Alteration in Melanin Content in Retinal Pigment Epithelial Cells upon Hydroquinone Exposure.

Abnormal pigmentation or depigmentation of the retinal pigment epithelium (RPE) is a precursor to neovascular age-related macular degeneration (nAMD). In this study, we evaluated the effects of hydroquinone (HQ), the most potent reductant in cigarette smoke, on the melanin production in RPE cells. Induced pluripotent stem cell (iPS)-derived RPE and adult retinal pigment epithelial (ARPE-19) cells were cultured with HQ. Real-time reverse transcription polymerase chain reaction revealed that the expression of melanin-related genes decreased due to the addition of HQ for 1 day. Enzyme-linked immunosorbent immunoassay showed that the concentration of melanin significantly decreased due to the addition of HQ for 24 h. A suspension of RPE cells with HQ for 24 h was prepared, and the absorbance was measured. The absorbance decreased particularly under blue light, suggesting that blue light may reach the choroid and cause choroidal inflammation. Additionally, melanin levels significantly decreased due to the addition of HQ for 1 week. After blue light irradiation on the RPE with HQ for 1 week, the vascular endothelial growth factor in the medium was significantly higher in the HQ group than in the control group. HQ-induced changes in melanin production may be responsible for the uneven pigmentation of the RPE, and these changes may cause nAMD.

Acute retinal necrosis in a patient on immunosuppressive treatment for COVID-19 pneumonia: a case report.

BACKGROUND: Patients with coronavirus disease 2019 (COVID-19) occasionally develop ocular complications. We report a case of acute retinal necrosis (ARN) caused by Epstein-Barr Virus (EBV) that developed in a patient who had severe acute respiratory syndrome due to SARS-CoV-2 infection. CASE PRESENTATION: A 68-year-old woman complained of floaters and blurred vision in her right eye as she was receiving systemic prednisolone for COVID-19 pneumonia under isolation in our hospital. The patient visited an ophthalmologist following her discharge from the hospital and after the 2 weeks of isolation had ended. At the initial examination, her best-corrected visual acuity (BCVA) was 20/100 in the right eye, and the eye showed moderate anterior segment inflammation and vitreous opacities. Treatment was initiated with topical 0.1% betamethasone and 1.5% levofloxacin. After 1 month, the inflammation in the right eye decreased and her BCVA improved to 20/40. However, on day 48 from her initial visit, the inflammation in her right eye worsened and her BCVA decreased to 20/2000 by day 80. Pars plana vitrectomy with silicone oil tamponade was performed to remove the vitreous opacities, and expanded white exudates peripherally and retinal vessels with white sheathing suggestive of acute retinal necrosis (ARN) were seen intraoperatively. Analysis of the vitreous sample revealed EBV positivity on polymerase chain reaction. The patient was diagnosed with EBV-associated ARN and treated with systemic steroids and valaciclovir. The ocular inflammation gradually decreased, and she was discharged from the hospital. However, a week later, the inflammation in the right eye markedly worsened. Despite another course of steroids, the inflammation worsened, resulting in total retinal detachment and absolute glaucoma. Because of the severe pain, the right eye was enucleated. CONCLUSIONS: Clinicians should be aware that COVID-19 and immunosuppressive treatment can reactivate EBV in the eye.

Decreased melatonin secretion in patients with glaucoma: Quantitative association with glaucoma severity in the LIGHT study.

Glaucoma may be associated with circadian disruption due to its association with a loss of intrinsically photosensitive retinal ganglion cells. Clinical evidence demonstrating an association between glaucoma and circadian disruption is limited, and no large-scale studies have been performed. The purpose of this cross-sectional study was to determine whether the presence and severity of glaucoma is correlated with the urinary 6-sulfatoxymelatonin levels as a circadian rhythm parameter. We measured the level of urinary 6-sulfatoxymelatonin excretion (UME) in 118 glaucoma patients and 395 control participants without glaucoma. The UME in the glaucoma group was significantly lower than that of the control group without glaucoma (3.05 and 3.24 log ng/mg creatinine, respectively; P = .010). Next, we examined association of the severity of glaucoma and melatonin levels. In stratification analysis of the glaucoma groups, multivariable linear regression analyses adjusted for potential confounders indicated significantly lower UME by 0.30 log ng/mg creatinine in patients with functional severe glaucoma (visual field mean deviation ≤ -6 dB) compared with mild glaucoma (mean deviation > -6 dB; P = .040) and lower UME by 0.05 log ng/mg creatinine with each 10 µm thinning of the circumpapillary retinal nerve fiber layer thickness as the index of structural severity of glaucoma (P = .011). In conclusion, significant association between glaucoma and lower urinary 6-sulfatoxymelatonin was found. In addition, patients with functional and structural severe glaucoma were significantly associated with lower urinary 6-sulfatoxymelatonin levels. Our results indicate the possibility of a circadian disruption in patients with glaucoma.

Case of primary intraocular lymphoproliferative disorder caused by Epstein-Barr Virus.

BACKGROUND: Cases of panuveitis caused by Epstein-Barr virus (EBV) associated with primary intraocular lymphoproliferative disorder (LPD) are rare in immunocompetent individuals. CASE PRESENTATION: A 67-year-old man noted blurred vision in both eyes and was referred to our hospital. His best-corrected visual acuity (BCVA) was 20/20 in both eyes. He had mild inflammation in the anterior chamber but not in the vitreous of both eyes. The inflammation was resolved with topical corticosteroid but 10 months later both eyes presented recurrence. Treatment with a sub-Tenon's injection of steroid was effective for OS but not for OD and 2 months after, the inflammation in the anterior chamber and vitreous opacities got worsen in OD and BCVA decreased to 6/20 OD. Thus, pars plana vitrectomy was performed on OD, and EBV was detected in the aqueous humor by multiplex polymerase chain reaction, and an infiltration of CD19κ positive B cells was revealed in the vitreous specimens by flow cytometry. Systemic workup revealed no other sites of lymphoproliferation, no active EBV infection, or underlying immunodeficiency. CONCLUSION: Panuveitis caused by EBV associated with primary intraocular LPD can occur in patients with no history of congenital or acquired immunodeficiencies.

Clinical implications of pachyvessels in polypoidal choroidal vasculopathy.

BACKGROUND: Polypoidal choroidal vasculopathy (PCV) is one of the disorders within the pachychoroid spectrum diseases. The presence of pachyvessels is one of the characteristics of pachychoroid disorders. However, the relationship between the presence of pachyvessels and the clinical characteristics of PCV eyes has not been determined. The purpose of this study was to determine the relationship between the presence of choroidal pachyvessels and the clinical characteristics of eyes with PCV. METHODS: The medical records of patients who were diagnosed with PCV and were treatment-naïve were reviewed. Fluorescein and indocyanine green angiography, fundus photography, spectral domain optical coherence tomography (SD-OCT), and enhanced depth imaging OCT (EDI-OCT) were used to obtain images of the choroid. The presence of pathologically dilated outer choroidal vessels, pachyvessels, was determined by ICGA images. These pachyvessels were confirmed to correspond with the large choroidal vessels in the EDI OCT images. The PCV eyes were divided into two groups based on the presence or absence of pachyvessels and clinical features and subfoveal choroidal thickness (SFCT) were evaluated between the two groups. RESULTS: Eighty-six eyes of 84 patients with PCV were evaluated. Pachyvessels were detected in 48 eyes (55.8%). The mean SFCT was 203.9 ± 83.9 µm in all 86 eyes, and it was significantly thinner in eyes with pachyvessels (+) than without pachyvessels (-) (183.2 ± 58.4 µm vs 230.2 ± 103.1 µm; P = 0.01). The differences in the incidence of subretinal fluid, pigment epithelial detachments, and hemorrhages between the two groups were not significant. However, the PCV eyes in pachyvessels (+) group with hemorrhage had the thinnest choroid (P = 0.047). The choroidal features of the fellow eyes were similar to those of the PCV affected eyes, that is, the fellow eyes in pachyvessels (+) group had pachyvessels and the fellow eyes in pachyvessels (-) group did not have pachyvessels. CONCLUSIONS: Pachyvessels were presented 55.8% in eyes with PCV, and these eyes had the thin SFCT. The presence of pachyvessels and attenuation of the inner choroid were probably due to the pathological changes in the eyes with PCV.

Increased Nighttime Blood Pressure in Patients with Glaucoma: Cross-sectional Analysis of the LIGHT Study.

PURPOSE: To determine whether the presence of glaucoma is associated significantly with nighttime blood pressure (BP) and dipping pattern. DESIGN: Observational, cross-sectional study. PARTICIPANTS: We assessed 109 glaucoma patients (mean age, 71.0 years) from the Longitudinal Study of Biological Circadian Rhythms in Glaucoma Patients: Home Testing of Circadian Intraocular Pressure and Biological Parameters (LIGHT) study and 708 healthy control participants without glaucoma (mean age, 70.8 years) from a community-based cohort. METHODS: All of the glaucoma patients and healthy control participants underwent ophthalmic examinations. The ambulatory BP was measured every 30 minutes for 48 hours. The daytime and nighttime periods were based on the sleep diary entries. A nondipper pattern of BP was defined as a decrease in the mean nighttime systolic BP by less than 10% of the mean daytime systolic BP. MAIN OUTCOME MEASURES: Nighttime BP and dipping pattern. RESULTS: After adjusting for potential confounders, multivariable linear regression analyses indicated that nighttime systolic BP was significantly higher by 4.1 mmHg (95% confidence interval [CI], 1.0-7.2; P = 0.01) in the glaucoma group than in the control group. The prevalence of the nondipper pattern was significantly higher in the glaucoma group (45.0%) than in the control group (27.5%; P < 0.001). Multivariable logistic regression analyses indicated a significantly higher odds ratio (OR) for the nondipper pattern in the glaucoma group than in the control group (OR, 1.96; 95% CI, 1.26-3.05; P = 0.003). CONCLUSIONS: The presence of glaucoma was associated significantly with increased nighttime BP and the nondipper pattern of the BP independent of potential confounders such as aging, obesity, and diabetes. Further prospective studies are needed to determine whether the glaucoma severity and progression are associated with the nighttime BP.

Cataracts and Subclinical Carotid Atherosclerosis in Older Adults　- A Cross-Sectional Study of the HEIJO-KYO Cohort.

BACKGROUND: Decreased light reception because of cataracts leads to potential circadian misalignment, resulting in exacerbation of atherosclerosis; however, little is known about the association between cataracts and atherosclerosis in populations.Methods and Results:In this cross-sectional study, cataracts were graded using slit lamp biomicroscopy with the Lens Opacities Classification System III and carotid atherosclerosis was assessed based on carotid intima-media thickness (IMT) measured using ultrasonography of the common carotid artery in 442 elderly participants (mean age, 70.0 years). Cataract was defined as nuclear cataract grade ≥3.0, cortical cataract grade ≥2.0, or posterior subcapsular cataract grade ≥2.0 in both eyes. The mean and maximal carotid IMT was 0.86±0.15 mm and 1.07±0.29 mm, respectively. In multivariable analysis adjusted for potential confounders, the mean and maximal carotid IMT were significantly greater in the cataract group than in the non-cataract group by 0.04 mm (95% confidence interval (CI), 0.01-0.06) and 0.07 mm (95% CI, 0.01-0.12), respectively. Logistic regression analysis adjusted for confounders revealed a significantly higher odds ratio for carotid atherosclerosis (maximal carotid IMT ≥1.1 mm) in the cataract group than in the non-cataract group (odds ratio, 1.78; 95% CI, 1.14-2.78). CONCLUSIONS: Cataracts may be independently associated with subclinical carotid atherosclerosis in the elderly population, indicating a need for further prospective studies.

Effects of concentration of amyloid ß (Aß) on viability of cultured retinal pigment epithelial cells.

BACKGROUND: Amyloid beta (Aß) is a constituent of drusen that is a common sign of age-related macular degeneration (AMD). The purpose of this study was to investigate the effect of Aß on human retinal pigment epithelial (RPE) cells in culture. METHODS: Cells from a human RPE cell line (ARPE-19) were exposed to 0 to 25 µM of Aß 1-40 for 48 h, and the number of living cells was determined by WST-8 cleavage. Replicative DNA synthesis was measured by the incorporation of 5'-bromo-2'-deoxyuridine. The cell death pathway was investigated by the WST-8 cleavage assay after the addition of caspase-9 inhibitor, an anti-apoptotic factor. Real-time qRT-PCR was performed using Aß-exposed cellular RNA to determine the level of vascular endothelial growth factor (VEGF)-A and pigment epithelium derived factor (PEDF). To determine the effect of receptor-for-advanced glycation end products (RAGE), the siRNA for RAGE was inserted into ARPE-19 treated with Aß, and the levels of expression of VEGF-A and PEDF were determined. RESULTS: The number of living ARPE-19 cells was increased by exposure to 5 µM Aß but was decreased by exposure to 25 µM of Aß. Replicative DNA synthesis by ARPE-19 cells exposed to 25 µM of Aß was significantly decreased indicating that 25 µM of Aß inhibited cell proliferation. Real-time RT-PCR showed that the level of the mRNA of PEDF was increased by exposure to 5 µM Aß, and the levels of the mRNAs of PEDF and VEGF-A were also increased by exposure to 25 µM Aß. The addition of an inhibitor of caspase-9 blocked the decrease the number of ARPE-19 cells exposed to 25 µM Aß. Exposure to si-RAGE attenuated the increase of VEGF-A and PEDF mRNA expression in ARPE-19 exposed to Aß. CONCLUSIONS: Exposure of ARPE-19 cells to low concentrations of Aß increases the level of PEDF which then inhibits the apoptosis of ARPE-19 cells leading to RPE cell proliferation. Exposure to high concentrations of Aß induces RPE cell death and enhances the expression of the mRNA of VEGF-A in RPE cells. The Aß-RAGE pathway may lead to the expression VEGF-A and PEDF in RPE cells. These results suggest that Aß is strongly related to the pathogenesis of choroidal neovascularization.

Effects of intravitreal injection of ranibizumab on choroidal structure and blood flow in eyes with diabetic macular edema.

PURPOSE: To determine the effects of an intravitreal injection of ranibizumab (IVR) on the choroidal structure and blood flow in eyes with diabetic macular edema (DME). METHODS: Twenty-eight consecutive patients with DME who received an IVR and 20 non-diabetic, age-matched controls were followed for 1 month. The eyes with DME were divided into those with prior panretinal photocoagulation (PRP, n = 16) and those without prior PRP (no-PRP, n = 12). The enhanced depth imaging optical coherence tomography (EDI-OCT) scans and Niblack's image binarization were performed to determine the choroidal structure. The choroidal blood flow was determined by laser speckle flowgraphy. RESULTS: The subfoveal choroidal thickness at the baseline was significantly thicker in the no-PRP group than in the PRP-treated group. After IVR, the best-corrected visual acuity (BCVA) and central retinal thickness in eyes with DME were significantly improved compared to the baseline values. There were significant differences in the choroidal thickness, total choroidal area, and choroidal vascularity index between the groups after IVR. Choroidal vascular index and choroidal blood flow were significantly reduced only in the no-PRP group and not in the PRP-treated group. In addition, the correlation between the central retinal thickness and the choroidal blood flow was significant in the no-PRP group (r = 0.47, P < 0.05). CONCLUSIONS: A single IVR will reduce the central retinal thickness and improve the BCVA in eyes with DME in both the no-PRP and PRP-treated group. IVR affected the choroidal vasculature and blood flow significantly, and a significant correlation was found between the central retinal thickness and the choroidal blood flow in eyes without PRP.

Macular retinoschisis in eyes with glaucomatous optic neuropathy: Vitrectomy and natural course.

PURPOSE: Our purpose was to determine the effectiveness of vitrectomy in resolving the macular retinoschisis in an eye with glaucomatous optic neuropathy and also to determine the natural course of macular retinoschisis. METHODS: This was a retrospective case series of patients who were diagnosed with macular retinoschisis and glaucomatous optic neuropathy. Fourteen eyes of 13 patients were studied. Patients with high myopia, vitreomacular traction syndrome, and the pit macular syndrome were excluded. RESULTS: There were three men and ten women, and 12 had unilateral and one had bilateral macular retinoschisis. Vitrectomy was performed for a serous retinal detachment, macular hole, or severe visual loss in five eyes. The mean follow-up time was 68.8 months in these five eyes, and the macular retinoschisis was resolved and the best-corrected visual acuity (BCVA) at the final visit was significantly improved in all eyes (P = 0.007). However, two of these fiv e eyes developed a macular hole and required a second vitrectomy. Of the nine eyes without treatment with a mean follow-up time of 29.0 months, the BCVA at the final visit remained unchanged from the baseline BCVA in all eyes. The macular retinoschisis was resolved or reduced in three eyes without treatment. CONCLUSIONS: Vitrectomy was effective for the resolution of macular retinoschisis in eyes with glaucomatous optic neuropathy and serous retinal detachment or macular hole or severe reduction of the BCVA. Macular retinoschisis can be resolved without a reduction of the BCVA in some cases without treatment.

CHOROIDAL BLOOD FLOW AND THICKNESS AS PREDICTORS FOR RESPONSE TO ANTI-VASCULAR ENDOTHELIAL GROWTH FACTOR THERAPY IN MACULAR EDEMA SECONDARY TO BRANCH RETINAL VEIN OCCLUSION.

PURPOSE: To determine the choroidal blood flow and subfoveal choroidal thickness (SCT) in eyes with macular edema secondary to branch retinal vein occlusion (BRVO). METHODS: Thirty-two eyes of 32 patients with macular edema secondary to a BRVO were treated with a single intravitreal injection of ranibizumab (IVR) and were followed for 2 months. The central retinal thickness and SCT, and the retinal and choroidal blood flows were evaluated, and they were compared between the recurrent and resolved groups. RESULTS: At the baseline, the SCT of eyes with a BRVO was significantly thicker than that of the fellow eye (P < 0.01). It was also significantly thicker in the recurrent group than in the resolved group (P = 0.03). The reduction of the retinal blood flow was found only after 1 week in the resolved group. The SCT and choroidal blood flow were significantly reduced during the follow-up period in the resolved group but not in the recurrent group. CONCLUSION: The choroid is involved in the pathology of BRVO and the SCT at the baseline may be a predictive factor in the treatment of intravitreal injection of ranibizumab for macular edema secondary to BRVO.

Iris metastasis preceding diagnosis of gastric signet ring cell adenocarcinoma: a case report.

BACKGROUND: A case of iris metastasis preceding the diagnosis of gastric signet ring cell adenocarcinoma is very rare. To report the findings in a patient who presented with an iris tumor that was later identified to have metastasized from a gastric signet ring cell adenocarcinoma. CASE PRESENTATION: A-74-year-old woman presented with visual disturbance and an increased intraocular pressure (IOP) in the right eye. She had no history of systemic cancer. She was initially diagnosed with acute iritis from diabetes mellitus and secondary glaucoma. She underwent trabeculectomy because of the uncontrolled IOP. After the IOP was controlled, she presented thick iris with corectopia, iris hemorrhage, and white, frog spawn-like mass resembling fibrin in the anterior chamber. An analysis of an iris biopsy suggested that the iris mass was an adenocarcinoma. Examination by esophagogastroduodenoscopy revealed advanced gastric signet ring cell adenocarcinoma as the primary source for the iris tumor. CONCLUSIONS: We recommend that patients with acute iritis with atypical iris mass resembling fibrin and secondary glaucoma should be examined comprehensively for systemic tumors.

Effect of fluid-air exchange on reducing residual silicone oil after silicone oil removal.

PURPOSE: Our purpose was to determine the effect of fluid-air exchange on the amount of silicone oil (SO) droplets remaining in the vitreous cavity after removal of the main body of the SO. METHODS: This was a retrospective comparative study of 56 eyes of 56 patients that had undergone vitrectomy with SO tamponade. Fluid-air exchange was performed during surgery in 30 eyes [Air Ex(+) group] and was not done in 26 eyes [Air Ex(-) group]. All of the eyes were examined by ultrasonography, and the images were converted to binarized image. The amount of residual SO droplets/vitreal area in the images was expressed as the, "silicone oil index (SOI)". The correlations between SOI and clinical findings were determined. RESULTS: The SOI was significantly correlated with the axial length (AL, R = 0.444, P = 0.023). The SOI in the Air Ex(+) group was significantly higher (7.4 ± 2.6%) than in the Air Ex(-) group (4.9 ± 3.4%; P = 0.004). Multiple linear regression analyses showed that the SOI was independently and significantly correlated with the AL and the Air Ex(+) group (P = 0.003, P = 0.006, respectively). CONCLUSIONS: Fluid-air exchange during vitrectomy to remove residual SO is not effective. Our findings indicate that it may increase the amount of residual SO droplets.

EFFECTS OF PANRETINAL PHOTOCOAGULATION ON CHOROIDAL THICKNESS AND CHOROIDAL BLOOD FLOW IN PATIENTS WITH SEVERE NONPROLIFERATIVE DIABETIC RETINOPATHY.

PURPOSE: To evaluate the choroidal thickness and choroidal blood flow in the subfoveal region quantitatively after panretinal photocoagulation (PRP) in eyes with severe nonproliferative diabetic retinopathy. METHODS: This was a prospective comparative study of 24 eyes of 24 patients with type II diabetes and severe nonproliferative diabetic retinopathy with no macula edema. The foveal retinal thickness and choroidal thickness were measured by enhanced depth imaging optical coherence tomography. The subfoveal choroidal blood flow was represented by the mean blur rate obtained by laser speckle flowgraphy. The intraocular pressure, blood pressure, pulse rate, and hemoglobin A1c level (HbA1c) were also measured before and after PRP. RESULTS: The mean foveal retinal thickness did not change significantly during the follow-up period. The mean subfoveal choroidal thickness was reduced significantly from 327.4 µm at the baseline to 286.3 µm at 1 month and 285.0 µm at 3 months after PRP. The mean blur rate ratio decreased significantly to 87.5% at 1 month and 86.0% at 3 months of the baseline values. There was a significant correlation between the subfoveal choroidal thickness and subfoveal choroidal blood flow after PRP. After PRP, the best-corrected visual acuity, intraocular pressure, mean arterial pressure, ocular perfusion pressure, pulse rate, and HbA1c did not change significantly. CONCLUSION: The success of PRP in treating eyes with severe nonproliferative diabetic retinopathy is probably due to the significant reduction of the subfoveal choroidal thickness and subfoveal choroidal blood flow after PRP.

[Efficacy and Safety of A0001 (Brilliant Blue G250) for Internal Limiting Membrane Staining and Peeling: Phase III Investigator-initiated Multicenter Clinical Trial].

PURPOSE: To investigate the efficacy and safety of A0001 (brilliant blue G250) for visualization of the internal limiting membrane (ILM) during and after vitrectomy. METHODS: Patients (n = 31) requiring ILM peeling during vitrectomy were enrolled in this clinical trial. After injection of A0001 (range: 0.0625 to 0. 125 mg), the staining grade and the peeling ease of the ILM were evaluated in five steps (levels 0 to 4). The safety of A0001 was investigated for 7 days after surgery. RESULTS: From the evaluation of a primary endpoint by the Independent Data Monitoring Committee (IDMC) and a secondary endpoint by each surgeon, A0001 was effective in all cases at three or more levels ( ≥ level 2 was defined as effective) for evaluation of the grade of visualization and operating ease. Adverse events occurring in two or more cases included elevated intraocular pressure, eye pain, eye discharges, and retinal bleeding. One serious adverse event was a case of unclosed macular hole after vitrectomy, but the patient recovered after reoperation. CONCLUSIONS: A0001 was effective and safe for visualization of the ILM during vitrectomy, and there was an improvement in ease of operation.

High Myopia Associated with Triple X Syndrome.

We report our findings in a 3-year-old girl who was suspected of having triple X syndrome because she was taller than +4.35 standard deviations for her age. She also had high myopia. Optical coherence tomography (OCT) showed that her retinas were thin, the lenses were subluxated, and the axial length was elongated. Our findings indicate that for a female child with tall stature, there should be thorough evaluations for endocrinological disorders, overgrowth syndromes, connective tissue disorders, and genetic disorders. If there are also behavioral issues, this may lead to consideration of 47 XXX in a female or 47 XXY in a male infant. The 47 XXX syndrome is a potential and neglected cause for tall stature and requires a high index of suspicion.

Comparisons of Objective Sleep Quality Between Elderly Individuals With and Without Cataract Surgery: A Cross-Sectional Study of the HEIJO-KYO Cohort.

BACKGROUND: Cataract surgery (CS) drastically increases the capacity for light reception to the retina. Several previous studies have suggested the beneficial effect of CS on subjectively measured sleep quality; however, the association between CS and objectively measured sleep quality remains uncertain. METHODS: To evaluate the association between CS and objectively measured sleep quality in home settings, we conducted a cross-sectional study in 1037 elderly individuals (mean age, 71.9 years). We evaluated actigraphically measured sleep quality, urinary 6-sulfatoxymelatonin excretion, and ambulatory light levels, in addition to CS status. RESULTS: The CS group (n = 174) showed significantly higher sleep efficiency and shorter wake after sleep onset than the no CS group (n = 863), even after adjustment for age, gender, body mass index, current smoking status, alcohol consumption, hypertension, diabetes, sleep medication, bedtime, rising time, daytime physical activity, daytime and nighttime light exposure, and urinary 6-sulfatoxymelatonin excretion (sleep efficiency: 85.8% in the CS group vs 84.4% in the no CS group, P = 0.042; wake after sleep onset: 45.7 min vs 50.6 min, respectively, P = 0.033). In contrast, urinary 6-sulfatoxymelatonin excretion, sleep onset latency, total sleep time, and sleep-mid time did not differ significantly between the CS and no CS groups. CONCLUSIONS: Among a community-dwelling elderly population, CS is significantly associated with objectively measured sleep quality, but urinary levels of melatonin metabolite do not differ between individuals with and without CS. These associations are independent of daily light exposure profiles.

Relationship between foveal microstructures and visual outcomes in eyes with resolved central serous chorioretinopathy.

PURPOSE: To determine whether significant correlations exist between the foveal microstructures and visual outcomes in eyes with resolved central serous chorioretinopathy (CSC). METHODS: We retrospectively reviewed the medical records of patients who had a complete resolution of the serous retinal detachment (SRD) and had an intact ellipsoid zone in the fovea in the spectral-domain optical coherence tomographic (SD-OCT) images. Twenty-five eyes with CSC (CSC group) and 18 unaffected fellow eyes (control group) of 23 patients were evaluated. The eyes in the CSC group were divided into those with (n = 11) and those without (n = 14) visual disturbances after resolution of the SRD. The thickness of each retinal layer at the fovea was measured in the SD-OCT images. RESULTS: The photoreceptor outer segment (OS) length in the CSC group was significantly shorter than that in the control group (p = 0.0003). In addition, the photoreceptor OS length in the visual disturbances group was significantly shorter and the duration of SRD was significantly longer than that in the no visual disturbances group (p = 0.0230, p = 0.0021, respectively). CONCLUSIONS: The photoreceptor OS length is a good parameter to indicate the integrity of the foveal photoreceptors in eyes with a resolved CSC.

Relationship between presence of foveal bulge in optical coherence tomographic images and visual acuity after rhegmatogenous retinal detachment repair.

PURPOSE: To determine whether a significant correlation exists between the presence of a bulge in the photoreceptor inner segment/outer segment line and the best-corrected visual acuity in eyes after successful rhegmatogenous retinal detachment (RRD) repair. METHODS: Patients who had undergone successful RRD repair and had an intact inner segment/outer segment line at the central fovea in the spectral-domain optical coherence tomographic images were retrospectively studied. Thirty-five eyes of 35 patients were evaluated, and the eyes were classified preoperatively into those with macula-on RRD (n = 14) and those with macula-off RRD (n = 21). Examination of the spectral-domain optical coherence tomographic images of normal eyes showed that the inner segment/outer segment line has a bulge at the central fovea. The 35 eyes with successful retinal reattachment were classified by the presence or absence of foveal bulge. RESULTS: The presence of foveal bulge differed significantly between macula-on RRD (100%) and macula-off RRD group (28.6%; P < 0.0001). In the macula-off RRD group, the best-corrected visual acuity was significantly better in eyes with a foveal bulge than in eyes without a foveal bulge (P = 0.0028). CONCLUSION: The foveal bulge is a good marker to determine the functional properties of the fovea in eyes with successful RRD repair.