[A case of non-atherothrombotic cerebroretinal small vessel disease].

BACKGROUND: There is an increasing interest in the relation between retinal artery abnormalities and cerebral small-vessel diseases (SVD), because retinal vessels share common properties with cerebral small vessels. We report a case of juvenile cerebrovascular disease presenting retinal vessel abnormalities, which clinically resembled cerebral autosomal dominant arteriopathy with stroke and ischemic leukoencephalopathy (CADASIL) but in which Notch3 gene mutations were not detected. CASE: A 42-year old woman was hospitalized at the department of Neurology in our hospital, complaining of headache and dysarthria. MRI showed bilateral spotted white matter lesions in the paraventricular area and the temporal lobe, and an ovoid lesion in the right corona radiata. Despite steroid pulse therapy, she developed right incomplete hemiparesis and new lesions were detected in the anterior temporal pole and external capsule. Her genetic analysis showed no mutations in the Notch 3 gene. Ophthalmological examination revealed arterial sheathing in the peripapillary region. Fluorescein angiography showed narrowing of the retinal arterioles and distinguished a peripheral vascular network. CONCLUSION: In this case, ophthalmological examination revealed retinal vessel abnormalities in a relatively young woman with no risk factors such as hypertention or artheriosclerosis, presenting recurrent subcortical strokes. This actual case indicates the association between retinal vessel abnormalities and cerebral SVDs.

Intrascleral fixation technique using catheter needles and 30-gauge ultrathin needles: lock-and-lead technique.

UNLABELLED: We report a new intrascleral fixation technique for a standard 3-piece posterior intraocular lens (IOL) using catheter needles and 30-gauge ultrathin needles instead of a special forceps and minimal intraocular manipulation in eyes without capsule support. Modified catheter needles are used to deliver the IOL haptic. The IOL haptic is secured extraocularly between the cannula and needle of a catheter needle and then advanced through the sclerotomy site. Scleral tunnels are created using 30-gauge ultrathin needles, which also serve as a guide to introduce the haptics. This technique can be performed even in cases in which miosis and corneal edema prevent anterior chamber observation. The guide needle facilitates haptic insertion into the long and narrow scleral tunnels. The procedure is a good alternative to current techniques. FINANCIAL DISCLOSURE: Dr. Akimoto is a consultant to Kowa Co., Ltd. No other author has a financial or proprietary interest in any material or method mentioned.

Transconjunctival sutureless intrascleral intraocular lens fixation using intrascleral tunnels guided with catheter and 30-gauge needles.

We invented a new method for fixing an intraocular lens (IOL) in the scleral tunnel without using a wide conjunctival incision. Modified bent catheter needles were used to penetrate the IOL haptics through the sclerotomy sites. The IOL haptics were inserted into 30-guage (G) scleral tunnels guided by double 30-G needles piercing the sclera. All procedures were performed through the conjunctiva without wide incision. The procedure does not require special forceps, trocars or fibrin glue, only catheter and 30-G needles. The aid of an assistant was not required to support the IOL haptic. The procedures were easily learnt based on our previous method. As with other transconjunctival sutureless surgeries, patients feel less discomfort and the conjunctiva can be conserved for future glaucoma surgery. Complications included two cases of vitreous haemorrhage (16.7%), and one case each of postoperative hypotony, and iris capture (8.3%). Astigmatism induced by intraocular aberration was the same as we reported previously. Our method for fixing the IOL into the scleral tunnel is innovative, less expensive, less invasive and quick. This modified method is a good alternative for fixing IOL haptics into the sclera.

Targeted disruption of the CD18 or ICAM-1 gene inhibits choroidal neovascularization.

PURPOSE: To investigate the role of the leukocyte adhesion molecules CD18 and intercellular adhesion molecule (ICAM)-1 in the development of choroidal neovascularization (CNV). METHODS: Laser photocoagulation was used to induce CNV in wild-type C57BL/6J mice and species-specific counterparts with targeted homozygous disruption of the CD18 or ICAM-1 gene. Expression of CD18 and ICAM-1 after laser injury was assessed by immunostaining. CNV responses were compared on the basis of en masse volumetric measurements obtained by confocal microscopy 2 weeks after laser injury and by determination of fluorescein angiographic leakage at 1, 2, and 4 weeks after laser injury. RESULTS: The site of laser injury showed upregulation of ICAM-1 and invasion by CD18-positive leukocytes within 1 day of laser injury. Significantly fewer lesions exhibited fluorescein leakage defined to be pathologically significant in CD18-deficient mice at weeks 1, 2, and 4 weeks and in ICAM-1-deficient mice at 1 and 4 weeks, compared with the control. There were a significantly greater number of lesions without fluorescein leakage in CD18-deficient mice than in the other two groups at all time points. The volume of CNV in CD18- and ICAM-1-deficient mice was significantly less than in wild type. CONCLUSIONS: These data suggest a nonredundant role for leukocyte adhesion to vascular endothelium in the development of laser-induced choroidal neovascularization.

Using catheter needles to deliver an intraocular lens for intrascleral fixation.

UNLABELLED: A new method for delivering intraocular lens (IOL) haptics through sclerotomies for intrascleral fixation using catheter needles was evaluated in pig eyes. A bent catheter needle was used to penetrate the surgical corneal wound from the presumed sclerotomy. Extraocularly, the leading haptic of the IOL was fixated between the external tube and the internal needle of the catheter needle. The fixation was strong enough to support the IOL and to extract the leading haptic through the sclerotomy site. The trailing haptic was fixated using another catheter needle extraocularly and was subsequently delivered through another sclerotomy site. Guiding with a needle was the only intraocular manipulation when delivering the trailing haptic and catheter needle through the sclerotomy. This new method is easy and safe and does not require special devices compared with other methods. Clinical evaluation in human eyes should be performed. FINANCIAL DISCLOSURE: Dr. Akimoto is a consultant to Kowa Co. Ltd. A patent application on the modified catheter needle is planned. No other author has a financial or proprietary interest in any material or method mentioned.