Navigated direct photocoagulation with a 30-ms short-pulse laser for treating microaneurysms in diabetic macular edema exhibits a high closure rate.

This study carried out direct photocoagulation for treating microaneurysms (MAs) in diabetic macular edema (DME) using a navigation laser system with a 30-ms pulse duration. The MA closure rate after 3 months was investigated using pre and postoperative fluorescein angiography images. MAs primarily inside the edematous area based on optical coherence tomography (OCT) maps were selected for treatment, and leaking MAs (n = 1151) were analyzed in 11 eyes (eight patients). The total MA closure rate was 90.1% (1034/1151), and the mean MA closure rate in each eye was 86.5 ± 8.4%. Mean central retinal thickness (CRT) decreased from 471.9 ± 73.0 µm to 420.0 ± 87.5 µm (P = 0.049), and there was a correlation between the MA closure rate and the CRT reduction rate (r = 0.63, P = 0.037). There was no difference in the MA closure rate depending on the degree of edema thickness based on a false-color topographic OCT map image. Direct photocoagulation for DME with a short pulse using the navigated photocoagulator resulted in a high MA closure rate in just 3 months and a corresponding improvement in retinal thickness. These findings encourage the use of a new therapeutic approach for DME.

Microperimetric analysis of diabetic macular edema after navigated direct photocoagulation with short-pulse laser for microaneurysms.

BACKGROUND: Focal laser photocoagulation is an important treatment option for diabetic macular edema (DME). This study aimed to examine the retinal sensitivity (RS) and morphological changes at the coagulated site after direct photocoagulation of microaneurysms (MAs) in patients with DME using a navigated laser photocoagulator with a short-pulse duration of 30 ms. METHODS: Images of early-phase fluorescein angiography were merged with images from the optical coherence tomography (OCT) map with 9 Early Treatment Diabetic Retinopathy Study grid circles, and MAs inside the edema area were selected for direct photocoagulation. The best-corrected visual acuity (BCVA), parameters of the OCT map including central retinal thickness and retinal thickness in edema range, central RS, and RS in the edema area were assessed at 1 and 3 months after the laser treatment. The RS points that overlapped with the laser spots were identified by merging the Navilas' digital treatment reports and the microperimetry images. RESULTS: Seventeen eyes from 14 patients were studied. The mean retinal thickness in the edema range decreased at 3 months compared with pretreatment (P = 0.042), but the BCVA, central retinal thickness, central RS, and RS in the edema area remained unchanged. Overall, 32 of 400 sensitivity points overlapped with the laser-coagulated spots. The mean RS at these spots were 22.4 ± 5.3 dB at 1 month and 22.5 ± 4.8 dB at 3 months, with no significant change from the baseline of 22.7 ± 3.5 dB. CONCLUSIONS: Retinal thickness improved in the coagulated edema area without a decrease in RS after direct photocoagulation of MAs with a short 30-ms pulse using Navilas. This promising therapeutic strategy for DME is effective and minimally invasive.

Macular and peripapillary retinal nerve fiber layer thinning in eyes with prediabetes in the elderly population: OTASSHA study.

PURPOSE: To investigate retinal thickness parameters in the elderly with prediabetes mellitus (preDM) and type 2 DM without retinopathy (non-diabetic retinopathy [NDR]). METHODS: This cross-sectional study included a total of 1273 eyes without retinal pathologies of 699 volunteers aged ≥ 65 years were included. The eyes were categorized into non-DM (606 eyes), preDM (480 eyes), and NDR (187 eyes) groups according to their HbA1c levels. Fundus photography, swept-source optical coherence tomography, and comprehensive systemic examination were conducted. The thicknesses of the retinal nerve fiber layer in the macula (mRNFL) and peripapillary (pRNFL), ganglion cell complex (GCC), and ganglion cell inner plexiform layer (GCIPL), as well as central subfield thickness (CST) and central foveal thickness (CFT) were investigated for their association with DM stage using linear mixed model. RESULTS: A statistically significant thinning of mRNFL was observed in preDM vs. non-DM and in NDR vs. preDM in 3/6 sectors. A significant thinning of pRNFL was observed in preDM vs. non-DM and in NDR vs. preDM in 2/12 sectors. Such DM stage-dependent thinning of RNFL was observed mainly in the temporal and superior sectors. GCIPL and GCC were less sensitive to reflect DM-dependent inner retinal thinning. CST and CFT were not significantly associated with different DM stages. CONCLUSION: The thinning of mRNFL in the temporal and superior sectors might be a sensitive parameter associated with early neurodegeneration in preDM and NDR.

ASSOCIATION OF PREDIABETES WITH RETINAL MICROVASCULATURE ON SWEPT-SOURCE OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY IN THE ELDERLY: OTASSHA Study.

PURPOSE: To investigate the retinal microvasculature in the elderly persons with prediabetes mellitus (preDM) and type 2 DM. METHODS: This cross-sectional study included a total of 452 eyes without retinal pathologies of 301 elderly volunteers aged ≥65 years, and they were categorized into nonDM (225 eyes), preDM (177 eyes), and DM (50 eyes) groups based on their HbA1c. Fundus photography, swept-source optical coherence tomography and angiography, and comprehensive systemic examinations were conducted. Vessel density (VD) and foveal avascular zone in superficial and deep retinal microvasculature were investigated for their association with DM stages using linear mixed model. RESULTS: Superficial VD (sVD) mean values in nonDM, preDM, and DM groups were 35.2%, 34.9%, and 34.8%, respectively. sVD in preDM was equivalent to sVD in DM, whereas significantly lower compared with sVD in nonDM (difference [95% CI] -0.19 [-0.33 to -0.049], P = 0.009). Deep VD (dVD) mean values in nonDM, preDM, and DM groups were 35.0%, 35.0%, and 34.4%, respectively. dVD in preDM was equivalent to dVD in nonDM, whereas significantly higher compared with dVD in DM (difference [95% CI] 0.31 [0.046-0.57], P = 0.02). There was no significant association between foveal avascular zone area and DM stages. CONCLUSION: Retinal microvasculature may be affected at the prediabetic stage in the elderly.

Morphological alternation and influence of aqueous flare in idiopathic epiretinal membrane.

BACKGROUND: Idiopathic epiretinal membrane (iERM) is a common retinal disease in the elderly population. The exact pathogenesis of iERM is unknown. The present study aimed to evaluate the relationship between aqueous flare and morphology of iERM using swept-source optical coherence tomography (OCT). METHODS: A consecutive series of 36 eyes of 33 patients with iERM and 109 control eyes of 109 patients were retrospectively examined. Aqueous flare measurements and OCT images were obtained on the same day. The average total retinal, inner retinal, outer retinal, and choroidal thicknesses were calculated using the thickness map mode with an Early Treatment Diabetic Retinopathy Study nine-zone grid that was divided into three zones. The maximum depth of the retinal folds in iERMs was manually measured. The correlation among flare value, maximum depth of folds, and retinal and choroidal thicknesses was evaluated. The morphological changes between the control eyes and the eyes with iERM in different stages were examined. RESULTS: The result demonstrated a significant positive correlation between the aqueous flare value and total and inner retinal thicknesses in the early stage of iERM. There was a significant positive correlation between the maximum depth of folds and total and inner retinal thicknesses in the early stage of iERM, and the maximum depth of folds significantly increased in the advanced stage. The total and inner retinal thicknesses and proportion of inner retinal thickness significantly increased as the stage of iERM progressed. CONCLUSIONS: The aqueous flare value was associated with retinal thickness in the early stage of iERM, which supports the idea that inflammation or breakdown of blood-ocular barrier is involved in the process of iERM formation. The maximum retinal folds increased as the stage of iERM progressed and retinal thickness increased, which indicates that the tangential force increases as the iERM stage progresses.

Distinguishing Features of Anterior Uveitis Caused by Herpes Simplex Virus, Varicella-Zoster Virus, and Cytomegalovirus.

PURPOSE: To determine distinguishing features of the clinical characteristics of anterior uveitis (AU) caused by herpes simplex virus (HSV), varicella-zoster virus (VZV), and cytomegalovirus (CMV). DESIGN: Retrospective, multicenter case series. METHODS: Consecutive patients with herpetic AU examined at 11 tertiary centers in Japan between January 2012 and December 2017 and who were followed for ≥3 months were evaluated. Diagnosis was made by polymerase chain reaction (PCR) for HSV, VZV, or CMV in the aqueous humor, or classical signs of herpes zoster ophthalmicus. RESULTS: This study enrolled 259 herpetic AU patients, including PCR-proven HSV-AU (30 patients), VZV-AU (50), and CMV-AU (147), and herpes zoster ophthalmicus (32). All HSV-AU and VZV-AU patients were unilateral, while 3% of CMV-AU patients were bilateral. Most HSV-AU and VZV-AU patients were sudden onset with an acute clinical course, while CMV-AU had a more insidious onset and chronic course. There were no significant differences for all surveyed symptoms, signs, and complications between HSV-AU and VZV-AU. However, significant differences were detected for many items between CMV-AU and the other two herpetic AU types. Ocular hyperemia and pain, blurring of vision, ciliary injection, medium-to-large keratic precipitates (KPs), cells and flare in the anterior chamber, and posterior synechia significantly more often occurred in HSV-AU and VZV-AU vs CMV-AU. In contrast, small KPs, coin-shaped KPs, diffuse iris atrophy, elevated intraocular pressure, and glaucoma surgery were significantly more frequent in CMV-AU vs HSV-AU and VZV-AU. CONCLUSION: This multicenter, retrospective study identified distinguishing features of HSV-AU, VZV-AU, and CMV-AU.

Continued smoking and posterior vitreous adhesion in the elderly evaluated on swept-source optical coherence tomography.

In this cross-sectional study including 1150 eyes of 681 volunteers ≧ 65 years old without retinal pathology, factors affecting the progression of posterior vitreous detachment (PVD) were investigated. PVD stages were diagnosed based on swept-source optical coherence tomography (SS-OCT). Linear mixed effect model was used to determine whether age, gender, diabetes mellitus (DM), hypertension (HT), dyslipidemia (DL), and smoking status were associated with various stages of PVD. As a result, the multivariable analysis disclosed that the associations between older age and higher PVD stages (estimate [95% CI], 0.031 [0.020 to 0.042]; P < 0.0001), and current smokers and lower PVD stages (estimate [95% CI], - 0.24 [- 0.43 to - 0.056]; P = 0.011) were statistically significant. In contrast, female gender was not an independent factor affecting PVD stages in the elderly. Our analysis indicated that higher PVD stages observed in female eyes may be due to confounding effect, in which current smokers were predominantly males (i.e., 12.6% among males vs. 3.9% among females, P < 0.0001). In conclusion, our findings suggest that continuous smoking is associated with an adherent vitreoretinal interface in the elderly.

Posterior vitreous detachment and macular microvasculature in the elderly.

PURPOSE: To investigate the association between different stages of posterior vitreous detachment (PVD) and macular microvasculature in the elderly. METHODS: Swept-source optical coherence tomography (OCT), OCT angiography, and color fundus images of 490 eyes without retinal pathologies of 322 participants aged ≥65 years were evaluated. PVD was classified using enhanced vitreous visualization mode as no apparent PVD (stage 0/1), vitreous adhesions at the fovea and optic disc (stage 2), adhesion at the optic disc (stage 3), or complete PVD (stage 4). Microvascular parameters, including foveal avascular zone (FAZ) and vessel density (VD), were analyzed for their associations with complete PVD. Additionally, the association between PVD and central retinal thickness (CRT) was also addressed. RESULTS: Overall, 80, 31, 31, and 349 eyes were categorized into stages 0/1, 2, 3, and 4, respectively. Using multivariate mixed-effects model, the mean superficial FAZ area was smaller in stage 4 compared with stages 0-3 (0.29 vs. 0.32 mm2; P = 0.014), and the mean superficial VD was lower in stage 4 compared with stages 0-3 (34.96% vs. 35.24%; P = 0.0089). However, PVD was not significantly associated with deep macular microvascular parameters or CRT. CONCLUSIONS: Complete PVD was associated with smaller FAZ area and lower VD in superficial macular microvasculature, while it was not associated with central retinal thickness.

Visual acuity improvement after phacoemulsification cataract surgery in patients aged ≥90 years.

BACKGROUND: Visual acuity (VA) outcomes after phacoemulsification cataract surgery in the very elderly (≥90 years) compared to those in younger patients remain unclear till date. METHODS: We retrospectively investigated 138 (group 1) and 152 (group 2) eyes in patients aged ≥90 and < 80 years, respectively, with senile cataracts who underwent phacoemulsification and intraocular lens implantation between 2014 and 2016. Four highly experienced ophthalmic surgeons performed the procedures. Intra- and post-operative complications were compared between the two groups. To investigate the effectiveness of cataract surgery in improving best-corrected VA (BCVA) at 1 and 3 months postoperatively, multiple regression analysis was performed with variables of age, cataract grades, sex, and history of diabetes mellitus (DM) and hypertension. RESULTS: The intra- and post-operative complication rates were similar between the two groups. After adjusting for the difference in cataract grades, multiple regression analysis indicated that BCVA improvement was equally favorable in both groups at 1 and 3 months postoperatively but was less favorable in patients with a history of DM at 3 months postoperatively (P = 0.042). CONCLUSION: Phacoemulsification in patients aged ≥90 years improves VA as effectively and safely as it does in younger patients, at least when performed by experienced surgeons.

Clinical characteristics and ocular complications of patients with scleritis in Japanese.

PURPOSE: To investigate the clinical characteristics of Japanese patients with scleritis STUDY DESIGN: Retrospective study METHODS: The clinical records of 123 patients with scleritis, who presented to the University of Tokyo Hospital between January, 2004 and December, 2015, were retrospectively reviewed. RESULTS: The cohort comprised 55 men and 68 women (mean age, 57.8±16.4 years), of which 76 showed anterior diffuse scleritis, 17 showed anterior nodular scleritis, 10 showed anterior necrotizing scleritis, and 20 showed posterior scleritis. The underlying etiology was identified in 39 patients. Autoimmune diseases were present in 32 patients, including eight with rheumatoid arthritis, seven with antineutrophil cytoplasmic antibody-associated vascular disease, and six with relapsing polychondritis. Ocular hypertension was the most common ocular complication (41%), followed by anterior chamber cells (38%). Fifty-three percent of patients required systemic immunosuppressive medication. Systemic corticosteroids were the most commonly used medication (45%), followed by methotrexate (11%). A, decrease in vision was observed in one-third of patients with anterior necrotizing scleritis or posterior scleritis, of which secondary glaucoma and optic neuritis were the major causes. CONCLUSION: Autoimmune diseases were present in 26% of patients. One-third of patients with anterior necrotizing scleritis or posterior scleritis experienced decreased vision, mostly due to secondary glaucoma and optic neuritis. Therefore, controlling intraocular pressure by methods such as administration of steroid-sparing immunosuppressive medication and appropriate treatment for posterior scleritis are essential for scleritis treatment.

Monoclonal immunoglobulin heavy chain gene rearrangement in Fuchs' uveitis.

BACKGROUND: Fuchs' uveitis (FU) is occasionarlly complicated with heavy vitreous opacity. We have performed vitrectomy procedures to remove vitreous opacity in affected patients as part of differential diagnosis for primary vitreoretinal lymphoma (PVRL). CASE PRESENTATION: We retrospectively reviewed the clinical records of five patients who first visited the Uveitis Clinic of the University of Tokyo Hospital between 2009 and 2013, were diagnosed with FU and underwent a vitrectomy for removal of dense vitreous opacity. All were diagnosed as FU by ocular findings and elevation of Goldmann-Witmer coefficient (GWC) value for the rubella virus (RV) antibody. In examinations of the vitreous body, cytological diagnosis, elevation of IL-10/IL-6 ratio, and the kappa/lambda ratio in flow cytometry findings were negative in all cases, whereas monoclonal immunoglobulin heavy chain (IgH) gene rearrangement was positive in 4 cases and negative in 1 case. CONCLUSIONS: Although monoclonal IgH gene rearrangement is thought to be a reliable biomarker for PVRL, a high percentage of vitreous specimens from our FU patients showed pseudo-positive results. Ophthalmologists must take care regarding possible pseudo-positive findings when performing differential diagnosis between FU and PVRL. Combinations of results of cytological diagnosis, IL-10/IL-6 ratio, kappa/lambda ratio, and IgH gene rearrangement may be necessary for a definitive diagnosis of PVRL and differentiation from FU.

The association between structure-function relationships and cognitive impairment in elderly glaucoma patients.

Accurate measurement of visual field (VF) is important in accessing glaucoma, however this may not be achieved in patients with dementia or mild cognitive impairment (CI). We investigated the association between CI and structure-function relationships in elderly glaucoma patients. The study included 94 eyes of 51 glaucoma patients aged ≥75 years with no diagnoses of dementia. CI was assessed using the Mini Mental State Examination (MMSE). Using the leave-one-out cross-validation, the mean deviation (MD) of the Humphrey 30-2 VF was predicted from measurements of optical coherence tomography, and the relationship between the squared prediction error and the MMSE score, together with age, fixation loss (FL), false positive (FP), and false negative (FN) percentages that were analyzed using the linear mixed model. A high prevalence of MCI or dementia was observed in the elderly population. The squared prediction error value of the MD was 17.0 ± 21.1 (mean ± standard deviation). The squared prediction error increased with decreasing MMSE total score, but age, FL, FP, and FN were not related. Careful consideration is needed when interpreting the VF results of these patients, because VF can be over- or underestimated, as suggested by the decreased structure-function relationships.

Fungal endophthalmitis in an elderly woman: differing responses in each eye.

Candida endophthalmitis is caused by hematogenous metastasis of the yeast. To ensure early diagnosis, serodiagnosis, or surveillance culturing is usually performed. If fungemia is apparent upon successive serological testing (in at least two tests: blood culture and/or measurement of ß-d-glucan level), ophthalmic consultation is necessary, even if no ophthalmic complaint is evident. This is because early detection with prompt prescription of systemic antifungal agents inhibits progression of the distinctive cholioretinitis. If the initial fungemia is not promptly diagnosed, or if it is missed, fungal endophthalmitis may develop, associated with a poor prognosis in terms of visual acuity. Here, we report on a case of Candida endophthalmitis in a 92-year-old woman with severe visual disturbance in one eye that was first diagnosed on ophthalmic examination. It was already difficult to recover. Fungemic systemic/ophthalmic symptoms must be checked in the early stage; in addition, prompt ophthalmological consultation is essential.

Ocular Behçet's disease is less complicated with allergic disorders. A nationwide survey in Japan.

OBJECTIVES: Behçet's disease (BD) is a systemic inflammatory disorder polarised to the Th1 and Th17 immune systems. Allergic diseases are polarised to the Th2 immune system. The aim of the present study is to investigate the prevalence of allergic diseases in patients who have BD. METHODS: The study involved a large-scale interview survey of Japanese patients with BD at 21 institutes of ophthalmology; 353 patients (255 males and 98 females) were recruited for this study. We analysed the history of allergic diseases such as atopic dermatitis (AD), allergic rhinitis (AR), bronchial asthma (BA) and drug/food allergies (FA). RESULTS: Oral aphthous ulcers, ocular lesions, skin lesions, genital ulcers, arthritis, neurological lesions, intestinal lesions, deep vein thrombosis and epididymitis were reported in 95.8%, 98.6%, 72.5%, 44.8%, 13.9%, 6.8%, 6.2%, 3.7% and 1.4% of the patients, respectively. It was also reported that 73 patients (20.7%) had histories of allergic diseases: AD (5 cases, 1.4%), AR (36 cases, 10.2%), BA (19 cases, 5.4%) and FA (30 cases, 8.5%). This percentage was significantly lower than in a survey that Japan's Ministry of Health, Labour and Welfare conducted for healthy population (47.6%) (odds ratio = 0.29, 95% confidence interval = 0.22-0.38, p=4.9×10-22). Frequencies of posterior/pan-uveitis, relatively severe ocular findings, and visual prognosis were not affected by a history of allergic diseases in BD. CONCLUSIONS: Patients with BD had fewer complications from allergic diseases than did the entire population of Japan.

[Foreign Body in the Anterior Chamber 10 Months after Uneventful Cataract Surgery].

PURPOSE: A foreign body detected in the anterior chamber 10 months after uneventful sutureless cataract surgery. CASE REPORT: Clear corneal phacoemulsification and intraocular lens placement (PEA + IOL) were performed on a 74-year-old man suffering from vision loss caused by senile cataracts. After uneventful surgery, the postoperative course appeared to be problem-free. OBSERVATION: However, 10 months after the operation, the patient reported blurred vision. Slit-lamp examination revealed an oil droplet, reminiscent of a foreign body, about 1 mm in diameter, on the IOL surface. The visual acuity problem did not become exacerbated and the anterior segment of the eye remained intact. Although we removed the foreign body, qualitative testing was impossible because the body disintegrated. CONCLUSIONS: A rare case of a foreign body in the anterior chamber 10 months after uneventful PEA + IOL. We are of the view that the body may have been composed of ophthalmic ointment delivered from the conjunctival sac at the end of surgery.

Risk Factors for Age-Related Macular Degeneration in an Elderly Japanese Population: The Hatoyama Study.

PURPOSE: To estimate the risk factors of AMD in an elderly Japanese population from a suburban area north of metropolitan Tokyo. METHODS: The Hatoyama Cohort Study was launched in 2010, and 742 persons participated in the baseline study. Among these participants, 596 persons who attended the 2-year follow-up examinations in 2012 were evaluated, and the presence of early and late AMD was determined via grading of their fundus photographs. Based on the cohorts' data, logistic regression analyses were performed to identify the risk factors for AMD. The possible risk factors that we examined were age, sex, medical history of systemic disorders, smoking, inflammatory markers at baseline, and the complement factor H (CFH) I62V and age-related maculopathy susceptibility 2 (ARMS2) A69S variants. RESULTS: We assessed 480 participants (40.0% women) who had gradable fundus photographs. The prevalence of early AMD was 37.9% and the prevalence of late AMD was 0.6%. Mantel-Haenszel analysis revealed that the CFH I62V and ARMS2 A69S variants were significantly associated with the prevalence of AMD (P = 0.029 and 0.025, respectively). CONCLUSIONS: The CFH I62V and ARMS2 A69S variants were significantly associated with the prevalence of AMD. (www.umin.ac.jp/ctr number, UMIN000014520.).

Statistical analyses of Endogenous Uveitis Patients (2007-2009) in central Tokyo area and Comparison with Previous Studies (1963-2006).

PURPOSE: To investigate the frequencies of the diseases in the new patients with uveitis during 2007-2009 and compare them with previously-reported data from the University of Tokyo Hospital. METHODS: We retrospectively analyzed the clinical records of patients who visited the outpatient clinic from January 2007 to December 2009, and compared them with those of 1963-2006. RESULTS: During 2007-2009, 468 new patients visited our hospital. Definite diagnoses were made in 63.0%. Frequent diagnoses include sarcoidosis (9.4%), Vogt-Koyanagi-Harada (VKH) disease (7.9%), herpetic iritis (6.0%), Behçet's disease (5.6%), Posner-Schlossman syndrome (4.3%), HLA-B27-associated uveitis (3.0%), and intraocular malignant lymphoma (2.8%). Compared with our former findings, the ratios of sarcoidosis, herpetic iritis, CMV retinitis, Fuch's heterochromic iridocyclitis, acute retinal necrosis and intraocular lymphoma increased, while that of Behçet's disease decreased. CONCLUSIONS: Top three uveitis during 2007-2009 were sarcoidosis, VKH disease, herpetic iritis. Reduced frequency of Behçet's disease was one of the most prominent characteristics.

The utility of rebound tonometer in late elderly subjects.

BACKGROUND: To compare intraocular pressure (IOP) readings using the Icare rebound tonometer (RBT) versus the Goldmann applanation tonometer (GAT) in late elderly (aged 75 years or older) subjects with or without glaucoma, and to evaluate the influence of central corneal thickness (CCT) on IOP readings. METHODS: The IOP measurements were obtained using the RBT and GAT, and CCT was measured using a specular-type microscope. Bland-Altman analysis was used to assess the clinical agreement between the two instruments. The influence of CCT adjusted for age on IOP readings was analyzed by multiple linear regression analysis. RESULTS: This study included 58 eyes of 29 normal subjects and 54 eyes of 28 glaucoma patients. The mean age was 80.7±4.3 years (normal subjects) and 83.1±5.1 years (glaucoma patients). The mean IOP readings were 13.6±3.5 mmHg and 13.2±2.8 mmHg (using the RBT and GAT, respectively) for normal subjects, and 13.6±3.3 mmHg and 13.5±2.9 mmHg for glaucoma patients. The 95% confidence interval of the differences between the two instruments was -3.3 to 4.0 mmHg for normal subjects and -2.9 to 1.6 mmHg for glaucoma patients. The IOP readings by two instruments were significantly correlated with CCT in eyes with glaucoma (for the RBT, ß=0.036 and P=0.002, and for the GAT, ß=0.021 and P=0.033) but not in normal eyes. CONCLUSION: IOP readings measured using the RBT and GAT showed within the allowable range in the late elderly subjects with or without glaucoma. Eyes with glaucoma were correlated closely with CCT using each instrument.

Treatment of recurrent anterior uveitis with infliximab in patient with ankylosing spondylitis.

BACKGROUND: We describe a HLA-B27-positive Japanese man with recurrent severe anterior uveitis OU and ankylosing spondylitis (AS) who was successfully treated with infliximab. CASE: A 25-year-old HLA-B27-positive Japanese man presented with recurrent anterior uveitis OU. The symptoms were consistent with typical HLA-B27-associated uveitis, whereas the subsequent course, which consisted of frequent episodes of recurrent severe anterior uveitis, was atypical. Although the patient was treated with intensive topical corticosteroids, cycloplegic treatment, sub-Tenon triamcinolone acetonide injections, systemic corticosteroids and immunosuppressive agents, recurrence of the anterior uveitis persisted. Over 8 years there were 14 documented episodes of recurrent anterior uveitis OD and 10 OSs. At age 33, the patient was diagnosed with AS after a radiographic examination. We began infusions of infliximab (2.5 mg/kg) at 0, 2 and 6 weeks, and then every 8 weeks thereafter. The recurrent uveitis disappeared, and the immunosuppressive agents and oral corticosteroids were tapered and discontinued without relapse. All drugs other than infliximab were successfully stopped in October 2010. During the follow-up period, there were no adverse events. CONCLUSION: A case of severe recurrent anterior uveitis OU in a patient with AS with infliximab was successfully treated. This is the first report describing the efficacy of infliximab in AS-associated uveitis in Japan.

Common variants on chromosome 9p21 are associated with normal tension glaucoma.

Although intraocular pressure (IOP) is the most definitive cause of glaucoma, a subtype of open angle glaucoma (OAG) termed normal tension glaucoma (NTG), which occurs in spite of normal IOP, accounts for a large part of glaucoma cases, especially in Japan. To find common genetic variants contributing to NTG in Japanese patients, we conducted a genome-wide association study (GWAS). We performed the first screening for 531,009 autosomal SNPs with a discovery cohort of 286 cases and 557 controls, and then a second screening for the top 30 suggestive loci in an independent cohort of 183 cases and 514 controls. Our findings identified a significantly associated SNP; rs523096 [combined p-value = 7.40× 10(-8), odds ratio (OR)= 2.00 with 95% confidence interval (CI) 1.55-2.58] located 10 kbp upstream of CDKN2B on chromosome 9p21. Moreover, analysis of another independent case-control set successfully replicated the results of the screening studies (combined values of all 3 stages p = 4.96 × 10(-11), OR= 2.13 with 95% CI 1.69-2.68). The SNPs near rs523096 were recently reported to be associated with OAG associated with elevated IOP in primary open-angle glaucoma (POAG), the predominant subtype of glaucoma in Caucasian populations. Our results revealed that the 9p21 locus is also associated with NTG in Japanese. In addition, we identified SNPs more strongly associated with NTG.