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: PurposeTo describe a newly developed stabilized retinal laser Doppler instrument, to report the reproducibility of retinal blood flow measurements, and to present examples of its clinical application.: DesignExperimental study.: MethodsThe intrasession, intersession, and interobserver reproducibility of retinal blood flow measurements obtained using the Canon Laser Blood Flowmeter model CLBF 100 was assessed. Intrasession: the coefficients of variation (CV) for repeated measurements (5X) of retinal vessel diameter (D), time-average centerline blood velocity (Vav), and blood flow (F) were calculated at 18 sites along temporal retinal arteries and 18 sites along temporal retinal veins using both eyes in six healthy volunteers. Intersession: the correlation coefficients and average differences between two sets of measurements at the same 36 retinal sites made by one examiner on two different days were calculated. Interobserver: the correlation coefficients and average differences between two sets of measurements at nine sites (five arterial and four venous) in five eyes of five of the volunteers made by two examiners on the same day were calculated. Results from two patients, one with branch retinal vein occlusion (BRVO), and one with central retinal vein occlusion (CRVO), are used to illustrate abnormal retinal circulatory characteristics.: ResultsIntrasession: CV (mean ± SD) for D, Vav, and F were 5.5% ± 2.2%, 13.1% ± 6.3%, and 13.8% ± 4.7% in arteries and 3.5% ± 2.1%, 11.9% ± 5.9%, and 12.7% ± 5.5% in veins. Intersession/interobserver: strong correlations between measurements made by one examiner on two different days and by two examiners on the same day were found in D, Vav, and F. Average differences in F were 16.4% ± 12.8% for intersession and 12.6% ± 7.0% for interobserver comparisons. Results from the patient with BRVO show marked differences in flow characteristics in the affected quadrant compared with an unaffected quadrant in the same eye, and to the fellow eye. Results from the patient with CRVO show a dramatic improvement in flow characteristics after clearing of the occlusion.: ConclusionsThe reproducibility results and the fact that blood flow is measured in actual units of μl/min indicate that the instrument can be used for reliable comparison of blood flow characterictics at different retinal vascular sites in the same eye, at comparable sites in both eyes, and for comparison between patients and healthy control subjects. [Copyright &y& Elsevier]

Purpose: To determine when posterior vitreous detachment (PVD) develops in the fellow eye after development in the first eye.Design: Prospective, observational case series.Participants: Fifty-one patients with acute unilateral PVD participated in the study.Methods: All patients underwent a comprehensive ocular examination, including a dynamic vitreous examination using biomicroscopy with and without a preset lens and retinal examination with scleral depression, every 3 months at least until PVD developed in the fellow eye.Results: Posterior vitreous detachment developed in 4 eyes (8%) within 6 months, 12 eyes (24%) within 1 year, 24 eyes (47%) within 18 months, 33 eyes (65%) within 2 years, 41 eyes (80%) within 30 months, and 46 eyes (90%) within 3 years. In 5 eyes (10%), PVD did not develop during the follow-up period of more than 3 years.Conclusions: Posterior vitreous detachment develops frequently in the fellow eye from 6 months to 2 years after development in the first. These findings are useful for the management of patients with unilateral PVD. [Copyright &y& Elsevier]

Purpose: To analyze the vitreomacular interface in idiopathic full-thickness macular holes (MHs) using spectral-domain optical coherence tomography. Design: Prospective cross-sectional case series. Methods: Ninety-one eyes of 86 consecutive patients with a MH were examined by spectral-domain optical coherence tomography. The vitreomacular interface was assessed and the presence or absence of an operculum was analyzed. Results: Fifty-two eyes had a stage 2 MH, 12 eyes a stage 3 MH, and 27 eyes a stage 4 MH. No posterior hyaloid membrane was detected in any eyes with a stage 4 MH. In 35 (54.7%) of the 64 eyes with an MH without a complete posterior vitreous detachment (PVD), we saw a perifoveal PVD with vitreofoveal adhesion and partial dehiscence of the raised inner retina with an outer retinal separation in the MHs. In 24 (37.5%) of the 64 eyes without a complete PVD, an operculum, which is a hyperreflective structure of the foveal retina, was in front of the MH. The posterior hyaloid membrane was separated completely but adhered to the optic disc. In 2 (3.1%) of the 64 eyes without a complete PVD, the posterior hyaloid membrane was separated from the macula without an operculum. In 3 (4.7%) of the 64 eyes without a complete PVD, vitreofoveal adhesion on both edges of the hole was connected to the taut posterior hyaloid membrane without an operculum. Conclusions: The vitreomacular interface had 4 configurations in MHs without a complete PVD. Approximately 55% of cases with an open roof in the eyes without a complete PVD may be at risk for progression to operculum formation (loss of retinal tissue). [ABSTRACT FROM AUTHOR]

Purpose: To estimate the rate of macular hole formation in fellow eyes with a perifoveal posterior vitreous detachment (PVD) and early stage 1 intrafoveal lesions in patients with a unilateral idiopathic full-thickness macular hole (MH) using optical coherence tomography (OCT). Design: Retrospective observational case series. Methods: Fellow eyes of consecutive patients with a unilateral full-thickness MH were examined on OCT. A subset of fellow eyes with a perifoveal PVD had been followed to investigate the rates of macular hole formation in fellow eyes with early stage 1 intrafoveal lesions. Results: Of 176 patients with a unilateral full-thickness MH, 42 fellow eyes (42 patients) with a perifoveal PVD were identified. During follow-up, a foveolar detachment was seen in 16 eyes, and 4 eyes had a foveal pseudocyst alone. In the 16 eyes with a foveolar detachment, 9 eyes had concurrent inner foveal splits. Within another 2 years of follow-up, OCT showed that 5 of 16 fellow eyes (31%) with a foveolar detachment developed a second full-thickness MH and 5 of 9 fellow eyes with a foveolar detachment and inner foveal splits developed a second full-thickness MH. Two of 4 eyes with a foveal pseudocyst alone developed vitreofoveal separation without hole formation. The remaining 2 eyes with a foveal pseudocyst alone remained stable at the last follow-up visit. Conclusions: Fellow eyes with a foveolar detachment and a perifoveal PVD may be at high risk, and fellow eyes with a foveolar detachment and inner foveal splits might be at higher risk for progression to macular hole formation. [ABSTRACT FROM AUTHOR]

Objective: To report the case of a stage 1 macular hole and the sequential intrafoveal changes with spectral-domain optical coherence tomography (SD-OCT). Design: Single, observational case report. Participant: A 51-year-old woman with a stage 1A macular hole that progressed to a stage 2 macular hole. Methods: Clinical ophthalmologic examinations were repeated, including SD-OCT, during follow-up at intervals of several weeks. Main Outcome Measures: Sequential intrafoveal tomographic alterations in a patient with a stage 1 macular hole. Foveal splits in the inner retina progressed to an enlarged pseudocyst that disrupted the outer retinal layer (ORL) resulting from the vitreous traction associated with a perifoveal posterior vitreous detachment (PPVD). Results: The patient was referred for decreased vision in the left eye. Her best-corrected visual acuity was 20/32 in the left eye. The SD-OCT showed intrafoveal splits of a typical stage 1A macular hole with a PPVD. Two weeks later, a small, triangularly shaped foveal detachment was detected beneath the central fovea. Four weeks after the initial visit, the splits expanded and the foveal surface was elevated anteriorly; a columnar structure between the splits beneath the central fovea was seen. Eight weeks after the initial visit, the columnar structure was pulled from the outer retina with formation of the PPVD; the structure had shortened anteriorly and formed a cone-shaped structure under the roof. Eleven weeks after the initial visit, the cone-shaped structure shortened and became smaller under the inner roof, and the ORL was separated completely. The anatomic features of the foveal pseudocyst were comparable with that of a typical stage 1B macular hole. Eighteen weeks after the initial visit, the cone-shaped structure disappeared under the inner roof. Thirty weeks after the initial visit, the roof opened with formation of the PPVD. The foveal anatomic features of the full-thickness macular hole became comparable with that of a typical stage 2 macular hole. Conclusions: These OCT findings suggested that the cone-shaped structure was pulled from the outer retina by anteroposterior vitreous traction. This may cause a progressively enlarging pseudocyst that disrupts the ORL in some cases of stage 1 macular holes. Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article. [Copyright &y& Elsevier]

: ObjectiveTo study the prevalence of drusen in the fellow eye of Japanese patients with age-related macular degeneration (AMD).: DesignRetrospective, cross-sectional study.: ParticipantsSeventeen eyes of 17 Japanese patients with unilateral AMD.: Main outcome measuresTo compare the frequency of drusen based on photography and scanning laser ophthalmoscopy with confocal and ring apertures and a diode laser (780 nm).: ResultsUsing the scanning laser ophthalmoscope (SLO) with a ring aperture, drusen were detected clearly as in topographic imaging. In the fellow eyes of the study patients with AMD, photography showed drusen in 10 cases (58.8%); however, SLO imaging detected drusen in 15 cases (88.2%). The number of drusen detected using SLO imaging was significantly greater than when using photography (P < 0.05).: ConclusionsScanning laser ophthalmoscope imaging is superior to photography for detecting drusen in the fellow eyes of Japanese patients with unilateral AMD. The prevalence of drusen in the fellow eye of Japanese patients with AMD is much higher than previously speculated. [Copyright &y& Elsevier]

: ObjectiveTo investigate the relationship between preoperative photoreceptor displacement and postoperative scotoma after unilateral idiopathic macular hole surgery.: DesignProspective nonrandomized comparative self-controlled trial.: ParticipantsTwenty patients who underwent successful surgery for unilateral idiopathic macular hole participated in the study.: MethodsKinetic perimetry using red and green filter glasses, black binocular fixation targets, and red and green selective monocular stimuli was performed preoperatively. Scanning laser ophthalmoscope (SLO) microperimetry was performed preoperatively and postoperatively.: ResultsSixteen patients had photoreceptor displacement preoperatively. In preoperative SLO microperimetry, all eyes with a macular hole had a scotoma; postoperatively, 12 of 16 had no scotoma. All four eyes with no preoperative photoreceptor displacement were noted to have a postoperative scotoma. The prevalence of postoperative scotoma in patients with preoperative photoreceptor displacement (4 of 16; 25%) was significantly lower than that in patients without preoperative photoreceptor displacement (4 of 4; 100%) (P = 0.03).: ConclusionsThe presence or absence of photoreceptor displacement preoperatively should affect postsurgical visual function. Photoreceptor damage may occur in eyes without photoreceptor displacement preoperatively, resulting in scotoma postoperatively. [Copyright &y& Elsevier]

Purpose: To evaluate serum prorenin levels in preterm infants with or without retinopathy of prematurity (ROP). Design: Noncomparative retrospective case control study. Methods: Serum prorenin levels in children with a gestational age younger than 36 weeks were measured with antibody-activating direct enzyme kinetic assay. Results: The mean prorenin concentrations were higher in preterm infants with ROP than in infants without ROP at every time point: from 26 to 30 weeks, 2326 ± 334 μg/ml (mean ± SE [standard error]) (n = 3) and 1164 ± 234 μg/ml (n = 3), respectively (P < .05); from 31 to 35 weeks, 1760 ± 496 μg/ml (n = 10) and 957.1 ± 139 μg/ml (n = 25) (P < .05); from 36 to 40 weeks, 958.2 ± 194.2 μg/ml (n = 23) and 470.1 ± 32.6 μg/ml (n = 67) (P < .01); and from 41 to 45 weeks, 575.8 ± 148.4 (n = 9) and 385.6 ± 47.9 (n = 13), which is not significantly different. Conclusions: Prorenin levels in preterm infants can predict which infants will develop ROP. [Copyright &y& Elsevier]

Purpose: To investigate the association between a photoreceptor irregularity and visual acuity (VA) after macular hole (MH) surgery.Design: Prospective observational case series.Methods: Twenty-four eyes with an idiopathic MH that resolved after vitreous surgery were examined by new optical coherence tomography (OCT 3000). The images were divided into regular photoreceptor, detected as a straight line above the retinal pigment epithelium reflex, and irregular, which cannot be detected by it.Results: Regular images were observed in 12 eyes (80%) and irregular images in 3 eyes (20%) with good VA (≥0.7). Regular images were seen in 3 eyes (33%) and irregular images in 6 eyes (67%) with poor VA (<0.7). The percentage of regular images in the group with good VA was significantly higher than that in the group with poor VA (P <.05).Conclusion: A photoreceptor irregularity after MH surgery may prevent VA improvement. [Copyright &y& Elsevier]

Purpose: To investigate the relationship between the choroidal thickness and choroidal blood flow in healthy young subjects. Design: Retrospective, cross-sectional study. Methods: We examined 25 eyes of 25 healthy young Japanese subjects. The subfoveal choroidal thickness was measured by enhanced depth imaging optical coherence tomography (EDI-OCT). The total choroidal blood flow and subfoveal choroidal blood flow were evaluated by pulsatile ocular blood flow using Langham OBF computerized tonometry and the choroidal blood flow using laser Doppler flowmetry. The refractive error, intraocular pressure, and axial length were also measured. Results: The mean refractive error was −3.4 ± 3.1 diopters, mean intraocular pressure 15.3 ± 1.7 mm Hg, and axial length 25.4 ± 2.0 mm. The subfoveal choroidal thickness was correlated positively (r = 0.785, P < .01) with the refractive error and negatively (r = −0.735, P < .001) with the axial length. No significant correlation was found between the subfoveal choroidal thickness and the pulsatile ocular blood flow or choroidal blood flow. Conclusion: Our results suggested that there were no significant correlations between the subfoveal choroidal thickness and the total choroidal blood flow and the subfoveal choroidal blood flow in healthy young subjects; however, decreased subfoveal choroidal thickness was associated with decreased refractive error and axial length. [ABSTRACT FROM AUTHOR]

Purpose: To investigate whether plasma pentosidine, a well-defined advanced glycation end product, is associated with retinal hemodynamic abnormalities in patients with type 2 diabetes. Design: Prospective cross-sectional study. Methods: Forty-two eyes with type 2 diabetes mellitus were evaluated. The type 2 diabetic eyes were divided into 2 groups: 22 eyes (22 patients; mean age, 61 years) with nondiabetic retinopathy (NDR) and 20 eyes (20 patients; mean age, 61 years) with mild nonproliferative diabetic retinopathy (NPDR). We used a retinal laser Doppler system to measure the arterial diameter, velocity, and blood flow in the major temporal retinal arteries. The pulsatility ratio, a resistive index expressed as the peak systolic to the end diastolic velocity ratio, was calculated from the blood velocity traces. Plasma pentosidine was measured in 42 patients with diabetes using a commercially available competitive enzyme-linked immunosorbent assay. Results: The pulsatility ratio significantly increased in patients with NPDR (4.8 ± 1.5) compared with patients with NDR (3.7 ± 0.8) (P = .0061). No differences in velocity, diameter, or blood flow were seen between the 2 groups. Plasma pentosidine levels also increased significantly (P = .0085) in patients with NPDR (0.057 ± 0.015) compared to patients with NDR (0.047 ± 0.012). The pulsatility ratio was correlated positively with the plasma pentosidine levels in patients with NPDR (Pearson correlation, r = 0.45, P = .044). Multiple regression analysis showed that the plasma pentosidine level was significantly associated with the pulsatility ratio (standardized coefficient, 0.62; P = .009). Conclusions: The vascular rigidity of the retinal arteries may increase with increasing plasma pentosidine in patients with type 2 diabetes with retinopathy. [Copyright &y& Elsevier]