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SptP is a virulence effector protein of Salmonella that is involved in bacterial invasion into a host cell. For effective secretion, SptP forms a complex with SptP-specific chaperone SicP through its chaperone-binding domain, residues 35–139. Here, we suggest the possibility that residues 106–136 of SptP are important for complex formation with SicP by in vitro reconstitution experiments.

Purpose: To compare the efficacy of surgically removing or not removing the internal limiting membrane (ILM) during pars plana vitrectomy on the visual acuity and retinal thickness in eyes with diabetic macular edema. Methods: A prospective, case-control study was carried out on 30 eyes of 29 patients undergoing pars plana vitrectomy for diabetic macular edema. Fifteen eyes underwent pars plana vitrectomy with ILM removal and 15 eyes without ILM removal. Results: In 7 of 15 eyes (47%) in the ILM-removed group, the visual acuity improved by 0.2 or more log of the minimum angle of resolution (log MAR) units and remained unchanged in 8 eyes (53%). In the ILM-preserved group, the final visual acuity improved in 9 of 15 eyes (60%) and remained unchanged in 6 eyes (40%). The difference in visual acuity between the two groups after 11 months the surgery was not significant (Fisher’s exact test, p = 0.4938). In the ILM-removed group, the final retinal thickness decreased by more than 20% of the preoperative retinal thickness in 12 of 15 eyes (80%), remained unchanged in 2 of 15 eyes (13%), and increased in 1 of 15 eyes (7%). In the ILM-preserved group, the final retinal thickness decreased in 13 of 15 eyes (87%) and remained unchanged in 2 of 15 eyes (23%). The differences in the changes in the retinal thickness between the two groups were not statistically significant (Fisher’s exact test, p = 0.5945). Conclusion: Vitrectomy in eyes with diabetic macular edema without ILM removal was as effective in reducing the retinal thickness and improving the visual acuity as eyes with ILM removal. We conclude that ILM need not be removed to treat eyes with diabetic macular edema.

To evaluate the efficacy of internal limiting membrane (ILM) or epiretinal membrane removal during pars plana vitrectomy for a retinal detachment resulting from a macular hole in myopic eyes.A retrospective study was conducted in a single institution. Twenty-six highly myopic eyes with a retinal detachment resulting from a macular hole were studied. During pars plana vitrectomy, ILM peeling (ILM-peeled group) was performed on 13 eyes, and the ILM was not removed (ILM-preserved group) in 12 eyes. Main outcome measures were anatomic reattachment, optical coherence tomography-determined macular hole closure, and visual acuity. Follow-up periods were longer than 12 months in all cases.The anatomic reattachment rate after the initial surgery was significantly higher in the ILM-peeled group (92.3%) than in the ILM-preserved group (50%). The macular holes of 8 (72.7%) of the 11 ILM-peeled and reattached eyes and 2 (50%) of the 4 ILM-preserved and reattached eyes were successfully closed by the initial surgery. No significant difference was found in the postoperative visual acuity and the improvement of visual acuity between the ILM-peeled group and the ILM-preserved group. There was also no significant difference of the postoperative visual acuity and improvement of the visual acuity between the two groups in cases with an initial anatomic success.These results indicate that removal of the ILM contributes to a successful reattachment and is an effective treatment for macular hole and retinal detachment in highly myopic eyes. The authors suggest that the higher success rate after ILM peeling resulted from the release of the traction of the prefoveal vitreous and the epiretinal membrane over the detached retina.

Formation of epiretinal membranes (ERMs) in the posterior fundus results in progressive deterioration of vision. ERMs have been associated with numerous clinical conditions including proliferative diabetic retinopathy (PDR), but its pathogenic mechanisms are still unknown. This study was conducted to examine whether or not nuclear factor kappa B (NF-kappaB), a transcription factor that can be activated by various pathological conditions, is involved in the formation of ERMs after PDR.ERM samples were obtained by vitrectomy from 22 cases with PDR aged 56+/-11 years with 18+/-10 years of diabetes and 15 cases with idiopathic ERM. They were processed for reverse transcription-polymerase chain reaction (RT-PCR) analysis. In addition, 5 ERM samples from PDR patients aged 51+/-16 years with 15+/-6 years of diabetes were processed for immunohistochemical analysis.NF-kappaB mRNA expression levels were higher (20 out of 22 cases vs. 9 out of 15 subjects in idiopathic ERM, p0.05) in PDR subjects. Immunohistochemical analysis showed NF-kappaB protein expression in all the 5 ERMs derived from PDR patients, and that region was partially double-labelled with interleukin-8 (IL-8) and von Willebrand factor (vWF).These results suggest a possibility that NF-kappaB is involved in the formation of ERMs after PDR, especially for the development of vascular endothelial cell component.

Cone electroretinograms (ERGs), elicited by different color flashes under Ganzfeld conditions, were recorded from 6 patients with multiple evanescent white dot syndrome (MEWDS). All of the patients had normal color vision as determined by the Farnsworth Panel D-15 except for one who showed non-specific errors. The b-waves elicited from short wavelength sensitive (S-) cones were reduced more than the mixed long (L-) and middle (M-) wavelength sensitive cones in the affected eyes. The ratio of the S-cone b-wave amplitude of the affected eyes to that of the normal fellow eyes was significantly lower than the comparable ratio for the L- and M-cone ERG b-waves (p= 0.012). The S-cone ERGs recorded from 2 patients recovered to normal levels after their symptoms abated. These ERG results indicate that the S-cone system is more impaired than the L- and M-cone systems in the acute stage of MEWDS, and the changes in the S-cones may be reversible.

OBJECTIVE—Formation of epiretinal membranes (ERMs) in the posterior fundus results in progressive deterioration of vision. ERMs have been associated with numerous clinical conditions, including proliferative diabetic retinopathy (PDR), but its pathogenic mechanisms are still unknown. This study was conducted to determine whether neurotrophic factor receptors (tyrosine kinase receptors trkA, trkB, and trkC; low-affinity neurotrophin [NT] receptor p75 [p75NTR]; glial cell line–derived neurotrophic factor receptor-α1 [GFRα1] and GFRα2; and Ret) are involved in the formation of ERMs after PDR. RESEARCH DESIGN AND METHODS—ERM samples were obtained by vitrectomy from 19 subjects with PDR aged 57 ± 8 years with 17 ± 8 years of diabetes and 15 subjects with idiopathic ERM. They were processed for RT-PCR analysis. In addition, 11 ERM samples from PDR patients aged 47 ± 18 years with 13 ± 4 years of diabetes were processed for immunohistochemical analysis. RESULTS—Expressions of trkA, trkB, trkC, p75NTR, and Ret mRNAs were similar in both groups. In contrast, GFRα2 expression levels were significantly higher (17 of 19 vs. 2 of 15 subjects in idiopathic ERM, P < 0.0001) in PDR subjects. Accordingly, immunohistochemical analysis revealed expression of GFRα2 protein in all of the 11 ERMs derived from PDR patients, and that region was double-labeled with glial cell-specific markers. On the other hand, GFRα1 expression was lower (8 of 19 vs. 12 of 15 subjects with idiopathic ERM, P = 0.0258) in PDR subjects. CONCLUSIONS—These results suggest a possibility that glial cell line-derived neurotrophic factor receptor (GDNF) subtypes are differently involved in the formation of ERMs.

Purpose: To assess the potential role of monocyte chemotactic protein-1 (MCP-1) in the pathogenesis of proliferative vitreoretinopathy (PVR) and to investigate its possible interaction with the macrophage migration inhibitory factor (MIF). Methods: We assayed MCP-1 and MIF levels in the vitreous samples of 85 consecutive patients with PVR (29 eyes), rhegmatogenous retinal detachment (RRD; 22 eyes), and macular hole or idiopathic epimacular membrane (controls; 34 eyes), by enzyme-linked immunosorbent assay. Results: Vitreous levels of MCP-1 were 1760.7 ± 471.3 pg/mL (mean ± SD) in PVR patients, 1200.4 ± 579.8 pg/mL in RRD patients, and 436.3 ± 286.1 pg/mL in the controls. Vitreous MCP-1 levels in PVR patients were significantly higher than those in RRD patients and in the controls (P < .0001, respectively). MCP-1 levels in grade C of PVR (1883.7 ± 479.5 pg/mL) were significantly greater than those in grade D (1437.8 ± 258.8 pg/mL) (P = .0112). Vitreous concentrations of MCP-1 had no correlation with those of MIF. Conclusions: The results indicate the possibility that MCP-1 may have a role mainly in the early stage of PVR and that the role of MCP-1 in PVR may differ from that of MIF.

To evaluate the surgical efficacy of pars plana vitrectomy on eyes with diabetic macular edema in the presence or absence of a complete posterior vitreous detachment and with or without an epimacular membrane.Pars plana vitrectomy was performed on 30 eyes of 29 cases with diabetic macular edema. Visual acuity was measured, and retinal thickness was determined by optical coherence tomography before and after vitrectomy. To evaluate the relationship between the effects of vitrectomy and the presence or absence of posterior vitreous detachment and/or epimacular membrane, all eyes were placed into one of four groups: group A, eyes with posterior vitreous detachment and epimacular membrane; B, eyes with posterior vitreous detachment and without epimacular membrane; C, eyes without posterior vitreous detachment and with epimacular membrane; and D, eyes without posterior vitreous detachment and without epimacular membrane. The expression of vascular endothelial growth factor and interleukin-6 was investigated immunohistochemically in epimacular membrane specimens obtained from seven eyes with diffuse diabetic macular edema.The postoperative mean visual acuity (0.653 +/- 0.350: mean +/- SD logarithm of minimal angle of resolution [logMAR]) was significantly better than the mean preoperative visual acuity (0.891 +/- 0.319 logMAR; Wilcoxon signed-rank test, P =.0007). The postoperative foveal thickness (264.5 +/- 118.6 microm) was significantly thinner than the preoperative foveal thickness (477.8 +/- 147.7 microm; Wilcoxon signed-rank test, P.0001). There were no significant differences in the improvement of visual acuity and decrease of foveal thickness between the four groups (Kruskal-Wallis test, P =.13, P =.65, respectively). All of the epimacular membranes obtained at surgery expressed vascular endothelial growth factor and interleukin-6.These results demonstrated that vitrectomy with removal of epimacular membrane is generally an effective procedure in reducing diabetic macular edema, and the outcome does not depend on the presence absence of posterior vitreous detachment and epimacular membrane.

Purpose: To determine the correlation between the tomographic features and the visual functions of eyes with diabetic macular edema. Methods: Optical coherence tomographic (OCT) images and multifocal electroretinograms were obtained from 45 eyes of 25 patients with diabetic macular edema and from 21 eyes of 21 normal subjects. Results: The OCT images showed cystoid macular edema in 18 eyes and diffuse retinal swelling without cystoid edema in the other 27 eyes. The fovea was significantly thicker in eyes with cystoid macular edema and in those with diffuse retinal swelling than in normal eyes. The fovea of eyes with cystoid edema was significantly thicker than the fovea of eyes with diffuse swelling. The best-corrected visual acuity and the electrical response density from the macular area were significantly reduced in eyes with diabetic macular edema, particularly in those with cystoid edema. The best-corrected visual acuity and macular response density of the multifocal ERGs were inversely correlated, and the implicit times were directly correlated with foveal thickness. Conclusion: The visual acuity was correlated significantly with morphological changes revealed by OCT and with multifocal ERGs. The combination of OCT and multifocal ERGs may provide objective criteria for the evaluation and assessment of diabetic macular edema.

Purpose: To investigate the correlation between monocyte chemotactic protein-1 (MCP-1) levels in the vitreous and clinical findings in eyes with proliferative diabetic retinopathy (PDR). Methods: We assayed MCP-1 levels by ELISA in vitreous samples of 88 consecutive patients with PDR (52 eyes) and macular holes or idiopathic epimacular membrane (controls, 36 eyes). Results: The level of MCP-1 in the vitreous was 2,097.5 ± 1,099.4 pg/ml (mean ± SD) in PDR, and 504.3 ± 405.6 pg/ml in the controls. In PDR eyes, multivariate regression analysis revealed a significant association between MCP-1 levels in the vitreous and the degree of proliferative membrane, and a significant negative association between MCP-1 levels and the extent of preoperative retinal photocoagulation. Conclusion: The results suggest that MCP-1 may play a role in the development of the proliferative phase of PDR.

Purpose: It has been hypothesized that the increase in the b-wave during light adaptation is directly related to the level of cone malfunction in patients with retinitis pigmentosa (RP). Because this hypothesis has important bearing on the mechanism for the increase in the electroretinogram (ERG), we examined the increase in the amplitude of the cone ERG during light adaptation in patients with typical RP. Methods: Cone ERGs were recorded to Ganzfeld white flash stimuli in the presence of white background illumination in 51 RP patients and in 27 normal subjects. Results: In the normals, the increase in the b-wave amplitude during light adaptation ranged from 14–92% of the dark-adapted amplitude. All RP patients showed an amplitude increase that ranged from 5 to 100% of the baseline amplitude. This increase was not significantly different from that of the normals (p=0.71, unpaired t-test). The baseline amplitudes and the increase in the relative amplitude were weakly correlated in the RP patients (r=0.31; p=0.029). No significant difference was observed in the amplitude increase between patients with near normal b-wave implicit times and those with delayed times (p=0.17, unpaired t-test). Changes of the b-wave implicit time were not significantly different from those in the controls. Conclusion: These findings that the changes in the cone ERG with light adaptation in the RP patients were very similar to those in normal subjects do not support the proposed hypothesis that the increase in the b-wave amplitude during light adaptation was directly related to the level of cone malfunction.

Silicone oil has been used to fill the vitreous cavity for long-term or permanent internal tamponade in eyes with proliferative vitreoretinopathy or complicated retinal detachment due to ocular trauma, giant retinal tears, proliferative diabetic retinopathy, and cytomegalovirus retinitis. Reports from the Silicone Study confirmed its efficacy in the treatment of proliferative vitreoretinopathy and addressed outcome differences in vitrectomized and nonvitrectomized eyes, combined retinotomy, silicone oil removal, and complications associated with silicone oil tamponade, such as intraocular pressure abnormalities and corneal abnormalities. Because silicone oil is lighter than water and not adequate in supporting the inferior quadrants, several heavier-than-water materials have been introduced for intraocular tamponade. Silicone oil can be a potential vehicle for delivering antiproliferative agents to treat proliferative vitreoretinopathy.

PURPOSE: To elucidate details of the pathologic changes in the ciliary epithelium associated with atopic dermatitis and blunt ocular trauma. METHODS: We examined prospectively 52 eyes of 42 patients with detachment of the nonpigmented epithelium of the ciliary body associated with atopic dermatitis and blunt ocular trauma. All the eyes underwent ultrasound biomicroscopic examination as an adjunct to binocular indirect ophthalmoscopy with scleral depression and slit-lamp biomicroscopy. RESULTS: Of the 52 eyes examined, high-resolution ultrasound biomicroscopy and conventional diagnostic methods (that is, binocular indirect ophthalmoscopy with scleral depression and slit-lamp biomicroscopy) disclosed breaks at the anterior vitreous base border in 40 eyes, at the pars plicata of the ciliary body in 27 eyes, and at the white midline (that is, the line located in the mid pars plana anterior to the anterior vitreous base border) in four eyes. In 40 eyes the breaks at the anterior vitreous base border could be detected with conventional methods but in only 28 eyes could they be diagnosed with ultrasound biomicroscopy. Conversely, in 27 eyes the breaks of the pars plicata could be observed with ultrasound biomicroscopy but in 25 eyes they were detected with conventional methods. In 21 eyes with breaks only at the anterior vitreous base border, the detachment of the nonpigmented ciliary epithelium was limited posterior to the white midline. In all 27 eyes with the nonpigmented ciliary epithelial detachment anterior to the white midline, the breaks of the pars plicata were identified by ultrasound biomicroscopy. CONCLUSION: Because of the minimum deformation of the globe during examination, ultrasound biomicroscopy contributed to the diagnosis of detailed structural change in the ciliary body associated with atopic dermatitis and blunt ocular trauma in relation to the white midline. In our sample of patients, the white midline may act as a barrier against ciliary nonpigmented epithelial detachment, and detachment of the nonpigmented epithelium anterior to the white midline indicated the presence of the pars plicata break in most cases.

Purpose: To evaluate the properties of the retina of a Japanese patient with enhanced S-cone syndrome by analyzing electroretinograms (ERGs) and visual evoked potentials (VEPs) elicited by different spectral stimuli. Methods: Ganzfeld spectral flashes in the presence of strong white adapting background illumination were used to elicit cone ERGs and VEPs. Results: The cone ERG elicited in the patient by short wavelength stimuli was distinctly different from the normal S-cone ERG. The action spectrum of the cone ERG confirmed its relative hypersensitivity to short wavelengths. The action spectrum of the VEP for the patient showed a similar relative hypersensitivity to short wavelengths. The response of the VEPs to short wavelength stimuli was different in waveform from the VEP response to longer wavelength stimuli observed in a normal subject. Conclusions: These results indicate that the hypersensitivity to short wavelengths is transmitted to the central nervous system and that there is a short wavelength transducing photopigment in many of the photoreceptors, either abnormal S-cones or photopic rods.

Cone electroretinograms (ERGs) elicited by different chromatic stimuli were recorded from patients with typical retinitis pigmentosa (RP) younger than 50 years of age. Ganzfeld color flashes on a bright white background illumination were used to elicit short-wavelength-sensitive (S-), and mixed long- (L-) and middle- (M-) wavelength-sensitive cone ERGs. Three patients with dominant inheritance, 22 patients with non-dominant inheritance, and 27 age-similar normal subjects were compared. Although the b-wave amplitudes of both the S- and L,M-cone ERGs were reduced in the RP patients, the S-cones were reduced to a greater degree than the L,M-cones. No significant difference in the S-cone reduction was observed between patients with dominant inheritance and those with non-dominant inheritance. The selective reduction of the S-cone system, reported previously in psychophysical studies, may be attributable not only to the macular region but also to the entire retina.

Cone electroretinograms (ERGs) in response to different color flashes were examined using a Ganzfeld stimulus in 19 eyes after successful retinal detachment surgery. In the operated eyes, the short wavelength sensitive (S-) cone b-wave was reduced more than the mixed long (L-) and middle (M-) wavelength sensitive cone b-waves. The ratio of the S-cone ERG b-wave amplitude between operated eyes and fellow eyes was significantly lower than the L- and M-cone ERG b-waves (P < .01). These ERG results indicated that the S-cone system is more impaired than the L- and M-cone systems after retinal detachment surgery.

The short wavelength-sensitive (S-) cone electroretinogram (ERG) is selectively reduced in diabetic patients both with and without retinopathy, but the exact mechanism of the vulnerability of the S-cone system is still unclear. This study examined relationships of the S-cone ERG to systemic factors in diabetes. Cone ERGs to different color flash stimuli were examined in the presence of bright white background illumination in 17 diabetic patients without retinopathy and in 17 diabetics with background retinopathy. Relationships of the amplitude and implicit time of the S-cone ERG to the following systemic factors were statistically analyzed: patients' age, hemoglobin A1 level, method of diabetic control, presence of retinopathy, and presence of nephropathy. The amplitude of the S-cone ERG b-wave was significantly reduced in diabetics treated with insulin and in those associated with nephropathy. No significant correlation was found between the S-cone ERG and patient's age, hemoglobin A1 level and presence or absence of retinopathy. A selective reduction of the S-cone ERG is observed in patients whose metabolic control has been poor for a longer period, suggesting that microvascular changes may play a role in the S-cone ERG impairment.

To survey non-infectious endophthalmitis related to triamcinolone acetonide (TA) for ocular diseases in Japan.A questionnaire was sent to the 24 committee members of the Japanese Retina and Vitreous Society requesting information regarding non-infectious endophthalmitis related to intravitreous TA administered from January through December 2009. The survey specifically covered the use of TA in intravitreal injections and intraoperatively during vitrectomy procedures.All 24 members responded to the survey involving intraviteal TA use in 562 eyes; 325 eyes for diabetic macular edema, 118 eyes for retinal vein occlusion, 91 eyes for uveitis, 11 eyes for age-related macular degeneration and 17 eyes had adjunctive use in retinal photocoagulation. Intraoperative use for visualizing vitreous was done in 6973 eyes. Noninfectious endophthalmitis occurred in 9 eyes (1.6%) after intravitreous TA and 7 eyes (0.1%) after intraoperative TA. The most frequent symptom was blurred vision with no pain or mild conjunctival injection. Sudden severe anterior chamber and vitreous inflammation occurred beginning on the day following surgery, but it disappeared spontaneously without complications.It was found that non-infectious endophthalmitis occurred after intravitreous TA. Although the visual prognosis is good, this complication should be recognized by retina specialists.

Purpose: To evaluate retrospectively clinical features and surgical outcomes of rhegmatogenous retinal detachment in juvenile patients. Methods: Between 1991 and 1996, 28 patients younger than 15 years of age with rhegmatogenous retinal detachment (32 eyes) underwent the first surgical procedure, scleral buckling and/or pars plana vitrectomy, at our hospital. Results: The major types of juvenile detachment, in order of frequency, were idiopathic, familial exudative vitreoretinopathy, trauma, and high myopia. Proliferative vitreoretinopathy (PVR) of grade C or D was involved in 12 cases (37.5%). Among the 12 eyes with PVR, 7 attained retinal reattachment after the first surgery with scleral buckling. The overall reattachment rate was 28/32 (87.5%) after the first operation and 30/32 (93.8%) after the second operation. Conclusion: These findings indicate that the reattachment rate and visual prognosis can be as good in juvenile retinal detachment as in adult cases, when appropriate surgical procedures are used.

PURPOSE: To determine whether the hepatocyte growth factor is increased in the vitreous of patients with proliferative vitreoretinopathy. METHODS: We assayed hepatocyte growth factor levels by enzyme-linked immunosorbent assay (ELISA) in vitreous samples from 65 consecutive eyes (65 patients) with proliferative vitreoretinopathy (23 eyes), rhegmatogenous retinal detachment (22 eyes), and macular hole or idiopathic epiretinal membrane (control subjects, 20 eyes) having undergone pars plana vitrectomy. RESULTS: Vitreous levels of hepatocyte growth factor were 3.94 ± 2.29 (mean ± SD) ng/ml in proliferative vitreoretinopathy, 2.02 ± 0.84 ng/ml in rhegmatogenous retinal detachment, and 2.16 ± 1.39 ng/ml in the control subjects. The vitreous levels in proliferative vitreoretinopathy were much greater than levels in rhegmatogenous retinal detachment ( P = .0002) and in the control subjects ( P =.0007). In proliferative vitreoretinopathy, there was a tendency toward higher levels in eyes with grade D by the Retina Society terminology. CONCLUSION: The results suggest the possibility that hepatocyte growth factor may play a role in the pathogenesis of proliferative vitreoretinopathy.

Purpose: To alert ophthalmologists to ocular manifestations that could indicate polyarteritis nodosa. Case: A 71-year-old man exhibited unilateral episcleritis as the primary clinical manifestation of polyarteritis nodosa. Observations: The patient's ocular symptoms did not respond well to either topical betamethasone eye drops or low-dose oral prednisone. Five months after the onset of ocular symptoms, the patient progressively developed fever, pneumonia, and renal dysfunction. Positive antineutrophil cytoplasmic antibody indicated polyarteritis nodosa as the underlying systemic disease. Intravenous methylprednisolone (1 g/day) was started; however, the patient succumbed 10 days later after intracranial hemorrhage. Conclusions: Ophthalmologists should be aware that such a common ocular manifestation as episcleritis can be the initial manifestation of polyarteritis nodosa and that its early diagnosis can reduce mortality from this disease.

To survey the use of silicone oil in clinical ophthalmology in Japan.Questionnaires were sent to 1,240 hospitals registered as being ophthalmology residency training institutions with the Japanese Ophthalmological Society as of September 2007. Responses were collected via the Internet and results totaled. The use of silicone oil at each institution for the 2006 one-year period was assessed, included queries regarding type of silicone oil, indication for use, results and complications. Hospitals were divided into non-specialty institutions, intermediate-specialty institutions and specialty institutions based on number of vitrectomy procedures performed in the one-year period, and trends were analyzed based on these divisions.Responses were received from 272 institutions (21.9% response rate). Of a total of 36,104 vitrectomy procedures, silicone oil was used in 2,170 cases (6.0%). The diagnosis was proliferative vitreoretinopathy in the majority of cases, followed by proliferative diabetic retinopathy and rhegmatogenous retinal detachment. The majority of institutions replied that the indication for use was complicated case. The type of silicone oil used was ophthalmic formulation in 120 institutions (54.1%) and industrial formulation in 73 institutions (32.9%). Specialty institutions had a higher rate of use of the industrial formulation. The average volume used at one time was 6.4 ml. The majority of institutions responded that silicone oil removal was performed at 3 months after the initial vitrectomy. Silicone oil was not removed in 530 cases in which continued tamponade was judged to be appropriate; this comprised 53.3% of cases at non-specialty institutions. The overall evaluation for silicone oil use was good; silicone oil was rated as being indispensable in 72 cases (31.2%) and effective in 130 cases (56.3%). Responses stating a high need for silicone oil were most frequent for proliferative vitreoretinopathy and proliferative diabetic retinopathy. Complications related to silicone oil use were glaucoma in 125 cases (5.6%), intraocular pressure elevation in 411 cases (18.4%), hypotony in 28 cases (1.3%), endophthalmitis in 5 cases (0.22%), retinal detachment in 13 cases (0.58%), corneal opacification in 105 cases (4.7%), inadvertant subretinal infusion in 31 cases (1.4%) and silicone oil emulsification in 82 cases (3.7%). It was the opinion of many institutions that, in cases where silicone oil could not be used, the number of necessary surgical procedures increased, with lower rates of cure and greater burden on the patient.Silicone oil was utilized in approximately 1 in every 17 vitrectomy procedures performed in 2006 by the Japanese institutions surveyed. Complications were observed, however overall the indications were appropriate and the use of silicone oil was judged to be necessary by nearly 90% of institutions surveyed.

To survey the use of long-lasting expanding gases in ophthalmology in Japan.A questionnaire was sent to 1,236 teaching hospitals approved by the Japanese Ophthalmological Society requesting information regarding indications, methods, efficacy and complications related to the use of long-lasting expanding gases administered from January through December 2005.Four-hundred and fifty-nine hospitals responded to the survey (response rate 37.1%). A total of 174,221 ophthalmic surgeries were performed during the survey period, with long-lasting expanding gases used in 19,816 of cases (11.4%). The surgical procedure was vitrectomy in 89.6% of cases in which gas was administered. The most frequent indication for gas use was rhegmatogenous retinal detachment, for which SF6 was the preferred gas. Industrial use gas was utilized in 76.1% of cases, while 22.4% of cases received medical use gas. Increase in intraocular pressure was the most common complication of intraocular gas tamponade (3121 cases, 15.7%), followed by cataract formation. Ninety-eight percent of ophthalmologists responding supported the use of long-lasting expanding gases with vitrectomy, 85% with scleral buckling procedures, and 84% with surgery to remove subretinal hemorrhage. The consensus was that substantial deterioration of surgical results would occur if long-lasting expanding gases could not be used.Long-lasting expanding gases are being widely administered in ophthalmology in Japan, and appear to have good efficacy for a variety of indications. Several complications related to the use of these gases were reported, however the rates of complications were low.

To survey the use of triamcinolone acetonide (TA) for ocular disease in Japan.A questionnaire was sent to 1,236 teaching hospitals approved by the Japanese Ophthalmological Society requesting information regarding indications, methods, efficacy and complications of TA administered from January through December 2005. The survey specifically covered the use of TA in intravitreal injections, sub-Tenon's injections and intraoperatively during vitrectomy procedures.Four-hundred and fifty-nine hospitals responded to the survey (response rate 36.9%) involving TA use in 44,827 eyes. Intravitreal injections of TA were administered to 5,665 eyes in 159 hospitals. The average dose was 6.53 mg for a single injection and was reported to have highest efficacy in eyes with diabetic macular edema, followed by retinal vein occlusion. Complications included cataract formation in 116 eyes (2.04%), glaucoma requiring filtration surgery in 32 eyes (0.56%), endophthalmitis in 7 eyes (0.12%), and blepharoptosis in 8 eyes (0.14%). Sub-Tenon's injections of TA were administered to 12,343 eyes in 308 hospitals. The average dose was 19.87 mg for a single injection and had the highest efficacy in eyes with diabetic macular edema, followed by retinal vein occlusion. Sub-Tenon's administration of TA was also frequently used for uveitis. Complications reported were cataract formation in 191 eyes (1.55%), glaucoma requiring filtration surgery in 33 eyes (0.26%), endophthalmitis in 1 eye (0.008%), periocular infection in 5 eyes (0.04%) and blepharoptosis in 43 eyes (0.35%). TA was used as an adjunct to vitrectomy in 26,819 eyes in 270 hospitals and was judged to be most useful in the separation of posterior hyaloid from the retina. Complications included cataract formation in 49 eyes (0.18%), glaucoma requiring filtration surgery in 32 eyes (0.56%), and endophthalmitis in 7 eyes (0.026%).TA is being widely administered for ocular diseases in Japan, and appears to have good efficacy in a variety of indications. Several complications related to TA use were reported, however the rates of complications were low.

To evaluate the surgical outcome of retinal reattachment, the reattachment rate according to the range of detachment, and postoperative visual acuity for macular hole retinal detachment (MHRD).Sixty-eight eyes of 67 patients with MHRD were analyzed. The mean follow-up period was 54 months.Retinal reattachment occurred in 42/68 eyes (62%) after initial surgery. The reattachment rates were 6/23 eyes (26%) in the gas tamponade group, 13/19 eyes (68%) in the vitrectomy group, 23/ 26 eyes (88%) in the group that underwent removal of internal limiting membrane as adjunct to vitrectomy (ILM) group. In the additional surgery, the reattachment rates were 5/9 eyes (56%) in the gas tamponade group, 13 eyes (100%) in the vitrectomy group, 1/2 eyes (50%) in the ILM group, and 6 eyes (100%) in the macular prombe buckling group. No significant differences were seen in the detachment extent-related reattachment rate within the same surgery and the postoperative visual acuity between the groups.The results show that removal of ILM contributes to successful reattachment in the initial surgery, and that for non-reattachable eyes, macular buckling in the second surgery is the most reliable method.

To evaluate transpupillary thermotherapy(TTT), the treatment was reviewed in two cases of retinal hemangioma which resisted photocoagulation. CASE 1: A 25-year-old man was referred to us for visual impairment in his right eye caused by retinal hemangioma. Although photocoagulation had been performed once in a previous hospital, the treatment was unsuccessful. His visual acuity was 0.1 OD. Ophthalmoscopic examination revealed a hemangioma located in the superotemporal peripheral retina with serous retinal detachment. We performed photocoagulation of the afferent artery and TTT of the hemangioma two times each. The hemangioma regressed and the serous retinal detachment resolved. The patient's visual acuity OD improved to 0.2. CASE 2: A 13-year-old girl was referred to us for visual impairment in her right eye caused by retinal hemangioma. Photocoagulation had been performed five times in a previous hospital, but the treatment was unsuccessful. Her visual acuity was 0.05 OD. Opthalmoscopic examination revealed a hemangioma located in the inferonasal peripheral retina with serous retinal detachment. We performed photocoagulation of the afferent artery two times and TTT of the hemangioma four times. The hemangioma regressed and the serous retinal detachment resolved.TTT is performed with a larger spot size, a longer wavelength, and a longer duration than photocoagulation. TTT could be an effective treatment for retinal hemangioma.

To analyze the long-term effects of pars plana vitrectomy for diabetic macular edema.Sixty-nine patients (73 eyes) with diabetic macular edema were examined retrospectively after pars plana vitrectomy. The mean follow-up time was 24.6 +/- 7.3 months.The postoperative best-corrected visual acuity (BCVA) at 12 months was significantly better than the preoperative BCVA, and the improvement was maintained for at least 24 months. The mean central retinal thickness (RT) at 3 months after surgery was significantly thinner than the preoperative central RT, and was maintained for at least 24 months in the cases followed for this period. The postoperative BCVA was significantly worse than the preoperative BCVA at 2 years after surgery in eyes with a preoperative BCVA ofor =0.05. In addition, there was lower probability that the postoperative BCVA would beor =0.5 in eyes with a preoperative BCVA of0.3.The results indicate that the improvement in the BCVA is attained by 12 months postvitrectomy, and is maintained for at least 24 months. The reduction in RT can be maintained for up to 24 months. The results also indicate that vitrectomy should be performed when the preoperative BCVA is0.05 at worst.

To assess the effect of vitrectomy with circumferential peripheral retinotomy on massive subretinal hemorrhage.Eight patients (8 eyes) with massive subretinal hemorrhage of more than 2 quadrants, underwent pars plana vitrectomy between May 2000 and February 2004. The average age was 73.5 years. Seven patients (7 eyes) were male, and one was female (1 eye). An average of 207.5 degree circumferential peripheral retinotomy was carried out for removal of subretinal hemorrhage. The amount of postoperative subretinal hemorrhage, the improvement of visual acuity, and postoperative complications were evaluated.Postoperatively, the volume of subretinal hemorrhage decreased in all cases. The visual acuity improved in 7 of the 8 eyes (87.5%). Postoperatively, none of the cases developed proliferative vitreoretinopathy, but subretinal hemorrhage recurred in 2 eyes.Vitrectomy with circumferential peripheral retinotomy may reduce massive subretinal hemorrhage and increase visual acuity.

AIM The short wavelength sensitive (S) cone electroretinograms (ERGs) were examined in two patients with Oguchi’s disease to study S cone function. METHODS Ganzfeld colour flashes under bright white background illumination were used to elicit S cone, and mixed long (L) and middle (M) wavelength sensitive cone ERGs. RESULTS The S cone ERG b-wave was normal with short wavelength stimuli with normal L and M cone responses in both patients. CONCLUSIONS These ERG results indicate that the S cone system as well as the L and M cone system is not defective in Oguchi’s disease, while the S cone responses are not detectable in the complete type of congenital stationary night blindness as reported previously. The results imply that there is a significant difference in the way the S cone system is affected in different forms of stationary night blindness, and that the S cone and rod do not share the same arrestin system.

Purpose compare the results of vitrectomy with or without arteriovenous (AV) crossing sheathotomy for macular edema associated with branch retinal vein occlusion (BRVO). Design Interventional case series. Methods A retrospective study of 36 eyes with BRVO-associated macular edema. Twenty eyes underwent AV sheathotomy (AS group), and 16 eyes underwent posterior vitreous detachment (PVD group). Best-corrected visual acuity (BCVA), fluorescein angiography (FA), and optical coherence tomography to determine foveal thickness were conducted preoperatively and at 12 months postoperatively. Results The mean postoperative BCVAs were significantly better in both the AS and the PVD group ( P = .008 and P = .001, respectively). Foveal thickness decreased significantly 1 month after surgery in both groups ( P = .002 and P = .007) and continued to decrease up to 12 months. The postoperative mean BCVA and improvement of BCVA and foveal thickness were not significantly different for the two groups at any postoperative period. Postoperative FA showed reperfusion of the occluded vein in 10 eyes in the AS group and 2 eyes in the PVD group, and formation of shunt vessels at the AV crossing site or around the macular region in all of the other eyes of both groups. Conclusions Both AV sheathotomy and simple PVD significantly reduced macular edema associated with BRVO. However, there was no significant difference in the improvement of macular function following either procedure. Postoperative improvement of retinal circulation by either reperfusion of the occluded vein or collateral vessel formation was found. This accounted for functional and morphologic improvements.

To evaluate the surgical outcome of vitrectomy and foveal thickness before and after vitrectomy for idiopathic epiretinal membranes.Twenty-three eyes of 21 patients with idiopathic epiretinal membranes were analyzed. The mean follow-up period was 17.8 months. In 16 eyes of 14 patients, foveal thickness was measured by optical coherence tomography (OCT).Preoperative visual acuity ranged from 0.1 to 0.7. Postoperatively, 17 eyes achieved a final visual acuity of 1.0 or better, and 21 eyes achieved 0.5 or better. Preoperative foveal thickness ranged from 205 to 575 microns (mean +/- standard deviation, 409.9 +/- 103.3 microns). Postoperatively, mean foveal thickness was 347.7 +/- 106.0 microns (1 week follow up), 338.6 +/- 103.7 microns (2 months), 304.6 +/- 97.0 microns (6 months), and 274.3 +/- 78.7 microns (1 year). There was a weak negative correlation between visual acuity and foveal thickness.Visual acuity improves significantly after surgery. OCT is useful for idiopathic epiretinal membrane surgery.

Formation of epiretinal membranes (ERMs) after proliferative diabetic retinopathy (PDR) and proliferative vitreoretinopathy (PVR) results in progressive deterioration of vision, but its pathogenic mechanisms are still unknown. This study was conducted to examine the role of nuclear factor kappa B (NF-kappaB) in the formation of ERMs after PDR and PVR.ERM samples were obtained by vitrectomy from 10 patients with PDR (aged 53+/-12 years with 14+/-5 years of diabetes), 20 patients with PVR, and 17 patients with idiopathic ERMs. Ten PVR and 17 idiopathic ERM samples were processed for reverse transcription-polymerase chain reaction (RT-PCR) analysis. In addition, 10 PDR and 10 PVR membranes were processed for immunohistochemical analysis.NF-kappaB mRNA expression levels were significantly higher (10 of 10 versus 9 of 17 subjects in idiopathic ERM, p=0.0119) in PVR subjects. Immunohistochemical analysis showed NF-kappaB protein expression in 8 of the 10 PDR samples as well as all 10 PVR samples, and NF-kappaB positive cells were partially double labeled with glial cell markers. Interestingly, NF-kappaB protein was also overlapped with angiogenic factor interleukin-8 (IL-8) in glial cells as well as vascular endothelial cells.These results suggest that NF-kappaB is involved in the formation of both glial and vascular endothelial cell components, and that these two cell types might have functional interactions that lead to the enlargement of intraocular proliferative membranes.

Cone electroretinograms (ERGs), elicited by different color flashes under Ganzfeld conditions, were recorded from 6 patients with multiple evanescent white dot syndrome (MEWDS). All of the patients had normal color vision as determined by the Farnsworth Panel D-15 except for one who showed non-specific errors. The b-waves elicited from short wavelength sensitive (S-) cones were reduced more than the mixed long (L-) and middle (M-) wavelength sensitive cones in the affected eyes. The ratio of the S-cone b-wave amplitude of the affected eyes to that of the normal fellow eyes was significantly lower than the comparable ratio for the L- and M-cone ERG b-waves (p=0.012). The S-cone ERGs recorded from 2 patients recovered to normal levels after their symptoms abated. These ERG results indicate that the S-cone system is more impaired than the L- and M-cone systems in the acute stage of MEWDS, and the changes in the S-cones may be reversible.

To present two patients who underwent surgery for an idiopathic macular hole (IMH) with internal limiting membrane (ILM) peeling and developed an epimacular proliferative response.Observational case report. Two patients with an IMH underwent pars plana vitrectomy with ILM peeling. Ophthalmic examination including optical coherence tomography (OCT) was performed pre- and postoperatively. In both cases, scanning laser ophthalmoscopy (SLO) was performed postoperatively.In the first case, the closure of the macular hole (MH) was confirmed ophthalmoscopically and by OCT following the surgery. At 2 months postoperatively, a thin epiretinal membrane (ERM) developed over the nasal macula area where the ILM had been peeled. The patient's visual acuity had recovered to 1.0 but she complained of metamorphopsia. At 18 months postoperatively, the thin ERM around the nasal fovea remained and her visual acuity was still 1.0. In the second case, the MH was sealed after the surgery, and the patient's visual acuity had improved to 1.0 at 3 months, but an indistinct ERM developed in the macular region where the ILM had been peeled. Two years after the operation, her VA was still 1.0. One and two years postoperatively, a thin epimacular proliferation remained unchanged; in addition, the OCT and SLO images remained stable.Two patients who underwent IMH surgery with ILM peeling developed an epimacular proliferative response postoperatively. We suggest that the injury associated with the ILM peeling may have stimulated glial proliferation.

Purpose: To determine whether tenascin-C levels are elevated in the vitreous of patients with proliferative vitreoretinopathy (PVR). Methods: We assayed tenascin-C levels in vitreous samples of 110 consecutive patients with PVR (30 eyes), rhegmatogenous retinal detachment (RRD; 32 eyes), and macular hole or idiopathic epiretinal membrane (controls, 48 eyes) using an enzyme-linked immunosorbent assay. Results: Vitreous levels of tenascin-C (median [range]) were significantly greater in PVR (845.0 ng/ml [411.0–1,050.0]) than in RRD (21.9 ng/ml [13.2–127.0]) and in the controls (18.0 ng/ml [9.9–199.0]) (p < 0.0001). Conclusion: The results indicate the possibility that tenascin-C is involved in the pathogenesis of PVR.

Aims: To evaluate the effect of pars plana vitrectomy (PPV) with or without internal limiting membrane (ILM) peeling on the closure and configuration of idiopathic macular holes (IMH). Methods: PPV was performed for IMH on 44 eyes with ILM peeling (ILM peeled group) and on 42 eyes without ILM removal (ILM preserved group). Optical coherence tomography (OCT) was performed on 34 ILM peeled eyes and 14 ILM preserved eyes after successful surgery. The repaired macular holes were classified by the OCT images as being of “good shape” (nearly normal foveal contour) or “poor shape” (abnormal foveal contour with flat fovea and steep edge, or with a thick retina without a foveal pit). Results: The anatomical closure rate was significantly higher in the ILM peeled group (93.2%) than in the ILM preserved group (76.2%) (p = 0.028). In the ILM peeled group, 31 eyes had a fovea of good shape and three eyes had a fovea with a poor shape, while in the ILM preserved group, six eyes had a fovea of good shape and eight eyes had a fovea of poor shape. The percentage of eyes with good macular configuration in the ILM peeled group was significantly higher than in the ILM preserved group (p = 0.0003). No significant difference was found in the postoperative visual acuity and the increase of visual acuity between the ILM peeled group and the ILM preserved group (p = 0.26, and p = 0.91 respectively). There was also no significant difference in the postoperative visual acuity and improvement in visual acuity between eyes with a fovea of good shape and those with fovea of poor shape fovea (p = 0.99 and p = 0.66, respectively). Conclusions: ILM peeling may provide better anatomical success and recovery of the macular shape, but the postoperative visual acuity and improvement of visual acuity were not related to the morphological results.

To examine the electroretinograms (ERGs) of the short-wavelength-sensitive (S-) and the mixed long- and middle-wavelength-sensitive (L,M-) cones, and the ON- and OFF-responses of the cone ERGs in three patients with X-linked juvenile retinoschisis (XLRS).Cone ERGs elicited by different color flashes and those elicited by long duration stimuli under Ganzfeld conditions were recorded from three patients with XLRS.The S-cone b-waves were undetectable to short-wavelength stimuli in all three XLRS patients, while the L,M-cone ERG b-waves were within the normal range. To long-duration white stimuli, the ON-response (b-wave) was reduced and delayed in all patients compared with that of the normal subjects, while the d-wave or OFF-response appeared normal in amplitude and implicit time.These results support the hypothesis that the normal S-cone ERG arises primarily from the ON-pathway of the cone ERGs and the hypothesis that ON-bipolar cells are predominant in the S-cone system.

Purpose: To examine the expression of activin A in eyes and to determine the possible functions of activin A in proliferative vitreoretinal diseases. Methods: The activin A concentration in vitreous specimens obtained from eyes with or without retinal ischemia was measured by a bioassay using erythroid differentiation factor effects of activin A. The expression of activin A and activin receptors in the preretinal membranes was observed by immunohistochemical analysis. Results: The mean concentration of activin A in the eyes with proliferative diabetic retinopathy was 1.50 ± 1.27 ng/mL (mean ± SD; n = 10), and that in the nondiabetic eyes without retinal ischemia (macular hole and epiretinal membrane) was 0.90 ± 0.55 ng/mL (n = 5). Neither difference was significant. Activin A and its receptors were detected in the vascular endothelial cells, fibroblast-like cells and round-shaped macrophage-like cells in preretinal proliferative membranes by immunohistochemical analysis. Conclusions: Activin A is involved in the proliferative membrane formation in both ischemic and nonischemic vitreoretinal proliferative diseases. Activin A, a member of TGF-β superfamily, regulates angiogenesis and tissue fibrosis in the wound healing process.

AIMS—To assess the potential role of macrophage migration inhibitory factor (MIF) in the pathogenesis of proliferative diabetic retinopathy (PDR). METHODS—MIF levels were assayed in the vitreous and paired serum samples of 73 consecutive patients with PDR (32 eyes) and macular hole or idiopathic epiretinal membrane (controls, 41 eyes). An enzyme linked immunosorbent assay technique was used to determine the concentrations of MIF. RESULTS—The median vitreous level of MIF was 11.93 ng/ml (range 4.16-103.85) in the patients with PDR, and 1.79 ng/ml (undetectable-8.93) in the controls. Vitreous levels in eyes with PDR were significantly greater than those in the controls (p

Purpose: An evaluation of surgical outcome of vitrectomy in the treatment of expulsive hemorrhage associated with intraocular surgery. Methods: We reviewed 12 eyes from 12 patients with expulsive hemorrhage, occurring after or during cataract extraction (4 eyes), phacoemulsification (2 eyes), glaucoma filtering surgery (4 eyes), or vitrectomy (2 eyes). Mean follow-up period was 21 months. Results: The retina was reattached in 6 eyes (50%) after the initial surgery and ultimately in 9 eyes (75%). Three eyes, which failed to achieve retinal reattachment, resulted in phthisis bulbi. Final visual acuity was 0.1 or better in 4 eyes and 0.01 to 0.09 in 4 eyes. The incidence of expulsive hemorrhage was 0% for cataract surgery, 0.57% for trabeculectomy, and 0.09% for vitrectomy at Toho University Sakura Hospital. Conclusion: In the treatment of expulsive hemorrhage, vitrectomy is an effective surgical procedure to improve the visual function.

To assess the potential role of macrophage migration inhibitory factor (MIF) in the pathogenesis of proliferative vitreoretinopathy.We assayed MIF levels in vitreous and paired serum samples of 74 consecutive patients with proliferative vitreoretinopathy (26 eyes), rhegmatogenous retinal detachment (22 eyes), and macular hole or idiopathic epiretinal membrane (control, 26 eyes) by enzyme-linked immunosorbent assay.Vitreous levels of MIF were 51.33 +/- 49.21 ng/ml (mean +/- SD) in proliferative vitreoretinopathy, 19.11 +/- 16.13 ng/ml in rhegmatogenous retinal detachment, and 2.98 +/- 2.55 ng/ml in the controls. The vitreous levels in eyes with proliferative vitreoretinopathy were significantly higher than levels in eyes with rhegmatogenous retinal detachment (P = .0005) and in the control subjects (P.0001). The vitreous levels were significantly higher than the serum levels in proliferative vitreoretinopathy (P.0001) and rhegmatogenous retinal detachment (P = .0019), respectively.The results suggest that MIF may be involved in the pathogenesis of proliferative vitreoretinopathy.

Editor,—Intraocular filariasis is an uncommon disease in civilised countries. In only a few cases has the worm been surgically removed from the posterior portion of the eye and identified.1 In this report we describe a patient who had a filaria-like worm in an epimacular and/or submacular lesion, which was successfully removed surgically. ### CASE REPORT A 38 year old woman complained of decreased visual acuity in her left eye of 5 days’ duration. Her medical history was unremarkable. The patient had two pet dogs, and she had not travelled to foreign countries in recent years. On examination, her corrected visual acuity was 20/20 in the right eye and 20/100 in the left. No inflammation was present in the anterior segment or vitreous cavity bilaterally. Ophthalmoscopic examination disclosed a white worm, approximately 3 disc diameters in length, equivalent …