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The current study aimed to address whether ripasudil, a Rho-associated coiled-coil containing protein kinase (ROCK) inhibitor developed to treat glaucoma and ocular hypertension (OH), improves diabetic macular edema (DME) since it is known that ROCK upregulates vascular endothelial growth factor. We retrospectively investigated the foveal thickness (FT) measured by spectral-domain optical coherence tomography, visual acuity (VA), and intraocular pressure (IOP) in 12 eyes with DME that received ripasudil treatment for primary open-angle glaucoma or OH and compared them with 14 eyes that received no treatment. One month after ripasudil therapy, the mean FT decreased significantly from 439 ± 72 µm to 395 ± 62 µm (P = 0.003); this change was significantly different from that in the controls, in which the mean FT increased by 1 ± 39 µm (P = 0.01). Ripasudil also caused a significant decrease in IOP from 17.3 ± 5.2 mmHg to 14.6 ± 4.0 mmHg (P = 0.02); this change was significantly greater than that in the controls, in which IOP changed by 0.0 ± 1.6 mmHg (P

We report a case of Vogt–Koyanagi–Harada (VKH) disease that recurred with sensorineural hearing loss and choroidal thickening. We measured the choroidal thickness using enhanced-depth imaging optical coherence tomography (EDI-OCT) in a patient with VKH during corticosteroid-tapering therapy. A71-year-old male presented with fever, headache, and anorthopia associated with wavy choroidal folds and aserous retinal detachment (SRD). The EDI-OCT images showed choroidal thickening ([600 l m at the subfovea), and he was diagnosed with VKH disease. After treatment with pulsed intravenous methylprednisolone, the choroidal folds and SRD resolved and the choroidal thickness decreased. About 6 months after subsequent treatment with an oral corticosteroid started, headache, tinnitus, and sensorineural hearing loss developed, and increased choroidal thickness was observed without other evidence of increased ocular inflammation. A high-dose corticosteroid was injected and tapered, and the sensorineural hearing loss improved immediately and the choroidal thickness decreased. In the current case, sensorineural hearing loss occurred with recurrent VKH disease;however, there were no ocular inflammatory signs except for rebound choroidal thickening. Measuring the choroidal thickness using EDI-OCT can sensitively identify recurrent VKH disease.

To assess the short-term effect of intravitreal ranibizumab (IVR) on macular edema after branch retinal vein occlusion.Twenty-three eyes with macular edema after branch retinal vein occlusion were enrolled in a prospective observational study. After administering one IVR injection (0.5 mg) for the first time, the authors measured the foveal thickness (FT) before and 2 hours, 1 and 3 days, 1 week, and 1 month later and the best-corrected visual acuity at all times except 2 hours, and determined the changes from baseline (ΔFT and ΔVA).The mean FT decreased significantly (P0.0001) from 522 ± 131 μm to 458 ± 96 μm after 2 hours. The mean logarithm of the minimum angle of resolution (logMAR) visual acuity improved significantly (P0.05) after 1 day from 0.69 ± 0.40 to 0.55 ± 0.34 (20/98-20/70, Snellen equivalent). The ΔFT after 2 hours was significantly positively correlated with the ΔFT after 1 week (r = 0.76, P0.001) and 1 month (r = 0.67, P0.001). The ΔVA after 1 day was correlated positively with the ΔVA after 1 week (r = 0.80, P0.001) and 1 month (r = 0.59, P0.01).Structural and functional effects of IVR for branch retinal vein occlusion occurred within 1 day. The short-term effects of IVR may predict the outcome of the therapy at 1 week and 1 month after IVR in macular edema secondary to branch retinal vein occlusion.

Purpose To investigate the association between patterns of eye drop prescription and medication usage in patients with glaucoma. Patients and methods Sixty-seven Japanese patients with glaucoma who were prescribed topical antiglaucoma medications including a prostaglandin analogue bilaterally for >6 months at Nayoro City General Hospital, Nayoro, Japan, were included in the study. A self-administered, 5-item patient questionnaire was administered to determine how patients routinely use medications, including the method of eye drop administration, number of eye drops per instillation, accuracy of eye drop placement, weekly frequency of eye drop application, and their awareness of local side effects. The number of prostaglandin analogue bottles prescribed monthly was compared in each factor. Results The mean patient age was 74.4±10.0 years (range, 52 to 95 y; 39 women, 28 men). The mean duration of glaucoma treatment was 4.2±3.2 years (range, 0.7 to 10.6 y). Patients who placed the eye drops outside the eye were prescribed significantly more bottles monthly (P=0.008). The other factors had no significant effect on the number of bottles prescribed monthly. Conclusions Patients with glaucoma who used eye drops incorrectly were routinely prescribed additional bottles of eye drops. Ophthalmologists should determine whether patients who request an unusual number of eye drops are using the eye drops correctly.

PURPOSE. We evaluated the effect of hemodialysis on the choroidal thickness in patients with and without diabetes who have end-stage kidney disease (ESKD). METHODS. Forty-one patients with ESKD were recruited and divided into two groups: those with ESKD due to diabetic nephropathy (DM group, 37 eyes of 20 patients) and those with nondiabetic ESKD (NDM group, 40 eyes of 21 patients). Using spectral-domain optical coherence tomography (SD-OCT), the subfoveal choroidal thickness (SCT) was measured before and after hemodialysis, and the change ratio (DSCT [%]) was calculated. RESULTS. The SCT decreased in all eyes after hemodialysis. The DSCT value in the DM group (� 12.6 6 2.7%) was significantly (P ¼ 0.00027) larger than that in the NDM group (� 6.9 6 2.3%). Moreover, the DSCT per body fluid removal (BFR [L]) in the DM group was significantly (P ¼ 0.013) greater than in the NDM group. In the DM group, the mean DSCT in the eyes treated with panretinal photocoagulation (PRP; n ¼ 19) was significantly (P ¼ 0.035) larger than that in eyes not treated with PRP (n ¼ 18). The relationship between the DSCT and BFR was not significant (R 2 ¼ 0.0038, P ¼ 0.80) in the DM group but was significant (R 2 ¼ 0.54, P ¼ 0.00013) in the NDM group. CONCLUSIONS. The current results may reflect that systemic fluid accumulation has a greater effect on the diabetic choroid, probably due to damage to the choroidal vasculature, in patients with ESKD.