Anterior capsule coverage and rotational stability of an acrylic toric intraocular lens.

PURPOSE: To investigate factors related to the rotational stability of an acrylic toric intraocular lens (IOL). SETTING: Four ophthalmic surgical sites in Japan. DESIGN: Prospective case series. METHODS: The study included 120 eyes of 120 patients undergoing phacoemulsification and implantation of a toric IOL (AcrySof IQ, Alcon Laboratories, Inc.). At 1 hour postoperatively, the area of continuous curvilinear capsulorhexis (CCC) was measured, and the state of anterior capsule coverage on the IOL optic (total on or partial on) was recorded. The toric IOL axis orientation was assessed at the end of surgery and at 1 hour, 1 week, 1 month, and 6 months postoperatively. Multiple regression analysis was performed to explore any clinical factors relevant to IOL rotation from the end of surgery to 6 months postoperatively. The explanatory variables included age, anterior chamber depth preoperatively, axial length, type of corneal astigmatism (with-the-rule, against-the-rule, or oblique astigmatism), area of CCC, state of anterior capsule overlap on IOL optic (total coverage vs partial coverage), and surgical sites (surgeons). RESULTS: The multiple regression analysis in 110 eyes of 110 patients indicated that anterior capsule overlap on the IOL optic was the only variable associated with IOL rotation at 6 months postoperatively (P = .0482). The mean absolute rotation at 6 months was 1.96 ± 1.81 degrees in the total on group and 3.79 ± 3.12 degrees in the partial on group (P = .0004). CONCLUSIONS: Rotational stability of a single-piece, acrylic toric IOL was better in eyes with total anterior capsule coverage than that in those with partial anterior capsule coverage on the IOL optic.

Vestibular symptoms in acute hemispheric strokes.

A prospective study focused on whether vestibular symptoms are seen in acute hemispheric strokes, and if so, the frequency and lateralization of causative lesions on MRI. Among 668 patients with hemispheric infarction, we prospectively included those with chief complaints of acute vestibular symptoms, such as vertigo/dizziness, nausea/vomiting and gait instability, in the "VS" group. We also retrospectively reviewed MRI of all stroke patients, and included cases with the findings of parieto-insular vestibular cortex (PIVC) or temporo-periSylvian vestibular cortex (TPSVC) lesion by diffusion-weighted MRI, in the "PIVC" group. Eight patients were found to belong to the VS group, and six other patients to the PIVC group. In the VS group, six patients had the responsible lesion on the right hemisphere, in the middle cerebral artery (MCA) territory except one case and two on the left MCA territory, particularly in the insula, retro-insular region, superior/middle temporal gyrus, angular gyrus, supra-marginal gyrus, putamen and hippocampus/para-hippocampal gyrus. In contrast, none of the six other patients of the PIVC group had vestibular symptoms. One of them had a lesion in the right hemisphere and five in the left hemisphere. Four lesions were located in the insular area and two within the temporal lobe. In conclusion, cerebral hemispheric infarction limited to the PIVC or TPSVC does not necessarily cause vertigo. However, unilateral hemispheric infarctions, restricted to the areas belonging to the vestibular cortical network may cause vestibular symptoms. The lesions responsible for vestibular symptoms are located more often in the right hemisphere.

Clinical Features of Japanese Patients With Anti-α-enolase Antibody-Positive Autoimmune Retinopathy: Novel Subtype of Multiple Drusen.

PURPOSE: To evaluate clinical features of Japanese patients with anti-α-enolase antibody-positive autoimmune retinopathy (anti-enolase AIR). DESIGN: Multicenter retrospective observational case series. METHODS: Forty-nine eyes of 25 Japanese anti-enolase AIR patients (16 female and 9 male; mean age at first visit, 60.8 years) were included. Fundus characteristics, perimetry, spectral-domain optical coherence tomography (SD-OCT), electroretinography (ERG), best-corrected visual acuity (BCVA), and complicating systemic tumors were assessed. Protein localization of α-enolase was examined by immunohistochemistry in an enucleated eye of 1 patient. RESULTS: Patients were classified into 3 groups: multiple drusen (48%), retinal degeneration (36%), and normal fundus (16%). Drusen varied in size from small deposits to vitelliform-like lesions. Images on SD-OCT revealed dome-shaped hyperreflectivity beneath the retinal pigment epithelium (RPE), corresponding to drusen. Perimetry showed that ring scotoma was the most frequent (39%). Rod-system and/or single-flash cone responses revealed decreased responses in 81% of the eyes. Combined rod and cone system responses demonstrated significantly lower a-wave amplitudes in the degeneration group than in the drusen group (P = .005). BCVA was improved or maintained in 80% of the eyes during follow-up. Malignant or benign tumors were detected in 30% of patients. The RPE and photoreceptor layers were immunopositive for α-enolase. CONCLUSIONS: The drusen subtype, scarcely described in the literature, is suggested to characterize Japanese patients with anti-enolase AIR. The different funduscopic features with different functional severities may have resulted from antibody-mediated damage to RPE as well as photoreceptor cells.

Influence of surface light scattering and glistenings of intraocular lenses on visual function 15 to 20 years after surgery.

PURPOSE: To assess the long-term influence of surface light scattering and glistenings of hydrophobic acrylic (Acrysof), silicone, and poly(methyl methacrylate) (PMMA) intraocular lenses (IOLs) on visual function. SETTING: Eleven surgical sites, Japan. DESIGN: Retrospective case series. METHODS: Patients who had cataract surgery with implantation of a hydrophobic acrylic, silicone, or PMMA IOL from 1994 to 2000 were examined. Silicone and PMMA IOLs were not restricted to specific manufacturers or models. Patients were included if their corrected distance visual acuity (CDVA) within 3 months postoperatively (baseline CDVA) was 20/25 or better. The CDVA, contrast sensitivity, degree of surface light scattering measured with Pentacam densitometry, and glistening grades were recorded at the patient's latest visit. RESULTS: Of the eyes, 31 had a hydrophobic acrylic IOL, 37 a silicone IOL, and 30 a PMMA IOL. Surface light scattering and glistenings were significantly greater with the hydrophobic acrylic IOL than with silicone and PMMA IOLs (P < .0001). The CDVA at the latest visit as well as the changes in CDVA from the baseline to the latest visit did not differ between the IOLs and was unaffected by surface light scattering and glistenings, as was the contrast sensitivity. CONCLUSIONS: The hydrophobic acrylic IOL was associated with a significantly greater level of surface light scattering and glistenings than the silicone IOLs and PMMA IOLs 15 to 20 years postoperatively. However, the optical phenomena within the optics of the hydrophobic acrylic IOL did not influence the patients' visual function.

EFFECTS OF INTERNAL LIMITING MEMBRANE PEELING COMBINED WITH REMOVAL OF IDIOPATHIC EPIRETINAL MEMBRANE: A Systematic Review of Literature and Meta-Analysis.

PURPOSE: To evaluate the effects on postoperative prognosis of internal limiting membrane (ILM) peeling in conjunction with removal of idiopathic epiretinal membranes (ERMs). METHODS: MEDLINE, Cochrane Central Register of Controlled Trials (CENTRAL), and EMBASE were systematically searched for studies that compared ILM peeling with no ILM peeling in surgery to remove idiopathic ERM. Outcome measures were best-corrected visual acuity, central macular thickness, and ERM recurrence. Studies that compared ILM peeling with no ILM peeling for the treatment of idiopathic ERM were selected. RESULTS: Sixteen studies that included 1,286 eyes were selected. All the included studies were retrospective or prospective comparative studies; no randomized controlled study was identified. Baseline preoperative best-corrected visual acuity and central macular thickness were equal between ILM peeling and no ILM peeling groups. Postoperatively, there was no statistically significant difference in best-corrected visual acuity (mean difference 0.01 logarithm of the minimum angle of resolution [equivalent to 0.5 Early Treatment Diabetic Retinopathy Study letter]; 95% CI -0.05 to 0.07 [-3.5 to 2.5 Early Treatment Diabetic Retinopathy Study letters]; P = 0.83) or central macular thickness (mean difference 13.13 µm; 95% CI -10.66 to 36.93; P = 0.28). However, the recurrence rate of ERM was significantly lower with ILM peeling than with no ILM peeling (odds ratio 0.25; 95% CI 0.12-0.49; P < 0.0001). CONCLUSION: Currently available evidence in the literature indicates that additional ILM peeling in vitrectomy for idiopathic ERM could result in a significantly lower ERM recurrence rate, but it does not significantly influence postoperative best-corrected visual acuity and central macular thickness.

Outbreak of Subacute-Onset Toxic Anterior Segment Syndrome Associated with Single-Piece Acrylic Intraocular Lenses.

PURPOSE: To report the results of a clinical investigation after an outbreak of subacute-onset toxic anterior segment syndrome (TASS) after implantation of single-piece acrylic intraocular lenses (IOLs), which then were recalled voluntarily from the market. DESIGN: Retrospective, multicenter, observational case series. PARTICIPANTS: Cases reported to the manufacturer from January 2015 through March 2016 of unusual ocular inflammation after cataract surgery using AcrySof ReSTOR, ReSTOR toric, or AcrySof IQ toric SN6AT6-9 IOLs (Alcon Laboratories, Inc., Fort Worth, TX). METHODS: The independent investigation committee, not Alcon, directly requested the surgeons for data on 304 eyes from 184 facilities. RESULTS: Consent for data collection was obtained for 201 eyes from 130 facilities. By excluding cases with infectious endophthalmitis and inconclusive cases, the investigation committee identified 147 cases of subacute-onset TASS. AcrySof ReSTOR or ReSTOR toric IOLs and AcrySof IQ toric SN6AT6-9 IOLs were implanted in 94 eyes (63.9%) and 53 eyes (36.1%), respectively. The mean onset time was 13.1±16.4 days after surgery (range, 1-88 days), with 84 eyes (57.1%) demonstrating symptoms within 7 days after surgery. Typical clinical symptoms were mild to moderate exacerbation of inflammation in the anterior chamber after an uneventful clinical course for a few days after surgery. One hundred four eyes (70.7%) were treated with medication alone, and 43 eyes (29.3%) underwent surgery, including irrigation of the anterior chamber, vitrectomy, and removal of the IOL. The mean best-corrected visual acuity (BCVA) at the final visit (-0.012±0.175 logarithm of the minimum angle of resolution [logMAR]) was significantly better than the BCVA at the onset of TASS (0.158±0.351 logMAR) and did not differ from that before inflammation developed (-0.004±0.162 logMAR). Overall treatment outcomes were favorable. CONCLUSIONS: A large-scale outbreak of subacute-onset TASS developed after implantation of a specific model of IOL.

Toric intraocular lenses in eyes with with-the-rule, against-the-rule, and oblique astigmatism: One-year results.

PURPOSE: To assess 1-year clinical results of toric intraocular lenses (IOLs) in eyes having with-the-rule (WTR), against-the-rule (ATR), or oblique corneal astigmatism. SETTING: Four ophthalmic surgical sites, Japan. DESIGN: Prospective case series. METHODS: One of 3 toric IOLs or 1 nontoric IOL was implanted in eyes having phacoemulsification and IOL implantation. RESULTS: The study comprised 218 eyes (155 patients). Based on the suggestion of an online toric calculator with anterior corneal curvature data, 63 eyes received the SN6AT3 IOL with a cylinder power of 1.50 diopters [D] at IOL plane (1.50 D cylinder IOL) 55 eyes the SN6AT4 IOL with a cylinder power of 2.25 D at IOL plane (2.25 D cylinder IOL), and 58 eyes the SN6AT5 IOL with a cylinder power of 3.00 D at IOL plane (3.00 D cylinder IOL) (all Acrysof IQ toric), and 42 eyes received the SN60WF IOL (nontoric IOL). One hundred ninety-four eyes (89.0%) completed 1-year of follow-up. The centroid error in predicted residual astigmatism calculated using vector analysis was close to the origin in eyes with WTR astigmatism (0.17 diopter [D] @ 174.9 ± 0.54 D), while those with ATR and oblique astigmatism were significantly shifted toward the ATR direction (P < .001). The distance from the origin was significantly smaller in the WTR group than in ATR and oblique groups (P < .05). The centroid errors were shifted toward ATR in all toric IOL groups (P < .001); however, the distance from the origin was not different between groups (P = .52). Postoperatively, the mean absolute misalignment of the IOLs was 5.92 degrees ± 5.59 (SD) at 1 day and 6.24 ± 5.87 degrees at 1 year. The results of other clinical parameters were excellent, with no significant differences between astigmatism categories or IOL models. CONCLUSION: Based on anterior corneal curvature alone, toric IOLs undercorrected ATR and oblique astigmatism; however, 1-year clinical results of toric IOLs were highly stable and satisfactory. FINANCIAL DISCLOSURE: None of the authors has a financial or proprietary interest in any material or method mentioned.

[Postcataract endophthalmitis caused by Enterococcus faecalis].

PURPOSE: Enterococcus faecalis is a major endophthalmitis-causing pathogen and often causes significant visual impairment. We investigated the clinical background, treatment and the visual outcome of patients with E. faecalis endophthalmitis after cataract surgery. METHODS: We retrospectively conducted a postal survey directed mainly at the members of Japanese Society of Cataract and Refractive Surgery, and collected data on 30 eyes of 30 patients with E. faecalis endophthalmitis. RESULTS: The mean age of the patients was 73.5 years, and 10 cases had diabetes mellitus. The average time between cataract surgery and diagnosis of endophthalmitis was 4.8 days, and in 16 cases the disease developed 2 days after surgery. Final visual acuity was better than 40/200 in 13 eyes and 20/200 to no light perception in 15 eyes. CONCLUSIONS: E. faecalis caused acute-onset endophthalmitis. The visual outcome of the patients can be divided into good and poor groups.

Exclusion of influences of ARMS2 polymorphisms on the central visual field in retinitis pigmentosa.

PURPOSE: To investigate the effects of polymorphisms of the age-related maculopathy susceptibility 2 (ARMS2) gene on the central visual field defects in retinitis pigmentosa (RP). SUBJECTS AND METHODS: The visual field was evaluated using the 10-2 Swedish Interactive Threshold Algorithm Fast Program and mean deviation (MD) slope, and regression coefficients of average sensitivity of the central 4 points (Cent4) were compared between each genetic subgroup. RESULTS: The MD slope (right/left) was as follows: GG, -1.37 ± 2.18/ -0.89 ± 1.15; GT, -0.56 ± 1.40/-0.77 ± 1.04; TT, -0.75 ± 0.64/ -0.38 ± 0.92 dB/year. The Cent4 was as follows: GG, -1.34 ± 2.37/-1.60 ± 3.21; GT, -1.15 ± 2.08/1.07 ± 1.80; TT, -1.20 ± 0.91/-0.65 ± 1.37 dB/year. No significant differences in the degree of progression were observed when comparing groups. CONCLUSIONS: These data suggest that polymorphisms of the ARMS2 do not modify the progression of the central field of vision in RP patients.

Association of inflammatory factors with macular edema in branch retinal vein occlusion.

OBJECTIVE: To evaluate the association between vitreous fluid levels of inflammatory factors and macular edema in patients with branch retinal vein occlusion (BRVO). METHODS: In 39 patients with BRVO and macular edema and 21 individuals with idiopathic macular hole (MH) serving as controls, vitreous fluid samples were obtained during vitreoretinal surgery, and the levels of vascular endothelial growth factor (VEGF), soluble VEGF receptor 2 (sVEGFR-2), soluble intercellular adhesion molecule 1 (sICAM-1), interleukin 6 (IL-6), monocyte chemotactic protein 1 (MCP-1), pentraxin 3 (PTX3), and pigment epithelium-derived factor (PEDF) were measured by enzyme-linked immunosorbent assay. Macular edema was examined by optical coherence tomography. RESULTS: Vitreous fluid levels of sVEGFR-2, VEGF, sICAM-1, IL-6, MCP-1, and PTX3 were significantly higher in the patients with BRVO than in those with MH; however, the PEDF level was significantly lower in the BRVO group. Vitreous fluid levels of all 7 factors were significantly correlated with the retinal thickness at the central fovea. There were also significant correlations of sVEGFR-2 with sICAM-1, IL-6, MCP-1, and PTX3 but no correlation with VEGF. However, there were significant correlations of VEGF with sICAM-1, IL-6, MCP-1, and PEDF in the BRVO group. CONCLUSIONS: Vitreous fluid levels of sVEGFR-2, VEGF, sICAM-1, IL-6, MCP-1, PTX3, and PEDF are strongly correlated with retinal vascular permeability and the severity of macular edema in patients with BRVO. These findings may be useful for understanding macular edema and developing new treatments for BRVO.

Vascular endothelial growth factor receptor-2 in macular oedema with retinal vein occlusion.

BACKGROUND: To evaluate the relationships among vitreous fluid levels of soluble vascular endothelial growth factor receptor-2 (sVEGFR-2), vascular endothelial growth factor (VEGF), and the severity of macular oedema secondary to branch retinal vein occlusion (BRVO). METHODS: Twenty-five BRVO patients with macular oedema were enrolled. Vitreous fluid samples were obtained during vitreoretinal surgery to measure the levels of sVEGFR-2 and VEGF. Macular oedema was examined by optical coherence tomography. RESULTS: The vitreous fluid levels of VEGF and sVEGFR-2 were significantly correlated with the severity of macular oedema (ρ = 0.54, p = 0.008 and ρ = 0.40, p = 0.047, respectively). The sVEGFR-2 × VEGF product was also significantly correlated with the severity of macular oedema (ρ = 0.62, p = 0.003). CONCLUSIONS: The severity of macular oedema was more closely associated with sVEGFR-2 × VEGF than sVEGFR-2 or VEGF alone, suggesting that macular oedema in BRVO patients may be influenced by both VEGF and sVEGFR-2.

Inflammatory factors in major and macular branch retinal vein occlusion.

Concentrations of inflammatory factors were measured in 40 patients with macular edema due to major branch retinal vein occlusion (BRVO) or macular BRVO who were treated by pars plana vitrectomy. Vitreous fluid levels of vascular endothelial growth factor (VEGF), soluble intercellular adhesion molecule-1 (sICAM-1), and pigment epithelium-derived factor (PEDF) were determined. Visual acuity and central macular thickness were significantly improved at 6 months in both groups. Vitreous fluid levels of VEGF and sICAM-1 were higher in the major BRVO group than the macular BRVO group, while the PEDF level was lower in the major group than the macular group. The mean visual acuity and central macular thickness at 6 months were not significantly different between the macular and major groups. In conclusion, patients with major BRVO had higher vitreous levels of inflammatory factors and lower vitreous levels of anti-inflammatory PEDF. Accordingly, regulating inflammatory factors might be more important in major BRVO than macular BRVO.

Vitreous inflammatory factors and serous macular detachment in branch retinal vein occlusion.

PURPOSE: To investigate whether vascular endothelial growth factor, soluble intercellular adhesion molecule-1 (sICAM-1), and pigment epithelium-derived factor are associated with serous retinal detachment (SRD) secondary to branch retinal vein occlusion. METHODS: The subjects were 44 branch retinal vein occlusion patients with macular edema and 16 controls. Patients were divided into 2 groups by optical coherence tomography findings, that is, 18 patients with SRD and 26 with cystoid macular edema. The area of capillary nonperfusion was measured with fluorescein angiography and Scion Image software. Vitreous fluid samples obtained during pars plana vitrectomy were examined by enzyme-linked immunosorbent assay. RESULTS: The incidence of major branch retinal vein occlusion was significantly higher in SRD patients (17/18, 94%) than in cystoid macular edema patients (15/26, 58%, P = 0.007), while the nonperfused retinal area was significantly larger in SRD patients (P = 0.006). Vitreous fluid levels of vascular endothelial growth factor and soluble intercellular adhesion molecule-1 (sICAM-1) showed a significant increase across the 3 groups (control group, cystoid macular edema group, and SRD group) (P trend < 0.001 and P trend < 0.001, respectively), while the pigment epithelium-derived factor level showed a significant decrease across the 3 groups (P trend < 0.001). CONCLUSION: An excessive increase of vascular permeability secondary to upregulation of vascular endothelial growth factor and soluble intercellular adhesion molecule-1 (sICAM-1) along with downregulation of pigment epithelium-derived factor may contribute to the development of SRD in BRVO patients.

Vitreous inflammatory factors and serous retinal detachment in central retinal vein occlusion: a case control series.

BACKGROUND: This study investigated whether the vitreous fluid levels of soluble vascular endothelial growth factor receptor-2 (sVEGFR-2), pigment epithelium-derived factor (PEDF), and soluble intercellular adhesion molecule 1 (sICAM-1) were associated with the occurrence of serous retinal detachment (SRD) in patients with central retinal vein occlusion (CRVO). METHODS: We recruited 33 patients with CRVO and macular edema, as well as 18 controls with nonischemic ocular diseases. Eighteen of the 33 patients with CRVO showed SRD on optical coherence tomography of the macula (defined as subretinal accumulation of fluid with low reflectivity), while the other 15 patients only had cystoid macular edema (CME, defined as hyporeflective intraretinal cavities). Retinal ischemia was evaluated by measuring the area of capillary non-perfusion using fluorescein angiography and the public domain Scion Image program, while central macular thickness (CMT) was examined by optical coherence tomography. Vitreous fluid samples were obtained during pars plana vitrectomy and levels of the target molecules were measured by enzyme-linked immunosorbent assay. RESULTS: Ischemia was significantly more common in the SRD group (17/18 patients) than in the CME group (5/15 patients) (P < 0.001). The vitreous fluid level of sICAM-1 increased significantly across the three groups from the control group (4.98 ± 1.73 ng/ml) to the CME group (15.4 ± 10.1 ng/ml) and the SRD group (27.1 ± 17.7 ng/ml) (ptrend< 0.001). The vitreous fluid level of sVEGFR-2 also showed a significant increase across the three groups (1083 ± 541 pg/ml, 1181 ± 522 pg/ml, and 1535 ± 617 pg/ml, respectively, ptrend = 0.019). On the other hand, the vitreous fluid level of PEDF showed a significant decrease across the three groups (56.4 ± 40.0 ng/ml, 24.3 ± 17.3 ng/ml, and 16.4 ± 12.6 ng/ml, respectively, ptrend< 0.001). CONCLUSIONS: Higher levels of inflammatory factors (sICAM-1 and sVEGFR-2) and lower levels of anti-inflammatory PEDF were observed in macular edema patients with SRD, suggesting that inflammation plays a key role in determining the severity of CRVO.

Influence of vitreous factors after vitrectomy for macular edema in patients with central retinal vein occlusion.

To investigate whether vitreous fluid levels of vascular endothelial growth factor (VEGF), pigment epithelium-derived factor (PEDF), and soluble intercellular adhesion molecule 1 (sICAM-1) influence visual prognosis and macular edema in patients with central retinal vein occlusion (CRVO). A prospective observational study was performed in 31 consecutive CRVO patients (31 eyes) with macular edema who underwent vitrectomy. Best-corrected visual acuity (BCVA), retinal thickness (examined by OCT), and vitreous fluid levels of VEGF, PEDF, and sICAM-1 were determined. Patients were followed for at least 6 months after surgery. Both visual acuity and retinal thickness showed significant improvement at 6 months postoperatively (P = 0.012 and P < 0.001, respectively). Vitreous fluid levels of VEGF were significantly higher (P = 0.027) in patients who showed less improvement of BCVA after vitrectomy than in those with a better outcome. Conversely, vitreous levels of PEDF were significantly lower (P = 0.047) in patients with less improvement of BCVA than in those with a better outcome. Vitreous levels of sICAM-1 were not significantly correlated with BCVA after vitrectomy (P = 0.731). Multiple regression analysis demonstrated that vitreous fluid levels of VEGF and PEDF were significant determinants of the improvement of BCVA (P = 0.013 and P = 0.007, respectively). These results suggest that vitreous fluid levels of VEGF and PEDF might influence visual prognosis after vitrectomy in CRVO patients with macular edema.

Soluble vascular endothelial growth factor receptor-2 and inflammatory factors in macular edema with branch retinal vein occlusion.

PURPOSE: To investigate relationships among vitreous fluid levels of soluble vascular endothelial growth factor receptor-2 (sVEGFR-2), vascular endothelial growth factor (VEGF), and soluble intercellular adhesion molecule 1 (sICAM-1) in patients with branch retinal vein occlusion (BRVO) and macular edema or patients with idiopathic macular hole. DESIGN: Retrospective case-control study. SETTING: Tokyo Women's Medical University and Eguchi Eye Hospital. PATIENT POPULATION: Forty-nine Japanese patients who underwent unilateral vitrectomy (27 with BRVO and 22 with macular hole). OBSERVATION PROCEDURES: Vitreous fluid samples were obtained during vitreoretinal surgery to measure the levels of sVEGFR-2, VEGF, and sICAM-1. Retinal ischemia was evaluated from capillary nonperfusion on fluorescein angiography. Macular edema was examined by optical coherence tomography. MAIN OUTCOME MEASURES: Vitreous fluid levels of the 3 molecules and severity of macular edema. RESULTS: BRVO patients had a significantly higher vitreous fluid level of sVEGFR-2 (median, 1670 pg/mL; interquartile range [IQL], 1205 to 2225 pg/mL) than macular hole patients (median, 1265 pg/mL; IQR, 731 to 1800 pg/mL; P = .017), as was the case for VEGF (median, 237 pg/mL; IQR, 42.2 to 1305 pg/mL; vs median, 15.6 pg/mL; IQR, 15.6 to 15.6 pg/mL; P < .001) and sICAM-1 (median, 10.1 ng/mL; IQR, 6.3 to 22.5 ng/mL; vs median, 4.1 ng/mL; IQR, 3.3 to 6.0 ng/mL; P < .001). In BRVO patients, there was a significant positive correlation between vitreous fluid levels of sVEGFR-2 or VEGF and sICAM-1, but not between sVEGFR-2 and VEGF. Vitreous fluid levels of all 3 molecules were correlated significantly the with severity of macular edema in BRVO patients. CONCLUSIONS: sVEGFR-2 may induce an increase of vascular permeability together with or via sICAM-1, or both with and via sICAM-1, in BRVO patients with macular edema.

Vitreous inflammatory factors in macular edema with central retinal vein occlusion.

PURPOSE: To investigate the correlation of soluble intercellular adhesion molecule 1 (sICAM-1) and vascular endothelial growth factor (VEGF) with macular edema in patients with central retinal vein occlusion (CRVO). METHODS: Twenty-nine patients who had CRVO with macular edema and 16 patients with non-ischemic ocular diseases (control group) participated. Retinal ischemia was evaluated by measuring the area of capillary non-perfusion with fluorescein angiography and the public domain Scion Image program. Macular edema was examined by optical coherence tomography. Vitreous samples were obtained during pars plana vitrectomy. VEGF and sICAM-1 levels in vitreous fluid and plasma were determined by enzyme-linked immunosorbent assay. RESULTS: The median vitreous levels of VEGF and sICAM-1 were significantly higher in the CRVO patients than in the control group [366 vs. 15.6 pg/ml (P < 0.001) and 20.5 vs. 5.0 ng/ml (P < 0.001), respectively]. Vitreous levels of both VEGF and sICAM-1 were also significantly higher in the CRVO patients who had retinal ischemia than in those without ischemia (P < 0.001 and P = 0.011, respectively). Vitreous levels of VEGF and sICAM-1 were also significantly correlated with the severity of macular edema (P = 0.004 and P = 0.012, respectively). CONCLUSIONS: VEGF and sICAM-1 may both increase vascular permeability in CRVO patients with macular edema, with sICAM-1 acting together with and/or via VEGF.

Visual prognosis and vitreous molecules after vitrectomy for macular edema with branch retinal vein occlusion.

This study investigated whether vascular endothelial growth factor (VEGF), soluble intercellular adhesion molecule-1 (sICAM-1), and pigment epithelium-derived factor (PEDF) influence the visual prognosis of patients with macular edema and branch retinal vein occlusion (BRVO). In 47 consecutive patients (47 eyes) undergoing vitrectomy, retinal thickness was examined by optical coherence tomography. Best-corrected visual acuity and the vitreous fluid levels of VEGF, sICAM-1, and PEDF were also determined. Patients were followed for at least 6 months after surgery. Vitreous fluid levels of VEGF and sICAM-1 were significantly lower in the patients with more marked improvement of visual acuity after vitrectomy, while PEDF was significantly higher. VEGF and sICAM-1 levels were significantly higher in patients with greater postoperative improvement of macular edema, while PEDF was significantly lower. In BRVO patients, vitreous fluid levels of VEGF, sICAM-1, and PEDF may influence both the response of macular edema to vitrectomy and the visual prognosis.

Vitreous levels of pigment epithelium-derived factor and vascular endothelial growth factor in macular edema with central retinal vein occlusion.

PURPOSE: To investigate whether pigment epithelium-derived factor (PEDF) or vascular endothelial growth factor (VEGF) influences macular edema in patients with central retinal vein occlusion (CRVO). MATERIALS AND METHODS: In 27 patients who had CRVO with macular edema and 21 patients with nonischemic ocular diseases (control group), retinal ischemia was evaluated by measuring the area of capillary nonperfusion on fluorescein angiography and macular edema was examined by optical coherence tomography. Vitreous fluid samples were obtained during pars plana vitrectomy. RESULTS: The vitreous level of VEGF was significantly higher in the CRVO patients than in the controls (median: 366 vs. 15.6 pg/ml, P < 0.0001), while the vitreous level of PEDF was significantly lower in the patients than in the controls (median: 17.5 vs. 28.4 ng/ml, P = 0.0298). Vitreous levels of VEGF were significantly higher in CRVO patients with retinal ischemia than in those without ischemia (P < 0.0001), while PEDF levels did not show a significant difference. Vitreous levels of VEGF and PEDF were related to the retinal thickness at the central fovea (P = 0.0059 and P = 0.0308, respectively). CONCLUSIONS: VEGF and PEDF may independently influence retinal vascular permeability in CRVO patients with macular edema.