Tetsuro Koyama

A Proposed Mild Type of Acute Retinal Necrosis Syndrome

Six patients had peripheral to midperipheral pale yellow retinal exudates typical of acute retinal necrosis syndrome but which extended gradually to the posterior pole and remained isolated without becoming confluent. These exudates resulted in localized retinochoroidal degeneration without retinal detachment, in contrast to acute retinal necrosis syndrome. Antibody titers in aqueous humor were increased to varicella-zoster virus in some of the patients examined. The findings led us to hypothesize that this mild, self-limiting course is one of the natural developments of acute retinal necrosis syndrome, although somewhat modified by corticosteroid or acyclovir therapy, and that acute retinal necrosis syndrome consists of varying degrees of severity from mild to fulminant types.

Retinal circulation times in quantitative fluorescein angiography.

We tried to obtain an overview of the quantitative state of the retinal circulation. Optical density measurements by an image analyzer were performed on video fluorescein angiograms for the determination of dye-dilution curves. To ensure that curves with a sharp peak were obtained, 1 ml sodium fluorescein 10% was flushed with 20 ml physiological saline. From dilution curves of a retinal arteriole and the corresponding venule, various retinal circulation times, T (x) (x=1, 25, 50, 75, and 100) and Tm, were calculated. T(1) corresponds to the difference in the time of initial dye appearance; T(50), to the so-called half-maxim time difference; T(100), to the difference in the time to peak intensity; and Tm, to the mean circulation time. T(50) showed the best reproducibility when it was examined at 49 retinal regions of 10 healthy volunteers with a double video-fluorescein angiogram that was obtained within 1 min. Normal values (mean ± SD) at the temporal superior region of 37 healthy volunteers were as follows: T (1) = 0.87 ± 0.66 s, T(25)=1.52±0.48 s, T(50)=1.83±0.50 s, T(75)=2.12±0.56 s, T(t00) = 2.73±0.76 s, and Tm = 2.69±1.25 s. We believe that these values give a general overview of the quantitative state of normal retinal circulation.

Multifocal pigment epithelial damages with serous retinal detachment in systemic lupus erythematosus

We experienced 2 females with systemic lupus erythematosus (SLE) who developed serous retinal detachment in the posterior pole of both eyes in its active phase. Fluorescein angiography showed multifocal pigment epithelial damages with fluorescein leakage into the subretinal space. However, retinal hemorrhages or cotton-wool spots typical of SLE were not observed in their courses.

Immune Complex Containing Herpesvirus Antigen in a Patient With Acute Retinal Necrosis

A 21-year-old man with acute retinal necrosis showed a marked increase in the convalescent titer to herpes simplex type 1 virus, especially in the aqueous humor obtained by anterior chamber paracentesis. Using an enzyme-linked immunosorbent assay, we tried to detect the herpesvirus antigen in the circulating immune complex obtained from this patient. The immune complex contained an antigen or antigens that reacted with antiherpes simplex type 1 antibody.

Retinal Vasculitis as a Complication of Rheumatoid Arthritis

Two middle-aged women developed retinal vasculitis in the moderately active phase of classical rheumatoid arthritis. Fluorescein angiography disclosed diffuse leakage from the retinal capillaries and cystoid macular edema, which subsided in response to oral steroid. They did not show any clinical signs of vasculitis in other parts of the body. Retinal vasculitis should be included in the list of complications observed in rheumatoid arthritis.

Cytological and immunological study of the aqueous humor in acute retinal necrosis syndrome

We experienced 4 cases of acute retinal necrosis syndrome, and performed anterior chamber paracentesis as a diagnostic aid in their acute and convalescent phases. The aqueous humor obtained by it was used for measuring antibody titers to herpes group virus and electron microscopic observation. One case showed elevated titer to herpes simplex virus type 1 in the convalescent phase, while the other to varicella-zoster virus, suggesting that these 2 viruses could cause this disease. Electron microscopy showed persistent lymphocytes and macrophages throughout the course, while plasma cells appeared at the height of the inflammation corresponding to the locally elevated antibody titers. There was no electron microscopic evidence of viral infection in the aqueous cells examined.

Wegener's Granulomatosis with Destructive Ocular Manifestations

A 27-year-old man developed bilateral destructive ocular manifestations of generalized Wegeners granulomatosis. Before the appearance of necrotic granuloma, which replaced almost all the original ocular components, the patient had suffered from severe headache and restricted ocular motility for five years. A general remission was achieved with azathioprine and prednisolone treatment although the patient is blind because of destruction of the globes.