Masahiro Fujimoto

Features and Function of Multiple Evanescent White Dot Syndrome

OBJECTIVE To describe and compare the tomographic features and macular abnormalities of multiple evanescent white dot syndrome (MEWDS) during the disease course. METHODS In 5 patients (5 eyes) with characteristic MEWDS lesions (hypofluorescent in the late phase of indocyanine green angiography [IA]), results of microperimetric retinal sensitivity examination and IA were compared with findings from enhanced spectral-domain optical coherence tomography (SD-OCT) at diagnosis and until clinical resolution. RESULTS Enhanced SD-OCT revealed moderately reflective focal lesions within the outer photoreceptor layer, where the inner and outer segment junction was disrupted, that corresponded with hypofluorescent areas in the late phase of IA. Areas of decreased retinal sensitivity on microperimetric examination matched areas of disruption in the inner/outer segment junction on SD-OCT images. In the first month after diagnosis, microperimetric examination and enhanced SD-OCT showed a shift in areas of decreased retinal sensitivity and disruption in the inner/outer segment junction from around the optic disc to the temporal macula. Retinal sensitivity and the inner/outer segment junction returned to almost normal in all eyes about a month after diagnosis of MEWDS. CONCLUSION Enhanced SD-OCT revealed abnormalities in the photoreceptor layer that were specific to MEWDS and that, with retinal shape and function, seemed to change location during clinical recovery from MEWDS.

Features Associated With Foveal Retinal Detachment in Myopic Macular Retinoschisis

PURPOSE To determine the retinal features seen on enhanced spectral-domain optical coherence tomography (SD-OCT) associated with foveal retinal detachment in eyes with myopic macular retinoschisis. DESIGN Retrospective case series. METHODS We reviewed fundus photographs and conventional and enhanced SD-OCT images of 21 eyes of 19 patients with myopic macular retinoschisis. Features seen on enhanced SD-OCT images were identified and compared between eyes with and without foveal detachment. RESULTS On enhanced SD-OCT images, the retinoschisis in the outer retina was accompanied by splitting in the inner plexiform layer (IPL) in 11 eyes (50.0%) and a detachment of the inner limiting membrane (ILM) in 11 eyes (50.0%) in the superior and/or inferior peripheral macula; 9 eyes (42.9%) had both features. Multiple columnar structures were seen throughout the outer retinoschisis in 20 of 21 eyes (95.2%), and in ILM detachment/IPL retinoschisis in all eyes. Thirteen eyes had or progressed to a foveal detachment; an ILM detachment developed in 10 eyes (76.9%) with a foveal detachment and in 1 eye (12.5%) without a foveal detachment (P = .008). IPL retinoschisis was detected in 8 eyes (61.5%) with a foveal detachment and 3 eyes (37.5%) without a foveal detachment, but this difference was not significant. CONCLUSIONS An ILM detachment in the superior and/or inferior peripheral macula was associated with a foveal retinal detachment in highly myopic eyes with macular retinoschisis. This feature may indicate strong tractional forces on the ILM that are transmitted to the outer retina through the dense columnar structures, resulting in a foveal retinal detachment.

Relationship between Functional and Structural Changes in Diabetic Vessels in Optical Coherence Tomography Angiography

The decorrelation signals in optical coherence tomography angiography (OCTA) are derived from the flow of erythrocytes and concomitantly delineate the retinal vasculature. We compared the structural and functional characteristics of vascular lesions visualized in fluorescein angiography (FA), OCTA, and en-face OCT images in 53 eyes (28 patients) with diabetic retinopathy (DR). The foveal avascular zone (FAZ) areas in OCTA images in the superficial layer almost corresponded to those in FA images. The FAZ areas in the en-face OCT images in the superficial layer were smaller than those in the FA images and correlated with each other, which agreed with the finding that en-face OCT images often delineated the vascular structure in the nonperfused areas in FA images. Microaneurysms appeared as fusiform, saccular, or coiled capillaries in OCTA images and ringed, round, or oval hyperreflective lesions in en-face OCT images. OCTA and en-face OCT images detected 41.0 ± 16.1% and 40.1 ± 18.6%, respectively, of microaneurysms in FA images, although both depicted only 13.9 ± 16.4%. The number of microaneurysms in FA images was correlated with that in OCTA and en-face OCT images. Comparisons of these modalities showed the associations and dissociations between blood flow and vascular structures, which improves the understanding of the pathogenesis of DR.

Distribution of normalized critical current of bent multifilamentary Bi2223 composite tape

The distribution of the normalized critical transport current (critical current normalized with respect to the original value) of Bi2223/Ag/Ag alloy composite tape under bending strain of 0%–0.833% was studied experimentally and analytically. The experimental results were analyzed by a modeling approach based on the relation of the heterogeneous damage evolution to the distribution of the critical current. The main results are summarized as follows. (1) The measured distribution of the critical current values varying with bending strain was described well by the present approach. (2) When all specimens were damaged at high bending strains (0.338%–0.833% in the present work), the distribution of the critical current of the bent-damaged specimens was expressed by the three-parameter Weibull distribution function, the reason for which was revealed. (3) The distribution of the irreversible strain was estimated, with which the influence of the increase in the fraction of damaged specimens on the variation of c...

Simulation on the relation of distribution of overall critical transport current to that of local one in bent-damaged Bi2223 superconducting composite tape

The superconducting Bi2223/Ag/Ag alloy composite tape specimens with a length 6 cm, composed of a series circuit of six local elements with a length 1 cm, were bent by 0.37% and 1.0% for measurement of distributions of the overall (6 cm) and local (1 cm) critical transport current and n-value. When the damage amount was small (0.37% bending strain), the distributions of the measured local and overall critical currents were described by the three parameter Weibull distribution function, while when the damage amount was large (1.0% bending strain), those were described by the bimodal Weibull distribution function. The distributions of n-value in the diagram of n-value versus critical current for both local elements and overall specimens were expressed by the regression curve of n-value as a function of critical current and the normal distribution function for the deviation of the measured n-values from the regression curve. The experimentally measured critical current distribution and the diagram of the n-v...

Structural and Functional Analyses in Nonarteritic Anterior Ischemic Optic Neuropathy: Optical Coherence Tomography Angiography Study.

Background: Retinal and optic disc perfusion in nonarteritic anterior ischemic optic neuropathy (NAION) is incompletely understood. Our aim was to investigate the characteristics of the microvascular structures at the peripapillary area and optic disc, and their associations with retinal structure and function in patients with NAION. Methods: We conducted a prospective, observational case series study. Thirty-four eyes, consisting of 15 NAION eyes and 19 normal eyes, were included. Optical coherence tomography (OCT) angiography was used to measure the vessel densities in the peripapillary superficial retina and whole-depth mode inside the optic disc. Measurement of circumpapillary retinal nerve fiber layer (cpRNFL) thickness was performed using OCT. Sectorial division analysis of cpRNFL was performed by eliminating the influences of the difference in disc rotation between OCT images and OCT angiography images. Results: The vessel densities of peripapillary retina and inside the optic disc were significantly reduced in the NAION compared to the normal (both P < 0.001). Both the severity of visual field defect and cpRNFL thinning were significantly associated with the peripapillary vessel density (P = 0.006, P = 0.046), but not with the optic disc vessel density (P = 0.981, P = 0.856). cpRNFL and peripapillary vessel density showed reduction predominantly in the superior sectors, corresponding to the visual field defect. However, the correlations showed discrepancy of the sectors. Conclusions: The microvascular structures in the peripapillary retina and optic disc were reduced, but the cpRNFL thinning was associated with vessel density only in the peripapillary retina, indicating that the vessel densities in the peripapillary retina and optic disc may be differently affected in the pathological process of NAION.

In Vivo Choroidal Vascular Lesions in Diabetes on Swept-Source Optical Coherence Tomography.

Diabetes induces microvascular diseases including diabetic retinopathy and choroidopathy which reciprocally promote the pathogenesis, although optical coherence tomography images of diabetic choroidopathy remains to be documented. Here we evaluated the qualitative characteristics of choroidal vascular lesions in patients with diabetes and their association with diabetic retinopathy on swept-source optical coherence tomography (SS-OCT) images. We retrospectively reviewed 110 consecutive eyes of 110 patients with diabetes and 35 eyes of 35 healthy subjects for whom SS-OCT images (6x6-mm scans centered on the fovea) of sufficient quality were acquired. The curve of chorioretinal sections was flattened using Bruch’s membrane as a reference surface, followed by generation of en-face images. We characterized choroidal vascular lesions and evaluated their association with the logarithm of the minimum angle of resolution visual acuity (logMAR VA), retinal and choroidal thicknesses, and diabetic retinopathy severity. En-face SS-OCT images showed unvisualized vessels in Sattler’s layer in 33 eyes (30.0%). Focal narrowing was seen in choroidal vessels in Haller’s layer in 56 eyes (50.9%). The choroidal vessels ended in the superficial or middle portion of Haller’s layer, referred to as vascular stumps, in 20 eyes (18.2%). Diabetic eyes had these findings more frequently than nondiabetic eyes. The subfoveal choroid was thicker in eyes with focal vascular narrowing and vascular stumps than in eyes without such lesions. Vascular stumps in Haller’s layer were significantly related to diabetic retinopathy severity, logMAR VA, and central retinal and choroidal thicknesses. These novel findings on SS-OCT images would promote the better understanding of complicated pathogenesis in diabetic retinopathy and choroidopathy.

Clinical relevance of reduced decorrelation signals in the diabetic inner choroid on optical coherence tomography angiography

Diabetes induces lesions of the retinal and choroidal capillaries, which promote the pathogenesis of diabetic retinopathy (DR). The decorrelation signals in optical coherence tomography angiography (OCTA) represent the blood flow and vascular structure, and three-dimensional OCTA images enable individual capillary layers to be evaluated separately. The current study documented that en-face OCTA images revealed spots of flow void in the choriocapillaris layer in eyes with DR. Quantitative investigation demonstrated that non-flow areas within the central subfield (CSF) increased in eyes with more severe DR grades. The non-flow areas in the choriocapillaris layer were also associated with poorer visual acuity (VA) in all 108 eyes. A modest correlation was noted between the areas of flow void and poorer VA in 69 eyes without DME, whereas the non-flow areas were not related to VA or to CSF thickness measured by OCT in 39 eyes with DME. In 12 eyes with ischemic maculopathy, the choriocapillaris layer beneath the disrupted ellipsoid zone of the photoreceptor (EZ) had greater areas of flow void than did the area beneath an intact EZ. These data suggested that disrupted choroidal circulation has clinical relevance and contributes to the pathogenesis of DR.

Characterization of Inner Retinal Spots With Inverted Reflectivity on En Face Optical Coherence Tomography in Diabetic Retinopathy.

PURPOSE The purpose of this study was to characterize inner retinal spots with inverted reflectivity on en face images of swept-source optical coherence tomography (SS-OCT) in diabetic retinopathy (DR). METHODS We retrospectively reviewed seventy-five eyes of 75 patients with DR (15 eyes with individual grades of DR severity). We obtained three-dimensional images (6 × 6 mm) centered on the fovea, followed by the generation of en face images. We investigated the morphologic characteristics of spots with inverted reflectivity, which had lower reflectivity than the surrounding areas in the nerve fiber layer (NFL) and higher reflectivity in the ganglion cell layer (GCL). RESULTS Thirty-seven of 45 eyes (82.2%) with moderate nonproliferative diabetic retinopathy (NPDR) or more severe grades were accompanied with well-defined spots with inverted reflectivity, whereas 30 eyes with no apparent retinopathy or mild NPDR had no such lesions. These spots had various shapes in the NFL and GCL on en face OCT images; the mean area was 0.126 ± 0.052 mm2 at the NFL level. In all 75 eyes, 153 of 184 spots (83.2%) were localized in the NFL and GCL, whereas 31 spots (16.8%) extended to retinal layers deeper than the GCL. One-hundred sixty-nine spots (91.8%) were not visible on color fundus photographs, and 15 spots (8.2%) were accompanied by whitish-yellow lesions in the corresponding areas. In 45 eyes for which fluorescein angiography images were obtained, mild hypofluorescence was seen in 156 spots (84.8%) and focal nonperfused areas in 17 spots (9.2%). CONCLUSIONS En face images of SS-OCT showed spots with inverted reflectivity in the NFL and GCL in DR.

Evaluation of dacryocystorhinostomy using optical coherence tomography and rebamipide ophthalmic suspension.

Purpose To evaluate the surgical outcome of dacryocystorhinostomy (DCR) by measuring the tear meniscus, using optical coherence tomography and rebamipide ophthalmic suspension. Methods Patients with nasolacrimal obstruction and chronic dacryocystitis who were scheduled for an endonasal DCR underwent tear meniscus examinations before and 2 months after surgery. Vertical scans of the inferior menisci were performed before and at 1, 3, 5, 7, and 10 minutes after the instillation of rebamipide ophthalmic suspension. The tear menisci areas were measured with imaging software. Ten young adults without epiphora formed the control group. Results Anatomical success was achieved on 22 sides of 21 patients. The patients’ postoperative tear menisci were significantly smaller than the preoperative menisci at all points during the test, and the response to volume loading in the postoperative patients was corrected to nearly that of the young, healthy adults. Nevertheless, the postoperative meniscus area tended to be larger than that of the young adults at all points. Conclusion The reduced tear meniscus area after DCR reflected the success of the surgical procedure. However, incomplete recovery of the meniscus after the test might suggest a residual disorder of the lacrimal drainage system after DCR.