Late Dislocation of In-the-Bag Intraocular Lens in Three Patients with Multiple Chorioretinal Atrophy Associated with Sarcoidosis.

PURPOSE: A late dislocation of an in-the-bag intraocular lens (IOL) is strongly associated with pseudoexfoliation and less with retinitis pigmentosa, prior vitreoretinal surgery, and uveitis. We present our findings of late in-the-bag IOL dislocation in three patients with multiple chorioretinal atrophy associated with sarcoidosis. METHODS: Observational study of three elderly female Japanese patients with a history of uveitis from sarcoidosis who presented with a late dislocation of an in-the-bag IOL. RESULTS: The late in-the-bag IOL dislocation occurred in the convalescent/quiescent stage of the sarcoidosis. Peripheral multifocal chorioretinal atrophy was the main manifestation in all patients who were diagnosed with definite or presumed sarcoidosis. The dislocated IOLs were successfully removed and new IOLs were implanted with scleral suture fixation followed by no remarkable active uveitis. CONCLUSION: Clinicians should be aware that patients with peripheral multifocal chorioretinal atrophy associated with sarcoidosis can have a late in-the-bag IOL dislocation.

Macular Hole Formation in Eye After Cryotherapy and Intravitreal Bevacizumab Treatment for Vasoproliferative Tumor.

PURPOSE: To report a case of a full-thickness macular hole (MH) that developed after cryotherapy and intravitreal bevacizumab injection (IVB) to treat a retinal vasoproliferative tumor (VPT). METHODS: Case report of a man with a retinal VPT. RESULTS: A 64-year-old Japanese man complained of blurred vision in his right eye. At the initial examination, his best-corrected visual acuity (BCVA) was 20/25 in the right eye and 20/20 in the left eye. Ophthalmoscopy showed a VPT in the lower peripheral retina of the right eye. An exudative retinal detachment and hard exudates were seen around the tumor. Cryotherapy and intravitreal injections of bevacizumab (IVB) were performed. Although the exudative changes were reduced, a MH developed two months after the initial IVB treatment. He underwent 25-gauge pars plana vitrectomy, and the MH was closed. His postoperative BCVA was 20/32 and the VPT was inactive. The reduced BCVA was due to damage of the outer retinal layers. CONCLUSION: Our findings indicate that cryotherapy and IVB are effective treatments for VPT although the possibility of developing a MH should be considered.

Stereopsis After Unilateral Macular Hole Surgery with Internal Limiting Membrane Peeling.

PURPOSE: We have shown distinct morphological changes of the foveal retina such as horizontally asymmetrical retinal thicknesses and displacements of the fovea toward the optic disc after successful idiopathic macular hole (MH) closure by MH surgery with internal limiting membrane (ILM) peeling. The purpose of this study was to determine whether these morphological changes will alter the stereoacuity. SETTING: This was a non-randomized, retrospective study conducted on patients who underwent MH surgery at the Matsumoto Dental University Hospital, Nagano, Japan. METHODS: Forty patients (22 women, 18 men) who underwent MH surgery with ILM peeling for a unilateral MH were studied. At >6 months after the PPV, the stereoacuity was measured with the Titmus stereotest (TST) and the TNO stereotest (TNO). The relationship between the stereoacuity and the age, MH size, best-corrected visual acuity (BCVA), foveal retinal thickness, and amount of nasal shift of the retina was determined. RESULTS: The mean postoperative BCVA was -0.05 ± 0.11 logarithm of the minimum angle of resolution (logMAR) units. The percentage of cases with good stereoacuity of ≤100 sec of arc was 87.5% with the TST and ≤240" was 90% with the TNO test. A better stereoacuity was significantly correlated with a younger age (r = 0.36, P <0.05; with TNO), smaller MH (r = 0.51, P < 0.001, with TST), better postoperative BCVA (r = 0.43 P <0.01 with TST; r = 0.49, P <0.01 with TNO), but not with the parafoveal retinal thickness or degree of nasal shift. CONCLUSION: The postoperative stereopsis is relatively good in patients with better postoperative BCVA after MH surgery with ILM peeling, even though foveal morphological changes had occurred.

Comparisons of foveal thickness and slope after macular hole surgery with and without internal limiting membrane peeling.

BACKGROUND: We have shown that the foveal contour was asymmetrical after idiopathic macular hole (MH) closure by pars plana vitrectomy (PPV) with internal limiting membrane (ILM) peeling. The purpose of this study was to determine whether these morphological changes differ in eyes after PPV without ILM peeling. METHODS: Ten eyes of 10 patients that underwent PPV without ILM peeling and 12 eyes of 11 patients with ILM peeling were studied. The MH in all eyes was <400 µm in diameter. Six months after the PPV, the macular thickness and foveal slope around the closed MH were determined by spectral-domain optical coherence tomography. The thickness of the ganglion cell complex was measured by another spectral-domain optical coherence tomography instrument >6 months after the surgery. RESULTS: The mean parafoveal retinal thickness in the non-peeled group was 367.1 µm in the nasal (N), 353.0 µm in the temporal (T), 366.9 µm in the superior (S), and 357.3 µm in the inferior (I) sectors. The T, S, and I sectors were significantly thicker than the corresponding sectors in the ILM peeled group (p=0.0008, 0.003, and 0.03, respectively). The mean ganglion cell complex was thicker not only in the N sector but also in the T sector in the non-peeled group. The mean retinal slopes in the non-peeled group (N, 40.2°; T, 37.6°; S, 41.2°; I, 39.5°) were flatter than those in the peeled group (N, 52.3°; T, 43.6°; S, 50.8°; I, 51.9°; p=0.009, 0.09, 0.008, and 0.017, respectively). CONCLUSION: The symmetrical fovea after MH surgery in the non-ILM peeled eyes indicates that the asymmetrical fovea after ILM peeling was probably due to the ILM peeling.

Displacement of fovea toward optic disk after macular hole surgery with internal limiting membrane peeling.

PURPOSE: The purpose of this study was to demonstrate a displacement of the foveal depression toward the optic disk after idiopathic macular hole (MH) surgery with internal limiting membrane (ILM) peeling. METHODS: Two patients with a unilateral MH developed an MH in the fellow eyes. Vitrectomy with ILM peeling was performed on the fellow eye to close the MH. Images of spectral-domain optical coherence tomography (SD-OCT) were used to measure the disk-to-fovea distances pre MH formation, after MH formation, and 6 months after the closure of the MH. RESULTS: The disk-to-fovea distance was shorter at 6 months than after the development of the MH (4,109 µm and 4,174 µm in Case 1 and 4,001 µm and 4,051 µm in Case 2). CONCLUSION: These results indicate that the fovea moves nasally after the MH surgery with ILM peeling.

Transient Increase of Retinal Nerve Fiber Layer Thickness after Vitrectomy with ILM Peeling for Idiopathic Macular Hole.

Purpose. The purpose of this study was to determine the long-term changes in the circumpapillary retinal nerve fiber layer (RNFL) thickness following macular hole surgery with internal limiting membrane (ILM) peeling combined with phacoemulsification. Methods. Thirty-eight eyes of 37 patients who had pars plana vitrectomy (n = 36) between 2010 and 2014 were studied. The average thicknesses of the global and the six sectors of the RNFL were determined before and at 1, 3, 6, 12, and 24 (n = 22) months (M) after the surgery by spectral-domain optical coherent tomography. The postoperative mean RNFL thickness at each time was compared to that before the surgery by paired t-tests. Results. The RNFL of the operated eyes was significantly thicker at 1 month (1 M) and 3 M in all but the inferior-nasal sectors. The significant increase remained until 12 M in the superior-temporal and superior-nasal sectors. In addition, the RNFL was also significantly thicker in the temporal-inferior sector at 12 M based on the findings in 38 eyes. Conclusions. The postoperative RNFL was thicker in all but the nasal-inferior sector for at least 12 M after surgery. This prolonged increase of the RNFL thickness may indicate damage and mild edema of the RNFL.

Asymmetrical steepening of the foveal contour after macular hole surgery with internal limiting membrane peeling.

PURPOSE: We have previously shown that the thickness of the parafoveal retina was asymmetrical in spectral-domain optical coherence tomographic (SD-OCT) images after idiopathic macular hole (MH) closure by pars plana vitrectomy (PPV) with internal limiting membrane (ILM) peeling. The aim of this study was to determine whether the foveal slopes around the closed MH were also asymmetrical. METHODS: Forty-three eyes with an MH treated with PPV with ILM peeling at Matsumoto Dental University Hospital were studied. The foveal slope was determined with ImageJ software in both the horizontal and vertical images obtained by SD-OCT at 6 months after the surgery. The possible related factors were also compared. RESULTS: The mean angles of the foveal slopes of the nasal, superior, inferior, and temporal sectors were 31.4° ± 6.2°, 31.2° ± 5.4°, 31.6° ± 7.4°, and 29.9° ± 6.6°, respectively, in the fellow eyes. The corresponding values in the operated eyes were significantly steeper at 50.4° ± 9.1°, 46.9° ± 11.3°, 48.6° ± 11.3°, and 41.3° ± 11.2°, respectively (P < 0.00001). Both the nasal and inferior slopes were significantly steeper than the temporal slopes of the same operated eye (P = 0.002 and P = 0.023, respectively). There was no significant correlation between each slope and the visual acuity, MH size, area of peeled ILM, postoperative parafoveal retinal thickness, defect of the retinal outer layers, disc-foveal distance, stage, and use of dye for ILM peeling. CONCLUSIONS: Although the postoperative foveal contour was markedly changed asymmetrically, the significance of the change was not determined.

Retinal angiomatous proliferation in an eye with cuticular drusen.

PURPOSE: To report the presence of retinal angiomatous proliferation (RAP) in an eye with cuticular drusen detected by fluorescein and indocyanine green angiography by confocal scanning laser ophthalmoscopy and by spectral-domain optical coherence tomography (SD-OCT). METHODS: Case report of a 65-year-old Japanese woman with cuticular drusen. RESULTS: At her first ophthalmic examination, her visual acuity was 20/20 in both eyes. An ophthalmoscopy showed many small subretinal pigment epithelial deposits in both eyes. These deposits had a 'saw-tooth pattern' in the SD-OCT images. During the follow-up examination, retinal hemorrhages were observed, and fluorescein angiography showed a 'stars-in-the-sky' appearance and intraretinal neovascularization. The patient was diagnosed with cuticular drusen associated with RAP. CONCLUSION: We suggest that the cuticular drusen were associated with RAP, so periodic follow-up examinations are needed for patients with cuticular drusen for the early detection and treatment of RAP.

Retinal involvement in uveitis associated with Hodgkin disease.

PURPOSE: To describe a patient with Hodgkin disease with posterior uveitis who also had a thinning of the retina and an antiretinal autoantibody in his serum. METHODS: Our patient was a 58-year-old man who had been diagnosed with Hodgkin disease. He had a complete ophthalmologic examination including fluorescein angiography, electroretinography, perimetry, and spectral-domain optical coherence tomography. A search for antiretinal antibodies in the serum was made by Western blot analysis, and the retinal sites reactive to the antibodies were determined by immunohistochemistry. RESULTS: The ocular signs were mild cellular infiltration in the anterior chamber and vitreous, and small, round chorioretinal lesions in the peripheral retina. The electroretinograms were slightly reduced. Small ring-like scotomas were detected in the Goldmann visual fields. An antiretina-specific 116-kDa antibody was detected in the serum by Western blot analysis, and the antibody reacted with the ganglion cell and inner nuclear layers of mice retinas. Although the visual acuities were maintained for over eight years, the macular thickness measured in the spectral-domain optical coherence tomography images was reduced. CONCLUSION: The presence of an antiretinal autoantibody, granulomatous uveitis, and retinal thinning in a patient with Hodgkin disease suggests that the patient had a granulomatous uveitis associated with Hodgkin disease or lymphoma-associated uveitis with retinal involvement.

Retinal thickness in eyes with idiopathic macular hole after vitrectomy with internal limiting membrane peeling.

PURPOSE: To compare the thickness of each retinal layer in the parafoveal and perifoveal regions of eyes after successful closure of a macular hole (MH) by pars plana vitrectomy with internal limiting membrane (ILM) peeling to the corresponding areas of the normal fellow eyes. METHODS: Twenty-two eyes of 22 patients with an idiopathic MH who underwent PPV with ILM peeling at the Matsumoto Dental University Hospital were studied. The retinal thickness was measured manually with the volume scan mode of the Spectralis HRA + OCT (Heidelberg Engineering, Germany). RESULTS: The average postoperative parafoveal thickness of the temporal sector was 314.8 µm, and that of the corresponding area of the fellow eyes was 325.0 µm (P = 0.01). The parafoveal thickness of the nasal sector was 360.7 µm, and that of the fellow eyes was 339.6 µm (P < 0.0001). Changes in the inner retinal layer thicknesses contributed to the decreased temporal and increased nasal sectors. The perifoveal retinal thickness was significantly increased in all sectors after PPV, probably due to an increase in the outer nuclear layer thickness. CONCLUSIONS: PPV with ILM peeling for MHs can cause microstructural changes in wide areas of the macula region, suggesting a loss of longitudinal support of the Müller cells.

Retinoschisis detected by spectral-domain optical coherence tomography in von hippel-lindau disease.

PURPOSE: To report the presence of retinoschises in a case of von Hippel-Lindau disease detected by spectral-domain optical coherence tomography. METHODS: Case report of a 23-year-old man with von Hippel-Lindau disease who was seen for a regular follow-up examination. RESULTS: Ophthalmoscopy showed several retinal capillary hemangioblastomas in both eyes. Spectral-domain optical coherence tomography showed retinoschises around the retinal capillary hemangioblastoma and also around the feeder and draining vessels of the peripheral larger hemangioblastoma. The retinoschises were found under the internal limiting membrane and also in the inner and outer retinal layers. Intraretinal columns were observed in the retinoschises. CONCLUSION: Our observations show that retinoschises can develop in eyes with von Hippel-Lindau disease. The extensiveness of the retinoschises suggests that the retina is fragile in von Hippel-Lindau disease.

Effects of the feeding of wild Yeso sika deer (Cervus nippon yesoensis) on the prevention of damage due to bark stripping and the use of feeding sites.

Feeding sites for wild Yeso sika deer around Lake Akan, Japan, were established. Effects on the number of deer using the feeding sites, the prevention of bark stripping damage, the amount of feeding, and eating time in a 5-year period (1999-2003) were evaluated. The number of deer using feeding sites increased with years during the feeding period. The damaged tree ratio after the initiation of feeding markedly decreased compared with 16.5% before the initiation of feeding. After the start of feeding, there were no trees with damage the entire circumference. According to tree species, the number of damaged trees of Ulmus laciniata Mayr as a percentage of all investigated trees was high (5.2%). The total amount of beet pulp feeding increased with the feeding year, showing 4.5-fold increase. At feeding sites in deer culling, eating behavior was observed during the night. The preventive effects on bark stripping damage continued during the 5-year feeding period. However, with the course of feeding years, the number of deer using feeding sites and the level of feeding increased.

Retinal thickness of myopic eyes determined by spectralis optical coherence tomography.

AIMS: To determine the relationship between the macular thickness and volume determined by spectral domain optical coherence tomography (SD-OCT) and the refractive error (RE) and axial length (AL). METHODS: 48 eyes of 24 healthy Japanese subjects were examined. The REs (spherical equivalent) were measured with the Tonoref RKT-7000 autorefractometer (Nidek Inc, Aichi, Japan), and the ALs were determined by the IOL-Master (Carl Zeiss Meditec Inc, Dublin, California, USA). The thicknesses and volumes of the central, inner, and outer macular areas were measured by Spectralis SD-OCT (Heidelberg Engineering, Heidelberg, Germany). The correlations between the macular thickness and volume and the RE and AL were determined by linear regression analyses. RESULTS: The average central foveal thickness (within 1 mm) was 278.7±10.8 µm and the volume was 0.22±0.01 mm(3). The foveal thickness was negatively correlated with the RE and positively correlated with the AL (p<0.01 for both). Similar correlations were also found for the volume of the central macular areas. CONCLUSIONS: The significant correlation of the foveal thickness and the RE and AL in healthy eyes should be considered when these parameters are evaluated in eyes with retinal diseases.

Spectral domain optical coherence tomographic findings at convalescent stage of acute zonal occult outer retinopathy.

PURPOSE: To describe the morphology of the retina at the convalescent stage of acute zonal occult outer retinopathy (AZOOR) from images obtained by spectral domain optical coherence tomography (SD-OCT). METHODS: The visual fields, electroretinograms (ERGs), and OCT images were reviewed in two women aged 24 and 33 years. The patients were followed for one and four years, respectively. RESULTS: In both cases, the anterior and posterior segments were almost normal, although both patients had a sudden unilateral vision decrease and photopsia. Goldmann perimetry revealed enlarged blind spots and scotomas. The ERGs were reduced in both cases. SD-OCT showed that the junction of the inner and outer segment, the IS/OS line, of the photoreceptors was irregular or lost in the affected retinas. The retina in these areas was thinner due to a decrease in the thickness of both the outer nuclear layer (ONL) and inner nuclear layer (INL) in Case 2. CONCLUSIONS: The decrease in retinal thickness at the convalescent stage of AZOOR is most likely due to a shortening of not only the photoreceptors and ONL but also to a thinning of the INL in a severe case.

[Two-year results following photodynamic therapy for age-related macular degeneration].

PURPOSE: To investigate the visual outcome 2 years after photodynamic therapy (PDT) in patients with exudative age-related macular degeneration (AMD) and polypoidal choroidal vasculopathy (PCV). METHODS: Thirty-six eyes undergoing PDT were retrospectively studied. Seventeen eyes of AMD (AMD group) and nineteen eyes of PCV (PCV group) were evaluated. RESULTS: In the AMD group, the mean pre-PDT visual acuity was 0.19. The mean post-PDT visual acuity was 0.16 two years after the PDT. Two years after PDT, the Log MAR visual acuity improved by 0.2 or more in 3 eyes (17.7%), but it decreased by 0.2 or more in 4 eyes (23.5%). In the PCV group, the mean pre-PDT visual acuity was 0.34. The mean post-PDT visual acuity was 0.20 two years after PDT. The Log MAR visual acuity improved by 0.2 or more in 5 eyes (26.3%), but it decreased by 0.2 or more in 7 eyes (36.8%). CONCLUSIONS: In this series of patients, more than half of the two groups were able to maintain their visual acuity for 2 years after PDT. Although the average visual acuity of the AMD group was worse than that of the PCV group, the AMD group was able to maintain their visual acuity for 2 years after PDT. The average visual acuity of the PCV group decreased 2 years after PDT.