Kenichiro Sho

Two-Year Visual Results for Older Asian Women Treated With Photodynamic Therapy or Bevacizumab for Myopic Choroidal Neovascularization

PURPOSE To compare the long-term visual and anatomic outcome of treatment with photodynamic therapy (PDT) or intravitreal bevacizumab (IVB; Avastin; Genentech Inc, South San Francisco, California, USA) for choroidal neovascularization attributable to pathologic myopia (mCNV). DESIGN An open-label, interventional case series. METHODS SETTING Multi-institutional. PATIENTS Thirty-one eyes of Japanese women who received either PDT or IVB for mCNV. Inclusion criteria were age 50 years or older, greatest linear dimension (GLD) 1200 to 3000 microm, and baseline best-corrected visual acuity (BCVA) 20/200 to 20/40. INTERVENTION PROCEDURES: Patients received either PDT or IVB (1 mg/40 microL) throughout the study, with re-treatment when necessary. MAIN OUTCOME MEASURES BCVA and visual gain/loss at 3, 6, 12, 18, and 24 months after the initial treatment. RESULTS Age, BCVA, location of CNV, refractive error, and symptom duration at baseline did not differ significantly between groups. BCVA was significantly improved at 3 to 12 months (P < .05); however, the significance was lost at 18 and 24 months in the IVB group. The PDT group showed no significant improvement within the first year, and vision slowly worsened after 12 months, becoming significantly worse at 18 and 24 months compared to baseline (P< .01). BCVA was significantly higher in the IVB group at 6 months (P< .05), and 12 months or further (P < .01). Visual gain was significantly greater in the IVB group at 6, 12, 18, and 24 months (P < .05 for 6, 18, and 24 months and P < .01 for 12 months). CONCLUSIONS These findings indicate that the effects of PDT and IVB have a different time course, and that IVB provides a significantly better BCVA than PDT for mCNV over the long-term.

Histopathological findings of X-linked retinoschisis with neovascular glaucoma.

Abstract · Background: X-linked retinoschisis (XLRS) is rarely complicated by neovascular glaucoma. Only a few reports of XLRS histopathological findings with neovascular glaucoma have been published. · Methods: A 41-year-old man with XLRS complicated by neovascular glaucoma in his left eye was examined with electroretinography, B-scan, ultrasound biomicroscopy and computed tomography. He was examined by ophthalmoscopy and fluorescein angiography in the other eye. An enucleation was performed in his left eye due to uncontrollable high intraocular pressure and persistent ocular pain. We examined the enucleated eye histopathologically. · Results: Examination of the enucleated eye showed nuclear sclerosis of the lens, pigmented retrolental membrane and retinoschisis which separated the inner layer of the retina and made a large space in the vitreous cavity without any apparent detachment of the outer layers of the retina. Sclerotic vessels were present histopathologically in both the inner and outer layers of the retina. There was a peripheral anterior synechia, ectropion uveae and a fibrovascular membrane, which contained many lumina of neovascularization, indicating marked rubeosis iridis. Small cystic spaces were observed in both the schitic retina in the peripheral region and the foveal schisis at the outer layer of the retina. The photoreceptor cells had become markedly atrophied and multiple regions of calcification were observed. The optic nerve showed severe atrophy with gliosis, but the central retinal artery and vein were still open within the nerve. · Conclusions: These histopathological findings suggest that rubeosis iridis may have developed secondarily to retinal ischemia due to occlusion of the retinal blood vessels.

Initial non-responders to ranibizumab in the treatment of age-related macular degeneration (AMD).

Background Patients with exudative age-related macular degeneration (AMD) who did not respond to ranibizumab at the induction phase were assessed and referred to as initial non-responders. Methods We retrospectively reviewed the medical records of 215 patients (218 eyes) with exudative AMD. For the initial treatments, patients received three intravitreal injections of ranibizumab (IVR) every 4 weeks. Minimum follow-up period was 12 months. We defined patients with no improvement of best corrected logMAR visual acuity (BCVA), and with no decrease of central retinal thickness (CRT) at the end of the initial treatment, as initial non-responders. Patients who had previous treatment history prior to this investigation were included, but patients who had photodynamic therapy (PDT) with IVR were excluded. Results Twenty-two eyes (10.1%) were identified as initial non-responders. The mean BCVA of initial non-responders before IVR and after induction phase were 0.39 and 0.36, respectively. There was no significant difference between these values, however the mean BCVA decreased significantly to 0.55 at 12 months after the beginning of the induction phase (P = 0.021). The mean greatest linear dimension (GLD) of the lesion before IVR of initial non-responders was 4,121 μm. We found 16 eyes with typical AMD, and six eyes with polypoidal choroidal vasculopathy. One eye had predominantly classic choroidal neovascularization (CNV), and others had occult CNV of typical AMD. As additional treatments, twelve eyes received PDT, and in three of the eyes exudation remained after PDT. Conclusion Initial non-responders were more prevalent in patients with occult CNV than in patients with other CNV types. Some of the initial non-responders did not respond to PDT. This study suggested possible involvement of other factors, in addition to vascular endothelial growth factor, in the occurrence of CNV in initial non-responder patients.

Long term follow up in a case of successfully treated idiopathic retinal vasculitis, aneurysms, and neuroretinitis (IRVAN)

The idiopathic retinal vasculitis, aneurysm, and neuroretinitis (IRVAN) syndrome is a rare clinical entity characterised by peripheral retinal vascular occlusion, retinal vasculitis, and multiple posterior retinal arterial aneurysms.1,2 In most reported cases, visual acuity was aggravated.2–4 We report a case of successfully treated IRVAN syndrome in which good long term visual acuity has been maintained. A 36 year old woman visited the Kansai Medical University Hospital on January 1999, complaining of flies flying in her right eye for the past year. She also had visual disturbance and metamorphopsia for 2 months in her right eye. Her best corrected visual acuity was 20/40 in the right eye and 20/16 in the left eye. Inflammatory cells …

Staging of idiopathic choroidal neovascularization by optical coherence tomography

Abstract. Purpose: To assess the clinical course of idiopathic choroidal neovascularization (ICNV) by optical coherence tomography (OCT). Methods: Thirty-two patients with a clinical diagnosis of ICNV were examined between December 1995 and October 1999. The ages of the patients ranged from 18 to 53 (mean 35.9) years, and the mean period of observation was 5.8 months. Color fundus photography, fluorescein angiography, Indocyanine green angiography, and OCT were performed. The stage of the ICNV was classified as active, intermediate, or cicatricial, based on past history, fundus findings, and fluorescein angiography (FAG). The characteristic OCT images at these three stages were determined. Results: OCT revealed that there were characteristic tomographic images of the choroidal neovascularization (CNV) at each stage. In the active stage, OCT revealed the CNV as a highly reflective, multi-layered area protruding into the subretinal space. In the intermediate stage, the reflectivity of the CNV became stronger and its margin in the subretinal space became smooth. With regression of the ICNV, the lesions consisted of two different areas: a most reflective area corresponding to the fibrotic changes of the CNV (imaged white in OCT images), and a reddish highly reflective area representing a compound protrusion of the CNV. In the cicatricial stage, the ICNV was observed as a moderately high reflective area covered by a dome-shaped highly reflective layer corresponding to the retinal pigment epithelium. Conclusion: These findings demonstrated clearly the changes in the OCT images during the development and regression of ICNV. OCT was useful for following the clinical course and understanding the mechanism of the CNV regression.

Anti-Aquaporin-4 Antibody-Positive Optic Neuritis Treated with Double-Filtration Plasmapheresis

PURPOSE The anti-aquaporin-4 (AQP4) antibody was recently reported to be associated with neuromyelitis optica (NMO). Optic nerve involvements in many NMO cases are bilateral and the prognosis is poor. However, it has been suggested that plasma exchange is effective for those patients when steroid pulse therapy is ineffective. Herein, we report successful treatment of a patient with NMO using double-filtration plasmapheresis (DFPP). CASE A 22-year-old woman consulted a neurologist for neck pain in March 2008. High-intensity lesions were shown in the cervical spinal cord by T2-weighted magnetic resonance imaging. On July 15, the patient was referred to our department for a headache and pain and blurred vision in the left eye. The best-corrected visual acuity was 20/50 and 20/500 in the right and left eyes, respectively, with visual field defects observed in both. After 3 courses of steroid pulse therapy, anti-AQP4 antibodies were positive. In November, the patient again noticed visual acuity loss in the left eye and was treated by additional steroid pulse therapy, which was not effective. Next, she underwent plasma exchange therapy, though it was stopped due to hypotension and dyspnea. The next day, the patient underwent DFPP treatment and visual function gradually recovered. CONCLUSION It is important to consider NMO when steroid pulse therapy is not effective. We successfully and safely treated NMO in a young adult patient using DFPP.

Quantitative evaluation of ischemia–Reperfusion injury by optical coherence tomography in the rat retina

PurposeTo determine whether optical coherence tomography (OCT) can detect early retinal changes after ischemia–reperfusion injury in rats.MethodsThe intraocular pressure (IOP) was elevated to induce retinal ischemia in brown Norway rats. After 90 min of ischemia, the IOP was reduced, and after reperfusion of 1, 2, 4, or 7 days, OCT was performed. After the OCT examination, the eyes were enucleated and histological sections were made.ResultsThe OCT-determined mean retinal thickness was 168 ± 16.9 µm in the untreated control group, and 177 ± 2.16, 170 ± 7.55, 159 ± 5.34, and 140 ± 5.56 µm on days 1, 2, 4, and 7, respectively, in the ischemia–reperfusion group. The histologically determined retinal thicknesses correlated with those obtained by tomographic images, but the histologic thicknesses were 9.5% to 18.5% thinner than those obtained by OCT. Fixation and dehydration of the histological specimens most likely caused tissue shrinkage.ConclusionsOCT can detect retinal changes quantitatively after ischemia–reperfusion injury, and the retinal thicknesses obtained from OCT images are probably a better measure of the true retinal thickness than those measured on histological sections.

Three-year results of a modified photodynamic therapy procedure (ironing PDT) for age-related macular degeneration patients with large lesions

Background To evaluate the effect of photodynamic therapy (PDT) using a modified procedure on exudative age-related macular degeneration having been conventionally difficult to treat. Methods The medical records of eight consecutive patients (eight eyes) with age-related macular degeneration treated with modified PDT were reviewed retrospectively. Modified PDT was used for the lesions that could not be covered by conventional use of PDT, either because the lesion was too large or too close to the optic disc. A moving PDT laser spot at constant speed, for 83 seconds, was used to cover the entire lesion, and was named “Ironing PDT.” This retrospective study was performed with informed patient consent. It was approved by the Institutional Review Board of Kansai Medical University. Results No exudation could be found 36 months after treatment in five eyes (62.5%). There was no significant difference between the best-corrected visual acuity before PDT (0.95 logMAR) and after PDT (1.09 logMAR). The logMAR best-corrected visual acuity was improved in one eye, maintained in five eyes, and deteriorated in two eyes. Conclusion Ironing PDT decreased subfoveal fluid and preserved visual acuity in some patients with age-related macular degeneration difficult to treat with conventional therapy.