Leukocytes mediate retinal vascular remodeling during development and vaso-obliteration in disease.

Retinal ischemia can cause vision-threatening pathological neovascularization. The mechanisms of retinal ischemia are not fully understood, however. Here we have shown that leukocytes prune the retinal vasculature during normal development and obliterate it in disease. Beginning at postnatal day 5 (P5) in the normal rat, vascular pruning began centrally and extended peripherally, leaving behind a less dense, smaller-caliber vasculature. The pruning was correlated with retinal vascular expression of intercellular adhesion molecule-1 (ICAM-1) and coincided with an outward-moving wave of adherent leukocytes composed in part of cytotoxic T lymphocytes. The leukocytes adhered to the vasculature through CD18 and remodeled it through Fas ligand (FasL)-mediated endothelial cell apoptosis. In a model of oxygen-induced ischemic retinopathy, this process was exaggerated. Leukocytes used CD18 and FasL to obliterate the retinal vasculature, leaving behind large areas of ischemic retina. In vitro, T lymphocytes isolated from oxygen-exposed neonates induced a FasL-mediated apoptosis of hyperoxygenated endothelial cells. Targeting these pathways may prove useful in the treatment of retinal ischemia, a leading cause of vision loss and blindness.

VEGF164-mediated inflammation is required for pathological, but not physiological, ischemia-induced retinal neovascularization.

Hypoxia-induced VEGF governs both physiological retinal vascular development and pathological retinal neovascularization. In the current paper, the mechanisms of physiological and pathological neovascularization are compared and contrasted. During pathological neovascularization, both the absolute and relative expression levels for VEGF164 increased to a greater degree than during physiological neovascularization. Furthermore, extensive leukocyte adhesion was observed at the leading edge of pathological, but not physiological, neovascularization. When a VEGF164-specific neutralizing aptamer was administered, it potently suppressed the leukocyte adhesion and pathological neovascularization, whereas it had little or no effect on physiological neovascularization. In parallel experiments, genetically altered VEGF164-deficient (VEGF120/188) mice exhibited no difference in physiological neovascularization when compared with wild-type (VEGF+/+) controls. In contrast, administration of a VEGFR-1/Fc fusion protein, which blocks all VEGF isoforms, led to significant suppression of both pathological and physiological neovascularization. In addition, the targeted inactivation of monocyte lineage cells with clodronate-liposomes led to the suppression of pathological neovascularization. Conversely, the blockade of T lymphocyte-mediated immune responses with an anti-CD2 antibody exacerbated pathological neovascularization. These data highlight important molecular and cellular differences between physiological and pathological retinal neovascularization. During pathological neovascularization, VEGF164 selectively induces inflammation and cellular immunity. These processes provide positive and negative angiogenic regulation, respectively. Together, new therapeutic approaches for selectively targeting pathological, but not physiological, retinal neovascularization are outlined.

Clinical features of polypoidal choroidal vasculopathy and visual outcomes in the absence of classic choroidal neovascularization.

BACKGROUND/AIMS: To report on the clinical features of polypoidal choroidal vasculopathy (PCV) and to delineate visual outcomes in the absence of classic choroidal neovascularization (CNV). METHODS: Records were retrospectively reviewed of 233 eyes of 215 patients diagnosed with 'definite' PCV using Japanese criteria. RESULTS: Of patients with definite PCV, 72.1% were men and 91.6% had unilateral disease. A history of systemic hypertension was elicited in 18.1% of patients, and blood pressure measurement revealed possible hypertension in 27.4% of patients. At the initial evaluation, 28.3% of eyes had classic CNV as assessed by fluorescein angiography and were treated by photodynamic therapy or other means. Of 112 eyes with active exudation but no classic CNV and no recent decreased vision, best-corrected visual acuity (BCVA) at 3 months improved by > or = 0.2 logarithm of the minimum angle of resolution (logMAR) in 17%, was unchanged in 72% and worsened by > or = 0.2 logMAR in 11%. In 67 eyes of which 1-year data were available, BCVA improved in 19%, was unchanged in 64% and worsened in 16%. CONCLUSIONS: The majority of PCV patients were men, with a high rate of diagnosed or suspected hypertension. More than two thirds of eyes had no evidence of classic CNV, of which 89% had stable or improved vision at 3 months without specific treatment. Of eyes followed for 12 months, 83% had stable or improved vision.

[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.

[Clinical features of endophthalmitis after cataract surgery evaluated by the presence of background factors].

PURPOSE: The clinical features and visual prognosis after vitrectomy for endophthalmitis which had developed after cataract surgery were compared in two groups with or without background factors, including malignant tumor, diabetes, oral steroid administration, collagen disease, dacryocystitis, and lid closure disturbance. METHOD: Fifty-two patients (53 eyes) who underwent a vitrectomy for the treatment of endophthalmitis which had developed within 6 weeks after cataract surgery. They were divided into two groups according to the presence (21 eyes, group A) or absence (32 eyes, group B) of background factors, and were retrospectively compared based on their medical records. RESULTS: The culture-positive rate was 62% in group A and 69% in group B. The incidence of a final visual acuity of more than 20/20 was significantly lower in group A (14%) than in group B (47%, p < 0.05). Methicillin-resistant Staphylococcus aureus, alpha-hemolytic Streptococcus and Enterococcus were frequently identified in group A. Leakage from the cataract wound was found in about 80% of the patients with corneal incisions, and a wound that had not been covered by the conjunctiva was significantly more frequent as a factor in group A (group A, 13 eyes; group B, 10 eyes; p < 0.05). CONCLUSION: Postoperative endophthalmitis may have a less favorable visual prognosis in patients with background factors, so precise wound construction during cataract surgery is important in these patients.

[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.

Phototoxic effects of commercial photographic flash lamp on rat eyes.

BACKGROUND: To determine whether exposure of the cornea and retina of rats to flashes from a commercial photographic flash lamp is phototoxic. METHODS: Sprague-Dawley rats were exposed to 10, 100, or 1,000 flashes of the OPTICAM 16M photographic flash lamp (Fujikoeki, Japan) placed 0.1, 1, or 3 m from the eyes. Corneal damage was assessed by a fluorescein staining score, and the retinal damage by eletroretinography (ERG) and histology before and 24 h after exposure. RESULTS: Exposure of the eyes to 1,000 flashes at 0.1 m increased the fluorescein staining score significantly (P = 0.009, the Mann-Whitney test). Scanning electron microscopy (SEM) of the cornea showed a detachment of the epithelial cells from the surface after this exposure. The amplitude of the a-wave was decreased significantly by 23.0% (P = 0.026) of the amplitude before the exposure, and the b-wave by 19.7% (P = 0.0478) following 1,000 flashes at 0.1 m but not by the other exposures. TUNEL-positive cells were present in the outer nuclear layer only after the extreme exposure, but no significant decrease in retinal thickness was seen under any condition. The fluorescein staining score and ERGs recovered to control levels within 1 week. CONCLUSIONS: Light exposure to a photographic flash lamp does not induce damage to the cornea and retina except when they are exposed to 1,000 flashes at 0.1 m.

Vitrectomy for myopic posterior retinoschisis or foveal detachment.

PURPOSE: To evaluate the efficacy of vitrectomy for posterior retinoschisis (RS) or foveal detachment (FD) associated with posterior staphyloma in myopic eyes. METHODS: We reviewed the records of 14 consecutive patients (53-77 years of age; 16 eyes) with progressive visual impairment as a result of myopic RS or FD. Optical coherence tomography demonstrated the presence of a variety of RS and FD characteristics. Five eyes had RS alone, and 11 eyes had RS and FD. Two eyes with RS and severe FD developed retinal detachment in conjunction with a tiny macular hole. Vitrectomy, including posterior vitreous separation in all eyes and internal limiting membrane (ILM) peeling in six eyes, had been performed. The patients were followed postoperatively for 6 to 66 months (mean, 24 months). The anatomical outcome and visual acuity were retrospectively analyzed in this study. RESULTS: Although the two eyes with RS and severe FD developed retinal detachment with a macular hole after an initial vitrectomy, final retinal reattachment was achieved in all 16 eyes. Visual acuity improved in nine eyes and remained unchanged in seven eyes. CONCLUSIONS: Vitrectomy with posterior vitreous separation is effective for reattaching the macula and preventing a deterioration of vision, although eyes with RS and severe FD may be at risk for the development of a macular hole after the initial vitrectomy.

Long-term results of vitrectomy without laser treatment for macular detachment associated with an optic disc pit.

PURPOSE: To evaluate the efficacy of vitrectomy and gas tamponade, without laser photocoagulation to the margin of the optic nerve, for the treatment of macular detachment associated with an optic disc pit. DESIGN: Noncomparative interventional case series. PARTICIPANTS: Eleven consecutive patients (8-47 years of age) who presented with unilateral macular detachment associated with an optic disc pit. INTERVENTION: Pars plana vitrectomy, induction of posterior vitreous detachment (PVD), and gas tamponade were performed, with postoperative facedown positioning for 1 week. The presence of a double-layer detachment consisting of an inner layer separation and an outer layer detachment was observed in 10 of 11 eyes either preoperatively or postoperatively. Patients were observed for 10 to 98 months (mean, 47) after surgery. MAIN OUTCOME MEASURES: Anatomic outcome and visual acuity were retrospectively analyzed for all eyes. Optical coherence tomography was used to observe anatomic changes in the macula in some eyes. RESULTS: Complete retinal reattachment was achieved in 10 of 11 eyes, although these eyes required nearly 1 year to reach this state. The one eye with persistent retinal detachment was observed to have a marked reduction of the detachment by 10 months postoperatively. No recurrences were observed. Visual acuity improvement was documented in 7 of 11 eyes. CONCLUSIONS: These results suggest that vitrectomy with induction of PVD and gas tamponade, without additional laser treatment, is successful in reattaching the macula and improving central vision in most patients with optic disc pit maculopathy.

Unusual posterior hyaloid strand in a young child with optic disc pit maculopathy: intraoperative and histopathological findings.

BACKGROUND: The mechanism responsible for optic disc pit maculopathy is unclear, but abnormal vitreous structures, including the anomalous Cloquet's canal at the optic disc pit, have been suggested as important factors. CASE: We report the intraoperative and ultrastructural findings of an unusual posterior vitreous strand in the eye of an 8-year-old girl with optic disc pit maculopathy. OBSERVATIONS: The patient presented with decreased vision in the left eye. Examination of the left eye revealed a best-corrected visual acuity (VA) of 0.08 and a macular detachment associated with an optic disc pit. Vitrectomy was performed with the adjunctive use of triamcinolone acetonide intraoperatively. The presence of an unusual posterior hyaloid strand tightly attached to the margin of the optic disc pit was noted. An unusual movement of this strand was observed during the surgery. The strand was excised, and fluid-gas exchange was performed using gas tamponade with 20% SF(6). After 12 months, a complete macular reattachment was obtained, with the VA improving to 1.2. Electron microscopic examination of the removed strand revealed abundant thick collagen fibrils with a frame of fine fibrils. CONCLUSION: The unusual posterior vitreous strand connected to the optic disc pit may have contributed to the pathogenesis of maculopathy in this young child.

Multilayered retinoschisis associated with optic disc pit.

BACKGROUND: Recently, optical coherence tomography (OCT) analysis has contributed greatly to the detection of posterior retinoschisis associated with optic disc pits. We report an unusual case of optic disc pit maculopathy. CASE: A 37-year-old woman with a multilayered structure of posterior retinoschisis associated with a very small, shallow optic disc pit was treated. OBSERVATIONS: The patient came to our clinic after a few weeks of decreased vision in her right eye. Fundus examination showed a shallow macular detachment with a tiny, shallow pit at the temporal edge of the optic disc. OCT revealed an unusual multilayered structure of retinoschisis connected to the optic disc. We performed vitrectomy with induction of the posterior hyaloid separation and gas tamponade. After vitrectomy, OCT showed a marked fluid resolution in the retinoschisis, and the patient's vision improved rapidly. CONCLUSION: The multilayered separation of retinoschisis can be caused by traction of the optic disc with a tiny, shallow pit at the temporal edge of the disc.

[A case report illustrating the effectiveness of reading performance assessments in the diagnosis and treatment of psychogenic visual disturbances].

PURPOSE: An optimal strategy for treating psychogenic visual disturbances in adults has not been established. We report a patient with psychogenic visual disturbances who recovered his visual acuity and showed an improvement in his reading performance after undergoing training based on a reading performance assessment. CASE: A 37-year-old man who had been diagnosed as having myopic macular degeneration was referred to our clinic. Three months after his initial diagnosis, no changes in his fundi were observed, but his visual acuity had significantly decreased and his peripheral field of vision had become severely restricted. In view of his tunnel vision, the discrepancy among the visual acuity results obtained by different test methods, the results of a reading assessment, objective eye examination data, and his behavioral patterns, we diagnosed a psychogenic visual disturbance in the patient and referred him to an ophthalmologist and a psychiatrist for follow-up care. In our low vision clinic, we assessed his visual function, including reading performance, and developed a training program including reading, writing, and computer skills. We also provided information to help the patient find a job. The training program included instructions on how to manipulate reading aids and how to select reading materials to maximize his vision; these instructions were effective. Nine months after his rapid decrease in visual acuity, the results of his visual function tests showed an improvement. The patient also became motivated to find a job. CONCLUSION: Reading assessments are a useful tool for diagnosing psychogenic visual disturbances in adults and for coping with functional vision impairment.

Elevated expression of O-GlcNAc-modified proteins and O-GlcNAc transferase in corneas of diabetic Goto-Kakizaki rats.

PURPOSE: The hexosamine biosynthetic pathway is one of the possible mechanisms involved in diabetic keratopathy. The purpose of this study was to examine the role of O-glycoside-linked N-acetylglucosamine (O-GlcNAc) modification of proteins in the pathogenesis of diabetic keratopathy in the Goto-Kakizaki (GK) rat, which has spontaneous development of diabetes. METHODS: An anti-O-GlcNAc antibody, an anti-O-GlcNAc transferase antibody, and digoxigenin (DIG)-labeled cRNA probes were used to examine the localization of O-GlcNAc-modified proteins, O-GlcNAc transferase protein and mRNA in the corneas of diabetic GK rats and in those of nondiabetic Wistar rats. The corneas from Wistar rats were organ cultured in control medium or in medium containing 100 micro M O-(2-acetamide-2-deoxy-D-glucopyranosylidene) amino-N-phenyl-carbamate (PUGNAc), an inhibitor of O-GlcNAcase, the enzyme that removes O-GlcNAc from proteins. The morphologic changes were examined by electron microscopy. RESULTS: In normal corneas, immunoreactive O-GlcNAc and O-GlcNAc transferase were observed in the epithelial, endothelial, and stromal cells. In the diabetic corneas, their immunoreactivities in the epithelium were increased in intensity. Morphologically, the number of hemidesmosomes in the epithelial basal cells was lower than that in those cells from the nondiabetic rats. In some areas, the basement membrane had detached from the epithelial basal cells. The PUGNAc treatment of Wistar rat corneas increased the level of O-GlcNAc immunoreactivity and caused a decrease in the number of hemidesmosomes and the detachment of corneal epithelial cells from the basement membrane. CONCLUSIONS: The elevated expression of O-GlcNAc-modified proteins and O-GlcNAc transferase may play a causative role in the corneal epithelial disorders of diabetic GK rats.

VEGF164 is proinflammatory in the diabetic retina.

PURPOSE: The objectives of this study were to characterize the differential potency of two major VEGF isoforms, VEGF(120) and VEGF(164), for inducing leukocyte stasis (leukostasis) within the retinal vasculature and blood-retinal barrier (BRB) breakdown and to determine whether endogenous VEGF(164) mediates retinal leukostasis and BRB breakdown in early and established diabetes. METHODS: Retinal leukostasis and BRB breakdown were simultaneously quantified by combining concanavalin A lectin (ConA) perfusion labeling with a fluorophotometric dextran leakage assay. CD45 immunohistochemistry was performed to confirm that ConA-stained cells within the vasculature were leukocytes. Retinal leukostasis and BRB breakdown were compared in nondiabetic rats receiving intravitreous injections of VEGF(120) or VEGF(164). Retinal intercellular adhesion molecule (ICAM)-1 and VEGF protein levels were studied by Western blot and ELISA, respectively. An anti-VEGF(164(165)) aptamer (EYE001) was administered by intravitreous injection to 2-week and 3-month diabetic rats, and the effect on retinal leukostasis and BRB breakdown was quantified. RESULTS: Compared with VEGF(120), VEGF(164) more potently increased retinal ICAM-1 levels (2.2-fold), leukostasis (1.9-fold), and BRB breakdown (2.1-fold, P < 0.01 for all), despite negligible differences in vitreoretinal VEGF levels at the time of evaluation (P > 0.05). Retinal leukostasis and leakage increased with the duration of diabetes (P < 0.01) and correlated closely (P < 0.01, r = 0.889). The isoform-specific blockade of endogenous VEGF(164) with EYE001 resulted in a significant suppression of retinal leukostasis and BRB breakdown in both early (72.4% and 82.6%, respectively) and established (48.5% and 55.0%, respectively) diabetes (P < 0.01). CONCLUSIONS: On an equimolar basis, VEGF(164) is at least twice as potent as VEGF(120) at inducing ICAM-1-mediated retinal leukostasis and BRB breakdown in vivo. The inhibition of diabetic retinal leukostasis and BRB breakdown with EYE001 in early and established diabetes indicates that VEGF(164) is an important isoform in the pathogenesis of early diabetic retinopathy.

Histological effect and protein expression in subthreshold transpupillary thermotherapy in rabbit eyes.

OBJECTIVE: To investigate the histological effect of subthreshold transpupillary thermotherapy (TTT) on the retina. METHODS: We performed TTT in normal pigmented rabbit eyes using an 810-nm diode laser with spot size of 1.2 mm, power of 50 mW, and varying durations of 15, 30, or 60 seconds. Four weeks later, fluorescein angiography was performed, and the enucleated eyes were examined by means of electron microscopy and immunohistochemical staining. RESULTS: Funduscopy immediately and at 4 weeks showed no discernable changes at TTT sites, and fluorescein angiography at 4 weeks showed no abnormalities. However, electron microscopy showed photoreceptor and retinal pigment epithelium cell disruption, changes more prominent with longer durations of treatment. Immunohistochemical staining was positive for heat shock protein 60, heat shock protein 70, tumor necrosis factor alpha, and vascular cell adhesion molecule 1 in the photoreceptors and retinal pigment epithelium at TTT sites. Untreated control eyes showed no staining. CONCLUSIONS: Despite the absence of changes evident by funduscopy and fluorescein angiography, TTT resulted in dose-dependent histological changes in photoreceptors and retinal pigment epithelium. The induction of heat shock proteins, cytokines, and cell adhesion molecules may play a role in the tissue response to subthreshold TTT. Clinical Relevance Unrecognized damage to the retina and retinal pigment epithelium may contribute to visual loss in eyes that undergo subthreshold TTT.

Macular dystrophy in a Japanese family with fundus albipunctatus.

PURPOSE: To report a Japanese family with fundus albipunctatus and macular dystrophy associated with a mutation in the 11-cis retinol dehydrogenase (RDH5) gene. DESIGN: Observational case report. METHOD: Ophthalmic examinations and DNA analysis were performed. RESULTS: The fundi of a 56-year-old man and his 51-year-old sister showed numerous yellow-white punctata. He also had bull's-eye maculopathy and prepappillary arterial loops, whereas she did not, and his best-corrected visual acuity was impaired, whereas hers was normal. Their kinetic visual fields did, however, show central or paracentral scotoma, and both had tritanomalous color vision. Their scotopic electroretinograms were typical of fundus albipunctatus, and photopic electroretinograms were significantly reduced. A homozygous Gly107Arg mutation in the RDH5 gene was detected in both siblings. CONCLUSIONS: We suggest that the macular dystrophy is caused by the RDH5 gene mutation as a phenotype variation in fundus albipunctatus.

[Long-term complications of MIRAgel exoplants in scleral buckling surgery].

BACKGROUND: Long-term complications of extrusion have been reported in patients who received MIRAgel buckles for retinal detachment. All ophthalmologists need to recognize the clinical characteristics of these severe complications, and how the clinical course of complication after the use of MIRAgel buckles differs from that of silicone buckles. METHODS: Case reports and a review of the literature. RESULTS: Severe deterioration of MIRAgel buckles may occur when left in place for 5 years or longer, causing adverse symptoms and occasionally intraocular complications. This deterioration is associated with changes in the microstructural architecture of the hydrogel material in the MIRAgel buckles. CONCLUSION: Long-term follow-up is necessary for patients with MIRAgel buckles, and the buckles should be removed prophylactically when advisable. When severe ocular motility disturbances and/or presence of a tumor-like extraocular mass are observed in patients several years after retinal detachment surgery, the cause may be a swollen MIRAgel buckle.

[A case of endogenous Aeromonas hydrophila endophthalmitis].

BACKGROUND: Aeromonas hydrophila(A. hydrophila) may cause septicemia in immunocompromised hosts, but endophthalmitis due to this agent is quite rare. To our knowledge, there have been no reports of A. hydrophila endophthalmitis in Japan. We report a case of endogenous endophthalmitis caused by Aeromonas hydrophila. CASE: The patient was a previously healthy 71-year-old man and no source of the endogenous endophthalmitis was found. A diagnostic/therapeutic vitrectomy was performed, but it was impossible to successfully treat this case because of extended retinal necrosis. A. hydrophila was isolated from the vitreous specimen. CONCLUSION: Endophthalmitis due to A. hydrophila had a rapid clinical course and poor prognosis.

[Sweet syndrome presenting as orbital cellulitis].

BACKGROUND: A case of Sweet syndrome mimicking orbital cellulitis is reported. CASE: A 17-year-old girl presented with painful eyelid swelling, limited ocular movement in the right eye, and an increased white cell count. The patient was initially diagnosed as having infectious orbital cellulitis, but her symptoms did not improve with administration of intravenous carbanpenem and cefzon. Systemic examination revealed erythema of the extremities, and blood tests showed elevated C-reactive protein. These findings are consistent with a diagnosis of Sweet syndrome, and the patient was treated with 30 mg of oral prednisone. The eyelid swelling and erythema of the extremities decreased one day after the initiation of corticosteroid therapy. Skin biopsy showed infiltration of neutrophils and histiocytes in the dermis, confirming the diagnosis of Sweet syndrome. CONCLUSION: Sweet syndrome with eyelid and orbital involvement may mimic infectious orbital cellulitis.