Acute Zonal Occult Outer Retinopathy in Japanese Patients : Clinical Features, Visual Function, and Factors Affecting Visual Function

Purpose To evaluate the clinical features and investigate their relationship with visual function in Japanese patients with acute zonal occult outer retinopathy (AZOOR). Methods Fifty-two eyes of 38 Japanese AZOOR patients (31 female and 7 male patients; mean age at first visit, 35.0 years; median follow-up duration, 31 months) were retrospectively collected: 31 untreated eyes with good visual acuity and 21 systemic corticosteroid-treated eyes with progressive visual acuity loss. Variables affecting the logMAR values of best-corrected visual acuity (BCVA) and the mean deviation (MD) on Humphrey perimetry at initial and final visits were examined using multiple stepwise linear regression analysis. Results In untreated eyes, the mean MD at the final visit was significantly higher than that at the initial visit (P = 0.00002). In corticosteroid-treated eyes, the logMAR BCVA and MD at the final visit were significantly better than the initial values (P = 0.007 and P = 0.02, respectively). The final logMAR BCVA was 0.0 or less in 85% of patients. Variables affecting initial visual function were moderate anterior vitreous cells, myopia severity, and a-wave amplitudes on electroretinography; factors affecting final visual function were the initial MD values, female sex, moderate anterior vitreous cells, and retinal atrophy. Conclusions Our data indicated that visual functions in enrolled patients significantly improved spontaneously or after systemic corticosteroids therapy, suggesting that Japanese patients with AZOOR have good visual outcomes during the follow-up period of this study. Furthermore, initial visual field defects, gender, anterior vitreous cells, and retinal atrophy affected final visual functions in these patients

Clinical Features of the Present Study and a Previous Study.^#

<p>^# Gass JDM et al., Am J Ophthalmol 2002;</p><p>* Median (range);</p><p>BCVA = best-corrected visual acuity</p><p>Clinical Features of the Present Study and a Previous Study.<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0125133#t004fn001" target="_blank">^#</a></p

Visual Field Findings at Onset of AZOOR in 52 Eyes with AZOOR.

<p>AZOOR = acute zonal occult outer retinopathy</p><p>BSE = blind spot enlargement; PCS = paracentral scotoma</p><p>Visual Field Findings at Onset of AZOOR in 52 Eyes with AZOOR.</p

Photographs of the left eye at the initial visit in a 36-year-old male patient with AZOOR.

<p>(A) Fundus photograph shows normal appearance, except for retinal arterial narrowing. (B) Late-phase fluorescein angiography shows staining of the retinal vein walls (arrows) and leakages from the retinal vessels (arrowheads). (C) Goldmann perimetry reveals a central scotoma of 80 × 70°. LogMAR value of the best-corrected visual acuity (BCVA) decreased to 2.0. (D) Multifocal electroretinography (ERG) shows reduced responses corresponding to the visual field defect. (E) Horizontal optical coherence tomography through the fovea shows diffuse ellipsoid zone loss (arrows) in the macular area.</p

Photographs of the left eye 5 years (A–D) and 8 years (E) after systemic corticosteroid therapy in a patient shown in Fig 2.

<p>(A) Fundus photograph shows the development to zonal retinal atrophy at the retinal pigment epithelium level along the retinal arcade vessels. (B) Late-phase fluorescein angiography indicates the resolution of retinal vasculitis and the window defect corresponding to the zonal retinal atrophy. (C) Spectral-domain optical coherence tomography shows recovery of the ellipsoid zone and the interdigitation zone at the fovea, but the ellipsoid zone (arrows) and the interdigitation zone (arrowheads) are lost in the surrounding area. (D) Goldmann perimetry shows central scotoma shrinkage associated with central sensitivity recovery; the logMAR BCVA recovered to -0.18. (E) Fundus autofluorescence demonstrates decreased autofluorescence in the corresponding zonal retinal atrophy.</p

Changes in mean deviation (MD) values on Humphrey perimetry from baseline to 6 months (A) and the final visit (B).

<p>(A) MD values increased by 30% or more in 71.9% of all eyes (83.3% of untreated eyes and 57.1% of treated eyes). None of the eyes showed a worsening of 30% or more. (B) MD values increased by 30% or more in 63.2% of all eyes (76.2% of untreated eyes and 47.1% of treated eyes), but decreased by 30% or more in only 2.6% of all eyes.</p

Photographs of the left eye before (A-E) and after (F-H) systemic corticosteroids therapy in a 39-year-old woman with AZOOR.

<p>(A) Fundus photograph shows normal retinal appearance except for narrowing and tortuosity of the retinal arteries (arrowheads). The patient’s logMAR BCVA was 0.52. (B) Indocyanine green angiography (ICGA) in the late phase shows hyperfluorescence along with choroidal middle or large vessels (arrows) and hypofluorescent patches (arrowheads). (C) Goldmann perimetry shows paracentral and isolated scotomata together with peripheral contraction. (D) Multifocal ERG reveals decreased responses corresponding to the visual field defects. (E, F) Composite color map of laser speckle flowgraphy. Mean blur rate (MBR), an index of relative blood flow velocity, increased three weeks after corticosteroid pulse therapy (F) compared to the pretreatment level (E), suggesting an improvement in choroidal circulation impairment after treatment. Warm color indicates high MBR and cool color low MBR. (G) On late-phase ICGA three weeks after treatment, hyperfluorecence along with choroidal vessels disappeared. Her logMAR BCVA improved to 0.10. (H) On Goldmann perimetry at 14 months after treatment, scotomata and peripheral contraction ameliorated with BCVA further improving to -0.18.</p

Variables Affecting Visual Functions at Final Visit in Patients with AZOOR.

<p>BCVA = best-corrected visual acuity; MD = mean deviation; ant.vit.cells = anterior vitreous cells; ERG = electroretinography</p><p>* <i>P</i> < 0.05;</p><p>** <i>P</i> < 0.01</p><p>Variables Affecting Visual Functions at Final Visit in Patients with AZOOR.</p

Evaluation of Changes in Activities of Daily Living and Quality of Life of Patients with Bone Metastasis Who Underwent Conservative Therapy through Bone Metastasis Cancer Boards

Background and Objectives: Changes in activities of daily living (ADL) and quality of life (QOL) of patients with bone metastasis who underwent surgical treatment through Bone Metastasis Cancer Boards (BMCBs), a recent multidisciplinary approach for managing bone metastases, have been reported; however, no reports exist on patients who undergo conservative treatment. In this study, we aimed to evaluate these patients’ ADL and QOL and examine the factors influencing changes in these parameters. Materials and Methods: We retrospectively reviewed 200 patients with bone metastases who underwent conservative therapy through BMCBs between 2013 and 2021. A reassessment was conducted within 2–8 weeks after the initial assessment. Patients’ background and changes in performance status (PS), Barthel Index (BI), EuroQol five-dimension (EQ-5D) scores, and Numerical Rating Scale (NRS) scores were initially assessed. Furthermore, we categorized patients into two groups based on improvements or deteriorations in ADL and QOL and performed comparative analyses. Results: Significant improvements in EQ-5D (0.57 ± 0.02 versus [vs.] 0.64 ± 0.02), NRS max (5.21 ± 0.24 vs. 3.56 ± 0.21), and NRS average (2.98 ± 0.18 vs. 1.85 ± 0.13) scores were observed between the initial assessment and reassessment (all p p = 0.06, and 0.054, respectively). In addition, spinal cord paralysis (odds ratio [OR]: 3.69, p = 0.049; OR: 8.42, p p = 0.02; OR: 0.25, p = 0.007), and NRS average scores (OR: 0.38, p = 0.02; OR: 0.14, p Conclusions: Patients with bone metastases who underwent conservative treatment through BMCBs exhibited an increase in QOL without a decline in ADL. The presence of spinal cord paralysis, absence of chemotherapy, and poor pain control were associated with a higher risk of deterioration in ADL and QOL