Aqueous humor cytokine levels in patients with polypoidal choroidal vasculopathy and neovascular age-related macular degeneration.

PURPOSE: To investigate the possible roles of various cytokines or growth factors in the pathogenesis of exudative age-related macular degeneration (AMD) by comparing aqueous humor levels of 14 cytokines between eyes with polypoidal choroidal vasculopathy (PCV) and those with neovascular AMD. METHODS: Forty eyes from 40 patients with treatment-naïve exudative AMD consisting of 18 eyes with neovascular AMD and 22 eyes with PCV were studied. Twenty eyes from 20 patients with no retinal pathology who underwent cataract surgery served as controls. Aqueous humor samples were collected just before intravitreal ranibizumab injection in 40 eyes with exudative AMD and before cataract surgery in 20 control eyes. Concentrations of 14 cytokines were determined by chemiluminescence-based ELISA: interleukin (IL)-1α, IL-2, IL-4, IL-6, IL-8, IL-10, IL-12, IL-13, IL-15, IL-17, vascular endothelial growth factor (VEGF), monocyte chemoattractant protein 1, interferon-γ-inducible protein (IP)-10 and C-reactive protein (CRP). RESULTS: After adjusting for gender, age and axial length, concentrations of CRP and IP-10 were significantly higher in eyes with neovascular AMD or PCV compared with control eyes (p < 0.05), and IP-10 levels were strongly associated with lesion size (p = 0.002). None of the 14 cytokines, including VEGF, were significantly different between eyes with neovascular AMD and those with PCV. CONCLUSION: Aqueous humor concentrations of CRP and IP-10 were elevated in eyes with PCV or neovascular AMD. IP-10 could be associated with the pathogenesis of neovascular AMD and PCV.

Temporal changes in retinal thickness after removal of the epiretinal membrane.

PURPOSE: We aimed to study the temporal aspects of the postoperative reduction of retinal thickness in eyes with epiretinal membrane after vitrectomy with peeling of the epiretinal membrane and internal limiting membrane. METHODS: In a retrospective study performed as a non-comparative, interventional case series, 16 eyes from 15 patients with idiopathic epiretinal membrane who underwent vitrectomy and removal of the epiretinal membrane were followed up using optical coherence tomography measurements. Retinal thickness in the macular area was assessed by the foveal thickness and macular volume in a circle 6 mm in diameter. RESULTS: Scattergrams of the foveal thickness and macular volume were best fitted with exponential curves. The average time constants of the exponential curve for foveal thickness and macular volume changes were 31 days (range 4-109 days) and 36 days (range 5-100 days), respectively. The average expected final values for foveal thickness and macular volume were 334 microm (range 206-408 microm) and 7.53 mm(3) (range 6.57-8.66 mm(3)), respectively, which were significantly greater than those in normal controls (p < 0.0001, t-test). CONCLUSIONS: Retinal thickness decreases rapidly immediately after surgical removal of the epiretinal membrane and the reduction rate gradually slows thereafter. Approximation of the exponential curve provides an estimation of final retinal thickness after surgical removal of the epiretinal membrane; final thickness is expected to be greater than in normal eyes.

Additional intravitreal gas injection in the early postoperative period for an unclosed macular hole treated with internal limiting membrane peeling.

PURPOSE: To study the efficacy of additional intravitreal gas injection for unclosed macular holes within 2 weeks after surgery with internal limiting membrane peeling. METHODS: We reviewed the results for five consecutive eyes receiving additional intravitreal gas injection for unclosed macular holes within 2 weeks after initial macular hole surgery with internal limiting membrane peeling. The initial surgery consisted of standard pars plana vitrectomy with phacoemulsification and intraocular lens implantation, indocyanine green-assisted peeling of the retinal internal limiting membrane, and fluid-gas exchange with 20% sulfur hexafluoride. The patients were instructed to assume face down positioning for > or =7 days after surgery. If an unclosed macular hole was found after the residual gas volume decreased to <30% of the eyeball volume, fluid-gas exchange was performed using 15% octafluoropropane. RESULTS: All five eyes receiving additional intravitreal gas 7 to 14 days after vitrectomy had complete macular hole closure with macular flattening, as shown by optical coherence tomography 1 month after the additional gas injection. Visual acuity improved (range, 20/100 to 20/30). A minimum of 9 months of follow-up revealed no reopening or serious complications. CONCLUSION: Additional gas injection during the early postoperative period is recommended for eyes with unclosed macular holes that have undergone vitrectomy with internal limiting membrane peeling.

Spontaneous closure of stage 2 macular hole observed with optical coherence tomography.

PURPOSE: To report the clinical course and images of optical coherence tomography of an eye with a stage 2 macular hole which closed spontaneously. DESIGN: Observational case report. METHODS: Serial optical coherence tomographic images were obtained. RESULTS: A 67-year-old woman received a diagnosis of stage 2 idiopathic macular hole in her right eye. The diagnosis was made with a tomographic image of a full-thickness dehiscence of the neurosensory retina at the fovea. The posterior hyaloid membrane was adhering to the edge of the dehiscence. Four weeks later, the closure of the macular hole was ascertained with optical coherence tomography. The posterior hyaloid membrane was fully separated from the fovea. CONCLUSION: A stage 2 macular hole may close spontaneously with the separation of the hyaloid membrane.