Taiji Hasegawa

Choroidal thickness in children with hyperopic anisometropic amblyopia

Purpose To determine the choroidal thickness (CT) in the macular area of eyes of children with hyperopic anisometropic amblyopia and to compare the thickness with that of fellow eyes and age-matched controls. Materials and methods Twenty-five patients (6.6±2.2 years, mean±SD) with hyperopic anisometropic amblyopia and twenty age-matched controls (6.7±1.9 years) were studied. The CT was measured with the enhanced depth imaging programme of a spectral domain optical coherence tomographic instrument in all patients and controls. The CT of the subfoveal area and at 1 mm and 3 mm diameter around the fovea was determined. In addition, the correlation between the CT and axial length was calculated. Results The mean subfoveal CT was 351.3±54.7 µm in the amblyopic eyes, 283.5±55.2 µm in the fellow eyes and 282.7±73.3 µm in the control eyes. The subfoveal choroid in amblyopic eyes was significantly thicker than that of the fellow eyes and control eyes (p=0.001). There was a significant negative correlation between the subfoveal CT and the axial length in the amblyopic eyes (amblyopic eyes: r=−0.51, p=0.01) and the control eyes (r=−0.46, p=0.01). Conclusions The subfoveal choroid of eyes with hyperopic anisometropic amblyopia is significantly thicker than that of the fellow eye and the age-matched controls. The profile of the CT in the amblyopic eyes was different from that of the fellow eyes and control eyes.

Presence of foveal bulge in optical coherence tomographic images in eyes with macular edema associated with branch retinal vein occlusion.

PURPOSE To determine whether a significant correlation exists between the presence of a bulge in the photoreceptor inner segment/outer segment (IS/OS) line and the best-corrected visual acuity (BCVA) in eyes with resolved macular edema associated with branch retinal vein occlusion (BRVO). DESIGN Retrospective, observational case series. METHODS We retrospectively reviewed the medical records of patients who had a complete resolution of macular edema and had an intact IS/OS line in the central fovea in the spectral-domain optical coherence tomographic (SDOCT) images. Thirty-one eyes with macular edema associated with BRVO (BRVO group) and 31 unaffected fellow eyes (control group) of 31 patients were evaluated. In normal eyes, the intact IS/OS line determined by SDOCT has a bulge at the central fovea, called the foveal bulge. The eyes in the BRVO group were classified by the presence or absence of foveal bulge, and the characteristics of the 2 groups were compared. RESULTS A foveal bulge was present in 7 of 31 eyes in the BRVO group. The incidence of a foveal bulge was significantly lower in the BRVO group (22.6%) than in the control group (100%; P < .0001). All 7 eyes with foveal bulge had a decimal BCVA of ≥1.0 at the final visit. The incidence of a foveal bulge was significantly higher in eyes with BCVA of ≥1.0 (77.8%) than in the eyes with BCVA of <1.0 (0%; P < .0001). CONCLUSIONS The foveal bulge is a good marker of the functional properties of the fovea in eyes with resolved macular edema associated with BRVO.

Response of serous retinal pigment epithelial detachments to intravitreal aflibercept in polypoidal choroidal vasculopathy refractory to ranibizumab

Purpose To report the effects of aflibercept on eyes with large retinal pigment epithelial detachment (PED) associted with polypoidal choroidal vasculopathy (PCV). Methods We reviewed the medical records of patients with PEDs associated with PCV that were treated with aflibercept after intravitreal ranibizumab had failed. Results Three eyes of patients aged 72, 79, and 80 years were studied. Reflective material was seen in the PED along the outer surface of the retinal pigment epithelium (RPE) by spectral-domain optical coherence tomography (SD-OCT). A complete resolution of the serous PEDs was found after two aflibercept injections; however, all eyes had a fibrovascular PED. In addition, one eye developed a retinal hemorrhage and a recurrent PED just after the third injection of aflibercept. The visual acuity in this eye decreased from 10/20 to 2/20. Conclusion The reflective material below the outer surface of the RPE in serous PED suggests the presence of neovascularization. Intravitreal aflibercept could be considered for large PEDs in eyes with PCV but should be carefully applied.

Relationship between presence of foveal bulge in optical coherence tomographic images and visual acuity after rhegmatogenous retinal detachment repair.

Purpose: To determine whether a significant correlation exists between the presence of a bulge in the photoreceptor inner segment/outer segment line and the best-corrected visual acuity in eyes after successful rhegmatogenous retinal detachment (RRD) repair. Methods: Patients who had undergone successful RRD repair and had an intact inner segment/outer segment line at the central fovea in the spectral-domain optical coherence tomographic images were retrospectively studied. Thirty-five eyes of 35 patients were evaluated, and the eyes were classified preoperatively into those with macula-on RRD (n = 14) and those with macula-off RRD (n = 21). Examination of the spectral-domain optical coherence tomographic images of normal eyes showed that the inner segment/outer segment line has a bulge at the central fovea. The 35 eyes with successful retinal reattachment were classified by the presence or absence of foveal bulge. Results: The presence of foveal bulge differed significantly between macula-on RRD (100%) and macula-off RRD group (28.6%; P < 0.0001). In the macula-off RRD group, the best-corrected visual acuity was significantly better in eyes with a foveal bulge than in eyes without a foveal bulge (P = 0.0028). Conclusion: The foveal bulge is a good marker to determine the functional properties of the fovea in eyes with successful RRD repair.

CHOROIDAL BLOOD FLOW VISUALIZATION IN HIGHLY MYOPIA USING A PROJECTION ARTIFACT METHOD IN OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY.

Purpose: To visualize choroidal blood flow in larger vessels in highly myopic eyes using a phenomenon of the projection artifact to in the sclera using optical coherence tomography angiography. Methods: The retrospective study included 92 eyes (54 patients) with greater than 8 diopters of myopia. All eyes were examined using optical coherence tomography angiography (RTVue XR Avanti; Optovue Inc, Fremont, CA). The blood flow in choroidal vessels was evaluated by attempting to directly segment the choroid and also by placing the segmentation layer behind the choroid, within the sclera. Subfoveal choroidal thickness was also measured at the same time. The authors also evaluated the 54 normal eyes (54 cases) without high myopia as a control group. Results: Segmentation artifacts occurred in 68 cases (73.9%) and precluded direct visualization of the choroidal blood flow in larger vessels. When the segmentation slab was placed posterior to the choroid within the sclera, the choroidal blood flow was visualized in 41 eyes (44.6%). The mean subfoveal choroidal thickness in eyes with visualization of choroidal blood flow was thinner than without visualization (50.3 ± 42.2 &mgr;m vs. 100.3 ± 44.4 &mgr;m, P < 0.01). Choroidal blood flow in larger vessels was imaged in no control eye. Conclusion: The choroidal vessel anatomy could be imaged by detecting flow using the projection artifact in the sclera with optical coherence tomography angiography. This technique may be useful in estimating the vascularity of the choroid.

Highly Reflective Line in Optical Coherence Tomography Images of Eyes With Macular Edema Associated With Branch Retinal Vein Occlusion

PURPOSE To determine whether the highly reflective vertical lines seen in spectral-domain optical coherence tomographic (SD OCT) images, which we have termed track lines, after resolution of macular edema associated with branch retinal vein occlusion are related to the integrity of the photoreceptors. DESIGN Retrospective, observational, cross-sectional study. METHODS We reviewed the medical records of 59 eyes with resolved macular edema associated with branch retinal vein occlusion. The eyes were classified by the presence or absence of the track lines in the SD OCT images after the resolution of macular edema. The correlation between the presence of the track lines and the integrity of the photoreceptors was determined. RESULTS Twenty-one of 59 (36%) eyes had track lines in the SD OCT images after a resolution of the macular edema during the follow-up period. At the final visit, 17 (81%) of 21 eyes with the track lines had an interrupted ellipsoid zone at the fovea, whereas 3 eyes (14%) had an intact ellipsoid zone and 1 eye (5%) had an absent ellipsoid zone (P < .0001). The percentage of eyes with a disrupted external limiting membrane at the initial visit was significantly higher in eyes with track lines (90%) than that in eyes without track lines (63%; P = .0324). CONCLUSIONS The presence of highly reflective vertical lines in the SD OCT image is associated with a disrupted external limiting membrane before the resolution of macular edema and is associated with an interruption of the ellipsoid zone after resolution of macular edema. Thus, the vertical lines are useful markers of damage to the photoreceptors.

Relationship between foveal microstructures and visual outcomes in eyes with resolved central serous chorioretinopathy

PurposeTo determine whether significant correlations exist between the foveal microstructures and visual outcomes in eyes with resolved central serous chorioretinopathy (CSC).MethodsWe retrospectively reviewed the medical records of patients who had a complete resolution of the serous retinal detachment (SRD) and had an intact ellipsoid zone in the fovea in the spectral-domain optical coherence tomographic (SD-OCT) images. Twenty-five eyes with CSC (CSC group) and 18 unaffected fellow eyes (control group) of 23 patients were evaluated. The eyes in the CSC group were divided into those with (n = 11) and those without (n = 14) visual disturbances after resolution of the SRD. The thickness of each retinal layer at the fovea was measured in the SD-OCT images.ResultsThe photoreceptor outer segment (OS) length in the CSC group was significantly shorter than that in the control group (p = 0.0003). In addition, the photoreceptor OS length in the visual disturbances group was significantly shorter and the duration of SRD was significantly longer than that in the no visual disturbances group (p = 0.0230, p = 0.0021, respectively).ConclusionsThe photoreceptor OS length is a good parameter to indicate the integrity of the foveal photoreceptors in eyes with a resolved CSC.

Retinal thickness in children with anisohypermetropic amblyopia

Purpose To determine the thickness of the fovea in eyes of children with anisohypermetropic amblyopia, their fellow eyes and eyes of age-matched controls. Additionally, to assess the effects of optical treatment on the foveal thickness in eyes with anisohypermetropic amblyopia. Materials and methods Twenty-one patients (6.0±2.3 years, mean±SD) with anisohypermetropic amblyopia and 25 age-matched controls (5.6±1.9 years) were studied. Spectral-domain optical coherence tomography (SD-OCT) was used to obtain OCT images. The foveal thickness and the thickness of the outer nuclear layer (ONL), photoreceptor inner segment (IS) layer and outer segment (OS) layer were measured by the embedded OCT software. Results The length of the OS was significantly greater in the fellow eyes (48.0±6.6 µm) than in the amblyopic eyes (42.4±4.6 µm, p=0.03). One year after the optical treatment of the anisohypermetropia, the best-corrected visual acuity (BCVA) improved and the length of the OS was significantly increased (p=0.0001). After optical treatment, there was no more significant difference in the OS length between the amblyopic eyes and the fellow eyes (p=0.95). The change of BCVA was significantly correlated with the change of the length of the OS 1 year after the treatment (r=0.52; p=0.0004). Conclusions Anisohypermetropic amblyopic eyes have qualitative and quantitative differences in the retinal microstructures of the fovea from normal eyes. An increase in the OS length was detected in the amblyopic eyes after the optical treatment. A significant correlation was found between the increased OS length and better BCVA. Trial registration number The trial registration number of the internal review board of Nara Medical University was 774.

The effect of blue-blocking intraocular lenses on circadian biological rhythm: protocol for a randomised controlled trial (CLOCK-IOL colour study)

Introduction Blue light information plays an important role in synchronising internal biological rhythm within the external environment. Circadian misalignment is associated with the increased risk of sleep disturbance, obesity, diabetes mellitus, depression, ischaemic heart disease, stroke and cancer. Meanwhile, blue light causes photochemical damage to the retina, and may be associated with age-related macular degeneration (AMD). At present, clear intraocular lenses (IOLs) and blue-blocking IOLs are both widely used for cataract surgery; there is currently a lack of randomised controlled trials to determine whether clear or blue-blocking IOLs should be used. Methods and analysis This randomised controlled trial will recruit 1000 cataract patients and randomly allocate them to receive clear IOLs or blue-blocking IOLs in a ratio of 1:1. The primary outcomes are mortality and the incidence of cardiovascular disease, cancer and AMD. Secondary outcomes are fasting plasma glucose, triglycerides, cholesterol, glycated haemoglobin, sleep quality, daytime sleepiness depressive symptoms, light sensitivity, the circadian rhythm of physical activity, wrist skin temperature and urinary melatonin metabolite. Primary outcomes will be followed until 20 years after surgery, and secondary outcomes will be assessed at baseline and 1 year after surgery. Ethics and dissemination Ethical approval has been obtained from the Institutional Review Board of Nara Medical University (No. 13-032). The findings of this study will be communicated to healthcare professionals, participants and the public through peer-reviewed publications, scientific conferences and the University Hospital Medical Information Network Clinical Trials Registry (UMIN-CTR) home page. Trial registration number UMIN000014680.

Choroidal Blood Vessels In Retinal Pigment Epithelial Atrophy Using Optical Coherence Tomography Angiography.

Purpose: To observe choroidal blood vessels in cases sharply demarcated with retinal pigment epithelium (RPE) atrophy at the macular area using en-face optical coherence tomography angiography (OCTA) and standard en-face optical coherence tomography (OCT). Methods: The retrospective study included 12 eyes (8 patients; 5 men, 3 women; average age, 64.3 years) with RPE atrophy seen by ophthalmoscopy. The macular areas with normal and atrophic RPE sections were examined using en-face OCTA with an 840-nm light source (RTVue XR Avanti; Optovue Inc), which system can obtain standard en-face OCT images at identical areas. Images on en-face OCTA and standard en-face OCT were compared with each other when the segmentation range was being set as the full thickness of the choroid by the attached software. Results: Choroidal blood vessels were seen as black on standard en-face OCT images in all cases. However, the choroidal vessels on OCTA were depicted as white in the RPE atrophic area and black in the normal areas. Conclusion: Choroidal blood vessels in the normal sections of RPE were visualized in black on standard en-face OCT and OCTA with an 840-nm light source; however, those in the atrophic parts were observed as white, or with bloodstream, on OCTA images. Choroidal blood vessels cannot be evaluated accurately in commercially available OCTA systems because of blockage of light by the RPE.