Bilateral choroidal detachment after cord blood stem cell transplantation in an adult patient with acute myeloid leukemia.

We report on bilateral choroidal detachment after a cord blood stem cell transplantation procedure. A 52-year-old woman had graft-versus-host disease 49 days after CBSCT for acute myeloid leukemia. She developed bilateral conjunctival chemosis and choroidal detachment 66 days after CBSCT. The annular choroidal detachment gradually increased in both eyes, with no improvement noted over the following month. At 106 days after CBSCT, the patient died from multiple organ failure. Graft-versus-host disease can be associated with bilateral choroidal detachment after CBSCT.

Asymptomatic subconjunctival entrapment of a cilium.

We report an unusual case of asymptomatic subconjunctival entrapment of a cilium. A 64-year-old man presented with a 3 month history of a painless black line in the conjunctiva of the left eye, and slit-lamp examination revealed a cilium under the conjunctiva. The patient remained asymptomatic without conjunctival edema or hyperemia during a 2 week follow-up. To the best of our knowledge, this is the first report of an asymptomatic cilium inside the subconjunctival space.

Inhibition of choroidal neovascularization by blocking vascular endothelial growth factor receptor tyrosine kinase.

PURPOSE: To investigate the role played by receptors of vascular endothelial growth factors, Flt-1 and KDR/Flk-1, on an experimental model of choroidal neovascularization (CNV). METHODS: The vascular endothelial growth factor-A (VEGF-A) receptor-specific tyrosine kinase inhibitor SU5416 was administered to a laser-induced mouse model of CNV. The formation of CNV and the degree of vascular permeability in Flt-1 tyrosine kinase domain-deficient mice were also investigated. RESULTS: SU5416 reduced vascularity and vascular endothelial cell proliferation, and promoted endothelial cell apoptosis within CNV. Furthermore, the formation of CNV and the degree of vascular permeability were significantly reduced in Flt-1 tyrosine kinase domain-deficient mice, and this effect was enhanced by the administration of SU5416. CONCLUSIONS: Both Flt-1 and KDR/Flk-1 have a significant role in CNV formation. Suppression of apoptosis may be involved in the process.

Relationship between intensity of reflected light and temperature increase: assessment of fundus pigmentation for transpupillary thermotherapy.

PURPOSE: To develop a new device for measuring reflected light during diode-laser irradiation in transpupillary thermotherapy (TTT) and to assess the correlation between fundus pigmentation, the measured intensity of reflected light, and the increase in fundus temperature. METHODS: We developed a device to measure reflected light by modifying a slit-lamp-mounted 810-nm diode-laser delivery system used clinically for TTT. The diode laser was used to irradiate test charts with various degrees of reflectance in in vitro experiments, and the fundus of nonpigmented or pigmented rabbits in in vivo experiments; then, the intensity of the reflected light and the temperature increase at the target were measured. The retinal sections were also examined histologically. RESULTS: There was a significant negative correlation between the intensity of the reflected light and the temperature increase in the target that depended on the degree of reflectance of the charts or the pigmentation of the rabbit eyes. On histopathologic examination, the extent of the changes in the irradiated retina after TTT was clearly different between pigmented and nonpigmented rabbits. CONCLUSIONS: Correlations between fundus pigmentation, the intensity of reflected light during diode-laser irradiation, and the temperature increase in TTT were demonstrated in vitro and in vivo. Our results suggest that measurement of the intensity of reflected light should be helpful for modulating the laser power in TTT according to the degree of fundus pigmentation.

Polypoidal choroidal vasculopathy and retinochoroidal anastomosis in Japanese patients eligible for photodynamic therapy for exudative age-related macular degeneration.

PURPOSE: To determine the percentage of Japanese patients with age-related macular degeneration (AMD) who are eligible for photodynamic therapy (PDT) with verteporfin who have either polypoidal choroidal vasculopathy (PCV) or choroidal neovascularization (CNV) with retinochoroidal anastomosis (RCA). METHODS: The medical charts of 82 consecutive patients (83 eyes) with subfoveal CNV due to AMD were reviewed. Initially, we determined which of these eyes were eligible for PDT by using the criteria reported by two large randomized control studies, that is, the Treatment of Age-related Macular Degeneration with Photodynamic Therapy (TAP) study and the Verteporfin in Photodynamic Therapy (VIP) study. Among the PDT-eligible patients, the percentage of eyes with PCV or CNV with RCA was determined by indocyanine green angiography (ICGA). RESULTS: In total, 36 eyes (43%) of the 83 eyes were PDT-eligible; 17 (20%) based on the TAP study criteria, and 19 (23%) based on the VIP study criteria. Among these PDT-eligible eyes, ICGA revealed that 12 (33%) had PCV and 2 (6%) had CNV with RCA. CONCLUSIONS: With ICGA, PCV or CNV with RCA were recognized in a substantial proportion of cases eligible for PDT based on the two clinical studies. Considering that the treatment efficacy of PDT for PCV or RCA has not been established, detection of PCV or RCA prior to PDT with ICGA is highly recommended.