Birth Year-Dependent Increase in Axial Length of Japanese Adult.

PURPOSE: To determine whether the correlations between the axial length and the aging-dependent and birth year-dependent age are significant. DESIGN: Retrospective cross-sectional study. METHODS: This study included Japanese patients ≥50 years who had undergone cataract surgery at numerous clinics from 2002 to 2020. Only 1 eye/patient was analyzed. The axial length was measured with the IOL Master. The age-dependent changes were determined by the significance of the correlation between the axial length and age by the birth year. The birth year-dependent changes were determined by the significance of the correlation between the axial length and birth year in the different age groups. The age refers to the age at the time of the cataract surgery. Spearman correlations were calculated. The turning points were identified by the LOESS, NLIN, and HPMIXED procedures. RESULTS: A total of 62,362 eyes (35,508 women, 26,854 men) were studied. The mean age was 72.9 ± 8.4 (standard deviation) years (range, 50-101 years), and the mean axial length was 23.90 ± 1.66 mm (standard deviation) (range, 19.20-37.07 mm). The birth year ranged from 1908 to 1970. Analyses of the birth year-dependent changes showed significant positive correlations in 48 of 81 (59.3%) groups for women and men. The increase in the axial length was birth year-dependent, and the turning point was 1939.4 for women and 1936.7 for men. CONCLUSIONS: The negative and significant correlation between the axial length and age is due to birth year-dependent changes. A birth year-dependent increase in axial length might have continued for several decades from the birth year of the late 1930s.

Incidence of late-onset ocular hypertension following uncomplicated pars plana vitrectomy in pseudophakic eyes.

PURPOSE: To determine the incidence of late-onset ocular hypertension following uncomplicated vitrectomy in pseudophakic eyes with an open angle. DESIGN: A retrospective observational case series. METHODS: Seven hundred and sixty-seven eyes of 767 patients that underwent vitrectomy combined with cataract surgery in 1 eye were studied. There were 383 men and 384 women. The indications for vitrectomy were: 308 eyes with rhegmatogenous retinal detachment, 202 eyes with epiretinal membrane, 169 eyes with macular hole, 44 eyes with vitreous hemorrhage, 16 eyes with subretinal hemorrhage, 15 eyes with vitreomacular traction syndrome, 12 eyes with vitreous opacity, and 1 eye with retinoschisis. Of these, 176 eyes underwent vitrectomy alone because of previous cataract surgery. Late-onset ocular hypertension was defined as an intraocular pressure (IOP) >21 mm Hg that developed more than 2 months postoperatively in at least 2 postoperative visits. An increase in the IOP >4 mm Hg over the preoperative IOP was necessary. Eyes with ocular hypertension, glaucoma (suspect), or a possibility of IOP elevation were excluded. RESULTS: The mean age was 63 ± 11 years. The mean follow-up duration after vitrectomy was 47.8 ± 25.3 months. Thirty-two eyes (4.2%) developed late-onset ocular hypertension. The mean age was 60 ± 10 years. The mean interval between vitrectomy and development of ocular hypertension was 31.1 ± 26.0 months. There were no significant differences in the incidence of late-onset ocular hypertension and the vitreoretinal disease for vitrectomy, sex, or gauge of instruments for vitrectomy. CONCLUSION: Long-term IOP monitoring is necessary after vitrectomy.

Dampening of diurnal intraocular pressure fluctuation by combined trabeculotomy and sinusotomy in eyes with open-angle glaucoma.

PURPOSE: Large diurnal intraocular pressure (IOP) fluctuation ([INCREMENT]IOP) is believed to be one of the causes of progression in glaucomatous changes. Some fully medicated glaucoma patients whose IOPs are controlled during the regular office hours (10:00 to 16:00 h) still have progression in glaucomatous changes and IOP elevation during off-office hours. The purpose of this study was to determine whether [INCREMENT]IOP is dampened after combined trabeculotomy and sinusotomy (LOT+SIN) in glaucoma patients with low IOPs during the regular office hours. PATIENTS AND METHODS: Fourteen eyes of 8 open-angle glaucoma patients who had large [INCREMENT]IOP despite low IOPs during the office hours were studied. The IOP was measured every 3 hours for 24 hours before and >3 months after the operation. The IOPs were measured in the sitting position with a Goldmann applanation tonometer. All patients underwent LOT+SIN. RESULTS: All patients had IOP elevations >20 mm Hg between 0:00 and 3:00 hours before the operation, and none had an IOP peak after the operation. The postoperative mean IOP (16.5±1.7 to 13.9±2.0 mm Hg, P=0.00064), the maximum IOP (21.9±2.4 to 16.1±2.5 mm Hg, P=0.0020), and [INCREMENT]IOP (8.9±2.7 to 4.3±1.2 mm Hg, P=0.0032) were significantly lower than the preoperative values. However, the minimum IOP was not reduced significantly (13.0±1.9 to 11.7±1.7 mm Hg). CONCLUSIONS: The diurnal [INCREMENT]IOPs are dampened by LOT+SIN in glaucoma patients with controlled IOPs during regular office hours. These results indicate that these surgical procedures can be used for the treatment of open-angle glaucoma patients.

[Long-term surgical results of initial trabeculotomy combined with sinusotomy performed inferiorly].

PURPOSE: To evaluate retrospectively the long-term effects of initial trabeculotomy combined with sinusotomy performed inferiorly. PATIENTS AND METHOD: Enrolled were 128 eyes of 100 patients who received initial glaucoma surgery. In 36 eyes, the removal of Schlemm's canal endothelium was also performed (removed group). The results were compared with the intact group RESULTS: In the primary open angle glaucoma (POAG), mean intraocular pressure (IOP) at 3 years after surgery was 14.6 (intact) and 15.4 mmHg (removed). Kaplan-Meier life-table analysis showed that qualified success rates for the intact group at 8 years were 62.2% and for the removed group at 5 years 45.2% defined by 20 mmHg or lower. The results in developmental glaucoma (DG) were similar to those in POAG. No statistical differences in postoperative IOP between the intact and removed groups were seen in either POAG or DG. In exfoliation glaucoma (XFG), mean IOPs for the intact group at 3 years were 17.3 mmHg and for the removed group at 2 years 15.4 mmHg. The success rates for the intact group at 3.5 years were 25.2% and for the removed group at 4.5 years 64.3%. The results in the intact group were worse than in the POAG patients. Although visual disturbance was seen in 13% of the patients, the major cause was the progression of the cataracts. CONCLUSIONS: The long-term results were the same as those of previous reports on surgery performed superiorly, including the frequency of visual disturbance. However the removal of Schlemm's canal endothelium is necessary in XFG for better IOP control.

The 2009 prospective multi-center epidemiologic survey of uveitis in Japan.

PURPOSE: To investigate etiologic data on intraocular inflammation in Japan collected in the 2009 epidemiologic survey of uveitis in Japan and assess the current state of etiology compared with that reported in a previous survey. METHODS: Thirty-six university hospitals participated in this prospective etiologic study. Patients who visited the outpatient uveitis clinic of each hospital for the first time between 1 June 2009 and 31 May 2010 were enrolled in the study. Uveitic diseases were diagnosed according to the guidelines when available or following commonly accepted diagnostic criteria. RESULTS: A total of 3,830 patients were enrolled in the survey and 2,556 cases of uveitis were identified, of which 1,274 cases were described as unclassified intraocular inflammation. In the identified cases, the most frequent intraocular inflammatory disease was sarcoidosis (10.6 %), followed by Vogt-Koyanagi-Harada disease (7.0 %), acute anterior uveitis (6.5 %), scleritis (6.1 %), herpetic iridocyclitis (4.2 %), Behçet's disease (3.9 %), bacterial endophthalmitis (2.5 %), masquerade syndrome (2.5 %), Posner-Schlossman syndrome (1.8 %), and retinal vasculitis (1.6 %). CONCLUSIONS: The current etiology of uveitis in Japan was elucidated by means of a multi-center prospective survey. Conducting such surveys on a periodic basis may help clinicians in their management of uveitis.

Improvement of the topographic parameters of the optic discs after trabeculotomy in two patients with developmental glaucoma.

Changes in the optic discs before and after trabeculotomy were evaluated with the Heidelberg retina tomograph (Heidelberg Engineering GmbH, Heidelberg, Germany) in two patients with developmental glaucoma. The topographic parameters of each optic disc improved considerably compared with adult patients in previous reports. This improvement may have been the result of the elasticity of the histologic structure of the optic disc in younger patients.

Intraocular pressure (IOP) reduction by latanoprost in Japanese normal tension glaucoma patients over a five-year period stratified by presenting IOP.

PURPOSE: We examined the effectiveness of latanoprost for reducing intraocular pressure (IOP) in Japanese patients with normal tension glaucoma (NTG) over a 5-year period. DESIGN: Prospective interventional case series. The patients were classified into 2 groups based on mean IOP. METHODS: A total of 38 patients with NTG were studied after being classified into the high-tension (mean IOP 16 mmHg or greater, n = 27) and low-tension (mean IOP lower than 15 mmHg, n = 11) groups. IOP was measured and Humphrey Field Analyzer (HFA) examinations were conducted at 6, 12, 24, 36, 48, and 60 months after beginning a daily administration of latanoprost. RESULTS: Mean IOP before administration was 17.6 mmHg in the high-tension group, which was reduced to 13.9, 14.6, 14.4, 14.1, 13.6, and 14.6 mmHg at 6, 12, 24, 36, 48, and 60 months, respectively, after beginning administration. That in the low-tension group was 13.6 mmHg before administration, and then was reduced to 12.2, 11.4, 11.5, 12.5, 10.5, and 11.5 mmHg, respectively, after beginning administration was noted. Mean deviation (MD) values in the HFA examinations were reduced by -4.27 and -1.49 dB after 5 years in the high- and low-tension groups, respectively. CONCLUSIONS: Latanoprost administration was effective in reducing IOP over a 5-year period in a range of 3.1-4.1 and 1.3-3.6 mmHg in NTG patients with high- and low-tension levels, respectively. In addition, our results indicate that latanoprost helped to prevent a decrease in MD values in both groups, as shown by the results of HFA examinations.

Ocular toxicity caused by Paclitaxel in neonatal sprague-dawley rats.

BACKGROUND: The toxic effects of paclitaxel (PTX) on neonatal eyes have not been evaluated. MATERIALS AND METHODS: PTX was dissolved in solvent containing polyethoxylated castor oil and intraperitoneally administered to male and female Sprague-Dawley rats at a dose of 0, 2, 4 and 8 mg/kg at 0 day of age, 4 mg/kg at 14 days of age, or 8 mg/kg at 12-18 weeks of age. Eyes were histologically examined 1 and/or 7 days after PTX. RESULTS: Male and female rats that received 4 mg/kg or more of PTX at 0 days of age developed cataracts and retinal dysplasias, while the rats that received other dosing regimens did not develop ocular lesions. Epithelial cells in the lens were apoptotic on day 1, and lens fibers were degenerative at day 7, indicating the development of cataracts. Scattered foci of apoptosis in the neuroblastic layer of the retina on day 1, and rosettes were seen on day 7, suggestive of retinal dysplasia. CONCLUSION: Neonatal rats that received a threshold dose of PTX (4 mg/kg) at a critical period (0 days of age) developed cataracts and retinal dysplasia; however, the 2 mg/kg dose at 0 days of age and the 4 or 8 mg/kg dose at 14 days of age or older caused no ocular damage. Thus, the determination of the dose and timing of PTX treatment administered during the early developmental stage requires great care to avoid ocular toxicity.

Levels of vascular endothelial growth factor and pigment epithelium-derived factor in eyes before and after intravitreal injection of bevacizumab.

PURPOSE: Bevacizumab is a human monoclonal IgG1 antibody that blocks the action of vascular endothelial growth factor (VEGF). The purpose of this study was to determine the level of VEGF and pigment epithelium-derived factor (PEDF) in eyes with proliferative diabetic retinopathy (PDR) before and after an intravitreal injection of bevacizumab. METHODS: Eleven eyes of ten patients were studied. Patients were included if they had neovascular glaucoma, rubeosis of the iris with PDR, or aggressive PDR. Samples of aqueous humor were collected just before the injection of bevacizumab and the vitrectomy. The concentrations of VEGF and PEDF in the aqueous humor were measured by enzyme-linked immunosorbent assay, and the effects of bevacizumab on PDR were evaluated. RESULTS: The free VEGF concentration before the injection was 676.5 +/- 186.7 pg/ml (mean +/- SEM, n = 11). Seven days later, it was significantly reduced to 7.1 +/- 7.1 pg/ml (P < 0.005, n = 9). The PEDF concentration before the injection was 2.32 +/- 0.49 microg/ml (n = 11), and 7 days later, it was 3.23 +/- 0.76 microg/ml (P = 0.33). During the vitrectomy, patients had less intraoperative bleeding when the neovascular tissues were cut. CONCLUSIONS: An intravitreal injection of bevacizumab significantly decreased the free VEGF in the aqueous humor by 7 days, indicating that the clinical effects of bevacizumab appear rapidly. However, intravitreal bevacizumab did not affect the level of intraocular PEDF.

[A rapidly progressed metastatic choroidal tumor from a hepatocellular carcinoma].

BACKGROUND: Metastatic choroidal tumor stemming from a hepatocellular carcinoma (HCC) is very rare. We report a case of a metastatic choroidal tumor stemming from a hepatocellular carcinoma. CASE: A 50-year-old man became aware of a visual field defect in his left eye starting 1 month previously. He had undergone surgery for HCC nine years before, and had received radiation therapy for lung and brain metastasis of HCC. Funduscopic examination revealed a red choroidal mass with subretinal bleeding. One month later, light perception of the left eye disappeared with rapid growth of the tumor and high intraocular pressure. Because the ocular pain was uncontrollable, enucleation of the left eyeball was performed. In histopathological examination, the choroidal tumor consisted of tumor cells showing characteristics of HCC such as intracytoplasmic glycogen granules, fatty degeneration, and necrosis of the tumor cells. CONCLUSION: The clinical characteristics of metastatic choroidal tumors from an HCC are a red appearance and rapid growth with retinal detachment and subretinal hemorrhage.

Severe optic neuropathy caused by dichloromethane inhalation.

PURPOSE: In this paper, we report a case of severe optic neuropathy caused by dichloromethane inhalation. CASE: A 65-year-old man fell unconsciousness while cleaning a dichloromethane tank containing a small amount of dichloromethane (purity greater than 99%) and was transported to the emergency department of our hospital, after which he was treated with hyperbaric oxygen therapy. After 1 month, narrowing of the visual field in both eyes was noted and the patient was referred to our department for additional examinations. Visual acuity was 0.3 in both eyes, which demonstrated normal reactions to light, while the critical flicker frequency (CFF) values were 30 and 25 Hz in the right and left eye, respectively. There were no abnormal findings shown in slit-lamp and fundus examinations, except for a mild cataract. Concentric contractions of the visual field by 10 degrees in both eyes were shown by a Goldmann perimetry examination, while an electroretinogram (ERG) and visual evoked cortical potential (VECP) examination exhibited nearly normal results. We diagnosed the condition as optic neuropathy caused by organic solvent poisoning, based on the decreased visual acuity, decreased CFF values, and visual-field narrowing. Although the patient was treated with vitamin B(12), visual disturbance, optic nerve atrophy, and results of VECP examinations worsened in both eyes, whereas ERG examination results were normal. CONCLUSIONS: Based on our findings, we considered that the central nervous system, including the optic nerve, was more severely damaged than the retina due to the normal findings in the ocular fundus and ERG examinations. Since dichloromethane produces carbon monoxide when catabolized in the liver, carbon monoxide toxicity together with the direct toxic effect of dichloromethane were considered to contribute to optic neuropathy in this case. The outcome for the present patient was poor.

Posterior sub-Tenon injection of triamcinolone acetonide as pretreatment for focal laser photocoagulation in diabetic macular edema patients.

PURPOSE: To determine whether a posterior sub-Tenon injection of triamcinolone acetonide (TA) before focal photocoagulation is safe and effective in patients with diabetic macular edema. METHODS: Sixteen eyes of 11 diabetic patients with unresolved diffuse macular edema were treated with a 20-mg sub-Tenon injection of TA 1 to 2 months before focal photocoagulation. Focal photocoagulation was applied only to microaneurysms, and grid laser photocoagulation was not performed. The main outcome measures used were visual acuity (VA), central macular thickness (CMT) determined by optical coherence tomography (OCT), and the fluorescein angiographic appearance of the retina. Patients were followed for at least 6 months. RESULTS: One month after the sub-Tenon injection of TA, the macular edema was resolved with a significant reduction of the CMT on OCT. VA improved slightly. Subsequent focal photocoagulation of the microaneurysms maintained the significant reduction of CMT for up to 6 months. A significant improvement of VA was observed in 37.5% patients at 6 months, and there was no decrease in VA in any of the patients. CONCLUSIONS: A 20-mg sub-Tenon TA injection prior to focal laser photocoagulation is a safe and beneficial treatment in patients with diabetic macular edema.

Role of soluble vascular endothelial growth factor receptor-1 in the vitreous in proliferative diabetic retinopathy.

PURPOSE: To determine the vitreous level of soluble vascular endothelial growth factor receptor-1 (sVEGFR-1) in patients with proliferative diabetic retinopathy (PDR) or idiopathic macular hole (MH). Furthermore, to investigate the relationships among sVEGFR-1, vascular endothelial growth factor (VEGF), and pigment epithelium-derived factor (PEDF). DESIGN: Retrospective case-control study. PARTICIPANTS: Thirty-eight patients who underwent vitrectomy (PDR [27 eyes in 26 patients] or MH [12 eyes in 12 patients]). METHODS: In vitreous fluid samples obtained during vitreoretinal surgery, sVEGFR-1, VEGF, and PEDF levels were measured by enzyme-linked immunosorbent assay. Effects of sVEGFR-1 on VEGF-A-induced tube formation were investigated using human umbilical vein endothelial cells co-cultured with fibroblasts. MAIN OUTCOME MEASURES: Levels of sVEGFR-1 and the relationships among sVEGFR-1, VEGF, and PEDF in vitreous fluids from patients with PDR or MH. RESULTS: In PDR (vs MH), there were significantly higher vitreous concentrations of both sVEGFR-1 (3949.4+/-608.9 pg/mL [mean +/- standard error, n = 27] vs 1568.8+/-595.0 pg/mL [n = 12, P = 0.009]) and VEGF (1316.2+/-404.6 pg/mL [n = 27] vs 11.7+/-8.1 pg/mL [n = 12, P = 0.003]), whereas the vitreous concentration of PEDF was significantly lower (2.1+/-1.1 ng/mL [n = 27] vs 41.6+/-17.0 ng/mL [n = 12, P = 0.041]). In PDR, there was a significant positive correlation between the sVEGFR-1 and VEGF vitreous concentrations (r = 0.414, P = 0.032), but not between PEDF and VEGF (r = 0.196, P = 0.328) or between sVEGFR-1 and PEDF (r = 0.167, P = 0.406). In vitro, sVEGFR-1 (0.1-1000 ng/mL) concentration-dependently inhibited VEGF-A-induced tube formation, its effect being significant at 100 to 1000 ng/mL on the tube area, length, and path. CONCLUSIONS: In the vitreous fluids of patients with PDR, the sVEGFR-1 level was increased (vs that in patients with MH), and sVEGFR-1 correlated significantly with VEGF. In vitro, sVEGFR-1 reduced VEGF-induced angiogenesis. Thus, sVEGFR-1 may play a pivotal antiangiogenic role in PDR.

Relationship between pigment epithelium-derived factor (PEDF) and renal function in patients with diabetic retinopathy.

PURPOSE: Diabetic retinopathy and nephropathy are microvascular complications in patients with diabetes that are considered to be related. Pigment epithelium-derived factor (PEDF), a strong inhibitor of angiogenesis, is significantly elevated in the blood of diabetic patients, especially those with proliferative diabetic retinopathy (PDR). The level of PEDF in the blood, on the other hand, is reported to be low in a diabetic nephropathy. The aim of this study was to determine the relationship between PEDF and renal function in patients with diabetic retinopathy. METHODS: A total of 243 type 2 diabetic patients were studied. The relationship between the diabetic retinopathy and levels of PEDF, HbA1c, blood urea nitrogen (BUN), and creatinine were evaluated. RESULTS: The mean plasma PEDF level in patients with PDR (7.69+/-6.14 microg/ml; mean+/-standard error) was significantly higher than that of mild-to-moderate nonproliferative diabetic retinopathy (5.07+/-4.37 microg/ml, p=0.02). The level of BUN and creatinine increased significantly as the stage of diabetic retinopathy advanced. The plasma PEDF levels were significantly correlated with the levels of BUN and creatinine (r=0.54, p<0.0001; r=0.57, p<0.0001, respectively). CONCLUSIONS: The levels of plasma PEDF increases with advances in both diabetic retinopathy and nephropathy. Thus, increased levels of PEDF in the blood may indicate microvascular damages in diabetic patients and may be predictor of the progression of retinopathy and nephropathy.

Case of retinochoroiditis associated with porcine ascarids diagnosed by antibodies in subretinal fluid.

PURPOSE: To determine the cause of retinochorioditis in a patient with a granulomatous retinal exudate and an exudative retinal detachment. CASE: A 45-year-old man presented at another hospital with increased visual disturbances of the left eye. He was diagnosed with uveitis, and treated with topical steroids for 1 month. However, the uveitis worsened, and he was referred to our hospital. Ophthalmoscopy showed a yellowish-white granulomatous exudate, and an exudative retinal detachment in the lower peripheral retina. The retinal detachment worsened and affected the macula. Pars plana vitrectomy was performed, and the retina was reattached. During the surgery, ocular samples were collected for further examinations. The titers of antibodies against 12 kinds of ascaridis were examined, and elevated titers of specific antibodies against porcine ascarids were detected in the subretinal fluid, but not in the aqueous humor, vitreous, or serum. CONCLUSIONS: Vitrectomy with the collection of ocular samples, especially subretinal fluid, was a key procedure in the diagnosis and treatment of retinochoroiditis associated with the porcine ascarids.

Hypericin inhibits pathological retinal neovascularization in a mouse model of oxygen-induced retinopathy.

PURPOSE: Ocular neovascularization is a leading cause of blindness in ischemic retinopathies. Hypericin is an active ingredient in the medical herb St. John's Wort (SJW). Because hypericin inhibits intracellular signaling pathways that are believed to participate in the regulation of angiogenesis, we investigated the actions of hypericin and SJW in retinal neovascularization, using a mouse model of oxygen-induced retinopathy (OIR). METHODS: C57BL/6 neonatal mice were exposed to a 75% concentration of oxygen from postnatal day 7 (P7) to P12 and returned to room air from P12 to P17 to induce retinal neovascularization. SJW (15 mg/kg/day), hypericin (15, 45, or 135 mug/kg/day), or vehicle was given by gavage once a day for five days from P12 to P17. To quantify the area of retinal neovascularization and vasoobliteration, we stained retinas with isolectin B4 at P17. Phosphorylation of extracellular signal-regulated kinase (ERK) in ischemic retinas was determined by western blot analysis. To estimate retinal vascularization, we stained retinas with isolectin B4 at P7 after treatment with SJW, hypericin, or vehicle from P3 to P7. RESULTS: Gavage administration of hypericin or SJW significantly inhibited the degree of retinal neovascularization, but did not affect the area of retinal vasoobliteration in a mouse model of OIR. Both SJW and hypericin had no effect on normal vascularization over the treatment time course. Treatment with SJW or hypericin reduced phosphorylation of ERK in the retina. CONCLUSIONS: These data suggest that hypericin and SJW reduce pathological retinal neovascularization and that administration of these agents could have clinical utility for treatment of ischemic retinopathies.

Intraocular pressure elevation after injection of triamcinolone acetonide: a multicenter retrospective case-control study.

PURPOSE: To determine the risk factors for intraocular pressure (IOP) elevation after the injection of triamcinolone acetonide (TA). DESIGN: Retrospective interventional case-control study. SETTING: Multicenter. PATIENT POPULATION: Four hundred and twenty-seven patients. OBSERVATION PROCEDURES: Intraocular pressure levels after TA treatment by the sub-Tenon capsule injection (STI; 12 mg, 20 mg, or 40 mg), intravitreal injection (IVI; 4 mg or 8 mg), or the combination of STI (20 mg) and IVI (4 mg), and IOP levels after two TA treatments. MAIN OUTCOME MEASURE: Risk factors for IOP levels of 24 mm Hg or higher. RESULTS: Younger age (hazards ratio [HR], 0.96/year; P < .0001), IVI (HR, 1.89/year; P < .0001), and higher baseline IOP (HR, 1.15/mm Hg; P = .003) were identified as risk factors. Dose dependency was shown in STI-treated eyes (HR, 1.07/mg; P = .0006), as well as after IVI (HR, 1.64/mg; P = .013). The combination of STI and IVI was a significant risk factor (HR, 2.27; P = .003) compared with STI alone. In eyes receiving two TA treatments, IVI (HR, 2.60; P = .010), higher IOP elevation after the first injection (HR, 1.18/mm Hg; P = .011), and increased dosage of STI (HR, 1.07/mm Hg; P = .033) were risk factors. CONCLUSIONS: Younger age, higher baseline IOP, IVI, and increased TA dosage were associated with TA-induced IOP elevation. IOP elevation after repeated TA injection was frequently associated with eyes treated with IVI, high IOP elevation after the first injection, and high doses of STI.

Prospective study comparing the effectiveness of scleral buckling to vitreous surgery for rhegmatogenous retinal detachment.

PURPOSE: To compare the effectiveness of scleral buckling to vitrectomy for the treatment of rhegmatogenous retinal detachment (RRD) due to equatorial retinal tears. METHODS: Forty-six patients (46 eyes) > or =50 years of age with RRD due to equatorial retinal tears were studied. One group of 23 patients was selected by the randomized envelope method to be treated by scleral buckling and a second group of 23 to be treated by vitrectomy. The rate of retinal reattachment, the visual acuity, optical coherence tomography findings, and postoperative complications were determined. In addition, a questionnaire was filled out by the patients on their subjective assessment of the surgery and recovery. RESULTS: The rate of retinal reattachment was identical in the two groups. The postoperative visual acuity, the number of patients with visual acuity > or =0.8 and the mean visual acuity were significantly better in the vitrectomy group (chi-squared and Mann-Whitney U tests, P < 0.05) within 12 months after surgery. At 24 and 36 months, the differences in the visual acuity were not significant. The answers to the questionnaire given by the patients in the vitrectomy group suggested that their surgical experiences and visual recovery were better than those of patients in the scleral buckling group. CONCLUSION: In patients > or =50 years of age, vitrectomy was more effective than scleral buckling for obtaining good visual acuity in the short term.

[Case with metastasis of a squamous esophageal cancer of the iris with resemblance to hypopyon].

BACKGROUND: Metastasis of a malignant tumor to the iris is rare. We treated a patient with such a metastasis from esophageal cancer. CASE: A 58-year-old man who had had an operation for squamous esophageal cancer complained of conjunctival injection affecting the left eye. On examination, visual acuity in both eyes was 1.2, and intraocular pressure (IOP) in both eyes was 18 mmHg. A grayish tumor with irregular contours was found on the surface of the iris of the left eye at 2 o'clock, and cottonlike material was pooled in the anterior chamber. No metastases elsewhere in the body were clinically evident. After IOP rose to 34 mmHg accompanied by ocular pain, we performed a peripheral iridectomy for diagnosis. Pathologic findings indicated squamous esophageal cancer metastatic to the iris. Metastases to lung and liver were found by computed tomography shortly after hospitalization. Radiotherapy 40 Gy was applied to the iris tumor. IOP then fell, and ocular pain disappeared. CONCLUSION: Metastasis of a squamous esophageal cancer to the iris can resemble a hypopyon. Radiotherapy was effective in this patient.