Tomoka Ishida

Fundus autofluorescence patterns in eyes with primary intraocular lymphoma.

Purpose: To evaluate the fundus autofluorescence (FAF) patterns in the eyes with primary intraocular lymphomas (PIOLs). Methods: A review of the medical charts of four consecutive patients (five eyes) with PIOL who had been studied by FAF. A fundus camera was used to obtain the FAF images. Optical coherence tomography was also performed. Results: The ophthalmoscopically observed brown clumps on the surface of greasy yellowish masses beneath the retinal pigmented epithelium had a bright hyperfluorescence appearance by FAF. This FAF hyperfluorescence was completely reversed to hypofluorescence in the fluorescein angiograms. The diffuse infiltration of the cells making up the PIOL above the retinal pigmented epithelium was ophthalmoscopically observed as a retinal whitening and was hypofluorescent by FAF. These areas of hypofluorescence were also reversed to areas of hyperfluorescence in the fluorescein angiogram. Fundus autofluorescence clearly delineated the retinal pigmented epithelium atrophy, which developed after the spontaneous resolution of the PIOL as a hypoautofluorescent area. Conclusion: Because FAF can reveal various findings of PIOLs, it can be used to differentiate the patients with PIOL from those with ocular inflammatory diseases. Although further studies are required to determine whether these findings are characteristic to PIOL, this noninvasive method can then lead to earlier diagnosis and treatment.

Prophylactic vitrectomy for acute retinal necrosis

PurposeTo evaluate the efficacy of prophylactic vitrectomy for acute retinal necrosis.MethodsThe clinical charts of 17 patients (18 eyes) with acute retinal necrosis and no retinal break or rhegmatogenous retinal detachment (RRD) were retrospectively analyzed for the efficacy of prophylactic vitrectomy. The retinal necrotic lesions at the initial presentation were classified into three groups according to the lesion site as described by Holland: zone 1 (posterior pole; n = 3), zone 2 (midperiphery; n = 12), and zone 3 (periphery; n = 3). All patients were treated with intravenous antiviral therapy. Three zone 1 eyes and eight zone 2 eyes underwent prophylactic vitrectomy. Four zone 2 eyes and three zone 3 eyes did not receive prophylactic vitrectomy.ResultsAll zone 1 eyes developed RRD despite prophylactic vitrectomy. Among the 12 zone 2 eyes, eight of the eyes that underwent prophylactic vitrectomy did not develop RRD, whereas three of the four zone 2 eyes without prophylactic vitrectomy developed RRD. All zone 3 eyes were cured with only antiviral medication.ConclusionsProphylactic vitrectomy is effective in preventing the development of RRD in eyes where necrotic lesions do not extend beyond the midperiphery (zone 2).

Autofluorescence of metastatic choroidal tumor.

Metastatic choroidal carcinomas are the most common intraocular neoplasms [1]; diagnosis is made by ophthalmoscopic, fluorescein angiographic (FA), and indocyanine green angiographic (IA) findings together with a history of cancer especially of the breasts and lungs. However, the general health of these patients is often poor, and it is difficult to perform these invasive examinations. Fundus autofluorescence (AF) is a noninvasive imaging technique that can detect lipofuscin in the retinal pigmented epithelial (RPE) cells [2]. A continuous AF pattern is an indication of normal metabolic activity of the RPE cells, and the loss of AF indicates that the photoreceptors or RPE cells are dysfunctional. Because FA and IA are generally not recommended in such ill patients, we questioned whether the AF pattern can be used to diagnose and follow the course of carcinomas after treatment. A Medline search did not extract any articles describing the AF findings in eyes with choroidal carcinomas. A retrospective review of patients with a choroidal carcinoma in our hospital extracted two patients who had undergone FA, IA, and AF. Thus, the purpose of this study was to determine the AF characteristics in these two eyes with a choroidal carcinoma.

Radial Tracts Emanating from Staphyloma Edge in Eyes with Pathologic Myopia

EMILY Y. CHEW, MD MICHAEL L. KLEIN, MD TRACI E. CLEMONS, PHD ELVIRA AGRON, MA GONCALO R. ABECASIS, PHD Clinical Trials Branch, Division of Epidemiology and Clinical Applications, National Eye Institute/National Institutes of Health, Bethesda, Maryland; Casey Eye Institute, Oregon Health & Science University, Portland, Oregon; The EMMES Corporation, Rockville, Maryland; Center for Statistical Genetics, Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, Michigan

Polypoidal choroidal vasculopathy in a case with retinitis pigmentosa

There have been no reports describing polypoidal choroidal vasculopathy (PCV) in eyes with retinitis pigmentosa (RP). A 63-year-old woman who had been diagnosed as having RP was referred to us because of sudden onset of blurred vision in her right eye. Funduscopic examination revealed retinal findings typical of RP in both eyes. The macular area of the right fundus showed polypoidal lesions with massive hemorrhages. Fluorescein angiography and indocyanine green angiography showed multiple polypoidal lesions. Optical coherence tomography showed a large hemorrhagic retinal pigment epithelial (RPE) detachment and polypoidal lesions. The PCV subsided after three applications of anti-vascular endothelial growth factor (VEGF) therapy and a single application of photodynamic therapy, but “mottled lesions” with hyper- and hypofluorescence appeared temporal to the macula after disappearance of hemorrhage. We present a case of PCV in an eye with RP. Further studies are necessary to clarify whether anti-VEGF therapies could affect RPE status in eyes with RP.

PERIPAPILLARY ARTERIAL RING OF ZINN-HALLER IN HIGHLY MYOPIC EYES AS DETECTED BY OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY.

Purpose: To visualize the arterial circle of Zinn-Haller (ZHAC) in highly myopic patients by using OCT-A. Methods: Two hundred and fifty-three eyes of 146 consecutive patients with axial length ≥26.5 mm who underwent OCT-A centered onto the optic disk were studied. Results: Arterial circle of Zinn-Haller was detectable on OCT-A images within the area of the parapapillary myopic conus in 26 (10%) of 253 eyes. The ZHAC was annular in 18 (69%) eyes, triangular in (15%) 4 eyes, and irregular (15%) in 4 eyes. The visibility of the ZHAC on OCT-A images was similar to the visibility on indocyanine green angiograms and significantly better than on conventional fundus photos. Optical coherence tomography angiography visualized details of the ZHAC including the entry of the short posterior ciliary arteries into the circle up to the branches in direction to the optic nerve and ZHAC-associated cilioretinal arteries. In three eyes, the ZHAC was composed of multiple rings. Conclusion: Noninvasive OCT-A allowed the visualization of ZHAC up to smaller vessel branches in 10% of highly myopic eyes. Because ZHAC is the main blood supply to lamina cribrosa of optic nerve, OCT-A-based assessment of ZHAC could become of interest in diseases such as glaucomatous optic neuropathy.

Establishment of novel therapy to reduce progression of myopia in rats with experimental myopia by fibroblast transplantation on sclera: Fibroblasts transplantation for experimental myopic rat eyes

Myopia is one of the most common visual disorders, and is characterized by a progressive axial elongation of the eye. Several methods have been tried to reduce the progression of axial elongation and myopia, but there are still no well‐accepted procedures. We hypothesized that transplantation of fibroblasts on the sclera would lead to the synthesis of collagen fibrils on the sclera and reinforce it, and reduce the degree of axial elongation of eyes with form deprivation myopia. To examine this, we developed a form deprivation myopia model in albino Wistar rats and examined the effects of human fibroblasts (hFbs) transplantation on the sclera in the progression of myopia and axial elongation. We found that the form deprivation by eyelid suture induced a myopic shift and axial elongation associated with a thinner sclera and smaller‐diameter collagen fibrils in Wistar rats. We also found that the transplanted hFbs synthesized type 1 collagen fibrils on the rat sclera, and these eyes with form deprivation had significantly reduced ocular elongation and myopic shift than the eyes without hFbs transplantation. Some of the synthesized collagen fibrils migrated into the sclera and had a bundle‐like appearance and a stripe‐like pattern, indicating they had mature characteristics. These findings suggest that the rat sclera was reinforced by the newly synthesized collagen fibrils and the axial elongation was reduced. These results can provide important information for the development of a therapy targeting myopia in humans. Copyright

Possible connection of short posterior ciliary arteries to choroidal neovascularisations in eyes with pathologic myopia

Purpose To determine the connection between myopic choroidal neovascularisations (CNVs) and intrascleral vessels examined by swept-source optical coherence tomography (OCT). Methods The data of 124 eyes of 112 consecutive patients with myopic CNVs were retrospectively analysed. A myopic CNV was defined as a CNV occurring in eyes with pathologic myopia based on the META-PM study classification. The images obtained by swept-source OCT were analysed to determine the relationship between perforating scleral vessels and CNVs. The continuity of the scleral vessels and the CNV was also analysed. The OCT angiographic (OCTA) characteristics of the myopic CNVs at the active, scar and atrophic phases were also analysed. Results OCTA images showed that CNVs had blood flow in the active, scar and atrophic phases. Scleral perforating vessels were detected just below or around the CNV in 93 eyes (75%). In 10 of the 93 eyes, the scleral vessels and CNV appeared to be continuous through a defect of Bruch’s membrane in the OCT images. Indocyanine green angiography showed that these perforating vessels were intrascleral arteries originating from the short posterior ciliary arteries (SPCAs). Conclusions Swept-source OCT showed that some of the myopic CNVs were continuous with scleral vessels mainly the SPCA. Further studies to confirm angiographical continuity between these two components are necessary.

Potential role of sirtuin 1 in Müller glial cells in mice choroidal neovascularization

This study investigated the potential role of sirtuin 1 in Müller glial cells in choroidal neovascularization. In the in vitro study, primary Müller glial cells were cultured and treated with resveratrol, a sirtuin 1 activator. Glial fibrillary acidic protein expression and angiogenesis-related gene expression were examined using quantitative polymerase chain reaction and phagocytosis, as a marker of Müller glial cell function; in addition, a latex bead assay was used to analyze cell function. For the in vivo study, choroidal neovascularization was induced in C57BL/6 mice via laser photocoagulation, and resveratrol was administered intravitreally. Eyecup whole mounts were created to measure choroidal neovascularization volumes on day 7. Immunohistochemical analysis with anti-glial fibrillary acidic protein antibody was used to detect Müller glial cell activation in eyes with choroidal neovascularization on day 1, 3, 5, and 7 after laser surgery. Resveratrol significantly promoted glial fibrillary acidic protein, anti-angiogenic factor, pigment epithelium-derived factor, and thrombospondin-1 expression in the cells as well as the phagocytic activities. Treatment of the choroidal neovascularization model with resveratrol resulted in early activation of Müller glial cells near choroidal neovascularization sites. Resveratrol-activated cells but not the controls migrated to the top of choroidal neovascularization sites and into the lesions from day 3. Resveratrol reduced the choroidal neovascularization size relative to controls. In conclusion, sirtuin 1 activation in Müller glial cells suppressed the development of choroidal neovascularization, and therefore, might be a therapeutic option.

Swept-source optical coherence tomographic findings in eyes with metastatic choroidal tumor

Purpose To report the swept-source optical coherence tomographic (OCT) findings in two eyes with choroidal metastases. Observations Two patients with choroidal metastasis were studied. The metastasis was from a breast cancer in Case 1 and from a lung cancer in Case 2. In Case 1, swept-source OCT showed a highly reflective solid tumor with low optical reflective tissues that had replaced the choroidal tissue. Swept-source OCT was able to image the choroidal mass where other fundus imaging methods such as fluorescein angiography did not show the mass. Ophthalmoscopy of Case 2 showed hemorrhages in the inner retina, on the tumor, and in the vitreous. Swept-source OCT showed a subretinal mass with a steeple-crowned cap and a ruptured Bruchs membrane on the tumor. Conclusion and importance Swept-source OCT imaging can detect the inner structure of a choroidal mass and retina around it in good detail.