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PURPOSE To elucidate clinical factors related to the presence of loculation of fluid (LOF) in the posterior choroid in central serous chorioretinopathy (CSC). DESIGN Retrospective, cross-sectional study. METHODS This single-center study included 158 eyes from 158 patients with CSC who were classified into LOF and non-LOF groups. The groups were compared for age, sex, spherical equivalent, axial length, subfoveal choroidal thickness (SCT), and scleral thickness. Using swept-source optical coherence tomography (OCT), we determined the presence of LOF based on B-scan and en face images. Scleral thickness was measured 6 mm posterior to the scleral spur in four directions using anterior segment OCT. RESULTS The 158 eyes were classified into 98 eyes in the LOF group and 60 eyes in the non-LOF group. In univariable analyses, the LOF group was younger (P = .01) and had a higher male ratio (P = .03) and greater SCT (P < .001) than the non-LOF group. All scleral thicknesses at the superior, temporal, inferior, and nasal points were greater in the LOF group than in the non-LOF group (426.2 μm vs. 395.1 μm, 445.7 μm vs. 414.9 μm, 459.2 μm vs. 428.8 μm, 445.4 μm vs. 414.3 μm, all P < .05). Multivariable analyses found that SCT (odds ratio [OR]: 1.02, 95% confidence interval [CI]: 1.01-1.02, P < .001) and mean scleral thickness (OR: 1.02, 95% CI: 1.02-1.03, P = .002) were significantly associated with the presence of LOF. CONCLUSION A thick choroid and thick sclera appeared to be related to the presence of LOF in CSC.

PURPOSE Asymmetric dilated vortex vein (ADVV) observed in eyes with pachychoroid spectrum diseases is thought to be due to congestion of choroidal blood flow. The purpose of this study was to quantitatively investigate the blood flow velocity of ADVV using laser speckle flowgraphy (LSFG). STUDY DESIGN Retrospective case series. METHODS This was a retrospective case series with 23 eyes of 18 patients with ADVV on en-face OCT. A pair of choroidal veins from ADVV side (defined as ADVV vein) and non-ADVV side (defined as non-ADVV vein) was selected in each eye under the following criteria: (i) equivalent proximity to the deviated watershed, (ii) does not overlap with retinal blood vessels in the en-face OCT image, (iii) has approximately the same blood vessel diameter. Rubber bands were placed on the selected choroidal veins on the LSFG color map. Mean blur rate (MBR) values of ADVV and non-ADVV veins were statistically compared. RESULTS The average MBR was 10.11 ± 1.9 in the ADVV veins and 13.49 ± 6.2 in the non-ADVV veins, showing significantly lower values in the ADVV veins (P = 0.03). The blood vessel diameter of the ADVV was 10.26 ± 3.0 and in the non-ADVV veins, 10.63 ± 2.9 pixels; not significantly different (P = 0.66). The distance from the deviated watershed to the ADVV was 53.3 ± 24.8 and to the non-ADVV veins, 46.80 ± 20.3 pixels; not significantly different (P = 0.41). CONCLUSION In eyes with ADVV, the blood flow velocity in the ADVV veins was lower than in the non-ADVV veins, suggesting anatomical congestion of ADVV.

Purpose To report the 2-year outcomes of intravitreal aflibercept injections (IAIs) in Japanese patients with neovascular age-related macular degeneration (AMD) using a 1-month adjusted treat-and-extend (TAE) regimen. Design Multicenter, prospective, nonrandomized, interventional study. Participants Ninety-seven eyes of 97 patients with treatment-naive AMD were studied at 3 tertiary ophthalmological institutions. Methods The patients were treated with 3 consecutive monthly IAIs followed by the TAE regimen with a 1-month adjustment for a maximum of 3 months. Our TAE regimen allowed us to shorten and extend the treatment intervals even after a 3-month or 1-month treatment interval, or both, were reached. Best-corrected visual acuity (BCVA), central retinal thickness (CRT), and subfoveal choroidal thickness (SCT) were analyzed. Main Outcome Measures The mean changes in the BCVA, CRT, and SCT from the baseline to 2 years after initiating the treatment were determined. In addition, the number of injections also was determined. Results The mean BCVA significantly improved from 0.27 logarithm of the minimum angle of resolution (logMAR) units to 0.14 logMAR at 2 years (P Conclusions Intravitreal aflibercept injections with a 1-month adjusted TAE regimen significantly improved the BCVA and CRT with a reduced number of injections at 2 years. The treatment interval was adjusted to extend to 3 months in 60% and to shorten to 1 month in 20% of the eyes at 2 years.

Polypoidal choroidal vasculopathy (PCV) is a condition characterized by multiple, recurrent, serosanguineous pigment epithelial detachments, and neurosensory retinal detachments due to abnormal aneurysmal neovascular lesions. It is generally considered as a variant of neovascular age-related macular degeneration, but there are some differences between the clinical presentation, natural history, and treatment response between patients with PCV and typical neovascular age-related macular degeneration patients. Over the past decade, new research and technological advancements have greatly improved our understanding of the PCV disease process and the management of PCV. This review aims to summarize the recent research findings to highlight the epidemiology, pathogenesis, genetics, the application of various diagnostic tools for PCV, and the available treatment options for PCV.

To determine the density of the choroidal vasculature by high-quality structure en face optical coherence tomography (OCT) scanned at the same time as OCT angiography in eyes with central serous chorioretinopathy (CSC).Thirty-five eyes of 30 patients with CSC (20 men and 10 women; average age, 48.4 years) were studied. Volume scans (12 × 12 mm-square) were obtained at the same time as OCT angiographic scans (Plex Elite 9000; Swept-Source OCT, Zeiss). High-quality structure en face images were flattened at Bruch membrane and binarized to identify and quantify the choroidal vascular density by the Bernsen method of the segmentation slab of one-half of the choroidal thickness. Similarly, high-quality structure en face choroidal images of 35 healthy eyes of 29 patients (18 men and 11 women; average age, 51.7 years) were binarized and analyzed as controls. The en face images were cropped to exclude the optic disk.The mean cropped image size was 9.57 mm × 9.57 mm in the eyes with CSC and 9.48 mm × 9.48 mm in the healthy eyes (P = 0.41). In the eyes with CSC, the choroidal vascular density was 61.6 ± 7.5% of the choroid, which was significantly greater than that in the healthy eyes at 49.4 ± 7.5% (P0.01).High-quality structure en face OCT can be used to assess the density of the choroidal vessels quantitatively and noninvasively in eyes with CSC.

In the last few years, new services and systems have begun to emerge every day as a result of the remarkable technological development that enabled the utilization of enormous amounts of data. There are high hopes for human co-creative consensus building abilities that will enables us not merely to make proper use of them, but also to address as-yet-unseen social issues. This study clarifies the factors involved in consensus building that enhance the participant’s performance in workshop-type dialogue.

To evaluate the flow signals in subretinal hyperreflective material (SHRM) that represents classic choroidal neovascularization (CNV) on fluorescein angiography in eyes with polypoidal choroidal vasculopathy.We retrospectively reviewed 20 eyes with polypoidal choroidal vasculopathy that appeared to have classic CNV on fluorescein angiography, accompanied by SHRM on optical coherence tomography (OCT) at the same location. Using OCT angiography (OCTA), we analyzed intrinsic flow signals in the SHRM (cross-sectional B-scans and en face). The possible association between pretreatment OCT angiography findings and fibrotic scar formation after antivascular endothelial growth factor (VEGF) treatment was evaluated.Six of 20 eyes (30%) showed vascular SHRM; the remaining 14 eyes (70%) showed avascular SHRM at the classic CNV site at baseline. The SHRM corresponded with polypoidal lesions seen on indocyanine green angiography in 5 of 6 eyes with vascular SHRM and in all 14 eyes with avascular SHRM. After anti-VEGF treatment, all 6 eyes with vascular SHRM left a fibrotic scar, whereas all 14 eyes with avascular SHRM showed no scar formation (P0.001).Using OCT angiography, we evaluated the flow signals in SHRM that represented classic CNV in eyes with polypoidal choroidal vasculopathy and successfully differentiated true Type 2 macular neovascularization from pseudo classic CNV.

The chronic eye disorder, neovascular age-related macular degeneration (nAMD), is a common cause of permanent vision impairment and blindness among the elderly in developed countries, including Japan. This study aimed to investigate the disease burden of nAMD patients under treatment, using data from the Japan National Health and Wellness surveys 2009–2014. Out of 147,272 respondents, 100 nAMD patients reported currently receiving treatment. Controls without nAMD were selected by 1:4 propensity score matching. Healthcare Resource Utilisation (HRU), Health-Related Quality of Life (HRQoL), and work productivity loss were compared between the groups. Regarding HRU, nAMD patients had significantly increased number of visits to any healthcare provider (HCP) (13.8 vs. 8.2), ophthalmologist (5.6 vs. 0.8), and other HCP (9.5 vs. 7.1) compared to controls after adjusting for confounding factors. Additionally, nAMD patients had reduced HRQoL and work productivity, i.e., reduced physical component summary (PCS) score (46.3 vs. 47.9), increased absenteeism (18.14% vs. 0.24%), presenteeism (23.89% vs. 12.44%), and total work productivity impairment (33.57% vs. 16.24%). The increased number of ophthalmologist visits were associated with decreased PCS score, increased presenteeism and total work productivity impairment. The current study highlighted substantial burden for nAMD patients, requiring further attention for future healthcare planning and treatment development.

The diversity and density of urban functions have been known to affect urban vibrancy positively, but the relation between the two has not been empirically examined; if high density is associated with low diversity in an area, its vibrancy may not increase. To obtain a better understanding of the metabolism of cities and directions for urban planning interventions, this paper offers empirical evidence on the association between the diversity and density of urban functions in the Tokyo Metropolitan Area, using a robust density index that was determined via a Monte Carlo simulation. By conducting association analyses, it was found that highly dense station areas tended to display low diversity at multiple scales. Further investigation indicated that this negative correlation was owing to different spatial characteristics of functions and complementary functioning among highly accessible station areas. This paper argues for considering both diversity and density in urban planning to make station areas vibrant and resilient., 17 pages, 5 figures, 3 Tables. To be published in Computers, Environment and Urban Systems

To observe choroidal blood vessels in cases sharply demarcated with retinal pigment epithelium (RPE) atrophy at the macular area using en-face optical coherence tomography angiography (OCTA) and standard en-face optical coherence tomography (OCT).The retrospective study included 12 eyes (8 patients; 5 men, 3 women; average age, 64.3 years) with RPE atrophy seen by ophthalmoscopy. The macular areas with normal and atrophic RPE sections were examined using en-face OCTA with an 840-nm light source (RTVue XR Avanti; Optovue Inc), which system can obtain standard en-face OCT images at identical areas. Images on en-face OCTA and standard en-face OCT were compared with each other when the segmentation range was being set as the full thickness of the choroid by the attached software.Choroidal blood vessels were seen as black on standard en-face OCT images in all cases. However, the choroidal vessels on OCTA were depicted as white in the RPE atrophic area and black in the normal areas.Choroidal blood vessels in the normal sections of RPE were visualized in black on standard en-face OCT and OCTA with an 840-nm light source; however, those in the atrophic parts were observed as white, or with bloodstream, on OCTA images. Choroidal blood vessels cannot be evaluated accurately in commercially available OCTA systems because of blockage of light by the RPE.

Purpose: The purpose of this article is to investigate the differences in intrachoroidal structures between eyes with idiopathic central serous chorioretinopathy (CSC) and those with steroid-induced CSC. Methods: Thirty eyes of 30 patients with idiopathic CSC and 17 eyes of 15 patients with steroid-induced CSC were studied. Cross-sectional swept-source optical coherence tomography images of eyes with idiopathic and steroid-induced CSC were retrospectively analyzed by the manual layer delineation technique and by the binarization technique. Results: The mean subfoveal choroidal thickness (SCT) was not significantly different between the eyes with idiopathic CSC (408.0 ± 106.6 µm) and those with steroid-induced (389.9 ± 105.4 µm; P = .67) CSC. Manual layer delineation showed that the mean ratio of the large choroidal vessel layer thickness to the SCT was significantly higher in eyes with idiopathic CSC (0.874 ± 0.070) than in eyes with steroid-induced CSC (0.828 ± 0.083; P = .02). The binarization method showed that the mean ratio of the luminal areas to the choroidal areas centered at the fovea was significantly higher in eyes with idiopathic CSC (0.747 ± 0.064) than in eyes with steroid-induced CSC (0.701 ± 0.046; P = .01). Conclusion: The intrachoroidal structures in steroid-induced CSC were different from those in idiopathic CSC. These findings suggest different pathophysiologic mechanisms may be involved in the pathogenesis of these 2 entities.

Purpose To investigate the clinical and morphological factors related to asymmetric dilated vortex veins in central serous chorioretinopathy (CSC). Design Retrospective, comparative study. Participants One hundred fifty-eight eyes of 158 patients with CSC. Methods All CSC patients underwent ophthalmic examination and multimodal imaging, including measurements of axial length (AL), fluorescein angiography, indocyanine green angiography, swept-source optical coherence tomography (OCT), and anterior-segment OCT. Using en face OCT images at the level of the outer choroid, the eyes were divided into two groups: eyes with symmetric vortex veins (symmetry group) and those with asymmetric vortex veins (asymmetry group). Main Outcome Measures Clinical and morphological factors related to asymmetric vortex veins in CSC. Results Of the 158 eyes, 120 (75.9%) were classified into the asymmetry group and 38 (24.1%) into the symmetry group. The asymmetry group significantly showed greater spherical equivalent (-0.32 ± 1.78 diopters vs. -1.35 ± 2.64 diopters; P = 0.033), shorter AL (23.52 ± 0.86 mm vs. 24.10 ± 1.06 mm; P = 0.005), and greater subfoveal choroidal thickness (414.6 ± 105.3 μm vs. 360.4 ± 91.8 μm; P = 0.005) than the symmetry group. No significant differences existed between the two groups regarding the age, sex, and all scleral thicknesses at the superior, temporal, inferior, and nasal points. In the multivariable analyses, shorter AL (odds ratio, 0.56; 95% confidence interval, 0.36–0.88; P = 0.011) was found to be significantly associated with the presence of asymmetric vortex veins. Conclusions The asymmetric dilated vortex vein is a common finding in patients with CSC. Our results suggest that certain biometric factors, such as short AL, may be associated with developing asymmetric dilated vortex veins in CSC.

Gender differences in risks for macrovascular complications in type 2 diabetes mellitus (T2DM) have been well established. However, the impact of gender differences on diabetic retinopathy (DR) has not been fully elucidated. We therefore retrospectively explored gender-specific determinants for DR in patients with T2DM in a small sized Japanese cohort in Okinawa. There were 214 patients who were diagnosed as no DR (n = 142) and non-proliferative DR (n = 72) in 2009. During the follow-up of median 7 years, 41/142 of incidence, 26/72 of progression, and 67/214 of incidence and progression were observed, respectively. DR was assessed using the modified international clinical DR severity scales. The risks for incidence, progression as well as incidence and progression of DR were comparable between men and women, respectively. Cox proportional hazard models in multivariate analyses demonstrated that the only common determinant in both men and women for DR was the duration of T2DM. Regarding gender-specific determinants, lower level of serum albumin in men as well as higher HbA1c, lower level of estimated glomerular filtration rate, and lower level of serum uric acid in women were extracted, respectively. Although precise mechanisms for such gender-specific determinants of DR still remain unsolved, the present study would highlight a couple of factors associated with gender-specific determinants for DR in a limited numbers of Japanese cohort. Prospective observational studies on gender-specific determinants of DR in a large scale cohort are warranted to further clarify underlying mechanisms.

This study aims to propose a method of aggregating and analyzing data in various fields such as land use, population, households, landscape, health and long-term care insurance, and sociological surveys, into a small geographical area named the “street unit.” Since the spatial extent of “street units” set up in this study is sufficiently small, their use is technically beneficial in that it is roughly equivalent to the spatial range at which people experience its value and in that each unit has a certain homogeneity, even in mixed-use urban neighborhoods. The analysis revealed that (1) it is possible to combine socio-economic data with streetscapes by using street-level images, (2) it is possible to link personal information, which has been challenging to analyze geographically, to specific locations, and (3) it is possible to treat subjective reports on places by residents and visitors as quantitative geospatial data.

To evaluate the temporary changes in visual outcomes and anterior segment parameters after cataract surgery plus low-add bifocal intraocular lens (IOL) implantation for primary angle closure disease (PACD). This retrospective comparative case–control study included two groups: low-add-power segmented IOL and monofocal IOL. Postoperative examination involved evaluation of uncorrected distance visual acuity (UDVA), uncorrected near visual acuity (UNVA), uncorrected intermediate visual acuity (UIVA), and spherical equivalent (SE). Anterior segment examination was performed using anterior segment optical coherence tomography. This study included 19 eyes of 11 consecutive patients who underwent cataract surgery. The low-add group had better UDVA than the monofocal group at 3 months postoperatively, better UIVA at 1 month postoperatively, better UNVA at 1 week postoperatively. In the low-add group, SE increased at 1 and 3 months postoperatively compared with 1 week postoperatively. In the monofocal group, objective SE decreased at 1 and 3 months postoperatively compared with 1 week postoperatively. In the low-add group, the anterior chamber depth (ACD) became significantly deep gradually at 1 and 3 months compared with at 1 week postoperatively. In the monofocal group, the ACD became significantly shallow gradually at 1 and 3 months than at 1 week postoperatively. The low-add-power segmented IOL achieved better far and intermediate distance visual acuity after cataract surgery in PACD patients than did the monofocal IOL. The ACD became deeper and SE showed a hyperopic shift with the low-add-power segmented IOL at 1 and 3 months after cataract surgery compared with at 1 week after cataract surgery.

To evaluate scleral thickness in central serous chorioretinopathy (CSC) using anterior segment (AS) OCT.Retrospective, comparative study.Forty-seven eyes of 40 patients with CSC and 53 eyes of 47 age- and gender-matched normal control participants.Spherical equivalent, axial length, subfoveal choroidal thickness, and scleral thickness were compared between the CSC and control groups. Scleral thickness was measured by AS OCT 6 mm posterior to the scleral spur in 4 directions.Scleral thickness in CSC eyes.No differences were found between the 2 groups in age, gender, spherical equivalent, or axial length. Subfoveal choroidal thickness was significantly greater in CSC eyes than in normal control eyes (424.0 ± 101.4 μm vs. 324.3 ± 91.8 μm; P0.001). Scleral thickness was significantly greater in CSC eyes than in normal control eyes at the superior (429.4 ± 50.3 μm vs. 395.2 ± 55.4 μm; P = 0.005), temporal (447.7 ± 45.7 μm vs. 396.5 ± 64.1 μm; P0.001), inferior (455.7 ± 81.2 μm vs. 437.8 ± 46.9 μm; P = 0.022), and nasal (454.9 ± 44.7 μm vs. 416.6 ± 51.2 μm; P = 0.001) points.Scleral thickness measured by AS OCT was significantly greater in CSC eyes than in normal control eyes, although no differences were found in spherical equivalent or axial length. Thick sclera may have a role in the pathogenesis of CSC.

To evaluate and compare the intrachoroidal structures of eyes with typical neovascular age-related macular degeneration (AMD) with those of eyes with polypoidal choroidal vasculopathy (PCV). Retrospective and comparative case series. Eighty-four treatment-naive eyes of 84 patients (22 women and 62 men) with typical neovascular AMD or PCV located in the subfoveal region were studied. Cross-sectional images of the retina and choroid were obtained by swept-source optical coherence tomography (SS-OCT). The horizontal SS-OCT images were analyzed by a manual delineation technique and by a binarization method. Thirty-nine eyes with typical neovascular AMD and 45 eyes with PCV were studied. Although the subfoveal choroidal thickness (SCT) did not differ significantly between the 2 subtypes (255.1 ± 86.7 µm in typical neovascular AMD and 289.2 ± 116.5 µm in PCV, P = 0.29), the ratio of the large choroidal vessel layer (LCVL) thickness to the SCT was significantly larger in the eyes with PCV than in the eyes with typical neovascular AMD (0.863 ± 0.084 vs 0.803 ± 0.125, P = 0.023). The binarization method did not find significant differences in the choroidal structure between the 2 subtypes. Multivariate logistic regression analyses found the ratio of the LCVL thickness to the SCT to be the only significantly different factor between typical neovascular AMD and PCV (P = 0.035). The intrachoroidal structures of typical neovascular AMD and PCV eyes differ significantly. In eyes with PCV, there seemed to be a greater dilation of the large choroidal vessels.

Purpose:To determine the relationship between the clinical findings and the response to ranibizumab therapy in eyes with macular edema associated with branch retinal vein occlusion.Methods:We reviewed the medical records of 68 patients with macular edema associated with a branch retinal vein occlusi

This study investigated the pathophysiological features of pachychoroid neovasculopathy (PNV) and neovascular age-related macular degeneration (nAMD) by analysing and comparing cytokine profiles in aqueous humour (AH) collected from 18 PNV, 18 nAMD and 11 control patients. Responses to intravitreal injection of aflibercept were also analysed in the PNV and nAMD groups. In the PNV group, vascular endothelial growth factor (VEGF)-A was significantly lower than in the nAMD group (p = 0.03) but was almost identical to that in the control group (p = 0.86). The nAMD group showed positive correlations between interleukin (IL)-6 and IL-8 (r = 0.78, p r = 0.68, p = 0.002) and IL-8 and MCP-1 (r = 0.68, p = 0.002). In the nAMD group, eyes with dry maculae one month after the first aflibercept injection showed significantly lower VEGF-A and placental growth factor (PlGF) at baseline than those with wet maculae (p = 0.02 for both). However, there was no significant difference between dry and wet maculae in the PNV group. The results suggest that angiogenic factors and proinflammatory cytokines may play the distinct roles in the pathogenesis of PNV and nAMD.

PURPOSE: To report the clinical characteristics of eyes with an unmeasurable small size of foveal avascular zone (FAZ) in the optical coherence tomography angiographic (OCTA) images. METHODS: Two-hundred sixty-seven eyes of 255 patients (mean age 60.4 years) without retinal and choroidal disorders to cause any type of visual impairment were examined by optical coherence tomography angiography (OCTA; RTVue XR Avanti, Optovue, Fremont, CA). Cross-sectional images at the fovea (DRI-OCT, Topcon, Japan) and fundus autofluorescence (CX-1 MYD/NM, Canon, Japan) were also recorded from all eyes. RESULTS: Four eyes (1.5%) of 3 patients (2 men, 1 woman; average age, 63.3 years) were found to have an unmeasurable small size of FAZ in the OCTA images. The best-corrected visual acuity was better than 20/20 in all eyes. Cross-sectional OCT images showed the presence of a foveal depression and the inner retinal layers in the foveal depression. These inner retinal layers were detected as a hyperreflective bands at the fovea. Fundus autofluorescence showed hypo-autofluorescence at the fovea as in normal eyes. CONCLUSIONS: An unmeasurable small size of FAZ without visual impairment was detected in 1.5% of 267 normal eyes. These eyes may be classified as low-grade foveal hypoplasia.

Purpose To report a case of branch retinal vein occlusion (BRVO) in which rapid formation of macular pucker was observed after an intravitreal ranibizumab (IVR) injection. Observations A 66-year-old patient was referred to our department for the treatment of macular edema (ME) secondary to BRVO in the left eye. On the initial visit, widespread retinal hemorrhage was observed around the superior temporal vascular arcade, and the decimal best-corrected visual acuity (BCVA) was 0.7 (Snellen equivalent 20/29) in the left eye. Optical coherence tomography demonstrated a thin epiretinal membrane (ERM) accompanied by diffuse retinal thickening. A 0.5 mg IVR injection was administered for the treatment of ME and prompt resolution of retinal hemorrhage. Fourteen days after IVR administration, the ERM had progressed remarkably into a macular pucker and had spread from the superior macula to the equator, accompanied by partial tractional retinal detachment. We performed pars plana vitrectomy combined with encircling scleral buckling. Three months after the surgery, the decimal BCVA was 0.4 (Snellen equivalent 20/50), the retina was attached, and no recurrence of ME or proliferation was observed. Conclusions and Importance IVR for BRVO may cause rapid formation of macular pucker in the eye, especially in the presence of pre-existing ERM. Careful observation of patients with BRVO is essential after administration of anti-VEGF agents, especially in eyes with pre-existing ERM.

To evaluate the development and rate of growth in macular atrophy after intravitreal injections of aflibercept (IVAs) for neovascular age-related macular degeneration (AMD) over a 2-year period. Retrospective, interventional, consecutive case series. This study included 94 eyes of 92 patients with treatment-naive AMD involving the foveal center treated with IVAs at 3 university hospitals in Japan. The patients underwent IVAs bimonthly after 3 initial monthly doses in the first year. The protocol was converted to a treat-and-extend regimen in the second year. The incidence and growth rate of macular atrophy were quantified based on hypoautofluorescence detected by fundus autofluorescence images. Additionally, possible background factors related to the development and rate of growth of macular atrophy were investigated. Of 94 eyes, 39 (41.5%) had typical AMD and 55 (58.5%) had polypoidal choroidal vasculopathy. Ten eyes (10.6%) had macular atrophy at the baseline. Of the remaining 84 eyes, 14 (16.7%) had developed new macular atrophy at 2 years, the square root of the growth rate of atrophy was 0.52 mm/year. In multivariate analyses, a poorer best-corrected visual acuity (P = 0.01) and the presence of intraretinal fluid (P = 0.04) at baseline were found to be the independent predictors for the development of macular atrophy. No factors were found that were significantly related to the growth rate of the macular atrophy. Our study determined the incidence and rate of growth of macular atrophy after IVAs for neovascular AMD in clinical settings. Eyes with vision reduction and intraretinal fluid at the baseline develop macular atrophy more frequently after IVAs for neovascular AMD.

A paracentesis prior to an intravitreal injection is a very safe procedure and can prevent IOP-spikes after injections. As these spikes pose the risk of inducing glaucomatous changes particularly in patients with frequent injections and/or with a risk profile, a regular paracentesis prior to an injection may be considered and discussed with the patient.

Aim To determine whether the low reflective spaces in the retinal nerve fibre layer (RNFL) in the optical coherence tomographic (OCT) images are related to the presence of the retinal non-perfused areas in eyes with macular oedema associated with a retinal vein occlusion (RVO). Methods We reviewed the medical records of 97 eyes with macular oedema associated with RVO. At the initial visit, eyes with macular oedema were classified into those with and those without low reflective spaces in the RNFL in the OCT images. In the fluorescein angiographic (FA) images, the eyes with more than one disc diameter of retinal non-perfusion in the area of OCT vertical scan were classified as having retinal non-perfused areas. Results At the initial visit, low reflective spaces were observed in the RNFL in 19 of the 97 eyes with macular oedema associated with a RVO (19.6%). The percentage of eyes with a retinal non-perfused area in the FA was 84.2% in the eyes with low reflective space group but only 14.1% in those without low reflective spaces. The presence of low reflective spaces in the RNFL was significantly correlated with the presence of non-perfused areas (p Conclusion The presence of low reflective spaces in the RNFL in the OCT images can predict the presence of retinal non-perfused areas in eyes with macular oedema associated with a RVO.

To investigate the changes in the intrachoroidal structures after half-dose verteporfin photodynamic therapy (PDT) for central serous chorioretinopathy (CSC).Swept-source optical coherence tomography cross-sectional images of 22 eyes of 22 patients with CSC were retrospectively analysed by a manual delineation technique and binarisation method.In the 22 eyes, the mean subfoveal choroidal thickness decreased from 412.9±112.9 μm at baseline to 340.0±111.0 μm at 3 months (p0.0001). The mean thickness of the large choroidal vessel layer decreased from 368.7±112.7 μm at baseline to 292.2±118.0 μm at 3 months (p0.0001), but the mean choriocapillaris-medium choroidal vessel layer thickness did not change from 44.2±29.2 μm at baseline to 47.8±25.7 μm at 3 months (p=0.85). Analyses of the binarised choroidal images showed that a 3 mm subfoveal choroidal area decreased from 1.141±0.290 mmHalf-dose PDT reduces subfoveal choroidal thickness and alters the intrachoroidal structures in eyes with CSC.

Purpose To investigate changes in subfoveal choroidal thickness after intravitreal aflibercept injections (IAIs) for neovascular age-related macular degeneration (AMD) at 12 months. Design Retrospective, consecutive, interventional case series. Participants One hundred forty-four patients with treatment-naive neovascular AMD examined at 3 university hospitals. Methods After a loading phase of 3 monthly 2.0-mg IAIs, the patients were injected bimonthly with additional rescue injections performed for worsening. Subfoveal choroidal thickness in IAI-treated eyes was evaluated using enhanced depth imaging optical coherence tomography (OCT) or swept-source OCT. Main Outcome Measures Changes in subfoveal choroidal thickness over a 12-month period. Results Of the 144 treated eyes, 58 (40.3%) had typical neovascular AMD and 86 (59.7%) had polypoidal choroidal vasculopathy (PCV). The mean subfoveal choroidal thickness of treated eyes decreased from 268.1±101.3 μm at baseline to 233.0±99.7 μm at 3 months and remained unchanged at 232.4±99.6 μm at 12 months (percentage decrease, 13.3% at 12 months compared with baseline; P P = 0.0087; R = 0.28), but not for eyes with typical neovascular AMD ( P = 0.17; R = 0.18). Eyes without persistent or recurrent retinal fluid after the loading phase showed greater decrease in subfoveal choroidal thickness compared with those with persistent or recurrent retinal fluid, in both typical neovascular AMD ( P = 0.042) and PCV ( P = 0.038) eyes. Conclusions Subfoveal choroidal thickness decreased over 12 months with IAI therapy in eyes with neovascular AMD. Changes in subfoveal choroidal thickness after IAIs seem to be related to visual and anatomic outcomes.

To investigate short-term outcomes of intravitreal aflibercept injections (IAIs) for polypoidal choroidal vasculopathy (PCV).91 eyes of 88 consecutive patients with treatment-naive PCV examined at three university hospitals received IAI monthly for 3 months. One month after the third IAI, changes in best-corrected visual acuity (BCVA) and macular morphology were retrospectively evaluated. Additionally, possible baseline characteristics predictive of persistent retinal fluid were analysed.The mean BCVA (logarithm of the minimum angle of resolution units) of the 91 eyes improved from 0.31 at baseline to 0.21 at 3 months (p0.0001). The mean central retinal thickness and mean subfoveal choroidal thickness decreased from 323 μm and 270 μm at baseline to 185 μm and 232 μm at 3 months, respectively (p0.0001 for both). Seventy-three eyes (80.2%) achieved a dry macula defined as absence of retinal fluid. Presence of the baseline characteristics of subretinal haemorrhage and greater size of the largest polyp were significantly associated with inability to achieve a dry macula (p=0.008 and 0.03, respectively). However, this association was not found on multivariate logistic regression. Of the 90 eyes that underwent indocyanine green angiography at 3 months, 43 eyes (47.8%) showed complete and 28 eyes (31.1%) showed partial resolution of polyps. Twenty-four eyes (24.4%) also showed partial regression of branching choroidal vascular networks.IAIs for the treatment of a large number of PCV eyes were found to improve both visual acuity and macular morphology over the short term.

We conducted a genome-wide association study (GWAS) on the outcome of anti-VEGF treatment for exudative age-related macular degeneration (AMD) in a prospective cohort. Four hundred and sixty-one treatment-naïve AMD patients were recruited at 13 clinical centers and all patients were treated with 3 monthly injections of ranibizumab followed by pro re nata regimen treatment for one year. Genomic DNA was collected from all patients for a 2-stage GWAS on achieving dry macula after the initial treatment, the requirement for an additional treatment, and visual acuity changes during the 12-month observation period. In addition, we evaluated 9 single-nucleotide polymorphisms (SNPs) in 8 previously reported AMD-related genes for their associations with treatment outcome. The discovery stage with 256 patients evaluated 8,480,849 SNPs, but no SNPs showed genome-wide level significance in association with treatment outcomes. Although SNPs with P-values of −6 were evaluated in replication samples of 205 patients, no SNP was significantly associated with treatment outcomes. Among AMD-susceptibility genes, rs10490924 in ARMS2/HTRA1 was significantly associated with additional treatment requirement in the discovery stage (P = 0.0023), and pooled analysis with the replication stage further confirmed this association (P = 0.0013). ARMS2/HTRA1 polymorphism might be able to predict the frequency of injection after initial ranibizumab treatment.

To determine factors predictive of visual outcomes in eyes treated with intravitreal aflibercept injections (IAIs) for typical neovascular age-related macular degeneration (AMD) or polypoidal choroidal vasculopathy (PCV). Retrospective, multicenter, institutional, consecutive, interventional case series. One hundred nine eyes (107 patients) with treatment-naive neovascular AMD at 3 university hospitals were studied. After a loading phase of 3 monthly 2.0-mg IAIs, injections were administered every 2 months. The baseline clinical characteristics were investigated in relation to the 12-month visual outcomes. Changes in the mean best-corrected visual acuity (BCVA) were measured at 12 months after initiation of aflibercept therapy. Forty-five eyes (41.3%) had typical neovascular AMD, and 64 eyes (58.7%) had PCV. The changes in the mean BCVA at 12 months compared with baseline did not differ significantly (P = .737) between the 2 groups. Stepwise analysis showed that larger gains in the BCVA at 12 months were associated with poor BCVA (P < .001), no pigment epithelial detachment (P = .004), and subretinal fluid (P = .039) at baseline in eyes with typical neovascular AMD; larger gains in the BCVA were associated with poorer BCVA (P < .001), presence of choroidal vascular hyperpermeability (CVH) (P = .013), and subretinal fluid (P = .044) at baseline in eyes with PCV. Although poorer BCVA and the presence of subretinal fluid predicted larger gains in BCVA in both subtypes treated with aflibercept, eyes with typical neovascular AMD had greater improvement if no pigment epithelial detachment was present, while eyes with PCV had greater improvement if CVH was present.

PURPOSE To report a case of macular telangiectasia Type 2 that showed a resolution of a foveal cystic change accompanying the release of vitreomacular attachment. METHODS Retrospective chart review. REPORT OF THE CASE A 75-year-old man presented with a bilateral decrease in visual acuity and metamorphopsia. At the initial visit, the left eye demonstrated a hyporeflective foveal cyst and a perifoveal vitreous detachment on optical coherence tomography. The characteristic clinical findings were consistent with the diagnosis of macular telangiectasia Type 2. Fifteen months later, the patient returned with a remission of the metamorphopsia in the left eye. The left eye had a vitreous detachment from the macula, and the hyporeflective foveal cyst was completely resolved. CONCLUSION At least in some cases, vitreous traction or attachment may play a role in the morphologic changes seen in macular telangiectasia Type 2.

Polypoidal choroidal vasculopathy was initially described as a type of macula disorder presenting with recurrent subretinal pigment epithelial hemorrhage. Since then, more have been known about this particular disease. Current of the disease enables us to identify it as a separate entity to other macular disorders. It is characterized by the presence of subretinal hemorrhage, exudation, and reduction in central vision. Imaging characteristics include polypoidal lesions and branching vascular network seen on indocyanine-green angiography. Specific treatment has been devised, which includes antivascular endothelial growth factor injections into the vitreous, and also the combination of photodynamic therapy, in hope to induce regression of the polypoidal lesions. These will be discussed into detail in this chapter, with clear illustrations of the condition with clinical photos.

Purpose To compare the efficacy of the subthreshold micropulse laser (SML) to conventional laser (CL) in treating focal leakages of the retinal pigment epithelium (RPE) in the eyes with central serous chorioretinopathy (CSC). Methods Twenty-nine eyes of 28 patients with CSC and typical focal leakage were treated with CL or SML. Both treatments were made with a 577 nm yellow laser (CL: NIDEK MC-500, SML: IRIDEX IQ577). The percentage of eyes with a complete resolution, the distance of the laser burns from the fovea, and injury of the RPE after treatment were studied. Results A complete resolution was seen in 10 of 15 eyes (66.7%) after CL and 9 of 14 eyes (64.3%) after SML (P = 0.89). The average distance from the foveal center to the leakage point was 1282±596 μm for eyes treated with CL and 1271±993 μm for eyes treated with SML (P = 0.4). Only three eyes treated with SML had treatment sites within 500 μm of the fovea. RPE damage determined by fundus autofluorescence was found in all eyes treated with CL and only one eye treated with SML (P

Background/aimsTo evaluate the axial length (AL) and refractive status in central serous chorioretinopathy (CSC).MethodsThis retrospective observational case series involved 140 patients with CSC (180 eyes) and 78 age-matched and gender-matched control subjects. A detailed ophthalmic examination was performed, including an interferometer measurement of AL. Multimodal imaging comprised colour fundus photography, fluorescein angiography, indocyanine green angiography, fundus autofluorescence photography and spectral domain optical coherence tomography.ResultsEighty eyes of 40 patients were categorised into the bilateral-CSC (b-CSC) group and 100 eyes of 100 patients were categorised into the unilateral-CSC (u-CSC) group. AL of the b-CSC (23.19 mm) and u-CSC (23.75 mm) groups was significantly shorter than that of the control (24.85 mm) group (pConclusionAnatomical features, such as shorter AL and greater SE, may be associated with the pathogenesis of CSC.

Purpose To clarify the distinct molecular pathogenesis of central serous chorioretinopathy (CSC) and pachychoroid neovasculopathy (PNV). Methods Aqueous humor (AH) was collected from 18 acute CSC, 20 chronic CSC, and 20 PNV patients. Concentrations of 30 cytokines in the AH were analyzed using a multiplex bead immunoassay, and the cytokine profiles were compared among these three groups of patients. The areas of choroidal vascular hyperpermeability (CVH) and choroidal thickness (CT), including measurement of the vascular layers, were investigated to analyze the features of choroidal abnormality in acute CSC, chronic CSC, and PNV. Additionally, associations between cytokine profiles and choroidal abnormalities were analyzed. Results Proinflammatory cytokines, IL-6 and IL-8 were significantly upregulated in the chronic CSC group compared with the acute CSC or PNV groups. Angiogenic cytokines and VEGF-A were upregulated at levels that almost reached significance along with disease progression from acute to chronic CSC, whereas the upregulation was not significant from chronic CSC to PNV. In the chronic CSC group, strong positive correlations were confirmed between VEGF-A and placental growth factor (PlGF) (r = 0.75, P < 0.001) and IL-6 and VEGF-A (r = 0.74, P < 0.001), and angiogenesis-related cytokines were positively correlated with the typical choroidal abnormalities, areas of CVH, mean CT, and mean large choroidal vessel layer thickness. However, there was no association between these choroidal abnormality parameters and AH cytokines in the PNV group. Conclusions The results suggest that choroidal abnormalities in chronic CSC may be associated with upregulated angiogenesis.

To report the identification of macular hole formation using intraoperative optical coherence tomography (OCT) during vitrectomy for vitreomacular traction syndrome. A 58-year-old woman with vitreomacular traction syndrome underwent the vitrectomy using the 25-gauge system with scanning the macular area using the integrated and intraoperative OCT (Rescan 700, Zeiss). When posterior vitreous detachment at the fovea was performed using a vitreous cutter, the hyperreflective tissue thought to be the rupture of the internal limiting membrane and the full-thickness macular hole were identified on the horizontal and vertical scans simultaneously in intraoperative OCT. The procedure was completed after internal limiting membrane peeling and 25% SF6 gas tamponade for closure of macular hole. The closure was confirmed using Swept-Source OCT 1-month after surgery. It is possible to change the surgical approach using the real-time intraoperative OCT because the development of macular hole can be visualized during vitrectomy for vitreomacular traction syndrome.

To visualize choroidal blood flow in larger vessels in highly myopic eyes using a phenomenon of the projection artifact to in the sclera using optical coherence tomography angiography.The retrospective study included 92 eyes (54 patients) with greater than 8 diopters of myopia. All eyes were examined using optical coherence tomography angiography (RTVue XR Avanti; Optovue Inc, Fremont, CA). The blood flow in choroidal vessels was evaluated by attempting to directly segment the choroid and also by placing the segmentation layer behind the choroid, within the sclera. Subfoveal choroidal thickness was also measured at the same time. The authors also evaluated the 54 normal eyes (54 cases) without high myopia as a control group.Segmentation artifacts occurred in 68 cases (73.9%) and precluded direct visualization of the choroidal blood flow in larger vessels. When the segmentation slab was placed posterior to the choroid within the sclera, the choroidal blood flow was visualized in 41 eyes (44.6%). The mean subfoveal choroidal thickness in eyes with visualization of choroidal blood flow was thinner than without visualization (50.3 ± 42.2 μm vs. 100.3 ± 44.4 μm, P0.01). Choroidal blood flow in larger vessels was imaged in no control eye.The choroidal vessel anatomy could be imaged by detecting flow using the projection artifact in the sclera with optical coherence tomography angiography. This technique may be useful in estimating the vascularity of the choroid.

Purpose To investigate the changes in subfoveal choroidal thickness after intravitreal injections of ranibizumab (IVRs) for neovascular age-related macular degeneration (AMD). Design Prospective, consecutive, interventional case series. Participants Eighty eyes (40 affected eyes with neovascular AMD and 40 unaffected fellow eyes) of 40 patients. Methods Forty eyes with neovascular AMD were treated with 0.5-mg IVRs monthly for 3 months and received additional IVRs as needed over the following 9-month period. Subfoveal choroidal thickness in all 80 eyes was measured by use of enhanced depth imaging optical coherence tomography images before and after starting the IVRs. Main Outcome Measures Changes in subfoveal choroidal thickness after treatment by IVRs over a 12-month period. Results Twenty-three eyes (57.5%) were diagnosed with typical neovascular AMD, 16 eyes (40%) were diagnosed with polypoidal choroidal vasculopathy, and 1 eye (2.5%) was diagnosed with retinal angiomatous proliferation. Fifteen eyes (38%) had received some previous treatments for the neovascular lesion before undergoing the IVRs. The mean best-corrected visual acuity of the affected eyes was improved from 0.54 logarithm of the minimum angle of resolution units at baseline to 0.42 at 12 months ( P = 0.020). The mean subfoveal choroidal thickness in the affected eyes decreased from 244±62 μm at baseline to 234±66 μm at 1 month ( P = 0.013), 226±68 μm at 3 months ( P P = 0.002), and 226±66 μm at 12 months ( P = 0.002; the change ratio, 93%), whereas that in the unaffected eyes changed from 237±80 μm at baseline to 238±83 μm at 12 months ( P = 0.78). In the affected eyes, the change ratio of subfoveal choroidal thickness at 12 months was not correlated with the number of IVRs (mean, 5.8±2.9). Subfoveal choroidal thickness demonstrated a similar trend toward decreasing during the following period independent of the subtypes of neovascular AMD or the treatment histories. Conclusions Subfoveal choroidal thickness decreased after IVRs in eyes with neovascular AMD. Intravitreal injections of ranibizumab may provide a pharmacologic effect not only on the neovascular lesion but also on the underlying choroid. Financial Disclosure(s) The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Purpose To investigate and compare the characteristics of fundus autofluorescence (FAF) in polypoidal choroidal vasculopathy (PCV) with those in typical neovascular age-related macular degeneration (AMD). Design Retrospective, observational, consecutive case series. Participants Ninety-two patients with PCV (92 affected eyes and 86 unaffected fellow eyes) and 31 patients with typical neovascular occult AMD with no classic choroidal neovascularization (31 affected eyes and 24 unaffected fellow eyes). Methods All study eyes underwent FAF photography with a fundus camera–based system. The incidence and distribution of hypoautofluorescence, that is, the manifestation of retinal pigment epithelium (RPE) damages, were evaluated. Main Outcome Measures The characteristic FAF findings in PCV. Results In the affected eyes with PCV, the sites of the neovascular lesions showed 2 distinct FAF patterns: (1) the confluent hypoautofluorescence at the polypoidal lesions and (2) the granular hypoautofluorescence at the branching choroidal vascular networks. The confluent hypoautofluorescence, most of which was surrounded by a hyperautofluorescent ring, was seen in 74 eyes (80.4%) with PCV but was seen in no eyes with typical neovascular AMD ( P P = 0.014). In addition, the eyes with PCV more frequently showed hypoautofluorescence outside the macular area than those with typical neovascular AMD ( P = 0.021). In the unaffected fellow eyes, the hypoautofluorescence was more frequently observed in patients with PCV than in those with typical neovascular AMD, inside the macular area and in the entire FAF image ( P = 0.012, P = 0.003, respectively). Conclusions In eyes with PCV, the polypoidal lesions and the branching choroidal vascular networks appeared to affect the RPE and induce peculiar FAF findings. When compared with the patients with typical neovascular AMD, widespread RPE damage was more frequently observed in the patients with PCV, both in the affected eyes and in the unaffected fellow eyes. Financial Disclosure(s) The authors have no proprietary or commercial interest in any materials discussed in this article.

To investigate the subfoveal choroidal thickness in eyes with typical age-related macular degeneration (AMD) and polypoidal choroidal vasculopathy (PCV), using enhanced depth imaging optical coherence tomography.Retrospective observational case series of 44 eyes of 44 patients (12 females and 32 males) with typical AMD or PCV located in the subfoveal region. Cross-sectional images of the choroid of each of the involved eyes were obtained by a spectral-domain OCT. The choroidal thickness under the fovea was retrospectively studied.Of the 44 eyes involved in this study, 21 eyes were diagnosed as typical AMD and the other 23 eyes were diagnosed as PCV. The difference in subfoveal choroidal thickness between the eyes with typical AMD (245 μm) and those with PCV (293 μm) was statistically significant, even after adjusting for age, spherical equivalent, and gender distribution (P = 0.045). When compared to eyes with subfoveal choroidal thickness less than 300 μm, those with subfoveal choroidal thickness of 300 μm or more were 5.6 times more likely to have PCV (adjusted odds ratio 5.60, 95% confidence interval 1.30-24.0, P = 0.021).The choroid under the fovea was thicker in eyes with PCV than those with typical AMD. This result suggests that the choroidal vascular lesion seen in PCV may not be just the choroidal neovascularization accompanied by saccular capillary dilations at the border, but may have a significant structural difference in the choroid compared to typical AMD.

Background/aims To investigate the characteristics of fundus autofluorescence (FAF) in acute Vogt–Koyanagi–Harada (VKH) disease. Methods FAF photography with blue light (BL-FAF) and near-infrared light (NIR-FAF) was performed on 10 eyes of five patients using a confocal scanning laser ophthalmoscope before and after treatment. The FAF images were followed for 6 months and retrospectively reviewed with comparisons of the other imaging modalities. Results At presentation, four eyes of two patients who presented soon after the initial ocular symptoms showed mild and uniform hyperautofluorescence in the macula mixed with hypoautofluorescence in the areas of serous retinal detachment. After immediate treatment with an intravenous high-dose steroid, the abnormal FAF returned to normal at 6 months. The other six eyes of three patients, who presented weeks after the symptoms, initially demonstrated diffuse and mottled hyperautofluorescence over the posterior pole, mixed with hypoautofluorescence induced by serous retinal detachment in four eyes. After treatment with an intravenous high-dose steroid, all six eyes showed scattered and widespread hyperautofluorescence, which gradually became evident and concentrated in the macula, partially resulting in some hypoautofluorescent dots at 6 months. The BL-FAF and the NIR-FAF demonstrated similar FAF patterns, but more evidently in NIR-FAF. Conclusion FAF photography non-invasively visualised sequential metabolic and functional changes in the retinal pigment epithelium (RPE) in acute VKH disease. The results suggest that early and sufficient treatment with a high-dose steroid might prevent persistent RPE damage. In addition, NIR-FAF can be an alternative method for the early detection of RPE abnormality.

Purpose To examine the ultrastructural correlates of spectral-domain optical coherence tomography (SD-OCT) findings in patients with vitreomacular traction (VMT). Design Observational case series. Methods Retrospective analysis of six eyes of consecutive patients who underwent vitrectomy surgery for VMT was performed in this single-center, noncomparative study. One patient had a concurrent macular hole. Preoperative assessment included SD-OCT examination with 3-dimensional image reconstruction. During surgery the vitreous cone was dissected from the vitreous body using scissors, then removed from the surface of the retina with a combination of sharp dissection and peeling, and subsequently submitted for histologic and transmission electron microscopic processing. Results SD-OCT showed prominent vitreal-foveal adhesion in all six eyes. Each eye had an epiretinal membrane (ERM) under the detached perifoveal posterior vitreous detachment. In all eyes this ERM appeared to course up the cone of attached vitreous and along the back surface of the posterior vitreous face. Ultrastructural analysis showed fibrocellular proliferations in the vitreous specimens in all six cases, which included retinal pigment epithelium (RPE) cells (five eyes), fibrocytes (four eyes), and macrophages (three eyes). Conclusions The adhesion between the vitreous and fovea in vitreomacular traction syndrome is accompanied by fibrocellular proliferation along the exposed surfaces of the inner retina and the posterior surface of the vitreous. This fibrocellular proliferation may augment the adhesion between the vitreous and fovea, and may account for the prominent OCT signal seen along the posterior surface of the vitreous in these cases.

It has been reported that some herbal medicines may be effective for acute episodes of chronic nonspecific lower back pain. Spondylolisthesis is one of the causes of lower back or neck pain. To our knowledge, successful treatment of symptomatic spondylolisthesis with medicinal herbs has not been previously reported in the published work. A 63-year-old female had suffered from back pain for 4 years. Radiographs revealed spondylolisthesis at the L3 level. In another case, an 82-year-old female suffered from neck pain. X-ray examinations revealed cervical spondylolisthesis at the C4 level. Several herbs were administered to these patients with symptomatic spondylolisthesis according to the guidelines for herbal medicine. Significant improvements in pain were obtained within 4 weeks in both patients. The pain completely disappeared after 20 weeks (case 1) and 6 weeks (case 2) of treatment. Although surgical treatment is often performed for symptomatic spondylolisthesis, the findings of the present cases imply the therapeutic potential of herbal medicine in selected patients.

Purpose To describe the macular holes in patients with idiopathic parafoveal telangiectasis (IPT) and to propose a pathophysiologic explanation for their formation. Methods Four eyes of two patients with IPT were evaluated with biomicroscopy and optical coherence tomography (OCT). Results One patient had a nearly full-thickness hole with preservation of only the internal limiting membrane (ILM), but had a 20/60 visual acuity. The other patient had a large full-thickness macular hole, but retained 20/40 visual acuity. Each patient had a fellow eye showing prominent central inner foveal cavitation under a very thin ILM, which was devoid of associated tissue. Conclusions This report describes the findings of two patients with IPT who developed pronounced central foveal structural abnormalities. The induced anatomic changes noted in our patients suggest that there is a loss of the structural aspects afforded by Muller cells, particularly the Muller cell cone, in the central macula in patients with IPT. The preservation of good visual acuity in our patients implies that the holes were the result of lateral separation of the photoreceptors within the fovea and that there could not have been profound atrophy of the photoreceptors.

Idiopathic macular aneurysmal telangiectasia or so-called Coats' disease is usually a unilateral retinal vascular abnormality in males. It has been rarely reported to occur bilaterally with and without associated abnormalities, and its occurrence in a familial setting is even rarer.This is a report of a familial occurrence of bilateral macular aneurysmal telangiectasia or Coats' disease in a father and daughter.A 44-year-old woman and her father had bilateral macular angiopathy with macular telangiectasia, aneurysms, ischemia, and leakage, including lipid deposition. The clinical findings were confirmed with fluorescein angiography and optical coherence tomography. There was no history of systemic disease associated with a retinal vascular abnormality.To our knowledge, this is the first report of a familial occurrence of bilateral macular aneurysmal telangiectasia or Coats' disease in a daughter and father without associated systemic disease.

Purpose To describe a case of a pigment epithelial detachment (PED) that likely led to a branch retinal vein occlusion (BRVO). Methods Color photography, fluorescein angiography, and three-dimensional spectral optical coherence tomography (3D-spectral OCT) were performed. Results Fluorescein angiography identified a PED at the site of a BRVO, and 3D-spectral OCT illustrated compression and distortion of the overlying retina at the location of the venous obstruction. Conclusion It is well known that retinal arterial disease can compress an underlying vein and lead to a BRVO. A theoretically possible, but previously unrecognized cause of a BRVO is compression of an overlying vein by an underlying PED. Our case reminds us to continue to explore local anatomical factors in addition to systemic factors in patients with venous occlusive disease.

The resins from hops (Humulus lupulus L.), which add the bitter taste to beer, are classified into two main sub-fractions, namely, soft and hard resins. α- and β-Acids in soft resin and their transformation during the wort boiling process are well-studied; however, other constituents in resins, especially hard resin, have been unidentified. In this study, we identified humulinones and hulupones as soft-resin components, in addition to 4'-hydroxyallohumulinones and tricyclooxyisohumulones A and B as hard-resin components. These compounds are all oxidation products derived from α- or β-acids. We also investigated compositional changes in the hard resin during the wort boiling process, which has a significant effect on the taste of the beer, by using model boiling experiments. The major changes were identified to be isomerization of 4'-hydroxyallohumulinones into 4'-hydroxyallo-cis-humulinones, followed by decomposition into cis-oxyhumulinic acids. These findings will be helpful in systematically evaluating and optimizing the effect of the hard resin on beer quality.