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Central Corneal Thickness and Optic Disc Hemorrhages Financial Disclosure: None reported. 27. Yardley J, Leroy BP, Hart-Holden N, et al. Mutations of VMD2 splicing regu- lators cause nanophthalmos and autosomal dominant vitreoretinochoroido- Funding/Support: This study was supported by grants pathy (ADVIRC). Invest Ophthalmol Vis Sci. 2004;45(10):3683-3689. from Åke Wibergs stiftelse, the Swedish Medical Re- search Council, and Foundation Fighting Blindness and by grant EY13053 from the National Institutes of Health (Dr Adamus). Central Corneal Thickness and Optic Disc Additional Contributions: Susanne Boystrom provided Hemorrhages: The Beijing Eye Study skillful technical assistance. entral corneal thickness (CCT) has been de- 1. Thirkill CE, Fitzgerald P, Sergott RC, Roth AM, Tyler NK, Kaltner JL. Cancer- associated retinopathy (CAR-syndrome) with antibodies reacting with reti- scribed to be a predictor for the development nal, optic nerve, and cancer cells. N Engl J Med. 1989;321(23):1589-1594. of primary open-angle glaucoma and the pro- 2. Adamus G, Aptsiauri N, Guy J, Heckenlively J, Flannery J, Hargrave PA. C gression of glaucomatous visual field defects in the Ocu- The occurrence of serum autoantibodies against enolase in cancer- 1 associated retinopathy. Clin Immunol Immunopathol. 1996;78(2):120-129. lar Hypertension Treatment Study and other investiga- 3. Adamus G. Autoantibody-induced apoptosis as a possible mechanism of au- tions.2,3 Correspondingly, a previous investigation by toimmune retinopathy. Autoimmun Rev. 2003;2(2):63-68. Herndon and colleagues3 found that CCT was the most 4. Keltner JL, Thirkill CE, Yip PT. Clinical and immunologic characteristics of melanoma-associated retinopathy syndrome: eleven new cases and a review consistent predictor of the degree of glaucomatous dam- of 51 previously published cases. J Neuroophthalmol. 2001;21(3):173-187. age in their hospital-based cross-sectional study. How- 5. Milam AH, Saari JC, Jacobson SG, et al. Autoantibodies against retinal bi- polar cells in cutaneous melanoma-associated retinopathy. Invest Ophthal- ever, CCT also influences applanation tonometry, so it mol Vis Sci. 1993;34(1):91-100. has remained unclear whether the reported findings are 6. Berson EL, Lessell S. Paraneoplastic night blindness with malignant melanoma. due to the dependence of intraocular pressure measure- Am J Ophthalmol. 1988;106(3):307-311. 7. Kellner U, Bornfeld N, Foerster H. Severe course of cutaneous melanoma as- ments on CCT and a corresponding selection artifact of sociated paraneoplastic retinopathy. Br J Ophthalmol. 1995;79(8):746-752. patients or whether a thin cornea may predispose the eye 8. Borkowski LM, Grover S, Fishman GA, Jampol LM. Retinal findings in mela- to a higher glaucoma susceptibility. Since optic disc hem- noma-associated retinopathy. Am J Ophthalmol. 2001;132(2):273-275. 9. Zacks DN, Pinnolis MK, Berson EL, Gragoudas ES. Melanoma-associated reti- orrhages can indicate progression of glaucomatous op- nopathy and recurrent exudative retinal detachments in a patient with cho- tic neuropathy and because most of the previous inves- roidal melanoma. Am J Ophthalmol. 2001;132(4):578-581. 10. Palmowski AM, Haus AH, Pfo¨hler C, et al. Bilateral multifocal chorioreti- tigations were hospital-based studies with a possible nopathy in a woman with cutaneous malignant melanoma. Arch Ophthalmol. referral bias, it was the purpose of our population-based 2002;120(12):1756-1761. study to assess whether CCT influences the develop- 11. Jampol LM, Kim HH, Bryar PJ, Shankle JB, Lee RT, Johnston RL. Multiple serous retinal detachments and subretinal deposits as the presenting signs ment of disc hemorrhages. of metastatic melanoma. Retina. 2004;24(2):320-322. 12. Sotodeh M, Paridaens D, Keunen J, van Schooneveld M, Adamus G, Baarsma Methods. The Beijing Eye Study is a population-based S. Paraneoplastic vitelliform retinopathy associated with cutaneous or uveal mela- 4 noma and metastases. Klin Monatsbl Augenheilkd. 2005;222(11):910-914. cohort study in northern China. The medical ethics com- 13. Marmor MF, Holder GE, Seeliger MW, Yamamoto S; International Society mittee of the Beijing Tongren Hospital approved the study for Clinical Electrophysiology of Vision. Standard for clinical electroreti- nography (2004 update). Doc Ophthalmol. 2004;108(2):107-114. protocol and all of the participants gave informed con- 14. Brown M, Marmor M, Vaegan , Zrenner E, Brigell M, Bach M. ISCEV Stan- sent according to the Declaration of Helsinki. Of 5324 dard for Clinical Electro-oculography (EOG) 2006. Doc Ophthalmol. 2006; individuals aged 40 years or older residing in the study 113(3):205-212. 15. Adamus G, Ren G, Weleber RG. Autoantibodies against retinal proteins in para- area, 4439 individuals (2505 women) participated in the neoplastic and autoimmune retinopathy. BMC Ophthalmol. 2004;4(1):5. eye examination (response rate, 83.4%) in the year 2001 16. Keltner JL, Thirkill CE. The 22-kDa antigen in optic nerve and retinal diseases. as described in detail previously.4 In 2006, the same popu- J Neuroophthalmol. 1999;19(2):71-83. 17. Flynn MF, Fisherman GA, Adamus G. Antiretinal Muller cell antibodies in lation was invited for a reexamination, with 3251 sub- patients with melanoma associated and autoimmune retinopathy [ARVO jects participating (response rate, 73.3%). All of the par- abstract]. Invest Ophthalmol Vis Sci. 2000;41:s567. 18. Potter MJ, Adamus G, Szabo SM, Lee R, Mohaseb K, Behn D. Autoantibod- ticipants underwent a standardized ophthalmic ies to transducin in a patient with melanoma-associated retinopathy. Am J examination including CCT measurement by slitlamp op- Ophthalmol. 2002;134(1):128-130. tical coherence tomography. Only 1 randomly selected 19. Pfo¨hler C, Preuss K-D, Tilgen W, et al. Mitofilin and titin as target antigens in melanoma-associated retinopathy. Int J Cancer. 2006;120(4):788-795. eye was taken for statistical analysis. Glaucoma was de- 20. Ladewig G, Reinhold U, Thirkill CE, Kerber A, Tilgen W, Pfo¨hlerC.Inci- fined by the appearance of the optic nerve head as de- dence of antiretinal antibodies in melanoma: screening of 77 serum samples scribed recently (Table).4 from 51 patients with American Joint Committee on Cancer stage I-IV. Br J Dermatol. 2005;152(5):931-938. 21. Jacobson DM, Adamus G. Retinal anti-bipolar cell antibodies in a patient Results. Of the 3251 subjects, CCT measurements were with paraneoplastic retinopathy and colon carcinoma. Am J Ophthalmol. 2001; 131(6):806-808. available for 3100 subjects (95.4%); 32 of them (1.0%) 22. Weleber RG, Watzke RC, Shults WT, et al. Clinical and electrophysiological showed an optic disc hemorrhage. The CCT was slightly characterization of paraneoplastic and autoimmune retinopathies associated greater in the hemorrhagic group (mean [SD] CCT, 569.5 with antienolase antibodies. Am J Ophthalmol. 2005;139(5):780-794. 23. Marmorstein AD, Marmorstein LY, Rayborn M, Wang X, Hollyfield JG, Pe- [33.8] µm) than in the nonhemorrhagic group (mean [SD] trukhin K. Bestrophin, the product of the Best vitelliform macular dystrophy CCT, 556.0 [33.0] µm) (P=.03; after application of the gene (VMD2), localizes to the basolateral plasma membrane of the retinal pig- Bonferroni method to correct for performing multiple sta- ment epithelium. Proc Natl Acad Sci U S A. 2000;97(23):12758-12763. 24. Rosenthal R, Bakall B, Kinnick T, et al. Expression of bestrophin-1, the prod- tistical analyses, P=.06) (Figure). Including glaucoma- uct of the VMD2 gene, modulates voltage-dependent Ca2ϩchannels in reti- tous eyes (n=77) only, the CCT did not vary signifi- nal pigment epithelial cells. FASEB J. 2006;20(1):178-180. 25. Schatz P, Klar J, Andre´asson S, Ponjavic V, Dahl N. Variant phenotype of cantly between the hemorrhagic group (n=5 eyes [6%]; Best vitelliform macular dystrophy associated with compound heterozy- mean [SD] CCT, 571.8 [36.1] µm) and the nonhemor- gous mutations in VMD2. Ophthalmic Genet. 2006;27(2):51-56. rhagic group (n=72 eyes [94%]; mean [SD] CCT, 549.3 26. Marmorstein LY, Wu J, McLaughlin P, et al. The light peak of the electro- retinogram is dependent on voltage-gated calcium channels and antago- [31.4] µm) (P=.24), with the hemorrhagic group having nized by bestrophin (best-1). J Gen Physiol. 2006;127(5):577-589. slightly thicker corneas than the nonhemorrhagic group. (REPRINTED) ARCH OPHTHALMOL / VOL 126 (NO. 3), MAR 2008 WWW.ARCHOPHTHALMOL.COM 435 ©2008 American Medical Association. All rights reserved. Downloaded From: https://jamanetwork.com/ on 10/01/2021 port a thin cornea to be a pathogenic risk factor for Table. Criteria for the Definition of Glaucoma glaucoma progression. in the Beijing Eye Studya Liang Xu, MD Criteria Typeb Criteria Haitao Zhang, MD Absolutec Neuroretinal rim notch in the temporal inferior region Ya Xing Wang, MD and/or the temporal superior region, so that the Jost B. Jonas, MD ISNT rule was not fulfilled (in eyes with an optic cup sufficiently large to allow an assessment of the Correspondence: Dr Jonas, Universita¨ts-Augenklinik, neuroretinal shape) Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany Localized retinal nerve layer defect that could not be explained by any cause other than glaucoma ([email protected]). Abnormally large cup in relation to the size of the Financial Disclosure: None reported. optic disc Funding/Support: This work was supported by grant Relative Neuroretinal rim was markedly thinner in the inferior 7071003 from the Beijing Natural Science Foundation. disc region compared with the superior disc region, even if the smallest part of the neuroretinal rim was 1. Gordon MO, Beiser JA, Brandt JD, et al. The Ocular Hypertension Treatment located in the temporal horizontal disc region Study: baseline factors that predict the onset of primary open-angle glaucoma. Diffuse decrease in the visibility of the retinal nerve Arch Ophthalmol. 2002;120(6):714-720. fiber layer (particularly in eyes with small optic 2.
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