RETINAL BLOOD FLOW AFTER INTRAVITREAL BEVACIZUMAB IS A PREDICTIVE FACTOR FOR OUTCOMES OF MACULAR EDEMA ASSOCIATED WITH CENTRAL RETINAL VEIN OCCLUSION.

PURPOSE: To investigate whether retinal blood flow levels after intravitreal bevacizumab (IVB) treatment are correlated with the outcomes of patients with macular edema secondary to central retinal vein occlusion. METHODS: This retrospective observational case study enrolled 44 cases nonischemic central retinal vein occlusion. In each patient, visual acuity, central retinal thickness, and mean blur rate, which was measured by laser speckle flowgraphy and represents retinal blood flow velocity, were examined. RESULTS: At the end of the follow-up period (19.8 ± 8.8 months), 4 of 44 eyes (9.1%) converted to the ischemic type (converted group), whereas 40 (90.9%) remained unchanged (nonischemic group). Mean central retinal thickness significantly decreased and mean visual acuity significantly improved at 1 month after the first IVB injection in each group. Mean mean blur rate in the nonischemic group significantly increased, whereas it was unchanged in the converted group. The difference between the two groups was already significant after the first IVB injection. Subsequently, visual acuity worsened in the converted group. Multiple linear regression analysis indicated that the strongest correlation was between the last visual acuity and the last mean blur rate. CONCLUSION: Blood flow measurements are useful for evaluating IVB treatments. Blood flow after IVB can predict outcomes in patients with central retinal vein occlusion.

Visual outcomes and prognostic factors in open-globe injuries.

BACKGROUND: Ocular trauma is an important cause of visual loss worldwide. Improvements in our knowledge of the pathophysiology and management of ocular trauma during the past 30 years, in conjunction with advances in the instrumentation and techniques of ocular surgery, have improved the efficacy of vitreoretinal surgery in injured eyes. The aim of the current study was to determine the visual outcomes and prognostic factors of open-globe injuries in the Japanese population. METHODS: Retrospective study of 59 eyes of 59 patients presented with open globe injuries between September 2008 and March 2014 at Nagasaki University Hospital was conducted. Demographic factors including age, gender, and clinical data such as cause of injury, presenting visual acuity (VA), location of injury, type of injury, lens status, presence of intraocular foreign body, types of required surgeries, and final VA were recorded. According to the classification of Ocular Trauma Classification Group, wound location was classified into three zones. Chi-square test was used to compare presented data. RESULTS: Out of the 59 patients, 46 were placed in the Light Perception (LP) group, and 13 were placed in the No Light Perception (NLP) group. Work-related trauma was the most common cause (27 eyes) followed by falls (19eyes). Work-related trauma was common in males (P = 0.004), while falls was significantly common in females (P = 0.00001). Zone III injuries had statistically significantly poor prognostic factor compared to other zones (P = 0.04). All cases of NLP group (100%) presented with rupture globe. Poor VA at first visit (P = 0.00001), rupture globe (P = 0.026), history of penetrating keratoplasty (PK) (P = 0.017), retinal detachment (RD) (P = 0.0001), vitreous hemorrhage (VH) (P = 0.044), and dislocation of crystalline lens (P = 0.0003) were considered as poor prognostic factors. CONCLUSION: Poor VA at first visit, rupture globe, zone III injuries, history of penetrating keratoplasty, RD, VH, and dislocation of crystalline lens were found to be poor prognostic factors. PPV had a good prognostic value in open globe injuries associated with posterior segment involvement.

Spontaneous dislocation of the posterior chamber intraocular lens.

AIM: To evaluate the possible risk factors for posterior chamber intraocular lens dislocation either in-the-bag (ITB) dislocation or out-of-the-bag (OOTB) dislocation. METHODS: All subjects who sustained late intraocular lens dislocation from January 2011 until May 2014 and presented to the Nagasaki University Hospital were included in the study. This study is a retrospective evaluation of all cases of posterior chamber intraocular lens dislocation in this defined period. All cases had history of uncomplicated cataract surgery with implantation of posterior chamber intraocular lens. Patients with history of trauma (before cataract surgery) were excluded from the study. The main outcome measures of the study were evaluation of risk factors for dislocation of both groups and determination of the interval between cataract surgery and dislocation. RESULTS: Thirty-six eyes (69.23%) suffered ITB dislocation, and 16 eyes (30.77%) suffered OOTB dislocation. Intraocular lens dislocation was common in males (42 eyes = 80.77%) than females (10 eyes = 19.23%). Patients of ITB dislocation group were significantly older than OOTB dislocation group at the time of initial intraocular lens implantation and at the time of exchange surgery. CONCLUSION: The most prevalent risk factors in both groups were axial myopia in 18 eyes (34.61%), vitreoretinal surgery in 16 eyes (30.77%), and pseudoexfoliation in 13 eyes (25%) in all cases.

Acute Corneal Toxicity of Diquas.

AIM: This study aimed to investigate acute corneal toxicity of commercially available diquafosol 3% ophthalmic solution (Diquas®), which contains C12 benzalkonium chloride (BAC) as a preservative. METHODS: Corneal transepithelial electrical resistance (TER) changes after a 60-second exposure to Diquas® (diquafosol 3% preserved with 0.0075% C12 BAC); 0.0075% C12 BAC and 0.0075% C12, C14, C16 BAC mixture were measured in living rabbits. Corneal damage was also examined by scanning electron microscopy (SEM). Hank's balanced salt solution (HBSS) was used as a control. RESULTS: Diquas® and 0.0075% C12 BAC did not produce any significant decrease in the corneal TER as compared to the HBSS control eyes. There was a significant decrease in the corneal TER after exposure of the cornea to the 0.0075% C12, C14, C16 BAC mixture (p < 0.01). SEM revealed that the superficial cells of the corneas exposed to the 0.0075% BAC mixture were damaged and exhibited degenerated microvilli. Conversely, the superficial cells of corneas exposed to Diquas® or 0.0075% C12 BAC appeared normal and had normal microvilli under SEM examinations. CONCLUSION: The acute corneal toxicity of Diquas® is less than that of the 0.0075% BAC mixture. Diquas® preserved with 0.0075% C12 BAC did not show acute corneal toxicity.

Acute corneal toxicity of latanoprost with different preservatives.

PURPOSE: To investigate the corneal toxicity of Xalatan and three latanoprost generics using transepithelial electrical resistance (TER) and scanning electron microscopy (SEM). METHODS: Corneal TER changes after a 60-s exposure to Xalatan (latanoprost 0.005% preserved with 0.02% BAC), and latanoprost generics (Latanoprost PF BAC free, Latanoprost Nitten SB containing sodium benzoate and Latanoprost Towa containing 0.01% BAC with sodium chloride polysorbate 80 as additive) were measured in living rabbits. Corneal damage was also examined by SEM. Hank's balanced salt solution (HBSS) was used as a control. RESULTS: There was a significant decrease in the corneal TER after exposure of the cornea to Xalatan (p < 0.01) and all latanoprost generics (p < 0.01: Latanoprost PF, p < 0.05: Latanoprost Nitten SB, Latanoprost Towa) as compared to HBSS. All latanoprost generics showed less TER decrease in the corneal TER as compared to Xalatan (p < 0.01). SEM revealed that superficial cells of Xalatan-treated corneas were damaged and exhibited degenerated microvilli. Conversely, the superficial cells of corneas exposed to HBSS or all latanoprost generics appeared normal and had normal microvilli under SEM examinations. CONCLUSION: The corneal toxicity of Xalatan is greater than that of latanoprost generics. Xalatan contains 0.02% BAC, which may be responsible for the corneal toxicity.

RETINAL BLOOD FLOW CORRELATES TO AQUEOUS VASCULAR ENDOTHELIAL GROWTH FACTOR IN CENTRAL RETINAL VEIN OCCLUSION.

PURPOSE: As laser speckle flowgraphy can measure blood flow distribution in the ocular fundus, the authors analyzed the relationship between retinal blood flow and aqueous vascular endothelial growth factor (VEGF) concentration in central retinal vein occlusion. METHODS: This prospective observational study examined 45 eyes of 45 patients with central retinal vein occlusion before treatment. Blood flow in large vessels around and at the optic disk, aqueous VEGF concentration, and arteriovenous passage time were examined. Blood flow was evaluated as mean blur rate by laser speckle flowgraphy. RESULTS: Fluorescein angiography found 20 ischemic and 25 nonischemic type eyes. Aqueous VEGF concentration in the ischemic type was significantly higher than that in the nonischemic type (P = 0.01). Arteriovenous passage time was significantly correlated to the logarithm of the aqueous VEGF concentration (P = 0.0001). Mean blur rate of the affected eye/mean blur rate of the unaffected eye of the ischemic type was significantly lower than the nonischemic type (P = 0.039). Additionally, mean blur rate was significantly correlated both to the logarithm of the aqueous VEGF concentration (P < 0.0001) and to the arteriovenous passage time (P = 0.0001). CONCLUSION: Laser speckle flowgraphy may be useful for predicting aqueous VEGF concentration and severity of central retinal vein occlusion.

Imaging of laser-photocoagulated diabetic microaneurysm with spectral domain optical coherence tomography.

PURPOSE: To analyze the morphology of microaneurysms before and after direct photocoagulation using spectral domain optical coherence tomography. METHODS: In 13 eyes of diabetic patients who underwent focal photocoagulation for clinically significant macular edema, microaneurysms were evaluated before, immediately after, 1 month after, and 2 months after photocoagulation with spectral domain optical coherence tomography. The microaneurysms were also evaluated by fluorescein angiography and color fundus photography. The patients underwent focal photocoagulation for microaneurysm. RESULTS: The microaneurysms before photocoagulation in spectral domain optical coherence tomography were observed as circular or elliptical structures with hyperreflective foci within vessel walls. Immediately after photocoagulation, the microaneurysms were changed to indistinct lesions with hyperreflectivity around the microaneurysms. Acoustic shadows developed on the choroidal side of the microaneurysms. If photocoagulation for microaneurysms was appropriately done, retinal changes were limited to within the inner retina around the microaneurysms and no changes were observed in retinal pigment epithelium. Within 2 months after photocoagulation, the microaneurysms changed into fine scars and the retinal structure normalized. Average retinal thickness of the fovea was 432 ± 70 µm before the procedure but reduced to 373 ± 84 µm at 2 months post surgery. CONCLUSION: Focal photocoagulation may be a less invasive method for treating microaneurysms, and spectral domain optical coherence tomography is useful for evaluating the efficacy of photocoagulation.

Systemic factors influence the prognosis of diabetic macular edema after pars plana vitrectomy with internal limiting membrane peeling.

BACKGROUND: To evaluate the prognostic factors for the best-corrected visual acuity (BCVA) and foveal average retinal thickness after vitrectomy with internal limiting membrane (ILM) peeling for diabetic macular edema. DESIGN: Retrospective, single-center study. PARTICIPANTS: This study involved 31 eyes of 27 patients who had undergone vitrectomy with ILM peeling between January 2005 and March 2008. METHODS: Relationships between preoperative systemic or ocular factors and BCVA or foveal average retinal thickness before and 6 months after the operation were evaluated. MAIN OUTCOME MEASURES: BCVA and foveal average retinal thickness before and 6 months after the operation. RESULTS: The mean logarithm of the minimum angle of resolution improved from 0.84 ± 0.64 (mean ± standard deviation) preoperatively to 0.64 ± 0.38 six months postoperatively (p = 0.393). Foveal average retinal thickness significantly improved from 473 ± 146 µm preoperatively to 318 ± 108 µm 6 months after the operation (p < 0.0001). Preoperative foveal average retinal thickness was significantly thicker with cardiovascular disease or cerebral infarction (p = 0.0019) or cystoid macular edema (p = 0.0028), while preoperative BCVA was significantly lower when an epiretinal membrane (p = 0.042) was present. Foveal average retinal thickness at the 6-month follow-up was significantly thicker when patients had a higher body mass index (p = 0.0088), were not on dialysis (p = 0.012), or did not have proliferative diabetic retinopathy (p = 0.013). BCVA at the 6-month follow-up was significantly lower in the group with no history of diabetes treatment until diabetic retinopathy was found (p = 0.023) and in patients with a higher preoperative glycosylated hemoglobin (p = 0.033). CONCLUSIONS: Preoperatively, BCVA and foveal average retinal thickness were primarily associated with ocular factors, while they were strongly associated with systemic factors, postoperatively. Ocular factor improvements may be related to the surgical procedure.

Visual field defects after macular hole surgery with indocyanine green-assisted internal limiting membrane peeling.

PURPOSE: To report visual field defects after macular hole surgery with indocyanine green (ICG)-assisted internal limiting membrane (ILM) peeling. DESIGN: Interventional consecutive case series. METHODS: A retrospective review of 140 eyes with macular hole after vitrectomy with ILM peeling. The group with 0.25% of ICG for ILM peeling consisted of 96 eyes. The group without ICG consisted of 44 eyes. RESULTS: Nasal visual field defects occurred in 11 eyes, temporal visual field defects in seven eyes, and concentric visual field defects in one eye. In the group with ICG, nasal visual field defects were far higher in the left eye than in the right eye. CONCLUSIONS: We speculate that the postoperative nasal visual field defects were caused by the enhanced toxicity of ICG resulting from the exposure to illumination.

[Hyperintense optic nerve lesion on T2-weighted MRI imaging in the acute stage of Leber's hereditary optic neuropathy: a case report].

A 46-year-old man was admitted to our hospital for acute onset, bilateral visual disturbance. Neither papilledema nor optic atrophy was found. Brain MRI revealed a hyperintense lesion in the optic chiasm on T2-weighted imaging. No enhancement was detected in gadolinium-enhanced MRIs. Based on these results, a diagnosis of retrobulbar neuritis was made, and steroid pulse therapy was performed. However, the visual acuity did not improve at all. We therefore suspected Leber's hereditary optic neuropathy (LHON) and thus performed a PCR analysis of the mitochondrial DNA. It revealed a G to A transition at nucleotide position 11778 of the mitochondrial DNA, which has been frequently observed in LHON patients in Japan. Based on the above findings, when middle-aged patients present an acute onset of visual loss, LHON should be included in the differential diagnosis.

Acute Corneal Toxicity of Combined Antiglaucoma Topical Eyedrops.

PURPOSE: To investigate the corneal toxicity of three combined antiglaucoma topical eyedrops using transepithelial electrical resistance (TER) and scanning electron microscopy (SEM). METHODS: Corneal TER changes after a 60-s exposure to latanoprost/timolol with 0.02% benzalkonium chloride (BAC), travoprost/timolol with polyquaternium-1, and dorzolamide/timolol with 0.005% BAC were measured in living rabbits. Corneal damage was also examined by SEM. Hank's balanced salt solution (HBSS) was used as a control. RESULTS: There was a significant decrease in the corneal TER after exposure of the cornea to latanoprost/timolol with 0.02% BAC. Travoprost/timolol with polyquaternium-1 and dorzolamide/timolol with 0.005% BAC did not produce any significant decrease in the corneal TER as compared to HBSS control eyes. SEM revealed that superficial cells of corneas treated with latanoprost/timolol with 0.02% BAC were damaged and exhibited degenerated microvilli. Conversely, the superficial cells of corneas exposed to travoprost/timolol with polyquaternium-1 or dorzolamide/timolol with 0.005% BAC appeared normal and had normal microvilli under SEM examinations. CONCLUSION: The corneal toxicity of latanoprost/timolol with 0.02% BAC is greater than that of travoprost/timolol with polyquaternium-1 and dorzolamide/timolol with 0.005% BAC. Latanoprost/timolol contains 0.02% BAC, which may be responsible for the corneal toxicity.

Less Invasive Corneal Transepithelial Electrical Resistance Measurement Method.

PURPOSE: To evaluate acute corneal permeability changes after instillation of benzalkonium chloride (BAC) using a newly developed in vivo less invasive corneal transepithelial electrical resistance (TER) measurement method in animals and humans. METHODS: We previously developed an in vivo method for measuring corneal TER using intraocular electrodes in animals. This method can be used to precisely measure the decline of the corneal barrier function after instillation of BAC. To lessen the invasiveness of that procedure, we further refined the method for measuring the corneal TER by developing electrodes that could be placed on the surface of the cornea and in the conjunctival sac instead of inserting them into the anterior chamber. Corneal TER changes before and after exposure to 0.02% BAC were determined in this study using the new device in both rabbits and humans. RESULTS: There was a significant decrease in the corneal TER after exposure of the cornea to 0.02% BAC solution in both rabbits and humans (P<.01). The results of this new less invasive method agreed with those of formerly established anterior chamber methods in rabbit experiments. CONCLUSION: This new less invasive corneal TER measurement method enables us for the first time to measure TER of the human cornea, allowing safe and reliable investigation of the direct effect of different eye drop treatments on the corneal epithelium.

Success Rates of Vitrectomy in Treatment of Rhegmatogenous Retinal Detachment.

Aim. To investigate the anatomical success rates of pars plana vitrectomy (PPV) after primary rhegmatogenous retinal detachment (RRD). Methods. This retrospective study was conducted between December 2008 and October 2014 at Nagasaki University Hospital. The preoperative data recorded included the lens status, location of the retinal tear, whether a tear was visualized, presence of multiple tears, macula status, presence of peripheral lattice retinal degeneration, and best-corrected visual acuity (BCVA). The primary outcome measures were anatomical (primary and final) and functional success (visual acuity better than 6/60). Results. This study evaluated 422 eyes of 411 patients with a mean age of 57.7 ± 11.2 years. The single-operation reattachment rate (primary anatomical success) was 89.8%. The final anatomical success rate was 100% after 2-6 operations (mean = 3.14 ± 1.03). Functional success rate after the primary reattachment operation was 96.7%, while it was 97.2% at the end of the follow-up. Multiple logistic regression analysis of the possible risk factors for the primary anatomical failure showed a significant relation with the 25 G instruments (P = 0.002) and the presence of multiple tears (P = 0.01). Conclusion. The primary anatomical success of PPV for primary uncomplicated RRD was 89.8% and the final anatomical success rate was 100%.

A novel in vivo corneal trans-epithelial electrical resistance measurement device.

PURPOSE: To develop a device that is capable of easily measuring corneal transepithelial electrical resistance (TER) and changes in the corneal barrier function. METHODS: We had previously developed an in vivo method for measuring corneal TER using intraocular electrode. This method can be used to precisely measure the decline of the corneal barrier function after instillation of benzalkonium chloride (BAC). In order to lessen the invasiveness of that procedure, we further refined the method for measuring the corneal TER by developing electrodes that could be placed on the cornea and in the conjunctival sac instead of inserting them into the anterior chamber. TER was then calculated by subtracting the electrical resistance, which lacked the corneal epithelial input, from the whole electrical resistance that was measured between the electrodes. Slit lamp examination and scanning electron microscopy (SEM) were used to determine safety of the new device. Corneal TER changes after exposure to 0.02% BAC were determined using the new device as well as SEM and transmission electron microscopy (TEM). RESULTS: Slit lamp examination before and after exposure of rabbits' corneas to the sensor confirmed safety of the device. SEM examination revealed no difference of the corneal epithelium which exposed to the new device with normal corneas. SEM and TEM pictures revealed damaged microvilli and tight junctions after instillation of 0.02% BAC. TER change after treatment with 0.02%BAC was similar to those determined by the established anterior chamber method. CONCLUSION: We succeeded to develop a less invasive device for corneal TER measurement in vivo in animals. This new device may be applicable in the future for clinical use in humans.

Antibodies to myelin oligodendrocyte glycoprotein in idiopathic optic neuritis.

OBJECTIVES: To investigate the differences of clinical features, cerebrospinal fluid (CSF), MRI findings and response to steroid therapies between patients with optic neuritis (ON) who have myelin oligodendrocyte glycoprotein (MOG) antibodies and those who have seronegative ON. SETTING: We recruited participants in the department of neurology and ophthalmology in our hospital in Japan. METHODS: We retrospectively evaluated the clinical features and response to steroid therapies of patients with ON. Sera from patients were tested for antibodies to MOG and aquaporin-4 (AQP4) with a cell-based assay. PARTICIPANTS: Between April 2009 and March 2014, we enrolled serial 57 patients with ON (27 males, 30 females; age range 16-84 years) who ophthalmologists had diagnosed as having or suspected to have ON with acute visual impairment and declined critical flicker frequency, abnormal findings of brain MRI, optical coherence tomography and fluorescein fundus angiography at their onset or recurrence. We excluded those patients who fulfilled the diagnostic criteria of neuromyelitis optica (NMO)/NMO spectrum disorders (NMOSD), MS McDonald's criteria, and so on. Finally we defined 29 patients with idiopathic ON (14 males, 15 females, age range 16-84 years). RESULTS: 27.6% (8/29) were positive for MOG antibodies and 3.4% (1/29) were positive for AQP4. Among the eight patients with MOG antibodies, five had optic pain (p=0.001) and three had prodromal infection (p=0.179). Three of the eight MOG-positive patients showed significantly high CSF levels of myelin basic protein (p=0.021) and none were positive for oligoclonal band in CSF. On MRIs, seven MOG-positive patients showed high signal intensity on optic nerve, three had a cerebral lesion and one had a spinal cord lesion. Seven of the eight MOG-positive patients had a good response to steroid therapy. CONCLUSIONS: Although not proving primary pathogenicity of anti-MOG antibodies, the present results indicate that the measurement of MOG antibodies is useful in diagnosing and treating ON.

Retinal blood flow levels measured by laser speckle flowgraphy in patients who received intravitreal bevacizumab injection for macular edema secondary to central retinal vein occlusion.

PURPOSE: To report retinal blood flow levels measured by Laser speckle flowgraphy in three patients after they received an intravitreal bevacizumab injection (IVB) for macular edema secondary to central retinal vein occlusion (CRVO). METHODS: Three patients (3 eyes) being treated with IVB (1.25 mg/0.05 mL) for secondary macular edema of CRVO were examined. Laser speckle flowgraphy analyses of the blood flow were based on the examinations of mean blur rate (MBR) at the major vessels of the optic disk. Central retinal thickness (CRT) was measured by optical coherence tomography using Macular Cube 512 × 128 scanning protocol. RESULTS: After the first IVB, Case 1 exhibited an increase in MBR and decrease in CRT. After 4 months, an additional injection was required because of a subsequent MBR decrease and CRT increase, which led to an increase in MBR and decrease in CRT similar to that observed after the first treatment. Subsequently, blood flow has continued to improve without additional IVB. Macular edema recurrence in Case 2 led to 3 further IVBs over a 6-month period. Although increases in MBR and decreases in CRT were noted, MBR values tended to decline after each IVB. In Case 3, macular edema recurrence led to 5 additional IVBs being carried out within a 1-year period. Continuous MBR increases and CRT decreases were observed in the patient after each IVB. By measuring MBR using laser speckle flowgraphy, we may predict the prognosis of CRVO. CONCLUSION: Mean blur rate increases after IVB were confirmed by laser speckle flowgraphy in three patients. Even though CRVO pathology backgrounds can vary, laser speckle flowgraphy may be useful in both determining the CRVO prognosis and in evaluating treatment efficacy.

Systemic factors influence the prognosis of diabetic macular edema after pars plana vitrectomy with internal limiting membrane peeling.

PURPOSE/AIMS: To evaluate the prognostic factors for the best corrected visual acuity (BCVA) and central subfield macular thickness (CSMT) after vitrectomy with internal limiting membrane (ILM) peeling for diabetic macular edema. MATERIALS AND METHODS: A total of 44 eyes of 35 patients who had undergone vitrectomy with ILM peeling between March 2008 and September 2009 were examined. The relationships between preoperative systemic or ocular factors and BCVA or CSMT were evaluated before and at 6 months after the surgical procedure. RESULTS: Mean logarithm of the minimum angle of resolution improved from 0.74 ± 0.35 (mean ± SD) preoperatively to 0.55 ± 0.4 at 6 months postoperatively (p = 0.001). There was a significant improvement of the CSMT from 482 ± 116 µm before the operation to 355 ± 126 µm 6 months after the operation (p < 0.0001). The preoperative CSMT was significantly thicker with ischemic disease (p = 0.0016). Preoperative BCVA was significantly lower when subfoveal hard exudate was present (p = 0.0005). At the 6-month follow-up, CSMT was significantly thicker when there was a higher glycosylated hemoglobin (p = 0.008). BCVA at the 6-month follow-up was significantly lower in the group without any diabetes treatment history (p = 0.0075) prior to the diagnosis of diabetic retinopathy. CONCLUSIONS: While BCVA and CSMT were associated with ocular factors before surgery, they were associated with glycemic control postoperatively. Glycemic control may be important for retinal thickness after ocular surgery.

Succinate increases in the vitreous fluid of patients with active proliferative diabetic retinopathy.

PURPOSE: To examine vitreous succinate levels from proliferative diabetic retinopathy (PDR) patients and ascertain their association with PDR activity. DESIGN: Comparative case series. METHODS: A total of 81 eyes of 72 PDR patients were divided into active PDR (22 eyes), quiescent PDR (21 eyes), and active PDR with intravitreal bevacizumab injection (38 eyes). Twenty epiretinal membrane (ERM) patients (21 eyes) served as controls. RESULTS: Mean vitreous succinate levels were 1.27 µM in ERM and 2.20 µM in PDR, with the differences statistically significant (P = .03). When comparing mean vitreous succinate levels (active PDR: 3.32 µM; quiescent PDR: 1.02 µM; active PDR with intravitreal bevacizumab injection: 1.20 µM), significant differences were found between active and quiescent PDR (P < .01) and between active PDR and active PDR with intravitreal bevacizumab injection (P < .01). Even though succinate levels were low, retinopathy activities were very high in patients with active PDR with intravitreal bevacizumab injection. Mean vitreous vascular endothelial growth factor (VEGF) levels (active PDR: 1696 pg/mL; quiescent PDR: 110 pg/mL; active PDR with intravitreal bevacizumab injection: n.d.) were similar to previous reports. Mean vitreous erythropoietin levels (active PDR: 703 mIU/mL; quiescent PDR: 305 mIU/mL; active PDR with intravitreal bevacizumab injection: 1562 mIU/mL) suggested very high retinopathy activities in patients with active PDR with intravitreal bevacizumab injection. CONCLUSIONS: Succinate, like VEGF, may be an angiogenic factor that is induced by ischemia in PDR. Although succinate is reported to promote VEGF expression, VEGF inhibition decreases succinate. Thus, VEGF, via a positive feedback mechanism, may regulate succinate.

Spontaneous dislocation of in-the-bag intraocular lens primarily in cases with prior vitrectomy.

PURPOSE: To report cases of late onset spontaneous in-the-bag dislocation of the intraocular lens (IOL) and to compare these results with past reports. METHODS: We retrospectively studied 21 eyes of 18 patients with dislocation of the entire capsular bag containing the IOL. Gender, age, interval between original surgery and IOL dislocation, and the predisposing factors were examined. Cases occurring after trauma were excluded. RESULTS: The mean ± SD age of the 12 men (57.1%) and 9 women included in the study was 67.8 ± 8.6 years at the time of the IOL removal procedure. The interval between the original surgery and the IOL dislocation was 7.9 ± 8.6. Associated clinical conditions included vitrectomy in 8 eyes (40.0%) of 7 patients, high myopia in 3 eyes (14%) of 2 patients, uveitis in 2 eyes (9.5%) of 2 patients, retinitis pigmentosa in 2 eyes (9.5%) of 1 patient, and pseudoexfoliation in 1 eye (4.8%) of 1 patient. There was no identifiable associated condition in 2 eyes (9.5%) of 2 patients, who were comparatively younger than the other cases. This result differs from previously published reports that have found a higher frequency of pseudoexfoliation and lower frequency of prior vitrectomy. CONCLUSIONS: In-the-bag IOL dislocation was frequently associated with prior vitrectomy and sometimes occurred without specific conditions.

Comparing central retinal thickness in diabetic macular edema measured by two different spectral-domain optical coherence tomography devices.

PURPOSE: We evaluated central retinal thickness (CRT) in diabetic macular edema (DME) using two different spectral-domain (SD) optical coherence tomography (OCT) instruments: the Cirrus and Spectralis OCTs. METHODS: CRT was measured in 63 eyes of 32 patients with DME using both instruments on the same day. RESULTS: CRT measurements were significantly greater for the Spectralis than the Cirrus (p < 0.0003, n = 63, paired t test); mean CRT values were 382 ± 136 µm with the Cirrus and 394 ± 139 µm with the Spectralis. In eyes with poor best-corrected visual acuity (BCVA) (<20/40), mean CRT was 378 ± 130 µm with the Cirrus and 395 ± 139 µm with the Spectralis (p < 0.007, n = 29). In eyes with good acuity (equal to or better than 20/40), the mean CRT was 385 ± 142 µm with the Cirrus and 393 ± 140 µm with the Spectralis (p < 0.005, n = 34). CONCLUSIONS: Foveal retinal thickness measurements may vary among SD-OCT devices. The differences between instruments could affect the results of a multicenter study.