Language：Japanese   Publisher：眼科臨床紀要会  

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Language：Japanese   Publisher：眼科臨床紀要会  

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Language：Japanese   Publisher：眼科臨床紀要会  

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Language：English   Publishing type：Research paper (scientific journal)  

PURPOSE: To evaluate retinal circulation in eyes with central retinal artery occlusion (CRAO). METHODS: The best-corrected visual acuity (BCVA), fluorescein angiography (FA), and laser speckle flowgraphy (LSFG) values were measured at the first visit in 42 patients with CRAO (42 eyes; mean age, 66.0±14.0 years. LSFG was performed at baseline, 1 week, and 1, 3, and 6 months; the difference between the mean blur rate vessel area and mean blur rate tissue area (MV-MT), reflecting the retinal vessel blood flow, was measured. FA measured the arteriovenous passage (AV) time. Time-course changes in the MV-MT and BCVA and the relationship between MV-MT and final BCVA were examined. RESULTS: MV-MT was significantly correlated with AV time (P<0.001). The MV-MT increased significantly after 1, 3, and 6 months (P<0.001). The VA improved significantly until 1 month (P<0.01). Multivariate analysis showed a significant correlation between the baseline BCVA (P<0.001) and MV-MT at 1 month (P=0.01) and the final BCVA. Age and MV-MT were significantly negatively correlated at 1 month (P<0.001). CONCLUSIONS: The retinal circulation improved significantly within 1 month; younger patients had better retinal circulation improvement. The baseline BCVA and retinal circulation within 1 month were correlated with the final BCVA.

DOI： 10.1097/IAE.0000000000004264

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Publishing type：Research paper (scientific journal)   Publisher：Elsevier BV  

DOI： 10.1016/j.xops.2024.100528

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Language：Japanese   Publisher：(公財)日本眼科学会  

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Language：Japanese   Publisher：(公財)日本眼科学会  

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Language：English   Publishing type：Research paper (scientific journal)  

To characterize and compare macular vessel density in central retinal artery occlusion (CRAO) eyes with retinal arterial cannulation and CRAO eyes with standard treatment. This study was Cross-sectional, observational study. Twenty-two eyes with nonarteric CRAO which underwent retinal arterial cannulation and 19 eyes with nonarteric CRAO with standard treatment were included. Optical coherent tomography angiography (OCTA)-based macular vessel density and visual acuity were examined. The dynamic ranged-based normalized rates of vessel density was compared within each group at the first visit to the clinic and 7 days after the onset. Macular vessel density in cannulation group was significantly better at 7 days after the onset than that at the first visit (3.73 ± 3.02 mm-1 vs. 7.89 ± 1.02 mm-1, P = 0.0001), while there wasn't significant improvement of macular vessel density in standard treatment group at 7 days after the onset (2.13 ± 1.62 mm-1 vs. 2.89 ± 0.22 mm-1, P = 0.067). At one month after the onset, mean LogMAR visual acuity in CRAO eyes with cannulation significantly improved compared with that at the first visit after the onset (1.678 vs. 0.979, P = 0.00012). Macular vessel density loss in CRAO eyes was improved by retinal arterial cannulation. Early intervention of retinal arterial cannulation is useful for minimizing visual impairment in CRAO eyes.

DOI： 10.1038/s41598-023-46267-w

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Language：Japanese   Publisher：眼科臨床紀要会  

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Language：Japanese   Publisher：眼科臨床紀要会  

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Language：Japanese   Publisher：眼科臨床紀要会  

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Language：Japanese   Publisher：眼科臨床紀要会  

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Language：Japanese   Publisher：眼科臨床紀要会  

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Language：English   Publishing type：Research paper (scientific journal)  

PURPOSE: To evaluate the relationship between retinal haemorrhages detected on Ultra-widefield (UWF) red channel images and perfusion status in eyes with acute central retinal vein occlusion (CRVO). METHODS: UWF fundus images were split into green and red channels using ImageJ software. The retinal haemorrhages were calculated quantitatively with both the green and red channel images, resulting in green channel haemorrhages (GCH) and red channel haemorrhages (RCH). The nonperfusion area (NPA) was also calculated from fluorescein angiography in each eye. The relationships between both the GCH and RCH with the NPA were investigated. RESULTS: Thirty-two eyes of 32 patients with acute CRVO (18 men, 14 women) were included. The mean GCH and RCH values were 10.4% ± 8.2% and 1.7% ± 1.7%, respectively. The mean NPA was 39.2% ± 28.8%. Significant correlations were seen between the GCH and NPA (r = 0.38; P = 0.022) and RCH and NPA (r = 0.44; P = 0.010, linear regression analysis). Multivariate analysis suggested that only the RCHs were correlated significantly with the NPA. CONCLUSIONS: Retinal haemorrhages detected by UWF red channel imaging were less compared to green channel imaging and associated closely with retinal NPAs in eyes with acute CRVO. UWF red channel imaging allowed us to identify ischaemia-related haemorrhage.

DOI： 10.1038/s41433-022-02337-3

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PURPOSE: The current study aims to investigate the postoperative refractive outcomes in eyes that underwent the flanged intrascleral IOL fixation combined with vitrectomy with or without gas/air tamponade. METHODS: We divided the eyes into two groups (Group A; eyes that underwent flanged intrascleral IOL fixation with gas/air tamponade, Group B; eyes that underwent flanged intrascleral IOL fixation without gas/air tamponade). The predicted spherical equivalent (SE) refraction values were calculated using the SRK/T formula. Then, the prediction error (PE) was calculated by subtracting the predicted SE refraction from the postoperative objective SE refraction and the absolute prediction error (AE) was calculated as the absolute value of the PE for each eye. RESULTS: A total of 68 eyes were included in the current study. There was a significant correlation between the predicted and postoperative SE refraction in both groups (Group A, r = 0.968, p<0.0001, Group B, r = 0.943, p<0.0001, linear regression analysis). The PE demonstrated a mild myopic shift after the flanged intrascleral IOL fixation in both groups (Group A, -0.40 ± 0.96 D, Group B, -0.59 ± 0.95 D). There was no significant difference in PE and AE between the two groups (p=0.44, p=0.70, Wilcoxon rank sum test). CONCLUSION: The postoperative SE refraction after flanged intrascleral IOL fixation was not influenced by gas/air tamponade.

DOI： 10.1097/IAE.0000000000003860

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PURPOSE: To evaluate the efficacy of anterior segment optical coherent tomography (AS OCT) in estimating the length of the pars plana and optimizing the sclerotomy entry site in vitrectomy for highly myopic eyes, facilitating membrane peeling. METHODS: Twenty-three eyes with myopic traction maculopathy were studied. The pars plana was examined using two methods: preoperative AS OCT and intraoperative measurement. The distance from the limbus to the ora serrata in two groups was measured to compare differences in length. The actual length of the entry site from the limbus and forceps used were noted in all eyes studied. RESULTS: The mean axial length was 29.2 ± 2.3 mm for all 23 eyes. The average length between the limbus and ora serrata measured with AS OCT and intraoperative examination was 6,710 µ m (SD ± 459) and 6,671 µ m (SD ± 402), respectively, in the superotemporal region ( P > 0.05), and 6,340 µ m (SD ± 321) and 6,204 µ m (SD ± 402), respectively, in the superonasal region ( P >0.05). The mean length of the entry site from the limbus was 6.2 mm, and 28-mm forceps were used in 17 of 23 eyes (77%). CONCLUSION: The length of the pars plana varies depending on the axial length of the eye. Preoperative AS OCT enables accurate measurement of the pars plana in eyes with high myopia. AS OCT examination can help determine the optimal site for sclerotomy, allowing easier access to the macular region for membrane peeling in highly myopic eyes.

DOI： 10.1097/IAE.0000000000003736

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PURPOSE: To investigate the time courses of morphologic changes in the transplanted grafts, including the retinal layer, the ellipsoid zone (EZ) and the visual acuity (VA) after autologous retinal transplantation (ART) in patients with primary large macular holes (MHs). DESIGN: Single-center, retrospective cohort study. SUBJECTS: The study included 17 eyes of 17 patients who had undergone ART. All patients fulfilled the following criteria: (1) MH was the only disease-causing anatomic abnormality of the macula; (2) they could be followed up for at least 12 months after ART surgery; (3) they had no other systemic disorders; and (4) the MH was > 400 μm in diameter. METHODS: Data of all patients who underwent assessment of the VA and spectral-domain (SD)-OCT at 1, 3, 6, and 12 months after surgery were analyzed. The morphologic features of the graft and the EZ were measured by SD-OCT. MAIN OUTCOME MEASURES: Changes in the morphologic features of the graft (graft thickness, overall graft area, graft length, area of outer retina, and EZ) and VA over 1 year after surgery. RESULTS: Closure of the MH was achieved in all patients. The VA was 0.59 ± 0.27 (logarithm of the minimal angle of resolution units) at 1-year postsurgery compared with 0.84 ± 0.22 before surgery (P < 0.05). The retinal layers gradually became smoothly connected. Although a decrease in graft thickness and overall graft area was observed, the length and area of the outer retina were maintained throughout the follow-up period. The presence of the EZ was observed in 9 patients (52.9%) and our analyses revealed significantly greater improvement of VA in these patients than in those without the EZ (P < 0.05). Moreover, the incidence of macular edema (ME) was higher in the group without the EZ (P = 0.04; chi-square test). CONCLUSION: Patients showed significant improvements of the VA. Morphologically, the layers were gradually connected to each other, and the outer retina was particularly maintained. Especially, patients in whom an EZ was restored in the graft showed a low prevalence of ME and greater improvement of the VA. FINANCIAL DISCLOSURE(S): The author(s) have no proprietary or commercial interest in any materials discussed in this article.

DOI： 10.1016/j.oret.2022.12.004

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Language：Japanese   Publisher：(公財)日本眼科学会  

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Language：English   Publisher：(公財)日本眼科学会  

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Language：Japanese   Publisher：(公財)日本眼科学会  

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Language：Japanese   Publisher：眼科臨床紀要会  

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Language：English   Publishing type：Research paper (scientific journal)  

Purpose: To evaluate the repeatability of macular hole (MH) diameter measurement on en face slab optical coherence tomography (OCT) reflectance images and assess its potential to predict visual acuity (VA). Methods: We enrolled 27 eyes with full-thickness MHs in this study. Preoperative en face slab OCT reflectance images were obtained. Image binarization, ellipse approximation, and uncorrected measurement of minimum diameter, min(ef_uc), and maximum diameter, max(ef_uc), were performed using ImageJ. In addition, magnification-corrected diameters were calculated as min(ef) and max(ef) using the Littman and modified Bennett formulas. Spectral-domain OCT horizontal images were used as the conventional method for the analysis: min(conv) and max(conv). The inter-rater reliability of the method was evaluated by calculating the intraclass correlation coefficient (ICC). The following relationships were analyzed: (1) between logMAR VA and min(ef_uc), min(ef), and min(conv); and (2) between logMAR VA and max(ef_uc), max(ef), and max(conv). Results: The min(ef) and max(ef) values were 439.4 ± 240.5 µm and 720.7 ± 346.1 µm, respectively. The ICC values were 0.985 and 0.999 for min(ef) and max(ef), and 0.885 and 0.909 for min(conv) and max(conv), respectively. Multivariate analysis suggested that min(ef), but not min(ef_uc) or min(conv), was associated with pre- and postoperative logMAR VA. Furthermore, max(ef), but not max(ef_uc) or max(conv), was also closely correlated with pre- and postoperative logMAR VA. Conclusions: The MH diameter measured by our method is highly reproducible and closely associated with VA compared to that measured by the conventional method. Translational Relevance: The MH diameter measured by this modality might serve as an accurate biomarker to predict visual function in eyes with MH.

DOI： 10.1167/tvst.11.10.13

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Language：Japanese   Publisher：眼科臨床紀要会  

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Language：English   Publishing type：Research paper (scientific journal)  

Anastomosis on graft retina was studied after autologous retinal transplantation (ART) on 26 eyes with primary and refractory macular holes. Angiogenesis and anastomosis were seen in 35% of the eyes with successful ART, likely contributing to the survival of the transplanted retina.

DOI： 10.1016/j.oret.2022.05.007

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Publishing type：Research paper (scientific journal)   Publisher：Springer Science and Business Media LLC  

DOI： 10.1007/s00417-022-05717-3

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Other Link： https://link.springer.com/article/10.1007/s00417-022-05717-3/fulltext.html

Language：English  

Purpose: To evaluate an outbreak of endophthalmitis caused by Fusarium oxysporum after cataract surgery. Methods: In the present study, we conducted a retrospective review of the medical records of cases of endophthalmitis that developed after cataract surgery. All eyes underwent phacoemulsification and intraocular lens implantation (PEA + IOL) at a single eye clinic on the same date. Symptoms of endophthalmitis occurred 21.5 ± 3.4 days after the cataract surgery. Results: Nine eyes of 9 patients with fungal endophthalmitis (5 males and 4 females) were enrolled in the current study. The mean age of the patients was 63.4 ± 8.5 years. Soon after the diagnosis of endophthalmitis, pars plana vitrectomy (PPV) had been performed in all the eyes. However, because there was no response to the first PPV plus antibacterial drug therapy, we performed repeat PPV for all the eyes, combined with IOL removal and antifungal therapy (natamycin eye drops plus oral voriconazole or fosfluconazole). After the antifungal drug therapy, no recurrence of endophthalmitis was observed in any of the operated eyes, and good visual outcomes were obtained. Fusarium oxysporum was identified by culture and sequencing analysis. Conclusion: Early diagnosis and appropriate, adequate treatment are needed for successful management of fungal endophthalmitis.

DOI： 10.1016/j.ajoc.2022.101397

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To evaluate the 1-year visual outcomes and anatomic responses of Japanese patients who received intravitreal brolucizumab (IVBr) injections for polypoidal choroidal vasculopathy (PCV). This was a retrospective study of 17 treatment-naïve eyes with PCV that were treated with IVBr. We evaluated the best-corrected visual acuity (BCVA), central macular thickness (CMT), central choroidal thickness (CCT) and number of injections for 1 year. The eradication of polypoidal lesions was also evaluated using by indocyanine green angiography during the 1-year follow-up. Non-infectious intraocular inflammation developed in two (11.8%) eyes; 15 eyes were assessed at the 1-year follow-up examination. The mean BCVA improved significantly from 0.28 at baseline to 0.13 (P < 0.05) at 1 year. The CMT and CCT decreased significantly after 1 year. The mean number of injections was 6.4 ± 0.13. The rate of complete resolution of polypoidal lesions at 1 year was 93.3%. A dry macula was achieved in 13 eyes (86.6%) after the loading phase and in 11 eyes (73.3%) at 1 year. The IVBr injections appeared to be effective for improving both functional and anatomic outcomes in Japanese patients with PCV, with a high regression rate of polypoidal lesions.

DOI： 10.1038/s41598-022-12216-2

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PURPOSE: To analyze the vessel density around the optic nerve head (ONH) by optical coherence tomography angiography (OCTA) in patients with retinitis pigmentosa (RP), and to evaluate its correlation with visual functions. METHODS: Thirty-eight eyes with RP with visual field constriction within the central 10° were enrolled. The mean (± SD) age of the patients was 43.7 ± 15.1 years. In addition to visual acuity (VA) measurements and visual field tests (Humphrey Field Analyzer 10-2 test), we also measured the vessel density at the macula by OCTA (superficial and deep vessel density: sVD(m) and dVD(m)) and in multiple layers around the ONH (vessel density in the radial peripapillary capillary [RPC] layer and in the nerve head [NH] layer: VDrpc and VDnh). The vessel density was calculated by binarizing the OCTA images. The associations between the logMAR VA and mean deviation (MD) values and the variables of central retinal thickness (CRT), sVD(m), dVD(m), VDrpc, VDnh, and also the size of the foveal avascular zone were investigated. RESULTS: The mean logMAR VA was 0.16 ± 0.34 and the MD value was - 17.2 ± 10.3 dB; the MD value was significantly related to the logMAR VA (p = 0.0028). Multivariate analysis with AICc model selection suggested only dVD(m) was associated with logMAR VA. On the other hand, the optimal model for the MD value included the CRT, dVD(m), and VDnh. CONCLUSION: The vessel density in the deep layer around the ONH was significantly associated with the visual field deterioration in patients with RP.

DOI： 10.1007/s00417-021-05288-9

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Language：Japanese   Publisher：(公財)日本眼科学会  

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Language：Japanese   Publisher：(公財)日本眼科学会  

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：Nature Research  

The purpose of this study was to report the incidence of elevated intraocular pressure (IOP) after intravitreal injection (IVI) of anti-vascular endothelial growth factor (VEGF) in Japanese patients with age-related macular degeneration (AMD). A retrospective study of chart review of patients who underwent ≥ 10 intravitreal anti-VEGF injections between April 2009 and December 2019 was conducted. Elevated IOP was defined as IOP ≥ 25 mmHg at one visit. Cases with elevated IOP resulting from IVI were identified. Furthermore, the association between elevated IOP and some parameters, as the risk factors that influence elevated IOP, was investigated. A total of 402 eyes of 370 patients were included in this study. Twenty-eight eyes of 26 patients (7.0%) were identified as cases with elevated IOP after IVI. The mean time of elevation after baseline was 50.6 ± 26.5 months. History of glaucoma (p = 0.021
odds ratio, 5.85), treatment modality (p = 0.019
odds ratio, 6.32), and total number of injections (p = 0.003
odds ratio, 1.03) were significantly associated with elevated IOP. A late complication of elevated IOP is associated with IVI in patients with AMD. Particularly, history of glaucoma and treat and extend regimen with frequent injections were found to be risk factors of elevated IOP.

DOI： 10.1038/s41598-021-91832-w

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PURPOSE: To compare the foveal microstructures, such as the prevalence of epiretinal proliferation (EP) and residual ellipsoid zone (EZ), in eyes with lamellar macular hole (LMH), epiretinal retinal membrane (ERM) foveoschisis and macular pseudohole (MPH), and to investigate the association of the foveal microstructure with visual functions. METHOD: In addition to the prevalence of EP, we calculated the residual EZ index within 1mm and 3 mm (rEZ1 and rEZ3) in all examined eyes. Comparisons were conducted to baseline characteristics (logMAR visual acuity [logMAR VA], metamorphopsia score [Mave], central retinal thickness [CRT], the prevalence of EP, rEZ1 and rEZ3) between MPH, ERM foveoschisis and LMH subgroups. The relationships (1) between logMAR VA and each of age, type (MPH, ERM foveoschisis and LMH), the prevalence of EP, rEZ1, rEZ3, spherical equivalent (SE) and CRT and (2) between Mave and each of variables were investigated. RESULTS: Fifty-one eyes of 48 patients were enroled. The mean age was 65.2 ± 11.1 years. Ten eyes were diagnosed as LMH, 22 eyes as ERM foveoschisis and 19 eyes as MPH, respectively. There was a significant difference in CRT only between LMH and ERM foveoschisis (p = 0.023). There was a tendency toward significance in rEZ1 between LMH and ERM foveoschisis (p = 0.057), but not in rEZ3. The optimal model for logMAR VA included age, rEZ1, SE and CRT. On the other hand, the optimal model for Mave included the prevalence of EP, rEZ1 and SE. CONCLUSION: Microstructural observations are useful to predict visual functions in LMH, ERM foveoshisis and MPH.

DOI： 10.1038/s41433-021-01818-1

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Language：Japanese   Publisher：眼科臨床紀要会  

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Language：English   Publishing type：Research paper (scientific journal)  

Non-vascularized pigment epithelial detachments (PED) are usually associated with dry age-related macular degeneration (AMD). In this study, we aimed to investigate the correlation between visual function and morphologic parameters. Seventeen eyes of eleven patients with non-vascularized AMD were enrolled. In addition to conventional optical coherence tomography (OCT), polarization-sensitive optical coherence tomography (PS-OCT) measurements were performed by evaluating the regularity of retinal pigment epithelium (RPE) entropy within the PED area. Retinal sensitivity was measured with MP-3 microperimetry, and retinal sensitivities within (RSin) and outside (RSout) the PED area were calculated. The relationship between OCT parameters and visual function was analyzed. As a result, there was a significant difference between the RSin and RSout (p < 0.001, Wilcoxon signed rank test). Moreover, RSin was significantly related to logMAR VA (p = 0.033, linear mixed model). The regularity of RPE entropy was significantly related to visual acuity and RSin (p = 0.00038, p = 0.031, linear mixed model), although neither the height nor area of PED correlated with visual function. Our results suggest that retinal sensitivity is significantly deteriorated within the PED area and RPE entropy measured with PS-OCT was closely related to visual function in eyes with non-vascularized PED.

DOI： 10.1038/s41598-021-96151-8

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Purpose: This study investigated the relationship between retinal artery angle and visual function in eyes with idiopathic epiretinal membrane (ERM). Methods: Ultra-wide field fundus imaging was conducted to analyze ERM and normal contralateral eyes. In addition to the logMAR visual acuity (VA) measurement, the average of the vertical and horizontal metamorphopsia scores (Mave) was measured using m-Charts for each eye. We calculated the retinal artery angle (Yugami correlated angle [YCA]) in all the examined eyes using ImageJ software. The YCAs were then compared between the ERM and normal contralateral eyes. Additionally, the relationship between YCA and visual function was investigated in the ERM eyes. Results: Data from 40 patients with ERM were analyzed. The mean age of the participants was 67.1 ± 8.1 years. The YCA was significantly smaller in the ERM eyes, compared with the contralateral eyes (P < 0.001, respectively; Wilcoxon signed rank test). Among age, axial length, YCAs, central retinal thickness (CRT), and central choroidal thickness (CCT), the optimal model for logMAR VA included age, YCA, and CRT. On the other hand, the optimal model for Mave included YCA and CCT. Conclusions: The retinal artery angle may be useful for predicting visual function in eyes with ERM. Translational Relevance: Our established quantitative measurements in fundus photography have potential clinical use in predicting visual function in ERM.

DOI： 10.1167/tvst.10.9.35

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Purpose: To investigate the associations between visual function and the optical coherence tomography (OCT) parameters in eyes with idiopathic epiretinal membrane (ERM). Methods: Thirty-nine consecutive eyes with ERM were enrolled. In addition to OCT parameters, such as central retinal thickness (CRT), the area of gap between the ERM and the retinal surface (SUKIMA) was newly defined and calculated from the vertical and horizontal OCT images (SUKIMAv and SUKIMAh). The average of SUKIMAv and SUKIMAh (SUKIMAave) was used for the statistical analysis. The vertical and horizontal metamorphopsia scores (MV, MH) and the average of MV and MH (Mave) were also used for the analysis. Results: The Mave was not significantly associated with logMAR visual acuity (VA) (P = 0.57, linear regression analysis). Analysis using second-order bias-corrected Akaike information criterion model selection identified the age, CRT, and SUKIMAave as being associated with logMAR VA. On the other hand, among the OCT parameters, SUKIMAave and CRT were associated with the Mave. In addition, there was a significant relationship between SUKIMAh and MV (P = 0.011) and between SUKIMAv and MH (P = 0.0014). Conclusions: We identified SUKIMA as a novel OCT parameter that is useful to predict both VA and metamorphopsia in patients with ERM.

DOI： 10.1167/iovs.62.6.6

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：Association for Research in Vision and Ophthalmology Inc.  

PURPOSE. The purpose of this study was to compare the results of near-infrared autofluorescence (NIRAF) and short-wavelength autofluorescence (SWAF) imaging of eyes with resolved central serous chorioretinopathy (CSC) and to assess the retinal sensitivity (RS) in areas with abnormal autofluorescence (AF) using white-on-white (WW) and blue-onyellow (BY) perimetries. METHODS. We examined 20 consecutive eyes with resolved CSC. We calculated the areas of abnormal AF detected by SWAF and NIRAF imaging as SWAF-area and NIRAF-area, respectively, and the number of measurement points within and outside abnormal SWAF and NIRAF regions were counted. The results of WW and BY perimetries were superimposed on the AF images, and the mean overall RS within and outside abnormal SWAF and NIRAF regions were calculated using both WW and BY perimetries (W-RSin-SWAF, W-RSout-SWAF, W-RSin-NIRAF, W-RSout-NIRAF, B-RSin-SWAF, BRSout- SWAF, B-RSin-NIRAF, and B-RSout-NIRAF, respectively). RESULTS. The mean age of the participants was 54.1 years. The SWAF-area was significantly smaller than the NIRAF-area (P &lt
0.0001, Wilcoxon signed rank test). A ?2 test suggested a significant relationship between the number of measurement points within/outside abnormal SWAF and NIRAF regions (P &lt
0.0001). In the results of measurement by WW perimetry, there was a significant difference between WRSin- NIRAF and W-RSout-NIRAF (P &lt
0.0001), but not between W-RSin-SWAF and WRSout- SWAF (P = 0.060, Wilcoxon rank sum test). In contrast, on BY perimetry, there were significant differences between both B-RSin-SWAF and B-RSout-SWAF and between B-RSin-NIRAF and B-RSout-NIRAF (P &lt
0.0001). CONCLUSIONS. NIRAF was useful for predicting impaired RS in eyes with resolved CSC.

DOI： 10.1167/IOVS.62.3.36

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OBJECTIVE: To investigate the association between serum soluble fms-like tyrosine kinase-1 (sFlt-1) and the choroidal structure during the pregnancy. METHODS AND ANALYSIS: This prospective study enrolled 24 eyes of 12 consecutive healthy pregnant women. Each participant was evaluated during the first, second and third trimester of pregnancy and the postpartum period. The central choroidal thickness (CCT) and Choroidal Vascular Index (CVI) were measured using enhanced depth-imaging optical coherence tomography. Moreover, serum sFlt-1 and vascular endothelial growth factor (VEGF) concentrations were measured manually using ELISA. The association between choroidal structural parameters and serum sFlt-1/VEGF was analysed using a linear mixed model. RESULTS: The CCT was significantly thicker in the second and third trimester than the postpartum period (p<0.05). In contrast, there was no significant difference in the CVI throughout pregnancy or the postpartum period. Serum sFlt-1 levels were significantly higher during pregnancy than the postpartum period (p<0.05), whereas the serum VEGF levels were significantly lower during pregnancy than the postpartum period (p<0.05). Furthermore, serum sFlt-1 levels were significantly associated with CCT throughout pregnancy (p=0.011, linear mixed model). On the contrary, sFlt-1 levels was not associated with the CVI during the pregnancy. CONCLUSION: Our results suggest that serum sFlt-1 might have an influence on the choroidal thickness during the pregnancy.

DOI： 10.1136/bmjophth-2021-000888

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PURPOSE: To evaluate the visual outcomes of vitrectomy for lamellar macular hole (LMH) and epiretinal membrane (ERM) foveoschisis and to investigate the prognostic factor for postoperative visual acuity. METHODS: We retrospectively reviewed 15 LMH and 17 ERM foveoschisis eyes that had undergone a standard three-port pars plana vitrectomy with (12 eyes) or without (20 eyes) cataract surgery. Best-corrected visual acuity (BCVA) at postoperative three months and the final visit were compared to the preoperative measurements. We investigated the relationship between BCVA at the final visit and baseline parameters (age, preoperative BCVA, the presence of epiretinal proliferation [EP] and ellipsoid zone [EZ] disruption). The best explanatory variables for the final BCVA were investigated using the corrected Akaike information criterion (AICc) model selection. RESULTS: The mean age was 67.2 years. The mean follow-up duration was 30.7 months. Fifteen of 32 examined eyes were diagnosed as LMH and 17 eyes as ERM foveoschisis. Twelve eyes in LMH had EP and 13 eyes showed the disruption of EZ integrity. In total, BCVA significantly improved at 3 months postoperatively (p = 0.0013). A significant improvement was observed in ERM foveoschisis (p = 0.0085) but not in LMH group (p = 0.071). Comparing the BCVA between the baseline and the final visit, significant improvements were observed in total, ERM foveoschisis and LMH group (p<0.001, p<0.001 and p = 0.026, respectively). The optimal model for BCVA at the final visit included preoperative BCVA and the presence of EZ disruption (p<0.001 and p<0.001, respectively). CONCLUSION: Our results suggested that the final BCVA was dependent on preoperative BCVA and the presence of EZ disruption. Surgical indications might be warranted for LMHs with EZ disruption.

DOI： 10.1371/journal.pone.0247509

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PURPOSE: To examine the usefulness of red channel fundus imaging to detect the ischemic status in eyes with central retinal vein occlusion (CRVO). METHODS: Ultra-widefield (UWF) fundus images were obtained from 42 eyes with CRVO. Twenty-one eyes were ischemic, and 21 eyes were non-ischemic. Rubeosis was found in 11 ischemic eyes. UWF images were split into red and green channels using ImageJ software. Both the color and red channel images were used to predict the presence or absence of ischemia when examined by masked graders. The sensitivity and specificity of UWF imagings for the detection of ischemia were calculated in Group A (total 42 eyes), Group B (32 eyes excluding non-rubeotic ischemic CRVO) and Group C (31 eyes excluding rubeotic ischemic CRVO), respectively. Moreover, a linear mixed model was conducted to investigate the relationship between the type of images and the accuracy of prediction in each group. RESULTS: No significant difference in the sensitivity of color fundus imaging was seen between Group A and Group B. By contrast, a significant difference in the sensitivity of red channel imaging was seen between Group A and Group B (p = 0.031). The accuracies of the predictions were not associated with the type of image in Group A and Group B, but were significantly associated in Group C (p = 0.026). CONCLUSIONS: UWF red channel imaging enabled more accurate detection of the ischemic status, compared with color fundus images, especially in non-rubeotic CRVO eyes.

DOI： 10.1371/journal.pone.0260383

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PURPOSE: A smoking habit can cause various health problems encompassing retinal diseases including central serous chorioretinopathy (CSC). The aim of the current study was to investigate the effect of smoking on the choroidal structure in patients with CSC. METHODS: The choroidal vascular index (CVI) was calculated using the binarized OCT images. Baseline parameters (age, refractive error [SE], subfoveal choroidal thickness [SFCT] and CVI) were compared between smokers and non-smokers using Wilcoxon rank sum test. Moreover, the associations between SFCT and the baseline parameters were analyzed using a multivariate linear regression followed by the AICc model selection. RESULTS: Among 75 CSC patients, 45 patients were smokers and 30 patients were non-smokers. No significant differences in age and SE were seen between the smoking group and the non-smoking group. A significant difference in the SFCT was seen between two groups (382.0 ± 68.2 μm in the smoking group vs. 339.3 ± 52.3 μm in the non-smoking group, p = 0.0038), while no significant difference was observed in the CVI (p = 0.32). The optimal model for SFCT included the variables of age, SE and past history of smoking among the baseline parameters. Additionally, increased pack years was associated with increased SFCT. CONCLUSION: Cigarette smoking was associated with an increased SFCT in patients with CSC. Thicker choroid in smoking CSC patients may be an important modulator of the disease.

DOI： 10.1371/journal.pone.0249073

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PURPOSE: To report the outcomes of autologous neurosensory retinal transplant as a primary treatment for patients with large chronic macular holes and evaluate the safety and feasibility of the procedure. DESIGN: Retrospective study, consecutive case series. METHODS: We reviewed seven patients with a primary chronic large macular hole, who underwent autologous neurosensory retinal transplant. Mean preoperative minimum and maximum hole diameters were 643 µm and 1214 µm, respectively. Changes in visual acuity were measured postsurgery, and optical coherence tomography, fluorescein angiography, and microperimetry-3 were analyzed after the procedure. RESULTS: Closure of the macular hole was achieved in all seven eyes in the study. At 1 year post-surgery, there was significant improvement in mean visual acuity (LogMAR 1.10 vs. 0.68, P = 0.001). Optical coherence tomography showed that all grafts had formed attachments to the retinal epithelial cells of the recipient retina. Mean preoperative ellipsoid zone defect was 1,089 ± 403.8 µm (range, 918-1,329 µm) which further decreased to 921 ± 129.1 µm (range, 670-1,201 µm) at final follow up (P = 0.09). Microperimetry-3 testing indicated retinal sensitivity in the graft in five eyes. CONCLUSION: Autologous retinal transplantation may help rebuild the macular structure resulting in functional improvement for eyes with primary chronic large macular hole.

DOI： 10.1097/IAE.0000000000002693

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Language：Japanese   Publisher：眼科臨床紀要会  

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Purpose: To describe the findings of long-term follow-up of a case of amyloidosis-associated chorioretinopathy by multimodal imagings, including optical coherence tomography (OCT). Observations: A 47-year-old woman who had been diagnosed as having systemic amyloidosis was found to have a best corrected visual acuity of 20/13 in both eyes at the age of 41, which subsequently decreased to 20/100 in the left eye and 20/20 in the right eye at age 47. Visual field examination demonstrated worsening of the central scotoma during the follow-up period. Funduscopic examination revealed bilateral white deposits along the choroidal vessels, which became more pronounced over time, along with diffuse pigmentary changes. The fluorescein angiography and indocyanine green angiography findings were consistent not only with atrophic lesions, but also with amyloid deposition (i.e., staining of the vessels).At the baseline, macula OCT revealed a thick hyporeflective band at the choriocapillaris, however, at the last follow-up, it revealed an absent ellipsoid zone, and bilateral progressive retinal pigment epithelium irregularities in both eyes. Conclusions: Patients diagnosed as having amyloidosis-related chorioretinopathy may have maintained visual function at the first detection of retinal amyloid deposition, and a number of years may elapse before the patient manifests visual deterioration.

DOI： 10.1016/j.ajoc.2020.100846

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PURPOSE: To identify the functional outcome and evaluate the morphologic changes of patients with pachychoroid neovasculopathy (PNV) undergoing intravitreal anti-vascular endothelial growth factor (VEGF) combined with photodynamic therapy (PDT) at the 1-year follow-up. METHODS: We retrospectively studied all the treatment-naïve PNV patients who were scheduled to undergo combination therapy between September 2017 and November 2018. All the patients received three consecutive monthly injections of 0.5 mg/0.05 mL ranibizumab as loading doses. Full-dose PDT was performed within 1 week of the first injection. Retreatment was allowed if evidence of clinical deterioration or the presence of fluid on spectral-domain optical coherence tomography examination performed at the 1-month follow-up was noted. The best-corrected visual acuity (BCVA) was compared before treatment and at 3, 6, and 12 months after the initial treatment. Changes in the central foveal thickness (CFT), central choroidal thickness (CCT), and retreatment rate during the maintenance phase were also evaluated. RESULTS: Eleven eyes were enrolled in this study. Significantly, better BCVA was observed at 12 months than at baseline (P = 0.010). The mean CFT significantly decreased from 331 ± 93 to 237 ± 72 μm at 12 months (P < 0.001). The mean CCT also significantly decreased from 361 ± 74 to 310 ± 83 μm at 12 months (P < 0.001). The mean number of injections per eye was 3.9 ± 1.3 during the follow-up period. A total of 45.5% (5 /11) of the patients required retreatment during the maintenance phase. CONCLUSION: Anti-VEGF combined with full-dose PDT was well tolerated and appeared to be effective treatment for patients with treatment-naïve PNV. Combination therapy might also reduce the treatment burden with fewer injections in patients with PNV.

DOI： 10.1007/s00417-020-04661-4

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Language：Japanese   Publisher：金原出版(株)  

＜文献概要＞目的 網膜中心動脈閉塞症(CRAO)の網膜内循環時間の測定におけるレーザースペックルフローグラフィ(LSFG)の有用性を検討する。対象および方法 横浜市立大学附属市民総合医療センター眼科において2015年5月から2019年2月までにCRAOと診断された患者28例28眼(男性22例22眼,女性6例6眼,平均年齢74.0±10.6歳)を対象とした。フルオレセイン蛍光眼底造影検査(FA)を用いて網膜内循環時間(RC time)を測定した。また,LSFGを用いてCRAOと診断された患者の視神経乳頭部の血流値(MBR)を乳頭部血管成分(MV),乳頭部組織成分(MT)の各血流値に分類し,MV-MTを測定した。また,MV-MT,RC time,最高矯正視力(logMAR)との関連性も検討した。統計にはSpearmanの順位相関行列を用い,P<0.05を統計学的有意とした。結果 MV-MT,RC timeおよびlogMARの平均値は,それぞれ7.7±5.9,194.8±231.7秒,2.0±0.8であった。MV-MTとRC timeとの間に有意な相関があった(r=-0.65,P<0.001)。また,LogMARとMV-MT(r=-0.49,P=0.03),LogMARとRC time(r=0.43,P=0.02)の間にも有意な相関がみられた。結論 CRAO眼のLSFGの測定は,安全かつ簡便に行うことができる。LSFGはCRAO眼の循環時間の評価の有用な手段となり得る。

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Other Link： https://search.jamas.or.jp/default/link?pub_year=2020&ichushi_jid=J00293&link_issn=&doc_id=20200609270014&doc_link_id=10.18888%2Fga.0000001662&url=https%3A%2F%2Fdoi.org%2F10.18888%2Fga.0000001662&type=%E5%8C%BB%E6%9B%B8.jp_%E3%82%AA%E3%83%BC%E3%83%AB%E3%82%A2%E3%82%AF%E3%82%BB%E3%82%B9&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00024_2.gif

Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：Igaku-Shoin Ltd  

Purpose : To report a rare case of bilateral dacryoadenitis associated with infectious mononucleosis caused by Epstein-Barr virus (EBV). Case ' A 21-year-old female had bilateral lacrimal gland enlargement as detected by MRI. Laboratory investigation showed liver damage and atypical lymphocytes. The titer of viral capsid antigen (VCA)~ IgM was 1 • 2, VCA-IgG was 1 • 640 and EB-nuclear antigen (EBNA) was 1-10. The patient was diagnosed with infectious mononucleosis. Symptoms and signs regressed spontaneonsly. Conclusion : Lacrimal inflammation in young people should be considered in infectious mononucleosis in the differential diognosis.

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PURPOSE: Early detection and treatment are important management strategies for neovascular age-related macular degeneration (AMD). The purpose of this study was to determine the sensitivity and specificity in detecting neovascular AMD using two wide-field imaging systems: ClarusTM (CLARUS 500™, Carl Zeiss Meditec AG, Jena, Germany) and Optos®(Optos California®, Optos PLC, Dunfermline, United Kingdom), compared to conventional digital fundus photographs. METHODS: We retrospectively analyzed 109 eyes of 73 consecutive patients with neovascular AMD, who underwent standard examination and multimodal imaging, including fundus photography, and optical coherence tomography (OCT). Unmasked graders utilized slit-lamp biomicroscopy and OCT to diagnose neovascular AMD. Masked graders evaluated ClarusTM, Optos®, and digital fundus photograph methods to determine the presence of choroidal neovascularization associated with AMD. Sensitivity and specificity analyses were performed using combined fundoscopy and OCT as the reference standard. RESULTS: Ninety eyes were diagnosed with neovascular AMD and the remaining 19 eyes were normal based on the reference standard. Of these, neovascular AMD was detected using ClarusTM in 94.4% (85/90). The sensitivities of Optos® and digital fundus photographs were 81.1% (73/90) and 87.8% (79/90), respectively. The specificities using ClarusTM, Optos®, and digital fundus photographs were 89.5% (17/19), 94.7% (18/19), and 89.5% (17/19), respectively. CONCLUSION: ClarusTM, with its ability to image high-resolution wide field fundus, was considered superior for diagnosing neovascular AMD with high sensitivity and specificity. It may be a useful screening tool for early detection of neovascular AMD, facilitating prompt referral and treatment.

DOI： 10.1371/journal.pone.0238072

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PURPOSE: To compare the 1-year visual outcomes and anatomical responses of patients who received photodynamic therapy (PDT) combined with intravitreal ranibizumab (IVR) injections with those of patients who received PDT combined with intravitreal aflibercept (IVA) injections for treating polypoidal choroidal vasculopathy (PCV). METHODS: We retrospectively studied all treatment-naïve patients with PCV who received PDT combined with either IVR or IVA. Best-corrected visual acuity (BCVA), central macular thickness (CMT), central choroidal thickness (CCT), the number of additional injections, and the presence of polypoidal lesions, as indicated by indocyanine green angiography (ICGA), during 1 year were evaluated. RESULTS: Forty-four eyes were assessed at the 1-year follow-up examination. Of these, 23 were treated with PDT combined with IVR (PDT/IVR group), and 21 were treated with PDT combined with IVA (PDT/IVA group). In both groups, BCVA was shown to be significantly improved 1 year after the initial treatment. CMT and CCT were also significantly decreased after 1 year. There were no significant differences in the changes in BCVA or CMT between the two groups. However, the change in CCT in the PDT/IVA group was significantly larger than that of the PDT/IVR group (P < 0.001). The mean number of additional injections was 0.78 ± 0.21 in the PDT/IVR group and 0.57 ± 0.21 in the PDT/IVA group with no significant difference between the two groups (P = 0.45). The polyp regression rate at 12 months was 78.2% in the PDT/IVR group and 78.9% in the PDT/IVA group with no significant difference between the two groups. CONCLUSIONS: PDT combined with either IVR or IVA was well tolerated and appeared to improve both vision and anatomy in patients with PCV. PDT/IVA may have a more pronounced effect on macular choroidal thickness at 1-year follow-up.

DOI： 10.1371/journal.pone.0235213

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Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：Igaku-Shoin Ltd  

Purpose: To report and compare the outcome of Baerveldt glaucoma implant (BGI) and Ahmed glaucoma valve (AGV) for neovascular glaucoma. Cases and Method: This retrospective study was made on 37 eyes of 36 patients with neovascular glaucoma. BGI was implanted in 21 eyes and AGV was implanted in 16 eyes. Cases were followed up for 6 months or longer. The age of 36 patients averaged 65 years. Results: Intraocular pressure (lOP) in 21 eyes implanted with BGI averaged 38.1 ± 9.9 mmHg before surgery and 15.7 ±5.5 mmHg 6 months after surgery. IOP in 16 eyes implanted with AGV averaged 41.6 ±8.9 mmHg before surgery and 14.7∗5.3 mmHg 6 months after surgery. In both groups, IOP decreased significantly after surgery. There was no significant difference between the two groups regarding decrease of IOP. Adverse effects after implantation of BGI comprised tube occlusion in 2 eyes, hyphema in one eye, vitreous hemorrhage in one eye, and choroidal detachment in 3 eyes. Adverse effect after implantation of AGV comprised tube occlusion, hyphema and retinal detachment in one eye each. Conclusion: IOP decreased 6 months after implantation of BGI or AGV in eyes with neovascular glaucoma. There was no significant difference in the incidence of complications between BGI and AGV.

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OBJECTIVES: To examine the causes of congenital nasolacrimal duct obstruction (CNLDO) using dacryoendoscopy, and to evaluate the surgical outcomes of primary transcanalicular endoscopic dacryoplasty. METHODS: The subjects of this study were a total of 56 eyes of 46 Japanese children aged one to five years old (mean, 29.1 ± 14.0 months old) with clinically diagnosed CNLDO. The blockage was visualized and probed using a dacryoendoscope (MD10 with a 20 G probe, Fiber Tech Co., Ltd., Japan) under general anesthesia. We used a self-retaining bicanalicular lacrimal stent (Lacrifast®, Kaneka Co., Ltd., Japan) for nasolacrimal duct intubation. RESULTS: In each case the obstruction was found to be caused by a single focal blockage at the distal end of the duct. A nasolacrimal dacryolith was observed in 5 eyes (9%) and successfully removed using the dacryoendoscope. The success rate of probing by subsequent nasolacrimal duct intubation was 100%. No complications were observed. CONCLUSIONS: We obtained a 100% success rate with primary transcanalicular endoscopic dacryoplasty for the treatment of CNLDO. Direct visualization inside the lacrimal passage allowed for precise probing, even in infants, leading to successful treatment of CNLDO without any complications.

DOI： 10.1038/s41433-019-0374-6

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DOI： 10.1097/IAE.0000000000002455

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Oxidative stress and inflammation play a critical role in the initiation and progression of age-related ocular abnormalities as cataract, glaucoma, diabetic retinopathy, and macular degeneration. Therefore, phytochemicals with proven antioxidant and anti-inflammatory activities, such as carotenoids and polyphenols, could be of benefit in these diseases. We searched PubMed and Web of Science databases for original studies investigating the benefits of different carotenoids and polyphenols in age-related ophthalmic diseases. Our results showed that several polyphenols (such as anthocyanins, Ginkgo biloba, quercetin, and resveratrol) and carotenoids (such as lutein, zeaxanthin, and mezoxanthin) have shown significant preventive and therapeutic benefits against the aforementioned conditions. The involved mechanisms in these findings include mitigating the production of reactive oxygen species, inhibiting the tumor necrosis factor-α and vascular endothelial growth factor pathways, suppressing p53-dependent apoptosis, and suppressing the production of inflammatory markers, such as interleukin- (IL-) 8, IL-6, IL-1a, and endothelial leucocyte adhesion molecule-1. Consumption of products containing these phytochemicals may be protective against these diseases; however, adequate human data are lacking. This review discusses the role and mechanisms of polyphenols and carotenoids and their possible synergistic effects on the prevention and treatment of age-related eye diseases that are induced or augmented by oxidative stress and inflammation.

DOI： 10.1155/2019/9783429

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Purpose: To report the results of 9-year follow-up examinations and predictive factors for visual acuity outcome after intravitreal injection of anti-vascular endothelial growth factor (VEGF) agents to treat retinal angiomatous proliferation (RAP). Methods: We conducted a retrospective observational study of 85 treatment-naïve eyes in 61 patients (21 men, 40 women; age range, 70-95 years; mean age, 84.0 years) treated with intravitreal injections of anti-VEGF agents. All patients received three consecutive monthly injections as an induction treatment. During the maintenance phase, the patients received intravitreal injections as needed or fixed dosing. The primary outcome measures were best-corrected visual acuity (BCVA) during the follow-up period. Furthermore, we investigated potential predictive factors of improvement in visual acuity. The proportion of patients who developed specific complications were also analyzed. Results: The mean BCVA gradually decreased from 0.58 at baseline to 0.70 at 36 months (P = 0.146), 0.82 at 48 months (P = 0.004), and 0.92 at 108 months (P = 0.021). Improvement in visual acuity at the final visits was associated with baseline visual acuity and central foveal thickness. Massive subretinal hemorrhage, fibrotic scars, and macular atrophy developed in 4 (4.7%), 9 (10.6%), and 50 (56.8%) eyes, respectively, at the final visits, and were all significantly associated with final visual acuity (P = 0.013, P < 0.001, and P = 0.001, respectively). Conclusion: Long-term stabilization of vision in patients with RAP, regardless of treatment modality, was difficult to achieve by using intravitreal injections of anti-VEGF agents. Earlier detection and treatment are important to maintain visual acuity in patients with RAP.

DOI： 10.2147/OPTH.S224319

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：Nature Publishing Group  

Central retinal artery occlusion (CRAO) is a severe disease, often causing blindness. We evaluated the efficacy and safety of a surgical procedure for the treatment of acute CRAO in which retinal arterial cannulation with tissue plasminogen activator (tPA) is performed. The surgical procedure consisted of vitrectomy followed by cannulation of the central retinal artery and injection of tPA (200 μg) using a 47-gauge microneedle. Thirteen CRAO patients were treated within 48 hours of the onset of symptoms. The central retinal artery of all 13 eyes was successfully cannulated. The mean interval between the onset of symptoms and surgery was 38.7 hours. The results for all 13 eyes treated showed a statistically significant improvement in mean visual acuity between before and one month after treatment (-1.60 vs. -0.82 logarithmic values for minimum angle resolution (LogMAR), p = 0.0021). Fluorescein angiography showed complete reperfusion and incomplete reperfusion in 10 eyes and 3 eyes, respectively. Recently developed surgical instruments have made retinal-arterial cannulation feasible. Intra-retinal-arterial cannulation has potential as a method of improving visual function and microcirculation in eyes affected by CRAO.

DOI： 10.1038/s41598-018-19747-7

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Language：Japanese   Publisher：(公財)日本眼科学会  

目的:光干渉断層計(OCT)を用いて網膜静脈分枝閉塞症(BRVO)の動静脈交叉部を観察し、交叉部形態の特徴を調べる。対象と方法:動静脈交叉部を同定できたBRVOの連続症例111例111眼を対象とし、OCTを用いて動静脈交叉部を中心に2方向撮影を行い、交叉部の動静脈交叉パターン、交叉部静脈の狭窄の有無、交叉部静脈内血栓の有無と存在部位を観察した。結果:閉塞部の動静脈交叉パターンは動脈が静脈の上を走行するAVパターンが55眼(49.5%)、静脈が動脈の上を走行するVAパターンが56眼(50.5%)であった。交叉部静脈の狭窄は9眼(8.1%)でみられ、すべてVAパターンで、内境界膜と交叉部動脈に圧迫されていた。102眼(91.9%)では交叉部静脈の彎曲はみられるものの内腔は保たれていた。交叉部静脈内血栓は15眼(13.5%)でみられ、内訳はAVパターン55眼中2眼(3.6%)とVAパターン56眼中13眼(23.2%)であった。血栓の部位は、交叉部の上流が3眼、交叉部が4眼、下流が5眼、交叉部から下流にまたがるものが1眼、交叉部の上流から下流にまたがるものが2眼であった。結論:従来AVパターンが多いといわれていたが、約半数の動静脈交叉部はVAパターンであった。OCTはBRVOにおける動静脈交叉部形態の観察に有用であった。(著者抄録)

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Other Link： https://search.jamas.or.jp/default/link?pub_year=2018&ichushi_jid=J01049&link_issn=&doc_id=20181213310003&doc_link_id=%2Fdz1nigan%2F2018%2F012212%2F003%2F0920-0927%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fdz1nigan%2F2018%2F012212%2F003%2F0920-0927%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

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PURPOSE: To evaluate the prognosis and response of neovascular age-related macular degeneration (AMD) to anti-vascular endothelial growth factor (VEGF), according to the components of subretinal hyperreflective material (SHRM) classified using optical coherence tomography angiography (OCTA), is the aim of this study. METHODS: We retrospectively studied 39 eyes of 39 consecutive patients with SHRM associated with exudative AMD, who underwent standard examination and multimodal imaging, including fundus photography, optical coherence tomography (OCT), and OCTA. We classified SHRM into type 2 neovascularization (NV), fibrosis, subretinal hyperreflective exudation (SHE), and hemorrhage using OCTA. If compound SHRM was found, components in the foveal center were considered. All patients except one with fibrosis received anti-VEGF treatment for more than 12 months. The best-corrected visual acuity (BCVA) values measured before treatment and at 3, 6, and 12 months after the first injection were compared according to the components of SHRM. RESULTS: Using OCTA, 11 eyes with type 2 NV showed abnormal blood flow and 1 eye with fibrosis showed strong surface projection. Both SHE and hemorrhage components showed projection artifact with no intrinsic flow. However, OCTA enabled eyes with SHE (17 eyes) to be distinguished from those with hemorrhage (10 eyes) because hemorrhage showed masking of choriocapillaris flow. Eyes with SHE showed a significant improvement in the mean logMAR BCVA as compared with the value at the baseline, which was sustained throughout the 12-month follow-up period (p < 0.05). In eyes with type 2 NV and hemorrhage, no significant difference in the mean BCVA values was observed at any follow-up time-point (all, p > 0.05). CONCLUSION: OCTA was useful to noninvasively distinguish SHRM components. It may be important to consider the components of SHRM to predict the visual acuity in patients with AMD.

DOI： 10.1007/s00417-018-4121-7

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Language：Chinese   Publishing type：Research paper (international conference proceedings)   Publisher：Igaku-Shoin Ltd  

Purpose: To report findings by widefield indocyanine green angiography (LA.) in 3 eyes with Vogt-Koyanagi-Harada (VKH) disease. Case and Method: This study was made on 3 cases of VKH disease. All the eyes showed multiple exudative retinal detachment and hyperemia of optic disc and were diagnosed with VKH disease. Optos California was used for widefield IA. Findings: Widefield IA showed indistinct choroidal vessels around the optic disc and vortex veins before treatment. One month after start of pulsed corticosteroid therapy, widefield IA showed more distinct findings of choroidal vessels and vortex veins. Conclusion: Optos California was useful in evaluating the choroidal vessels in eyes with VKH disease. Inflammatory changes in the interstitial cells may have induced mechanical displacement of choroidal vessels in the early stage of VKH disease.

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PURPOSE: To compare the 3-year follow-up results of intravitreal injections of aflibercept between fixed dosing (FD) regimen and a pro re nata (PRN) regimen after three initial monthly doses for the treatment of polypoidal choroidal vasculopathy and to analyze factors influencing improvement in visual acuity. METHODS: We retrospectively studied all treatment-naive patients with polypoidal choroidal vasculopathy who were scheduled to receive intravitreal aflibercept injections FD or PRN after induction treatment between March 2013 and May 2014. Best-corrected visual acuity was evaluated before treatment and at 4, 12, 24, and 36 months after initial treatment. Factors that influence improvement in visual acuity were also investigated. RESULTS: Thirty-three eyes were assessed at the 3-year follow-up examination. Twenty-three eyes were treated with intravitreal aflibercept injections every 2 months for at least 1 year after three initial monthly doses (FD group), and 10 eyes were treated PRN after loading doses (PRN group). In the FD group, during the follow-up period from 1 to 3 years, quarterly dosing with capped PRN or a treat and extend regimen were selected. The mean number of administered intravitreal aflibercept was 15.3 ± 4.6 in the FD group and 9.0 ± 8.9 in the PRN group, with a significant difference between the two groups (P = 0.004). Significant improvement of the mean logarithm of the minimum angle of resolution values for best-corrected visual acuity was shown at 36 months, as compared to baseline values (P = 0.019). No significant difference in the improvement of best-corrected visual acuity between the two groups was observed at baseline or at 4, 12, 24, and 36 months after treatment (all P > 0.05), although there was a trend toward better results in the FD group. Multiple regression analysis showed that the FD group had better visual acuity at 36 months and greater improvement in visual acuity than the PRN group (P = 0.031 for both comparisons). CONCLUSION: Intravitreal aflibercept was effective in improving the vision of patients with polypoidal choroidal vasculopathy, as evaluated at the 3-year follow-up. Fixed treatment might be an important factor influencing improvement in visual acuity.

DOI： 10.1097/IAE.0000000000001818

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DOI： 10.1097/IAE.0000000000002030

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DOI： 10.1016/j.ophtha.2017.07.008

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：SPRINGER  

The aim of this study was to evaluate the one-year efficacy, ability to lower intraocular pressure, and tolerability of ripasudil, a rho-kinase inhibitor, in patients with glaucoma inadequately controlled with maximum medical therapy.
This prospective, non-comparative, interventional case-series study included 39 patients with primary open-angle glaucoma inadequately controlled with maximum medical therapy before treatment with ripasudil. Ripasudil was administered twice per day as adjunctive therapy to ongoing glaucoma treatment. The primary endpoint was the degree of intraocular pressure reduction after 12 months of treatment; the secondary endpoints were the incidence of adverse events.
We examined 39 eyes. The intraocular pressure reduction (given as the relative percentage of intraocular pressure reduction) from baseline was -2.6 mmHg (-15.5%; 95% confidence interval, -1.1 to -3.9 mmHg; P &lt; 0.001) after 12 months of treatment. The adverse events were conjunctival hyperemia (all patients), blepharitis (three), allergic conjunctivitis (two), punctate keratitis (two), and ophthalmalgia (one).
Treatment with ripasudil decreased intraocular pressure in patients with glaucoma that was poorly controlled with maximal medical therapy, and it was well-tolerated.

DOI： 10.1007/s00417-017-3727-5

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PURPOSE: To report the clinical outcomes of a new technique for transconjunctival intrascleral fixation of an intraocular lens (IOL). DESIGN: Prospective, noncomparative, interventional case series. PARTICIPANTS: One hundred eyes of 97 consecutive patients with aphakia, dislocated IOL, or subluxated crystalline lens who underwent posterior chamber sutureless implantation of an IOL were studied. METHODS: Two angled incisions parallel to the limbus were made by 30-gauge thin-wall needles. Haptics of an IOL were externalized with the needles and cauterized to make a flange of the haptics. The flange of the haptics were pushed back and fixed into the scleral tunnels. MAIN OUTCOME MEASURES: Best-corrected visual acuity (VA), corneal endothelial cell density, IOL tilt, and complications were determined. RESULTS: The IOLs were fixed with exact centration and axial stability. The mean preoperative best-corrected VA was 0.25 logarithm of the minimum angle of resolution (logMAR) units; after surgery, it improved significantly to 0.11 logMAR, 0.09 logMAR, 0.12 logMAR, and 0.04 logMAR at 6, 12, 24, and 36 months, respectively (P < 0.01, P < 0.01, P = 0.03, and P = 0.10, respectively). The mean corneal endothelial cell density decreased from 2341 cells/mm2 before surgery to 2313 cells/mm2, 2240 cells/mm2, 2189 cells/mm2, and 2244 cells/mm2 at 6, 12, 24, and 36 months, respectively (P < 0.01, P < 0.01, P < 0.01, and P = 0.17, respectively). The mean IOL tilt was 3.4°±2.5°. The postoperative complications included iris capture by the IOL in 8 eyes (8%), vitreous hemorrhage in 5 eyes (5%), and cystoid macular edema in 1 eye (1%). There were no incidents of postoperative retinal detachment, endophthalmitis, or IOL dislocation. CONCLUSIONS: We have developed a new technique for intrascleral IOL fixation. The flanged IOL fixation technique is a simple and minimally invasive method for achieving good IOL fixation with firm haptic fixation.

DOI： 10.1016/j.ophtha.2017.03.036

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：Dove Medical Press Ltd  

Purpose: To evaluate the efficacy of intravitreal aflibercept therapy in treatment-naïve Japanese patients with polypoidal choroidal vasculopathy (PCV) using Early Treatment Diabetic Retinopathy Study (ETDRS) letter scores. Subjects and methods: This study was a prospective, nonrandomized, interventional exploratory clinical trial performed in an institutional setting. Patients with PCV were treated with intravitreal aflibercept 2 mg/0.05 mL every 2 months after 3 initial monthly doses, for 1 year. Visual acuity test using the ETDRS chart and indocyanine green angiography was performed at baseline and at 6 and 12 months after initiating the treatment, in addition to routine examinations performed at each visit. The main outcome measure was the proportion of patients who achieved &lt
15 ETDRS letter score loss. Results: Twenty-two patients were enrolled in this study. Nineteen (86%) patients were eligible for analysis. All the patients maintained their visual acuity (&lt
15 ETDRS letter score loss) at 12 months. The ETDRS letter scores were 64.1 at baseline and 69.8 at 12 months (P&lt
0.039). The polyps regressed completely in 14 (74%) patients at 12 months. Cataract progressed in 1 eye, but this progression was considered to be a senile change. Conclusions: Japanese patients with treatment-naïve PCV, who were treated with intravitreal aflibercept every 2 months after 3 initial monthly doses, exhibited a significant increase in ETDRS letter scores and a high rate of polyp resolution at 12 months.

DOI： 10.2147/OPTH.S129164

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：LIPPINCOTT WILLIAMS & WILKINS  

Purpose of the Study: The purpose of the study was to evaluate the intraocular pressure (IOP)-lowering effect and tolerability of ripasudil, a rho-kinase inhibitor, in patients with glaucoma inadequately controlled with maximum medical therapy.
Patients and Methods: This prospective, noncomparative, interventional case series study included 35 patients with primary open angle glaucoma, in whom the glaucoma was poorly controlled with maximum medical therapy before starting the treatment with ripasudil. Ripasudil was instilled twice a day as adjunctive therapy to the ongoing glaucoma treatment. The primary end point was the degree of IOP reduction after 3 months of treatment, whereas the secondary end points were the percentage of patients reaching the predefined target IOP and the incidence of adverse events.
Results: We examined 35 eyes of 35 patients with primary open angle glaucoma. The IOP reduction (relative percentage IOP reduction) from baseline was -2.8mm Hg (-15.5%; 95% confidence interval, -1.6 to -3.9mm Hg; P&lt; 0.001) after 3 months of treatment. The predefined target IOP was achieved in 48.5% (17/35) of the patients. The adverse events were conjunctival hyperemia (all patients), allergic conjunctivitis (2 patients), and ophthalmalgia (1 patient).
Conclusions: The addition of ripasudil was effective in lowering the IOP in patients with glaucoma poorly controlled with maximal medical therapy; moreover, the drug was well tolerated. In 48.5% of the patients in whom the predefined target IOP was achieved, this adjunctive therapy helped avoid glaucoma surgery at least in the short term.

DOI： 10.1097/IJG.0000000000000552

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：ELSEVIER SCIENCE INC  

PURPOSE: To quantify the temporal properties of the acquired vitelliform lesion (AVL) life cycle, define the clinical characteristics of choroidal neovascularization (NV) in this setting, and determine the predictors of long-term visual outcomes.
DESIGN: Retrospective cohort study.
METHODS: Clinical and imaging data from 199 eyes of 124 consecutive patients with AVLs associated with age related macular degeneration (AMD) and adult-onset foveomacular vitelliform dystrophy (AOFVD) were analyzed. Volumetric calculations of vitelliform material were determined using spectral-domain optical coherence tomography and the temporal properties of the AVL life cycle were quantified. The clinical characteristics of NV were assessed, as were the predictors of final best corrected visual acuity (BCVA) and change in BCVA.
RESULTS: Mean age was 79.2 +/- 12.1 years. AVLs grew and collapsed at approximately the same rate (P = .275). Fifteen eyes (7.5%) developed NV, of which all were type 1. In 13 of these eyes, NV occurred during the collapse phase of the AVL life cycle, after the peak AVL volume was reached. The risk of NV (P = .006) and the decline in BCVA (P = .001) were both significantly greater among eyes with AMD. Foveal atrophy was the characteristic most significantly associated with. final BCVA and change in BCVA from baseline (both P &lt; .0005). The development of NV was not predictive of long-term visual outcomes (all P = .216).
CONCLUSIONS: Complications associated with AVLs typically occur during the collapse phase of the AVL life cycle. Visual outcomes and risk of NV are related to the underlying disease associated with AVLs. ((C) 2016 Elsevier Inc. All rights reserved.)

DOI： 10.1016/j.ajo.2016.09.008

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：OXFORD UNIV PRESS  

Age-related macular degeneration (AMD) is a major cause of blindness in the elderly. Previous sequencing studies of AMD susceptibility genes have revealed the association of rare coding variants in CFH, CFI, C3 and C9 in European population; however, the impact of rare or low-frequency coding variants on AMD susceptibility in other populations is largely unknown. To identify the role of low-frequency coding variants on exudative AMD susceptibility in a Japanese population, we analysed the association of coding variants of 34 AMD candidate genes in the two-stage design by a multiplex PCR-based target sequencing method. We used a total of 2,886 (1st: 827, 2nd: 2,059) exudative AMD cases including typical AMD, polypoidal choroidal vasculopathy, and retinal angiomatous proliferation and 9,337 (1st: 3,247 2nd: 6,090) controls. Gene-based analysis found a significant association of low-frequency variants (minor allele frequency (MAF) < 0.05) in CETP, C2 and CFB. The association of CETP remained after conditioned with all known genome-wide association study (GWAS) associated variants. In addition, when we included only disruptive variants, enrichment of rare variants (MAF < 0.01) was also observed after conditioned with all GWAS associated variants (P = 1.03 × 10−6, odds ratio (OR) = 2.48). Haplotype and conditional analysis of the C2-CFB-SKIV2L locus showed a low-frequency variant (R74H) in CFB would be individually associated with AMD susceptibility independent of the GWAS associated SNP. These findings highlight the importance of target sequencing to reveal the impact of rare or low-frequency coding variants on disease susceptibility in different ethnic populations.

DOI： 10.1093/hmg/ddw335

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Purpose: To determine if the area of the foveal avascular zone (FAZ) is correlated with visual acuity (VA) in diabetic retinopathy (DR) and retinal vein occlusion (RVO).
Design: Cross-sectional study.
Participants: Ninety-five eyes of 66 subjects with DR (65 eyes), branch retinal vein occlusion (19 eyes), and central retinal vein occlusion (11 eyes).
Methods: Structural optical coherence tomography (OCT; Spectralis, Heidelberg Engineering) and OCT angiography (OCTA; Avanti, Optovue RTVue XR) data from a single visit were analyzed. FAZ area, point thickness of central fovea, central 1-mm subfield thickness, the occurrence of intraretinal cysts, ellipsoid zone disruption, and disorganization of retinal inner layers (DRIL) length were measured. VA was also recorded. Correlations between FAZ area and VA were explored using regression models. Main outcome measure was VA.
Results: Mean age was 62.9 +/- 13.2 years. There was no difference in demographic and OCT-derived anatomic measurements between branch retinal vein occlusion and central retinal vein occlusion groups (all P &gt;= 0.058); therefore, data from the 2 groups were pooled together to a single RVO group for further statistical comparisons. Univariate and multiple regression analysis showed that the area of the FAZ was significantly correlated with VA in DR and RVO (all P &lt;= 0.003). The relationship between FAZ area and VA varied with age (P = 0.026) such that for a constant FAZ area, an increase in patient age was associated with poorer vision (rise in logarithm of the minimum angle of resolution visual acuity). Disruption of the ellipsoid zone was significantly correlated with VA in univariate and multiple regression analysis (both P &lt; 0.001). Occurrence of intraretinal cysts, DRIL length, and lens status were significantly correlated with VA in the univariate regression analysis (P &lt;= 0.018) but not the multiple regression analysis (P &gt;= 0.210). Remaining variables evaluated in this study were not predictive of VA (all P &gt;= 0.225).
Conclusions: The area of the FAZ is significantly correlated with VA in DR and RVO and this relationship is modulated by patient age. Further study about FAZ area and VA correlations during the natural course of retinal vascular diseases and following treatment is warranted. (C) 2016 by the American Academy of Ophthalmology.

DOI： 10.1016/j.ophtha.2016.07.008

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PURPOSE: To compare time to retreatment and visual function between patients with treatment-naïve neovascular age-related macular degeneration (AMD) treated with either intravitreal ranibizumab (IVR) or intravitreal aflibercept (IVA) in routine clinical practice. DESIGN: Retrospective, interventional comparative case series. PARTICIPANTS: A total of 200 eyes of 197 patients with neovascular AMD. METHODS: A total of 99 patients in the IVR group and 101 patients in the IVA group who met the inclusion criteria with 12 months of follow-up were included in the present study. All patients received 3 consecutive monthly injections of 0.5 mg/0.05 mL ranibizumab or 2.0 mg/0.05 mL aflibercept as loading doses. Retreatment was allowed if evidence of clinical deterioration or the presence of intraretinal edema or subretinal fluid on spectral-domain optical coherence tomography examination performed at the 1-month follow-up was noted. The time to retreatment after the third injection during the loading phase to the first recurrence during the maintenance phase was compared between treatments using the Kaplan-Meier analysis. Functional and anatomic outcomes were also compared between the IVR and IVA groups. RESULTS: The median time to retreatment after the last induction dose was 5 months in both groups. The proportion of IVR patients who required injection retreatment was not significantly higher than that of IVA patients (67.7% and 63.4%, respectively, at the 12-month follow up; log-rank test, P = .554). In both groups, significant improvements in postoperative best-corrected visual acuity (BCVA) compared with preoperative visual acuity was observed over the 12-month follow-up period (P < .05 for both). Central foveal thickness (CFT) decreased from the baseline values in both groups during the follow-up period (P < .001 for both). Although there was a trend toward greater BCVA improvements in the IVA group, no significant differences in BCVA or CFT were observed between the treatment groups. CONCLUSIONS: Both IVR and IVA were well tolerated and demonstrated efficacy in improving the visual acuity in treatment-naïve patients with AMD. Despite a trend toward greater BCVA improvements in the IVA group, a similar injection burden was observed following the loading phases of both ranibizumab and aflibercept.

DOI： 10.1016/j.ajo.2016.06.021

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：LIPPINCOTT WILLIAMS & WILKINS  

Purpose: To evaluate the functional and morphologic outcomes of patients with polypoidal choroidal vasculopathy undergoing intravitreal aflibercept (IVA) treatment using every 2-month injections compared with a pro re nata (PRN) regimen after 3 initial monthly doses.
Methods: The authors prospectively studied all the treatment-naive patients with polypoidal choroidal vasculopathy who were scheduled to undergo IVA using every 2-month injections or PRN after induction treatment between March 2013 and October 2013. All patients who had a follow-up period of 1 year or longer were included in the study. The best-corrected visual acuity in the 2 groups was compared before treatment and at 4 months, 6 months, and 12 months after the initial treatment. The regression of the polyps was also assessed using indocyanine-green angiography at baseline and 12 months.
Results: Forty-two eyes were assessed at the 12-month follow-up examination. Twenty-five eyes were treated with IVA injections every 2-month after 3 initial monthly doses, and 17 eyes were treated using PRN after loading doses. The mean number of administered IVA was 7.0 in the every 2-month group and 5.0 +/- 2.9 in the PRN group, with significant difference between the 2 groups (P &lt; 0.01). Both groups showed significant improvement of the mean logarithm of the minimum angle of resolution values for best-corrected visual acuity at 12 months, as compared with baseline values (P &lt; 0.01 in every 8-week group and P = 0.03 in PRN group, respectively). No significant difference in the improvement of best-corrected visual acuity between the 2 groups was observed at baseline or at 4 months, 6 months, and 12 months after treatment (P &gt; 0.05, respectively) although there was a trend toward better results in the every 8-week group. The rate of polyp regression was 48.0% (12/25) in the every 8-week group and 52.9% (9/17) in the PRN group, with no significant difference between the 2 groups (P = 0.50).
Conclusion: Among the 2 treatment modalities, IVA was well tolerated and improved the visual outcomes in patients with polypoidal choroidal vasculopathy as evaluated at 1-year follow-up examinations. However, there was a trend toward better vision improvement with fixed treatment every 2 months.

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：Elsevier Inc  

Purpose The aim of this study was to describe high-resolution dacryoendoscopy findings for nasolacrimal duct obstruction (NLDO) in three representative pediatric cases with different etiologies. Observations In a case of congenital NLDO, a mucosal membranous obstruction was observed at the distal end of the nasolacrimal duct (NLD), and a slit-shaped opening of the NLD was observed after perforation. In a case of acquired NLDO secondary to an adenoviral infection, a membranous obstruction was observed at the proximal NLD. In a case of NLDO with chronic dacryocystitis in a patient with Down syndrome, diffuse fibrous obstruction was observed. Conclusion and importance High-resolution dacryoendoscopy enables a clearer visualization of pediatric lacrimal duct obstructions, leading to an improved understanding of their features.

DOI： 10.1016/j.ajoc.2016.03.003

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This case-control study reports the association between nutrient intake and neovascular age-related macular degeneration (AMD) in Japan. The nutrient intake of 161 neovascular AMD cases from two university hospitals and 369 population-based control subjects from a cohort study was assessed using a brief-type self-administered questionnaire on diet history, which required respondent recall of the usual intake of 58 foods during the preceding month. Energy-adjusted nutrient intake values were compared between the groups. Logistic regression analysis was used to estimate odds ratios (ORs) and 95% CIs adjusted for smoking history, age, sex, chronic disease history, supplement use, and alcohol consumption. Logistic regression analysis demonstrated that low intakes of n-3 fatty acid, α-tocopherol, zinc, vitamin D, vitamin C, and β-carotene were associated with neovascular AMD (Trend P < 0.0001 for n-3 fatty acid, Trend P < 0.0001 for α-tocopherol, Trend P < 0.0001 for zinc, Trend P = 0.002 for vitamin D, Trend P = 0.04 for vitamin C, Trend P = 0.0004 for β-carotene). There was no association with retinol or cryptoxanthin intake and neovascular AMD (P = 0.67, 0.06).

DOI： 10.1038/srep20723

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：LIPPINCOTT WILLIAMS & WILKINS  

Purpose: To evaluate the functional and morphologic outcomes of patients with polypoidal choroidal vasculopathy who underwent intravitreal aflibercept treatment.
Methods: We prospectively studied all the treatment-naive patients with polypoidal choroidal vasculopathy who were scheduled to undergo intravitreal aflibercept between February 2013 and July 2013. The best-corrected visual acuity was compared before treatment and at 6 months after the initial treatment. Changes in the central foveal thickness, choroidal thickness, presence/absence of subretinal fluid, fibrin, pigment epithelial detachment, and subretinal hemorrhage were also evaluated. The regression of the polyps was assessed using indocyanine green angiography.
Results: A total of 16 patients were included in this study. A significantly better best-corrected visual acuity at 6 months was seen, compared with that at baseline (P = 0.041). The mean central foveal thickness significantly decreased from 417 +/- 127 mu m to 187 +/- 50 mu m (P &lt; 0.001). The mean choroidal thickness also significantly decreased from 250 +/- 63 mu m to 217 +/- 64 mu m (P = 0.011). Overall, a complete resolution was obtained in 93.3% (14/15) of the cases with subretinal fluid, 75.0% (3/4) of the cases with fibrin, and 88.9% (8/9) of the cases with subretinal hemorrhage. Fifty-six percent (5/9) of the cases with pigment epithelial detachment obtained a complete improvement, whereas 33.3%(3/9) exhibited a partial decrease. The rate of polyp regression was 75.0% (12/16).
Conclusion: Intravitreal aflibercept was well tolerated and had improved the vision of treatment-naive patients with polypoidal choroidal vasculopathy when it was evaluated at short-term follow-up examinations. Intravitreal aflibercept might be associated with a high possibility of achieving involution of polyps and reducing exudative findings.

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：Dove Medical Press Ltd  

Conclusion: IVR was well tolerated and improved vision in these patients with age-related macular degeneration, as evaluated at one-year follow-up examinations. IVR also enabled good subjective perception, as indicated by higher composite NEI VFQ-25 scores. Maintaining good visual acuity may be an important factor for improving vision-related quality of life.
Background: The purpose of this study was to assess visual function and vision-related ­quality of life after intravitreal injection of ranibizumab (IVR) using a pro re nata regimen for the treatment of age-related macular degeneration.
Methods: A prospective study of 54 eyes in 54 patients scheduled to undergo IVR for the treatment of exudative age-related macular degeneration was performed. A self-administered, 25-item National Eye Institute Visual Function Questionnaire (NEI VFQ-25) was completed before and 3 and 12 months after the initial IVR treatment. We evaluated logMAR visual acuity and NEI VFQ-25 scores preoperatively and postoperatively. Further, associations between the changes in NEI VFQ-25 scores and patient characteristics were investigated at 12 months.
Results: Postoperative best-corrected visual acuity improved significantly when compared with the preoperative visual acuity throughout the 12-month period (P&lt
0.05 at 3 and 12 months, respectively). On the other hand, IVR treatment significantly improved the postoperative NEI VFQ-25 mean composite score at both 3 and 12 months (P&lt
0.05, respectively). Better visual acuity at 12 months was associated with a greater improvement in NEI VFQ-25 score at 12 months (P&lt
0.05).

DOI： 10.2147/OPTH.S68293

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：WICHTIG EDITORE  

Purpose: To evaluate hyperreflective linear structures (HLS), as assessed using spectral-domain optical coherence tomography (SD-OCT), identified under the retinal pigment epithelium (RPE) in patients with age-related macular degeneration (AMD).
Methods: This retrospective observational case study was conducted on 427 eyes of 408 consecutive patients who were scheduled to undergo anti-vascular endothelial growth factor (anti-VEGF) therapy for AMD. Patients with HLS under the RPE were investigated based on the SD-OCT findings at baseline or during the follow-up period. The associations between HLS and the lesion subtypes, localization in SD-OCT, clinical findings, and structural change after anti-VEGF treatment were also investigated.
Results: HLS were identified in 18 eyes of 16 patients. From the eyes with HLS, 12 eyes (66.7%) were diagnosed with retinal angiomatous proliferation (RAP), 4 eyes (22.2%) were diagnosed with occult choroidal neovascularization, and the remaining 2 eyes (11.1%) were diagnosed with polypoidal choroidal vasculopathy, HLS were multifocal and exhibited multilocalization under the RPE in all the eyes. Although it was difficult to identify these structures in the clinical findings at baseline, crystalline deposits correlated with the linear bands were observed during the follow-up period in 16 eyes (88.9%). After the anti-VEGF treatments, the HLS remained between the Bruch membrane and RPE or combined with the fibrovascular component.
Conclusions: HLS are rare SD-OCT findings found in patients with AMD, found in only 4.2% of the patients examined in this study. HLS were found especially in RAP lesions.

DOI： 10.5301/ejo.5000433

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Language：English   Publishing type：Part of collection (book)   Publisher：S. Karger AG  

Epiretinal membrane (ERM) is a relatively common macular disease, which forms along the surface of the internal limiting membrane of the retina. Currently, microincision vitrectomy surgery (MIVS) has been confirmed as a minimally invasive and very safe modality of treatment that is useful for improving vision. However, some cases have shown poor visual recovery even after complete removal of the ERM. Since the introduction of spectral domain optical coherence tomography (SD-OCT) was demonstrated to be useful for the noninvasive diagnosis and monitoring of macular diseases, the appearance of the photoreceptor layer on SD-OCT images has been found to be an important prognostic factor for visual recovery and postoperative best-corrected visual acuity after MIVS. Although deciding when to perform a vitrectomy can be difficult, it might be better to schedule vitrectomy surgery while the photoreceptor inner segment/outer segment (IS/OS) junction remains intact. If the preoperative IS/OS junction has already been disrupted, the surgery should be scheduled as early as possible to avoid further disturbances of visual improvement.

DOI： 10.1159/000360462

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：BMJ PUBLISHING GROUP  

Purpose To report the results of 3-year follow-up examinations after intravitreal ranibizumab (IVR) injection for the treatment of retinal angiomatous proliferation (RAP) and to examine the utility of an advanced retinal pigment epithelium (RPE) analysis performed using spectral-domain optical coherence tomography (SD-OCT).
Methods We retrospectively reviewed 17 treatment naive eyes in 14 patients (4 men, 10 women; age range 71-87 years; mean age 80 years) treated with IVR. All the patients received three consecutive monthly injections of 0.5 mg/0.05 mL of ranibizumab as an induction treatment. Retreatment was allowed if evidence of clinical deterioration was noted or if an SD-OCT examination performed at a 1-month follow-up showed intraretinal oedema, subretinal fluid, or recurrent pigment epithelial detachment. The primary outcome measures were best-corrected visual acuity (BCVA) and central foveal thickness (CFT) as evaluated using SD-OCT. Furthermore, we investigated the atrophic area at 36 months using advanced RPE analysis provided by SD-OCT and analysed the correlation with the BCVA.
Results The mean BCVA was well maintained from 0.57 at baseline to 0.52 at 36 months (p=0.219). The CFT decreased significantly from 317 to 223 mm at 36 months (p&lt;0.001). The mean number of injections was 10.2. Sixteen of the 17 patients (94.1%) showed recurrence during the maintenance phase. Better visual acuity at 36 months was also associated with better visual acuity at baseline and absence of macular atrophy (MA) identified with advanced RPE analysis at 36 months (p&lt;0.001, p=0.012, respectively).
Conclusions The intravitreal injection of ranibizumab was effective for stabilising vision in patients with RAP, as evaluated at a 3-year follow-up examination. Advanced RPE analysis is useful for investigating atrophic areas after IVR. Visual acuity at baseline and progression of MA might be important for BCVA after IVR.

DOI： 10.1136/bjophthalmol-2013-304251

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：Dove Medical Press  

Background: The purpose of this study was to evaluate visual outcomes of arteriovenous sheathotomy for macular edema due to branch retinal vein occlusion (BRVO). Methods: The medical records of 45 eyes from 45 patients who had undergone vitrectomy surgery with arteriovenous sheathotomy for BRVO were studied. Forty-five eyes of 45 patients with a BRVO but without intervention were studied as the control group. The best-corrected visual acuity and central macular thickness were compared between the two groups at baseline and at 1, 3, 6, and 12 months postoperatively. Results: Improvement of best-corrected visual acuity was 0.42 logarithm of the minimum angle of resolution (logMAR) units in the sheathotomy group and 0.22 logMAR units in the control group (P=0.007). The mean postoperative central macular thickness was significantly thinner in the sheathotomy group at 1 month (P=0.01), but not at 3, 6, and 12 months (P=0.75, P=0.81, and P=0.46, respectively). Improvement of best-corrected visual acuity at 12 months was significantly correlated with baseline best-corrected visual acuity, age, duration of symptoms, and sheathotomy (P&lt
0.05). Conclusion: Arteriovenous sheathotomy for BRVO improves best-corrected visual acuity significantly more than the natural course of the BRVO disease process. © 2014 Yamane et al.

DOI： 10.2147/OPTH.S58681

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：ELSEVIER SCIENCE INC  

Purpose: To report a new technique for performing sutureless intrascleral fixation of a posterior chamber intraocular lens (IOL).
Design: Prospective, noncomparative, interventional case series on the results of sutureless intrascleral fixation of a posterior chamber IOL.
Participants: Thirty-five eyes of 34 consecutive patients with aphakia, dislocated IOL, or subluxated crystalline lens who underwent posterior chamber sutureless implantation of an IOL were studied.
Methods: The haptics of the IOL were externalized with a 27-gauge needle passed through the ciliary sulcus using the double needle technique. The haptics were fixed in a scleral tunnel made by lamellar scleral dissection. The postoperative tilt of the IOL was measured by swept source optical coherence tomography.
Main Outcome Measures: The best-corrected visual acuity (BCVA), corneal endothelial cell density, IOL tilt, and complications were determined.
Results: The IOLs were fixed with exact centration and axial stability. No wound leakage was seen even without any sutures. The mean BCVA was 0.48 logarithm of the minimum angle of resolution (logMAR) units preoperatively and 0.17 logMAR units at 3 months postoperatively (P = 0.003). The mean corneal endothelial cell loss was 6.0 +/- 7.3% (P = 0.63) at 3 months. The mean IOL tilt was 2.3 +/- 1.9 degrees. The postoperative complications included iris capture by the IOL in 3 eyes (8.6%), ocular hypertension in 2 (5.7%), and cystoid macular edema in 1 (2.9%). There was no postoperative retinal detachment, endophthalmitis, IOL dislocation, or vitreous hemorrhage.
Conclusions: The 27-gauge needle-guided intrascleral posterior chamber IOL implantation technique provides good IOL fixation with reliable wound closure without the use of any sutures. We recommend this technique for secondary IOL implantation. (C) 2014 by the American Academy of Ophthalmology.

DOI： 10.1016/j.ophtha.2013.08.043

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Language：Japanese   Publishing type：Research paper (scientific journal)  

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DOI： 10.1001/jamaophthalmol.2013.2585

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PURPOSE: The purpose of this study was to evaluate the prognosis and response to intravitreal ranibizumab (IVR) of neovascular age-related macular degeneration, according to the type of pigment epithelial detachment (PED). METHODS: The authors prospectively studied 57 eyes of 57 consecutive patients with PED associated with exudative age-related macular degeneration, who were treated by IVR. All patients received 3 consecutive monthly injections of 0.5 mg/0.05 mL of ranibizumab as induction treatment. Retreatment was allowed if evidence of clinical deterioration was noted or spectral domain optical coherence tomography at the 1-month follow-up showed intraretinal edema, subretinal fluid, or recurrent PED. The best-corrected visual acuity (BCVA) values measured before and at 3, 6, and 12 months after the first injection were compared according to the type of PED. Changes in the height of PED to treatment with IVR were also investigated. RESULTS: Fifty-six eyes were assessed at the 12-month follow-up examination. There were 4 types of PED, including serous PED in 11 patients (19.6%), fibrovascular PED in 28 patients (50.0%), mixed PED with serous and fibrovascular component in 7 patients (12.5%), and hemorrhagic PED in 10 patients (17.9%). Eyes with serous PED showed significant improvement of the mean logarithm of the minimum angle of resolution (logMAR) BCVA as compared with the value at the baseline, which was sustained throughout the 12-month period (P &lt
0.05). Regarding the eyes with fibrovascular and mixed PED, significant improvement of the mean logMAR BCVA was observed compared with the value at the baseline at 3 months
however, a slight decrease was observed at 6 and 12 months. In the eyes with hemorrhagic PED, no significant difference in the mean BCVA values compared with the value at the baseline was observed at any follow-up time point. In relation to the height of the PED, all eyes in the serous and mixed PED group, 17 eyes in the fibrovascular PED group (60.7%), and 9 eyes in the hemorrhagic PED group (90.0%) showed reduction of the maximum PED height by 100 μm or more. The PED response to IVR was not correlated with the final BCVA. CONCLUSION: Intravitreal ranibizumab for the treatment of exudative age-related macular degeneration is effective for stabilizing vision in patients with PED, but it may be better tolerated in patients with serous PED. Although it may be important to consider the type of PED to predict the visual acuity in patients treated by IVR, the anatomical response of the PED may not correlate directly with the visual outcome. Copyright © by Ophthalmic communications Society, Inc.

DOI： 10.1097/IAE.0b013e3182755793

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DOI： 10.1097/IAE.0b013e3182807629

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The EzSpec (a disposable eyelid speculum recently designed for intravitreal injections) is a useful device for removing eyelash artifacts and for potentially increasing the sensitivity of the Optos Optomap system, thereby improving the detection of retinal lesions. © 2013 American Medical Association. All rights reserved.

DOI： 10.1001/jamaophthalmol.2013.750

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Language：Japanese   Publishing type：Research paper (international conference proceedings)  

Background: Neurosarcoidosis is rarely preceded by impaired oculomotor symptoms. Purpose: To report a case of neurosarcoidosis that showed diplopia as the initial manifestation and that responded to systemic gamma globulin therapy. Case: A 73-year-old female presented with diplopia and weakness in her left leg. Corrected visual acuity was 1.2 in either eye. No abnormality was present in the anterior chamber, optical media or the fundus. The right eye showed abducens palsy and oculomotor paresis. Magnetic resonance imaging showed normal findings in the orbit and brain. She was diagnosed with chronic inflammatory demyelinating polyneuropathy and was treated by intravenous human immunoglobulin. Diplopia started to improve 9 days later. Computed tomography of the lung showed nodules that proved to be non-necrotizing granulomatous lymphadenitis leading to the diagnosis of sarcoidosis. Conclusion: Systemic immunoglobulin was effective for neurosarcoidosis with oculomotor disorder.

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：ELSEVIER SCIENCE INC  

center dot PURPOSE: To determine the relationship between a ciliochoroidal detachment and intraocular pressure (IOP) after microincision vitrectomy surgery (M1VS).
center dot DESIGN: Prospective, consecutive, observational case series.
center dot METHODS: Thirty eyes of 30 patients with an epiretinal membrane that underwent M1VS were prospectively studied. The intraocular pressure (IOP) was measured before 3-port MIVS, and at 1 minute, 1 and 3 hours, and at 1 day postoperatively. All of the 90 sclerotomies were examined by swept source optical coherence tomography to assess the wound and presence of a ciliochoroidal detachment at 3 hours and at 1 day postoperatively. The mean IOP and closure rate of the sclerotomies were compared between eyes with and without a ciliochoroidal detachment. The correlation between the presence of ciliochoroidal detachment and postoperative IOP was determined.
center dot RESULTS: The incidence of ciliochoroidal detachment was 63.3% (19 eyes) during the 1-day observation period. The mean postoperative IOPs were significantly lower than the preoperative IOPs in eyes with a ciliochoroidal detachment (P &lt; .05). The mean postoperative IOPs were significantly higher in eyes without a ciliochoroidal detachment than in eyes with a ciliochoroidal detachment (P &lt; .05). The incidence of open sclerotomies was significantly higher in eyes with a ciliochoroidal detachment than in eyes without a ciliochoroidal detachment at 3 hours postoperatively (P = .03).
center dot CONCLUSIONS: A shallow ciliochoroidal detachment develops in 63.3% of eyes after M1VS. Hypotony at the early postoperative period may be a risk factor for a ciliochoroidal detachment. (Am J Ophthalmol 2012; 153:1099-1103. (C) 2012 by Elsevier Inc. All rights reserved.)

DOI： 10.1016/j.ajo.2011.11.001

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Language：Japanese   Publishing type：Research paper (scientific journal)  

Purpose: To report a case of adenocarcinoma of the lung with choroidal metastasis that responded to systemic chemotherapy. Case: A 60-yearld female presented with impaired visual acuity in the left eye. She had had cough and phlegm and was suspected of lung malignancy. Finding: Corrected visual acuity was 1.2 right and 0.4 left. The left fundus showed a white tumor of 3.5 disc diameters superior to the optic disc. She was diagnosed with adenocarcinoma of the lung with metastasis to the liver, bones and lymphnodes. The lesions failed to respond to 2 months of peroral treatment with TS-1®. Switching to carboplatin and paclitaxel resulted in decreased size of lung tumor and retinal detachment. Visual acuity improved to 0.8. She has been doing well for 14 months until present. Conclusion: This case illustrates that chemotherapy may be effective for adenocarcinoma of the lung with systemic metastases.

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：ELSEVIER SCIENCE INC  

PURPOSE: To evaluate the long-term anatomic features as assessed by optical coherence tomography (OCT) in patients with spontaneously closed full-thickness macular hole (MH).
DESIGN: Retrospective, noncomparative, observational case series.
METHODS: Six eyes of 6 patients who eventually showed spontaneous resolution of idiopathic MH were studied. The best-corrected visual acuity (BCVA) and OCT images of the fovea were examined before and until at least 3 years after spontaneous resolution.
RESULTS: The MH closed spontaneously 1 to 4 months after the initial examination. There were 2 distinct macular abnormalities in the early period after spontaneous closure: 4 eyes showed outer foveal defects and the remaining 2 eyes showed persistent foveal detachment. However, the fovea regained its normal configuration and the photoreceptor inner segment/outer segment (IS/OS) junction recovered completely in all eyes. Although all 6 eyes showed visual improvement after the hole closure, the BCVA in the 4 eyes that showed delayed recovery of the IS/OS junction and foveal detachment was limited to 20/25 or worse.
CONCLUSION: Spontaneous closure of MH could acquire complete anatomic reconstruction. However, delayed restoration of the IS/OS junction and persistent foveal detachment after spontaneous closure might influence the functional outcomes. (Am J Ophthalmol 2012;153:687-691. (C) 2012 by Elsevier Inc. All rights reserved.)

DOI： 10.1016/j.ajo.2011.09.017

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：LIPPINCOTT WILLIAMS & WILKINS  

Purpose: To compare the wound closure and postoperative hypotony after sclerotomy with a microvitreoretinal (MVR) blade trocar with those with a beveled trocar for microincision vitrectomy.
Methods: The study design is a prospective randomized control study. Forty eyes of 40 patients with an epiretinal membrane that underwent 25-gauge transconjunctival sutureless vitrectomy were studied. One hundred and twenty sclerotomies were observed by swept source optical coherence tomography at 3 hours and at 1, 3, 7, and 14 days postoperatively. A closure of the sclerotomy site was defined as an absence of a scleral gap in the swept source optical coherence tomography images. The closure rate of the sclerotomies, intraocular pressures, and the incidence of complications were compared between the sclerotomies performed with an MVR blade and those with a beveled trocar.
Results: The rates of sclerotomy closure at 3 hours and at 1, 3, 7, and 14 days were 30.0%, 38.3%, 43.3%, 66.7%, and 95.0% with the MVR blade trocar and 21.7%, 26.7%, 36.7%, 53.3%, and 86.7% with the beveled trocar, respectively (P &gt; 0.05 for all, Fisher exact test). The mean size of the sclerotomy was 143.9 +/- 45.5 mu m with the MVR blade and 158.7 +/- 61.7 mu m with the beveled trocar (P = 0.55, Mann-Whitney U test). The mean angle of the sclerotomies was significantly larger with the MVR blade trocar (48.9 degrees vs. 45.8 degrees; P = 0.049, Mann-Whitney U test). No significant difference in the speed of wound closure was found between the 2 groups (P = 0.174). Hypotony was not observed in both groups, and the intraocular pressure did not differ significantly between the two groups.
Conclusion: The absence of significant better rates of self-sealing and faster recovery of sclerotomies made with the MVR blade trocar and the bevel trocar indicates that these factors are not related to the type of trocar. RETINA 32:140-145, 2012

DOI： 10.1097/IAE.0b013e318217ff70

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：KARGER  

Purpose: To evaluate the anatomic and functional outcomes as assessed by spectral-domain optical coherence tomography in patients with a preoperative disrupted or irregular photoreceptor inner/outer segment (IS/OS) junction who underwent idiopathic epiretinal membrane (ERM) surgery and were followed for at least 2 years. Methods: We retrospectively studied all of the patients with idiopathic ERM who had a preoperative disrupted IS/OS junction and were scheduled to undergo a transconjunctival 25-gauge vitrectomy between September 2007 and October 2009. All of the patients who had a 2-year or longer follow-up period were included in the study. The best-corrected visual acuity (BCVA) and structural changes in the IS/OS junction were examined before and 3, 6, 12, and 24 months after surgery. Furthermore, patients were divided into two groups based on whether the preoperative disrupted IS/OS junction had been caused by a lamellar macular hole (LMH type) or swelling as a result of ERM traction (S type). Morphologic changes in the IS/OS junctions of each type were also investigated. Results: A total of 17 patients were identified in this study. Overall, a significantly better postoperative BCVA was seen after surgery; in particular, the BCVA at 24 months was significantly better than that at 12 months (p = 0.018). Although the disrupted IS/OS junction appeared normal in 1 out of 17 eyes at 12 months, 7 eyes appeared normal at 24 months. These 7 eyes showed significant postoperative improvement in BCVA compared with the remaining 10 eyes (p = 0.045, p = 0.021, p = 0.019, and p = 0.015 at 3, 6, 12, and 24 months, respectively). The preoperative disrupted IS/OS junction was classified as LMH type in 8 eyes and as S type in 9 eyes. The LMH type, rather than the S type, tended to show a persistently disrupted IS/OS junction at 24 months, although the difference was not significant. Conclusion: Anatomic and functional recovery of preoperative disrupted IS/OS junctions can be acquired even after more than 1 year postoperatively. However, eyes with persistent irregularities of the IS/OS junction at a 2-year follow-up, especially those with LMH type irregularities, might have a limited visual improvement. Copyright (C) 2012 S. Karger AG, Basel

DOI： 10.1159/000341606

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Language：Japanese   Publishing type：Research paper (international conference proceedings)  

Purpose: To report a case of bilateral multifocal posterior pigment epitheliopathy (MPPE) that responded to intravitreal bevacizumab. Case: A 51-year-old male presented with impaired visual acuity in both eyes. He had had repeated episodess of visual impairment in both eyes since 13 years before. He had been diagnosed with MPPE. Photocoagulation was not effective. Findings: Corrected visual acuity was 0.6 right and 0.4 left. Both eyes showed serous retinal detachment in the posterior fundus. Detachment of retinal pigment epithelium was present in the left eye. Retinal detachment in the right eye exacerbated 3 months later with visual acuity down to 0.03 and foveal thickness of 1,134 μm. The right eye started receiving intravitreal bevacizumab at a monthly interval. Visual acuity started to improve after the third session to attain 0.09 with foveal thickness of 120μm. Retinal detachment in the left eye got well spontaneously to result in visual acuity of 0.6. Conclusion: This case illustrates that intravitreal bevacizumab may be effective for protracted MPPE.

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DOI： 10.1097/IAE.0b013e318203c156

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：LIPPINCOTT WILLIAMS & WILKINS  

Purpose: To investigate the effect of gas tamponade on wound closure and postoperative hypotony by comparing fluid-filled and gas-filled eyes after 25-gauge sutureless vitrectomy using three-dimensional corneal and anterior segment optical coherence tomography.
Methods: Twenty-four eyes of 24 patients who underwent a 25-gauge transconjunctival sutureless vitrectomy were included in this prospective study. A total of 72 scleral wounds were observed using three-dimensional corneal and anterior segment optical coherence tomography at 3 hours and at 1, 3, 7, and 14 days postoperatively. Scleral wound closure was defined as the absence of a scleral gap at the sclerotomy site, as observed using three-dimensional corneal and anterior segment optical coherence tomography. The rate of wound closure, intraocular pressure, and the incidence of complications were compared between the fluid-and gas-filled eyes.
Results: The rates of scleral wound closure at 3 hours and at 1, 3, 7, and 14 days were 26.2%, 28.6%, 35.7%, 52.4%, and 85.7% in fluid-filled eyes and 53.3%, 73.3%, 76.7%, 83.3%, and 93.3% in gas-filled eyes; these rates were significantly higher for the gas-filled eyes. The intraocular pressure was significantly higher in the gas-filled eyes than in the fluid-filled eyes on postoperative Day 1 but did not differ significantly between the 2 groups on postoperative Day 3 and thereafter.
Conclusion: Three-dimensional corneal and anterior segment optical coherence tomography provided clear images of 25-gauge sutureless vitrectomy wounds and revealed that the sclerotomies closed faster in gas-filled eyes than in fluid-filled eyes. Thus, gas tamponade might be effective for the closure of sutureless vitrectomy wounds. RETINA 31: 702-706, 2011

DOI： 10.1097/IAE.0b013e3181f0d2e6

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：KARGER  

Background: Our purpose was to report the results of 1-year follow-up examinations after intravitreal bevacizumab injection for the treatment of chronic central serous chorioretinopathy (CSC). Methods: Five eyes in 5 patients with chronic CSC were intravitreally injected with 1.25 mg/0.05 ml of bevacizumab. The need for retreatment was evaluated if spectral-domain optical coherence tomography showed the presence of subretinal fluid at the time of a 1-month follow-up examination. Best-corrected visual acuity and central foveal thickness were compared between baseline and 1 year after the first injection. Results: The mean logarithm of the minimum angle of resolution (logMAR) best-corrected visual acuity improved from 0.23 +/- 0.46 to 0.17 +/- 0.47 and the mean central foveal thickness significantly decreased from 323 +/- 98 mu m to 171 +/- 63 mu m (p &lt; 0.05). Conclusion: The intravitreal injection of bevacizumab is well tolerated in maintaining vision and reducing serous retinal detachment in patients with chronic CSC, as evaluated at a 1-year follow-up examination. Copyright (C) 2010 S. Karger AG, Basel

DOI： 10.1159/000314709

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DOI： 10.1016/j.ajo.2010.06.006

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：SLACK INC  

BACKGROUND AND OBJECTIVE: To evaluate the outcome of 25-gauge transconjunctival pars plana vitrectomy and compare it with that of 20-gauge pars plana vitrectomy for primary repair of rhegmatogenous retinal detachment.
PATIENTS AND METHODS: A retrospective study of a consecutive series of 166 eyes of 164 patients who underwent pars plana vitrectomy for primary rhegmatogenous retinal detachment was performed. One hundred nineteen eyes underwent 25-gauge vitrectomy and 47 eyes underwent 20-gauge vitrectomy.
RESULTS: The anatomic success rates after the initial surgery in the 25-gauge vitrectomy and 20-gauge vitrectomy groups were 93.3% and 91.5%, respectively. The median visual acuity improved significantly from 20/80 preoperatively to 20/30 postoperatively in the 25-gauge group, and from 20/90 to 20/30 in the 20-gauge group.
CONCLUSION: Good anatomic and functional results were achieved with 25-gauge vitrectomy and the outcomes compared favorably with those of 20-gauge vitrectomy for the treatment of rhegmatogenous retinal detachment.

DOI： 10.3928/15428877-20100726-03

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：WICHTIG EDITORE  

PURPOSE. To report a case of bilateral regression of choroidal metastasis with adenocarcinoma of the lung treated with gefitinib.
METHODS. Retrospective case review of a 68-year-old woman with pulmonary adenocarcinoma with choroidal metastasis who presented with visual loss in the left eye as the initial manifestation. Her visual acuity was 6/6 in the right eye and 6/60 in the left eye before the start of gefitinib administration. Best-corrected visual acuity and spectral-domain optical coherence tomography were compared between baseline and 3 months after treatment.
RESULTS. Best-corrected visual acuity in the left eye had improved to 6/30 3 months after oral gefitinib. The elevated lesions of the right eye disappeared, with decrease of subretinal fluid and retinal pigment epithelial atrophy. Spectral-domain optical coherence tomography showed that subretinal fluid of the left eye was also reduced.
CONCLUSIONS. Oral gefitinib could be effective for regression of choroidal metastasis in patients with adenocarcinoma of the lung and provides a potential treatment option. (Eur J Ophthalmol 2010; 20: 963-5)

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：LIPPINCOTT WILLIAMS & WILKINS  

Purpose: The purpose of this study was to report the results of 1-year follow-up examinations after intravitreal bevacizumab injection for the treatment of idiopathic choroidal neovascularization.
Methods: Seven eyes in 7 patients with idiopathic choroidal neovascularization were intravitreally injected with 1.25 mg/0.05 mL of bevacizumab. The need for retreatment was evaluated if spectral-domain optical coherence tomography showed intraretinal edema or subretinal fluid at the time of a 1-month follow-up examination. Fluorescein angiography was performed 1 year after the first injection. The primary outcome measures were best-corrected visual acuity and central foveal thickness using spectral-domain optical coherence tomography.
Results: All 7 eyes were assessed at a 1-year follow-up examination. The mean number of injections per eye was 2.7. The mean logarithm of the minimum angle of resolution best-corrected visual acuity improved significantly from 0.31 +/- 0.29 to 0.15 +/- 0.38 (P &lt; 0.05). The mean central foveal thickness decreased from 332 +/- 83 mu m to 261 +/- 66 mu m (P &lt; 0.01). Fluorescein angiography showed no leakage at 1 year in all eyes. All patients whose best-corrected visual acuity improved by &gt;= 0.2 logarithm of the minimum angle of resolution had a visual acuity of &gt;= 20/40 when first injected at baseline.
Conclusion: The intravitreal injection of bevacizumab is effective for stabilizing or improving vision in patients with idiopathic choroidal neovascularization, as evaluated at a 1-year follow-up examination. In particular, this treatment may be well tolerated in patients with a visual acuity of &gt;= 20/40 at baseline. Additional investigations are needed to assess the long-term safety and the optimal protocol for intravitreal bevacizumab administration. RETINA 30:733-738, 2010

DOI： 10.1097/IAE.0b013e3181c9699c

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：ELSEVIER SCIENCE INC  

We describe a primary posterior capsulotomy technique using a 25-gauge vitreous cutter to prevent postoperative posterior capsule opacification (PCO) in patients with vitreoretinal diseases who must have a vitrectomy combined with cataract surgery. Following phacoemulsification, a 25-gauge vitrectomy, and intraocular lens implantation in the capsular bag, the posterior capsule is removed via a pars plana approach using a 25-gauge vitreous cutter; the removed capsule is round, well centered, and approximately 5.0 mm in diameter. This technique prevents postoperative PCO completely, improving vision and enabling detailed examination of the fundus after surgery.

DOI： 10.1016/j.jcrs.2009.07.049

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：LIPPINCOTT WILLIAMS & WILKINS  

Purpose: To examine the effects of perfluorocarbon liquid (PFCL) and silicone oil (SO) on human retinal Pigment epithelium (RPE) cells and retinal ganglion cells (RGCs) in vitro.
Methods: Human RPE cells (ARPE-19 cells), seeded on microporous inserts, were exposed to PFCL or SO and incubated for 3 or 7 days. Perfluorocarbon liquid was in contact with cells at the apical or baso-lateral side, quantification of cell proliferation and cell viability were evaluated by WST-1 assay. In the same way, RGCs were exposed for 1 hour or 3 days, and the number of viable RGCs was counted by using a fluorescence viability agent.
Results: Perfluorocarbon liquid affected the survival of ARPE-19 cells and RGCs when compared with the nontreated control group. ARPE-19 cells decreased significantly after being in contact with PFCL at the baso-lateral side for 7 days. However, PFCL contact at the apical side reduced the number of RGCs in a time-dependent manner. In case of SO, the viability of the ARPE-19 cells decreased significantly after being in contact with SO at the baso-lateral side for 7 days. However, SO did not reduce the number of RGCs after a 3-day exposure.
Conclusion: Perfluorocarbon liquid is directly toxic to ARPE-19 cells when exposed to the cells for 7 days. On the contrary, it seems that RGCs are damaged in a time-dependent manner by the more mechanical rather than toxic effects of PFCL. Silicone oil seems to exert mechanical rather than toxic effects on ARPE-19 cells. When PFCL is used as a postoperative tamponade clinically, understanding the difference in the effects will lead to more effective and safer results. RETINA 29:677-681, 2009

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：SPRINGER  

To evaluate the ability of spectral-domain optical coherence tomography (SD-OCT) images of the inner/outer segment (IS/OS) junction to predict macular hole surgery outcomes.
Fifty-four eyes in 53 patients with idiopathic macular holes were studied. Postoperative visual acuity and SD-OCT images of the fovea were examined before and 12 months after surgery. The total area and the maximum length of the IS/OS junction defect were measured.
The macular holes were successfully closed in all the eyes included in this series. The mean logMAR visual acuity improved significantly from 0.67 +/- 0.25 preoperatively to 0.16 +/- 0.22 postoperatively (p &lt; 0.001). The mean total area and maximum length of the IS/OS junction defect at 12 months after surgery were 10,185 +/- 1,537 mu m(2) and 100.5 +/- 10.4 mu m respectively; these values were significantly negatively correlated with the postoperative visual acuity.
SD-OCT is useful for quantitatively measuring IS/OS junction defects. The postoperative IS/OS junction may play an important role in visual recovery after macular hole surgery.

DOI： 10.1007/s00417-008-0999-9

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Language：Japanese   Publishing type：Research paper (international conference proceedings)  

Purpose : To report and discuss impaired choroidal circulation after photodynamic therapy for age-related macular degeneration (AMD). Cases and Method : This study was made on 46 eyes of 45 patients who received photodynamic therapy for AMD and who were followed up for 6 months or longer. The series comprised 35 male and 11 female eyes. The age ranged from 50 to 86 years, average 73 years. Indocyanine green angiography was performed 3 months after treatment. Eyes were assigned to hypofluoresent group when the treated area showed hypofluorescence. When otherwise, eyes were assigned to nonhypofluorescent group. Visual acuity was evaluated as logMAR. Results : Eighteen eyes (39%) were assigned to hypofluorescent group and the other 28 eyes (61%) to nonhypoflurescent group. Final visual acuity decreased by 0.3 or more in 5 eyes (28%) in the former group and in one eye (4%) in the latter. The difference was significant (p &lt
0.05). Conclusion : There is a possibility that visual acuity may be impaired secondary to choroidal ischemia following photodynamic therapy for AMD.

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Language：Japanese   Publisher：(公財)日本眼科学会  

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Language：Japanese   Publishing type：Research paper (scientific journal)  

Purpose : To report successful removal of perfluorocarbon retained in the subfoveal space. Case : A 32-year-old male received vitreous surgery for retinal detachment in his right eye. The retina became reattached under silicone oil in the vitreous. Retinal detachment recurred and resulted in proliferative vitreoretinopathy. Reattachment was obtained after surgery with the use of liquid perfluorocarbon. A dome-shaped elevation was detected posterior to the fovea 26 days after surgery. Optical coherence tomography showed an empty subfoveal space. The visual acuity was 0.08. The finding was diagnosed with subretinal migration of perfluorocarbon. It was surgically removed through an intentional retinal break created temporal to the fovea 40 days after surgery. The fovea regained its depression with visual acuity improving to 0.2. Conclusion : Visual function improved after successful removal of liquid hydrocarbon through an intentional retinal break temporal to the fovea.

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Language：Japanese   Publishing type：Research paper (scientific journal)  

Purpose: To report the visual outcome of photodynamic therapy (PDT) for age-related macular degeneration (AMD). Cases and Method: This retrospective study was made on 115 eyes of 112 patients with AMD. The series comprised 86 male eyes and 29 female eyes. The age ranged from 50 to 86 years, average 72 years. Soft drusen was present in 22 eyes and adsent in 93 eyes. Visual acuity was evaluated in terms of logMAR. Difference in 0.3 or over was judged as improvement or deterioration. All the cases were followed up for 6 months or longer regarding frequency of PDT, size of macular lesion, and choroidal circulatory disorder. Results: Final visual acuity deteriorated in 7 out of 22 eyes (32%) with drusen and in 14 out of 93 eyes (15%) without. The difference was significant (p&lt
0.04). Eyes without soft drusen showed a tendency for visual acuity to remain unchanged or to improve after PDT. There were no significant differences between the two groups regarding other factors. Conclusion: Presence of soft drusen in AMD affects the visual outcome after PDT.

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Language：Japanese   Publisher：(公財)日本眼科学会  

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Language：English   Publisher：Lippincott Williams and Wilkins  

DOI： 10.1016/j.ajo.2016.11.008

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Language：English   Publishing type：Research paper, summary (international conference)   Publisher：ASSOC RESEARCH VISION OPHTHALMOLOGY INC  

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Language：English   Publishing type：Rapid communication, short report, research note, etc. (scientific journal)   Publisher：LIPPINCOTT WILLIAMS & WILKINS  

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Language：English   Publisher：LIPPINCOTT WILLIAMS & WILKINS  

DOI： 10.1097/IAE.0000000000000774

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Language：English   Publisher：Lippincott Williams and Wilkins  

Purpose: To describe the use of optical coherence tomography angiography (OCT-A) for evaluating the spectrum of polypoidal vascular diseases. Methods: Retrospective observational case series of seven patients with polypoidal choroidal vasculopathy (three cases) or polypoidal choroidal neovascularization (four cases). Optical coherence tomography angiography information was acquired using two different OCT-A devices (the Optovue RTVue XR Avanti SD-OCT and the Spectralis OCT angiography). Flow signals within branching vascular networks, type 1 neovascularization and polyps were evaluated. Comparisons were made between en face and cross-sectional OCT-A images. Vascular information from OCT-A was also compared with indocyanine green angiography. Results: En face images from OCT-A provided anatomical information about branching vascular networks that were comparable to indocyanine green angiography. Polyps were poorly resolved on en face OCT-A images but were clearly defined on cross-sectional OCTA images. Cross-sectional OCT-A revealed flow signals within focal regions of the polyps with a significant portion of the polyp lumen being devoid of flow signal. Flow signals from cross-sectional OCT-A images also showed that branching vascular networks, type 1 neovascularization, and polyps were confined to the anatomic compartment between the retinal pigment epithelium and Bruch's membrane. It was not possible to detect leakage on en face or cross-sectional OCT-A. Conclusion: The combination of en face and cross-sectional OCT-A images provides anatomical information about polypoidal structures that is comparable to indocyanine green angiography. OCT-A may be a useful modality for the management of polypoidal diseases. However, the limitations of OCT-A identified in this study suggest that it is not a replacement for indocyanine green angiography.

DOI： 10.1097/IAE.0000000000000777

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Language：English   Publisher：SPRINGER JAPAN KK  

To evaluate the results of a 3-year follow-up of intravitreal pegaptanib sodium injection as maintenance therapy for the treatment of neovascular age-related macular degeneration (AMD) in Japanese patients.
In this prospective, uncontrolled interventional study, 20 eyes of 19 patients with treatment-na &lt; ve AMD who had received 3 consecutive monthly injections of 0.5 mg/0.05 mL ranibizumab as the induction treatment and had shown clinical/anatomical improvement were enrolled. An intravitreal injection of 0.3 mg/0.09 mL pegaptanib sodium was administered as the maintenance therapy every 6 weeks. Booster treatments using ranibizumab were allowed if clinical deterioration was judged to be present. The primary outcome measures were the best-corrected visual acuity (BCVA) and the central foveal thickness (CFT) as evaluated using spectral-domain optical coherence tomography.
Sixteen of the 20 eyes (80 %) were assessed at the 3-year follow-up. The mean logMAR BCVA improved significantly from 0.56 +/- A 0.31 before the induction treatment to 0.24 +/- A 0.25 at baseline (P &lt; 0.001) and was well maintained at 156 weeks (0.25 +/- A 0.28, P = 0.938). Moreover, the mean CFT also decreased significantly from 346 +/- A 111 mu m before the induction treatment to 232 +/- A 54 mu m at baseline (P &lt; 0.001) and was well preserved at 156 weeks (210 +/- A 59 mu m, P = 0.278). Thirteen eyes (81.3 %) received an unscheduled booster treatment, and no severe systemic or ocular side effects occurred during follow-up.
Intravitreal pegaptanib sodium injection as the maintenance therapy was effective in stabilizing the vision of patients with AMD in whom induction treatment led to improved BCVA, as evaluated at the 3-year follow-up.

DOI： 10.1007/s10384-015-0374-4

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Language：English   Publisher：Dove Medical Press Ltd  

Purpose: To evaluate the anatomic and functional effect of microincision vitrectomy surgery (MIVS) with internal limiting membrane (ILM) peeling for macular edema secondary to branch retinal vein occlusion (BRVO). Methods: The medical records of 101 eyes of 101 patients who had undergone MIVS with ILM peeling for macular edema secondary to BRVO were studied. Patients were classified into ischemic and non-ischemic BRVO based on angiograph. The best-corrected visual acuity (BCVA) and central foveal thickness (CFT), determined by spectral domain optical coherence tomography, were evaluated at baseline and at 1, 3, 6, and 12 months postoperatively. Results: Preoperative mean logarithm of the minimum angle of resolution (logMAR) BCVA ± standard deviation (SD) was 0.52±0.43 and mean CFT ± SD was 489.4±224.9 μm. Postoperative mean BCVA ± SD values were 0.41±0.35, 0.35±0.41, 0.29±0.36, and 0.25±0.41, and mean CFT values were 370.1±148.9, 327.5±157.5, 310.9±154.9, and 274.4±135.3 μm at 1, 3, 6, 12 months, respectively. The mean BCVA was significantly improved at 3, 6, and 12 months postoperatively (all P,0.05), and the mean CFT was significantly decreased at all postoperative follow-up time points (all P,0.05). At the 12-month postoperative evaluation, BCVA had improved by 0.2 logMAR units in 50 eyes (60.0%) with ischemic BRVO and in nine eyes (50.0%) with non-ischemic BRVO. Six eyes (6.0%) experienced recurrence or persistence of macular edema at 12 months postoperatively. Conclusion: MIVS with ILM peeling for macular edema secondary to BRVO is effective in improving visual acuity and foveal morphology with low recurrence of macular edema.

DOI： 10.2147/OPTH.S75659

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Purpose: To report a case of fundus albipunctatus who developed choroidal neovascularization and who received vitreal injection of anti-VEGF agents. Case: A 74-year-old male presented with blurring and metamorphopsia in the left eye since 11 days before. Findings: Corrected visual acuity was 1.2 right and 0.9 left. Both eyes showed numerous white dots in the posterior fundus area. The left macula showed choroidal neovascularization with subretinal hemorrhage and retinal detachment. He was diagnosed as fundus albipunctatus with choroidal neovascularization. The left eye received 4 sessions of intravitreal injection of ranibi-zumab. Recurrence was treated by 3 sessions of aflibercept. Subretinal hemorrhage and white dots disappeared with visual acuity of 0.6 for 12 months until present. Conclusion: Choroidal neovascularization in a case of fundus albipunctatus subsided after multiple sessions of intravitreal injection of ranibizumab and aflibercept.

DOI： 10.11477/mf.1410211418

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Language：English   Publisher：ELSEVIER SCIENCE INC  

Objective: To study the anatomic and visual outcomes of a surgical procedure in which tissue plasminogen activator and air are injected subretinally to displace massive submacular hemorrhages secondary to age-related macular degeneration.
Design: Prospective, consecutive, interventional case series.
Participants: Thirteen consecutive patients (13 eyes) with massive submacular hemorrhages secondary to age-related macular degeneration.
Intervention: The surgical procedure consisted of a 25-gauge vitrectomy and submacular injection of tissue plasminogen activator (25 mu g) and 0.4 ml air with a microneedle having an outer diameter of 50 mu m. The procedure was followed by having the patient remain in the prone position overnight.
Main Outcome Measures: Mean visual acuity change from baseline, mean central lesion thickness change from baseline, fluorescein angiography findings, and surgical complications.
Results: Total subfoveal blood displacement was achieved in all 13 eyes (100%). Central lesion thickness decreased from a mean baseline value of 867 mm to a mean value of 379 mu m at 1 month after surgery. There was visual improvement in 11 eyes, no visual improvement in 1 eye, and poorer vision in 1 eye. The mean change in Early Treatment Diabetic Retinopathy Study letter score from baseline was 19.4 letters at 1 month (P = 0.006) and 23.3 letters at 3 months (P = 0.001). There was intraoperative macular hole formation.
Conclusions: Submacular air injection with a microneedle facilitates displacement of clots dissolved with tissue plasminogen activator with fewcomplications and results in earlier visual improvement. (C) 2015 by the American Academy of Ophthalmology.

DOI： 10.1016/j.ophtha.2014.07.027

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Language：English   Publishing type：Rapid communication, short report, research note, etc. (scientific journal)   Publisher：ELSEVIER SCIENCE INC  

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Language：English   Publishing type：Rapid communication, short report, research note, etc. (scientific journal)   Publisher：Elsevier Inc.  

DOI： 10.1016/j.ophtha.2014.03.018

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Language：Japanese  

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Other Link： http://search.jamas.or.jp/link/ui/2013273275

Language：English   Publishing type：Rapid communication, short report, research note, etc. (scientific journal)   Publisher：LIPPINCOTT WILLIAMS & WILKINS  

DOI： 10.1097/IAE.0b013e3181d2f189

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