Frequency and clinical features of intraocular inflammation in Tokyo.

BACKGROUND: To investigate frequencies and clinical features of intraocular inflammation (uveitis) in Tokyo, Japan. METHODS: Records of 834 consecutive new referral patients (352 men, 482 women) examined at the Kyorin University Hospital from April 2000 to December 2007 were retrospectively reviewed. RESULTS: Mean age at onset was 44.8 years for men and 47.0 years for women. By anatomical classification, 229 patients (27.4%) had anterior uveitis, 10 (1.2%) had intermediate uveitis, 183 (21.9%) had posterior uveitis and 412 (49.4%) had panuveitis. The most common diagnoses were Vogt-Koyanagi-Harada (VKH) disease (11.0%), sarcoidosis (6.9%), acute anterior uveitis (6.5%), Behçet's disease (5.8%) and tuberculosis (4.3%). In the third and fourth decades, the most common diseases were Behçet's disease for men and VKH for women, whereas over 60 years of age, the most common diseases were VKH for men and sarcoidosis for women. Systemic corticosteroids were used in 25.5% of patients, and other immunomodulatory agents were required in 8.7% of patients. CONCLUSIONS: The most frequent diagnoses were sarcoidosis, VKH disease, acute anterior uveitis, Behçet's disease and tuberculosis, with Behçet's disease being common in young men and sarcoidosis being common in elderly women. One-fourth of patients received systemic corticosteroids and 8.7% of patients required other immunomodulatory agents.

[Clinical features of endophthalmitis after cataract surgery evaluated by the presence of background factors].

PURPOSE: The clinical features and visual prognosis after vitrectomy for endophthalmitis which had developed after cataract surgery were compared in two groups with or without background factors, including malignant tumor, diabetes, oral steroid administration, collagen disease, dacryocystitis, and lid closure disturbance. METHOD: Fifty-two patients (53 eyes) who underwent a vitrectomy for the treatment of endophthalmitis which had developed within 6 weeks after cataract surgery. They were divided into two groups according to the presence (21 eyes, group A) or absence (32 eyes, group B) of background factors, and were retrospectively compared based on their medical records. RESULTS: The culture-positive rate was 62% in group A and 69% in group B. The incidence of a final visual acuity of more than 20/20 was significantly lower in group A (14%) than in group B (47%, p < 0.05). Methicillin-resistant Staphylococcus aureus, alpha-hemolytic Streptococcus and Enterococcus were frequently identified in group A. Leakage from the cataract wound was found in about 80% of the patients with corneal incisions, and a wound that had not been covered by the conjunctiva was significantly more frequent as a factor in group A (group A, 13 eyes; group B, 10 eyes; p < 0.05). CONCLUSION: Postoperative endophthalmitis may have a less favorable visual prognosis in patients with background factors, so precise wound construction during cataract surgery is important in these patients.

Two-year outcomes of pro re nata ranibizumab monotherapy for exudative age-related macular degeneration in Japanese patients.

PURPOSE: To describe outcomes of intravitreal ranibizumab using a pro re nata regimen for treatment-naive exudative age-related macular degeneration (AMD), in Japanese patients over the first 2 years. METHODS: Clinical records were retrospectively reviewed of 48 eyes of 48 patients with treatment-naive exudative AMD who underwent intravitreal ranibizumab therapy. After three monthly injections (induction), patients were examined monthly, and subsequent injections were performed as needed (pro re nata) for any residual activity, by fundus biomicroscopy and imaging studies, regardless of severity. RESULTS: Twenty-nine (60%) of the patients were men, and 19 (40%) were women; the mean age was 76.1 years. Of the 48 eyes evaluated, 17 (35%) had findings consistent with polypoidal choroidal vasculopathy, and five (10%) with retinal angiomatous proliferation. A mean of 6.0 ranibizumab injections were given in the first year, 3.5 in the second year, and 9.5 over the 2-year period. The best-corrected visual acuity (logarithm of minimum angle of resolution) improved significantly, from 0.35 at baseline to 0.21 at 12 months (P < 0.01), and remained stable at 0.21 at 24 months (P < 0.01). The mean central macular thickness decreased significantly, from 355.4 µm at baseline to 237.9 µm at 12 months (P < 0.01) and 247.7 µm at 24 months (P < 0.01). CONCLUSION: Improved visual acuity and decreased central macular thickness were observed and maintained over a 2-year period, in a Japanese population receiving 3 monthly induction injections followed by a pro re nata regimen of ranibizumab for exudative AMD.

Refractive changes in silicone oil-filled pseudophakic eyes.

PURPOSE: We examined the refractive changes in pseudophakic eyes of patients with idiopathic macular hole treated with silicone oil injection. METHODS: Twenty consecutive eyes of 19 patients with idiopathic macular hole who had undergone successful pars plana vitrectomy using silicone oil tamponade were studied retrospectively. Lensectomy with intraocular lens (IOL) implantation was performed on each patient before vitreous surgery. Five biconvex type IOL models were used. After pars plana vitrectomy and fluid-air exchange, silicone oil was injected to replace the air completely. Macular hole closure was confirmed by optical coherence tomography, and silicone oil removal was performed. Manifest refractions before silicone oil filling, with silicone oil filling, and after silicone oil removal were determined. RESULTS: A mean hyperopic shift +/- SD in spherical equivalents of +5.69 +/- 1.71 diopters (P < 0.0001) was observed with silicone oil instillation. In contrast, a mean myopic shift +/- SD of -5.63 +/- 1.33 diopters was observed after silicone oil removal (P < 0.0001). The absolute value of the refractive shift showed a strong correlation with the posterior radius of the IOL (r = 0.699, P < 0.0001). CONCLUSION: IOL models with steeper posterior convex curvature result in larger refractive deviations in patients scheduled for silicone oil instillation.

Pars plana vitrectomy without long-acting gas tamponade for primary rhegmatogenous retinal detachment.

PURPOSE: To report the anatomical and visual results of primary pars plana vitrectomy (PPV) without long-acting gas tamponade to repair primary rhegmatogenous retinal detachments (RRDs). METHODS: Twenty-seven consecutive patients (27 eyes) with peripheral retinal tears and new RRDs were treated according to the surgical protocol. Patients underwent PPV with fluid-air exchange and endolaser treatment to repair the RRD. Neither long-acting gas nor silicone oil tamponade was combined with PPV. All patients were followed from 6 to 26 months with an average follow-up of 11 months. Reattachment of the retina and visual outcome were compared to the results of previously published studies. RESULTS: Reattachment was achieved in 24 of 27 eyes (89%) with a single operation, and in all 27 (100%) eyes, the retina was ultimately reattached with subsequent operations. The median initial visual acuity was 0.4, and the median final visual acuity was 1.0. CONCLUSIONS: Primary PPV with fluid-air exchange alone and laser treatment is a safe, effective method for the repair of primary retinal detachments. The anatomical reattachment rate and the visual acuity obtained with this technique appear to be at least as good as those reported in the literature for primary PPV combined with long-acting gas tamponade.