Development of Stage 4 Macular Hole after Spontaneous Closure in a Patient with Stage 2 Macular Hole and a Lamellar Macular Hole-Associated Epiretinal Proliferation

Herein, we report the longitudinal observation of a case with reopening of the macular hole associated with a lamellar macular hole-associated epiretinal proliferation (LHEP) followed by spontaneous closure in patients with stage 2 idiopathic macular hole. A 64-year-old woman was referred for the decreased visual acuity (VA) and acute anorthopia in the right eye. Funduscopy and optical coherence tomography (OCT) showed stage 2 full-thickness macular hole without posterior vitreous detachment (PVD) and operculum formation. Her best-corrected visual acuity (BCVA) was 20/32. One month later, the diameter of the macular hole was getting small and VA improved. Six months later, the macular hole was treated spontaneously with the attached hyaloid membrane to the macula by OCT and the BCVA improved to 20/20. Fourteen months after the first visit, the BCVA decreased to 20/50 and the patient was diagnosed with stage 4 macular hole with complete PVD. OCT showed full-thickness macular hole with a LHEP in the right eye. After 25G-gauge vitrectomy with the peeling of internal limiting membrane (ILM) and LHEP, the macular hole was closed and BCVA finally improved to 20/25. Spontaneous macular hole closure without PVD may rarely occur in patients with LHEP. The surgical removal of ILM and LHEP may contribute to the successful macular hole closure after vitrectomy

Correlation between short- and long-term effects of intravitreal ranibizumab therapy on macular edema after branch retinal vein occlusion: a prospective observational study

Abstract Background The correlation between the short- and long-term effects of intravitreal ranibizumab (IVR) on macular edema after branch retinal vein occlusion (BRVO) remains unclear. We assessed the correlation between the short- and long-term effects of IVR on macular edema after BRVO. Methods Twenty-one eyes with macular edema after BRVO were enrolled in this prospective observational study. We measured the foveal thickness (FT) and the best-corrected visual acuity (BCVA) before, 1 day after, and 1 month after IVR (0.5 mg) and then at least every 2 months thereafter until 6 months after the injection. If the macular edema recurred, another injection was administered. The primary endpoint was the change from baseline in the BCVA (ΔVA). Results The mean logarithm of the minimum angle of resolution VA improved significantly (p = 0.01, p < 0.0001, respectively) after 1 day from 0.65 ± 0.28 to 0.51 ± 0.21 (20/89 to 20/63, Snellen equivalent) and after 6 months to 0.29 ± 0.24 (20/39, Snellen equivalent). The mean FT decreased significantly (p < 0.0001) after 1 day from 482 ± 85 μm to 349 ± 75 μm and after 6 months to 305 ± 84 μm. The 1-day VA was significantly (r = 0.68, p = 0.0007) positively correlated with the 6-month VA. The 1-day ΔVA was significantly (r = 0.79, p < 0.0001) positively correlated with the 6-month ΔVA. Conclusions The short-term effects of IVR may predict the long-term effects of IVR in macular edema secondary to BRVO. Trial registration Trial registration number: UMIN000027003 . Retrospectively registered. (April/15/2017

Histamine-Induced Dilation of Isolated Porcine Retinal Arterioles: Role of Endothelium-Derived Hyperpolarizing Factor

Citation: Otani S, Nagaoka T, Omae T, et al. Histamine-induced dilation of isolated porcine retinal arterioles: role of endothelium-derived hyperpolarizing factor. Invest Ophthalmol Vis Sci. 2016;57:4791-4798. DOI:10.1167/iovs.15-19038 PURPOSE. Although endothelium-dependent nitric oxide (NO)-mediated dilation of retinal arterioles has been well described, the role of endothelium-derived hyperpolarizing factor (EDHF) in the retinal arteriolar response remains unclear. In the current study, we examined the contribution of EDHF to the retinal arteriolar dilation to the inflammatory agent histamine and investigated the signaling mechanisms underlying this vasomotor activity. METHODS. Porcine retinal arterioles were isolated, cannulated, and pressurized without flow for functional study by using video microscopic techniques. The immunohistochemical staining was performed to determine histamine receptor subtypes. RESULTS. Histamine (0.1-30 lM) produced concentration-dependent dilation of retinal arterioles in a manner sensitive to H1-and H2-receptor antagonists chlorpheniramine and famotidine, respectively. Histamine-induced vasodilation was almost abolished after endothelial removal. In the intact vessels, vasodilation to histamine was partially inhibited by the inhibitors of cyclooxygenase (indomethacin), NO synthase (N G -nitro-L-arginine methyl ester, L-NAME), or Ca 2þ -activated K þ (K Ca ) channels (apamin plus charybdotoxin). Combination of the above inhibitors abolished histamine-induced vasodilation. Residual vasodilation in the presence of indomethacin and L-NAME was further reduced by the cytochrome P450 enzyme inhibitor sulfaphenazole but not by the gap junction inhibitor carbenoxolone or the hydrogen peroxide scavenger catalase. Immunohistochemical signals for H1-and H2-receptor expression were found only in the endothelium. CONCLUSIONS. The endothelium plays an essential role in the dilation of porcine retinal arterioles to histamine via H1-and H2-receptor activation. The EDHF derived from cytochrome P450 contributed in part to this vasodilation via K Ca channel activation, in addition to the endothelial release of NO and prostanoids

生理的刺激に対する眼循環調節機構の解明

出版社版眼循環は様々な生理的刺激に対し,生体の恒常性を維持するように合目的に血流を調節している.この生理的血流調節機構の破綻が重篤な網膜疾患の発症進展に関与すると考えられ,この調節機構の解明とその評価法の確立は日常臨床においても重要な意味を持つと考えられる.眼循環に影響を及ぼす生理的刺激に関し,我々はこれまで低酸素,高二酸化炭素,血圧上昇に対する網膜循環の反応とそのメカニズムを解明してきた.生理的刺激の一つである温度変化に関しては,近年加齢黄斑変性の治療法として経瞳孔温熱療法(TTT)が行われるようになり,TTTの眼循環への影響を検討した報告が散見されるが,眼組織温度変化による眼循環への影響に関しては詳しい検討がなされていない.そこで,我々は健常成人を対象とし,手持ち罨法器を用いて眼球を10分間加熱し,負荷前後においてレーザードップラ眼底血流計(キャノンCLBF model 100)で網膜血流量を,中心窩脈絡膜血流量をレーザードップラ血流計でそれぞれ測定した.得られた結果から,眼球加熱負荷により網膜血流量は増加するが,中心窩脈絡膜血流量は反対に減少することが明らかとなった.今回観察された網膜血流増加および中心窩脈絡膜血流量の減少は,網膜組織温度を一定に保つ眼循環の生理学的調節機構を反映すると推測され

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雑誌掲載

A case of acute syphilitic posterior placoid chorioretinitis showing improved choroidal blood flow after treatment

Purpose: Acute syphilitic posterior placoid chorioretinitis (ASPPC) is a rare form of ocular syphilis. However, its pathophysiology is not fully understood. Laser speckle flowgraphy (LSFG) can facilitate the non-invasive evaluation of blood flow and allow investigations into the effects of treatments in various ocular diseases. We report a case of ASPPC that presented with symptoms only in the right eye but showed bilateral disease in LSFG. Observations: A 54-year-old man presented with decreased vision and visual field defects in the right eye 2 days prior to the initial visit. Fundoscopy images showed a typical yellowish placoid lesion in the macular area, and optical coherence tomography showed disruption of the outer retinal layers and nodular appearance of the retinal pigment epithelium. Fluorescence angiography showed excessive leakage of the placoid lesion characterized by hypofluorescent dots in the inner area (“leopard spotting”). The patient was diagnosed with unilateral ASPPC based on multiple imaging and serological tests. Penicillin was administered for 2 weeks, and the patient showed improvement in symptoms and restoration of the retinal structure. The mean blur rate of the right/left eye was 2.1/5.9 arbitrary units (AU) before treatment and increased to 4.5/9.3 AU 6 months after treatment. Conclusions and importance: Despite the absence of typical imaging signs and symptoms in the left eye, both eyes may have been affected with different degrees of severity. Thus, LSFG may facilitate the evaluation of treatment effects and the prediction of ocular inflammatory diseases in the early stages

眼科医のための先端医療 高脂血症治療薬で眼疾患を治療できる？

出版社

Abnormality of retinal arterial velocity profiles using Doppler Fourier-domain optical coherence tomography in a case of Takayasu's arteritis with aortic regurgitation

Purpose: To evaluate the retinal microcirculation using a segmental-scanning Doppler optical coherence tomography (DOCT) flowmeter in a patient with Takayasu's arteritis (TA) with aortic valve regurgitation (AR). Observations: We measured the retinal blood velocity (V), retinal blood flow (RBF), and retinal blood velocity profiles (RBVP) of the major retinal arterioles using a DOCT flowmeter. The arteries were measured at the straight portion 1 disc diameter from the optic disc. Horizontal velocity profiles were extracted to evaluate the RBVP during one cardiac cycle. A patient with TA with stage 2 Takayasu retinopathy (TR) and AR, had normal RBF and V, and the RBVP had a parabolic pattern in the systolic phase. However, the V was very slow and the RBVP had an abnormal pattern in the diastolic phase. Conclusions and importance: The current study showed for the first time that segmental-scanning DOCT flowmeter enables evaluation of an abnormal flow pattern of the RVBP in the retinal arterioles in a patient with TA and AR. Measurement of the retinal arterial blood flow may detect aortic valve dysfunction and shed light on the pathogenesis of TR

【網膜硝子体疾患診療の進歩2012】 診断法の進歩 網膜血流測定法の進歩

雑誌掲載版1.網膜血管は生体で唯一観察可能な血管である。2.レーザードップラー眼底血流計では、網膜大血管の血流量の絶対値を測定できる。3.2型糖尿病患者では網膜症発症前から網膜血流量が低下している。4.眼血流装置は、その特徴をよく理解して、データを解釈することが重要である