NVG was preoperative IVB for the treatment of vitreous hemorrhage.

To evaluate the prevalence of and risk factors for age-related macular degeneration (AMD) in a representative Korean population.A nationwide population-based cross-sectional study was conducted among the civilian, noninstitutionalized Korean population aged 40 and older (mean age, 55.7 years; 95% confidence interval [CI], 55.4-56.0). A total of 16,109 older (≥40 years of age) subjects participated in the Korean National Health and Nutrition Survey 2008-2011. All participants underwent standardized interviews and comprehensive ophthalmic examinations. Using physiologic mydriasis, a 45° digital fundus photograph was taken of both eyes of each participant. All fundus photographs were graded according to an international classification and grading system. Main outcome measures consisted of prevalence of early- and late-AMD.Of the 16,109 subjects, fundus photographs were gradable for 14,352 (89.1%). The prevalence of early- and late-AMD in the Korean population was 6.0 and 0.6%, respectively. The prevalence of early-AMD increased from 1.5% in those aged 40-49 years to 16.2% in those aged ≥70 years. After adjusting for confounders, the prevalence of early-AMD increased with increasing age (odds ratio [OR], 1.08; CI, 1.06-1.09). For late-AMD, old age (OR, 1.09; CI, 1.04-1.14), male gender (OR, 2.45; CI, 1.11-5.37), high systolic blood pressure (OR, 1.03; CI, 1.00-1.06) and high fasting glucose level (OR, 0.97; CI, 0.94-0.99) were significant risk factors. Smoking was not associated with either early- or late-AMD in this Korean population.The present study provides the first population-based data on the prevalence of and risk factors for AMD in a representative Korean population. The prevalences of early- and late-AMD in this population were 6.0 and 0.6%, respectively. The prevalence of AMD in Koreans is higher than for those in other Asian countries and similar to that of Caucasians in Western countries.

To determine characteristics of diabetic macular edema patients with serous retinal detachment (SRD). We classified naïve diabetic macular edema (DME) patients with or without SRD, and compared their baseline characteristics; intravitreal bevacizumab (IVB) responsiveness; aqueous concentrations of IL (interleukin)-1β, -2, -8, -10, -17, placental growth factor (PlGF), and vascular endothelial growth factor (VEGF). In addition, factors associated with the existence of SRD were identified. Of the 64 DME patients, 14 had SRD. The average levels of aqueous VEGF and PlGF were significantly higher in the SRD group than in the control group (P = .022 and P = .041, respectively). The best-corrected visual acuity (BCVA) and central subfield thickness (CST) did not differ significantly between the 2 groups at baseline or after 3 consecutive monthly IVBs. In multivariate logistic regression analysis, the level of aqueous VEGF was the only factor associated with the existence of SRD (odds ratio: 1.03; P = .038). Rather than aqueous inflammatory cytokines, levels of aqueous VEGFs were associated with the occurrence of SRD in DME patients. In terms of prognosis, the existence of SRD was not related with BCVA or CST changes.

PURPOSE: The aim of this study was to determine the normal range of interocular peripapillary retinal nerve fiber layer (RNFL) thickness symmetry value in young adults. Factors affecting interocular RNFL thickness symmetry were also investigated. MATERIALS AND METHODS: Both eyes of 241 ophthalmologically and neurologically normal subjects were scanned using optical coherence tomography (200×200 optic disc cube protocol). The effect of ocular cyclotorsion on interocular RNFL thickness symmetry was determined and mathematically accounted for. Symmetry value between the right and left RNFL thickness values was calculated. Linear regression analyses were used to identify correlations between the corrected interocular symmetry value and interocular differences in refractive error, axial length, superior and inferior temporal retinal artery and vein location, and optical coherence tomography signal strength. RESULTS: The mean interocular RNFL thickness symmetry value before and after correction of ocular cyclotorsion was 0.8791±0.0665 and 0.9044±0.0571 (P

Purpose of the study The purpose of study was to measure the diagnostic utility of interocular retinal nerve fiber layer (RNFL) symmetry and interocular RNFL thickness comparison. Methods Both eyes of 103 normal subjects and 106 glaucoma patients (31 patients with early glaucoma and 75 patients with moderate to severe glaucoma) received comprehensive ophthalmologic evaluation including visual field testing and optic disc scanning using optical coherence tomography. RNFL thickness values for 256 measurement points were rearranged according to a new reference line connecting the optic disc center and the foveola. The interocular RNFL thickness symmetry value and absolute and fractional interocular difference in RNFL thickness were calculated and compared between groups. Area under the receiver operating characteristic curves (AUROCs) were calculated and compared. Result Among the parameters reflecting whole RNFL status, the corrected interocular RNFL thickness symmetry exhibited the largest AUROCs at all glaucoma stages. RNFL thickness and absolute and fractional interocular difference in RNFL thickness exhibited largest AUROC in the inferotemporal area, regardless of glaucoma stage. In the early glaucoma group, absolute and fractional interocular RNFL thickness differences in the temporal and superotemporal areas exhibited equal to or larger AUROCs than RNFL thickness. The AUROCs for RNFL thickness were greater than those for absolute and fractional interocular RNFL thickness differences in the moderate to severe glaucoma group except in the nasal and temporal area. Conclusions The corrected interocular RNFL thickness symmetry value is an effective diagnostic tool for glaucoma. Interocular comparison of RNFL thickness has good diagnostic performance and gives information about the RNFL beyond just the RNFL thickness itself.

Background: To examine the effectiveness of prolonged oral acyclovir treatment in patients with acute retinal necrosis (ARN).Methods: Fifty-five ARN patients (62 eyes) who had been treated with short-term or long-term oral acyclovir were identified in this retrospective study: one group treated with prolonged oral acyclovir (≥14 weeks) and the other group treated with a shorter duration of oral acyclovir (

Purpose To evaluate the effect of the Honan intraocular pressure reducer (HIPR) on vitreous reflux during intravitreal (IVT) injection. Methods Prospective, comparative, controlled, investigator-blinded, randomized clinical study. Sixty eyes of 60 patients who underwent IVT injection were allocated into 2 groups with or without using the HIPR. Vitreous reflux was estimated by measuring largest diameter of the conjunctival bleb formed after IVT injection. Preoperative intraocular pressure (IOP) before and after application of the HIPR and IOP immediately postoperatively and 3 and 10 minutes postoperatively were evaluated. Results The mean amount of vitreous reflux was significantly less with the HIPR than without the HIPR (1.46±1.04 mm vs 2.61±1.37 mm; pConclusions The HIPR prevents vitreous reflux after IVT through a reduction in the preoperative IOP. However, the HIPR appears not to affect the postoperative course of transient IOP elevation.

To compare the effects of the 4-haptic angulated (FA) intraocular lens (IOL) with the 2-haptic non-angulated (TNA) IOL vis-a-vis post-operative refractive error following phacovitrectomy with gas tamponade.A prospective study was conducted on 40 eyes of 40 patients who underwent phacovitrectomy with gas tamponade for repair of macular holes. During surgery, FA (n=20) or TNA (n=20) IOLs were implanted randomly. Post-operative prediction of mean numeric error (MNE) and mean absolute error (MAE), and anterior chamber depth (ACD) were evaluated 3 months post-operatively. Forty eyes undergoing phacoemulsification-only were used as controls.The MAE of the FA IOL group was significantly less than that of the TNA IOL group (0.41±0.94 versus 0.91±1.24 D, respectively) (p=0.040). The post-operative ACD of the FA IOL group (4.02±0.25 mm) was significantly greater than that of the TNA IOL group (3.54±0.31 mm) (p=0.031). There was less of a difference in ACDs between the phacovitrectomy and the phacoemulsification-only groups with FA IOLs (0.21±0.04 mm) than between those with TNA IOLs (0.51±0.06 mm) (p=0.010).Eyes undergoing phacovitrectomy with FA IOL implantation showed less myopic shift than did eyes with TNA IOL implantation. Anterior shift of the IOL in the FA IOL group was less than that of the TNA IOL group, as shown by ACD measurements. Thus, a myopic shift should be taken into account when calculating IOL power with TNA IOLs following phacovitrectomy with intraocular gas tamponade.

To determine the effect of the Honan intraocular pressure reducer (HIPR) on the rise in intraocular pressure (IOP) after an intravitreal injection using a tunneled scleral incision. This was a prospective, comparative, controlled, non-randomized clinical study. Sixty eyes of 60 patients who received intravitreal injections with the tunneled scleral technique were allocated into two groups, one with and one without application of the HIPR. The pre-operative IOP both before and after application of the HIPR, and the IOP immediately postoperative, and at 3 and 10 min postoperatively were evaluated. The vitreous reflux was estimated by measuring the large diameter of the sub-conjunctival bleb formed after intravitreal injection. The pre-operative IOP in the HIPR group was significantly lower than that in the non-HIPR group following application of the HIPR. The immediate postoperative IOP was significantly lower in the HIPR group than in the non-HIPR group. The IOP at 10 min postoperatively was lower in the HIPR group than in the non-HIPR group. There was no difference in the amount of vitreous reflux between the HIPR and the non-HIPR groups. The use of the HIPR reduces the IOP after an intravitreal injection using the tunneled scleral technique. However, the HIPR does not appear to affect a reduction in the vitreous reflux.

Objectives: Open-angle glaucoma (OAG) imposes high disease burden in South Korea. Although various effective interventions are available to manage the progression of OAG, there is limited data on the cost-effectiveness of these treatment strategies in South Korea. Methods: Using a Markov cohort model, we evaluated the cost-effectiveness of 3 major treatment strategies (medication, laser trabeculoplasty, and trabeculectomy) for South Korean patients with OAG. We projected a 25-year time horizon to study a hypothetical cohort of 10,000 patients of age 40 with mild OAG. The outcome measures were quality-adjusted life-years (QALYs) gained, cost from the societal perspective, and the incremental cost-effectiveness ratio (ICER) of medication, laser trabeculoplasty, and trabeculectomy. Interventions were evaluated at a willingness-to-pay (WTP) threshold of 30,000,000 KRW ($29,152) per QALY gained. Deterministic and probabilistic sensitivity analyses were conducted to address the model uncertainty. Results: The mean costs for medication, laser trabeculoplasty, and trabeculectomy were 29,661,740 KRW, 17,34,1342 KRW, and 22,275,438 KRW, respectively. The mean QALYs gained were 15.7, 15.3, and 14.8 for medication, laser trabeculoplasty, and trabeculectomy, respectively. Surgery was strongly dominated because it generated fewer expected QALYs but incurred greater expected cost than laser. The ICER was 30,885,179 KRW per QALY for medication versus laser trabeculoplasty. Laser was cost-effective, however, at a lower WTP threshold of 21,000,000 KRW per QALY gained or below. The results were most sensitive to the progression rates from mild to moderate glaucoma under laser treatment. Conclusion: Under the WTP threshold of 30,000,000 KRW per QALY, medication was cost-effective compared with laser trabeculoplasty and trabeculectomy for treating mild OAG in South Korean population. Laser, however, can be a cost-effective alternative in more resource-limited settings.

Due to the rapidly increasing life-expectancy, the prevalence of glaucoma has increased steadily in recent years. We aimed to evaluate the patterns of care and primary treatment strategy patterns in Korea according to glaucoma subtypes to assess the quality of care for glaucoma patients. In this serial cross-sectional survey, the claims data from the Korean National Health Insurance Service was used to identify and group glaucoma patients into primary open-angle glaucoma (POAG), primary angle-closure glaucoma (PACG), other types of glaucoma, and ocular hypertension from 2002 to 2013. Records for outpatient visits, hospitalizations, drug prescriptions, admissions, and surgical interventions were used to determine the patterns of care and identify primary treatment strategies. Both the prevalence (0.11% in 2002 to 0.43% in 2013) and incidence rates (0.06% in 2003 to 0.11% in 2013) for glaucoma increased over time. The mean number of outpatient visits increased (4.9–6.0 visits per year), while the proportion of hospitalized patients (2.3–1.0% of patients) and duration of hospital stay (4.5–3.4 days among hospitalized patients) decreased between 2002 and 2013 for patients with POAG. The proportion of patients not being managed by medication or surgery decreased, with POAG and PACG patients receiving medications increasing from 70.9% and 59.2% in 2002 to 88.4% and 63.3% in 2013, respectively. Finally, while the proportion of trabeculectomy decreased (22.2% to 10.0% of surgical procedures in 2002 and 2013, respectively), more patients with PACG have received iridectomy (59.3% to 86.0% of surgical procedures in 2002 and 2013, respectively). Between 2002 and 2013, the pattern of care for both patients with POAG and PACG has shifted toward management by outpatient visits and intervention with anti-glaucoma medications in Korea.

To evaluate the risk of myocardial infarction (MI) after receiving intravitreal bevacizumab (IVB) injection. We retrospectively reviewed the charts of patients who had received IVB injection in 2016, and grouped them according to whether they received the injection for age-related macular degeneration (AMD), diabetes-related complications, or retinal vein occlusion (RVO). We then investigated the prevalence of MI within 2 months after IVB injection and analyzed the possible association of IVB with MI. During 2016, 724 patients were enrolled and received a total of 1870 IVB injections. Seven patients were diagnosed with MI within 2 months after receiving an IVB injection. Of 274 patients with AMD, 2 were diagnosed with MI; of 311 patients with diabetes-related complications, 3 were diagnosed with MI; and of 139 patients with RVO, 2 were diagnosed with MI (P = 0.785). All MIs occurred between 3 days and 3 weeks after IVB injection (mean = 14.00 ± 6.45 days). The MIs after receiving IVB were associated with previous history of MI or cerebrovascular infarction in multivariate logistic regression analysis (P = 0.005). There was no significant difference in MI prevalence after IVB injection according to the reason for receiving the injection. However, care should be taken when administering IVB injections, especially to patients with risk factors such as history of MI or cerebrovascular infarction.

Purpose To investigate the association between blood 25-hydroxyvitamin D levels and pterygium. Methods Korean National Health and Nutrition Examination Survey 2008–2011 were used for the present epidemiologic study. A total of 19,178 participants aged ≥ 30 years were evaluated for blood 25-hydroxyvitamin D levels and performed ophthalmic slit lamp examinations. Pterygium was considered as a growth of fibrovascular tissue over the cornea. Results The average blood 25-hydroxyvitamin D levels were 18.6 ng/mL, and prevalence of pterygium was 6.5%. The odds of pterygium significantly increased across blood 25-hydroxyvitamin D quintiles after controlling sun exposure time as well as other confounders such as sex, age, smoking, diabetes, hypertension (P < 0.001). The odds ratios (OR) for pterygium was 1.51 (95% Confidence Interval[95%CI]; 1.19–1.92) in the highest blood vitamin D quintile. Stratified analysis by sex showed a positive association between blood 25-hydroxyvitamin D levels and pterygium in both men (quintile 5 versus 1, OR; 1.68, 95%CI; 1.19–2.37) and women (quintile 5 versus 1, OR; 1.37, 95% CI; 1.00–1.88). Conclusions Even after controlling sun light exposure time, we found a positive association between blood 25-hydroxyvitamin D levels and pterygium in a representative Korean population. The mechanism underlying this association is unknown.

Purpose To investigate the association between sleep duration and diabetic retinopathy (DR). Methods A population-based cross-sectional study using a nation-wide, systemically stratified, multistage, clustered sampling method included a total of 1670 subjects aged ≥40 years with diabetes who participated in the Korean National Health and Nutrition Examination Survey during 2008–2012. All participants performed standardized interviews, including self-reported sleep duration, and comprehensive ophthalmic examinations. Seven standard retinal fundus photographs were obtained from both eyes after pupil dilatation. Diabetic retinopathy (DR) was graded and classified as any DR and vision-threatening DR. Participants were stratified into men and women. Results The mean sleep duration was 6.71 hr/day. In men, adjusted OR of any DR was 1.88 [95% confidence interval (OR), 1.01–3.59] in those with ≤5 hr sleep, and 2.19 (95% CI, 1.01–4.89) in those with ≥9 hr sleep, compared to in subjects with 6–8 hr sleep, after adjusting for potential confounders including age, body mass index (BMI), diabetes duration, fasting glucose level, haemoglobin A1c levels and hypertension. In women, however, no significant association between sleep duration and DR was found. The vision-threatening DR was not significantly associated with sleep duration in either men or women. Conclusions Short and long sleep was associated with high prevalence of DR in men. Sleep deprivation may be involved in the pathogenesis of DR development.

Purpose To investigate the association between blood lead levels and prevalence of age-related macular degeneration (AMD). Methods A nationwide population-based cross-sectional study included 4,933 subjects aged over 40 years who participated in the 2008–2012 Korean National Health and Nutrition Examination Survey, and for whom fundus photographs were available. All participants underwent a standardized interview, evaluation of blood lead concentration, and a comprehensive ophthalmic examination. Digital fundus photographs (45°) were taken of both eyes under physiological mydriasis. All fundus photographs were graded using an international classification and grading system. Results Mean blood lead levels were 3.15 μg/dL in men and 2.27 μg/dL in women (P < 0.001). After adjusting for potential confounders including age, gender, smoking status, total cholesterol levels, triglyceride levels, heart problems and strokes, the adjusted odds ratio (OR) in women for any AMD was 1.86 (95% Confidence Interval [CI], 1.03–3.36) and for early AMD was 1.92 (95% CI, 1.06–3.48), for those in the highest quintile of lead level compared with the lowest quintile. In men, however, blood lead level was not significantly associated with AMD. Conclusions Blood lead levels were higher in men, but were only associated with AMD in women. Increased levels of blood lead may be involved in the pathogenesis of AMD development in women.

The effect of ALS-L1023, an extract of Melissa officinalis L. (Labiatae; lemon balm) leaves, on experimental choroidal neovascularization (CNV) in mice was evaluated.C57BL/6 mice were given either vehicle or ALS-L1023 daily via oral gavage for 3 weeks (days 0-21). CNV was induced by rupturing Bruch's membrane using laser photocoagulation (day 7). Two weeks after laser injury (day 21), the CNV lesions were evaluated by an examination of choroidal flat mounts using fluorescein-labelled dextran, immunofluorescence staining with isolectin B4 and fluorescence angiography. The effects of ALS-L1023 on endothelial cell tube formation and the expression of phosphorylated extracellular signal-regulated kinase 1/2 were evaluated using human umbilical vein endothelial cells.The extent of CNV was reduced by ALS-L1023. Mice treated with 100 and 200 mg/kg/day of the material exhibited 44.3 and 68.1% reductions in the extent of CNV lesions, respectively, compared to the vehicle group (P 0.001). The size of the isolectin B4-labelled area was also significantly decreased in the ALS-L1023-treated groups (P 0.001). On fluorescein angiography, ALS-L1023-treated mice exhibited significantly less leakage of fluorescent material than did vehicle-treated mice. ALS-L1023 decreased vascular endothelial growth factor-induced human umbilical vein endothelial cell tube formation in a dose-dependent manner. The expression of phosphorylated extracellular signal-regulated kinase 1/2 was suppressed by ALS-L1023.The laser-induced CNV in mice can be inhibited by ALS-L1023. Therefore, it may have therapeutic potential for the treatment of diseases involving CNV.

We described a technique to perform anterior synechiolysis with a healon needle and Viscoat® ophthalmic viscosurgical devices (OVDs) through anterior lamellar dissection in penetrating keratoplasty.OVDs were gently injected between iridocorneal adhesions with a healon needle to make a blunt dissection after anterior lamellar corneal dissection. Anterior synechiolysis at 360 degrees was completed with a healon needle and OVDs. Subsequently, the deep corneal lamella was cut with right and left Troutman-Katzin corneal scissors. 24 interrupted sutures were made with 10-0 nylon suture to implant the donor cornea.In two eyes from two patients, with corneal opacity and nearly total anterior synechiae, clear grafts and relatively deep anterior chambers were achieved. Penetrating keratoplasty with anterior synechiolysis was thus successful with a healon needle and OVDs through lamellar dissection.Anterior synechiolysis with a healon needle and OVDs through lamellar dissection is a safe and efficient technique for keratoplasty in patients with corneal opacity with anterior synechiae.

PURPOSE:To determine the interocular retinal nerve fiber layer (RNFL) thickness difference of normal subjects. METHODS:Both eyes of 230 normal adults received peripapillary RNFL thickness measurements using OCT. The effect of ocular cyclotorsion on the RNFL thickness profile was mathematically corrected. The fractional and absolute interocular RNFL thickness differences at 256 points of peripapillary area were calculated. We divided the subjects into 3 groups according to the locations of superior and inferior peak thickness, respectively, and compared the interocular RNFL thickness differences between the subgroups. RESULTS:The fractional interocular RNFL thickness difference exhibited smaller regional variations than the absolute interocular difference. The means of fractional interocular differences were 0.100 ± 0.077 in the temporal half area and 0.146 ± 0.105 in the nasal half area, and the tolerance limits for the 95th and 99 th distributions were about 0.246 and 0.344 in the temporal half area and 0.293 and 0.408 in the nasal half area, respectively. The fractional interocular differences of subgroups classified by the locations of superior and inferior peak RNFL thickness showed difference at smaller areas than the absolute interocular differences (19 and 8 points versus 49 and 23 points, respectively). CONCLUSION:Glaucoma can be strongly suspected, if interocular fractional RNFL thickness difference is over 25% at 5 consecutive points or over 35% at 3 consecutive points in the temporal half area. The fractional interocular comparison is a better diagnostic approach because the fractional interocular RNFL thickness difference is less influenced by the locations of peak RNFL thickness.