[Show abstract][Hide abstract] ABSTRACT: To investigate the clinical characteristics and accompanying macular lesions in Japanese patients with basal laminar drusen (BLD).
Retrospective cross-sectional study. PATIENTS and
Fifty four eyes of 27 Japanese patients with BLD were examined for the clinical characteristics of BLD and accompanying macular lesions using retro-mode imaging (Scanning Laser Ophthalmoscope F-10, Nidek) in addition to current methods such as fluorescein angiography (FA), indocyanine green angiography (IA), fundus autofluorescence (FAF) and spectral domain optical coherence tomography (SD-OCT).
1)BLD was more clearly identified using retro-mode imaging than any of the other current imaging methods, and was divided into two types: a crater type (relatively sparsely distributed BLD with many soft drusens) and a mesh type (uniformly distributed BLD). 2) BLD in both eyes was more common in female patients, and had the same type, distribution and similar macular lesions in both eyes. 3) Among the macular lesions, we observed macular atrophy, retinal angiomatous proliferation and vitelliform detachment in many patients, in contrast to few cases of choroidal neovascularization and no polypoidal choroidal vasculopathy.
BLD may be regarded as a disease that is different from age-related macular degeneration (AMD).
No preview · Article · Oct 2013 · Nippon Ganka Gakkai zasshi
[Show abstract][Hide abstract] ABSTRACT: To investigate the relationship between increased permeability of choroidal vessels revealed by indocyanine green angiography (ICGA) and lesions of retinal pigment epithelium (RPE) revealed by Retro-mode (RM) in the eyes of patients with central serous chorioretinopathy (CSC).
A retrospective cross-sectional study.
We examined the minute granular lesions (MGLs) of the RPE using RM imaging (scanning laser ophthalmoscopy), in relation to the choroidal hyperpermeability visualized by indocyanine green angiography (ICGA) in 40 eyes of 20 Japanese patients with CSC. We classified them into two groups: eyes (25 eyes) with various retinal lesions and eyes without retinal lesions (15 eyes).
MGLs of the RPE in RM imaging were seen in 38 of 40 eyes (95%). The MGLs were detected in all 25 eyes in the group of various retinal lesions, and in 13 of 15 eyes (87%)in the group without retinal lesions. The area of MGLs exceeded the choroidal hyperpermeability in 18 eyes (45%), was the same as choroidal hyperpermeability in 15 eyes (38%), while 7 eyes (17%) had no hyperpermeability.
Choroidal hyperpermeability may be a possible cause of MGLs in the eyes of patients with CSC.
No preview · Article · Feb 2013 · Nippon Ganka Gakkai zasshi
[Show abstract][Hide abstract] ABSTRACT: To detect by Retro-mode (RM) imaging the nature and frequency of vascular indentation of the retinal pigment epithelium (RPE) due to polypoidal vessels and vascular networks in polypoidal choroidal vasculopathy (PCV).
Retrospective cross-sectional study.
Thirty eyes of 29 Japanese patients with PCV diagnosed by ophthalmoscopy and indocyanine green angiography (IA) were retrospectively analyzed by RM imaging. We evaluated the ratio of detection of polypoidal and network vessels in PCV by RM, the main causes hindering vascular indentation of the RPE, and the relationship of the findings in IA(late phase) to RM imaging.
In 13 out of the 30 eyes (43.3%) all of the polypoidal vessels of PCV were identified by RM imaging, whereas in 8 eyes (26.7%) only one part could be identified and none could be identified in the remaining 9 eyes (30%). Network vessels were detected completely in 15 eyes (50%), and partially in 5 eyes (16.7%)whereas none could be detected in the remaining 10 eyes (30.3%). In many cases the main causes of the hindered vascular indentation of the RPE were either serous retinal detachment and/or cystoid macular edema; fibrin, hemorrhagic pigment epithelial detachment, subretinal hemorrhages and pigment epithelial atrophy were also seen. Regarding the relationship of the findings of network vessels in IA (late phase) to RM imaging, RM imaging was superior or of equal value in finding network vessels in 14 (46.7%)of the 30 eyes.
RM imaging detected polypoidal vessels and network vessels of PCV as vascular indentations of the RPE.
No preview · Article · Oct 2012 · Nippon Ganka Gakkai zasshi
[Show abstract][Hide abstract] ABSTRACT: Using the Retro-mode (RM), to detect drusen and other minute lesions of the retinal pigment epithelium (RPE) invisible in current imaging methods in the fellow eye of Japanese patients with exudative age-related macular degeneration(AMD).
A retrospective cross-sectional study.
The fellow eyes of nineteen Japanese patients with unilateral exudative AMD were examined using RM imaging (F-10 fundus camera, Nidek), in contrast with fluorescein angiography, indocyanine green angiography, and optic coherence tomography (3D OCT-1000, Topcon Co). We were able to identify the type of drusen and minute granular lesions (MGLs) in the RPE.
In all patients, RM imaging gave easier to identify images of all types of drusen than other current imaging methods. Moreover, MGLs of the RPE either adjacent to drusen or without drusen, invisible in other current methods, were detected by RM imaging.
The RM provides clearer imaging of all kind of drusen, and MGLs of the RPE invisible with current methods. These MGLs are possible precursors of drusen.
[Show abstract][Hide abstract] ABSTRACT: To study the clinical features of vitreous hemorrhage (VH) after photodynamic therapy (PDT) for age-related macular degeneration(AMD).
Twelve patients (12 eyes: 1.7% of the 718 eyes on which PDT was performed) who had vitrectomy due to massive VH after PDT for AMD were studied. Their medical records were reviewed and courses and characteristics were studied.
Eight eyes (67%) were diagnosed as polypoidal choroidal vasculopathy and 7 eyes showed multiple clusters of grape-like lesions. Average greatest linear dimension (GLD) was 4533 microm, larger than common AMD. After vitrectomy, some cases retained choroidal neovascularization. Five eyes had another PDT and 3 eyes had a second vitrectomy due to recurrent vitreous hemorrhage.
Both PCV and a large GLD are risk factors for a massive vitreous hemorrhage after PDT therapy for AMD. As many cases retain choroidal neovascularization many patients require additional treatment. Continued observation after vitrectomy is essential.
No preview · Article · May 2009 · Nippon Ganka Gakkai zasshi
[Show abstract][Hide abstract] ABSTRACT: To study the visualization of the vitreoretinal interface in diabetic macular edema patients using three-dimensional optical coherence tomography (3 D-OCT) and to compare it to surgical findings.
We prospectively examined the medical records of 25 patients (30 eyes) with diabetic macular edema measured by 3 D-OCT (optic disc and macular lesions) who received vitrectomy between August 2006 and February 2007. We compared the findings of 3 D-OCT to the findings during surgery using triamcinolone acetonide.
Posterior vitreous membrane was found in 18 eyes using 3 D-OCT. The findings in all cases corresponded to operative findings. Six cases were characterized by posterior vitreous membrane attached to the optic disc and macular area. Twelve cases were characterized by posterior vitreous membrane diffusely attached to the posterior pole.
Vitreoretinal interfaces were visualized using 3D-OCT and confirmed by operative findings. 3 D-OCT is an effective tool to determine the pathogenesis of diabetic macular edema.
No preview · Article · Jun 2008 · Nippon Ganka Gakkai zasshi
[Show abstract][Hide abstract] ABSTRACT: We treated a patient with multifocal choroiditis (MFC) associated with serpiginous choroiditis and choroidal neovascularization (CNV).
In a 27-year-old woman whose left eye showed serpiginous choroiditis near the optic disc and multiple irregular chorioretinal scars and exudates in peripheral and near-peripheral zones, fluorescein angiography demonstrated diffusely scattered hyperfluorescent dots and late leakage from retinal vessels. The lesion near the optic disc showed hypofluorescence in the early venous phase, and hyperfluorescence in the late phase. Sub-Tenon injection of triamcinolone acetonide did not effectively treat the CNV secondary to serpiginous choroiditis, but direct laser photocoagulation was successful, achieving improved visual acuity.
We suggest that this patient's MFC and serpiginous choroiditis represented a single process rather than independent events. With lesions at the posterior pole, CNV developed secondarily. In this case, direct laser photocoagulation proved useful.
No preview · Article · May 2008 · Nippon Ganka Gakkai zasshi
[Show abstract][Hide abstract] ABSTRACT: To study the outcome after vitrectomy for chronic and acute macular edema associated with branch retinal vein occlusion (BRVO).
Medical charts of fifty-five patients (55 eyes) who underwent vitrectomy for macular edema associated with BRVO were reviewed retrospectively. Patients were followed up for more than one year after the vitrectomy. We compared the visual and structural outcome between an early group (i. e., edema lasting less than one year) and a late group (i.e., edema lasting more than one year).
The mean visual acuity improved significantly from 0.088 to 0.163 in the early group and from 0.147 to 0.132 in the late group. Seventy percent of the cases improved in angiographic findings and eighty percent of the cases improved in optical coherence tomography findings.
Vitrectomy for chronic macular edema even lasting more than one year after BRVO seems to be effective, depending on the case.
No preview · Article · Aug 2007 · Nippon Ganka Gakkai zasshi
[Show abstract][Hide abstract] ABSTRACT: To evaluate the effects of photodynamic therapy (PDT) with verteporfin 1 year after treatment in Japanese patients with age-related macular degeneration (AMD) and subfoveal choroidal neovascularization.
Between May 2004 and March 2005, PDT was performed on 102 eyes of 98 patients (60 men and 38 women) with AMD and subfoveal choroidal neovascularization. Patients were followed for at least 12 months after PDT.
The mean visual acuities in logarithm of the minimum angle of resolution (logMAR) units were 0.978 at baseline, 0.919 at 3 months, 0.895 at 6 months, 0.892 at 9 months, and 0.874 at 12 months. After PDT, the logMAR visual acuity improved by >0.3 logMAR units or more in 28 eyes (27%) and deteriorated by >0.3 logMAR units or more in 13 eyes (13%). Stable or improved vision was achieved in 93% of patients with polypoidal choroidal vasculopathy (PCV).
The visual outcome in our patients was similar to that of an earlier major Japanese study, and similar to or better than outcomes in Western studies. Differences between Caucasians and Japanese might influence the characteristics of PCV. It is possible that PDT is more effective for AMD patients with PCV than for other AMD patients. Further observations and longer follow-up are necessary.
No preview · Article · Jun 2007 · Japanese Journal of Ophthalmology
[Show abstract][Hide abstract] ABSTRACT: To study the factors for poor visual outcome in photodynamic therapy(PDT) for age-related macular degeneration (AMD) patients with subfoveal choroidal neovascularization.
Medical charts of eighty-five patients (88 eyes) who had AMD with subfoveal choroidal neovascularization were reviewed in the study. All patients were followed up by visual acuity assessment, angiography, and optical coherence tomography at least 6 months after PDT.
Out of 11 cases of poor visual outcome, 7 cases showed cystoid macular edema (CME) before treatment and 4 cases showed massive subretinal hemorrhage and/or vitreous hemorrhage after treatment. Some cases with CME had a worse visual outcome than cases without CME.
Some of the factors for poor visual outcome after PDT for AMD are the existence of CME before treatment and polypoidal choroidal vasculopathy (PCV). In some cases, PCV caused massive subretinal hemorrhage and/or vitreous hemorrhage after treatment.
No preview · Article · May 2007 · Nippon Ganka Gakkai zasshi
[Show abstract][Hide abstract] ABSTRACT: We report three cases of combined hamartoma of the retina and retinal pigment epithelium(combined hamartoma). One was typical and the other two cases showed a different picture in funduscopic examination because of their general complications.
Three patients, aged between 14 and 30, developed combined hamartoma showing various clinical feautures. The tumors were located on the optic disc or at the posterior poles. The tumors were pigmented and elevated with epiretinal membrane. The size of the lesion was 1.5 to 6 disc diameters and the color was yellowish-brown or black. Fluorescein angiography demonstrated hypofluorescence of the tumor in the early phase and hyperfluoresence of the capillaries of the tumor which were connected to retinal vessels. Indocyanine green angiography demonstrated leakage of probable capillaries of the tumor. One case showed tractional retinal detachment and the others showed retinal neovascularization or cystoid edema. The patients' vision did not improve, but the size of their lesions was stable during the follow-up period.
Combined hamartoma is usually benign. None of the patients developed tumor growth in our cases. However, two patients had severe visual loss because of complications.
No preview · Article · Feb 2007 · Nippon Ganka Gakkai zasshi
[Show abstract][Hide abstract] ABSTRACT: To report two cases of rhegmatogenous retinal detachment following rupture of retinal arterial macroaneurysm.
Observational case report.
Review of clinical records of 75 consecutive eyes (73 patients) with macroaneurysm.
Ruptured macroaneurysm was present in 68 of the 75 eyes, and rhegmatogenous retinal detachment developed spontaneously in 2 (2.9%) of the 68 eyes. In the 2 eyes with retinal detachment, there were no predisposing lesions to retinal detachment and the detachment occurred either 2 weeks or 1 month after the rupture of a macroaneurysm. Retinal detachment and posterior vitreous detachment developed simultaneously after bleeding from the macroaneurysm spread into the vitreous in 1 eye.
We report the occurrence of retinal detachment after macroaneurysmal rupture. Detailed fun-dus examination is required to detect retinal detachment in the follow-up of patients with ruptured macroaneurysm.
No preview · Article · Oct 2003 · American Journal of Ophthalmology
[Show abstract][Hide abstract] ABSTRACT: Various complications for choroidal melanoma have been reported. However, there are no reports on choroidal melanoma complicated with central retinal vein occlusion.
A 37-year-old male showed an elevated yellowish white tumor of about 8 discs in diameter, and involving the optic disc in the left eye. Serous retinal detachment and subretinal exudate were noted around the tumor. Central retinal vein occlusion occurred concurrently. Fluorescein angiography revealed blocks due to hemorrhage and fluorescence leakage from the retinal vein. Dilation of retinal capillary vessels and marked leakage of fluorescence from the retinal vein and capillary vessels were found in the tumorous region. In the late stage, the entire tumor presented hyper-fluorescence. On indocyanine green angiography, the tumor on the whole presented hypo-fluorescence from the early to late stage, and an insular hyper-fluorescence suggestive of the presence of intratumor vessels with leakage of fluorescence was seen inside. Ultrasonography revealed choroidal excavation. General examination showed no abnormality. On the basis of these findings the patient was diagnosed with choroidal melanoma.
We report a case of choroidal melanoma, which was complicated with central retinal vein occlusion by mechanical compression and invasion of the optic disc from the first medical examination.
No preview · Article · Jun 2003 · Nippon Ganka Gakkai zasshi
[Show abstract][Hide abstract] ABSTRACT: To report four cases of macular hole formation following ruptured retinal arterial macroaneurysm.
Review of clinical records of 75 consecutive eyes (73 patients) with macroaneurysm. Macroaneurysms were confirmed using either fluorescein angiography or indocyanine green angiography or both that indicated a telangiectatic retinal vascular change. Clinical data of patients with macroaneurysm with and without macular hole (MH) formation were compared retrospectively.
Of 75 eyes, four (5.3%; four patients) with macroaneurysm had a macular hole. In one of the four eyes, a macular hole was detected 2 days after the rupture. The distance from the macroaneurysm to the center of the fovea was significantly closer in the four eyes with a macular hole (MH group, 1.1 +/- 0.4 (mean +/- standard deviation [SD]) disk diameter) than in the 71 eyes without a macular hole (non-MH group, 1.9 +/- 0.9 disk diameter) (P =.0196). The incidence of subretinal hemorrhage in the macula was significantly greater in the MH group (100%) than in the non-MH group (35.2%) (P =.0195).
Macular hole formation associated with ruptured macroaneurysm is not as uncommon as previously thought. We suggest that there might be early onset of macular hole formation following ruptured macroaneurysm. Macroaneurysms with early-onset macular hole are present near the center of the macula and are accompanied by subretinal hemorrhage in the macula.
No preview · Article · May 2003 · American Journal of Ophthalmology
[Show abstract][Hide abstract] ABSTRACT: Background:
We encountered a patient who developed serous retinal detachment in one eye first, subsequently showed multiple small subretinal punctuated opacity looking like acute posterior multifocal placoid pigment epitheliopathy (APMPPE) in both eyes, and had repeated recurrence.
A 28-year-old female presented with serous retinal detachment accompanied by multifocal small subretinal white punctuated opacity at the posterior pole of the fundus in the left eye. Fluorescein angiography (FAG) revealed many small punctuated hypofluorescent lesions scattered all over the eye in the early stage and multiple subretinal spotty leakage of fluorescein, subretinal accumulation of dye, and leakage of fluorescein from the optic disc in the late stage. Indocyanine green angiography (ICG) revealed small punctuated hypofluorescent lesions from the early to late stage in both eyes. The disease recurred five and a half months after, and there appeared many yellowish white round opaque parts and serous retinal detachment at the posterior pole in both eyes. FAG showed a reversal phenomenon of fluorescein in both eyes. On ICG many small punctuated hypofluorescent lesions were noted and in the late stage insular faint hypofluorescence consistent with serous retinal detachment, light tissue stain and fluorescent leakage in the center of the hypofluorescent lesion were also found. The disease recurred three times thereafter. At present, about two years after the first medical examination, the fundus does not show any sunset glow-like fundus, and vision of 1.2 is maintained on the right and left.
A rare case of Harada disease complicated with APMPPE-like recurrence is presented.
No preview · Article · Feb 2001 · Japanese Journal of Ophthalmology
[Show abstract][Hide abstract] ABSTRACT: To evaluate the clinical features of knobby choroidal neovascularization (CNV) which was detected using indocyanine green (ICG) angiography and the association between knobby CNV and idiopathic polypoidal choroidal vasculopathy (IPCV).
We studied 164 eyes with retinal pigment epithelial detachment (PED) accompanied with CNV. These patients were older than 50 years. We detected knobby CNV in 96 eyes of 164 PED eyes (58.5%). Knobby CNV was defined as follows: knobbed blood vessels were observed from the early phase and remained hyperfluorescent through the ICG angiography. We classified 3 groups on the basis of the types of vessels with knobby CNV: group I, multiple isolated knobby CNVs without continuous vessels (24 eyes); group II, knobby dilatations in some parts of CNV (45 eyes); group III, network vessels ending in multiple aneurysmal swelling as in IPCV (27 eyes).
We found knobby CNV in only 20% of eyes with serous PED, but about 70% in neovascular, serosanguineous, and hemorrhagic PED. The ratio of each group showed no distinction statistically. Knobby CNV mostly appeared in macular areas, and was frequently accompanied with subretinal or subpigment epithelial hemorrhage. Subretinal reddishorange lesions were seen in 50% of group I, 60% of group II, and 89% of group III. Knobby CNV showed occult CNV in fluorescein angiography. In late phase ICG angiography, knobby CNV leaked ICG. New lesions occurred in all groups.
We think that knobby CNV is a common finding in subpigment epithelial neovascularization, and that IPCV vascular lesion is one type of subpigment epithelial neovascularization.
No preview · Article · Aug 1999 · Nippon Ganka Gakkai zasshi