Masashi Fujihara

Autologous Induced Stem-Cell–Derived Retinal Cells for Macular Degeneration

We assessed the feasibility of transplanting a sheet of retinal pigment epithelial (RPE) cells differentiated from induced pluripotent stem cells (iPSCs) in a patient with neovascular age‐related macular degeneration. The iPSCs were generated from skin fibroblasts obtained from two patients with advanced neovascular age‐related macular degeneration and were differentiated into RPE cells. The RPE cells and the iPSCs from which they were derived were subject to extensive testing. A surgery that included the removal of the neovascular membrane and transplantation of the autologous iPSC‐derived RPE cell sheet under the retina was performed in one of the patients. At 1 year after surgery, the transplanted sheet remained intact, best corrected visual acuity had not improved or worsened, and cystoid macular edema was present. (Funded by Highway Program for Realization of Regenerative Medicine and others; University Hospital Medical Information Network Clinical Trials Registry [UMIN‐CTR] number, UMIN000011929.)

Comparison of the Effect of Ranibizumab and Verteporfin for Polypoidal Choroidal Vasculopathy: 12-Month LAPTOP Study Results

PURPOSEnTo compare the effect of photodynamic therapy (PDT) and intravitreal ranibizumab in patients with polypoidal choroidal vasculopathy (PCV).nnnDESIGNnRandomized clinical trial.nnnMETHODSnnnnSETTINGnMulticenter.nnnSTUDY POPULATIONnTotal of 93 patients with treatment-naïve PCV.nnnINTERVENTIONnPatients were randomized to 2 arms. Patients in the PDT arm underwent a single session of PDT with verteporfin, and patients in the ranibizumab arm received 3 monthly ranibizumab injections at baseline. Additional treatment was performed as needed in each arm.nnnMAIN OUTCOME MEASURESnPrimary outcome measurement was the proportion of patients gaining or losing more than 0.2 logarithm of minimal angle of resolution (logMAR) units from baseline. Mean change of logMAR and central retinal thickness (CRT) were also evaluated.nnnRESULTSnIn the PDT arm (n = 47), 17.0% achieved visual acuity gain, 55.3% had no change, and 27.7% experienced visual acuity loss. The results were 30.4%, 60.9%, and 8.7%, respectively, in the ranibizumab arm (n = 46), significantly better than the PDT arm (P = .039). In the PDT arm, mean CRT improved (366.8 ± 113.6 μm to 289.1 ± 202.3 μm, P < .001), but logMAR was unchanged (0.57 ± 0.31 to 0.62 ± 0.40). The ranibizumab arm demonstrated improvement in both CRT (418.9 ± 168.6 μm to 311.2 ± 146.9 μm, P < .001) and logMAR (0.48 ± 0.27 to 0.39 ± 0.26, P = .003). Mean change of logMAR was also greater in the ranibizumab arm (P = .011).nnnCONCLUSIONnIntravitreal injection of ranibizumab is more effective than PDT for treatment-naïve PCV.

Triamcinolone acetonide with vitrectomy for treatment of macular edema associated with branch retinal vein occlusion.

Purpose: To review the efficacy of a combination of triamcinolone acetonide (TA) injection and pars plana vitrectomy (PPV) for the treatment of macular edema associated with branch retinal vein occlusion (BRVO). Methods: Seventeen eyes with macular edema associated with BRVO underwent PPV with an intraoperative injection of TA (10 mg) into the vitreous cavity. Residual or recurrent macular edema was treated with postoperative sub–Tenon capsule injections of TA (20 mg). Results: With PPV and an intraoperative injection of TA, 82% of eyes showed rapid reduction of macular edema; foveal thickness decreased from 507 ± 115 μm preoperatively to 261 ± 123 μm 2 months after surgery (P = 0.0041). However, 59% of eyes showed recurrence of macular edema during the follow-up period. Twelve eyes with residual or recurrent macular edema received sub–Tenon capsule injections of TA; of these eyes, 9 showed substantial reduction of macular edema. Foveal thickness decreased from 381 ± 102 μm to 256 ± 56 μm (P = 0.0076) 2 weeks after postoperative injections of TA. At the final visit, visual acuity (logMAR) improved from 0.74 ± 0.40 preoperatively to 0.40 ± 0.34 (P = 0.010). Conclusion: An intraoperative injection of TA in combination with PPV has the potential to facilitate the absorption of macular edema associated with BRVO. In addition, residual or recurrent macular edema can be treated with additional sub–Tenon capsule injections of TA.

Methanol-induced Retinal Toxicity Patient Examined by Optical Coherence Tomography

BackgroundMethanol is a highly toxic substance used as an industrial solvent and automotive antifreeze. Human consumption of methanol may result in severe visual disturbances. Because optical coherence tomography (OCT) is very useful for evaluating retinal edema and nerve fiber swelling, we used OCT to examine a patient with methanol-induced retinal toxicity.CaseA 37-year-old man who drank industrial alcohol (100u2009ml/day) for 4 days.ObservationsThe retinal profiles were evaluated by OCT and fluorescein angiography during the course of treatment. OCT demonstrated peripapillary nerve fiber swelling and accumulation of intraretinal fluid in the acute phase. In the chronic phase, the retinal thickness was diffusely decreased. Steroid pulse therapy was not effective, and his visual acuity was 6/200 OD and 4/100 OS 2 years after the event.ConclusionOCT was very useful for evaluating the severity of the retinal edema and the temporal changes in the retinal profile.u2003Jpn J Ophthalmol 2006;50:239–241

Visual outcome of photodynamic therapy for typical neovascular age-related macular degeneration and polypoidal choroidal vasculopathy over 5 years of follow-up.

PurposeTo evaluate the long-term effects of photodynamic therapy (PDT) on typical neovascular age-related macular degeneration (tAMD) and polypoidal choroidal vasculopathy (PCV).MethodsThis was a multicenter prospective study of 139 eyes from 136 patients (tAMD: 74 eyes; PCV: 65 eyes) who underwent PDT as the initial treatment. The change in best-corrected visual acuity (BCVA), predictive factors for the BCVA at 60xa0months, frequency of recurrence, and mean recurrence period were analyzed.ResultsThe pre-PDT BCVA and greatest linear dimension (GLD) did not differ between the two groups. The mean BCVA (logMAR) was significantly improved at 6xa0months post-initial PDT (post-PDT) in the PCV group (−0.11, Pxa0=xa00.0091). However, at 60xa0months post-PDT, the mean BCVA was significantly worse than baseline in the tAMD (+0.21, Pxa0=xa00.0035) and PCV (+0.21, Pxa0=xa00.0076) groups. Pre-PDT BCVA, age, and GLD were the factors significantly associated with the BCVA at 60xa0months post-PDT. Although the frequency of recurrence did not significantly differ between the two phenotype groups, the mean recurrence period was significantly longer in the PCV group than in the tAMD group (15.7 vs. 8.6xa0months, Pxa0=xa00.0020).ConclusionsPDT may not have benefits for visual acuity in cases of tAMD and PCV over 5xa0years of follow-up.

Comparison of the effect between pegaptanib and ranibizumab on exudative age-related macular degeneration with small lesion size

Purpose To compare the effect of pegaptanib versus ranibizumab on exudative age-related macular degeneration (AMD) with small lesion size. Methods This is a retrospective study of 81 eyes from 78 patients with exudative AMD treated and followed up over 12 months. Patients with baseline best corrected visual acuity (BCVA) under 20/400 and with a greatest linear dimension of lesion over 4500 μm were excluded from the study. Twenty-six eyes from 25 patients were treated with three consecutive intravitreal injections of pegaptanib (IVP group) and 55 eyes from 54 patients were treated with three consecutive ranibizumab injections (IVR group). Each therapy was repeated as needed. The alteration in BCVA was evaluated in the IVP and IVR groups. Results No differences were detected in baseline parameters between the IVP and IVR groups. The mean BCVA (logMAR) at month 1, 3, 6 and 12 after the initial treatment was improved from baseline in the IVP group (−0.095, −0.17, −0.18 and −0.18, respectively) and in the IVR group (−0.077, −0.15, −0.17 and −0.11, respectively), which was statistically significant. There was no difference in the change in mean BCVA between IVP and IVR groups at the same time periods. Conclusions The visual outcome of IVP was equivalent with IVR in exudative AMD with small lesion size.

Neovascular glaucoma after branch retinal artery occlusion

BackgroundNeovascular glaucoma (NVG) occurring after branch retinal artery occlusion (BRAO) might not be as rare as previously thought. We report a case of unilateral NVG after BRAO.CaseA 72-year-old man with chronic heart failure suffered from BRAO in the left eye. Funduscopic examination showed retinal edema and many cotton wool spots in the superotemporal retina.ObservationsFive weeks later, he had increased blurring of vision due to a second BRAO in the inferotemporal retina of the left eye. Three days later, he felt pain and had severe visual loss in the left eye. In the presence of angle neovascularization, intraocular pressure (IOP) in the left eye rose to 35u2009mmHg. Immediate focal photocoagulation to the affected retina diminished the neovascularization and lowered the IOP.ConclusionIt is possible for NVG to occur as a complication of BRAO. Jpn J Ophthalmol 2005;49:388–390

Efficacy of additional topical betamethasone in persistent cystoid macular oedema after carbonic anhydrase inhibitor treatments in retinitis pigmentosa

Objective We investigated the efficacy of additional topical betamethasone in persistent cystoid macular oedema (CMO) after carbonic anhydrase inhibitors (CAIs) therapy. Methods and analysis This retrospective cohort study included 16 eyes of 10 patients with retinitis pigmentosa (RP). All patients were previously administered CAI for at least 3u2009months to treat CMO secondary to RP and lacking an effective reduction (≥11%) of central foveal thickness (CFT). We administered topical 0.1% betamethasone daily in each affected eye following a preceding course of the CAI medication as a first treatment. CMO was diagnosed using spectral-domain optical coherence tomography. CFT was regarded as the average of vertical and horizontal foveal thickness. Best-corrected visual acuity (BCVA) and intraocular pressure (IOP) were obtained from patient medical records. We compared the CFT and BCVA between baseline and the average of 1–3, 5–7, 10–14 and 16–20 months period. Results In treatments with brinzolamide in 14 eyes, dorzolamide in 2 eyes and bromfenac in 2 eyes, CFT effectively decreased in 12 of 16 eyes (81%). CFT decreased significantly in 1–3 months (326±102u2009µm; n=16; P=0.029) and 5–7 months (297±102u2009µm; n=12; P=0.022) compared with baseline but not within 10–14 months (271±96u2009µm; n=9; P=0.485) or 16–20 months (281±134u2009µm; n=9; P=0.289). There were no significant intergroup differences in BCVA throughout the study. Betamethasone treatment was stopped in three patients because of IOP elevation. Conclusion Our data suggested that additional betamethasone might improve treatments for persistent CMO. Topical steroids could be an alternative option for managing persistent CMO in RP.