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

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

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

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

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

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

Monoclonal immunoglobulin heavy chain gene rearrangement in Fuchs' uveitis.

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

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

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

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

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

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

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

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

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

[Phase III open-label study of nepafenac ophthalmic suspension 0.1% for inflammation and ocular pain following ophthalmic surgery].

PURPOSE: To examine the efficacy and safety of nepafenac ophthalmic suspension 0.1% on postoperative inflammation and eye pain with intraocular surgery, other than cataract surgery. PATIENTS AND METHODS: Patients scheduled to undergo vitreous surgery, trabeculectomy, laser iridotomy, laser trabeculoplasty and laser posterior capsulotomy were investigated in a multicenter, open-label study. RESULTS: The total rate of patients cured in all the intraocular surgery methods was 85.6% (95/111), and that of the patients who were pain free was 91.0% (101/111). The rate cured by vitreous surgery was 80.4% (45/56), by laser iridotomy 93.3% (14/15) and by laser posterior capsulotomy was 94.6% (35/37). The rate of patients free from pain following vitreous surgery was 85.7% (48/56), laser iridotomy 100.0% (15/15) and by laser posterior capsulotomy was 94.6% (35/37). A total of 23 adverse events were reported in 22 patients (19.6%). Allergic conjunctivitis was observed in one patient (0.9%) as an adverse event, in which the relationship cannot be denied. This allergic conjunctivitis was mild and resolved after treatment. CONCLUSION: Nepafenac ophthalmic suspension 0.1% is considered safe and efficious not only following cataract surgery but also for postoperative inflammation and eye pain in intraocular surgery.

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

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

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

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

Genetic association of HLA-A*2601 with ocular Behçet's disease in Japanese patients.

OBJECTIVES: Behçet's disease (BD) is known to be associated with HLA-B*51, especially HLA-B*5101, in many different ethnic groups. Recently, several HLA-A or -B alleles have been proposed as possible candidate genes for BD in addition to HLA-B*5101. To investigate those associations, we studied HLA-A and -B alleles in Japanese ocular BD patients and the association of possible susceptibility HLA genes with visual prognosis. METHODS: Eighty-eight Japanese BD patients with uveitis and 104 healthy controls were enrolled for analyses of HLA-A and B alleles. Statistical analysis was performed with Fisher's exact test and odds ratio (OR). Association of the possible susceptible HLA gene and visual prognosis was also examined. RESULTS: The phenotype frequency (PF) of HLA-A*2601 was significantly higher in the patients (37.5%) than the controls (14.4%) (pc=0.00529, OR=3.56), especially in patients without HLA-B*5101 (57.4% vs. 14.1%, pc=4.58x10-6, OR=8.21). In contrast, the PF of HLA-A*2601 was not increased in patients with HLA-B*5101 (14.6% vs. 15.8%). Also, the PF in patients possessing HLA-A*2601 or HLAB* 5101 was increased up to 77.3%. Interestingly, the PF of HLA-A*2601 was significantly associated with poor visual prognosis corresponding to visual acuity of 0.1 or less in the worse eye (p=0.0262). CONCLUSIONS: Our results indicate that HLA-A*2601 is possibly associated with ocular BD, independent of HLAB* 5101, indicating that HLA-A*2601 is an additional susceptibility allele candidate of ocular BD in Japan. HLAA* 2601 would also be a possible marker for poor visual prognosis.

Best-corrected visual acuity and frequency of ocular attacks during the initial 10 years in patients with Behçet's disease.

BACKGROUND: Recent publications have suggested considerable improvements in the clinical outcomes of ocular Behcet's disease (BD) patients. However, the long-term time course of clinical ocular features of BD in recent cases remains largely unknown. In this study, we investigated annual time-course changes of best-corrected visual acuity (BCVA) during ocular convalescent stages, as well as annual frequency of ocular attacks during the initial 10 years of follow-up in patients with BD. METHODS: We studied 75 eyes in 39 patients (31 men, eight women) with BD, who were referred to our hospital between 1980 and 1996 within 1 year after the initial ocular attack and followed them up continuously for more than 10 years. The clinical courses of BCVA at the ocular convalescent stage from the onset of ocular disease were retrospectively examined, and the numbers of ocular attacks per eye per year were determined. RESULTS: Mean BCVA was 0.59 at 1 year, 0.31 at 3 years, and 0.12 at 10 years from the onset of ocular disease, while the numbers of ocular attacks per eye were 4.1 +/- 3.1 at 1 year, 2.2 +/- 1.9 at 5 years, and 1.4 +/- 1.8 at 10 years. Ocular attacks were still observed in 33 eyes (45%) of 21 patients (54%) with BD even after 10 years. Final BCVA in 42 eyes (56%) became lower than 0.5. The major reasons for poor visual prognosis were macular atrophy (41%) and chorioretinal atrophy (26%). CONCLUSIONS: The decline of BVCA continued, and nearly half the patients still suffered from ocular attacks at 10 years after the onset of ocular BD.

Endogenous Candida albicans infection causing subretinal abscess.

PURPOSE: We report a case of Candida albicans endophthalmitis with subretinal abscess formation in a patient who underwent liver transplantation. METHODS: Case report. RESULTS: A 51-year-old Japanese woman complained of deep pain and ciliary injection in her right eye. Three months prior, the patient had undergone liver transplantation for cirrhosis caused by hepatitis C. A slit-lamp examination revealed intense anterior chamber inflammation with hypopyon and fundoscopy showed a yellowish-white subretinal mass lesion in the inferior peripheral fundus. Systemic and topical antibiotics did not prevent further progression of the infection. The patient underwent pars plana vitrectomy treatment three times and a histopathological study of a vitreous specimen revealed C. albicans to be the causative organism. CONCLUSION: A subretinal abscess, previously reported in Nocardia, Pseudomonas, Staphylococcus, and Aspergillus infection cases, can also occur in patients infected with Candida. Therefore, Candida infection should be considered as a potential cause of subretinal abscess in organ transplant recipients.

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

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

Posterior vitreous detachment and macular microvasculature in the elderly.

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

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

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

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

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

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

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

Intraocular metabolites of isopropyl unoprostone.

PURPOSE: It is still unknown which metabolite of isopropyl unoprostone is responsible for reducing intraocular pressure. This study was carried out to measure intraocular metabolites of isopropyl unoprostone in the aqueous humor of primate and human eyes. METHODS: Nine monkeys were randomly divided into three groups, all of which received isopropyl unoprostone. In group I, the drug was scheduled to be instilled at 0 hr, in group II at 1 hr, and in group III at 2 hr, prior to aqueous humor aspiration in order to determine metabolite concentration. Furthermore, 27 patients scheduled for cataract surgery and intraocular lens implantation were divided into five groups that received isopropyl unoprostone. In group A, the drug was scheduled to be instilled at 0 hr, in group B at 1 hr, in group C at 2 hr, in group D at 3 hr, and in group E at 4 hr, prior to surgery. At the beginning of the operation, the aqueous humor was aspirated. Metabolites of isopropyl unoprostone in the aqueous humor were determined by high-performance liquid chromatography. RESULTS: M1 (3-[(1R,2R,3R,5S)-3,5-dihydroxy-2-(3-oxodecyl)cyclopentyl]propionic acid) (unoprostone free acid) and M2 ((Z)-7-[(1R,2R,3R,5S)-3,5-dihydroxy-2-(3-oxodecyl)cyclopentyl]hept-5-enoic acid), an intraocular oxidized metabolite of isopropyl unoprostone, were measured. M1:M2 in monkeys was respectively 0:0 ng/ml in group I, 150.2 +/- 45.1:9.5 +/- 1.7 (p < 0.05) in group II, and 74.6 +/- 31.4:19.2 +/- 5.3 (p < 0.01) in group III. M1:M2 in humans was respectively 0:0 ng/ml in group A, 50.6 +/- 22.3:3.2 +/- 1.3 (p < 0.05) in group B, 125.0 +/- 23.1:12.2 +/- 3.4 (p < 0.001) in group C, 144.9 +/- 33.8:24.5 +/- 6.2 (p < 0.01) in group D, and 56.7 +/- 21.5:18.7 +/- 5.3 (p < 0.05) in group E. CONCLUSIONS: A free acid of isopropyl unoprostone is the major intraocular metabolite of isopropyl unoprostone that is expected to act on target tissues in the eyes of both monkeys and humans.