Pinguecula and contact lenses.

PURPOSE: To assess the relationship between age and the incidence and severity (determined by a grading system) of pinguecula in contact lens (CL) wearers, and to compare the grade of pinguecula between CL wearers and non-wearers. METHODS: A total of 600 CL wearers (94 wore hard CLs (HCLs) and 506 wore soft CLs (SCLs)) aged 11-60 years and 579 non-wearers aged 10-60 years were enrolled. The age, gender, medical history, ocular history, and grade of pinguecula at two locations (nasal and temporal) were determined in all subjects. RESULTS: There was an age-related increase in the grade of pinguecula among both CL wearers and non-wearers. The grade of pinguecula at the temporal conjunctiva was higher in CL wearers than in non-wearers (P=0.01907), whereas it was higher in HCL wearers than SCL wearers at both the nasal and temporal conjunctiva (P<0.00001 and P<0.00001). CONCLUSIONS: This was the first assessment of the severity of pinguecula in a large consecutive series of CL wearers. Our results suggest that the use of CLs is an important risk factor for pinguecula.

Macular microcirculation and macular oedema in branch retinal vein occlusion.

BACKGROUND/AIMS: The relationship between the blood-flow velocity in the perifoveal capillaries and macular oedema was investigated in patients with branch retinal vein occlusion (BRVO). METHODS: This study compared 18 patients with BRVO and 16 healthy volunteers. Perifoveal capillary blood-flow velocity was measured on fluorescein angiograms with a scanning laser ophthalmoscope by the tracing method. Retinal thickness at the central fovea was measured by optical coherence tomography. Then, the relation between perifoveal capillary blood-flow velocity and retinal thickness at the central fovea was investigated. RESULTS: Perifoveal capillary blood-flow velocity was significantly lower in the patients with BRVO (1.08 (SD 0.28) mm/s) than in the healthy volunteers (1.49 (0.11) mm/s) (p<0.0001). Capillary blood-flow velocity showed a negative correlation with the retinal thickness at the central fovea in the two groups (r = -0.8426, p<0.0001). Multivariate linear regression analysis with stepwise variable selection confirmed that capillary blood-flow velocity was an independent determinant of the retinal thickness at the central fovea (p<0.001). CONCLUSION: A reduction in perifoveal capillary blood-flow velocity may be involved in the development of macular oedema in patients with BRVO.

Relationship between refraction and allergic conjunctivitis.

PURPOSE: External allergens are the main causative factor in the pathogenesis of allergic diseases; however, little is known about internal factors such as the biometrical structure of the eye. We investigated the relationship between refractive error and allergic conjunctivitis in order to reveal possible insights into the pathogenesis in 1015 subjects. METHODS: The patients were divided into four groups: contact lens wearers with allergic conjunctivitis (n=73), contact lens wearers without allergic conjunctivitis (n=59), non-contact lens wearers with allergic conjunctivitis (n=224), and non-contact lens wearers without allergic conjunctivitis (n=659). The spherical power, cylindrical power, corneal radius, and minimum and maximum corneal refractive powers were measured in all subjects. RESULTS: In the non-contact lens wearers, the spherical equivalent and spherical power were significantly lower in patients with allergic conjunctivitis than in patients without allergic conjunctivitis (-3.01+/-3.83 D vs-1.36+/-3.08 D, P<0.0001, and -2.64+/-3.63 D vs-1.05+/-2.88 D, P<0.0001, respectively), while there was no significant difference in any of the parameters between the contact lens wearers with and without allergic conjunctivitis. CONCLUSION: Refractive error may be a risk factor for allergic conjunctivitis.

CT colonography to detect rectosigmoid involvement in patients with primary ovarian cancer.

INTRODUCTION: We retrospectively evaluated the performance of preoperative computed tomographic (CT) colonography to detect tumor involvement of the rectosigmoid wall and predict the need for rectosigmoid resection in patients with primary ovarian cancer. METHODS: Thirty-three patients with primary ovarian cancer who underwent preoperative CT colonographic examination were evaluated. The images of the examination were analyzed and compared with the subsequent surgical findings. RESULTS: All abnormal findings (malignant infiltration of the rectosigmoid mucosa and extrinsic compression) revealed by conventional colonoscopy were correctly observed as extrinsic compression using CT colonography. The sensitivity, specificity, positive predictive value and negative predictive value of CT colonography for the prediction of rectosigmoid resection were 100%, 64.7%, 72.7%, and 100%, respectively. Though conventional colonoscopic examinations could not be completed in five patients because of the presence of extrinsic stenosis and occlusion at the sigmoid colon, CT colonography enabled the entire large bowel to be examined in these patients. CONCLUSIONS: This preliminary study showed that the CT colonographic examination is feasible and safe. CT colonography seems to have several advantages over conventional colonoscopy for the detection of rectosigmoid involvement in patients with advanced ovarian cancer. For confirmation of the efficacy of CT colonography, further large prospective studies are needed.

Changes of vascular endothelial growth factor after vitrectomy for macular edema secondary to retinal vein occlusion.

PURPOSE: To examine whether vitrectomy combined with retinal photocoagulation reduces the vitreous level of vascular endothelial growth factor (VEGF) in patients with macular edema associated with retinal vein occlusion (RVO). METHODS: The authors measured VEGF levels in vitreous samples from four eyes of four patients with RVO during vitrectomy and fluid samples obtained during revitrectomy 3 to 9 months postoperatively for complications: an epiretinal membrane in two patients, macular holes in one patient, and vitreous hemorrhage in one patient. During vitrectomy, retinal photocoagulation was performed on the ischemic region of the retina in all cases (mean of 510 shots). RESULTS: In four eyes with RVO, there was a difference in the vitreous VEGF levels between the vitreous samples obtained during vitrectomy (mean of 2692 pg/mL, range of 15.6-9040 pg/mL) and the fluid samples obtained at the time of revitrectomy (mean of 947 pg/mL, range of 15.6-3430 pg/mL). CONCLUSIONS: The results suggest that the vitreous levels of VEGF may be reduced by vitrectomy combined with retinal photocoagulation for macular edema with RVO. It may be important to reduce the vitreous levels of VEGF by vitrectomy and retinal photocoagulation for ischemic retina in macular edema with RVO.

Aqueous humour levels of cytokines are correlated to vitreous levels and severity of macular oedema in branch retinal vein occlusion.

AIM: To investigate whether the aqueous levels of vascular endothelial growth factor (VEGF) and interleukin-6 (IL-6) are correlated to the vitreous levels of these substances and to the severity of macular oedema in branch retinal vein occlusion (BRVO). METHODS: Aqueous and vitreous samples were obtained during cataract and vitreous surgery from 24 patients (24 eyes) with macular oedema in BRVO. The VEGF and IL-6 levels in aqueous humour, vitreous fluid, and plasma were determined by enzyme-linked immunosorbent assay. The degree of retinal ischaemia was evaluated in terms of the area of capillary nonperfusion using the Scion Image. The severity of macular oedema was evaluated using the OCT. RESULTS: The aqueous level of VEGF was significantly correlated with the vitreous level of VEGF (P<0.0001). Vitreous levels of VEGF and IL-6 were significantly correlated with the nonperfusion area of BRVO (P<0.0001, P=0.0061, respectively), as were the aqueous levels of VEGF and IL-6 (P<0.0001, P=0.0267, respectively). Furthermore, the vitreous levels of VEGF and IL-6 and the aqueous level of VEGF were significantly correlated with the severity of macular oedema of BRVO (P=0.0001, P=0.0331, P=0.0272, respectively). CONCLUSION: Our results suggest that the aqueous level of VEGF may reflect its vitreous level. Measurement of the aqueous level of VEGF may be clinically useful to indicate the severity of macular oedema with BRVO.

Risk evaluation of outcome of vitreous surgery based on vitreous levels of cytokines.

AIM: To ascertain whether vitreous and plasma levels of vascular endothelial growth factor (VEGF), interleukin-6 (IL-6) and fundus findings could predict the outcome of vitreous surgery in patients with proliferative diabetic retinopathy (PDR). METHODS: Vitreous fluid samples were obtained during vitreoretinal surgery from 73 consecutive eyes with PDR. The levels of VEGF and IL-6 in vitreous fluid and plasma were determined by enzyme-linked immunosorbent assay. Patients were prospectively followed for 6 months and the postoperative outcome was analysed by logistic regression analysis. RESULTS: No improvement and/or progression of PDR occurred in 23 (32%) of the 73 eyes (progression group). The vitreous levels of VEGF and IL-6 were significantly higher in eyes from the progression group than in eyes with regression of PDR (regression group) (P=0.0032 and 0.0088, respectively). Multivariate logistic regression analysis showed that higher vitreous levels of VEGF were associated with the progression of PDR after vitreous surgery (odds ratio 2.72, P=0.0003). CONCLUSIONS: High vitreous levels of VEGF identified as a significant risk factor for the outcome of vitreous surgery in patients with PDR. A model was developed to predict the probability of PDR progression and measurement of the vitreous level of VEGF may be useful for predicting the outcome of surgery.

Allergens in Japanese patients with allergic conjunctivitis in autumn.

PURPOSE: The purpose of the current study is to evaluate the relation between various specific class E immunoglobulins (IgE) in the serum and allergic conjunctivitis in autumn. METHODS: Total IgE and specific IgE to 12 inhalant allergens were measured using the CAP system in 32 patients with allergic conjunctivitis in spring (spring group), 27 patients with allergic conjunctivitis in autumn (autumn group), and 40 healthy volunteers (control group). RESULTS: Specific IgE levels caused by house dust, Dermatophagoides pteronyssinus, and orchard grass were higher in the autumn group than in the spring group. The highest positivity rate for a specific allergen was 51.9% for house dust, followed by D. pteronyssinus(48.1%) in the autumn group, while the highest rate was 68.8 % for cedar pollen, followed by cypress pollen (59.4%) in the spring group. Correlation analysis showed that house dust was significantly correlated with animal epithelia, D. pteronyssinus, acarus, and Alternaria tenuis in the autumn group (P<0.001). CONCLUSIONS: These results suggest that house dust is the main cause of allergic conjunctivitis during autumn. In spring, cypress pollen is the largest cause of allergic conjunctivitis, while indoor allergens such as house dust, animal epithelia, D. pteronyssinus, and acarus are not causative allergens in Japan.

Risk evaluation of outcome of vitreous surgery for proliferative diabetic retinopathy based on vitreous level of vascular endothelial growth factor and angiotensin II.

AIMS: To ascertain whether measurement of the vitreous fluid levels of vascular endothelial growth factor (VEGF) or angiotensin II (Ang II) could predict the outcome of vitreous surgery in patients with proliferative diabetic retinopathy (PDR). METHODS: A prospective observational case study was performed in 61 consecutive patients (61 eyes) with PDR who underwent vitreoretinal surgery. Vitreous fluid samples were obtained during surgery. The VEGF level in vitreous fluid and plasma was determined by enzyme linked immunosorbent assay, while the Ang II level was measured by radioimmunoassay. Patients were prospectively followed for 6 months and the postoperative outcome was analysed by logistic regression analysis. RESULTS: No improvement and/or progression of PDR was seen in 15 (25%) of the 61 eyes. Vitreous levels of VEGF and Ang II were significantly higher in eyes with progression of PDR than in eyes with regression of PDR (p = 0.0044, and p = 0.0178, respectively). Multivariate logistic regression analysis showed that the vitreous VEGF level increased along with the progression of PDR after vitreous surgery (odds ratio 2.48, p = 0.0008). CONCLUSION: A high vitreous fluid VEGF level is associated with a significant risk of postoperative progression of PDR. The vitreous level of VEGF at the time of surgery may be a useful predictor of the outcome.

Development and progression of diabetic retinopathy in patients with Type 1 diabetes who are positive for GAD autoantibody.

AIMS: To investigate the relationship between autoantibodies to glutamic acid decarboxylase (GAD) and proliferative diabetic retinopathy (PDR) to assess the role of autoimmunity in retinopathy. METHODS: Patients with Type 1 diabetes for more than 10 years who had been diagnosed under age 30 (13-28 years) were studied. They were classified into three groups. The PDR group consisted of 22 patients, the pre-PDR group was 26 patients, while the non-DR group was 32 patients who had Type 1 diabetes without retinopathy. Blood was collected to measure autoantibodies to GAD, and the relationship between PDR and GAD positivity was investigated in a cross-sectional study. RESULTS: The highest positivity rate of GAD autoantibodies was 50.0% in the non-DR group, followed by the pre-PDR group (30.8%) and the PDR group (18.2%). CONCLUSIONS: Production or existence of GAD autoantibodies may contribute to the prevention of retinopathy.

Angiotensin II and vascular endothelial growth factor in the vitreous fluid of patients with proliferative diabetic retinopathy.

AIMS: To investigate the correlation between the level of angiotensin II and vascular endothelial growth factor (VEGF) in the vitreous fluid and the severity of proliferative diabetic retinopathy (PDR). METHODS: During vitreoretinal surgery at the Tokyo Women's Medical University, vitreous fluid samples were obtained from 51 eyes of diabetic patients with PDR, six eyes of diabetic patients without retinopathy, and 16 eyes of non-diabetic patients with ocular disease (controls). The VEGF levels in vitreous fluid and plasma were determined by enzyme linked immunosorbent assay, while angiotensin II levels were measured by radioimmunoassay. RESULTS: The vitreous fluid levels of VEGF and angiotensin II were significantly higher in patients with PDR than in non-diabetic patients or diabetic patients without retinopathy (all p<0.0001). The vitreous fluid level of angiotensin II was significantly correlated with that of VEGF (p<0.0001), and the vitreous concentrations of both VEGF and angiotensin II were significantly higher in patients with active PDR than in those with quiescent PDR (p<0.0001 and p=0.0005, respectively). CONCLUSION: The authors found that both angiotensin II and VEGF levels were significantly higher in the vitreous fluid of patients with PDR than in that of non-diabetic patients or diabetic patients without retinopathy, and that the levels of both angiotensin II and VEGF were elevated in the active stage of PDR. These findings suggest that angiotensin II contributes to the development and progression of PDR in combination with VEGF.

Relationship between vascular endothelial growth factor and interleukin-6 in diabetic retinopathy.

PURPOSE: To determine the relationship between the severity of diabetic retinopathy and the levels of interleukin-6 (IL-6) and vascular endothelial growth factor (VEGF) in aqueous humor and plasma. METHODS: Forty-four eyes of 34 diabetic patients were studied. The concentrations of VEGF and IL-6 in plasma samples and in aqueous specimens obtained from the eyes during cataract surgery were measured by enzyme-linked immunosorbent assay. RESULTS: Aqueous levels of VEGF and IL-6 were significantly correlated with the severity of diabetic retinopathy (p = 0.793 and p = 0.744, respectively). Vascular endothelial growth factor and IL-6 levels in aqueous humor were significantly correlated with the aqueous protein concentration (p = 0.641 and p = 0.646, respectively). The aqueous level of VEGF was significantly correlated with that of IL-6 (p = 0.627). Aqueous levels of VEGF and IL-6 were also significantly correlated with the grade of fundus findings. Vascular endothelial growth factor and IL-6 concentrations were higher in the aqueous than in the plasma. CONCLUSION: The results of the current study suggest that there is a relationship between VEGF and IL-6 but the role of IL-6 in diabetic retinopathy is unclear and may warrant further investigation.

[The role of cytokines in the pathogenesis of diabetic retinopathy].

PURPOSE: To investigate the role of cytokines and advanced glycation end products(AGEs) in the pathogenesis of diabetic retinopathy, we measured vascular endothelial growth factor(VEGF), interleukin-6(IL-6), tumor necrosis factor-alpha(TNF-alpha), transforming growth factor-beta 1(TGF-beta 1), and pentosidine(an AGE) levels in aqueous, vitreous, and paired plasma obtained from diabetic patients. RESULTS: The aqueous levels of VEGF and IL-6 were positively correlated with the grade of clinical severity of diabetic retinopathy (both VEGF and IL-6, p < 0.001). Other cytokines and pentosidine levels were not significantly associated. The aqueous levels of VEGF and IL-6 were higher than the plasma levels(VEGF p = 0.02, IL-6 p < 0.001). CONCLUSION: Within the intraocular area VEGF and IL-6 are produced and participate in the pathogenesis of hyperpermeability of retinal vessels in preproliferative diabetic retinopathy.

Stimulation and inhibition of angiogenesis in diabetic retinopathy.

PURPOSE: To investigate the role of stimulators and inhibitors of angiogenesis in the pathogenesis of diabetic retinopathy. METHODS: Undiluted vitreous samples and simultaneous paired plasma samples were obtained from 30 diabetic patients (35 eyes) undergoing vitreous surgery. The levels of vascular endothelial growth factor (VEGF), endostatin, and platelet factor-4 (PF-4) were measured simultaneously in each specimen by enzyme-linked immunosorbent assay. The severity of diabetic retinopathy was evaluated according to the modified Early Treatment Diabetic Retinopathy Study retinopathy severity scale. RESULTS: Vitreous levels of VEGF and endostatin were significantly correlated with the severity of diabetic retinopathy (rho = 0.52, rho = 0.48, respectively), but the vitreous level of PF-4 was not (rho = 0.12). Vitreous levels of VEGF, endostatin, and PF-4 were not significantly correlated with their plasma levels. The vitreous level of VEGF was significantly correlated with that of endostatin (rho = 0.42). The VEGF concentration was significantly higher in the vitreous than in the plasma, while the endostatin concentration was not. CONCLUSIONS: The present study showed that VEGF and endostatin were expressed in the vitreous of patients with diabetic retinopathy and may be involved in the pathogenesis of this condition.

Present status of ophthalmological care for diabetic patients in Japan.

PURPOSE: To investigate the present status of diabetic care provided by ophthalmologists working in hospitals and private clinics in Japan. METHODS: Questionnaires were mailed to 315 ophthalmologists. There was a return rate of 73%. RESULTS: Problems identified in the clinics were: (1) many diabetic patients who complain chiefly of ophthalmological symptoms voluntarily request their first ophthalmological examination; (2) appropriate cooperation between ophthalmologists and physicians is not established; (3) assessing the level of blood glucose control is difficult; and (4) scheduling of appointments is inadequate. Moreover, (1) inadequate handling of patients who discontinue their ophthalmological examinations, and (2) the lack of an established patient education program were seen as problems common to both hospitals and clinics. CONCLUSIONS: For the resolution of these problems, comprehensive countermeasures should be developed urgently by medical associations, medical administrators, and other relevant entities.

Fluorescein 5'-isothiocyanate-modified Na+, K+ -ATPase, at Lys-501 of the alpha-chain, accepts ATP independent of pyridoxal 5'-diphospho-5'-adenosine modification at Lys-480.

The modification of Na+,K+-ATPase with increasing pyridoxal 5'-diphospho-5'-adenosine (AP2PL) concentrations resulted in saturation of the approximately 0.5 mol AP2PL probe incorporation into the Lys-480/mol catalytic alpha-chain and reduced the Na+,K+-ATPase activity to around half without affecting the phosphorylation by acetyl phosphate (AcP), and led to increases in the AP2PL fluorescence caused by ATP and AcP. Further modification with fluorescein 5'-isothiocyanate (FITC) resulted in approximately 0.9 mol FITC probe incorporation into the Lys-501/mol alpha-chain and reduced the activity to below 5% without affecting the phosphorylation by AcP and these fluorescence increases. The ATP binding capacity of the AP2PL-FITC enzyme was shown to be at least 50% of that of the control enzyme (approximately 0.8 mol/mol alpha-chain). This is the first direct demonstration that Na+-bound FITC-modified enzymes accept ATP with an affinity for ATP (K(1/2) > 150 microM) reduced by two orders of magnitude. The data also suggest half site reactivity of Lys-480 as to AP2PL and all site reactivity of Lys-501 as to FITC in the catalytic subunits.

[The present status of ophthalmological management for diabetics].

A questionnaire regarding management of patients with diabetes was mailed to 315 ophthalmologists. The status of ophthalmological management at the hospitals and clinics was investigated. The return rate of questionnaires was 73%. The problems at the clinics were 1. many cases have ophthalmological symptoms at the first ophthalmological examination (longer time from the onset of diabetes to the first ophthalmological examination), 2. appropriate cooperation between ophthalmology and internal medicine is lacking, 3. the collection of information on blood glucose control level is difficult, and 4. there is not enough consultation by appointment. The common problems to both hospitals and clinics were 1. satisfactory measures are not taken regarding dropout ophthalmology patients, and 2. a system of patient education does not exist. There is a pressing need for comprehensive measures to be taken by medical association leaders and medical administrators to settle these problems.