Variants in IL23R-C1orf141 and ADO-ZNF365-EGR2 are associated with susceptibility to Vogt-Koyanagi-Harada disease in Japanese population.

Vogt-Koyanagi-Harada (VKH) disease is a systemic inflammatory disorder that affects pigment cell-containing organs such as the eye (e.g., chronic and/or recurrent granulomatous panuveitis). While the exact etiology and pathogenic mechanism of VKH disease are unclear, HLA-DR4 alleles have been documented to be strongly associated with VKH disease in various ethnic groups. Recently, a genome-wide association study (GWAS) found two new genetic risk factors (IL23R-C1orf141 and ADO-ZNF365-EGR2) in a non-HLA region from a Han Chinese population. In this study, we replicated these GWAS findings in a Japanese population. A total of 1,643 Japanese samples (380 cases with VKH disease and 1,263 healthy controls) were recruited. We assessed four single nucleotide polymorphisms (SNPs) shown in previous GWAS: rs78377598 and rs117633859 in IL23R-C1orf141, and rs442309 and rs224058 in ADO-ZNF365-EGR2. A significant allelic association with VKH disease was observed for all of the four SNPs (rs78377598: pc = 0.0057; rs117633859: pc = 0.0017; rs442309: pc = 0.021; rs224058: pc = 0.035). In genotypic association analysis, the minor alleles of IL23R-C1orf141 rs78377598 and rs117633859 had the strongest association with disease susceptibility under the additive model (pc = 0.0075 and pc = 0.0026, respectively). The minor alleles of ADO-ZNF365-EGR2 rs442309 and rs224058 were most strongly associated with disease susceptibility under the dominant model (pc = 0.00099 and pc = 0.0023, respectively). The meta-analysis of the current and previous studies found that all of the four SNPs exhibited a significantly strong association with VKH disease (meta-p < 0.00001: rs78377598, meta-odds ratio (OR) = 1.69; rs1176338, meta-OR = 1.82; rs442309, meta-OR = 1.34; rs224058, meta-OR = 1.33). In summary, our study replicated significant associations with VKH disease susceptibility reported in a previous GWAS. Thus, the IL23R-C1orf141 and ADO-ZNF365-EGR2 loci may play important roles in the development of VKH disease through genetic polymorphisms.

Association Study of ARMC9 Gene Variants with Vogt-Koyanagi-Harada Disease in Japanese Patients.

Purpose: To investigate whether variants in the ARMC9 gene encoding KU-MEL-1 are associated with Vogt-Koyanagi-Harada (VKH) disease in a Japanese population. Methods: We recruited 380 Japanese patients with VKH disease and 744 Japanese healthy controls to genotype seven single-nucleotide polymorphisms (SNPs) in ARMC9. We also performed imputation analysis of the ARMC9 region and 195 imputed SNPs were included in the statistical analysis. Results: We observed an increased frequency of the A allele of rs28690417 in patients compared with controls (P = 0.0097, odds ratio (OR) = 1.46). The A allele had a dominant effect on VKH disease risk (P = 0.011, OR = 1.51). However, these significant differences disappeared after Bonferroni correction (corrected P > 0.05). The remaining 201 SNPs did not show any significant association with disease risk. Conclusions: Our study suggests that ARMC9 variants do not play a critical role in the development of VKH disease.

[Clinical features of 19 cases of Fisher syndrome].

PURPOSE: To determine the clinical symptoms of Fisher syndrome (FS). METHODS: We performed a retrospective study of 19 patients who had been diagnosed as having FS. RESULTS: The study involved 19 patients (13 men and 6 women) whose mean age of onset was 42.0 years. Ophthalmoplegia included 16 cases of abducens nerve palsy, 2 cases of total external ophthalmoplegia, and 1 combined case of abducens nerve palsy and impaired eye elevation. Although all cases of abducens nerve palsy were bilateral, in 5 cases the degree of the affliction was asymmetric. Other neurologic symptoms included 5 cases of nystamus, 5 cases of pain on eye movement, 5 cases of pupillary defects, 6 cases of blepharoptosis, 2 cases of facial palsy, 9 cases of dysesthesia in the limbs, 3 cases of ataxia and 1 case of bulbar palsy. Anti-GQ1b antibodies were detected in 74% of the patients. Sixteen patients were followed without treatment while 1 patient, was given oral vitamin B12 and 2 patients received intravenous immunoglobulin. Double vision improved in all cases, and the mean duration of double vision was approximately 70 days. CONCLUSIONS: FS develops in people of all ages and is more common in men. Also, abducens nerve palsy is common in FS. While it is rare to observe the triad of ophthalmoplegia, ataxia and areflexia, the frequency in which the disorder is complicated by neurologic symptoms other than the triad is high. Double vision has a good prognosis and improves even without treatment.

Transcorneal electrical stimulation improves visual function in eyes with branch retinal artery occlusion.

PURPOSE: To investigate the effects of transcorneal electrical stimulation (TES) on eyes that have a branch retinal artery occlusion (BRAO). SUBJECTS AND METHOD: We studied two eyes having a BRAO, with an interval between the onset of symptoms and the beginning of treatment of >16 weeks (longstanding cases), and in three eyes with an interval of <16 weeks (fresh cases). The visual functions of the eyes were assessed by the best-corrected visual acuity (BCVA), multifocal electroretinograms (mfERGs), and automated static perimetry with the Humphrey field analyzer (HFA). The mfERGs were recorded before and 1 month after the TES, and perimetry with the HFA was done before and at 1 and 3 months after the TES. The amplitudes and implicit times of the N1, P1, and N2 components of the mfERGs were analyzed. RESULTS: TES did not alter the BCVA significantly in all eyes, but it led to a significant increase in the amplitude of the N2 wave of the mfERGs (P < 0.01). The amplitude of the N1-P1 was also increased but not significantly. The implicit times of N1 (P < 0.01) and P1 (P < 0.05) were significantly shorter than that before the TES. The mean deviation of the HFA was increased after the TES but only in the longstanding cases. CONCLUSION: Our results indicate that TES improves the visual function in eyes with BRAO, mainly in longstanding cases.

[A case of idiopathic orbital inflammatory disease with variable ocular manifestations].

PURPOSE: We present a case of idiopathic orbital inflammatory disease with dilatation and tortuosity of the retinal veins. CASE: A 74-year-old man presented at his local eye hospital with left conjunctival edema and pain. He was referred to our hospital. At the initial examination, the intraocular pressure was 19 mmHg OD and 40 mmHg OS. Examination of the left eye revealed conjunctival edema with dilated and tortuous blood vessels, and dilatation and tortuousity of the retinal veins. Magnetic resonance imaging showed marked thickening of the left extraocular muscles, and suspected compression of the left superior and inferior ophthalmic veins. We diagnosed left idiopathic orbital inflammatory disease, and administered a tapering course of prednisolone starting at 40 mg daily. Thirteen days later, the conjunctival findings improved, but the left fundus showed signs of non-ischaemic central retinal vein occlusion. Subsequently, the dilatation and tortuousity of the retinal veins gradually improved. At the final examination, recurrence was not noted. CONCLUSION: We report a case of idiopathic orbital inflammatory diseases with central retinal vein occlusion. The dilatation and tortuousity of the conjunctiva and central retinal vein occlusion improved with steroid therapy only. These Conditions improved because the inflammatory swelling of the extraocular muscle disappeared and the pressure to the vein was relieved.

Transcorneal electrical stimulation increases chorioretinal blood flow in normal human subjects.

PURPOSE: The aim of this article is to investigate the effect of transcorneal electrical stimulation (TES) on chorioretinal blood flow in healthy human subjects. METHODS: The chorioretinal blood flow of 10 healthy subjects was measured before and after TES by laser speckle flowgraphy and expressed as the square blur rate (SBR). The chorioretinal blood flow was determined before and immediately after TES and 0.5, 1, 1.5, 2, 2.5, 3, 24, and 40 h after TES in three different areas: the margin of the optic disc, a point located midway between the optic disc and macula, and the macula area. The SBR of the stimulated eye is expressed relative to the value of the fellow eye. The mean standardized blur ratio was calculated as the ratio of the standardized SBR to the baseline SBR. The changes of intraocular pressure (IOP), blood pressure (BP), and pulse rate (PR) were determined after each measurement of the SBR. The ocular perfusion pressure (OPP) was calculated from BP and IOP. RESULTS: The mean standardized blur ratio at the optic disc did not change significantly throughout the course of the experiment. However, the mean standardized blur ratio midway between the optic disc and macula and at the macula area were significantly higher after TES than that after sham stimulation at 3 and 24 h (P < 0.05, P < 0.01, respectively). At all times, the mean BP, PR, IOP, and OPP were not significantly different from the prestimulation values. CONCLUSIONS: TES increases the chorioretinal blood flow in normal subjects with minimal effects on the systemic blood circulation and the IOP. The increase in chorioretinal blood flow may be one of the beneficial effects that TES has on ischemic retinal diseases.

Pyroglutamic acid promotes survival of retinal ganglion cells after optic nerve injury.

PURPOSE: To determine whether pyroglutamic acid (PGA) enhances the survival of retinal ganglion cells (RGCs) after optic nerve (ON) transection in vivo and RGCs in culture. METHODS: The RGCs of rats were retrogradely labeled by Fluorogold (FG)-soaked sponges placed on both superior colliculi. Seven days later, the ON was transected, and PGA was immediately injected into the vitreous. Seven or fourteen days later, the number of FG-labeled RGCs was counted on flat-mounted retinas to obtain the mean densities of FG-labeled RGCs. To determine whether the survival effect of PGA was related to excitatory amino acid transporter (EAAT), L-trans-pyrrolidine-2,4 dicarboxylate (PDC), a nonselective glutamate transport inhibitor, was injected into vitreous with the PGA. In primary retinal cultures, RGCs were identified as cells that were immunopositive to beta III tubulin three days after beginning the culture with and without PDC. RESULTS: The mean density of FG-labeled RGCs was reduced from 2249 +/- 210 to 920 +/- 202 cells/mm(2) (p < 0.001) on day 7 after the ON transection. The mean density RGCs was significantly higher at 1213 +/- 159 cells/mm(2) after 0.5% PGA injection immediately after the ON transaction than eyes injected with the vehicle at 1007 +/- 122 cells/mm(2) (p = 0.035). One percent PGA was the most effective concentration for survival-promoting effects on RGCs, and the mean density of the RGCs was 1464 +/- 102/mm(2) (p < 0.001). Fourteen days after 1% PGA, the mean density of FG-labeled RGCs was significantly higher than that with vehicle (204 +/- 23/mm(2) versus 145 +/- 17 cells/mm(2); p < 0.01). Simultaneous application of 1% PGA and PDC blocked the survival effects of PGA on day 7 after ON transection. The presence of PGA increased the number of beta III tubulin-positive cells. CONCLUSIONS: PGA promotes the survival of axotomized RGCs in adult mammalian retinas possibly mediated by the EAATs.

Cilostazol promotes survival of axotomized retinal ganglion cells in adult rats.

Cilostazol (CLZ), a selective inhibitor of cyclic nucleotide phosphodiesterase 3, has been shown to reduce neuronal cell death after a transient cerebral infarction. The mechanism for this reduction was suggested to be an elevation of intracellular cAMP or an inhibition of tumor necrosis factor alpha. Optic nerve injury leads to retinal ganglion cell (RGC) death possibly from a deprivation of neurotrophic factors and/or the down-regulation of intracellular cAMP. The purpose of this study was to determine if CLZ can rescue RGCs after optic nerve transection by inhibiting cyclic nucleotide phosphodiesterase 3. To examine this, the mean densities of surviving RGCs after optic nerve transection were determined in retinas that received an intravitreal injection of CLZ and in retinas that received vehicle. Our results showed that the density of surviving RGCs in the retina with intravitreal CLZ were significantly higher than that with vehicle injection on day 7. The CLZ was effective in promoting the survival at more than 0.05% concentration. The neuroprotective effects induced by 0.05% CLZ could be observed even 14 days after optic nerve transection. Furthermore, combined application of protein kinase A (PKA) inhibitor, KT5720 (10 microM) and 0.05% CLZ significantly decreased the density of surviving RGCs compared to that with only 0.05% CLZ. Based on these data, we concluded that CLZ enhances the survival of axotomized RGC in vivo, possibly depending on the activation of PKA pathway.

Acute bilateral peripheral cone system dysfunction.

PURPOSE: To report electrophysiological and psychophysical findings in an unusual case with acute loss of the peripheral visual field bilaterally. METHODS: A 19-year-old woman underwent fundus photography, fluorescein angiography, visual field testing, determination of full-field electroretinograms (ERGs) and multifocal ERGs (mfERGs), and rod-cone perimetry in addition to routine ophthalmologic examinations. RESULTS: Findings of fundus examination and fluorescein angiography were completely normal, and best-corrected visual acuity was 1.0 in both eyes. However, static perimetry revealed a temporal field defect in the right eye and an arcuate scotoma in the left eye. Full-field ERG cone responses were significantly reduced, but rod responses were normal in both eyes. Psychophysical rod-cone perimetry demonstrated that the peripheral cone system was impaired whereas the rod sensitivity was completely normal. mfERGs showed that the local cone responses were well preserved in the central retina but were severely reduced in the peripheral retina in both eyes. CONCLUSIONS: These results indicate that there is an unusual retinopathy showing acute dysfunction of the peripheral cone system bilaterally whereas the rod system is functioning normally.