Eye diseases in women.

Although eye diseases are considered to be relatively less affected by patient sex, it is noteworthy that the presence of hormone receptors have been confirmed in various ocular tissues, which were considered to have few sex-based differences. Female hormone levels are known to change because of menstruation, pregnancy, and menopause. When female hormone levels markedly fluctuate in such situations, the disease state may change.The fluctuations in the levels of sex hormones affect the corneal thickness conditions of uveitis.Estrogen may be a possible therapeutic option for glaucoma because it protects the eyes from damage caused by glaucoma and reduces intraocular pressure;it is particularly promising in the treatment of postmenopausal women with glaucoma.Estrogen is considered to have a prophylactic effect against eye diseases. However, there is a report that female sex is an independent risk factor for the progression of diabetic retinopathy, so it may not always exert a prophylactic effect. Thus, caution should be exercised.Based on recent progression of studies on this field, the importance of treatment according to gender has been recognized in the treatment of eye diseases.

Multicenter randomized clinical trial of retinal photocoagulation for preproliferative diabetic retinopathy.

PURPOSE: To evaluate the effectiveness of selective photocoagulation (S-PC) for nonperfusion areas (NPA) in preproliferative diabetic retinopathy (PPDR). SUBJECTS AND METHODS: A multicenter randomized controlled clinical trial of 69 patients with PPDR showing NPA comparable to or larger than those on reference photographs. The patients were assigned to 2 groups; one was treated with S-PC (PC group: 32 patients), while the other did not receive S-PS (non-PC group: 37 patients). In the non-PC group, panretinal photocoagulation (PRP) was performed whenever proliferative diabetic retinopathy (PDR) developed. In the PC group, S-PC of the NPA was performed followed by additional coagulation whenever the NPA extended, and PRP was performed whenever PDR developed. The primary outcome was the development of PDR. RESULTS: During the entire course, PDR developed in 18 (26%) of the 69 patients. The incidence was significantly higher in the non-PC group than in the PC group. Comparison of the visual acuity at the time of registration and after 36 months showed no significant differences between the two groups. CONCLUSIONS: S-PC for NPA in PPDR is effective at preventing PDR development.

Reconsideration of the most appropriate criterion in the lowest classification of vision disability in Japan.

PURPOSE: To verify the current Japanese classification of vision disability in regard to visual acuity. METHODS: A questionnaire was sent to 100 ophthalmology services in Japan. Each service was asked to extract 300 of their outpatient records. From these records, patients who had a sum of corrected visual acuity in both eyes of less than or equal to 0.62 were selected for the questionnaire. The questionnaire consisted of items related to prevalence, age, sex, with or without vision-disabled certification at any grade, the corrected visual acuity of each eye and the name of any disease the subject may have had. RESULTS: Sixty-five services responded, and, of 20,235 total records reviewed, 971 patients were eligible for the questionnaire. The average age was 66.9 ± 20.0 years, and 74.6% were over 60 years old. The distribution of corrected visual acuity showed three categories. CONCLUSIONS: Our analysis indicates that a new candidate criterion for vision-disabled certification is needed for the sixth grade, which, at present is defined as, "The sum of the corrected visual acuity of both eyes is more than 0.2, but less than or equal to 0.4."

[Visual course for proliferative diabetic retinopathy after pars plana vitrectomy].

PURPOSE: To investigate retrospectively the visual course for proliferative diabetic retinopathy after pars plana vitrectomy. CASES AND METHODS: From January 2002 to December 2004, we operated 209 eyes with proliferative diabetic retinopathy. For this study, we selected 28 eyes in which the visual acuity could be followed for 6 months or longer after the vitrectomy. RESULT: The mean time period for reaching the best visual acuity after vitrectomy was 14.7 +/- 12.0 months. Depending on the type of diabetic maculopathy, the ischemic type, deposit type, and cystoid macular edema type required a mean time of 16 approximately 19 months. For the diffuse edema type, the mean was 9 months. It is significant that vitrectomy with triamcinolone acetonide (TA) resulted in visual improvement earlier than vitrectmy without TA (p value = 0.03).

[Optic nerve atrophy after vitrectomy for diabetic retinopathy: its systemic and local risk factors].

PURPOSE: To evaluate the incidence and risk factors of optic nerve atrophy after vitrectomy for diabetic retinopathy. SUBJECTS AND METHODS: Clinical charts of 48 eyes of 40 patients who underwent vitrectomy for diabetic retinopathy were retrospectively reviewed. The relationship between postoperative optic nerve atrophy and patients' physical condition was statistically analyzed. RESULT: Postoperative optic nerve atrophy, distinct from glaucomatous optic nerve atrophy, occurred in 5 eyes (10.4%). Its incidence was correlated with higher plasma creatinine concentration (p=0.001), proliferative diabetic retinopathy (p= 0.046), and retinal white vessel formation (p= 0.007). Maintenance of the best postoperative visual acuity was difficult in the patients with optic nerve atrophy. CONCLUSION: Patients with proliferative diabetic retinopathy accompanied by renal dysfunction were at high risk of optic nerve atrophy after vitrectomy.

[Anterior segment fluorescein angiography for evaluating the effect of vitrectomy for neovascular glaucoma].

PURPOSE: Using anterior segment fluorescein angiography(AFA), we evaluated the relationship between the effect of vitrectomy combined with endophotocoagulation for neovascular glaucoma and the postoperative angiographic changes. SUBJECTS AND METHODS: Seven eyes of 7 patients (six eyes of 6 patients had proliferative diabetic retinopathy and 1 eye of 1 patient had central retinal vein occlusion) with neovascular glaucoma underwent both vitrectomy combined with endophotocoagulation and AFA before and after surgery. RESULTS: Of the 7 cases, the three eyes(42.9%), ther received one vitreous surgery alone had a reduction in intraocular pressure (IOP). The other 4 with uncontrollable IOP underwent trabeculectomy additionally, and three of them achieved good control of IOP. AFA showed less dye leakage in the iris after surgery in all cases. Three of 4 eyes with less dye leakage in the chamber angle showed good IOP control. Two of 3 eyes without the change in dye leakage were treated additionally by trabeculectomy. CONCLUSION: AFA is a sensitive technique in the assessment of neovascularization in the anterior segment, so that it is useful in evaluating the effect of vitrectomy combined with endophotocoagulation for neovascular glaucoma.

[Effects of treatment for diabetic retinopathy on reperfusion of the capillary bed].

PURPOSE: We studied the effects of treatment for diabetic retinopathy on reperfusion and obstruction of the capillary bed. SUBJECT AND METHODS: In a retrospective study, we studied fluorescein angiograms of 66 patients (98 eyes) with diabetic retinopathy treated in our hospital between January 1998 and July 2002. Fluorescein angiography was performed at the first visit and each treatment (vitrectomy, photocoagulation, and follow-up). Angiographic findings of reperfusion and obstruction in the temporal raphe area were evaluated. RESULTS: In the patients who had undergone vitrectomy, reperfusion of the capillary bed was observed in 10 of 24 (42%) eyes and regularity or obstruction was observed in 14 (58%). In the patients treated by photocoagulation, reperfusion was observed in 11 of 56 (20%) eyes and regularity or obstruction was observed in 45 (80%). In the patients without treatment, reperfusion was observed in 1 of 18 (6 %) eyes and regularity or obstruction was observed in 17 (94%). CONCLUSION: Reperfusion of the capillary bed was significantly greater in the vitrectomy patients than in the photocoagulation and follow-up patients. Treatment for diabetic retinopathy influenced reperfusion and obstruction of the capillary bed in the temporal raphe area.