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Objectives To investigate the topographic relationship between the shape of the optic nerve head (ONH) margin detected by optical coherence tomography (OCT) and the clinical characteristics of papillomacular retinoschisis (PMRS) in glaucomatous eyes. Methods The medical record of patients with a PMRS in a glaucomatous eye were reviewed. The eyes were placed into two groups determined by the shape of the ONH margin in the OCT images; eyes with an externally oblique ONH margin (Group 1) and the eyes with an internally oblique ONH margin (Group 2). We compared the clinical characteristics of the PMRS between these two groups. Results We studied 31 eyes of 29 patients with PMRS and glaucoma with 24 eyes in Group 1 and 7 eyes in Group 2. The optic nerve fiber layer schisis on the lamina cribosa (LC), beta zone, and gamma zone, and the LC defects were detected significantly more frequently in Group 1 than in Group 2 eyes (P P

Purpose To evaluate the efficacy of using intraoperative optical coherence tomography (iOCT) to adjust the tilting of an intraocular lens (IOL) during implantation with intrascleral fixation. Setting Kyorin University Hospital, Tokyo, Japan. Design Retrospective, case-control, single-center study. Methods Thirty-seven eyes of 37 patients who had undergone pars plana vitrectomy with intrascleral fixation of an IOL by a single surgeon were retrospectively studied. The length of the externalized haptics was determined when the anterior surface of the IOL was parallel to the plane of the iris as observed by iOCT. The maximal IOL tilt relative to the visual axis and to the iris plane was measured by anterior segment OCT (CASIA2; Tomey Corp.). Results Intraoperative crosssectional OCT (RESCAN 700: Carl Zeiss Meditec AG) scans were used to adjust the degree of IOL tilt in 23 eyes (iOCT group) and not used in 14 eyes (control group). The maximal angle of IOL tilt relative to the visual axis was significantly smaller in the iOCT group than that in the control group (5.45 ± 2.63 degrees vs 10.38 ± 10.48 degrees, P = .034). The maximal angle of the IOL tilt to the iris plane was also significantly smaller in the iOCT group than that in the control group (4.58 ± 1.86 degrees vs 9.60 ± 10.82 degrees; P = .040). The distance of decentration was greater in the iOCT group (0.56 ± 0.29 mm) than that of the control group (0.41 ± 0.41 mm, P = .005). Conclusions Intraoperative OCT can be used to adjust the degree of IOL tilt to reduce the lenticular astigmatism during intrascleral fixation surgery.

Background: The blood metabolome profiles depend on the meal intake time zone regardless of having the same meal. The serum albumin (Alb) level, which is important in managing geriatric patients with chronic diseases, is included in the metabolome analysis. In this study, we aimed to examine the relationship between Alb and the nutritional value of hospital meals consumed at breakfast, lunch, and dinner among geriatric patients. Chrononutrition was considered while drawing inferences. Methods: We retrospectively surveyed 52 geriatric patients with chronic diseases (aged 79.7 ± 8.7 years) admitted at a small-scale hospital providing combined healthcare measures and oral nutritional support. The dietary intake per kilogram of body weight of nutritional components for breakfast, lunch, and dinner was individually expressed as the ratio to the whole daily food intake. The dietary pattern was determined by principal component analysis. We also conducted linear regression analysis, with Alb as the dependent variable, and age, sex, and grade assigned in this study as well as the first, second, and third principal components of the dietary patterns as the independent variables. Results: Three principal components with an eigenvalue of > 1 were extracted. The second principal component was a significantly negative determinant factor for Alb (B = -0.108, P = 0.016). In patients with high Alb levels, the energy, protein, and fat ratios at lunch were positively correlated, while the energy and carbohydrate ratios at dinner were negatively correlated. Mealtimes were fixed. Conclusions: The results of this study showed that the dietary pattern predominantly observed in patients with high Alb levels may be positively associated with Alb synthesis. J Clin Med Res. 2021;13(6):334-342 doi: https://doi.org/10.14740/jocmr4524

Musculocontractural Ehlers–Danlos syndrome, caused by biallelic loss-of-function variants for dermatan sulfate epimerase (mcEDS-DSE), is a rare connective tissue disorder. Eight patients with mcEDS-DSE have been described with ocular complications, including blue sclera, strabismus, high refractive errors, and elevated intraocular pressure. However, a case with rhegmatogenous retinal detachment (RRD) has not been reported. We report our findings in a 24-year-old woman who was diagnosed with mcEDS-DSE in childhood and presented to our clinic with an RRD in the left eye. The RRD extended to the macula and was associated with an atrophic hole. The patient underwent scleral buckling surgery and cryopexy with drainage of subretinal fluid through a sclerotomy under local anesthesia. The sclera did not appear blue but was very thin at the sclerotomy site. The patient developed frequent bradycardia during the surgery. Subretinal or choroidal hemorrhages were not observed intraoperatively; however, a peripapillary hemorrhage was observed one day after operation. The retina was reattached postoperatively, and the peripapillary hemorrhage was absorbed after one month. The peripapillary retinal hemorrhages, thin sclera, and bradycardia were most likely due to the fragility of the eye. The genetic diagnosis of mcEDS-DSE played an important role before and during the surgery by alerting the surgeons to possible surgical complications due to the thin sclera.

We reviewed the medical records of 438 eyes in 431 patients who had undergone surgeries for rhegmatogenous retinal detachments (RRD) or proliferative vitreoretinopathy (PVR ≥ Grade C) to determine whether the COVID-19 pandemic had affected outcomes. The patients were divided into 203 eyes in Group A that had undergone surgery from April to September 2020, during the pandemic, and 235 eyes in Group B that had undergone surgery from April to September 2019, before the pandemic. The pre- and postoperative visual acuity, macular detachment, type of retinal breaks, size of the RRD, and surgical outcomes were compared. The number of eyes in Group A was fewer by 14%. The incidence of men (p = 0.005) and PVR (p = 0.004) was significantly higher in Group A. Additionally, the patients in Group A were significantly younger than in Group B (p = 0.04). The differences in the preoperative and final visual acuity, incidence of macular detachment, posterior vitreous detachment, types of retinal breaks, and size of the RRD between the two groups were not significant. The initial reattachment rate was significantly lower at 92.6% in Group A than 98.3% in Group B (p = 0.004). The COVID-19 pandemic affected the surgical outcomes for RRD with higher incidences of men and PVR, younger aged patients and lower initial reattachment rates even though the final surgical outcomes were comparable.

Vitreoretinal lymphoma (VRL) is a subtype of diffuse large B-cell lymphoma and is sight- and life-threatening in the vast majority of patients. Lymphoma cells infiltrate the vitreous body and/or subretinal space and exhibit clinical signs of vitreous opacities and creamy white subretinal lesions. Although the intraocular signs can serve as clues to suspect VRL, they are nonspecific and may be misdiagnosed as uveitis. Histopathological evidence of malignant cells on vitreous biopsy, for instance, is the gold standard for diagnosis of VRL; however, cytological examination of the vitreous often results in a low success rate owing to the small quantity and poor quality of tissues and cells in the sample. Recent advancements in immunological, molecular, and gene analyses using intraocular samples have made it possible to accurately diagnose VRL. As for the management of VRL, local treatments with irradiation and/or intravitreal injections of anti-tumor agents (methotrexate or rituximab) are effective in suppressing intraocular VRL lesions. However, the effect of systemic chemotherapy, with or without brain irradiation, on preventing central nervous system involvements remains controversial. In this review article, we discuss the following concepts based on previous literature and our unpublished results: current ocular imaging examinations such as optical coherence tomography and fundus autofluorescence; immunological, molecular, and gene expression characterization of intraocular biopsies with special attention to flow cytometry; immunoglobulin gene rearrangement assays that use the polymerase chain reaction test; cytokine assays; gene mutations (MYD88, CD79B); and current local and systemic treatments of VRL.

It is known that the retinal detachments (RDs) associated with a morning glory disc anomaly (MGDA) usually appear from around the disc anomaly and complications by peripheral fibrovascular proliferation and tractional RD are very rare. We report our findings in an eye with MGDA that had a tractional RD, massive exudation from a peripheral temporal fibrovascular proliferation and vasculatures stretched by this proliferation and by a contraction of the hyaloidal membrane. The RD was successfully treated by vitrectomy and encircling buckling surgery.

Purpose Vasoproliferative tumors (VPTs) are rare benign tumors, and detailed indocyanine green angiographic (ICGA) findings in eyes with VPTs have not been reported. We present the characteristic ICGA findings in seven eyes with a VPT. Observations We present the fluorescein angiographic (FA) and ICGA findings of seven consecutive patients who were diagnosed with primary VPT from April 2013 to March 2015 in the Oncology Service of the Department of Ophthalmology, Tokyo Medical and Dental University. We reviewed the demographics of the seven patients with VPTs. Abnormal vessels within the tumor were observed in three cases with active tumors. These vessels were hypofluorescent in the ICGA images in the scar phase. On the other hand, three cases in which the exudation remained from the initial visit to the last examination had abnormal vessels in the ICGA images. The remaining case had one straight vessel in the tumor from the initial to the last examination in the scar phase. FA in the active phase changed from hyperfluorescent leakage to staining in one eye, and the remaining six eyes continued to show hyperfluorescent leakage throughout the examination period. Conclusions The leakage of fluorescein continued from the initial to the final examination even after the activity of the tumor had decreased. In the active phase, ICGA showed abnormal vessels with or without leakage, and the tumors at the scar phase show a hypofluorescent lesion. Importance ICGA supported the ophthalmoscopic findings, and can be used as a diagnostic aid to confirm a regression of the VPTs.

Novel paravascular lesions with abnormal autofluorescence (AF) were found in eyes with pathologic myopia. Most lesions were uniform hypo-AF, followed by hyper-AF, and granular hypo-AF. Optical coherence tomography showed retinal thinning with or without defects of the retinal pigment epithelium. Pathologic myopia (PM) is characterized by an increase in the axial length of the eye and formation of posterior staphylomas. Much attention has been paid to the macular lesions in the clinical management of patients with PM. However, recent studies have shown that wider areas of the fundus can be affected such as radial tracts that emanate from the upper staphyloma edges and peripheral avascular zones. These findings suggested that PM may not simply be a macular disorder but a disorder with various pathologies in wide areas of the fundus including the far periphery.

Purpose To investigate the efficacy of intravitreal administration of resveratrol (RSV) in a microbead-induced high intraocular pressure (IOP) murine model for glaucoma. Methods Experiments were performed using adult C57BL/6JJcl mice. Polystyrene microbeads were injected into the anterior chamber to induce IOP elevation. Retinal flat-mounts and sections were assessed by immunohistochemistry to detect the expression of reactive oxygen species and acetyl-p53 in retinal ganglion cells (RGCs), brain-derived neurotrophic factor (BDNF) in Muller glial cells (MGCs), and the receptor tropomyosin receptor kinase B (TrkB) in RGCs. Light cycler real-time PCR was also used for confirming gene expression of BDNF in primary cultured MGCs exposed to RSV. Results Microbeads induced high IOP followed by RGC death and axon loss. Administration of RSV rescued RGCs via decreased reactive oxygen species generation and acetyl-p53 expression in RGCs and upregulated BDNF in MGCs and TrkB expression in RGCs, which exhibited a strong cytoprotective action against cell death through multiple pathways under high IOP. Conclusions Our data suggest that administration of RSV may delay the progress of visual dysfunction during glaucoma and may therefore have therapeutic potential.

Posterior staphylomas involve a wider area than the area covered in 50 degree fundus photos. Wide-field fundus images can accommodate an entire extent of wide staphylomas. Although wide-field fundus images do not provide 3D information, the pigmentary alterations along the staphyloma edges may be a good indicator of staphylomas.

PurposeTo determine the connection between myopic choroidal neovascularisations (CNVs) and intrascleral vessels examined by swept-source optical coherence tomography (OCT).MethodsThe data of 124 eyes of 112 consecutive patients with myopic CNVs were retrospectively analysed. A myopic CNV was defined as a CNV occurring in eyes with pathologic myopia based on the META-PM study classification. The images obtained by swept-source OCT were analysed to determine the relationship between perforating scleral vessels and CNVs. The continuity of the scleral vessels and the CNV was also analysed. The OCT angiographic (OCTA) characteristics of the myopic CNVs at the active, scar and atrophic phases were also analysed.ResultsOCTA images showed that CNVs had blood flow in the active, scar and atrophic phases. Scleral perforating vessels were detected just below or around the CNV in 93 eyes (75%). In 10 of the 93 eyes, the scleral vessels and CNV appeared to be continuous through a defect of Bruch’s membrane in the OCT images. Indocyanine green angiography showed that these perforating vessels were intrascleral arteries originating from the short posterior ciliary arteries (SPCAs).ConclusionsSwept-source OCT showed that some of the myopic CNVs were continuous with scleral vessels mainly the SPCA. Further studies to confirm angiographical continuity between these two components are necessary.

Myopia is one of the most common visual disorders, and is characterized by a progressive axial elongation of the eye. Several methods have been tried to reduce the progression of axial elongation and myopia, but there are still no well-accepted procedures. We hypothesized that transplantation of fibroblasts on the sclera would lead to the synthesis of collagen fibrils on the sclera and reinforce it, and reduce the degree of axial elongation of eyes with form deprivation myopia. To examine this, we developed a form deprivation myopia model in albino Wistar rats and examined the effects of human fibroblasts (hFbs) transplantation on the sclera in the progression of myopia and axial elongation. We found that the form deprivation by eyelid suture induced a myopic shift and axial elongation associated with a thinner sclera and smaller-diameter collagen fibrils in Wistar rats. We also found that the transplanted hFbs synthesized type 1 collagen fibrils on the rat sclera, and these eyes with form deprivation had significantly reduced ocular elongation and myopic shift than the eyes without hFbs transplantation. Some of the synthesized collagen fibrils migrated into the sclera and had a bundle-like appearance and a stripe-like pattern, indicating they had mature characteristics. These findings suggest that the rat sclera was reinforced by the newly synthesized collagen fibrils and the axial elongation was reduced. These results can provide important information for the development of a therapy targeting myopia in humans. Copyright © 2017 John Wiley & Sons, Ltd.

To visualize the arterial circle of Zinn-Haller (ZHAC) in highly myopic patients by using OCT-A.Two hundred and fifty-three eyes of 146 consecutive patients with axial length ≥26.5 mm who underwent OCT-A centered onto the optic disk were studied.Arterial circle of Zinn-Haller was detectable on OCT-A images within the area of the parapapillary myopic conus in 26 (10%) of 253 eyes. The ZHAC was annular in 18 (69%) eyes, triangular in (15%) 4 eyes, and irregular (15%) in 4 eyes. The visibility of the ZHAC on OCT-A images was similar to the visibility on indocyanine green angiograms and significantly better than on conventional fundus photos. Optical coherence tomography angiography visualized details of the ZHAC including the entry of the short posterior ciliary arteries into the circle up to the branches in direction to the optic nerve and ZHAC-associated cilioretinal arteries. In three eyes, the ZHAC was composed of multiple rings.Noninvasive OCT-A allowed the visualization of ZHAC up to smaller vessel branches in 10% of highly myopic eyes. Because ZHAC is the main blood supply to lamina cribrosa of optic nerve, OCT-A-based assessment of ZHAC could become of interest in diseases such as glaucomatous optic neuropathy.

Purpose To report the findings determined by multimodal imaging in an eye with secondary vitreoretinal lymphoma (VRL) with optic neuritis and retinal vasculitis. Observation The case was a 71-year-old woman with a secondary VRL exhibiting optic neuritis and retinal vasculitis in her right eye. Color fundus photographs and fluorescein angiograms showed optic neuritis and vasculitis in the posterior pole of the right eye. Indocyanine green angiography showed dye staining of the retinal vein walls in the late phase. Fundus autofluorescence showed fuzzy hyper-autofluorescence surrounded by mottled hyper-and hypo-autofluorescence in the right eye. OCT showed a retina with uniform infiltration and a thickened retinal pigmented epithelium (RPE) layer, perforated RPE, small RPE detachments, and hyperrefrective or isorefrective masses on the degenerated RPE layer in the marginal area. Her left eye showed a degenerated RPE and oval shaped iso-reflective lesions on the RPE. Conclusion The findings indicate that it is important to examine the marginal areas of eyes clinically diagnosed with VRL accompanied by optic neuritis and retinal vasculitis by multimodal imaging because these images can show the inflammatory signs of typical VRL including the sub-RPE lesions.

To examine the progression pattern of myopic maculopathy.Retrospective, observational case series.Highly myopic patients who had been followed up for 10 years or more.Using fundus photographs, myopic features were differentiated according to Meta-analysis of Pathologic Myopia (META-PM) Study Group recommendations.Progression pattern of maculopathy.The study included 810 eyes of 432 patients (mean age, 42.3±16.8 years; mean axial length, 28.8±1.9 mm; mean follow-up, 18.7±7.1 years). The progression rate of myopic maculopathy was 47.0 per 1000 eye-years. Within the pathologic myopia (PM) group (n = 521 eyes), progression of myopic maculopathy was associated with female gender (odds ratio [OR], 2.21; P = 0.001), older age (OR, 1.03; P = 0.002), longer axial length (OR, 1.20; P = 0.007), greater axial elongation (OR, 1.45; P = 0.005), and development of parapapillary atrophy (PPA; OR, 3.14; P0.001). Diffuse atrophy, found in 217 eyes without choroidal neovascularization (CNV) or lacquer cracks (LCs) at baseline, progressed in 111 (51%) eyes, leading to macular diffuse atrophy (n = 64; 64/111 or 58%), patchy atrophy (n = 59; 53%), myopic CNV (n = 18; 16%), LCs (n = 9; 5%), and patchy-related macular atrophy (n = 3; 3%). Patchy atrophy, detected in 63 eyes without CNV or LCs at baseline, showed progression in 60 eyes (95%), leading to enlargement of original patchy atrophy (n = 59; 59/60 or 98%), new patchy atrophy (n = 29; 48%), CNV-related macular atrophy (n = 13; 22%), and patchy-related macular atrophy (n = 5; 8%). Of 66 eyes with LCs, 43 eyes (65%) showed progression with development of new patchy atrophy (n = 38; 38/43 or 88%) and new LCs (n = 7; 16%). Reduction in best-corrected visual acuity (BCVA) was associated mainly (all P0.001) with the development of CNV or CNV-related macular atrophy and enlargement of macular atrophy.The most frequent progression patterns were an extension of peripapillary diffuse atrophy to macular diffuse atrophy in diffuse atrophy, enlargement of the original atrophic lesion in patchy atrophy, and development of patchy atrophy in LCs. Main risk factors for progression were older age, longer axial length, and development of PPA.

Purpose To determine characteristics of peri-dome choroidal deepening (PDCD) surrounding dome-shaped maculas (DSMs) in highly myopic eyes. Design Observational case series. Methods Applying swept-source optical coherence tomography, we examined the posterior pole of highly myopic eyes with DSMs. Results The study included 91 highly myopic eyes (67 patients; mean age: 60.0 ± 15.1 years; mean axial length: 30.0 ± 7.4 mm) with a mean dome height of the DSM of 232 ± 132 μm. PDCDs were detected in 53 (58%) eyes. Subfoveal choroidal thickness was significantly thinner in eyes with vs without PDCDs (35 ± 29 μm vs 62 ± 48 μm; P = .016), while both groups did not vary significantly (all P ≥ .25) in age, axial length, and dome height. In contrast to peripapillary intrachoroidal cavitations (ICCs), PDCDs consisted of a widened choroid without large low-reflective suprachoroidal spaces. Unlike peripapillary ICCs or macular ICCs, PDCDs were not associated with caving of the overlying retina or backward bowing of the sclera. In the region of the PDCDs, the Bruch membrane (BM) was shorter than the inner scleral surface. Defects of the BM overlying the PDCDs were detected in 20 (38%) eyes. Conclusions PDCDs were common findings in highly myopic eyes with DSMs. PDCDs may be associated with a dome-induced inward push of the BM at the top of the DSM, leading to a compression of the subfoveal choroid and, owing to an increased strain of the BM on the dome's slopes, to a relative detachment of BM in the peri-dome region.

This study investigated the potential role of sirtuin 1 in Müller glial cells in choroidal neovascularization. In the in vitro study, primary Müller glial cells were cultured and treated with resveratrol, a sirtuin 1 activator. Glial fibrillary acidic protein expression and angiogenesis-related gene expression were examined using quantitative polymerase chain reaction and phagocytosis, as a marker of Müller glial cell function; in addition, a latex bead assay was used to analyze cell function. For the in vivo study, choroidal neovascularization was induced in C57BL/6 mice via laser photocoagulation, and resveratrol was administered intravitreally. Eyecup whole mounts were created to measure choroidal neovascularization volumes on day 7. Immunohistochemical analysis with anti-glial fibrillary acidic protein antibody was used to detect Müller glial cell activation in eyes with choroidal neovascularization on day 1, 3, 5, and 7 after laser surgery. Resveratrol significantly promoted glial fibrillary acidic protein, anti-angiogenic factor, pigment epithelium-derived factor, and thrombospondin-1 expression in the cells as well as the phagocytic activities. Treatment of the choroidal neovascularization model with resveratrol resulted in early activation of Müller glial cells near choroidal neovascularization sites. Resveratrol-activated cells but not the controls migrated to the top of choroidal neovascularization sites and into the lesions from day 3. Resveratrol reduced the choroidal neovascularization size relative to controls. In conclusion, sirtuin 1 activation in Müller glial cells suppressed the development of choroidal neovascularization, and therefore, might be a therapeutic option.

Rationale Proliferation of retinal pigment epithelium (RPE) is typically observed in limited ocular disorders, in connection with the local mechanism of RPE proliferation-mediated wound repair. Bilateral and diffuse type RPE proliferation is considered to be associated with paraneoplastic syndromes, such as a bilateral diffuse uveal melanocytic proliferation. However, other reported diseases that induce bilateral diffuse RPE proliferation are quite rare, especially for patients who are considered to have a non-malignant status. Patient concerns The bilateral eyes of a 47-year-old woman with bilateral ocular inflammation, presented united multiple small to medium white retinal lesions during the disease progress. Diagnoses Optical coherence tomography showed scattered serous retinal detachments, choroidal folds, choroidal thickening and diffuse RPE proliferation. As autofluorescence and angiography showed a "giraffe pattern", bilateral diffuse uveal melanocytic proliferation was suspected. However, systemic investigations identified no malignancy. In consideration of the above findings, choroidal inflammation was thought to be the major cause of this condition. Interventions The patient was administered intensive systemic steroids. Over the next 2 months, the amount of steroid was tapered off. Outcomes After administration, the bilateral diffuse RPE proliferation settled down. During the 2-year follow-up, there was no recurrence of ocular inflammation and diffuse RPE proliferation, or any other malignancy found. Lessons This finding demonstrates that bilateral diffuse RPE proliferation can be generated as a secondary phenomenon of choroidal inflammation in patients with a non-malignant status.

Myopia is one of the most common visual disorders, and is characterized by a progressive axial elongation of the eye. Several methods have been tried to reduce the progression of axial elongation and myopia, but there are still no well-accepted procedures. We hypothesized that transplantation of fibroblasts on the sclera would lead to the synthesis of collagen fibrils on the sclera and reinforce it, and reduce the degree of axial elongation of eyes with form deprivation myopia. To examine this, we developed a form deprivation myopia model in albino Wistar rats and examined the effects of human fibroblasts (hFbs) transplantation on the sclera in the progression of myopia and axial elongation. We found that the form deprivation by eyelid suture induced a myopic shift and axial elongation associated with a thinner sclera and smaller-diameter collagen fibrils in Wistar rats. We also found that the transplanted hFbs synthesized type 1 collagen fibrils on the rat sclera, and these eyes with form deprivation had significantly reduced ocular elongation and myopic shift than the eyes without hFbs transplantation. Some of the synthesized collagen fibrils migrated into the sclera and had a bundle-like appearance and a stripe-like pattern, indicating they had mature characteristics. These findings suggest that the rat sclera was reinforced by the newly synthesized collagen fibrils and the axial elongation was reduced. These results can provide important information for the development of a therapy targeting myopia in humans. Copyright © 2017 John WileySons, Ltd.

There have been no reports describing polypoidal choroidal vasculopathy (PCV) in eyes with retinitis pigmentosa (RP). A 63-year-old woman who had been diagnosed as having RP was referred to us because of sudden onset of blurred vision in her right eye. Funduscopic examination revealed retinal findings typical of RP in both eyes. The macular area of the right fundus showed polypoidal lesions with massive hemorrhages. Fluorescein angiography and indocyanine green angiography showed multiple polypoidal lesions. Optical coherence tomography showed a large hemorrhagic retinal pigment epithelial (RPE) detachment and polypoidal lesions. The PCV subsided after three applications of anti-vascular endothelial growth factor (VEGF) therapy and a single application of photodynamic therapy, but "mottled lesions" with hyper- and hypofluorescence appeared temporal to the macula after disappearance of hemorrhage. We present a case of PCV in an eye with RP. Further studies are necessary to clarify whether anti-VEGF therapies could affect RPE status in eyes with RP.

To evaluate the efficacy of prophylactic vitrectomy for acute retinal necrosis. The clinical charts of 17 patients (18 eyes) with acute retinal necrosis and no retinal break or rhegmatogenous retinal detachment (RRD) were retrospectively analyzed for the efficacy of prophylactic vitrectomy. The retinal necrotic lesions at the initial presentation were classified into three groups according to the lesion site as described by Holland: zone 1 (posterior pole; n = 3), zone 2 (midperiphery; n = 12), and zone 3 (periphery; n = 3). All patients were treated with intravenous antiviral therapy. Three zone 1 eyes and eight zone 2 eyes underwent prophylactic vitrectomy. Four zone 2 eyes and three zone 3 eyes did not receive prophylactic vitrectomy. All zone 1 eyes developed RRD despite prophylactic vitrectomy. Among the 12 zone 2 eyes, eight of the eyes that underwent prophylactic vitrectomy did not develop RRD, whereas three of the four zone 2 eyes without prophylactic vitrectomy developed RRD. All zone 3 eyes were cured with only antiviral medication. Prophylactic vitrectomy is effective in preventing the development of RRD in eyes where necrotic lesions do not extend beyond the midperiphery (zone 2).

Metastatic choroidal carcinomas are the most common intraocular neoplasms [1]; diagnosis is made by ophthalmoscopic, fluorescein angiographic (FA), and indocyanine green angiographic (IA) findings together with a history of cancer especially of the breasts and lungs. However, the general health of these patients is often poor, and it is difficult to perform these invasive examinations. Fundus autofluorescence (AF) is a noninvasive imaging technique that can detect lipofuscin in the retinal pigmented epithelial (RPE) cells [2]. A continuous AF pattern is an indication of normal metabolic activity of the RPE cells, and the loss of AF indicates that the photoreceptors or RPE cells are dysfunctional. Because FA and IA are generally not recommended in such ill patients, we questioned whether the AF pattern can be used to diagnose and follow the course of carcinomas after treatment. A Medline search did not extract any articles describing the AF findings in eyes with choroidal carcinomas. A retrospective review of patients with a choroidal carcinoma in our hospital extracted two patients who had undergone FA, IA, and AF. Thus, the purpose of this study was to determine the AF characteristics in these two eyes with a choroidal carcinoma.

Purpose To evaluate the fundus autofluorescence (FAF) patterns in the eyes with primary intraocular lymphomas (PIOLs). Methods A review of the medical charts of four consecutive patients (five eyes) with PIOL who had been studied by FAF. A fundus camera was used to obtain the FAF images. Optical coherence tomography was also performed. Results The ophthalmoscopically observed brown clumps on the surface of greasy yellowish masses beneath the retinal pigmented epithelium had a bright hyperfluorescence appearance by FAF. This FAF hyperfluorescence was completely reversed to hypofluorescence in the fluorescein angiograms. The diffuse infiltration of the cells making up the PIOL above the retinal pigmented epithelium was ophthalmoscopically observed as a retinal whitening and was hypofluorescent by FAF. These areas of hypofluorescence were also reversed to areas of hyperfluorescence in the fluorescein angiogram. Fundus autofluorescence clearly delineated the retinal pigmented epithelium atrophy, which developed after the spontaneous resolution of the PIOL as a hypoautofluorescent area. Conclusion Because FAF can reveal various findings of PIOLs, it can be used to differentiate the patients with PIOL from those with ocular inflammatory diseases. Although further studies are required to determine whether these findings are characteristic to PIOL, this noninvasive method can then lead to earlier diagnosis and treatment.

Purpose To determine the frequency and clinical characteristics of chorioretinal folds emanating from the edge of a staphyloma in highly myopic patients. Design Observational case series. Methods Eight hundred and eighty-three eyes of 463 patients with an axial length ≥26.5 mm in at least 1 eye were studied. The fellow eyes of patients with unilateral high myopia were also included. Wide-field fundus images and fundus autofluorescence images were used to detect chorioretinal folds emanating from the staphyloma edge. In 100 patients, the eye shape was analyzed by 3-dimensional magnetic resonance imaging (3D MRI). Results A posterior staphyloma was found in 459 of the 883 eyes (52.0%). Choroidal folds radiating from the staphyloma edge were found in 6 of the 459 eyes (1.3%) with a posterior staphyloma in wide-field autofluorescent images. The axial length varied greatly from 24.3 mm to 32.5 mm. Regardless of the axial length, all of the 6 eyes had a wide, macular type of staphyloma. Chorioretinal folds emanated from the upper or upper-temporal staphyloma edge. 3D MRI images showed the presence of a notch along the upper or temporal edge of the outpouching, and the eye curvature became flatter toward the steep edge of the outpouching. Conclusions Chorioretinal folds can emanate from the staphyloma edge in highly myopic patients even though the edge was away from the macula. Some directional force toward the steeper edge of the staphyloma might be related to the development of chorioretinal folds.