Central Serous Chorioretinopathy and Blood Serotonin Concentrations.

BACKGROUND: To investigate blood serotonin (5-hydroxytryptamine (5-HT)) concentrations and their relationships with selected characteristics in patients with central serous chorioretinopathy (CSC). METHODS: This was a prospective study including 93 patients with active CSC. Blood concentrations of 5-HT, adrenocorticotropic hormone, and cortisol were measured in patients with CSC. Selected patient characteristics, including disease history (acute or chronic), medication use, smoking history, mood status, best-corrected visual acuity (BCVA), subfoveal choroidal thickness (SCT), findings on fluorescein and indocyanine green angiography, and anatomical changes were evaluated during follow-up. RESULTS: Eleven of the 93 patients had low 5-HT concentrations (<57 ng/mL) (12%, eight men and three women; mean age 55 years); we identified no significant relationship with acute/chronic disease status. The patients with low 5-HT were significantly more likely to have five or more fluorescein leakage sites (p = 0.0275), recurrence of subretinal fluids (p < 0.0001), and failure to achieve significant improvement in BCVA during follow-up (p = 0.862) than patients with 5-HT within the normal range. CONCLUSIONS: Blood serotonin concentrations may influence the pathophysiology and prognosis of CSC.

Visualization of microaneurysms in macular telangiectasia type 1 on optical coherence tomography angiography before and after photocoagulation.

PURPOSE: To evaluate changes in the visualization of microaneurysms (MAs) in cases of macular telangiectasia (Mac Tel) type 1 on optical coherence tomography angiography (OCTA) before and after treatment with direct photocoagulation and to evaluate their relationship with treatment efficacy. METHODS: The study included 12 eyes from 12 patients (8 men, 4 women; mean age 72.1 years) with Mac Tel type 1 accompanied by cystoid macular edema. OCTA for the evaluation of MAs was performed before and 15 min and 6, 12, and 24 weeks after photocoagulation. The best-corrected visual acuity (BCVA) and central retinal thickness (CRT) were also evaluated. RESULTS: A total of 73 MAs were detected within the areas of macular edema on OCTA, and 39 of these underwent photocoagulation. At 15 min after treatment, 17 MAs were no longer visible on OCTA. At 6 weeks, two MAs had reappeared, whereas five additional MAs were no longer visible. The CRT in eyes with resolved MA was significantly less than that in eyes with persistent MAs (p = 0.016). At 24 weeks, seven eyes had no visible MAs, and the BCVA was not significantly different from baseline. CONCLUSION: OCTA can monitor changes in the visualization of MAs associated with Mac Tel type 1 after direct photocoagulation. Eyes in which MAs disappeared after treatment could recover from cystoid macular edema.

Indocyanine Green Dye Filling Time for Polypoidal Lesions in Polypoidal Choroidal Vasculopathy Affects the Visibility of the Lesions on OCT Angiography.

PURPOSE: To elucidate the factors that affect the visibility of polypoidal lesions on OCT angiography (OCTA) based on indocyanine green angiography (ICGA) findings in eyes with polypoidal choroidal vasculopathy (PCV). DESIGN: Retrospective, consecutive case series. PARTICIPANTS: Thirty-one eyes of 31 patients with PCV diagnosed on ICGA. METHODS: We compared the numbers of polyps visible on ICGA and on OCTA. The following time points and durations were determined: first appearance of dye in the choroidal arteries, first appearance of dye within a polyp, and the time it took the dye to fill entire lesions. Then we compared visible and invisible polyps on OCTA in these respects. MAIN OUTCOME MEASURES: The visibility of polypoidal lessons on OCTA and, in relation to this, the time it took the indocyanine green dye to fill the polypoidal lesions. RESULTS: The total number of polyps detected on ICGA was 62, and 49 of these (79.0%) were imaged on OCTA. The time points determined were not significantly different, but elapsed time from the first appearance of the dye in the choroidal arteries to the first appearance of the dye within a polyp was significantly longer for the polyps that were not detected on OCTA than for those that were (5.15±2.30 seconds vs. 2.08±1.08 seconds; P < 0.001). CONCLUSIONS: The visibility of polyps on OCTA decreases when blood flow is slower as manifested by a longer choroid-to-polyp dye infusion time on ICGA.

Detection of Asymptomatic Choroiditis by Fundus Examination in Vogt-Koyanagi-Harada Disease.

PURPOSE: To describe the ophthalmoscopic changes of the choroidal vessels in the posterior pole of Vogt-Koyanagi-Harada disease patients whose choroid is thickened due to asymptomatic choroiditis. METHODS: Three patients whose choroidal vessels are indistinct or not visible in the posterior pole by ophthalmoscopy were examined by fundus photography and enhanced-depth imaging optical coherence tomography (EDI-OCT). RESULTS: They did not complain of vision problems, and visual acuity was good. Serous retinal detachment was not observed by ophthalmoscopy or by OCT. However, choroidal thickening was observed in the EDI-OCT, while choroidal vessels became blurred or invisible on ophthalmoscopy. After steroid therapy, choroidal thickness decreased to normal levels and the small and large choroidal vessels previously indiscernible became visible by ophthalmoscopy and fundus photography. CONCLUSIONS: Asymptomatic choroiditis not accompanied by serous retinal detachment can be detected and assessed by observing the changes in the choroidal vessels by ophthalmoscopy and fundus photography.

Protective effect of a laser-induced sub-lethal temperature rise on RPE cells from oxidative stress.

Recently introduced new technologies that enable temperature-controlled laser irradiation on the RPE allowed us to investigate temperature-resolved RPE cell responses. In this study we aimed primarily to establish an experimental setup that can realize laser irradiation on RPE cell culture with the similar temperature distribution as in the clinical application, with a precise time/temperature history. With this setup, we conducted investigations to elucidate the temperature-dependent RPE cell biochemical responses and the effect of transient hyperthermia on the responses of RPE cells to the secondary-exposed oxidative stress. Porcine RPE cells cultivated in a culture dish (inner diameter = 30 mm) with culture medium were used, on which laser radiation (λ = 1940 nm, spot diameter = 30 mm) over 10 s was applied as a heat source. The irradiation provides a radially decreasing temperature profile which is close to a Gaussian shape with the highest temperature in the center. Power setting for irradiation was determined such that the peak temperature (Tmax) in the center of the laser spot at the cells reaches from 40 °C to 58 °C (40, 43, 46, 50, 58 °C). Cell viability was investigated with ethidium homodimer III staining at the time points of 3 and 24 h following laser irradiation. Twenty four hours after laser irradiation the cells were exposed to hydrogen peroxide (H2O2) for 5 h, followed by the measurement of intracellular glutathione, intracellular 4-hydroxynonenal (HNE) protein adducts, and secreted vascular endothelial growth factor (VEGF). The mean temperature threshold for RPE cell death after 3 h was found to be around 52 °C, and for 24 h around 50 °C with the current irradiation setting. A sub-lethal preconditioning on Tmax = 43 °C significantly induced the reduced glutathione (GSH)/oxidized glutathione (GSSG) ratio, and decreased H2O2-induced increase of intracellular 4-HNE protein adducts. Although sub-lethal hyperthermia (Tmax = 40 °C, 43 °C, and 46 °C) caused a slight increase of VEGF secretion in 6 h directly following irradiation, secondary exposed H2O2-induced VEGF secretion was significantly reduced in the sub-lethally preheated groups, where the largest effect was seen following the irradiation with Tmax = 43 °C. In summary, the current results suggest that sub-lethal thermal laser irradiation on the RPE at Tmax = 43 °C for 10 s enhances cell defense system against oxidative stress, with increasing the GSH/GSSG ratio. Together with the results that the decreased amount of H2O2-induced 4-HNE in sub-lethally preheated RPE cells was accompanied by the lower secretion of VEGF, it is also strongly suggested that the sub-lethal hyperthermia may modify RPE cell functionality to protect RPE cells from oxidative stress and associated functional decrease, which are considered to play a significant role in the pathogenesis of age-related macular degeneration and other chorioretinal degenerative diseases.

Two-year results of reduced-fluence photodynamic therapy combined with intravitreal ranibizumab for typical age-related macular degeneration and polypoidal choroidal vasculopathy.

PURPOSE: To report the 2-year results of reduced-fluence photodynamic therapy (RF-PDT) combined with intravitreal ranibizumab (IVR) for typical age-related macular degeneration (AMD) and polypoidal choroidal vasculopathy (PCV). METHODS: Twenty-four previously untreated eyes of 23 AMD patients with decimal best-corrected visual acuity (BCVA) of less than 0.7 received the combined therapy, followed by retreatments as needed over the subsequent 2 years. When the BCVA was better than or equal to 0.7, only 3 monthly IVR injections were performed during the retreatment. RESULTS: The BCVAs were maintained in 7 of 10 typical AMD eyes and in 13 of 14 PCV eyes at month 24. The mean BCVA improved in the PCV group (P < 0.05) but not in the typical AMD group. The central foveal thickness decreased in both groups (P < 0.01, P < 0.001). The mean numbers of the total PDT and IVR injections were 1.8 and 7.2 in the typical AMD group and 1.8 and 6.4 in the PCV group. CONCLUSION: After RF-PDT combined therapy with administration of retreatments as needed that consisted of either 3 IVR injections alone or combined therapy, the BCVA was maintained in typical AMD and improved in PCV during a 2-year follow-up period.

Progression of cataracts following photodynamic therapy combined with intravitreous triamcinolone injection in cases of age-related macular degeneration.

BACKGROUND: To present long-term data on the progression of cataracts following photodynamic therapy (PDT) combined with 4 mg intravitreal triamcinolone acetonide (IVTA) for age-related macular degeneration (AMD). METHODS: Fifty-seven phakic eyes of 56 patients underwent the treatment between October 2004 and November 2006. The follow-up period ranged from 12 to 38 months with 3 months interval of observation and repeated treatment at recurrence. RESULTS: Cataract progression was noted in 40 eyes 5-21 months after treatment, consisting of 4 eyes between 3 and < 6 months after treatment, 22 eyes between 6 and < 12 months, 8 eyes between 12 and < 18 months, and 6 eyes between 18 and < 24 months. The percentage of the eyes with cataract progression began to decrease 5 months after treatment and, occurred most frequently during the period from 6 months to 12 months after treatment. There was no significant difference in age, follow-up period, or the frequency of the treatment between the cataract progression group and the non progression group. Twenty four eyes underwent surgery 10-31 months after treatment, showing significant improvement in visual acuity. CONCLUSIONS: This study showed high incidence of cataract during a long-term follow-up after PDT combined with IVTA and significant reduction of visual acuity due to cataract.