Seiyo Harino

Vitreous levels of interleukin-6 and vascular endothelial growth factor in macular edema with central retinal vein occlusion.

OBJECTIVE To investigate whether interleukin (IL)-6 or vascular endothelial growth factor (VEGF) influences macular edema in patients with central retinal vein occlusion (CRVO). DESIGN Retrospective case-control study. PARTICIPANTS Twenty-seven patients who had macular edema with CRVO and 16 patients with nonischemic ocular diseases (control group). METHODS Retinal ischemia was evaluated by measuring the area of capillary nonperfusion using fluorescein angiography and the public domain Scion Image program, and macular edema was examined by optical coherence tomography. Vitreous fluid samples were obtained at pars plana vitrectomy. VEGF and IL-6 levels in vitreous fluid and plasma were determined with enzyme-linked immunosorbent assay kits. MAIN OUTCOME MEASURES Vitreous fluid levels of IL-6 and VEGF. RESULTS The vitreous fluid levels of VEGF (median: 435 pg/ml) and IL-6 (median: 51.2 pg/ml) were significantly higher in the patients with CRVO than in the control group (median: 62.4 pg/ml and 1.07 pg/ml, respectively; P = 0.0046 and P<0.0001, respectively). The vitreous fluid level of VEGF was significantly correlated with that of IL-6 (P = 0.0029). Vitreous fluid levels of both VEGF and IL-6 were significantly higher in patients with CRVO who had retinal ischemia than in those without ischemia (P<0.0001 and P = 0.0003, respectively). Vitreous fluid levels of VEGF and IL-6 were also significantly correlated with the severity of macular edema (P = 0.0014 and P = 0.0047, respectively). CONCLUSIONS Both IL-6 and VEGF were elevated in the vitreous fluid of patients with ischemic CRVO and macular edema. VEGF may increase vascular permeability in patients with macular edema and CRVO, whereas IL-6 may also contribute by acting together with or via VEGF. FINANCIAL DISCLOSURE(S) The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Two-year follow-up study comparing primary vitrectomy with scleral buckling for macula-off rhegmatogenous retinal detachment.

PURPOSE To compare the anatomic and visual outcomes achieved by scleral buckling and primary vitrectomy for the repair of macula-off rhegmatogenous retinal detachment. METHODS The records were reviewed for a consecutive series of 167 patients (167 eyes) who were initially treated with scleral buckling or pars plana vitrectomy for primary macula-off retinal detachment. Patients were treated between January 1993 and December 1996. After adjustments for preoperative characteristics, data from 102 cases (55 scleral buckle cases and 47 primary vitrectomy cases) were used for the final comparison. There had been a minimum follow-up period of 24 months. RESULTS No significant differences in single-procedure reattachment incidence (91%), final success incidence (100%) and incidence of postoperative proliferative vitreoretinopathy development (4%) were observed between the two treatment groups. Preoperative visual acuity, preoperative intraocular pressure, and duration of macular detachment were the three best predictors of postoperative visual recovery in both groups. Favorable overall visual recovery was obtained postoperatively, with no significant differences between the two groups throughout the follow-up period. However, in the eyes with poor preoperative visual acuity (<0.1), ocular hypotony (intraocular pressure <7 mm Hg), or prolonged macular detachment (more than 7 days), visual recovery in the primary vitrectomy group was significantly better (P <.05) than in the scleral buckle group from the first postoperative month. CONCLUSION Both procedures achieved favorable anatomic and visual outcomes in the majority of patients with primary macula-off retinal detachment. Primary vitrectomy may be more effective than scleral buckling for achieving early visual rehabilitation in cases complicated by poor preoperative vision, ocular hypotony, and prolonged macular detachment.

Reduction of retinal blood flow in high myopia

PurposeTo investigate changes in retinal vessel diameter and blood velocity in high myopia using laser Doppler velocimetry.MethodsThirty-nine subjects (39 eyes) were enrolled in the study. The subjects were divided into three groups according to their refractive status; 15 eyes (15 patients) with emmetropia (within ±3.0 diopters), 14 eyes (14 patients) with mild myopia (between −3.0 and −8.0 diopters), and 10 eyes (10 patients) with high myopia (>−8.0 diopters). Patient age was matched between groups. Blood velocity and vessel diameter of the upper or lower temporal retinal artery were measured using laser Doppler velocimetry with an eye-tracking system, and measurements were compared between groups.ResultsThe average retinal blood flow and vessel diameter in highly myopic eyes were significantly decreased compared with emmetropic eyes or mild myopic eyes (Mann-Whitney U test, p<0.05). Also, there was significant difference regarding retinal blood flow and vessel diameter between eyes with mild myopia and the other groups. In addition, there was no significant difference in blood velocity between the three groups.ConclusionsRetinal blood flow was decreased in high myopia, mainly due to the narrowing of the retinal vessel diameter. Impaired retinal blood flow might have a role in the development of chorioretinal atrophy in high myopia.

Indocyanine green angiographic findings in Vogt-Koyanagi-Harada disease.

PURPOSE To report the indocyanine green angiographic findings associated with Vogt-Koyanagi-Harada disease and compare them with fluorescein angiographic findings and monochromatic scanning laser images. METHODS In a prospective study, indocyanine green angiography, by scanning laser ophthalmoscopy or infrared fundus photography, was performed in ten consecutive patients (20 eyes) with Vogt-Koyanagi-Harada disease during the acute stage before and recovery stage after corticosteroid treatment. Findings were compared with fluorescein angiographic features and monochromatic scanning laser imaging. RESULTS During the acute stage of the disease, indocyanine green angiography disclosed a dark background in the early phase and multiple, non-uniform hypofluorescent lesions in the midphases. Lesions were more numerous and extensive than areas either of serous retinal detachment on monochromatic scanning laser imaging or of punctate hyperfluorescence on fluorescein angiography. During the recovery stage, the abnormal dark background on indocyanine green angiography at initial examination resolved, with choroidal vessels visible in all cases, but nonuniform hypofluorescent lesions persisted in most eyes. Fluorescein angiography disclosed hypofluorescent patchy areas, and confocal infrared laser imaging showed some bright reflective lesions in three patients with especially severe clinical symptoms. On final examination after an average of 17.7 months, both angiographies still disclosed abnormal findings in these three patients. CONCLUSIONS Indocyanine green angiographic findings suggest that choroidal inflammation may cause a transient choroidal circulatory disturbance during the acute stage of Vogt-Koyanagi-Harada disease. In more severe cases, this dysfunction may secondarily damage the retinal pigment epithelium.

Transient hyperopia with lens swelling at initial therapy in diabetes.

The clinical courses of 10 eyes of five diabetic patients who exhibited bilateral transient hyperopia (maximum: 1:1-4.9 dioptres, spherical equivalent) after initiation of strict control of diabetes with or without insulin are reported. The hyperopia occurred within a few days after abrupt decrease in plasma glucose, progressed to maximum at days 7-14, and regressed gradually over 1 month thereafter. Transient cycloplegia had no effect on refractive error. During hyperopia, there were no significant changes in axial length or corneal curvature. However, thickened lens, decreased anterior chamber depth, and transient cataract were observed to significant degrees. It is suggested that the transient hyperopia, with lens swelling and opacity, was caused by decreased lens refractive index following water influx.

A high incidence of Staphylococcus aureus colonization in the external eyes of patients with atopic dermatitis

OBJECTIVE To determine the frequency distribution of bacteria on the external surface of eyes of patients with atopic dermatitis (AD) and to investigate the relationship between the frequency of bacterial colonization and the grade of atopy or ocular diseases associated with AD. DESIGN Comparative cross-sectional study. PARTICIPANTS Thirty-six AD patients (mean age, 24.5 years) and 16 nonatopic, age-matched control participants (mean age, 25.5 years). INTERVENTION The eyelid margins and conjunctival sacs were scraped with sterile swabs. These samples were inoculated into aerobic and anaerobic culture media. MAIN OUTCOME MEASURES The frequency distribution of bacteria isolated from the eyelid margins and conjunctival sacs. RESULTS Bacteria isolated from AD patients were: Staphylococcus aureus in 21 of 36 patients (including methicillin-resistant Staphylococcus aureus in two patients); Staphylococcus epidermidis in two patients (including methicillin-resistant Staphylococcus epidermidis in one patient); other coagulase-negative Staphylococcus in six patients;alpha-streptococcus in three patients; Corynebacterium species in three patients; Neisseria species in two patients; and Propionibacterium acnes in one patient. From the nonatopic control participants, we isolated S. aureus in one patient, S. epidermidis in two patients and alpha-streptococcus in one patient. S. aureus was isolated from 67% of the AD patients, and any type of bacteria was isolated from 86% of the patients. These rates were significantly higher than those of nonatopic control participants (6% S. aureus and 25% any bacteria). There was no significant relationship between the frequency distribution of bacteria and the grade of atopy or associated ocular diseases. CONCLUSIONS High rates of bacterial colonization, especially S. aureus, were found in the conjunctival sacs and eyelid margins of AD patients. In case management of AD patients, this unique distribution of bacteria must be carefully considered.

Comparative study of intraocular lens implantation through 3.0 mm temporal clear corneal and superior scleral tunnel self-sealing incisions.

Purpose: To compare the clinical outcome of phacoemulsification and foldable silicone intraocular lens (IOL) implantation through a 3.0 mm temporal clear corneal incision and a 3.0 mm superior scleral tunnel incision. Setting: Department of Ophthalmology, Yodogawa Christian Hospital, Osaka, Japan. Methods: Eighty cataractous eyes of 78 patients with pre‐existing against‐the‐rule (ATR) astigmatism were recruited for this prospective, randomized study. The patients were assigned to one of the two groups. Data on uncorrected and corrected visual acuities, keratometry, flare intensity measurement, and central cornea endothelial cell count were evaluated preoperatively and at 2 days, 1 week, and 1 and 3 months postoperatively. Results: Although the pre‐existing keratometric cylinder decreased in the temporal clear corneal incision group and increased in the superior scleral tunnel incision group, the amount of cylinder shift was not significantly different. Mean scalar shift of keratometric cylinder in the corneal incision group was 1.19 diopters (D) at 2 days postoperatively, 0.86 D at 1 week, and 0.56 D at 3 months and in the scleral incision group, 1.09 D at 2 days, 0.76 D at 1 week, and 0.65 D at 3 months. Eighty percent of the eyes in each group achieved an uncorrected visual acuity of 20/40 or better from the second day postoperatively. No statistically significant difference in visual rehabilitation or other parameters was noted between the groups throughout the study. Complications including corneal endothelial cell loss and wound incompetence requiring suturing were observed in the temporal clear corneal incision group. Conclusions: Both incisions offered satisfactory clinical results, but the superior scleral tunnel incision resulted in fewer complications. Minimal corneal keratometric change induced by a 3.0 mm incision was not related to uncorrected visual rehabilitation.

The effects of protease inhibitors on histidine decarboxylase activities and assay of enzyme in various rat tissues

Histidine decarboxylase (L-histidine carboxy-lyase, EC 4.1.1.22) of an extract of rat stomach was inactivated by a pancreatic extract. This inactivation was prevented by the protease inhibitors leupeptin, antipan, chymostatin, pepstatin, Trasylol and phenylmethanesulfonyl fluoride. Leupeptin, antipain, chymostatin and pepstatin together and phenylmethanesulfonyl fluoride alone prevented complete inactivation of the enzyme, while Trasylol had a weak protective effect. The inactivation and protection of histidine decarboxylase purified from whole fetal rats were similar to those of the stomach enzyme: both enzymes were strongly inactivated by trypsin and chymotrypsin, but not by elatase or carboxypeptidase Y. The histidine decarboxylase activities of various rat tissues were assayed in the presence of protease inhibitors: activity was highest in mast cells followed by the whole bodies of fetal rats and the stomach, while the activities were lower in decreasing order in the brain, spleen, lung and liver. Heart and kidney had no activity.

Macular microcirculation and macular oedema in branch retinal vein occlusion

Background/aims: The relationship between the blood-flow velocity in the perifoveal capillaries and macular oedema was investigated in patients with branch retinal vein occlusion (BRVO). Methods: This study compared 18 patients with BRVO and 16 healthy volunteers. Perifoveal capillary blood-flow velocity was measured on fluorescein angiograms with a scanning laser ophthalmoscope by the tracing method. Retinal thickness at the central fovea was measured by optical coherence tomography. Then, the relation between perifoveal capillary blood-flow velocity and retinal thickness at the central fovea was investigated. Results: Perifoveal capillary blood-flow velocity was significantly lower in the patients with BRVO (1.08 (SD 0.28) mm/s) than in the healthy volunteers (1.49 (0.11) mm/s) (p<0.0001). Capillary blood-flow velocity showed a negative correlation with the retinal thickness at the central fovea in the two groups (r = −0.8426, p<0.0001). Multivariate linear regression analysis with stepwise variable selection confirmed that capillary blood-flow velocity was an independent determinant of the retinal thickness at the central fovea (p<0.001). Conclusion: A reduction in perifoveal capillary blood-flow velocity may be involved in the development of macular oedema in patients with BRVO.

SCANNING LASER OPHTHALMOSCOPE MICROPERIMETRIC ASSESSMENT IN PATIENTS WITH SUCCESSFUL LASER TREATMENT FOR JUXTAFOVEAL CHOROIDAL NEOVASCULARIZATION

PURPOSE To evaluate fixation stability and changes in retinal function in patients with laser scar expansion after successful macular photocoagulation for juxtafoveal choroidal neovascularization (CNV). METHODS A consecutive series of 35 patients was examined in this prospective study. Only patients who had been successfully treated with laser photocoagulation for juxtafoveal CNV and who could be followed over a period of at least 6 months were enrolled. Fixation stability and localized light sensitivity were examined by microperimetry using a scanning laser ophthalmoscope. Visual acuity was measured 2 weeks and 3 and 6 months after the laser treatment. The correlation between changes in the logarithm of the minimum angle of resolution (LogMAR) visual acuity and the distance between fixation and the center of the fovea was evaluated. RESULTS Of 22 eyes of 20 patients that underwent data analysis, laser scar expansion was observed in 16 (72.7%). Ten (62.5%) of the 16 eyes had relative scotomas corresponding to the expanded laser scars. Mean laser scar expansion ratio was 28.7% in the ARMD group and 109.2% in the myopia group, a statistically significant difference (P < 0.01). The change in LogMAR visual acuity was significantly correlated with the distance of fixation locus from the center of the fovea (r = 0.76). CONCLUSIONS Laser scars produced by photocoagulation for juxtafoveal CNV may expand and extend into the fovea, causing secondary retinal dysfunction. Scanning laser ophthalmoscopic assessment may be useful in evaluating fixation stability and subclinical changes in retinal function surrounding the laser scars before visual disturbance appears.