Yoshitsugu Matsui

Changes in Outer Retinal Microstructures during Six Month Period in Eyes with Acute Zonal Occult Outer Retinopathy-Complex

Purpose To study the changes in the outer retinal microstructures during a six month period after the onset of acute zonal occult outer retinopathy (AZOOR)-complex by spectral-domain optical coherence tomography (SD-OCT). Methods Seventeen eyes of 17 patients with the AZOOR-complex were studied. The integrity of the external limiting membrane (ELM), ellipsoid zone (EZ; also called the inner/outer segment junction), and interdigitation zone (IDZ; also called the cone outer segment tips) were evaluated in the SD-OCT images obtained at the initial visit and at six months. The three highly reflective bands were divided into three types; continuous, discontinuous, and absent. The integrity of the outer nuclear layer (ONL) was also assessed. Results Among the three highly reflective bands, the IDZ was most altered at the initial visit and least recovered at six months. Fifteen of 17 eyes (88%) had a recovery of at least one of the three bands at six months in the retinal area where the ONL was intact, and these areas showed an improvement of visual field. Three eyes (18%) had retinal areas where the ONL was absent at the initial visit, and there was no recovery in both the retinal structures and visual fields in these areas. Conclusions Our results indicate that more than 85% eyes with AZOOR-complex show some recovery in the microstructures of the outer retina during a six month period if the ONL is intact. We conclude that SD-OCT is a useful method to monitor the changes of the outer retinal microstructure in eyes with the AZOOR-complex.

Incidence of retinal detachment associated with atopic dermatitis in Japan: review of cases from 1992 to 2011

Purpose The present study aims to investigate the number and characteristics of retinal detachment with atopic dermatitis (AD) in these 20 years, and the number of the first visit AD outpatients in almost the same period. Methods A retrospective review of 101 consecutive surgically treated retinal detachments with AD patients from 1992 to 2011 was conducted. Retinal detachments were divided into two groups: eyes operated on from 1992 to 2001 (former AD group, n=63) and eyes operated on from 2002 to 2011 (recent AD group, n=38). We also reviewed the records of the first visit AD outpatients from 1993 to 2011 except 1998. Results The percentage of bilateral detachment was significantly higher in the former AD group (14/63) than that in the recent AD group (0/38) (P=0.0002). In addition, patients in the recent AD group were significantly older than those in the former AD group (P=0.0084). The annual cases with non-AD retinal detachment remained invariant for 20 years. The ratio of the retinal detachment with AD for the total retinal detachment was significantly lower in the recent (38/847) AD group than that in the former (63/796) AD group (P=0.0038). The number of the first visit AD outpatients linearly decreased in these 19 years (153 cases in 1993 and 65 cases in 2011). Conclusion Our study indicates an apparent decrease in retinal detachment with AD in the recent 10 years, and might suggest the importance of dermatitis control for prevention of retinal detachment with AD.

Ultra-WideField fluorescein angiography by oral administration of fluorescein.

Dear Editor, U tilization of pars plana vitrectomy (PPV) for rhegmatogenous retinaldetachment (RRD)hasexpanded in the past decade mostly due to refinements in surgical techniquesandmodern equipment. Several reports have highlighted the benefits of smaller gauge intraocular instruments and higher cutting speeds. Surgeons can choose machine variables and generally seem to use their preferred system for PPV, relying on a vitrector equipped with either Venturi or peristaltic pumps. There is no detailed evidence comparing peristaltic and Venturi pump systems concerning anatomic success rates. To compare the anatomic results when different vitrectomy machine parameters (gauge, pump and cutting speed) are applied in RRD repair, the European VitreoRetinal Society (EVRS) analysed the data gathered during the EVRS RD Study. The Study includes outcome of 7678 cases of RRD operated on by 176 surgeons from 48 countries with at least 3-month follow-up. In this manuscript, we included cases that RD was treated by primary PPV and excluded cases that previous investigation had shown other independent factors influencing outcome (such as hypotony and choroidal detachment). From the collected data on 4976 cases of PPV, we evaluated preoperative clinical findings, vitrector gauge, aspiration pump type and cutting rate. Detailed methodology is available in the EVRS RD Study Reports Numbers 1 and 2 (Adelman et al. 2013a,b). Twenty-four per cent of vitrectomies were performed using a flow control machine and 76% using a vacuum control machine. The initial distribution of PVR grades between groups was similar. The primary outcome measure was the final anatomical failure rate. Operations were considered successful when the retina remained attached throughout the study period. ‘Level 1’ failure was determined as cases where the retina remained detached by the conclusion of the study. ‘Level 2’ failure was the percentage of eyes with remaining silicone oil. ‘Level 3’ failure was the percentage of cases with recurrence of retinal detachment. Three vitrectomymachine parameters were associated with higher failure rate: First, in univariate analysis, the ‘Level 1’ failure rate of procedures carried out with 20 Gauge instrumentation was higher than that of 23 Gauge (p = 0.009). After adjusting for the level of PVR, there was no statistically significant difference in the failure rates between 20G or 23G vitrectomy. This may be because surgeons performed 20 Gauge PPV in more complex cases where advanced PVR was present. Thus 20 Gauge was not an independent risk factor for failure. Second, Venturi pump vitrectomy equipment was associated with a significantly (odds ratio = 2.9) higher Level 1 failure rate compared with peristaltic pump vitrectomy (p = 0.006) Third, when used with Venturi pump systems, high-speed vitrectomy cutters resulted in a lower failure rate than low-speed cutters (p = 0.014; OR = 0.5). High-speed cutting is employed to decrease the risk of cutting the retina, but complete removal of adherent vitreous may be difficult. These are statistical correlations and we would like to point out that overall, anatomical results with both systems are very satisfactory and the attachment rate is high.

Peripheral capillary nonperfusion and full-field electroretinographic changes in eyes with frosted branch-like appearance retinal vasculitis.

We report a patient with frosted branch-like appearance retinal vasculitis associated with peripheral capillary nonperfusion and full-field electroretinographic changes. A 62-year-old man presented with sudden bilateral decreased vision accompanied by headaches. His best-corrected visual acuity was 0.01 in both eyes. Fundus examination and fluorescein angiography showed bilateral frosted branch-like appearance retinal vasculitis, and spectral-domain optical coherence tomography showed severe macular edema in both eyes. The cerebrospinal fluid analyses showed an increased lymphocyte count and protein levels. He was treated with systemic corticosteroid therapy, and his best-corrected visual acuity improved to 0.8 OD and 1.0 OS at 6 months after onset. However, fluorescein angiography showed a lack of capillary perfusion in the periphery, and the oscillatory potentials on full-field electroretinography were severely reduced in both eyes. These findings indicated extensive retinal ischemia and inner retinal dysfunction, and that fluorescein angiography and full-field electroretinograms can be useful during follow-up of eyes with frosted branch-like appearance retinal vasculitis.

Bilateral retinal detachment in Werner syndrome.

PURPOSE To report the development of bilateral retinal detachment in a patient with Werner syndrome. METHODS Retrospective chart review. A 44-year-old woman diagnosed with Werner syndrome developed bilateral retinal detachment. The fundus in both eyes showed patchy chorioretinal atrophy similar to that seen in high myopia, with the retinal detachment limited to the posterior pole. Two weeks after performing vitrectomy in the right eye, vitrectomy was performed in the left eye. RESULTS After the surgeries, both retinas were reattached. During the surgeries, we observed an excessively liquefied vitreous and a posterior hyaloid membrane that was tightly attached to the retina. The retinal break was located along the superotemporal arcade and over an area of the patchy chorioretinal atrophy in both eyes. The chorioretinal atrophy and vitreous liquefaction appeared to be excessive for the patients age and axial lengths (right: 26.66 mm, left: 27.04 mm). CONCLUSION Vitreoretinal changes found in this case might have been partially because of the premature aging associated with Werner syndrome.

Retinal detachment because of macular hole and an additional break within the staphyloma.

PURPOSE To report the finding of retinal detachment because of macular hole and an additional break within the posterior staphyloma. METHODS A 63-year-old woman presented with progressive central scotoma of the right eye for 1-month duration. The fundus in the right eye showed retinal detachment that was localized within the posterior staphyloma and macular hole. An additional retinal break was observed within the staphyloma using ophthalmoscope, and optical coherence tomography confirmed that both the breaks were within the staphyloma. Macular buckling was scheduled because the two breaks were close enough to each other and the patient was unable to maintain a prone position. RESULTS The retinal detachment was successfully reattached using macular buckling procedure. CONCLUSION In the present case, optical coherence tomography proved to be very useful in helping to make the correct diagnosis of a full-thickness break before surgery.