Eisuke Uchino

Spontaneous closure of traumatic macular hole

PURPOSE To report eight cases of spontaneous closure of traumatic macular hole. DESIGN Consecutive observational case series. PATIENTS AND METHODS In a consecutive series of 18 eyes of 18 patients with traumatic macular hole, eight patients achieved spontaneous closure of traumatic macular hole. Clinical records of the eight eyes of eight patients were reviewed, together with the results of optical coherence tomography performed in three eyes. RESULTS All eight patients with spontaneous closure of traumatic macular hole were males, with a mean age of 14.6 years (range, 11-21 years). The major cause of blunt trauma was sports-related accidents. Six eyes developed visual symptoms immediately after trauma and two eyes 10 to 12 days later. In all eight eyes, contact lens biomicroscopy revealed a small, full-thickness macular hole not complicated by epiretinal membrane, cuff of subretinal fluid, or posterior vitreous detachment. The macular hole closed spontaneously 1 week to 4 months after trauma. All eight eyes had visual acuity improvement with the final best-corrected visual acuity of 0.5 or better in four (50%) eyes. Optical coherence tomography in three eyes revealed two distinct abnormalities. Two eyes presented with acute foveal dehiscence without involvement of the posterior vitreous cortex. The remaining eye showed at presentation perifoveal vitreous detachment with residual vitreous adhesion to the edge of updrawn fovea and developed release of the vitreofoveal adhesion at the time of hole closure. CONCLUSIONS Spontaneous closure of traumatic macular hole is not uncommon. An observation for a period of up to four months may be a management of choice for traumatic macular hole. There may be clinically and pathogenetically two distinct mechanisms of traumatic macular formation; one type that causes immediate visual loss due to primary dehiscence of the fovea, and the other type that leads to delayed visual loss due to dehiscence of the fovea secondary to persistent vitreofoveal adhesion.

Choroidal Structure in Normal Eyes and After Photodynamic Therapy Determined by Binarization of Optical Coherence Tomographic Images

PURPOSE To determine changes in choroidal structure by binarization of optical coherence tomographic (OCT) images. METHODS Choroidal images were recorded by enhanced depth imaging OCT. The subfoveal choroidal images were analyzed, and the luminal and interstitial areas were converted to binary images by the Niblack method. The interrater, intrarater, and intersession agreements of the binary images were determined for healthy eyes. In eyes with age-related macular degeneration (AMD), the binary images of the choroid before photodynamic therapy (PDT) were compared to those after PDT. The untreated fellow eyes were studied as controls. RESULTS In healthy eyes, the average ratio of the luminal to choroidal area was 65.4%. The interrater agreement rate was high, with intraclass correlation coefficient (ICC) 0.985 and 0.988 for the choroid and luminal areas, respectively. The intrarater ICC was 0.996 for the choroid and 0.997 for the luminal areas. The intersession ICC was 0.993 for the choroid and 0.984 for the luminal areas. In eyes with AMD, the subfoveal choroidal area, the luminal area, and the interstitial areas were thinner 6 months after PDT (all P < 0.01, Wilcoxon signed-rank sum test). The ratio of the luminal to choroidal area was significantly decreased to 62.8% (P < 0.01, Wilcoxon signed-rank sum test). The ratio for the fellow eyes was not significantly changed. CONCLUSIONS The Niblack binarization method can be used to analyze the luminal area of choroid in an OCT image with good repeatability and reproducibility. The change in the subfoveal choroidal area after PDT is due mainly to a decrease in the luminal areas.

Postsurgical evaluation of idiopathic vitreomacular traction syndrome by optical coherence tomography.

PURPOSE To report a case of idiopathic vitreomacular traction syndrome with preoperative and postoperative evaluation by optical coherence tomography. DESIGN Interventional case report. METHODS A 62-year-old woman presented with blurred vision in the left eye because of idiopathic vitreomacular traction syndrome, and she underwent a pars plana vitrectomy. Optical coherence tomography was performed before and after surgery. RESULTS Preoperative optical coherence tomography, right eye, revealed residual adhesion of incomplete posterior vitreous detachment and edematous, thickened outer retina in the macula. A successful vitrectomy relieved vitreoretinal traction with nearly complete resolution of cystoid macular edema within 1 month after surgery, followed in subsequent months by gradual foveal depression resembling a lamellar macular hole. Resolution of subretinal serous fluid was delayed with complete disappearance, some 12 months after surgery, which correlated with a gradual improvement in visual acuity. CONCLUSION Optical coherence tomography provides a sensitive anatomical evaluation of vitreomacular traction syndrome. Reorganization of retinal tissue after surgical intervention for vitreoretinal traction may be slower than is apparent from conventional examinations.

Inflammatory cytokine of basal and reflex tears analysed by multicytokine assay

Tear cytokine has a major role in various pathophysiological conditions of the ocular surface. So far, studies on tear cytokines have shown significant progress in providing an understanding of ocular surface diseases.1–3 The information that could be acquired from each subject, however, until recently has been severely hampered by limited sample volume and assay sensitivity. More importantly, it has become apparent that the relative balance between various cytokines and combinations of cytokines could be more important than absolute concentrations. Previous studies showed that the composition of basic and reflex tears was different, which made it more difficult to understand the ocular surface disorder correctly or to treat the patients suitably.4,5 Cytometric bead array (CBA) is a microparticle based flow cytometric assay that allows us to quantify multiple molecules from a very small sample.3,6,7 Using this method, we evaluated the inflammatory cytokines of basal and reflex tears from a single sample of individual eyes. Twenty three normal volunteers (11 males and 12 females, 22–44 years of age, average 28 years) were recruited for this …

Two patients with severe corneal disease in KID syndrome

PURPOSE To report two independent Japanese patients with keratitis, ichthyosis, and deafness (KID) syndrome and severe corneal disorder. DESIGN Observational case reports. METHODS Clinical observation of a 5-year-old boy (Patient 1) and a 64-year-old man (Patient 2) with KID syndrome, presenting prominent corneal diseases. Molecular genetic assessment of the GJB2 gene encoding connexin-26 was performed. RESULTS Patient 1 had bilateral diffuse superficial punctuate keratopathy with severe corneal neovascularization. He had a missense mutation of the GJB2 gene. Patient 2 had bilateral corneal stromal keratitis and right corneal ulceration with rupture of the Descemet membrane. He did not have any pathologic mutation of the GJB2 gene. The area of palisades of Vogt was diminished and tear production reduced in both patients. Topical eye drops, and corticosteroid or antibiotics, respectively, relieved them effectively. CONCLUSION The impaired ocular surface regulating system might be a cause of corneal disease in KID syndrome and it can be treated by eye drops.

Diurnal variations in luminal and stromal areas of choroid in normal eyes

Aims To determine the diurnal variations of the luminal and stromal areas of the choroid in normal eyes. Methods This was a prospective observational study of 38 eyes of 38 normal subjects. The blood pressure, heart rate, intraocular pressure and enhanced depth imaging optical coherence tomographic (EDI-OCT) images were recorded every 3 hours between 6:00 and 21:00 hours. The horizontal EDI-OCT images of the subfoveal choroid were converted to binary images. The central choroidal thickness (CCT), total cross-sectional choroidal area, the luminal areas, stromal areas and the ratio of luminal area to total choroidal area (L/C ratio) were determined. Results There were significant diurnal variations in the CCT, total choroidal area, luminal area and L/C ratio with the maximum values at 6:00 hours and the minimum values at 15:00 hours (p<0.001 for the CCT, p=0.011 for the total choroidal area, p<0.001 for the luminal area and p=0.014 for the L/C ratio). There was no significant variation in the stromal area (p=0.216). The range of fluctuation in the CCT was significantly correlated with that in the luminal area and the total choroidal area (p<0.001). However, there was no significant correlation between the fluctuation range in the CCT and that in the stromal area (p=0.095). There was no statistical relationship between the systemic parameters and the choroidal parameters. Conclusions The changes in the luminal area are most likely responsible for the diurnal change in the CCT and subfoveal choroidal area. Trial registration number UMIN000019060, Pre-results.

Structural Changes of Inner and Outer Choroid in Central Serous Chorioretinopathy Determined by Optical Coherence Tomography

Purpose To determine the structural changes of the choroid in eyes with central serous chorioretinopathy (CSC) by enhanced depth imaging optical coherence tomography (EDI-OCT). Methods A retrospective comparative study was performed at two academic institutions. Forty eyes with CSC, their fellow eyes, and 40 eyes of age-matched controls were studied. Subfoveal cross sectional EDI-OCT images were recorded, and the hypo reflective and hyperreflective areas of the inner and outer choroid in the EDI-OCT images were separately measured. The images were analyzed by a binarization method to determine the sizes of the hyporeflective and hyperreflective areas. Results In the inner choroid, the hyperreflective area was significantly larger in the CSC eyes (35,640±10,229 μm2) than the fellow eyes (22,908±8,522 μm2) and the control eyes (20,630±8,128 μm2; P<0.01 vs control for both, Wilcoxon signed-rank test). In the outer choroid, the hyporeflective area was significantly larger in the CSC eyes (446,549±121,214 μm2) than the control eyes (235,680±97,352 μm2, P<0.01). The average ratio of the hyporeflective area to the total choroidal area was smaller in the CSC eyes (67.0%) than the fellow eyes (76.5%) and the control eyes (76.7%) in the inner choroid (P<0.01, both). However, the ratio was larger in the CSC eyes (75.2%) and fellow eyes (71.7%) than in the control eyes (64.7%) in the outer choroid (P<0.01, both). Conclusions The larger hyperreflective area in the inner choroid is related to the inflammation and edema of the stroma of the choroid in the acute stage of CSC. The larger hyporeflective areas in the outer choroid is due to a dilatation of the vascular lumens of the larger blood vessels. These are the essential characteristics of eyes with CSC regardless of the onset.

Changes of choroidal structure after corticosteroid treatment in eyes with Vogt–Koyanagi–Harada disease

Aims To report the changes of the choroidal structure in the enhanced depth imaging optical coherence tomographic (EDI-OCT) images after high-dose corticosteroid treatment for acute Vogt–Koyanagi–Harada (VKH) disease. Methods Retrospective, observational case series. Thirty-four eyes of 17 patients with acute VKH disease were examined by EDI-OCT before, and 1, 4 and 52 weeks after the treatment. The EDI-OCT images were binarised by ImageJ, a publicly accessible software. The luminal, stromal and total choroidal areas and ratio of luminal/stromal area (L/S ratio) were measured in the subfoveal choroid of 1500 µm width. The area of the peripapillary atrophy (PPA) was measured in the fundus photographs at 1 and 52 weeks. For statistical analyses, a generalised estimating equation method was used to eliminate the effect of within-subject intereye correlations. Results Before treatment, the EDI-OCT images could not be binarised because of poor image quality in most of the cases. After treatment, the luminal, stromal and total choroidal areas were significantly decreased during the follow-up period (all p<0.05). The L/S ratio significantly fluctuated over time (p=0.0201), and was significantly lower at 4 weeks than at 1 week (p=0.0158). The L/S ratio at 1 week was significantly correlated with increase in the PPA area, subsequent chronic recurrences and total dose of corticosteroid (p<0.0001, p=0.0006, p=0.0037, respectively). Conclusions The L/S ratio measured by binarisation of EDI-OCT images was predictive factor for the progression of PPA, subsequent chronic recurrences and total dose of corticosteroid, and may serve as a marker for degree of choroidal inflammation in the VKH disease.

Selective Gene Transfer to the Retina Using Intravitreal Ultrasound Irradiation

This paper aims to evaluate the efficacy of intravitreal ultrasound (US) irradiation for green fluorescent protein (GFP) plasmid transfer into the rabbit retina using a miniature US transducer. Intravitreal US irradiation was performed by a slight modification of the transconjunctival sutureless vitrectomy system utilizing a small probe. After vitrectomy, the US probe was inserted through a scleral incision. A mixture of GFP plasmid (50 μL) and bubble liposomes (BLs; 50 μL) was injected into the vitreous cavity, and US was generated to the retina using a SonoPore 4000. The control group was not exposed to US. After 72 h, the gene-transfer efficiency was quantified by counting the number of GFP-positive cells. The retinas that received plasmid, BL, and US showed a significant increase in the number (average ± SEM) of GFP-positive cells (32 ± 4.9; n = 7; P < 0.01 ). No GFP-positive cells were observed in the control eyes (n = 7). Intravitreal retinal US irradiation can transfer the GFP plasmid into the retina without causing any apparent damage. This procedure could be used to transfer genes and drugs directly to the retina and therefore has potential therapeutic value.

Choroidal neovascularization of optic disk melanocytoma treated with bevacizumab.

Purpose To report a case of choroidal neovascularization (CNV) associated with optic disk melanocytoma successfully treated with bevacizumab. Methods A 63-year-old man complained of visual impairment in his left eye. His visual acuity was 0.9 OS. Fundus examination showed optic disk melanocytoma associated with serous retinal detachment and mild hemorrhage. Fluorescein and indocyanine green angiography revealed CNV adjacent to the optic disc. Intravitreous bevacizumab (IVB) was performed 3 times. Results Choroidal neovascularization and serous retinal detachment disappeared at 5 months after IVB. Visual acuity recovered to 1.5 OS and has been stable for 1 year follow-up. No adverse events were found related to IVB. Conclusions Intravitreous bevacizumab can be a beneficial treatment for CNV associated with optic disc melanocytoma.