Tomoaki Tatsumi

Long-term therapeutic efficacy of the subthreshold micropulse diode laser photocoagulation for diabetic macular edema

PurposeTo investigate the long-term efficacy of subthreshold micropulse diode laser photocoagulation (SMDLP) on diabetic macular edema (DME).MethodsThe effects of SMDLP (810 nm) were studied on 56 eyes of 44 patients with DME. Optical coherence tomography-determined foveal thickness and best-corrected visual acuity (BCVA) were evaluated at 1, 3, 6, and 12 months after the SMDLP.ResultsThe mean foveal thickness was 504 μm before the SMDLP, and it was significantly reduced to 439 μm at 1 month (P = 0.001), 409 μm at 3 months (P < 0.0001), 358 μm at 6 months (P < 0.0001), and 320 μm at 12 months (P < 0.0001). The mean BCVA at baseline was 0.47 logarithm of the minimal angle of resolution (logMAR) units, and it was not changed significantly at all of the postoperative examinations. Among the 56 eyes, 10 (17.8%) had an improvement of BCVA of >0.2 logMAR units, 36 (64.2%) remained the same, and 10 eyes (17.8%) had a reduction of >0.2 logMAR units at 12 months postoperatively.ConclusionOur results indicate that SMDLP has a beneficial effect on DME. However, prospective studies are needed to evaluate this technique in more detail.

Outer retinal thickness and retinal sensitivity in macula-off rhegmatogenous retinal detachment after successful reattachment

Purpose. To determine the relationship between the retinal thickness and sensitivity of the macular region after successful reattachment of an acute macula-off rhegmatogenous retinal detachment (RRD). Methods. Twenty-three eyes of 23 patients with an acute macula-off RRD were studied (17 men, 6 women). The mean age of the patients was 53.2±14.7 years with a range from 20 to 73 years. The interval between the decrease in vision and surgery was <14 days in all cases. At 3 and 6 months after the surgery, the thickness of the inner and outer retina was determined by spectral-domain optical coherence tomography, and the retinal sensitivity was measured by microperimetry with MP-1. The values were compared to those obtained from the unaffected fellow eyes. Changes in the best-corrected visual acuity (BCVA), retinal thickness, and retinal sensitivity at 3 and 6 months from the baseline values were studied. Results. Ten eyes were treated by scleral buckling (SB) and 13 eyes by pars plana vitrectomy (PPV), and the retina was reattached in all eyes. The mean BCVA was significantly improved at 3 and 6 months postoperatively (p<0.001, <0.001). The outer retina of macula was significantly thicker after SB than after PPV (p=0.023 at 3 months; p=0.045 at 6 months). The retinal sensitivity of the central 10 degrees of the retinas after SB was lower than that of eyes after PPV (p=0.029 at 3 months and p=0.008 at 6 months). Conclusions. The delay in the recovery of outer retinal thickness may be the cause of the lower sensitivity of the macula.

Functional and morphologic outcomes after reoperation for persistent idiopathic macular hole

Purpose To determine the relationship between preoperative and postoperative characteristics and visual outcomes after successful surgery for unclosed macular hole (MH). Methods The medical charts of 166 eyes of 161 patients who underwent vitrectomy for a MH were reviewed. The MH was not closed in 9 eyes of 9 patients after the initial surgery. The second vitrectomy with additional internal limiting membrane (ILM) peeling and gas tamponade was performed. The preoperative and postoperative best-corrected visual acuity (BCVA), optical coherence tomographic images, MH size, duration of MH before the first operation, and area of ILM peeling were studied. Results The MH was closed in all eyes after the second surgery. The BCVA significantly improved from 0.77 to 0.25 logMAR units (20/118 to 20/36, p = 0.002). The postoperative subfoveal ellipsoid zone (EZ) was distinct and continuous in 3 eyes with good visual recovery. The final BCVA was not significantly correlated with the baseline characteristics and area of ILM peeling but was correlated with the postoperative status of the EZ. Conclusions All MHs were closed and the mean postoperative visual acuity was significantly improved. The reason for poor visual recovery was the reduced microstructural recovery after the second surgery.

Comparisons of Efficacy of Intravitreal Aflibercept and Ranibizumab in Eyes with Diabetic Macular Edema

We compared the efficacy of intravitreal aflibercept (IVA) to intravitreal ranibizumab (IVR) injections in eyes with diabetic macular edema (DME). The medical records of 49 eyes of 36 patients who were diagnosed with DME and had received IVR and 46 eyes of 40 patients who had received IVA treatment were reviewed. The central macular thickness (CMT) and best-corrected visual acuity (BCVA) were measured at the baseline and at 1, 3, and 6 months after the IVR or IVA. The mean number of injections of IVR was 2.6 ± 1.1 and of IVA was 2.7 ± 1.4. At 6 months, the CMT was significantly thinner than the baseline after IVR and after IVA. The mean BCVA was significantly better than the baseline after IVR only at 1 and 3 months and after IVA at 1 and 6 months. The BCVA of eyes with serous retinal detachment (SRD) was significantly better at 1 month after the IVR and at 1 month and 6 months after the IVA. The BCVAs improved more significantly in the SRD+ group than in the SRD− group. The effects of IVA persist longer than that of IVR. The effectiveness of both IVR and IVA was not dependent on the presence of SRD (IRB#2107).

Efficacy of One-Year Treatment with Aflibercept for Diabetic Macular Edema with Practical Protocol

The purpose of this study was to determine the efficacy of one-year treatment of diabetic macular edema (DME) with intravitreal aflibercept (IVA) injections on a practical protocol. The medical records of 51 eyes of 43 patients who were diagnosed with DME and had received IVA treatments were reviewed. The best-corrected visual acuity (BCVA) and the central macular thickness (CMT) were measured at the baseline and at 1, 3, 6, and 12 months after the IVA. The mean number of IVA injections was 3.8 ± 2.4. The mean BCVA was significantly better and the CMT was thinner after the IVA at all follow-up times (P < 0.05). The BCVA was better in eyes with a serous retinal detachment (SRD) than without a SRD (P < 0.01). There was a significant correlation between the photoreceptor outer segment (PROS) length and BCVA at the baseline and at 12 months after the IVA (P < 0.05). A fewer number of IVA injections significantly improved the BCVA and the CMT in eyes with DME after one-year treatment. IVA was more effective in the SRD+ group than in the SRD− group. The PROS length may be a predictive marker for visual outcomes after one-year treatment with IVA for DME (IRB#2272).

Comparison of the Efficacy of Sub-Tenon versus Intravitreal Triamcinolone Acetonide Injection during Cataract Surgery for Diabetic Macular Edema

Purpose: We compared the efficacy of sub-Tenon triamcinolone acetonide (STTA) to intravitreal triamcinolone acetonide (IVTA) injections during cataract surgery (CS) for patients with diabetic macular edema (DME). Methods: The medical records of 33 eyes (26 patients) with DME which had undergone CS with STTA were compared to those of 34 eyes (27 patients) with DME which had undergone CS with IVTA. Central foveal thickness and best-corrected visual acuity (BCVA) were measured at the baseline and 1, 3, and 6 months after the surgery. Results: The BCVAs after STTA and IVTA were significantly improved at 3 and 6 months. Thirteen eyes in the IVTA group and 21 eyes in the STTA group required other therapies (p < 0.05). One case developed intraocular pressure elevation after IVTA and underwent selective la ser trabeculoplasty. Conclusions: Ophthalmologists should consider the merits and demerits of IVTA and STTA for DME treatment after CS.

Case of retinal detachment due to retinal break splitting macula vertically in a patient with cognitive disorder

We report a patient with cognitive disorder who had a rhegmatogenous retinal detachment (RRD). A 17-year-old Japanese man presented with a RRD with a vitreous hemorrhage in his right eye. An unusual vertical splitting of the macula accompanied by a giant retinal tear was observed intraoperatively. The retina was successfully reattached by pars plana vitrectomy with silicone oil tamponade and scleral buckling. Visual function appeared to have improved from the behavior of the patient. Although the precise mechanism causing the break which split the macula was not determined, self-inflicted blunt trauma to the eye was suspected.