Subfoveal choroidal thickness changes after intravitreal ranibizumab and photodynamic therapy for retinal angiomatous proliferation.

PURPOSE: To evaluate the subfoveal choroidal thickness changes after intravitreal ranibizumab and photodynamic therapy in patients with retinal angiomatous proliferation. METHODS: Subfoveal choroidal thickness was retrospectively measured using enhanced depth imaging optical coherence tomography. RESULTS: Thirty-two eyes of 26 patients (average age, 82 years) with newly diagnosed retinal angiomatous proliferation were examined. All eyes were treated with intravitreal ranibizumab and photodynamic therapy. In 14 eyes without recurrence over 6-month follow-up (average, 8.4 months), mean subfoveal choroidal thickness decreased from 198 µm at baseline to 169 µm (85.4%) at 3 months and to 173 µm (87.3%) at 6 months after treatment (P < 0.01 compared with baseline, respectively). In 18 eyes with recurrence over 3-month follow-up, mean subfoveal choroidal thickness decreased from 199 µm at baseline to 171 µm (85.9%) at 3 months after treatment and 176 µm (88.4%) even at recurrence (P < 0.01 compared with baseline, respectively). CONCLUSION: Subfoveal choroidal thickness after intravitreal ranibizumab and photodynamic therapy for retinal angiomatous proliferation decreased to approximately 85% compared with baseline by 3 months after treatment, and the trend persisted in eyes with or without recurrence during follow-up. This may indicate that choroidal changes are not associated with recurrence in retinal angiomatous proliferation.

Choroidal thickness changes after intravitreal ranibizumab and photodynamic therapy in recurrent polypoidal choroidal vasculopathy.

PURPOSE: To evaluate subfoveal choroidal thickness changes in cases with recurrent polypoidal choroidal vasculopathy (PCV) after combination therapy with intravitreal ranibizumab and photodynamic therapy (PDT). DESIGN: Retrospective observational case series study. METHODS: We measured subfoveal choroidal thickness in PCV using optical coherence tomography (OCT) before and after PDT. In recurrent cases, the choroidal thickness was measured at the time of the recurrence. In nonrecurrent cases, choroidal thickness was measured 1 year after PDT. RESULTS: Combination therapy was performed in 27 eyes (27 patients). Polypoidal lesions regressed within 3 months after initial treatment in all eyes. Retreatment was needed in 10 of 27 eyes (37.0%) after more than 3 months of follow-up. In recurrent cases, subfoveal choroid decreased from 188 µm at baseline to 157 µm 3 months after PDT (P < .01); however, choroidal thickness increased to 179 µm with recurrence (P = .54 compared to baseline; average, 8.0 months). In nonrecurrent cases, subfoveal choroid decreased from 257 µm at baseline to 210 µm 3 months after PDT and 212 µm 1 year after PDT (P < .01, respectively). CONCLUSION: Subfoveal choroidal thickness in PCV at the time of recurrence returned to the baseline level after choroidal thinning as a result of PDT treatment. Choroidal thickness changes after PDT examined using OCT may reflect disease activity in PCV.

Conservative treatment for late-onset bleb leaks after trabeculectomy with mitomycin C in patients with ocular surface disease.

BACKGROUND: Sodium hyaluronate and autologous serum eye drops are used to treat ocular surface disease (OSD) and are reported to prevent and treat late-onset bleb leaks following trabeculectomy with mitomycin C. In this study, we evaluated the efficacy of a combination of sodium hyaluronate and autologous serum eye drops and treatment for obstructive meibomian gland dysfunction as a therapy for late-onset bleb leaks after trabeculectomy with mitomycin C. METHODS: This was a retrospective, interventional, nonsimultaneous study of 12 subjects (12 eyes) of mean age of 64.3 ± 18.3 years with OSD and apparent late-onset bleb leaks following trabeculectomy with mitomycin C between 1998 and 2008. We compared patients diagnosed with leakages before July 2005, who had been treated with separate eye drop solutions containing 0.1% sodium hyaluronate, 50% autologous serum, and 0.3% ofloxacin (sodium hyaluronate and autologous serum group, n = 7), with patients diagnosed from August 2005 to December 2008, who were treated with a combination of eye drops (0.1% sodium hyaluronate, 50% autologous serum, and 0.08% levofloxacin hydrate) and eyelid massage and warm compresses for obstructive meibomian gland dysfunction (combination eye drop group, n = 5). RESULTS: Leakage was resolved in one patient (14.3%) in the separately treated sodium hyaluronate and autologous serum eye drop group and in five patients (100%) in the combination eye drop group (P = 0.015). The period after resolution of leakage with conservative treatment was 23 months in the one eye in the sodium hyaluronate and autologous serum group and 36-61 (mean 52.4 ± 10.1) months in the five eyes in the combination eye drop group. CONCLUSION: Late-onset bleb leaks following trabeculectomy with mitomycin C can be treated effectively using a combination of sodium hyaluronate and autologous serum eye drops, eyelid massage, and warm compresses. Furthermore, combining eye drops may improve patient adherence to the drug regimen by decreasing the frequency of administration.

Morphologic analysis in pathologic myopia using high-penetration optical coherence tomography.

PURPOSE: We evaluated retrospectively the morphologic choroidal and scleral characteristics in eyes with pathologic myopia using high-penetration optical coherence tomography (HP-OCT) or swept-source OCT (SS-OCT). METHODS: The subfoveal choroidal and scleral thicknesses were measured using the prototype HP-OCT with a 1060 nm light source. We also measured the scleral thickness 3 mm superior, inferior, nasal, and temporal to the fovea on the horizontal and vertical OCT sections. The axial length (AL) in all eyes was measured using optical biometry. RESULTS: We examined 58 eyes of 35 patients (7 men and 28 women, mean age 65.5 years) with an AL exceeding 26.5 mm. The mean AL was 29.0 ± 1.4 mm. The full-thickness choroid and sclera were visualized in all eyes. The mean subfoveal choroidal and scleral thicknesses were 52 ± 38 and 335 ± 130 µm, respectively. The mean scleral thicknesses 3 mm superior, inferior, nasal, and temporal to the fovea were 266 ± 78 (n = 57), 259 ± 72 (n = 56), 324 ± 109 (n = 39), and 253 ± 79 (n = 58) µm, respectively. The subfoveal sclera was thicker than 3 mm outside the fovea (P < 0.05, for each comparison). CONCLUSIONS: The full-thickness choroid and sclera in all eyes with pathologic myopia were visualized using a prototype HP-OCT. The subfoveal sclera was thicker than 3 mm outside the fovea. HP-OCT is a useful tool for morphologic analyses of pathologic myopia.

Demographic features of idiopathic macular telangiectasia in Japanese patients.

PURPOSE: Idiopathic macular telangiectasia (MacTel) is classified into aneurysmal telangiectasia (type 1), perifoveal telangiectasia (type 2) and occlusive telangiectasia (type 3). Most instances of telangiectasia in Western countries are type 2. This study reports clinical and demographic features of MacTel in Japanese patients. METHODS: Newly diagnosed patients with MacTel were examined retrospectively. All patients underwent fluorescein angiography and optical coherence tomography. RESULTS: Thirty-four eyes of 27 patients with MacTel were included. Twenty eyes of 20 patients (74.1%) had type 1, ten eyes of five patients (18.5%) had type 2, and four eyes of two patients (7.4%) had type 3. Foveal capillary dilatation and microaneurysms were observed in all except for one eye of early stage type 2 MacTel. Optical coherence tomography revealed cystoid macular edema in type 1, temporal foveal thinning and a loss of boundary between the inner and outer segments of photoreceptors in type 2, and thinning of all retinal layers around the fovea in type 3. CONCLUSION: The most frequent among our patients was aneurysmal MacTel, whereas perifoveal MacTel was not common. Although the clinical characteristics were similar, the most common type was different from that in Western countries.

Morphologic choroidal and scleral changes at the macula in tilted disc syndrome with staphyloma using optical coherence tomography.

PURPOSE: To evaluate the macular choroidal and scleral changes in tilted disc syndrome (TDS) with staphyloma using optical coherence tomography (OCT) to determine the mechanism of serous retinal detachment (SRD) formation. METHODS: All eyes underwent fluorescein (FA) and indocyanine green angiography (ICGA) in this retrospective, observational study. Enhanced-depth imaging (EDI) OCT and prototype high-penetration (HP) OCT were used to examine the choroid and sclera, respectively, at the upper and lower optical areas and the subfovea on vertical OCT sections. RESULTS: Twenty-four eyes with TDS with inferior staphyloma were included. FA showed the macular area with the superior edge of staphyloma had a granular hyperfluorescent pattern and ICGA showed belt-like hypofluorescence. OCT showed SRDs in seven eyes. The mean EDI-OCT choroidal thicknesses in 19 eyes were: upper area, 211 ± 79 µm; subfovea, 153 ± 70 µm; and lower area, 158 ± 42 µm. The mean subfoveal and lower choroid were significantly (P < 0.01 for both) thinner than the upper area. The mean HP-OCT scleral thicknesses in 14 eyes were: upper area, 414 ± 36 µm; subfovea, 493 ± 40 µm; and lower area, 398 ± 83 µm. The subfoveal sclera was significantly (P < 0.01) thicker than the others. CONCLUSIONS: The subfoveal choroid was relatively thin and the subfoveal sclera thickened in TDS with a staphyloma edge at the macula. The area with retinal pigment epithelial (RPE) atrophy was hyperfluorescent on FA; choriocapillaris occlusion was hypofluorescent on ICGA. Characteristic anatomic subfoveal scleral alterations might lead to a thinner choroid and inhibit chorioscleral outflow; a secondary RPE disorder subsequently could cause SRDs.

Subfoveal choroidal thickness after treatment of Vogt-Koyanagi-Harada disease.

PURPOSE: To evaluate the subfoveal choroidal thickness in Vogt-Koyanagi-Harada (VKH) disease using enhanced depth imaging optical coherence tomography. METHODS: Retrospective observational study. Subfoveal choroidal thickness was measured using enhanced depth imaging optical coherence tomography, in which the optical coherence tomography instrument was placed close enough to the eye to obtain an inverted image, which was averaged for 100 scans. All patients were diagnosed as having the ocular findings of VKH disease with or without extraocular disorders. The patients were followed during their initial treatment with corticosteroids. RESULTS: All 8 patients (16 eyes) with acute phase VKH disease presented with thickening of the choroid. The serous retinal detachment disappeared in 1 month after corticosteroid treatment. The mean choroidal thickness in 16 eyes decreased from 805 ± 173 µm at the first visit to 524 ± 151 µm at 3 days (P < 0.001) and 341 ± 70 µm by 2 weeks (P < 0.001). CONCLUSION: Patients with active VKH disease have markedly thickened choroids, possibly related not only to inflammatory infiltration but also to increased exudation. Both the choroidal thickness and the exudative retinal detachment decreased quickly with corticosteroid treatment. Enhanced depth imaging optical coherence tomography can be used to evaluate the choroidal involvement in VKH disease in the acute stages and may prove useful in the diagnosis and management of this disease noninvasively.

A pilot study on pupillary and cardiovascular changes induced by stereoscopic video movies.

BACKGROUND: Taking advantage of developed image technology, it is expected that image presentation would be utilized to promote health in the field of medical care and public health. To accumulate knowledge on biomedical effects induced by image presentation, an essential prerequisite for these purposes, studies on autonomic responses in more than one physiological system would be necessary. In this study, changes in parameters of the pupillary light reflex and cardiovascular reflex evoked by motion pictures were examined, which would be utilized to evaluate the effects of images, and to avoid side effects. METHODS: Three stereoscopic video movies with different properties were field-sequentially rear-projected through two LCD projectors on an 80-inch screen. Seven healthy young subjects watched movies in a dark room. Pupillary parameters were measured before and after presentation of movies by an infrared pupillometer. ECG and radial blood pressure were continuously monitored. The maximum cross-correlation coefficient between heart rate and blood pressure, rho max, was used as an index to evaluate changes in the cardiovascular reflex. RESULTS: Parameters of pupillary and cardiovascular reflexes changed differently after subjects watched three different video movies. Amplitudes of the pupillary light reflex, CR, increased when subjects watched two CG movies (movies A and D), while they did not change after watching a movie with the real scenery (movie R). The rho max was significantly larger after presentation of the movie D. Scores of the questionnaire for subjective evaluation of physical condition increased after presentation of all movies, but their relationship with changes in CR and rho max was different in three movies. Possible causes of these biomedical differences are discussed. CONCLUSION: The autonomic responses were effective to monitor biomedical effects induced by image presentation. Further accumulation of data on multiple autonomic functions would contribute to develop the tools which evaluate the effects of image presentation to select applicable procedures and to avoid side effects in the medical care and rehabilitation.

Distribution and variable expression of secretory pathway protein reticulocalbin in normal human organs and non-neoplastic pathological conditions.

Reticulocalbin (RCN) is one member of the Ca(2+)-binding proteins in the secretory pathway and is localized in the endoplasmic reticulum. RCN may play a role in the normal behavior and life of cells, although its detailed role remains unknown. Overexpression of RCN may also play a role in tumorigenesis, tumor invasion, and drug resistance. The new antibody for human RCN is used in the distribution of RCN in normal human organs of fetuses and adults with or without inflammation. Immunohistochemical examination demonstrated a broad distribution of RCN in various organs of fetuses and adults, predominantly in the endocrine and exocrine organs. However, RCN expression was heterogeneous in each constituent cell of some organs. Among non-epithelial organs, vascular endothelial cells, testicular germ cells, neurons, and follicular dendritic cells showed strong staining. Plasma cells were the only RCN-positive cells among hematopoietic and lymphoid cells. In inflammatory conditions, RCN expression was enhanced in both epithelial and non-epithelial cells. Heterogeneous expression of RCN indicates that the amount of RCN needed for cell behavior and life may be variable, depending on each cell type and, therefore, RCN may be helpful in establishing the cell origin of neoplasms in some organs. However, further study is needed to establish the significance of RCN in tumorigenesis and in some peculiar features of neoplasms.

Pupillary and cardiovascular responses to a video movie in senior human subjects.

The effects of watching video movies on autonomic functions were estimated by measuring changes in pupillary and cardiovascular parameters in 10 senior subjects. The subjects looked at a series of video images (with accompanied sounds) taken during the execution of motor vehicles. The images were rear-projected on a large screen for 15 min. Pupil diameter and parameters of the light reflex were measured by an infrared pupillometer before and after the video presentation. Their electrocardiograms (ECG) and blood pressure were measured continuously. Subjects were divided into two groups depending on their values of blood pressure and fasting plasma glucose level. Subjects in Group A had blood pressures of less than 140 mm Hg and a fasting plasma glucose level of less than 7 mmol/dl (normal group). Other subjects were included in Group B (mild hypertension or diabetes mellitus group). While changes in pupillary light reflex after video viewing were minimal in the members of Group A, amplitudes of the pupillary reflex in the members of Group B varied over a significantly wide range. By the spectral analysis of cardiovascular rhythm, %LF and %HF components of blood pressure rhythm were significantly different between the two groups before video viewing. However, the ratios of frequency components before and after video viewing were not significantly different between the two groups. Our findings suggest that pupillary light reflex was less precisely controlled in subjects with mild autonomic dysfunction after prolonged audiovisual stimulation.