Takashi Shiono

Comparative Therapy Evaluation of Intravitreal Bevacizumab and Triamcinolone Acetonide on Persistent Diffuse Diabetic Macular Edema

PURPOSE To compare the effect of an intravitreal injection of bevacizumab, an anti-vascular endothelial growth factor (VEGF) antibody, with that of triamcinolone acetonide, a corticosteroid for reduction of diabetic macular edema (DME). DESIGN Prospective, comparative interventional case series. METHODS Twenty-eight eyes of 14 patients with bilateral DME participated in this study. In each patient, one eye received an intravitreal injection of 4 mg triamcinolone acetonide and the other eye received 1.25 mg bevacizumab. The clinical course of best-corrected visual acuity (VA) with a logarithm of the minimum angle of resolution chart and averaged foveal thickness using optical coherence tomography was monitored for up to 24 weeks after the injection. RESULTS Before the injection, foveal thickness and VA were 522.3 +/- 91.3 microm and 0.64 +/- 0.28 microm in the triamcinolone-injected eye, and 527.6 +/- 78.8 microm and 0.61 +/- 0.18 microm in the bevacizumab-injected eye, respectively; there was no significant difference between the eyes. One week after the injection, both eyes showed significant regression of macular edema. The triamcinolone-injected eye (342.6 +/- 85.5 microm and 0.33 +/- 0.21 microm) showed significantly better results than the bevacizumab-injected eye (397.6 +/- 103.0 microm and 0.37 +/- 0.17 microm). However, both eyes showed the recurrence of macular edema with time, even at 24 weeks. Triamcinolone (410.4 +/- 82.4 microm and 0.47 +/- 0.25 microm) kept better results than bevacizumab (501.6 +/- 92.5 microm and 0.61 +/- 0.17 microm). CONCLUSIONS With the generally used concentration, intravitreal injection of triamcinolone acetonide showed better results in reducing DME and in the improvement of VA than that of bevacizumab, suggesting that the pathogenesis of DME is not only attributable to VEGF-dependency, but is also attributable to other mechanisms suppressed by corticosteroid.

POINT MUTATIONS OF RHODOPSIN GENE FOUND IN JAPANESE FAMILIES WITH AUTOSOMAL DOMINANT RETINITIS PIGMENTOSA (ADRP)

SummaryThe mutations of codon 17, 23, 58, and 347 of rhodopsin gene were investigated in 24 unrelated Japanese families including 33 patients with autosomal dominant retinitis pigmentosa (ADRP). A patient with codon 17 mutation (Thr-17-Met, ACG→ATG) and a family including 4 patients with codon 347 mutation (Pro-347-Leu, CCG→CTG) were detected among them. Their clinical findings were extremely different between the two mutations. The former showed type 2 and the latter showed type 1 ADRP. No mutation of codon 23 and 58 was detected in any families so far analyzed in the present study. Clinical findings associated with the mutation in codon 17 and 347 of the rhodopsin gene show an existence of allelic heterogeneity.

Visual Outcome After Intravitreal Triamcinolone Acetonide Depends On Optical Coherence Tomographic Patterns In Patients With Diffuse Diabetic Macular Edema

Purpose: To evaluate the effectiveness of intravitreal triamcinolone acetonide (IVTA) on the reduction of diffuse diabetic macular edema with different optical coherence tomographic patterns. Methods: One hundred and thirty-five eyes with diffuse diabetic macular edema without any treatment that had received a single dose (4 mg in 0.1 mL) of IVTA were retrospectively examined. Each preoperative macular optical coherence tomographic image was classified according to its appearance as follows: sponge-like diffuse retinal thickening, cystoid macular edema (CME), and serous retinal detachment (SRD). Central macular thickness with optical coherence tomographic images and visual acuity with a logarithm of the minimum angle of resolution chart were assessed at 3 months postoperatively. Results: Of 135 eligible eyes, 49 eyes were identified as having only sponge-like diffuse retinal thickening, 45 eyes with CME, and 26 eyes with SRD. Of those 135 eyes, 15 eyes exhibited the combination of all types of diffuse diabetic macular edema, defined as FULL. After IVTA, central macular thickness was reduced to 31.0 ± 15.9% in the sponge-like diffuse retinal thickening, 40.7 ± 14.2% in the CME, 23.4 ± 15.0% in the SRD, and 25.8 ± 14.8% in the FULL group (P < 0.001; one-factor analysis of variance), while improvement in logarithm of the minimum angle of resolution visual acuity was −0.26 ± 0.21 in the sponge-like diffuse retinal thickening, −0.32 ± 0.20 in the CME, −0.17 ± 0.20 in the SRD, and −0.14 ± 0.22 in the FULL group (P = 0.018; one-factor analysis of variance). Conclusion: The effectiveness of IVTA on diffuse diabetic macular edema was dependent on the optical coherence tomographic pattern, and IVTA was found to be more effective in patients with CME, while IVTA was less effective in those with SRD.

Pretreatment of posterior subtenon injection of triamcinolone acetonide has beneficial effects for grid pattern photocoagulation against diffuse diabetic macular oedema

Aim: To prospectively evaluate the efficacy of subtenon injection of triamcinolone acetonide (TA) before laser grid pattern photocoagulation (G-PC) for the treatment of diffuse diabetic macular oedema (DDME). Methods: 42 eyes of 37 consecutive patients with DDME were studied. 1 week before G-PC, 21 eyes received TA subtenon injection, and the other eyes served as control. The clinical course of visual acuity (VA) and foveal thickness (FT) was monitored for up to 24 weeks after G-PC. Mean deviation (MD) of perimetry with 30-2 program on Humphrey Perimeter (Zeiss-Humphrey, Dublin, California, USA) was also measured. The average laser intensity was recorded. Results: After TA injection, FT and VA were improved, and subsequent G-PC maintained the improvement for up to 24 weeks without recurrence of diffuse diabetic macular oedema. In contrast, G-PC without TA injection induced transient worsening of FT and VA, then both were gradually improved. At 24 weeks after G-PC, MD in the TA-injected eyes was better than those in control. The required laser intensity in TA-injected eyes was less than that for control. Conclusion: Subtenon injection of TA prior to G-PC allows for treatment with a lower intensity of laser spots and also prevents the decrease in central visual field sensitivity, all of which have clinical advantages for G-PC.

A Scanning Electron Microscopic Study of Nylon Degradation by Ocular Tissue Extracts

A scanning electron microscopic study showed that the surface of the nylon used for corneoscleral wound closure was smooth, while the nylon suture thread used to fix the intraocular lens against the iris showed cracks and roughness on its surface. The surface of the nylon thread was also roughened after treatment with bovine iris-ciliary body extracts. The nylon-degrading factor in the extract was nondialyzable, heat-labile, active at acidic pH, and inhibited in part by leupeptin, suggesting that lysosomal enzymes may be a factor in this phenomenon. Of the bovine ocular tissues, ciliary body extract degraded the surface of the nylon thread most significantly. The nylon surface was moderately digested by the retinal pigment epithelial extract, and slightly eroded by the extracts from the iris, sensory retina, and choroid. Corneal and lenticular extracts did not affect the nylon surface. Nylon suture thread may be hydrolyzed by lysosomal enzymes and should be considered a late-degrading suture.

X linked ocular albinism in Japanese patients.

Thirteen affected Japanese male patients and 13 female carriers with X linked ocular albinism from seven families were examined to assess their clinical findings and to compare them with those of white and black patients. Affected Japanese patients had poor visual acuity, horizontal nystagmus, macular hypoplasia, and loss of stereopsis. Some affected patients had non-albinotic fundus with moderate pigmentation. The amount of pigment in the fundus varied among affected patients and appeared to be between that of the white and black patients. All affected patients had brown irides that show no translucency. Interestingly, two affected patients had megalocornea and a third affected patient had posterior embryotoxon. All female carriers exhibited good visual acuity, normal eye position, stereopsis, brown irides without translucency, and the typical mosaic pattern in the fundus. The pigmented iris and fundus made the correct diagnosis of these affected patients difficult. Nine affected patients (70%) had been diagnosed initially as having congenital nystagmus, with or without macular hypoplasia, until they were reviewed for this study.

Abnormal sclerocytes in nanophthalmos

Scleral tissue from a nanophthalmic patient was examined morphologically and by a tissue culture method. Collagen in the unusually thickened scleral tissue was arranged in irregularly interlacing bundles. Results of tissue culture studies showed sclerocytes that seemed to secrete many granules that stained positively with Alcian blue and periodic acid-Schiff (PAS). No granules were seen in cells of scleral tissue cultured from two control eyes. These findings may be the result of the modified glycosaminoglycan metabolism, which in turn contributes to the abnormal packing of collagen bundles and thickening of sclera in nanophthalmos.

Visual prognosis and vitreous cytokine levels after arteriovenous sheathotomy in branch retinal vein occlusion associated with macular oedema

Purpose:  To investigate the relationship between vitreous levels of cytokines, including interleukin‐6 (IL‐6) and vascular endothelial growth factor (VEGF), and visual prognosis after pars plana vitrectomy (PPV) with arteriovenous sheathotomy in patients with branch retinal vein occlusion (BRVO) associated with macular oedema.

Vitreous, retinal and subretinal hemorrhages associated with von Willebrand's syndrome

Two patients with von Willebrands syndrome had intraocular hemorrhages without trauma or neovascularization. A 13-year-old Japanese girl complained of sudden spotted vision in her left eye. Vitreous, peripapillary retinal, and subretinal hemorrhages were seen by ophthalmoscopy in the affected eye. In addition, a 19-year-old Japanese man had repeated vitreous hemorrhage and epistaxis. Also noted was gyrate atrophy of the choroid and retina. Analysis of the coagulation-fibrinolysis system revealed decreased activities of Factor VIII and von Willebrands factor in both patients. The amount of von Willebrands factor antigen also was decreased. These results suggested that the patients had von Willebrands syndrome. The bleeding tendency in the disorder appeared to be responsible for the pathogenesis of the intraocular hemorrhages seen in these patients.

Pigment Deposition in the Anterior Segment Caused by Melanocytoma of the Optic Disc

A 34-year-old Japanese woman had a melanocytoma of the optic disc with scattered pigment particles in the vitreous in the left eye in 1970. Fifteen years later, we noticed pigment dispersion on the posterior lens surface, iris root, and trabecular meshwork, which resembled findings often caused by ocular malignant melanoma. Because the melanocytoma of the optic disc had decreased in size and the number of dispersed pigment particles in the vitreous cavity was reduced, it appeared that the pigmented particles produced by partial necrosis of the melanocytoma had resulted in the pigmentation of the anterior segment.