Miina Hiraoka

Vascular abnormalities in aggressive posterior retinopathy of prematurity detected by fluorescein angiography.

PURPOSE To evaluate fluorescein angiography (FA) in eyes with aggressive posterior retinopathy of prematurity (AP-ROP). DESIGN Retrospective, nonrandomized case series. PARTICIPANTS Three patients (6 eyes) with AP-ROP. METHODS Three patients (6 eyes) diagnosed with AP-ROP during ROP screening between July 2007 and July 2008 were included in this study. Fundus photographs and FA were obtained before and after laser and surgical treatment using a wide-field digital pediatric imaging system. MAIN OUTCOME MEASURES Fluorescein angiography and fundus photographs. RESULTS At the initial stage of AP-ROP, FA showed vascular abnormalities, including capillary nonperfusion throughout the vascularized retina, shunting in the vascularized retina, a circumferential demarcation line, and limited vessel development, which was difficult to identify only by ophthalmoscopy. After treatment, FA showed poorly developed retinal vessels, including 4 small major vessels without an arcade pattern, small macular vessels, an inhomogeneous capillary bed, and absence of a capillary-free zone in the fovea. CONCLUSIONS Capillary bed loss throughout the vascularized posterior retina is characteristic of AP-ROP and may exacerbate retinopathy.

Choroidal neovascularization in a child following laser pointer-induced macular injury

in a patient with Candida vaginitis and onychomycosis; both patients were treated with antibiotics. The current patient had no systemic abnormalities but evidently had endogenous Candida endophthalmitis because PCR analysis detected suffi cient quantities of Candida DNA in the vitreous and the cerebrospinal fl uid to diagnose the infection. FA fi ndings of abnormal vasculature in the peripheral retina are usually seen in eyes with retinopathy of prematurity or familial exudative vitreoretinopathy, which prompted us to suspect that the Candida infection in the present case was congenital. Generally, a congenital Candida infection occurs by vertical transmission through the uterus or vagina and is associated with systemic involvement, including dermatitis, meningitis, anomaly of the brain, and oral mucositis. However, the patient was delivered by Caesarean section, and no signs of Candida infection were detected in the mother. Thus, acquired Candida infection was the most likely diagnosis in the present case. Intravenous antibiotics delivered 2 weeks before the onset of bilateral endophthalmitis likely caused iatrogenic Candida infection because of inadvertent manipulation. Possible insuffi cient growth of the retinal vasculature might have facilitated the proliferation of Candida in the patient’s retina. To diagnose and treat such a diffi cult case, broad-range PCR for the 18S ribosomal RNA sequence is a good screening tool. Moreover, real-time PCR can examine the quantity of the pathogen and determine its relation to the endophthalmitis. Early treatment of infectious endophthalmitis is essential in infants, in whom vision develops rapidly. Thus, a broad-range, real-time PCR system using ocular samples is useful when the patient has uveitis or endophthalmitis of unknown origin.

Factors contributing to corneal complications after vitrectomy in diabetic patients

PURPOSE To elucidate factors contributing to corneal complications after vitrectomy in diabetic patients. METHODS The records of a series of 129 diabetic patients (202 eyes) who underwent pars plana vitrectomy performed by a single surgeon between March 1997 and February 1999 were analyzed retrospectively. Logistic regression analysis was performed to determine possible factors contributing to corneal complications. RESULTS Of the 202 eyes, 102 (50.5%) developed corneal complications after surgery; 90 (44.6%) had epithelial disturbance; and 48 (23.8%) had corneal edema. The degree of surgical invasion during vitrectomy was significantly correlated with the occurrence of epithelial disturbance and corneal edema. CONCLUSION Surgical invasion is a risk factor for corneal complications after vitrectomy in diabetic patients.

Effect of Early Vitreous Surgery for Aggressive Posterior Retinopathy of Prematurity Detected by Fundus Fluorescein Angiography

OBJECTIVE To assess the effect of early vitrectomy for aggressive posterior retinopathy of prematurity (APROP) using fundus fluorescein angiography. DESIGN Retrospective, observational case series. PARTICIPANTS Eleven eyes of 7 patients with APROP that underwent early vitreous surgery. METHODS All eyes underwent vitrectomy with lensectomy that removed the vitreous gel around the fibrovascular proliferative tissue, but not the proliferative tissue when fibrovascular proliferation and retinal detachment occurred despite retinal photocoagulation. Fundus fluorescein angiography was performed before and after the early vitreous surgery. MAIN OUTCOME MEASURES Dye leakage from the fibrovascular tissue, dilation and tortuosity of the retinal vasculature, and shunt vessels were evaluated by fundus fluorescein angiography. The status of the retinal reattachment was assessed postoperatively. RESULTS Nine eyes had severe dye leakage from the fibrovascular tissue and 2 eyes had moderate leakage seen by preoperative fluorescein angiography. Severe dilation and tortuosity of the retinal vessels were detected in 10 eyes and shunt vessels in 7 eyes. Six to 12 days after successful surgery, the retina reattached and dilation and tortuosity of the retinal vessels decreased substantially. Dye leakage diminished markedly in all eyes, resolved completely in 7 eyes, and was still apparent slightly in 4. At the final examination, fibrovascular proliferation and retinal detachment did not progress in any eyes; however, 2 eyes had a dragged or folded retina. Follow-up ranged from 6 to 19 months (mean, 9.2). CONCLUSIONS Early vitrectomy that removes vitreous gel from around the proliferative tissue promptly reduces vascular activity and may limit progression of retinal detachment in APROP.

Glial extrusion from regressed retinoblastoma after conservative treatment.

van den Biesen PR, Berenschot T, Verdaasdonk RM et al. (2000): Endoillumination during vitrectomy and phototoxicity thresholds. Br J Ophthalmol 84: 1372– 1375. Eckardt C (2003): Twin lights: a new chandelier illumination for bimanual surgery. Retina 23: 893–894. Gaynon MW, Schepens CL & Hirose T (1986): Four-port bimanual vitrectomy. Arch Ophthalmol 104: 1088–1089. Kadonosono K, Kamezawa H, Uchio E et al. (2006): Bimanual vitreous surgery with slitbeam illumination and multicoated contact lens. Retina 26: 708–709. Shimada H, Hattori H, Mori R et al. (2007): Thermal injury caused by chandelier fibre probe. Am J Ophthalmol 143: 167–169.

Evaluation of scleral buckling for stage 4A retinopathy of prematurity by fluorescein angiography.

PURPOSE To determine the early efficacy of scleral buckling for active neovascularization by fundus fluorescein angiography (FA) in eyes with stage 4A retinopathy of prematurity. DESIGN A retrospective, nonrandomized, observational case series. METHODS Patients who underwent scleral buckling for stage 4A ROP at the National Center for Child Health and Development, Tokyo, Japan, from October 2007 through November 2008 were included. Preoperative and postoperative FA and fundus photographs obtained with a wide-field digital pediatric imaging system were reviewed. Three patients (5 eyes; gestational ages at birth, 23 to 25 weeks; birth weights, 574 to 811 g) with zone II stage 4A ROP who underwent postoperative FA, 2 weeks or less after scleral buckling (range, 7 to 12 days; postmenstrual ages at postoperative FA, 41 to 45 weeks) were evaluated. Patients who underwent postoperative FA 2 weeks or more after scleral buckling were excluded. RESULTS Despite fluorescein leakage from fibrovascular tissue in all eyes before surgery, markedly decreased leakage occurred only between 7 to 12 days after surgery. The retinas were reattached completely in all eyes after surgery. CONCLUSIONS Scleral buckling may prevent progression of retinal detachment in stage 4A ROP by reducing the tractional force and stabilizing the neovascular activity of the fibrovascular tissue.

Cataract Surgery and Intraocular Lens Implantation in Patients With Behçet's Disease

PURPOSE To evaluate the outcome of cataract surgery in patients with Behçets disease. METHODS The results of 27 eyes of 19 patients with Behçets disease that had undergone cataract surgery with or without intraocular lens implantation from October 1993 to December 1996 were retrospectively analyzed. The postoperative follow-up period ranged from 13 to 50 months (average, 28 months). FINDINGS Visual acuity improved postoperatively in 25 eyes, to 20/40 or better in 9 eyes. In 19 eyes, ocular attacks were seen within the preoperative 6 months in 2 eyes, and within the postoperative 6 months in 8 eyes. In 8 eyes, the first ocular attacks occurred within 2 months after the surgery. The frequency of ocular attacks increased after the surgery in 7 patients who received immunosuppressive a gents, with relatively short duration of the disease. CONCLUSION These results suggest that the frequency of ocular attacks increases after cataract surgery in some patients who use immunosuppressive agents for controlling ocular attacks, even though they had no inflammatory history for a long period before the surgery.

Fluorescein staining of the vitreous during vitrectomy for retinopathy of prematurity.

V itreous staining using triamcinolone acetonide 1 or fluorescein generally has been used even in children to visualize the preretinal membrane and vitreous during vitrectomy. During the surgery for retinopathy of prematurity (ROP), careful segmentation and extensive vitreous cutting are required around the base of tractional retinal detachments, vitreous base, and fibrovascular tissue. Removal of the formed vitreous around the fibrovascular tissue and the vitreous base is a key factor for a successful surgery. To remove the vitreous safely, good intraoperative visualization of the vitreous is essential. In the current study, we included cases of aggressive posterior ROP in which wide-field vitrectomies are necessary to evaluate the staining of the entire vitreous. We describe a technique for staining the vitreous with fluorescein and compared it with staining using triamcinolone in these patients with ROP.

Congenital Rotated Macula with Good Vision and Binocular Function

BackgroundTwo patients presented with congenital rotated macula with good vision and binocular function.CasesTwo patients had retinal folds with an extremely rotated macula OD as the result of peripheral fibrous proliferation on the retina. Each macula was substantially rotated to the nasal border of the disc.ObservationsA 3-year-old girl (case 1) with best-corrected visual acuity (VA) of 0.5 OD and 1.0 OS was treated for amblyopia, after which she successfully achieved 1.0 bilaterally as well as good stereopsis of 120 seconds of arc measured with the TNO test. A 6-year-old girl (case 2) obtained a VA of 0.7 OD and 1.0 OS, and her stereopsis was of 240 seconds of arc.ConclusionsGood VA and stereopsis may be achieved by adaptation in the brain and an extremely large fusional potential at an early infantile age or a gradual shift of the macula. Appropriate treatment of amblyopia should be performed in patients with rotated macula if the macula appears normal.

Case of aggressive posterior retinopathy of prematurity with atypical neovascular growth

acteristically, a solitary subretinal granuloma is found either in the peripheral retina or macula or on the optic nerve. Peripheral granulomas are the most common and are associated with the most visual morbidity because of tractional bands inciting cystoid macular edema (37.5%) or tractional retinal detachment (29.2%). Other clinical presentations include vitritis (91.7%), retinal hemorrhage (20.1%), and optic disc swelling (16.7%). Neovascularization of the disc and rubeosis are rare (4.2%). Chronicity and recurrence of the disorder as seen in our patient may be related to a viable larvae within the eye, as has also been demonstrated in primate models, which have shown that in the quiescent form no larva is found. The diagnosis of ocular toxocariasis is usually clinically based, as it may not be associated with eosinophilia or serum antitoxocara antibody positivity. Thus, even when investigating exudative retinal detachment, clinicians should be vigilant. In the literature, there are no reports of ocular toxocariasis with transvitreal migration or multiple granulomas as seen in our patient, who had two granulomas within the same eye.