Evaluation of the relationship between quality of vision and visual function in Japanese glaucoma patients

Hideko Sawada, Takeo Fukuchi, Haruki AbeDepartment of Ophthalmology, Niigata University Medical and Dental Hospital, Niigata, JapanPurpose: To evaluate the correlation between quality of vision (QOV) and visual function in glaucoma patients.Patients and methods: The relationship between QOV and visual function was investigated in 200 Japanese glaucoma patients. QOV was assessed using the Japanese version of the 25-item National Eye Institute Visual Function Questionnaire. The better eye and the worse eye were defined based on the mean deviation (MD) value of the Humphrey Field Analyzer program 30-2. A single linear regression analysis was applied to assess the relationship.Results: The lowest subscale score was observed in general health followed by general vision and driving. Visual acuity and the central 10° MD value in the better eye and the central 30° MD value in the worse eye were highly correlated with QOV. Threshold MD values at which patients began to have lower QOV ranged from —2 to —12 dB in the better eye and from —7 to —16 dB in the worse eye.Conclusion: Loss of visual function in both the better and the worse eye is significantly correlated to QOV. QOV of glaucoma patients begins to decrease in the early stages of visual field defects.Keywords: glaucoma, 25-item National Eye Institute Visual Function Questionnaire, visual field, visual acuity, quality of visio

Fibrin membrane pupillary-block glaucoma after uneventful cataract surgery treated with intracameral tissue plasminogen activator: a case report

<p>Abstract</p> <p>Background</p> <p>Fibrin pupillary-block glaucoma is a rare complication after cataract surgery. The treatment for this condition is still controversial, since Nd:YAG laser fibrin membranotomy tends to reocclude and laser peripheral iridotomy entails the risk of damaging the corneal endothelium in the presence of corneal edema associated with elevated intraocular pressure.</p> <p>Case presentation</p> <p>A 62-year-old man with diabetes mellitus developed acute elevation of intraocular pressure with a shallow anterior chamber five days after uneventful cataract surgery. Initially, slit lamp examination provided only limited information due to severe corneal edema. After resolution of corneal edema with systemic glaucoma therapy, a complete fibrin membrane was observed across the pupil by slit lamp examination. Anterior segment optic coherence tomography clearly revealed a thin fibrin membrane covering the entire pupillary space, a shallow anterior chamber, and a deep posterior chamber. The intraocular lens was not observed by anterior segment optic coherence tomography. In contrast, ultrasound biomicroscopy, which has superior penetration depth, was able to visualize the intraocular lens deep in the posterior chamber. Injection of tissue plasminogen activator into the anterior chamber resulted in complete fibrinolysis and released the pupillary block.</p> <p>Conclusion</p> <p>This case suggests that ocular anterior segment imaging modalities, especially ultrasound biomicroscopy, serve as powerful diagnostic tools to identify mechanisms of acute angle closure glaucoma, which is often accompanied by poor intraocular visibility. This is the first reported case of fibrin pupillary-block glaucoma after cataract surgery successfully treated with intracameral tissue plasminogen activator.</p

COMBINATION THERAPY OF INTRAVITREAL RANIBIZUMAB AND SUBTHRESHOLD MICROPULSE PHOTOCOAGULATION FOR MACULAR EDEMA SECONDARY TO BRANCH RETINAL VEIN OCCLUSION

Purpose: To determine the efficacy of the combination therapy of intravitreal ranibizumab (IVR) and 577-nm yellow laser subthreshold micropulse laser photocoagulation (SMLP) for macular edema secondary to branch retinal vein occlusion cystoid macular edema.Methods: Retrospective, consecutive, case–control study. Forty-six eyes of 46 patients with treatment-naive branch retinal vein occlusion cystoid macular edema were enrolled. The IVR + SMLP group consisted of 22 patients who had undergone both SMLP and IVR. Intravitreal ranibizumab group consisted of 24 patients who had undergone IVR monotherapy. Intravitreal ranibizumab therapy was one initial injection and on a pro re nata in both groups, and SMLP was performed at 1 month after IVR in the IVR + SMLP group. Preoperatively and monthly, best-corrected visual acuity and central retinal thickness were evaluated using swept source optical coherence tomography.Results: Best-corrected visual acuity and central retinal thickness significantly improved at 6 months in IVR + SMLP and IVR groups. Best-corrected visual acuity and central retinal thickness were not significantly different between the two groups at any time points. The number of IVR injections during initial 6 months in IVR group (2.3 ± 0.9) was significantly greater (P = 0.034) than that in IVR + SMLP group (1.9 ± 0.8).Conclusion: The combination therapy of IVR and SMLP can treat branch retinal vein occlusion cystoid macular edema effectively, by decreasing the frequency of IVR injections while maintaining good visual acuity

BDNF is upregulated by postnatal development and visual experience: quantitative and immunohistochemical analyses

PURPOSE. This study sought to elucidate changes in the levels and distribution of brain-derived neurotrophic factor (BDNF) in the retina throughout aging and depending on visual experience. METHODS. Protein and mRNA levels of BDNF were quantified by enzyme-linked immunosorbent assay (ELISA) and semiquantitative reverse transcription-polymerase chain reaction (RT-PCR), respectively. Levels were assayed in the retinas of rats on postnatal day (P)2, P7, and P14 (approximate time of eye opening) and at 1 month (M), 3M, 8M, and 18M of age. Changes in BDNF expression and localization in the retina were assessed by immunohistochemistry. The effect of monocular deprivation during infancy on retinal BDNF expression was also examined, by ELISA and immunohistochemistry. RESULTS. Both protein and mRNA levels of BDNF in the rat retina increased after P14. Immunohistochemical analyses revealed that the increase in BDNF protein levels occurred in retinal ganglion cells (RGCs) between P14 and 1M. BDNF immunoreactivity in Müller cell processes was observed in the inner nuclear layer at 1M, but not at P14. The levels of BDNF protein in the retinas of visually deprived eyes were lower than those of control eyes, as quantified by ELISA. Immunohistochemistry showed that BDNF immunoreactivity in RGCs was diminished by visual deprivation, whereas Müller cells were unaffected. CONCLUSIONS. These observations indicate that BDNF expression in RGCs is upregulated in an activity-dependent manner, whereas that in Müller cells is regulated only by development. (Invest Ophthalmol Vis Sci. 2003;44:3211-3218) DOI: 10.1167/iovs.02-1089 T he neurotrophin family of ligands contains nerve growth factor, brain-derived neurotrophic factor (BDNF), neurotrophin-3, and neurotrophin-4/5. Neurotrophins and their cognate receptors, TrkA, TrkB, and TrkC, are expressed primarily in neurons to mediate pleiotropic effects, promoting the differentiation, maturation, and survival of neurons in both the peripheral and central nervous systems. 1 Accumulating evidence also suggests that neurotrophins affect synaptic functions. 9 Immunocytochemistry of retinal cell culture revealed that BDNF protein was found primarily in RGCs. 16 The high-affinity BDNF receptor TrkB is also present within the retina. 17,18 TrkB mRNA 10 and protein 11 are detectable in the GCL, inner plexiform layer (IPL), and INL. As neurotrophins and their receptors colocalize in the retina, neurotrophins likely act on retinal neurons in an autocrine and/or paracrine manner. 12 It is thought that the expression of BDNF, but not other neurotrophins, is regulated by neural activity. MATERIALS AND METHODS Animals All experimental procedures using animals were performed in accordance with the ARVO Statement for the Use of Animals in Ophthalmic and Vision Research and the institutional guidelines for care and use of laboratory animals. Male Wistar rats (Japan SLC, Hamamatsu, Japan) were housed in standard lighting conditions (12-hour light-dark cycle) for at least 7 days before experimentation. To examine age-related changes in BDNF protein and mRNA levels in the retina, animals were anesthetized by chloral hydrate and killed by decapitation on postnatal From th

Restoration of the Ellipsoid Zone and Visual Prognosis at 1 Year after Surgical Macular Hole Closure

Purpose. To evaluate the restoration of the ellipsoid zone (EZ) and its influence on visual prognosis 1 year after surgical macular hole (MH) closure. Method. Subjects were patients with stage 2, 3, or 4 idiopathic MH who underwent primary vitrectomy that resulted in successful hole closure. Nineteen eyes with both EZ disruption with foveal detachment and a continuous external limiting membrane on optical coherence tomography during the early postoperative period were included in this study. Result. EZ disruption was restored in 10 eyes (53%, Group A) and remained in 9 eyes (47%, Group B) at 1 year after surgery. In Group B, the diameter of the residual EZ disruption was 54.7±33.1 μm. LogMAR visual acuity (VA) 1 year after surgery was significantly better than preoperative VA in each group (Group A: -0.007±0.102; P<0.001; Group B: 0.051±0.148; P<0.001), but there was no significant difference between the 2 groups (P=0.332). There was no significant correlation between logMAR VA and EZ disruption diameter at 1 year after surgery. Conclusion. EZ was restored in 53% of eyes at 1 year after surgical closure of idiopathic MH. Mean residual EZ disruption diameter was 54.7±33.1 μm. Neither resolved nor residual EZ disruption influenced postoperative VA

The effect of concentric constriction of the visual field to 10 and 15 degrees on simulated motor vehicle accidents

金沢大学附属病院眼科Purpose: Traffic accidents are associated with the visual function of drivers, as well as many other factors. Driving simulator systems have the advantage of controlling for traffic- and automobile-related conditions, and using pinhole glasses can control the degree of concentric concentration of the visual field. We evaluated the effect of concentric constriction of the visual field on automobile driving, using driving simulator tests. Methods: Subjects meeting criteria for normal eyesight were included in the study. Pinhole glasses with variable aperture sizes were adjusted to mimic the conditions of concentric visual field constrictions of 10° and 15°, using a CLOCK CHART®. The test contained 8 scenarios (2 oncoming right-turning cars and 6 jump-out events from the side). Results: Eighty-eight subjects were included in the study; 37(mean age = 52.9±15.8 years) subjects were assigned to the 15° group, and 51 (mean = 48.6±15.5 years) were assigned to the 10° group. For all 8 scenarios, the number of accidents was significantly higher among pinhole wearing subjects. The average number of all types of accidents per person was significantly higher in the pinhole 10° group (4.59±1.81) than the pinhole 15° group (3.68±1.49) (P = 0.032). The number of accidents associated with jump-out scenarios, in which a vehicle approaches from the side on a straight road with a good view, was significantly higher in the pinhole 10° group than in the pinhole 15° group. Conclusions: Concentric constriction of the visual field was associated with increased number of traffic accidents. The simulation findings indicated that a visual field of 10° to 15° may be important for avoiding collisions in places where there is a straight road with a good view. © 2018 Udagawa et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited