Choroidal Microvasculature Dropout Is Associated with Progressive Retinal Nerve Fiber Layer Thinning in Glaucoma with Disc Hemorrhage

Park, Hae-Young Lopilly,Kim, Jin Woo,Park, Chan Kee Elsevier 2018 Ophthalmology Vol.125 No.7

<P><B>Objective</B></P> <P>We used OCT angiography (OCT-A) to investigate parapapillary choroidal microvasculature dropout (MvD) in glaucomatous eyes with or without disc hemorrhage (DH), and the association with changes in retinal nerve fiber layer (RNFL) thickness.</P> <P><B>Design</B></P> <P>An observational case-control study.</P> <P><B>Participants</B></P> <P>Eighty-two open-angle glaucoma (OAG) eyes with DH and 68 OAG eyes without DH that underwent at least 4 serial OCT examinations were included.</P> <P><B>Methods</B></P> <P>MvD was defined as complete loss of microvasculature within the choroidal layer of the parapapillary region, as revealed by standardized assessment of OCTA-derived density maps of the vessels of the optic nerve head. The circumferential extent of MvD was measured on OCT-A images. The RNFL thinning rate was calculated using a linear mixed model. Kaplan-Meier survival analysis and the log-rank test were used to compare the cumulative risk ratio of progression between groups stratified by DH and MvD.</P> <P><B>Main Outcome Measures</B></P> <P>MvD detection rate, the extent of MvD as measured by the MvD angle, and RNFL thinning rate.</P> <P><B>Results</B></P> <P>MvD was found in 38 (46.3%) eyes with DH at the prior DH site, which was found in only 20 (29.4%) eyes without DH, which was significantly different between the 2 groups (<I>P</I> = 0.025). Patients with progressive glaucoma exhibited significantly more MvD than the stable patients in both DH and no-DH groups. There were statistically significant differences between groups subdivided by the presence of DH and MvD as assessed by Kaplan-Meier analysis (log-rank test, <I>P</I> < 0.001). The angle of MvD was significantly greater in eyes with recurrent DH compared with eyes with single DH. Presence of DH, recurrent DH, and presence of MvD were factors associated with progressive RNFL thinning.</P> <P><B>Conclusions</B></P> <P>We found that MvD was frequent in progressive OAG eyes on the choroidal map of OCT-A, which was more frequently found at the prior DH locations in eyes with DH. This means that observing the presence of MvD using OCT-A may provide a biomarker for glaucoma progression, especially in eyes with DH.</P>

Influence of the lamina cribrosa on the rate of global and localized retinal nerve fiber layer thinning in open-angle glaucoma

Park, Hae-Young Lopilly,Kim, Sung In,Park, Chan Kee Williams & Wilkins Co 2017 Medicine Vol.96 No.14

<P>The advent of optical coherence tomography (OCT) imaging allows identification of the structural contribution of the lamina cribrosa (LC) to glaucoma progression. This study aimed to determine the role of various LC features, such as the LC depth (LCD), LC thickness (LCT), and focal LC defects, on the future rate of progressive retinal nerve fiber layer (RNFL) thinning in patients with glaucoma. One hundred eighteen patients with glaucoma who had undergone at least 4 OCT examinations were included. Features of LC, including the LCD, LCT, and presence of focal LC defects, from serial scan of the optic disc using the enhanced depth imaging of Spectralis OCT; were analyzed at baseline. Eyes were classified as those with or without progressive RNFL thinning using the guided progression analysis of Cirrus OCT. Factors associated with the rate of RNFL thinning (linear regression analysis against time for global average, inferior, and superior RNFL thicknesses, mu m/year) were evaluated using a general linear model. Greater baseline LCD and thinner baseline LCT were significantly associated with the rate of superior RNFL thinning. Focal LC defects were significantly more frequent in eyes with progressive inferior RNFL thinning (93.8%) and the location of the focal LC defect was only related to the location of progression RNFL thinning in the inferior region (P<0.001). A deeper and thinner LC was related to the rate of superior RNFL thinning, and the presence of focal LC defects was related to the rate of inferior RNFL thinning.</P>

Cases of Pseudophakic Pseudoexfoliation in Glaucoma Patients

( Hae Young Lopilly Park ),( Myung Douk Ahn ) 대한안과학회 2012 Korean Journal of Ophthalmology Vol.26 No.5

We present cases of primary open angle glaucoma patients without previous history of pseudoexfoliation who developed pseudoexfoliative materials on the anterior surface of the intraocular lens after cataract surgery. Among 5 unilateral pseudophakic pseudoexfoliation cases, 3 showed a more advanced state of glaucoma in the affected eye. The other 2 cases showed progression of glaucoma in the affected eye after the development of pseudophakic pseudoexfoliation, while the unaffected eyes remained stable. In the latter 2 cases, control of intraocular pressure was difficult, and more glaucoma medication was needed in the affected eye. Pseudophakic pseudoexfoliation in glaucoma patients with no history of pseudoexfoliation syndrome or pseudoexfoliative glaucoma has not been reported. In our cases, the eyes which developed pseudophakic pseudoexfoliation showed a more advanced state of glaucoma, more difficulty controlling intraocular pressure, and faster progression of glaucoma. More observation is needed, but we cautiously postulate that pseudophakic pseudoexfoliation may have a role as a clinical risk factor in the prediction of glaucoma progression.

Long-term changes in endothelial cell counts after early phacoemulsification versus laser peripheral iridotomy using sequential argon:YAG laser technique in acute primary angle closure.

Park, Hae-Young Lopilly,Lee, Na Young,Park, Chan Kee,Kim, Man Soo Springer-Verlag 2012 Graefe's archive for clinical and experimental oph Vol.250 No.11

<P>To compare the change in endothelial cell counts (ECC) after early phacoemulsification and laser peripheral iridotomy (LPI) using sequential argon:yttrium-aluminum-garnet (YAG) laser technique for the treatment of acute primary angle closure (APAC).</P>

Molecular analysis of <i>myocilin</i> and <i>optineurin</i> genes in Korean primary glaucoma patients

Park, Joonhong,Kim, Myungshin,Park, Chan Kee,Chae, Hyojin,Lee, Seungok,Kim, Yonggoo,Jang, Woori,Chi, Hyun Young,Park, Hae-Young Lopilly,Park, Shin Hae D.A. Spandidos 2016 MOLECULAR MEDICINE REPORTS Vol.14 No.3

<P>To investigate the underlying genetic influences of primary glaucoma in Korea, molecular analysis was performed in 112 sporadic cases, and results compared with healthy controls. The <I>myocilin</I> (<I>MYOC</I>) and <I>optineurin</I> (<I>OPTN</I>) genes were directly sequenced in 112 unrelated patients, including 17 with primary open-angle glaucoma, 19 with juvenile open-angle glaucoma, and 76 with normal tension glaucoma. Healthy unrelated Korean individuals (n=100) were used as the non-selected population control. A total of three <I>MYOC</I> and four <I>OPTN</I> variants potentially associated with primary glaucoma were identified in 4 and 18 patients, respectively. A novel variant of <I>MYOC</I>, <I>p.Leu255Pro</I>, was predicted to be potentially pathogenic by <I>in silico</I> analysis. Another, <I>p.Thr353Ile</I>, has been previously reported. These two missense variants were detected in patients with a family history of glaucoma. Combined heterozygous variants <I>p.[Thr123=;Ile288=]</I> were identified in 2 of 112 (2%) patients but not in healthy controls. Among <I>OPTN</I> variants, a novel variant <I>p.Arg271Cys</I> was identified. Homozygous <I>p.[Thr34=;Thr34=]</I> (4/112, 4%), homozygous <I>p.[Met98Lys;Met98Lys]</I> (4/112, 4%), or combined heterozygous <I>p.[Thr34=;Arg545Gln]</I> (9/112, 8%) was significantly associated with the development of primary glaucoma [odds ratio (OR)=8.768, 95% confidence interval (CI)=1.972–38.988; relative risk=1.818, 95% CI=1.473–2.244; P=0.001]. The present study provides insight into the genetic or haplotype variants of <I>MYOC</I> and <I>OPTN</I> genes contributing to primary glaucoma. Haplotype variants identified in the present study may be regarded as potential contributing factors of primary glaucoma in Korea. Further studies, including those on additional genes, are required to elucidate the underlying pathogenic mechanism using a larger cohort to provide additional statistical power.</P>

Features of the Choroidal Microvasculature in Peripapillary Atrophy Are Associated With Visual Field Damage in Myopic Patients

Park, Hae-Young Lopilly,Jeon, Soo Ji,Park, Chan Kee Elsevier 2018 American journal of ophthalmology Vol.192 No.-

<P><B>Purpose</B></P> <P>Optical coherence tomography angiography (OCT-A) was used to investigate the features of choroidal microcirculation within the β-zone peripapillary atrophy (PPA) and its association with visual field (VF) defects in myopic patients.</P> <P><B>Design</B></P> <P>Cross-sectional study.</P> <P><B>Methods</B></P> <P> <U>Participants</U>: Eighty-four myopic patients with a unilateral glaucomatous VF defect. <U>Observation Procedures</U>: Comparison was performed between VF-affected eyes and contralateral normal eyes. Area of β-zone PPA was measured on disc photographs and the choroidal map of OCT-A. The presence of regional microvasculature dropout (MvD) was defined as a complete loss of microvasculature in OCT-A images. Analyses were performed to investigate factors associated with the presence of VF defects or central VF defects within the 10-degree region. <U>Main Outcome Measures</U>: The β-zone PPA area, OCT-A PPA area, and MvD detection percentage.</P> <P><B>Results</B></P> <P>The PPA area was greater in myopic eyes with VF defects compared to myopic eyes without VF defects (<I>P</I> = .039 and <I>P</I> = .027, respectively) on both disc photographs and OCT-A images. MvD was found significantly more frequently (77.4%) in glaucomatous eyes with central scotoma than in eyes without central scotoma (36.4%; <I>P</I> = .019). Larger PPA area on OCT-A than on disc photographs was independently associated with the presence of glaucomatous VF damage in myopic eyes. The presence of MvD was significantly associated with the presence of central scotoma in myopic eyes.</P> <P><B>Conclusions</B></P> <P>Glaucomatous VF damage, especially central VF damage, was present in myopic eyes with a larger PPA or with the presence of MvD on the choroidal map of OCT-A.</P>

Impact of Age and Myopia on the Rate of Visual Field Progression in Glaucoma Patients

Park, Hae-Young Lopilly,Hong, Kyung Euy,Park, Chan Kee Williams & Wilkins Co 2016 Medicine Vol.95 No.21

<P>Myopia is rapidly increasing in young populations and patients with glaucoma associated with myopia are reported to be young aged in East Asia. These young patients have a longer life expectancy, which increases their risk of end-of-life visual disabilities. There is a need to understand the clinical course of myopic glaucoma patients, which may be important for the care of these myopic populations. In this study, we evaluated the relationship between the age at presentation and the rate of glaucoma progression in the visual field (VF) according to the presence of myopia. The study was conducted as a prospective observational study including 179 patients with open-angle glaucoma who had undergone at least 5 VF examinations with a follow-up of at least 5 years. The progression rate of the mean deviation (MD) and the pattern standard deviation (PSD) are expressed as change in decibels (dB) per year. The slopes of the MD and PSD were calculated by linear regression analyses. Factors related to the slope of VF MD changes were analyzed with correlation and regression analyses. The slope of the linear fit line plotted against age at presentation and the rate of change in the VF MD was -0.026 (P<0.001) in the myopic group and -0.008 (P=0.167) in the nonmyopic group; the relationship was more prominent in the myopic group than the nonmyopic group. In the myopic group, age (=-0.417; 95% confidence intervals (CI), -0.651 to -0.200; P=0.050) and baseline untreated intraocular pressure (=-0.179; 95% CI, -0.331 to -0.028; P=0.022) were significantly related to the rate of change in the MD, which was only the presence of disc hemorrhage (=-0.335; 95% CI, -0.568 to -0.018; P=0.022) in the nonmyopic group. Age at presentation was significantly related to the rate of change in the VF in glaucomatous eyes with myopia compared to eyes without myopia. Older age was significantly related to the rate of change in the VF only in myopic glaucomatous eyes.</P>

No Evidence of Association of Heterozygous Galactosylceramidase Deletion With Normal-Tension Glaucoma in a Korean Population

Shin, Hye-Young,Park, Sung-Won,Jung, Seung-Hyun,Park, Hae-Young Lopilly,Jung, Kyoung-In,Chung, Yeun-Jun,Park, Chan Kee Raven Press 2016 Journal of glaucoma Vol.25 No.5

PURPOSE:: A significant association between primary open-angle glaucoma risk and copy-number variation in the galactosylceramidase (GALC) gene was reported recently. This study investigated whether a heterozygous deletion of the GALC gene plays a significant role in normal-tension glaucoma (NTG) in Koreans. METHODS:: A 3-primer polymerase chain reaction assay was used to examine the heterozygous deletion of GALC in all Korean NTG cases (n=276) and controls (n=135). RESULTS:: We did not identify any deletion variant of GALC gene in the NTG patients. CONCLUSIONS:: This is the first copy-number variation study of the GALC gene in the Korean population with NTG. We demonstrated that a heterozygous GALC deletion does not play a significant role in the pathogenesis of NTG in a representative clinic-based population of South Koreans, unlike whites.

Tight orbit syndrome resulting from large globe with high myopia: intractable glaucoma treated by orbital decompression

Park, Hae‐,Young Lopilly,Paik, Ji Sun,Cho, Won‐,Kyung,Park, Chan Kee,Yang, Suk‐,Woo Blackwell Publishing Asia 2012 Clinical & experimental ophthalmology Vol.40 No.2

Relationship between corneal deformation amplitude and optic nerve head structure in primary open-angle glaucoma :

Jung, Younhea,Park, Hae-Young Lopilly,Park, Chan Kee Williams & Wilkins Co 2019 Medicine Vol.98 No.38