[Show abstract][Hide abstract] ABSTRACT: Purpose: To introduce a simple technique to create a posterior vitreous detachment (PVD) through the posterior precortical vitreous pocket (PPVP) during microincision vitreous surgery using a wide-angle viewing system (WAVS). Methods: This study included 20 eyes of 20 consecutive patients (mean age, 65.6 years; range, 56-76) with a stage 2 or 3 idiopathic macular hole who underwent 25-gauge microincision vitreous surgery using a WAVS and phacoemulsification surgery. A triamcinolone suspension was injected into the vitreous cavity. The triamcinolone facilitated visualization of the posterior wall of the PPVP. Using a vitreous cutter, we suctioned the outer margin of the PPVP. After a resultant small break of the posterior hyaloid membrane developed and enlarged rapidly, a PVD easily expanded at the periphery. Results: Using this technique, we induced a PVD without close proximity to the optic disk and macula. Conclusion: This technique is an easy and safe method for creating a PVD during microincision vitreous surgery using a WAVS.
[Show abstract][Hide abstract] ABSTRACT: To investigate the relationship between age and chorioretinal hemodynamics in normal volunteers examined with Laser speckle flowgraphy (LSFG-NAVI).
107 eyes of 107 healthy volunteers aged from 21 to 78 years old were included. Laser speckle flowgraphy measurements of relative blood velocity (mean blur rate: MBR), skewness in the wave of blood velocity (Skew) and blowout score (BOS), which indicates ease of blood flow, were obtained as parameters of chorioretinal hemodynamics. MBR and BOS were measured on the optic disc and macula, and BOS and Skew were measured in retinal arteries and veins.
There was a negative correlation between age and MBR on the optic disc and macula. There was a negative correlation between age and BOS on the optic disc, macula, retinal arteries and retinal veins.
There was a negative correlation between MBR, BOS and age in all measurement areas. MBR and BOS may serve as indexes for a new interpretation of fundus pathology including age-related arterial sclerosis.
No preview · Article · Feb 2013 · Nippon Ganka Gakkai zasshi
[Show abstract][Hide abstract] ABSTRACT: To evaluate the protective effect of intravitreal bevacizumab (IVB) and sub-Tenon triamcinolone acetonide (TA) against choriocapillaris occlusion induced by photodynamic therapy (PDT).
This prospective, nonrandomized, consecutive study included 80 eyes of 80 patients with polypoidal choroidal vasculopathy who underwent an initial PDT. The posttherapeutic follow-up periods were more than 3 months (mean, 9.3 months). Patients were divided into three groups consecutively: the PDT group included 21 eyes of 21 patients treated with only PDT, the TA group included 32 eyes of 32 patients treated with PDT and a sub-Tenon injection of 20 mg TA, and the IVB group included 27 eyes of 27 patients treated with PDT and an intravitreal injection of 1.25 mg bevacizumab. Indocyanine green angiography (ICGA) was performed before and 3 months after PDT. The degree of choriocapillaris occlusion was assessed in the marginal zone of the PDT area based on the background hypofluorescence seen on ICGA quantified by densitometry (Imagenet).
ICGA at 1 and 5 min showed hypofluorescence in the marginal zone in all eyes 3 months after PDT. The hypofluorescence became indistinguishable from the background fluorescence 15 min after treatment in some eyes; however, the relative hypofluorescence persisted in some cases. The rates of fluorescence intensity in the marginal zone compared to those in the untreated area, i.e. the percentage of baseline fluorescence, were 0.60, 0.65 and 0.73 at 1, 5 and 15 min after dye injection in the PDT group, respectively, 0.64, 0.68 and 0.82 in the TA group, and 0.64, 0.73 and 0.90 in the IVB group. The intensity of the fluorescence was significantly (p < 0.05) higher in the TA group at 15 min and in the IVB group at 1, 5 and 15 min compared with the PDT group.
IVB and TA reduced choriocapillaris occlusion after PDT. IVB appeared to have a stronger protective effect than TA in this therapeutic regimen.
[Show abstract][Hide abstract] ABSTRACT: To compare the images of choroidal vasculature obtained by laser speckle flowgraphy (LSFG) and indocyanine green angiography (IA), and to evaluate the imaging of choroidal hemodynamics in eyes with polypoidal choroidal vasculopathy (PCV) using LSFG.
We performed IA and wide-field LSFG, which measures the index of blood velocity (mean square blur rate; MBR) in 25 eyes with PCV. We constructed an MBR map of the sequential MBR images (600 x 280 pixels) from four or five pulsations during measurement (4.5 s). A grayscale composite map of a still image was obtained by averaging the cumulative sum of the MBR map. We compared the angiographic images of the grayscale composite map to IA results and evaluated the choroidal hemodynamics of 25 eyes with PCV in the MBR map.
The choroidal vasculature on the grayscale map had a resolution similar to the IA results. The grayscale map detected branching network vessels in 20 (80%) of the 25 eyes and polypoidal lesions in 11 (44%) eyes. The MBR map showed that the pulsations of the branching network vessels and polypoidal lesions were synchronized with the cardiac rhythm. The fluctuation rates of the PCV lesions during one pulsation ranged from 8.3% to 26.7% (mean, 13.6%) and from 7.3% to 24.6% (mean, 15.9%) for the intact choroid. The MBR map showed the watershed zone and highest signal intensity in the macula.
Using an MBR map, wide-field LSFG revealed the pulsating choroidal hemodynamics of the posterior fundus. A grayscale composite map showed the fine choroidal vasculature whose resolution was comparable to that of IA. The branching network vessels of PCV showed that pulsation was synchronized with the choroidal vessels. Wide-field LSFG showed the highest choroidal blood flow in the macular area and the presence of a watershed zone.
No preview · Article · May 2008 · Japanese Journal of Ophthalmology
[Show abstract][Hide abstract] ABSTRACT: To identify the tomographic features of the branching vascular networks in patients with polypoidal choroidal vasculopathy (PCV).
We prospectively performed third-generation optical coherence tomography (OCT) and fluorescein angiography for 44 eyes of 42 patients (mean age +/- SD, 67.1 +/- 9.1 years) with PCV. All eyes had branching vascular networks and polypoidal lesions that were confirmed by indocyanine green angiography.
OCT showed double reflective layers that consisted of retinal pigment epithelium (RPE) and another highly reflective layer beneath the RPE ("double-layer sign") in the area of the branching network vessels in 26 (59%) of 44 eyes. The remaining 18 eyes had no double-layer sign, but 17 (94%) of 18 eyes had a slightly elevated RPE. A serous retinal detachment was present in 23 (88%) of 26 eyes with a double-layer sign, while only 1 (6%) of 18 eyes without the sign had a serous retinal detachment.
In PCV, the double-layer sign is seen frequently in the area of the network vessels, particularly in eyes with a serous retinal detachment. The sign may reflect fluid accumulation between RPE and Bruch membrane resulting from leakage from the network of abnormal vessels.