Yukari Jo

Ocular risk factors for choroidal neovascularization in pathologic myopia.

UNLABELLED PURPOSE. To identify the risk factors for development of myopic choroidal neovascularization (mCNV), a major cause of visual impairment. METHODS. Enrolled in the study were 23 consecutive patients with bilateral high myopia (axial length, > or =26.5 mm or refractive error, < or =8 D) and unilateral newly developed mCNV who presented to the Myopia Clinic, Osaka University Hospital. Spectral-domain optical coherence tomography (SD-OCT) showed that the fellow eyes had a normal macula. The parameters in the affected and fellow eyes were compared between the individual patients, including best-corrected visual acuity (BCVA), intraocular pressure (IOP), refractive error, axial length, choroidal thickness (CT) (subfoveal, 1.5 mm superiorly and inferiorly), posterior staphyloma height 3 mm from the fovea, length of retinal pigment epithelium (RPE) curvature within 6 mm measured on SD-OCT images, and choroidal degeneration and lacquer crack formation, graded according to a published METHOD RESULTS. The IOP, axial length, refractive error, and chorioretinal degeneration did not differ significantly. Affected eyes had a significantly higher lacquer crack grade (P < 0.05). The superior CT was not significantly different; the subfoveal and inferior CTs were significantly lower in the affected eyes (P < 0.05 and P < 0.001, respectively). The absolute value of the nasal posterior staphyloma height from the fovea was significantly greater in the affected eyes (P < 0.05), and the affected eyes had a significantly (P < 0.05) longer RPE curvature. CONCLUSIONS. Choroidal thinning resulting from increased RPE/choroid curvature is a risk factor for unilateral mCNV.

Choroidal thinning in high myopia measured by optical coherence tomography.

Purpose To investigate the rate of choroidal thinning in highly myopic eyes. Patients and methods A retrospective observational study of 37 eyes of 26 subjects (nine males and 17 females, mean age 39.6 ± 7.7 years) with high myopia but no pathologies who had undergone spectral domain optical coherence tomography and repeated the test 1 year later (1 ± 0.25 year) at Osaka University Hospital, Osaka, Japan. Patients older than 50 years with visual acuity worse than 20/40 or with whitish chorioretinal atrophy involving the macula were excluded. Two masked raters measured the choroidal thicknesses (CTs) at the fovea, 3 mm superiorly, inferiorly, temporally, and nasally on the images and averaged the values. The second examination was about 365 days after the baseline examination. The CT reduction per year (CTRPY) was defined as (CT 1 year after – baseline CT)/days between the two examinations × 365. The retinal thicknesses were also investigated. Results The CTRPY at the fovea was −1.0 ± 22.0 μm (range −50.2 to 98.5) at the fovea, −6.5 ± 24.3 μm (range −65.8 to 90.2) temporally, −0.5 ± 22.3 μm (range −27.1 to 82.5) nasally, −9.7 ± 21.7 μm (range −40.1 to 60.1) superiorly, and −1.4 ± 25.5 μm (range −85.6 to 75.2) inferiorly. There were no significant differences in the CTRPY at each location (P = 0.34). The CT decreased significantly (P < 0.05) only superiorly. The superior CTRPY was negatively correlated with the axial length (P < 0.05). The retinal thickness at the fovea did not change. Stepwise analysis for CTRPY selected axial length (P = 0.04, R2 = 0.13) and age (P = 0.08, R2 = 0.21) as relevant factors. Conclusions The highly myopic choroid might gradually thin and be affected by many factors. Location and axial length are key factors to regulate the rate of choroidal thinning in highly myopic eyes. Overall choroidal thickness was not found to change significantly. Longer follow-ups are needed.

Retinoschisis: a predictive factor in vitrectomy for macular holes without retinal detachment in highly myopic eyes

Aim To explore the factors affecting surgical outcomes of highly myopic macular holes (HMMHs). Methods This is a retrospective cross-sectional study. Twenty-two eyes that underwent vitrectomy for HMMHs were included. The eyes were studied retrospectively and divided into two groups by preoperative optical coherence tomography (OCT): 10 eyes with retinoschisis around HMMH and 12 without. Preoperative status including age and posterior staphyloma height measured by OCT, and surgical outcome including postoperative final best-corrected visual acuity and reoperation rate, were evaluated and compared. Results The schisis group was significantly older (p<0.01) with a worse visual acuity (p<0.05) and greater posterior staphyloma height (p<0.05). The preoperative best-corrected visual acuity and the presence or absence of retinoschisis were significantly (p<0.01 and p=0.01, respectively) associated with the postoperative best-corrected visual acuity; age was borderline (p=0.06). Conclusion There are two types of macular holes (MHs) in highly myopic eyes with distinctly different prognoses. Preoperative OCT images must be interpreted carefully to determine the precise surgical results. Retinoschisis negatively impacts vitrectomy for HMMHs.

Three-year visual and anatomic results of administrating intravitreal bevacizumab in inflammatory ocular neovascularization

OBJECTIVE To assess the 3-year visual outcome of intravitreal bevacizumab in inflammatory ocular neovascularization. DESIGN Experimental study. METHODS Retrospective multicenter consecutive case series in 81 patients with inflammatory ocular neovascularization refractory to standard therapy and treated with intravitreal bevacizumab. The outcome measures included improvement of best corrected visual acuity expressed as logarithm of minimum angle of resolution (logMAR) and paired comparison decrease in central foveal thickness by optical coherence tomography. RESULTS Mean best corrected visual acuity improved from baseline 0.699 (6/30 or 20/101) (SD 0.434) to 0.426 (6/16 or 20/53) (SD 0.428) (n = 81; p < 0.001), a gain of 2.7 lines (median 3 injections; 81 eyes; 81 patients). Paired comparisons revealed significant central foveal flattening at 3 years of 97.9 μm (n = 51; p < 0.001). In a subgroup analysis, visual improvement was significant for ocular histoplasmosis (p = 0.026); multifocal choroiditis (p = 0.05); serpiginous choroiditis (p = 0.028); ocular toxoplasmosis (p = 0.042); and punctate inner choroidopathy (p = 0.015). In a subgroup analysis, foveal flattening was significant for ocular histoplasmosis (p = 0.004); multifocal choroiditis (p = 0.007); serpiginous choroiditis (p = 0.011); and punctate inner choroidopathy (p = 0.001). Of the group, 5 eyes developed submacular fibrosis, 1 eye retinal pigment epithelial tear, and 1 eye macular ischemia in the context of vasculitis. CONCLUSION At 3 years, intravitreal bevacizumab sustained significant visual improvement of 2.7 lines and significant foveal flattening of 98 μm in a wide variety of inflammatory ocular diseases without major complications after a median of 3 injections.

Comparison of enhanced depth imaging and high-penetration optical coherence tomography for imaging deep optic nerve head and parapapillary structures

Purpose To evaluate and compare the abilities of enhanced depth imaging (EDI) and high-penetration optical coherence tomography (HP-OCT) to visualize the deep optic nerve head (ONH) and deep parapapillary structures. Methods Horizontal and vertical optic nerve images were obtained using EDI-OCT and HP-OCT, during the same visit, from 24 eyes of 12 patients with glaucoma. Three graders, using a three-point grading system, independently graded the visibility of the deep ONH structures (prelaminar tissue surface, anterior laminar surface, posterior laminar border, and laminar pores) and deep parapapillary structures (intrascleral vessels, cerebrospinal fluid space, and parapapillary choroid). The differences in the visibility scores between the EDI-OCT and the HP-OCT images and among the image locations were analyzed statistically. The agreement in scoring among the graders also was analyzed. Results The visibility of three ONH structures, the anterior laminar surface, posterior laminar border, and laminar pores, was significantly better with EDI-OCT (P = 0.0010, P < 0.0001, and P = 0.0141, respectively). In contrast, the visibility of all parapapillary structures was significantly better with HP-OCT (P < 0.0001, P = 0.0176, and P < 0.0001, respectively). The visibility scores were better in the vertical images compared with the horizontal images and were best in the temporal quadrants. The intergrader agreement was moderate for all parameters examined. Conclusion Both EDI-OCT and HP-OCT are useful for evaluating the deep ONH and parapapillary structures. The visibility scores of the deep ONH structures were better with EDI-OCT, in contrast to the better visibility scores of the deep parapapillary structures with HP-OCT. Both systems should be chosen depending on the target tissue to observe.

Transient Choroidal Thinning after Intravitreal Bevacizumab Injection for Myopic Choroidal Neovascularization

Purpose: To evaluate the choroidal thickness changes in the eyes with myopic choroidal neovascularization (mCNV) after intravitreal injection of bevacizumab (IVB). Methods: Ten highly myopic eyes with mCNV treated with IVB were included. All patients underwent a single, horizontal B-scan image centered on the fovea, before, and 1 month and 3 month after IVB using Heidelberg optical coherence tomography (OCT). Choroidal thickness (CT) defined as the distance from the retinal pigment epithelium to the chorio-scleral interface in OCT image at the fovea, 2mm nasally and 2mm temporally was measured. Results: Foveal mean CT was 52.8 microns before IVB, and it significantly decreased to 37.5 microns 1 month after (P<0.05). Similarly, the 2mm temporal mean CT was 80.5 microns before IVB, and it significantly decreased to 69.5 microns 1 month after (P<0.05). On 3 months after IVB, mean CT at the fovea improved to 48.9 microns (P=0.67); however, the mean temporal CT remained thin as 67.0 microns (P=0.07 vs. baseline). The mean nasal CT remained at the similar throughout the follow-up (P=0.90 and 0.56) The change in CT on 1 month after IVB was significantly correlated with age and preoperative CT (P=0.01 and 0.04, respectively). Conclusions: Subfoveal and temporal choroidal thinning is transiently observed. IVB may affect the choroidal circulation in such myopic eyes as with thin choroid.

Choroidal thickness changes after diabetes type 2 and blood pressure control in a hospitalized situation.

Purpose: To investigate the effect of acute diabetic control on choroidal thickness in patients with Type 2 diabetes. Methods: Seventeen eyes of 17 patients with Type 2 diabetes were included in this prospective observational study. The patients with Type 2 diabetes who were scheduled to undergo a program of intensive diabetic control underwent prototype high-penetration optical coherence tomography before and 2 weeks after the start of treatment. The choroidal thickness changes 2 weeks after the protocol of intensive diabetic control were assessed, and associated ophthalmologic and general parameters were explored. Seventeen eyes of 17 healthy volunteers were included to compare diabetic patients. The choroidal thickness also was measured in this group at baseline and after 2 weeks. And the intraobserver and interobserver reproducibility were verified using this control group. Results: The intraobserver (intraclass coefficient, 0.992) and interobserver reproducibility (0.982) in our subfoveal choroidal thickness measurement were high. The mean subfoveal choroidal thickness after 2 weeks (226 ± 56 &mgr;m) was significantly greater than at baseline (215 ± 52 &mgr;m, P < 0.05); there was no difference between the baseline and 2-week values in the control group (baseline, 312 ± 113 vs. 2-week value, 307 ± 103 &mgr;m; P = 0.17). The changes in refractive error (P < 0.001), axial length (P < 0.01), and diastolic blood pressure (P < 0.01) were associated significantly with changes in choroidal thickness 2 weeks after the intensive control. The pretreatment body mass index (P < 0.05) and hemoglobin A1c (P < 0.005) also were associated significantly with increased choroidal thickness. Conclusion: Diabetic patients showed a significant increase of choroidal thickness after the intensive control. Various ophthalmologic and systemic parameters seem to affect the choroidal thickness changes. This may be related to the progression of retinopathy after acute glycemic control.

Comparison of visual prognoses between natural course of simple hemorrhage and choroidal neovascularization treated with intravitreal bevacizumab in highly myopic eyes: a 1-year follow-up.

Purpose: To compare the long-term outcomes of simple hemorrhage (SH) without any treatments and myopic choroidal neovascularization (mCNV) treated with intravitreal bevacizumab in highly myopic eyes. Methods: Twenty eyes (17 patients) with SH and 28 eyes (27 patients) with mCNV were included. We retrospectively evaluated the refractive error, axial length, age, best-corrected visual acuity, and the integrity of photoreceptor inner segment/outer segment junction and compared the two groups. Results: The mean patient age was 41.6 ± 11.2 years, the mean refractive error −12.7 ± 3.57 diopters, and the mean axial length was 29.64 ± 1.42 mm. Patients in the SH group were significantly (P < 0.001) younger than those in the mCNV group (34.8 vs. 46.5 years, respectively). There were no significant differences in other parameters between the groups. Compared with baseline, the best-corrected visual acuity improved significantly (P < 0.01) at 12 months in both groups. The change in vision at 12 months in the SH group was significantly (P < 0.05) better than that in the mCNV group, although there were no significant differences at 3 months or 6 months. The final integrity of photoreceptor inner segment/outer segment junction was significantly associated with the final best-corrected visual acuity (P < 0.05). Conclusion: Eyes with SH had a more favorable visual prognosis compared with eyes with mCNV treated with intravitreal bevacizumab. The differential diagnosis of these pathologies is important.

Spectral-domain optical coherence tomographic findings in punctate inner choroidopathy.

PURPOSE To investigate the pathology of punctate inner choroidopathy (PIC) using spectral-domain optical coherence tomography. METHODS We retrospectively reviewed spectral-domain optical coherence tomography findings of 14 cases with active PIC. We obtained specific appearance of the active PIC lesion that were characterized by yellowish/white round spots in fundus examination with fluorescein leakage. Fluorescein angiogram and confocal indocyanine green angiogram were also reviewed. RESULTS Three cases (21%) of 14 were found to have specific findings. Case 1 was a 33-year-old woman who showed old choroidal neovascularization and active PIC. Spectral-domain optical coherence tomography showed multiple pigment epithelial detachments with hyperreflective contents and an irregular faint hyperreflective signal at the outer retina. The blurred vision resolved without treatment, at which time all the pathologies resolved. Case 2 was a 42-year-old woman who showed previously treated choroidal neovascularization and active PIC. Spectral-domain optical coherence tomography disclosed small retinal pigment epithelium breaks through which sub-retinal pigment epithelium material migrated into the outer retina. The patient was observed, and the best-corrected visual acuity improved. Case 3 was a 32-year-old woman who showed obsolete PIC. Spectral-domain optical coherence tomography disclosed a retinal pigment epithelium defect. CONCLUSION Multiple pigment epithelial detachments filled with hyperreflective material presumed to be because of inflammatory product and faint signals at the outer retina are common in active phase of PIC. These signs disappear according to the resolution of acute phase.

Deformation of macula area under compulsory increase of eye pressure

This paper discusses the deformation of macula of retina by applying a compulsory eye pressure increase through a probe with force gauge. By using the caribration data between the eye pressure and the force gauge, we impart the force corresponding to 50 [mmHg] of eye pressure to eyelid. Through OCT data before and after compulsory eye pressure increase, we analyze the deformation of macula for three different layers. An interesting observation is that macula suffered by glaucoma has thinner layer and smaller deformation than that of normal subjects, especially the characteristic is enhanced in both the surface and bottom layers, while it is not in the middle layer.