SptP106-136 plays a role in the complex formation with SptP-specific chaperone SicP.

SptP is a virulence effector protein of Salmonella that is involved in bacterial invasion into a host cell. For effective secretion, SptP forms a complex with SptP-specific chaperone SicP through its chaperone-binding domain, residues 35-139. Here, we suggest the possibility that residues 106-136 of SptP are important for complex formation with SicP by in vitro reconstitution experiments.

[Survey of triamcinolone-related non-infectious endophthalmitis].

PURPOSE: To survey non-infectious endophthalmitis related to triamcinolone acetonide (TA) for ocular diseases in Japan. SUBJECTS AND METHODS: A questionnaire was sent to the 24 committee members of the Japanese Retina and Vitreous Society requesting information regarding non-infectious endophthalmitis related to intravitreous TA administered from January through December 2009. The survey specifically covered the use of TA in intravitreal injections and intraoperatively during vitrectomy procedures. RESULTS: All 24 members responded to the survey involving intraviteal TA use in 562 eyes; 325 eyes for diabetic macular edema, 118 eyes for retinal vein occlusion, 91 eyes for uveitis, 11 eyes for age-related macular degeneration and 17 eyes had adjunctive use in retinal photocoagulation. Intraoperative use for visualizing vitreous was done in 6973 eyes. Noninfectious endophthalmitis occurred in 9 eyes (1.6%) after intravitreous TA and 7 eyes (0.1%) after intraoperative TA. The most frequent symptom was blurred vision with no pain or mild conjunctival injection. Sudden severe anterior chamber and vitreous inflammation occurred beginning on the day following surgery, but it disappeared spontaneously without complications. CONCLUSIONS: It was found that non-infectious endophthalmitis occurred after intravitreous TA. Although the visual prognosis is good, this complication should be recognized by retina specialists.

[Survey of the use of long-lasting expanding gases in ophthalmology in Japan].

PURPOSE: To survey the use of long-lasting expanding gases in ophthalmology in Japan. SUBJECTS AND METHODS: A questionnaire was sent to 1,236 teaching hospitals approved by the Japanese Ophthalmological Society requesting information regarding indications, methods, efficacy and complications related to the use of long-lasting expanding gases administered from January through December 2005. RESULTS: Four-hundred and fifty-nine hospitals responded to the survey (response rate 37.1%). A total of 174,221 ophthalmic surgeries were performed during the survey period, with long-lasting expanding gases used in 19,816 of cases (11.4%). The surgical procedure was vitrectomy in 89.6% of cases in which gas was administered. The most frequent indication for gas use was rhegmatogenous retinal detachment, for which SF6 was the preferred gas. Industrial use gas was utilized in 76.1% of cases, while 22.4% of cases received medical use gas. Increase in intraocular pressure was the most common complication of intraocular gas tamponade (3121 cases, 15.7%), followed by cataract formation. Ninety-eight percent of ophthalmologists responding supported the use of long-lasting expanding gases with vitrectomy, 85% with scleral buckling procedures, and 84% with surgery to remove subretinal hemorrhage. The consensus was that substantial deterioration of surgical results would occur if long-lasting expanding gases could not be used. CONCLUSIONS: Long-lasting expanding gases are being widely administered in ophthalmology in Japan, and appear to have good efficacy for a variety of indications. Several complications related to the use of these gases were reported, however the rates of complications were low.

[Survey of silicone oil for ocular diseases in Japan].

PURPOSE: To survey the use of silicone oil in clinical ophthalmology in Japan. SUBJECTS AND METHODS: Questionnaires were sent to 1,240 hospitals registered as being ophthalmology residency training institutions with the Japanese Ophthalmological Society as of September 2007. Responses were collected via the Internet and results totaled. The use of silicone oil at each institution for the 2006 one-year period was assessed, included queries regarding type of silicone oil, indication for use, results and complications. Hospitals were divided into non-specialty institutions, intermediate-specialty institutions and specialty institutions based on number of vitrectomy procedures performed in the one-year period, and trends were analyzed based on these divisions. RESULTS: Responses were received from 272 institutions (21.9% response rate). Of a total of 36,104 vitrectomy procedures, silicone oil was used in 2,170 cases (6.0%). The diagnosis was proliferative vitreoretinopathy in the majority of cases, followed by proliferative diabetic retinopathy and rhegmatogenous retinal detachment. The majority of institutions replied that the indication for use was complicated case. The type of silicone oil used was ophthalmic formulation in 120 institutions (54.1%) and industrial formulation in 73 institutions (32.9%). Specialty institutions had a higher rate of use of the industrial formulation. The average volume used at one time was 6.4 ml. The majority of institutions responded that silicone oil removal was performed at 3 months after the initial vitrectomy. Silicone oil was not removed in 530 cases in which continued tamponade was judged to be appropriate; this comprised 53.3% of cases at non-specialty institutions. The overall evaluation for silicone oil use was good; silicone oil was rated as being indispensable in 72 cases (31.2%) and effective in 130 cases (56.3%). Responses stating a high need for silicone oil were most frequent for proliferative vitreoretinopathy and proliferative diabetic retinopathy. Complications related to silicone oil use were glaucoma in 125 cases (5.6%), intraocular pressure elevation in 411 cases (18.4%), hypotony in 28 cases (1.3%), endophthalmitis in 5 cases (0.22%), retinal detachment in 13 cases (0.58%), corneal opacification in 105 cases (4.7%), inadvertant subretinal infusion in 31 cases (1.4%) and silicone oil emulsification in 82 cases (3.7%). It was the opinion of many institutions that, in cases where silicone oil could not be used, the number of necessary surgical procedures increased, with lower rates of cure and greater burden on the patient. CONCLUSIONS: Silicone oil was utilized in approximately 1 in every 17 vitrectomy procedures performed in 2006 by the Japanese institutions surveyed. Complications were observed, however overall the indications were appropriate and the use of silicone oil was judged to be necessary by nearly 90% of institutions surveyed.

Long-term follow-up results of pars plana vitrectomy for diabetic macular edema.

PURPOSE: To analyze the long-term effects of pars plana vitrectomy for diabetic macular edema. METHODS: Sixty-nine patients (73 eyes) with diabetic macular edema were examined retrospectively after pars plana vitrectomy. The mean follow-up time was 24.6 +/- 7.3 months. RESULTS: The postoperative best-corrected visual acuity (BCVA) at 12 months was significantly better than the preoperative BCVA, and the improvement was maintained for at least 24 months. The mean central retinal thickness (RT) at 3 months after surgery was significantly thinner than the preoperative central RT, and was maintained for at least 24 months in the cases followed for this period. The postoperative BCVA was significantly worse than the preoperative BCVA at 2 years after surgery in eyes with a preoperative BCVA of < or =0.05. In addition, there was lower probability that the postoperative BCVA would be > or =0.5 in eyes with a preoperative BCVA of <0.3. CONCLUSIONS: The results indicate that the improvement in the BCVA is attained by 12 months postvitrectomy, and is maintained for at least 24 months. The reduction in RT can be maintained for up to 24 months. The results also indicate that vitrectomy should be performed when the preoperative BCVA is >0.05 at worst.

[Study of surgical procedures for retinal detachment with macular hole].

PURPOSE: To evaluate the surgical outcome of retinal reattachment, the reattachment rate according to the range of detachment, and postoperative visual acuity for macular hole retinal detachment (MHRD). SUBJECTS AND METHODS: Sixty-eight eyes of 67 patients with MHRD were analyzed. The mean follow-up period was 54 months. RESULTS: Retinal reattachment occurred in 42/68 eyes (62%) after initial surgery. The reattachment rates were 6/23 eyes (26%) in the gas tamponade group, 13/19 eyes (68%) in the vitrectomy group, 23/ 26 eyes (88%) in the group that underwent removal of internal limiting membrane as adjunct to vitrectomy (ILM) group. In the additional surgery, the reattachment rates were 5/9 eyes (56%) in the gas tamponade group, 13 eyes (100%) in the vitrectomy group, 1/2 eyes (50%) in the ILM group, and 6 eyes (100%) in the macular prombe buckling group. No significant differences were seen in the detachment extent-related reattachment rate within the same surgery and the postoperative visual acuity between the groups. CONCLUSION: The results show that removal of ILM contributes to successful reattachment in the initial surgery, and that for non-reattachable eyes, macular buckling in the second surgery is the most reliable method.

[Survey of triamcinolone acetonide for ocular diseases in Japan].

PURPOSE: To survey the use of triamcinolone acetonide (TA) for ocular disease in Japan. SUBJECTS AND METHODS: A questionnaire was sent to 1,236 teaching hospitals approved by the Japanese Ophthalmological Society requesting information regarding indications, methods, efficacy and complications of TA administered from January through December 2005. The survey specifically covered the use of TA in intravitreal injections, sub-Tenon's injections and intraoperatively during vitrectomy procedures. RESULTS: Four-hundred and fifty-nine hospitals responded to the survey (response rate 36.9%) involving TA use in 44,827 eyes. Intravitreal injections of TA were administered to 5,665 eyes in 159 hospitals. The average dose was 6.53 mg for a single injection and was reported to have highest efficacy in eyes with diabetic macular edema, followed by retinal vein occlusion. Complications included cataract formation in 116 eyes (2.04%), glaucoma requiring filtration surgery in 32 eyes (0.56%), endophthalmitis in 7 eyes (0.12%), and blepharoptosis in 8 eyes (0.14%). Sub-Tenon's injections of TA were administered to 12,343 eyes in 308 hospitals. The average dose was 19.87 mg for a single injection and had the highest efficacy in eyes with diabetic macular edema, followed by retinal vein occlusion. Sub-Tenon's administration of TA was also frequently used for uveitis. Complications reported were cataract formation in 191 eyes (1.55%), glaucoma requiring filtration surgery in 33 eyes (0.26%), endophthalmitis in 1 eye (0.008%), periocular infection in 5 eyes (0.04%) and blepharoptosis in 43 eyes (0.35%). TA was used as an adjunct to vitrectomy in 26,819 eyes in 270 hospitals and was judged to be most useful in the separation of posterior hyaloid from the retina. Complications included cataract formation in 49 eyes (0.18%), glaucoma requiring filtration surgery in 32 eyes (0.56%), and endophthalmitis in 7 eyes (0.026%). CONCLUSIONS: TA is being widely administered for ocular diseases in Japan, and appears to have good efficacy in a variety of indications. Several complications related to TA use were reported, however the rates of complications were low.

[Two cases of retinal hemangioma treated by transpupillary thermotherapy].

PURPOSE: To evaluate transpupillary thermotherapy(TTT), the treatment was reviewed in two cases of retinal hemangioma which resisted photocoagulation. CASE 1: A 25-year-old man was referred to us for visual impairment in his right eye caused by retinal hemangioma. Although photocoagulation had been performed once in a previous hospital, the treatment was unsuccessful. His visual acuity was 0.1 OD. Ophthalmoscopic examination revealed a hemangioma located in the superotemporal peripheral retina with serous retinal detachment. We performed photocoagulation of the afferent artery and TTT of the hemangioma two times each. The hemangioma regressed and the serous retinal detachment resolved. The patient's visual acuity OD improved to 0.2. CASE 2: A 13-year-old girl was referred to us for visual impairment in her right eye caused by retinal hemangioma. Photocoagulation had been performed five times in a previous hospital, but the treatment was unsuccessful. Her visual acuity was 0.05 OD. Opthalmoscopic examination revealed a hemangioma located in the inferonasal peripheral retina with serous retinal detachment. We performed photocoagulation of the afferent artery two times and TTT of the hemangioma four times. The hemangioma regressed and the serous retinal detachment resolved. CONCLUSION: TTT is performed with a larger spot size, a longer wavelength, and a longer duration than photocoagulation. TTT could be an effective treatment for retinal hemangioma.

[Vitrectomy with circumferential peripheral retinotomy for massive subretinal hemorrhage].

PURPOSE: To assess the effect of vitrectomy with circumferential peripheral retinotomy on massive subretinal hemorrhage. METHOD: Eight patients (8 eyes) with massive subretinal hemorrhage of more than 2 quadrants, underwent pars plana vitrectomy between May 2000 and February 2004. The average age was 73.5 years. Seven patients (7 eyes) were male, and one was female (1 eye). An average of 207.5 degree circumferential peripheral retinotomy was carried out for removal of subretinal hemorrhage. The amount of postoperative subretinal hemorrhage, the improvement of visual acuity, and postoperative complications were evaluated. RESULTS: Postoperatively, the volume of subretinal hemorrhage decreased in all cases. The visual acuity improved in 7 of the 8 eyes (87.5%). Postoperatively, none of the cases developed proliferative vitreoretinopathy, but subretinal hemorrhage recurred in 2 eyes. CONCLUSIONS: Vitrectomy with circumferential peripheral retinotomy may reduce massive subretinal hemorrhage and increase visual acuity.

Changes in retinal pigment epithelium after indocyanine green-assisted internal limiting lamina peeling during macular hole surgery.

PURPOSE: To determine the changes in the retinal pigment epithelium (retinal pigment epithelium) and secondary changes in the choroid and fovea after indocyanine green (ICG) staining of the internal limiting lamina during surgery for an idiopathic macular hole (MH). DESIGN: Observational case series. METHODS: The medical charts of 31 patients who underwent MH surgical procedures with internal limiting lamina staining and peeling were reviewed. The eyes were examined by optical coherence tomography, scanning laser ophthalmoscopy, fluorescein, and ICG angiography. RESULTS: In three cases that experienced retinal pigment epithelium changes, there was foveal thinning and choriocapillary atrophy in the area of the previous MH. The visual acuity was markedly worse, and the retina was markedly thinner in these three cases than in the other cases without retinal pigment epithelium changes (P = .003, P = .009, respectively). CONCLUSION: The use of ICG dye with illumination may increase the risk of retinal pigment epithelium damage and secondary choroidal and foveal morphologic changes.

Neurotrophic factor receptors in epiretinal membranes after human diabetic retinopathy.

OBJECTIVE: Formation of epiretinal membranes (ERMs) in the posterior fundus results in progressive deterioration of vision. ERMs have been associated with numerous clinical conditions, including proliferative diabetic retinopathy (PDR), but its pathogenic mechanisms are still unknown. This study was conducted to determine whether neurotrophic factor receptors (tyrosine kinase receptors trkA, trkB, and trkC; low-affinity neurotrophin [NT] receptor p75 [p75(NTR)]; glial cell line-derived neurotrophic factor receptor-alpha1 [GFR alpha 1] and GFR alpha 2; and Ret) are involved in the formation of ERMs after PDR. RESEARCH DESIGN AND METHODS: ERM samples were obtained by vitrectomy from 19 subjects with PDR aged 57 +/- 8 years with 17 +/- 8 years of diabetes and 15 subjects with idiopathic ERM. They were processed for RT-PCR analysis. In addition, 11 ERM samples from PDR patients aged 47 +/- 18 years with 13 +/- 4 years of diabetes were processed for immunohistochemical analysis. RESULTS: Expressions of trkA, trkB, trkC, p75(NTR), and Ret mRNAs were similar in both groups. In contrast, GFR alpha 2 expression levels were significantly higher (17 of 19 vs. 2 of 15 subjects in idiopathic ERM, P < 0.0001) in PDR subjects. Accordingly, immunohistochemical analysis revealed expression of GFR alpha 2 protein in all of the 11 ERMs derived from PDR patients, and that region was double-labeled with glial cell-specific markers. On the other hand, GFR alpha 1 expression was lower (8 of 19 vs. 12 of 15 subjects with idiopathic ERM, P = 0.0258) in PDR subjects. CONCLUSIONS: These results suggest a possibility that glial cell line-derived neurotrophic factor receptor (GDNF) subtypes are differently involved in the formation of ERMs.

Diverse NF-kappaB expression in epiretinal membranes after human diabetic retinopathy and proliferative vitreoretinopathy.

PURPOSE: Formation of epiretinal membranes (ERMs) after proliferative diabetic retinopathy (PDR) and proliferative vitreoretinopathy (PVR) results in progressive deterioration of vision, but its pathogenic mechanisms are still unknown. This study was conducted to examine the role of nuclear factor kappa B (NF-kappaB) in the formation of ERMs after PDR and PVR. METHODS: ERM samples were obtained by vitrectomy from 10 patients with PDR (aged 53+/-12 years with 14+/-5 years of diabetes), 20 patients with PVR, and 17 patients with idiopathic ERMs. Ten PVR and 17 idiopathic ERM samples were processed for reverse transcription-polymerase chain reaction (RT-PCR) analysis. In addition, 10 PDR and 10 PVR membranes were processed for immunohistochemical analysis. RESULTS: NF-kappaB mRNA expression levels were significantly higher (10 of 10 versus 9 of 17 subjects in idiopathic ERM, p=0.0119) in PVR subjects. Immunohistochemical analysis showed NF-kappaB protein expression in 8 of the 10 PDR samples as well as all 10 PVR samples, and NF-kappaB positive cells were partially double labeled with glial cell markers. Interestingly, NF-kappaB protein was also overlapped with angiogenic factor interleukin-8 (IL-8) in glial cells as well as vascular endothelial cells. CONCLUSIONS: These results suggest that NF-kappaB is involved in the formation of both glial and vascular endothelial cell components, and that these two cell types might have functional interactions that lead to the enlargement of intraocular proliferative membranes.

Vitrectomy with or without arteriovenous adventitial sheathotomy for macular edema associated with branch retinal vein occlusion.

PURPOSE: compare the results of vitrectomy with or without arteriovenous (AV) crossing sheathotomy for macular edema associated with branch retinal vein occlusion (BRVO). DESIGN: Interventional case series. METHODS: A retrospective study of 36 eyes with BRVO-associated macular edema. Twenty eyes underwent AV sheathotomy (AS group), and 16 eyes underwent posterior vitreous detachment (PVD group). Best-corrected visual acuity (BCVA), fluorescein angiography (FA), and optical coherence tomography to determine foveal thickness were conducted preoperatively and at 12 months postoperatively. RESULTS: The mean postoperative BCVAs were significantly better in both the AS and the PVD group (P = .008 and P = .001, respectively). Foveal thickness decreased significantly 1 month after surgery in both groups (P = .002 and P = .007) and continued to decrease up to 12 months. The postoperative mean BCVA and improvement of BCVA and foveal thickness were not significantly different for the two groups at any postoperative period. Postoperative FA showed reperfusion of the occluded vein in 10 eyes in the AS group and 2 eyes in the PVD group, and formation of shunt vessels at the AV crossing site or around the macular region in all of the other eyes of both groups. CONCLUSIONS: Both AV sheathotomy and simple PVD significantly reduced macular edema associated with BRVO. However, there was no significant difference in the improvement of macular function following either procedure. Postoperative improvement of retinal circulation by either reperfusion of the occluded vein or collateral vessel formation was found. This accounted for functional and morphologic improvements.

Early postoperative retinal thickness changes and complications after vitrectomy for diabetic macular edema.

PURPOSE: To determine the early postoperative changes in retinal thickness and complications after pars plana vitrectomy for diabetic macular edema. DESIGN: Consecutive interventional case series. METHODS: Studied retrospectively, pars plana vitrectomy was performed on 65 consecutive eyes of 63 patients with diabetic macular edema. The follow-up interval ranged from 6 to 36 months (12.6 +/- 7.4 months [mean +/- standard deviation (SD)]). The indications of pars plana vitrectomy in this study were (1) diffuse diabetic macular edema, (2) preoperative visual acuity less than 20/40, and (3) noneffective macular photocoagulation therapy. Preoperative and postoperative examinations by stereoscopic biomicroscopy, color fundus photography of the macula and optical coherence tomography (OCT) were performed on all eyes. Preoperatively, direct photocoagulation to microaneurysms in the macula had been performed in 48 eyes, and focal/grid photocoagulation had been performed in five eyes. Preoperative examination showed that epiretinal membranes were observed in 20 eyes, cystoid macular edema in 40 eyes, and 23 eyes had a complete posterior vitreous detachment (PVD). Epimacular membranes, removed during surgery, were examined histopathologically. RESULTS: The postoperative mean best-corrected visual acuity (logarithm of the minimum angle of resolution [logMAR] = 0.696 +/- 0.491 [mean +/- SD]) was significantly better than the preoperative mean best-corrected visual acuity (0.827 +/- 0.361; P <.0001; Wilcoxon signed-rank test). The final visual acuity improved by 2 or more lines in 32 of 65 eyes (45%), remained unchanged in 32 of 65 eyes (49%), and exacerbated after the surgery in 4 of 65 eyes (6%) due to neovascular glaucoma (2 eyes) and residual cystoid macular edema (2 eyes). The postoperative foveal retinal thickness (224.9 +/- 116.9 microm) at the last visit was significantly thinner than the preoperative foveal retinal thickness (463.7 +/- 177.3 microm; P <.0001; Wilcoxon signed-rank test). The foveal retinal thickness did not decrease linearly but fluctuated: The mean postoperative retinal thickness had decreased significantly 7 days after surgery, then remained unchanged for approximately 1 month, and thereafter gradually decreased until 4 months. The intraoperative and postoperative complications included peripheral retinal tear in 3 of 65 (4.6%) eyes, postoperative rhegmatogenous retinal detachment in 1 of 65 (1.5%) eyes, neovascular glaucoma in 3 of 65 (5%) eyes, recurrent vitreous hemorrhage in 1 of 65 (1.5%) eyes, hard exudates in the center of the macula in 3 of 56 (4.6%) eyes, postoperative epiretinal membrane formation in 9 of 65 (13.8%) eyes, and a lamellar macular hole in 1 of 65 (1.5%) eyes. CONCLUSIONS: Vitrectomy for diabetic macular edema is an effective procedure for reducing the edema and improving visual acuity. Because the postoperative reduction in retinal thickness is not complete until 4 months, the assessment of vitrectomy on foveal thickness should not be made until this time. In addition, there are severe complications from vitrectomy for diabetic macular edema, and careful preoperative and postoperative examinations and surgical methods are required.

Monocyte chemotactic protein-1 levels in the vitreous of patients with proliferative vitreoretinopathy.

PURPOSE: To assess the potential role of monocyte chemotactic protein-1 (MCP-1) in the pathogenesis of proliferative vitreoretinopathy (PVR) and to investigate its possible interaction with the macrophage migration inhibitory factor (MIF). METHODS: We assayed MCP-1 and MIF levels in the vitreous samples of 85 consecutive patients with PVR (29 eyes), rhegmatogenous retinal detachment (RRD; 22 eyes), and macular hole or idiopathic epimacular membrane (controls; 34 eyes), by enzyme-linked immunosorbent assay. RESULTS: Vitreous levels of MCP-1 were 1760.7 +/- 471.3 pg/mL (mean +/- SD) in PVR patients, 1200.4 +/- 579.8 pg/mL in RRD patients, and 436.3 +/- 286.1 pg/mL in the controls. Vitreous MCP-1 levels in PVR patients were significantly higher than those in RRD patients and in the controls (P <.0001, respectively). MCP-1 levels in grade C of PVR (1883.7 +/- 479.5 pg/mL) were significantly greater than those in grade D (1437.8 +/- 258.8 pg/mL) (P =.0112). Vitreous concentrations of MCP-1 had no correlation with those of MIF. CONCLUSIONS: The results indicate the possibility that MCP-1 may have a role mainly in the early stage of PVR and that the role of MCP-1 in PVR may differ from that of MIF.

[Birdshot chorioretinopathy--a case report and a case study in Japanese patients].

PURPOSE: There have been numerous case reports of birdshot chorioretinopathy(BC) from Europe and USA. However, only 10 cases of BC have been reported in Japan. We report the case of a Japanese patient with BC and review the clinical characteristics of BC among Japanese patients previously reported. PATIENTS AND METHODS: We report the case of a 64-year-old Japanese man, who was seen at our clinic and then diagnosed as hasing BC. 20 eyes of 11 patients with BC reported in the Japanese literature previously, including our patient, were studied. Age at the initial onset, sex, ocular findings, prognosis of visual acuity and the human leucocyte antigen (HLA) were evaluated. RESULTS: In our case bilateral cream-colored subretinal exudates presented symmetrically and in time developed depigmented atrophic 'birdshot like' scar lesions. Ocular inflammation responded to oral prednisolone without exacerbation and good visual acuity was maintained. The age at the onset ranged from 19 to 78 years(mean 54.5), and 8 patients were women. Cystoid macular edema(CME) was found in 30% of 11 Japanese patients, and optic disc edema was seen in 50%. Final visual acuity was more than 20/40 in 75% and less than 20/200 in 12.5% of the cases. HLA-A 29, which is frequently associated with Caucasian patients, was not positive in any of the Japanese patients, and no specific locus was determined. CONCLUSIONS: We observed a rare case of BC. Age at initial onset, sex, and ocular findings of Japanese patients with BC were consistent with those of Europe and the US and good visual acuity was maintained in almost all cases. We suggest that the disease mechanism of BC in Japanese patients is different from that of Caucasian patients, because HLA-A 29 was negative in all Japanease patients.

[The surgical outcome of vitrectomy for idiopathic epiretinal membranes and foveal thickness before and after surgery].

PURPOSE: To evaluate the surgical outcome of vitrectomy and foveal thickness before and after vitrectomy for idiopathic epiretinal membranes. SUBJECTS AND METHODS: Twenty-three eyes of 21 patients with idiopathic epiretinal membranes were analyzed. The mean follow-up period was 17.8 months. In 16 eyes of 14 patients, foveal thickness was measured by optical coherence tomography (OCT). RESULTS: Preoperative visual acuity ranged from 0.1 to 0.7. Postoperatively, 17 eyes achieved a final visual acuity of 1.0 or better, and 21 eyes achieved 0.5 or better. Preoperative foveal thickness ranged from 205 to 575 microns (mean +/- standard deviation, 409.9 +/- 103.3 microns). Postoperatively, mean foveal thickness was 347.7 +/- 106.0 microns (1 week follow up), 338.6 +/- 103.7 microns (2 months), 304.6 +/- 97.0 microns (6 months), and 274.3 +/- 78.7 microns (1 year). There was a weak negative correlation between visual acuity and foveal thickness. CONCLUSION: Visual acuity improves significantly after surgery. OCT is useful for idiopathic epiretinal membrane surgery.

Vitrectomy for diabetic macular edema with and without internal limiting membrane removal.

PURPOSE: To compare the efficacy of surgically removing or not removing the internal limiting membrane (ILM) during pars plana vitrectomy on the visual acuity and retinal thickness in eyes with diabetic macular edema. METHODS: A prospective, case-control study was carried out on 30 eyes of 29 patients undergoing pars plana vitrectomy for diabetic macular edema. Fifteen eyes underwent pars plana vitrectomy with ILM removal and 15 eyes without ILM removal. RESULTS: In 7 of 15 eyes (47%) in the ILM-removed group, the visual acuity improved by 0.2 or more log of the minimum angle of resolution (log MAR) units and remained unchanged in 8 eyes (53%). In the ILM-preserved group, the final visual acuity improved in 9 of 15 eyes (60%) and remained unchanged in 6 eyes (40%). The difference in visual acuity between the two groups after 11 months the surgery was not significant (Fisher's exact test, p=0.4938). In the ILM-removed group, the final retinal thickness decreased by more than 20% of the preoperative retinal thickness in 12 of 15 eyes (80%), remained unchanged in 2 of 15 eyes (13%), and increased in 1 of 15 eyes (7%). In the ILM-preserved group, the final retinal thickness decreased in 13 of 15 eyes (87%) and remained unchanged in 2 of 15 eyes (23%). The differences in the changes in the retinal thickness between the two groups were not statistically significant (Fisher's exact test, p=0.5945). CONCLUSION: Vitrectomy in eyes with diabetic macular edema without ILM removal was as effective in reducing the retinal thickness and improving the visual acuity as eyes with ILM removal. We conclude that ILM need not be removed to treat eyes with diabetic macular edema.

Epimacular proliferative response following internal limiting membrane peeling for idiopathic macular holes.

PURPOSE: To present two patients who underwent surgery for an idiopathic macular hole (IMH) with internal limiting membrane (ILM) peeling and developed an epimacular proliferative response. METHODS: Observational case report. Two patients with an IMH underwent pars plana vitrectomy with ILM peeling. Ophthalmic examination including optical coherence tomography (OCT) was performed pre- and postoperatively. In both cases, scanning laser ophthalmoscopy (SLO) was performed postoperatively. RESULTS: In the first case, the closure of the macular hole (MH) was confirmed ophthalmoscopically and by OCT following the surgery. At 2 months postoperatively, a thin epiretinal membrane (ERM) developed over the nasal macula area where the ILM had been peeled. The patient's visual acuity had recovered to 1.0 but she complained of metamorphopsia. At 18 months postoperatively, the thin ERM around the nasal fovea remained and her visual acuity was still 1.0. In the second case, the MH was sealed after the surgery, and the patient's visual acuity had improved to 1.0 at 3 months, but an indistinct ERM developed in the macular region where the ILM had been peeled. Two years after the operation, her VA was still 1.0. One and two years postoperatively, a thin epimacular proliferation remained unchanged; in addition, the OCT and SLO images remained stable. CONCLUSION: Two patients who underwent IMH surgery with ILM peeling developed an epimacular proliferative response postoperatively. We suggest that the injury associated with the ILM peeling may have stimulated glial proliferation.