Satoshi Ishiko

Comparison of short- and long-term effects of betaxolol and timolol on human retinal circulation.

Purpose To determine the short- and long-term effects of betaxolol and timolol on human retinal circulation.Methods In a double-masked, randomised, placebo-controlled study we evaluated the effects of both a one-drop application and a twice-daily 2-week application of either topical 0.5% betaxolol hydrochloride or topical 0.5% timolol maleate on the retinal circulation in 12 healthy volunteers. Laser Doppler velocimetry was used to detect changes in the retinal venous blood flow.Results In both betaxolol- and timolol-treated eyes, intraocular pressure decreased significantly compared with baseline values after both 90 min and 2 weeks. In betaxolol-treated eyes, retinal blood flow did not change significantly after 90 min, but increased significantly (14 ± 9%; p = 0.02) compared with baseline after 2 weeks. In timolol-treated eyes, retinal blood flow decreased significantly (18 ± 5%: p = 0.04) compared with baseline after 90 min, and also decreased significantly (14 ± 6%; p - 0.04) compared with baseline after 2 weeks.Conclusions Retinal blood flow increases as a long-term effect of betaxolol and decreases as both a short- and long-term effects of timolol.

Macular hole formation in fellow eyes with a perifoveal posterior vitreous detachment of patients with a unilateral macular hole.

PURPOSEnTo estimate the rate of macular hole formation in fellow eyes with a perifoveal posterior vitreous detachment (PVD) and early stage 1 intrafoveal lesions in patients with a unilateral idiopathic full-thickness macular hole (MH) using optical coherence tomography (OCT).nnnDESIGNnRetrospective observational case series.nnnMETHODSnFellow eyes of consecutive patients with a unilateral full-thickness MH were examined on OCT. A subset of fellow eyes with a perifoveal PVD had been followed to investigate the rates of macular hole formation in fellow eyes with early stage 1 intrafoveal lesions.nnnRESULTSnOf 176 patients with a unilateral full-thickness MH, 42 fellow eyes (42 patients) with a perifoveal PVD were identified. During follow-up, a foveolar detachment was seen in 16 eyes, and 4 eyes had a foveal pseudocyst alone. In the 16 eyes with a foveolar detachment, 9 eyes had concurrent inner foveal splits. Within another 2 years of follow-up, OCT showed that 5 of 16 fellow eyes (31%) with a foveolar detachment developed a second full-thickness MH and 5 of 9 fellow eyes with a foveolar detachment and inner foveal splits developed a second full-thickness MH. Two of 4 eyes with a foveal pseudocyst alone developed vitreofoveal separation without hole formation. The remaining 2 eyes with a foveal pseudocyst alone remained stable at the last follow-up visit.nnnCONCLUSIONSnFellow eyes with a foveolar detachment and a perifoveal PVD may be at high risk, and fellow eyes with a foveolar detachment and inner foveal splits might be at higher risk for progression to macular hole formation.

Idiopathic Full-Thickness Macular Holes and the Vitreomacular Interface: A High-Resolution Spectral-Domain Optical Coherence Tomography Study

PURPOSEnTo analyze the vitreomacular interface in idiopathic full-thickness macular holes (MHs) using spectral-domain optical coherence tomography.nnnDESIGNnProspective cross-sectional case series.nnnMETHODSnNinety-one eyes of 86 consecutive patients with a MH were examined by spectral-domain optical coherence tomography. The vitreomacular interface was assessed and the presence or absence of an operculum was analyzed.nnnRESULTSnFifty-two eyes had a stage 2 MH, 12 eyes a stage 3 MH, and 27 eyes a stage 4 MH. No posterior hyaloid membrane was detected in any eyes with a stage 4 MH. In 35 (54.7%) of the 64 eyes with an MH without a complete posterior vitreous detachment (PVD), we saw a perifoveal PVD with vitreofoveal adhesion and partial dehiscence of the raised inner retina with an outer retinal separation in the MHs. In 24 (37.5%) of the 64 eyes without a complete PVD, an operculum, which is a hyperreflective structure of the foveal retina, was in front of the MH. The posterior hyaloid membrane was separated completely but adhered to the optic disc. In 2 (3.1%) of the 64 eyes without a complete PVD, the posterior hyaloid membrane was separated from the macula without an operculum. In 3 (4.7%) of the 64 eyes without a complete PVD, vitreofoveal adhesion on both edges of the hole was connected to the taut posterior hyaloid membrane without an operculum.nnnCONCLUSIONSnThe vitreomacular interface had 4 configurations in MHs without a complete PVD. Approximately 55% of cases with an open roof in the eyes without a complete PVD may be at risk for progression to operculum formation (loss of retinal tissue).

Corneal and Lens Autofluorescence in Young Insulin-Dependent Diabetic Patients

To study the early ocular abnormalities in young diabetic patients, corneal and lens autofluorescence was measured by fluorophotometry in 30 eyes of 30 insulin-dependent diabetic patients without retinopathy. The lens [f(l)] and the corneal [f(c)] autofluorescence values in diabetic patients were significantly higher than in controls. In diabetic patients, f(l) was significantly correlated with the duration of diabetes, the f(c) was significantly correlated with the duration of diabetes and the indices of metabolic control, i.e. HbA1c and fructosamine. Our study demonstrated that young diabetic patients clearly had corneal and lens abnormalities before the appearance of overt diabetic retinopathy. The f(c) value might be a good indicator of metabolic control in diabetic patients.

Hypertensive choroidopathy with eclampsia viewed on spectral-domain optical coherence tomography

PurposeWe report a case of hypertensive choroidopathy with detailed retinal images obtained using spectral-domain optical coherence tomography (SD-OCT).CaseA 19-year-old pregnant woman with no history of high blood pressure had an eclamptic seizure at the 39th week of pregnancy; the baby was delivered by emergency Caesarean section. Six days later, she presented with bilateral blurred vision (best-corrected visual acuity [VA], 0.5, right eye; 0.3, left eye). Bilateral extensive, punctate, pale-yellow Elschnig’s spots were present in the posterior fundus. SD-OCT showed a serous retinal detachment (SRD) and retinal pigment epithelium detachment (PED) representing a waveform retinal pigment epithelium (RPE) layer in each eye. The reflective intensity decreased partly at the waveform RPE. A wavy structure suggestive of fibrin was present in both foveas between the photoreceptor ellipsoid zone and the RPE-outer segment line. Four weeks after delivery and oral antihypertensive treatment, the SRDs, PEDs and wavy structure resolved and the VA recovered.ConclusionSD-OCT visualized SRDs, PEDs, wavy structures under the photoreceptor ellipsoid zone, and areas of low intensity RPE layer in hypertensive choroidopathy.

Indirect imaging of branch retinal vein occlusion using a scanning laser ophthalmoscope

Cystoid macular edema (CME) is a common cause of visual loss in several macular diseases including branch retinal vein occlusion (BRVO) [1]. To determine the severity of the visual impairment, it is important to evaluate the patient’s macular pathology. The necessary procedures can be enhanced with infrared (790 nm) indirect imaging using a digital scanning laser ophthalmoscope (SLO) F-10 (Nidek, Gamagori, Japan) with a new aperture; here we refer to this as the retro-mode. This apparatus can visualize retinal features undetectable by other methods. Herein we report the retinal findings evaluated by the retro-mode in a patient with BRVO. Case report

A low meat diet increases the risk of open-angle glaucoma in women—The results of population-based, cross-sectional study in Japan

Background Studies identifying modifiable lifestyle risk factors related to open-angle glaucoma (OAG) are limited, especially from Asian countries. This study aimed to identify lifestyle risk factors for OAG in a Japanese population. Methods and findings This population-based, cross-sectional study recruited Japanese participants aged 40 years or older from January 2013 to March 2015. We took fundus photographs for OAG screening, determined lifestyle and health characteristics through a questionnaire and performed physical examinations. The participants who had suspect findings in the fundus photographs were sent for a detailed ophthalmic examination to diagnose OAG. Lifestyle and heath characteristics were statistically compared between the OAG and non-OAG participants. A total of 1583 participants were included in the study, of which 42 had OAG and 1541 did not have OAG. The number of days per week that the female participants consumed meat (mean±SD; OAG: 1.7±1.2 days, non-OAG: 2.7±1.5 days) was negatively associated with OAG (OR = 0.61; 95% CI: 0.43–0.88; p = 0.007). Higher intraocular pressure was positively associated with OAG in men (OR = 1.20; 95% CI: 1.05–1.38, p = 0.009). No significant difference between participants with and without OAG was observed for a range of other lifestyle factors and health criteria including self-report of diabetes, number of family living together, body mass index, blood pressure, pulse rate, coffee drinking, tea drinking, alcohol drinking, number of fruits consumed per day and days of fish consumption per week. Conclusions A higher weekly consumption of meat appears to be negatively associated with OAG in Japanese women. Increasing the dietary intake of meat can contribute to reducing the risk of developing OAG.

Effect of spectacle lenses designed to reduce relative peripheral hyperopia on myopia progression in Japanese children: a 2-year multicenter randomized controlled trial

PurposeNovel spectacle lenses (MyoVision, Carl Zeiss) designed to reduce relative peripheral hyperopia have been developed and reported to be effective for preventing myopia progression in a subgroup of Chinese children. In this study we examined the efficacy of MyoVision lenses in Japanese children.Study designThis was a multicenter prospective randomized double-blind placebo-controlled trial.MethodWe enrolled 207 participants (aged 6–12 years) with spherical equivalent refractions (SERs) ranging from −1.5 to −4.5 diopters (D) and with at least 1 myopic parent. The participants were randomized to receive either single vision lenses (SVLs) or MyoVision lenses and were followed up every 6 months for 2 years. The primary outcome was myopia progression evaluated by cycloplegic autorefraction, and the secondary outcome was elongation of axial length.ResultsA total of 203 children (98.1%) completed the follow-up. The mean adjusted change in SER was −1.43 ± 0.10 D in the MyoVision group, which was not significantly different from that of the control group wearing SVLs (−1.39 ± 0.07 D) at the 24-month visit (P = .65). The adjusted axial length elongation was 0.73 ± 0.04 mm in the MyoVision group, which was not significantly different from that in the control group wearing SVLs (0.69 ± 0.03 mm) at the 24-month visit (P = .28).ConclusionThe results of this clinical trial could not verify the therapeutic effect of MyoVision for slowing down myopia progression in Japanese children. Additional studies are needed to design lenses that can reduce peripheral hyperopic defocus individually and to examine the effectiveness of these lenses in preventing myopia progression.

Retinal and choroidal hyperreflective foci on spectral-domain optical coherence tomographic images in a patient with retinitis pigmentosa accompanied by diabetic retinopathy

Purpose To report the detailed macular morphology documented by spectral-domain optical coherence tomography (SD-OCT) in a patient with retinitis pigmentosa (RP) and diabetic retinopathy (DR). Observations A 54-year-old man with a hemoglobin A1c level of 11.4% was referred for decreased visual acuity (VA) bilaterally (right eye, 20/100; left eye, 20/40). Funduscopy showed typical retinal findings of RP bilaterally. The macular area of both fundi showed retinal dot-and-blot hemorrhages, hard exudates. Time-domain OCT revealed macular edema in the right eye. The patient was diagnosed with RP accompanied by DR bilaterally. Five years after the first visit, the BCVAs remained 20/100 in the right eye and 20/40 in the left eye. SD-OCT showed that the retinas were thinner temporal to the maculas. The external limiting membrane line (ELM) and the ellipsoid zone of the photoreceptors line (EZ) was not visible in the foveal region in the right eye and temporal to the macula in both eyes. The image revealed the characteristic intraretinal and intrachoroidal hyrerreflective foci, the number of which increased corresponding to the extent of the disappearance of the ELM and EZ line with thinning of the outer nuclear layer (ONL). In addition, the image also showed a great number of the hyperreflective foci in the ONL and the choriocapillaris in the foveal region in the right eye compared with the left eye. Conclusions In the current case, the SD-OCT findings suggested that the characteristic hyrerreflective foci clinically observed in the fundi of a patient with RP accompanied by DR are present in the retinal layers and the choroid. In addition, the foci in the retinal and choroidal layers in the foveal region may increase as vision declines corresponding to the disappearance of the ELM and EZ line.