[show abstract][hide abstract] ABSTRACT: Patients with exudative age-related macular degeneration (AMD) who did not respond to ranibizumab at the induction phase were assessed and referred to as initial non-responders.
We retrospectively reviewed the medical records of 215 patients (218 eyes) with exudative AMD. For the initial treatments, patients received three intravitreal injections of ranibizumab (IVR) every 4 weeks. Minimum follow-up period was 12 months. We defined patients with no improvement of best corrected logMAR visual acuity (BCVA), and with no decrease of central retinal thickness (CRT) at the end of the initial treatment, as initial non-responders. Patients who had previous treatment history prior to this investigation were included, but patients who had photodynamic therapy (PDT) with IVR were excluded.
Twenty-two eyes (10.1%) were identified as initial non-responders. The mean BCVA of initial non-responders before IVR and after induction phase were 0.39 and 0.36, respectively. There was no significant difference between these values, however the mean BCVA decreased significantly to 0.55 at 12 months after the beginning of the induction phase (P = 0.021). The mean greatest linear dimension (GLD) of the lesion before IVR of initial non-responders was 4,121 μm. We found 16 eyes with typical AMD, and six eyes with polypoidal choroidal vasculopathy. One eye had predominantly classic choroidal neovascularization (CNV), and others had occult CNV of typical AMD. As additional treatments, twelve eyes received PDT, and in three of the eyes exudation remained after PDT.
Initial non-responders were more prevalent in patients with occult CNV than in patients with other CNV types. Some of the initial non-responders did not respond to PDT. This study suggested possible involvement of other factors, in addition to vascular endothelial growth factor, in the occurrence of CNV in initial non-responder patients.
[show abstract][hide abstract] ABSTRACT: Intraocular lymphomas are rare, and they have poor prognosis. Thus, early diagnosis and treatment are needed. A definitive diagnosis of a lymphoma is based on cytological analysis of the intraocular fluids or tissues. We report two cases of intraocular lymphoma diagnosed by the analyses of vitreous and infusion fluid.
Case 1 was a 66-year-old woman who complained of eye floaters and was found to have diffuse vitreous opacification bilaterally. She received corticosteroid therapy, however the vitreous opacification was not resolved, and her visual acuity (VA) remained reduced. She underwent pars plana vitrectomy (PPV), and vitreous and infusion fluid were collected to determine the cause of the reduced VA. The undiluted vitreous obtained from core PPV was submitted for cytokine analysis, and infusion fluid was obtained from the machine cassette after full PPV and used for cytological analysis. Case 2 was a 62-year-old man referred with low vision and was found to have diffuse vitreous opacification in the right eye and dot hemorrhages in both eyes. Four years earlier, he had been diagnosed with diffuse large B-cell lymphoma of the paranasal sinuses and was in remission after chemotherapy. Because metastasis of the lymphoma was suspected, he underwent PPV, and intraocular samples were collected as in Case 1.
Atypical lymphoid cells were detected from the infusion fluid in both cases. The ratio of interleukin (IL)-10 to IL-6 was greater than 1.0 in both cases. These results allowed us to make a diagnosis of intraocular lymphoma: primary intraocular lymphoma in Case 1 and metastatic intraocular lymphoma in Case 2.
Vitreous and infusion fluid collected during PPV can be used for diagnosing an intraocular lymphoma.
[show abstract][hide abstract] ABSTRACT: Peripapillary and macular retinoschisis are usually associated with optic disc pits. We report a rare case of peripapillary retinoschisis with optic disc hypoplasia. A 59-year-old woman presented with asthenopia. Her best-corrected visual acuity was 20/20 OD. Ophthalmoscopy of the right eye revealed peripapillary retinoschisis, optic disc hypoplasia and dilated and tortuous radial peripapillary capillaries. There was no obvious optic disc pit or vitreous traction on optical coherence tomography (OCT) or fluorescein angiography. OCT showed retinoschisis around the optic disc, a thin sheet of fenestrated tissue on the optic disc and absence of serous retinal detachment. These findings had been almost the same at a previous visit to our hospital 17 years previously. Peripapillary retinoschisis may occur in patients with optic disc hypoplasia. We report a case in which visual acuity and symptoms did not change significantly after 17 years of follow-up.
[show abstract][hide abstract] ABSTRACT: PURPOSE:: Large diurnal intraocular pressure (IOP) fluctuation (▵IOP) is believed to be one of the causes of progression in glaucomatous changes. Some fully medicated glaucoma patients whose IOPs are controlled during the regular office hours (10:00 to 16:00 h) still have progression in glaucomatous changes and IOP elevation during off-office hours. The purpose of this study was to determine whether ▵IOP is dampened after combined trabeculotomy and sinusotomy (LOT+SIN) in glaucoma patients with low IOPs during the regular office hours. PATIENTS AND METHODS:: Fourteen eyes of 8 open-angle glaucoma patients who had large ▵IOP despite low IOPs during the office hours were studied. The IOP was measured every 3 hours for 24 hours before and >3 months after the operation. The IOPs were measured in the sitting position with a Goldmann applanation tonometer. All patients underwent LOT+SIN. RESULTS:: All patients had IOP elevations >20 mm Hg between 0:00 and 3:00 hours before the operation, and none had an IOP peak after the operation. The postoperative mean IOP (16.5±1.7 to 13.9±2.0 mm Hg, P=0.00064), the maximum IOP (21.9±2.4 to 16.1±2.5 mm Hg, P=0.0020), and ▵IOP (8.9±2.7 to 4.3±1.2 mm Hg, P=0.0032) were significantly lower than the preoperative values. However, the minimum IOP was not reduced significantly (13.0±1.9 to 11.7±1.7 mm Hg). CONCLUSIONS:: The diurnal ▵IOPs are dampened by LOT+SIN in glaucoma patients with controlled IOPs during regular office hours. These results indicate that these surgical procedures can be used for the treatment of open-angle glaucoma patients.
[show abstract][hide abstract] ABSTRACT: The purpose of this paper is to report two cases of sarcoidosis with conflicting signs in which vitreous cytology was useful for supporting the diagnosis. Case 1 was a 56-year-old man who was referred with blurred vision, and was found to have iridocyclitis, vitreous opacities, and optic neuritis bilaterally. He also had a swelling of both mandibular glands. He received pulsed corticosteroid therapy, but the vitreous opacities and papilledema did not resolve. The second case was a 77-year-old man referred with blurred vision, and both eyes had snowball-like vitreous opacities and optic neuritis. The ocular findings in both cases strongly suggested sarcoidosis, but the systemic findings did not meet the diagnostic criteria for sarcoidosis. We performed pars plana vitrectomy to remove the vitreous opacities, and the collected vitreous samples were sent for cytological analyses. Epithelioid and multinucleated giant cells pathognomonic of sarcoidosis were found in the vitreous samples which enabled us to make a diagnosis of sarcoidosis. Vitreous cytology can help in supporting a diagnosis of sarcoidosis, especially in cases of ocular inflammation suggesting sarcoidosis but systemic findings that do not satisfy the diagnostic criteria for this disease.
[show abstract][hide abstract] ABSTRACT: Whether an intravitreal injection of bevacizumab in 1 eye will have any effect on the fellow eye has been discussed. The aim of this study was to determine the level of vascular endothelial growth factor (VEGF) in the fellow eyes after an intravitreal injection of bevacizumab in 1 eye with proliferative diabetic retinopathy.
Eight patients who had similar findings of proliferative diabetic retinopathy in both eyes were studied. Four patients had rubeosis (rubeosis group), and 4 patients did not have rubeosis (no-rubeosis group) in the anterior chamber. All patients received an intravitreal injection of bevacizumab (1.25 mg) in 1 eye. Samples of aqueous humor were collected from the injected eyes just before the injection of bevacizumab and 1 day after the first injection just before vitrectomy. Samples of aqueous humor from the fellow eyes were collected just before a second injection of bevacizumab in the fellow eye at 7 days after the first injection. The concentration of VEGF in the aqueous humor was measured by enzyme-linked immunosorbent assay.
After 1 day, the concentration of VEGF in injected eyes was significantly reduced from 3,230.3±2,136.8 to 3.1±3.6 pg/mL (P<0.05) in eyes with rubeosis and 465.0±78.8 to 0 pg/mL (P<0.05) in those without rubeosis. After 7 days, the VEGF level of the fellow eyes was still significantly lower than that in the injected eye just before the injection of bevacizumab (688.5±443.1 pg/mL) in the rubeosis group, and it was 7.8±13.2 pg/mL in the no-rubeosis group (P<0.05).
A single intravitreal injection of bevacizumab significantly reduced the VEGF concentrations in the aqueous humor of the fellow untreated eye. Thus, we need to be observant of the fellow eyes after a unilateral injection and also examine the patients for systemic changes.
Journal of ocular pharmacology and therapeutics: the official journal of the Association for Ocular Pharmacology and Therapeutics 08/2011; 27(4):379-83. · 1.46 Impact Factor
[show abstract][hide abstract] ABSTRACT: The anti-aquaporin-4 (AQP4) antibody was recently reported to be associated with neuromyelitis optica (NMO). Optic nerve involvements in many NMO cases are bilateral and the prognosis is poor. However, it has been suggested that plasma exchange is effective for those patients when steroid pulse therapy is ineffective. Herein, we report successful treatment of a patient with NMO using double-filtration plasmapheresis (DFPP).
A 22-year-old woman consulted a neurologist for neck pain in March 2008. High-intensity lesions were shown in the cervical spinal cord by T2-weighted magnetic resonance imaging. On July 15, the patient was referred to our department for a headache and pain and blurred vision in the left eye. The best-corrected visual acuity was 20/50 and 20/500 in the right and left eyes, respectively, with visual field defects observed in both. After 3 courses of steroid pulse therapy, anti-AQP4 antibodies were positive. In November, the patient again noticed visual acuity loss in the left eye and was treated by additional steroid pulse therapy, which was not effective. Next, she underwent plasma exchange therapy, though it was stopped due to hypotension and dyspnea. The next day, the patient underwent DFPP treatment and visual function gradually recovered.
It is important to consider NMO when steroid pulse therapy is not effective. We successfully and safely treated NMO in a young adult patient using DFPP.
Journal of ocular pharmacology and therapeutics: the official journal of the Association for Ocular Pharmacology and Therapeutics 08/2010; 26(4):381-5. · 1.46 Impact Factor
[show abstract][hide abstract] ABSTRACT: We examined the effectiveness of latanoprost for reducing intraocular pressure (IOP) in Japanese patients with normal tension glaucoma (NTG) over a 5-year period. Design: Prospective interventional case series. The patients were classified into 2 groups based on mean IOP.
A total of 38 patients with NTG were studied after being classified into the high-tension (mean IOP 16 mmHg or greater, n = 27) and low-tension (mean IOP lower than 15 mmHg, n = 11) groups. IOP was measured and Humphrey Field Analyzer (HFA) examinations were conducted at 6, 12, 24, 36, 48, and 60 months after beginning a daily administration of latanoprost.
Mean IOP before administration was 17.6 mmHg in the high-tension group, which was reduced to 13.9, 14.6, 14.4, 14.1, 13.6, and 14.6 mmHg at 6, 12, 24, 36, 48, and 60 months, respectively, after beginning administration. That in the low-tension group was 13.6 mmHg before administration, and then was reduced to 12.2, 11.4, 11.5, 12.5, 10.5, and 11.5 mmHg, respectively, after beginning administration was noted. Mean deviation (MD) values in the HFA examinations were reduced by -4.27 and -1.49 dB after 5 years in the high- and low-tension groups, respectively.
Latanoprost administration was effective in reducing IOP over a 5-year period in a range of 3.1-4.1 and 1.3-3.6 mmHg in NTG patients with high- and low-tension levels, respectively. In addition, our results indicate that latanoprost helped to prevent a decrease in MD values in both groups, as shown by the results of HFA examinations.
Journal of ocular pharmacology and therapeutics: the official journal of the Association for Ocular Pharmacology and Therapeutics 10/2009; 25(5):441-5. · 1.46 Impact Factor
[show abstract][hide abstract] ABSTRACT: To determine the cause of retinochorioditis in a patient with a granulomatous retinal exudate and an exudative retinal detachment.
A 45-year-old man presented at another hospital with increased visual disturbances of the left eye. He was diagnosed with uveitis, and treated with topical steroids for 1 month. However, the uveitis worsened, and he was referred to our hospital. Ophthalmoscopy showed a yellowish-white granulomatous exudate, and an exudative retinal detachment in the lower peripheral retina. The retinal detachment worsened and affected the macula. Pars plana vitrectomy was performed, and the retina was reattached. During the surgery, ocular samples were collected for further examinations. The titers of antibodies against 12 kinds of ascaridis were examined, and elevated titers of specific antibodies against porcine ascarids were detected in the subretinal fluid, but not in the aqueous humor, vitreous, or serum.
Vitrectomy with the collection of ocular samples, especially subretinal fluid, was a key procedure in the diagnosis and treatment of retinochoroiditis associated with the porcine ascarids.
Albrecht von Graæes Archiv für Ophthalmologie 08/2008; 246(7):1065-7. · 1.93 Impact Factor
[show abstract][hide abstract] ABSTRACT: Metastasis of a malignant tumor to the iris is rare. We treated a patient with such a metastasis from esophageal cancer.
A 58-year-old man who had had an operation for squamous esophageal cancer complained of conjunctival injection affecting the left eye. On examination, visual acuity in both eyes was 1.2, and intraocular pressure (IOP) in both eyes was 18 mmHg. A grayish tumor with irregular contours was found on the surface of the iris of the left eye at 2 o'clock, and cottonlike material was pooled in the anterior chamber. No metastases elsewhere in the body were clinically evident. After IOP rose to 34 mmHg accompanied by ocular pain, we performed a peripheral iridectomy for diagnosis. Pathologic findings indicated squamous esophageal cancer metastatic to the iris. Metastases to lung and liver were found by computed tomography shortly after hospitalization. Radiotherapy 40 Gy was applied to the iris tumor. IOP then fell, and ocular pain disappeared.
Metastasis of a squamous esophageal cancer to the iris can resemble a hypopyon. Radiotherapy was effective in this patient.
[show abstract][hide abstract] ABSTRACT: To compare the effectiveness of scleral buckling to vitrectomy for the treatment of rhegmatogenous retinal detachment (RRD) due to equatorial retinal tears.
Forty-six patients (46 eyes) > or =50 years of age with RRD due to equatorial retinal tears were studied. One group of 23 patients was selected by the randomized envelope method to be treated by scleral buckling and a second group of 23 to be treated by vitrectomy. The rate of retinal reattachment, the visual acuity, optical coherence tomography findings, and postoperative complications were determined. In addition, a questionnaire was filled out by the patients on their subjective assessment of the surgery and recovery.
The rate of retinal reattachment was identical in the two groups. The postoperative visual acuity, the number of patients with visual acuity > or =0.8 and the mean visual acuity were significantly better in the vitrectomy group (chi-squared and Mann-Whitney U tests, P < 0.05) within 12 months after surgery. At 24 and 36 months, the differences in the visual acuity were not significant. The answers to the questionnaire given by the patients in the vitrectomy group suggested that their surgical experiences and visual recovery were better than those of patients in the scleral buckling group.
In patients > or =50 years of age, vitrectomy was more effective than scleral buckling for obtaining good visual acuity in the short term.
Japanese Journal of Ophthalmology 01/2007; 51(5):360-7. · 1.27 Impact Factor
[show abstract][hide abstract] ABSTRACT: Sympathetic ophthalmia occurred after removal of silicone oil(SO) from a blind eye with chronic retinal detachment for 20 years. The enucleated eye was examined histopathologically.
A 22-year-old man had been diagnosed with traumatic retinal detachment from blunt trauma to his left eye when he was 3 years old. Pars plana vitrectomy with SO injection was performed at that time, but he lost the sense of light in that eye. Twenty years later, he experienced ocular pain because of absolute glaucoma. Sympathetic ophthalmia has occurred after pars plana vitrectomy with removal of SO and cyclophotocoagulation. The left eye was enucleated and examined histopathologically.
Histopathological study of the enucleated eye revealed necrosis of the ciliary body due to cyclophotocoagulation. Multiple small round empty spaces which may have been SO droplets were observed in the preretinal membrane, the subretinal space, and the choroidal stroma. In the choroid, diffuse granulomatous inflammation which could be called "silicone oil granuloma" was observed. Calcified drusens were seen at the peripheral fundus.
An eye containing injected SO for a long period might develop SO granuloma in the choroid and such condition could be the basis for subsequent sympathetic ophthalmia if a second operation with uveal damage was added.
[show abstract][hide abstract] ABSTRACT: To investigate the mechanism by which traumatic macular hole closes spontaneously.
Consecutive observational case series of three patients with unilateral traumatic macular hole who consulted medical staff at the Kansai Medical University between 1997 and 2000.
Three patients who sustained unilateral blunt trauma to the eye and developed traumatic macular hole were followed with ophthalmic examination, fundus photography, fluorescein angiography, and optical coherence tomography (OCT).
Case 1 was an 11-year-old boy. He had neither a macular hole nor prominent macular edema at his first consultation, but a macular hole opened 3 weeks later. OCT showed macular edema and a full-thickness macular hole. The tissue around the edge of the macular hole protruded inward toward the center and finally closed spontaneously 18 weeks later. Case 2 was a 19-year-old man. He had a tiny rough-edged macular hole at his first consultation with a local ophthalmologist. OCT showed macular hole enlargement and worsening of the macular edema during follow up. The macular hole finally closed 4 months after injury. Case 3 was a 15-year-old boy. He had a tiny rough-edged macular hole at his first consultation with a local ophthalmologist. The macular hole finally closed 6 months after injury.
Macular hole can be a result of severe damage from ocular concussion or damage to the retina. For 6 months following injury, traumatic macular hole should probably be observed rather than surgically repaired, because of the possibility that the macular hole may close spontaneously.
American Journal of Ophthalmology 10/2002; 134(3):340-7. · 3.63 Impact Factor
[show abstract][hide abstract] ABSTRACT: To determine the levels of pigment epithelium-derived factor (PEDF) and vascular endothelial growth factor (VEGF) in the vitreous of patients with diabetic retinopathy (DR).
Experimental study of PEDF and VEGF levels in vitreous samples collected during vitrectomy.
The levels of PEDF and VEGF were measured by enzyme-linked immunosorbent assay in the vitreous of 46 eyes of 43 patients who underwent vitrectomy with diabetic retinopathy (DR) (32 eyes of 29 patients) and an idiopathic macular hole (MH) (14 eyes of 14 patients).
The vitreal concentration of PEDF was significantly lower at 1.11 +/- 0.14 microg/ml (mean +/- standard error) in eyes with DR than in eyes with MH at 1.71 +/- 0.22 microg/ml (P =.021). The VEGF level was 1799 +/- 478 pg/ml in eyes with DR and not detectable in MH. The PEDF level in proliferative DR (PDR) (0.94 +/- 0.12 microg/ml) was lower than that in nonproliferative DR (NPDR) (2.25 +/- 0.32 microg/ml), and that in active DR (0.85 +/- 0.14 microg/ml) was significantly lower than that in inactive DR (1.59 +/- 0.24 microg/ml; P =.01). The VEGF level was 2025 +/- 533 pg/ml in PDR and 215 +/- 201 pg/ml in NPDR and that in active DR (2543 +/- 673 pg/ml) was significantly higher than that in inactive DR (395 +/- 188 pg/ml; P =.0098).
These results suggest that lower levels of PEDF and higher levels of VEGF may be related to the angiogenesis in DR that leads to active PDR.
American Journal of Ophthalmology 10/2002; 134(3):348-53. · 3.63 Impact Factor
[show abstract][hide abstract] ABSTRACT: To determine the vitreous levels of pigment epithelium-derived factor and vascular endothelial growth factor in eyes with rhegmatogenous retinal detachment and proliferative vitreoretinopathy.
Prospective, noncomparative case series.
Pigment epithelium-derived factor and vascular endothelial growth factor concentrations were measured by enzyme-linked immunosorbent assay in 26 eyes with retinal detachment, 6 with proliferative vitreoretinopathy, and 14 with an idiopathic macular hole.
Pigment epithelium-derived factor concentration in proliferative vitreoretinopathy (0.57 +/- 0.05 microg/ml) was lower (P =.0069), and retinal detachment (2.37 +/- 0.34 microg/ml) was higher (P =.16) than that in macular hole (1.71 +/- 0.22 microg/ml). Vascular endothelial growth factor concentration (168 +/- 139 microg/ml) in proliferative vitreoretinopathy was significantly higher than that in retinal detachment (11 +/- 11 microg/ml, P =.0084) and macular hole (not detectable, P =.0095).
Lower levels of pigment epithelium-derived factor and higher levels of vascular endothelial growth factor may be related to ocular cell proliferation.
American Journal of Ophthalmology 07/2002; 133(6):851-2. · 3.63 Impact Factor