Kohei Ishikawa

Optical Coherence Tomography Before and After Vitrectomy with Internal Limiting Membrane Removal in a Child with Optic Disc Pit Maculopathy

BackgroundThe pathogenesis of optic disc pit maculopathy is still unknown, although recent optical coherence tomographic (OCT) analyses have made a great contribution to clarifying its morphological appearance. The best treatment for this disease is also controversial.CaseWe report on a 7-year-old girl with optic disc pit maculopathy associated with a separation of the internal limiting membrane (ILM) near the optic disc.ObservationsThe OCT images before treatment showed a conduit from the perineural space to the schisislike separation of the sensory retina with a dome-shaped separation of the ILM. A serous detachment (SD) in the macula, centered on the fovea, was also present. In OCT images after laser photocoagulation, the conduit appeared to be closed, but the SD was still present. Vitrectomy with ILM removal and gas tamponade resulted in a marked reduction of the SD in the macular area. Focal macular electroretinograms and visual acuity demonstrated a recovery of macular function.ConclusionThe dome-shaped separation of the ILM suggested that the vitreous might be exerting a tractional force on the optic disc pit, and vitrectomy with ILM peeling released the traction on the optic disc pit. Jpn J Ophthalmol 2005;49:411–413

Half-dose vs one-third-dose photodynamic therapy for chronic central serous chorioretinopathy

PurposeTo prospectively compare the effects of half-dose verteporfin (3 mg/m2) photodynamic therapy (1/2 PDT) with those of one-third-dose verteporfin (2 mg/m2) PDT (1/3 PDT) for chronic central serous chorioretinopathy (CSC).MethodsSixteen eyes of 16 consecutive patients with chronic CSC were enrolled and followed up for a 3-month study period. The first 10 patients received 1/2 PDT and the next 6 patients received 1/3 PDT. The resolution rate of subretinal fluid (SRF) was compared between the two groups. The changes in the choroidal thickness inside and outside the PDT-applied area in both groups were also evaluated.ResultsSRF disappeared in all eyes (100%) in the 1/2 PDT group and in two eyes (33%) in the 1/3 PDT group. In the 1/2 PDT group, choroidal thickness inside and outside the PDT-applied area reduced significantly from the baseline (inside, from 387±24 to 325±25 μm; outside, from 292±25 to 249±19 μm; both P=0.005). In the 1/3 PDT group, choroidal thickness decreased in two eyes where SRF disappeared (inside, 87.2 and 90.9% of the baseline; outside, 91.4 and 92.6% of the baseline), but did not change in the other four eyes where SRF remained (inside, 104.1, 100.0, 105.1, and 100.5% of the baseline; outside, 98.9, 103.0, 100.0, and 99.0% of the baseline).Conclusions1/2 PDT is more effective than 1/3 PDT in the resolution of SRF for chronic CSC. Decrease in the choroidal thickness after PDT may be related to the resolution of SRF in chronic CSC.

C9-R95X Polymorphism in Patients with Neovascular Age-Related Macular Degeneration

PURPOSE A non-sense mutation at codon 95 in the gene encoding complement factor C9 (C9-R95X) is found most frequently among Japanese. The authors investigated the association between C9-R95X and Japanese patients with neovascular age-related macular degeneration (AMD) and polypoidal choroidal vasculopathy (PCV). METHODS The presence of the C9-R95X polymorphism was assessed by direct sequencing in Japanese patients with either PCV (n = 105) or neovascular AMD (n = 198) and 396 control subjects. Multivariate regression analyses were conducted. Photocoagulation was applied in the eyes of mice with a heterozygous defect in the C3 gene and control wild-type mice. Photocoagulation was also applied to wild-type mice before either anti-C9 antibody or isotype IgG was injected into the eyes. The eyes were collected later for measurement of vascular endothelial growth factor (VEGF) and histological evaluation of choroidal neovascularization (CNV). RESULTS The frequency of those with one or two C9-R95X variants was lower in neovascular AMD (2.02%) than in PCV (5.71%) and controls (6.05%). The presence of C9-R95X conferred a 4.7-fold reduction (95% confidence interval, 1.2-18.1; P = 0.021) in the risk for neovascular AMD after adjusting for the major AMD risk factors. A heterozygous defect in the C3 gene was associated with the reduced growth of laser-induced CNV, as was intraocular injection of anti-C9 antibody. This reduced CNV growth was accompanied by a decreased level of secreted VEGF in the intraocular fluid. CONCLUSIONS These findings support the notion that the haploinsufficiency of C9, a terminal complement complex component, engenders reduced intraocular secretion of VEGF and decreased risk for CNV development.

Displacement of foveal area toward optic disc after macular hole surgery with internal limiting membrane peeling

PurposeTo determine whether there is a displacement of the fovea toward the optic disc after successful macular hole (MH) surgery with internal limiting membrane (ILM) peeling.MethodsThe medical records of 54 eyes of 53 patients that had undergone pars plana vitrectomy with ILM peeling and gas or air tamponade for an idiopathic MH were evaluated. Spectral-domain optical coherence tomography (OCT) had been performed before and >6 months after the surgery. The preoperative distances between the center of the MH and the optic disc (MH-OD), center of the MH and the bifurcation or crossing of retinal vessels (MH-RV) were measured in the OCT images. In addition, the postoperative distance between the center of the fovea and optic disc (F-OD) and the center of the fovea and the same bifurcation or crossing of retinal vessels (F-RV) were measured in the OCT images.ResultsThe F-OD was 2.67±0.33 disc diameters (DD), which was significantly shorter than that of the MH-OD of 2.77±0.33 DD (P<0.001). The F-RV was also significantly shorter than the MH-RV on the inner nasal area (from 0.85±0.16DD to 0.79±0.15DD; P<0.001), the inner temporal area (from 0.82±0.15DD to 0.77±0.14DD; P<0.001), and outer nasal area (from 1.70±0.31DD to 1.65±0.32DD; P<0.001), but it was significantly longer than the MH-RV in the outer temporal area (from 1.65±0.29DD to 1.68±0.29DD; P<0.001).ConclusionOur results showed that successful closure of a MH by vitrectomy with ILM peeling and gas tamponade leads to a displacement of the center of the macula toward the optic disc.

Differences in macular morphology between polypoidal choroidal vasculopathy and exudative age-related macular degeneration detected by optical coherence tomography.

Purpose: To evaluate the differences in the optical coherence tomographically determined macular morphology in eyes with polypoidal choroidal vasculopathy (PCV) from eyes with exudative age-related macular degeneration (AMD) quantitatively. Methods: The medical records of 208 eyes of 203 Japanese patients with PCV or exudative AMD who were newly treated for choroidal neovascularization were reviewed. The six linear, low-resolution, high-speed scans of 6 mm were analyzed using a manually assisted computer algorithm, which allowed us to manually draw spline lines arbitrarily on the images so that the subretinal fluid and neurosensory retina could be segmented. The thickness of the neurosensory retina and height of the serous retinal detachment (SRD) within the central 3-mm and 6-mm areas were calculated. Results: SRDs were observed in 53% (63/119) of the eyes with exudative AMD and in 78% (69/89) of the eyes with PCV (P < 0.001). The height of the SRD was 21.9 ± 3.7 &mgr;m (±SEMs) in eyes with exudative AMD and 56.3 ± 7.4 &mgr;m in eyes with PCV (P < 0.001). The thickness of the neurosensory retina was 300.0 ± 5.2 &mgr;m in eyes with exudative AMD and 275.8 ± 4.7 &mgr;m in eyes with PCV (P < 0.001). Conclusion: Eyes with PCV are characterized by a higher incidence of SRDs, greater SRD height, and less intraretinal edema than eyes with exudative AMD.

Axial length increases and related changes in highly myopic normal eyes with myopic complications in fellow eyes.

Purpose: To determine whether the axial length (AL) in highly myopic normal adult eyes with myopic complications in the fellow eyes increases significantly during a 1-year interval and to investigate the relationships between the changes in the AL and different ocular parameters. Methods: The medical records of 20 highly myopic normal eyes whose fellow eyes had myopic complications were reviewed. The AL, subfoveal choroidal thickness, height of a posterior staphyloma, and length of the retinal pigment epithelium from the fovea to 3-mm superior, inferior, nasal, and temporal retina were measured twice at an interval of approximately 1 year. The changes in these ocular parameters and their correlations were investigated. Results: The AL increased, the choroid became thinner (both P < 0.001), the superior (P < 0.05) and temporal (P < 0.01) staphyloma height increased, and the superior and temporal retinal pigment epithelial length increased (both P < 0.01). All the changes were significant. Stepwise analyses indicated that the factor most associated with the increase in the AL was the increase in the superior retinal pigment epithelial length (P < 0.001). Conclusion: Our results indicate that the AL can increase significantly in highly myopic normal adult eyes during a 1-year interval, and the increase in the posterior staphyloma height is the most likely cause for the increased AL.

Morphologic and angiographic assessment of the macula after macular translocation surgery with 360° retinotomy

Abstract Purpose To compare the optical coherence tomographic assessment of retinal thickness and the fluorescein angiographic appearance after macular translocation surgery for subfoveal choroidal neovascularization. Design Retrospective, noncomparative, interventional case series. Participants Twenty-three consecutive eyes. Intervention and testing Optical coherence tomography and fluorescein angiography were performed before and 6 to 15 months (mean ± standard error [SE], 10.4±0.7) after macular translocation surgery with a 360° retinotomy in 23 patients, ages 48 to 79 years, with age-related macular degeneration (12 eyes), polypoidal choroidal vasculopathy (2 eyes), and high myopia (9 eyes). The diameter of the choroidal neovascularizations ranged from 0.3 to 2.6 disc diameters (mean ± SE, 1.2±0.2), and the angle of rotation of the retina ranged from 11° to 45° (mean ± SE, 29.1±2.1°). Results The preoperative best-corrected visual acuity ranged from hand motions to 20/100, and the postoperative best-corrected visual acuity ranged from 20/667 to 20/25. Optical coherence tomography demonstrated a concave foveal configuration after surgery in all 23 eyes, with a mean foveal thickness of 150±11 μm (mean ± SE). Fluorescein angiography showed various degrees of fluorescein leakage with a pattern similar to cystoid macular edema in 16 of 23 eyes (70%). Conclusions The newly located macula after macular translocation surgery with a 360° retinotomy had cystoid macular edema on fluorescein angiography and normal macular configuration with normal thickness in optical coherence tomography.

Visual function 5 years or more after macular translocation surgery for myopic choroidal neovascularisation and age-related macular degeneration

PurposeTo evaluate the changes in the best-corrected visual acuity (BCVA) after 1 year and after ≥5 years after macular translocation for age-related macular degeneration (AMD) or myopic choroidal neovascularisation (mCNV).MethodsThe medical records of 61 consecutive patients who underwent macular translocation with 360° retinotomy for AMD (35 eyes) or mCNV (26 eyes) were reviewed. Overall, 40 patients, 17 mCNV and 23 AMD, were followed for at least 5 years. BCVA and area of the Goldmann visual field (VF) measured before, 12 months after surgery, and at the final visit.ResultsIn the 23 AMD eyes followed for ≥5 years, the mean preoperative BCVA was 1.149±0.105 logMAR units, which significantly improved to 0.69±0.06 logMAR units at 1 year (P<0.001). This BCVA was maintained at 0.633±0.083 logMAR units on their final examination. In the 17 eyes with mCNV followed for ≥5 years, the mean preoperative BCVA was 1.083±0.119 logMAR units, which was significantly improved to 0.689±0.121 logMAR units at 1 year (P=0.001). This BCVA was maintained at 0.678±0.142 logMAR units on their final examination. The area of the VF was significantly decreased at 12 months and did not change significantly thereafter.ConclusionsOur results show that macular translocation surgery significantly improves the BCVA and significantly decreases the VF area of eyes with mCNV or AMD after first 1 year. The BCVA and VF area do not change significantly from the values at 1 year for at least 5 years.

Effect of photodynamic therapy alone or combined with posterior subtenon triamcinolone acetonide or intravitreal bevacizumab on choroidal hypofluorescence by indocyanine green angiography.

Purpose: Choroidal hypofluorescence has been reported beneath the photodynamic therapy (PDT) site in clinical studies. We evaluated the choroidal hypofluorescence after combined PDT with posterior subtenon injection of triamcinolone acetonide or PDT with an intravitreal injection of bevacizumab for age-related macular degeneration. Methods: Two hundred and forty-two eyes with a subfoveal choroidal neovascularization caused by age-related macular degeneration were studied. Ninety-two eyes underwent PDT alone, 90 eyes underwent PDT with sub-Tenon injection of triamcinolone acetonide, and 60 eyes underwent PDT with intravitreal injection of bevacizumab. Verteporfin-induced choroidal hypoperfusion was determined by indocyanine green angiograms. The intensity of the diffuse fluorescence within the PDT site away from the choroidal neovascularization lesion and from the normal retina just peripheral to the optic disk was measured by densitometry (Topcon IMAGEnet computer system, Topcon, Tokyo, Japan) in the indocyanine green angiogram images obtained at 10 minutes 3 months after the PDT. The ratio of the average brightness of the retina within the PDT area to that of the retina peripheral to the optic disk (irradiated/nonirradiated retinal brightness ratio) was calculated for each angiogram. Results: The irradiated/nonirradiated retinal brightness ratio of the angiograms was 0.96 in the PDT-alone group, 0.85 in the sub-Tenon injection of triamcinolone acetonide-PDT group, and 0.89 in the intravitreal injection of bevacizumab-PDT group (Kruskal-Wallis H test, P < 0.05). Conclusion: The degree of choroidal hypofluorescence in the indocyanine green angiogram images 3 months after PDT in the sub-Tenon injection of triamcinolone acetonide and intravitreal injection of bevacizumab group was higher than that of PDT-alone group. Sub-Tenon injection of triamcinolone acetonide and intravitreal injection of bevacizumab can prolong the duration of the choroidal hypofluorescence after PDT.

Focal macular electroretinograms in eyes with wet-type age-related macular degeneration.

PURPOSE To study the properties of the focal macular electroretinograms (fmERGs) in eyes with untreated wet-type age-related macular degeneration (AMD). METHODS fmERGs were recorded from 157 eyes of 157 consecutive patients with untreated wet-type AMD (113 men, 44 women; age, 71.3 +/- 8.0 years). The fmERGs were recorded under direct fundus observation using a modified infrared fundus camera and a 15 degrees stimulus spot. Amplitudes and implicit times of the fmERGs recorded from the AMD patients were compared with those from 21 age-similar healthy controls. RESULTS The amplitudes of fmERGs in the AMD patients were significantly smaller (P < 0.001) and the implicit times were significantly longer (P < 0.001) than the corresponding values in the control eyes. There was a significant correlation between amplitude and implicit time of the fmERG and visual acuity (logMAR), but the degree of correlation was weak. The difference in the b/a amplitude ratio between the AMD patients and healthy controls was not significant. CONCLUSIONS The significant reduction in amplitude and the severe delay in implicit times of a- and b-waves of the fmERGs indicated significant functional alterations in the inner and the outer retinal layers of the macular area of eyes with wet-type AMD.