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To assess preretinal abnormal tissue (PAT) using en face OCT in eyes with idiopathic macular holes (MHs).Retrospective, observational study.Patients with MH who received 6 × 6-mm spectral-domain-OCT scans.Preretinal abnormal tissue was detected by en face OCT images with a custom slab, defined with an anterior boundary of 6 μm anterior to the internal limiting membrane (ILM) and a posterior boundary at 3 μm posterior to the ILM. The PAT was defined as any abnormal tissues observed in en face OCT.Characteristics of preoperative and postoperative PAT.Sixty eyes with MH from 60 patients were included. Fifty-one eyes underwent preoperative analysis, and 46 eyes underwent postoperative examination. Before surgery, 48 (94%) eyes had a mean (standard deviation [SD]) PAT of 6.6 (9.8) mmEn face OCT revealed PAT in most eyes with MHs. Peri-MH PAT was associated with worse VA and was seen more frequently in male patients. Postoperative PAT proliferation may be triggered by ILM peeling, but it is not associated with worse VA.

To investigate the risk factors, onset timing, and progression of epiretinal membrane (ERM) after pars plana vitrectomy (PPV) for rhegmatogenous retinal detachment (RRD).Retrospective, comparative case series.The study included 322 eyes of 322 patients who underwent primary PPV for RRD from January 2014 through December 2016.Patients underwent OCT before and 1, 3, 6, and 12 months after surgery. Patients showing hyperreflective lines above the inner retinal surface and deformation of the foveal pit were defined as ERM cases. Those with loss of the foveal pit were defined as advanced ERM cases. A multivariate logistic regression model was used to evaluate the risk factors of postoperative ERM. The onset timing of ERM and progression to advanced ERM after PPV for RRD were also investigated based on the OCT findings.Risk factors, onset timing, and progression of ERM after PPV for RRD.In the multivariate analysis, the incidence of postoperative ERM was significantly higher in eyes with preoperative vitreous hemorrhage (VH; P = 0.011) and without internal limiting membrane (ILM) peeling (P0.001). Among the patients who underwent ILM peeling, none demonstrated postoperative ERM. Postoperative ERM was observed in 39 of the 322 eyes (12.1%) within 1 year after surgery; in 30 of these eyes (76.9%), ERM occurred within 3 months after surgery. Advanced ERM was observed in 12 eyes (12/39 eyes [30.8%]). Among these, 9 eyes (9/12 eyes [75%]) showed progression within 3 months after surgery.Preoperative VH can increase the occurrence of postoperative ERM. In most patients with ERM, the occurrence and progression were detected relatively early after surgery; therefore, in high-risk patients, careful follow-up is encouraged until 3 months after surgery.

Aims/Introduction Diabetic polyneuropathy (DPN) and diabetic retinopathy (DR) are traditionally regarded as microvascular complications. However, these complications may share similar neurodegenerative pathologies. Here we evaluate the correlations in the severity of DPN and changes in the thickness of neuroretinal layers to elucidate whether these complications exist at similar stages of progression. Materials and Methods A total of 43 patients with type 2 diabetes underwent a nerve conduction study (NCS), a macular optical coherence tomography, and a carotid artery ultrasound scan. Diabetic polyneuropathy was classified according to Baba’s classification using NCS. The retina was automatically segmented into four layers; ganglion cell complex (GCC), inner nuclear layer/outer plexiform layer (INL/OPL), outer nuclear layer/photoreceptor inner and outer segments, and retinal pigment epithelium (RPE). The thickness of each retinal layer was separately analyzed for the fovea and the parafovea. Results Fourteen patients were classified as having moderate to severe diabetic polyneuropathy. The thicknesses of the foveal and parafoveal INL/OPL increased in patients with diabetic polyneuropathy compared with patients without. The thickness of the parafoveal retinal pigment epithelium decreased in patients with diabetic polyneuropathy. The thinning of parafoveal ganglion cell complex and foveal and parafoveal retinal pigment epithelium were positively correlated with deterioration of nerve functions in the nerve conduction study, but the thickening of INL/OPL was positively correlated with the nerve function deterioration. The thinning of parafoveal ganglion cell complex and foveal retinal pigment epithelium were positively correlated with the thickening of the carotid intima‐media. Conclusions Depending on the progression of diabetic polyneuropathy, the ganglion cell complex and retinal pigment epithelium became thinner and the INL/OPL became thicker. These retinal changes might be noteworthy for pathological investigations and for the assessment of diabetic polyneuropathy and diabetic retinopathy., (1) The thickness of the foveal and parafoveal inner nuclear layer/outer plexiform layer increased in patients with clinical diabetic polyneuropathy compared with patients without clinical diabetic polyneuropathy. (2) A decrease in the thickness of the parafoveal ganglion cell complex correlated with deterioration of nerve functions in the nerve conduction study. (3) A decrease in the thickness of the parafoveal ganglion cell complex was positively correlated with an increase in the parameters of atherosclerosis and cardiovascular risk factors.

To evaluate the capability of anterior segment Scheimpflug imaging for detecting primary angle closure disease (PACD): primary angle closure suspect, primary angle closure, and primary angle closure glaucoma, using cutoff points derived from reference databases of healthy subjects. Eighty-seven patients with PACD and 49 age-matched control subjects were included. We evaluated the sensitivity and specificity of anterior chamber depth (ACD), anterior chamber volume (ACV), and anterior chamber angle (ACA) to differentiate patients with PACD from controls. Additionally, the study’s raw data was analyzed via receiver operating characteristic curves for comparison. One standard deviation from the normative data’s mean values was used as the cutoff point and yielded a sensitivity and specificity of 96.2% and 92.6% for ACD, 97.1% and 75.9% for ACV, and 93.3% and 72.2% for ACA, respectively. Receiver operating characteristic analysis of the raw data showed the area under the curve to be 0.984, 0.975, and 0.931 for ACD, ACV, and ACA, respectively. Our study demonstrated that the parameters of anterior segment Scheimpflug imaging, particularly ACD, accurately discriminate PACD. This was the first study to validate the device’s normative data in a separate population. With its high reproducibility, ease of use, non-invasiveness, and speed, anterior segment Scheimpflug imaging is a potentially powerful screening tool for PACD.

A 13-year-old Japanese female diagnosed with spondyloepiphyseal dysplasia congenita (SEDC) was referred for ophthalmologic evaluation. Examination with slit-lamp and optical coherence tomography revealed bilateral thin cornea with diffuse corneal opacity which was localised at the posterior stromal depth in the central cornea. Unlike the two previously reported cases of diffuse and nodular patterns of corneal opacity in SEDC, the current case exhibited a rare form of corneal opacity. SEDC is one of the type II collagenopathies, characterised by dwarfism because the mutations in COL2A1 prevent bone growth. Although the existence of type II collagen has not been reported in the human corneal stroma, the aetiology of the opacity in the corneal stroma in SEDC type II collagenopathy is of interest.

Purpose To evaluate changes in the foveal avascular zone (FAZ) area during the postoperative period of macular hole (MH) surgery using the optical coherence tomography angiography (OCTA) and to investigate its relationship to visual acuity (VA). Methods Consecutive unilateral MH patients who underwent successful MH closure with at least a six-month observation period were studied retrospectively. To evaluate the FAZ area, OCTA images were obtained at the preoperative visit, the first postoperative visit, and the six-month visit. Main outcome measures were postoperative FAZ change and its relationship to VA change after MH closure. Results Fifty-one cases were studied. The FAZ area was 0.42 ± 0.11 mm2 at the preoperative visit, 0.25 ± 0.091 mm2 at the first postoperative visit and 0.31 ± 0.11 mm2 at the six-month visit. FAZ area at the first postoperative visit was significantly smaller (P < 0.0001) than at the preoperative visit. FAZ area at the six-month visit was significantly greater (P < 0.0001) than at the first postoperative visit, but still significantly smaller (P = 0.0002) compared to the normal fellow eye. The postoperative FAZ area enlargement from the first postoperative visit to the six-month visit was significantly correlated with the postoperative VA recovery (P = 0.0322) and the postoperative photoreceptor reconstruction (P = 0.0213). Conclusions The FAZ area once decreases along with MH closure; it thereafter increases toward the normal value over time. The postoperative FAZ change was correlated with the VA recovery. Translational Relevance This study suggests that the postoperative FAZ area enlargement might be a potential biomarker indicating foveal reconstruction after MH closure.

Purpose To report a case with solitary circumscribed neuroma (SCN) in the palpebral conjunctiva. Methods This is a retrospective observational case report of a 78-year-old female who showed a yellowish, smooth-surface, dome-shaped mass in the right lower palpebral conjunctiva near the punctum. The mass was completely removed under local anesthesia. Results Pathological examination revealed that it was composed of benign spindle-shaped cells and tapering nuclei arranged in bundles. Immunocytochemical analyses for the S100, neurofilament, CD34, and epithelial membrane antigens were all positive. These pathological findings were consistent with a SCN. At the 6-month follow-up, there was no evidence of recurrence. Conclusion This is the first case report of SCN in the palpebral conjunctiva. Although SCN had similar clinicopathological features to other benign peripheral nerve sheath tumors, including neurofibroma and schwannoma, immunocytochemical analyses were helpful for correct diagnosis of this case.

Orbital floor fractures commonly occur just medial to the junction of the infraorbital nerve and the inferior orbital fissure because the bone is thinner posteromedial to the infraorbital nerve than that lateral to the nerve. The authors previously reported 2 pediatric patients with an isolated orbital floor fracture lateral to the infraorbital nerve. The authors showed that, on the unaffected side of these patients, the lateral portion of the orbital floor was thinner than the medial portion. In the present study of 5 adult patients with an isolated orbital floor fracture lateral to the infraorbital nerve, the authors compared the thickness of the medial and lateral portions of the orbital floor with that of the infraorbital nerve on the unaffected side. Computed tomographic images showed that the bone lateral to the infraorbital nerve was somewhat thinner than bone in the medial portion. Because the orbital structures are generally symmetrical, our findings suggest that these 5 patients had partial anatomical weakness in the lateral portion of the infraorbital nerve on the affected side, resulting in an isolated orbital floor fracture lateral to the infraorbital nerve.

Purpose To evaluate correlations between persistent macular edema associated with branch retinal vein occlusion (BRVO) and the macular perfusion status in the superficial capillary plexus (SCP) and deep capillary plexus (DCP) using optical coherence tomography angiography (OCTA). Methods Retrospective, case-control study. Twenty patients with BRVO followed for 12 months or more were enrolled. Persistent macular edema was defined as central retinal thickness exceeding 300 μm that persisted or recurred less than 3 months after the final treatment. We compared two groups (i.e., seven eyes with persistent macular edema and 13 eyes without macular edema). The macular perfusion status was evaluated using OCTA. We defined a gap vessel as a residual vessel in the SCP that existed simultaneously with capillary loss in the DCP. The gap vessels were determined by subtracting the vessel images of the DCP from the images of the SCP using an image processing technique. Results In eyes with persistent macular edema, the area with gap vessels was significantly (P = 0.0013) larger than in eyes without macular edema (14.34% vs. 8.02%). Other factors evaluated (i.e., the area of the foveal avascular zone, superficial vessel density, and deep vessel density) did not differ significantly (P = 0.66, P = 0.23, P = 0.34, respectively) between the groups. Conclusions The difference in capillary loss between the SCP and DCP can facilitate development of persistent macular edema in BRVO.

Continuous ambulatory peritoneal dialysis (CAPD) is now accepted world widely as effective dialytic method for chronic renal failure.In this review, the procedure, characteristics of solutes and fluid removal, complications and management are introduced. Some aspects of metabolic consequences such as glucose, potein and lipid metabolism, calcium, phosphorus, parathyroid hormone, vitamin D and dialytic bone disease are discussed.Additionaly, the clinical experience of CAPD in Japan are discribed.In Japan, dialytic system is promptly operated, however, the rehabilitation status is far from satisfaction, because of lower population of kidney transplantation than that of other countries. In this situation, CAPD migt be substitutable for kidney transplantation as anoher advantageous dialytic method for achieving good rehabilitation.

糖尿病由来の慢性血液透析患者は近年, 増加しているが, blood access troubleのために本治療の実施が困難となる症例も少なくない. そこで, 当院で慢性血液透析中の腎不全患者30例 (糖尿病群15例, 非糖尿病群15例) を対象にtroubleの頻度, 種類, 治療内容および病因解明の糸口として血液粘度, 血小板機能およびblood accessにおける循環動態の変化を検討し, 以下のごとき結果を得た.1) 糖尿病群での血栓性の血管閉塞の頻度は著しく高く, 19.4 patient monthに1回の再建手術を必要としたが, 非糖尿病群では113.5 patient monthに1回の頻度であった. 2) 血液粘度, 血小板機能は両群間に有意差は認められなかった. 3) 糖尿病群でのblood access部の循環動態の変化は著しく, 特に坐位では透析後のシャント血流量が著明に減衰するのが認められた.このblood access部での循環動態の変化が糖尿病群における高頻度のblood access troubleの主因と思われた.

先天性肝線維症,髄質嚢胞腎に痛風関節炎を合併した剖検例を経験したので報告する.症例は26才,男性で右母趾基関節痛の精査のため入院し腎不全,痛風と診断し,画像診断では肝線維症が示唆された.しかしHBs抗原陽性である以外肝機能障害は認めなかった.経過中肝機能障害が出現,激症肝炎の像を呈し肝不全にて死亡した.剖検で肝は先天性肝線維症に激症肝炎が加わった所見であり,腎は髄質嚢胞腎に尿酸塩の沈着による二次的な障害の加わった所見であった.本例のごとく先天性肝線維症に合併した髄質嚢胞腎に尿酸塩沈着を認めたとの報告はなく貴重な症例と考え報告した.

Background This is the third reported case of a steatocystoma simplex in the lacrimal caruncle. Case presentation A 60-year-old male presented with a history of a slowly progressing mass in the right lacrimal caruncle since several years before his initial visit. At the first examination, a yellowish, relatively smooth surface mass was observed in the right lacrimal caruncle. The caruncular mass was completely removed under local anesthesia. The pathological findings of this mass were consistent with a steatocystoma. At the 6-month follow-up, there was no sign of recurrence or development of the steatocystoma or any other masses. Conclusion Although steatocystoma simplex rarely occurs in the lacrimal caruncle, it needs to be considered as a possible diagnosis for patients with a mass lesion in the caruncle.