Cystoid Macular Edema Associated with Oral Antineoplastic Agent S-1 in a Patient with Diabetic Retinopathy

A 60-year-old man with neovascular glaucoma due to diabetic retinopathy received an intravitreal injection of 1.25 mg bevacizumab (IVB) followed by extensive panretinal photocoagulation in the right eye. The anterior segment neovascularization regressed within 10 days after IVB. One and a half months later, the patient underwent gastrectomy for stage IIIb gastric cancer. Two months later, he was started on S-1 orally (100 mg/day for 48, 26, and 32 consecutive days in the first, second, and third treatment cycle, respectively). The interval between the first and second treatment cycle was 20 days and between the second and third cycle it was 24 days. The patient developed anemia and diarrhea. At the end of the second S-1 cycle, cystoid macular edema developed in the right eye, although diabetic retinopathy and neovascular glaucoma were stable. Macular edema persisted for 5 months despite another IVB, and disappeared 3 months after termination of S-1 therapy. The time course of the magnitude of macular edema correlated well with the severity of anemia. The macular edema was possibly associated with anemia, which is a major side effect of S-1. Further studies are warranted to investigate the relationship between anemia and macular edema in patients with diabetic retinopathy

メラトニンの網膜における神経保護作用の検討

金沢大学附属病院1.ラット網膜内メラトニン含量の測定ラット網膜のメラトニン含量をHPLCおよび電気化学検出器(東ソー,EC-8020)を用いて測定した。Eicompak MA-5ODSカラムを使用して25%メタノール,25℃の条件で標準物質を流し,100pgまでメラトニンを検出することができた。ブラウンノルウエーラットを用いて網膜内メラトニン含量が最大となる暗期間の中間時点(午前2時)において暗赤色光下で網膜を摘出しメラトニン含量の測定を行ったが,検出限界以下であった。5mg/kgのメラトニンの腹腔内投与20分後の網膜内メラトニン含量は約15ng/mg proteinであった。2.メラトニン合成酵素(serotonin-N-acetyltransferase,NAT)のmRNA量の測定ラットのNATcDNA塩基配列から1対のプライマーを設定し(5\u27-ATCTCAGTCTCGGGTACCTG-3\u27および3\u27TGTCACCGACGACTGGGTTC-5\u27),ラット網膜から抽出したpolyA-RNAを鋳型としてRT-PCRを行った。目的の462塩基対のDNA断片が増幅され,RT-PCR産物の直接DNAシークエンスを行いNATcDNAに一致することが確認された。3.ラット網膜光障害モデルの作成とメラトニン腹腔内投与の神経保護効果ケタラールおよびセラクタールによる全身麻酔下でラットの片眼に光ファイバーにより30分間光照射(角膜面照度20,000lx以上)を行った。1週間後,眼底中央に円形の網膜変性巣が観察され,網膜電図のa,b波の減弱傾向がみられた。光照射10分前に5mg/kgのメラトニンの腹腔内投与を行った場合,網膜変性は明らかに抑制された。研究課題/領域番号:10770923, 研究期間(年度):1998 – 1999出典：「メラトニンの網膜における神経保護作用の検討」研究成果報告書　課題番号10770923（KAKEN：科学研究費助成事業データベース（国立情報学研究所））（https://kaken.nii.ac.jp/ja/grant/KAKENHI-PROJECT-10770923/)を加工して作

網膜神経節細胞特異的な免疫毒素を用いた新しい緑内障モデルの確立

金沢大学附属病院免疫毒素硝子体内注入モデルの作成アポトーシスによる細胞死を来たすリボゾーム不活性化タンパクであるSaporinと網膜神経節細胞(GC)に特異的なThy-1,に対する抗体を結合した免疫毒素(OX7-SAP)5μgをBrown Norwayラットの片眼の硝子体内に投与した。対照として抗ヒトIgG抗体10μg、抗Thy-1抗体2.5μgおよびSaporinを硝子体内投与した。1)硝子体内投与7日後に眼球摘出し、4%パラフォルムアルデヒドで固定し、網膜の凍結切片を作成した。OX7-SAP、抗ヒトIgG抗体、抗Thy-1抗体を投与した眼には、著明な網膜障害はみられなかったが、Saporin 5μgあるいは0.5μgを投与した眼には、特に視細胞に著明な変性がみられた。Saporinが視細胞に取り込まれる際の結合タンパクの同定を試みたが困難であった。2)抗Thy-1抗体とFITC標識による免疫染色において、OX7-SAP投与眼においてのみ網膜神経節細胞層(NFL)の蛍光の減弱がみられた。3)硝子体内投与1ヶ月後、走査レーザー検眼鏡(SLO)にて投与眼のNFLの反射の減弱がみられた。1)、2)、3)からOX7-SAPのラット硝子体内投与によって、GC選択的な網膜障害モデルを作成できる可能性が示された。他のGC障害モデルとの比較慢性高眼圧モデルは、トノペンなど種々の方法を試したが、眼圧測定の信頼性が低かったため評価できなかった。網膜虚血再灌流モデルでは、1週後にSLOにてびまん性で顕著なNFLの脱落がみられた。視神経挫滅モデルでは、1週後にはSLOにて明らかなNFLの変化はみられなかったが、2週目以降進行性でびまん性のNFLの脱落がみられた。今後、SLOなどを用いて免疫毒素硝子体内注入モデルと他のGC障害モデルでのNFLやGCの障害過程やそれに対する神経保護の可能性を明らかにしていく予定である。研究課題/領域番号:14770945, 研究期間(年度):2002-2003出典：「網膜神経節細胞特異的な免疫毒素を用いた新しい緑内障モデルの確立」研究成果報告書　課題番号14770945（KAKEN：科学研究費助成事業データベース（国立情報学研究所））（https://kaken.nii.ac.jp/ja/grant/KAKENHI-PROJECT-14770945/)を加工して作

神経保護評価に向けた網膜神経節細胞の細胞体と軸索の生体内定量的観察法の確立

走査レーザー検眼鏡(SLO)によるラット網膜神経線維層(RNFL)の観察と定量性の検討Brown NorwayラットのRNFLは、SLOによって明瞭に観察された。SLOの共焦点口径を最小としてRNFLが観察される屈折値の幅(ΔF)を決定した。視神経挫滅モデル(片眼の視神経を眼窩内で30秒間挫滅)では、挫滅後2週目からΔFは有意に減少し、虚血再灌流モデル(片眼の前房に45分間160mmHgを負荷)では虚血後1週目からΔFは有意に減少した。対照眼のΔFは不変であった。また、両モデルにおいてSLO撮影後に網膜組織切片を作成しRNFLの厚み(NFLT)を定量したところ、SLOでのΔFと網膜組織切片でのNFLTは有意に相関した。したがって、SLOはラットRNFLを生体内で定量的に観察するのに有用である。SLOによるラツト網膜神経節細胞体(RGC)の観察と定量性の検討上丘に注入されたDiA(4-(4-(dihexadecylamino)styryl)-N-methylpyridinium iodine)によって逆行染色されたRGCは、SLO(フルオレセイン蛍光眼底造影用フィルター使用)によって明瞭に観察された。1眼1ヶ所の任意の設定部位においてSLOにて蛍光(+)細胞数を経時的に計測したところ、視神経挫滅後1週目から有意に細胞数は減少した。視神経挫滅前のSLO画像を白黒反転し、挫滅後のSLO画像と重ね合わせることによって新たに生じた蛍光点は、isolectin B4蛍光染色によってミクログリアに一致することが判明した。したがって、視神経挫滅後にSLOにおいて新たに生じた蛍光点を差し引いて蛍光(+)細胞数を定量したところ、網膜伸展標本でのRGC数とよく一致した。したがって、SLOはラットRGCを生体内で定量的に観察するのに有用である。1) In vivo imaging and quantitative evaluation of rat retinal nerve fiber layer (RNFL) by scanning laser ophthalmoscopy (SLO)Methods: Fundus images of both eyes were recorded over time by SLO using an argon blue laser (488 nm) in unilateral optic nerve crush or ischemia-reperfusion model. The focused plane was sequentially moved by changing the refractive values in the SLO setting. The range of refractive values (AF) in which RNFL reflex was clearly observed was determined. The RNFL thickness in retinal sections was measured and compared to the DF value. Results: The QF value was unchanged 1 week after the crush, but then decreased significantly after the second week, while it decreased significantly from the 1st week after the ischemia-reperfusion. The OF value correlated significantly with the histologically determined RNFL thickness.2) In vivo imaging and counting of rat retinal ganglion cells (RGCs) by SLOMethods: RGCs of Brown Norway rats were retrogradely labeled bilaterally with the fluorescent dye, 4-(4-(dihexadecylamino)styryl)-N-methylpyridinium iodine (DiA). RGCs were imaged in vivo with a SLO using an argon blue laser and optical filter sets for fluorescein angiography, before and 1, 2, and 4 weeks after the crush. Fluorescent cells were also counted on retinal flatmounts. An image overlay analysis was performed to check cell positions in the SLO images over time. Lectin histochemical analysis was performed to determine the relationship of microglia to the newly emerged DiA fluorescence detected by image overlay analysis after the optic nerve crush. Results: Fluorescent RGCs were visible in vivo by SLO. RGC survival decreased gradually after the crush. Newly emerged DiA fluorescence detected by image overlay analysis corresponded to fluorescent cells morphologically different from RGCs in the retinal flatmount and was colocalized mostly with lectin-stained microglial processes. RGC counts by SLO were comparable to those by retinal flatmounts.3) Conclusions: The SLO is useful for in vivo imaging and quantitative evaluation of rat RNFL and RGCs, and therefore may be a valuable tool for monitoring RNFL and RGC changes over time in various rat models of RGC damage.研究課題/領域番号:17591825, 研究期間(年度):2005-200

Fundus autofluorescence and spectral-domain optical coherence tomography findings of leopard spots in nanophthalmic uveal effusion syndrome

金沢大学附属病院眼科Purpose: To describe fundus autofluorescence (FAF) imaging and spectral domain optical coherence tomography (SD-OCT) findings of leopard spots in nanophthalmic uveal effusion syndrome. Methods: A 34-year-old man with retinal detachment associated with nanophthalmic uveal effusion syndrome in the right eye underwent sclerotomy three times. After the final surgery, the subretinal fluid resolved gradually. Then, SD-OCT examination, FAF photography, fluorescein angiography (FA), and indocyanine green angiography (ICGA) were performed simultaneously with the spectralis Heidelberg retina angiograph + OCT system. Results: SD-OCT revealed focal thickening of the retinal pigment epithelium (RPE) layer at the same locations as leopard spots, which appeared hypofluorescent on FA and ICGA. These spots showed hyperautofluorescence on FAF imaging. Six months later, focal thickening of the RPE layer became smaller on OCT and hyperautofluorescence was attenuated on FAF imaging. Conclusions: Simultaneous imaging of the fundus with multiple modalities including OCT, FAF, FA, and ICGA indicates that leopard spots in the fundus of uveal effusion syndrome may show hyperautofluorescence and correspond to focal thickening of the RPE layer by SD-OCT. This imaging method may help elucidate the pathology of various fundus lesions in vivo. © 2010 Springer-Verlag

A thin honeycomb-patterned film as an adhesion barrier in an animal model of glaucoma filtration surgery.

金沢大学附属病院眼科PURPOSE: To evaluate the effectiveness and safety of a thin honeycomb-patterned biodegradable film for glaucoma filtration surgery in rabbits. METHODS: A 7 microm-thick film made from poly(L-lactide-co-epsilon-caprolactone) was placed in the subconjunctival space in one eye of rabbits, with or without full thickness filtration surgery. The film had a honeycomb-patterned surface that faced the subconjunctival Tenon tissue and the other side was smooth. Filtration surgery was also performed in the fellow eye, which received either no adjunctive treatment or 0.4 mg/mL mitomycin C (MMC; n=6 each). Intraocular pressure (IOP) measurements and bleb evaluations using ultrasound biomicroscopy were performed periodically for 28 days after surgery followed by histologic observation. RESULTS: Postoperative IOPs of the film-treated eyes were significantly lower than that of control eyes from day 10 to day 28 (P<0.05), but were not significantly different from those of MMC-treated eyes. The subconjunctival filtration space, detected by ultrasound biomicroscopy, disappeared in 5 control eyes, 1 MMC-treated eye, but none of the film-treated eyes. A bleb leak occurred postoperatively in 2 MMC-treated eyes. Histologically, in eyes without filtration surgery, fibrotic tissue with the film partly attached to it was noted on the honeycomb side, but was minimal on the sclera that faced the smooth side of the film. In eyes with filtration surgery, the honeycomb-patterned film lined the inner bleb wall with minimal inflammatory reaction. CONCLUSIONS: The thin honeycomb-patterned film that attached to the inner bleb wall worked as an adhesion barrier in glaucoma filtration surgery in rabbits, which is worthy of further investigation

Differentiation by imaging of superior segmental optic hypoplasia and normal-tension glaucoma with inferior visual field defects only

Purpose: To differentiate superior segmental optic hypoplasia (SSOH) from normal-tension glaucoma (NTG) with inferior visual field defects only. Methods: Eighteen eyes with SSOH (SSOH group) and 19 eyes with NTG (NTG group) were examined by optical coherence tomography (OCT), Heidelberg retina tomography (Heidelberg Retinal Tomograph II, HRT II) and standard automated perimetry. Results: Retinal nerve fiber layer thickness (RNFLT) based on OCT measurements was significantly reduced (thinner) in the superior to superonasal sectors and significantly greater (thicker) in the inferotemporal sector in the SSOH group than in the NTG group. The cup was significantly smaller and the rim significantly larger in the superotemporal and temporal sectors in the SSOH group than in the NTG group based on HRT II measurements. The greatest area under the receiver operating characteristic curve for discrimination of SSOH from NTG by OCT and HRT II was for the RNFLT ratio of 1 + 2 o\u27clock/10 + 11 o\u27clock (0.985) and for the ratio of the superonasal to superotemporal sector of rim to disc area ratio and cup to disc area ratio (0.955), respectively. The frequent location of the inferior visual field defects corresponded to the difference in structural changes in both groups. Conclusions: Comparison of the superonasal to superotemporal sectors by OCT and HRT II were useful in differentiating SSOH from NTG with only inferior visual field defects. © 2012 Japanese Ophthalmological Society