Osamu Miyauchi

Protective Effect of Docosahexaenoic Acid against Retinal Ischemic Injury: An Electroretinographic Study

Purpose: To determine whether docosahexaenoic acid (DHA) can reduce the retinal damage induced by transient retinal ischemia. Methods: Retinal ischemia was induced by increasing intraocular pressure (IOP). Retinal circulation was restored by lowering IOP. An intraperitoneal injection of 1,000 mg/kg of DHA-ester (DHA-E) was given 5 h before the ischemia. Electroretinograms were recorded just before the ischemia and at 60-min intervals up to 4 h after circulation was restored. Results: The ratio of the amplitudes after the ischemia to that just before ischemia was significantly higher in eyes administered DHA-E than in controls at each time point (p < 0.01). Conclusion: DHA-E is effective in protecting the retina against transient retinal ischemia.

Criteria for early detection of temporal hemianopia in asymptomatic pituitary tumor

Purpose To determine new criteria for early detection of temporal hemianopia in patients with asymptomatic pituitary tumor.Methods Fifteen patients without visual symptoms had pituitary tumor and subtle defects or normal visual fields by Goldmann perimetry. Twelve patients with visual symptoms had pituitary adenoma and visual field defects detected by Goldmann perimetry. All were examined by automated perimetry. The relationship between the tumor and the optic chiasm was graded by magnetic resonance imaging (MRI) on a scale of 0–4. Grade number increased with extent of compression. Temporal hemianopia observed by automated perimetry was estimated from normal data (52 normal fields). Vertical step was determined from the number of adjacent pairs along the midline; sensitivity was lower in the temporal field than in the nasal field. Temporal depression was calculated by the quadrant sum of sensitivity.Results All patients with symptomatic pituitary adenoma had vertical step and temporal depression in the upper field. Nine of 15 patients without visual symptoms had vertical step or temporal depression. Of nine patients with temporal hemianopia, two of four patients had grade 1 compression, three of five had grade 2, and four of four had grade 3.Conclusion New criteria by automated perimetry could detect temporal hemianopia in patients with asymptomatic pituitary tumor.

Pattern visual evoked potentials in traumatic optic neuropathy

To evaluate the characteristics of pattern visual evoked potentials (PVEPs) in traumatic optic neuropathy (TON) compared with optic neuritis (ON), we retrospectively studied 47 patients with TON and 64 patients with unilateral ON. PVEPs elicited by the stimulation with 3 reversals/s were recorded in all patients. A PVEP could be recorded in 29.8% of the TON patients and 49.6% of the ON patients at their first visit. In the 14 patients with TON and recordable PVEPs, the mean amplitude ratio (affected/fellow eye) was 0.29 ± 0.03 (SE) and the mean delay of the peak latency was 17.9 ± 2.9 ms. In the 30 patients with ON and recordable PVEPs, the mean amplitude ratio was 0.48 ± 0.04 (SE) and the mean delay of the peak latency was 23.5 ± 2.5 ms. The amplitude ratio was significantly lower in patients with TON than in those with ON.

Comparison of Yatabe-Guilford personality test results in retinitis pigmentosa and glaucoma patients.

PURPOSE To determine the psychological state and personality traits of patients with retinitis pigmentosa (RP) or glaucoma so that a closer and better relationship can be developed with the patients. METHODS The Yatabe-Guilford personality test was administered to 75 RP patients and 42 glaucoma patients. The latter group included 29 cases of primary open-angle glaucoma, 6 of primary angle-closure glaucoma, and 7 of normal-tension glaucoma. The patients were being treated at the Department of Ophthalmology, Chiba University Hospital. As controls, 47 age-matched volunteers were tested. RESULTS A comparison of these three groups showed that the proportions of patients with cyclic tendency, rhathymia, and lack of cooperativeness traits were significantly higher in the RP group than in the glaucoma group. The lack of cooperativeness value was especially higher in the RP than in the glaucoma group and the control group (Fisher exact test, P <.05). On the other hand, the nervousness value was significantly higher in the glaucoma group than in the RP group and than in controls (Fisher exact test, P <.05). Factors of sex, age, type of disease, corrected visual acuity, and central visual fields did not influence the profiles of the RP and glaucoma groups. CONCLUSION RP patients had relatively well-stabilized personalities and were optimistic, while glaucoma patients tended toward nervousness in comparison with RP patients and controls.

Bilateral Leopard Spot Fundus of Hypertensive Choroidopathy and Its Visual Function

Accessible online at: www.karger.com/journals/oph We report the case of a Japanese patient whose fundus appearance showed so-called leopard spots which were hardly observed in the fundus of coloured patients, and visual function abnormalities. A 76-year-old Japanese man was referred to our clinic on January 13, 1999, for an ophthalmic examination prior to receiving hemodialysis therapy. He had no visual complaints and no history of eye complaints. The patient had been diagnosed 2 years earlier as having chronic nephritis after suffering from hypertension. He had not previously received any chemotherapy. On examination, his visual acuity was 0.4 (n.c.) RE and 0.3 (0.6 ! +0.5 dpt) LE. Slit-lamp examination showed a slight cataract in both eyes. Funduscopic examination of both eyes disclosed a leopard spot appearance, with brown pigment diffusely scattered from adjacent to the optic disc out to the periphery of the whole retina. Each brown spot was approximately 100–200 Ìm in diameter and resembled spots made by laser photocoagulation (fig. 1). Fluorescein angiography revealed scattered hypofluorescence corresponding to the brown spots of pigment which had been observed ophthalmoscopically (fig. 2a, b). Indocyanine green angiography demonstrated hypofluorescence of the pigmented spots (fig. 2c, d). Visual fields were normal by Goldmann perimetry. Dark adaptometry showed an increase of approximately 1.0 log unit in the second curve. Colour vision tested by SPP II and Panel D-15 revealed a blue-yellow defect. Both the aand b-waves of photopic and scotopic electroretinograms were reduced to half of the normal values, while pattern visually evoked cortical potentials were normal. This case represents an extreme example of hypertensive choroidopathy [1] with Elschnig spots. The pigmented lesions are clinically consistent with Elschnig spots representing retinal pigment epithelium clumping which occurs as a result of closures within the choriocapillaris [1, 2]. The leopard spot pattern of pigment clumping seen in our patient with chronic nephritis was similar to that seen in uveal effusion syndrome, organ transplant chorioretinopathy and leukaemia. Since this patient had had hypertension severe enough to produce renal failure, it is reasonable to expect hypertensive changes in other organs including the eye.

Cytogenetic analysis of the retained products of conception after missed abortion following blastocyst transfer: a retrospective, large-scale, single-centre study

Cytogenetic analysis of the retained products of conception (POC) is the most effective test for identifying miscarriage causes. However, there has been no large-scale study limited to blastocyst transfer. This study retrospectively reports the findings of 1030 cases in which POC analysis was performed after missed abortion following single blastocyst transfer performed at the Shinbashi Yume Clinic. We identified 19.4% as normal karyotypes and 80.6% as aneuploid. These cases broke down into: 62.3% trisomy; 7.8% double trisomy; 0.5% triple or quadruple trisomy; 1.3% monosomy 21; 3.2% monosomy X; 0.1% 47,XXY; 1.0% polyploidy; 1.0% mixed; 1.1% embryonic mosaicism; and 2.4% structural anomalies. In samples with normal karyotypes, 49.5% were female while 50.5% were male. The occurrence of trisomy and double trisomy were both significantly more frequent in the ≥38 years group than in the ≤37 years group (P < 0.01). Trisomy was significantly more frequently associated with fetal heartbeat (P < 0.01); double trisomy, polyploidy and normal karyotype were significantly more frequent with no fetal heartbeat (P < 0.01). There was no significant difference in the frequency of chromosomal abnormalities between the number of miscarriages or blastocyst quality. Thus, POC cytogenetic testing is highly valuable for ascertaining the cause of miscarriage.

Pattern visual evoked cortical potentials predict postoperative visual acuity after cataract surgery in patients with glaucoma

Visual acuity after cataract surgery in patients with glaucoma cannot be predicted accurately. We studied preoperative recordings of pattern visual evoked cortical potentials (PVECPs) to evaluate postoperative vision in patients with glaucoma and cataract. Fifty patients with glaucoma and no cataract and 31 patients with glaucoma and cataract who underwent phacoemulsification were included in this study. Age and P100 component significantly correlated with postoperative visual acuity with multiple linear regression analysis. A significantly greater number of patients with glaucoma, cataract, and a P100 component preoperatively showed a visual acuity of 0.7 or better postoperatively, as compared to those without a P100 component. PVECP before cataract surgery was able to predict postoperative good visual acuity in patients with glaucoma and cataract.

Clinical profiles of patients with optic neuritis at the Ophthalmological Department of Chiba University

Objective: To determine the clinical features of 272 patients who were diagnosed with optic neuritis at an ophthalmological clinic in Japan. Methods: We reviewed the records of patients examined between January 1977 and late June 1999. Results: The ratio of women to men was 1.7 : 1. The mean age at onset was 35 years and 80.5% were unilateral. The most frequent complaint was a vision decrease in 82.4%. The disc appeared normal in 38.5%. The median visual acuity at onset was 0.1; it was 1.0 at the recovered stage. The mean time required for visual recovery was 92.3 days from the onset. The most common known cause of optic neuritis was multiple sclerosis (MS)(22.8%). The recurrence rate was 22.0% and the mean number of recurrences was 2.9. The time for the development of disc pallor was 124.8 days. Conclusions: We found no racial difference in the incidence of MS as has been reported between Caucasians and Japanese.

A Novel Treatment for Cervical and Cesarean Section Scar Pregnancies by Transvaginal Injection of Absolute Ethanol to Trophoblasts: Efficacy in 19 Cases

STUDY OBJECTIVE To evaluate the efficacy of a nonsurgical treatment for cervical pregnancy (CP) and cesarean section scar pregnancy (CSP). DESIGN Retrospective clinical study (Canadian Task Force classification III). SETTING Private assisted reproductive technology practice. PATIENTS Nineteen women with CP (n = 16) or CSP (n = 3), including 6 patients with positive fetal heartbeat. INTERVENTION Transvaginal local injection of absolute ethanol (AE) into the hyperechoic ring (lacunar space) around the gestational sac under ultrasound guidance. MEASUREMENTS AND MAIN RESULTS Serum beta-human chorionic gonadotropin (β-hCG) was measured at frequent intervals, and ultrasound and/or magnetic resonance imaging was used to observe the gestational sac. In 9 patients, the serum β-hCG level was effectively reduced with a single AE injection at 2 hours. In the remaining 10 patients, the level decreased but then increased in 4 and slowly decreased in the other 6; all of these 10 patients required 2 to 5 repeat AE injections. In all patients, serum β-hCG level was reduced by 50% within 3 days and decreased to <10% of the initial level within 14 days. In 18 patients (95%), the level was decreased to 1.0 mIU/mL within 40 days. Seven patients were treated on an outpatient basis. Twelve patients received no anesthesia. Five patients subsequently became pregnant, and each had a live birth. There was no recurrent CP or CSP. The procedure was successful in all 19 patients. CONCLUSION This procedure is an effective treatment for CP or CSP that could be used in place of conventional surgical interventions and medical treatment using MTX.

Efficient Subtractive Cloning of Genes Activated by Lipopolysaccharide and Interferon γ in Primary-Cultured Cortical Cells of Newborn Mice

Innate immune responses play a central role in neuroprotection and neurotoxicity during inflammatory processes that are triggered by pathogen-associated molecular pattern-exhibiting agents such as bacterial lipopolysaccharide (LPS) and that are modulated by inflammatory cytokines such as interferon γ (IFNγ). Recent findings describing the unexpected complexity of mammalian genomes and transcriptomes have stimulated further identification of novel transcripts involved in specific physiological and pathological processes, such as the neural innate immune response that alters the expression of many genes. We developed a system for efficient subtractive cloning that employs both sense and antisense cRNA drivers, and coupled it with in-house cDNA microarray analysis. This system enabled effective direct cloning of differentially expressed transcripts, from a small amount (0.5 µg) of total RNA. We applied this system to isolation of genes activated by LPS and IFNγ in primary-cultured cortical cells that were derived from newborn mice, to investigate the mechanisms involved in neuroprotection and neurotoxicity in maternal/perinatal infections that cause various brain injuries including periventricular leukomalacia. A number of genes involved in the immune and inflammatory response were identified, showing that neonatal neuronal/glial cells are highly responsive to LPS and IFNγ. Subsequent RNA blot analysis revealed that the identified genes were activated by LPS and IFNγ in a cooperative or distinctive manner, thereby supporting the notion that these bacterial and cellular inflammatory mediators can affect the brain through direct but complicated pathways. We also identified several novel clones of apparently non-coding RNAs that potentially harbor various regulatory functions. Characterization of the presently identified genes will give insights into mechanisms and interventions not only for perinatal infection-induced brain damage, but also for many other innate immunity-related brain disorders.