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Aim: To present a patient who developed bilateral endogenous endophthalmitis secondary to Streptococcus pneumoniae meningitis. Methods: A 44-year-old man who was unconscious because of bacterial meningitis was referred to us for conjunctival hyperemia and decreased pupillary light reflexes. Ophthalmoscopy revealed inflammation in the anterior chamber and vitreous opacities in both eyes. He was diagnosed as having endogenous endophthalmitis associated with the meningitis. Ceftazidime and vancomycin hydrochloride were injected intravitreally and subconjunctivally repeatedly in both eyes. Results: Vision improved to 20/200 in the left eye 1 month later, but the right eye became hypotonic and blind. Vision deteriorated to light perception in the left eye due to a retinal detachment with proliferative vitreoretinopathy, and vitreous surgery successfully reattached the retina. Vision recovered to 20/80, and the retina has remained attached for 1 year. Conclusions: We recommend that endogenous endophthalmitis be suspected in cases of meningitis, and if present, intravitreal and subconjunctival antibiotics should be promptly given to preserve vision.

We describe a patient with Leber's hereditary optic neuropathy (LHON) who had a unilateral involvement and a gradual recovery of vision. A 50-year-old woman was referred to our clinic in December 2004 for the treatment of left optic neuritis. The visual acuity was 0.01 in her left eye and 1.5 in her right eye. The left eye had a central scotoma and a relative afferent pupillary defect. Ophthalmoscopy revealed a hyperaemic optic disc with indistinct margins in the left eye. Fluorescein angiography showed circumpapillary microangiopathy in both eyes and staining of the left optic disc. An nt 11778 mutation was identified and she was diagnosed with LHON. The central scotoma gradually improved, and the visual acuity had recovered to 0.3 in August 2007. LHON should still be considered even in older female patients presenting with unilateral acute visual loss when microangiopathy is seen. In such cases, molecular testing is effective in confirming a diagnosis of LHON.

To report a 25-gauge trocar-cannula that enhances wound closure and reduces the incidence of postoperative hypotony.Development of surgical instruments.A 25-gauge cannula with a microvitreoretinal (MVR) blade trocar was constructed. The resistance of inserting this trocar cannula was compared with that of the conventional 25-gauge trocar cannula (Alcon Laboratories; Fort Worth, Texas, USA). Vitreous surgery was performed on 55 eyes with the trocar cannula with an oblique sclerotomy incision, and the results were compared with those from 68 eyes that underwent surgery with the conventional trocar cannula.The resistance of inserting the trocar cannula was less than that with the conventional trocar cannula. A temporary hypotony (intraocular pressure [IOP]6 mm Hg) was found in one eye (2%) with the trocar cannula and in 12 eyes (18%) with the conventional trocar cannula (P = .006, Fisher exact probability test).The trocar cannula with a MVR blade was effective in postoperative wound closure and prevention of postoperative hypotony.

We report two cases of anterior ischaemic optic neuropathy in whom tissue blood flow at the disc rim was correlated with the visual field defect. Tissue blood flow of each eye was evaluated with Heidelberg retina flowmeter. Both cases experienced acute visual loss and an altitudinal hemianopsia associated with optic disc oedema in the affected eye. In each case, the tissue blood flow at the affected (upper or lower half) disc rim corresponding to visual field deficit was reduced compared with that at the opposite-sided half disc rim in the affected eye and with the corresponding area in the fellow eye. The reduction of blood flow in the affected half disc rim associated with the visual field defect demonstrated that retina flowmetry can detect differences in tissue blood flow between superior and inferior sectional disc rim areas as well as between eyes non-invasively.

The effect of the diameter of an intraocular lens (IOL) implanted in enucleated porcine eyes on the intraocular pressure induced by scleral depression was investigated. Two IOLs of 6 mm and 7 mm optic diameter were implanted. The intraocular pressure (IOP) was monitored during scleral depression by a transducer placed in the midvitreous through a sclerotomy at 6 o’clock. The area under the curve (AUC) of the IOP changes from the beginning of the indentation to the point when the peripheral retinal surface was observed through the IOL optics was measured. The AUC was significantly larger in eyes with a 6 mm IOL than in eyes with a 7 mm IOL (p<0.05). The IOP elevation at the endpoint was higher in eyes with the 6 mm IOL than in eyes with the 7 mm IOL. We conclude that the AUC may represent the degree of stress induced by scleral depression. The higher AUC value with the X-60 may be because of the longer distance from the peripheral retina to the edge of the IOL optics.

'Cone dystrophy with a supernormal rod electroretinogram (ERG)' is rare form of cone dystrophy, and no longitudinal description of the disease course has been reported in a Japanese population. Here, we describe long-term courses of 10 to 15 years in four Japanese patients with mutations in the KCNV2 gene.Four patients from three families were recruited. Two were siblings (Case 1, 24 y/o women; Case 2, 17 y/o man), and two were sporadic cases (Case 3, 17 y/o women; Case 4, 21 y/o women). All the patients presented with characteristic ERG findings. There were minimal abnormalities in fundus appearance: slight mottling of retinal pigment epithelium in the macula in all four cases, and granular change in the macula in Case 4. The visual acuity in Cases 1 and 2 did not change during the follow-up period, but the acuity in Cases 3 and 4 gradually decreased. Photoreceptor abnormalities in optical coherence tomography were found in all the cases, but were more severe in Cases 3 and 4.The long-term courses in Japanese patients were variable. The OCT was helpful in evaluating the disease progression.

Background. To report the outcome of pars plana vitrectomy (PPV) combined with intraoperative endolaser focal photocoagulation (PC) on eyes with idiopathic macular telangiectasis (MacTel) type 1.Methods. This was a retrospective study of two female patients with MacTel type 1 who were resistant to focal photocoagulation, sub-Tenon triamcinolone injection, and/or antiangiogenic drugs. The best-corrected visual acuity (BCVA) was determined, and fluorescein angiography (FA) and spectral domain optical coherence tomography (SD-OCT) were performed before and after surgery for up to 19 months.Results. After surgery, the BCVA gradually improved from 20/100 to 20/20 at 19 months in Case 1 and from 20/50 to 20/13 at 13 months in Case 2. Fluorescein angiography (FA) showed leakage at the late phase, and OCT showed that the cystoid macular edema was resolved and the fovea was considerably thinner postoperatively.Conclusion. Patients with MacTel type 1 who are refractory to the other types of treatments can benefit from PPV combined with intraoperative endolaser focal PC with functional and morphological improvements.

The purpose of this study was to investigate the characteristics of microcystic macular edema (MME) determined from theen faceimages obtained by an adaptive optics (AO) fundus camera in patients with autosomal dominant optic atrophy (ADOA) and to try to determine the mechanisms underlying the degeneration of the inner retinal cells and RNFL by using the advantage of AO. Six patients from 4 families with ADOA underwent detailed ophthalmic examinations including spectral domain optical coherence tomography (SD-OCT). Mutational screening of all coding and flanking intron sequences of theOPA1gene was performed by DNA sequencing. SD-OCT showed a severe reduction in the retinal nerve fiber layer (RNFL) thickness in all patients. A new splicing defect and two new frameshift mutations with premature termination of the Opa1 protein were identified in three families. A reported nonsense mutation was identified in one family. SD-OCT of one patient showed MME in the inner nuclear layer (INL) of the retina. AO images showed microcysts in theen faceimages of the INL. Our data indicate that AO is a useful method to identify MME in neurodegenerative diseases and may also help determine the mechanisms underlying the degeneration of the inner retinal cells and RNFL.

Purpose: To evaluate the usefulness of a liquid crystal display (LCD) with higher driving frequency and shorter response time (2 ms) as a visual stimulator to elicit pattern reversal visually evoked potentials (p-VEPs). Method: p-VEPs were recorded from 12 eyes of 12 healthy volunteers (28.3 ± 9 years). The p-VEPs elicited by a conventional cathode ray tube (CRT) screen were compared to those elicited by a high-speed LCD screen (2-ms LCD, GD245HQbid, Acer, Taipei, Taiwan). The luminance changes of each monitor were measured with a photodiode. Results: During the reversal phase the luminance of the 2-ms LCD screen with 97% contrast was transiently reduced, which can elicit an electroretinogram (ERG) and therefore a flash VEP. The 2-ms LCD with 81% contrast checkerboard had a minimal luminance reduction during the reversal phase, and therefore no ERGs were elicited. No significant differences in the amplitude of P100 and the implicit times of N75 and P100 were observed in the p-VEPs elicited by a CRT or the 2-ms LCD screens as stimulators. Conclusion: The luminance change can elicit flash VEPs, and this artifact can be minimized by using a 2-ms LCD screen with reduced contrast of the checkerboard stimulus.

Purpose To determine the clinical and genetic characteristics of Japanese patients with occult macular dystrophy (OMD) in a nationwide multicenter study. Methods Twenty-three patients from 21 families with clinically diagnosed OMD were studied at 10 institutions throughout Japan. Ophthalmologic examinations including spectral-domain optic coherence tomography were performed. Patients were classified into two phenotype groups: a classical group having both blurred ellipsoid zone and absence of interdigitation zone of the photoreceptors, and a nonclassical group lacking at least one of these two features. Whole-exome sequencing, direct sequencing, and in silico molecular analysis were performed to detect the pathogenic RP1L1 variants. Statistical associations between the phenotype and genotypes based on the presence of pathogenic RP1L1 variants were investigated. Results There were 12 families with the classical findings and 9 families with the nonclassical findings. Nine pathogenic RP1L1 missense variants were identified in 12 families (57%) including three reported variants, namely, p.R45W, p.S1199C, and p.G1200A, and six novel variants, p.G221R, p.T1194M, p.T1196I, p.G1200D, p.G1200V, and p.V1201G. The pathogenic missense variants in seven families (33%) were located between amino acid numbers 1196 and 1201. A significant association was found between the photoreceptor microstructural phenotypes and molecular genotypes. Conclusions The spectrum of the morphologic phenotypes and pathogenic RP1L1 variants was documented in a well-characterized Japanese cohort with OMD. A unique motif including six amino acids (1196-1201) downstream of the doublecortin domain could be a hot spot for RP1L1 pathogenic variants. The significant association of the morphologic phenotypes and genotypes indicates that there are two types of pathophysiology underlying the occult macular dysfunction syndrome: a hereditary OMD with the classical phenotype (Miyake's disease), and a nonhereditary OMD-like syndrome with progressive occult maculopathy.

PurposeTo evaluate retinal function by intraoperative electroretinograms (ERGs) before and after core vitrectomy.DesignRetrospective consecutive case series.MethodFull-field photopic ERGs were recorded prior to the beginning and just after core vitrectomy using a sterilized contact lens electrode in 20 eyes that underwent non-complicated vitreous surgery. A light-emitted diode was embedded into the contact lens, and a stimulus of 150 ms on and 350 ms off at 2 Hz was delivered. The amplitudes and latencies of the a-, b-, and d-waves, photopic negative response (PhNR), and oscillatory potentials (OPs) were analyzed. The intraocular temperature at the mid-vitreous was measured at the beginning and just after the surgery with a thermoprobe.ResultsThe intraocular temperature was 33.2 ± 1.3°C before and 29.4 ± 1.7°C after the vitrectomy. The amplitudes of the PhNR and OPs were significantly smaller after surgery, and the latencies of all components were prolonged after the surgery. These changes were not significantly correlated with the changes of the temperature.ConclusionRetinal function is reduced just after core vitrectomy in conjunction with significant temperature reduction. The differences in the degree of alterations of each ERG component suggests different sensitivity of each type of retinal neuron.

Kyoko Fujita,1 Kei Shinoda,1,2 Celso Soiti Matsumoto,2 Yutaka Imamura,3 Etsuko Tanaka,4 Yoshihiro Mizutani,1 Atsushi Mizota,2 Mitsuko Yuzawa11Department of Ophthalmology, Surugadai Nihon University Hospital, Tokyo, 2Teikyo University School of Medicine, University Hospital Itabashi, Tokyo, 3Teikyo University School of Medicine, University Hospital Mizonokuchi, Kanagawa, 4Kyorin University School of Medicine, Mitaka, JapanBackground: The purpose of this study was to determine baseline clinical factors to correlate the outcome of half-dose verteporfin photodynamic therapy (PDT) in eyes with chronic central serous chorioretinopathy (CSC).Methods: In this prospective, non-comparative, interventional case series, 14 eyes of 14 patients with chronic CSC who received half-dose verteporfin PDT were examined. The best-corrected visual acuity (BCVA), macular sensitivity in the central 4, 8, and 12 degrees, and fixation stability were evaluated at baseline and at months 1, 3, 6, and 12 after half-dose verteporfin PDT. Macular sensitivity and fixation stability were determined by MP-1 microperimetry.Results: Mean retinal sensitivity in the central 4 and 8 degrees was significantly better at 1, 3, 6, and 12 months after half-dose verteporfin PDT than at baseline. BCVA was significantly better after half-dose verteporfin PDT but only after 3 months. Fixation was relatively unstable in three eyes at baseline, but became stable at 12 months. BCVA at 12 months was significantly correlated with pre-PDT fixation stability (r = 0.7120, P = 0.0038).Conclusion: Half-dose verteporfin PDT results in a significant increase in mean central retinal sensitivity for at least 12 months. Our findings indicate that microperimetry is a useful method for evaluating the functional benefits of half-dose verteporfin PDT in eyes with chronic CSC.Keywords: microperimetry, fixation point, retinal sensitivity, photodynamic therapy, chronic central serous chorioretinopathy

To report an improvement of the visual acuity after transcorneal electrical stimulation (TES) in a case of Best vitelliform macular dystrophy (BVMD).A 26-year-old woman diagnosed with BVMD presented with reduced vision. Her best corrected visual acuity (BCVA) was reduced to 20/200 in the right eye, and TES was performed once a month for two sessions. The current of the biphasic pulses (anodic first; duration, 10 msec; frequency, 20 Hz) was delivered using a DTL-electrode, and the duration of the TES was 30 min.The BCVA in the right eye slowly improved after the TES, and 6 months later the BCVA was 20/25. The results of Humphrey visual field tests (VF) and multifocal ERGs (mfERGs) were only slightly changed. Two years later, the BCVA decreased, and it was improved again after another session of TES with the same parameters of the electrical pulses.The improvement of the visual acuity in our case of BVMD indicates that TES should be tried in other cases of retinal dystrophy. Further clinical and laboratory studies on TES are needed.

The cathode-ray tube (CRT) screen has recently been replaced by liquid crystal display (LCD) screens as visual stimulators for pattern-reversal visually evoked potentials (p-VEPs). The aim of the study was to evaluate the usefulness of LCD screen to elicit p-VEPs. The waveforms of the p-VEPs elicited by a LCD panel were compared with those elicited by a conventional CRT screen. The changes in the luminance of each screen were measured with a photodiode, and the mean luminance change was measured with a luminance meter. VEPs and electroretinograms (ERGs) were also recorded when the monitor was covered by a diffuser. The p-VEPs elicited by the LCD consisted of the N75 and P100 components of the conventional VEPs and had good reproducibility. The average latency of these components was significantly delayed by 9.8 ms for N75 and 10.2 ms for P100, and the N75-P100 amplitude was significantly larger than the conventional p-VEP elicited by the CRT screen. During the reversal phase, especially from black-to-white, the luminance of the LCD screen was transiently reduced, and it elicited a flash VEP and ERG. A reduction in the contrast of the checks minimized the transient change in the luminance, and the VEP waveform was more similar to that elicited by the CRT screen. The results suggest that when an LCD monitor is used as an alternative visual stimulator to elicit p-VEPs, the delay in the luminance change and the flash effect needs to be taken into account.

To report the clinical characteristics of occult macular dystrophy (OMD) in members of one family with a mutation of the RP1L1 gene.Fourteen members with a p.Arg45Trp mutation in the RP1L1 gene were examined. The visual acuity, visual fields, fundus photographs, fluorescein angiograms, full-field electroretinograms, multifocal electroretinograms, and optical coherence tomographic images were examined. The clinical symptoms and signs and course of the disease were documented.All the members with the RP1L1 mutation except one woman had ocular symptoms and signs of OMD. The fundus was normal in all the patients during the entire follow-up period except in one patient with diabetic retinopathy. Optical coherence tomography detected the early morphologic abnormalities both in the photoreceptor inner/outer segment line and cone outer segment tip line. However, the multifocal electroretinograms were more reliable in detecting minimal macular dysfunction at an early stage of OMD.The abnormalities in the multifocal electroretinograms and optical coherence tomography observed in the OMD patients of different durations strongly support the contribution of RP1L1 mutation to the presence of this disease.

Background The aim was to determine the low luminance visual acuity in eyes with central serous chorioretinopathy. Methods Seven eyes of seven patients with central serous chorioretinopathy and six eyes of six age-matched normal volunteers were examined. Low luminance visual acuity charts were created by an Apple Power Mac G5 computer and displayed on a cathode ray tube monitor (SONY GDM-F500). The background luminance was set at six different levels from 78.20 cd/m2 to 0.37 cd/m2. The visual acuities of the eyes with central serous chorioretinopathy at each of the six luminance levels were compared to those from their fellow eyes and to normal eyes. Results The mean visual acuities varied from 0.13, 0.23, 0.29, 0.42, 0.62 to 0.70 logMAR units as luminance varied from high to low. At the lowest luminance (0.37 cd/m2), five of the seven eyes could not read any character. The mean visual acuities of the fellow eyes at the same luminance levels were 0.03, 0.06, 0.11, 0.20, 0.27 and 0.45 logMAR units and those of the normal volunteers were 0, 0.03, 0.08, 0.14, 0.23 and 0.38 logMAR units, respectively. The visual acuities of the eyes with central serous chorioretinopathy were significantly poorer than those of the normal eyes at all luminance levels except 0.37 cd/m2 (p

The purpose of this study was to report a patient with Oguchi disease whose ophthalmological characteristics were masked by retinitis pigmentosa (RP). The method used in this study was case report. A 53-year-old man had a progressive decrease in his visual acuity and was diagnosed with RP because of night blindness, fundoscopic findings, ring scotoma, and extinguished single-flash electroretinograms (ERGs). However, a faint golden-yellowish reflex of the retina prompted us to make a more detailed examination of the fundus after a long period of dark adaptation, ERGs, and genetic analysis. Examinations showed the Mizuo-Nakamura phenomenon, relative intact photopic ERGs, and a SAG mutation, and the patient was diagnosed with RP associated with Oguchi disease. When RP accompanies Oguchi disease, the clinical characteristics of Oguchi disease might be masked. In such a situation, the correct diagnosis is difficult. However, careful analysis of clinical findings will suggest Oguchi disease, which can be confirmed by molecular genetics.

To determine the incidence of eyes that have an increase in the intraocular pressure (IOP) after subtenon injections of triamcinolone acetonide (TA).The medical records of 147 patients treated with single or multiple subtenon injections of TA (10 mg) were reviewed. The incidence of an IOP elevation (ΔIOP) ≥5 mmHg or an IOP of21 mmHg was determined. The peak ΔIOP, defined as the difference in the IOP at the peak to the baseline IOP, was also evaluated. Multivariate analyses were used to evaluate the relation between the IOP elevation and the age, gender, refractive error, and lens status.A ΔIOP ≥5 mmHg was found in 75 eyes (46%), and an IOP21 mmHg was found in 48 eyes (30%) after a single injection of TA. The IOP increased within 3 months in 39 eyes (81%) and after 4 months in 9 eyes (19%). The IOP began to increase significantly from 2 weeks up to 5 months (P0.05) and returned to the baseline IOP in 10 months. The incidence of ΔIOP ≥5 mmHg or an IOP of21 mmHg after multiple subtenon injections of TA was significantly higher than after a single injection (62%; P=0.027, 47%; P=0.013, respectively). The incidence of IOP21 mmHg and the peak ΔIOP were significantly related with younger age (P=0.002, P=0.021, Forward stepwise regression analysis). A weak but significant negative correlation was found between the peak ΔIOP and the age (r=-0.216, P=0.006, Pearson's correlation coefficient test), and the peak ΔIOP and the refractive error (r=-0.198; P=0.018).Repeated injections of TAs and injection of younger patients or myopic eyes increase the incidence of an IOP elevation.

PURPOSE: We present favorable results with amniotic membrane transplantation in a patient who developed fat adherence syndrome after retinal surgery. DESIGN: Interventional case report. METHODS: A 37-year-old man had diplopia resulting from hypotropia of the left eye after retinal detachment surgery. Removal of a previously implanted silicon sponge had little effect because of fibrous adhesion between the inferior rectus muscle and adjacent periorbital fat. We performed amniotic membrane transplantation combined with conventional extraocular muscle surgery. RESULTS: Postoperatively, supraduction of the left eye became almost full. The field of binocular vision was extended markedly by treatment, both in the primary position and with downward gaze. These improvements remained stable over 1 year of follow-up. CONCLUSION: Amniotic membrane transplantation appears to be effective for preventing regrowth of restrictive scar tissue in the fat adherence syndrome.

Objective: To report the incidence, intraoperative findings, and surgical outcome of secondary ptosis that developed after a sub-Tenon injection of triamcinolone acetonide (TA). Study Design: Retrospective, cross-sectional study. Participants: One hundred forty-seven cases with a total of 286 sub-Tenon TA injections. Methods: The medical records of 163 eyes of 147 cases treated with a sub-Tenon injection of 10 mg or 20 mg TA were reviewed. The incidence of secondary ptosis (palpebral fissure >2 mm narrower than that of the fellow eye) after a sub-Tenon TA injection was determined. The preoperative levator function and margin reflex distance (MRD) of the affected eyes, and the intraoperative findings in eyes that underwent reconstructive surgery, were evaluated. Results: Eight eyes (5%) developed secondary ptosis after the injection and 6 eyes were treated by reconstructive surgery. The preoperative levator function of the affected eyes did not differ from that of the fellow eyes. Intraoperatively, no septal disruption or fat herniation was noted, but an aponeurotic disinsertion was identified and repaired with an advancement of the leading edge to the anterior tarsal plate. The surgery led to satisfactory results, with improvement of the MRD from −1.3 (SD 1.5) mm preoperatively to 2.3 (SD 0.5) mm postoperatively ( p = 0.027). Additional sub-Tenon TA injections were required in 2 eyes after eyelid surgery but the ptosis did not worsen. Conclusions: A sub-Tenon TA injection can occasionally cause ptosis by inducing a disinsertion of the levator aponeurosis. However, surgical reconstruction can lead to successful resolution of the ptosis.

To report on a 23-gauge cannula with a microvitreoretinal (MVR) blade trocar which improved wound closure after vitrectomy and reduced the incidence of postoperative hypotony.The resistance of inserting a 23-gauge MVR trocar-cannula through the porcine sclera was compared with that with the conventional 23-gauge trocar-cannula. The incidence of postoperative hypotony (intraocular pressure6 mm Hg) was determined for 48 eyes that underwent vitrectomy with the 23-gauge MVR trocar-cannula and 30 eyes with the conventional 23-gauge trocar-cannula. The eyes were examined on postoperative days 1, 2 and 7. The closure of the sclerotomies was examined by optical coherence tomography in nine eyes in each group on postoperative days 1, 3 and 7, and 1 month.The resistance of inserting the MVR trocar-cannula was lower than that with the conventional trocar-cannula. In patients, a transient hypotony was found at postoperative day 1 after the vitrectomy in two eyes (4%) with the MVR trocar-cannula, and in seven eyes (23%) with the conventional trocar-cannula (p=0.023). An unclosed incision was detected in nine sclerotomies (50%) with the MVR trocar-cannula and 16 sclerotomies (89%) with the conventional trocar-cannula (p=0.028) on postoperative day 1, and the incidence of an opened incision was also significantly higher with the conventional trocar-cannula on days 3 and 7 but not after 1 month (p=0.003, p=0.008, p=0.486, respectively).The MVR trocar-cannula leads to better postoperative wound closure and reduces the incidence of postoperative hypotony.

To determine the relationship between visual acuity and three-dimensional optical coherence tomographic (3D-OCT) findings of the macula in eyes with Vogt–Koyanagi–Harada (VKH) disease. Twelve eyes of six patients (three men and three woman, average age 53.2 years) in the acute phase of VKH disease were examined with a 3D-OCT instrument. All of the eyes had a serous macular detachment. The height of the sensory retinal detachment (SRD) and the sensory retinal thickness (SRT) were measured by OCT before treatment (acute stage) and at the convalescent stage. The correlation between the retinal morphology and visual acuity was evaluated. The height of the SRD and the SRT were 612.5 ± 371.2 and 136. 7 ± 22.0 μm, respectively. The initial visual acuity was significantly worse in eyes with a higher SRD (P = 0.014, r = 0.68) but the correlation between initial visual acuity and SRT was not significant. The recovery of visual acuity was attained in 50.7 ± 44.1 days and the complete resolution of the SRD was attained in 30.5 ± 23.2 days. The final visual acuity was attained several days after the complete resolution of the SRD in all four eyes of patients over 60 years of age, but the recovery of visual acuity often preceded the complete resolution of the SRD. The OCT images provided a noninvasive indicator of the severity of the disease and dynamic changes in the macular morphology, reflecting the effect of treatment in association with the improvement in visual acuity. Monitoring the SRD by 3D-OCT may guide the tapering of systemic corticosteroid treatment.

Objective To evaluate the early effects of triamcinolone acetonide (TA) on inflammation, proliferation, and vascular endothelial growth factor (VEGF) in human choroidal neovascularization (CNV). Methods Retrospective review of an interventional case series of 29 patients who underwent macular translocation. Fourteen CNV membranes without previous therapy (control CNV group) and 4 CNV membranes excised 3 days after photodynamic therapy (PDT CNV group) comprised the control groups. Eleven patients were treated with intravitreal TA (TA CNV group; n = 5) or PDT and TA combined (PDT+TA CNV group; n = 6) 3 to 9 days preoperatively. The CNV membranes were stained for cytokeratin 18, CD34, VEGF, intercellular adhesion molecule-1 (ICAM-1), E-selectin, CD68, CD45, Ki-67, and Thy-1. Results Treatment with TA and PDT+TA resulted in increased immunostaining of ICAM-1 in endothelial cells and the stroma and a higher percentage of Thy-1 expression than controls. The density of macrophages was significantly increased in PDT+TA CNV membranes. Leukocyte density and proliferative activity were lower in TA and PDT+TA CNV membranes. The total VEGF score was significantly increased in TA and PDT+TA CNV membranes compared with the control CNV membranes. Evidence of VEGF in the retinal pigment epithelium of PDT+TA CNV membranes was stronger than in control CNV membranes. Conclusions Triamcinolone acetonide has no inhibitory effect on macrophage infiltration or ICAM-1, Thy-1, or VEGF expression in CNV membranes in the early term. The clinical benefits of TA are probably not based on pure antiinflammatory or VEGF-suppressing mechanisms.

girl was referred for evaluation of a retinal tumour in her left eye. Her visual acuity was 20 ⁄ 20 bilaterally. A solitary translucent retinal tumour measuring 1.5 · 3.0 disc diameters was seen inferior to the optic disc (Fig. 1A). The retinal arteries passing through the tumour appeared white. The sensitivity over the tumour was not altered in Humphrey visual field tests (Fig. 1B). Fluorescein fundus angiography (FA) showed retinal circulation to be intact with only weak staining of a section of the tumour (Fig. 1C,D). An ultrasound B-mode echography showed a mass inferior to the optic disc; no calcifications were observed (Fig. 1E). The fundus was scanned with optical coherence tomography (OCT) (3D OCT-1000; Topcon, Tokyo, Japan). The measurement beam was focused on the macular area with a system

Purpose: To investigate the visual sensations experienced by patients during vitrectomy under retrobulbar anesthesia. Methods: 30 men and 45 women with a mean age of 65.3 ± 10.6 years underwent vitrectomy under retrobulbar anesthesia for macular disease. 28 eyes had an idiopathic epiretinal membrane, 13 had an idiopathic macular hole, 32 had macular edema (17 diabetic retinopathy and 15 retinal vein occlusion), and 2 had submacular hemorrhage. 49 patients with nonmacular disease underwent similar vitrectomy procedures and were used for comparison. An interview was conducted with the patient about his/her visual sensations during and within 3 h of the vitrectomy. Results: 70 (93.3%) of the patients reported seeing lights, 53 (70.7%) reported seeing colors, and 48 (64.0%) reported seeing movements or moving objects. Of the patients who reported seeing movements or moving objects, 44 (58.7%) reported seeing surgical instruments, and 5 (6.7%) saw the surgeon’s fingers or hands. Patients with macular diseases tended to report more visual sensations than patients with nonmacular diseases. The patients’ description and drawings appeared to arise mainly from the shadows cast by the intravitreal objects, and some patients perceived highly accurate details including the movements and color of the objects. Conclusions: Visual sensations are experienced by approximately 90% of the patients, and there may be a common mechanism by which patients perceive the intravitreal objects that are not focused on by the retina through the eye’s optical system.

To evaluate the effect of bevacizumab (Avastin; Genentech, Inc, South San Francisco, California) on inflammation and proliferation in human choroidal neovascularization (CNV) secondary to age-related macular degeneration.Retrospective review of interventional series of 38 patients who underwent choroidal neaovascular membrane (CNVM) extraction. Twenty-four patients received intravitreal bevacizumab 1 to 154 days preoperatively (bevacizumab CNV group). Fourteen patients received no preoperative therapy (control CNV group). The CNVM were stained for cytokeratin 18, CD68, CD45, intercellular adhesion molecule (ICAM)-1, E-selectin, Ki-67, Thy-1, and endostatin.No significant difference was detected in ICAM-1 and E-selectin expression between groups. The density of leukocytes in the bevacizumab CNV group (median, 271.61 cells/mm(2)) was higher than in the control CNV group (median, 116.87 cells/mm(2); P = .07), but without significance. Density of macrophages (median, 4661.95 cells/mm(2)), proliferative activity (median, 160.19 cells/mm(2)), and percentage of Thy-1-expressing vessels (median, 100%) were significantly higher in the bevacizumab CNV group than in the control CNV group (median, 882.66 cells/mm(2), P.001; median, 34.34 cells/mm(2), P.001; and median, 80%, P.001, respectively). Endostatin immunoreactivity was considerably stronger in the retina pigment epithelium (RPE)-Bruch membrane complex (median, 3; range, 2-3; P.001), and stroma (median, 3; range, 1-3; P.001) of the bevacizumab CNV group than control CNV group (median, 1.5; range, 0-3 and median, 1; range, 0-3, respectively).Unexpectedly, CNVM from patients treated by bevacizumab are characterized by significantly high inflammatory and proliferative activity and enhanced endostatin expression. These characteristics need to be considered when protocols for combination therapies are established.

This reports the preliminary outcome of a transpalpebral electrical retinal stimulation therapy for age-related macular degeneration (ARMD).Twenty-one patients consisting of 16 with wet-type (Group-W) and 5 with dry-type (Group-D) ARMD with a mean age of 73.9 ± 9.5 years (range 51 to 85 years) were recruited for this study. Transpalpebral electrical retinal stimulation (20 minutes, 800 muA) was applied on the patients 4 times per day for up to 1 month. The mean best-corrected visual acuity (Early Treatment Diabetic Retinopathy Study [ETDRS] score) changed from 29.5±5.1 to 31.8±5.0 in Group-W and from 39.8±4.7 to 42.9±4.9 in Group-D. Neither ocular nor systemic adverse effects were observed with the exception of one patient who developed contact dermatitis. Due to several limitations such as lack of control, patients' learning effect, etc, the efficacy of the therapy could not be drawn. This preliminary study, however, showed that the transpalpebral electrical retinal stimulation therapy can be non-invasively applied on wet-type ARMD patients.

PURPOSE. The distribution of the electrical current over the retina when electrical pulses are delivered transsclerally has not been clearly determined objectively and quantitatively in humans. The purpose of this study was to determine the pattern of electrically evoked neural activity in the monkey retina by using intrinsic signal imaging. METHODS. The intrinsic signals of monkey retinas were recorded as changes in the reflectance of infrared light from the retina after transscleral electrical stimulation by DTL electrodes. The effects of changing the stimulus parameters (e.g., intensity, duration, and frequency) of the electrical current, were investigated. RESULTS. Electrical stimulation evoked a uniform change in the reflectivity across the posterior pole of the retina; that is, the intrinsic signals changed uniformly. A peak of the intrinsic signal was not observed at the fovea. The threshold of the intrinsic signal was not significantly different for the macula, perimacula, and optic disc, and the threshold did not differ under dark- and light-adapted conditions. The strength of the signals increased with longer stimulus durations, and the maximum signals were obtained when the stimulus frequency was between 15 and 20 Hz. CONCLUSIONS. Intrinsic signals of the monkey retina evoked by transscleral electrical stimulation are elicited uniformly across the posterior pole of the fundus and most likely arise from activation of the inner or middle layers of the retina. These functional measurements could serve as a diagnostic tool for mapping the inner retinal activity, by which the site of a lesion can be noninvasively imaged. (Invest Ophthalmol Vis Sci. 2008;49:2193‐2200) DOI:10.1167/iovs.07-0727

This study set out to document the early electrophysiological and immunohistochemical changes that occur in the retina of experimentally induced diabetic rats.Diabetes was induced in rats by intraperitoneal injection of 60 mg/kg of streptozotocin (STZ). Electroretinogram readings were taken monthly under either short-duration or long-duration stimuli for up to 3 months after STZ. Oscillatory potentials (OP) and the amplitudes and implicit times of a- and b-waves were analysed, and b-wave amplitudes were analysed using a Naka-Rushton fit. Scotopic a-waves were analysed with photoreceptor models, and Rmp3 (the maximum a-wave amplitude) and S (sensitivity) were calculated. Three months after STZ injection, immunohistochemistry for glial fibrillary acidic protein was performed on the retinas of the STZ-treated rats and age-matched controls.The implicit OP times were significantly longer in the diabetic rats as compared with the controls, and this difference was noted as early as 1 month following STZ treatment. Other electrophysiological parameters, such as OP amplitudes, a- and b-wave amplitude as well as the implicit times, did not differ from controls at this stage. The sacrificed STZ-treated rats also demonstrated marked enhancement of glial fibrillary acidic protein immunoreactivity, suggesting that at least in experimentally induced diabetic retinopathy there is increased Müller cell reactivity.The results of this study indicated that functional alterations in the retina develop rapidly after the onset of diabetes. Analysis of each electroretinogram component may be useful in further investigating the development mechanisms of diabetic retinopathy.

We investigated the relationship between the retinal thickness and electroretinogram (ERG) components in patients with central retinal artery occlusion (CRAO). The optical coherence tomographic (OCT) images and ERGs of the nine patients (six men and three women; mean age, 61.8 years) were retrospectively analyzed. The thickness of the inner and outer retinal layers at 1 and 2 mm nasal and temporal to the fovea was measured in the horizontally scanned OCT images. The ratio of the inner layer thickness/sensory retinal thickness (IT/ST ratio) was calculated. The amplitudes of the a- and b-waves of the mixed rod-cone ERGs and the photopic negative response (PhNR) of the photopic ERGs were analyzed. The ratio of the amplitude of each component in the affected eye to that of the healthy fellow eye (a/f ratio) was calculated. In the chronic phase (1 to 8 months after onset, eight eyes), the inner layer was significantly thinner than that in the acute phase (P = 0.0147, 0.0076, 0.002, and 0.0003 for 2 mm nasal, 1 mm nasal, 1 mm temporal, and 2 mm temporal respectively, within 5 days of onset, six eyes), while the thickness of outer layer was not significantly changed. The ERGs were recorded 6.4 ± 1.5 days after the onset of CRAO. The median of the a/f ratio was 0.84 in the a-wave, 0.56 in the b-wave, and 0.27 in the PhNR. The IT/ST in the chronic phase was positively correlated with the a/f ratio of the amplitude of the PhNR. Measurement of retinal thickness by OCT can be useful for monitoring the changes following CRAO. The correlation between the retinal thickness, especially inner layer thickness, and the ERG components was determined, suggesting that the PhNR in the acute phase might be a good indicator for predicting the thinning of the damaged retina in the chronic phase.

Purpose: To determine the relationship of the photopic negative response (PhNR) of the photopic electroretinogram (ERG) with the degree of circulatory disturbances in eyes following central retinal artery occlusion (CRAO). Methods: The circulatory disturbance was graded as mild (group 1) when the arm-to-retina transmission time was 30 s and severe (group 3) when concurrent choroidal circulatory damage was found. For statistical analysis, groups 1, 2 and 3 were scored as 1, 2 and 3, respectively. Photopic ERGs were elicited by either short-flash (SF) or long-flash (LF) stimuli. Results: Both the SF and LF PhNR were significantly reduced in groups 2 and 3. The PhNR amplitude was negatively correlated with the severity of the ocular circulatory disturbances (p = 0.0498, ρ = –0.507 for SF PhNR; p = 0.0050, ρ = –0.750 for LF PhNR). Conclusion: The amplitude of the PhNR became more reduced as the severity of the circulatory disturbances increased in eyes with CRAO.

The efficacy of a two-step, oblique incision procedure during 25-gauge vitrectomy on postoperative hypotony was evaluated by a retrospective, case-control study. The transconjunctival incision during 25-gauge vitrectomy was made in two steps: penetration with a microvitreoretinal blade followed by a penetrater instrument of a blunt trocar. The two-step procedure was performed on 89 eyes and with the conventional incision on 68 eyes. The incidence of hypotony (intraocular pressure

Purpose: To determine whether vitrectomy with 25-gauge instruments contributes to better postoperative visual recovery after macular hole (MH) surgery. Methods: The medical records for 46 consecutive eyes operated for MH by a single surgeon were retrospectively examined. Vitrectomy had been performed with a 25-gauge instrument in 23 eyes (25-G group) and with a 20-gauge instrument in 23 eyes (20-G group). Postoperative visual acuity (VA) in logMAR (logarithm of the minimum angle of resolution) units after 1 week and 1, 3, 6, 9 and 12 months, operating time, and volume of intraocular irrigating fluid were compared between the two groups. Results: Mean preoperative logMAR VA was 0.72 in the 25-G group and 0.68 in the 20-G group (p = 0.282, unpaired t-test). One week after surgery, VA was significantly better in the 25-G group (0.40 ± 0.34) than in the 20-G group (0.58 ± 0.30) (p = 0.020). This significant difference was maintained until 9 months after surgery, but was no longer evident at 12 months (p = 0.182). Operating time was significantly shorter in the 25-G group (56 ± 16 mins) than in the 20-G group (85 ± 28 mins) (p = 0.003, unpaired t-test). The volume of intraocular irrigating fluid was significantly less in the 25-G group (244 ± 72 ml) than in the 20-G group (416 ± 113 ml) (p

Purpose: To examine the short- and long-term consequences of verteporfin photodynamic therapy (PDT) on inflammation with regard to infiltration of macrophages and leukocytes and expression of thy-1 in human choroidal neovascularization membranes (CNV) secondary to age-related macular degeneration (AMD). Methods: Retrospective review of an interventional case series of 43 patients who underwent removal of CNV. Twenty patients were treated with PDT 3 to 246 days preoperatively. Twenty-three CNV without previous treatment were used as control. CNV were stained for CD34, CD105, cytokeratin18, Ki-67, thy-1, an endothelial cell glycoprotein known to be upregulated only by inflammatory cytokines, CD68 (macrophages), and CD45 (common leukocyte antigen). Results: Specimens treated by PDT 3 days previously showed significantly reduced endothelial thy-1 expression (P = 0.008), leukocyte (P = 0.04) and macrophage (P = 0.0063) infiltration, and proliferative activity (P = 0.02) compared to control CNV. Specimens at longer intervals after PDT, in contrast, disclosed a significantly increased expression of thy-1 (P = 0.004), infiltration with leukocytes (P = 0.044) and macrophages (P = 0.01), and proliferative activity (P = 0.03) compared to CNV excised 3 days after PDT. Conclusions: The rebound effect after PDT seems to be based on an inflammatory response that contributes to enhanced proliferation. These data support the need for an anti-inflammatory therapy as adjuvant to PDT.

A healthy 40-year-old man developed unilateral ocular ischemic syndrome as the only manifestation of a spontaneous internal carotid artery dissection.

PURPOSE Intrinsic signal imaging is a newly developed technique that can map the neural activity of tissues noninvasively. It has been used to map the functional organization of the retina by recording flash-induced light reflectance changes in the cone and rod photoreceptors. The purpose of this study was to investigate the properties of the intrinsic signals in the monkey's retina. To accomplish this, the intrinsic signals and the electroretinograms (ERGs) evoked by the same stimuli were measured under different recording conditions. METHODS The fundus of macaque monkeys was observed with infrared light and recorded with a charge-coupled device (CCD) camera. The intrinsic signals were measured as retinal light reflectance changes induced by diffuse or focal flash stimuli. ERGs were recorded under the same stimulating conditions. The reflectance changes induced by different flash intensities, flash intervals, and background luminance were compared. RESULTS The intrinsic signals were categorized into different groups based on the location in the fundus. Fast signals (peak: approximately 100 ms) were recorded from the posterior retina including the fovea, and slow signals (peak: 5.0-6.0 seconds) were recorded from the optic disc and nonfoveal posterior retina. The threshold of the slow signal changes was comparable to that of the ERG b-wave, and the thresholds of the fast signals were higher than that of the ERG a- and b-waves. CONCLUSIONS The retinal intrinsic signals are composed of several components with different response properties and different sources. This recording technique may be useful for mapping the retinal function in eyes with various disorders.

Objectives To assess the feasibility of optical coherence tomography (OCT) for examining the cat ocular fundus, to provide normative data on retinal thickness in different fundus regions, and to demonstrate selected surgically induced vitreoretinal pathologies in the cat. Animal studied Forty-five eyes of 28 healthy domestic cats and two eyes of domestic cats that had undergone subretinal implantation surgery for a visual prosthesis were examined. Procedures An optical coherence tomograph (Zeiss-Humphrey) was used to examine the anesthetized animals. At least five vertical and five horizontal scans in regular distribution were recorded for each cat including (1) the peripapillary region, (2) the area centralis, and (3) the peripheral retina. Thickness was measured manually at five locations in each scan. Retinal thickness was compared in the three above-mentioned fundus regions, between eyes and between vertical and horizontal scans. OCT was additionally performed in animals with retinal detachment and a subretinal visual prosthesis. Results OCT measurements required only minimal adjustments of human settings and yielded high quality images. In comparison to humans intraretinal layers were more difficult to differentiate. Retinal thickness was highest in the peripapillary region (245 ± 21 µm), followed by the peripheral retina (204 ± 11 µm) and the area centralis (182 ± 11 µm; all P

Purpose To investigate the visual sensations experienced by patients during vitrectomy under retrobulbar anesthesia. Design Cross-sectional study. Methods Fifty-six men and 45 women with a mean age of 62.2 ± 11.9 years (range, 30 to 89 years) were studied. Twenty-two eyes had an idiopathic epiretinal membrane, 10 had an idiopathic macular hole, 29 had macular edema (16 resulting from diabetic retinopathy and 13 resulting from retinal vein occlusion), 14 had proliferative diabetic retinopathy, 13 had rhegmatogenous retinal detachment, four had proliferative vitreoretinopathy, and nine had other retinal diseases. The patients were questioned about their visual sensations during and within three hours after vitrectomy, which was performed under retrobulbar anesthesia using 2% lidocaine hydrochloride. Visual sensations perceived by the patients during surgery were reviewed. Results Ninety-one of the 101 patients experienced some type of visual sensation during the vitrectomy. Ninety-one (90.1%) patients reported seeing lights, 73 (72.3%) patients reported seeing one or more colors, and 57 (56.4%) patients reported seeing movements or moving objects. Of these latter 57 patients, 54 saw instruments and nine (8.9%) saw the surgeon's fingers or hands. In the 94 cases that had triamcinolone-assisted vitrectomy, 35 (37.2%) reported seeing many diffuse whirling black spots. Six patients (5.9%) found the visual experiences frightening. Conclusions Visual sensations are experienced by approximately 90% of the patients despite full pain control, and surgeons should warn patients of these possibilities because they can be frightening. This should minimize patients' anxiety and stress during the surgery.

Rapid diagnosis of patients with acute visual loss is critical1 but is difficult if the retina appears normal ophthalmoscopically. We report the case of a patient who presented with acute unilateral visual loss and a central scotoma. A 75-year-old man complained of a sudden and painless decrease of vision in his left eye. He had undergone surgery for an unruptured intracranial aneurysm 20 years earlier and was taking 7 mg/day of systemic prednisolone for rheumatoid arthritis. He had also had diabetic mellitus without retinopathy for 5 years. He was being followed for a left hemianopsia and normal tension glaucoma for the previous 3 years. On examination, a left relative afferent papillary defect (RAPD) was observed, and visual acuity (VA) was 20/30 OD and 20/2000 OS. All …

To present a patient who developed bilateral endogenous endophthalmitis secondary to Streptococcus pneumoniae meningitis.A 44-year-old man who was unconscious because of bacterial meningitis was referred to us for conjunctival hyperemia and decreased pupillary light reflexes. Ophthalmoscopy revealed inflammation in the anterior chamber and vitreous opacities in both eyes. He was diagnosed as having endogenous endophthalmitis associated with the meningitis. Ceftazidime and vancomycin hydrochloride were injected intravitreally and subconjunctivally repeatedly in both eyes.Vision improved to 20/200 in the left eye 1 month later, but the right eye became hypotonic and blind. Vision deteriorated to light perception in the left eye due to a retinal detachment with proliferative vitreoretinopathy, and vitreous surgery successfully reattached the retina. Vision recovered to 20/80, and the retina has remained attached for 1 year.We recommend that endogenous endophthalmitis be suspected in cases of meningitis, and if present, intravitreal and subconjunctival antibiotics should be promptly given to preserve vision.

Retinal implants are intended to replace photoreceptors in patients suffering from degenerative retinal diseases such as retinitis pigmentosa. Data show that photodiodes in subretinal implants are not powerful enough to stimulate overlying retinal tissue by simply transforming light energy into electrical energy. Therefore, infrared (IR) irradiation has been envisioned to supply additional energy. While epiretinal implants mostly use induction coils for wireless energy transfer, IR irradiation seems to be an additional option. This study investigated the feasibility of an IR energy supply for an active subretinal implant by assessing thermal effects of IR irradiation onto the rabbit retina.Polyimide foil strips carrying an optical sensor as well as a thermal sensor were implanted into the subretinal space of the eyes of nine rabbits using a transchoroidal surgical approach. The area of the thermal sensor was irradiated by an IR laser (830 nm) focused on the device. The sensor provided simultaneous real-time measurements of absolute temperature and irradiation density, allowing direct correlation of the temperature increase to different intensities of IR irradiation. Possible IR-related damage to the retina was examined in histological sections. Temperature changes in living and dead animals were evaluated as a function of IR irradiation power of between 0.1 mW and 40 mW (0.03 mW/mm2-12.7 mW/mm2).We found an exponential relationship between IR irradiation power and temperature increase over the whole range (up to 12.7 mW/mm2) in the living animal. The maximum temperature increase caused by IR irradiation of 40 mW (12.7 mW/mm2) was 4.5 degrees C. The ratio of temperature increase to IR irradiation density postmortem (i.e., without ocular blood flow) was linear over the whole range, with 1.15 degrees C per 1 mW/mm2. Thus, the cooling effect of ocular blood flow varied depending on IR irradiance density. In histological sections, no IR-induced damage to the retina was detected.A temperature increase of 3.2 degrees C in the living rabbit eye is to be expected when powering a subretinal implant with 15 mW (4.8 mW/mm2) IR power, the wattage used in an external power supply for an active implant with 1,500 electrodes. This appears to be a tolerable increase for ocular tissue.