[Side Effects of Low Dose Atropine].

PURPOSE: Because highmyopia causes severe visual impairment, it is important to prevent the progression of myopia. Recently, the prevention of myopia progression by low dose atropine was reported from Singapore. We started the study of low dose atropine in Japanese children, with the aim of investigating the side effects of low dose atropine. SUBJECT AND METHODS: The participants were 16 children between the age of 6 and 12. They receive 0.01% atropine once nightly in both eyes. Refractive error, distant vision, near vision, accommodation and pupil diameter were checked before (baseline) and two weeks after the treatment (second baseline). Also, we checked subjective symptoms and adverse events. RESULTS: There was no significant change between baseline and second baseline in the refractive error, distant vision, near vision. Accommodation decreased mean 1.5 D (p < 0.01) and the pupil diameter was mean 0.7 mm larger (p < 0.0001), but the subjective symptoms were minimal. Accommodation and pupil diameter showed significant changes. Severe subjective symptoms and adverse events were not found in any of the cases. CONCLUSION: The side effects of low dose atropine were not severe. The treatment could be continued for the prevention of myopia.

Natural course of myopic traction maculopathy and factors associated with progression or resolution.

PURPOSE: To investigate the natural course of myopic traction maculopathy and to identify the factors associated with its progression or resolution in 207 highly myopic eyes. DESIGN: Retrospective, consecutive case series. METHODS: We investigated 207 highly myopic eyes with myopic traction maculopathy by optical coherence tomography (OCT) and followed the patients for at least 24 months. The size of the macular retinoschisis was categorized according to its extent and location relative to the fovea. The clinical data, status of the myopic traction maculopathy, and changes in the posterior vitreous and inner limiting membrane (ILM) were analyzed during the natural course of the disease process. RESULTS: During a mean follow-up of 36.2 ± 6.2 months, 8 of 207 eyes (3.9%) showed a decrease or complete resolution of the macular retinoschisis. Of these 8 eyes, 6 had release of retinal traction in the OCT images, and 4 of the 6 eyes developed posterior vitreous detachment. A spontaneous disruption of the ILM occurred in 2 eyes before the improvement of the myopic traction maculopathy. Of the 207 eyes, 24 (11.6%) experienced progression of the myopic traction maculopathy. The eyes with more extensive macular retinoschisis showed progression significantly more commonly (42.9%) than the eyes having less extensive macular retinoschisis areas (6.7%). CONCLUSIONS: The natural course of myopic traction maculopathy varies, and eyes with more extensive macular retinoschisis tend to progress more commonly. A complete resolution of macular retinoschisis can occur after a release of traction on the retina. These findings can be used to determine whether surgery should be performed.

Changes of axial length measured by IOL master during 2 years in eyes of adults with pathologic myopia.

OBJECTIVE: To examine the change of the axial length measured by IOL Master in adults with high myopia during a 2-year period. DESIGN: Open-label, consecutive, prospective longitudinal case series. METHODS: One hundred and eighty-five eyes of 185 consecutive patients with bilateral high myopia (myopia ≤ -6 diopters (D) or axial length ≥ 26.5 mm) were studied. The mean age of the patients was 48.4 ± 12.2 years, with a range of 22 to 84 years. The axial length, the anterior chamber depth, and the radius of curvature of the cornea were measured by IOL Master at the initial examination and at 2 years after the first visit. The significance of the changes in the axial length after the 2-year periods was determined. Multiple regression analyses were performed to identify the factors which were significantly associated with the increase of the axial length. RESULTS: The mean axial length increased significantly from 29.35 ± 1.80 mm to 29.48 ± 1.85 mm in 2 years, a mean increase of 0.13 mm with a range of -0.12 to 1.10 mm. The difference in the increase of the axial length between the patients with and without a posterior staphyloma was not significant. Among the possible explanatory factors, age, axial length, anterior chamber depth, the radius of curvature of the cornea, and intraocular pressure at the initial examination, the increase in the axial length was significantly and positively correlated with the axial length at the initial examination. CONCLUSIONS: The measurement by IOL Master in a large population of highly myopic patients clearly showed that the axial length continued to increase in a span of 2 years even in the 4th decade of life. The eyes with longer axial length showed a greater increase of axial length, suggesting the possibility that the more myopic eyes become more myopic with increasing age.

Association between shape of sclera and myopic retinochoroidal lesions in patients with pathologic myopia.

PURPOSE: The purpose of the study was to analyze the shape of the sclera determined by swept-source optical coherence tomography (OCT) and to determine the relationship between the shape and the myopic retinochoroidal lesions. METHODS: We studied 488 eyes of 272 patients with high myopia (refractive error ≥-8.00 diopters [D] or axial length >26.5 mm) and 43 emmetropic eyes of 43 controls (refractive error ≤±3 D). An image of the sclera was obtained by a swept-source OCT prototype instrument that uses a wavelength sweeping laser centered on 1 µm wavelength with an A-scan repetition rate of 100,000 Hz. The scans were 12 mm radial scans centered on the fovea. Seventy eyes were also examined by three-dimensional magnetic resonance imaging (3D MRI) to obtain the contour of the outer surface of the eyes. The main outcome measures, visibility of the entire sclera layer, scleral thickness, scleral contour, and location of the most protruded point of the globe, were obtained by swept-source OCT and 3D MRI. RESULTS: The entire thickness of the sclera was observed in 278 of 488 (57.0%) highly myopic eyes, but the outer border was not observed in any of the emmetropic eyes. The mean subfoveal scleral thickness was 227.9 ± 82.0 µm in the highly myopic eyes. The sclera was thickest at 3000 µm nasal to the fovea. The curvatures of the inner scleral surface of highly myopic eyes could be divided into curvatures that sloped toward the optic nerve, those that were symmetrical and centered on the fovea, those that were asymmetrical, and those that were irregular. Patients with irregular curvature were significantly older and had significantly longer axial lengths than those with other curvatures. Myopic fundus lesions were present significantly more frequently in the eyes with irregular curvature. All of the eyes whose scleral curvature sloped toward the optic nerve had nasally distorted shape in the 3D MRI images, and all eyes with temporally dislocated shape had irregular curvature. CONCLUSIONS: In vivo evaluations of the sclera in highly myopic eyes by swept-source OCT can provide important information on deformations of the sclera and how such deformities are related to myopic fundus lesions.

Quantitative analyses of high-resolution 3D MR images of highly myopic eyes to determine their shapes.

PURPOSE: We analyzed the symmetry and pointedness of the posterior segment of highly myopic eyes. METHODS: We studied 234 eyes of 117 patients with bilateral high myopia (refractive error ≤-8.00 diopters [D]) and 40 eyes of 20 patients with emmetropia (refractive error between -1.0 and +1.0 D). Volume renderings of high-resolution magnetic resonance (MR) images were performed to obtain 3D images of the eye. To analyze the symmetry and pointedness of the posterior surface, a software was developed to measure the area and angle of a fan-shaped segment formed by selected points on the MR images. RESULTS: All of the emmetropic eyes were symmetrical in the horizontal and sagittal planes with no deformity. In highly myopic eyes, the shape was symmetrical in the horizontal plane in 146 eyes (62.4%) and in the sagittal plane in 162 (69.2%). The shape of the posterior pole was pointed (angle of fan-shaped segment <150°) in 45.7% and blunted (angle ≥150°) in 54.3% of highly myopic eyes. The most common shape was symmetrical in the horizontal and sagittal planes, and the posterior surface was blunt. The shape of the two eyes of the same individual was the same in 61 of 117 patients (52.1%). In 56 patients whose two eyes had different shapes, the most frequent pattern was a difference in the pointedness (51.8%). CONCLUSIONS: Quantitative assessments of the shape of eyes were useful in determining the pattern of eye shape deformity specific to pathologic myopia.

Intrachoroidal cavitation in macular area of eyes with pathologic myopia.

PURPOSE: To determine the incidence and characteristics of intrachoroidal cavitations in the macular area of eyes with high myopia. DESIGN: Prospective, noninterventional case series. METHODS: We evaluated 56 eyes of 44 patients with pathologic myopia (myopic spherical equivalent >8 diopters) and with patchy chorioretinal atrophy using a swept-source optical coherence tomographic (OCT) system with a center wavelength of 1050 nm. We focused on the changes in the scleral curvature in the area of patchy atrophy. The relationship of the macular intrachoroidal cavitation and retinoschisis was also analyzed. Sixty-eight consecutive patients with pathologic myopia but without patchy atrophy were analyzed as controls. RESULTS: In 31 of 56 eyes (55.4%) with patchy atrophy, the swept-source OCT images showed that the sclera was bowed posteriorly in and around the patchy atrophy compared to neighboring sclera, whereas none of the 68 patients without patchy atrophy showed this finding. Macular intrachoroidal cavitation had OCT features similar to peripapillary intrachoroidal cavitation; the choroid in the macular intrachoroidal cavitation area appeared thickened and the retina was caved into the cavitation. There was a direct communication between the vitreous and intrachoroidal cavitation in 3 eyes. Retinoschisis was observed significantly more frequently in or around the patchy atrophy in eyes with macular intrachoroidal cavitation than in those without cavitation. CONCLUSIONS: These findings suggest that patchy atrophy affects the scleral contour within posterior staphyloma beyond the funduscopically identified patchy atrophy by macular intrachoroidal cavitation. Such deformation of sclera may facilitate the development of retinoschisis in and around the patchy atrophy.

Acquired optic nerve and peripapillary pits in pathologic myopia.

PURPOSE: To examine the incidence and characteristics of pit-like structures around the optic disc and myopic conus in eyes with high myopia. DESIGN: Prospective, observational case series. PARTICIPANTS: We evaluated 198 eyes of 119 patients with pathologic myopia (spherical equivalent >-8 diopters [D]). We also evaluated 32 eyes of 32 subjects with emmetropia (refractive error ≤±3 D) as controls. METHODS: The papillary and peripapillary areas were examined with a prototype swept-source optical coherence tomography (OCT) system with a center wavelength of 1050 nm. We studied the structural characteristics of pit-like changes. MAIN OUTCOME MEASURES: The incidence and characteristics of the optic nerve (ON) pits in eyes with high myopia. RESULTS: Pit-like clefts were found at the outer border of the ON or within the adjacent scleral crescent in 32 of 198 highly myopic eyes (16.2%) but in none of the emmetropic eyes. The eyes with these pits were more myopic, had significantly longer axial lengths, and had significantly larger optic discs than the highly myopic eyes without pits. The pits were located in the optic disc area (optic disc pits) in 11 of 32 eyes and in the area of the conus outside the optic disc (conus pits) in 22 of 32 eyes. One eye had both optic disc pits and conus pits. The optic disc pits existed in the superior or inferior border of the optic disc. All but 1 eye with conus pits had a type IX staphyloma, and the location of the conus pits were present nasal to the scleral ridge or outside the ridge temporal to the nerve. The optic disc pits were associated with discontinuities of the lamina cribrosa, whereas the conus pits appeared to develop from a scleral stretch-associated schisis or to emissary openings for the short posterior ciliary arteries in the sclera. The nerve fiber tissue overlying the pits was discontinuous at the site of the pits. CONCLUSIONS: Optic nerve pits are common in highly myopic eyes. The ON pits are barely visible ophthalmoscopically but can be demonstrated by using swept-source OCT.

Two-year outcomes of intravitreal bevacizumab for choroidal neovascularization in Japanese patients with pathologic myopia.

PURPOSE: To determine the 2-year results of intravitreal bevacizumab in highly myopic eyes with choroidal neovascularization (CNV). METHODS: An open-label, consecutive, interventional case series. Seventy-five eyes of 69 consecutive Japanese patients with either subfoveal or nonsubfoveal myopic CNVs were studied. The eyes were treated with intravitreal bevacizumab and followed-up for at least 2 years. The best-corrected visual acuities at the baseline in eyes with subfoveal CNV were compared with that in eyes with nonsubfoveal CNV at 2 years after the intravitreal bevacizumab. RESULTS: The difference between the mean best-corrected visual acuity at the baseline and that at 2 years in eyes with a subfoveal CNV was not significant. However, the mean best-corrected visual acuity in eyes with nonsubfoveal CNV was significantly improved from 0.53 ± 0.36 logarithm of the minimal angle of resolution units (Snellen 20/66) before intravitreal bevacizumab to 0.29 ± 0.36 logMAR units (Snellen 20/40) (P < 0.001) 2 years after intravitreal bevacizumab. The incidence of chorioretinal atrophy after 2 years was 3 of 49 (6.1%) in eyes with nonsubfoveal CNV and 21 of 26 (80.8%) in eyes with which subfoveal CNV (P < 0.001). Furthermore, the chorioretinal atrophy area with nonsubfoveal CNV was 0.05 ± 0.21 mm, which was also significantly smaller than that of subfoveal CNV at 1.76 ± 1.60 mm (P < 0.001). CONCLUSION: Intravitreal bevacizumab is a good treatment for eyes with nonsubfoveal CNV; however, another treatment is necessary for eyes with a subfoveally located CNV.

Imaging retrobulbar subarachnoid space around optic nerve by swept-source optical coherence tomography in eyes with pathologic myopia.

PURPOSE: To examine the subarachnoid space (SAS) of eyes with pathologic myopia and analyze the characteristics of the SAS and the surrounding tissues by swept-source optical coherence tomography (OCT). METHODS: One hundred thirty-three eyes of 76 patients with pathologic myopia (spherical equivalent refractive error of >-8.00 diopters (D) or an axial length >26.5 mm) and 32 eyes of 32 subjects with emmetropia were enrolled. The eyes in both groups were not tested to determine whether glaucoma was present. The papillary and peripapillary areas were examined with a swept-source OCT prototype system that uses a wavelength sweeping laser operated at 100,000 Hz A-scan repetition rate in 1-µm wavelength. RESULTS: In the B-scan images, the arachnoid trabeculae inside the SAS were clearly observed as a pattern of reticular lines and dots interspersed with hyporeflective zones consistent with fluid, whereas orbital fat had more uniform features with gray intervening spaces. The SAS was triangular, with the base toward the eye surrounding the optic nerve in the region of the scleral flange. An SAS was found in 124 highly myopic eyes (93.2%) but not in the emmetropic eyes. The shortest distance between the inner surface of lamina cribrosa and SAS was 252.4 ± 110.9 µm, and the thinnest region of peripapillary sclera above SAS (scleral flange thickness) was 190.6 ± 51.2 µm. In one myopic patient, there appeared to be direct communication between the intraocular cavity and SAS through pitlike pores. CONCLUSIONS: Optic SAS is seen in 93% of highly myopic eyes, and the SAS appears to be dilated in highly myopic eyes. The expanded area of exposure to CSF pressure along with thinning of the posterior eye wall may influence staphyloma formation and the way in which certain diseases, such as glaucoma, are manifested.

Characteristics of periconus choroidal neovascularization in pathologic myopia.

PURPOSE: To examine the clinical characteristics of periconus choroidal neovascularizations (CNVs) in eyes with pathologic myopia. DESIGN: Retrospective observational case series. METHODS: We reviewed the medical records of 260 eyes of 254 patients with a myopic CNV and selected those with a periconus CNV. A periconus CNV was defined as a CNV that is located next to a myopic conus. To differentiate a periconus CNV from a subfoveal CNV that has expanded to the edge of the disc, eyes whose CNV involved the fovea were excluded. The data of the eyes with a subfoveal CNV were used for comparison. RESULTS: Eleven eyes (4.2%) of 11 patients had a periconus CNV. These CNVs had a triangular or oval shape whose base was directed toward the myopic conus. The eyes with a periconus CNV had a significantly larger myopic conus than eyes with a subfoveal myopic CNV. The degree of myopia and axial length were not significantly associated with the incidence of periconus CNV. In 5 of the 11patients, the periconus CNV had a spontaneous regression without treatment, and none had a recurrence. The other 6 patients received treatment and obtained an angiographic closure after a single treatment. A chorioretinal atrophy (ChRA) developed in 3 eyes, and the ChRA enlarged over the fovea in 2 of these eyes, which led to a significant decrease of vision. CONCLUSION: A periconus CNV is rare (4.2%) among the eyes with a myopic CNV and is more likely to develop in eyes with a large myopic conus. The absence of a significant association between the degree of myopia and incidence of periconus CNV suggests that the morphologic characteristics of the eye are not the causes of the periconus CNV. Although an angiographic closure can be easily attained with or without the treatment, the later development and progression of ChRA can impair vision.

Long-term development of significant visual field defects in highly myopic eyes.

PURPOSE: To identify the characteristics that are associated significantly with visual field (VF) defects in highly myopic eyes. DESIGN: Retrospective, observational series. METHODS: The medical records of 492 eyes of 308 patients with high myopia (myopic refractive error > 8 diopters or axial length ≥ 26.5 mm) with a follow-up of 5 years or more were reviewed. The VFs were determined by Goldmann kinetic perimetry, and the VFs were quantified in 100 sectors within the V4 isopter. Eyes with loss of 10% or more of the sectors were classified as having significant VF defects, and a further loss of 10% or more during the follow-up period was classified as a significant progression. To avoid the influence of the posterior fundus changes resulting from the high myopia, eyes with any type of myopic macular or peripheral lesions that could cause visual field defects were excluded. RESULTS: Significant VF defects were newly developed in 13.2% of these selected highly myopic eyes during a mean follow-up ± standard deviation of 11.6 ± 5.5 years. The incidence of significant VF defects in myopic eyes was significantly higher in eyes with an oval optic disc than that in eyes with a round optic disc. An oval optic disc was present significantly more frequently in the myopic eyes with VF defects. Temporal and nasal VF defects were present in the same eye. Among the eyes with significant VF defect, the temporal VF defects were observed in 61.5% of the eyes with round discs, in 75.0% of the eyes with vertically oval discs, and in 68.2% of the eyes with obliquely oval discs. During a mean follow-up ± standard deviation of 10.2 ± 3.4 years, 73.8% of the eyes showed a significant progression of the VF defects. An abrupt change of the scleral curvature (types VII and IX staphyloma by Curtin) was the only factor significantly associated with a progression of the VF defects. CONCLUSIONS: Because the VF defects are progressive, we suggest that high myopia is a high risk factor for VF defects and that these eyes be examined at least once yearly. The combination of stretching and distortion of the optic nerve fibers resulting from an abrupt change of scleral curvature may be the factors that lead to the damage of the optic nerve fibers in highly myopic eyes.

Macular detachment after successful intravitreal bevacizumab for myopic choroidal neovascularization.

PURPOSE: To determine the incidence and features of macular retinal detachment (RD) after successful intravitreal injection of bevacizumab (IVB) for the treatment of myopic choroidal neovascularizations (CNVs). METHODS: Seventy-four eyes of 74 patients who received IVB for myopic CNV were studied. Fluorescein angiography (FA) and optical coherence tomography (OCT) were performed at baseline, at 1 week after IVB, and every month thereafter. The shortest follow-up period was 6 months. RESULTS: Four eyes (5.4%) either developed or had increased macular RD after successful IVB. In the three eyes, macular RD newly developed 1 month after IVB despite the absence of dye leakage. The remaining eye had a limited area of macular RD at baseline and increased despite the disappearance of dye leakage from the CNV after the IVB. The four eyes that developed a macular RD had retinoschisis around the CNV before IVB, whereas none of the 70 other patients had a retinoschisis throughout the follow-up period. In all four eyes that either developed or had increased macular RD, outer lamellar holes were detected at the upper edge of the RD by OCT examinations, whereas none of the patients who did not develop a macular RD after IVB showed outer lamellar holes. CONCLUSIONS: These results suggest that there is a risk of developing macular RD after IVB in eyes with myopic CNV. Periodic OCT examinations are recommended for patients with myopic CNV to search for RDs after IVB.

Topographic analyses of shape of eyes with pathologic myopia by high-resolution three-dimensional magnetic resonance imaging.

OBJECTIVE: To analyze the topography of human eyes with pathologic myopia by high-resolution magnetic resonance imaging (MRI) with volume rendering of the acquired images. DESIGN: Observational case series. PARTICIPANTS: Eighty-six eyes of 44 patients with high myopia (refractive error ≥-8.00 diopters [D] or axial length >26.5 mm) were studied. Forty emmetropic eyes were examined as controls. METHODS: The participants were examined with an MRI scanner (Signa HDxt 1.5T, GE Healthcare, Waukesha, WI), and T(2)-weighted cubes were obtained. Volume renderings of the images from high-resolution 3-dimensional (3D) data were done by computer workstation. The margins of globes were then identified semiautomatically by the signal intensity, and the tissues outside the globes were removed. MAIN OUTCOME MEASURES: The 3D topographic characteristic of the globes and the distribution of the 4 distinct shapes of globes according to the symmetry and the radius of curvature of the contour of the posterior segment: the barrel, cylindric, nasally distorted, and temporally distorted types. RESULTS: In 69.8% of the patients with bilateral high myopia, both eyes had the same ocular shape. The most protruded part of the globe existed along the central sagittal axis in 78.3% of eyes and was slightly inferior to the central axis in the remaining eyes. In 38 of 68 eyes (55.9%) with bilateral pathologic myopia, multiple protrusions were observed. The eyes with 2 protrusions were subdivided into those with nasal protrusions and those with temporal protrusions. The eyes with 3 protrusions were subdivided into nasal, temporal superior, and temporal inferior protrusions. The eyes with visual field defects that could not be explained by myopic fundus lesions significantly more frequently had a temporally distorted shape. Eyes with ≥2 protrusions had myopic chorioretinal atrophy significantly more frequently than eyes with ≤1 protrusion. CONCLUSIONS: Our results demonstrate that it is possible to obtain a complete topographic image of human eyes by high-resolution MRI with volume-rendering techniques. The results showed that there are different ocular shapes in eyes with pathologic myopia, and that the difference in the ocular shape is correlated with the development of vision-threatening conditions in eyes with pathologic myopia. FINANCIAL DISCLOSURE(S): The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Natural history of lamellar macular holes in highly myopic eyes.

PURPOSE: To determine the natural course of lamellar macular holes (MHs) in highly myopic eyes. DESIGN: Prospective and observational case series. METHODS: Twenty-four eyes of 21 consecutive patients with a lamellar MH and high myopia (myopic refractive error >8 diopters or axial length ≥26.5 mm) were followed for ≥12 months. The changes of the optical coherence tomography (OCT) findings and the best-corrected visual acuity (BCVA) were analyzed. The progression of the lamellar MH to a full-thickness MH and the change of the BCVA were analyzed. RESULTS: At the initial examination, an epiretinal membrane was identified by OCT in 17 of the 24 eyes (70.8%) and 7 eyes (29.2%) had macular retinoschisis. Twenty-three of 24 eyes (95.8%) did not show any changes of the lamellar MH in the OCT images during a mean follow-up of 19.2 ± 10.2 months. However, the remaining eye progressed to a full-thickness MH and pars plana vitrectomy was required to close the MH. Except for this 1 eye, the BCVA was maintained (within 0.2 logMAR change) during the follow-up period of at least 1 year. CONCLUSIONS: A lamellar MH in highly myopic eyes is a relatively stable condition.

Clinical characteristics of patients with congenital high myopia.

BACKGROUND: Four cases of congenital high myopia showing similar myopic fundus changes. CASES: The clinical characteristics of four cases of congenital high myopia are presented, and the long-term course of one of these cases is described. OBSERVATIONS: One patient had a history of preterm delivery; however, the remaining patients had no ocular or systemic abnormalities that could account for the congenital myopia. All of the cases showed similar fundus findings, including tilting of the optic disc, temporal conus, and tessellated fundus. A type II posterior staphyloma was found in three of the cases. All of the patients had best-corrected visual acuity (BCVA) ≥ 0.4. One patient was followed for 30 years (from 6 to 36 years of age), and during those 30 years, the posterior fundus showed only a slight enlargement of a myopic conus and slight increase of the tilting of the optic disc despite a 3.0-mm increase in the axial length, and final BCVA was 1.0 OU. CONCLUSIONS: Long-term follow-up showed that the posterior fundus did not change radically and good vision as maintained in spite of a significant increase in the axial length.

Reduced expression of the ATRX gene, a chromatin-remodeling factor, causes hippocampal dysfunction in mice.

Mutations of the ATRX gene, which encodes an ATP-dependent chromatin-remodeling factor, were identified in patients with α-thalassemia X-linked mental retardation (ATR-X) syndrome. There is a milder variant of ATR-X syndrome caused by mutations in the Exon 2 of the gene. To examine the impact of the Exon 2 mutation on neuronal development, we generated ATRX mutant (ATRX(ΔE2)) mice. Truncated ATRX protein was produced from the ATRX(ΔE2) mutant allele with reduced expression level. The ATRX(ΔE2) mice survived and reproduced normally. There was no significant difference in Morris water maze test between wild-type and ATRX(ΔE2) mice. In a contextual fear conditioning test, however, total freezing time was decreased in ATRX(ΔE2) mice compared to wild-type mice, suggesting that ATRX(ΔE2) mice have impaired contextual fear memory. ATRX(ΔE2) mice showed significantly reduced long-term potentiation in the hippocampal CA1 region evoked by high-frequency stimulation. Moreover, autophosphorylation of calcium-calmodulin-dependent kinase II (αCaMKII) and phosphorylation of glutamate receptor, ionotropic, AMPA 1 (GluR1) were decreased in the hippocampi of the ATRX(ΔE2) mice compared to wild-type mice. These findings suggest that ATRX(ΔE2) mice may have fear-associated learning impairment with the dysfunction of αCaMKII and GluR1. The ATRX(ΔE2) mice would be useful tools to investigate the role of the chromatin-remodeling factor in the pathogenesis of abnormal behaviors and learning impairment.

Long-term results of photodynamic therapy for choroidal neovascularization in Japanese patients with pathologic myopia.

OBJECTIVE: To determine the results of photodynamic therapy (PDT) in highly myopic eyes with choroidal neovascularization (CNV). DESIGN: Open-label, consecutive, interventional case series. METHODS: Forty-eight eyes of 46 consecutive Japanese patients with a myopic CNV were studied. The eyes were treated with PDT and were followed up from 1 to 4 years. The best-corrected visual acuities (BCVAs) at the baseline and after the PDT were compared. Multivariate regression analyses were used to determine the factors that were significantly associated with the BCVA at 3 or 4 years. RESULTS: The mean follow-up period was 3.2 years. Sixty-nine percent of the patients obtained angiographic closure by a single PDT treatment, and the average number of PDT treatments was 1.4. Chorioretinal atrophy developed in 61% of the eyes at 3 years and in 70% of the eyes at 4 years. The BCVA did not change significantly after the PDT. Multivariate regression analyses showed that the BCVA at 3 years was significantly correlated with the baseline BCVA and area of chorioretinal atrophy. Analyses of the 20 patients at 4 years or more showed that in 5 of 7 (71.4%) patients with juxtafoveal CNV, chorioretinal atrophy did not develop and that all had BCVA of 0.5 or better. However, in 12 of the 13 patients with a subfoveal CNV, chorioretinal atrophy developed at 4 years, and 10 of these patients had BCVA of 0.1 or worse. CONCLUSIONS: In highly myopic patients, 69% obtained angiographic closure by a single PDT treatment, and recurrence was rare. These findings indicate that PDT is still a good option for treating CNVs in highly myopic patients.

Correlation between visual prognosis and fundus autofluorescence and optical coherence tomographic findings in highly myopic eyes with submacular hemorrhage and without choroidal neovascularization.

PURPOSE: To determine whether a significant correlation existed between the visual prognosis and fundus autofluorescence and optical coherence tomographic images in highly myopic eyes with simple macular bleeding. METHODS: We reviewed the charts of 31 eyes of 28 patients with high myopia and simple bleeding. The patients were divided into those whose best-corrected visual acuity (BCVA) was 20/32 and those with BCVA <20/32 at 6 months after absorption of the hemorrhage. RESULTS: At 6 months, 19 eyes had BCVA ≥0.7 and 12 eyes had BCVA <0.7. In the former group, the inner segment/outer segment line of photoreceptors was intact in optical coherence tomographic images at the onset but was defective in 75% of the eyes in the latter group. At 6 months, the inner segment/outer segment defect was absent in all the eyes in the former group but was observed in 67% of the latter group. A hypoautofluorescence was present at the area of the bleeding more frequently in the poor BCVA groups. CONCLUSION: An inner segment/outer segment defect at the onset of simple bleeding might be a useful sign to predict a limited visual recovery. The persistent hypofluorescence in fundus autofluorescence is probably caused by damage to the retinal pigment epithelium by the subretinal hemorrhage.