[Two cases of Vogt-Koyanagi-Harada disease presenting shallow anterior chamber].

PURPOSE: We report two cases of Vogt-Koyanagi-Harada disease (VKH) in which shallow anterior chambers were improved after steroid pulse therapy. CASE: The patients were women aged 65 and 72. They had headaches, decreased visual acuity and shallow anterior chamber in both eyes. There was no inflammation in the anterior chamber. Ultrasound biomicroscopy (UBM) showed ciliary edema, ciliochoroidal detachment, and angle closure. One case showed high intraocular pressure (IOP), and a diagnosis of acute primary angle closure was made. Although cataract surgery was performed in the left eye, postoperative optical coherence tomography (OCT) revealed serous retinal detachment in both eyes. The shallow anterior chamber and UBM findings were improved and serous retinal detachment disappeared after steroid pulse therapy in both cases. CONCLUSION: VKH may cause shallow anterior chamber and angle closure. The inflammatory changes of VKH in the anterior segment, i. e. ciliary edema and ciliochoroidal detachment, may exacerbate the shallow anterior chambers and narrow angles and result in an acute increase in IOP in eyes with short axial length. VKH associated with shallow anterior chamber may be misdiagnosed as acute primary angle closure. For differential diagnosis, examinations of the ocular fundus including OCT are useful.

Short-term efficacy of intravitreal aflibercept for patients with treatment-naïve polypoidal choroidal vasculopathy.

PURPOSE: To evaluate the short-term efficacy of aflibercept monotherapy for patients with treatment-naïve polypoidal choroidal vasculopathy (PCV). DESIGN: Prospective, consecutive case series. METHODS: Thirty-three consecutive eyes of 33 symptomatic PCV patients (17 men, 16 women, mean age 75 ± 8.7 years), not treated previously, received an intravitreal injection of 2.0 mg of aflibercept monthly for 3 months. Changes in best-corrected visual acuity (BCVA), optical coherence tomography (OCT) findings, and indocyanine green angiography (ICGA) findings 3 months after initial injection were evaluated. RESULTS: Compared with baseline, mean BCVA at 3-month visit significantly improved (0.40 ± 0.34 vs 0.22 ± 0.20 log minimum angle of resolution [logMAR] unit, P < 12 0.001). Eight eyes (24 %) showed improvement in BCVA ≥ 0.3 logMAR unit, and no eyes (0 %) showed a decrease in BCVA of ≥ 0.3 logMAR unit. Mean foveal thickness improved significantly (348 ± 184 µm at baseline vs 194 ± 32 µm at 3-month visit, P < 15 0.001). At 3-month visit, 31 eyes (97 %) achieved dry macula evaluated on OCT. Polypoidal lesions disappeared completely on ICGA in 16 eyes (48 %), and the number and/or the size of polypoidal lesions decreased in nine eyes (27 %). The remaining eight eyes (24 %) had unchanged polypoidal lesions. A branching vascular network remained and was unchanged in diameter in all 27 eyes in which it was detected at baseline. CONCLUSION: Intravitreal aflibercept was well-tolerated in patients with treatment-naïve PCV over the short-term.

Unilateral choroidal excavation in the macula detected by spectral-domain optical coherence tomography.

PURPOSE: To report clinical findings of three patients with unilateral peculiar choroidal excavation in the macula detected by spectral-domain (SD) optical coherence tomography (OCT). METHODS: Three cases with unilateral choroidal excavation in the macula detected by SD OCT. Fluorescein angiography (FA), indocyanine green angiography (IA), ultrasonography, visual field tests and multifocal electroretinography (mfERG) were performed. RESULTS: Although all three patients complained of metamorphopsia, visual acuity and central visual field were normal in the affected eyes. SD OCT demonstrated choroidal excavation in the macula despite a normal foveal contour along the inner retinal surface. The excavation involved the outer retinal layers up to the external limiting membrane in cases 1 and 2, while only the retinal pigment epithelium was involved in case 3. The excavation corresponded to foveal pigment mottling in cases 1 and 2 and to a parafoveal yellowish fusiform lesion in case 3. The lesions appeared hypoautofluorescent and unremarkable in FA except for circumferential hyperfluorescence in case 3 and hypofluorescent in IA. B-scan ultrasonography was unremarkable. MfERG in cases 1 and 2 was normal. CONCLUSIONS: SD OCT demonstrated two types of choroidal excavation in the macula. More case accumulation and a longer follow-up will elucidate the pathogenesis and prognosis of the lesions.

Takayasu disease on the centenary of its discovery.

Takayasu disease was first reported in 1908 by Mikito Takayasu as "a case of peculiar changes in the central retinal vessels." Because in these patients the pulse of the radial artery is impalpable, investigations focusing on the ischemic symptoms of the upper body were conducted. In 1948, Shimizu and Sano named this pathological condition "pulseless disease." Since then, the lesions of Takayasu disease have been detected not only in the aortic arch and its main branches but also in various vessels, including the abdominal aorta and renal arteries. The ocular symptoms of Takayasu disease are considered to be due to ischemia in the retina and choroid. The typical wreath-like arteriovenous anastomosis around the disc reported by Takayasu is observed at a relatively late stage of the disease. The characteristic fundus findings of Takayasu disease include tortuosity and dilatation of the central retinal artery and vein, retinal arteriovenous anastomosis, prominent retinal vasculature, microaneurysms in the capillaries, occlusion of retinal arterioles, soft exudate, choked disc, and optic atrophy. Fluorescein angiography reveals retinal microaneurysms, sludging, slower blood flow, dilatation of retinal vessels, leakage of fluorescence dye due to increased vascular permeability, and arteriovenous anastomosis. Arteriovenous anastomosis initially appears in the periphery at the early stage, and in the arteriovenous crossing at the advanced stage. Systemic administration of corticosteroids is required to prevent vascular stenosis during the early stages of Takayasu disease. Reconstruction of the carotid artery may improve subjective symptoms and fundus findings.

Evaluation of visual acuity and color vision in normal human eyes with a sutureless temporary amniotic membrane patch.

PURPOSE: To evaluate how sutureless amniotic membrane patches may affect visual functions in normal human eyes. DESIGN: Prospective intervention study. METHODS: Ten sets of sutureless amniotic membrane patch manufactured as PROKERA were inserted in one eye of six normal patients. Four sets (one each) were inserted in four patients, while six sets (three each) were inserted in two patients. Uncorrected distant and near visual acuities, color vision, amniotic membrane thickness measured by pachymetry, and total symptom scores were compared before and after insertion. RESULTS: Within 30 minutes after insertion, mean distant visual acuities decreased from -0.22 +/- 0.06 to 0.92 +/- 0.45 logarithmic minimum angle of resolution (logMAR). Among 10 sets of PROKERA inserted, the largest optotype (1.0 logMAR) of the near vision chart could not be recognized in five, but color vision evaluated by Panel D-15 was still preserved in all. Total symptom scores increased to 47.8 +/- 9.1 points (maximum, 100 points). Among symptoms, total scores for foreign body sensation (17.8 +/- 3.6) and blurred vision (17.8 +/- 4.4) were high. Loss of distant visual acuity and increases of symptom scores were not correlated with amniotic membrane thickness, of which the mean was 67.6 +/- 25.2 mum. However, amniotic membrane that was less opaque tended to provide relatively good visual acuities. CONCLUSION: Because of the relative non-transparency of sutureless amniotic membrane patches in PROKERA, distant and near visual acuities decreased in normal human eyes. The foreign body sensation noted after insertion is primarily derived from the rigid supporting skirt.

Measurement of light transmission of human limbal epithelial cells cultured on human amniotic membranes.

PURPOSE: To measure the light transmission properties of human limbal epithelial cell sheets (LECSs) cultured on human amniotic membranes (AMs) and compare them with those of AMs with and without amniotic epithelium. METHODS: Total light transmission of 3 kinds of tissue (LECSs, intact AMs, denuded AMs) was measured in the 250- to 800-nm range by using a spectrophotometer. RESULTS: The percent transmission of each kind of tissue decreased gradually and continually throughout the spectrum as the wavelength shortened and dropped rapidly at 300 nm to less than 20% at 250 nm. All tissues transmitted more than 70% of light in the wavelength region greater than 400 nm and more than 90% in that greater than 600 nm. The percent transmission spectrum of all tissues showed identical curves in the visible light and UV-A regions. However, the percent transmission of LECSs was lower than that of either intact or denuded AMs in the UV-B and UV-C regions. CONCLUSIONS: In the visible and UV-A light region, the percent transmission profiles of amnion-related tissues (LECSs, intact AMs, denuded AMs) are not altered by the presence of either amniotic epithelium or multilayered limbal corneal epithelium. However, the presence of multilayered limbal corneal epithelium, but not amniotic epithelium, on amniotic stroma reduced UV-B and -C transmission significantly. Further study concerning light transmission and other physical properties of LECSs is necessary to fully understand the ocular physiology of eyes grafted with such newly developed bioengineered tissues.

Measurement of light transmittance of cryopreserved human amniotic membrane.

PURPOSE: To measure the light transmission of human amniotic membrane (AM) and compare it with that of therapeutic soft contact lens (TSCL). METHODS: Total light transmittance of each sample (4 AMs and 2 TSCLs) was measured in the 250- to 800-nm range by using a spectrophotometer. RESULTS: The percent light transmission of TSCL was nearly 100% at wavelengths greater than 450 nm, decreased gradually in the sub-450-nm range, and reached 78.4 +/- 3.7 at 250 nm. In contrast, the percent transmission of the 4 AMs decreased gradually and continually throughout the spectrum as wavelength shortened. The transmission of light through AM dropped to less than 20% at 250 nm but remained 90% or more at wavelengths more than 600 nm. CONCLUSION: Light transmittance properties of cryopreserved human AM and human cornea are relatively similar, but AM (and not cornea) allows transmission of 24.6% of UVC.

Disappearance of honeycomb opacity of Thiel-Behnke corneal dystrophy after Thygeson superficial punctate keratitis.

PURPOSE: To present an unusual case in which the honeycomb opacities of Thiel-Behnke corneal dystrophy disappeared during a course of chronic Thygeson superficial punctate keratitis. CASE: A 29-year-old woman with a 5-year history of decreased visual acuity in both eyes had bilateral honeycomb-shaped corneal opacities, located mainly in the superficial central cornea. She was diagnosed as having Thiel-Behnke corneal dystrophy, which we confirmed genetically. During follow-up, her left eye was affected by chronic Thygeson superficial punctate keratitis, and the honeycomb opacity in this eye was noted to have disappeared. CONCLUSIONS: We observed the dissolution of honeycomb-like corneal opacities in a patient with confirmed Thiel-Behnke corneal dystrophy after the patient subsequently contracted chronic Thygeson superficial punctate keratitis. We surmise that epithelial inflammation associated with Thygeson epithelial keratitis may play a role in dissolving the honeycomb opacities.

Detection of corneal epithelial defect through amniotic membrane patch by fluorescein.

PURPOSE: To demonstrate the usefulness of fluorescein dye to detect a corneal epithelial defect through an amniotic membrane patch in 4 cases. PATIENTS AND METHOD: Two patients with painful bullous keratopathy, 1 patient with total limbal deficiency, and 1 patient with acute chemical burn underwent surgeries in conjunction with amniotic membrane as patch. Postoperatively, slit-lamp biomicroscopic examination with and without fluorescein staining was performed. RESULTS: The status of epithelialization, ie, corneal epithelial defect on either denuded corneal stroma or amniotic membrane graft, was indiscernible by slit-lamp biomicroscopy through the amniotic membrane patch. Nevertheless, it could be detected by fluorescein staining, especially after saline rinse, in all 4 cases. CONCLUSIONS: Fluorescein staining permits clinicians to avoid prematurely removing the amniotic membrane patch during the treatment of a persistent corneal epithelial defect.