[Evaluation of revised diagnosis criteria for sarcoidosis].

PURPOSE: Based on diagnostic criteria revised in 2006, we investigate whether a simple examination will provide a diagnosis for uveitis of sarcoidosis. SUBJECTS AND METHODS: Two hundred and six patients with uveitis suspected of having sarcoidosis who visited 4 hospitals from 1978 to 2008 were evaluated according to Their ocular and systemic findings. RESULTS: One hundred and six patients were diagnosed as having sarcoidosis. Most patients had more than 4 ocular criteria. Bilateral hilar lymphadenopathy (BHL) was seen in 103 (97.2%) of the patients. When BHL was not detected with conventional chest X-rays, chest computerized tomography (CT) was useful in detecting BHL, especially in patients who were tuberculin negative. CONCLUSIONS: When sarcoidosis is suspected from ocular findings, chest X-rays, a tuberculin skin test and serum angiotensin converting enzyme should be performed first. Even if BHL is not detected, a chest CT is useful in cases that are tuberculin negative.

Long-term outcome of trabeculotomy for the treatment of developmental glaucoma.

OBJECTIVE: To elucidate long-term outcome of trabeculotomy in primary and secondary developmental glaucoma. METHODS: One hundred forty-nine eyes of 89 patients with developmental glaucoma who underwent trabeculotomy were retrospectively studied. Intraocular pressure (IOP), success probabilities, visual acuities, and visual field were determined during follow-up and at the final visit. RESULTS: The mean +/- SD IOP of 112 eyes with primary developmental glaucoma at the final visit with an mean +/- SD follow-up period of 9.5 +/- 7.1 years was 15.6 +/- 5.0 mm Hg. The average IOP for 37 eyes with secondary developmental glaucoma was 16.7 +/- 4.2 mm Hg. One hundred eyes (89.3%) with primary developmental glaucoma were defined as achieving success at the final visit. Complete and qualified successes were achieved in 71 eyes (63.4%) and 29 eyes (25.9%), respectively. Visual acuities were 20/40 or better in 78 (59.5%) of 131 eyes examined and were poorer than 20/200 in 32 eyes (24.4%). The causes of poor visual acuities were mainly progression of glaucoma, including delay of detection of onset or surgery and amblyopia. Eyes with glaucoma that existed before 2 months of age or eyes that needed several trabeculotomies were considered to have poor visual acuity. Visual fields were classified as normal or almost normal in 21 (44.7%) of 47 eyes. CONCLUSIONS: Trabeculotomy for developmental glaucoma is effective over a long time. There is a fairly good prognosis for visual function of eyes with developmental glaucoma with early detection of the onset, proper treatment, and proper management after trabeculotomy.

[The influence of hard exudates on the results of vitrectomy for macular edema due to diabetic retinopathy].

PURPOSE: To demonstrate surgical results of diabetic macular edema from the distribution of hard exudates. METHODS: We reviewed 485 eyes of 325 patients followed up more than 1 year who underwent vitreous surgery for diabetic macular edema. Four groups were identified from the distribution of hard exudates in the macular region: no hard exudate type, 179 eyes; hard exudate type, 211 eyes; macular deposit type, 73 eyes; and waxy type, 22 eyes. We evaluated the preoperative characteristics, the period required for absorption of macular edema, visual outcome, and postoperative complications among the four types. RESULTS: In the waxy type, the macular edema was absorbed more slowly than no hard exudate type and hard exudate type(p < 0.05) more patients had proteinurea and were treated by grid photocoagulation before surgery than the other types, and the rate of occurrence of rubeotic glaucoma and attrition by death was higher than in the other types. Visual acuity was significantly improved in all types postoperatively(p < 0.05). Preoperative and postoperative visual acuity were as follows: no hard exudate type, 0.28, 0.48; hard exudate type, 0.21, 0.33; macular deposit type, 0.10, 0.17; and waxy type, 0.04, 0.11. CONCLUSION: The distribution of hard exudates was directly related to surgical results for diabetic macular edema. The waxy type had poor prognosis.

[Subretinal washout for subtle subfoveal hard exudates in diabetic macular edema].

PURPOSE: To evaluate the efficacy of subretinal washout for subtle subfoveal hard exudates in diabetic macular edema. METHODS: This study was done retrospectively on a series of patients with diffuse diabetic macular edema accompanied with subtle subfoveal hard exudates and operated on by one surgeon(NO). Patients ranged in age from 30 to 76 years(mean, 59 years). The postoperative follow-up interval ranged from 12 to 76 months, with a mean of 35 months. Two groups were identified. The first group contained all 26 eyes that had vitreous surgery with subretinal washout. This was compared with a second group of 51 eyes without subretinal washout. We compared the rate of occurrence of postoperative massive foveal hard exudates, visual acuity results, and complications with and without subretinal washout. RESULT: There was no significant difference in base line demographics between the two groups. Massive foveal hard exudates did not occur in eyes with subretinal washout, but occurred in 29 (57%) of the eyes without subretinal washout(p < 0.0001) and in 15 eyes which had undergone reoperation with subretinal washout. Visual acuity improved in 54% of the subretinal washout eyes and 45% of the eyes without it. Visual acuity improved to 20/30 or better in 23% of the eyes with subretinal washout and in 8% of the eyes without subretinal washout. There was no serious complication related to subretinal washout. CONCLUSION: Subretinal washout for subtle subfoveal hard exudates in diabetic macular edema may prevent massive subfoveal exudates and improve visual results. Further study is needed to investigate the pathogenesis.

[Vitreous surgery for macular edema in branch retinal vein occlusion].

PURPOSE: To examine the efficacy of vitreous surgery for macular edema in branch retinal vein occlusion (BRVO). PATIENTS AND METHODS: This study included 183 patients (183 eyes) that underwent vitreous surgery for macular edema in BRVO. They were 77 males and 106 females. The average age of the patients was 65 years (range, 35-87 years). The average duration of macular edema was 18 weeks (range, 1-161 weeks). Mean preoperative visual acuity was 0.32 (0.01-1.2). Preoperative visual acuity was less than 0.1 in 27% and more than 0.5 in 26% of the cases. The average follow-up period was 24 months (range, 12-83 months). RESULTS: Macular edema was absorbed in 21% at 1 month, 54% at 3 months, 81% at 6 months, and 95% at 12 months postoperatively. The mean absorption period of macular edema was 4.5 months. Postoperative visual acuity improved to 0.68, which was statistically significant. Postoperative visual acuity was less than 0.1 in 9% of the cases, more than 0.5 in 68%, and more than 0.8 in 47%. CONCLUSION: After vitreous surgery for macular edema in BRVO, macular edema was absorbed rapidly and visual acuity improved. Vitreous surgery may be an effective treatment.

[Internal limiting membrane peeling in vitreous surgery for diabetic macular edema].

PURPOSE: To evaluate the effect of internal limiting membrane (ILM) peeling in vitreous surgery for diabetic macular edema. METHODS: This study was done on 135 eyes of 103 patients who all underwent diabetic macular edema surgery under the same surgeon. The subjects were 74 eyes of 55 males and 61 eyes of 48 females, aged 35-81 years, with an average of 62 years. The postoperative follow-up period ranged from 12 to 39 months, with an average of 20 months. The ILM peeling was performed in 74 eyes. The subjects were divided in two types of macular edema from the presence (type II, 81 eyes) or absence (type I, 54 eyes) of hard exudates in the macular region. We evaluated the effects of the ILM peeling on the absorption rate of macular edema, the period required for absorption of macular edema, and the postoperative visual acuity. RESULTS: The absorption rate of macular edema was more than 90% with or without the ILM peeling. The period required for absorption of macular edema in eyes with ILM peeling was shorter in type II. There was no difference in the postoperative visual acuity with or without ILM peeling. ILM peeling was not an important factor for the postoperative visual acuity. RESULTS: ILM peeling accelerates the absorption of edema in more severe diabetic macular edema, but we could not find any improvement of visual acuity.

[Surgical removal of subfoveal hard exudates in diabetic maculopathy].

PURPOSE: To examine the efficacy of surgical removal of subfoveal hard exudates during surgery in diabetic maculopathy. PATIENTS AND METHODS: This study was done on 60 patients (66 eyes) that all underwent surgical removal of subfoveal hard exudates under the same surgeon. Thirty-two men (37 eyes) and 28 women (29 eyes) were included in this study. The average age of the patients was 60 years (range, 30-77 years). The average follow-up period was 21 months (range, 12-48 months). All eyes were classified into 3 groups: 13 postoperative massive type eyes, 31 massive type eyes, and 22 scatter type eyes. We evaluated the visual results of these types. RESULTS: Preoperative and postoperative mean visual acuity was as follows: postoperative massive type 0.11, 0.22, massive type 0.12, 0.29, and scatter type 0.19, 0.33. Postoperatively visual acuity improved significantly in all types. There were no subfoveal hard exudates postoperatively in any eyes. CONCLUSION: Surgical removal of massive subfoveal hard exudates is effective, but its effects on vision are limited. Surgical removal of deposited subfoveal hard exudates may prevent massive subfoveal hard exudates postoperatively and improve visual prognosis.