Case of persistent corneal epithelial damage after cataract surgery leading to diagnosis of vitamin A deficiency.

PURPOSE: To report our findings of reduced full-field electroretinograms (ff-ERGs) and abnormal optical coherence tomographic (OCT) images in a patient with poor visual acuity after cataract surgery who was eventually diagnosed with vitamin A deficiency (VAD). METHODS: This was a clinical study of a patient who complained of blurred vision after cataract surgery. To determine the cause of the reduced vision, we recorded full-field electroretinograms (ff-ERGs) to determine the scotopic and photopic status of the retina. We also performed optical coherence tomography to assess the changes in the retinal structure. Serological tests were performed. RESULTS: A 74-year-old man presented with persistent corneal epithelial damages and reduced vision that developed after conventional cataract surgery. OCT showed an interrupted ellipsoid zone, and fundus autofluorescence (FAF) showed a severe hypofluorescence in the retina of the left eye. The scotopic ff-ERGs were severely reduced, and the photopic ff-ERGs were mildly reduced. Serological examinations revealed a vitamin A concentration < 7 IU/dL (normal, 97-316 IU/dL). Based on these findings, we diagnosed the patient with VAD and started treatment with oral vitamin A supplements. After three months, his visual acuity, ff-ERGs, and OCT findings recovered to normal levels. The amplitudes and implicit times of the RETeval flicker ERGs increased to be within the normal range, and the hypofluorescence of the left eye disappeared. The length of the photoreceptor outer segments increased after the vitamin A supplementation. CONCLUSION: Our findings indicate that the ERGs are helpful for diagnosing patients with VAD associated with persistent corneal epithelial damages.

Lutein and Zeaxanthin Distribution in the Healthy Macula and Its Association with Various Demographic Factors Examined in Pseudophakic Eyes.

The macular pigment consisting of lutein (L) and zeaxanthin (Z) protects photoreceptors via its antioxidative and barrier activities. This study aimed to determine L and Z distribution in the healthy macula and their association with various demographic factors. Macular pigment optical density (MPOD) was measured using fundus autofluorescence spectroscopy in 352 pseudophakic eyes with no fundus diseases. Pseudophakia was chosen to avoid the influence of cataract in the measurement of fundus autofluorescence. The mean patient age was 72.3 ± 8.6 years. MPOD was analyzed separately in three zones, i.e., A: a central area within a radius of 0.5°, mainly containing Z; B: a ring area with radii from 0.5° to 1.3°, containing Z and L; C: a ring area with radii from 1.3° to 9°, containing L. Multivariate analyses were performed with MPOD as the dependent variable and sex, supplement intake, smoking habits, glaucoma, diabetes, age, body mass index (BMI), skin carotenoid levels, retinal thickness, retinal volume, axial length as the independent variables. The mean total MPOD volume within 9° eccentricity was 20,121 ± 6293. Age was positively associated with MPOD in all zones. Supplement and BMI were positively and negatively associated with MPOD in zones B and C. Smoking was negatively associated with MPOD in zone A. This study revealed the standard MP values of aged Japanese, which resulted to be higher than the previously reported values in other races. Age was found to have a positive association with MP values. L in the outer foveola was affected by BMI and supplements, but Z in the foveola was not. The amount of Z in the Müller cell cone may not be changed easily by factors such as hunger and satiety in the context of preservation of homeostasis in the human body, but tobacco had a negative effect on Z.

Preliminary analysis of the relationship between serum lutein and zeaxanthin levels and macular pigment optical density.

PURPOSE: To assess the relationship between combined serum lutein and zeaxanthin (L+Z) concentration and macular pigment optical density (MPOD), and to investigate the effect of L+Z+docosahexaenoic acid (DHA) dietary supplementation on the spatial distribution of MPOD. METHODS: Twenty healthy fellow eyes with unilateral wet age-related macular degeneration or chronic central serous chorioretinopathy were included. All participants received a dietary supplement for 6 months that contained 20 mg L, 1 mg Z, and 200 mg DHA. The best-corrected visual acuity and contrast sensitivity (CS) were measured at baseline and at 1, 3, and 6 months. Serum L+Z concentrations were measured at baseline and at 3 months. MPOD was calculated at each time point using fundus autofluorescent images. RESULTS: Serum L+Z concentration was correlated with MPOD at 1°-2° eccentricity at baseline (r=0.63, P=0.003) and 3 months (r=0.53, P=0.015). Serum L+Z concentration increased by a factor of 2.3±1.0 (P<0.0001). At 6 months, MPOD was significantly higher compared to the baseline level at 0°-0.25° (P=0.034) and 0.25°-0.5° (P=0.032) eccentricity. CS improved after 3 or 6 months of L+Z+DHA supplementation (P<0.05). CONCLUSION: Juxtafoveal MPOD was associated with serum L+Z concentration. Foveal MPOD was increased by L+Z+DHA dietary supplementation.