Nagako Kondo

Intravitreal injection of bevacizumab for macular edema secondary to branch retinal vein occlusion:results after 12 months and multiple regression analysis.

Purpose: To evaluate the 12-month follow-up results of intravitreal bevacizumab therapy for macular edema secondary to branch retinal vein occlusion and to identify the pretreatment factors that were associated with an improvement of the final visual outcome. Methods: Fifty eyes of 50 patients with macular edema secondary to branch retinal vein occlusion received an injection of 1.25 mg/0.05 mL bevacizumab. Additional injections were done when recurrence of macular edema occurred or the treatment was not effective. The best-corrected visual acuity and foveal thickness were measured. Stepwise multiple regression analyses were also performed. Results: The mean logarithm of the minimum angle of resolution visual acuity improved significantly from 0.53 to 0.26, and the mean foveal thickness decreased significantly from 523 to 305 &mgr;m during the 12-month follow-up period. The mean number of injections was 2.0 (range, 1–4). Stepwise multiple regression analyses showed that younger patients had both better visual acuity at 12 months and greater improvement of visual acuity during 12 months. In addition, better pretreatment visual acuity was associated with better visual acuity at 12 months but with less improvement of the visual acuity. Conclusion: Intravitreal bevacizumab therapy can be a long-term effective treatment for macular edema secondary to branch retinal vein occlusion.

Multifocal pupillary light response fields in normal subjects and patients with visual field defects

The optimal conditions for recording focal pupillary light responses with a multifocal stimulation technique were determined, and the technique was applied to normal subjects and patients with visual field defects. Thirty-seven hexagonal stimuli were presented on a TV monitor with a visual field of 40 degrees diameter under a constant background illumination. Using a slow (4.7 Hz) m-sequence, reliable focal responses were obtained in both normal subjects and patients. The pupillary field and visual field were well correlated in patients with retinal diseases, but the correlation was not strong in patients with optic-nerve diseases. Pupillary light responses were reduced in the blind hemifield in patients with post-geniculate lesions. These results indicate that the multifocal stimulation technique can be used clinically to obtain a pupillary field for objective visual field testing.

Changes in areas of capillary nonperfusion after intravitreal injection of bevacizumab in eyes with branch retinal vein occlusion.

Purpose: To study the effect of an intravitreal bevacizumab (IVB) on the retinal ischemia in eyes with a branch retinal vein occlusion. Methods: Fluorescein angiography was performed before and 1 month after the IVB (1.25 mg/0.05 mL) in 58 consecutive eyes of 58 patients with macular edema secondary to a branch retinal vein occlusion. The area of capillary nonperfusion was measured on an early-phase fluorescein angiography image by an area measurement program, and the area was expressed relative to the optic disk area (DA). A blockage of the fluorescence by the retinal hemorrhage was distinguished from nonperfusion by comparisons with retinal photographs. Results: Thirty-seven of 58 eyes did not have any capillary nonperfusion before the IVB, and capillary nonperfusion developed in 3 of these 37 eyes 1 month after the IVB. The area of nonperfusion in these 3 eyes was 0.13, 0.47, and 0.60 DA. Twenty-one of the 58 eyes had capillary nonperfusion before the IVB, and the mean (±SD) area of nonperfusion was 3.45 ± 4.66 DA before the IVB and 3.45 ± 5.19 DA 1 month after the IVB. This change was not significant (P = 0.36). An increase in the area of capillary nonperfusion of >1.0 DA after the IVB was seen in only 1 of all 58 eyes. Conclusion: These results suggest that the incidence of a significant increase in the area of capillary nonperfusion (>1 DA) during the 1 month after the IVB is very low in eyes with branch retinal vein occlusion.

High Prevalence of Myopia in Japanese Patients with Multiple Evanescent White Dot Syndrome

PurposeTo compare the incidence of refractive errors in Japanese patients with multiple evanescent white dot syndrome (MEWDS) with that in age- and sex-matched controls.MethodsFifty Japanese patients with MEWDS (11 males and 39 females; ages, 15–58; mean 29.9 years) were studied retrospectively. The refractive errors (spherical equivalent) in the patients were compared with those of 150 age- and sex-matched controls.ResultsThe mean refractive error in the patient group was −5.30 ± 4.58 diopters (D) which was significantly greater than that in the controls (−2.57 ± 2.94 D, P = 0.0005). Twenty-two (44.0%) of the 50 MEWDS patients had refractive errors >−6.00 D; whereas 14 (9.3%) of 150 normal subjects had this degree of myopia. This difference was statistically significant (P < 0.005).ConclusionJapanese patients with MEWDS tend to be highly myopic.

Acute idiopathic blind spot enlargement syndrome: prolonged retinal dysfunction revealed by multifocal electroretinogram technique

PURPOSE To report the multifocal electroretinographic findings of a patient with acute idiopathic blind spot enlargement syndrome recorded at 2 weeks and 4 months after the onset. METHODS A 35-year-old patient underwent static visual field (Humphrey, 30-2) and multifocal electroretinogram testing at 2 weeks and 4 months after the onset of acute idiopathic blind spot enlargement. The stimulus array for the multifocal electroretinogram consisted of 61 hexagons, and the total recording time was about 4 minutes. RESULTS At 2 weeks, the patient had a large, well-demarcated scotoma centered on the blind spot, and its margin extended to within 5 degrees of fixation. The multifocal electroretinograms were depressed in the areas corresponding to the scotoma. At 4 months, her visual symptoms disappeared and static visual fields showed normal sensitivities at almost all locations. However, the multifocal electroretinograms still revealed reduced focal responses in a broad area around the blind spot. CONCLUSION These results suggest that multifocal electroretinograms may be used to detect subclinical retinal dysfunction in patients with acute idiopathic blind spot enlargement.

Analyses of erG in a patient with intraocular lymphoma

Purpose To follow the changes in the electroretinograms (ERGs) in a patient with primary intraocular lymphoma (PIOL) who had a complete remission after chemotherapy. Methods ERGs were recorded in a 41-year-old woman with PIOL during and after complete remission with chemotherapy. The patient was diagnosed with PIOL from both the ocular signs and the medical history of cranial lymphoma. Results The ERGs were depressed in the subject. The amplitudes of the bright white flash b-waves were smaller than the a-waves, resulting in a “negative type” ERG. Six weeks after the beginning of chemotherapy, the ocular changes had resolved, and the ERGs, although not of the “negative type”, still showed signs that the amplitude had not returned to normal levels. Conclusion The negative type ERGs indicated that the inner retina had been damaged to a greater extent than the outer retina. In the convalescent stage, when the ocular manifestations were resolved, the ERGs were still not fully recovered. Although only one case was studied, we suggest that ERGs can be used to evaluate and follow patients with a PIOL.

High Resolution Ultrasonography in Eyes with Angle-Closure Glaucoma Associated with the Cicatricial Stage of Retinopathy of Prematurity

BackgroundAngle-closure glaucoma in children at the cicatricial stage of retinopathy of prematurity (ROP) has been thought to be caused by the anterior displacement of the lens–iris diaphragm resulting from contraction of a retrolental fibrous membrane. Other possible mechanisms include pupillary block and ciliary block.CasesThree patients (three eyes) at the cicatricial stage of ROP with angle-closure glaucoma were examined by high-resolution ultrasonography before and after peripheral iridectomy.ObservationsHigh-resolution ultrasonography preoperatively showed that the angle was closed. A retrolental fibrous membrane was attached behind the lens. After the iridectomy, ultrasonography showed an open angle, and the intraocular pressure was normal.ConclusionsThe angle closure in our three patients was caused mainly by a pupillary block and could be treated by peripheral iridectomy. Jpn J Ophthalmol 2005;49:312–314

Studies on ocular positions at close distance with a new system of measuring ocular positions

The purpose of our study was to develop a new system of measuring ocular positions and to assess its clinical applicability. This system is derived from that of the Hess coordimeter and is used at a distance of 40 cm. Our system enables us to distinguish tropia from phoria by testing the ocular positions both with and without a fusional target which can be seen by both eyes. All devices are installed in one structure and it can be used in a lighted room. The system was checked in 10 normal subjects by plotting the data of the charts onto a graph and deriving a static eye position curve. There was no significant vertical deviation, and there was an exodeviation of 5.32 +/- 3.78 (mean +/- standard deviation) degrees without a fusional target, but no significant deviation occurred when the fusional target was lighted. In 37 of the 38 patients with ocular motor disturbance, the results with this system corresponded well with those obtained by the Hess coordimeter or prism cover test. One particular case with extraocular myositis involving more than two extraocular muscles showed an atypical complicated pattern. We believe that our system is simple and easy for clinical evaluation of ocular movement abnormality in ophthalmic diagnosis.