Risk Factors for Second Eye Involvement in Eyes with Unilateral Polypoidal Choroidal Vasculopathy.

PURPOSE: To investigate risk factors associated with developing polypoidal choroidal vasculopathy (PCV) lesions in the unaffected fellow eye of patients with unilateral PCV. METHODS: We studied 179 patients with initial unilateral PCV who were followed up for a period of 24 months or longer to monitor for second eye involvement. All patients underwent genotyping for CFH I62V (rs800292) and ARMS2 A69S (rs10490924) using TaqMan technology. RESULTS: During the follow-up period ranging from 5-180 months, 20 (11.2%) of 179 patients developed PCV in the initially unaffected fellow eye. The risk allele (T) of ARMS2 A69S was significantly more prevalent in patients with second eye involvement compared to those without PCV in the fellow eye (p = 0.0046). Cox regression analysis demonstrated that the ARMS2 A69S genotype is a risk factor for developing PCV in the fellow eye (p = 0.027, odds ratio 2.53, confidence interval 1.11-5.73). Survival analysis revealed that the fellow eye of patients with the risk-associated homozygous genotype (TT) of ARMS2 A69S was affected significantly earlier than those with other genotypes (p = 0.0177, log rank test). CONCLUSIONS: Development of PCV in the unaffected fellow eye is associated with ARMS2 A69S genotype in patients with unilateral PCV.

Aqueous humor cytokine levels in patients with polypoidal choroidal vasculopathy and neovascular age-related macular degeneration.

PURPOSE: To investigate the possible roles of various cytokines or growth factors in the pathogenesis of exudative age-related macular degeneration (AMD) by comparing aqueous humor levels of 14 cytokines between eyes with polypoidal choroidal vasculopathy (PCV) and those with neovascular AMD. METHODS: Forty eyes from 40 patients with treatment-naïve exudative AMD consisting of 18 eyes with neovascular AMD and 22 eyes with PCV were studied. Twenty eyes from 20 patients with no retinal pathology who underwent cataract surgery served as controls. Aqueous humor samples were collected just before intravitreal ranibizumab injection in 40 eyes with exudative AMD and before cataract surgery in 20 control eyes. Concentrations of 14 cytokines were determined by chemiluminescence-based ELISA: interleukin (IL)-1α, IL-2, IL-4, IL-6, IL-8, IL-10, IL-12, IL-13, IL-15, IL-17, vascular endothelial growth factor (VEGF), monocyte chemoattractant protein 1, interferon-γ-inducible protein (IP)-10 and C-reactive protein (CRP). RESULTS: After adjusting for gender, age and axial length, concentrations of CRP and IP-10 were significantly higher in eyes with neovascular AMD or PCV compared with control eyes (p < 0.05), and IP-10 levels were strongly associated with lesion size (p = 0.002). None of the 14 cytokines, including VEGF, were significantly different between eyes with neovascular AMD and those with PCV. CONCLUSION: Aqueous humor concentrations of CRP and IP-10 were elevated in eyes with PCV or neovascular AMD. IP-10 could be associated with the pathogenesis of neovascular AMD and PCV.

Macular slippage after macular hole surgery with internal limiting membrane peeling.

PURPOSE: To describe macular slippage toward the optic disc after macular hole surgery with internal limiting membrane (ILM) peeling. MATERIALS AND METHODS: A total of 27 eyes of 27 patients with idiopathic macular hole were included in this retrospective study. The fovea-to-disc distance (FDD) was measured from digital color fundus images before and at least six months after surgery. The position of the fovea was determined as the center of the macular hole before surgery and the center of the macular pigment area after surgery. The thickness of the nasal and temporal macula was measured using spectral-domain optical coherence tomography. The difference in thickness between the nasal and temporal macula was determined as the degree of parafoveal asymmetry (PFA). RESULTS: The postoperative FDD was significantly shorter than the preoperative FDD: 4.00 ± 0.33 mm and 3.82 ± 0.34 mm, respectively (p < 0.0001). The mean decreased ratio of FDD was 4.68% (range, 0.38-9.24%). The appearance of the dissociated optic nerve fiber layer (DONFL) was finally found in 21 eyes (78%). The decreased FDD ratio was significantly larger in eyes with the DONFL appearance than in those without it: 5.61 ± 1.74% and 1.44 ± 1.12%, respectively (p < 0.0001). The decreased ratio of FDD was correlated with the postoperative PFA (r = 0.63, p = 0.0004). CONCLUSION: A macula in which the ILM has peeled off would slip toward the optic disc after macular hole surgery. Macular slippage can be a reasonable cause for the macular alterations such as an appearance of DONFL and changes in asymmetrical parafoveal thickness.

Role of complement factor H I62V and age-related maculopathy susceptibility 2 A69S variants in the clinical expression of polypoidal choroidal vasculopathy.

PURPOSE: To investigate the role of complement factor H (CFH) I62V (rs800292) and age-related maculopathy susceptibility 2 (ARMS2) A69S (rs10490924) variants in the clinical characteristics of polypoidal choroidal vasculopathy (PCV). DESIGN: Cross-sectional study. PARTICIPANTS: A total of 226 Japanese patients with PCV in both eyes (44 cases) or in 1 eye (182 cases). METHODS: Genotyping was performed in all cases for CFH I62V using TaqMan technology and for ARMS2 A69S by denaturing high-performance chromatography. The incidence of 5 characteristic funduscopic findings was studied, including serous retinal detachment, subretinal hemorrhage, serous pigment epithelial detachment (PED), hemorrhagic PED, and classic choroidal neovascularization (CNV). MAIN OUTCOME MEASURES: The association of clinical phenotypes, including the incidence of each of 5 specific fundus findings, bilaterality of the disease, and age at onset, with variants of CFH I62V or ARMS2 A69S. RESULTS: Although there was no association of CFH I62V variants with any of the phenotypes in PCV, at-risk variants of ARMS2 A69S were associated with higher incidences of subretinal hemorrhage, serous PED, and hemorrhagic PED. In particular, the at-risk allele homozygosity of ARMS2 A69S increased the likelihood for hemorrhagic PED by 12.4-fold compared with non-carriers of the allele (confidence interval, 1.60-95.1, P = 0.0001). However, the at-risk allele of ARMS2 A69S was associated with a lower incidence of serous retinal detachment (P = 0.0092). Classic CNV was not associated with either variant. The mean age at the onset of PCV was significantly younger (68.8 years) in those with homozygosity of the at-risk allele of ARMS2 A69S than in those with heterozygosity (71.6 years) or in non-carriers (72.6 years) (P = 0.026). Moreover, the at-risk allele frequencies of the ARMS2 A69S were significantly higher in bilateral cases than in unilateral cases (75.0% vs. 59.3%, P = 0.007). CONCLUSIONS: ARMS2 A69S variants were significantly associated with hemorrhagic or subpigment epithelium lesions of PCV, and with earlier onset and bilateral involvement. The genotyping of ARMS2 A69S is more informative than that of CFH I62V in understanding the clinical features in patients with PCV.

Changes in anterior chamber depth due to contusion.

PURPOSE: We aimed to investigate changes in anterior chamber depth (ACD) prospectively in patients with recent unilateral contusion but no signs of angle recession, using a scanning peripheral anterior chamber depth analyzer (SPAC). METHODS: Among patients whose chief complaint was recent unilateral contusion and who showed no signs of angle recession by gonioscopy in 2006 and 2007, those who satisfied the following criteria were subjected to SPAC evaluation of ACD from the central to the peripheral region: no history of ocular diseases or ocular surgery including laser treatment, and similar refractory error in both eyes before trauma. RESULTS: Thirty-seven patients satisfied the criteria (29 males, 8 females; age: 28.6 +/- 23.5 years). Fourteen patients presented with commotio retinae. Fifteen showed no ocular manifestations related to the contusion. The mean SPAC-determined ACD grades of contused and noncontused eyes were 10.7 +/- 1.6 and 9.8 +/- 2.1, respectively, demonstrating that the contused eyes had significantly larger ACD values than the noncontused ones (p = 0.0005). The contused eyes had larger ACD values in both the central and the peripheral regions. The difference in ACD between the contused and noncontused eyes tended to increase with greater distance from the center. The equivalent refractive errors were -2.3 +/- 2.2 and -1.7 +/- 2.1 dpt, respectively (p = 0.004). There were no significant differences in best-corrected visual acuity and intraocular pressure between the contused and the noncontused eyes. CONCLUSION: Contusion may increase ACD particularly in the peripheral region even in patients who have no apparent manifestations in the anterior ocular segment.