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

Successful treatment of corneal wasp sting-induced panuveitis with vitrectomy

BACKGROUND: This study aims to present the management and clinical findings of a case of corneal wasp sting and to report the outcome of corneal change and panuveitis after vitrectomy. FINDINGS: Clinical findings, anterior segment photographs, corneal endothelial changes, and medical treatment of corneal wasp sting-induced panuveitis are presented. A 95-year-man was stung by a wasp on his left cornea. A severe conjunctival hyperemia, marked corneal edema, corneal epithelial defect, and uveitis developed. As soon as the patient visited our clinic, topical corticosteroid and antibiotics were given, but corneal endothelial damage and uveitis did not improve. Anterior chamber irrigation was performed with oxiglutatione solution to rinse out the wasp venom. Corneal edema and anterior uveitis improved but the endothelial cell density gradually decreased and the vitreous opacity deteriorated. Therefore, a 23-gauge vitrectomy was performed. Subsequently, the corneal edema and panuveitis improved. CONCLUSIONS: Vitrectomy may be an effective treatment for corneal endothelial damage and endophthalmitis induced by a corneal wasp sting

高安病発見から1世紀 : たった1例の日本語症例報告から世界の高安病へ [巻頭言]

金沢大学医薬保健研究域医学系[巻頭言

Visualization of precut DSAEK and pre-stripped DMEK donor corneas by intraoperative optical coherence tomography using the RESCAN 700

Background: To report the feasibility of intraoperative spectral domain optical coherence tomography (OCT) using the RESCAN 700 for the visualization and evaluation of precut Descemet\u27s stripping automated endothelial keratoplasty (DSAEK) and prestripped Descemet\u27s membrane endothelial keratoplasty (DMEK) donor tissue. Methods: Precut DSAEK (n = 11), prestripped DMEK (n = 4) preserved in a viewing chamber were examined by intraoperative OCT. Wholly intact donor corneas for penetrating keratoplasty (PK) (n = 8) were also examined as controls. The obtained images were analyzed qualitatively for characteristics of each type of donor. Results: For each type of donor, characteristic images were consistently obtained by intraoperative OCT in both the front and back views through the viewing chamber. In wholly intact donors for PK, appearance of normal corneal curvature and stromal texture with high reflectivity of epithelium and endothelium cell layers were clearly visualized. In precut DSAEK donors, precut lines were characteristically visualized in addition to the intact donor cornea images. In prestripped DMEK donors, identical OCT images to the intact donor cornea were noted when observed from the anterior surface. However, peripheral partial detachments of Descemet\u27s membrane were characteristically observed in all prestripped DMEK donors when viewed from the back of the viewing chamber. Conclusion: Rapid visualization and rough evaluation of donor tissues for PK, precut DSAEK and prestripped DMEK donor corneas by intraoperative OCT was consistently possible through the viewing chamber. Therefore, this device may be used as an alternative of AS-OCT when the eyebank does not have their own AS-OCT. Although the peripheral detachment in DMEK donors are quite common and clinically non-problematic in DMEK donor quality and subsequent DMEK surgeries, it may be useful to distinguish between wholly intact PK donors and prestripped DMEK donors, enabling to prevent mix-ups of donors, especially when several different types of keratoplasties are scheduled in a same day in one operating theater. © 2016 Kobayashi et al

Swelling-activated potassium channel in porcine pigmented ciliary epithelial cells.

Ion channels in the ciliary epithelium play critical roles in the formation of aqueous humor in the eye. The present study identified a novel, swelling-activated K(+) current in freshly dissociated porcine pigmented ciliary epithelial cells. Ciliary epithelial cells were freshly dissociated from porcine eyes. Whole-cell currents were recorded by the patch-clamp technique in pigmented and nonpigmented ciliary epithelial cell (PCE-NPCE) pairs or single PCE cells. The 0-current potential was -49 ± 13 mV in PCE-NPCE cell pairs (n = 97) and -52 ± 12 mV in single PCE cells (n = 30). Whole-cell currents in these cells were dominated by an outwardly rectifying K(+) current activated by potentials more positive than -90 mV, which never inactivated during prolonged depolarization. The K(+) current was significantly augmented by hypotonic cell perfusion. External Ba(2+) was a blocker of this K(+) conductance (IC(50) of 0.38 mM), but the conductance was insensitive to external TEA(+). Linopirdine, a specific inhibitor of KCNQ channels, effectively blocked the K(+) current in these PCE cells. Porcine PCE cells express a swelling-activated K(+) channel, which may be a member of the KCNQ/Kv7 channel family. This K(+) channel is active near resting potentials and could contribute to the regulation of cell volume and water transport via the ciliary epithelia

Clinical Aspects of IgG4-Related Orbital Inflammation in a Case Series of Ocular Adnexal Lymphoproliferative Disorders

The most frequent ocular adnexal tumors and simulating lesions are lymphoproliferative disorders (LPDs), including malignant lymphomas and orbital inflammation with lymphoid hyperplasia or infiltration. IgG4-related orbital inflammation (IgG4-ROI) often involves lacrimal glands and other orbital tissues and is an important differential diagnosis. The present study evaluated clinical aspects of IgG4-ROI in a case series of orbital LPD. Sixty-two consecutive cases of orbital LPD, pathologically diagnosed from November, 2004, through March, 2011, were investigated. Histological types were 22 cases with MALT lymphoma, 11 cases with diffuse large B-cell lymphoma (DLBCL), 3 cases with other malignant lymphomas, 16 cases with IgG4-ROI, and 10 cases with non-IgG4-ROI. Ages of the IgG4-ROI group (56 ± 10 yrs) were significantly lower than the MALT lymphoma (71 ± 12 yrs) and DLBCL (75 ± 14 yrs) groups. Orbital lesions other than lacrimal glands were present in six cases including extraocular muscle swelling, mass lesions surrounding the optic nerve, and supraorbital and infraorbital nerves enlargements. Although none of the malignant lymphomas were related to IgG4, previous evidence suggested that malignant lymphomas can arise from IgG4-ROI. Based on this study (26%) and another report (33%), it is likely that nearly a quarter of orbital LPD are IgG4-ROI

Development of a Donor Tissue Holding Technique for Descemet’s Membrane Endothelial Keratoplasty Using a 25-Gauge Graft Manipulator

Purpose: To report a modified surgical technique called the “donor tissue holding technique for Descemet’s membrane endothelial keratoplasty (DMEK)” using a newly developed 25-gauge graft manipulator. Methods: Six consecutive patients exhibiting endothelial dysfunction were enrolled and treated by DMEK. In brief, after insertion of a DMEK donor into the anterior chamber, the edge of the roll was grasped using a graft manipulator and this grasp was maintained throughout the centering and opening of the roll (holding technique). The following parameters were evaluated in comparison to the previous 10 consecutive DMEK cases in which the no touch technique was used: time of graft unfolding, incidence of intra-/postoperative complications, and best spectacle-corrected visual acuity (BCVA) and endothelial cell density (ECD) 6 months after the procedure. Results: In both technique groups, neither intra- nor postoperative complications were noted in any case. No differences were observed between the two groups in postoperative BCVA (p = 0.88). Also, no differences were observed between the two groups in postoperative ECD (holding technique group: 2,108.3 cells/mm2, no touch technique group: 1,491.7 cells/mm2) (p = 0.08) Most notably, the time of graft unfolding prior to filling with air was significantly reduced in the holding technique group (305.5 s) compared to that of the no touch technique group (1,310.0 s; p = 0.01). Conclusions: This donor tissue holding technique enabled rapid and safe DMEK in a reproducible manner, even in Asian eyes with shallow anterior chambers with high vitreous pressure

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