Kouichi Ohta

Microperimetric determination of retinal sensitivity in areas of dissociated optic nerve fiber layer following internal limiting membrane peeling

PurposeTo investigate the effects of a dissociated optic nerve fiber layer (DONFL) on retinal sensitivity.MethodsThe medical records of 17 eyes with an idiopathic macular hole that underwent vitrectomy and internal limiting membrane (ILM) peeling were examined. All patients underwent a complete ophthalmic examination, color fundus photography, and argon blue-filter photography to determine whether a DONFL was present. The retinal function was assessed by comparing the mean retinal sensitivities in the DONFL area to those in the surrounding normal retina by static microperimetry >3 months after the surgery. The retinal sensitivities of eight regions nearest the fovea and all at the same distance from it were determined in all patients. We divided the retinal sensitivities in the two areas, that is, inside and outside the area of the DONFL, and compared each mean value.ResultsFollowing the initial vitrectomy, the macular holes of all eyes were closed. The mean retinal sensitivities in the area of the DONFL did not differ significantly from those in the surrounding areas (P = 0.60).ConclusionsDONFL associated with ILM peeling does not alter retinal function in the area of the DONFL as it does with a nerve fiber layer defect.

Retinal thickness in eyes with idiopathic macular hole after vitrectomy with internal limiting membrane peeling

PurposeTo compare the thickness of each retinal layer in the parafoveal and perifoveal regions of eyes after successful closure of a macular hole (MH) by pars plana vitrectomy with internal limiting membrane (ILM) peeling to the corresponding areas of the normal fellow eyes.MethodsTwenty-two eyes of 22 patients with an idiopathic MH who underwent PPV with ILM peeling at the Matsumoto Dental University Hospital were studied. The retinal thickness was measured manually with the volume scan mode of the Spectralis HRAu2009+u2009OCT (Heidelberg Engineering, Germany).ResultsThe average postoperative parafoveal thickness of the temporal sector was 314.8xa0μm, and that of the corresponding area of the fellow eyes was 325.0xa0μm (Pu2009=u20090.01). The parafoveal thickness of the nasal sector was 360.7xa0μm, and that of the fellow eyes was 339.6xa0μm (Pu2009<u20090.0001). Changes in the inner retinal layer thicknesses contributed to the decreased temporal and increased nasal sectors. The perifoveal retinal thickness was significantly increased in all sectors after PPV, probably due to an increase in the outer nuclear layer thickness.ConclusionsPPV with ILM peeling for MHs can cause microstructural changes in wide areas of the macula region, suggesting a loss of longitudinal support of the Müller cells.

Cytokine and Molecular Analyses of Intraocular Lymphoma

Purpose: The authors investigate the efficacy of using the cytokine levels and clonal heavy-chain immunoglobulin (IgH) gene rearrangements in the vitreous as adjunctive tools to diagnose intraocular lymphoma (IOL). Methods: The IL-10 and IL-6 levels and IgH gene rearrangements were analyzed in vitreous samples from 8 cases of IOL and in 14 uveitis patients. Results: The level of IL-10 with an IL-10/IL-6 ratio > 1 was significantly higher in all eyes with IOL. B-cell monoclonality was detected in only 5 of 8 eyes with IOL. Conclusions: The measurements of the levels of cytokines are valuable as a reliable biomarker.

Vogt-Koyanagi-Harada disease associated with brainstem encephalitis.

We report on a 28-year-old man with a 2-year history of Vogt-Koyanagi-Harada disease (VKH), who developed one-and-a-half syndrome, facial hypoesthesia, facial nerve palsy, hearing loss and limb ataxia on the right side. An MRI showed inflammatory lesions in the pons extending into the left middle cerebellar peduncle. Corticosteroid treatment successfully ameliorated his symptoms and lesions. This patient demonstrated the possible association of brainstem encephalitis with VKH.

μ-Crystallin, New Candidate Protein in Endotoxin-Induced Uveitis

PURPOSE. micro-Crystallin (CRYM) is a major taxon-specific lens protein. The purpose of this study was to investigate the function of CRYM in eyes of mice with endotoxin-induced uveitis (EIU). METHODS. EIU was induced by an injection of a lipopolysaccharide (LPS) into the footpad of male C57BL/6J, CRYM knockout (CRYM(-/-)), and wild-type (CRYM(+/+)) mice. The expression of CRYM in the iris-ciliary body (ICB) was investigated by Western blot analyses and real-time RT-PCR at 12 hours and 1, 3, and 5 days after the LPS injection. The number of cells that had infiltrated the anterior chamber (AC) of the CRYM(+/+) mice was compared to that in the CRYM(-/-) mice at 1, 3, 5, and 7 days. The expressions of the mRNA of interleukin (IL)-1alpha, IL-6, tumor necrosis factor (TNF)-alpha, and granulocyte macrophage-colony stimulating factor (GM-CSF) in the ICB of the two groups of mice were compared. RESULTS. The mRNA of CRYM was upregulated at 12 hours after LPS injection, and CRYM protein increased at 3 days. The number of inflammatory cells in the AC of the CRYM(-/-) mice was not significantly different on day 1 from that in the CRYM(+/+) mice, but was significantly lower (17.9 +/- 1.6 vs. 27.1 +/- 2.4 cells/section) on day 5. Expression of the mRNA of IL-1alpha and -6 in the CRYM(-/-) mice was significantly lower than that in the CRYM(+/+) mice on day 5. CONCLUSIONS. CRYM plays an important role in the development of the second peak of murine EIU.

Slowly progressive non-neoplastic autoimmune-like retinopathy

Dear Editor, Paraneoplastic and autoimmune retinopathies (AIRs) are immunologically mediated retinal degeneration associated with antibodies directed against antigens in retinal cells. Three main types of AIR have been identified: cancer-associated retinopathy (CAR), melanoma-associated retinopathy, and non-neoplastic autoimmune retinopathy (np-AIR) [2]. Although an acute decrease of vision is usually common in cases of AIRs, we report a case of slowly progressive decrease of vision that was confirmed by Western blot (WB) and immunohistochemistry (IHC) to be an npAIR-like disease.

Asymmetrical steepening of the foveal contour after macular hole surgery with internal limiting membrane peeling.

PurposeWe have previously shown that the thickness of the parafoveal retina was asymmetrical in spectral-domain optical coherence tomographic (SD-OCT) images after idiopathic macular hole (MH) closure by pars plana vitrectomy (PPV) with internal limiting membrane (ILM) peeling. The aim of this study was to determine whether the foveal slopes around the closed MH were also asymmetrical.MethodsForty-three eyes with an MH treated with PPV with ILM peeling at Matsumoto Dental University Hospital were studied. The foveal slope was determined with ImageJ software in both the horizontal and vertical images obtained by SD-OCT at 6xa0months after the surgery. The possible related factors were also compared.ResultsThe mean angles of the foveal slopes of the nasal, superior, inferior, and temporal sectors were 31.4°xa0±xa06.2°, 31.2°xa0±xa05.4°, 31.6°xa0±xa07.4°, and 29.9°xa0±xa06.6°, respectively, in the fellow eyes. The corresponding values in the operated eyes were significantly steeper at 50.4°xa0±xa09.1°, 46.9°xa0±xa011.3°, 48.6°xa0±xa011.3°, and 41.3°xa0±xa011.2°, respectively (Pxa0<xa00.00001). Both the nasal and inferior slopes were significantly steeper than the temporal slopes of the same operated eye (Pxa0=xa00.002 and Pxa0=xa00.023, respectively). There was no significant correlation between each slope and the visual acuity, MH size, area of peeled ILM, postoperative parafoveal retinal thickness, defect of the retinal outer layers, disc-foveal distance, stage, and use of dye for ILM peeling.ConclusionsAlthough the postoperative foveal contour was markedly changed asymmetrically, the significance of the change was not determined.

Transient Increase of Retinal Nerve Fiber Layer Thickness after Vitrectomy with ILM Peeling for Idiopathic Macular Hole

Purpose. The purpose of this study was to determine the long-term changes in the circumpapillary retinal nerve fiber layer (RNFL) thickness following macular hole surgery with internal limiting membrane (ILM) peeling combined with phacoemulsification. Methods. Thirty-eight eyes of 37 patients who had pars plana vitrectomy (n = 36) between 2010 and 2014 were studied. The average thicknesses of the global and the six sectors of the RNFL were determined before and at 1, 3, 6, 12, and 24 (n = 22) months (M) after the surgery by spectral-domain optical coherent tomography. The postoperative mean RNFL thickness at each time was compared to that before the surgery by paired t-tests. Results. The RNFL of the operated eyes was significantly thicker at 1 month (1u2009M) and 3u2009M in all but the inferior-nasal sectors. The significant increase remained until 12u2009M in the superior-temporal and superior-nasal sectors. In addition, the RNFL was also significantly thicker in the temporal-inferior sector at 12u2009M based on the findings in 38 eyes. Conclusions. The postoperative RNFL was thicker in all but the nasal-inferior sector for at least 12u2009M after surgery. This prolonged increase of the RNFL thickness may indicate damage and mild edema of the RNFL.

Cancer-associated retinopathy in a patient with seminoma.

PURPOSEnThe purpose of this study was to report our findings on a patient with cancer-associated retinopathy who had seminoma.nnnMETHODSnA 43-year-old man, who had been diagnosed with Stage 1 seminoma, complained of blurred vision. Fundus examination revealed attenuated retinal arteries, mild optic disk pallor, and a thinning of the outer nuclear layer. Ring scotomas were found in the visual fields of both eyes. The amplitudes of the electroretinograms were moderately reduced. The patients serum was analyzed for antibodies.nnnRESULTSnAntibodies against recoverin, Hu, and Ma-2 antigens were not detected. However, Western blots of the serum detected 2 bands at 41 and 64 kDa. The 41-kDa band was an anti-retina-specific antibody. Immunoreactivity was identified in the photoreceptor layer of mice retinas. From these findings, we diagnosed the patient with cancer-associated retinopathy. The visual functions remained stable after the removal of the primary lesion at an early stage, treatment with steroids, and intravenous immunoglobulin.nnnCONCLUSIONnThis is the first case of cancer-associated retinopathy because of seminoma. The progression of the disease was reduced by removing the seminoma at an early stage, treatment with steroids, and intravenous immunoglobulin.

Preserved anterior chamber configuration after a core vitrectomy applied for corneal triple procedure.

Although the original application of an anterior core vitrectomy for penetrating keratoplasty (PKP) is as a preventive measure against vitreous prolapse, we have observed that this procedure provides a more anatomically preserved configuration of the anterior chamber (AC) compared with conventional cases (without core vitrectomy). Postoperative observation with ultrasound biomicroscopy after a corneal triple procedure showed a wideopen iridocorneal angle in those cases that had undergone prior core vitrectomy, even cases that had a preoperative shallow AC (Table 1, Fig. 1). A narrow angle and anterior synechiae were detected in conventional cases (Table 1, Fig. 1). A tendency towards a deeper AC was detected in cases receiving anterior core vitrectomy. The corneal triple procedure was performed by conventional methods consistently except for the addition of core vitrectomy. It is presumed that these outcomes may be due to (i) the effect of a reduced vitreous volume, which would flatten the iris plane and the iris–lens diaphragm, avoiding anterior shift; (ii) the effect of combined cataract surgery, which would deepen the angle regardless of the preoperative depth of the angle; and (iii) less inflammation as a result of a safer surgical procedure, which would suppress synechiae formation. The incidence of post-PKP glaucoma ranges between 9% and 35%. Even though several factors are involved in post-PKP glaucoma, the prevention of anterior synechiae would be expected to decrease the risk of its occurrence. Thus, it is suggested that the use of anterior core vitrectomy for PKP is effective in obtaining a more anatomically preserved AC configuration and could possibly prevent postPKP secondary angle closure glaucoma, in addition to increasing the safety of PKP surgery.