Maiko Inoue

Inner segment/outer segment junction assessed by spectral-domain optical coherence tomography in patients with idiopathic epiretinal membrane.

PURPOSE To evaluate the anatomic features of the photoreceptor inner/outer segment (IS/OS) junction before and after surgery by spectral-domain optical coherence tomography in patients undergoing idiopathic epiretinal membrane (ERM) surgery and to correlate these features with the functional outcomes. DESIGN Prospective, cohort study. METHODS We prospectively studied 45 eyes of 45 patients with idiopathic epiretinal membrane who had a preoperative visual acuity of 20/32 or less and were scheduled to undergo transconjunctival 25-gauge vitrectomy. The patients were divided into 2 groups based on the preoperative structural integrity of the IS/OS junction: the intact IS/OS junction group and the disrupted IS/OS junction group. Changes in the IS/OS junction and best-corrected visual acuity were compared between 2 groups before and at 3, 6, and 12 months after surgery. RESULTS A total of 45 patients were recruited for this study. There were 34 eyes with an intact IS/OS junction (group 1) and 11 eyes with a disrupted or irregular IS/OS junction (group 2), as determined before surgery. Significantly better postoperative best-corrected visual acuity was seen in group 1 as compared with that in group 2 at 3, 6, and 12 months after the surgery (P < .001). Significant improvement of visual acuity was also seen in group 1 when compared to group 2 (P < .05). Of the 34 eyes in group 1, 17 (50%) showed disruption of the IS/OS junction at 3 months after surgery, although this disruption was only transient and resolved completely by 12 months after the surgery. However, none of the eyes from group 2 showed a normal appearance of the IS/OS junction at any time point during the study period of 1 year. CONCLUSIONS The IS/OS junction can recover in eyes with preoperative intact IS/OS junction as assessed over a follow-up period of 1 year after surgery. Preoperative integrity of the IS/OS junction may be an important prognostic factor for better visual recovery and better improvement of the postoperative best-corrected visual acuity after epiretinal membrane surgery.

Preoperative inner segment/outer segment junction in spectral-domain optical coherence tomography as a prognostic factor in epiretinal membrane surgery.

Purpose: To evaluate the macular structure on spectral-domain optical coherence tomographic (SD-OCT) images to predict the outcome of surgery for idiopathic epiretinal membrane. Methods: Forty-five eyes of 45 consecutive patients with idiopathic epiretinal membrane who had a preoperative visual acuity of ≤20/32 and were scheduled to undergo a transconjunctival 25-gauge vitrectomy were involved in this prospective cohort study. The best-corrected visual acuity (BCVA) and SD-OCT images of the fovea were examined before the surgery and at 3, 6, and 12 months after the surgery. Associations between the visual acuity parameters and the preoperative SD-OCT features, including the morphology of the photoreceptor inner segment/outer segment junction, macular thickness, presence/absence of retinal cysts, and presence/absence of a macular pseudohole, were investigated as predictors of the outcome of the surgery. The main outcome measures were the association between the macular microstructure on preoperative SD-OCT images and the visual acuity parameters, such as the BCVA, at 12 months after the surgery (postoperative BCVA) and the difference between the preoperative visual acuity and the postoperative BCVA. Results: A total of 45 patients were enrolled in this study. The postoperative visual acuity was significantly better for the eyes with an intact inner segment/outer segment junction on the preoperative SD-OCT images than for those with an irregular or a disrupted inner segment/outer segment junction on the images (P < 0.001). Better preoperative visual acuity was associated with better visual acuity at 12 months and a lesser degree of improvement in the visual acuity (P < 0.001, respectively). Conclusion: The presence of an intact inner segment/outer segment junction on the preoperative SD-OCT images was found to be an important predictor of better visual recovery and better postoperative BCVA after epiretinal membrane surgery.

Effects of perfluorocarbon liquids and silicone oil on human retinal pigment epithelial cells and retinal ganglion cells.

Purpose: To examine the effects of perfluorocarbon liquid (PFCL) and silicone oil (SO) on human retinal pigment epithelium (RPE) cells and retinal ganglion cells (RGCs) in vitro. Methods: Human RPE cells (ARPE-19 cells), seeded on microporous inserts, were exposed to PFCL or SO and incubated for 3 or 7 days. Perfluorocarbon liquid was in contact with cells at the apical or baso-lateral side, not inhibiting cell feeding. Then, the quantification of cell proliferation and cell viability were evaluated by WST-1 assay. In the same way, RGCs were exposed for 1 hour or 3 days, and the number of viable RGCs was counted by using a fluorescence viability agent. Results: Perfluorocarbon liquid affected the survival of ARPE-19 cells and RGCs when compared with the nontreated control group. ARPE-19 cells decreased significantly after being in contact with PFCL at the baso-lateral side for 7 days. However, PFCL contact at the apical side reduced the number of RGCs in a time-dependent manner. In case of SO, the viability of the ARPE-19 cells decreased significantly after being in contact with SO at the baso-lateral side for 7 days. However, SO did not reduce the number of RGCs after a 3-day exposure. Conclusion: Perfluorocarbon liquid is directly toxic to ARPE-19 cells when exposed to the cells for 7 days. On the contrary, it seems that RGCs are damaged in a time-dependent manner by the more mechanical rather than toxic effects of PFCL. Silicone oil seems to exert mechanical rather than toxic effects on ARPE-19 cells. When PFCL is used as a postoperative tamponade clinically, understanding the difference in the effects will lead to more effective and safer results.

Short-term efficacy of intravitreal aflibercept in treatment-naive patients with polypoidal choroidal vasculopathy.

Purpose: To evaluate the functional and morphologic outcomes of patients with polypoidal choroidal vasculopathy who underwent intravitreal aflibercept treatment. Methods: We prospectively studied all the treatment-naive patients with polypoidal choroidal vasculopathy who were scheduled to undergo intravitreal aflibercept between February 2013 and July 2013. The best-corrected visual acuity was compared before treatment and at 6 months after the initial treatment. Changes in the central foveal thickness, choroidal thickness, presence/absence of subretinal fluid, fibrin, pigment epithelial detachment, and subretinal hemorrhage were also evaluated. The regression of the polyps was assessed using indocyanine green angiography. Results: A total of 16 patients were included in this study. A significantly better best-corrected visual acuity at 6 months was seen, compared with that at baseline (P = 0.041). The mean central foveal thickness significantly decreased from 417 ± 127 &mgr;m to 187 ± 50 &mgr;m (P < 0.001). The mean choroidal thickness also significantly decreased from 250 ± 63 &mgr;m to 217 ± 64 &mgr;m (P = 0.011). Overall, a complete resolution was obtained in 93.3% (14/15) of the cases with subretinal fluid, 75.0% (3/4) of the cases with fibrin, and 88.9% (8/9) of the cases with subretinal hemorrhage. Fifty-six percent (5/9) of the cases with pigment epithelial detachment obtained a complete improvement, whereas 33.3% (3/9) exhibited a partial decrease. The rate of polyp regression was 75.0% (12/16). Conclusion: Intravitreal aflibercept was well tolerated and had improved the vision of treatment-naive patients with polypoidal choroidal vasculopathy when it was evaluated at short-term follow-up examinations. Intravitreal aflibercept might be associated with a high possibility of achieving involution of polyps and reducing exudative findings.

Results of one-year follow-up examinations after intravitreal bevacizumab administration for chronic central serous chorioretinopathy.

Background: Our purpose was to report the results of 1-year follow-up examinations after intravitreal bevacizumab injection for the treatment of chronic central serous chorioretinopathy (CSC). Methods: Five eyes in 5 patients with chronic CSC were intravitreally injected with 1.25 mg/0.05 ml of bevacizumab. The need for retreatment was evaluated if spectral-domain optical coherence tomography showed the presence of subretinal fluid at the time of a 1-month follow-up examination. Best-corrected visual acuity and central foveal thickness were compared between baseline and 1 year after the first injection. Results: The mean logarithm of the minimum angle of resolution (logMAR) best-corrected visual acuity improved from 0.23 ± 0.46 to 0.17 ± 0.47 and the mean central foveal thickness significantly decreased from 323 ± 98 µm to 171 ± 63 µm (p < 0.05). Conclusion: The intravitreal injection of bevacizumab is well tolerated in maintaining vision and reducing serous retinal detachment in patients with chronic CSC, as evaluated at a 1-year follow-up examination.

Evaluation of the Incidence of Endophthalmitis after Intravitreal Injection of Anti-Vascular Endothelial Growth Factor

Aims: To report the incidence of infectious and noninfectious endophthalmitis after intravitreal injection of anti-vascular endothelial growth factor (VEGF) from a multicenter clinical trial in Japan. Methods: A retrospective multicenter review of the data of patients who received intravitreal anti-VEGF injections between January 2007 and March 2011 was undertaken. Cases with the clinical diagnosis of endophthalmitis resulting from intravitreal injection were identified and reviewed. Results: A total of 5,236 intravitreal anti-VEGF injections (1,209 intravitreal injections of bevacizumab, 3,827 injections of ranibizumab, and 200 injections of pegaptanib sodium) had been administered. Five patients (0.095%), all of whom had received bevacizumab, were diagnosed as having endophthalmitis after the intravitreal injection. All patients visited the institutes for re-examination within 1–2 days after the injection. Among the 5 patients, 2 (0.038%) were culture positive for Streptococcus oralis and Enterococcus faecalis, respectively. The remaining 3 eyes (0.057%) developed presumed noninfectious endophthalmitis. Conclusion: Although endophthalmitis is a rare complication associated with intravitreal injection, in this series intravitreal anti-VEGF injection caused infectious or noninfectious endophthalmitis at a relatively high frequency. Further investigations are needed to consider an appropriate injection protocol for minimizing the incidence rates of endophthalmitis, and to assess the optimal treatment protocol for intravitreal injection-related endophthalmitis although it was difficult to differentiate these two entities.

Results of 1-year follow-up examinations after intravitreal bevacizumab administration for idiopathic choroidal neovascularization.

Purpose: The purpose of this study was to report the results of 1-year follow-up examinations after intravitreal bevacizumab injection for the treatment of idiopathic choroidal neovascularization. Methods: Seven eyes in 7 patients with idiopathic choroidal neovascularization were intravitreally injected with 1.25 mg/0.05 mL of bevacizumab. The need for retreatment was evaluated if spectral-domain optical coherence tomography showed intraretinal edema or subretinal fluid at the time of a 1-month follow-up examination. Fluorescein angiography was performed 1 year after the first injection. The primary outcome measures were best-corrected visual acuity and central foveal thickness using spectral-domain optical coherence tomography. Results: All 7 eyes were assessed at a 1-year follow-up examination. The mean number of injections per eye was 2.7. The mean logarithm of the minimum angle of resolution best-corrected visual acuity improved significantly from 0.31 ± 0.29 to 0.15 ± 0.38 (P < 0.05). The mean central foveal thickness decreased from 332 ± 83 &mgr;m to 261 ± 66 &mgr;m (P < 0.01). Fluorescein angiography showed no leakage at 1 year in all eyes. All patients whose best-corrected visual acuity improved by ≥0.2 logarithm of the minimum angle of resolution had a visual acuity of ≥20/40 when first injected at baseline. Conclusion: The intravitreal injection of bevacizumab is effective for stabilizing or improving vision in patients with idiopathic choroidal neovascularization, as evaluated at a 1-year follow-up examination. In particular, this treatment may be well tolerated in patients with a visual acuity of ≥20/40 at baseline. Additional investigations are needed to assess the long-term safety and the optimal protocol for intravitreal bevacizumab administration.

Variable Response Of Vascularized Pigment Epithelial Detachments To Ranibizumab Based On Lesion Subtypes, Including Polypoidal Choroidal Vasculopathy

Purpose: The purpose of this study was to evaluate the prognosis and response to intravitreal ranibizumab (IVR) of neovascular age-related macular degeneration, according to the type of pigment epithelial detachment (PED). Methods: The authors prospectively studied 57 eyes of 57 consecutive patients with PED associated with exudative age-related macular degeneration, who were treated by IVR. All patients received 3 consecutive monthly injections of 0.5 mg/0.05 mL of ranibizumab as induction treatment. Retreatment was allowed if evidence of clinical deterioration was noted or spectral domain optical coherence tomography at the 1-month follow-up showed intraretinal edema, subretinal fluid, or recurrent PED. The best-corrected visual acuity (BCVA) values measured before and at 3, 6, and 12 months after the first injection were compared according to the type of PED. Changes in the height of PED to treatment with IVR were also investigated. Results: Fifty-six eyes were assessed at the 12-month follow-up examination. There were 4 types of PED, including serous PED in 11 patients (19.6%), fibrovascular PED in 28 patients (50.0%), mixed PED with serous and fibrovascular component in 7 patients (12.5%), and hemorrhagic PED in 10 patients (17.9%). Eyes with serous PED showed significant improvement of the mean logarithm of the minimum angle of resolution (logMAR) BCVA as compared with the value at the baseline, which was sustained throughout the 12-month period (P < 0.05). Regarding the eyes with fibrovascular and mixed PED, significant improvement of the mean logMAR BCVA was observed compared with the value at the baseline at 3 months; however, a slight decrease was observed at 6 and 12 months. In the eyes with hemorrhagic PED, no significant difference in the mean BCVA values compared with the value at the baseline was observed at any follow-up time point. In relation to the height of the PED, all eyes in the serous and mixed PED group, 17 eyes in the fibrovascular PED group (60.7%), and 9 eyes in the hemorrhagic PED group (90.0%) showed reduction of the maximum PED height by 100 &mgr;m or more. The PED response to IVR was not correlated with the final BCVA. Conclusion: Intravitreal ranibizumab for the treatment of exudative age-related macular degeneration is effective for stabilizing vision in patients with PED, but it may be better tolerated in patients with serous PED. Although it may be important to consider the type of PED to predict the visual acuity in patients treated by IVR, the anatomical response of the PED may not correlate directly with the visual outcome.

Long-term Outcome of Macular Microstructure Assessed by Optical Coherence Tomography in Eyes With Spontaneous Resolution of Macular Hole

PURPOSE To evaluate the long-term anatomic features as assessed by optical coherence tomography (OCT) in patients with spontaneously closed full-thickness macular hole (MH). DESIGN Retrospective, noncomparative, observational case series. METHODS Six eyes of 6 patients who eventually showed spontaneous resolution of idiopathic MH were studied. The best-corrected visual acuity (BCVA) and OCT images of the fovea were examined before and until at least 3 years after spontaneous resolution. RESULTS The MH closed spontaneously 1 to 4 months after the initial examination. There were 2 distinct macular abnormalities in the early period after spontaneous closure: 4 eyes showed outer foveal defects and the remaining 2 eyes showed persistent foveal detachment. However, the fovea regained its normal configuration and the photoreceptor inner segment/outer segment (IS/OS) junction recovered completely in all eyes. Although all 6 eyes showed visual improvement after the hole closure, the BCVA in the 4 eyes that showed delayed recovery of the IS/OS junction and foveal detachment was limited to 20/25 or worse. CONCLUSION Spontaneous closure of MH could acquire complete anatomic reconstruction. However, delayed restoration of the IS/OS junction and persistent foveal detachment after spontaneous closure might influence the functional outcomes.

Effect of intravitreal gas tamponade for sutureless vitrectomy wounds: three-dimensional corneal and anterior segment optical coherence tomography study.

Purpose: To investigate the effect of gas tamponade on wound closure and postoperative hypotony by comparing fluid-filled and gas-filled eyes after 25-gauge sutureless vitrectomy using three-dimensional corneal and anterior segment optical coherence tomography. Methods: Twenty-four eyes of 24 patients who underwent a 25-gauge transconjunctival sutureless vitrectomy were included in this prospective study. A total of 72 scleral wounds were observed using three-dimensional corneal and anterior segment optical coherence tomography at 3 hours and at 1, 3, 7, and 14 days postoperatively. Scleral wound closure was defined as the absence of a scleral gap at the sclerotomy site, as observed using three-dimensional corneal and anterior segment optical coherence tomography. The rate of wound closure, intraocular pressure, and the incidence of complications were compared between the fluid- and gas-filled eyes. Results: The rates of scleral wound closure at 3 hours and at 1, 3, 7, and 14 days were 26.2%, 28.6%, 35.7%, 52.4%, and 85.7% in fluid-filled eyes and 53.3%, 73.3%, 76.7%, 83.3%, and 93.3% in gas-filled eyes; these rates were significantly higher for the gas-filled eyes. The intraocular pressure was significantly higher in the gas-filled eyes than in the fluid-filled eyes on postoperative Day 1 but did not differ significantly between the 2 groups on postoperative Day 3 and thereafter. Conclusion: Three-dimensional corneal and anterior segment optical coherence tomography provided clear images of 25-gauge sutureless vitrectomy wounds and revealed that the sclerotomies closed faster in gas-filled eyes than in fluid-filled eyes. Thus, gas tamponade might be effective for the closure of sutureless vitrectomy wounds.