Immunobiotic Lactobacillus jensenii TL2937 Alleviates Dextran Sodium Sulfate-Induced Colitis by Differentially Modulating the Transcriptomic Response of Intestinal Epithelial Cells

Immunobiotics have emerged as a promising intervention to alleviate intestinal damage in inflammatory bowel disease (IBD). However, the beneficial properties of immunobiotics are strain dependent and, therefore, each strain has to be evaluated in order to demonstrate its potential application in IBD. Our previous in vitro and in vivo studies demonstrated that Lactobacillus jensenii TL2937 attenuates gut acute inflammatory response triggered by Toll-like receptor 4 activation. However, its effect on colitis has not been evaluated before. In this work, we studied whether the TL2937 strain was able to protect against the development of colitis in a dextran sodium sulfate (DSS)-induced mouse model and we delved into the mechanisms of action by evaluating the effect of the immunobiotic bacteria on the transcriptomic response of DSS-challenged intestinal epithelial cells. L. jensenii TL2937 was administered to adult BALB/c mice before the induction of colitis by the administration of DSS. Colitis and the associated inflammatory response were evaluated for 14 days. Mice fed with L. jensenii TL2937 had lower disease activity index and alterations of colon length when compared to control mice. Reduced myeloperoxidase activity, lower production of pro-inflammatory (TNF-α, IL-1, CXCL1, MCP-1, IL-15, and IL-17), and higher levels of immunoregulatory (IL-10 and IL-27) cytokines were found in the colon of TL2937-treated mice. In addition, the treatment of porcine intestinal epithelial (PIE) cells with L. jensenii TL2937 before the challenge with DSS differentially regulated the activation of the JNK pathway, leading to an increase in epithelial cell integrity and to a differential immunotranscriptomic response. TL2937-treated PIE cells had a significant reduction in the expression of inflammatory cytokines (TNF-α, IL-1α, IL-1β, IL-6, IL-15), chemokines (CCL2, CCL4, CCL8, CXCL4, CXCL5, CXCL9, CXCL10), adhesion molecules (SELE, SELL, EPCAM), and other immune factors (NCF1, NCF2, NOS2, SAA2) when compared to control cells after the challenge with DSS. The findings of this work indicate that (a) L. jensenii TL2937 is able to alleviate DSS-induced colitis suggesting a potential novel application for this immunobiotic strain, (b) the modulation of the transcriptomic response of intestinal epithelial cells would play a key role in the beneficial effects of the TL2937 strain on colitis, and (c) the in vitro PIE cell immunoassay system could be of value for the screening and selection of new immunobiotic strains for their application in IBD.

Evaluation of Porcine Intestinal Epitheliocytes as an In vitro Immunoassay System for the Selection of Probiotic Bifidobacteria to Alleviate Inflammatory Bowel Disease

The use of in vitro systems that allow efficient selection of probiotic candidates with immunomodulatory properties could significantly minimize the use of experimental animals. In this work, we generated an in vitro immunoassay system based on porcine intestinal epithelial (PIE) cells and dextran sodium sulfate (DSS) administration that could be useful for the selection and characterization of potential probiotic strains to be used in inflammatory bowel disease (IBD) patients. Our strategy was based on two fundamental pillars: on the one hand, the capacity of PIE cells to create a monolayer by attaching to neighboring cells and efficiently mount inflammatory responses and, on the other hand, the use of two probiotic bifidobacteria strains that have been characterized in terms of their immunomodulatory capacities, particularly in mouse IBD models and patients. Our results demonstrated that DSS administration can alter the epithelial barrier created in vitro by PIE cells and induce a potent inflammatory response, characterized by increases in the expression levels of several inflammatory factors including TNF-α, IL-1α, CCL4, CCL8, CCL11, CXCL5, CXCL9, CXCL10, SELL, SELE, EPCAM, VCAM, NCF2, and SAA2. In addition, we demonstrated that Bifidobacterium breve M-16V and B. longum BB536 are able to regulate the C-jun N-terminal kinase (JNK) intracellular signalling pathway, reducing the DSS-induced alterations of the in vitro epithelial barrier and differentially regulating the inflammatory response in a strain-dependent fashion. The good correlation between our in vitro findings in PIE cells and previous studies in animal models and IBD patients shows the potential value of our system to select new probiotic candidates in an efficient way.

Indocyanine Green Video-Angiographic Findings in Choroidal Osteoma

Indocyanine green video-angiography (ICG) was done twice on three patients with choroidal osteoma. Choroidal osteoma consisted of two portions, a yellow-white area and a surrounding orange area. The early phase of ICG angiography showed hypofluorescence due to blockage, corresponding to the osteoma. However, the hypofluorescence was greater in areas corresponding to the orange portions of the lesions than in the yellow-white parts. In the late phase, tumor staining was present, corresponding to the orange area. Although long-standing yellow-white lesions blocked fluorescence in the late phase, some of these showed hyperfluorescence. ICG video-angiography showed areas of blocked fluorescence in the early phase as well as hyperfluorescent areas accompanied by several small hypofluorescent foci in the late phase, corresponding to very slight ophthalmoscopically observed changes in the vicinity of the osteoma. During follow-up observation, fluorescein angiography confirmed the extension of the osteoma into this area. These results confirm that the characteristic findings of choroidal osteoma can be observed with ICG video-angiography. This imaging technique showed the lesions were larger than they appeared with ophthalmoscopy and fluorescein angiography.

Clinical Evaluation of Indocyanine Green Video-Angiography in the Diagnosis of Choroidal Neovascular Membrane Associated with Age-Related Macular Degeneration

The Authors compared ICG video-angiographic findings in 85 eyes of 78 cases of presumed choroidal neovascular membrane (CNM) associated with age-related macular degeneration with those diagnosed by fluorescein angiography. The detection rate of CNM was 68% with indocyanine green (ICG) video-angiography and 59% with fluorescein angiography. ICG video-angiography can be especially useful for identifying hemorrhagic or exudative detachments of the retinal pigment epithelium. In these cases, detection of CNM by ICG video-angiography was generally far superior to that by fluorescein angiography. However, some CNM in which leakage was identified with fluorescein angiography could not be visualized by ICG video-angiography.

Conjunctival Displacement to the Corneal Side for Oblique-Parallel Insertion in 25-Gauge Vitrectomy

Purpose

To assess the usefulness of the method of oblique-parallel trocar insertion with conjunctival displacement to the corneal side in 25-gauge (G) transconjunctival vitrectomy.

Methods

25-G vitrectomy was performed in 77 consecutive eyes. Before making oblique-parallel trocar insertions, the conjunctiva was conventionally displaced superiorly in 35 eyes, but was displaced toward the corneal side in 42 eyes. After surgery, the distance between the scleral and conjunctival wounds was measured with calipers. The frequency of scleral wound exposure was assessed.

Results

After cannula removal at the end of surgery, inferior repositioning of the superiorly displaced conjunctiva was observed, while marked posterior repositioning of the corneal side caused displacement of the conjunctiva due to gravity. The superior displacement distances between the sclera and conjunctival wounds were 2.4±0.3 mm at the infusion port, 2.0±0.4 mm at the superior temporal port, and 1.9±0.4 mm at the superior nasal port, while the corresponding distances for corneal side displacement were 3.6±0.5, 3.5±0.5, and 2.5±0.5 mm, and were all significantly (p<0.0001) greater with corneal side displacement. The frequency of scleral wound exposure due to conjunctival damage around the cannula (infusion port) was significantly (p=0.0164) lower for corneal side displacement (0/42; 16.7%) than superior displacement (5/35; 14.3%). There was no postoperative endophthalmitis in all 77 patients studied.

Conclusions

In 25-G transconjunctival vitrectomy, using oblique-parallel trocar insertions with the conjunctiva displaced toward the corneal side results in marked posterior repositioning of the conjunctiva after cannula extraction. Corneal side conjunctival displacement is technically easy and completely covers the scleral wound. This method is expected to be effective in preventing endophthalmitis.

Needle-shaped deposits on retinal surface in a case of ocular amyloidosis

PURPOSE

To report a case in which optical coherence tomography (OCT) showed needle-shaped deposits on the retinal surface oriented toward the vitreous cavity and immunohistochemical findings suggested light chain-related amyloidosis.

METHODS

A 59-year-old man with no systemic complications had bilateral neovascular glaucoma and vitreous opacities in the right eye. Vitrectomy was conducted on the right eye and the excised vitreous was examined histopathologically.

RESULTS

Glass wool-like opacities were observed during vitrectomy. Postoperative fundus examination of the right eye showed retinal hemorrhage and white deposits around blood vessels and on retinal surface. Fluorescein angiography revealed hyperfluorescence of the optic disc, non-perfusion areas, and vascular focal staining. OCT depicted needle-shaped deposits perpendicular to the retinal surface oriented toward the vitreous. Histologic examination of deposits revealed positive reaction for Congo red stain, and immunohistochemical examination demonstrated positive reactivities for anti-lambda and anti-kappa light chains (precursors of amyloid protein), suggesting a diagnosis of light chain-related amyloidosis.

CONCLUSIONS

In this case, OCT showed needle-shaped deposits perpendicular to the retinal surface. Special staining with Congo red revealed the deposit to be amyloid deposition. Immunohistochemical staining suggested light chain-related amyloidosis. Vascular obstructive lesions and neovascular glaucoma secondary to retinal vascular damage in amyloidosis warrant particular attention.

25-Gauge peripheral iridectomy during vitrectomy

PURPOSE

To report peripheral iridectomy using a 25-gauge vitreous cutter in a 42-year-old man with pupillary block due to adhesion of the internal iris surface to the continuous circular capsulorhexis.

METHODS

A corneal opening was made at 10 o'clock during vitrectomy. A 25-gauge vitreous cutter was inserted into the anterior chamber with the port facing downward, and peripheral iridectomy at the 12 o'clock position was performed. The vitreous cutter was set at a cutting speed of 2500 cpm and the aspiration pressure at 600 mmHg.

RESULTS

A 25-gauge vitreous cutter with a fine shaft could easily be inserted into the peripheral anterior chamber, and there was no contact with the corneal endothelium even when the anterior chamber became shallow in association with iridectomy. In this patient, pupillary block resolved with peripheral iridectomy, and ocular pressure was also controlled.

CONCLUSIONS

25-gauge peripheral iridectomy is a simple technique that permits iridectomy of appropriate size at any desirable location.

The origins of polypoidal choroidal vasculopathy

BACKGROUND/AIM

There are two theories on the pathogenesis of polypoidal choroidal vasculopathy (PCV): variants in choroidal neovascularisation (CNV) and inner choroidal vessel abnormalities. On indocyanine green angiography (IGA) with a video camera system, PCV has a characteristic appearance, but inadequate image quality has made detailed interpretation difficult. This study aims to improve imaging, using confocal scanning laser ophthalmoscopy (SLO), to elucidate the pathogenesis of PCV.

METHODS

High speed IGA with confocal SLO of 45 eyes (44 patients) showed typical PCV findings of a branching vascular network and polypoidal lesions.

RESULTS

Vessels comprising branching networks began to fill simultaneously with the surrounding choroidal arteries in 38 eyes. Small numbers of vessels filling within a branching network, in the arterial and arteriovenous phases of IGA, showed focal dilatation, constriction, and tortuousity. Vessel abnormalities, corresponding to polypoidal lesions, existed within a network in eight eyes and included loops similar in calibre to network vessels, and numerous microaneurysmal dilatations of small vessels. Vessel pulsation was seen in 24 eyes.

CONCLUSION

PCV is caused by inner choroidal vessel abnormalities, not CNV.

Indocyanine Green Angiographic Findings of Chorioretinal Folds

PURPOSE

To analyze indocyanine green (ICG) angiographic findings of chorioretinal folds.

METHODS

Eight patients (9 eyes) in whom chorioretinal folds had been diagnosed were enrolled in this study. Color photography, fluorescein angiography (FA) and ICG angiography (IA) were performed.

RESULTS

Indocyanine green angiography demonstrated choroidal venous congestion and a filling delay of the choroidal vessels in one case with an orbital tumor. In one posterior scleritis case, IA showed a filling delay of choroidal vessels in the early phase and multiple patchy hypofluorescent lesions scattered in the posterior pole during the late phase. Idiopathic cases showed choroidal venous dilatation. No abnormalities of the choroidal vasculature in the form of radial folds, were revealed in two cases of AMD. Linear hyperfluorescent areas suggestive of chorioretinal folds seen on IA were less numerous and wider than those observed on FA in some eyes. On the other hand, they were equally numerous and wider on IA than those on FA in other eyes.

CONCLUSION

Indocyanine green angiography is useful for evaluating both pathological conditions of the choroidal vasculature and the width of chorioretinal folds at the level of the choroidal vasculature.

Effects of word length on young children's memory performance

The standard working model that accounts for word length effects in young children has been questioned. This study explored two hypotheses suggested by Gathercole and Hitch (1993). In three experiments with serial recall tasks, the word presentation interval was adjusted so that participants could repeat both long and short words subvocally the same number of times in the intervals between the words presented. As a result, among children from 3 to 6 years of age, the word length effect was significantly reduced, whereas the same manipulation of the word presentation interval did not affect the word length effect in adults. These results suggest that the word length effects in young children reflect the process of retaining auditory information in the interval between presentations as well as readout of the phonological representation.

Roles of outcome expectations and self-efficacy in preschoolers' aggression

The present study examined preschool boys' beliefs for the outcome of aggression and their perceptions of self-efficacy for aggressive behaviors. 23 preschoolers (mean age 6.3 yr.; 12 aggressive boys and 11 nonaggressive boys) were presented stories about provocative situations and asked about three expectations for aggression: positive outcomes, peer rejection, and morality. Another 18 preschoolers (mean age 6.3 yr.; 9 aggressive boys and 9 nonaggressive boys) rated their self-efficacy for four strategies: aggression, verbal persuasion, seeking help from a teacher, and withdrawal. Aggressive preschoolers did not expect a negative outcome in the form of peer-rejection in response to aggression as much as nonaggressive boys, although the groups did not differ in their expectations of positive outcomes and morality. Also, aggressive preschoolers were more confident about aggression in situations including teasing or criticism but less confident about verbal persuasion than nonaggressive preschoolers.

[A case of subacute bacterial endocarditis showing acute macular neuroretinopathy-like lesions]

PURPOSE

We report one case of mimic fundus lesions with acute macular neuroretinopathy due to subacute bacterial endocarditis.

CASE

A 55-year-old male had about a 1 DD reddish petal-shaped lesion at the level of the retinal pigment epithelium in the macula and a white lesion about 1/6 DD at the level of the retinal pigment epithelium in the upper fovea. Fluorescein angiography showed the reddish lesion to be hypofluorescence due to a filling defect and indocyanine green angiography showed the hypofluorescence was due to a circulatory disturbance of the choriocapillaris. Additionally, we found that there was a severe choroidal circulatory obstruction in the white lesion on the retinal pigment epithelium. After the disappearance of the white lesion, secondary retinal pigment epithelium atrophy remained.

CONCLUSION

The macular lesions of acute macular neuroretinopathy were ischaemic lesions of the retinal pigment epithelium formed because of a disturbance at the level of the choriocapillaris.

Surgical excision versus laser photocoagulation for subfoveal choroidal neovascular membrane with age-related macular degeneration: comparison of visual outcomes

PURPOSE

This study was designed to compare visual acuity after laser photocoagulation with visual acuity after surgical excision of the subfoveal choroidal neovascular membrane in patients with age-related macular degeneration (AMD).

METHODS

We studied 54 patients (56 eyes) who underwent laser photocoagulation and 52 patients (52 eyes) who underwent surgical excision for new subfoveal choroidal neovascular membrane occurring with AMD. We compared mean log of minimal angle of resolution (MAR) visual acuity, and the percentages of eyes showing visual improvement and a visual acuity of 0.1 or better, between the two treatment groups at 12 months after treatment. The groups were also compared according to choroidal neovascular membrane size, ie, 1 disc diameter (DD) or smaller vs larger than 1 DD.

RESULTS

Mean corrected visual acuity (P <.01), percentage of eyes with improved vision (P <.01), and percentage with a visual acuity of at least 0.1 (P <.01) were higher in surgically treated eyes. The differences in mean log MAR visual acuity and the percentages were significant only for choroidal neovascular membrane of one DD or less in size.

CONCLUSIONS

Postoperative eyes, especially those with choroidal neovascular membranes 1 DD or less in size, had better visual outcomes. Patients who meet our eligibility criteria, especially with small choroidal neovascular membranes 1 DD or less in size, should undergo surgical excision.

Factors Influencing Visual Acuity Following Vitrectomy for Exudative Age-related Macular Degeneration

Purpose: We investigated the influence of various factors on visual results in patients undergoing surgical removal of choroidal neovascular membranes (CNVM) caused by age-related macular degeneration (AMD).Subjects and Methods: This study was performed in 55 eyes of 55 patients who underwent surgical removal of CNVM for AMD and followed them for 6 months or more. The criterion for surgical eligibility was active subfoveal choroidal neovascular membrane of 0.5 or more disc diameter above the retinal pigment epithelium with visual acuity of 0.3 or worse. We investigated the influence of various factors on the logarithm of the minimum angle of resolution (log MAR) final visual acuity. The factors were age, symptom duration, preoperative log MAR visual acuity, CNVM diameter, mean deviation with visual field analyzer, previous laser treatment, posterior vitreous detachment, findings of indocyanine green angiography, operative complications, and recurrence of CNVM.Results: Better preoperative visual acuity, shorter symptom duration, and smaller CNVM diameter were correlated with better postoperative final visual acuity.Conclusions: Surgical excision of subfoveal CNVM may be the better therapeutic choice in selected cases with AMD.

[Treatment of exudative age-related macular degeneration]

I PROPHYLACTIC TREATMENT: We followed 75 eyes contralateral to eyes with exudative age-related macular degeneration (AMD), using indocyanine green angiography (IA), for more than one year. Hyperfluorescent areas in the late phase of IA were seen in 19 eyes at the initial examination, and in 25 eyes during follow-up. Exudative AMD developed in 9 of the 25 eyes. Using timetable analysis, we estimated that 11% of these 27 eyes developed AMD within one year and 55% within three years. The hyperfluorescent areas seen on IA appeared to be latent choroidal neovascularization (CNV) under the retinal pigment epithelium. We propose that photocoagulation aimed at hyperfluorescent areas should be considered in such cases. We performed prophylactic laser photocoagulation in 21 eyes, which were then followed up for at least six months. These eyes all had 10 or more serous drusen within 1,500 microns of the fovea and did not show hyperfluorescence, suggesting latent CNV in the late phase of IA. The majority or a small fraction of the serous drusen disappeared in 48% and 18% of the 21 eyes, respectively. CNV appeared adjacent to the laser scar in one eye (5%). Judging from these results, it is important to establish a method of definitively abolishing drusen and preventing the development of CNV. II TREATMENT OF CNV: Of 229 eyes which showed occult CNV in fluorescein angiography (FA), 124 eyes (54%) showed classic CNV outside the fovea on IA. One hundred and two of the 124 eyes (45%) underwent laser photocoagulation. We evaluated indocyanine green guided laser photocoagulation of extrafoveal CNV in 139 eyes. The success rate was 81% at 3 months after laser photocoagulation. This was estimated using timetable analyses to have decreased to 78% at one year and 71% at three years. Eighty percent of successfully treated eyes showed maintained or improved visual acuity. These results did not differ significantly from those obtained with laser photocoagulation based on FA findings. When classic CNV is not detected on FA, IA is indicated and if classic CNV is detected outside the fovea, photocoagulation should be performed aggressively. We compared the histological findings of removed subfoveal CNV with the IA findings prior to removal. IA findings of CNV before removal were divided into four types. Types I and II showed numerous vascular lumina in von Willebrand factor staining. Prominent proliferation in types I and II was demonstrated with Ki-67. Vascular endothelial growth factor (VEGF) showed strong staining in types I, II and III. Therefore, CNV in eyes with types I, II and III, and especially type I, requires urgent treatment. We compared visual outcomes one year after treatment between 52 eyes that underwent removal and 56 eyes that underwent laser photocoagulation of subfoveal CNV. When CNV size was one disc diameter or less, mean visual acuity, the percentage of eyes with improved vision and with a visual acuity of 0.1 or more, was significantly greater in operated eyes than in coagulated eyes. Removal is therefore superior to photocoagulation in subfoveal CNV of one disc diameter or less in size. We evaluated preoperative factors influencing the best corrected visual acuity at least six months after removal of subfoveal CNV in 67 eyes. Factors influencing the best corrected visual acuity were IA findings, feeder vessel ingrowth sites and CNV sizes. Good indications for removal included types I, II and III IA findings, extra foveal location feeder vessel ingrowth sites, and small CNV. III LOW VISION CARE: We performed reading tests using the MN read J chart for 90 eyes with the scar stage of CNV. Reading speed profiles of the 90 eyes were classified into two groups: 48 eyes showing a plateau with a relatively constant reading rate at the maximum level; and 42 eyes showing steadily increasing reading rate without a plateau. Eyes without a plateau had worse visual acuity, worse reading acuity, and slower reading speed. We evaluated newspaper reading performance by comparing conventional versus new methods based on the critical print size of the MN read J chart. Magnification power based on the critical print size were similar to those finally chosen as the best aid by the patients. On the other hand, magnification power was lower when conventional methods were used. The critical print size of the MN Read J chart appears to be valuable for determining low vision aids which facilitate reading by AMD patients.

[Hyperfluorescent areas observed in late-phase indocyanine green angiography (IA) of IA findings in fellow eyes of unilateral age-related macular degeneration]

PURPOSE

To evaluate abnormal findings of indocyanine green angiography (IA), predisposing to exudative age-related macular degeneration (AMD) in fellow eyes of unilateral exudative AMD.

METHODS

We categorized 83 fellow eyes of unilateral exudative AMD into two groups, i.e. 55 eyes with early age-related maculopathy, and 28 eyes with normal aging. We performed IA.

RESULTS

The late phase of IA demonstrated hyperfluorescent areas in 27 of the 83 fellow eyes, which included 22 of the 55 eyes with early age-related maculopathy and five eyes of 28 eyes with normal aging. The prevalence of the late-phase hyperfluorescence was statistically significant in early age-related maculopathy. Eight of the 22 eyes with early age-related maculopathy and one of the five eyes with normal aging progressed to exudative AMD.

CONCLUSIONS

Hyperfluorescent areas observed in late-phase IA before the manifestation of exudative AMD suggested the possible presence of choroidal neovascular membrane in the subretinal pigment epithelial space.

Correlation of Indocyanine Green Angiography Findings and Expression of Vascular Endothelial Growth Factor in Surgically Excised Age-related Macular Degeneration-related Choroidal Neovascular Membranes

Purpose: We investigated the relationship between clinical classification by indocyanine green angiography (IA) and pathologic findings including the expression of vascular endothelial growth factor (VEGF) in age-related macular degeneration-related choroidal neovascular membranes.Subject and Methods: The subjects were 15 patients with age-related macular degeneration who underwent surgical excision for choroidal neovascular membrane. The patients were classified into 4 types: Type I, hyperfluorescence in both early and late phases (n = 7); Type II, hyperfluorescence in the early phase only (n = 2); Type III, hyperfluorescence in the late phase only (n = 3); and Type IV, no hyperfluorescence in any phase (n = 3). The excised choroidal neovascular membranes were fixed and stained by hematoxylin-eosin and azan. They were also examined by immunohistochemical staining for VEGF.Results: VEGF was expressed markedly in vascular endothelial cells and fibroblast-like cells of interstitial tissue of Types I, II and III. Its expression was weak in Type IV.Conclusion: Clinical classification by IA for age-related macular degeneration is consistent with the pathologic findings including the expression of VEGF.

Effects of dosing time and schedule on cisplatin-induced nephrotoxicity in rats

Renal dysfunction induced by a single injection of cisplatin depends on the timing of the dose. However, the effects of repeated administration of cisplatin on time-dependent toxicity have not been evaluated despite the fact that in clinical practice high doses are repeatedly injected at intervals or low doses are administered daily. We studied chrononephrotoxicity in rats after weekly or daily cisplatin injections. Weekly high doses (5 mg kg(-1)) or daily low doses (1.2 mg kg(-1)) of cisplatin were injected at four time points (3, 9, 15 and 21 h after the light was turned on (HALO)) for 3 weeks. Changes in body weight after weekly cisplatin administration were independent of the timing of the doses. In the group that received daily cisplatin, the loss in body weight in the 3 HALO group was smaller than in animals receiving injections at 15 and 21 HALO (P < 0.05 and 0.001, respectively). The blood urea nitrogen and serum creatinine levels in the control rats showed a significant circadian change (peak at 15 HALO and trough at 9 HALO), but these parameters were markedly elevated in both trials and their circadian variations were disturbed. In conclusion, cisplatin-induced nephrotoxicity was the lowest at 3HALO compared with other time points of both dose regimens.

Choroideremia associated with subretinal neovascular membrane

PURPOSE

To report two Japanese patients with choroideremia, one male and one heterozygous female, who developed subretinal neovascular membrane and/or subretinal fibrosis in the intermediate stage of the disease, and, in addition, to describe marked clinical manifestation in a heterozygous carrier female.

METHOD

Two patients were examined by slip-lamp biomicroscopy, ophthalmoscopy and other ophthalmoloscopic examinations.

RESULTS

Two cases showed moderately advanced ophthalmoscopic and functional abnormalitities compatible with choroideremia, and in addition, subretinal lesion in the fovea and/or midperiphery.

CONCLUSION

The intermediate stage of choroideremia may occasionally be complicated with choroidal neovascular membrane in the fovea, the midperiphery, or both, which resolves spontaneously and results in subretinal fibrous scarring. The occurrence of this complication in the fovea leads to episodic central visual loss, while midperipheral lesion may remain unrecognized.

[Factors influencing visual acuity following vitrectomy for exudative age-related macular degeneration]

PURPOSE

We investigated the influence of various factors on visual results in patients undergoing surgical removal of choroidal neovascular membranes (CNVM) caused by age-related macular degeneration (AMD).

SUBJECTS AND METHODS

This study was performed in 55 eyes of 55 patients who underwent surgical removal of CNVM for AMD and followed them for 6 months or more. The criterion for surgical eligibility was active subfoveal choroidal neovascular membrane of 0.5 or more disc diameter above the retinal pigment epithelium with visual acuity of 0.3 or worse. We investigated the influence of various factors on the logarithm of the minimum angle of resolution (log MAR) final visual acuity. The factors were age, symptom duration, preoperative log MAR visual acuity, CNVM diameter, mean deviation with visual field analyzer, previous laser treatment, posterior vitreous detachment, findings of indocyanine green angiography, operative complications, and recurrence of CNVM.

RESULTS

Better preoperative visual acuity, shorter symptom duration, and smaller CNVM diameter were correlated with better postoperative final visual acuity.

CONCLUSIONS

Surgical excision of subfoveal CNVM may be the better therapeutic choice in selected cases with AMD.

Indocyanine green angiography and histopathology of choroidal neovascular membrane in age-related macular degeneration

PURPOSE

Histopathological investigation of the choroidal neovascular membrane (CNM) in age-related macular degeneration (AMD) patients who showed various findings in indocyanine green angiography (IA).

METHODS

Before surgery, 20 eyes of 20 patients were classified into four types based on IA findings (Type I: both early and late phase hyperfluorescence; Type II: hyperfluorescence only in the early phase; Type III: hyperfluorescence only in the late phase; Type IV: virtually no hyperfluorescence in any phase). Seventeen surgically excised specimens stained with hematoxylin-eosin and azan, were examined by light microscopy. Three other specimens were examined by electron microscopy.

RESULTS

Type I membrane showed many vascular channels not present in the surrounding retinal pigment epithelium (RPE) cells, and little fibrous tissue. Type II membrane had many vascular channels but RPE cells surrounded the CNM. Type III membrane showed few vascular channels and RPE cell proliferation. Type IV membrane showed dense fibrous tissue.

CONCLUSION

The IA findings in AMD agreed with the CNM membrane structure in regard to the number of vascular channels, maturity of vessels, the extent of envelopment of RPE cells and the amount of fibrous tissue.

[Correlation of indocyanine green angiography findings and expression of vascular endothelial growth factor in surgically excised age-related macular degeneration-related choroidal neovascular membranes]

PURPOSE

We investigated the relationship between clinical classification by indocyanine green angiography (IA) and pathologic findings including the expression of vascular endothelial growth factor (VEGF) in age-related macular degeneration-related choroidal neovascular membranes.

SUBJECT AND METHODS

The subjects were 15 patients with age-related macular degeneration who underwent surgical excision for choroidal neovascular membrane. The patients were classified into 4 types: Type I, hyperfluorescence in both early and late phases (n = 7); Type II, hyperfluorescence in the early phase only (n = 2); Type III, hyperfluorescence in the late phase only (n = 3); and Type IV, no hyperfluorescence in any phase (n = 3). The excised choroidal neovascular membranes were fixed and stained by hematoxylin-eosin and azan. They were also examined by immunohistochemical staining for VEGF.

RESULTS

VEGF was expressed markedly in vascular endothelial cells and fibroblast-like cells of interstitial tissue of Types I, II and III. Its expression was weak in Type IV.

CONCLUSION

Clinical classification by IA for age-related macular degeneration is consistent with the pathologic findings including the expression of VEGF.

[Comparison between indocyanine green angiography and outcome of surgical removal of choroidal neovascular membrane in age-related macular degeneration]

PURPOSE

To review the outcome of surgical removal of choroidal neovascular membranes in age-related macular degeneration as classified by indocyanine green angiographic findings.

SUBJECTS AND METHOD

Surgery was performed in 42 eyes. They were divided into four types by indocyanine green angiographic findings prior to surgery. Type I comprised 29 eyes showing hyperfluorescence throughout the angiographic phases. Type II comprised 3 eyes showing hyperfluorescence during the early phase only. Type III comprised 5 eyes showing hyperfluorescence in the late phase only. Type IV comprised 5 eyes without hyperfluorescence throughout the angiographic phases. The results were evaluated according to the visual acuity expressed as log MAR before and after surgery.

RESULTS

Visual acuity improved significantly in Types I, II, and III after surgery. Visual acuity did not improve in Type IV.

CONCLUSION

The findings of indocyanine green angiography are thought to reflect the histological characteristics of the choroidal neovascular membrane. Neovascular membranes of Type IV may contain a smaller number of vessels and abundant fibrous tissue. Eye of Type IV will have atrophies in the neurosensory retina, retinal pigment epithelium, and choriocapillaris. Surgical removal of the choroidal neovascular membrane in Type IV is not effective in improving visual acuity.

[Intra-arterial infusion chemotherapy for superficial bladder cancer]

Intra-arterial infusion chemotherapy (AI) is widely used in the treatment of invasive bladder cancer, but few studies have been reported on its efficacy for superficial bladder cancer. We retrospectively examined the anti-tumor effect and prophylactic effect of AI in 18 cases which were either a case with multiple or extensive tumors which could not be controlled completely by transurethral resection (TUR), a case with grade 3 tumors or a recurrent case after TUR and/or intravesical chemotherapy. Fifty mg of adriamycin and 100 mg of cisplatin were administered into bilateral internal iliac arterys. This treatment was repeated 1-3 times every three weeks. Concerning the anti-tumor effect, 8 showed a complete response, 5 showed partial response and 5 showed no change; the overall response rate (CR + PR) was 72%. Concerning the prophylactic effect, 1-, 2- and 3-year recurrence-free rates were 58.8%, 41.1% and 32.9%, respectively. This study demonstrated the efficacy of AI in the anti-tumor treatment, but not in the prophylactic treatment of superficial bladder cancer.

[Comparison with indocyanine green angiography and immunohistochemical study of choroidal neovascular membrane in age-related macular degeneration]

PURPOSE

We classified choroidal neovascular membranes (CNMs) (48 eyes) in age-related macular degeneration (AMD) into four types using indocyanine green angiography.

METHODS

Surgically extracted CNMs were examined immunohistochemically. Specimens were stained with glial fibrillary acidic protein (GFAP), von Willebrand factor, Ki-67 antigen, actin, vascular endothelial growth factor (VEGF), basic fibroblast growth factor (b-FGF), and transforming growth factor (TGF-beta 1).

RESULTS

All types of CNM were positively stained with GFAP on the side opposite the retinal pigment epithelial (RPE) cells. This suggests the adherence of neurosensory retina to the CNM. Type I membranes which showed hyperfluorescence in the early and late phase of ICG angiography were significantly stained with Ki-67 antigen.

CONCLUSION

These results indicate that CNMs in AMD are extracted with neurosensory retina and RPE cells during surgery. Type I membranes have a high capability for proliferation.

[Intravesical instillation of epirubicin in the prophylactic treatment of recurrent superficial bladder cancer]

A retrospective study was performed to determine the efficacy of intravesical instillation of epirubicin in the prophylactic treatment for recurrent superficial bladder cancer when compared with no treatment controls. Seventeen patients with recurrent superficial bladder cancer received epirubicin (30 mg/40 ml in normal saline) seventeen times after transurethral resection (TUR). Historical controls consist of sixteen patients with recurrent superficial bladder cancer who received no adjuvant treatment after TUR. In the epirubicin group, 1-, 2- and 3-year recurrence free rates were 64.7%, 41.2% and 5.9%, respectively. In controls all of them recurred and 1- and 2-year recurrence free rates were 17.6% and 0%, respectively. The recurrence-free rate was significantly higher in the epirubicin group than in the controls (p < 0.05). We investigated whether intravesical instillation of epirubicin prolonged recurrence-free intervals when compared with recurrence-free intervals without adjuvant treatment after TUR in each patient. The 1- and 2-year recurrence free rates after initial TUR were 25% and 12.5%, respectively, and those with epirubicin treatment after TUR were 62.5% and 37.5%, respectively. Recurrence-free intervals were significantly prolonged by intravesical instillation of epirubicin as compared with those without adjuvant treatment in each patient. This study demonstrated the efficacy of intravesical instillation of epirubicin in the prophylactic treatment for superficial recurrent bladder cancer.

[Appropriate intravesical retention time of pirarubicin concentration based on its level in tumor tissue, anti-tumor effect and side effect in intravesical instillation therapy for bladder tumor]

The present study was designed to investigate the appropriate intravesical retention time of pirarubicin (THP) for the treatment of bladder tumor in terms of its anti-tumor effect and side effect. We administered THP to 22 patients with superficial bladder tumor intravesically and measured the THP concentration in the tumor tissues. Patients were divided into 3 groups by retention time; 8 for 30 minutes, 8 for 1 hour and 7 for 2 hours. Tumor tissues were obtained by transurethral resection 30 min., 1 or 2 hours after the intravesical instillation of THP at the fixed concentrations of 30 mg/30 ml. There was no significant difference in THP concentration between 3 groups. This indicates that the anti-tumor effect of intravesical instillation of the THP would be expected by only 30 min. of intravesical retention time at the THP concentration of 30 mg/30 ml. Then, we administered 30 mg/30 ml of THP solution for 30 min. to 10 patients intravesically 6 times every 48 hours to investigate its clinical anti-tumor effect and side effect. There were 2 complete responses, 3 partial responses and 5 cases with no changes for a total response rate of 50%. No side effect was observed. It is considered that 30 min. of intravesical retention time at the THP concentration of 30 mg/30 ml would be appropriate in terms of its anti-tumor effect and side effect.

[Gastrocystoplasty for severely contracted bladder following high dose pelvic irradiation: a case report]

A 24-year-old female who had received hysterectomy and adnexectomy of bilateral appendages for yolk sac tumor at the age of 12 years, followed by repeated surgery and pelvic irradiation over a total of 100 Gy for relapse of tumor, suffered from a severely contracted bladder and renal dysfunction of serum creatinine level over 2.0 mg/dl. The diagnosis was radiation-induced contracted bladder with renal dysfunction due to vesicoureteral reflux. Since the small intestine was not considered suitable after high dose irradiation, the stomach was used to reconstruct the bladder. The vesical pressure, which was 70 cmH2O at the capacity of 30 ml, was decreased to 22 cmH2O at the capacity of 100 ml, 5 weeks after surgery. The renal function was stable with a serum creatinine level below 1.4 mg/dl and the bladder capacity was 200 ml, 15 months after surgery. This method using the stomach was considered valuable for bladder reconstruction after large dose pelvic irradiation.

[A case of colo-vesico-vaginal fistula caused by sigmoid colon diverticulitis]

A 74-year-old woman was referred to our hospital with the chief complaints of pneumaturia, fecaluria and discharge of feces and urine from vagina. Fistulography on the vaginal side showed the presence of contrast medium both in the sigmoid colon and bladder. Colonoscopy revealed multiple diverticulosis of the sigmoid colon. Under diagnosis of colo-vesico-vaginal fistula due to sigmoid colon diverticulitis, a one-stage operation removing sigmoid colon, uterus-vaginal wall and urinary bladder wall including the fistula and careful reconstruction was performed. Postoperatively, urinary leakage from vagina in large amounts continued due to the recurrence of vesico-vaginal fistula. An attempt to use human fibrin glue in the recurrent fistula was successful, and the patient was asymptomatic at 21 months of follow-up. Colovesical fistula has been reported in about 10-20% of patients undergoing surgery for complicated diverticulitis, but a combined fistula is a rare condition. Furthermore, we recommend the use of human fibrin glue for a recurrent fistula.

Effect of citrate and pyrophosphate on the stability of calcium oxalate dihydrate

The effect of citrate and pyrophosphate on the stability of calcium oxalate dihydrate (COD) was studied in an aqueous solution over 7 days. COD was precipitated from 1.0 x 10(-2) mol/l calcium oxalate solution with the addition of citrate and/or pyrophosphate and separated by centrifugation immediately, 48 h and 7 days after the precipitation. The percentage of COD in the precipitate, determined by X-ray diffraction, increased with a rise in citrate or pyrophosphate concentration and reached > or =90% at a citrate concentration of 1.0 x 10(-3) mol/l or a pyrophosphate concentration of 2.0 x 10(-4) mol/l. The resulting COD was completely transformed into calcium oxalate monohydrate within 48 h when the precipitate was composed of <90% COD. Nearly pure COD produced with pyrophosphate was stable over 7 days while that with citrate underwent partial transformation within 48 h. An additive effect of citrate and pyrophosphate was found on the stability of COD. It was concluded that a pyrophosphate concentration above a critical point was sufficient to prevent solution-mediated transformation of COD, and this critical point might be lowered to the physiological range with the presence of citrate.

Smoking and neovascular form of age related macular degeneration in late middle aged males: findings from a case-control study in Japan. Research Committee on Chorioretinal Degenerations

AIMS

The risk of smoking habits for developing the neovascular form of age related macular degeneration (neovascular form of AMD) were studied by a case-control study in Japan.

METHODS

56 male patients with the neovascular form of AMD and 82 healthy male controls, aged 50 to 69 years, were enrolled. A self administered questionnaire provided necessary information for the study subjects. Questions on smoking included whether the study subjects have ever smoked or not, and if smoked, depth of smoke inhalation, use of extra filter, age at starting smoking, average number of cigarettes smoked per day, and duration of smoking. When a smoker had stopped smoking, age at cessation was also recorded. Unconditional logistic analysis was adapted to calculate age adjusted odds ratios and their 95% confidence intervals (CIs) for smoking related factors.

RESULTS

Age adjusted odds ratio of developing the neovascular form of AMD was 2.97 (95% CI 1.00-8.84) for current smokers and 2.09 (0.71-6.13) for ex smokers, compared with non-smokers. All smoking habit/smoking history related variables such as use of extra filter, smoke inhalation level, age at starting smoking, duration of smoking, and Brinkman index were found to be significantly related to an increased risk of the neovascular form of AMD.

CONCLUSIONS

Suggested is the strong possibility that cigarette smoking enhances the neovascular form of AMD risk in late middle aged males, though the magnitude of risk by smoking variables might be overestimated, in part, because of health oriented controls.

Report on the nationwide epidemiological survey of exudative age-related macular degeneration in Japan

The research Committee on Chorioretinal Degeneration, in cooperation with the Research Committee on the Epidemiology of Intractable Diseases, performed the second nationwide epidemiological survey of exudative age-related macular degeneration (AMD) in 1993. The number of exudative AMD patients in all ophthalmology departments throughout Japan was estimated to be 14,400 in 1993. This number was estimated to have almost doubled over the six year period since the initial survey in 1987. The number of people visiting ophthalmology departments due to exudative AMD was 53 males and 20 females per 100,000 population aged 50 years or over. The percentage of patients with bilateral disease increased with age and accounted for nearly 50% of those aged 80 years or over.

[Comparison between indocyanine green angiography and histopathological observations of choroidal neovascular membrane in age-related macular degeneration]

We classified choroidal neovascular membrane (CNM) (20 eyes) in age-related macular degeneration into four types (Type I: hyperfluorescence in both early and late phases, Type II: hyperfluorescence only in the early phase, Type III: hyperfluorescence only in the late phase, Type IV: virtually no hyperfluorescence in any phase) using indocyanine green angiography (IA). We performed surgery to remove CNM with these IA findings. After 17 surgically extracted specimens had been stained with hematoxylin-eosin and azan, they were examined by tight microscopy. Three other specimens were examined by electron microscopy. Type I showed many vascular channels, not present in the surrounding retinal pigment epithelium (RPE) cells, and little fibrous tissue. Type II had many vascular channels but RPE cells surrounded the CNM. Type III showed few vascular channels and RPE cell proliferation. Type IV showed abundant fibrous tissue. The IA findings of CNM were thought to be determined by the number of vascular channels, maturity of vessels, degree of surrounding by RPE cells, and the amount of fibrous tissue within the CNM.

[Antioxidants and angiogenetic factor associated with age-related macular degeneration (exudative type)]

To confirm the hypothesis that antioxidants and angiogenetic factors may be associated with the development of age-related macular degeneration (exudative type), we compared serum levels of vitamins A, C, and E and carotinoid, zinc, selenium and b-FGF (basic-fibroblast growth factor) in 35 patients with age-related macular degeneration (exudative type) with the levels in 66 controls. The average serum zinc level was significantly lower in the patient group than in the control group. Serum vitamin E-alpha levels also tended to be lower. Most serum b-FGF levels were below the standard value in each group. Based on the above results, we conclude that subnormal levels of zinc and vitamin E may be associated with the development of age-related macular degeneration.

Multicenter genetic study of retinitis pigmentosa in Japan: I. Genetic heterogeneity in typical retinitis pigmentosa

A nationwide, multicenter study of typical retinitis pigmentosa (RP) was carried out in collaboration with 18 hospitals throughout Japan to obtain current information for genetic counseling. We analyzed the genetic heterogeneity of RP based on the parental consanguinity of 434 probands registered during a 6-month period in 1990. A gradual decline in the frequency of consanguineous marriage was recognized among the normal parents of RP patients. The relative frequencies of inheritance patterns were estimated as: autosomal recessive, 25.2%; autosomal dominant, 16.9%; X-linked, 1.6%; and simplex, 56.3%. A comparison of these results with previous reports in Japan revealed a decline in the relative frequency of autosomal recessive cases and an increase in simplex cases. This suggests a decrease in the incidence of autosomal recessive retinitis pigmentosa in Japan, as well as the necessity for exhaustive investigations aimed at identifying inheritance patterns for RP patients seeking genetic counseling.

Multicenter genetic study of retinitis pigmentosa in Japan: II. Prevalence of autosomal recessive retinitis pigmentosa

Retinitis pigmentosa (RP) is a group of genetically heterogeneous diseases with autosomal recessive (AR), autosomal dominant, and X-linked modes of inheritance. Autosomal recessive retinitis pigmentosa (ARRP) is the most common form in Japan. A genetic analysis was done to determine the prevalence of ARRP indirectly, to provide an estimation of changing trends in the overall prevalence of RP. Data on the frequency of consanguinity and marriage year of normal parents of 59 ARRP patients were obtained from a nationwide multicenter survey of typical retinitis pigmentosa conducted in 1990. The gene frequency of ARRP was 0.01145 (Dahlberg's formula). In 1990, the number of young symptomatic ARRP patients decreased, while the number of patients aged 40 years and older increased. The total number of symptomatic ARRP patients in 1990 was nearly 21% higher than in 1970. Despite a dramatic decline in consanguinity in recent decades in Japan, the number of ARRP patients has increased. This increase is attributed to greater longevity and overall population growth. Our results suggest that the total number of RP patients has not decreased, and may even have increased.

Factors influencing visual acuity after photocoagulation for subfoveal choroidal neovascularization of exudative age-related macular degeneration

PURPOSE

To evaluate factors influencing visual acuity after laser photocoagulation for subfoveal choroidal neovascularization of exudative age-related macular degeneration.

METHODS

Subfoveal choroidal neovascular membranes were photocoagulated. Factors favoring a visual acuity of 20/200 or better were analyzed using Fisher's exact probability test or chi-square test on 28 eyes in which visual acuity was 20/200 or better, and 23 eyes with a visual acuity below 20/200 at the most recent follow-up examination.

RESULTS

Factors predicting a postoperative visual acuity of 20/200 or better were (1) distance between one lateral margin of the neovascular membrane and the center of the foveal avascular zone was one-third disc diameter or less, and (2) pretreatment retinal sensitivity at the fixation point was 10 dB or more.

CONCLUSION

Good indications for photocoagulation treatment of subfoveal choroidal neovascular membrane were a neovascular membrane margin near the center of the foveal avascular zone and relatively good retinal sensitivity at the fixation point adjacent to the scotoma. These factors predict a visual acuity of 20/200 or better after treatment.

[A case of multifocal choroiditis associated with progressive subretinal fibrosis]

Multifocal choroiditis associated with progressive subretinal fibrosis, which was reported by Cantrill and Folk in 1986, is characterized by acute multifocal choroiditis resulting in progressive subretinal fibrosis. All cases were young, healthy females. Our case was a 17-year-old female who complained of visual disturbance in her left eye. Ophalmoscopy showed multiple, small, yellowish-white hypopigmented, choroidial lesions in the posterior fundus of her left eye. These lesions showed hyperfluorescence in fluorescein angiography and hypofluorescence in indocyanine green (ICG) angiography. One month later the yellowish-white hypopigmented, choroidal lesions increased in number and subretinal fibrosis appeared in the macular area. Two months later subretinal fibrosis was also found in the area except for the macula. In her right eye, ophthalmoscopy and fluorescein angiography showed no abnormal findings, but ICG angiography revealed choroidal hypofluorescence areas. Two years later the subretinal fibrosis was increased and the yellowish-white lesions showed pigmentation.

Indocyanine green videoangiographic findings in detachment of the retinal pigment epithelium

BACKGROUND

Several forms of retinal pigment epithelial detachment have been reported. The authors used indocyanine green (ICG) videoangiography, which is useful to study the choroidal vasculature and Bruch membrane, to study pigment epithelial detachments.

METHODS

Ninety-eight pigment epithelial detachments in 75 eyes were classified based on the appearance of choroidal neovascular membranes or late phase findings of ICG videoangiography done at the initial examination. The authors also followed the evolution of 51 such detachments not associated with choroidal neovascularization (CNV).

RESULTS

Sixty-four pigment epithelial detachments without CNV were divided into five groups. Among eyes with pigment epithelial detachments that showed intense hyperfluorescence, all except one of the patients had both eyes involved and had several pigment epithelial detachments, sometimes with exudative retinal detachments. Weak hyperfluorescence was observed more often in younger patients. During follow-up of eyes with pigment epithelial detachments that showed irregular hypofluorescence, a neovascular membrane developed in one eye, microrips developed in four eyes and retinochoroidal folds in one eye. Most eyes that showed irregular hyperfluorescence developed atrophy of the retinal pigment epithelium. In 34 pigment epithelial detachments with CNV, either irregular hypofluorescence or absence of fluorescence was observed in areas that corresponded to the pigment epithelial detachment.

CONCLUSION

The intense hyperfluorescence is thought to be due to the accumulation of protein-rich fluid within the pigment epithelial detachment. Most pigment epithelial detachments that showed weak fluorescence probably represent variants of central serous choroidopathy. Pigment epithelial detachments that showed irregular hypofluorescence or hyperfluorescence were associated with age-related macular degeneration, and the former was correlated closely with CNV. Close follow-up therefore is recommended for eyes with pigment epithelial detachments that show irregular hypofluorescence.

[Changes of lymphocyte subpopulation in advanced renal cell carcinoma patients with marked response to alpha-interferon therapy]

At present, no sufficient therapy for advanced renal cell carcinoma is available. Interferon (IFN) therapy has been used to treat renal cell carcinoma, but the efficacy of it is low, with response rate being only about 20%. We experienced two patients with advanced renal cell carcinoma had marked response to IFN-alpha therapy in proximity effect. Using monoclonal anti-bodies of each subset of lymphocytes, the peripheral blood lymphocytes (PBL) in these patients were evaluated by two color flow-cytometry. And these results and clinical course were assessed. The lymphocyte subpopulation that change of clinical course is been similar to in these patients were Tc (CD11b-CD8+), TSI (leu8+ CD4+), ATS/C (CD8+ HLA-DR+) and ATH/SI (CD4+ HLA-DR+). And the pretherapeutic immunological status of these patients was characterized by significantly increased CD4+/CD8+ and TH/TS ratio. In conclusion, the clinical response of advanced renal cell carcinoma to IFN therapy might be found if CD4+/CD8+ and TH/TS ratio are increased at pretherapeutic immunological status. In addition, assessment of TSI, TC, ATH/SI, and ATS/C, as immune parameters for monitoring the actual immune status of patient is found to be necessary part of immunotherapy.

Observation of idiopathic full-thickness macular holes. Follow-up observation

OBJECTIVES

To evaluate the long-term follow-up observation of idiopathic full-thickness macular holes, with emphasis on the incidence and process of disappearance.

METHODS

The authors followed up 97 eyes with idiopathic full-thickness macular holes for a period ranging from 2 to 182 months (average, 66 months).

RESULTS

Apparent disappearance of the hole was observed in six eyes. Although improvement in visual acuity of at least 2 lines resulted in all six eyes, visual acuity improved to 20/30 or better in those eyes in which macular holes disappeared within 24 months of the initial examination.

CONCLUSION

The incidence of apparent disappearance of idiopathic full-thickness macular holes was low. Improvement in visual acuity was greater in those cases in which macular holes disappeared in a relatively short period of time.

Indocyanine green video angiographic findings in acute posterior multifocal placoid pigment epitheliopathy

The placoid lesions of acute posterior multifocal placoid pigment epitheliopathy consist of two distinct areas: a light yellow area surrounding a dark yellow center. On two occasions, the authors compared indocyanine green video angiographic with fluorescein angiographic findings in a typical case of acute posterior multifocal placoid pigment epitheliopathy. In the acute stage, the multiple placoid lesions observed in the early phase of indocyanine green video-angiography showed hypofluorescent lesions corresponding to those seen with fluorescein angiography which blocked choroidal vessels. Some fluorescent intermediate sized choroidal vessels, which traversed the hypofluorescent areas, were dark due to a slight degree of blocked fluorescence. On both indocyanine green video and fluorescein angiography, hypofluorescent lesions were almost the same size as the light yellow area and the dark yellow center of a placoid lesion. A hypofluorescent lesion, seen on fluorescein angiography, obscured a retinal vessel. When the placoid lesions had disappeared, fewer hypofluorescent lesions, corresponding to some of the hypofluorescent lesions originally observed, were seen in the early phase of indocyanine green video angiography. They were also smaller in size. These hypofluorescent lesions decreased in size and some had completely disappeared in the late phase. No hypofluorescent lesions were seen in the early phase of fluorescein angiography. Findings in the acute stage suggest that the hypofluorescence observed in the early phase of indocyanine green video and fluorescein angiography is mainly blockage due to a light yellow area of placoid. When the placoid lesion disappeared, filling delays, which were detectable on only indocyanine green video angiography, persisted in the choriocapillaris.

[Bietti's crystalline retinopathy]

The authors previously reported four cases with crystalline retinopathy and suggested that it be classified into three stages: 1) retinal pigment epithelium (RPE) atrophy in the posterior pole, 2) choriocapillaris atrophy appearing in the enlarged areas of RPE atrophy, and 3) prominent diffuse atrophy of both the RPE and choriocapillaris. We followed up 4 cases, including 2 cases which were previously been reported, and have now evaluated the clinical features of this disease. The results indicated that the above classification was clinically useful. Enlargement of the RPE atrophy from stage 2 to 3 was due to enlargement and confluence of the RPE atrophy between the posterior pole and the periphery. In addition, disturbances in ERG and color vision were thought to correlate with secondary dysfunction at the level of the photoreceptor cell layer within the diseased lesions.

[Foreign body stone of the ureter as a complication of acupuncture: report of a case]

A 47-year-old female was admitted to our clinic with the suspicion of ureteral foreign body. She had undergone acupuncture for left lumbago twelve years earlier. Plain X-ray film revealed a linear shadow and calcified shadows laterally to left third lumber vertebra. Computed tomographic scan and pyelogram showed them located in the left ureter. Left ureterolithotomy was performed successfully. The removed stone was accompanied by an acupuncture needle. Including our case, twelve cases of foreign bodies as a complication of acupuncture in the upper urinary tract reported in the Japanese literature were reviewed.