Clinical features of polypoidal choroidal vasculopathy and visual outcomes in the absence of classic choroidal neovascularization.

BACKGROUND/AIMS: To report on the clinical features of polypoidal choroidal vasculopathy (PCV) and to delineate visual outcomes in the absence of classic choroidal neovascularization (CNV). METHODS: Records were retrospectively reviewed of 233 eyes of 215 patients diagnosed with 'definite' PCV using Japanese criteria. RESULTS: Of patients with definite PCV, 72.1% were men and 91.6% had unilateral disease. A history of systemic hypertension was elicited in 18.1% of patients, and blood pressure measurement revealed possible hypertension in 27.4% of patients. At the initial evaluation, 28.3% of eyes had classic CNV as assessed by fluorescein angiography and were treated by photodynamic therapy or other means. Of 112 eyes with active exudation but no classic CNV and no recent decreased vision, best-corrected visual acuity (BCVA) at 3 months improved by > or = 0.2 logarithm of the minimum angle of resolution (logMAR) in 17%, was unchanged in 72% and worsened by > or = 0.2 logMAR in 11%. In 67 eyes of which 1-year data were available, BCVA improved in 19%, was unchanged in 64% and worsened in 16%. CONCLUSIONS: The majority of PCV patients were men, with a high rate of diagnosed or suspected hypertension. More than two thirds of eyes had no evidence of classic CNV, of which 89% had stable or improved vision at 3 months without specific treatment. Of eyes followed for 12 months, 83% had stable or improved vision.

[Survey of silicone oil for ocular diseases in Japan].

PURPOSE: To survey the use of silicone oil in clinical ophthalmology in Japan. SUBJECTS AND METHODS: Questionnaires were sent to 1,240 hospitals registered as being ophthalmology residency training institutions with the Japanese Ophthalmological Society as of September 2007. Responses were collected via the Internet and results totaled. The use of silicone oil at each institution for the 2006 one-year period was assessed, included queries regarding type of silicone oil, indication for use, results and complications. Hospitals were divided into non-specialty institutions, intermediate-specialty institutions and specialty institutions based on number of vitrectomy procedures performed in the one-year period, and trends were analyzed based on these divisions. RESULTS: Responses were received from 272 institutions (21.9% response rate). Of a total of 36,104 vitrectomy procedures, silicone oil was used in 2,170 cases (6.0%). The diagnosis was proliferative vitreoretinopathy in the majority of cases, followed by proliferative diabetic retinopathy and rhegmatogenous retinal detachment. The majority of institutions replied that the indication for use was complicated case. The type of silicone oil used was ophthalmic formulation in 120 institutions (54.1%) and industrial formulation in 73 institutions (32.9%). Specialty institutions had a higher rate of use of the industrial formulation. The average volume used at one time was 6.4 ml. The majority of institutions responded that silicone oil removal was performed at 3 months after the initial vitrectomy. Silicone oil was not removed in 530 cases in which continued tamponade was judged to be appropriate; this comprised 53.3% of cases at non-specialty institutions. The overall evaluation for silicone oil use was good; silicone oil was rated as being indispensable in 72 cases (31.2%) and effective in 130 cases (56.3%). Responses stating a high need for silicone oil were most frequent for proliferative vitreoretinopathy and proliferative diabetic retinopathy. Complications related to silicone oil use were glaucoma in 125 cases (5.6%), intraocular pressure elevation in 411 cases (18.4%), hypotony in 28 cases (1.3%), endophthalmitis in 5 cases (0.22%), retinal detachment in 13 cases (0.58%), corneal opacification in 105 cases (4.7%), inadvertant subretinal infusion in 31 cases (1.4%) and silicone oil emulsification in 82 cases (3.7%). It was the opinion of many institutions that, in cases where silicone oil could not be used, the number of necessary surgical procedures increased, with lower rates of cure and greater burden on the patient. CONCLUSIONS: Silicone oil was utilized in approximately 1 in every 17 vitrectomy procedures performed in 2006 by the Japanese institutions surveyed. Complications were observed, however overall the indications were appropriate and the use of silicone oil was judged to be necessary by nearly 90% of institutions surveyed.

[Clinical features of endophthalmitis after cataract surgery evaluated by the presence of background factors].

PURPOSE: The clinical features and visual prognosis after vitrectomy for endophthalmitis which had developed after cataract surgery were compared in two groups with or without background factors, including malignant tumor, diabetes, oral steroid administration, collagen disease, dacryocystitis, and lid closure disturbance. METHOD: Fifty-two patients (53 eyes) who underwent a vitrectomy for the treatment of endophthalmitis which had developed within 6 weeks after cataract surgery. They were divided into two groups according to the presence (21 eyes, group A) or absence (32 eyes, group B) of background factors, and were retrospectively compared based on their medical records. RESULTS: The culture-positive rate was 62% in group A and 69% in group B. The incidence of a final visual acuity of more than 20/20 was significantly lower in group A (14%) than in group B (47%, p < 0.05). Methicillin-resistant Staphylococcus aureus, alpha-hemolytic Streptococcus and Enterococcus were frequently identified in group A. Leakage from the cataract wound was found in about 80% of the patients with corneal incisions, and a wound that had not been covered by the conjunctiva was significantly more frequent as a factor in group A (group A, 13 eyes; group B, 10 eyes; p < 0.05). CONCLUSION: Postoperative endophthalmitis may have a less favorable visual prognosis in patients with background factors, so precise wound construction during cataract surgery is important in these patients.

[Survey of the use of long-lasting expanding gases in ophthalmology in Japan].

PURPOSE: To survey the use of long-lasting expanding gases in ophthalmology in Japan. SUBJECTS AND METHODS: A questionnaire was sent to 1,236 teaching hospitals approved by the Japanese Ophthalmological Society requesting information regarding indications, methods, efficacy and complications related to the use of long-lasting expanding gases administered from January through December 2005. RESULTS: Four-hundred and fifty-nine hospitals responded to the survey (response rate 37.1%). A total of 174,221 ophthalmic surgeries were performed during the survey period, with long-lasting expanding gases used in 19,816 of cases (11.4%). The surgical procedure was vitrectomy in 89.6% of cases in which gas was administered. The most frequent indication for gas use was rhegmatogenous retinal detachment, for which SF6 was the preferred gas. Industrial use gas was utilized in 76.1% of cases, while 22.4% of cases received medical use gas. Increase in intraocular pressure was the most common complication of intraocular gas tamponade (3121 cases, 15.7%), followed by cataract formation. Ninety-eight percent of ophthalmologists responding supported the use of long-lasting expanding gases with vitrectomy, 85% with scleral buckling procedures, and 84% with surgery to remove subretinal hemorrhage. The consensus was that substantial deterioration of surgical results would occur if long-lasting expanding gases could not be used. CONCLUSIONS: Long-lasting expanding gases are being widely administered in ophthalmology in Japan, and appear to have good efficacy for a variety of indications. Several complications related to the use of these gases were reported, however the rates of complications were low.

[Survey of triamcinolone acetonide for ocular diseases in Japan].

PURPOSE: To survey the use of triamcinolone acetonide (TA) for ocular disease in Japan. SUBJECTS AND METHODS: A questionnaire was sent to 1,236 teaching hospitals approved by the Japanese Ophthalmological Society requesting information regarding indications, methods, efficacy and complications of TA administered from January through December 2005. The survey specifically covered the use of TA in intravitreal injections, sub-Tenon's injections and intraoperatively during vitrectomy procedures. RESULTS: Four-hundred and fifty-nine hospitals responded to the survey (response rate 36.9%) involving TA use in 44,827 eyes. Intravitreal injections of TA were administered to 5,665 eyes in 159 hospitals. The average dose was 6.53 mg for a single injection and was reported to have highest efficacy in eyes with diabetic macular edema, followed by retinal vein occlusion. Complications included cataract formation in 116 eyes (2.04%), glaucoma requiring filtration surgery in 32 eyes (0.56%), endophthalmitis in 7 eyes (0.12%), and blepharoptosis in 8 eyes (0.14%). Sub-Tenon's injections of TA were administered to 12,343 eyes in 308 hospitals. The average dose was 19.87 mg for a single injection and had the highest efficacy in eyes with diabetic macular edema, followed by retinal vein occlusion. Sub-Tenon's administration of TA was also frequently used for uveitis. Complications reported were cataract formation in 191 eyes (1.55%), glaucoma requiring filtration surgery in 33 eyes (0.26%), endophthalmitis in 1 eye (0.008%), periocular infection in 5 eyes (0.04%) and blepharoptosis in 43 eyes (0.35%). TA was used as an adjunct to vitrectomy in 26,819 eyes in 270 hospitals and was judged to be most useful in the separation of posterior hyaloid from the retina. Complications included cataract formation in 49 eyes (0.18%), glaucoma requiring filtration surgery in 32 eyes (0.56%), and endophthalmitis in 7 eyes (0.026%). CONCLUSIONS: TA is being widely administered for ocular diseases in Japan, and appears to have good efficacy in a variety of indications. Several complications related to TA use were reported, however the rates of complications were low.

Phototoxic effects of commercial photographic flash lamp on rat eyes.

BACKGROUND: To determine whether exposure of the cornea and retina of rats to flashes from a commercial photographic flash lamp is phototoxic. METHODS: Sprague-Dawley rats were exposed to 10, 100, or 1,000 flashes of the OPTICAM 16M photographic flash lamp (Fujikoeki, Japan) placed 0.1, 1, or 3 m from the eyes. Corneal damage was assessed by a fluorescein staining score, and the retinal damage by eletroretinography (ERG) and histology before and 24 h after exposure. RESULTS: Exposure of the eyes to 1,000 flashes at 0.1 m increased the fluorescein staining score significantly (P = 0.009, the Mann-Whitney test). Scanning electron microscopy (SEM) of the cornea showed a detachment of the epithelial cells from the surface after this exposure. The amplitude of the a-wave was decreased significantly by 23.0% (P = 0.026) of the amplitude before the exposure, and the b-wave by 19.7% (P = 0.0478) following 1,000 flashes at 0.1 m but not by the other exposures. TUNEL-positive cells were present in the outer nuclear layer only after the extreme exposure, but no significant decrease in retinal thickness was seen under any condition. The fluorescein staining score and ERGs recovered to control levels within 1 week. CONCLUSIONS: Light exposure to a photographic flash lamp does not induce damage to the cornea and retina except when they are exposed to 1,000 flashes at 0.1 m.

Localization and ontogeny of aquaporin-1 and -4 expression in iris and ciliary epithelial cells in rats.

The precise localization of aquaporin (AQP)1 and AQP4 was studied in iris and ciliary epithelial cells, in both mature and developing rats, to elucidate the molecular mechanisms underlying aqueous humor balance. Anterior segments of eyes dissected from embryonic day (E)13, E15, E18, and E20, postnatal day (P)0, P7, and P14, and postnatal week 8 rats were subjected to immunofluorescence analysis with AQP isoform-specific antibodies. In adult rat eye, AQP1 was localized to the apical and basolateral plasma membranes of iris epithelial cell layers and of anterior ciliary non-pigmented epithelial (NPE) cells. Conversely, AQP4 was localized to the basolateral plasma membrane of NPE cells in ciliary epithelium and the posterior iris. Developmentally, AQP1 was detected as early as E15 in immature iris and ciliary epithelial cells, and expression persisted throughout development up to adulthood. In contrast, AQP4 was first observed at P7 in the developing pars plicata, and the AQP4-positive area gradually spread to cover the entire pars plicata as development proceeded. These findings indicate that both AQP1 and AQP4 contribute to aqueous humor secretion in the rat eye, thereby maintaining proper intraocular pressure. Moreover, AQP appears to play a major role in aqueous humor secretion in early eye development. This study thus provides a basis for understanding the molecular mechanisms of aqueous humor secretion in pathological and physiological conditions.

Vitrectomy for myopic posterior retinoschisis or foveal detachment.

PURPOSE: To evaluate the efficacy of vitrectomy for posterior retinoschisis (RS) or foveal detachment (FD) associated with posterior staphyloma in myopic eyes. METHODS: We reviewed the records of 14 consecutive patients (53-77 years of age; 16 eyes) with progressive visual impairment as a result of myopic RS or FD. Optical coherence tomography demonstrated the presence of a variety of RS and FD characteristics. Five eyes had RS alone, and 11 eyes had RS and FD. Two eyes with RS and severe FD developed retinal detachment in conjunction with a tiny macular hole. Vitrectomy, including posterior vitreous separation in all eyes and internal limiting membrane (ILM) peeling in six eyes, had been performed. The patients were followed postoperatively for 6 to 66 months (mean, 24 months). The anatomical outcome and visual acuity were retrospectively analyzed in this study. RESULTS: Although the two eyes with RS and severe FD developed retinal detachment with a macular hole after an initial vitrectomy, final retinal reattachment was achieved in all 16 eyes. Visual acuity improved in nine eyes and remained unchanged in seven eyes. CONCLUSIONS: Vitrectomy with posterior vitreous separation is effective for reattaching the macula and preventing a deterioration of vision, although eyes with RS and severe FD may be at risk for the development of a macular hole after the initial vitrectomy.

Negative electroretinograms in pericentral pigmentary retinal degeneration.

The clinical presentation and electrophysiological findings are described of three consecutive cases with pericentral pigmentary retinal degeneration. The responses to bright flashes after dark adaptation showed negative waveform shape in all cases. Rod responses were strongly reduced compared with cone responses. Cone electroretinograms elicited by long-duration stimuli showed greater loss of the on-response than the off-response. The ratio of the on-response amplitude to off-response amplitude of these patients (0.52 +/- 0.12; mean +/- SD, n = 6) was significantly smaller than that of normal subject (0.83 +/- 0.21; mean +/- SD, n = 8) (Mann-Whitney U-test, P < 0.01). The electrophysiological findings of these cases suggest a greater defect of inner retinal function, especially in transmission between photoreceptors and depolarizing bipolar cells.

[A case report illustrating the effectiveness of reading performance assessments in the diagnosis and treatment of psychogenic visual disturbances].

PURPOSE: An optimal strategy for treating psychogenic visual disturbances in adults has not been established. We report a patient with psychogenic visual disturbances who recovered his visual acuity and showed an improvement in his reading performance after undergoing training based on a reading performance assessment. CASE: A 37-year-old man who had been diagnosed as having myopic macular degeneration was referred to our clinic. Three months after his initial diagnosis, no changes in his fundi were observed, but his visual acuity had significantly decreased and his peripheral field of vision had become severely restricted. In view of his tunnel vision, the discrepancy among the visual acuity results obtained by different test methods, the results of a reading assessment, objective eye examination data, and his behavioral patterns, we diagnosed a psychogenic visual disturbance in the patient and referred him to an ophthalmologist and a psychiatrist for follow-up care. In our low vision clinic, we assessed his visual function, including reading performance, and developed a training program including reading, writing, and computer skills. We also provided information to help the patient find a job. The training program included instructions on how to manipulate reading aids and how to select reading materials to maximize his vision; these instructions were effective. Nine months after his rapid decrease in visual acuity, the results of his visual function tests showed an improvement. The patient also became motivated to find a job. CONCLUSION: Reading assessments are a useful tool for diagnosing psychogenic visual disturbances in adults and for coping with functional vision impairment.

Multilayered retinoschisis associated with optic disc pit.

BACKGROUND: Recently, optical coherence tomography (OCT) analysis has contributed greatly to the detection of posterior retinoschisis associated with optic disc pits. We report an unusual case of optic disc pit maculopathy. CASE: A 37-year-old woman with a multilayered structure of posterior retinoschisis associated with a very small, shallow optic disc pit was treated. OBSERVATIONS: The patient came to our clinic after a few weeks of decreased vision in her right eye. Fundus examination showed a shallow macular detachment with a tiny, shallow pit at the temporal edge of the optic disc. OCT revealed an unusual multilayered structure of retinoschisis connected to the optic disc. We performed vitrectomy with induction of the posterior hyaloid separation and gas tamponade. After vitrectomy, OCT showed a marked fluid resolution in the retinoschisis, and the patient's vision improved rapidly. CONCLUSION: The multilayered separation of retinoschisis can be caused by traction of the optic disc with a tiny, shallow pit at the temporal edge of the disc.

Long-term results of vitrectomy without laser treatment for macular detachment associated with an optic disc pit.

PURPOSE: To evaluate the efficacy of vitrectomy and gas tamponade, without laser photocoagulation to the margin of the optic nerve, for the treatment of macular detachment associated with an optic disc pit. DESIGN: Noncomparative interventional case series. PARTICIPANTS: Eleven consecutive patients (8-47 years of age) who presented with unilateral macular detachment associated with an optic disc pit. INTERVENTION: Pars plana vitrectomy, induction of posterior vitreous detachment (PVD), and gas tamponade were performed, with postoperative facedown positioning for 1 week. The presence of a double-layer detachment consisting of an inner layer separation and an outer layer detachment was observed in 10 of 11 eyes either preoperatively or postoperatively. Patients were observed for 10 to 98 months (mean, 47) after surgery. MAIN OUTCOME MEASURES: Anatomic outcome and visual acuity were retrospectively analyzed for all eyes. Optical coherence tomography was used to observe anatomic changes in the macula in some eyes. RESULTS: Complete retinal reattachment was achieved in 10 of 11 eyes, although these eyes required nearly 1 year to reach this state. The one eye with persistent retinal detachment was observed to have a marked reduction of the detachment by 10 months postoperatively. No recurrences were observed. Visual acuity improvement was documented in 7 of 11 eyes. CONCLUSIONS: These results suggest that vitrectomy with induction of PVD and gas tamponade, without additional laser treatment, is successful in reattaching the macula and improving central vision in most patients with optic disc pit maculopathy.

Unusual posterior hyaloid strand in a young child with optic disc pit maculopathy: intraoperative and histopathological findings.

BACKGROUND: The mechanism responsible for optic disc pit maculopathy is unclear, but abnormal vitreous structures, including the anomalous Cloquet's canal at the optic disc pit, have been suggested as important factors. CASE: We report the intraoperative and ultrastructural findings of an unusual posterior vitreous strand in the eye of an 8-year-old girl with optic disc pit maculopathy. OBSERVATIONS: The patient presented with decreased vision in the left eye. Examination of the left eye revealed a best-corrected visual acuity (VA) of 0.08 and a macular detachment associated with an optic disc pit. Vitrectomy was performed with the adjunctive use of triamcinolone acetonide intraoperatively. The presence of an unusual posterior hyaloid strand tightly attached to the margin of the optic disc pit was noted. An unusual movement of this strand was observed during the surgery. The strand was excised, and fluid-gas exchange was performed using gas tamponade with 20% SF(6). After 12 months, a complete macular reattachment was obtained, with the VA improving to 1.2. Electron microscopic examination of the removed strand revealed abundant thick collagen fibrils with a frame of fine fibrils. CONCLUSION: The unusual posterior vitreous strand connected to the optic disc pit may have contributed to the pathogenesis of maculopathy in this young child.

Histological effect and protein expression in subthreshold transpupillary thermotherapy in rabbit eyes.

OBJECTIVE: To investigate the histological effect of subthreshold transpupillary thermotherapy (TTT) on the retina. METHODS: We performed TTT in normal pigmented rabbit eyes using an 810-nm diode laser with spot size of 1.2 mm, power of 50 mW, and varying durations of 15, 30, or 60 seconds. Four weeks later, fluorescein angiography was performed, and the enucleated eyes were examined by means of electron microscopy and immunohistochemical staining. RESULTS: Funduscopy immediately and at 4 weeks showed no discernable changes at TTT sites, and fluorescein angiography at 4 weeks showed no abnormalities. However, electron microscopy showed photoreceptor and retinal pigment epithelium cell disruption, changes more prominent with longer durations of treatment. Immunohistochemical staining was positive for heat shock protein 60, heat shock protein 70, tumor necrosis factor alpha, and vascular cell adhesion molecule 1 in the photoreceptors and retinal pigment epithelium at TTT sites. Untreated control eyes showed no staining. CONCLUSIONS: Despite the absence of changes evident by funduscopy and fluorescein angiography, TTT resulted in dose-dependent histological changes in photoreceptors and retinal pigment epithelium. The induction of heat shock proteins, cytokines, and cell adhesion molecules may play a role in the tissue response to subthreshold TTT. Clinical Relevance Unrecognized damage to the retina and retinal pigment epithelium may contribute to visual loss in eyes that undergo subthreshold TTT.

[Diagnostic value of interleukin-10 and interleukin-6 in the vitreous of intraocular malignant lymphoma patients].

OBJECTIVE: Recent data suggest that the concentration of interleukin-10 (IL-10) is higher than that of interleukin-6 (IL-6) in the vitreous of eyes of patients with non-Hodgkin's lymphoma. In this study, we evaluated the utility of measuring intravitreal IL-10 and IL-6 concentrations in the diagnosis of intraocular lymphoma. METHODS: Specimens of undiluted vitreous were collected at the time of pars plana vitrectomy and IL-10 and IL-6 concentrations were determined. Vitreous specimens were obtained from 5 patients with suspected intraocular lymphoma and 10 patients with uveitis presumed to be unrelated to a neoplasm. RESULTS: In all 5 patients eventually diagnosed with intraocular lymphoma, the vitreous IL-10 concentration ranged from 3,040 to 11,200 pg/ml, and was higher than the vitreous IL-6 concentration in all cases. In 9 of the 10 patients with uveitis, the vitreous IL-10 concentrations ranged from less than 2 to 97 pg/ml, with an IL-10/IL-6 ratio of less than 0.11. However, in the remaining case diagnosed as uveitis of unknown etiology, the vitreous IL-10/IL-6 ratio was greater than 1. CONCLUSION: Our data suggest that the measurement of vitreous IL-10 concentrations would aid in the diagnosis of intraocular lymphoma.