Yukitoshi Shimoda

Restored Photoreceptor Outer Segment and Visual Recovery After Macular Hole Closure

PURPOSE To evaluate restoration of the photoreceptor outer segment and visual outcomes in closed macular holes. DESIGN Retrospective case series. METHODS We retrospectively observed the reparative process of macular holes in 28 eyes one, three, and six months postoperatively using spectral-domain optical coherence tomography. We evaluated the reflective line at the junction between the photoreceptor inner and outer segment (IS/OS) and the best-corrected visual acuity (BCVA). RESULTS The outer photoreceptor layer showed a foveal detachment, a disrupted IS/OS line, or both one month postoperatively. No eye had a continuous IS/OS line. These abnormalities were gradually restored at various levels. At six months, nine eyes had a normal outer photoreceptor layer, four eyes outer foveal defects with a continuous IS/OS line, 12 eyes a disrupted IS/OS line, and three eyes outer foveal defects with a disrupted IS/OS line. The mean BCVAs were significantly (P = .017) lower in groups with a disrupted IS/OS line compared to groups with a continuous IS/OS line with or without outer foveal defects. CONCLUSIONS Macular hole closure is attained by bridge formation (foveal detachment) and the IS/OS line heals in varying degrees. The visual outcomes were significantly better in eyes with a continuous IS/OS line than in those with a disrupted IS/OS line.

Restoration of Photoreceptor Outer Segment after Vitrectomy for Retinal Detachment

PURPOSE To report photoreceptor restoration and visual outcomes after vitrectomy for retinal detachment. DESIGN Retrospective, observational case series. METHODS We prospectively studied the tomographic features of reattached retinas in 20 eyes with a macula-off rhegmatogenous retinal detachment using spectral-domain optical coherence tomography 1, 3, and 6 months after 3-port vitrectomy with SF(6) gas tamponade. All eyes were examined more than 3 months after surgery. RESULTS The optical coherence tomography foveal findings were classified as a disrupted inner segment and outer segment (IS/OS) line, a residual foveal detachment, and a continuous IS/OS line. A disrupted IS/OS line was seen in 11 eyes (55%) at 1 month and in 8 eyes (40%) at 3 months, a foveal detachment was seen in 8 eyes (40%) at 1 month and in 7 eyes (35%) at 3 months, and a continuous IS/OS line was seen in 1 eye (5%) at 1 month and in 5 eyes (25%) at 3 months. In 18 eyes followed up for 6 months, optical coherence tomography showed a disrupted IS/OS line in 3 eyes (17%), a foveal detachment in 6 eyes (33%), and a continuous IS/OS line in 9 eyes (50%). The mean best-corrected visual acuities at 1 and 6 months were 0.26 and 0.16 with a disrupted IS/OS line, 0.60 and 0.95 with a foveal detachment, and 0.8 and 0.95 with a continuous IS/OS line. The mean best-corrected visual acuity was significantly (P < .0001) lower with a disrupted IS/OS line compared with the other formations at 6 months. CONCLUSIONS The IS/OS line at the fovea recovered gradually after surgery. The postoperative visual acuity was correlated with a restored IS/OS line.

Effect of intravitreal injection of high-dose Bevacizumab in monkey eyes.

PURPOSE To evaluate the ocular complications of intravitreal injection of high dose bevacizumab in monkey eyes. METHODS Four healthy monkeys (Macaca fuscata) received an intravitreal injection of either 6.25 or 12.5 mg bevacizumab in the right eye; the left control eye received an intravitreal injection of the same volume of saline. The eyes were examined using slit lamp and funduscopy, optical coherence tomography (OCT), electroretinography (ERG), fundus photography (FP), fluorescein angiography (FA), and indocyanine green angiography (ICGA). The eyes were enucleated 28 days after the intravitreal injection and subjected to light microscopy. RESULTS No pathologic changes were observed by FP, FA, ICGA, OCT, and light microscopy in the eyes injected with either of the two bevacizumab doses. ERG showed no toxic change in the eyes that received the 6.25-mg dose. In two eyes that received the 12.5-mg dose, ERG showed no significant difference between the right and left eyes 4 weeks after injection, although there were transient changes in scotopic responses. CONCLUSIONS No irreversible toxic effects were observed in monkey eyes receiving an intravitreal injection of high dose bevacizumab.

Retinal Ganglion Cell Analysis in Leber's Hereditary Optic Neuropathy

1. World Health Organization. Progress report 2011: Global HIV/ AIDS responseepidemic update and health sector progress towards universal access. Geneva: 2011. 2. Dennehy PJ, Warman R, Flynn JT, et al. Ocular manifestations in paediatric patients with acquired immunodeficiency syndrome. Arch Ophthalmol 1989;107:978–82. 3. De Smet MD, Butler KM, Rubin BI, et al. The ocular complications of HIV in the pediatric population. In: Recent advances in Uveitis. Proceedings of the 3rd International Symposium on Uveitis. Amsterdam: Kugler; 1993:315–9. 4. Kestelyn P, Lepage P, Karita E, Perre PV. Ocular manifestations of infection with the human immunodeficiency virus in an African paediatric population. Ocul Immunol Inflamm 2000;8:263–73. 5. Livingston PG, Kerr NC, Sullivan JL. Ocular disease in children with vertically acquired human immunodeficiency virus infection. J AAPOS 1998;2:177–81. 6. Padhani DH, Manji KP, Mtanda AT. Ocular manifestations in children with HIV infection in Dar es Salaam, Tanzania. J Trop Pediatr 2000;46:145–8.

Functional and morphologic consequences of light exposure in primate eyes.

PURPOSE To evaluate the morphologic and functional changes of the primate retina after light exposure using spectral-domain optical coherence tomography (SD-OCT) and electroretinography (ERG). METHODS Seven monkey eyes with light-emitting diode (LED) contact lenses were exposed to light for 8 hours. SD-OCT and ERG were performed bilaterally before, after the light exposure, and on days 1 and 14 in three monkeys. The tests were repeated after 4 months, followed by enucleation 12 hours later. Six eyes of three other animals were enucleated 12 hours after the first light exposure, and two eyes of one monkey were enucleated after 14 days, followed by microscopy. RESULTS Immediately after light exposure, SD-OCT showed increased reflectivity of the outer segment (OS). Electron microscopy showed intracellular vacuolated and irregular lamellar structures at the proximal OS, while the distal end of the OS was unfolded at the RPE interface. At 14 days, the histologic changes and the OCT images returned to normal. ERG showed decreased cone and rod responses immediately after light exposure and decreased cone responses on day 1. Normalization occurred on day 14. CONCLUSIONS Light exposure caused increased reflectivity of the photoreceptor OS, which corresponded to intracellular vacuolization and irregularity of the lamellar structure of the OS. OCT images returned to normal along with the histologic restoration. Rod and cone responses decreased transiently immediately after light exposure, which might be attributed to incomplete recovery from retinal bleaching.

Intravitreal gas injection without vitrectomy for macular detachment associated with an optic disk pit.

Purpose: To evaluate the clinical outcomes after gas tamponade without vitrectomy for retinal detachment associated with an optic disk pit using optical coherence tomography. Methods: Intravitreal gas injection was performed on 8 consecutive patients (mean age, 35.0 years; range, 15–74 years) with unilateral macular detachment associated with an optic disk pit. A 0.3-mL injection of 100% sulfur hexafluoride 6 gas was carried out without an anterior chamber tap. Patients treated with gas injection were instructed to remain facedown for 5 days. Results: Complete retinal reattachment after only gas tamponade was achieved in four out of eight eyes. The mean number of gas injections was 1.8. The mean best-corrected visual acuity before and after the treatment with gas tamponade was approximately 30/100 and 20/20, respectively. The period required for reattachment after final gas treatment was 12 months. There were no incidences of recurrence after complete reattachment by gas tamponade in any of the cases during the 94-month average follow-up period (range, 64–132 months). Conclusion: Gas tamponade appears to be an effective alternative method for macular detachment associated with an optic disk pit, even though the mechanisms of optic disk pit maculopathy are still unknown.

Tomographic Features of Spontaneous Closure of Full-Thickness Macular Holes

In cases of hereditary or acquired retinopathy, it is important to inform the patient of the long-term prognosis of the disease. Adamus et al. followed a patient with CAR for more than 4 years, and the patient’s vision decreased and stabilized at hand motion vision OU 3 years after she noticed her eye symptoms. Some CAR patients treated with corticosteroids have shown modest improvement of visual function, although this improvement is rarely sustained. The visual function of my patient after tumor resection deteriorated very slowly over 13 years but has stabilized in the past 2 years. No treatment has been reported that completely stops the progression of CAR; however, a long course of local steroid therapy might be benefi cial to slow down but not stop the progression. A search of Medline did not extract any reports of patients with CAR with this length of follow-up. Although our long-term fi ndings were made on only one case, they can be used to inform CAR patients of their long-term prognosis.

Retinal ganglion cell analysis in multiple evanescent white dot syndrome

BackgroundMultiple evanescent white dot syndrome (MEWDS) is an acute and usually unilateral retinopathy that occurs predominantly in young adults. This report presents the outcomes of ganglion cell analysis (GCA) in MEWDS.Case presentationA 41-year-old woman was diagnosed as MEWDS in right eye. At her initial visit, the deviation map of the ganglion cell analysis showed there was a decrease of the ganglion cell layer (GCL) + inner plexiform layer (IPL) thickness in both eyes, even though her left eye was not affected. A 29-year-old woman was also diagnosed as MEWDS in right eye. Although the deviation map of ganglion cell analysis showed there was a decrease of the GCL + IPL thickness in both eyes at her initial visit, her right eye was not affected.ConclusionGCA indicated there was a decrease (<1% of the distribution of normals) of the ganglion cell layer + inner plexiform layer thickness in both the affected and fellow eyes in 7 of 9 patients diagnosed as MEWDS in our hospital. Although the lesions responsible for MEWDS are thought to disrupt the photoreceptor outer segments, we observed changes in the inner retina in both the affected and fellow eye of MEWDS patients.

Evaluation of Fundus Blood Flow in Normal Individuals and Patients with Internal Carotid Artery Obstruction Using Laser Speckle Flowgraphy

Purpose We investigated whether laser speckle flowgraphy (LSFG) results are comparable in both eyes and whether it is useful in the diagnosis of disparity in ocular ischemic syndrome (OIS) patients. Methods We compared the mean blur rate (MBR) value for various fundus regions in both eyes of 41 healthy subjects and 15 internal carotid artery occlusion (ICAO) cases. We calculated the standard value of the Laterality Index (LI), which was the MBR comparison of both eyes in each of the regions, in the control subjects. We then investigated the correlation between both eyes for the LIs in the entire fundus, the degree of ICAO and visual function. Results The disparity of the LIs in both eyes was least in the entire area of the fundus in control subjects and there was a significant correlation between both eyes of the 41 healthy individuals (P = 0.019). Significant correlations were found for the LI, visual acuity and degree of ICAO. The specificity and sensitivity of LI in the entire area was 93.8% and 100%, respectively. Conclusions LSFG revealed normal individuals have symmetrical fundus blood flow. LSFG could detect OIS and might be a useful tool for detecting disparities in fundus blood flow.

Different Filling Patterns of the Choriocapillaris in Fluorescein and Indocyanine Green Angiography in Primate Eyes Under Elevated Intraocular Pressure

Purpose To investigate the hemodynamics of the choriocapillaris in primate eyes under elevated intraocular pressure. Methods Indocyanine green angiography (ICGA) and fluorescein angiography (FA) were performed in two monkeys after elevation of the intraocular pressure (IOP) to 35 and 60 mm Hg. Results ICGA and FA showed no perfusion delays in the choriocapillaris at 35 mm Hg. The slow dye filling at 60 mm Hg made it possible to observe the early phase angiography sequence. During ICGA, C-shaped precapillary arterioles multiplied in numbers and emerged in the posterior pole, forming the outer rim of the numerous mosaics or lobules. Dye subsequently infiltrated into the lobules. During FA, after numerous hyperfluorescent spots emerged in the posterior pole, each of the spots enlarged and became numerous mosaics with a dark outer rim. When the FA and ICGA images were superimposed, the C-shaped arterioles observed during the ICGA were shown to correspond to the outer dark rim of the mosaics seen during the FA. The earliest dye emergence was delayed during FA compared to ICGA, with 13 seconds elapsing in monkey 1 and 4 seconds in monkey 2. The horizontal diameter of the optic disc contained three to four mosaics in both monkeys. Conclusions The choriocapillaris lobules appear to be supplied from peripheral arterioles, not central. After blood perfuses the lobules, it drains into the venules at the center. Mosaic or lobular patterns during FA may reflect extravasated fluorescein from the fenestrated choriocapillaris.