Oral Iron Absorption of Ferric Citrate Hydrate and Hepcidin-25 in Hemodialysis Patients: A Prospective, Multicenter, Observational Riona-Oral Iron Absorption Trial.

Oral ferric citrate hydrate (FCH) is effective for iron deficiencies in hemodialysis patients; however, how iron balance in the body affects iron absorption in the intestinal tract remains unclear. This prospective observational study (Riona-Oral Iron Absorption Trial, R-OIAT, UMIN 000031406) was conducted at 42 hemodialysis centers in Japan, wherein 268 hemodialysis patients without inflammation were enrolled and treated with a fixed amount of FCH for 6 months. We assessed the predictive value of hepcidin-25 for iron absorption and iron shift between ferritin (FTN) and red blood cells (RBCs) following FCH therapy. Serum iron changes at 2 h (ΔFe2h) after FCH ingestion were evaluated as iron absorption. The primary outcome was the quantitative delineation of iron variables with respect to ΔFe2h, and the secondary outcome was the description of the predictors of the body's iron balance. Generalized estimating equations (GEEs) were used to identify the determinants of iron absorption during each phase of FCH treatment. ΔFe2h increased when hepcidin-25 and TSAT decreased (-0.459, -0.643 to -0.276, p = 0.000; -0.648, -1.099 to -0.197, p = 0.005, respectively) in GEEs. FTN increased when RBCs decreased (-1.392, -1.749 to -1.035, p = 0.000) and hepcidin-25 increased (0.297, 0.239 to 0.355, p = 0.000). Limiting erythropoiesis to maintain hemoglobin levels induces RBC reduction in hemodialysis patients, resulting in increased hepcidin-25 and FTN levels. Hepcidin-25 production may prompt an iron shift from RBC iron to FTN iron, inhibiting iron absorption even with continued FCH intake.

EXTREME MACULAR SCHISIS-SIMULATING RETINAL DETACHMENT IN EYES WITH PATHOLOGIC MYOPIA.

PURPOSE: To determine the clinical and imaging characteristics, natural course, and surgical outcomes of pathologic myopic eyes with an extreme macular schisis simulating a retinal detachment (EMSSRD). METHODS: The data of 617 highly myopic eyes with myopic traction maculopathy were studied. The diagnosis of EMSSRD in the optical coherence tomography images was made based on a high elevation of the retina (>500 µ m), less obvious columnar structures, and the presence of thin remnants of outer retinal tissues above the retinal pigment epithelium. RESULTS: Among 617 eyes, 25 eyes had an EMSSRD. All of the eyes with an EMSSRD had macular atrophy caused by myopic macular neovascularization. In the five eyes they had progressed to MHRD, the retinal detachment started away from the macular atrophy. Among the 10 eyes which required surgery, there was no significant difference in the presurgical and postsurgical best-corrected visual acuity between the eyes operated because of a worsening of the EMSSRD and the eyes operated because of a progression to MHRD. CONCLUSION: In severely myopic eyes with macular neovascularization-related macular atrophy, a novel condition termed EMSSRD can be present. The optical coherence tomography images resemble those of a MHRD except the presence of thin remnants of the retina remaining on the retinal pigment epithelium.

FUNCTIONAL AND STRUCTURAL OUTCOMES AFTER FOVEA-SPARING INTERNAL LIMITING MEMBRANE PEELING FOR MYOPIC MACULAR RETINOSCHISIS BY MICROPERIMETRY.

PURPOSE: To determine the morphological and physiological outcomes and safety of vitrectomy with fovea-sparing internal limiting membrane peeling for myopic macular retinoschisis (MRS). METHODS: Highly myopic eyes (refractive error greater than -8.0 diopters or an axial length longer than 26.5 mm) with MRS that underwent vitrectomy with fovea-sparing internal limiting membrane peeling were analyzed retrospectively. The best-corrected visual acuity, retinal morphology, and the central and paracentral retinal sensitivities at 2°/6° by microperimetry were evaluated before and after the surgery. Postoperative microscotomas were also determined. RESULTS: Thirty-three eyes with MRS; 16 eyes with and 17 eyes without a foveal retinal detachment, were studied. All 33 eyes had an improvement of MRS and foveal retinal detachment partially or completely after surgery, and none developed a full thickness macular hole. The postoperative best-corrected visual acuity, the central retinal sensitivity, and the retinal sensitivity at 2° were significantly better than the preoperative values. Sixteen eyes developed postoperative microscotomas at paracentral 2° and/or 6°. CONCLUSION: The results showed that vitrectomy with fovea-sparing internal limiting membrane peeling is an effective and safe method to treat an MRS regardless of the presence of a foveal retinal detachment. However, careful follow-up should be performed to detect postoperative microscotomas.

DEVELOPMENT OF MACULAR ATROPHY AFTER PARS PLANA VITRECTOMY FOR MYOPIC TRACTION MACULOPATHY AND MACULAR HOLE RETINAL DETACHMENT IN PATHOLOGIC MYOPIA.

PURPOSE: To determine the incidence and long-term outcome of macular atrophy (MA) after pars plana vitrectomy (PPV) in pathologic myopia. METHODS: Highly myopic patients who underwent PPV for myopic traction maculopathy and macular hole retinal detachment at Tokyo Medical and Dental University between 2012 and 2016 were studied. Fundus photographs and/or optical coherence tomography were examined before and after PPV at every visit. RESULTS: A total of 133 eyes were followed for 39 months with the mean age of 62.8 years and the mean axial length of 30.0 mm. Postoperatively, 14 eyes (10.5%) developed fovea-centered MA, observed initially as a small, isolated, whitish lesion at the center of fovea at 3.5 months after PPV. The appearance of the MA was distinctly different from the choroidal neovascularization-related MA or patchy atrophy-related MA. With time, the lesions enlarged circumferentially. In these 14 eyes, the final best-corrected visual acuity was worse than the baseline, although the difference was not significant. The occurrence of MA was significantly associated with the preoperative foveal status. CONCLUSION: The development of MA can occur in 11% of highly myopic eyes after PPV for myopic traction maculopathy and macular hole retinal detachment. This postoperative MA might be a new complication of pathologic myopia.

Impaired mental health status in patients with chronic kidney disease is associated with estimated glomerular filtration rate decline.

AIM: Deteriorated health-related quality of life (HRQOL) is associated with increased risk for death in both chronic kidney disease (CKD) and end-stage renal disease (ESRD) patients; however, the impact of HRQOL on CKD progression is not well investigated. METHODS: We aimed to evaluate the association between HRQOL and CKD progression in Japanese patients with CKD. One hundred and three outpatients who visited the department of nephrology at our hospital (mean estimated glomerular filtration rate (eGFR); 32.1 ± 11.2 mL/min per 1.73 m2 ) between April 2007 and March 2012 were enrolled in this study. The primary outcome was 30% decline of eGFR or ESRD. We assessed HRQOL of all participants at baseline, including the physical component summary (PCS), the mental component summary (MCS) and the role/social component summary (RCS), using SF-36. Based on the baseline score of PCS, MCS and RCS, we divided all subjects into two groups by median. RESULTS: We studied 66 men (64.1%) and 37 women aged 61.7 ± 10.0 years old. During approximately 2.5 years of follow-up period, 59 patients (57.3%) reached 30% eGFR decline or ESRD. Cox regression analyses demonstrated that lower MCS score was significantly associated with CKD progression (hazard ratio (HR) = 1.83, 95% CI = 1.04-3.21, P = 0.035), but that lower PCS score and RCS score were not (HR = 0.70, 95% CI = 0.39-1.25, P = 0.223; HR = 0.95, 95% CI = 0.54-1.67, P = 0.854, respectively). CONCLUSION: We found that impaired mental health was associated with CKD progression. The evaluation of the mental health should be performed in the patients with CKD.

Ultrawide-Field OCT to Investigate Relationships between Myopic Macular Retinoschisis and Posterior Staphyloma.

PURPOSE: To investigate the relationships between myopic macular retinoschisis (MRS) and posterior staphylomas and to reveal the characteristics of other retinal lesions associated with MRS. DESIGN: Retrospective, observational case series. PARTICIPANTS: Seven hundred twenty-nine eyes of 420 patients with high myopia, which was defined as myopic refractive error of more than -8.0 diopters or an axial length longer than 26.5 mm. METHODS: Highly myopic eyes were examined by ultrawide-field (UWF) swept-source (SS) OCT with scan width of up to 23 mm and scan depth of 5 mm. The OCT features of MRS and posterior staphylomas and their spatial relationship were examined in UWF SS OCT images. MAIN OUTCOME MEASURES: Associations between MRS and staphylomas. RESULTS: In 729 eyes with mean axial length of 30.2±2.1 mm, posterior staphyloma was detected in 482 eyes (66.1%) and MRS was detected in 136 eyes (18.7%). All 136 eyes with an MRS showed outer retinoschisis, and 40 eyes (29.4%) also showed inner retinoschisis. Posterior staphyloma was detected significantly more frequently in eyes with MRS (117/136 [86.0%]) than in eyes without MRS (365/593 [61.6%]; P < 0.001). In all eyes with both staphyloma and outer retinoschisis, the area of the outer retinoschisis was restricted to the area within the staphyloma. In 1 of the 19 eyes with outer retinoschisis but without staphyloma, the outer retinoschisis extended beyond the range of the scanned fundus area. Among the 40 eyes with inner retinoschisis, the inner retinoschisis was located within the region of the outer retinoschisis in 39 eyes (97.5%). In all eyes with inner retinoschisis, retinal lesions causing an inward-directed tractional force were found within the area of the inner retinoschisis. CONCLUSIONS: In highly myopic eyes, the sites of the MRS and staphylomas were spatially related to each other. Posterior-directed force in association with staphylomas, and an inward-directed force resulting from epiretinal membranes or vitreoretinal attachments, may act as causative factors for MRS. However, the exact mechanisms related to the development of an MRS are probably diverse and complex.

Suprachoroidal hemorrhage followed by swept-source optical coherence tomography: a case report.

BACKGROUND: To report a case of Suprachoroidal Hemorrhage followed by Swept-Source Optical Coherence Tomography. CASE PRESENTATION: A 66-year-old woman with a rhegmatogenous retinal detachment in her left eye underwent pars plana vitrectomy. During the intraocular photocoagulation for a retinal tear after fluid-air exchange, a vitreous hemorrhage and suprachoroidal hemorrhage (SCH) developed. The surgical incisions were closed after filling the vitreous cavity with silicone oil. Two weeks later, the hemolyzed hemorrhage was removed, and new silicone oil was injected. After the surgery, a low reflective region was detected near the macula in the swept-source optical coherence tomographic (SS-OCT) images. The low reflective region was caused by the residual hemorrhage. The size of the reflective region gradually decreased and was not present at 3 months. We conclude that SS-OCT can be used to follow the resolution of a suprachoroidal hemorrhage. CONCLUSION: SS-OCT can be used to detect and follow the natural course of a suprachoroidal hemorrhage including the absorptive processes.

TAFRO syndrome successfully treated with tocilizumab: A case report and systematic review.

Thrombocytopenia, anasarca, fever, reticulin fibrosis, and organomegaly (TAFRO) syndrome is considered as a unique clinicopathologic variant of multicentric Castleman's disease and is recently reported in Japan. This entity represents a severe inflammatory state leading to organ failures such as severe liver dysfunction seen in our case, and can be treated by immunosuppressive agents, steroids, and cyclosporine shown in several case reports. A systematic review and our case suggest the potential utility of tocilizumab as a treatment for TAFRO syndrome.

Peripapillary Diffuse Chorioretinal Atrophy in Children as a Sign of Eventual Pathologic Myopia in Adults.

PURPOSE: To search for a morphologic biomarker to differentiate between pathologic myopia and simple childhood myopia. DESIGN: Retrospective case series. PARTICIPANTS: The study included children (age ≤15 years) with high myopia (as defined by the Japanese Ministry of Health and Welfare) who attended the High Myopia Clinic between April 1982 and March 1994, had undergone fundus photography, and had a follow-up of 20 years or more. METHODS: Fundus photographs obtained in childhood and adulthood were examined for presence of pathologic myopia, defined by high myopia (myopic refractive error >8 diopters or axial length ≥26.5 mm) and the presence of stage 2 or higher myopic maculopathy. MAIN OUTCOME MEASURES: Myopic maculopathy in childhood. RESULTS: The study included 56 eyes of 29 patients with a mean age of 10.2±3.6 years at the initial visit and an age of 36.0±7.6 years at the last visit. Mean axial length was 27.0±1.4 mm at baseline and 29.7±2.0 mm at the last visit. At the last visit, 19 eyes (34%) had tessellated fundus alone, 31 eyes (55%) had diffuse chorioretinal atrophy, 3 eyes (5%) showed patchy chorioretinal atrophy, and 1 eye (2%) had macular atrophy. Thus, 35 eyes (63%) had pathologic myopia in adulthood. Among the 35 eyes, 29 (83%) already had diffuse chorioretinal atrophy at the initial visit in childhood and the remaining 6 eyes (17%) showed tessellated fundus in childhood. The diffuse chorioretinal atrophy seen in childhood was restricted to the area temporal to the peripapillary region. CONCLUSIONS: The presence of peripapillary diffuse chorioretinal atrophy in children with high axial myopia may be an indicator for the eventual development of advanced myopic chorioretinal atrophy in later life. These features in children may be helpful for differentiating simple childhood myopia from eventual pathologic myopia.

PERIPHERAL PIGMENTED STREAKS IN EYES WITH PATHOLOGIC MYOPIA.

PURPOSE: To determine the incidence and the characteristics of peripheral pigmented streaks in the eyes with pathologic myopia. METHODS: The widefield fundus images of 375 eyes (203 patients) with pathologic myopia were examined. The characteristics of the pigmented streaks existing in the peripheral fundus were analyzed. The spatial relationships between the steep edge of a staphyloma and the distribution of the streaks were also determined. RESULTS: Peripheral streaks were observed in 165 of the 375 eyes (44.0%) as dark, pigmented, radially oriented lesions resembling octopus tentacles. The streaks ran from the mid periphery to the equator. Large choroidal vessels were observed in the corresponding sites, so the streaks probably existed in the layer of the large choroidal vessels or deeper. The patients with streak lesions were significantly older and had a posterior staphyloma more frequently than the eyes without the streaks. The streaks were observed mainly in the area opposite the steep edge of a staphyloma. CONCLUSION: Peripheral pigmented streaks are seen in approximately 44% of eyes with pathologic myopia. The streaks existed in the layer of large choroidal vessels or deeper, and the thinning of the choroid-retina in highly myopic eyes contributes to the visibility of such deep lesions.

Comparison of Clinical Features in Highly Myopic Eyes with and without a Dome-Shaped Macula.

PURPOSE: To compare the clinical features of highly myopic eyes with a dome-shaped macula (DSM) with those without a DSM and to identify the funduscopic clues to suspect the presence of DSM. DESIGN: Retrospective case series. PATIENTS: A total of 586 patients (1118 eyes) with high myopia (refractive error <-8 diopters [D] or axial length ≥26.5 mm) who had optical coherence tomography (OCT) examinations through the central fovea at our High Myopia Clinic between February 2012 and November 2013. METHODS: Vertical and horizontal OCT scans across the central fovea were retrospectively analyzed. A DSM was defined by the presence of an inward bulge of >50 µm in the vertical OCT image. Fundus photographs also were analyzed to identify the funduscopic clues to suspect the presence of DSM. MAIN OUTCOME MEASURES: The rate of DSM in 1118 highly myopic eyes. The rate of DSM in highly myopic eyes with macular complications. Funduscopic features to suggest the presence of DSM. RESULTS: Among the 1118 eyes, 225 (20.1%) had a DSM. A DSM was present in both vertical and horizontal OCT sections in 20% of eyes, along only the vertical section in 77% of eyes, and in only the horizontal section in 2% of eyes. The results of multiple regression analyses showed that serous retinal detachment and foveal and extrafoveal retinoschisis were significantly associated with the presence of DSM and that choroidal neovascularization was not. Ophthalmoscopically, 91.4% of the eyes with the appearance of a horizontal ridge connecting the optic disc and the fovea had a DSM. CONCLUSIONS: A DSM is found in as many as 20% of highly myopic individuals. Horizontal ridges connecting the optic disc and the fovea might be an important clue to suspect the presence of a DSM on the basis of fundus photographs.

Myopic stretch lines: linear lesions in fundus of eyes with pathologic myopia that differ from lacquer cracks.

PURPOSE: To clarify the pathophysiology of linear hypofluorescent lesions observed by fluorescein angiography (FA) in the posterior fundus of eyes with pathologic myopia and to compare the features of these lesions with those of lacquer cracks. METHODS: Medical records of 117 eyes of 81 highly myopic patients, which had linear lesions with abnormal fluorescence by FA were reviewed. Features obtained by fundus autofluorescence, indocyanine green angiography, and optical coherence tomography were also analyzed. RESULTS: In 37 of 117 eyes, the linear lesions were hyperfluorescent in the fluorescein angiograms and appeared yellowish ophthalmoscopically. Optical coherence tomography showed discontinuities of retinal pigment epithelium; thus, they were considered to represent lacquer cracks. In the remaining 80 eyes, the linear lesions were hypofluorescent by FA and ophthalmoscopic observation showed pigmented brown lines. Optical coherence tomography showed clumps of retinal pigment epithelium at the corresponding sites. Although indocyanine green angiography showed hypofluorescence in both types of lesions, fundus autofluorescence showed hyperautofluorescence of hypofluorescent lines by FA and hypoautofluorescence of lacquer cracks. Hypofluorescent lines by FA were considered to be the same as myopic stretch lines. CONCLUSION: There are two types of linear lesions in the posterior fundus of highly myopic eyes; lacquer cracks and myopic stretch lines, and they should be differentiated.

Acoustic radiation force impulse elastography of the kidneys: is shear wave velocity affected by tissue fibrosis or renal blood flow?

OBJECTIVES: The aim of this study was to identify the main influencing factor of the shear wave velocity (SWV) of the kidneys measured by acoustic radiation force impulse elastography. METHODS: The SWV was measured in the kidneys of 14 healthy volunteers and 319 patients with chronic kidney disease. The estimated glomerular filtration rate was calculated by the serum creatinine concentration and age. As an indicator of arteriosclerosis of large vessels, the brachial-ankle pulse wave velocity was measured in 183 patients. RESULTS: Compared to the degree of interobserver and intraobserver deviation, a large variance of SWV values was observed in the kidneys of the patients with chronic kidney disease. Shear wave velocity values in the right and left kidneys of each patient correlated well, with high correlation coefficients (r = 0.580-0.732). The SWV decreased concurrently with a decline in the estimated glomerular filtration rate. A low SWV was obtained in patients with a high brachial-ankle pulse wave velocity. Despite progression of renal fibrosis in the advanced stages of chronic kidney disease, these results were in contrast to findings for chronic liver disease, in which progression of hepatic fibrosis results in an increase in the SWV. Considering that a high brachial-ankle pulse wave velocity represents the progression of arteriosclerosis in the large vessels, the reduction of elasticity succeeding diminution of blood flow was suspected to be the main influencing factor of the SWV in the kidneys. CONCLUSIONS: This study indicates that diminution of blood flow may affect SWV values in the kidneys more than the progression of tissue fibrosis. Future studies for reducing data variance are needed for effective use of acoustic radiation force impulse elastography in patients with chronic kidney disease.

Predictive factors for comorbid psychiatric disorders and their impact on vision-related quality of life in patients with high myopia.

To determine the incidence of depression and anxiety disorders in patients with high myopia as well as the factors that would predict the development of psychiatric complications and their impact on vision-related quality of life (VR-QoL). Two hundred and five patients with pathologic myopia (axial length ≥26.50 mm) were studied. Incidence of depression and anxiety disorders was determined using the Hospital Anxiety and Depression Scale (HADS). VR-QoL was determined by the 25-item National Eye Institute Visual Function Questionnaire. Incidence of depression was 22.0 % and incidence of anxiety disorder was 25.9 %. Absence of children was the only factor significantly associated with the presence of depression, and a past history of cataract surgery was the only factor significantly associated with the presence of anxiety disorder. Factors which decreased the VR-QoL were in order of importance--anxiety disorder, decreased visual acuity in the best eye, depression, and being female. Responses of the subjects to two HADS statements 'I can laugh and see the funny side of things' and 'I can enjoy a good book or radio or television program' identified 82.2 % of depressed patients, and 'I get sudden feelings of panic' and 'I can sit at ease and feel relaxed' identified 71.7 % of patients with anxiety disorder. Twenty-two to 26 % of highly myopic patients had psychiatric disorders which had a strong negative impact on their VR-QoL. Two statements from the HADS questionnaire can be used to screen highly myopic patients for depression or anxiety disorders.

A case diagnosed with IgA nephropathy during a complete remission of minimal change nephrotic syndrome treated with rituximab.

We herein report a case of IgA nephropathy in a 20-year-old male who maintained a complete remission of minimal change nephrotic syndrome (MCNS) through the administration of rituximab (RTX). He was diagnosed with nephrotic syndrome at 4 years of age. After he relapsed frequently, he was diagnosed with MCNS at 8 years of age based on the findings of a kidney biopsy. At 13 years of age, RTX therapy was initiated to maintain a complete remission after steroid treatment. MCNS recurred twice, including the time in which the interval between the RTX administrations was long. Whenever he relapsed, remission induction was achieved using steroids, and remission maintenance was achieved using RTX. Five months after the 7th RTX administration, the serum IgA level started to increase. After the 9th RTX administration, he demonstrated microhematuria despite the urinary protein level indicating complete remission. At the 10th administration, the urinary protein and the red-blood cell casts were also observed. A renal biopsy was performed 84 months after the initial administration of RTX, and the patient was diagnosed with complications of IgA nephropathy. RTX is not considered to be a useful treatment for IgA nephropathy. The reasons for this are due to the fact that IgA1 does not decrease even following the administration of RTX, because B cells residing in the mucosa may not be deleted by RTX, and IgA production may also continue due to the presence of CD20- long-lived plasma cells. Even when administering RTX, if there are findings of glomerulonephritis on urine testing, the possibility of IgA nephropathy must be considered.

Changes of axial length measured by IOL master during 2 years in eyes of adults with pathologic myopia.

OBJECTIVE: To examine the change of the axial length measured by IOL Master in adults with high myopia during a 2-year period. DESIGN: Open-label, consecutive, prospective longitudinal case series. METHODS: One hundred and eighty-five eyes of 185 consecutive patients with bilateral high myopia (myopia ≤ -6 diopters (D) or axial length ≥ 26.5 mm) were studied. The mean age of the patients was 48.4 ± 12.2 years, with a range of 22 to 84 years. The axial length, the anterior chamber depth, and the radius of curvature of the cornea were measured by IOL Master at the initial examination and at 2 years after the first visit. The significance of the changes in the axial length after the 2-year periods was determined. Multiple regression analyses were performed to identify the factors which were significantly associated with the increase of the axial length. RESULTS: The mean axial length increased significantly from 29.35 ± 1.80 mm to 29.48 ± 1.85 mm in 2 years, a mean increase of 0.13 mm with a range of -0.12 to 1.10 mm. The difference in the increase of the axial length between the patients with and without a posterior staphyloma was not significant. Among the possible explanatory factors, age, axial length, anterior chamber depth, the radius of curvature of the cornea, and intraocular pressure at the initial examination, the increase in the axial length was significantly and positively correlated with the axial length at the initial examination. CONCLUSIONS: The measurement by IOL Master in a large population of highly myopic patients clearly showed that the axial length continued to increase in a span of 2 years even in the 4th decade of life. The eyes with longer axial length showed a greater increase of axial length, suggesting the possibility that the more myopic eyes become more myopic with increasing age.

Evaluation of refractive error after cataract surgery in highly myopic eyes.

To analyze both targeted and measured refractive errors in highly myopic eyes after phacoemulsification and intraocular lens implantation (PEA + IOL) and to examine the preoperative factors which influenced these refractive errors, we reviewed medical records of patients who had undergone PEA + IOL. Highly myopic eye was defined as one with axial length (AL) ≥26.50 mm. Mean refractive error (ME), mean absolute refractive error (MAE), and incidence of mean refractive error (IME) within ± 1.00 diopter (D) of targeted refraction were determined. IOL power was selected by SRK/T formula. Consequently, after 568 eyes of the 429 patients were studied, 84 eyes out of 64 patients (15.1 %) had high myopia. ME was +0.45 ± 0.79 diopter (D), MAE was 0.72 ± 0.47 D, and 70 % of refractive errors were within ±1.00 D of the targeted refraction. Postoperative refractive error was significantly higher in eyes where AL ≥31.00 mm, ME = + 1.22 ± 0.64 D, MAE = + 1.22 ± 0.64 D, IME (within ±1.00 D) = 30 %. However, refractive error was minimal when the 2-set optimized A constants, positive and negative power IOLs, were used for calculation. In conclusion, in eyes with high myopia after cataract surgery, mild to moderate myopia was the most common refractive status. However, 14.1 % of these patients have selected emmetropia. Refractive error was higher in eyes with AL ≥31.00 mm.

Acquired optic nerve and peripapillary pits in pathologic myopia.

PURPOSE: To examine the incidence and characteristics of pit-like structures around the optic disc and myopic conus in eyes with high myopia. DESIGN: Prospective, observational case series. PARTICIPANTS: We evaluated 198 eyes of 119 patients with pathologic myopia (spherical equivalent >-8 diopters [D]). We also evaluated 32 eyes of 32 subjects with emmetropia (refractive error ≤±3 D) as controls. METHODS: The papillary and peripapillary areas were examined with a prototype swept-source optical coherence tomography (OCT) system with a center wavelength of 1050 nm. We studied the structural characteristics of pit-like changes. MAIN OUTCOME MEASURES: The incidence and characteristics of the optic nerve (ON) pits in eyes with high myopia. RESULTS: Pit-like clefts were found at the outer border of the ON or within the adjacent scleral crescent in 32 of 198 highly myopic eyes (16.2%) but in none of the emmetropic eyes. The eyes with these pits were more myopic, had significantly longer axial lengths, and had significantly larger optic discs than the highly myopic eyes without pits. The pits were located in the optic disc area (optic disc pits) in 11 of 32 eyes and in the area of the conus outside the optic disc (conus pits) in 22 of 32 eyes. One eye had both optic disc pits and conus pits. The optic disc pits existed in the superior or inferior border of the optic disc. All but 1 eye with conus pits had a type IX staphyloma, and the location of the conus pits were present nasal to the scleral ridge or outside the ridge temporal to the nerve. The optic disc pits were associated with discontinuities of the lamina cribrosa, whereas the conus pits appeared to develop from a scleral stretch-associated schisis or to emissary openings for the short posterior ciliary arteries in the sclera. The nerve fiber tissue overlying the pits was discontinuous at the site of the pits. CONCLUSIONS: Optic nerve pits are common in highly myopic eyes. The ON pits are barely visible ophthalmoscopically but can be demonstrated by using swept-source OCT.

Amyloid beta enhances migration of endothelial progenitor cells by upregulating CX3CR1 in response to fractalkine, which may be associated with development of choroidal neovascularization.

OBJECTIVE: Deposits that accumulate beneath retinal pigment epithelium, called drusen, are early signs of age-related macular degeneration (AMD). We have shown that amyloid ß (Aß) is present in drusen, and Aß may be involved in AMD development. We have also shown that endothelial progenitor cells (EPCs) may contribute to the development of choroidal neovascularization (CNV). Thus, the purpose of this study was to investigate the role played by CX3CR1, a chemokine receptor, in EPC migration and CNV formation. METHODS AND RESULTS: EPCs collected from human umbilical cords were found to express higher levels of CX3CR1 than human umbilical vein endothelial cells, and exposure of EPCs to Aß caused further upregulation of CX3CR1. This upregulation was decreased by blocking fractalkine, a ligand of CX3CR1. Exposure of EPCs to fractalkine increased their migration, but pretreatment with Aß enhanced the migration. The fractalkine-induced EPC migration was more inhibited by EPCs derived from CX3CR1(-/-) mice than wild-type mice. The area of laser-induced CNV was significantly smaller in wild-type mice that received bone marrow transplantation from CX3CR1(-/-) mice than in those that received transplantation from wild-type mice. CONCLUSIONS: These data suggest that Aß enhances EPC migration through the upregulation of CX3CR1. This upregulation might play a role in development of CNV.

Two-year outcomes of intravitreal bevacizumab for choroidal neovascularization in Japanese patients with pathologic myopia.

PURPOSE: To determine the 2-year results of intravitreal bevacizumab in highly myopic eyes with choroidal neovascularization (CNV). METHODS: An open-label, consecutive, interventional case series. Seventy-five eyes of 69 consecutive Japanese patients with either subfoveal or nonsubfoveal myopic CNVs were studied. The eyes were treated with intravitreal bevacizumab and followed-up for at least 2 years. The best-corrected visual acuities at the baseline in eyes with subfoveal CNV were compared with that in eyes with nonsubfoveal CNV at 2 years after the intravitreal bevacizumab. RESULTS: The difference between the mean best-corrected visual acuity at the baseline and that at 2 years in eyes with a subfoveal CNV was not significant. However, the mean best-corrected visual acuity in eyes with nonsubfoveal CNV was significantly improved from 0.53 ± 0.36 logarithm of the minimal angle of resolution units (Snellen 20/66) before intravitreal bevacizumab to 0.29 ± 0.36 logMAR units (Snellen 20/40) (P < 0.001) 2 years after intravitreal bevacizumab. The incidence of chorioretinal atrophy after 2 years was 3 of 49 (6.1%) in eyes with nonsubfoveal CNV and 21 of 26 (80.8%) in eyes with which subfoveal CNV (P < 0.001). Furthermore, the chorioretinal atrophy area with nonsubfoveal CNV was 0.05 ± 0.21 mm, which was also significantly smaller than that of subfoveal CNV at 1.76 ± 1.60 mm (P < 0.001). CONCLUSION: Intravitreal bevacizumab is a good treatment for eyes with nonsubfoveal CNV; however, another treatment is necessary for eyes with a subfoveally located CNV.