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ABSTRACT: Retinal pigment epithelial (RPE) cells form a blood-ocular barrier, and their polarized property is crucial for maintaining the barrier functions. Tumor necrosis factor alpha (TNF-α), a major pleotropic inflammatory cytokine that disrupts the barrier function and eventual angiogenesis, is expressed in the choroidal neovascularizations of age-related macular degeneration eyes. Thus, it most likely plays an important role in the progression of the disease. The purpose of this study was to compare the effects of TNF-α on the barrier function of polarized RPE cells. Non-polarized RPE cells were used as negative controls. Isolated porcine RPE cells were seeded on Transwell™ membranes. The polarization of the RPE cells was determined by their high transepithelial electrical resistance (TER >150 Ω cm2) and by their differential secretion of vascular endothelial growth factor (lower layer/upper layer >2.5X). Polarized RPE cells were incubated with 10 ng/ml of TNF-α and the TER was measured. TNF-α significantly decreased the TER of polarized RPE cells by 17.6 ± 2.7% (P < 0.001) of the control at 24 h and that of non-polarized RPE cells by 5.4 ± 6.5% (P = 0.401). The p38 mitogen-activated protein kinase (MAPK) inhibitor, SB203580, blocked the effects of TNF-α of decreasing the TER. Cell junction-related molecules, e.g., ZO-1, located between cells in control RPE cells, were disassembled by TNF-α, and this breakdown was suppressed by SB203580 in polarized RPEs. These results indicate that the breakdown of the RPE barrier function was caused exclusively by TNF-α in polarized RPEs, and TNF-α was acting through the p38 MAPK pathways. Investigations of polarized RPE cells should be more suitable for in vitro studies of the pathophysiology of retinochoroidal diseases.
Experimental Eye Research 02/2013; · 3.26 Impact Factor
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ABSTRACT: PURPOSE: To observe long-term changes in intraocular pressure (IOP) after a combined phacoemulsification, intraocular lens implantation, and vitrectomy procedure. METHODS: This was a retrospective case series at a single hospital. Of 105 consecutive cases that received combined phacoemulsification, intraocular lens implantation, and vitrectomy for macular hole or epiretinal membrane, 85 eyes (patients) were followed up for 1 year or longer. The IOP of both eyes in the subjects who had surgery in one eye was measured at baseline and at 1, 3, 6, 12, 24, 36, 48, and 60 months postoperatively. The IOP of the treated eye was compared with the fellow eye and with the baseline value at each follow-up visit. RESULTS: Intraocular pressure in the operated eyes at 3 months after surgery was significantly lower than that at baseline and than that in the respectively fellow eyes (P < 0.001, paired-t test with Bonferroni correction). The IOP subsequently returned to the baseline value or was the same as that of the fellow eye within 3 months of the observation time point. Only two treated eyes had elevated IOP exceeding 21 mmHg after 6 months postoperatively. CONCLUSIONS: The change in the IOP after phacovitrectomy may be limited, and care when using this procedure because some eyes show increased IOP compared to the fellow eye after a long period.
Japanese Journal of Ophthalmology 10/2012; · 0.92 Impact Factor
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ABSTRACT: Background/Aims: This study was conducted to establish a reliable method to determine macular hole (MH) closure of gas-filled eyes. Method: 21 consecutive eyes with MH underwent vitrectomy with gas tamponade, and spectral domain optical coherence tomography (SD-OCT) was performed using our diagnostic technique. The quality of OCT images was rated as signal strength (SS) and evaluated by masked observers. Results: The quality to determine MH closure (SS ≥4) was sufficient in all eyes. In addition, SD-OCT images (SS ≥6) obtained from 16/21 eyes showed detailed retinal structures including the inner segment/outer segment line. The next day after surgery, MH closure was confirmed in 12/21 eyes, and residual MH was observed in 9/21 eyes. Among these 9 eyes, 7 eyes were closed within 2 weeks. Conclusion: The present method provided clear SD-OCT images from gas-filled eyes, which is not only essential for the diagnosis of MH closure but also for establishing proper protocols and for studying the pathology of gas-filled eyes.
Ophthalmologica 10/2012; · 1.42 Impact Factor
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ABSTRACT: To compare subfoveal choroidal thickness (SCT) measurements of three different commercially available spectral-domain optical coherence tomography instruments with healthy eyes of Japanese.
A prospective, cross-sectional study was performed at a single institution. SCT of the right eye of 43 normal subjects was measured using three different SD-OCTs: Heidelberg Spectralis-OCT (Spectralis), Cirrus HD-OCT (Cirrus), and Topcon 3D OCT-1000 Mark II (Topcon). Two separate measurements were performed for the same eye with a maximum by a single examiner. SCT was defined as the distance from the posterior edge of the retinal pigment epithelium to the choroid/sclera junction. After manual segmentation, measurements were made using calipers equipped on each machine by masked raters. Intraclass, interrater, and intermachine agreements were assessed.
Forty-three subjects (mean age, 30.5 years) were enrolled. Of 43 eyes, the SCT of 39 eyes (90.7%) could be measured using each machine. Intraclass correlation coefficients (95% confidence intervals) were 0.976 (0.954-9.987), 0.958 (0.919-0.978), and 0.939 (0.895-0.971) with Spectralis, Cirrus, and Topcon, respectively. Interrater correlation coefficients (95% confident interval) were 0.944 (0.893 to 0.971), 0.956 (0.831 to 0.983), and 0.924 (0.825 to 0.964) with Spectralis, Cirrus, and Topcon, respectively. The average SCT was 272.6, 272.8, and 269.2 μm with Spectralis, Cirrus, and Topcon, respectively. The intermachine correlation coefficient was significantly high among the machines (P<0.001, Spearman), 0.97 (Spectralis-Cirrus), 0.96 (Cirrus-Topcon), and 0.98 (Topcon-Cirrus). Bland-Altman plot analysis showed no typical trend among the machines.
SCT measurements obtained with three different SD-OCTs were highly correlated and could be used interchangeably. (http://upload.umin.ac.jp number, UMIN000005287.).
Investigative ophthalmology & visual science 01/2012; 53(3):1102-7. · 3.43 Impact Factor
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Japanese Journal of Ophthalmology 09/2010; 54(5):504-5. · 0.92 Impact Factor
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ABSTRACT: To evaluate the ocular hypertensive response to repetitive cycles of high-dose systemic corticosteroid in young patients with acute lymphoblastic leukemia (ALL).
Five patients up to 6 years of age with ALL who received chemotherapy between November 2003 and March 2005 were examined. As maintenance therapy, they received oral or intravenous dexamethasone 6 to 12 mg/m²/day for 2 weeks, followed by 1-week taparing and 5 weeks break were used in 1 cycle. The duration of maintenance therapy was 15 cycles for 2.5 to 3 years. Comprehensive ophthalmic check-up, including best-corrected visual acuity, intraocular pressure (IOP), and slit-lamp and fundus examinations, were performed.
All patients were followed up until final cycle. Symmetrical IOP rise >21 mm Hg was observed in all patients. Right IOP increased to a maximum of mean 39.6 ± 7.2 mm Hg. (range: 28 to 47). The range of cycle to reach a maximal IOP was 5th to 11th. All patients were maintained IOP control with antiglaucoma medications. However, 1 patient already had severe glaucomatous optic atrophy at the time of consultation.
Systemic corticosteroid in childhood-ALL treatment has a risk for IOP elevation. Periodical and careful ophthalmic check-up is necessary, especially in patients with dexamethasone.
Journal of glaucoma 08/2009; 19(3):188-90. · 1.74 Impact Factor
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ABSTRACT: To evaluate the long-term course of visual field defects after intravitreal injection of indocyanine green (ICG) during vitrectomy.
Retrospective observational case series. The medical records of seven eyes of seven patients with visual field defects after the adjunctive use of ICG during macular hole surgery were studied. All of the surgeries were performed between February 2001 and January 2002. Humphrey static perimetry and best-corrected visual acuity were examined periodically, and the main outcome measure was the mean deviation (MD) determined by the Humphrey (30-2) SITA-Fast program.
All patients were observed for more than 4.5 years, for a mean of 60.7 months and a range of 54 to 66 months. The preoperative MD was -3.5 +/- 3.1 dB (mean +/- SD), and the postoperative MD was -13.3 +/- 4.9 dB at 1 year, -13.4 +/- 4.6 dB at 2 years, -16.2 +/- 5.1 dB at 3 years, and -15.6 +/- 5.1 dB at 4 years. The decrease in the mean MD between 1 and 3 years after surgery was significant (P < 0.05). Optic disk pallor in five eyes showed a decrease in the MD between 1 year and 3 years after the surgery. There was no significant difference in the postoperative best-corrected visual acuity at any time.
The visual field defect in eyes that had undergone vitrectomy with staining of the internal limiting membrane with ICG can continue to deteriorate for at least 3 years. Eyes receiving intravitreal ICG during vitrectomy should be followed for a longer period to determine the long-term effect of ICG.
Retina (Philadelphia, Pa.) 10/2008; 28(9):1228-33. · 2.93 Impact Factor
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ABSTRACT: To evaluate long-term intraocular pressure (IOP) response after intravitreal injections of different doses of triamcinolone acetonide (TA) upon completion of pars plana vitrectomy (PPV) for macular edema secondary to diabetic retinopathy or retinal vein occlusion.
Retrospective, consecutive, comparative, interventional case series. Twenty-seven eyes of 25 consecutive patients with macular edema associated with diabetic retinopathy (n=18) or retinal vein occlusion (n=9), who underwent PPV for the treatment of macular edema between January 2003 and December 2003, were included. Upon completion of vitrectomy, different doses of TA were injected into the vitreous cavity: 14 eyes with 5 mg of TA (group 1) and 13 eyes with 10 mg of TA (group 2). The main outcome measure was IOP.
All patients were followed up for at least 12 months. Preoperative IOP was 12.6+/-2.6 mm Hg (mean+/-standard deviation) in group 1 and 13.2+/-2.1 mm Hg in group 2. Postoperatively, IOP increased to a mean maximum of 20.6+/-5.5 mm Hg in group 1 and 31.5+/-3.5 mm Hg in group 2 (P<0.01 for both groups). The difference between groups was also significant (P<0.05). Five of 14 eyes (36%) in group 1 and 10 of 13 eyes (77%) in group 2 had an elevation of IOP exceeding 21 mm Hg (P=0.03). The median interval from surgery to reach maximal IOP was 7 days in both groups. The significant IOP elevation lasted for 3 months in group 1 and 6 months in group 2.
After injecting of TA into the vitreous cavity upon completion of PPV for macular edema, a dose-dependent IOP elevation was observed, starting from early postoperative days and returning to normal values after several months. These results show that intravitreal TA injection in the vitrectomized eyes might have different IOP changes from in the nonvitrectomized eyes.
Journal of Glaucoma 03/2007; 16(2):220-4. · 1.78 Impact Factor
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ABSTRACT: To analyze retinal nerve fiber layer (RNFL) thickness in eyes with or without visual field (VF) defects after indocyanine green-assisted vitrectomy for idiopathic macular holes using optical coherence tomography (OCT) and to investigate the relationship between postoperative VF defects and RNFL damage.
Retrospective interventional case series.
Thirty-four eyes of 32 patients with idiopathic macular holes that underwent vitrectomy between January 2001 and March 2003 were included in this study. Eyes were divided into 3 groups according to the occurrence of postoperative VF defects and the use of indocyanine green for internal limiting membrane peeling during surgery: 11 eyes with VF defects after indocyanine green-assisted vitrectomy (group 1), 9 eyes without VF defects despite the use of indocyanine green (group 2), and 14 eyes without VF defects that underwent vitrectomy without indocyanine green (group 3).
Retinal nerve fiber layer thickness in each of 4 quadrants (superior, inferior, nasal, temporal) was measured with OCT.
Retinal nerve fiber layer thickness around the optic disc.
The mean RNFL thickness in 3 of 4 quadrants (superior, nasal, inferior) in group 1 was significantly less than that in the corresponding quadrant in groups 2 and 3 (P<0.01). In the temporal quadrant, there was a significant difference between groups 1 and 3 (P = 0.02), but not between groups 1 and 2. The RNFL thickness in group 1 was significantly less in 3 quadrants in operated eyes than in fellow eyes (P<0.05).
The RNFL thickness was reduced in eyes with VF defects after indocyanine green-assisted vitrectomy for macular holes, suggesting that the postoperative VF defects may have been caused by RNFL damage relating to the use of indocyanine green.
Ophthalmology 03/2006; 113(2):280-4. · 5.45 Impact Factor
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ABSTRACT: The structure of the vitreous body is known to play an important role in the pathogenesis of proliferative diabetic retinopathy (PDR). The purpose of this study was to ascertain the pattern of fibrous membrane proliferation in PDR focusing on pre-optic disc canal-like fibrous proliferation.
The investigation comprised two parts. The first, prospective study involved examining ten eyes of ten patients with PDR who underwent triamcinolone acetonide-assisted pars plana vitrectomy (TA-PPV). The presence of canal-like intravitreous structures was determined during TA-PPV. The second, retrospective study included analysis of photographs and clinical records of 235 eyes examined in 207 patients with PDR. The clinical and surgical records of the 235 eyes treated with PPV were reviewed and were categorized into four groups based upon the pattern of fibrous proliferation (optic disc type, pre-cortical pocket type, mixed type, or other). Each clinical feature was studied. The clinical features of the four groups of PDR were compared.
A pre-optic disc canal-like structure was observed in seven of the ten eyes. In the retrospective study, 25 eyes (10.7%) were classified as optic disc type, 16 eyes (6.9%) as pre-cortical pocket type, 68 eyes (29.1%) as mixed type, and 126 eyes (53.4%) as other types. The patients with the optic disc type were significantly younger than the other three groups (P = 0.02). Other clinical features and post-operative outcome were not significantly different between the groups.
A pre-optic disc canal-like structure, probably Cloquet's canal and the area of Martegiani, was present in PDR eyes. The PDR patients with fibrous proliferation of this structure were younger than those with other patterns of fibrous proliferation.
Albrecht von Graæes Archiv für Ophthalmologie 04/2005; 243(3):204-9. · 2.17 Impact Factor
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ABSTRACT: To report the findings on a patient cohort with visual field defects after macular hole surgery with indocyanine green (ICG)-assisted internal limiting membrane peeling and to investigate the correlation between the defects and the use of ICG.
Retrospective, noncomparative interventional case series.
Thirty-nine eyes of 38 patients having the clinical diagnosis of a macular hole who underwent pars plana vitrectomy between January 1, 2001, and December 31, 2002, were enrolled in this study.
Indocyanine green-assisted internal limiting membrane peeling was performed on a series of 22 eyes: 12 eyes using a 0.5% ICG solution and 3-minute exposure to the retina (group 1), 4 eyes using a 0.5% ICG solution and immediate washout (group 2), and 6 eyes using a 0.25% ICG solution and immediate washout (group 3). The remaining 17 eyes underwent vitrectomy without ICG-assisted internal limiting membrane peeling (group 4).
Visual field, best-corrected visual acuity, and fundus photography were evaluated.
Postoperatively, all patients (100%) in group 1 and 1 (25%) of 4 eyes in group 2 had visual field defects. None of the patients in group 3 had a visual field defect. The visual field defects included 10 eyes (84%) with nasal defects, 1 eye (8%) with an inferotemporal defect, and 1 eye (8%) with an extensive visual field defect. Ophthalmoscopy revealed mild to moderate optic disc pallor in 8 (62%) of 13 eyes with postoperative visual field defects. Only 1 patient in group 4 had an inferotemporal defect; none of the other patients in group 4 had visual field defects. There was no statistically significant difference in postoperative visual acuity between patients with and without postoperative visual field defects.
Although this study was limited by the few patients enrolled, our experience indicates that visual field defects, specifically nasal defects, can occur after macular hole surgery with ICG-assisted internal limiting membrane peeling, and that the incidence depends on the concentration of the ICG solution and/or the exposure time to the retina. Further studies are needed to clarify the pathomechanism of visual field defects.
Archives of Ophthalmology 11/2004; 122(10):1447-51. · 3.71 Impact Factor
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ABSTRACT: To report a case of endophthalmitis after triamcinolone acetonide (TA)-assisted par plane vitrectomy (PPV).
A 60-year-old Japanese man developed endophthalmitis after TA-assisted PPV for diabetic macular edema. Preoperative visual acuity was 20/200. Four days after surgery, endophthalmitis associated with anterior chamber hypopyon was noticed; the patient's vision had deteriorated to hand motion. In spite of severe cell infiltration, the ciliary injection and ocular pain were not significant.
The additional PPV with irrigation of cefazolin (40 microg/ml) and gentamicin (8 microg/ml) was performed. Endophthalmitis resolved soon after this treatment. Staphylococcus epidermidis was detected in the intravitreous samples. The patient's visual acuity improved to 20/100.
Endophthalmitis may be a complication of TA-assisted PPV with unique signs and symptoms.
Albrecht von Graæes Archiv für Ophthalmologie 09/2004; 242(8):679-81. · 2.17 Impact Factor
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Taiji Sakamoto,
Hiroshi Enaida,
Toshiaki Kubota,
Masaaki Nakahara,
Keita Yamakiri, Takehiro Yamashita,
Mitsunobu Yokoyama,
Yasuaki Hata,
Toshinori Murata,
Kazunori Miyata,
Akinori Uemura,
Wataru Kimura,
Tatsuro Ishibashi
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ABSTRACT: To report the incidence of acute endophthalmitis after triamcinolone acetonide-assisted pars plana vitrectomy (PPV).
A retrospective multicenter interventional case series collected over 23 months.
We retrospectively reviewed the charts of all patients who underwent triamcinolone-assisted PPV at seven academic clinical centers or eye hospitals from January 2002 to November 2003.
Of a total of 1,886 cases, only 1 case showed acute endophthalmitis due to Staphylococcus epidermidis (0.053%). No other cases showed any signs of postoperative endophthalmitis.
Intraoperative use of triamcinolone during PPV is not a high risk factor for acute endophthalmitis.
American Journal of Ophthalmology 08/2004; 138(1):137-8. · 4.22 Impact Factor
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ABSTRACT: To report eight cases of spontaneous closure of traumatic macular hole.
Consecutive observational case series.
In a consecutive series of 18 eyes of 18 patients with traumatic macular hole, eight patients achieved spontaneous closure of traumatic macular hole. Clinical records of the eight eyes of eight patients were reviewed, together with the results of optical coherence tomography performed in three eyes.
All eight patients with spontaneous closure of traumatic macular hole were males, with a mean age of 14.6 years (range, 11-21 years). The major cause of blunt trauma was sports-related accidents. Six eyes developed visual symptoms immediately after trauma and two eyes 10 to 12 days later. In all eight eyes, contact lens biomicroscopy revealed a small, full-thickness macular hole not complicated by epiretinal membrane, cuff of subretinal fluid, or posterior vitreous detachment. The macular hole closed spontaneously 1 week to 4 months after trauma. All eight eyes had visual acuity improvement with the final best-corrected visual acuity of 0.5 or better in four (50%) eyes. Optical coherence tomography in three eyes revealed two distinct abnormalities. Two eyes presented with acute foveal dehiscence without involvement of the posterior vitreous cortex. The remaining eye showed at presentation perifoveal vitreous detachment with residual vitreous adhesion to the edge of updrawn fovea and developed release of the vitreofoveal adhesion at the time of hole closure.
Spontaneous closure of traumatic macular hole is not uncommon. An observation for a period of up to four months may be a management of choice for traumatic macular hole. There may be clinically and pathogenetically two distinct mechanisms of traumatic macular formation; one type that causes immediate visual loss due to primary dehiscence of the fovea, and the other type that leads to delayed visual loss due to dehiscence of the fovea secondary to persistent vitreofoveal adhesion.
American Journal of Ophthalmology 03/2002; 133(2):230-5. · 4.22 Impact Factor
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ABSTRACT: To understand the function of a mucin- like glycoprotein associated with photoreceptor cells (MLGAPC), MLGAPC-transfected Y79 retinoblastoma cells were analyzed biochemically and morphologically.
The cDNA for the core protein of human MLGAPC was isolated, cloned into a mammalian expression vector, pCAGGSneo, and then transfected into Y79 retinoblastoma cells. The cells and the medium were analyzed by means of Western blotting, and the morphology of the transfectants and parental cells was compared.
Western blot analysis of the culture medium revealed that the transfectants secreted MLGAPC into the medium. Lectin blot analysis of MLGAPC in the medium showed that it had a binding site for Maackia amurensis lectin II. No morphological difference was detected between the transfectants and parental cells.
As expected from the deduced amino acid sequence of MLGAPC, it was secreted into the medium. The secreted MLGAPC was found to carry sialoglycans (rod type). The expression of MLGAPC had no effect on the adhesion or morphology of the cultured cells, which suggests that its interaction with other components may be required for these effects.
Ophthalmic Research 34(2):70-6. · 1.56 Impact Factor
