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Purpose. To determine the effects of cataract surgery on contrast visual acuity and retinal sensitivity in patients with retinitis pigmentosa. Methods. Retinal sensitivity and contrast visual acuity were determined by microperimetry (MAIA) and contrast sensitivity acuity tester (CAT-CP), respectively, before and after cataract surgery. The significance of the correlations between visual acuity, retinal sensitivity, contrast visual acuity, improvements after surgery, and macular structure before and after cataract surgery was determined. Results. Retinal sensitivity and contrast visual acuity were significantly improved after cataract surgery. The correlations among postoperative visual acuity, postoperative retinal sensitivities, and preoperative ellipsoid zone length were significant. The postoperative retinal sensitivity of the central 10° and the ellipsoid zone length was particularly significantly correlated. Preoperative contrast visual acuity and the amount of improvement and preoperative retinal sensitivity and the amount of improvement were significantly negatively correlated. The contrast visual acuity under both the 100% and 10% photopic and mesopic conditions improved significantly after cataract surgery. Conclusions. Cataract surgery in retinitis pigmentosa patients with preserved ellipsoid zones significantly improved retinal sensitivity and contrast visual acuity. Cataract surgery can be expected to improve retinal sensitivity and contrast visual acuity under various conditions, even if preoperative visual parameters are low, as long as the ellipsoid zone is preserved.

Purpose. To determine the effects of cataract surgery and preoperative factors on the vision-related quality of life (QOL) in patients with retinitis pigmentosa (RP). Materials and Methods. This was a prospective, interventional study of 54 patients diagnosed with RP. The 25-item National Eye Institute Visual Function Questionnaire (NEI VFQ-25) was used to determine the QOL before and after the cataract surgery. The correlations between the scores of the questionnaire and the best-corrected visual acuity (BCVA), macular structure, and degree of improvement of the NEI VFQ-25 scores were also determined. Results. Statistically significant improvements were observed in the BCVA and all of the NEI VFQ-25 subscale scores except for color vision. The improvement of general vision was the largest. The postoperative BCVA of the better-seeing eye was more strongly and significantly correlated with the postoperative NEI VFQ-25 scores than that of the worse-seeing eye. All of the postoperative NEI VFQ-25 scores were significantly correlated with the length of the ellipsoid zone (EZ) of the photoreceptors. No significant correlation was found between the preoperative general vision, near vision, mental health scores, and EZ length. All of the preoperative NEI VFQ-25 scores except the social function and mental health scores were negatively and significantly correlated with the degree of improvement of the NEI VFQ-25 score. The EZ length was significantly correlated with the degree of improvement of the NEI VFQ-25 scores of the general vision, distance vision, mental health, dependency, and composite 9 scores. Conclusions. Cataract surgery can significantly improve the NEI VFQ-25 scores in RP patients. The EZ length can be used to predict the postoperative VFQ scores. We conclude that the NEI VFQ-25 is a useful method to evaluate the impact of cataract surgery on the BCVA in patients with RP.

We report a case of ocular toxoplasmosis that developed a full-thickness macular hole (FTMH) which was successfully treated by pars plana vitrectomy combined with an inverted internal limiting membrane (ILM) flap. A 49-years-old Japanese man was aware of blurred vision in his right eye. Slit-lamp biomicroscopy, ophthalmoscopy, and optical coherence tomography (OCT) of the right eye showed that there was a grayish-white subretinal lesion at the macula accompanied by retinal exudation and mild vitreous flare and iritis. An increase in the level of serum IgM for toxoplasma led to a diagnosis of ocular toxoplasmosis. He developed a FTMH adjacent to the lesion 2 weeks after administering sulfamethoxazole/trimethoprim, and his decimal visual acuity was 0.15. Because the FTMH remained 3 months after the resolution of inflammation and his metamorphopsia persisted, vitrectomy with an inverted ILM flap was performed. After the surgery, the visual acuity improved to 0.2 with the closure of the FTMH confirmed by OCT. A FTMH in an eye with ocular toxoplasmosis was successfully closed by vitrectomy with an inverted ILM flap.

Purpose: To determine whether there is a significant correlation between the retinal sensitivity and the integrity of the ellipsoid zone (EZ) of the photoreceptors in eyes with myopic chorioretinal atrophy (CRA). We also determined the significance of the correlation between the retinal sensitivity and the retinal and choroidal thicknesses. Methods: The medical records of 10 eyes of six subjects with myopic CRA were reviewed. The integrity of the EZ was determined in the spectral-domain optical coherence tomographic (OCT) images at 37 points of six scans corresponding to the locations where the retinal sensitivities were measured by MP-3 microperimetry. The mesopic retinal sensitivities were determined within the central 16°. The significance of the correlations between the integrity of the EZ and the mesopic retinal sensitivities was determined. The relationships between the retinal and choroidal thickness and the retinal sensitivity were also determined. Results: The average age of the patients was 70.0 ± 6.7 years, and the average axial length of the eye was 29.2 mm. The mesopic sensitivities at the points where the EZ was present were significantly higher than those where the EZ was absent ( p Conclusions: The significant correlation between the mesopic retinal sensitivity and the integrity of the EZ indicates that the mesopic sensitivities can be used to assess the integrity of the photoreceptors in eyes with myopic CRA.

Purpose: The purpose of this report was to present our findings in 4 cases of rhegmatogenous retinal detachment (RRD) that recurred 10, 11, 12, and 17 years after a reattachment surgery by pars plana vitrectomy (PPV). Methods: Four cases of a recurrent RRD had undergone scleral buckling surgery and vitrectomy. Patients: The recurrence of the RRD was observed 10–17 years after the successful attachment by PPV. The macula was detached in all cases, and none of the eyes had severe proliferative vitreoretinopathy. The cause of the recurrence was a new retinal break in 3 eyes and a reopening of an old retinal break in the other eye. The new breaks had a punched-out shape and had neither a horseshoe tear nor an atrophic hole associated with lattice degeneration. PPV combined with scleral buckling was performed, and a reattachment was achieved in all cases. The best-corrected visual acuity (BCVA) at the last visit ranged from 20/30 to 20/25, but the BCVA in 1 eye was 20/200 because of amblyopia. Conclusions: We experienced 4 rare cases of a recurrent retinal detachment 10–17 years after the primary RRD. PPV and scleral buckling were effective and the anatomical and the functional outcomes were good.

To determine the frequency and characteristics of rhegmatogenous retinal detachments (RRDs) that develop after an intravitreal injection of anti-vascular endothelial growth factor (VEGF) agent. A retrospective review of the medical charts. The charts of patients who received intravitreal injections for age-related macular degeneration (AMD), diabetic macular edema (DME), retinal vein occlusion (RVO), or myopic choroidal neovascularization (mCNV) between 2013 and 2020 were reviewed. We included the RRD cases that developed within 90 days of the most recent intravitreal injection. The baseline characteristics and surgical outcomes were analyzed. A total of 3040 patients received 28,190 intravitreal injections. Seven eyes of 7 cases developed a RRD. There were 6 cases of AMD and one of DME, with an incidence of one in 4027 injections (0.025%). The retinal break was in the superior quadrants in 5 eyes (71%), and in the inferior quadrants in 2 eyes. All eyes had a posterior vitreous detachment. The average number of injections before the development of RRD was 14.1 (range: 2–39). Four eyes were treated by vitrectomy, and 3 by scleral buckling. The primary success rate was 86%, and the final reattachment rate was 100%. The best-corrected visual acuity was 0.41 ± 0.26 logarithm of minimal angle of resolution (logMAR) units before developing the RRD, 0.78 ± 0.78 logMAR units before the surgery for RRD, and 0.45 ± 0.47 logMAR units at the final visit. The incidence of RRD after an intravitreal injection is very low (0.025%), and it can be reattached with recovery of the visual acuity.

Purpose. To report a case of persistent fetal vasculature (PFV) with a retinal detachment that worsened after cataract surgery. Pars plana vitrectomy (PPV) was performed which reduced the vitreous traction and reattached the retina. Observations. A 20-year-old Myanmarese woman presented with a mature cataract, and her vision was light perception. She underwent uneventful cataract surgery with implantation of an intraocular lens. Her visual acuity improved to 20/200 immediately after the surgery. However, fibrotic tissue was observed between the optic nerve head and the posterior capsule. She was diagnosed with PFV, and she was followed without any intervention. One and a half years after the cataract surgery, she had an advanced retinal detachment which extended over the inferior two quadrants. Her vision deteriorated to 20/400. She underwent PPV, and the PFV tissue was removed which resulted in the reattachment of the retina. The visual acuity improved to 20/60. Conclusions. Surgeons should be aware that it is possible to worsen a retinal detachment after cataract surgery in the eyes with PFV. A simple technique to release the anterior-posterior traction by the PPV was sufficient to achieve the reattachment of the retina.

Purpose: We aim to determine the effects of intravitreal aflibercept (IVA) on the mean sensitivity (MS) of the central retina, best-corrected visual acuity (BCVA), and central foveal thickness (CFT) in eyes with neovascular age-related macular degeneration (nAMD) with or without polypoidal choroidal vasculopathy (PCV). Methods: This was a prospective, interventional study. All eyes were treatment-naive with nAMD with or without PCV. Each eye received 3 monthly IVA injections followed by an IVA injection every 2 months for 12 months. The primary outcome was the change in the MS within the central 2°. The secondary outcomes were the changes in BCVA, CFT, greatest linear dimension (GLD), and percentage of eyes with a dry macula. Results: Thirty-seven eyes of 37 patients were studied. A significant improvement of the MS (dB) was observed +4.9 ± 4.6 dB (mean ± standard deviation) at 3 M (p < 0.001), +5.5 ± 4.9 dB at 6 (p < 0.001), and +7.0 ± 3.4 dB at 12 M (p < 0.001) compared to the baseline in all eyes. The MS of the eyes with non-PCV was not significantly different from that of eyes with PCV (p = 1.00, 1.00, 1.00, and 0.76 at baseline, 3, 6, and 12 M, respectively). The MS of 11 patients whose BCVA remained unchanged was significantly improved by +6.5 ± 2.8 dB at 3 M (p < 0.001), +6.1 ± 4.3 dB at 6 M (p < 0.001), and +6.4 ± 4.8 dB at 12 M (p = 0.003) compared to the baseline. The mean BCVA was significantly improved from the baseline to 3 M (p < 0.001), 6 M (p = 0.027), and 12 M (p = 0.003) in all eyes. The BCVA was improved or maintained in 97% of the patients at 12 M. The mean CFT and GLD were significantly reduced at 12 M (p < 0.001). Twenty-two eyes (71%) had a dry macula at 12 M. Conclusions: IVA administered by a fixed dosing regimen led to significant improvements of the central MS, BCVA, and macular morphology at 1 year in eyes with nAMD with or without PCV. These results were not significantly different between eyes with non-PCV and with PCV. The improvements of the MS of the retina of the central 2° in a subgroup whose BCVA remained unchanged through the 12-month experimental period was also significant. We conclude that the MS of the central 2° might be a better marker than the BCVA in determining the effectiveness of IVA treatments and might be helpful in determining early effects on the retina before BCVA changes can be detected.

The purpose of this study was to evaluate the long-term effects of half-time photodynamic therapy (PDT) on the retinal sensitivity in eyes with chronic central serous chorioretinopathy (CSC). Twenty-two eyes of 22 patients with chronic CSC were studied. PDT was applied with full-dose verteporfin and half-time laser duration. The best-corrected visual acuity (BCVA) and retinal sensitivity in the central 2 and 10 degrees were evaluated at the baseline, and at 12 and 24 months after the half-time PDT. The retinal sensitivity was determined by Macular Integrity Assessment microperimetry (MAIA, Centervue, Padova, Italy). The results showed that the mean retinal sensitivities in the central 2 and 10 degrees were significantly improved at 12 months (25.6±2.79 dB, median; 26.11 dB, 25.6±2.25 dB, median; 25.65 dB, respectively; P<0.001) and at 24 months (26.3±2.62 dB, median; 27.38 dB, 26.6±2.21 dB, median; 27.45 dB, respectively; P<0.001) after the treatment compared to that at the baseline (19.2±3.93 dB, median; 19.34 dB, 20.9±2.92 dB, median; 20.9 dB, respectively). The BCVA was also significantly improved from 0.18±0.19 median; 0.15 logarithm of the minimum angle of resolution (logMAR) units at the baseline to 0.07±0.15 median; 0 logMAR units at 12 months (P<0.001) and to 0.049±0.16 median; -0.039 logMAR units at 24 months (P<0.001). We conclude that half-time PDT results in a significant improvement of the mean central retinal sensitivity for at least 24 months in eyes with chronic CSC. Thus, half-time PDT is beneficial in resolving chronic CSC for a relatively long period.

To compare the outcomes of vitrectomy with removal of an idiopathic epiretinal membrane (ERM) in the myopic eyes with long axial length (AL) to that in the eyes with normal AL. This was a retrospective, observational, case-control study. Fifty-six eyes of 56 patients with an idiopathic ERM were studied. Twenty-eight of these eyes had an axial length longer than 26.0 mm (Group A), and the other 28 eyes had axial lengths < 26.0 mm (Group B). The age and visual acuity of the two groups were not significantly different. All subjects were treated by vitrectomy and peeling of the ERM with a 25- or 27-gauge system. The postoperative best-corrected visual acuity (BCVA) and optical coherence tomographic findings were determined at 3 and 6 months postoperatively. The mean BCVA improved from 0.35 ± 0.25 to 0.15 ± 0.25 logMAR units in the eyes with the long AL and from 0.35 ± 0.25 to 0.10 ± 0.21 logMAR units in the eyes with normal AL at 6 months postoperatively (both P < 0.001). The postoperative BCVA was not significantly different between the two groups at 6 months (P = 0.221). The central macula was thinner in the eyes of Group A than Group B (P < 0.001). The restorations of the ellipsoid zone and the external limiting membrane were observed in both groups, but the interdigitation zone was less frequently restored in Group A (P < 0.001). Vitrectomy with the removal of the epiretinal membrane is effective in attaining a good BCVA even in the myopic eyes with long AL.

PURPOSE To measure the vascular density (VD) of the retinal capillary plexuses by optical coherence tomography angiography (OCTA) after surgery for an idiopathic macular hole. METHODS Retrospective, observational case series.Sixteen eyes of 16 patients with an idiopathic macular hole underwent vitrectomy with internal limiting membrane peeling. The VDs of the superficial capillary plexus (SCP) and deep capillary plexus (DCP) were determined by OCTA, and the retinal sensitivity (RS) and the inner retinal thickness (IRT) were measured before, and at 3, 6, and 12 months after the surgery. The VD, RS, and IRT were measured at the four parafoveal quadrants. RESULTS The mean age was 68.9 years. The VDs of the SCP and DCP were significantly correlated with the RS and IRT at 12 months postoperatively (all P < 0.001 for both SCP and DCP). The VDs of the SCP and DCP were higher, the RS more sensitive, and the IRT thicker in the nasal than the temporal quadrant at 12 months (P < 0.001

Introduction: To compare the morphological and visual outcomes after pars plana vitrectomy (PPV) with internal limiting membrane (ILM) peeling and flap removal to that with flap insertion in eyes with myopic macular-hole retinal detachment (MHRD). Methods: Forty-six eyes of 45 patients with MHRD were studied. Eighteen eyes were treated by PPV with ILM peeling and flap removal and 28 eyes by flap insertion, respectively. The baseline characteristics and postoperative findings were compared between the 2 groups. Results: The average age of the cases was 70.0 ± 8.5 years. The best-corrected visual acuity (BCVA) improved, from 1.51 ± 0.14 to 1.31 ± 0.20 logMAR units in the flap removal group, and from 1.20 ± 0.10 to 0.88 ± 0.10 logMAR units in the flap insertion group (p = 0.049). A significantly larger number of MHs were closed in the flap insertion group (96 vs. 50% in the removed group; p < 0.001). Restoration of the ellipsoid zone (EZ) and external limiting membrane (ELM) was also better in the flap insertion group than in the flap removal group (EZ 14 vs. 6%, p = 0.003; ELM 36 vs. 6%, p < 0.001). Discussion: The technique of ILM peeling with flap insertion is more effective in closing the MH, and results in better BCVA and better restoration of the outer retinal microstructures than flap removal.

We report two cases of chronic rhegmatogenous retinal detachment with a nonperfused peripheral retinal area. Case 1 was an 84-year-old woman who presented with a bullous retinal detachment of the inferior retina and a best-corrected visual acuity of 20/500. A small horseshoe tear was detected in the peripheral superior retina. Fluorescein angiography showed a wide area of nonperfused retina in the inferior retina. The retina was successfully reattached by scleral buckling surgery. Case 2 was a 40-year-old woman who presented with a shallow retinal detachment involving the macula. There were multiple retinal breaks at the pars plana that were secondary to blunt trauma. Fluorescein angiography revealed a wide area of nonperfused retina in the inferior peripheral retina. She underwent scleral buckling surgery, and the retina was successfully reattached. Our findings indicate that clinicians should examine the peripheral retina carefully especially with fluorescein angiography to search for nonperfused areas in eyes with chronic rhegmatogenous retinal detachment.

To investigate the difference in clinical course after the first optic neuritis (ON) between aquaporin-4 IgG-associated disorder (AQPAD) and myelin oligodendrocyte glycoprotein-IgG-associated disorder (MOGAD) METHODS: In this study, 31 eyes in 24 patients with AQPAD and 26 eyes in 18 patients with MOGAD were included. The clinical course for the first 6 months after the first ON was monitored by a retrospective cohort study. Best-corrected visual acuity (BCVA) was observed before the onset and at nadir, 2 weeks (2 W), 1 month (1 M), 2 months (2 M), 3 months (3 M) and 6 months (6 M). The decimal BCVA was converted to the logarithm of the minimal angle of resolution (logMAR) for statistical analyses.MOGAD eyes showed longer median number of days from ON onset to nadir (6.0 vs. 11.5, P = 0.012) and to treatment (7.0 vs. 11.0, P = 0.020) than AQPAD eyes. The median logMAR was higher in AQPAD eyes than in MOGAD eyes at nadir (2.00 vs. 1.77, P = 0.050), 2 W (1.85 vs. 0.40, P = 0.001), 2 M (0.023 vs. - 0.079, P = 0.032) and 3 M (0.046 vs. - 0.079, P = 0.002). The median time to recovery of BCVA to 0.7 was longer in AQPAD eyes than in MOGAD eyes (44.0 vs. 21.0 days, P = 0.024), but that to BCVA 1.0 was not different between the two disorders (168.0 vs. 40.0 days, respectively, P = 0.056).Compared with MOGAD eyes, AQPAD eyes tended to show worse visual outcome even during the first ON episode.

Purpose To report a case in which an internal limiting membrane (ILM) flap that was used to cover an idiopathic macular hole (MH) during pars plana vitrectomy (PPV) with the inverted internal limiting membrane flap technique partially detached from the retina. Most interestingly, the flap fell back spontaneously to re-cover the MH. Observations A 70-year-old woman presented with a full-thickness MH, and her vision was 20/400. She underwent PPV with an inverted ILM flap and air tamponade. When the intraocular gas was absorbed, the ILM flap detached but was held to the retina where it had not been peeled and the MH was open. Her visual acuity at this time was 20/400. The patient did not want further treatment and was followed by observation alone. At three months after the initial surgery, the ILM flap was noted to have spontaneously re-covered the MH, and her visual acuity improved to 20/200. At 6 months after the re-covering, the flap remained over the MH and the visual acuity remained at 20/200. Conclusions and Importance Surgeons should be aware that it is possible for an ILM flap created by the inverted ILM flap technique to partially detach from the retina after the tamponade gas is resorbed. Most importantly, the flap can return to re-cover the MH spontaneously.

Background/purpose To report a diabetic patient with uveal effusion that developed proliferative diabetic retinopathy after unsuccessful scleral resection for the uveal effusion. Case report A 50-year-old Japanese man with nonproliferative diabetic retinopathy and uveal effusion in his right eye underwent partial thickness sclerectomies at the four quadrants to treat the uveal effusion. These procedures reduced the amount of subretinal fluid and thus the choroidal and retinal detachment. However, the retinal detachment recurred and proliferative diabetic retinopathy developed with pre- and subretinal proliferation at 5 months after the surgery. The patient then underwent pars plana vitrectomy combined with phacoemulsification and implantation of an intraocular lens. During the surgery, the vasoproliferative membrane was removed, panretinal photocoagulation was performed, and intraocular tamponade with silicone oil was performed. After the removal of the silicone oil, the retina remained attached but the visual acuity was 2/20 because of macular atrophy. Conclusion Clinicians should be aware that treatment of a uveal effusion by scleral resection can lead to a progression of nonproliferative diabetic retinopathy to proliferative diabetic retinopathy.

Macular hole has been believed to be a disorder of vitreomacular interface, which forms as a result of abnormal vitreous traction from incomplete vitreous detachment. However, our recent studies demonstrated that dynamic forces, caused by mobile posterior cortical vitreous with fluid currents, exist already at early stages of macular hole development. Therefore, in eyes with flexible vitreous, the contributions of tractional forces due to vitreous shrinkage are unlikely. These facts indicate that in the development of idiopathic macular holes, there is a greater contribution of dynamic forces than has been previously reported. This review also evaluates the recent findings in the assessment of the idiopathic macular holes and the recent therapeutic strategies for optimal management. Inner limiting membrane is considered to improve anatomical closure rate; however, it is still questionable if peeling is necessary in holes less than 250 µm. There are plenty of publications indicating that in the management of small and medium size hole (less than 400 µm), use of long-lasting gas and face-down position is not always required; however, it may be necessary for the treatment of large holes. Ocriplasmin and expansile gas had been reported to be successful for management of small- and medium-sized holes and vitreomacular attachment.

Purpose: To determine the efficacy of systemic sodium-glucose co-transporter 2 inhibitors (SGLT2i) on diabetic macular edema (DME). Methods: The medical records of patients with DME with a central retinal thickness (CRT) ≥320 µm in men and 305 µm in women, more than 6 months after the initiation of diabetes mellitus treatment, were reviewed. The CRT and best-corrected visual acuity (BCVA) were evaluated before and after the initiation of systemic SGLT2i and non-SGLT2i treatments. Results: There were 24 eyes of 19 patients with DME that were treatment naïve or had not received treatments for the DME within four months before the initiation of SGLT2i. In these patients, the BCVA had a 0.31 ± 0.39 logarithm of the minimum angle of resolution (logMAR) units at the baseline, and it did not improve significantly at 0.26 ± 0.29 logMAR units after the initiation of SGLT2i (p = 0.56). However, the SGLT2i treatment significantly reduced the CRT from 423.3 ± 79.8 µm to 379.6 ± 69.5 µm (p = 0.0001). In the same evaluation of 19 eyes of 14 patients with DME that were initiated with non-SGLT2i agents, there was no significant difference between the baseline BCVA and the BCVA after the initiation of non-SGLT2i (p = 0.47). The CRT increased significantly after the initiation of non-SGLT2i (p = 0.0011). In three eyes in which the SGLT2i treatments were administered at the time of anti-vascular endothelial growth factor (VEGF) treatments, the anti-VEGF treatment alone had only a limited effect on the DME, but the reduction in the DME was enhanced after the addition of SGLT2i. Conclusions: These findings indicate that systemic SGLT2i can reduce DMEs, and they suggest that SGLT2i may be an additional treatment option to anti-VEGF treatments for eyes with DMEs.

To determine the difference between the attempted and the achieved postoperative refractive error after sutureless intrascleral fixation of the haptics of an implanted intraocular lens (IOL). This was a retrospective study of the medical charts of patients who had undergone sutureless intrascleral fixation of an IOL. The IOLs were fixed by inserting the haptics into scleral tunnels with or without flanges. The differences between the attempted and achieved postoperative refractive error (spherical equivalent) were determined. The relationships between the surgical options and the differences of the refractive error and degree of astigmatism were also determined. Two hundred and twenty-three eyes were studied. There was a myopic shift of − 0.38 ± 1.13 diopters (D). The mean of the differences between the achieved postoperative and the attempted refractive error was 0.89 ± 0.79 D. The achieved refractive error was significantly correlated with the attempted refractive error (P

The purpose of this study was to compare the efficacies of one initial intravitreal injection of aflibercept followed by a pro re nata (PRN; 1+PRN) regimen to those of three consecutive monthly injections followed by the PRN (3+PRN) regimen for diabetic macular edema (DME) with practical protocols. The medical records of 95 eyes of 71 cases that were diagnosed with DME and had received intravitreal aflibercept (IVA) injections were reviewed. Fifty-seven eyes had received IVA with the 1+PRN regimen, and 38 eyes had received IVA with the 3+PRN regimen. The best-corrected visual acuity (BCVA) and the central macular thickness (CMT) were measured at the baseline and at 1, 3, 6, and 12 months after the IVA. The mean number of injections of the 1+PRN group was 2.9 ± 1.7 , which was significantly fewer than that of the 3+PRN group at 4.6 ± 1.4 ( P < 0.001 ). The change of the mean BCVA before and after the IVA at 12 months of the 3+PRN group was − 0.14 ± 0.17 logMAR units which was significantly better than that of the 1+PRN group of − 0.045 ± 0.25 logMAR units ( P = 0.02 ). The change of the CMT before and after the IVA at 6 months of the 3+PRN group was − 141.3 ± 152.4 μ m which was significantly more than that of the 1+PRN group at − 86.1 ± 117.8 μ m ( P = 0.013 ). Although the mean number of injections was more than that in the 1+PRN regimen, the 3+PRN regimen had better visual outcomes at 12 months. In a practical protocol, we recommend the 3+PRN regimen for patients with DME (IRB#3541).

Purpose. To evaluate the efficacy of switching from intravitreal antivascular endothelial growth factor (VEGF) agents to triamcinolone acetonide (TA) in eyes with diabetic macular edema (DME) or with retinal vein occlusion-associated macular edema (RVO-ME) on the resolution of the macular edema (ME). Methods. The medical records of 11 eyes of 11 patients with DME and 9 eyes of 9 patients with RVO-ME whose MEs were refractory to anti-VEGF treatment were reviewed. The central retinal thickness (CRT), best-corrected visual acuity (BCVA), intraocular pressure (IOP), and the mean interval of the recurrences were measured during the anti-VEGF treatment and after switching to the TA injections. Results. Switching to TA injections significantly increased the mean interval for recurrences from 9.2 ± 2.7 weeks to 22.3 ± 12.9 weeks in eyes with DME ( P = 0.006 ). In eyes with RVO-ME, the mean period of recurrence was 12.3 ± 5.6 weeks before and 11.6 ± 4.4 weeks after the switch ( P = 0.44 ). The mean interval for recurrence was extended to more than 8 weeks in 7 of 11 eyes with DME, but none of the eyes with RVO-ME had a prolongation of more than 4 weeks. An elevation of the IOP was observed in 3 of the 20 eyes after the TA injection. Conclusions. These findings indicate that switching to TA injections can be a good option for DME eyes refractory to anti-VEGF injections but not for the RVO-ME eyes.

We present our findings in an atypical case of ocular syphilis with optic disc neovascularization that was treated with intravitreal bevacizumab and followed by multimodal imaging and electroretinography. A 29-year-old man presented with a chief complaint of night blindness of one-year duration. Our initial examination showed that an optic disc neovascularization was present, and the optical coherence tomographic (OCT) images showed a reduction in the length of the ellipsoid zone of both eyes. Fluorescein angiography showed leakage from the optic disc neovascular tissue, and the presence of nonperfused areas in the peripheral retina. Blood test was strongly positive for syphilis. He was administered oral amoxicillin and prednisolone. He was also treated with an intravitreal injection of bevacizumab which led to a rapid suppression of the neovascularization. However, panretinal photocoagulation had to be performed because OCT angiography and fluorescein angiography detected residual neovascularization. Although these treatments suppressed the activity of the ocular syphilis, electrophysiological improvements were not seen even 1 year after the initial treatment. OCT angiography and electroretinogram are useful techniques for monitoring the effectiveness of the treatments.

To report the outcomes of pars plana vitrectomy in cases with breakthrough vitreous hemorrhage (VH) secondary to exudative age-related macular degeneration (AMD) and polypoidal choroidal vasculopathy. We also investigated the relationship between the preoperative b-mode ultrasonographic findings and the postoperative visual acuity to determine if the ultrasonographic findings can predict the surgical outcome after pars plana vitrectomy. This was a retrospective, interventional, case series. Twenty eyes of 20 patients were studied. The associations between the pre- and intraoperative factors and the final best-corrected visual acuity (BCVA) were determined. Recombinant tissue-plasminogen activator (tPA) was used in cases with massive hemorrhagic retinal detachment. Ten eyes with polypoidal choroidal vasculopathy (PCV), two eyes with choroidal neovascularization (CNV), and eight eyes with an unknown type of AMD were studied. The mean BCVA was 0.73 ± 0.57 logarithm of the minimum angle of resolution (logMAR) units before developing the VH, 2.25 ± 0.45 logMAR units before the surgery, and 1.52 ± 0.87 logMAR units after the surgery. The BCVA improved significantly after the surgery (P = 0.004) but was significantly worse than that before developing the VH (P = 0.012). The cases of PCV had better final BCVA than cases of CNV (P = 0.043, Mann–Whitney test). The preoperative presence of a subretinal elevation at the macula detected by ultrasonography was significantly associated with a poorer final BCVA (P = 0.031). Vitrectomy significantly improved visual function in the eyes with VH associated with exudative AMD. The eyes with PCV and no macular subretinal elevation on ultrasonography had a better visual prognosis.

Purpose To report two cases with retinitis pigmentosa (RP) who underwent vitreo-retinal surgery and developed severe retinal atrophy. Observations Case 1 was a 36-year old man who underwent 20-gauge pars plana vitrectomy (PPV) for a macular hole (MH), and Case 2 was a 71-year-old man who also underwent 20-gauge PPV for an epiretinal membrane (ERM). During 13 years follow-up period, severe retinal atrophy developed near the macula that progressed rapidly and the best-corrected visual acuity (BCVA) was reduced to 1.1 logarithm of the minimum angle of resolution (logMAR) units in the MH case and to no light perception in the ERM case. Conclusions and importance An unexpected severe retinal atrophy can develop long after vitreo-retinal surgery in RP patients.

Background Evidence-based criteria for the treatment of autoimmune retinopathy (AIR) have not been established. The pathology and clinical features of each antibody causing AIR, and its long-term course are still undetermined. We report our findings in a case of non-paraneoplastic AIR (npAIR) that developed in the fellow eye 10 years after the onset in the first eye. Case presentation Our patient had photophobia in both eyes and a rapidly progressing visual field defect in his right eye at the initial examination. He was diagnosed with non-paraneoplastic AIR based on the clinical findings and immunoblot analyses for anti-retinal antibodies, and he was treated with steroids. Ten years later, a visual field defect developed in the fellow eye, and a diagnosis of npAIR was made. Immunoblot analyses were positive for anti-α-enolase antibodies. He was treated with steroids, immunosuppressants, and plasma exchange. However, the response to the treatment was poor and both eyes eventually became blind. Conclusions As best we know, this is the first case report of npAIR that developed in the fellow eye over 10 years after the development in the first eye. Long-term follow-up and a search for tumor lesions are necessary in cases of npAIR. Further understanding of the long-term course of AIR can contribute to an understanding of the pathology and treatment of npAIR.

Background/AimTo determine the preoperative ocular factors and surgical methods that led to best-corrected visual acuity (BCVA) after pars plana vitrectomy (PPV) or scleral buckling (SB) for rhegmatogenous retinal detachment (RRD).MethodsThis was a prospective, nationwide, multicentre, observational study. Data from the Japanese Retina and Vitreous Society registry from 2016 to 2017 were used to determine the association between preoperative clinical factors, surgical procedures and postoperative BCVA at 6 months. Japanese individuals >40 years of age were included. Eyes with proliferative vitreoretinopathy were included. The primary outcome was the percentage of eyes that achieved 20/25 vision.ResultsOf the 3219 registered cases, 2192 met the inclusion criteria (344 SB, 1738 PPV, 110 PPV+SB). Cases with preoperative BCVA (≤0 logarithm of the minimum angle of resolution (logMAR) units) had good postoperative BCVA (OR=3.97, CI 2.87 to 5.51). Older age (>70 years), low intraocular pressure (4), giant retinal tear (>90°), wide retinal detachment (>3 quadrants) and macula-off detachment were associated with less probability of postoperative 20/25 vision (OR=0.39, 0.64, 0.62, 0.60, 0.12, 0.51 and 0.36, respectively). Postoperative BCVA was 0.03±0.23 and 0.10±0.32 logMAR units after SB and PPV, respectively. The percentage of cases that achieved 20/25 vision was not significantly different after PPV or SB if cases that had concurrent cataract surgery were excluded (p=0.251).ConclusionsBetter BCVA in patients with RRD who had undergone PPV was observed. However, if concurrent cataract surgery is not performed, BCVA will be comparable with either PPV or SB.

A 37-year-old Japanese man had his right eye hit by a fist. His right eye developed hypotony maculopathy and secondary cataract, and his visual acuity decreased to 20/200 with an intraocular pressure of 4 mmHg. He underwent phacoemulsification and aspiration, implantation of the intraocular lens, and encircling with a silicone tire. His visual acuity improved to 20/20 and stable for more than one year postoperatively. The intraocular pressure in his right eye increased to 12 mmHg, and maculopathy was resolved entirely. It was suggested that an encircling buckle obstructed the uveoscleral outflow through the cyclodialysis and increased intraocular pressure. Concurrent cataract surgery and encircling was sufficient to improve the vision.

A 61-year-old Japanese woman presented with impairment of her left vision due to macular schisis secondary to branch retinal vein occlusion. Her left vision was 20/50, and schisis was observed inferotemporally. She underwent phacoemulsification and aspiration, implantation of the intraocular lens, and removal of the epiretinal membrane and internal limiting membrane. Her visual acuity stabilized ~20/50 for two and a half years after the initial surgery. However, she developed macula-involving retinal detachment, and her visual acuity declined to counting fingers. She underwent pars plana vitrectomy and removal of the residual vitreous cortex together with the inner retina within the area of vein occlusion. After the removal of silicone oil and the addition of an encircling buckle, the retina remained attached and visual acuity improved to 20/60 at one year after the final surgery. The combination of rhegmatogenous and tractional detachment in the area of schisis was suspected, and vitrectomy with inner retinectomy was effective.

Purpose. Diabetic macular edema (DME) is a vision-threatening condition that develops in diabetic patients. The first-line therapy for DME is intravitreal injections of antivascular endothelial growth factor (anti-VEGF) agents; however, the high frequency of repeat injections, invasiveness of the procedure, and high cost are drawbacks for this treatment. The purpose of this report is to present our findings in 3 patients with chronic DME whose edema was resolved soon after oral doses of sodium-glucose cotransporter-2 (SGLT2) inhibitors were used. Case Presentation. Case 1 was a 66-year-old woman diagnosed with moderate nonproliferative diabetic retinopathy (DR) with DME that had developed a decade earlier. The DME persisted for 4 years in the left eye. The addition of oral empagliflozin, a SGLT2 inhibitor, led to a marked improvement of the DME after one month, and this improvement continued over two years. Case 2 was a 68-year-old woman who was diagnosed with preproliferative DR with bilateral DME. The addition of oral dapagliflozin led to the improvement of the DME after two months, and this improvement continued over one year. Case 3 was a 61-year-old woman who was diagnosed with moderate nonproliferative DR with DME. Oral luseogliflozin was given which led to better glycemic control, and her left central retinal thickness (CRT) was markedly reduced after only two weeks. This reduction was maintained in her left eye for six months without any additional ophthalmic procedures. Conclusions. Although this study involved only three cases, our findings indicate that SGLT2 inhibitors might have possible efficacy for chronic DME.

Purpose. To investigate the outcomes of pars plana vitrectomy (PPV) combined with scleral buckling (SB) in treating eyes with an early recurrent rhegmatogenous retinal detachment (rRRD). Methods. This was a retrospective, interventional case series of 21 eyes with an early rRRD treated by PPV combined with SB. The significance of the associations between the variants before the surgeries and the final best-corrected visual acuity (BCVA) was determined. Results. The average age of the patients was 61.0 ± 9.6 years. A retinal reattachment was observed in 20 of 21 eyes (95.2%) after a single reoperation. The BCVA was 0.91 ± 0.90 logMAR units before the initial surgery and 0.94 ± 0.94 logMAR units before the reoperations, and it improved significantly to 0.49 ± 0.50 logMAR units after the reoperation (P = 0.016,P = 0.002, respectively). The preoperative BCVA was significantly correlated with the final BCVA (P = 0.043, r = 0.445 before the primary surgery;P

The author report the structural changes in the inner and outer choroid determined by the binarization of enhanced depth imaging optical coherence tomographic images in 100 eyes with retinitis pigmentosa compared with 60 normal controls and significant correlations between the inner choroidal structures and visual functions in the eyes with retinitis pigmentosa., Purpose: To investigate the choroidal structures in the enhanced depth imaging optical coherence tomographic images in eyes with retinitis pigmentosa (RP) and to determine correlations between the choroidal structures and visual functions. Methods: The enhanced depth imaging optical coherence tomographic images of 100 eyes with typical RP and 60 age-, sex-, and axial length–matched normal eyes were binarized using ImageJ. The cross-sectional luminal and stromal areas of the inner and outer subfoveal choroid of 1,500-µm width were measured. The inner choroid included the choriocapillaris and medium vessel layer, and the outer choroid included the larger vessel layer. Results: In the inner choroid, the luminal area and the ratio of luminal/total choroidal area (L/C ratio) were significantly smaller in RP than in controls (P = 0.010, P < 0.001, respectively), whereas the stromal area was not significantly different (P = 0.114). The inner choroidal L/C ratio was significantly correlated with the best-corrected visual acuity, mean deviation, foveal sensitivity, width of the ellipsoid zone, and central foveal thickness in RP after adjusting for the axial length, age, and sex (all P < 0.005). Conclusion: The significant correlations between the inner choroidal structures and the visual functions and retinal structures indicate that the choroidal structures are altered in association with the progression of RP.

Purpose: We compared the efficacy of sub-Tenon triamcinolone acetonide (STTA) to intravitreal triamcinolone aceto­nide (IVTA) injections during cataract surgery (CS) for patients with diabetic macular edema (DME). Methods: The medical records of 33 eyes (26 patients) with DME which had undergone CS with STTA were compared to those of 34 eyes (27 patients) with DME which had undergone CS with IVTA. Central foveal thickness and best-corrected visual acuity (BCVA) were measured at the baseline and 1, 3, and 6 months after the surgery. Results: The BCVAs after STTA and IVTA were significantly improved at 3 and 6 months. Thirteen eyes in the IVTA group and 21 eyes in the STTA group required other therapies (p < 0.05). One case developed intraocular pressure elevation after IVTA and underwent selective la ser trabeculoplasty. Conclusions: Ophthalmologists should consider the merits and demerits of IVTA and STTA for DME treatment after CS.

Gen Miura, Takayuki Baba, Toshiyuki Oshitari, Shuichi Yamamoto Department of Ophthalmology and Visual Science, Chiba University Graduate School of Medicine, Chiba, Japan Purpose: The aim of this study is to determine the effect of pupil size of eyes with cataracts on the flicker electroretinograms (ERGs) elicited and recorded with the RETeval system.Patients and methods: Forty-one eyes of 41 patients (mean age, 76.5±7.3years) that had grade 2 nuclear or cortical cataract without any other abnormalities were studied. Flicker ERGs were recorded before and after mydriatic drops instillation. The ERGs were elicited by the white light delivered at the frequency of 28.3Hz and intensities of 2, 8, and 32 Td-s. The amplitudes and the implicit times of the flicker ERGs before and after mydriasis were compared.Results: There were no significant differences between the amplitudes before and after mydriasis (P=0.35, 2 Td-s; P=0.31, 8 Td-s; P=0.50, 32 Td-s). There were also no significant differences between the implicit times before and after mydriasis (P=0.86, 2 Td-s; P=0.98, 8 Td-s; P=0.95, 32 Td-s). The mean amplitudes and implicit times of the nuclear and cortical cataracts groups before the mydriasis were also not significantly different from those after mydriasis for all stimulus intensities.Conclusion: The lack of significant differences in the amplitudes and the implicit times of the flicker ERG of cataractous eyes before and after mydriasis indicated that the RETeval flicker ERGs in cataractous eyes is less affected by the pupil diameter. With our earlier study, it was assumed that the effect of cataracts on the RETeval flicker ERGs was due to the opacity of the crystalline lens, and the influence of the cataract would not be reduced or increased by mydriasis. Keywords: electroretinogram, ERG, flicker ERG, cataract, RETeval

The aim of this study was to determine the size of the foveal avascular zone (FAZ) by optical coherence tomography angiography (OCTA) after surgery for an idiopathic epiretinal membrane (ERM). This study comprised a retrospective, observational case series. In all, 17 eyes of 17 patients with an idiopathic ERM were studied. Pars plana vitrectomy was performed with internal limiting membrane (ILM) peeling. The area of the superficial FAZ and the central macular thickness were determined by OCTA. Retinal sensitivity was measured by microperimetry. The size of the preoperative FAZ was difficult to determine because of the poor images of the capillary network. The size of the FAZ was smaller than that of the control eyes at all time points (p < 0.001). There was a significant inverse correlation between the area of the postoperative FAZ and the CMT (r = −0.480, p = 0.048 at 3 months; r = −0.565, p = 0.018 at 6 months; r = −0.534, p = 0.027 at 12 months), and between the area of the FAZ and retinal sensitivity (r = −0.622, p = 0.008 at 3 months; r = −0.578, p = 0.015 at 6 months), postoperatively. The significantly small FAZ after ERM surgery indicates a macular deformity caused by a contraction of the ERM. This change persisted for at least 12 months after the surgery.

PurposeThe purpose of this study is to compare the amplitudes and peak times of the flicker electroretinograms (ERGs) recorded before and after cataract surgery with the RETeval system (LKC Technologies, Gaithersburg, MD, USA) from eyes without dilation.Patients and methodsThirty-two eyes of 32 patients (77.3±6.5 years) that had grade 2 Emery-Little nuclear or cortical cataract without any other abnormalities were studied. Flicker ERGs were recorded with the RETeval system under mydriatic-free conditions. Skin electrodes were used to pick-up the ERGs that were elicited by white light delivered at a rate of 28.3 Hz and intensity of 2, 8, and 32 Td-s. The amplitudes and peak times of the flicker ERGs before and after cataract surgery were compared.ResultsThe mean amplitudes were significantly increased after the removal of the cataractous lenses at the three stimulus intensities (2 Td-s, P0.0001; 8 Td-s, P0.0001; and 32 Td-s, P0.0001). The mean peak times of the flicker ERGs elicited by 2 and 8 Td-s were significantly shortened after the surgery (2 td-s, P0.0001 and 8 td-s, P=0.0127) but not at 32 td-s (P=0.595).ConclusionsThese results indicate that the presence of cataracts will affect both the amplitudes and the peak times of the flicker ERGs even if the cataract is mild. In addition, the results indicate that as stimulus intensity increases, the peak times is less affected by a cataract. The clarity of the crystalline lens should be considered when interpreting the flicker ERGs recorded with the RETeval system.

Purpose: We investigated whether scleral imbrication combined with pars plana vitrectomy without internal limiting membrane peeling would be effective in treating eyes with myopic macular schisis. Methods: In this retrospective, interventional case series, 8 eyes of 8 patients with myopic retinoschisis without a macular hole were studied. Scleral imbrication was done with 6-mm-wide mattress sutures placed at the temporal quadrants. Pars plana vitrectomy and removal of the vitreous cortex were performed, but the internal limiting membrane was not removed. The best-corrected visual acuity was measured, and the retinal morphology was determined by spectral-domain optical coherence tomography before and at 6 and 12 months postoperatively. Results: The mean age of the subjects was 67.1 years. The best-corrected visual acuity improved from 0.71 ± 0.25 to 0.36 ± 0.19 logarithm of the minimum angle of resolution units (Snellen equivalent: from 20/100 to 20/50) at 12 months (P = 0.028). The axial length was shortened from 29.5 ± 1.7 to 28.5 ± 2.5 at 12 months (P = 0.012). The central foveal thickness decreased from 540 ± 171 μm to 170 ± 85 μm at 12 months (P = 0.012). In the 6 macular-detached eyes, 5 eyes (83%) had a complete resolution. The curvature of posterior eye wall was flatter at 12 months (P = 0.049). No retinal complications were observed. Conclusion: Scleral imbrication combined with pars plana vitrectomy can be an effective method of treating myopic schisis.

To evaluate the safety and efficacy of transdermal electrical stimulation (TdES) with skin electrodes on improving the visual functions of patients with retinitis pigmentosa (RP), twenty eyes of 10 patients with RP underwent TdES (10-ms biphasic pulses, 20 Hz, 30 min) 6 times at 2 week intervals. All patients were stimulated bilaterally with 1.0 mA pulses. The primary endpoint was safety, and the secondary endpoints were the changes in the best-corrected visual acuity (BCVA), visual fields determined by the Humphrey field analyzer (HFA) 10-2 and Goldmann perimetry, and answers to the Visual Function Questionnaire-25. All of the 10 enrolled patients completed the study according to the protocol. No adverse events related to the treatments were reported during the follow-up examinations. The mean BCVA and Early Treatment Diabetic Retinopathy Study visual acuity were significantly improved after the TdES (P = 0.0078 and P = 0.001, respectively). The mean deviation of the HFA 10-2 was also significantly improved (P = 0.0076). We conclude that TdES with skin electrode is a safe therapeutic option and should be considered as a treatment option for patients with RP.

To report the demographics and clinical characteristics of patients with a primary retinal detachment (RD). Prospective cohort study by a registry design. Patients with RD treated at vitreoretinal sub-specialty institutions in Japan from February 2016 to March 2017. Descriptive statistics for the primary RD, and multivariable ordered logistic regression and multiple linear regression analyses were performed. 3178 eyes of 3178 cases were analyzed. The interval from onset to surgery was significantly shorter in patients in the 40-year age group than in other age groups except for the 50-year age group (P

To determine the effectiveness of a single or a combination of topical neurotrophic factors (NFs) in protecting retinal ganglion cells (RGCs) in the rat optic nerve crush (ONC) model, the left ONC was performed to induce the death of the RGCs in adult Sprague-Dawley rats. The NFs studied were tauroursodeoxycholic acid (TUDCA), citicoline, neurotrophin-4 (NT-4), combined TUDCA/citicoline (Doublet-1), combined TUDCA/NT-4 (Doublet-2), combined TUDCA/citicoline/NT-4 (Triplet), and PBS. After 2 weeks, the number of RGCs was determined by Brn3a immunostaining. The optic nerves were immunostained for anti-Growth Associated Protein-43(GAP-43) and -200kD neurofilament heavy antibody to study optic nerve regeneration. Two weeks after the ONC, the densities of RGCs in all treated eyes were significantly higher than that of the PBS treated eyes. In the Triplet group, the number of RGC axons after ONC was significantly higher than that in all of the single treatment groups and the number of TUNEL positive cells was significantly reduced and the number of GAP-43 immunopositive axons was significantly greater than those in the PBS group. Neovascularization was observed only in the Doublet-1 group. We conclude that the combination of the three NFs was the most effective way to protect RGCs after the ONC.

A 17-year-old male presented with acute bilateral paracentral scotomata and blurred vision. Funduscopic examination showed bilateral macular serous retinal detachment and yellow-white placoid lesions at the level of retinal pigment epithelium. OCT study showed typical VKH disease findings with marked choroidal thickening and macular serous retinal detachment partly with subretinal septa in both eyes. FA demonstrated hypofluorescence at the placoid lesions in the early phase and hyperfluorescence in the late phase. Laboratory investigation showed negative result for HLA-DR4 serotype and the patient’s cerebrospinal fluid test values were within normal range. We made the diagnosis of APMPPE from these results. At 2-month follow-up without the use of corticosteroids, OCT reexamination showed complete amelioration of subretinal fluid in both eyes. Patchy pigmentary lesions also resolved clinically with partial chorioretinal scars. The results in this case suggested OCT findings in APMPPE patients could be similar to characteristic features usually found in acute VKH disease. We recommend comprehensive assessments such as FA, cerebral spinal fluid analysis, and HLA typing which help in leading proper diagnosis.

To determine whether there are significant correlations between the N2 amplitude of the multifocal electroretinograms (mfERGs) and the retinal sensitivity and retinal nerve fiber layer (RNFL) thickness in glaucomatous and normal eyes. Thirty-eight glaucomatous and 11 normal eyes were studied. The mfERGs were elicited by red stimuli presented on a blue background. The responses from the central five elements within a 20° stimulated area were analyzed. The retinal sensitivity was determined by Humphrey Field Analyzer and the RNFL thickness by spectral-domain optical coherence tomography. The correlations between the N2 amplitude and the retinal sensitivity and the RNFL thickness were calculated. The N2 amplitude was significantly smaller in the glaucomatous eyes than the normal eyes in all areas (P

Diabetic keratopathy is characterized by impaired innervation of the cornea that leads to decreased sensitivity, with resultant difficulties with epithelial wound healing. These difficulties in wound healing put patients at risk for ocular complications such as surface irregularities, corneal infections, and stromal opacification. Pathological changes in corneal innervations in diabetic patients are an important early indicator of diabetic neuropathy. The decrease in corneal sensitivity is strongly correlated with the duration of diabetes as well as the severity of the neuropathy. This review presents recent findings in assessing the ocular surface as well as the recent therapeutic strategies for optimal management of individuals with diabetes who are susceptible to developing diabetic neuropathy.

Background To present our findings in a case of convulsive seizures and loss of consciousness that developed during recording electroretinograms (ERG). Case presentation A 34-year-old man had reduced vision in his left eye for about 15 years, and night blindness for about two years. His visual acuity was 20/15 in the right eye and 20/50 in the left eye. The fundus was normal but the sensitivity in the macular region of the left eye was decreased. Optical coherence tomography (OCT) showed partial loss of the interdigitation zone. Upon completion of the flicker ERG recording, a paralysis developed in both upper limbs, then convulsions of the lower limbs followed by a loss of consciousness. The convulsions disappeared after an intravenous injection of diazepam. After that incident, he reported that he had had previous conscious-loss seizures. Conclusions Photosensitive epileptic seizures can occur with the light stimuli used for conventional ERG recordings. We recommended that clinicians request information on any prior seizure episodes of the patients and their family members before ERG recordings.

Purpose. To compare the visual and surgical outcomes after a reuse or a replacement of a dislocated in-the-bag intraocular lens (IOL). Methods. This was a retrospective, nonrandomized case series at a single ophthalmological institution. Cases with an in-the-bag dislocation of an IOL were treated by pars plana vitrectomy and the reuse or the replacement of the IOL. The lens was held by intrascleral fixation of the haptics of the IOL under both conditions. The same dislocated IOL was reused in 6 eyes (group A) or it was replaced with another IOL in the other 9 eyes (group B). The pre- and postoperative parameters analyzed included the visual acuity, refractive error, corneal endothelial cell density, and intraocular pressure (IOP). Results. There was no significant difference between the two groups in the postoperative visual acuity (P=0.388), refractive error (P=0.955), IOP (P=0.529), and endothelial cell loss (P=0.940). A breakage or a tilting of the IOL was observed and required replacement in three eyes in the reuse group (P=0.044). Conclusions. Half of the cases with reused in-the-bag dislocated IOL had a breakage or a tilting of the IOL. The replacement of the in-the-bag dislocated IOL is better than the reuse of the IOL with intrascleral haptics fixation.

A 76-year-old woman was diagnosed with thyroid-associated orbitopathy (TAO) associated with hypothyroidism at another clinic. Magnetic resonance imaging showed enlargements of the extraocular muscles. Because her best-corrected visual acuity (BCVA) was 0.01OD, she was referred to the Chiba University Hospital. She had an elevation of serum IgG4. She was diagnosed with possible IgG4-related ophthalmic disease (IgG4-ROD) accompanied by optic nerve compression with the mass. She underwent methylprednisolone pulse therapy, and, two months later, her BCVA and visual field defect were greatly improved. Our findings indicate that ophthalmologists should be aware that IgG4-ROD can be masked by lesions associated with TAO.

Neuromyelitis optica spectrum disorder (NMO-SD) is an autoimmune inflammatory disorder associated with the anti-aquaporin-4 (AQP4) antibody. Over 90% of NMO-SD patients have poor prognosis, and pregnancy is a disease-worsening factor. The authors report the findings in a case of NMO-SD that recovered spontaneously during pregnancy. A 28-years-old woman developed optic neuritis (ON) of the right eye in the 14th week of pregnancy. Her best-correlated visual acuity (BCVA) was 0.02 OD, the critical flicker frequency (CFF) was not measurable, and the mean deviation (MD) of the Humphrey perimetry 30-2 was −42 dB. Magnetic resonance imaging (MRI; T2 short-tau inversion recovery [STIR]) showed high-intensity right optic nerve. The patient was diagnosed with NMO-SD by the detection of seropositive anti-AQP4 antibody in her serum. Corticosteroid pulse therapy was considered, but the patient declined any treatment. Two weeks later, her BCVA improved to 1.2 (OD). Nine weeks later, the MD of Humphrey perimetry 30-2 improved to −1.2 dB and the CFF was 39.8 Hz. There have been no signs of recurrence for 6 months. Spontaneously recovered cases of NMO-SD during pregnancy are very rare. Although the factors leading to good outcomes have not been identified, this case suggests that the immunological condition at the early stage of the pregnancy may have different from that at later stages. Further studies are needed to identify the relationship between pregnancy and NMO-SD.

To study the relationship between the retinal microstructures and the best-corrected visual acuity (BCVA) after cataract surgery in patients with retinitis pigmentosa (RP).58 eyes of 43 consecutive RP patients who underwent cataract surgery were studied. The BCVA was measured before and 3 months after the surgery. The appearance of the inner segment/outer segment (IS/OS) line of the photoreceptors in the optical coherence tomographic (OCT) images at the fovea was graded; Grade 1, IS/OS line not visible; Grade 2, IS/OS line abnormal or discontinuous; and Grade 3, IS/OS line normal. The central foveal thickness (CFT) and the length of the IS/OS line were measured in the spectral-domain OCT images.The postoperative BCVAs in logMAR units (Grade 1, 1.04±0.36; Grade 2, 0.33±0.16; Grade 3, 0.08±0.14) and the improvements in the BCVA in logMAR units (Grade 1, 0.22±0.28; Grade 2, 0.53±0.48; Grade 3, 0.54±0.35) were significantly different among Grade 1, 2 and 3 groups (p0.0001, p=0.0378; respectively). A postoperative BCVA of0.2 logMAR units was achieved in 0% in Grade 1, 20% in Grade 2 and 74% in Grade 3 (p0.0001). There was a significant correlation between the postoperative BCVA and the length of the IS/OS line (r=-0.601 p0.0001) or the CFT (r=-0.510, p0.0001).The presence of normal IS/OS line in the OCT images is associated with good visual recovery after cataract surgery in RP patients. The integrity of the IS/OS line may be important for predicting good postoperative BCVA.

The authors present findings in a 39-year-old man with polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy, and skin changes (POEMS) syndrome with bilateral optic disc oedema. He was successfully treated with bortezomib and dexamethasone followed by autologous peripheral blood stem cell transplantation. The peripapillary retinal thickness was reduced in the optical coherence tomographic (OCT) images along with a decrease of the serum vascular endothelial growth factor (VEGF) levels. The authors recommend OCT to monitor the changes in the signs of POEMS syndrome after treatments.

We compared the efficacy of intravitreal aflibercept (IVA) to intravitreal ranibizumab (IVR) injections in eyes with diabetic macular edema (DME). The medical records of 49 eyes of 36 patients who were diagnosed with DME and had received IVR and 46 eyes of 40 patients who had received IVA treatment were reviewed. The central macular thickness (CMT) and best-corrected visual acuity (BCVA) were measured at the baseline and at 1, 3, and 6 months after the IVR or IVA. The mean number of injections of IVR was 2.6±1.1 and of IVA was 2.7±1.4. At 6 months, the CMT was significantly thinner than the baseline after IVR and after IVA. The mean BCVA was significantly better than the baseline after IVR only at 1 and 3 months and after IVA at 1 and 6 months. The BCVA of eyes with serous retinal detachment (SRD) was significantly better at 1 month after the IVR and at 1 month and 6 months after the IVA. The BCVAs improved more significantly in the SRD+ group than in the SRD− group. The effects of IVA persist longer than that of IVR. The effectiveness of both IVR and IVA was not dependent on the presence of SRD (IRB#2107).

Diabetes mellitus is a disease with a devastating impact on population. Recent data revealed that early retinal neuropathy in patients with diabetic retinopathy involved a reduced expression of brain-derived neurotrophic factor. Retinal ganglion cells (RGC) neuropathy is a progressive optic nerve neuropathy with RGC death and axonal degeneration, and it leads to blindness in the elderly population worldwide. Thus, neuroprotective therapies that rescue damaged RGCs and inhibit the progression of RGC loss and axonal degeneration are needed. This review introduces potential neuroprotective therapies using different neurotrophic factors for damaged RGC in eyes with RGC neuropathy associated diseases.