Macular Degeneration: Kim SJ

Kim SJ, Bressler NM. · Department of Ophthalmology, Vanderbilt University, Nashville, Tennessee 37232-8808, USA. · Curr Opin Ophthalmol. · Pubmed #19093330 No free full text.

Abstract: PURPOSE OF REVIEW: To provide an unstructured review of the recent literature on the role of optical coherence tomography (OCT) in cataract surgery with specific focus on cystoid macular edema (CME) on the basis of expert opinion of the authors. RECENT FINDINGS: OCT appears to be a useful method to reveal clinically relevant postsurgical CME and is complementary to fluorescein angiography. A majority of eyes demonstrate minimal increases in postoperative retinal thickness after cataract surgery on OCT, though those eyes that do develop clinically relevant CME show substantial increases. Using at least 40% increase in retinal thickness from baseline on OCT may be a valid, objective, and uniform method of defining CME. Preoperative and postoperative OCT evaluations in selected eyes at high risk (diabetes, uveitis) for CME may be warranted. SUMMARY: OCT has become a useful diagnostic tool to assess CME after cataract surgery.

Kim SJ. · No affiliation provided · Ophthalmology. · Pubmed #19486803 No free full text.

This publication has no abstract.

Bélair ML, Kim SJ, Thorne JE, Dunn JP, Kedhar SR, Brown DM, Jabs DA. · Department of Ophthalmology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA. · Am J Ophthalmol. · Pubmed #19403110 No free full text.

Abstract: PURPOSE: To determine the incidence of cystoid macular edema (CME) after cataract surgery among eyes with and without uveitis using optical coherence tomography (OCT) and to determine risk factors for postoperative CME among eyes with uveitis. DESIGN: Prospective, comparative cohort study. METHODS: Single-center, academic practice. Forty-one eyes with uveitis and 52 eyes without uveitis underwent clinical examination and OCT testing within 4 weeks before cataract surgery and at 1-month and 3-month postoperative visits. The main outcome measure was incidence of CME at 1 and 3 months after surgery. RESULTS: Both uveitic and control eyes gained approximately 3 lines of vision (P = .6). Incidence of CME at 1 month was 12% (5 eyes) for uveitis and 4% (2 eyes) for controls (P = .2). Incidence of CME at 3 months was 8% (3 eyes) for uveitis and 0% for eyes without uveitis (P = .08). Eyes with uveitis treated with perioperative oral corticosteroids had a 7-fold reduction in postoperative CME (relative risk [RR], 0.14; P = .05). In uveitic eyes, active inflammation within 3 months before surgery increased the risk of CME when compared with eyes without inflammation (RR, 6.19; P = .04). CME was significantly associated with poorer vision (P = .01). CONCLUSIONS: Eyes with well-controlled uveitis may obtain similar outcomes to control eyes after cataract surgery (up to 3 months). Use of perioperative oral corticosteroids and control of uveitis for more than 3 months before surgery seemed to decrease the risk of postoperative CME among uveitic eyes in this study.

Kim SJ, Chung H, Yu HG. · Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea. · Ocul Immunol Inflamm. · Pubmed #19294570 No free full text.

Abstract: PURPOSE: To compare clinical characteristics and visual prognosis between HLA-B27-associated uveitis patients with and without posterior segment involvement. METHODS: Medical records of 78 patients with HLA-B27-associated uveitis were retrospectively analyzed. RESULTS: Neither demographic nor clinical characteristics were associated with the presence of posterior segment involvement. In patients with posterior segment involvement, more aggressive therapeutic strategies, including immunomodulatory therapy, were frequently required. The rate of visual acuity 20/50 or worse was higher in patients with posterior involvement than in patients without posterior involvement. CONCLUSION: Patients with posterior segment involvement showed worse visual outcome than patients without posterior involvement.

Yu SI, Kim JL, Lee SG, Kim HW, Kim SJ. · Department of Ophthalmology, College of Medicine, Inje University, Pusan, Korea. · Korean J Ophthalmol. · Pubmed #19096246 links to  free full text

Abstract: To report a case of Boucher-Neuhäuser syndrome, which is an autosomal recessive disorder characterized by the triad of spinocerebellar ataxia, chorioretinal dystrophy, and hypogonadotropic hypogonadism. An 18-year-old man was seen for visual problems, which had been diagnosed as retinitis pigmentosa at the age of 12 years. His puberty was delayed. At 16 years of age, the patient experienced progressive deterioration of his balance and gait disturbance. Then he was referred to our clinic because Boucher-Neuhäuser syndrome was suspected. He had no specific family history; his visual acuity was 0.04 in both eyes. We observed broad retinal pigment epithelium atrophy and degeneration in both fundi. Both fluorescein and indocyanine green angiography showed choriocapillaris atrophy in the posterior pole area and midperiphery. Macular optical coherence tomography showed thinning of the neurosensory retina. An electroretinographic examination showed no photopic or scotopic responses. The Boucher-Neuhäuser syndrome should be included in the differential diagnosis of patients with retinitis pigment epithelium atrophy and degeneration.

Kim SJ, Belair ML, Bressler NM, Dunn JP, Thorne JE, Kedhar SR, Jabs DA. · Department of Ophthalmology, Emory University School of Medicine, Atlanta, GA 30322, USA. · Retina. · Pubmed #18536605 No free full text.

Abstract: OBJECTIVE: To validate a method of reporting postcataract macular edema (ME) using optical coherence tomography (OCT). METHODS:: Data were analyzed for 130 eyes followed prospectively for ME after uncomplicated cataract surgery. Each eye underwent OCT within 4 weeks before surgery and at 1 month and 3 months after surgery. ME was defined by observation of cystoid changes by OCT. RESULTS: Incidence of ME was 14% (95% confidence interval, 8-20). Average increase in baseline center point thickness (CPT) +/- SD at 1 month for eyes with and without ME was 202 +/- 113 microm and 8 +/- 19 microm, respectively (P < 0.001), which resulted in a 1-letter loss (-0.02 logMAR [logarithm of the minimum angle of resolution]) and a 3-line gain (0.29 logMAR) in vision, respectively (P < 0.001). Percent change in baseline CPT +/- SD for eyes with and without ME was 115 +/- 67% and 6 +/- 11%, respectively (P < 0.001). A > or =40% increase in baseline CPT accurately determined 100% of eyes with ME and 99% of eyes without ME. CONCLUSIONS: A > or =40% increase in baseline CPT, determined by OCT, offers a valid and objective method of reporting clinically relevant postcataract ME. Standardized reporting of postcataract ME would allow objective assessment and comparison of treatment outcomes among clinical studies.

Kim SJ, Woo SJ, Yu HG. · Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea. · Korean J Ophthalmol. · Pubmed #17302207 links to  free full text

Abstract: PURPOSE: To characterize and report the phenotype of a Korean family with an early-onset autosomal dominant macular dystrophy resembling North Carolina macular dystrophy (NCMD). METHODS: Five members of a Korean family were examined clinically and underwent fundus photography, fluorescein angiography, indocyanine green angiography, optical coherence tomography, full field electroretinogram (ERG), multifocal ERG, electro-oculography (EOG), a color vision test, and a visual field test. RESULTS: Visual acuity ranged from 20/200 to 20/20. Fundus findings demonstrated varying degrees of involvement ranging from drusen only to chorioretinal involvement. Central scotoma corresponded to retinal lesions in two patients. Full field ERG was normal but multifocal ERG showed decreased amplitude and delayed implicit time in the macular area. EOG was normal except in one patient. Color vision tests were also normal. CONCLUSIONS: The phenotype of this Korean family is consistent with NCMD. Linkage analysis is required to confirm the diagnosis.

Kim SJ, Equi R, Bressler NM. · Retina Division, Wilmer Eye Institute (Department of Ophthalmology), Johns Hopkins University School of Medicine, Baltimore, Maryland, USA. · Ophthalmology. · Pubmed #17275910 No free full text.

Abstract: OBJECTIVE: To assess the incidence or progression of macular edema (ME) after cataract surgery in diabetic patients using optical coherence tomography (OCT) and correlating this with degree of diabetic retinopathy or other risk factors. DESIGN: Prospective cohort study. PARTICIPANTS: Fifty diabetic eyes undergoing cataract surgery. METHODS: Each eye underwent 7-field fundus photography no more than 3 months before surgery. Optical coherence tomography testing was performed within 4 weeks before surgery and at 1- and 3-month postoperative visits. Best-corrected visual acuity (BCVA) was recorded at each visit. Macular edema was defined as an increase of center point thickness on OCT > 30% from preoperative baseline. MAIN OUTCOME MEASURES: Changes in foveal thickness and BCVA. RESULTS: The incidence of ME on OCT was 22% (95% confidence interval, 13%-35%). The average increase in center point thickness at 1 month for eyes with ME was 202 microm, which resulted in a nearly 1-line loss of vision (0.07 logarithm of the minimum angle of resolution [logMAR] units) compared with eyes without ME gaining >2 lines of vision (0.24 logMAR units) (P>0.001). Eyes with no diabetic retinopathy developed minimal thickening of 18 mum and 14 mum at 1 and 3 months, respectively, associated with approximately 2 and 3 lines of improved vision, respectively (0.22 and 0.26 logMAR units). Eyes with moderate or severe nonproliferative diabetic retinopathy or proliferative diabetic retinopathy developed thickening of 145 mum and 131 mum at 1 and 3 months, respectively, associated with <1 and 2 lines of improved visual acuity, respectively (0.08 and 0.17 logMAR units). This difference (P = 0.05) in thickening (127 microm and 117 mum at 1 and 3 months, respectively) was correlated inversely with visual improvement (r = -0.662). Both duration of diabetes > or = 10 years (P = 0.04) and insulin dependence (P = 0.007) were associated with reduced visual improvement. CONCLUSIONS: Diabetic eyes have a high incidence of increased center point thickness on OCT after cataract surgery, associated with a loss of vision at 1 month, with limited visual recovery at 3 months. Treatment to prevent this might improve outcomes in similar individuals after surgery.