Yoko Takatsuna

Correlation of retinal sensitivity measured with fundus-related microperimetry to visual acuity and retinal thickness in eyes with diabetic macular edema

AimTo determine whether significant correlations exist between retinal sensitivity measured by fundus-related microperimetry and the visual acuity and the foveal thickness measured by optical coherence tomography (OCT) in eyes with diabetic macular edema (DME).MethodsA retrospective chart review of 32 eyes with DME and 17 normal healthy eyes that had undergone fundus-related microperimetry and OCT. The macular sensitivity was measured using the recently introduced fundus-related microperimeter, Micro Perimeter 1. The mean retinal sensitivities within the central 2° and 10° were correlated with the best-corrected visual acuity and OCT-measured foveal retinal thickness.ResultsThe mean sensitivities in the central 2° and 10° were significantly lower in patients with DME than in normal subjects (P<0.0001). The mean retinal sensitivities in the central 2° and 10° were inversely correlated with visual acuity (r2=0.623, P<0.0001; r2=0.581, P<0.0001) and foveal thickness (r2=0.581, P<0.0001; r2=0.551, P<0.0001).ConclusionsThe mean retinal sensitivities measured with fundus-related microperimetry were significantly lower in eyes with DME than in normal eyes. Because a significant correlation of the microperimeter-determined retinal sensitivity to visual acuity and foveal thickness was observed, the retinal sensitivities obtained by fundus-related microperimetry may be another measure that can be used to assess the effects of DME.

Functional and morphological changes of macula after subthreshold micropulse diode laser photocoagulation for diabetic macular oedema

PurposeTo examine the early changes of retinal sensitivity by fundus-related microperimetry after subthreshold micropulse diode laser photocoagulation (SMDLP) for diabetic macular oedema (DMO).MethodsTwenty-eight eyes of 28 patients with diffuse DMO were treated with SMDLP. The mean retinal sensitivity within the central 10 degrees measured with a fundus-related microperimeter, MP1, best corrected visual acuity (BCVA) in logarithm of minimum angle of resolution units, and optical coherence tomography-determined foveal thickness (FT) were examined before and 3 months after SMDLP. The pretreatment values of the retinal sensitivity, FT, BCVA, and funduscopic findings were compared with the corresponding values at 3 months after SMDLP.ResultsAt 3 months, the BCVA was significantly improved (P=0.03), and the FT was significantly reduced (P=0.0043). The mean retinal sensitivity within the central 10 degree, however, did not change significantly (P=0.70). The correlation between the changes in the retinal sensitivities and the decrease in the FT was not significant. The correlation between the changes in the retinal sensitivities and the BCVA was also not significant.ConclusionsSignificant improvements in retinal sensitivities within the central 10 degrees were not observed even though the decrease in FT and the improvement of BCVA were significant. On account of this difference of changes in retinal sensitivity and BCVA, the combination of retinal sensitivity by MP1 and BCVA may be beneficial in assessing the visual function from various angles after SMDLP for eyes with DMO.

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.

Distribution of phosphate-activated glutaminase-like immunoreactivity in the retina of rodents

The distribution of phosphate-activated glutaminase-like immunoreactivity was examined in the retinas of rodents. Intense glutaminase immunoreactivity was observed in many neuronal perikarya in the ganglion cell layer and inner nuclear layer including those of ganglion, bipolar and amacrine cells and possibly horizontal cells. Almost all bipolar cells containing protein kinase C were immunoreactive for glutaminase, suggesting that the majority of glutaminase immunoreactive bipolar cells were of the ON type. Intense glutaminase immunoreactivity was also found in the neuropil of the inner and outer plexiform layers and around the outer limiting membrane. Weak to moderate immunoreactivity was seen in the outer nuclear layer and photoreceptor inner and outer segments. Under electron microscopy, glutaminase immunoreactivity was seen in bipolar cell axons and amacrine cell processes in the inner plexiform layer. In the outer plexiform layer, immunoreactivity was found in the Müller cell processes, but not in the photoreceptor cell terminals. These results indicate that ganglion cells and ON type bipolar cells use glutaminase to produce transmitter glutamate and suggest glutaminase has additional roles in Müller cells. A population of amacrine cells and horizontal cells showed immunoreactivity to glutaminase.

Risk Factors for Refractory Diabetic Macular Oedema after Sub-Tenon's Capsule Triamcinolone Acetonide Injection.

The purpose of this study is to identify the risk factors for a recurrence or persistence of diabetic macular oedema (DME) after a sub-Tenons capsule triamcinolone acetonide (STTA) injection. The medical records of 124 patients (124 eyes) treated by STTA were reviewed. The age, sex, HbA1c level, best-corrected visual acuity, central macular thickness, insulin use, pioglitazone use, systemic hypertension, serous retinal detachment, proteinuria, panretinal photocoagulation, microaneurysm photocoagulation (MAPC), subthreshold micropulse diode laser photocoagulation (SMDLP), cataract surgery, and history of vitrectomy were examined by logistic regression analysis. Procedures of MAPC and SMDLP were significantly associated with DME treated with STTA (P = 0.0315, P = 0.04, resp.). However, a history of vitrectomy was found to have significantly fewer recurrences or persistent DME after STTA (P = 0.0464). In conclusion, patients who required combined MAPC or SMDLP with a STTA injection had significantly higher refractoriness to STTA, but postvitrectomy may prevent the recurrence or persistence of DME after STTA injection.

Long-Standing Follow-Up Electroretinographic Studies after Surgical Resection of Optic Nerve Glioma

We followed up electrophysiological findings in 2 patients who underwent optic nerve glioma resection. Case 1 showed a normal flash electroretinogram (ERG) 6 months after surgery. Case 2 showed a negative-type flash ERG and nonrecordable pattern ERG and flash visual-evoked cortical potentials 13 and 20 years after surgery. The flash ERG after surgical resection of the optic nerve was considered to be affected by the interruption of the central retinal artery during the surgery, and the preserved ERG suggested the possibility of developing the collateral circulation of the ciliary artery.

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).

Effects of sub-Tenon's capsule triamcinolone acetonide injection combined with microa- neurysm photocoagulation on diabetic macular edema

PURPOSE To compare the effects of sub-Tenons capsule triamcinolone acetonide (STTA) injection to that of STTA injection combined with microaneurysm photocoagulation (MAPC; STTA + MAPC) on eyes with diabetic macular edema (DME). PATIENTS AND METHODS The medical records of 138 eyes of 138 patients with DME treated by either STTA or STTA + MAPC were reviewed. The degree of DME was determined by the optical coherence tomographic features: patients with serous retinal detachment (SRD+; 38 eyes) and patients without SRD (non-SRD; 100 eyes). The central macular thickness (CMT) and the best-corrected visual acuity (BCVA) were measured periodically for 6 months after the treatments. RESULTS The BCVA was significantly improved in the non-SRD group after STTA + MAPC. The CMT was significantly improved in all groups and improved considerably more in the non-SRD group than in the SRD+ group after STTA + MAPC. CONCLUSION Our findings indicate that MAPC has an additive effect in the non-SRD type.

The effect of posterior sub-Tenon's capsule triamcinolone acetonide injection to that of pars plana vitrectomy for diabetic macular edema.

Purpose To compare the effect of posterior sub-Tenon’s capsule triamcinolone acetonide (STTA) injection to that of pars plana vitrectomy (PPV) for diabetic macular edema (DME). Patients and methods The medical records of 50 patients (52 eyes) with DME were reviewed. Twenty-six eyes underwent STTA (20 mg) and the other 26 eyes underwent vitrectomy combined with cataract surgery. The central macular thickness (CMT), measured by optical coherence tomography, and best-corrected visual acuity (BCVA) were determined before and 1, 3, and 6 months after treatment. Results The differences in the BCVA and the CMT between the STTA group and the PPV group were not significant before or at any time after the treatment. In both the STTA and PPV groups, there were significant differences between the pre-treatment CMT and BCVA at any time after treatment. Conclusion We recommend STTA injection for the treatment of DME.