A Case of Bilateral Papilledema With Improved Clinical Symptoms by Venous Stenting for Superior Sagittal Sinus Stenosis.

Superior sagittal sinus (SSS) obstruction causes intracranial hypertension, often requiring surgical stenting. Consensus on treating brain venous sinus stenosis, another cause, is lacking. This study reports a case of SSS stenosis and intracranial hypertension treated with venous stenting, improving bilateral papilledema. A 51-year-old with a headache and visual disturbance had papilledema and visual field loss. MR venography showed SSS stenosis, leading to a neurosurgery referral. Lumbar puncture confirmed intracranial hypertension (>35 cmH2O), prompting venous stenting. Post-procedure, papilledema, headache, and visual field loss improved. Venous stenting could be effective for SSS stenosis with clinically proven or recurrent pressure differences. Further cases are needed for standardization.

A Case Report on Premature Twins: Primary Congenital Glaucoma or Large Cupping Disks Mimicking Primary Congenital Glaucoma?

Large cupping of the optic disk in a baby or a child can be indicative of primary congenital glaucoma. Primary congenital glaucoma is often refractory to treatment, and lifelong management and follow-up are necessary; therefore, diagnosis requires careful consideration. In this study, we describe the case of twins in whom primary congenital glaucoma was initially suspected due to large cupping of the optic disks. Twin babies (a boy and a girl weighing 455 g and 592 g respectively), born prematurely (at 28 gestational weeks), were referred to our hospital eight months after birth because large cupping of the optic disks was detected during follow-up for retinopathy of prematurity. According to color fundus photographs, the cup/disk ratios in both eyes of both babies ranged from 0.75 to 0.86. However, the axial length ranged from 18.57 to 19.91 mm, the anterior chamber depth ranged from 2.68 to 2.93 mm, and the horizontal diameters of the corneas, which were clear, ranged from 10 to 10.5 mm. The intraocular pressures (IOPs), as measured by a rebound tonometer, were 15.3-19.7 mmHg. Glaucoma was strongly suspected due to the large cupping of the optics disks; however, other ocular biometric tests demonstrated that the eyes were normal. After eight months of follow-up without any medication or intervention, the IOPs stabilized between 6-22.1 mmHg, the refractive errors were between -2.5 and 0 diopters, and we found no apparent enlargement of the optic disks. In addition, we investigated both parents' optic disks to evaluate the genetic factors and found that they had relatively large C/D ratios (0.68-0.79). These premature twins exhibited glaucoma-like optic disks with large cupping, but no solid glaucomatous changes were observed with ocular biometry and IOP testing. We concluded, therefore, that the early birth and lower birth weights may have been associated with the large cupping of the patients' optic disks. To differentiate between normal physiological cupping and primary congenital glaucoma, ocular morphological examination of the eye, IOP measurements, and investigation of the parents' optic disks were useful.

Evaluation of Significance Maps and the Analysis of the Longitudinal Time Course of the Macular Ganglion Cell Complex Thicknesses in Acquired Occipital Homonymous Hemianopia Using Spectral-domain Optical Coherence Tomography.

The present study was performed to evaluate the ganglion cell complex (GCC) thickness as well as the significance map and analyse the time course of the change in GCC thickness in patients with homonymous hemianopia due to posterior cerebral artery (PCA) territory stroke using spectral-domain optical coherence tomography. This study included 40 control subjects and 11 patients with unilateral PCA territory stroke. The GCC parameters were quantified using a custom-built software programme. The GCC data, centred on the macula, was divided vertically into hemianopic and unaffected sides. GCC parameters were calculated using an average of those from both eyes. The relationship between the GCC parameters and the time after stroke was determined by regression analyses. The GCC parameters in the hemi-retinae corresponding to the affected hemifields significantly differed between the hemianopes and the control group. The area under the receiver operating characteristics curve of the GCC significance map areas was significantly high. A regression analysis revealed a significant relationship between the time after stroke and both the GCC significance map areas (r = 0.791, p = .004) and GCC thickness (r = -0.736, p = .010) on the hemianopic side. The GCC parameters on the hemianopic side were reduced in patients with acquired occipital homonymous hemianopia, and the reduction was slowly progressive probably due to transsynaptic retrograde degeneration of the retinal ganglion cells. A significance map analysis provides additional OCT parameters that could be used to investigate the effect of retrogeniculate lesions on the inner retina of patients.

A novel method to reduce noise in electroretinography using skin electrodes: a study of noise level, inter-session variability, and reproducibility.

To determine the feasibility of recording reproducible electroretinograms (ERGs) with skin electrodes using a new ERG system. Seventeen healthy volunteers were studied. The dark-adapted, bright-flash ERGs were recorded with a new ERG recording system (LE-4000, Tomey, Nagoya, Japan) in which the stimulus alternated between the eyes every 15 s, and each eye was stimulated eight times. The active skin electrode was placed on the lower eyelids of both eyes. The voltage changes of the non-stimulated eye were subtracted from that of the stimulated eye to try to increase the signal-to-noise ratio for eight stimulus cycles. The noise levels were measured from 12 subjects with and without the subtraction steps. ERGs were also recorded on five different days from five subjects, and the coefficient of variation (CV) and the intra-class correlation coefficients (ICCs) were calculated. The noise level without the subtraction step was 18.4 ± 8.4 µV, and it was significantly reduced to 13.8 ± 4.0 µV with the subtraction step (P = 0.001). Reproducible ERGs were obtained from each subject, and the average CV for the five subjects was 6.1 % for the a-wave amplitude, 7.7 % for the b-wave amplitude, and 7.7 % for the sum of the oscillatory potential (OP) amplitude. The ICC was 0.76 for the a-wave amplitude, 0.68 for the b-wave amplitude, and 0.72 for the sum of the OPs amplitude. These findings indicate that our new ERG recording methods shows noise reduction and good reproducibility with low inter-session variability even with skin electrodes.

[Long-term Outcomes in Eyes Receiving of Bevacizumab Early in the Course of Branch Retinal Vein Occlusion].

PURPOSE: To evaluate the effects of intravitreal bevacizumab (IVB) injections early in the course of branch retinal vein occlusion (BRVO). PATIENTS AND METHODS: We conducted a retrospective review of 30 patients (30 eyes) with macular edema (ME) secondary to BRVO. The mean duration from the onset to the first IVB injection was 5 weeks. The mean observation period was 30 months. All patients were followed monthly, with administration of additional IVB injections if there was persistent or recurrent ME within 6 months after the first injection. The main outcome parameter was best-corrected visual acuity (BCVA) at 12 and 24 months. Rescue therapy including laser photocoagulation was done as needed. RESULT: Mean BCVA improved significantly from logMAR 0.59 ± 0.24 at baseline to 0.04 ± 0.15 (p < 0.001)at 12 month, 0.06 ± 0.19(p < 0.001)at 24 month. CONCLUSION: IVB injections given shortly after onset of branch retinal vein occlusion may result in a significant increase in vision in some patients.

Retinal Ganglion Cell Atrophy in Homonymous Hemianopia due to Acquired Occipital Lesions Observed Using Cirrus High-Definition-OCT.

Purpose. To report a reduction in macular ganglion cell layer and inner plexiform layer (GCL+IPL) thickness and circumpapillary retinal nerve fiber layer (cpRNFL) thickness using spectral-domain optical coherence tomography in patients with homonymous hemianopia due to posterior cerebral artery (PCA) stroke. Methods. Seven patients with PCA stroke were examined using Cirrus high-definition-OCT. The GCL+IPL thicknesses were divided into the hemianopic and unaffected sides. The relationship between the time after stroke and the GCL+IPL thicknesses in the hemianopic side was evaluated. Results. The average thicknesses of the GCL+IPL were 64.6 and 82.0 µm on the hemianopic and unaffected sides, respectively, and the measurement was significantly thinner on the former side (p = 0.018). A regression analysis revealed a negative linear relationship (R (2) = 0.574, p = 0.049) between the time after stoke and the GCL+IPL thicknesses on the hemianopic side. The supratemporal and inferotemporal cpRNFL thicknesses in the eyes ipsilateral to the stroke showed a significant reduction. Conclusion. Our findings confirmed our previous observations that the degeneration of retinal ganglion cells can occur after PCA stroke. GCL+IPL thinning was demonstrated in the hemiretinae corresponding to the affected hemifields. Also, it is suggested that the retinal changes observed are progressive.

Repeatability of visual acuity testing using a psychometric function.

PURPOSE: To evaluate the repeatability of a new method of measurement of visual acuity by use of a psychometric function. METHODS: The visual acuity of 15 healthy adults was measured by use of a psychometric function (PFVA) and by use of a conventional method using a decimal visual acuity chart (DeVA). We performed two tests. To evaluate intra-rater reliability, a tester measured the visual acuity three times for each subject, and the intraclass correlation coefficients, ICC (1,1), were calculated for PFVA and DeVA. Next, to evaluate inter-rater reliability, three testers measured the visual acuity for one subject, and the ICC (2,1) were calculated for PFVA and DeVA. The PFVA and DeVA of five subjects with ocular diseases were also measured. RESULTS: In the evaluation of intra-rater reliability, the ICC (1,1) of the DeVA was 0.83 and the ICC (1,1) of the PFVA was 0.95. In the evaluation of inter-rater reliability, the ICC (2,1) of the DeVA was 0.88 and the ICC (2,1) of the PFVA was 0.93. In both tests the standard deviations of the PFVA were significantly lower than those of the DeVA. For four of the five subjects with ocular diseases, the PFVA was significantly improved by treatment. CONCLUSION: The repeatability of our method is better than that of the conventional method using a decimal visual acuity chart.

Quadrantal macular retinal thickness changes in strabismus subjects with abnormal binocular vision development.

PURPOSE: To investigate retinal morphological changes in strabismus patients with abnormal binocular vision development by comparing differences in quadrantal macular retinal thickness. METHODS: Six strabismus patients (6 dominant and 5 non-dominant eyes) with abnormal binocular vision (mean age 22 years), and 11 control subjects (11 dominant and 11 non-dominant eyes) (mean age 21 years) were enrolled. Macular retinal thickness measurements were performed by optical coherence tomography, with total macular retinal (TMR) and ganglion cell complex (GCC) thicknesses measured in 3- and 6-mm regions in each quadrant. Measurement values were then used to determine quadrant ratios. RESULTS: Compared to the dominant eyes of the controls, the superior/inferior (S/I) ratio of the TMR thickness and GCC thickness in the 3-mm region was significantly lower in the dominant eyes of the strabismus group (P < 0.05, each). The superior temporal/inferior temporal (ST/IT) ratio of the GCC thickness in the dominant eyes of the strabismus group was also significantly lower (P < 0.01). CONCLUSIONS: Dominant eyes of the strabismus group with abnormal binocular vision development exhibited thinner superior temporal GCC thicknesses in the 3-mm region. Retinal ganglion cells in this region might be affected by efferent neural degeneration that originates in the visual pathway responsible for adaptations to the visual experience.

[The influence of sodium hyaluronate solution and artificial tears on higher-order aberrations].

PURPOSE: To investigate the influence of sodium hyaluronate solution (HA) and artificial tears (AT) on higher-order aberrations (HOAs). SUBJECTS AND METHODS: Twenty four eyes of 24 normal subjects and 11 eyes of 11 dry eye patients were examined. Cornea and ocular wavefront aberrations (total, spherical-like and coma-like) were measured with a Hartmann-Shack wavefront aberrometer before and after 0.1% or 0.3% HA, AT. The consecutively obtained data of the cornea and ocular HOAs were analyzed in the central 4-mm diameter for coma-like, spherical-like and total HOAs. Average HOAs, as well as fluctuation index (FI) and stability index (SI) of the HOAs over time were compared between the two groups. RESULTS: In normal subjects, the AVE of all aberration parameters and FI showed an increase depending on viscosity of the HA (p < 0.001). After AT and 0.1% HA treatment the cornea aberration of the dry eye patients changed from a sawtooth pattern to a stable pattern. CONCLUSION: Cornea HOAs decreased, and the optical characteristics showed improvement after AT and 0.1% HA in the dry eye patients. HOAs increased depending on the viscosity of the HA, and optical stability worsened.

Influence of three-dimensional image viewing on visual function.

PURPOSE: A three-dimensional (3D) image viewing experiment was performed using a new 3D scenography system. The influence on visual function was investigated both in adults and in children employing both objective and subjective methods. METHODS: The subjects were 21 healthy adults (mean age ± standard deviation: 42.1 ± 10.0 years) and 21 healthy children (7.8 ± 1.5 years). The 3D image viewing time was set at 90 min for adults and 60 min for children, and the visual function was objectively evaluated using an accommodative microfluctuation analysis system both before and after 3D image viewing. In addition, subjective symptoms were surveyed employing a questionnaire both before and after viewing in the adult group to subjectively evaluate the visual function. RESULTS: No significant difference was noted in accommodative microfluctuation between the before and after viewing in either the adult or child group, nor was there a significant difference in subjective symptoms in the adult group based on the questionnaire. However, accommodative microfluctuation tended to increase after viewing in some subjects. CONCLUSIONS: Under the conditions of this study, 3D image viewing did not influence visual function, or only very slightly influenced it, if at all, but there are many unknown problems, requiring further surveys using 3D image viewing.

A case of Vogt-Koyanagi-Harada disease that developed relapsing polychondritis.

We report the case of a 56-year-old Japanese man with Vogt-Koyanagi-Harada disease in whom pain and diffuse swelling of the left auricle and bilateral episcleritis developed 3 years after diagnosis. Biopsy of the left ear showed acute chondritis, leading to another diagnosis of relapsing polychondritis. Additionally, he was found to carry human leukocyte antigen DR4, which has been reported to be associated with these inflammatory conditions. To our knowledge, our patient is the first reported case of the occurrence of relapsing polychondritis and Vogt-Koyanagi-Harada disease.

Classification of Duane's retraction syndrome: two additional electromyogram types.

BACKGROUND: Huber's clinical and electromyographical classifications of Duane's retraction syndrome have been considered to correspond to each other. However, cases that do not correspond to these classifications have been reported recently. CASES: Retrospectively, we tried to classify the clinical types and electromyogram types of 17 eyes (15 cases) with Duane's retraction syndrome according to Huber's classification. OBSERVATIONS. Eleven eyes could not be classified into any of Huber's electromyogram types. Among these eyes, two major additional electromyogram patterns were newly classified: a center-peak type, in which the lateral rectus or medial rectus muscle showed maximum activity in the primary position; and a type with continuous lateral rectus muscle discharge. Some minor electromyogram patterns were also recorded. CONCLUSION: The wide variation in these electromyogram patterns may be due to the diversity of the lesions in Duane's retraction syndrome, which can be the result of muscular, nuclear, internuclear, or supranuclear failure.