Makiko Matsumoto

RETINAL BLOOD FLOW CORRELATES TO AQUEOUS VASCULAR ENDOTHELIAL GROWTH FACTOR IN CENTRAL RETINAL VEIN OCCLUSION.

Purpose: As laser speckle flowgraphy can measure blood flow distribution in the ocular fundus, the authors analyzed the relationship between retinal blood flow and aqueous vascular endothelial growth factor (VEGF) concentration in central retinal vein occlusion. Methods: This prospective observational study examined 45 eyes of 45 patients with central retinal vein occlusion before treatment. Blood flow in large vessels around and at the optic disk, aqueous VEGF concentration, and arteriovenous passage time were examined. Blood flow was evaluated as mean blur rate by laser speckle flowgraphy. Results: Fluorescein angiography found 20 ischemic and 25 nonischemic type eyes. Aqueous VEGF concentration in the ischemic type was significantly higher than that in the nonischemic type (P = 0.01). Arteriovenous passage time was significantly correlated to the logarithm of the aqueous VEGF concentration (P = 0.0001). Mean blur rate of the affected eye/mean blur rate of the unaffected eye of the ischemic type was significantly lower than the nonischemic type (P = 0.039). Additionally, mean blur rate was significantly correlated both to the logarithm of the aqueous VEGF concentration (P < 0.0001) and to the arteriovenous passage time (P = 0.0001). Conclusion: Laser speckle flowgraphy may be useful for predicting aqueous VEGF concentration and severity of central retinal vein occlusion.

Spontaneous dislocation of in-the-bag intraocular lens primarily in cases with prior vitrectomy:

Purpose To report cases of late onset spontaneous in-the-bag dislocation of the intraocular lens (IOL) and to compare these results with past reports. Methods We retrospectively studied 21 eyes of 18 patients with dislocation of the entire capsular bag containing the IOL. Gender, age, interval between original surgery and IOL dislocation, and the predisposing factors were examined. Cases occurring after trauma were excluded. Results The mean ± SD age of the 12 men (57.1%) and 9 women included in the study was 67.8±8.6 years at the time of the IOL removal procedure. The interval between the original surgery and the IOL dislocation was 7.9±8.6. Associated clinical conditions included vitrectomy in 8 eyes (40.0%) of 7 patients, high myopia in 3 eyes (14%) of 2 patients, uveitis in 2 eyes (9.5%) of 2 patients, retinitis pigmentosa in 2 eyes (9.5%) of 1 patient, and pseudoexfoliation in 1 eye (4.8%) of 1 patient. There was no identifiable associated condition in 2 eyes (9.5%) of 2 patients, who were comparatively younger than the other cases. This result differs from previously published reports that have found a higher frequency of pseudoexfoliation and lower frequency of prior vitrectomy. Conclusions In-the-bag IOL dislocation was frequently associated with prior vitrectomy and sometimes occurred without specific conditions.

Retinal blood flow levels measured by laser speckle flowgraphy in patients who received intravitreal bevacizumab injection for macular edema secondary to central retinal vein occlusion.

PURPOSE To report retinal blood flow levels measured by Laser speckle flowgraphy in three patients after they received an intravitreal bevacizumab injection (IVB) for macular edema secondary to central retinal vein occlusion (CRVO). METHODS Three patients (3 eyes) being treated with IVB (1.25 mg/0.05 mL) for secondary macular edema of CRVO were examined. Laser speckle flowgraphy analyses of the blood flow were based on the examinations of mean blur rate (MBR) at the major vessels of the optic disk. Central retinal thickness (CRT) was measured by optical coherence tomography using Macular Cube 512 × 128 scanning protocol. RESULTS After the first IVB, Case 1 exhibited an increase in MBR and decrease in CRT. After 4 months, an additional injection was required because of a subsequent MBR decrease and CRT increase, which led to an increase in MBR and decrease in CRT similar to that observed after the first treatment. Subsequently, blood flow has continued to improve without additional IVB. Macular edema recurrence in Case 2 led to 3 further IVBs over a 6-month period. Although increases in MBR and decreases in CRT were noted, MBR values tended to decline after each IVB. In Case 3, macular edema recurrence led to 5 additional IVBs being carried out within a 1-year period. Continuous MBR increases and CRT decreases were observed in the patient after each IVB. By measuring MBR using laser speckle flowgraphy, we may predict the prognosis of CRVO. CONCLUSION Mean blur rate increases after IVB were confirmed by laser speckle flowgraphy in three patients. Even though CRVO pathology backgrounds can vary, laser speckle flowgraphy may be useful in both determining the CRVO prognosis and in evaluating treatment efficacy.

Conjunctival swabs and corneoscleral rim cultures from corneal transplantation donors as possible early indicators for posttransplant endopthalmitis.

PurposeTo determine by microbiological examinations the rate of conjunctiva and corneoscleral rim contamination of cadaver donor tissues.MethodsA prospective review of culture results for 98 cadaver donor conjunctival swabs [mean age 76.4 ± 12.9 years (±SD)]. Transplant patients were evaluated both before and after disinfection with gentamicin. Individual parameters evaluated included detection rates of bacteria, variety of detected bacteria, time interval from donor death to tissue harvest and age of donors.ResultsBefore disinfection, 60 out of 98 conjunctival swabs exhibited microbial growth, while only 36 out of 98 exhibited growth after disinfection (p = 0.0006). Longer intervals between death and tissue harvest were associated with higher positive microbial growth rates. Prior to disinfection, culture-positive donors (74.1 ± 13.6 years) were significantly younger than culture-negative donors (79.8 ± 10.8 years) (p = 0.024). Positive donor rim cultures were noted in 2 out of the 22 corneal transplantations. Microorganisms isolated from the corneal grafts matched those found in the conjunctiva.ConclusionsIt is recommended that the corneoscleral buttons be removed as soon as possible. Cultures of conjunctival swabs collected from donors after disinfection may be useful in determining treatment for postoperative infections occurring after corneal transplantation.

Retro-mode imaging of fibrovascular membrane in proliferative diabetic retinopathy after intravitreal bevacizumab injection

The F10 is a new commercially available scanning laser confocal ophthalmoscope (SLO) that can perform multiple functions. We determined the usefulness of noninvasive evaluation of proliferative diabetic retinopathy (PDR) pathologies before and after intravitreal injection of bevacizumab (IVB) using the new indirect viewing system of the retro-mode function of the F10 SLO, and compared the images histologically with surgically excised fibrovascular membrane from two cases. In PDR, neovascular vessels in fibrovascular membrane were clearly seen with the retro-mode, even after IVB and without blood flow. The F10 SLO may be useful in evaluating neovascular vessels in fibrovascular membrane in PDR and for determining the precise retinal changes in diabetic retinopathy.

Cyclic stretch and hypertension increase retinal succinate: potential mechanisms for exacerbation of ocular neovascularization by mechanical stress.

PURPOSE We investigated succinate metabolism in cells undergoing clinically relevant cyclic stretch and in spontaneously hypertensive rat (SHR) retina. METHODS We seeded ARPE-19 cells on 6-well BioFlex collagen I-coated, silicone elastomer-bottomed culture plates. Cells then were subjected to pulsatile stretch using a computer-controlled vacuum stretch apparatus. A physiologic stretch frequency of 60 cycles per minute and 5% to 15% prolongation of the elastomer-bottomed plates were used. Succinate concentration was assessed by enzymatic analysis and high-performance liquid chromatography-mass spectrometry. The VEGF was measured using enzyme-linked immunosorbent assays. The 12-week-old male SHRs and weight-matched Wistar-Kyoto (WKY) control rats were treated with or without 100 mg·kg(-1)·day(-1) captopril for 1 week. The vitreous body and retina of each rat were extracted after 1 week of therapy, and the vitreoretinal succinate concentration was measured. RESULTS Cells exposed to cyclic stretch accumulated intracellular succinate in a time- and magnitude-dependent manner, and also accumulated VEGF protein levels. Moreover, BAPTA/AM, an intracellular calcium chelate reagent, significantly inhibited the stretch-induced succinate increase. After cyclic stretch, levels of intracellular fumarate, a citric acid cycle intermediate, also were significantly increased compared to controls. The BAPTA/AM inhibited this increase. For the in vivo experiments, hypertension increased vitreoretinal succinate and fumarate in SHRs compared to the normotensive WKY controls. When hypertension was reduced using captopril, vitreoretinal succinate returned to baseline levels. CONCLUSIONS These findings suggest that cyclic stretch and hypertension increased intracellular succinate in cultured retinal pigment epithelial cells and the vitreoretinal succinate of SHRs through a calcium-dependent pathway.

Retinal Blood Flow After Intravitreal Bevacizumab Is A Predictive Factor For Outcomes Of Macular Edema Associated With Central Retinal Vein Occlusion

Purpose: To investigate whether retinal blood flow levels after intravitreal bevacizumab (IVB) treatment are correlated with the outcomes of patients with macular edema secondary to central retinal vein occlusion. Methods: This retrospective observational case study enrolled 44 cases nonischemic central retinal vein occlusion. In each patient, visual acuity, central retinal thickness, and mean blur rate, which was measured by laser speckle flowgraphy and represents retinal blood flow velocity, were examined. Results: At the end of the follow-up period (19.8 ± 8.8 months), 4 of 44 eyes (9.1%) converted to the ischemic type (converted group), whereas 40 (90.9%) remained unchanged (nonischemic group). Mean central retinal thickness significantly decreased and mean visual acuity significantly improved at 1 month after the first IVB injection in each group. Mean mean blur rate in the nonischemic group significantly increased, whereas it was unchanged in the converted group. The difference between the two groups was already significant after the first IVB injection. Subsequently, visual acuity worsened in the converted group. Multiple linear regression analysis indicated that the strongest correlation was between the last visual acuity and the last mean blur rate. Conclusion: Blood flow measurements are useful for evaluating IVB treatments. Blood flow after IVB can predict outcomes in patients with central retinal vein occlusion.

Transcorneal three-port vitrectomy without conjunctival incision.

We treated ERM in 7 eyes of 7 patients (female:male, 4:3; age, 39–77 years; mean, 66.1 years) between January 2005 and February 2007. A giant bleb developed in one patient after trabeculectomy. Phacoemulsification with a corneal incision was followed by continuous curvilinear capsulorhexis of the posterior capsule (Figure 1A). Three side-port limbal incisions weremade using a 23-gaugeV-lance (MANI, Utsunomiya, Japan) (MANI, Utsunomiya, Japan) at 9:30 o’clock, 2:30 o’clock, and 4 o’clock or 8 o’clock (at a temporal lower site) clock positions. We also performed 25-gauge transcorneal vitrectomy using a notched contact lens (Figure 1B) (which we made 3 cuts at the edge of a disposable silicon lens using a straight knife) and core vitrectomy and ERM peeling (Figure 1C). We inserted the intraocular lens into the capsular bag after vitrectomy (Figure 1D).

Visual outcomes and prognostic factors in open-globe injuries

BackgroundOcular trauma is an important cause of visual loss worldwide. Improvements in our knowledge of the pathophysiology and management of ocular trauma during the past 30 years, in conjunction with advances in the instrumentation and techniques of ocular surgery, have improved the efficacy of vitreoretinal surgery in injured eyes. The aim of the current study was to determine the visual outcomes and prognostic factors of open-globe injuries in the Japanese population.MethodsRetrospective study of 59 eyes of 59 patients presented with open globe injuries between September 2008 and March 2014 at Nagasaki University Hospital was conducted.Demographic factors including age, gender, and clinical data such as cause of injury, presenting visual acuity (VA), location of injury, type of injury, lens status, presence of intraocular foreign body, types of required surgeries, and final VA were recorded. According to the classification of Ocular Trauma Classification Group, wound location was classified into three zones. Chi-square test was used to compare presented data.ResultsOut of the 59 patients, 46 were placed in the Light Perception (LP) group, and 13 were placed in the No Light Perception (NLP) group. Work-related trauma was the most common cause (27 eyes) followed by falls (19eyes). Work-related trauma was common in males (P = 0.004), while falls was significantly common in females (P = 0.00001). Zone III injuries had statistically significantly poor prognostic factor compared to other zones (P = 0.04). All cases of NLP group (100%) presented with rupture globe. Poor VA at first visit (P = 0.00001), rupture globe (P = 0.026), history of penetrating keratoplasty (PK) (P = 0.017), retinal detachment (RD) (P = 0.0001), vitreous hemorrhage (VH) (P = 0.044), and dislocation of crystalline lens (P = 0.0003) were considered as poor prognostic factors.ConclusionPoor VA at first visit, rupture globe, zone III injuries, history of penetrating keratoplasty, RD, VH, and dislocation of crystalline lens were found to be poor prognostic factors. PPV had a good prognostic value in open globe injuries associated with posterior segment involvement.