[Show abstract][Hide abstract] ABSTRACT: Multiple evanescent white dot syndrome (MEWDS) is an acute and usually unilateral retinopathy that occurs predominantly in young adults. This report presents the outcomes of ganglion cell analysis (GCA) in MEWDS.
A 41-year-old woman was diagnosed as MEWDS in right eye. At her initial visit, the deviation map of the ganglion cell analysis showed there was a decrease of the ganglion cell layer (GCL) + inner plexiform layer (IPL) thickness in both eyes, even though her left eye was not affected. A 29-year-old woman was also diagnosed as MEWDS in right eye. Although the deviation map of ganglion cell analysis showed there was a decrease of the GCL + IPL thickness in both eyes at her initial visit, her right eye was not affected.
GCA indicated there was a decrease (<1% of the distribution of normals) of the ganglion cell layer + inner plexiform layer thickness in both the affected and fellow eyes in 7 of 9 patients diagnosed as MEWDS in our hospital. Although the lesions responsible for MEWDS are thought to disrupt the photoreceptor outer segments, we observed changes in the inner retina in both the affected and fellow eye of MEWDS patients.
[Show abstract][Hide abstract] ABSTRACT: Rupture of the extraocular muscle in the absence of significant injury to the eyeball and adnexa is uncommon. The authors report a case of blunt trauma of the eyeball associated with an inferior oblique muscle and an inferior rectus muscle rupture. A 55-year-old man slipped and fell down hitting his eye on an extended windshield wiper blade. Although he had treatment in the emergency room, he complained of diplopia in the primary position 1 day postoperatively. After noticing ruptures of the inferior oblique muscle and an inferior rectus muscle during exploratory surgery, the authors carefully repaired it. Diplopia in the primary position had disappeared within 1 month after the operation and by 6 months postoperatively. The movement of the eye had almost completely recovered.
Ophthalmic Plastic and Reconstructive Surgery 09/2014; · 0.91 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: We present a patient with an animal-type malignant melanoma associated with the nevus of Ota in the orbit who showed a good prognosis after a combination of orbital extirpation, chemotherapy, stereotactic radiotherapy, and gamma knife. A 42-year-old Japanese woman presented with two tumors, one pathologically diagnosed as right-sided intraconal animal-type malignant melanoma and the other intracranially, presumed to be of the same pathogenesis and both were considered to have arisen from the nevus of Ota. She underwent an extirpation of the orbit, chemotherapy (DAV therapy, which is a combination of dacarbazine, nimustine, and vincristine), stereotactic radiotherapy (54 Gy in 27 fractions), and gamma knife (marginal dose was 17 Gy, target volume was 0.2 ml). She has been alive for 33 months since the extirpation, with no sign of local recurrence, new metastasis, nor enlargement of the intracranial tumor. Not just combination therapy but also the low malignancy of animal-type melanoma may have contributed toward the good prognosis.This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License, where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially. http://creativecommons.org/licenses/by-nc-nd/3.0.
Melanoma research 03/2014; 24(3). · 2.06 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: PURPOSE. To observe the posterior vitreous in children using swept-source optical coherence tomography (SS-OCT). METHODS. The normal right eyes of 73 children (ages, 3-11) years were studied using SS-OCT with 12-mm horizontal and vertical scans in the posterior fundus. RESULTS. Posterior precortical vitreous pockets (PPVPs), narrow liquefied spaces along the vitreoretinal interface in the macula (mean, 165.4±35.2 µm (depth) x 3,327±615.7 µm (width), were observed at age 3 in horizontal scans. The PPVPs enlarged to 382.9±51.8 x 4,486.5±342.3 from ages 4 to 6 (P<0.01) and 524.9 ± 60.3 x 5,485.9±307.5 after age 7 (P<0.01). In all subjects, the depth and width were means of 426.4±38.2 and 4,834.4±228.1 µm, respectively. There were significant correlations between the PPVP size and age (PPVP depth, r=0.42, P<0.001; PPVP width, r=0.42, P<0.001) but not refractive error. The PPVP posterior wall was not visible in all eyes. The PPVP and Cloquet's canal appeared as separate spaces at ages 3 and 4 years. The connecting channel between the PPVPs and Cloquet's developed in 7.7%, 11.1%, 12.5%, 27.3%, 40%, 37.5%, and 50% at ages 5, 6, 7, 8, 9, 10, and 11, respectively. CONCLUSIONS. PPVPs emerged in front of the macula as a solitary space in early childhood. They first were narrow liquefied spaces anterior to the macula at age 3 and evolved to small boat-shaped spaces that gradually enlarged with age. The channels connecting the PPVPs and Cloquet's canal begin to form after age 5. Their presence suggests a physiologic role of the PPVPs.-
[Show abstract][Hide abstract] ABSTRACT: PURPOSE. To observe vitreous changes in high myopia using swept-source optical coherence tomography (SS-OCT). METHODS. We performed slit-lamp biomicroscopy and SS-OCT in the highly myopic right eyes of 151 patients (mean age, 52.7 years; mean refraction, -11.4 diopters [D]) and the right eyes with no myopia of 363 healthy control volunteers (mean age, 52.8 years; mean refraction, -1.4 D). To estimate the sizes of the posterior precortical vitreous pockets (PPVPs), we measured the height between the fovea and the anterior border of the PPVPs. RESULTS. Patients with partial posterior vitreous detachments (PVDs) around the macula and complete PVDs in high myopia were significantly (P<0.0001) younger (47.1±14.1 and 61.2±12.0 years, respectively) than in controls (59.0±9.6 and 69.7±6.6 years). The PPVPs with no PVDs were significantly (P<0.001) higher in 32 eyes with high myopia (984±292 µm) than 164 controls (553±166 µm). After a complete PVD with a Weiss ring developed, the vitreous cortex was on the macula in 40.5% of the eyes with high myopia, which differed significantly (P<0.0001) from the 8.7% of the controls. Myopic foveoschisis was present in 14 (9.3%) of 151 eyes. In eyes with foveoschisis, three (21.4%) eyes had partial PVDs and 11 (78.6%) eyes had complete PVDs; there was no residual cortex in eight (72.7%) of 11 eyes with complete PVDs. CONCLUSION. Highly myopic eyes may have larger PPVPs than normal eyes. Partial and complete PVDs occur at younger ages, and the vitreous cortex frequently remains on the macula after development of complete PVDs in high myopia.
[Show abstract][Hide abstract] ABSTRACT: Rebamipide was initially developed and approved for use in treating gastric ulcers and lesions associated with gastritis. Discovery of its ability to increase gastric mucin led to investigations of its effect on ocular surface mucin and the subsequent development for use in dry eye patients. Investigations have confirmed that rebamipide increases corneal and conjunctival mucin-like substances along with improving corneal and conjunctival injury. Clinically, rebamipide ophthalmic suspensions can effectively treat tear deficiency and mucin-caused corneal epithelial damage, and can restore the microstructure responsible for tear stability. Topical rebamipide has also been shown to be effective in treating other ocular surface disorders such as lagophthalmos, lid wiper epitheliopathy, and persistent corneal erosion. Rebamipide's ability to modify epithelial cell function, improve tear stability, and suppress inflammation in the absence of any known major side effects suggest that it may be a beneficial first drug of choice for severe dry eye treatment and other ocular surface disorders. This review summarizes the history and development of this innovative dry eye treatment from its initial use as an effective stomach medication to its current use in the treatment of dry eye in Japan.
[Show abstract][Hide abstract] ABSTRACT: To measure the alterations of the choroidal thickness in Carotid cavernous fistula (CCF) using enhanced depth imaging optical coherence tomography (EDI-OCT).
A 64-year-old woman was referred to us for redness, exophthalmos and visual disturbance in her right eye. She was diagnosed with CCF by magnetic resonance imaging (MRI) and magnetic resonance angiography.Observations; Embolization resulted in improvement of ocular symptoms, and there was a reduction of the subfoveal choroidal thickness in the right eye from 351 mum preoperatively to 142 mum postoperatively in EDI-OCT.
EDI-OCT demonstrated that the choroidal thickness increases occurred due to congestion in a CCF case.
[Show abstract][Hide abstract] ABSTRACT: To evaluate the clinical outcomes after gas tamponade without vitrectomy for retinal detachment associated with an optic disk pit using optical coherence tomography.
Intravitreal gas injection was performed on 8 consecutive patients (mean age, 35.0 years; range, 15-74 years) with unilateral macular detachment associated with an optic disk pit. A 0.3-mL injection of 100% sulfur hexafluoride 6 gas was carried out without an anterior chamber tap. Patients treated with gas injection were instructed to remain facedown for 5 days.
Complete retinal reattachment after only gas tamponade was achieved in four out of eight eyes. The mean number of gas injections was 1.8. The mean best-corrected visual acuity before and after the treatment with gas tamponade was approximately 30/100 and 20/20, respectively. The period required for reattachment after final gas treatment was 12 months. There were no incidences of recurrence after complete reattachment by gas tamponade in any of the cases during the 94-month average follow-up period (range, 64-132 months).
Gas tamponade appears to be an effective alternative method for macular detachment associated with an optic disk pit, even though the mechanisms of optic disk pit maculopathy are still unknown.
[Show abstract][Hide abstract] ABSTRACT: PURPOSE: To observe posterior precortical vitreous pockets (PPVPs) using swept-source optical coherence tomography (SS-OCT). METHODS: We performed SS-OCT in both eyes of 58 volunteers (36 men, 22 women) using 12-mm horizontal vertical scans through the macula and optic disc. To minimize age-related changes (liquefaction or posterior vitreous detachment), all subjects were a mean of 26.2 years (range, 22-40 years). The refractive errors ranged from -9.5 diopters (D) to +3.0 D. To estimate the PPVP size, we measured the height between the fovea and the anterior border of the PPVP and the maximal width in the 12-mm horizontal scan through the fovea and disc. RESULTS: SS-OCT visualized the PPVPs as boat-shaped lacunae in the macular area bilaterally in all subjects (maximal width, 3,114-9,887 µm; mean width, 6,420.6; central height, 208-1,877 µm; mean height, 708.1 in the right eyes, with no significant difference in the left eyes). There was a significant correlation between the PPVP height and myopic refractive error. The posterior wall of the PPVP was a thin vitreous cortex, thinnest at the fovea. The septum was between the nasal border of the pocket and Cloquet's canal, which extended forward and tilted superiorly in all cases. A channel connected Cloquet's canal and the PPVPs bilaterally in 54 (93.1%) of 58 cases. CONCLUSION: SS-OCT clarified the boat-shaped PPVP structure in vivo. Although the central height increased with the myopic refractive error, the width was unchanged. A channel connecting Cloquet's canal and PPVP suggested the route of aqueous humor into the PPVP.
[Show abstract][Hide abstract] ABSTRACT: Administration of topical rebamipide increases the mucin level of tear film and improves the ocular surface in short break-up time type of dry eye. Lid wiper epitheliopathy (LWE) is a disorder of the marginal conjunctiva of the upper eyelid with dry eye symptoms. LWE may be related to mechanical forces during blinking resulting in inflammation of the ocular surface. Rebamipide also has various anti-inflammatory effects. In this report, we tried treatment with topical rebamipide for two cases of LWE. One case had been treated with sodium hyaluronate ophthalmic solution and diquafosol sodium eye drops by other doctors for several weeks. The other case was not previously treated. In both cases, fluorescein staining of the cornea and lid margin was remarkably improved, ocular symptoms decreased, and tear film break-up times increased with rebamipide eye drops four times daily for 2-3 weeks. Topical rebamipide was effective for corneal and conjunctival disorders in LWE. This drug may provide a novel approach to the treatment of LWE.
[Show abstract][Hide abstract] ABSTRACT: Administration of topical rebamipide improves the ocular surface in dry eye. We consecutively studied seven eyes in seven cases (three males and four females) with mild lagophthalmos (three cases after eyelid surgery, two cases of incomplete facial nerve palsy, and two cases of senile ectropion) during the treatment of corneal disorders with rebamipide eye drops four times daily for 2 weeks. The fluorescein corneal staining (FCS) score, tear film break-up time (TBUT), Schirmer's test, and decimal visual acuity were examined. Ocular symptoms were examined and scored by questioning each patient before and after administration of the drug. In all seven eyes, inferior corneal erosion decreased or disappeared within 2 weeks after administration of topical rebamipide. The FCS score was significantly improved (P < 0.05). The TBUT was significantly extended from 2.9 ± 0.5 seconds to 5.2 ± 0.4 seconds (P < 0.05). The scores of ocular symptoms, such as eye pain, dryness, blurred vision, and foreign body sensations, were significantly improved (P < 0.05).Topical rebamipide was effective for corneal disorders in mild lagophthalmos. This drug may provide a novel approach to treat lagophthalmos.
[Show abstract][Hide abstract] ABSTRACT: Purpose. To evaluate the morphologic and functional changes of the primate retina after light exposure using spectral-domain optical coherence tomography (SD-OCT) and electroretinography (ERG). Methods. Seven monkey eyes with light-emitting diode (LED) contact lenses were exposed to light for 8 hours. SD-OCT and ERG were performed bilaterally before, after the light exposure, and on days 1 and 14 in three monkeys. The tests were repeated after 4 months, followed by enucleation 12 hours later. Six eyes of three other animals were enucleated 12 hours after the first light exposure, and two eyes of one monkey were enucleated after 14 days, followed by microscopy. Results. Immediately after light exposure, SD-OCT showed increased reflectivity of the outer segment (OS). Electron microscopy showed intracellular vacuolated and irregular lamellar structures at the proximal OS, while the distal end of the OS was unfolded at the RPE interface. At 14 days, the histologic changes and the OCT images returned to normal. ERG showed decreased cone and rod responses immediately after light exposure and decreased cone responses on day 1. Normalization occurred on day 14. Conclusions. Light exposure caused increased reflectivity of the photoreceptor OS, which corresponded to intracellular vacuolization and irregularity of the lamellar structure of the OS. OCT images returned to normal along with the histologic restoration. Rod and cone responses decreased transiently immediately after light exposure, which might be attributed to incomplete recovery from retinal bleaching.
[Show abstract][Hide abstract] ABSTRACT: We report a case of longitudinal avulsion of the inferior rectus muscle following orbital floor fracture and describe its clinical presentation, computed tomography (CT) features and management. A 53-year-old man felt vertical diplopia in all gaze immediately after the trauma. Orthoptic assessment showed left over right hypertropia of 20 prism diopters and left exotropia of 10 prism diopters in primary position. The left orbital floor fracture and the prolapse of orbital contents into the maxillary sinus were presented by CT. Exploration of the orbit was performed under general anesthesia. The displaced bone fragment was elevated and repositioned below the slastic implant. Diplopia continued in all directions of gaze, although the impairment of depression was reduced postoperatively. A residual left hypertropia of 10 prism diopters and exotropia of 10 prism diopters was present in primary position 1 month after surgery, though there were no enopthalmos or worsening of hypesthesia. Repeated CT revealed the muscle avulsion of inferior rectus at the lateral portion of the belly. The avulsion of a small segment of the inferior rectus and its herniation into maxillary sinus in more posterior views was detected by review of the preoperative images. Muscle avulsion should be considered in the management of orbital fracture if orbital tissue entrapment and nerve paresis are excluded as causes of reduction in ocular motility. A thorough review of the imaging studies for possible muscle injury is required before surgery in all cases of orbital fracture.
[Show abstract][Hide abstract] ABSTRACT: Rebamipide is an antiulcer agent used to treat gastric ulcer and gastritis. Biological effects of rebamipide include cytoprotection, wound healing, and anti-inflammatory properties that are known to be universal for a variety of tissues in addition to gastrointestinal mucosa. The therapeutic effects of rebamipide eye drops are due to its ability to increase corneal and conjunctival mucin-like substances and improve corneal and conjunctival injury in vivo. In this paper, we report a case of Sjögren's syndrome with complete disappearance of corneal erosion after administration of rebamipide eye drops. This was observed even though corneal erosion had not improved for 6 months after punctal occlusion surgery. The patient was a 33-year-old female, diagnosed with Sjögren's syndrome by a salivary gland biopsy. The corneal and conjunctival surfaces were filled with dense erosions, which did not improve with topical drugs. Punctal plugs were applied several times; however, the plugs were repeatedly shed. All four puncta of both eyelids were surgically occluded, and both corneal and conjunctival erosion was clearly improved. However, the erosion in the inferior cornea of both eyes had not improved for 6 months after surgery. We used the newly approved topical rebamipide for treatment of this patient. The corneal erosion gradually improved and completely disappeared 4 weeks after administration of the drug. Dry eye sensation disappeared at the same time. Both membrane-associated mucin and secreted mucin in the ocular surface are thought to be essential for maintenance of the tear film. Induction of mucin from ocular surface epithelium could be an effective treatment in cases of dry eye caused by mucin deficiency. Through its various mechanisms, rebamipide improves ocular surface conditions. To our knowledge, this is the first clinical case report using rebamipide ophthalmic solution. This drug may provide a novel approach to treat drying diseases of the eye.
[Show abstract][Hide abstract] ABSTRACT: A 30-year-old female patient was referred to our institution due to vitreous hemorrhage. Best corrected visual acuity of her right and left eyes at her initial visit was 10/20 and 20/20, respectively. Although hypochromic iris was observed in the superior iris between the 10 and 2 o'clock positions in her right eye, her entire left eye exhibited hypochromic iris. Hypopigmentation of the fundus was seen in the superior part of her right eye. This eye also had a huge neovascularization on the optic disc that was 7 discs in diameter. Conversely, her left fundi showed hypopigmentation of the fundus in the entire region of the left eye, and dot hemorrhages were observed all over the left fundi, although no neovascularization could be seen microscopically. Fluorescein angiography showed a huge neovascularization in the right eye and a tiny neovascularization in the left eye. Gene analysis revealed the presence of the PAX3 gene homeobox domain mutation, which led to her being diagnosed as Waardenburg syndrome type 1. Magnetic resonance angiography showed there was no obstructive region at either of the internal carotid arteries and ophthalmic arteries. The severity of the diabetic retinopathy appeared to be correlated with the degree of hypopigmentation in the posterior fundus. We speculate that hypopigmentation of the fundus in Waardenburg syndrome may be responsible for the reduction in retinal metabolism, which led to a reduction in oxygen consumption and prevented further aggravation of the diabetic retinopathy. Only laser treatments using short wavelengths was effective in this case. While the extinction coefficient for hemoglobin when using green light is higher than when using yellow light, the differences between these wavelengths tend to disappear when oxygenated hemoglobin is present. To the best of the authors' knowledge, this is the first case report of a patient with Waardenburg syndrome and diabetic retinopathy.
[Show abstract][Hide abstract] ABSTRACT: To evaluate the improvement in subjective symptoms of conjunctivochalasis after bipolar coagulation.
Forty-three eyes of 26 patients (average age, 75.7 ± 8.4 years) were included in this study. The inferior conjunctivas were cauterized between April 2009 and June 2010. Surgery involved pinching the excess conjunctiva and performing bipolar cauterization after subconjunctival injection of a local anesthetic agent. Patients were asked to describe the postoperative foreign-body sensation and change in subjective symptoms 1 month postoperatively, with the preoperative symptom score defined as 10.
Twenty-two patients (84.6%) reported symptom relief immediately after the procedure, though all patients had a mild gritty sensation for 1-2 weeks postoperatively. The mean postoperative symptom score obtained from the questionnaire was 3.27 ± 3.31, which was significantly lower than the preoperative score (P < 0.0001). No patients had experienced recurrent symptoms at the end of the follow-up period.
Thermal cauterization can achieve conjunctival shrinkage and adherence to the subconjunctival tissues. Operation time is only a few minutes, postoperative pain is not severe, and the procedure can be performed in an outpatient clinic, all of which represent benefits to the patients.
[Show abstract][Hide abstract] ABSTRACT: To evaluate the ocular complications of intravitreal injection of high dose bevacizumab in monkey eyes.
Four healthy monkeys (Macaca fuscata) received an intravitreal injection of either 6.25 or 12.5 mg bevacizumab in the right eye; the left control eye received an intravitreal injection of the same volume of saline. The eyes were examined using slit lamp and funduscopy, optical coherence tomography (OCT), electroretinography (ERG), fundus photography (FP), fluorescein angiography (FA), and indocyanine green angiography (ICGA). The eyes were enucleated 28 days after the intravitreal injection and subjected to light microscopy.
No pathologic changes were observed by FP, FA, ICGA, OCT, and light microscopy in the eyes injected with either of the two bevacizumab doses. ERG showed no toxic change in the eyes that received the 6.25-mg dose. In two eyes that received the 12.5-mg dose, ERG showed no significant difference between the right and left eyes 4 weeks after injection, although there were transient changes in scotopic responses.
No irreversible toxic effects were observed in monkey eyes receiving an intravitreal injection of high dose bevacizumab.
[Show abstract][Hide abstract] ABSTRACT: Bone marrow- (BM-) derived cells can differentiate into smooth muscle-like cells (SMLC), resulting in vascular pathogenesis. However, the molecular mechanism of the differentiation remains unknown. We have recently reported that Notch signaling promotes while a Notch target HERP1 inhibit the differentiation of mesenchymal cells to SMC. During the differentiation of BM-derived mononuclear cells into smooth muscle alpha-actin (SMA)-positive cells, expression of Jagged1 and SMC-specific Notch3 was increased. Blocking Notch with gamma-secretase inhibitor prevented the induction of SMA. Wire-mediated vascular injury was produced in femoral arteries in mice transplanted with green fluorescent protein (GFP)-positive cells. Many double-positive cells for GFP/Jagged1 or GFP/Notch3 were detected in the thickened neointima. In contrast, only a few SMA-positive cells were positive for GFP in neointima where HERP1, a suppressor for Notch, were abundantly expressed. In conclusion, Notch-HERP1 pathway plays an important role in differentiation of BM-derived mononuclear cells into SMLC.
Biochemical and Biophysical Research Communications 03/2009; 381(4):654-9. · 2.28 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To investigate the toxic effects of perfusion of intravitreal melphalan during vitrectomy on the rabbit retina.
We performed electoretinography (ERG) in 18 eyes of 18 healthy albino rabbits before and after intraocular melphalan perfusion at concentrations of 5-, 10-, and 20-microg/ml during pars plana vitrectomy. Fellow eyes that underwent vitrectomy without melphalan served as controls. The histopathologic retinal changes were observed in both eyes of two rabbits from each group.
In the 5-microg/ml perfusion group, the ERGs and histology showed no substantial changes compared with control fellow eyes during 28 days postoperatively. In the 10- and 20-microg/ml groups, the mean a-wave amplitude decreased to 52% and 31% respectively of the fellow eye; the mean b-wave amplitude decreased to 52% and 19% respectively. However, the peak implicit time of the a- and b-waves did not significantly differ in the 10- and 20-microg/ml groups during 28 days postoperatively. Histologic sections showed necrosis of the inner nuclear layer and thinning of the outer nuclear layer in the 10-microg/ml group. Loss of the outer nuclear layer and the photoreceptor layer and necrosis of the inner nuclear layer were observed in the 20-microg/ml group.
The intravitreal 5-microg/ml melphalan perfusion during vitrectomy appears to be nontoxic to the retina. This therapeutic modality might be a potential treatment for retinoblastoma with vitreous seeding.
Albrecht von Graæes Archiv für Ophthalmologie 05/2008; 246(4):501-8. · 2.33 Impact Factor