Foveal translocation with scleral imbrication in patients with myopic neovascular maculopathy.

PURPOSE: To report our surgical results of foveal translocation with scleral imbrication in patients with myopic neovascular maculopathy. DESIGN: Noncomparative, interventional, consecutive case series. METHODS: Ten eyes of 10 myopic patients with subfoveal neovascular membranes that had undergone foveal translocation with scleral imbrication were recruited for this retrospective study. Inclusion criteria were myopia 6.0 diopters or greater in refractive error (or axial length 26.5 mm or longer), subfoveal choroidal neovascularization, and preoperative best-corrected visual acuity of 20/100 or worse. None of these eyes had undergone prior laser photocoagulation or submacular surgery. The main outcome measures were surgical complications and postoperative visual function. RESULTS: Postoperatively, visual acuity had improved more than 3 lines in the logarithm of minimum angle of resolution (logMAR) measurement in all eyes. The mean preoperative, postoperative best, and final visual acuity were 0.12, 0.59, and 0.51, respectively. Of the 10 eyes, six achieved a postoperative final visual acuity of 20/40 or better. The mean postoperative foveal displacement was 0.78 disk diameter (range, 0.3--1.3 disk diameter). Two patients underwent a reoperation because of insufficient foveal displacement. Furthermore, one of these two patients required a third operation to reduce an excessive retinal fold involving the fovea induced by the second surgery. Of the 10 patients, two noted transient diplopia. This complaint, however, resolved over time as suppression developed. Although unintentional iatrogenic retinal tears formed intraoperatively in two eyes, these were successfully treated without serious complications. Postoperatively, mild retinal pigment epithelial changes were observed in all cases, but none led to significant deterioration of visual acuity during the follow-up period. All patients but one were followed for a minimum of 6 months. CONCLUSIONS: In eyes with myopic neovascular maculopathy, foveal translocation with scleral imbrication may be useful in improving visual acuity. Further refinements in surgical technique and assessment of the long-term complications will be needed to make this procedure safer and more useful.

Mizuo phenomenon observed by scanning laser ophthalmoscopy in a patient with Oguchi disease.

PURPOSE: To elucidate the origin of the abnormal fundus reflex in Oguchi disease. METHODS: The ocular fundus of a 63-year-old woman who showed a homozygous arrestin 1147delA mutation was observed by scanning laser ophthalmoscopy with the use of an argon blue laser (wavelength, 488 nm), a helium-neon laser (633 nm), and an infrared laser (780 nm). RESULTS: Diffuse, fine, white particles, which do not exist in normal subjects, were clearly demonstrated only with the helium-neon laser. After 4-hour dark adaptation, the abnormal particles disappeared, but then they reappeared gradually during 30 minutes of light adaptation, in accordance with the golden metallic reflex. CONCLUSION: The white particles found by helium-neon laser could be the origin of the abnormal fundus reflex in Oguchi disease.

Multifocal Electroretinogram in Central Serous Chorioretinopathy.

Purpose: An assessment of retinal function topographically in the affected eyes with central serous chorioretinopathy (CSC).Participants and Method: We recorded multifocal electroretimogram (mERG) in 5 patients with unilateral CSC, and analyzed the topographical properties in the central visual field (rings #1 + 2).Results: mERG amplitudes in the CSC eyes were significantly reduced compared with the fellow eyes, for P 1-N 1 (58.5 +/- 23.5%, p < 0.05) and for P 1-N 2 (47.5 +/- 15.0%, p < 0.05). mERG latencies in the CSC eyes were significantly increased compared with those in the fellow eyes, for N 1 (by 9.0 +/- 8.1%, p < 0.05) and for P 1 (by 8.4 +/- 7.0%, p < 0.05). mERG in the CSC eyes gradually recovered in the follow-up period. However, the responses did not recover to normal value during follow-up, even when the subretinal fluid disappeared ophthalmoscopically.Conclusions: These results show that a topographical analysis of the mERG is useful for clinical observation of CSC.

[Multifocal electroretinogram in central serous chorioretinopathy].

PURPOSE: To assess retinal function topographically in the affected eyes with central serous chorioretinopathy (CSC). PARTICIPANTS AND METHOD: We recorded multifocal electroretimogram (mERG) in 5 patients with unilateral CSC, and analyzed the topographical properties in the central visual field (rings #1 + 2). RESULTS: mERG amplitudes in the CSC eyes were significantly reduced compared with the fellow eyes, for P 1-N 1 (58.5 +/- 23.5%, p < 0.05) and for P 1-N 2 (47.5 +/- 15.0%, p < 0.05). mERG latencies in the CSC eyes were significantly increased compared with those in the fellow eyes, for N 1 (by 9.0 +/- 8.1%, p < 0.05) and for P 1 (by 8.4 +/- 7.0%, p < 0.05). mERGs in the CSC eyes gradually recovered in the follow-up period. However, the responses did not recover to normal value during follow-up, even when the subretinal fluid disappeared ophthalmoscopically. CONCLUSIONS: These results show that a topographical analysis of the mERG is useful for clinical observation of CSC.

[Proteoglycan molecules in scleral tissue of enlarged eyeball].

We studied scleral specimens from experimentally induced enlarged eyeball with axial elongation by the transmission electron microscopy following cationic dye (cuplonic blue) staining. The animal model was prepared by the injection of alpha-chymotrypsin into the posterior chamber of young albino rabbits. Cuprolinic blue staining was applied to scleral specimens obtained from equatorial lesion and portions of the scleral tissues were subjected to enzyme digestion by chondroitinase ABC, AC and B before cuprolinic blue staining. In control eyes, dermatan and chondroitin type sulfated proteoglycan filaments were identified. Large, electron dense, and abnormal by shaped proteoglycan filaments were seen in the transmission electron microscopy. Such abnormal proteoglycan filaments were susceptible to enzyme chondroitinase ABC and AC digestion but resistant to chondroitinase B, suggesting that they are chondroitin sulfate dominant proteoglycans. Our morphological data corroborated a previous biochemical report of abnormally induced proteoglycan molecules in sclera with enlarged, axially elongated eyes.

[Changes of expression in matrix metalloproteinase and its inhibitor level in the sclera from axially elongated eyes].

We studied the gelatinolytic activity, caseinolytic activity and the level of tissue inhibitor of metalloproteinase-1 (TIMP-1) in the sclera from experimentally induced axially elongated eyes. The animal models were made by the injection of 250U alpha-chymotrypsin into the posterior chamber of young albino rabbits. Animals were killed with overdoses of intravenous pentobarbital and eyes were enucleated gently. Sclera from the equatorial area was then subjected to organ culture. The enzyme activity in the media was investigated by zymography using gelatin- or casein-containing gels together with an image analyzer system. TIMP-1 levels in each medium were measured by enzyme immunoassay (EIA). All samples showed three major bands of gelatinolytic activity at molecular weights of 87, 61, and 57 kDa. Gelatinolytic activity of 87 kDa increased 1.1 to 2.9 times compared with control sclera. All of the caseinolytic activity (87, 82, 52, and 50 kDa) was also elevated 1.8 to 6.6 times in samples from experimental eyes. TIMP-1 levels were mildly increased (up to 1.41 times) in the experimental eyes. These data suggest that degradation processes might be accelerated in the sclera from experimentally induced elongated eyes.

[Intraoperative fluorescein angiography with an ultrasensitive imaging tube].

Fluorescein angiographic examination may be prevented by vitreous hemorrhage or opacities in vitreoretinal diseases before vitrectomy. We performed intraoperative fluorescein angiography for such cases, using a conventional light source and an ultrasensitive video camera equipped with a silicone intensifier target tube to avoid retinal phototoxicity. Intraoperative fluorescein angiograms allowed evaluation of neovascular vessels, proliferative tissues, and avascular areas associated with diabetic retinopathy. Indentation of the pars plicata enabled us to also record fluorescein images of the area. This device may aid intraoperative assessment of vitreoretinal diseases including diabetic retinopathy.