Hiroko Imaizumi

Time Course of Changes in Metamorphopsia, Visual Acuity, and OCT Parameters after Successful Epiretinal Membrane Surgery

PURPOSE To follow the changes in the metamorphopsia, visual acuity, and OCT parameters after epiretinal membrane (ERM) removal. METHODS The study included 49 eyes of 49 patients with an ERM who underwent vitrectomy and membrane peeling. The changes in the best-corrected visual acuity (BCVA), metamorphopsia, and central foveal thickness (CFT) were evaluated at baseline and 1, 3, 6, 9, and 12 months postoperatively. M-CHARTS were used to quantify metamorphopsia. RESULTS The mean BCVA, metamorphopsia scores for horizontal lines (MH) and vertical lines (MV), and CFT improved significantly at 12 months after surgery (P < 0.001). The baseline BCVA, MH score, and MV score were significantly correlated with the corresponding BCVA, MH score, and MV score at 12 months after surgery (P < 0.01). The MH and MV scores at 12 months was significantly correlated with the BCVA at 12 months (P < 0.01), and the baseline MV score was significantly correlated with the BCVA at 12 months (P < 0.05). The MH score but not the MV score was significantly correlated with the CFT at baseline and 12 months (P < 0.05). CONCLUSIONS The preoperative BCVA, MH score, and MV score were prognostic factors for the corresponding postoperative BCVA, MH score, and MV score. These results suggest that surgery for ERM should be considered before severe reduction in the BCVA or the degree of metamorphopsia. In addition, the preoperative MV score was a prognostic factor for postoperative BCVA. The MH score but not the MV score was correlated with the CFT preoperatively and postoperatively.

Macular hole formation following ruptured retinal arterial macroaneurysm

PURPOSE To report four cases of macular hole formation following ruptured retinal arterial macroaneurysm. DESIGN Case-control study. METHODS Review of clinical records of 75 consecutive eyes (73 patients) with macroaneurysm. Macroaneurysms were confirmed using either fluorescein angiography or indocyanine green angiography or both that indicated a telangiectatic retinal vascular change. Clinical data of patients with macroaneurysm with and without macular hole (MH) formation were compared retrospectively. RESULTS Of 75 eyes, four (5.3%; four patients) with macroaneurysm had a macular hole. In one of the four eyes, a macular hole was detected 2 days after the rupture. The distance from the macroaneurysm to the center of the fovea was significantly closer in the four eyes with a macular hole (MH group, 1.1 +/- 0.4 (mean +/- standard deviation [SD]) disk diameter) than in the 71 eyes without a macular hole (non-MH group, 1.9 +/- 0.9 disk diameter) (P =.0196). The incidence of subretinal hemorrhage in the macula was significantly greater in the MH group (100%) than in the non-MH group (35.2%) (P =.0195). CONCLUSIONS Macular hole formation associated with ruptured macroaneurysm is not as uncommon as previously thought. We suggest that there might be early onset of macular hole formation following ruptured macroaneurysm. Macroaneurysms with early-onset macular hole are present near the center of the macula and are accompanied by subretinal hemorrhage in the macula.

Photodynamic Therapy for Age-Related Macular Degeneration in Japanese Patients: Results After One Year

PurposeTo evaluate the effects of photodynamic therapy (PDT) with verteporfin 1 year after treatment in Japanese patients with age-related macular degeneration (AMD) and subfoveal choroidal neovascularization.MethodsBetween May 2004 and March 2005, PDT was performed on 102 eyes of 98 patients (60 men and 38 women) with AMD and subfoveal choroidal neovascularization. Patients were followed for at least 12 months after PDT.ResultsThe mean visual acuities in logarithm of the minimum angle of resolution (logMAR) units were 0.978 at baseline, 0.919 at 3 months, 0.895 at 6 months, 0.892 at 9 months, and 0.874 at 12 months. After PDT, the logMAR visual acuity improved by >0.3 logMAR units or more in 28 eyes (27%) and deteriorated by >0.3 logMAR units or more in 13 eyes (13%). Stable or improved vision was achieved in 93% of patients with polypoidal choroidal vasculopathy (PCV).ConclusionsThe visual outcome in our patients was similar to that of an earlier major Japanese study, and similar to or better than outcomes in Western studies. Differences between Caucasians and Japanese might influence the characteristics of PCV. It is possible that PDT is more effective for AMD patients with PCV than for other AMD patients. Further observations and longer follow-up are necessary. Jpn J Ophthalmol 2007;51:210–215

Knobby-like Choroidal Neovascularization Accompanied With Retinal Pigment Epithelial Detachment

PURPOSE To evaluate the clinical features of knobby choroidal neovascularization (CNV) which was detected using indocyanine green (ICG) angiography and the association between knobby CNV and idiopathic polypoidal choroidal vasculopathy (IPCV). METHOD We studied 164 eyes with retinal pigment epithelial detachment (PED) accompanied with CNV. These patients were older than 50 years. We detected knobby CNV in 96 eyes of 164 PED eyes (58.5%). Knobby CNV was defined as follows: knobbed blood vessels were observed from the early phase and remained hyperfluorescent through the ICG angiography. We classified 3 groups on the basis of the types of vessels with knobby CNV: group I, multiple isolated knobby CNVs without continuous vessels (24 eyes); group II, knobby dilatations in some parts of CNV (45 eyes); group III, network vessels ending in multiple aneurysmal swelling as in IPCV (27 eyes). RESULT We found knobby CNV in only 20% of eyes with serous PED, but about 70% in neovascular, serosanguineous, and hemorrhagic PED. The ratio of each group showed no distinction statistically. Knobby CNV mostly appeared in macular areas, and was frequently accompanied with subretinal or subpigment epithelial hemorrhage. Subretinal reddishorange lesions were seen in 50% of group I, 60% of group II, and 89% of group III. Knobby CNV showed occult CNV in fluorescein angiography. In late phase ICG angiography, knobby CNV leaked ICG. New lesions occurred in all groups. CONCLUSION We think that knobby CNV is a common finding in subpigment epithelial neovascularization, and that IPCV vascular lesion is one type of subpigment epithelial neovascularization.

Effects of Exercise on the Structure and Circulation of Choroid in Normal Eyes

Aims To determine the effects of dynamic exercise on the circulation and the luminal and stromal areas of the choroid in normal eyes. Methods This was a prospective interventional study of 38 eyes of 38 normal subjects enrolled by invitation. The systolic and diastolic blood pressures, heart rate, intraocularpressure, mean ocular perfusion pressure (MOPP), choroidal blood velocity, and enhanced depth imaging optical coherence tomographic (EDI-OCT) images were recorded before, and immediately after mild dynamic exercise. The same measurements were recorded after 10 min of rest. The choroidal blood velocity was measured bylaser speckle flowgraphy, and the mean blur rate was used for the evaluations. The horizontal EDI-OCT images of the subfoveal choroid were converted to binary images. The central choroidal thickness (CCT), total cross sectional choroidal area, luminal areas, stromal areas, and the ratio of luminal area to total choroidal area (L/C ratio) were determined from these images. Results The systolic and diastolic blood pressures, heart rate, MOPP, and the mean blur rate were significantly increased immediately after the exercise and significantly decreased 10 minutes after the exercise. There wereno significant changes in the mean CCT, the mean total choroidal area, the mean luminal and stromal areas, and the mean L/C ratio after the exercise. Conclusions Our results suggest that a rest period is needed before measurements of blood flow velocity but not necessary for the EDI-OCT imaging to determine the choroidal thickness and area.

Changes in metamorphopsia in daily life after successful epiretinal membrane surgery and correlation with M-CHARTS score

Purpose To determine the correlation between the changes in metamorphopsia in daily life environment and the M-CHARTS scores after epiretinal membrane (ERM) removal, and to determine the criterion for determining whether clinically significant changes in the metamorphopsia score have occurred in M-CHARTS. Methods We studied 65 eyes undergoing vitrectomy for unilateral ERM. Self-administered questionnaires were used to examine the metamorphopsia in their daily life. The degree of metamorphopsia was determined by M-CHARTS. The receiver operating characteristic curve was used to determine the best predictor of the changes in metamorphopsia in daily life. To determine the reproducibility of the M-CHARTS score, another set of 56 eyes with ERM was tested twice on two different days. Results The postoperative changes in the logarithm of the M-CHARTS score was defined as M2-value. The area under the receiver operating characteristic curve for the M2-value as a predictor of the changes in metamorphopsia in daily life was larger than area under the receiver operating characteristic curve obtained for any other parameter. The optimal cutoff value was −0.4. The 95% limits of agreement between test and retest measurements had a reproducibility of ±0.3 logarithm of the M-CHARTS score. Taking into account not only the reproducibility but also the consistency with the subjective changes, we determined the criterion for clinically significant changes in the M-CHARTS scores as a change of the M2-value by ≥0.4. Conclusion Evaluating the changes in the M-CHARTS scores in logarithmic form is favorable not only theoretically but also from the perspective of consistency with the subjective changes.

One Case of Harada Disease Complicated by Acute Posterior Multifocal Placoid Pigment Epitheliopathy-like Recurrence in Both Eyes.

Background: We encountered a patient who developed serous retinal detachment in one eye first, subsequently showed multiple small subretinal punctated opacity looking like acute posterior multifocal placoid pigment epitheliopathy (APMPPE) in both eyes, and had repeated recurrence.Case: A 28-year-old female presented with serous retinal detachment accompanied by multifocal small subretinal white punctated opacity at the posterior pole of the fundus in the left eye. Fluorescein angiography (FAG) revealed many small punctated hypofluorescent lesions scattered all over the eye in the early stage and multiple subretinal spotty leakage of fluorescein, subretinal accumulation of dye, and leakage of fluorescein from the optic disc in the late stage. Indocyanine green angiography (ICG) revealed small punctated hypofluorescent lesions from the early to late stage in both eyes. The disease recurred five and a half months after, and there appeared many yellowish white round opaque parts and serous retinal detachment at the posterior pole in both eyes. FAG showed a reversal phenomenon of fluorescein in both eyes. On ICG many small punctated hypofluorescent lesions were noted and in the late stage insular faint hypofluorescence consistent with serous retinal detachment, light tissue stain and fluorescent leakage in the center of the hypofluorescent lesion were also found. The disease recurred three times thereafter. At present, about two years after the first medical examination, the fundus does not show any sunset glow-like fundus, and vision of 1.2 is maintained on the right and left.Conclusion: A rare case of Harada disease complicated with APMPPE-like recurrence is presented.

DETECTION OF CHOROIDAL FOLDS IN PATIENTS WITH VOGT-KOYANAGI-HARADA DISEASE BY RETROMODE SCANNING LASER OPHTHALMOSCOPY.

PURPOSE To determine whether the choroidal folds in patients with Vogt-Koyanagi-Harada disease can be detected by retromode of a scanning laser ophthalmoscopy (SLO) with infrared laser light source. METHODS The authors examined two patients with Vogt-Koyanagi-Harada disease at the acute stage by retromode imaging scanning laser ophthalmoscopy with an infrared laser before and after steroid treatment. RESULTS The retromode imaging by scanning laser ophthalmoscopy clearly and noninvasively delineated the choroidal folds in both cases. The folds disappeared after steroid treatment and reappeared with recurrences of uveitis. CONCLUSION The retromode imaging by scanning laser ophthalmoscopy can detect the choroidal folds and should be useful for detecting and monitoring the choroidal folds in Vogt-Koyanagi-Harada disease.

Choroidal melanoma complicated by central retinal vein occlusion

BACKGROUND Various complications for choroidal melanoma have been reported. However, there are no reports on choroidal melanoma complicated with central retinal vein occlusion. CASE REPORT A 37-year-old male showed an elevated yellowish white tumor of about 8 discs in diameter, and involving the optic disc in the left eye. Serous retinal detachment and subretinal exudate were noted around the tumor. Central retinal vein occlusion occurred concurrently. Fluorescein angiography revealed blocks due to hemorrhage and fluorescence leakage from the retinal vein. Dilation of retinal capillary vessels and marked leakage of fluorescence from the retinal vein and capillary vessels were found in the tumorous region. In the late stage, the entire tumor presented hyper-fluorescence. On indocyanine green angiography, the tumor on the whole presented hypo-fluorescence from the early to late stage, and an insular hyper-fluorescence suggestive of the presence of intratumor vessels with leakage of fluorescence was seen inside. Ultrasonography revealed choroidal excavation. General examination showed no abnormality. On the basis of these findings the patient was diagnosed with choroidal melanoma. CONCLUSION We report a case of choroidal melanoma, which was complicated with central retinal vein occlusion by mechanical compression and invasion of the optic disc from the first medical examination.