Satoshi Mizunoya

Correlation of visual recovery and presence of photoreceptor inner/outer segment junction in optical coherence images after successful macular hole repair.

Purpose: To determine the relationship between the postoperative visual acuity (VA) and the presence of a photoreceptor inner segment (IS) and outer segment (OS) junction (IS/OS) in optical coherence tomographic (OCT) images after macular hole (MH) surgery. Methods: Twenty-three eyes of 23 cases of idiopathic MH treated by vitrectomy were studied. The postoperative VA and OCT3 images of the fovea at 1, 3, and 6 months were examined. The relationship between the presence of the IS/OS junction and the visual acuity was studied. Results: All MHs were successfully closed. The IS/OS junction appeared as a distinct, highly reflective line just vitread to the retinal pigment epithelial layer in the postoperative OCT3 images. A normal IS/OS junction was detected postoperatively in one eye at 1 month, three eyes at 3 months, and seven eyes at 6 months. The VA was significantly better in eyes in which a normal IS/OS junction was detected than in those not detected at 3 and 6 months postoperatively (P = 0.046 and P = 0.040, respectively). Conclusion: The normal IS/OS junction observed in OCT3 images is associated with good visual recovery after MH closure. The presence of normal IS/OS junction may be important for visual recovery after MH repair.

Correlation of retinal sensitivity measured with fundus-related microperimetry to visual acuity and retinal thickness in eyes with diabetic macular edema

AimTo determine whether significant correlations exist between retinal sensitivity measured by fundus-related microperimetry and the visual acuity and the foveal thickness measured by optical coherence tomography (OCT) in eyes with diabetic macular edema (DME).MethodsA retrospective chart review of 32 eyes with DME and 17 normal healthy eyes that had undergone fundus-related microperimetry and OCT. The macular sensitivity was measured using the recently introduced fundus-related microperimeter, Micro Perimeter 1. The mean retinal sensitivities within the central 2° and 10° were correlated with the best-corrected visual acuity and OCT-measured foveal retinal thickness.ResultsThe mean sensitivities in the central 2° and 10° were significantly lower in patients with DME than in normal subjects (P<0.0001). The mean retinal sensitivities in the central 2° and 10° were inversely correlated with visual acuity (r2=0.623, P<0.0001; r2=0.581, P<0.0001) and foveal thickness (r2=0.581, P<0.0001; r2=0.551, P<0.0001).ConclusionsThe mean retinal sensitivities measured with fundus-related microperimetry were significantly lower in eyes with DME than in normal eyes. Because a significant correlation of the microperimeter-determined retinal sensitivity to visual acuity and foveal thickness was observed, the retinal sensitivities obtained by fundus-related microperimetry may be another measure that can be used to assess the effects of DME.

Efficacy of Vitrectomy and Internal Limiting Membrane Removal for Macular Edema Associated with Branch Retinal Vein Occlusion

Aim: To compare the results of vitrectomy with internal limiting membrane (ILM) peeling to that without ILM peeling for macular edema associated with branch retinal vein occlusion (BRVO). Methods: The medical records of 47 eyes of 47 patients with BRVO-associated macular edema were examined. To treat the macular edema, a posterior vitreous detachment (PVD) was created, and the ILM was removed in 13 eyes (ILM-removed group), whereas a PVD was created and the ILM was not removed in 34 eyes (ILM-preserved group). The best-corrected visual acuity (BCVA) and the optical-coherence-tomography-determined foveal thickness were obtained preoperatively and at 6 months postoperatively. Results: The mean postoperative BCVA was significantly better than the preoperative BCVA in both the ILM-removed and in the ILM-preserved groups (p = 0.0017 and p = 0.0002, respectively). The fovea was significantly thinner at 1 month after surgery in both groups (p = 0.0007 and p < 0.0001, respectively). The postoperative improvement of the mean BCVA and the foveal thickness were not significantly different for the two groups at any postoperative period. Conclusions: Because there was no significant difference in the improvement of BCVA between the two groups at 6 months postoperatively, there may be no additional benefit in removing the ILM for BRVO-associated macular edema.

Early postoperative macular morphology and functional outcomes after successful macular hole surgery.

Purpose: To investigate the relationship between early postoperative macular morphology and postoperative visual acuity in eyes that had undergone successful macular hole (MH) surgery. Methods: Pars plana vitrectomy and internal limiting membrane peeling were performed during surgery for idiopathic MHs on 25 eyes. The macular configuration was determined by optical coherence tomography, and best-corrected VA (BCVA) was measured postoperatively. Results: Eleven eyes had nearly normal foveal morphology (normal group) and 14 eyes had subretinal fluid or intraretinal cysts (abnormal group) at 1 month. Among the 14 eyes in the abnormal morphology group, normal foveal morphology was confirmed in 9 eyes 3 months and in the remaining 5 eyes 6 months after surgery. Mean BCVA improved significantly from the preoperative values in both groups 6 months after surgery. Conclusions: The morphology of the macular area was abnormal in more than one half of eyes that had successful MH surgery 1 month after surgery. However, by 6 months, all eyes had normal macular configuration, and BCVA was not significantly different in the two groups. We conclude that an abnormal morphologic appearance of the macular area in the early postoperative period does not predict the final visual outcome.

Vitrectomy alone versus vitrectomy with simultaneous intravitreal injection of triamcinolone for macular edema associated with branch retinal vein occlusion.

BACKGROUND AND OBJECTIVE To evaluate the efficacy of vitrectomy with simultaneous intravitreal injection of triamcinolone acetonide for macular edema associated with branch retinal vein occlusion. PATIENTS AND METHODS A retrospective study of 45 eyes with macular edema associated with branch retinal vein occlusion. A posterior vitreous detachment was created and the vitreous cortex was completely removed, after which 23 eyes immediately had an intravitreal injection of triamcinolone acetonide (triamcinolone acetonide group) and 22 eyes did not (no triamcinolone acetonide group). Visual acuity, fluorescein angiograms, and foveal thickness determined by optical coherence tomography were examined preoperatively and postoperatively. RESULTS Mean postoperative visual acuity at 12 months was significantly better than the preoperative visual acuity in both groups. The fovea was significantly thinner 1 month postoperatively in both groups. Foveal thickness gradually decreased until 12 months in the no triamcinolone acetonide group; however, foveal thickness increased for 12 months in the triamcinolone acetonide group. A recurrence of macular edema was more frequent in the triamcinolone acetonide group than in the no triamcinolone acetonide group (P = .006). CONCLUSIONS Because there was no significant difference in the improvement of best-corrected visual acuity between the groups 12 months postoperatively, there may be no benefit in the use of intraoperative intravitreal triamcinolone acetonide.

Comparison of photodynamic therapy to transpupillary thermotherapy for polypoidal choroidal vasculopathy

PurposeTo compare the therapeutic efficacy of photodynamic therapy (PDT) to that of transpupillary thermotherapy (TTT) for polypoidal choroidal vasculopathy (PCV).MethodsPDT or TTT was performed on 46 eyes of 46 patients with PCV; 19 eyes were treated with TTT (TTT group) and 27 eyes with PDT (PDT group). PCV was diagnosed by fundus examination, fluorescein angiography (FA) , and indocyanine green angiography (ICGA) . The best-corrected visual acuity (BCVA) in logarithm of the minimum angle of resolution (logMAR) units and OCT-determined foveal thickness were evaluated before and after treatment. For statistical analyses, the Student’s t-test and χ2 test were used.ResultsThe number of treatments during the 12-month follow-up period was significantly higher in the TTT group (1.7 times) than in the PDT group (1.3 times; P=0.0134). The difference in the BCVA between the TTT and PDT groups at the baseline was not significant (P=0.3150), but the BCVA in the PDT group was significantly better than that in the TTT group at 3, 6, and 12 months after treatment (P=0.0093, P=0.0074, P=0.0006, respectively). The foveal thickness decreased markedly at 6 months after treatment in the PDT group (P<0.0001) but not significantly in the TTT group (P=0.8982). A vitreous haemorrhage was observed after treatment in two eyes in the TTT group.ConclusionsBCVA was significantly better and the fovea was significantly thinner in the PDT group than in the TTT group after treatment. Thus, PDT may be more effective than TTT for the treatment of eyes with PCV.

Case of POEMS Syndrome Associated with Bilateral Macular Detachment Resolved by Autologous Peripheral Blood Stem Cell Transplantation

the growth and tube formation of microvascular endothelial cells and upregulated VEGF mRNA levels via AP-1. It has been reported that the overexpression of the AP-1 gene induces severe angiogenesis in the rat brain, suggesting the involvement of AP-1 in in vivo angiogenesis. We have reported that phosphorylated c-Jun is widely expressed in the glial component of PDR ERM. In this study, c-Jun in cultured Müller cells was phosphorylated by the stimulation of glycated albumin, indicating that c-Jun is activated in glial cells under the conditions that mimic long-term hyperglycemia. Taken together, AP-1 in retinal glial cells may be involved in PDR angiogenesis by regulating the promoter activity and the expression of angiogenesis-related cytokines.

A Case of anterior ischemic optic neuropathy associated with Fabry’s disease

eye progressed so rapidly that eyeball luxation presented at the time of surgery, precluding any possible therapies. Besides the virulent nature of Bacillus cereus, other factors could have facilitated this eyeball luxation. First, a double-penetrating injury may have facilitated the infi ltration of vitreal material into the retrobulbar tissues. The scleral laceration could have been caused biochemically by various bacterial proteases or mechanically by the foreign body itself. Second, exotoxins, such as phospholipase C, hemolysin BL, and proteases complicated by Bacillus cereus may have potentially infl icted direct tissue damage, swelling, and destruction of the orbital tissues; hence, the whole eyeball may have been squeezed out of the lid, and, in a vicious circle, the eyeball luxation accelerated the necrosis of the ocular tissues. Third, the lens capsules were ruptured and phacoanaphylactic endophthalmitis may have been an additional factor promoting and worsening the infl ammation. This case emphasizes the severity of this devastating ocular infection. Rapid progress of proptosis warrants suspicion of double-penetrating injury and extremely urgent surgical intervention is crucial.

Orbital T-cell lymphoma in a multiple myeloma patient

PURPOSE To report an 82-year-old woman with multiple myeloma who developed an orbital T-cell lymphoma concomitantly. METHODS The patient presented with left upper eyelid swelling. Magnetic resonance imaging demonstrated an orbital mass compressing the eyeball. The mass was excised for diagnostic purposes and orbital decompression. RESULTS Histopathologic and immunohistochemical evaluation identified the mass as a T-cell lymphoma. The disease progressed rapidly despite chemotherapy. CONCLUSIONS Orbital T-cell lymphoma is rare and we are unaware of previous reports of orbital T-cell lymphoma in patients with multiple myeloma.

Case of Dominantly Inherited Drusen Accompanied by Choroidal Neovascularization

Winai Chaidaroon, Somsanguan Ausayakhun, Sumalee Pruksakorn, Sani-orn Jewsakul, and Kittika Kanjanaratanakorn 1 Department of Ophthalmology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand; 2 Department of Microbiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand; 3 Research Administration Section, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand