[Clinical features of idiopathic macular holes-differences between sexes and stages].

PURPOSE: The purpose of this study was to evaluate the differences in the clinical features of idiopathic macular holes between sexes and stages. METHODS: Five hundred and twenty-six eyes of 480 patients with stage 3 or 4 idiopathic macular hole that had undergone vitrectomy were observed consecutively in this study. The each stage ratio, bilaterality, and affected eye were examined and the differences in age, hole duration, hole size, visual acuity, refractive power, axial length, and corneal refractive power were evaluated. RESULTS: Twenty-six % of the cases were stage 4 in males and 31% in females. There were no significant differences in bilaterality or affected eye between the sexes. Younger age and larger size were found in females of stage 3. Larger size was found in stage 4. More myopic eye and longer axial length were found in males of stage 4. There were no significant differences in hole duration and visual acuity between sexes or stages. CONCLUSIONS: In females the onset of macular hole occurred at a younger age than in males, size of the hole was larger from an earlier stage, and refractive power was less myopic. More myopic eye and longer axial length were found in stage 4, especially in males. This fact might be related to the existence of posterior vitreous detachment. We concluded that there were some differences in the mechanism of the onset and the progression of idiopathic macular hole between males and females.

Variables That Influence Visual Acuity After Macular Hole Surgery.

Purpose: To evaluate the variables that influence visual acuity and visual improvement after macular hole surgery.Methods: Our study included 421 eyes in which macular holes were successfully closed after surgery and followed up at least 1 year after the last surgery. Surgical techniques were conventional methods (Group 1: 350 eyes) with retinal pigment scalping of the macular hole basis added in the refractory cases (Group 2: 71 eyes). The variables used for the multiple regression were gender, age, preoperative visual acuity, hole stage, duration of symptoms, hole size, and axial length.Results: The variables that most influenced postoperative visual acuity were as follows: Group 1: gender (r = -0.011, P =.016), age (r = -0.17, P =.005), preoperative visual acuity (r = 0.51, P <.0001), duration of symptoms (r = -0.015, P <.0001), and axial length (r = -0.090, P =.045). Group 2: age (r = -0.18, P =.047), and preoperative visual acuity (r = 0.47, P <.0001).Conclusions: The variables that influenced visual acuity and visual improvement after macular hole surgery were common. In Group 1: gender, age, preoperative visual acuity, duration of symptoms, and axial length; in Group 2: age and preoperative visual acuity.

Incidence of Reopening and Variables That Influence Reopening After Macular Hole Surgery.

Purpose: To evaluate the incidence and variables of reopening of macular holes after macular hole surgery.Methods: Our study included 467 eyes in which macular holes were successfully closed after surgery. Surgical techniques consisted of conventional methods (358 eyes) and scalping methods (109 eyes) with retinal pigment scalping of the macular hole basis added in such cases: reoperation, hole size (more than 0.4 disc diameter), duration of symptoms (more than 2 years). Long term incidence of reopening was predicted by life table method. After we compared reopened cases with non-reopened cases, the variables of gender, stage, biocular occurrence, age, duration of symptoms, hole size, preoperative visual acuity, refraction axial length ratio, and intraoperative retinal tears were used for the multiple regression.Results: Reopening was found in 20 eyes (5.6%) treated by conventional methods and in 10 eyes (9.2%) treated by scalping methods. Survival ratio was 87% for the conventional methods in 6 years and 79% for the scalping methods in 5 years. The variables influencing reopening were as follows: conventional methods: gender (r = 0.065, P =.19), biocular occurrence (r = 0.12, P =.026), and refraction axial length ratio (r = -0.11, P =.045); scalping methods: hole size (r = 0.14, P =.25).Conclusions: Incidence of reopening in scalping methods was high. The variables that influenced reopening after macular hole surgery were biocular occurrence and refraction axial length ratio in conventional methods. The shape of the eye may be related to reopening.

[Factors related to intraoperative retinal breaks in macular hole surgery].

PURPOSE: To evaluate the factors of intraoperative retinal breaks in macular hole surgery. METHODS: This study included 558 eyes of 506 patients who underwent idiopathic macular hole surgery by one surgeon. Multiple regression was performed using the variables of gender, age, affected eye, lens status, stage, duration of symptoms, hole size, axial length, and lattice degeneration. RESULTS: The rate of retinal breaks was higher in stage 3 (16.0%) than in stage 4 (8.2%) (p = 0.014). In eyes with lattice degeneration intraoperative retinal breaks occurred in about 40% of the cases. Major factors were as follows: lattice degeneration (r = 0.24, p < 0.0001) in all eyes, stage (r = 0.090, p = 0.048) in eyes without lattice degeneration, and gender (r = -0.18, p = 0.035) in eyes of stage 4 without lattice degeneration. CONCLUSIONS: The factors of intraoperative retinal breaks in macular hole surgery were lattice degeneration in all eyes and stage 3 in eyes without lattice degeneration. The high incidence of intraoperative retinal breaks in stage 3 was mainly due to the occurrence of posterior vitreous detachment. Male gender was a significant factor associated with intraoperative retinal breaks.

[Operculum in idiopathic macular holes].

PURPOSE: To detect the factors related to the operculum in idiopathic macular holes and present a pathogenesis of idiopathic macular holes. METHODS: This study included 583 eyes of idiopathic macular hole that underwent macular hole surgery. To detect the factor related to the operculum, the variables of age, duration of symptoms, hole size, preoperative visual acuity, refraction, axial length, refraction axial length ratio were used for the comparison between two groups and multiple regression. The success rate of surgery and postoperative visual acuity were examined whether the operculum was present or not. RESULTS: The variables that were significantly related to the operculum were as follows: refraction axial length ratio (r = 0.18, p = 0.0092) in women of stage 3, duration of symptoms (r = -0.44, p < 0.001), preoperative visual acuity (r = -0.33, p = 0.0025), and refraction axial length ratio (r = -0.22, p = 0.020) in women of stage 4, and age (r = 0.19, p = 0.047) in men of stage 3. There were no significant differences in the success rate of surgery and postoperative visual acuity whether the operculum was present or not. CONCLUSIONS: Generally, operculum tends to occur in aged and round eyes and possibly does not occur in younger and back projected eyes because of retinal fissure. In women of stage 4, the operculum is possibly a torn retina and does not occur in atrophic holes.

[Variables that influence visual acuity after macular hole surgery].

PURPOSE: To evaluate the variables that influence visual acuity and visual improvement after macular hole surgery. METHODS: Our study included 421 eyes in which maculor holes were successfully closed after surgery and followed up at least 1 year after the last surgery. Surgical techniques were conventional methods (Group 1: 350 eyes) with retinal pigment scalping of the macular hole basis added in the refractory cases (Group 2: 71 eyes). The variables used for the multiple regression were gender, age, preoperative visual acuity, hole stage, duration of symptoms, hole size, and axial length. RESULTS: The variables that most influenced postoperative visual acuity were as follows: Group 1: gender (r = -0.011, p = 0.016), age (r = -0.17, p = 0.005), preoperative visual acuity (r = 0.51, p < 0.0001), duration of symptoms (r = -0.015, p < 0.0001), and axial length (r = -0.090, p = 0.045). Group 2: age (r = -0.18, p = 0.047), and preoperative visual acuity (r = 0.47, p < 0.0001). CONCLUSIONS: The variables that influenced visual acuity and visual improvement after macular hole surgery were common. In Group 1: gender, age, preoperative visual acuity, duration of symptoms, and axial length; in Group 2: age and preoperative visual acuity.

[Incidence of reopening and variables that influence reopening after macular hole surgery].

PURPOSE: To evaluate the incidence and variables of reopening of macular holes after macular hole surgery. METHODS: Our study included 467 eyes in which maculor holes were successfully closed after surgery. Surgical techniques consisted of conventional methods (358 eyes) and scalping methods (109 eyes) with retinal pigment scalping of the macular hole basis added in such cases: reoperation, hole size (more than 0.4 disc diameter), duration of symptoms (more than 2 years). Long term incidence of reopening was predicted by life table method. After we compared reopened cases with non-reopened cases, the variables of gender, stage, biocular occurrence, age, duration of symptoms, hole size, preoperative visual acuity, refraction axial length ratio, and intraoperative retinal tears were used for the multiple regression. RESULTS: Reopening was found in 20 eyes (5.6%) treated by conventional methods and in 10 eyes (9.2%) treated by scalping methods. Survival ratio was 87% for the conventional methods in 6 years and 79% for the scalping methods in 5 years. The variables influencing reopening were as follows: conventional methods: gender (r = 0.065, p = 0.19), biocular occurrence (r = 0.12, p = 0.026), and refraction axial length ratio (r = -0.11, p = 0.045); scalping methods: hole size (r = 0.14, p = 0.25). CONCLUSIONS: Incidence of reopening in scalping methods was high. The variables that influenced reopening after macular hole surgery were biocular occurrence and refraction axial length ratio in conventional methods. The shape of the eye may be related to reopening.

[Factors related to initial success in macular hole surgery].

PURPOSE: To evaluate the factors of initial success in macular hole surgery. METHODS: This study included 526 eyes of 480 patients who underwent idiopathic macular hole surgery by one and the same surgeon. Surgical methods included conventional method (392 eyes), retinal pigment epithelium (RPE) scalping (61 eyes), internal limiting membrane (ILM) removal (62 eyes), and RPE scalping combined with ILM removal (11 eyes). To evaluate the factors of initial success multiple regression was performed using the variables of (gender, age, stage, duration of symptoms, hole size, axial length, and preoperative visual acuity). RESULTS: The rate of initial success was 81.4% in all eyes, 80.9% in the conventional method, 78.7% in RPE scalping, 83.9% in ILM removal, and 100% in RPE scalping combined with ILM removal. Significant factors of initial success were as follows: gender (r = -0.091, p = 0.053), age (r = -0.14, p = 0.0062), duration of symptoms (r = -0.23, p < 0.0001), hole size (r = -0.23, p < 0.0001), and axial length (r = -0.21, p < 0.0001) in the conventional method, hole size (r = -0.56, p = 0.0006) in ILM removal and stage (r = -0.43, p = 0.0011) and preoperative visual acuity (r = 0.30, p = 0.018) in RPE scalping. CONCLUSIONS: Significant factors of initial success were being male being young, shorter duration of symptoms, smaller hole size, and shorter axial length in the conventional method, smaller hole size in ILM removal and stage 4 and better preoperative visual acuity in RPE scalping method.

[Clinical features of idiopathic macular holes].

PURPOSE: The purpose of this study was to evaluate the clinical features of idiopathic macular holes. MATERIALS AND METHODS: The clinical features were examined in consequentive 526 eyes of 480 patients with idiopathic macular hole who underwent vitrectomy. RESULTS: Sixty-seven% of the patients were female. The mean onset age was 64.4 years of age and 60% of the cases were in their 60's at the time of onset. The mean refractive value was -0.66 dioptor and 40% of the cases were emmetropia with a refractive value between -1.0 dioptor and +1.0 dioptor. The onset age was positively correlated with refractive value. The visual acuity was negatively correlated with onset age, duration after onset, and the size of the macular hole. The duration was positively correlated with onset age. The size of the macular hole was positively correlated with age and duration. The factors for good visual acuity were determined by bilaterality, youth, or small size. Also we found the factors for large size of macular holes to be female gender, long duration of the hole, being in stage 4, and low visual acuity. CONCLUSIONS: The incidence of idiopathic macular hole is seen more in eyes of patients in their 60's and in emmetropic eyes. Patients with myopic eyes tend to have younger onset. The size of the macular hole in females tends to be larger than in males.

Expression of FGF5 in choroidal neovascular membranes associated with ARMD.

PURPOSE: The fibroblast growth factors (FGFs) are a family of 9 heparin binding proteins which have been proposed to play key roles in angiogenesis. Basic FGF (bFGF), acidic FGF (aFGF) and FGF5 have previously been demonstrated to be expressed in the normal retina and RPE. In this study, the expression of FGF5 was explored in choroidal neovascular membranes removed from patients with age-related macular degeneration (ARMD). METHOD: Three membranes were surgically removed from patients with ARMD, and were fixed, embedded and sectioned for immunohistochemistry. The membranes were immunostained with an affinity purified rabbit polyclonal antibody raised against the amino acid sequence for residues 175 to 185 of human FGF5 and visualized with the silver enhanced colloidal gold method for light microscopy. RESULTS: FGF5 was expressed in membranes arising from ARMD, and was found primarily in blood vessels and the surrounding extracellular matrix. CONCLUSIONS: These results suggest that FGF5 may have a functional role in the pathophysiology of ARMD.

Detached retina affects morphologic and biochemical changes in the retina adjacent to bullous retinal detachment in rabbits.

PURPOSE: Long-term results, more than 10 years after successful retinal detachment surgery, have shown gradually decreasing visual acuity in some cases. It is unclear if reduced functional recovery postoperatively is caused by anatomic changes or biochemical disorders. To determine the etiology of the reduced visual acuity, we cytochemically examined the changes in the cellular responses of the edges of retinal detachments. METHODS: We histochemically studied the glucose-6-phosphatase (G6P) and 5'-nucleotidase (5'-Nase) activity in the rabbit retina. Experimental rhegmatogenous retinal detachment was produced in a rabbit model after partial vitrectomy, followed by retinal tear formation. RESULTS: Although 5'-Nase activity gradually decreased during the period of detachment, activity was still detectable after 24 weeks. G6P activity increased in the region of the detached neural retina. Around the border of the detached retina, the decrease in 5'-Nase activity extended approximately 140 micrometers into the adjacent attached retina at 2 weeks after detachment and 270 micrometers at 24 weeks. CONCLUSIONS: These observations suggest that some anatomical and biochemical damages may occur in the retina adjacent to bullous retinal detachment and may explain the reduction in postoperative vision in some clinical cases.

Increasing cell density down-regulates the expression of acidic FGF by human RPE cells in vitro.

Previous studies have reported the expression of acidic fibroblast growth factor (aFGF) by rat, bovine, and human retinal pigment epithelium (RPE) in vivo. To critically examine the expression of aFGF by RPE cells, we studied the density dependence of steady-state levels of mRNA and protein expression in vitro. Northern blot analysis demonstrated 5 transcripts ranging from 4.5 kB to 1 kB. Steady-state levels of all the transcripts decreased as a function of culture density. A polyclonal antibody was raised against recombinant human aFGF and affinity purified on aFGF coupled to AffiGel-10. The resulting antibody crossreacted with bFGF but not FGF-5, but this crossreactivity could be eliminated by absorption of the antibody on bFGF coupled to AffiGel-10. The final antibody preparation recognized only a single band at approximately 18.5 kD in lysates of RPE. Immunohistochemical staining with this antibody preparation demonstrated a marked dependence on cell density after 3 days in culture. Low culture density yielded cells staining moderately for aFGF, while confluent cells exhibited little or no staining. The reduction of aFGF from RPE cells in culture in a density-dependent fashion could also be demonstrated by Western blot analysis.

Developmental expression of bFGF in the bovine retina.

PURPOSE: To examine the expression of bFGF in the developing bovine retina. METHODS: Fetal bovine eyes at 90, 120, 150, and 180 days gestational age, as well as adult bovine eyes, were immunohistochemically stained for the presence of bFGF. Detailed characterization of the anti-bFGF antibodies by immunoblot and Western blot analysis against pure FGF gene family standards and crude extracts of bovine retina were also performed. RESULTS: Expression of bFGF occurs beginning at 150 days of gestation, a period when photoreceptor development and secondary capillary network development is in process. No bFGF expression was found at 90 days, but primary capillaries were already apparent at this stage of development. CONCLUSIONS: Expression of bFGF in the developing bovine retina may play a functional role in outer retinal development.

Subcellular localization of bFGF in human retinal pigment epithelium in vitro.

Basic fibroblast growth factor is a polypeptide mitogen with potential biological roles in angiogenesis, differentiation, and the survival of neurons. To study the expression and subcellular distribution of basic fibroblast growth factor in human retinal pigment epithelium in vitro, affinity-purified antipeptide antibodies were generated against a 15 amino acid sequence in the amino-terminus of this growth factor. Analysis of the cross reactivity and specificity of the affinity-purified antibodies demonstrated no ability to recognize acidic fibroblast growth factor and the ability to label specifically the major known forms of basic fibroblast growth factor in whole-cell lysates of retinal pigment epithelium in vitro. Examination of paraformaldehyde- or glutaraldehyde-fixed pigment epithelium at the light and electron microscopic levels revealed prominent localization of basic fibroblast growth factor to the nucleus and nucleolus. In cells fixed with organic reagents, prominent cytoplasmic staining was noted in addition to the nuclear staining seen in aldehyde fixed cells. Investigation of subcellular fractions by Western blot analysis indicated cytosolic as well as nuclear localization of the basic fibroblast growth factor. These analyses, however, demonstrated that the higher molecular weight forms of basic fibroblast growth factor predominate in the nucleus.

Surgical techniques and visual prognosis in retinal detachment due to macular hole.

In 250 eyes with retinal detachment due to macular hole, the visual prognosis of each surgical technique was evaluated. (1) Macular diathermy adversely affected the visual prognosis. (2) Macular buckling+macular diathermy produced a poorer visual prognosis than macular buckling alone. (3) The visual prognosis resulting from gas tamponade alone or vitrectomy+gas tamponade was better than that resulting from macular diathermy. It is not clear whether there is a significant difference in visual prognosis between gas tamponade alone and vitrectomy+gas tamponade. (4) Macular laser photocoagulation does not adversely affect the visual prognosis. Judging from these results, gas tamponade, which has the possibility of better visual prognosis and less operation stress, should be selected as the initial technique.

Cytochemical studies of transitional area between retina and optic nerve.

We have investigated the fine structural features of the transitional area between retina and optic nerve with special emphasis on the identification of Müller cells using the cytochemical method for detecting the localization of G6Pase activity, which is specific to the endoplasmic reticulum (ER) of Müller cells in the guinea pig retina. This cytochemical method enabled us to differentiate Müller cells from astrocytes or other cells easily and also allowed topographical, three dimensional analysis by high voltage electron microscopy because of the high contrast of the reaction products. Our study demonstrates that Müller cells are a major constitutional element of intermediary tissue of Kuhnt, which is considered to be the possible site of barrier between optic nerve and retina. These findings may indicate that Müller cells contribute to the barrier function in this region of the eye.

Quantitative analysis of lens changes after vitrectomy by fluorophotometry.

We measured the amount of autofluorescence in the lens to evaluate quantitatively lens changes after vitrectomy. Thirteen phakic patients, ranging in age from 12 to 75 years, were studied after unilateral vitrectomy, with a follow-up period of more than two years (range, 26 to 55 months). Autofluorescence in the lens was measured at the center along the ocular axis by fluorophotometry. Lens autofluorescence in the eyes that underwent vitrectomy was significantly higher than in the contralateral eyes that were not operated on (P = .0003). The increase of autofluorescence was correlated significantly with the age at time of vitrectomy (P = .0008). There was no correlation between the increase in autofluorescence and the length of postoperative follow-up or the use of air during vitrectomy. Based on these results, we believe that oxidation of lens proteins intraoperatively may be one of the causes of development of nuclear cataract after vitrectomy.

Combined cytochemical detection of Müller-cell-specific enzyme activity and permeability tracers.

A combination of cytochemical methods in one tissue section was studied in order to detect the contribution of Müller cells to the blood-ocular barrier. Applications are shown for the detection of Müller cells and peroxidatic enzymes. The following advantages of the present method were demonstrated: superior sensitivity of glucose-6-phosphatase (G6Pase) activity, which allows the detection of these cells even in the coagulated retina. The reaction products showed no deleterious change after a subsequent reaction. These factors, and the contrasting reaction products of G6Pase and the enzymatic tracers (especially those of horseradish peroxidase) allow the distinction of Müller cells and the functional barrier site.

Surgical techniques and reattachment rates in retinal detachment due to macular hole.

We evaluated reattachment rates of the transvitreal and transscleral techniques for treating 250 eyes with retinal detachment due to macular hole. The initial success rate of the transvitreal approach was 56% (53/94). There was no difference between the results of gas tamponade alone and vitrectomy and gas tamponade. The initial success rate of the transscleral approach was 83% (130/156). Macular diathermy and macular buckling showed a higher reattachment rate than macular diathermy alone. The final success rates were the same (95%), regardless of which approach was selected as an initial technique. The patients whose initial transvitreal reattachment failed and who underwent additional transvitreal procedures (including macular laser photocoagulation) showed a success rate of 93%. We believe that gas tamponade, which has possibility of better visual prognosis, should be selected as an initial technique because the final success rate was found to be the same regardless of the initial surgical techniques.

Cytochemical studies on pathological Müller cells after argon laser photocoagulation.

The cytochemical localization of G6Pase activity, which is specific to the endoplasmic reticulum (ER) of Müller cells, was studied after argon laser photocoagulation in the guinea pig retina. After argon laser radiation, Müller cells exhibited enlargement of the cytoplasm, an increase of reactive ER and the nuclei, dislocation of the nuclei and diagonal stretching of the cytoplasm. However, cell attachment between Müller cells and the proliferated pigment epithelial cells or Bruch's membrane differed with the degree of retinal coagulation. This histo- and cytochemical method may be useful for examining Müller cells under various pathological conditions.