Intra-vitreal gas injection and supine positioning for hypotony post-intrascleral intraocular lens fixation.

PURPOSE: This study aimed to report a case of intravitreal gas injection in the supine position for hypotony after intrascleral intraocular lens (IOL) fixation in a patient with Vogt-Koyanagi-Harada (VKH) disease. OBSERVATIONS: A 72-year-old Japanese female patient presented with blurred vision in her right eye. Both eyes exhibited a sunset glow fundus due to VKH disease. The right IOL was dislocated; therefore, IOL fixation was performed. The patient's hypotony and choroidal effusion persisted postoperatively and her intraocular pressure (IOP) remained 2-4 mmHg despite the performance of two steroid courses. C3F8 (perfluoro pane gas) was injected into the vitreous cavity on postoperative day 35. The patient was instructed to assume a supine position on the third day after injection. At 6 days post-injection, her IOP began to rise; her IOP remained within the normal range until 1 year later. CONCLUSIONS AND IMPORTANCE: This is the first report of successful intravitreal gas injection in a supinated patient with VKH disease to treat postoperative hypotony.

Comparison of Surgical Outcomes Between Ab Interno Suture Trabeculotomy and Ab Externo Metal Trabeculotomy in Adult Patients with Glaucoma.

PURPOSE: To compare the outcomes of ab interno suture trabeculotomy (AbI-TLO) and ab externo metal trabeculotomy (AbE-TLO) in adult patients with glaucoma aged over 40 years. PATIENTS AND METHODS: A retrospective chart review was conducted, including adult patients with glaucoma who underwent AbI-TLO or AbE-TLO between January 2015 and June 2019. A single surgeon (YO) performed all the operations. Eighty-one patients (81 eyes) were included in this study. Surgical success was defined as a postoperative intraocular pressure (IOP) of ≤18 mmHg and an IOP reduction of ≥20% from the preoperative IOP, without requiring additional glaucoma surgery. Success rates were assessed using Kaplan-Meier survival curves and log-rank (Mantel-Cox) tests, while risk factors were analyzed using the Cox proportional hazards model. RESULTS: Forty-nine patients who underwent AbI-TLO and 32 patients who underwent AbE-TLO were studied; the preoperative IOPs were 27.9 ± 7.3 (mean ± standard deviation) mmHg and 25.6 ± 8.1 mmHg in the AbI-TLO and AbE-TLO groups, respectively (p=0.217). The 12-month postoperative IOPs were 15.8 ± 4.0 mmHg and 16.3 ± 4.2 mmHg in the AbI-TLO and AbE-TLO groups, respectively (p=0.724). The surgical success rates at 12 months were 77.6% and 62.5% in the AbI-TLO and AbE-TLO groups, respectively (p=0.144). Postoperative hyphema with level formation and ocular hypertension over 30 mmHg were observed in 22.4% and 26.5% of patients in the AbI-TLO group and 18.8% and 12.5% of those in the AbE-TLO group, respectively. Stepwise multivariate Cox regression analysis showed that a longer axial length was a risk factor for surgical failure (hazard ratio: 2.030; p=0.042). CONCLUSION: AbI-TLO and AbE-TLO had similar surgical outcomes and postoperative complications. A longer axial length was associated with an insufficient IOP reduction.

Subarachnoid hemorrhage-negative Terson syndrome after intracranial artery treatment with a flow diverter device.

PURPOSE: To report a case of subarachnoid hemorrhage-negative Terson syndrome following intracranial artery treatment with flow diverter stents. OBSERVATIONS: A 40-year-old Asian woman presented with floaters in her right eye after treatment of an intracranial aneurysm with flow diverter stents. Vitreous hemorrhage and sub-inner limiting membrane (sub-ILM) hemorrhage were present in her right eye. On fluorescein angiography, contrast perfusion and vascular occlusion were not noted. Magnetic resonance imaging (MRI) did not show any evidence of subarachnoid hemorrhage (SAH). We hypothesize that the bleeding was due to Terson syndrome associated with intracranial treatment with the flow diverter stents. During follow-up, the vitreous hemorrhage and sub-ILM hemorrhage disappeared, and the floaters in her vision improved. CONCLUSIONS AND IMPORTANCE: This is the first reported case of vitreous hemorrhage and sub-ILM hemorrhage that should be considered to be Terson syndrome, after flow diverter stents treatment in the absence of SAH.

Evaluating the Quality of Life of Glaucoma Patients Using the State-Trait Anxiety Inventory.

PURPOSE: To evaluate anxiety felt by glaucoma patients. PATIENTS AND METHODS: In total, 472 glaucoma patients responded to a questionnaire on anxiety, subjective symptoms, and vision-related quality of life (VR-QOL) associated with glaucoma. Anxiety was evaluated using the State-Trait Anxiety Inventory (STAI), state anxiety (STAI-State) subscale along with our novel questionnaire, assessing visual function and subjective symptoms, specialized for glaucoma. VR-QOL was evaluated using 5 subitems from the 25-item National Eye Institute Visual Function Questionnaire (VFQ-25). Adherence to ophthalmic antiglaucoma agents was confirmed. As indexes of visual function, corrected visual acuity (measured by eye chart), mean deviation (MD) score (measured with static perimetry), and 4 thresholds at the center of vision were determined. Stages were classified according to the Aulhorn Classification. From the STAI-State scores, the prevalence of anxiety in glaucoma patients was evaluated. We analyzed the correlation between the STAI-State and VFQ-25, anxiety, subjective symptoms, adherence, and visual function indexes. RESULTS: In total, 78% of glaucoma patients experienced at least an intermediate level of anxiety. The STAI-State correlated significantly with anxiety and subjective symptoms as measured by our novel questionnaire, particularly for questions "current anxiety about loss of vision" and "current anxiety in life" (r=0.468 and 0.500; both P<0.0001). However, STAI-State correlated weakly with VFQ-25, and not at all with visual function indexes and adherence. CONCLUSIONS: Many glaucoma patients feel anxiety. The STAI-State is correlated with the VR-QOL and anxiety in glaucoma patients, making it useful for understanding the anxiety present in glaucoma patients.

Evaluation of Quality of Life in Japanese Glaucoma Patients and its Relationship With Visual Function.

PURPOSE: We assessed vision-related quality of life (VR-QOL) in glaucoma patients and examined the relationship between VR-QOL and indices of visual function and subjective symptoms. PATIENTS AND METHODS: Four hundred seventy-two glaucoma patients completed a questionnaire concerning VR-QOL and subjective symptoms of glaucoma. VR-QOL was based on 5 subscales selected from the National Eye Institute 25-item Visual Function Questionnaire (NEI VFQ-25), whereas subjective symptoms were examined using original questions that we prepared. The following were selected as visual function indices: corrected visual acuity measured with a distance visual acuity chart, mean deviation scores measured with a static perimeter, and 4 threshold levels in the innermost center of a visual field (4 pericentral test points). Disease staging was conducted according to the Aulhorn classification system. Correlations of visual function with VR-QOL were evaluated using the Spearman test. RESULTS: Correlations were observed in almost all subscales of the NEI VFQ-25, including correlations with corrected vision, disease stage, mean deviation score, and minimum threshold values of the 4-point pericentral test on the temporal side (P<0.0001). Visual function indices affecting driving differed between daytime and night driving (P<0.0001). NEI VFQ-25 subscales were correlated with subjective symptoms felt by the patients while driving (P<0.0001). CONCLUSIONS: Minimum threshold values of the 4 pericentral test points on the temporal side are useful for the assessment of VR-QOL. Minimum threshold values of the 4 pericentral test points on the temporal side are useful for assessing visual field abnormalities that are associated with decreased VR-QOL.

Changes in axial length and choroidal thickness after intraocular pressure reduction resulting from trabeculectomy.

PURPOSE: To evaluate changes in axial length and choroidal thickness after trabeculectomy. PATIENTS AND METHODS: Fourteen patients under 80 years of age with glaucoma, were enrolled. The choroid was imaged using prototypical high-penetration optic coherence tomography (OCT) and the thickness was measured. Axial length, choroidal thickness, and intraocular pressure (IOP) were measured bilaterally at 3 pm 1 day before and 6 days after trabeculectomy. The choroidal thickness was measured at the fovea and four other locations (2 mm superior, temporal, inferior, and nasal to the center of the optic nerve head). RESULTS: The IOP and axial length significantly decreased in eyes that underwent trabeculectomy (P < 0.0001 for the IOP; P < 0.001 for axial length comparisons). The mean choroidal thicknesses significantly increased in eyes that underwent trabeculectomy compared to preoperatively (P < 0.0001 for the fovea; P < 0.01 for four locations around the optic disc). The mean magnitude of change in IOP was correlated positively with the mean magnitude of change in axial length, but not correlated with the mean magnitude of change in choroidal thickness at the fovea that underwent trabeculectomy. The sum of the axial length and subfoveal choroidal thickness in eyes decreased significantly postoperatively (P < 0.05). CONCLUSION: The axial length shortened, the choroid thickened, and the sum of the axial length and subfoveal choroidal thickness decreased with IOP reduction early after trabeculectomy.

[Retrospective study of ocular complications in patients with human immunodeficiency virus infection before and after HAART].

PURPOSE: To describe ocular complications in patients with human immunodeficiency virus (HIV) infection before and after highly active antiretroviral therapy(HAART). MATERIALS AND METHOD: We retrospectively reviewed the medical records of 261 patients who underwent HAART and visited our clinic between April, 2007 and March, 2010, and recorded ocular complications, CD4 cell counts, visual acuity and other relevant patient information. RESULTS: Befor HAART patients were found to have the following conditions: HIV retinopathy (41 cases), cytomegalovirus (CMV) retinitis (23 cases), and others (6 cases); and after HAART HIV retinopathy (5 cases), CMV retinitis (16 cases), Immune recovery uveitis(IRU) (4 cases), and others(9 cases). The average CD4+ T-cell counts at diagnosis of CMV retinitis were 45.2/microl before and 116.7/microl after HAART. CONCLUSIONS: Since a substantial number of patients develop CMV retinitis after the initiation of HAART, we need to examine patients to check for either the onset or reactivation of CMV retinitis and IRU even after HAART.

Intraocular pressure elevation is a delayed-onset complication after successful vitrectomy for stages 4 and 5 retinopathy of prematurity.

PURPOSE: To determine the incidence and risk factors for delayed-onset intraocular pressure (IOP) elevations after vitrectomy for Stages 4 and 5 retinopathy of prematurity and, in addition, to determine the results of treating the IOP elevations. METHODS: Fifty-five consecutive eyes with successful retinal reattachment and at least 24 months of follow-up after vitrectomy were studied. The ophthalmic examinations included slit-lamp biomicroscopy, wide-field digital retinal imaging, and IOP measurements. Eyes were classified into 2 groups: eyes with a postoperative IOP elevation to ≥ 21 mmHg and eyes whose IOP was always <21 mmHg. RESULTS: Eight eyes (14.5%) developed an IOP elevation to ≥ 21 mmHg from 2 months to 4 months (median: 2.5 months) after the vitrectomy. In two of these eyes, the IOP was controlled with antiglaucoma medications. In the other six eyes, trabeculotomy for eyes with open angles and trabeculectomy or goniosynechialysis for eyes with closed angles were performed. The IOPs were successfully controlled after an average of 1.5 glaucoma surgeries. Multivariate logistic regression analyses identified that a young gestational age (odds ratio = 1.147, 95% confidence interval: 1.024-1.346) and lensectomy (odds ratio = 8.795, 95% confidence interval: 1.262-183.3) were significantly associated with the IOP elevation. CONCLUSION: Delayed-onset IOP elevation after vitrectomy for retinopathy of prematurity occurs in 14.5% of the eyes, and it is significantly associated with a young gestational age and presence of lensectomy.

Relationship between relative lens position and appositional closure in eyes with narrow angles.

PURPOSE: To investigate the relationship between relative lens position (RLP) and appositional closure in eyes with narrow angles. METHODS: Ultrasound biomicroscopy (UBM) was used to measure anterior chamber depth (ACD) and lens thickness (LT), and the IOLMaster to measure axial length (AL). The number of quadrants with appositional closure was assessed by UBM under dark conditions. The RLP was calculated thus: RLP = 10 × (ACD + 0.5 LT) /AL. RESULTS: This study comprised 30 consecutive patients (30 eyes) with narrow-angle eyes defined as Shaffer grade 2 or lower and without peripheral anterior synechiae (24 women, 6 men; mean age ± SD, 67.3 ± 10.4 years; range, 42-87 years). Under dark conditions, 66.7% of the eyes with narrow angles showed appositional closure in at least one quadrant. Of the various ocular biometric parameters, only the RLP significantly decreased with appositional closure in at least one quadrant (P = 0.005). CONCLUSION: A decrease in the RLP can be predictive of appositional closure for narrow-angle eyes under dark conditions.

Phacoemulsification and trabeculotomy combined with goniosynechialysis for uncontrollable chronic angle-closure glaucoma.

BACKGROUND AND OBJECTIVE: To assess and explore the effectiveness of phacoemulsification and trabeculotomy combined with goniosynechialysis in lowering intraocular pressure in eyes with uncontrollable chronic angle-closure glaucoma. PATIENTS AND METHODS: The medical charts of 24 eyes of 22 patients with chronic angle-closure glaucoma were reviewed retrospectively. The probability of successful treatment in 12 eyes that had earlier glaucoma attacks and 12 that did not have an attack were evaluated with Kaplan-Meier life-table analysis with the target pressure set at 15 mm Hg. RESULTS: Mean preoperative intraocular pressure for all eyes was 33.3 +/- 12.0 mm Hg and decreased to 11.8 +/- 2.3 mm Hg. The success rate was 86.6% at 1 year after surgery. Life-table analysis showed that there was no significant difference in the two groups. CONCLUSION: Phacoemulsification and trabeculotomy combined with goniosynechialysis is an effective surgical treatment for chronic angle-closure glaucoma in eyes with or without a previous glaucoma attack.

The assessment of the filtering bleb function with anterior segment optical coherence tomography.

PURPOSE: To assess the usefulness of anterior segment optical coherence tomography (AS-OCT) in evaluating postoperative filtering bleb function. METHODS: Forty-eight eyes of 39 patients who had earlier undergone trabeculectomy were enrolled. Blebs were imaged with a commercially available AS-OCT system. The correlation between intraocular pressure (IOP) and 4 quantitative parameters, bleb height, bleb wall thickness, and the height and extent of internal cavity, and 2 qualitative parameters, bleb wall reflectivity, and the presence or absence of posterior episcleral fluid, were analyzed. RESULTS: Of the 39 participants, 25 (64.1%) were males (mean age, 65.3±10.0 y). The height and extent of the internal cavity and the bleb height were not correlated with the IOP. The bleb wall thickness was negatively (P=0.004) correlated with the IOP. The mean IOP in eyes with a low-reflectivity bleb wall was significantly (P=0.001) lower than in eyes with a high-reflectivity wall. The IOP levels were significantly (P=0.008) lower in eyes with posterior episcleral fluid than in eyes without it. CONCLUSIONS: AS-OCT is a useful tool to evaluate filtering bleb function. The height and extent of the total bleb and the internal cavity were not correlated with IOP control. A low-reflectivity wall and the presence of episcleral fluid were associated with lower IOP.

Intravitreal bevacizumab to treat iris neovascularization and neovascular glaucoma secondary to ischemic retinal diseases in 41 consecutive cases.

PURPOSE: To evaluate the biologic efficacy of intravitreal bevacizumab (IVB) for iris neovascularization (INV) or neovascular glaucoma (NVG) in patients with ischemic retinal disorders. DESIGN: Retrospective, consecutive, interventional case series. PARTICIPANTS: Thirty patients (41 eyes) with INV or NVG secondary to ischemic retinal disorders. METHODS: Patients received IVB (1 mg) as the initial treatment for INV or NVG and were followed up for at least 6 months. Ophthalmic evaluations included measurement of visual acuity and intraocular pressure (IOP), a complete ophthalmic examination, and fluorescein angiography. Patients were divided into 3 subgroups: INV without elevated IOP (INV group), NVG with an open angle (O-NVG group), and NVG with angle closure (C-NVG group) for outcomes analysis. MAIN OUTCOME MEASURES: The controllability of IOP by IVB, incidence of recurrence, and requirement for surgery to treat NVG. RESULTS: No significant ocular or systemic adverse events developed during follow-up (range, 6-22 months; mean, 13.3 months). The mean IOP levels were 14.7, 31.2, and 44.9 mmHg at baseline in the INV, O-NVG, and C-NVG groups, respectively. In the INV group (9 eyes), the INV regressed or resolved after 1 injection. Iris neovascularization recurred in 4 eyes by 6 months and stabilized after repeated injections without IOP elevation. In the O-NVG group (17 eyes), rapid neovascular regression with successful IOP normalization (

[Clinical study of anterior ocular segment topography in angle-closure glaucoma using the three-dimensional anterior segment analyzer Pentacam].

PURPOSE: The anterior ocular segment topography in angle-closure glaucoma was studied using the non-contact three-dimensional anterior segment analyzer Pentacam. SUBJECTS AND METHODS: The central anterior chamber (AC) depth, mid-peripheral AC depth, peripheral AC depth, AC volume, central AC depth/ocular axial length ratio and angles of a narrow angle group (47 eyes of 29 patients), a post laser iridotomy (LI) group (43 eyes of 30 patients), and an open-angle glaucoma (OAG) group (37 eyes of 21 patients) were measured and compared. In addition, changes in the parameters before and after LI (13 eyes of 9 patients) were investigated. RESULTS: The AC volume for the narrow angle group (74.5 +/- 21.1 microl) was significantly smaller than for the other groups (post LI group: 96.4 +/- 21.4 microl; OAG group: 144.2 +/- 31.6 microl, p<0.001). The most significant association was detected between AC volume and the peripheral AC depth. Only two parameters, AC volume and peripheral AC depth, increased significantly after LI (p< 0.001). DISCUSSION: Measurement of the AC volume and the peripheral AC depth using Pentacam is useful for evaluating the anterior ocular segment topography in narrow angle eyes.

Expression of AMPA receptor subunit proteins in purified retinal ganglion cells.

PURPOSE: To determine whether alpha-amino-3-hydroxy-5-methylisoxazole-4-propioate (AMPA) receptor (AMPAR) subunit proteins are expressed in cultured retinal ganglion cells (RGCs). METHODS: RGCs were purified from dissociated rat retinal cells (postnatal days 6-8), using a modified two-step panning method and cultured in serum-free medium containing neurotrophic factors and forskolin. Immunohistochemistry was performed on cultured RGCs on days 1, 3, and 7 in vitro (1 DIV, 3 DIV, and 7 DIV) using specific antibodies against AMPAR subunits GluR1 to 4 and microtubule-associated protein (MAP) 2, which is a neuronal marker. Glutamate-induced Ca(2+) influx was measured with fura-2 acetoxymethyl ester fluorescence. RESULTS: GluR1 to 4 proteins were expressed in the cell body of RGCs on 1 DIV. RGCs showed strong GluR1 to 4 immunoreactivity in both cell bodies and processes on 3 DIV and 7 DIV, with the gradual spreading of expression and the growth of processes. At all time points examined, GluR2 immunoreactivity was equal to that of the other subunits. Accumulation of intracellular Ca(2+) levels in RGCs induced by glutamate occurred equally on both 3 DIV and 7 DIV. CONCLUSION: All AMPAR subunits are almost equally expressed in cultured RGCs.

Repeated intravitreal triamcinolone injections in Behçet disease that is resistant to conventional therapy: one-year results.

PURPOSE: To determine whether repeated intravitreal triamcinolone (IVTA) injections in patients with Behçet disease that is resistant to conventional therapy will prevent recurrences of uveitis. DESIGN: Prospective preliminary clinical trial. METHODS: Nine eyes of five patients with Behçet disease with sight-threatening uveitis that was resistant to conventional therapy received repeated IVTA injections. Each patient was examined monthly, and IVTA was given when the TA particles that remained in the vitreous were judged to be gone before the next visit. RESULTS: Repeated IVTA completely prevented the recurrence of uveitis in eight eyes, and the one eye that had an attack experienced the uveitis when the TA particles disappeared quicker than expected. It was possible to stop systemic corticosteroid and/or immunosuppressive agents within 1 year after IVTA in three patients. CONCLUSION: These results indicate that repeated IVTA will prevent the recurrence of uveitis in patients with Behçet disease with frequent ocular attacks that is resistant to conventional therapy.

Protective effect of donepezil on retinal ganglion cells in vitro and in vivo.

The neuroprotective effect of donepezil, an acetylcholinesterase inhibitor on retinal ganglion cells (RGCs), was examined. The survival of purified RGCs after exposure to glutamate with or without donepezil (10(- 7) M to 10(- 5) M) was measured after 3 days in culture. In vivo, the neuroprotective effect of donepezil was examined by quantifying the number of viable RGCs 7 days after axotomy in adult rats. In vitro, donepezil dose-dependently reduced RGC death caused by glutamate toxicity. Oral administration of donepezil (10 mg kg(-1) day(-1)) significantly reduced RGC death after axotomy. In conclusion, donepezil exerts a protective effect on RGCs both in vitro and in vivo.

[The effect of substituting latanoprost 0.005% for unoprostone 0.12%].

PURPOSE: To evaluate the effect of substituting latanoprost(LAT) 0.005% for unoprostone(UNO) 0.12% after a trial of unilateral treatment. METHODS: We treated 30 patients with primary open-angle glaucoma(n = 8), ocular hypertension (n = 1), or normal-tension glaucoma(n = 21) with UNO for 4 weeks in one eye and then substituted LAT for UNO. Four weeks later we measured the intraocular pressure(IOP) in the ipsilateral eye. RESULTS: The mean baseline IOP level was 18.6 +/- 3.8(mean +/- standard deviation) mmHg. The mean IOP levels(reduction rates) after UNO and LAT therapy were 16.7 +/- 3.1 mmHg (16.6%) and 14.1 +/- 3.2 mmHg (28.9%), respectively(p < 0.001). All patients who responded to UNO also responded to LAT; however, 55% of those who did not respond to UNO responded to LAT. CONCLUSIONS: If LAT is substituted for UNO, it can be predicted that 63.3% of the patients will respond.