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Purpose: To investigate the relationship between age and chorioretinal hemodynamics in normal volunteers examined with Laser speckle flowgraphy (LSFG-NAVI)., Subjects and Methods: 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., Results: 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., Conclusion: 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.

Purpose: To elucidate the long-term outcome of internal limiting membrane (ILM) peeling on visual function during vitrectomy for idiopathic macular holes using scanning laser ophthalmoscope (SLO) microperimetry., Design: Prospective uncontrolled study., Patients and Methods: We studied 31 eyes (29 patients) with idiopathic macular holes. All patients underwent vitrectomy with ILM peeling. The SLO microperimetry was performed preoperatively, and once a year for 3 years postoperatively to detect scotomas in and around the macular holes, and both within and in close vicinity to the areas of ILM peeling., Results: Closure of macular holes after one surgery was confirmed in all cases except for 2 with second surgery. The visual acuity by logarithmic minimum angle of resolution (logMAR) averaged 0.71 +/- 0.36 before surgery, 0.23 +/- 0.31 one year, 0.14 +/- 0.27 two years and 0.12 +/- 0.26 three years after surgery. There was significant improvement up to 2 years after the surgery. All scotomas detected before surgery in the holes, and 77.4% of those detected around the holes decreased gradually. No scotomas were detected in or around the area of ILM peeling either before or after surgery., Conclusion: ILM peeling in vitrectomy for idiopathic macular holes successfully improved visual acuity and did not influence retinal sensitivity in and around the area of ILM peeling. The scotomas detected in and around the holes before surgery gradually reduced or disappeared.

We summarize the pathogenesis and the treatment strategy for macular edema in patients with branch retinal vein occlusion (BRVO), focusing on the role of the cytokines. Various cytokines are involved in the pathogenesis of macular edema associated with BRVO. When BRVO occurs, it leads to retinal ischemia that induces the production of cytokines such as vascular endothelial growth factor (VEGF) by retinal cells such as glial cells and vascular endothelial cells in the occluded region affected by anoxia. These cytokines interact with each other (cytokine network) and this results in impairment of the blood-retinal barrier and an increase of vascular permeability, considered important in the development of macular edema associated with BRVO. Treatment for this condition includes triamcinolone acetonide, anti-VEGF antibody, laser therapy and vitrectomy, all of which lead to the suppression of cytokine production. To manage macular edema associated with BRVO, it is important to control cytokine production with a combination of treatments.

Background: Traumatic neuropathy of the optic chiasm is a rare finding which occurs after severe blunt head trauma. It is often accompanied by dysfunction of the pituitary gland and hypothalamus and called traumatic chiasmal syndrome. We report a patient with traumatic chiasmal syndrome caused by a severe traffic accident., Case: A 25 year-old woman was referred for bitemporal visual field defects caused by a traffic accident two months before. Corrected visual acuity was 0.05 in the right eye and 1.2 in the left eye. Bilateral optic atrophy and relative afferent pupillary defect in the right eye were found. Magnetic resonance imaging revealed an enlarged optic chiasm. Computed tomography disclosed many fractures in the skull including the back wall of the sphenoid sinuses. She also suffered from diabetes insipidus and anosmia., Conclusion: Traumatic optic neuropathy of the optic chiasm is a rare condition which can be differentiated from neuropathy in the optic canal by considering the patterns of visual field defects and their accompanying signs.

This paper conducts an analysis and discussion of the pathogenesis and treatment strategies for diabetic retinopathy, a major cause of blindness. Histological examination of experimental and biopsied material found that the pericyte necrosis and basement membrane thickening were responsible for sclerosis of retinal microvessels. The macrophages were noted in the pathogenesis of retinopathy. The cytokines of intraocular fluid were analyzed, and the vascular endothelial growth factor and intercellular adhesion molecule-1 were found to be closely related to retinopathy and macular edema. These findings suggest that the inflammation lead to the complex pathology of retinopathy. Anti-inflammatory drugs need to be included in the therapeutic strategy. The Diabetic Eye Notebook is an important source of information for patients who were lost to followup.

Purpose: To compare 5 years transition of recognition, utilization, and purpose accomplishment in a diabetic eye notebook., Methods: A questionnaire survey regarding the diabetic eye notebook was conducted with ophthalmologists and physicians in 10 prefectures of 9 areas in 2003 and 2008., Results: The reply ratio of the questionnaire survey was 26% for ophthalmologists and 26% for physicians. The recognition and utilization ratio of diabetic eye notebook was significantly increased. The recognition and utilization ratio of diabetic eye notebooks in physicians was lower than in ophthalmologists. The improvement of cooperation of medical treatment, patients' understanding and consciousness of diabetic eye complications, and counter-measures of dropout by using diabetic eye notebooks have increased, but the significant difference was not., Conclusions: Although the recognition and utilization of diabetic eye notebooks has increased, there is still insufficient accomplishment of their purpose. There is a need for more elucidation of the importance of these notebooks not only for ophthalmologist but also for physicians and certified diabetes educators.

Background: We report a successful treatment by vitrectomy in an adult case of Prader-Willi syndrome., Case Report: We encountered a case of Prader-Willi syndrome in a 29-year-old male patient with proliferative diabetic retinopathy and cataract. We performed a vitrectomy and a cataract extraction on the patient. Initial examination showed proliferative diabetic retinopathy in both eyes. Funduscopy revealed tractional retinal detachment with atrophic retina in the right eye and retinal detachment in the inferior half of the fundus with vitreous hemorrhage in the left eye. We performed a vitrectomy with a combination of phacoemulsification and intraocular lens implantation only on the left eye. Visual acuity in the left eye increased from counting fingers preoperatively to 0.6(n.c) postoperatively. The right eye was left untreated because the visual prognosis was not expected to improve even if the eye received surgical intervention. The final visual acuity in the right eye was no light perception at the end of the follow-up period., Conclusion: Careful follow-up and early treatment are necessary for patients with diabetic retinopathy accompanied by Prader-Willi syndrome as it could develop into blindness.

Purpose: To investigate the awareness and understanding of ophthalmologic complications by diabetic patients and assess the problems., Subjects and Methods: In August 1999, a questionnaire survey was done of 3,613 diabetic outpatients attending the Department of Internal Medicine at Tokyo Women's Medical University Diabetes Center., Results: Patients who understood diabetic retinopathy as ophthalmological complications were 54.4% and those to whom physicians explained the complications were 33.8%. Patients who were recommended to receive an eye examination by physicians were 66.4% and those who continued to attend the eye clinic were 61.8%. Patients who had ophthalmological complications explained by physicians were 74.2%., Conclusion: Few patients understood diabetic retinopathy as a diabetic ophthalmological complication. To encourage the awareness and understanding concerning diabetic retinopathy, it is important to form a tight relationship between physicians and ophthalmologists and to improve the system for educating patients.