Korean journal of ophthalmology : KJO最新文献

Purpose: To evaluate functional and anatomical outcomes, including vessel morphology parameters on swept-source optical coherence tomography angiography (SS-OCTA), in eyes with neovascular age-related macular degeneration (nAMD) switched to brolucizumab.

Methods: This retrospective study included 37 eyes with nAMD that were switched from other anti-vascular endothelial growth factor (VEGF) agents to intravitreal brolucizumab. Best-corrected visual acuity (BCVA), injection intervals, central subfield thickness (CST), pigment epithelial detachment (PED) and presence of retinal fluid were compared between baseline and 12 months post-switch. SS-OCTA images were analyzed to quantify macular neovascularization (MNV) area, vessel density, fractal dimension (FD), and lacunarity.

Results: Switching to brolucizumab significantly extended injection intervals and reduced CST, PED height and retinal fluid, while maintaining BCVA at 12 months. Quantitative OCTA analysis showed reductions in MNV area and FD following the switch. When compared with the preceding 12 months of other anti-VEGF therapy, FD still showed a significant reduction after brolucizumab treatment (p = 0.019). Intraocular inflammation occurred in 1 eye and resolved with topical corticosteroids.

Conclusions: Intravitreal brolucizumab demonstrated favorable anatomical improvements and maintained visual outcomes over 12 months. Quantitative OCTA biomarkers, particularly FD, may serve as imaging indicators of disease activity and treatment response in eyes with nAMD undergoing a therapy switch.

Purpose: We sought to investigate the association between allergen-specific immunoglobulin E (IgE) sensitization and open-angle glaucoma (OAG) using a nationally representative Korean population.

Methods: This cross-sectional study used data from the 2010 Korea National Health and Nutrition Examination Survey (KNHANES). Among 8,958 participants, 1,334 subjects with complete ophthalmologic and allergen-specific IgE test results were included. Sensitization to indoor allergens (house dust mites, cockroaches, and dog dander) was assessed using ImmunoCAP assays. Multivariate logistic regression models were used to evaluate the association between allergen sensitization and OAG, adjusting for demographic, metabolic, and lifestyle factors.

Results: Among the 1,334 participants analyzed, 62 were diagnosed with OAG. Sensitization to cockroach allergens was associated with increased odds of OAG (adjusted OR = 1.19; 95% CI: 1.02-1.38), whereas sensitization to house dust mites was associated with lower odds (adjusted OR = 0.56; 95% CI: 0.31-1.00). No significant associations were found for total IgE levels or sensitization to dog allergens.

Conclusions: Allergen sensitization is differentially associated with OAG, depending on the allergen type. Cockroach sensitization was associated with greater odds of glaucoma, while house dust mite sensitization demonstrated an inverse association. These findings provide epidemiological evidence for a differential association between specific allergen sensitizations and OAG. Also, it support the hypothesis of immune-mediated mechanisms in glaucoma pathogenesis and justify further investigation into these inflammatory pathways.

Purpose: To determine the corneal stabilization timeline after pterygium excision adjusted for horizontal invasion length (HIL).

Methods: In this single-center retrospective cohort, we analyzed 88 eyes of 80 patients with nasal or temporal primary pterygium who underwent excision and perioperative evaluation with anterior segment swept-source OCT (AS SS-OCT, Anterion®). Anterior simulated mean keratometry (SimKmean; 3-mm ring) and HIL were measured on AS SS-OCT. Keratometric stabilization was assessed at postoperative cutoffs of 8, 12, 16, 20, and 24 weeks using analysis of covariance (ANCOVA) with HIL as a covariate. Subgroup analysis was performed after stratifying by the median HIL (3.82 mm).

Results: Mean anterior SimKmean increased from 42.95 ± 1.79 D preoperatively to 43.73 ± 1.53 D postoperatively (P < 0.001). Preoperative HIL correlated positively with the perioperative SimKmean change (r = 0.728 and P < 0.001). While postoperative duration showed no significant unadjusted correlation with keratometric change (r = -0.133 and P = 0.218), partial correlation controlling for HIL was negative (r = -0.248 and P = 0.021), indicating diminishing change over time after severity adjustment. ANCOVA demonstrated significant stabilization at 16 weeks (P = 0.036). In the HIL ≥ 3.82 mm subgroup, SimKmean change was greater before 20 weeks than after 20 weeks (1.73 ± 1.59 D vs 0.59 ± 0.74 D; P = 0.030), whereas no significant time-point differences were found for HIL < 3.82 mm.

Conclusion: Corneal keratometric stabilization after pterygium excision depends on preoperative HIL. A minimum of 16 weeks is recommended before cataract surgery planning, with at least 20 weeks for eyes with HIL ≥ 3.82 mm.

Purpose: To investigate the recent prescription patterns among Korean pediatric ophthalmologists to control myopia progression.

Methods: An online survey was distributed to the members of the Korean Association of Pediatric Ophthalmology and Strabismus (KAPOS) between August 22 and 31, 2023. Respondents selected treatment modalities that they prescribed to slow myopia progression. Multiple responses were allowed, and prescribing patterns were analyzed by respondents' characteristics, including years since board certification, practice type, practice location, and average number of pediatric myopia patients seen per week.

Results: Of 167 active members, 119 (71.3%) completed the survey, and 118 provided full responses. Most respondents practiced in Seoul or metropolitan areas (75.4%), worked in hospitals (73.7%), had >10 years of clinical experience (68.9%), and treated >20 pediatric myopia patients weekly (62.2%). With multiple responses allowed, 0.125% atropine eye drops (75.6%) were most commonly prescribed, followed by orthokeratology lenses (57.1%). When grouped into mutually exclusive categories (topical atropine only, optical interventions only, both and neither), the largest proportion of respondents (63.0%) selected both pharmacological and optical treatments. Treatment patterns did not differ by experience or location, but significant differences were observed by practice type and weekly pediatric myopia patient volume. Private practitioners more often prescribed orthokeratology, dual-focus soft contact lenses, and selected both pharmacologic and optical treatments, whereas hospital practitioners more commonly selected topical atropine alone. Those treating a higher volume of pediatric myopia patients showed a greater tendency to select both pharmacologic and optical treatments.

Conclusions: In this survey of KAPOS members, topical atropine, particularly the 0.125% commercial formulation, was the most commonly prescribed single modality for myopia control. Topical atropine and optical interventions emerged as the most common treatment strategies, particularly in private clinics. These findings indicate a trend towards more proactive and multimodal approaches to myopia control compared with earlier practice patterns in Korea.

Background: Keratoconus (KC) involves a progressive corneal deformation, recognized as having an inflammatory component, despite traditionally being considered non-inflammatory. This study investigates the notable tear film cytokines and their correlation with KC disease severity.

Objectives: i). To measure inflammatory tear biomarkers in the keratoconus patients and compare them with healthy controls. ii). To evaluate biomarker levels across different severity stages of keratoconus.

Study design: This study follows a case-control observational design, comparing inflammatory tear biomarkers in the keratoconus patients (cases) and normal individuals (controls), at a single point in time without intervention.

Methods: Eighteen KC patients and 25 healthy controls were enrolled. Tear samples were collected via Schirmer strips and analyzed for IL-1β, IL-4, IL-6, IL-10, MMP-9, and TNF-α using ELISA. Group comparisons were made using non parametric tests, and Spearman's correlation evaluated associations with disease severity.

Results: KC patients showed significantly elevated levels of IL-1β, IL-4, IL-6, IL-10, MMP-9, and TNF-α (p < 0.05). IL-1β, MMP-9, and TNF-α demonstrated strong associations with disease severity, while IL-6 and IL-10 exhibited moderate correlations, and IL-4 showed only a weak association with keratoconus progression.

Conclusion: The study emphasizes inflammation's role in keratoconus and identifies tear film inflammatory markers as promising tools for diagnosis, prognosis, early detection, disease monitoring, and personalized treatment.

Purpose: Corneal ulcer remains a major, ongoing health issue worldwide as it leads to blindness. The study analyzed the epidemiological patterns, microbiological profiles, antimicrobial resistance, and therapeutic outcomes trends across two time periods to assess changes associated with expanded diagnostic capacity.

Methods: A 10-year retrospective research was conducted at Cipto Mangunkusumo Hospital, Jakarta (2015-2019; 2022-2024). Clinical, microbiological, and treatment data were analyzed using Chi-square tests and multivariable regression with propensity score matching to identify predictors of improvement.

Results: A total of 1.100 eyes were examined. About two-thirds of patients were male, and the majority were aged 41-60 years, with trauma as the leading risk factor. Diagnostic testing increased markedly after 2022, revealing predominantly bacterial infections, most commonly Pseudomonas aeruginosa and coagulase-negative Staphylococci, with greater culture positivity and organism diversity. Antimicrobial resistance rose substantially, particularly to fluoroquinolones and aminoglycosides, whereas vancomycin (gram-positive) and ceftazidime (gram-negative) remained most effective. Clinical outcomes improved significantly in 2022-2024. Chi-square analysis showed ulcer location, size, depth, severity, and AC reaction were associated with improvement. Multivariable regression identified ulcer size, severity, surgical treatment, and later period as independent predictors of better outcomes, whereas antibiotic class did not independently influence healing.

Conclusion: Infectious corneal ulcer at our center remains predominantly bacterial, with evolving pathogen profiles and resistance patterns. Improved diagnostic access and standardized therapeutic protocols contributed to better outcomes. Routine culture testing and adherence to local resistance data are essential for guiding empiric therapy.

Purpose: This study aims to analyze the annual trends of intravitreal injection (IVI) in South Korea.

Methods: This retrospective study examined data from the Health Insurance Review and Assessment Service (HIRA)'s Health and Medical Big Data Open Portal. We investigated the number of patients who underwent IVIs and the total number of IVIs in Korea using the procedure code from 2014 to 2023, categorized by age group and type of healthcare facility. Patients aged under 40 years were excluded from the analysis. Additionally, trends in healthcare expenditures were analyzed.

Results: The number of patients undergoing IVI and the total number of IVI increased steadily, resulting in 92,124 patients (178.1 patients per 100,000 persons) and 291,784 injections in 2023, which contributed to an increase in medical expenses. The analysis of 10-year age intervals revealed that patients in their 70s were the most frequent recipients of IVI. The prevalence of IVI at primary healthcare facilities has been steadily increasing, from 20% in 2014 to 33% in 2023.

Conclusions: The patients receiving IVI and the total number of IVI have been steadily increasing, particularly in primary healthcare settings. Overall, medical expenses continue to rise. The findings of this study provide valuable evidence for the efficient allocation of medical resources in the future.

Purpose: To report the factors affecting visual outcomes after small incision lenticule extraction (SMILE) in eyes treated with the Visumax 800.

Methods: This is a retrospective study with cross-sectional design of eyes underwent SMILE Pro using Visumax 800 at Jakarta Eye Center. Patients ≤40 years old with a corrected distance visual acuity of >20 / 25, manifest refractive spherical equivalent ≤10.0 diopters (D), and cylinder refraction <5.0 D were included. Evaluation of visual outcomes was conducted at 1 day and 1 month postoperatively.

Results: A total of 258 eyes from 132 patients were analyzed. Among the total, 94% achieved an uncorrected distance visual acuity (UDVA) of 20 / 20 at 1 month postoperatively. Of the eyes with high myopia, 81% achieved a UDVA of 20 / 20, followed by 97% and 99% in moderate and low myopic eyes, respectively. Spherical equivalent refraction (r = 0.273, p < 0.01), optic zone (OZ; r = 0.260, p < 0.01), cap thickness (r = 0.209, p < 0.01), and residual stromal thickness (RST; r = 0.256, p < 0.01) showed a significant but weak correlation with UDVA at 1 month postoperatively. There is increasing risk to get <20 / 20 UDVA in right eyes (odds ratio [OR], 3.101; p < 0.045), eyes with high myopia (OR, 9.964; p < 0.01), 100-μm cap thickness (OR, 4.578; p < 0.01), ≤6 mm OZ (OR, 10.556; p < 0.01), and <300-μm RST (OR, 9.100; p < 0.01) at 1 month postoperatively.

Conclusions: SMILE Pro results in promising visual outcome in early postoperative period. Patients with low to moderate myopia have better visual outcomes than those with high myopia. A small OZ, thin cap thickness, and low RST could increase the risk of not achieving the maximum visual outcome after SMILE. A prospective study with a longer follow-up period that includes comprehensive variables is needed to fully understand the factors affecting visual acuity after SMILE.