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Background: To investigate blood flow velocity (BFV) in the perifoveal capillaries before and after vitreous surgery for patients with epiretinal membrane (ERM). Methods: Twenty-one eyes in patients with ERM and 16 eyes in healthy subjects were involved in this study. Fluorescein angiography was performed using a scanning laser ophthalmoscope and BFV was analyzed by the tracing method. Foveal thickness (FT) was measured by optical coherence tomography. Results: BFV was significantly slower in the ERM patients (1.04 ± 0.10 mm/s) than in the healthy subjects (1.49 ± 0.11 mm/s ) ( p = 0.0010). BFV in the ERM patients 6 months after vitreous surgery (6 M) (1.21 ± 0.02 mm/s) significantly increased compared with BFV before surgery (0 M) (1.04 ± 0.10 mm/s) ( p = 0.0061). BFV 1 year after vitreous surgery (1 Y) significantly increased (1.38 ± 0.02 mm/s) compared with BFV(6 M) (1.21 ± 0.02 mm/s) ( p = 0.0235). FT was significantly greater in the ERM patients (351.7 ± 87.1 μm) than in the healthy subjects (158.9 ± 16.9 μm) ( p = 0.0011). FT (6 M) significantly decreased (285.3 ± 36.9 μm) compared with FT before surgery (0 M) (351.7 ± 87.1 μm) ( p = 0.0212). FT did not show significant differences between (6 M) and (1 Y). No significant correlation was found between BFV and FT before surgery. Conclusions: Perifoveal capillary BFV in patients with ERM was slower than that in the healthy subjects, and significantly improved after vitreous surgery as time progressed. It can be said that perifoveal capillary BFV is related to the development and improvement of ERM in the long term. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the correlation of soluble intercellular adhesion molecule 1 (sICAM-1) and vascular endothelial growth factor (VEGF) with macular edema in patients with central retinal vein occlusion (CRVO). Methods: Twenty-nine patients who had CRVO with macular edema and 16 patients with non-ischemic ocular diseases (control group) participated. Retinal ischemia was evaluated by measuring the area of capillary non-perfusion with fluorescein angiography and the public domain Scion Image program. Macular edema was examined by optical coherence tomography. Vitreous samples were obtained during pars plana vitrectomy. VEGF and sICAM-1 levels in vitreous fluid and plasma were determined by enzyme-linked immunosorbent assay. Results: The median vitreous levels of VEGF and sICAM-1 were significantly higher in the CRVO patients than in the control group [366 vs. 15.6 pg/ml ( P < 0.001) and 20.5 vs. 5.0 ng/ml ( P < 0.001), respectively]. Vitreous levels of both VEGF and sICAM-1 were also significantly higher in the CRVO patients who had retinal ischemia than in those without ischemia ( P < 0.001 and P = 0.011, respectively). Vitreous levels of VEGF and sICAM-1 were also significantly correlated with the severity of macular edema ( P = 0.004 and P = 0.012, respectively). Conclusions: VEGF and sICAM-1 may both increase vascular permeability in CRVO patients with macular edema, with sICAM-1 acting together with and/or via VEGF. [ABSTRACT FROM AUTHOR]

Purpose: To investigate whether pigment epithelium-derived factor (PEDF) or vascular endothelial growth factor (VEGF) influences macular edema in patients with central retinal vein occlusion (CRVO). Materials and Methods: In 27 patients who had CRVO with macular edema and 21 patients with nonischemic ocular diseases (control group), retinal ischemia was evaluated by measuring the area of capillary nonperfusion on fluorescein angiography and macular edema was examined by optical coherence tomography. Vitreous fluid samples were obtained during pars plana vitrectomy. Results: The vitreous level of VEGF was significantly higher in the CRVO patients than in the controls (median: 366 vs. 15.6 pg/ml, P < 0.0001), while the vitreous level of PEDF was significantly lower in the patients than in the controls (median: 17.5 vs. 28.4 ng/ml, P == 0.0298). Vitreous levels of VEGF were significantly higher in CRVO patients with retinal ischemia than in those without ischemia ( P < 0.0001), while PEDF levels did not show a significant difference. Vitreous levels of VEGF and PEDF were related to the retinal thickness at the central fovea ( P == 0.0059 and P == 0.0308, respectively). Conclusions: VEGF and PEDF may independently influence retinal vascular permeability in CRVO patients with macular edema. [ABSTRACT FROM AUTHOR]

Background: We investigated whether pigment epithelium-derived factor (PEDF) or vascular endothelial growth factor (VEGF) influence macular edema in patients with branch retinal vein occlusion (BRVO). This investigation aimed to clarify the influence of PEDF in the vitreous fluid on retinal vascular permeability in patients with macular edema secondary to BRVO. The findings were expected to be useful for the treatment of macular edema in BRVO patients. Methods: This was a retrospective cross-sectional comparative case series. Thirty-three BRVO patients with macular edema and 24 control patients with nonischemic ocular diseases were enrolled. Retinal ischemia was evaluated by measuring the area of capillary nonperfusion on fluorescein angiography with Scion Image software. Macular edema was examined by optical coherence tomography. Vitreous fluid samples were obtained via pars plana vitrectomy, and the VEGF and PEDF levels were determined by enzyme-linked immunosorbent assay. Results: The vitreous level of VEGF was significantly higher in BRVO patients than controls ( P < 0.001). The vitreous PEDF level was significantly lower in BRVO patients than controls ( P = 0.026). In BRVO patients, vitreous levels of PEDF and VEGF showed a significant negative correlation with each other ( P < 0.001). Additionally, the vitreous VEGF level had a significant positive correlation ( P < 0.001) and the vitreous PEDF level had a significant negative correlation ( P < 0.001) with the nonperfused retinal area in BRVO patients. Furthermore, vitreous levels of VEGF and PEDF showed significant positive ( P = 0.001) and negative ( P = 0.014) correlations, respectively, with macular edema in BRVO patients. Conclusions: VEGF and PEDF may inversely influence retinal vascular permeability in patients with ischemic BRVO and macular edema. However, prospective validation will be needed to confirm these observations. [ABSTRACT FROM AUTHOR]

Background: In patients who have macular edema secondary to retinal vein occlusion, the role of vasoactive molecules such as growth factors and the influence of molecules related to leukocyte adhesion need to be investigated further. Methods: A prospective study was performed to investigate the relations between perifoveal capillary blood flow velocity and the vitreous levels of vascular endothelial growth factor (VEGF) and soluble intercellular adhesion molecule-1 (sICAM-1) in patients with macular edema and retinal vein occlusion. Undiluted vitreous specimens were obtained from 11 eyes of 11 patients with macular edema (nine had branch retinal vein occlusion and two had central retinal vein occlusion). VEGF and sICAM-1 levels were measured by enzyme-linked immunoabsorbent assay. Before vitreous sampling, perifoveal capillary blood flow velocity was measured by fluorescein angiography with a scanning laser ophthalmoscope and the tracing method. The relations between perifoveal capillary blood flow velocity and the vitreous levels of VEGF and sICAM-1 were investigated. Results: There was a significant correlation between perifoveal capillary blood flow velocity and the vitreous level of sICAM-1 ( ρ = −0.7303, p = 0.03). In contrast, there was no significant association between blood flow velocity and the vitreous level of VEGF ( ρ = −0.1458, p = 0.67). Conclusions: The vitreous level of sICAM-1 is associated with perifoveal capillary blood flow velocity in patients who have retinal vein occlusion and macular edema. [ABSTRACT FROM AUTHOR]

Purpose: To investigate perifoveal capillary blood flow velocity and retinal thickness at the central fovea in patients with branch retinal vein occlusion (BRVO) and macular edema and to assess their relation with visual acuity and visual prognosis. Methods: Eighteen patients with BRVO and 16 healthy volunteers were compared. Perifoveal capillary blood flow velocity was measured on fluorescein angiograms with a scanning laser ophthalmoscope by the tracing method. Retinal thickness was measured at the central fovea by optical coherence tomography. Best-corrected visual acuity (BCVA) was determined. Results: BCVA differed significantly between patients and controls ( P < 0.0001). Among patients, BCVA was negatively correlated with perifoveal capillary blood flow velocity by univariate analysis ( r = −0.7916, P < 0.0001), and positively correlated with retinal thickness at the central fovea ( r = 0.8970, P < 0.0001). Multivariate analysis showed that retinal thickness at the central fovea was the only independent determinant of BCVA ( P < 0.0001). Conclusions: In patients with BRVO, BCVA was more strongly influenced by retinal thickness at the central fovea than by perifoveal capillary blood flow velocity. [ABSTRACT FROM AUTHOR]

Acta Ophthalmol. 2010: 88: 646–651 Purpose: This study aimed to investigate whether vascular endothelial growth factor (VEGF) or interleukin-6 (IL-6) influence macular oedema in patients with central retinal vein occlusion (CRVO). Methods: Sixteen consecutive patients with unilateral CRVO and macular oedema were studied, along with eight age- and sex-matched patients without ischaemic ocular disease. Retinal ischaemia was evaluated from capillary non-perfusion on fluorescein angiography. Macular oedema was examined by optical coherence tomography. Aqueous humour (AH) samples were obtained during combined pars plana vitrectomy and cataract surgery, and were examined by enzyme-linked immunosorbent assay. Results: Aqueous levels of VEGF and IL-6 were significantly elevated in patients compared with controls (p = 0.0142 and p < 0.0001, respectively). Aqueous levels of both molecules were significantly higher in patients with ischaemia than in those without ischaemia (p = 0.0026 and p = 0.0487, respectively). Furthermore, AH levels of VEGF and IL-6 were correlated with the severity of macular oedema (ρ = 0.7265, p = 0.0049, ρ = 0.5324, and p = 0.0392, respectively). Conclusions: Both VEGF and IL-6 were elevated in the AH of patients with macular oedema and ischaemic CRVO, suggesting that these molecules may be related to the increase in vascular permeability in such patients. [ABSTRACT FROM AUTHOR]

Purpose: Our purpose was to determine whether a reduction in blood flow velocity (BFV) in the perifoveal capillaries is involved in the pathogenesis of branch retinal vein occlusion (BRVO) in patients with hypertension. Methods: Subjects included hypertensive patients with ( n = 12) and without ( n = 16) BRVO and healthy volunteers ( n = 16). Perifoveal BFV was measured by the tracing method using fluorescein angiography and a scanning laser ophthalmoscope. Logistic regression analysis was performed to assess factors that influenced the presence or absence of BRVO. Results: Mean BFV showed a significant decrease across the three groups (healthy controls: 1.49 ± 0.11 mm/second; hypertensive patients without BRVO: 1.36 ± 0.12 mm/second; hypertensive patients with BRVO: 1.16 ± 0.24 mm/second; ptrend < 0.001). Multivariate logistic regression analysis showed that BFV was a significant risk factor for the presence of BRVO. Conclusions: Perifoveal capillary BFV is reduced in hypertensive patients with and without BRVO. It is possible that a decrease in BFV may be involved in the occurrence of BRVO. Measurement of perifoveal capillary BFV may be useful for investigating the pathogenesis and progression of BRVO. [ABSTRACT FROM AUTHOR]

Purpose: To investigate independent risk factors related to the progression of non-proliferative diabetic retinopathy (NPDR) for Japanese Type 2 diabetic patients. Methods: One hundred and six patients with NPDR were followed up for 2 years. Diabetic retinopathy (DR) was determined by colour fundus photography. Multivariate logistic regression analysis was performed to assess variables independently associated with the progression of NPDR. Serum concentrations of novel risk factors for atherosclerotic vascular disease, including lipoprotein (a) [Lp(a)] and fibrinogen, were measured. Results: Thirty-three patients (31%) had progressed by two scale steps or more in 2 years. The progression of NPDR was significantly associated with HbA1c [odds ratio (OR) 2.12; 95% confidence interval (CI) 1.14–4.87], systolic blood pressure (OR 1.72; 95% CI 1.14–2.91), Lp(a) (OR 2.70; 95% CI 1.09–5.12) and fibrinogen (OR 1.68; 95% CI 1.03–3.08). Multivariate logistic regression analysis showed that HbA1c (OR 1.74; 95% CI 1.12–3.21) and Lp(a) level (OR 1.90; 95% CI 1.06–4.33) were significant and independent predictors of the progression of NPDR. Conclusion: These data suggest that serum Lp(a) level is an independent risk factor for the progression of NPDR in Type 2 diabetes patients. We recommend that further prospective validation of our findings be undertaken to confirm these observations. [ABSTRACT FROM AUTHOR]

Diabetic retinopathy, a cause of blindness, is often associated with the upregulation of vascular endothelial growth factor (VEGF) in the retina. Recently, leukocyte adhesion (leukostasis) is claimed for the occlusion of retinal capillary vascularity, which ultimately assists in the progression of diabetic retinopathy. In addition, intercellular adhesion molecule-1 (ICAM-1), a representative factor for leukostasis, is increased in diabetic retina. Endothelin (ET)-1, a potent vasoconstrictor peptide, is closely linked to the pathogenesis of diabetic retinopathy. Different therapeutic interventions concerning VEGF have already been proposed to prevent diabetic retinopathy. However, no study has yet reported concerning the effects of ET-1 receptor antagonist on the upregulated VEGF and ICAM-1 in morphologically intact diabetic retina. The current study investigated the effect of ETA receptor antagonist (TA-0201; 1 mg kg-1 day-1) on the expressions of VEGF and ICAM-1 in rat diabetic retina. Diabetes was induced by intraperitoneal injection of streptozotocin (70 mg/kg) in Sprague-Dawley rats, whereas control rats (Cont) received only citrate buffer. After 1 week, the streptozotocin-administered rats were randomly divided into two groups: ETA receptor antagonist-treated group (DM+TA-0201) and saline-treated group (DM+vehicle). After the treatment for 4 weeks, the retina was removed from the eyeball. In DM+vehicle group, the VEGF expression of retina was significantly increased (33.5 pg/mg) in comparison with that in the Cont group (25.1 pg/mg), and the upregulation of VEGF was reversed in DM+TA-0201 group (26.9 pg/mg), a phenomenon consistent with the change in VEGF mRNA levels. The expression of retinal ICAM-1 was increased in DM+vehicle group (55.1 pg/mg) compared with Cont group (43.8 pg/mg), and ET antagonism completely blocked this increase (43.8 pg/mg). Moreover, an increased leukostasis by 3.3-fold in DM+vehicle retina was returned to the control level by ET antagonism. In the current study, there was no obvious retinal morphological alteration from both the hematoxylin and eosin staining and the FITC-dextran angiography. Thus, ETA receptor antagonist might be useful in preventing the progression of diabetic retinopathy, as evidenced by suppressing the increase in VEGF and ICAM-1 levels as well as leukostasis in morphologically intact diabetic retina. [ABSTRACT FROM AUTHOR]

Thin plant-supporting poles penetrated the orbits of two patients. In one case (a 66-year-old female), the pole penetrated into the skull and reached the dorsal pons, producing a transient one-and-a-half syndrome. The lesion was confirmed by MRI. In the other (a 55-year-old female), the pole damaged the optic nerve at the orbital apex, leading to permanent monocular blindness. [ABSTRACT FROM AUTHOR]

Objective: To investigate the mechanisms of regulation between vascular endothelial growth factor (VEGF) as a stimulator and endostatin as an inhibitor of angiogenesis in diabetic retinopathy (DR). Methods: One hundred fifty-nine eyes of 120 diabetic patients were studied. Concentrations of VEGF and endostatin in vitreous fluid and aqueous humor, obtained from the eyes during ocular surgery, were measured by enzyme-linked immunosorbent assay. The severity of DR was quantified according to the Early Treatment Diabetic Retinopathy Study retinopathy severity scale; fundus findings, including soft exudates, intraretinal microvascular abnormalities, venous abnormalities, new vessels elsewhere, new vessels on the disc, vitreous hemorrhage, and retinal detachment, were graded and evaluated. Concentrations of VEGF and endostatin in plasma were also measured by enzyme-linked immunosorbent assay. Main Outcome Measures: Concentrations of VEGF and endostatin in vitreous fluid and plasma. The correlations among the clinical records and the levels of VEGF and endostatin were analyzed statistically. Results: The concentrations of VEGF in aqueous humor and vitreous fluid were significantly correlated with the severity of DR (ρ=0.447, P<.001 and ρ=0.363, P=.007, respectively). The concentrations of endostatin in aqueous humor and vitreous fluid were also significantly correlated with the severity of DR (p=0.302, P<.001 and p=0.344, P=.009, respectively). The slope of the regression line between the VEGF and endostatin concentrations in vitreous fluid differed significantly between active DR and quiescent DR (P=.04). The concentrations of VEGF and endostatin in the eyes were not correlated with those in the plasma. Conclusions: These results show that both VEGF and endostatin are correlated with angiogenesis in DR. Our study suggests that the regulation mechanism between VEGF and endostatin is associated with the activity of DR and may be a good candidate to develop... [ABSTRACT FROM AUTHOR]

It is a well known fact that the berry aneurysms, which are the direct cause of subarachnoid hemorrhage, develop at the apices of bifurcations of larger cerebral arteries. In order to elucidate the morphogenesis of the aneurysms in these sites, electron microscopic observation was made on one of their predilective regions, that is, the bifurcation of the first temporal branches from the middle cerebral arteries. Human autopsy cases from newborn and elderly patients were studied. The apices of the cerebral arterial bifurcations exhibited a medial defect immediately after birth, where collagen fibrils, ground substance and increased basement membrane-like substance were observed, suggesting that the defect might have resulted from necrosis of medial muscle cells. The tunica media adjacent to the defect became tapered into a wedge-like shape with the thin and towards the defect and the medial muscle cells were decreased in number. In young cases, medial muscle cells near the defect displayed focal cytoplasmic necrosis, and granulovesicular cell debris and lamellar increase of basement membrane-like substance were seen around the muscle cells with irregular profiles. With aging the defect gradually enlarged and the adjacent part of the media composed of lamellarly or reticularly increased basement membrane-like substance and granulovesicular cell debris, without muscle cells. In the media away from this area muscle cells were irregular and surrounded by granulovesicular cell debris, similarly increased basement membrane-like substance, and increased collagen fibrils, with enlarged intercellular spaces. The internal elastic lamina at the apices of bifurcations showed fragmentation and lumpy degradation both of which increased with age. Necrosis of medial muscle cells and subsequent enlargement of the medial defect together with degenerative changes in the internal elastic lamina, which are age-induced and presumed to be due to haemodynamic factors, are all considered to be important in the formation of berry aneurysms. [ABSTRACT FROM AUTHOR]

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The changes of perifoveal capillary blood flow velocity (BFV), visual acuity, and retinal thickness after pars plana vitrectomy (PPV) have been unclear in patients with branch retinal vein occlusion (BRVO) and macular edema. In a prospective study, PPV was performed on six eyes of six consecutive BRVO patients with macular edema (two women and four men; mean age: 66.3 ± 5.0 years). Patients were examined preoperatively and 6 months postoperatively. BFV was measured by fluorescein angiography using a scanning laser ophthalmoscope and the tracing method. Macular thickness was examined by optical coherence tomography. Visual acuity was measured preoperatively and postoperatively, and data were converted to the logarithm of the minimum angle of resolution (logMAR). In all six treated eyes, the macular thickness decreased significantly compared with before PPV (464 ± 98 μm versus 224 ± 55 μm, P = 0.0082), mean BFV increased significantly compared with before PPV (1.14 ± 0.14 mm/sec versus 1.46 ± 0.21 mm/sec, P = 0.0013), and mean logMAR decreased significantly compared with before PPV (0.57 ± 0.34 versus 0.17 ± 0.21, P = 0.0036). PPV may improve perifoveal microcirculation and the visual prognosis in BRVO patients with macular edema. [ABSTRACT FROM AUTHOR]

Presents several correspondence on ophthalmology as of May 1999. Graves ophthalmology; Roles of cytokines in diabetic retinopathy; Use of acronyms in journals.