Alteration in Melanin Content in Retinal Pigment Epithelial Cells upon Hydroquinone Exposure.

Abnormal pigmentation or depigmentation of the retinal pigment epithelium (RPE) is a precursor to neovascular age-related macular degeneration (nAMD). In this study, we evaluated the effects of hydroquinone (HQ), the most potent reductant in cigarette smoke, on the melanin production in RPE cells. Induced pluripotent stem cell (iPS)-derived RPE and adult retinal pigment epithelial (ARPE-19) cells were cultured with HQ. Real-time reverse transcription polymerase chain reaction revealed that the expression of melanin-related genes decreased due to the addition of HQ for 1 day. Enzyme-linked immunosorbent immunoassay showed that the concentration of melanin significantly decreased due to the addition of HQ for 24 h. A suspension of RPE cells with HQ for 24 h was prepared, and the absorbance was measured. The absorbance decreased particularly under blue light, suggesting that blue light may reach the choroid and cause choroidal inflammation. Additionally, melanin levels significantly decreased due to the addition of HQ for 1 week. After blue light irradiation on the RPE with HQ for 1 week, the vascular endothelial growth factor in the medium was significantly higher in the HQ group than in the control group. HQ-induced changes in melanin production may be responsible for the uneven pigmentation of the RPE, and these changes may cause nAMD.

Acute retinal necrosis in a patient on immunosuppressive treatment for COVID-19 pneumonia: a case report.

BACKGROUND: Patients with coronavirus disease 2019 (COVID-19) occasionally develop ocular complications. We report a case of acute retinal necrosis (ARN) caused by Epstein-Barr Virus (EBV) that developed in a patient who had severe acute respiratory syndrome due to SARS-CoV-2 infection. CASE PRESENTATION: A 68-year-old woman complained of floaters and blurred vision in her right eye as she was receiving systemic prednisolone for COVID-19 pneumonia under isolation in our hospital. The patient visited an ophthalmologist following her discharge from the hospital and after the 2 weeks of isolation had ended. At the initial examination, her best-corrected visual acuity (BCVA) was 20/100 in the right eye, and the eye showed moderate anterior segment inflammation and vitreous opacities. Treatment was initiated with topical 0.1% betamethasone and 1.5% levofloxacin. After 1 month, the inflammation in the right eye decreased and her BCVA improved to 20/40. However, on day 48 from her initial visit, the inflammation in her right eye worsened and her BCVA decreased to 20/2000 by day 80. Pars plana vitrectomy with silicone oil tamponade was performed to remove the vitreous opacities, and expanded white exudates peripherally and retinal vessels with white sheathing suggestive of acute retinal necrosis (ARN) were seen intraoperatively. Analysis of the vitreous sample revealed EBV positivity on polymerase chain reaction. The patient was diagnosed with EBV-associated ARN and treated with systemic steroids and valaciclovir. The ocular inflammation gradually decreased, and she was discharged from the hospital. However, a week later, the inflammation in the right eye markedly worsened. Despite another course of steroids, the inflammation worsened, resulting in total retinal detachment and absolute glaucoma. Because of the severe pain, the right eye was enucleated. CONCLUSIONS: Clinicians should be aware that COVID-19 and immunosuppressive treatment can reactivate EBV in the eye.

Clinical implications of pachyvessels in polypoidal choroidal vasculopathy.

BACKGROUND: Polypoidal choroidal vasculopathy (PCV) is one of the disorders within the pachychoroid spectrum diseases. The presence of pachyvessels is one of the characteristics of pachychoroid disorders. However, the relationship between the presence of pachyvessels and the clinical characteristics of PCV eyes has not been determined. The purpose of this study was to determine the relationship between the presence of choroidal pachyvessels and the clinical characteristics of eyes with PCV. METHODS: The medical records of patients who were diagnosed with PCV and were treatment-naïve were reviewed. Fluorescein and indocyanine green angiography, fundus photography, spectral domain optical coherence tomography (SD-OCT), and enhanced depth imaging OCT (EDI-OCT) were used to obtain images of the choroid. The presence of pathologically dilated outer choroidal vessels, pachyvessels, was determined by ICGA images. These pachyvessels were confirmed to correspond with the large choroidal vessels in the EDI OCT images. The PCV eyes were divided into two groups based on the presence or absence of pachyvessels and clinical features and subfoveal choroidal thickness (SFCT) were evaluated between the two groups. RESULTS: Eighty-six eyes of 84 patients with PCV were evaluated. Pachyvessels were detected in 48 eyes (55.8%). The mean SFCT was 203.9 ± 83.9 µm in all 86 eyes, and it was significantly thinner in eyes with pachyvessels (+) than without pachyvessels (-) (183.2 ± 58.4 µm vs 230.2 ± 103.1 µm; P = 0.01). The differences in the incidence of subretinal fluid, pigment epithelial detachments, and hemorrhages between the two groups were not significant. However, the PCV eyes in pachyvessels (+) group with hemorrhage had the thinnest choroid (P = 0.047). The choroidal features of the fellow eyes were similar to those of the PCV affected eyes, that is, the fellow eyes in pachyvessels (+) group had pachyvessels and the fellow eyes in pachyvessels (-) group did not have pachyvessels. CONCLUSIONS: Pachyvessels were presented 55.8% in eyes with PCV, and these eyes had the thin SFCT. The presence of pachyvessels and attenuation of the inner choroid were probably due to the pathological changes in the eyes with PCV.

Cataracts and Subclinical Carotid Atherosclerosis in Older Adults　- A Cross-Sectional Study of the HEIJO-KYO Cohort.

BACKGROUND: Decreased light reception because of cataracts leads to potential circadian misalignment, resulting in exacerbation of atherosclerosis; however, little is known about the association between cataracts and atherosclerosis in populations.Methods and Results:In this cross-sectional study, cataracts were graded using slit lamp biomicroscopy with the Lens Opacities Classification System III and carotid atherosclerosis was assessed based on carotid intima-media thickness (IMT) measured using ultrasonography of the common carotid artery in 442 elderly participants (mean age, 70.0 years). Cataract was defined as nuclear cataract grade ≥3.0, cortical cataract grade ≥2.0, or posterior subcapsular cataract grade ≥2.0 in both eyes. The mean and maximal carotid IMT was 0.86±0.15 mm and 1.07±0.29 mm, respectively. In multivariable analysis adjusted for potential confounders, the mean and maximal carotid IMT were significantly greater in the cataract group than in the non-cataract group by 0.04 mm (95% confidence interval (CI), 0.01-0.06) and 0.07 mm (95% CI, 0.01-0.12), respectively. Logistic regression analysis adjusted for confounders revealed a significantly higher odds ratio for carotid atherosclerosis (maximal carotid IMT ≥1.1 mm) in the cataract group than in the non-cataract group (odds ratio, 1.78; 95% CI, 1.14-2.78). CONCLUSIONS: Cataracts may be independently associated with subclinical carotid atherosclerosis in the elderly population, indicating a need for further prospective studies.

TRAFFIC ACCIDENT-RELATED OPEN GLOBE INJURIES.

PURPOSE: To evaluate the clinical characteristics and visual outcomes of patients with traffic accident-related open globe injuries, and to examine preoperative factors influencing the visual prognosis after pars plana vitrectomy, as compared with common open globe injuries. METHODS: Patients with open globe injuries, who underwent pars plana vitrectomy, were identified. Patients' demographic and clinical data were entered into a computerized database for review and analysis; data included age, sex, initial visual acuity, duration between onset of injury and surgery, information about the type and cause of injury, wound location and length, presence of ocular complications, and final visual acuity. RESULTS: Of the 355 open globe injuries, 14 were sustained during a traffic-related accident; the average age was 50.4 years (range: 20-85) and most (78.6%) were men. Of these 14 patients, 9 (64.3%) presented with rupture and 5 (35.7%) with laceration. Injuries were caused while driving (6 eyes; 42.9%), riding a bicycle (5 eyes; 35.7%), involved in car accident while walking (2 eyes; 14.3%), and riding a motorbike (1 eye; 7.1%). Initial visual acuity was significantly related to final visual acuity (P = 0.003, R = 0.80). The final visual acuity in patients with traffic accident-related open globe injuries was significantly better than that of the total group (P = 0.01). CONCLUSION: Traffic accident-related open globe injuries had better visual outcomes than common open globe injuries. Visual outcomes in patients with traffic accident-related open globe injuries were related to the initial visual acuity. No eyes developed endophthalmitis in patients with traffic accident-related open globe injuries.

Effects of concentration of amyloid ß (Aß) on viability of cultured retinal pigment epithelial cells.

BACKGROUND: Amyloid beta (Aß) is a constituent of drusen that is a common sign of age-related macular degeneration (AMD). The purpose of this study was to investigate the effect of Aß on human retinal pigment epithelial (RPE) cells in culture. METHODS: Cells from a human RPE cell line (ARPE-19) were exposed to 0 to 25 µM of Aß 1-40 for 48 h, and the number of living cells was determined by WST-8 cleavage. Replicative DNA synthesis was measured by the incorporation of 5'-bromo-2'-deoxyuridine. The cell death pathway was investigated by the WST-8 cleavage assay after the addition of caspase-9 inhibitor, an anti-apoptotic factor. Real-time qRT-PCR was performed using Aß-exposed cellular RNA to determine the level of vascular endothelial growth factor (VEGF)-A and pigment epithelium derived factor (PEDF). To determine the effect of receptor-for-advanced glycation end products (RAGE), the siRNA for RAGE was inserted into ARPE-19 treated with Aß, and the levels of expression of VEGF-A and PEDF were determined. RESULTS: The number of living ARPE-19 cells was increased by exposure to 5 µM Aß but was decreased by exposure to 25 µM of Aß. Replicative DNA synthesis by ARPE-19 cells exposed to 25 µM of Aß was significantly decreased indicating that 25 µM of Aß inhibited cell proliferation. Real-time RT-PCR showed that the level of the mRNA of PEDF was increased by exposure to 5 µM Aß, and the levels of the mRNAs of PEDF and VEGF-A were also increased by exposure to 25 µM Aß. The addition of an inhibitor of caspase-9 blocked the decrease the number of ARPE-19 cells exposed to 25 µM Aß. Exposure to si-RAGE attenuated the increase of VEGF-A and PEDF mRNA expression in ARPE-19 exposed to Aß. CONCLUSIONS: Exposure of ARPE-19 cells to low concentrations of Aß increases the level of PEDF which then inhibits the apoptosis of ARPE-19 cells leading to RPE cell proliferation. Exposure to high concentrations of Aß induces RPE cell death and enhances the expression of the mRNA of VEGF-A in RPE cells. The Aß-RAGE pathway may lead to the expression VEGF-A and PEDF in RPE cells. These results suggest that Aß is strongly related to the pathogenesis of choroidal neovascularization.

Clinical characteristics and outcomes of fall-related open globe injuries in Japan.

PURPOSE: To investigate the clinical characteristics and visual outcomes in patients with fall-related open globe injuries and to evaluate differences between fall-related and non-fall-related open globe injuries in Japan. METHODS: A retrospective review of patients with open globe injury who presented to Japan-Clinical Research of Study (J-CREST) hospitals between 2005 and 2015 was enrolled. Clinical information including age, sex, initial visual acuity, final visual acuity, type of injury, status of the crystalline lens, zone of injury, wound length, presence of retinal detachment, proliferative vitreoretinopathy, expulsive hemorrhage, and endophthalmitis was recorded. RESULTS: A total of 374 eyes were enrolled, of which 120 (32.1%) suffered from fall-related injury with average age of 73.7 ± 15.9 years (range, 11-101 years). A majority of patients were female (55.8%). Of 120 patients with fall-related injury, 109 (90.8%) presented with rupture and 11 (9.2%) with laceration. A multiple regression analysis revealed that final visual acuity was significantly associated with initial visual acuity (r = 0.99, P < 0.001). Compared to non-fall-related open globe injuries, fall-related open globe injuries were associated with elderly age, female sex, poorer initial and final visual acuity, rupture, absence of the lens, larger wound size, retinal detachment, expulsive hemorrhage, and absence of endophthalmitis (P < 0.01). CONCLUSIONS: Fall-related open globe injuries were more frequent in elderly female and accompanied by larger wound lengths and severer ocular complications. Visual outcomes in patients with fall-related open globe injuries were related to initial visual acuity.

Allometry in Physarum plasmodium during free locomotion: size versus shape, speed and rhythm.

Physarum plasmodium is a giant unicellular organism whose length can vary by more than three orders of magnitude. Using plasmodia ranging in size from 100 µm to 10 cm, we investigated the size dependency of their thickness distributions and locomotion speeds during free locomotion. (1) In the longitudinal direction, the organism is thickest close to the front, and decreases exponentially in thickness towards the rear. The slenderness ratio varies with body size according to a power law, such that large plasmodia are long and flat, whereas small plasmodia are short and thick. (2) The mean locomotion speed is proportional to the mean maximum thickness of the frontal part. By conducting a dimensional analysis, possible physical models are discussed. (3) The intrinsic period of the thickness oscillation, which is related to shuttle streaming (period 1-2 min), increases logarithmically with body size. (4) Various characteristics exhibit size-independent, long-period (20±10 min) oscillations, including speed, shape and intrinsic thickness oscillation period. These variations are closely coupled to formation of the entire cell shape, including undulation of thickness along the longitudinal axis and timing of branching of the frontal tip. Based on these experimental results and those reported previously, we propose a simple mathematical model for cell locomotion.

Patterns of cell thickness oscillations during directional migration of Physarum polycephalum.

The functional relationship between the velocity of cell locomotion and intracellular spatial patterns of thickness oscillations in the acellular slime mould Physarum polycephalum was studied. The freely migrating plasmodial cells of 300-800 µm length were tadpole-shaped and displayed thickness oscillations along their longitudinal (body) axis. Two distinct patterns of intracellular thickness oscillations were observed in dependence on the locomotive velocity. The first mode consisted of a single travelling wave that propagated from the rear to the front of the cell. This pattern occurred when the plasmodium migrated slowly. The second mode was a multinodal standing wave that was found during events of fast propagation. Transitions between these two types of cell thickness oscillation patterns took place in narrow propagation velocity intervals. We discuss the possible mechanism leading to these patterns, which are conjectured to modulate both the intracellular pressure and the velocity of free locomotion of the cell.

Relationship between foveal microstructures and visual outcomes in eyes with resolved central serous chorioretinopathy.

PURPOSE: To determine whether significant correlations exist between the foveal microstructures and visual outcomes in eyes with resolved central serous chorioretinopathy (CSC). METHODS: We retrospectively reviewed the medical records of patients who had a complete resolution of the serous retinal detachment (SRD) and had an intact ellipsoid zone in the fovea in the spectral-domain optical coherence tomographic (SD-OCT) images. Twenty-five eyes with CSC (CSC group) and 18 unaffected fellow eyes (control group) of 23 patients were evaluated. The eyes in the CSC group were divided into those with (n = 11) and those without (n = 14) visual disturbances after resolution of the SRD. The thickness of each retinal layer at the fovea was measured in the SD-OCT images. RESULTS: The photoreceptor outer segment (OS) length in the CSC group was significantly shorter than that in the control group (p = 0.0003). In addition, the photoreceptor OS length in the visual disturbances group was significantly shorter and the duration of SRD was significantly longer than that in the no visual disturbances group (p = 0.0230, p = 0.0021, respectively). CONCLUSIONS: The photoreceptor OS length is a good parameter to indicate the integrity of the foveal photoreceptors in eyes with a resolved CSC.

Topological specificity and hierarchical network of the circadian calcium rhythm in the suprachiasmatic nucleus.

The circadian pacemaker in the hypothalamic suprachiasmatic nucleus (SCN) is a hierarchical multioscillator system in which neuronal networks play crucial roles in expressing coherent rhythms in physiology and behavior. However, our understanding of the neuronal network is still incomplete. Intracellular calcium mediates the input signals, such as phase-resetting stimuli, to the core molecular loop involving clock genes for circadian rhythm generation and the output signals from the loop to various cellular functions, including changes in neurotransmitter release. Using a unique large-scale calcium imaging method with genetically encoded calcium sensors, we visualized intracellular calcium from the entire surface of SCN slice in culture including the regions where autonomous clock gene expression was undetectable. We found circadian calcium rhythms at a single-cell level in the SCN, which were topologically specific with a larger amplitude and more delayed phase in the ventral region than the dorsal. The robustness of the rhythm was reduced but persisted even after blocking the neuronal firing with tetrodotoxin (TTX). Notably, TTX dissociated the circadian calcium rhythms between the dorsal and ventral SCN. In contrast, a blocker of gap junctions, carbenoxolone, had only a minor effect on the calcium rhythms at both the single-cell and network levels. These results reveal the topological specificity of the circadian calcium rhythm in the SCN and the presence of coupled regional pacemakers in the dorsal and ventral regions. Neuronal firings are not necessary for the persistence of the calcium rhythms but indispensable for the hierarchical organization of rhythmicity in the SCN.

Relationship between presence of foveal bulge in optical coherence tomographic images and visual acuity after rhegmatogenous retinal detachment repair.

PURPOSE: To determine whether a significant correlation exists between the presence of a bulge in the photoreceptor inner segment/outer segment line and the best-corrected visual acuity in eyes after successful rhegmatogenous retinal detachment (RRD) repair. METHODS: Patients who had undergone successful RRD repair and had an intact inner segment/outer segment line at the central fovea in the spectral-domain optical coherence tomographic images were retrospectively studied. Thirty-five eyes of 35 patients were evaluated, and the eyes were classified preoperatively into those with macula-on RRD (n = 14) and those with macula-off RRD (n = 21). Examination of the spectral-domain optical coherence tomographic images of normal eyes showed that the inner segment/outer segment line has a bulge at the central fovea. The 35 eyes with successful retinal reattachment were classified by the presence or absence of foveal bulge. RESULTS: The presence of foveal bulge differed significantly between macula-on RRD (100%) and macula-off RRD group (28.6%; P < 0.0001). In the macula-off RRD group, the best-corrected visual acuity was significantly better in eyes with a foveal bulge than in eyes without a foveal bulge (P = 0.0028). CONCLUSION: The foveal bulge is a good marker to determine the functional properties of the fovea in eyes with successful RRD repair.

Evaluation of Choroidal Structure in Type 1 Macular Neovascularization Using Different Optical Coherence Tomography Analyses: Scale Bar and Binarization.

BACKGROUND: Macular neovascularization (MNV) has been evaluated by optical coherence tomography (OCT) imaging using various approaches. However, few studies have examined their differences. This study analyzed type 1 MNV with a combination of two approaches: scale bar and binarization. METHODS: We enrolled 84 patients with untreated type 1 MNV. We measured choroidal parameters using a scale bar and defined the ratios of superficial choroidal thickness to choroidal vessel diameter (SV ratios). We also used binarization and calculated the ratios of the luminal to the choroidal area (LC ratios) in two directions (horizontal and vertical). RESULTS: Fifty-one patients (61%) were classified as having polyps. SV ratios in the group with polyps were significantly lower than in the group without (p < 0.001). The receiver operating characteristic (ROC) curve showed that the SV ratio was predictive of polyps (AUC 0.733, 95% CI: 0.621-0.844). In patients without polyps, horizontal LC ratios were significantly higher in a subgroup with subretinal fluid than in those without (p = 0.047). The ROC curve showed that the LC ratio was predictive of subretinal fluid (AUC 0.722, 95% CI: 0.517-0.926). CONCLUSION: The SV ratio reflects the MNV disease type, whereas the LC ratio reflects MNV disease activity. Establishing cut-off values for each ratio may be useful for MNV diagnosis.

Efficacy, durability, and safety of faricimab with extended dosing up to every 16 weeks in diabetic macular edema: 2-year results from the Japan subgroup of the phase 3 YOSEMITE trial.

PURPOSE: To evaluate the 2-year efficacy, durability, and safety of faricimab in patients with diabetic macular edema (DME) in the YOSEMITE Japan subgroup. STUDY DESIGN: YOSEMITE/RHINE (NCT03622580/NCT03622593) subgroup analysis: global, multicenter, randomized, double-masked, active-comparator-controlled, phase 3 faricimab trials. METHODS: Patients were randomized 1:1:1 to intravitreal faricimab 6.0 mg every 8 weeks (Q8W) and per treat-and-extend (T&E) dosing, or aflibercept 2.0 mg Q8W. Outcomes were assessed through year 2 for the YOSEMITE Japan subgroup (N = 60) and the pooled YOSEMITE/RHINE global cohort (N = 1891). RESULTS: In the YOSEMITE Japan subgroup, 21, 19, and 20 patients were randomized to faricimab Q8W, faricimab T&E, and aflibercept Q8W, respectively (632, 632, and 627 patients in the pooled YOSEMITE/RHINE cohort). Vision gains and anatomic improvements with faricimab at year 1 were maintained over 2 years and were generally consistent between groups. Mean best-corrected visual acuity changes from baseline at year 2 (weeks 92-100 average) for the YOSEMITE Japan subgroup were +12.5, +9.0, and +5.0 letters in the faricimab Q8W, faricimab T&E and aflibercept Q8W arms, respectively (+10.8, +10.4, and +10.3 letters in the pooled YOSEMITE/RHINE cohort). At week 96, 61.1% of the YOSEMITE Japan subgroup and 78.1% of the pooled YOSEMITE/RHINE cohort were on ≥ Q12W dosing. Faricimab was well-tolerated with a safety profile comparable with aflibercept. CONCLUSION: Faricimab up to Q16W offered durable vision gains and anatomic improvements up to 2 years in patients with DME in the YOSEMITE Japan subgroup. Outcomes were generally consistent with the pooled YOSEMITE/RHINE cohort.

En-Face Optical Coherence Tomography Is Useful for Assessing Striated Lesions in Angioid Streaks: A Case Report.

Angioid streaks are mainly characterized by radially striated lesions around the optical disc and result in severe vision loss when choroidal neovascularization (CNV) develops at the macula. The prediction of visual prognosis in cases with angioid streaks remains an unsolved problem. In this study, we report the usefulness of en-face optical coherence tomography (OCT) to assess the bilateral striated lesions in angioid streaks. A 59-year-old female who was previously diagnosed with angioid streaks complained of decreased visual acuity in her left eye. However, on en-face OCT, the striated lesions in the right eye with better vision were shown as thicker continuous lesions than those in the left eye. Twenty-four months after the initial visit, her right visual acuity was worse than her left. En-face OCT showed fine-striated lesions extending from those thicker lesions to the macular area in the right eye. The thicker striated lesions observed at the initial visit may be a risk factor for future CNV development and vision loss. The evaluation of lesion size using en-face OCT may be useful for predicting the visual prognosis in angioid streaks.

Cytomegalovirus Retinitis in a Patient Taking Upadacitinib: A Case Report.

Upadacitinib is a relatively new drug used to treat autoimmune diseases. However, patients treated with upadacitinib may develop infections. We report a case of cytomegalovirus (CMV) retinitis that developed during upadacitinib administration. A 79-year-old woman presented with progressively decreasing vision in both eyes. Her decimal best-corrected visual acuity (BCVA) was 0.2 in the right and 0.01 in the left eye. The patient was taking upadacitinib for one year. Fundus examination revealed vitreous opacities and extensive white retinal lesions with hemorrhage in both eyes. CMV was detected in the anterior aqueous humor, vitreous humor, and blood samples. We diagnosed her with panuveitis and CMV retinitis, performed a vitrectomy in both eyes, and administered intravenous ganciclovir and steroids. After treatment, her BCVA improved to 0.6 in the right and 0.1 in the left eye. Ophthalmologists and physicians should be aware of CMV infections in patients being treated with upadacitinib.

Development of an Eccentric Macular Hole Followed by Reopening of the Original Macular Hole as a Long-term Sequelae of Internal Limiting Membrane Peeling and Focal Laser Photocoagulation: A Case Report.

A macular hole (MH) is a widely known disease among ophthalmologists. Vitrectomy with internal limiting membrane (ILM) peeling is a standard technique for full-thickness MHs. However, the recurrence of MHs is sometimes seen. In addition, an eccentric MH is known to rarely occur after vitrectomy. An eccentric MH has been considered to require no therapeutic intervention because of its lack of increase in size. This study reports a case of two MHs (a recurrent MH and an enlarged eccentric MH) developed after laser photocoagulation around the injured retina caused by ILM peeling at the initial surgery. A 56-year-old woman presented with an idiopathic MH in her left eye and best-corrected visual acuity (BCVA) was decreased to 20/80. She underwent phacoemulsification and vitrectomy combined with posterior hyaloid removal, ILM peeling, and 20% sulfur hexafluoride gas tamponade.  During the ILM peeling, we performed laser photocoagulation around the injured retina within the arcade. The MH was successfully closed and her BCVA was improved to 20/20 one month after surgery. Eight months after surgery, an eccentric MH occurred next to the photocoagulation spots. However, her BCVA remained 20/20; thus, we just followed up on her eye. Six years after surgery, her BCVA was decreased to 20/200. The eccentric MH increased in size and the original MH re-opened. The second vitrectomy was performed, but ILM had been already peeled within the arcade during the previous surgery and a usable sufficient size of ILM which could be auto-transplanted to the holes was not obtained. Thus, free flaps of the posterior lens capsule were harvested and placed within each hole. Two holes were successfully closed and her BCVA improved to 10/20 at three months after the surgery. Laser photocoagulation around the injured retina derived from ILM peeling may be a risk for recurrent MHs. .

Positive Association between Macular Pigment Optical Density and Glomerular Filtration Rate: A Cross-Sectional Study.

Although decreased macular pigment density is associated with the development of age-related macular degeneration (AMD), exactly how this decrease may contribute to the development of AMD is still not fully understood. In this study, we investigated the relationship between macular pigment optical density (MPOD) and estimated glomerular filtration rate (eGFR). MPOD was measured using MPS II (Electron Technology, Cambridge, UK) in 137 participants who showed no clinical signs of AMD at 3 months after cataract surgery, and simple and multiple linear regression analyses were performed to determine the associations with age, sex, abdominal circumference, diabetes, hypertension, smoking, intraocular lens color, visual acuity before and after surgery, and eGFR. The participants were divided into two groups based on the median MPOD (0.58): the high-pigment and low-pigment groups. The mean value of eGFR in the high-pigment group was significantly higher than that in the low-pigment group (64.2 vs. 58.1, p = 0.02). The simple linear regression analysis revealed a significant positive association between MPOD and eGFR (ß = 0.0034, 95% confidence interval [CI]: 0.0011-0.0056, p = 0.0038), and this association was independent of age, sex, abdominal circumference, diabetes, smoking, hypertension, best-corrected visual acuity (BCVA) before surgery, BCVA after surgery, and intraocular lens color (ß = 0.0033, 95% CI: 0.00090-0.0058, p = 0.0076). These results show a strong association of renal dysfunction with the decrease in MPOD.

Risk Factors for Legal Blindness in 237 Japanese Patients with Exogenous Endophthalmitis: A Multicenter Cohort Study from J-CREST.

PURPOSE: We investigated potential risk factors for visual prognosis in Japanese patients with exogenous endophthalmitis. METHODS: In this retrospective observational multicenter cohort study, risk factors for legal blindness at 12 weeks after treatment initiation were evaluated based on patient characteristics, initial BCVA, causative events, pathogens, ocular symptoms, duration from symptom onset to initial treatment, and selected treatments. RESULTS: Overall, 23.1% of eyes developed legal blindness. The six risk factors for legal blindness were presence of eye pain, pathogen identification, poor BCVA at the initial visit, longer duration from symptom onset to initial treatment, type of causative event, and type of causative pathogen. Regarding the type of causative pathogen, coagulase-negative staphylococci was associated with a better visual impairment outcome. CONCLUSION: Exogenous endophthalmitis remains a severe ocular infection; however, it can be managed with rapid treatment, as well as other advances in medical knowledge and technology.

Risk Factors for Legal Blindness in 77 Japanese Patients with Endogenous Endophthalmitis: A Multicenter Cohort Study from J-CREST.

PURPOSE: We investigated potential predictive factors for visual prognosis in Japanese patients with endogenous endophthalmitis. DESIGN: Retrospective observational multicenter cohort study. METHODS: We examined the characteristics of 77 Japanese patients with endogenous endophthalmitis and performed statistical analyses of these real-world data. The primary endpoint was the identification of factors associated with visual prognosis. We examined differences between patients in the better vision and legal blindness groups at 12 weeks after treatment initiation. RESULTS: The five risk factors for visual impairment at 12 weeks after treatment initiation were presence of pressure injuries, severe clinical symptoms (presence of eye pain and ciliary injection), pathogen identification, and poor best-corrected visual acuity at baseline. Staphylococcus aureus and fungus were associated with a better visual impairment outcome. CONCLUSIONS: Endogenous endophthalmitis remains a severe ocular infection; however, it can be managed with rapid treatments, as well as other advances in medical knowledge and technology.