Takatoshi Maeno

Relationship between Diabetic Macular Edema and Peripheral Th1/Th2 Balance

Purpose: To determine whether inflammatory reactions are involved in the pathogenesis of diabetic macular edema, we examined the relationship between diabetic macular edema and the ratio of T helper 1 (Th1) to T helper 2 (Th2) cells. Methods: Thirty-nine diabetic patients with diabetic retinopathy were evaluated at our hospital between February 2004 and February 2005. Blood samples were collected from each patient, and the ratio of CD4+ Th1 to Th2 cells (Th1/Th2) was determined by flow cytometry after fluorescent antibody staining for intracellular cytokines. Logistic regression analysis was used to determine the association of macular edema with age, gender, HbA1c level, interval after retinal photocoagulation and Th1/Th2 ratios. Differences in these parameters were also compared between patients with and without macular edema. Results: Logistic regression analysis showed that the Th1/Th2 ratios were significantly associated with macular edema (odds ratio = 0.838; p = 0.02), while other variables were not. The Th1/Th2 ratio was significantly lower in the patients with diabetic macular edema than in those without (p = 0.02; t test). Higher Th1/Th2 ratios tended to be associated with better visual acuity. Conclusions: Shifts in the balance of Th1/Th2 towards a predominance of Th2 may represent an exacerbating factor for diabetic macular edema, although a causal relationship has still not been definitively determined.

Causes of visual field defects after vitrectomy

PURPOSE An inferotemporal visual field defect sometimes occurs following vitreous surgery for idiopathic macular hole. There is a possibility that this visual field defect is due to damage to the superonasal retina by fluid or air irrigation through an inferonasal infusion port. We tested this hypothesis by placing the infusion port in the inferonasal sector during vitreous surgery. CASES AND METHOD We performed vitreous surgery on 31 eyes with idiopathic macular hole. The infusion port was placed in the inferonasal sector. The vitreous cavity was replanced either by 20% SF6 or 12% C3F8. We did not abrade the retinal pigment epithelium within the hole. The visual field was assessed before and 1 month after surgery using a Goldmann perimeter. FINDINGS Three eyes developed a wedge-shaped visual field defect in the inferonasal sector. No visual field defect developed in the other 28 eyes. CONCLUSION The findings show that visual field defect following surgery for idiopathic macular hole is dependent upon the site of the infusion port. We presume that the visual field defect is consequent to retinal damage caused by the flow of air or fluid during surgery.

Evaluation of Carotid Atherosclerosis, Peripheral Arterial Disease, and Chronic Kidney Disease in Patients with Exudative Age-Related Macular Degeneration without Coronary Artery Disease or Stroke.

Purpose: To evaluate the risk factors for acute atherothrombotic events in patients with exudative age-related macular degeneration (AMD) without a history of coronary artery disease or stroke. Methods: Two hundred fifty-nine patents with exudative AMD were evaluated for carotid atherosclerosis, peripheral arterial disease, and chronic kidney disease (CKD). Results: A mean intima-media thickness of ≥1.0 mm was found in 28.2% of patients; 8.9% of patients had severe carotid artery stenosis. The prevalence rates of severe atherosclerosis with a plaque score >10, peripheral arterial disease, and CKD were 16.6, 5.4, and 32%, respectively. Diabetes mellitus and AMD affecting eyes bilaterally were identified as risk factors for abnormal carotid artery thickening, and age and body mass index were identified as risk factors for CKD. Conclusion: The current study confirmed that potentially 30% of patients with exudative AMD without a history of coronary artery disease or stroke have a high risk of acute atherothrombotic events.

Edaravone (MCI-186) is effective as a free radical scavenger following arteriovenous sheathotomy for treatment of macular oedema associated with branch retinal vein occlusion

Aims: To determine whether edaravone (MCI-186), a free radical scavenger, can reduce macular oedema and improve the visual acuity after arteriovenous sheathotomy in eyes with a branch retinal vein occlusion (BRVO). Methods: Forty-seven eyes of 47 consecutive patients with a BRVO who were treated with arteriovenous sheathotomy were studied. The patients were assigned prospectively to either Group R who received 30 mg of edaravone (Radicut) systemically during the vitrectomy or Group N who did not receive any drugs. The postoperative visual acuity was measured before and 12 months after the operation. Results: At 12 months postoperatively, the best-corrected visual acuity (BCVA) in logarithm of the minimum angle of resolution (logMAR) units improved significantly from 0.22 to 0.56 logMAR units in Group R and from 0.20 to 0.27 units in Group N (p = 0.016). Twenty-three of 27 cases (85%) in Group R and four of 15 cases (27%) in Group N showed an improvement in BCVA of >0.2 logMAR units (p = 0.0025). Conclusion: The better visual acuity in patients given edaravone than those without endaravone during the arteriovenous sheathotomy suggests that edaravone improved the physiology of the retinal cells after the arteriovenous sheathotomy.

Vitreous Surgery on a Patient with Macular Hole Accompanied by Myelinated Retinal Nerve Fibers

1. Thach AB, Marak GE Jr, McLean IW, Green WR. Phacoanaphylactic endophthalmitis: a clinicopathologic review. Int Ophthalmol 1991;15:271–279. 2. Kalogeropoulos CD, Malamou-Mitsi VD, Asproudis I, Psilas K. The contribution of aqueous humor cytology in the differential diagnosis of anterior uvea infl ammations. Ocul Immunol Infl amm 2004;12:215–225. 3. Hochman M, Sugino IK, Lesko C, Friedman AH, Zarbin MA. Diagnosis of phacoanaphylactic endophthalmitis by fi ne needle aspiration biopsy. Ophthalmic Surg Lasers 1999;30:152–154. 4. Inomata H, Miyazaki M, Nishioka Y, Yoshikawa H, Kawabata K. A case of Behçet’s disease complicated by lens-induced endophthalmitis (in Japanese with English Abstract). Nihon Ganka Kiyo (Folia Ophthalmol Jpn) 1998;49:1021–1024. 5. Moffett DG Jr, Edward DP. Anterior segment necrosis associated with endogenous endophthalmitis secondary to group C streptococcal septicemia. Can J Ophthalmol 1991;26:283–287.

Risk factors for requirement of filtration surgery after vitrectomy in patients with proliferative diabetic retinopathy

Purpose We retrospectively reviewed patients with postoperative neovascular glaucoma (NVG) after vitrectomy for proliferative diabetic retinopathy to investigate how variables assessed before, during, and after vitrectomy are associated with the requirement for filtration surgery. Patients and methods The subjects in this retrospective, observational, comparative study were 55 consecutive patients (61 eyes) who underwent vitrectomy for proliferative diabetic retinopathy at Toho University Sakura Medical Center between December 2011 and November 2016, were followed up for at least 6 months after surgery, and developed NVG within 2 years after surgery. They comprised 44 men and 11 women of mean age 52.4±9.1 years, who were followed up for a mean 7.1±6.1 months. We collected data on the following 16 variables: sex, age, history of panretinal photocoagulation completed within 3 months before vitrectomy, presence/absence of a lens, obvious iris/angle neovascularization, tractional retinal detachment, diabetic macular edema, vitreous hemorrhage, visual acuity and intraocular pressure before vitrectomy and at the onset of NVG, glycated hemoglobin, fasting blood glucose, estimated glomerular filtration rate, and use of intraoperative gas tamponade. Results Logistic regression analysis with the backward elimination method identified preoperative fasting hyperglycemia (P=0.08), high intraocular pressure at the onset of NVG (P=0.04), and use of gas tamponade during vitrectomy (P=0.008) to be significant risk factors for requirement of filtration surgery. Conclusion Preoperative fasting hyperglycemia, high intraocular pressure at the onset of NVG, and use of gas tamponade during vitrectomy predispose patients to require filtration surgery in the event of postoperative NVG.

Risk factors for retinal breaks during macular hole surgery

Purpose To identify risk factors for retinal breaks during macular hole (MH) surgery. Patients and methods This retrospective, observational, comparative study included the medical records of 364 consecutive patients (382 eyes) who underwent vitrectomy for MH at Toho University Sakura Medical Center between January 2012 and May 2017. The patients comprised 135 men and 229 women with mean age 67.6±8.0 years. Six eyes with a pre-existing retinal tear treated by laser photocoagulation before MH surgery were excluded. Data on sex, age, presence or absence of lattice degeneration, axial length (measured using an IOL Master®), preoperative refraction, whether or not combined lens extraction/vitrectomy had been performed, whether or not the lens was pseudophakic before vitrectomy, and whether or not a posterior vitreous detachment had been created intraoperatively were collected. The lattice degeneration status was classified as none (0), treated using laser photocoagulation (1), or untreated (2). Results The only item identified in logistic regression analysis with the backward elimination method to be a significant risk factor for retinal breaks during MH surgery was the presence of lattice degeneration (P<0.001). Conclusion Ophthalmologists should be aware of the increased risk of retinal breaks during MH surgery in eyes with lattice degeneration. Intraoperative retinal breaks may be less likely to occur in eyes with lattice degeneration treated by photocoagulation preoperatively.

Comparison of Optic Nerve Head Blood Flow Autoregulation among Quadrants Induced by Decreased Ocular Perfusion Pressure during Vitrectomy

Purpose The present study aimed to examine changes in optic nerve head (ONH) blood flow autoregulation in 4 quadrants (superior, nasal, inferior, and temporal) with decreased ocular perfusion pressure (OPP) during vitrectomy in order to determine whether there is a significant difference of autoregulatory capacity in response to OPP decrease at each ONH quadrant. Methods This study included 24 eyes with an epiretinal membrane or macular hole that underwent vitrectomy at Toho University Sakura Medical Center. Following vitrectomy, the tissue mean blur rate (MBR), which reflects ONH blood flow, was measured. Mean tissue MBRs in the four quadrants were generated automatically in the software analysis report. Measurements were conducted before and 5 and 10 min after intraocular pressure (IOP) elevation of approximately 15 mmHg in the subjects without systemic disorders. Results The baseline tissue MBR of the temporal quadrant was significantly lower than that of the other 3 quadrants (all P < 0.05). However, the time courses of tissue MBR in response to OPP decrease were not significantly different among the four quadrants during vitrectomy (P = 0.23). Conclusions There is no significant difference in the autoregulatory capacity of the four ONH quadrants in patients without systemic disorders during vitrectomy.

Senior-loken syndrome complicated with severe coats disease-like exudative retinopathy.

BACKGROUND Senior-Loken syndrome is a rare disorder that combines juvenile nephronophthisis with retinitis pigmentosa. METHODS Case report. RESULTS A 9-year-old Japanese girl diagnosed with Senior-Loken syndrome subsequently developed severe Coats disease-like exudative retinopathy. Although retinal coagulation, pars plana lensectomy, and vitrectomy were performed, she lost light perception in both eyes. CONCLUSION Faulty vascular morphogenesis and its dysfunction might contribute to the development of Coats disease-like exudative retinopathy in Senior-Loken syndrome.