RECENT TRENDS IN THE CUMULATIVE INCIDENCE AND INTERVENTION PATTERNS OF RETINOPATHY OF PREMATURITY IN JAPAN: A Multicenter Analysis, 2011-2020

PURPOSE

To investigate recent trends in the cumulative incidence and treatment patterns of retinopathy of prematurity (ROP) in Japan.

METHODS

A retrospective multicenter cohort was conducted from 2011 to 2020 using the Diagnosis Procedure Combination inpatient database. Preterm newborns with birth weight <2,500 g were categorized by birth weight. The cumulative incidence of ROP, treatment patterns, and association between treatment and birth weight were investigated.

RESULTS

A total of 82,683 preterm infants were identified, of whom 9,335 (11.3%) were diagnosed with ROP. The cumulative incidence of ROP increased by 15% in those with birth weight <500 g over the study period. Among the ROP infants, 20.2% received treatment, including laser photocoagulation (94.8%), intravitreal injection (3.8%), or both (1.8%). The proportion receiving laser photocoagulation decreased followed by an increase in intravitreal injection. This shift in intervention pattern was most conspicuous for those with birth weight 750 to 1,249 g. The risk ratio of receiving laser and intravitreal injection for those weighing <500 g was 24.7 (95% confidence interval, 10.5-58.2) and 28.4 (5.8-138.1), respectively, as compared with infants weighing >1,500 g.

CONCLUSION

The cumulative incidence of ROP increased in infants with birth weight <500 g. A shift from laser photocoagulation to intravitreal injection was observed in the more recent years.

Vitrified before and after genome editing via electroporation

BACKGROUND

Cryopreservation of bovine zygotes allows for a flexible schedule of genome editing via electroporation. However, vitrification-induced cell membrane damage may not only affect embryonic development but also genome mutation.

OBJECTIVE

To investigate the effects of vitrification of zygotes before and after electroporation treatments on the development and genome mutation of bovine presumptive zygotes.

MATERIALS AND METHODS

In vitro-derived bovine zygotes were electroporated with the CRISPR/Cas9 system immediately (Vitrified-EP) or 2 h after incubation (Vitrified-2h-EP) following vitrification and warming, or electroporated before vitrification (EP-vitrified).

RESULTS

The development rates of vitrified-warmed zygotes were significantly lower (p < 0.05) than those of control zygotes that were not vitrified. Moreover, no differences were observed in the mutation rates and mutation efficiency of the blastocysts resulting from electroporated zygotes, irrespective of the timing of electroporation treatment.

CONCLUSION

Our results suggest that vitrification before and after electroporation treatments does not affect the genome editing of zygotes.

Relation between retrobulbar circulation and progression of diabetic retinopathy

AIMS

To investigate retrobulbar circulatory parameters in type 2 diabetic patients with and without diabetic retinopathy (DR) progression.

METHODS

This was a prospective cohort study. One eye of 35 diabetic patients with background DR (BDR) were included in the study. Eyes without DR, with proliferative DR, photocoagulation, past surgical procedures, or other ophthalmic disease except BDR and cataract were excluded. The study was masked. Colour Doppler imaging (CDI) was used to measure the retrobulbar circulation at the beginning of the study and after a mean follow up interval of 21 months. Peak systolic velocity (PSV), end diastolic velocity (EDV), and resistivity index (RI) in the central retinal artery and vein and the posterior ciliary artery were measured.

RESULTS

18 patients who developed DR progression showed significantly increased central retinal vein PSV ( 5.6 (3.5-9.1) p = 0.003), EDV ( 3.4 (2.3-4.4) p = 0.04), and RI ( 0.43 (0.20-0.56) p = 0.02) at the final measurement compared to the initial measurement (PSV = 4.6 (3.2-7.0); EDV = 3.0 (2.3-3.7); RI = 0.40 (0.17-0.52)). Circulatory parameters in the central retinal artery and the posterior ciliary artery did not alter significantly after progression of DR. 17 patients were without DR progression and they did not show any significant differences in the measured circulatory parameters on entry compared to the final measurement.

CONCLUSION

The authors suggest that the initial changes in the retrobulbar circulation during DR progression occur in the central retinal vein.

Retrobulbar circulation in myopic patients with or without myopic choroidal neovascularisation

AIM

To investigate the effect of myopia and myopic choroidal neovascularisation (CNV) on retrobulbar circulation in central retinal artery (CRA) and vein (CRV) and posterior ciliary artery (PCA).

METHODS

52 subjects with and without myopia were included in the study. Retrobulbar circulation was measured using colour Doppler imaging. Analysis of correlation of degree of myopia with blood flow velocity parameters was done. Circulatory differences between eyes of patients with unilateral neovascular degenerative myopia were estimated.

RESULTS

The analysis of correlation between dioptry and blood flow velocity in the CRA, CRV, and PCA showed a significant positive correlation. Axial length was also significantly correlated with CRA and CRV blood velocity and had a tendency to be correlated with PCA blood velocity. When compared with the fellow eye, the eye with myopic CNV had significantly higher resistivity index (RI) (p=0.048) in the PCA and no significant difference in the circulatory parameters of the CRA and CRV.

CONCLUSION

Central retinal and posterior ciliary blood velocity decreases with the increase of the degree of myopia. PCA RI is higher in myopic CNV.

Effect of topical unoprostone on circulation of human optic nerve head and retina

The purpose of the present study was to study the effect of topical unoprostone on the circulation of human optic nerve head (ONH) and retina in normal subjects. Using laser-speckle tissue blood flow analysis, normalized blur (NB), a quantitative index of tissue blood velocity, was measured every 0.125 sec at a temporal ONH site, free of visible surface vessels. Measurements were averaged for 3 cardiac cycles (NB(ONH)). Color Doppler imaging (CDI) was also used to evaluate peak systolic blood velocity (PSV), end-diastolic velocity (EDV), and resistive index (RI) in the central retinal artery (CRA) and mean blood velocity (MV) in the central retinal vein (CRV). For baseline comparison (Day 0), recordings of bilateral NB(ONH) and intraocular pressure (IOP), blood pressure (BP), and pulse rate (PR) were recorded in healthy volunteers before, and 45, 90, 180, and 270 min after instillation of one drop of unoprostone vehicle. On Day 1 (the day after baseline measurements), and twice daily for 7 days, one drop of 0.12% unoprostone was instilled into one eye and its vehicle into the other in a double-blinded manner. Measurements as on Day 0 were recorded on Days 1 and 7. CDI measurements were performed before and at 45 and 180 min after morning instillation on Days 1 and 7. During baseline recordings, there were no significant changes in any parameters. After administration of topical unoprostone, IOP was significantly lower bilaterally with more reduction in the unoprostone-treated eyes on Day 7. On Day 7, the NB(ONH) of the unoprostone-treated eyes was significantly higher 45 min after instillation than baseline (P = 0.035 with Bonferroni's correction). Analysis of variance for repeated measurements also revealed significant difference between Day 0 and Day 7 (P = 0.0017). BP, PR, NB(ONH) in the eye that received only the vehicle, PSV, EDV, and RI in the CRA in both eyes, and MV in the CRV in both eyes changed little. Tissue blood velocity in the ONH increased, at least temporarily, following instillation of unoprostone twice daily for 7 days. Although the clinical implication of the increase is unclear, the effects of topical unoprostone on human ONH circulation deserve further consideration.

Effects of topical latanoprost on optic nerve head circulation in rabbits, monkeys, and humans

PURPOSE

To evaluate the effect of topically administrated latanoprost on optic nerve head (ONH) circulation in Dutch rabbits, cynomolgus monkeys, and normal humans.

METHODS

The ONH tissue blood velocity (NB(ONH)) was determined using the laser speckle method. Latanoprost (0.005%, 30 microl) was instilled into one eye, and vehicle into the other eye as a control. In rabbits, NB(ONH) was measured for 90 minutes after a single instillation and before and after a 7-day once-daily instillation regimen. In monkeys, NB(ONH) was measured before and after 1, 4, and 7 days of a once-daily instillation regimen. The effect of intravenous indomethacin on the latanoprost-induced NB(ONH) change was also studied in rabbits and monkeys. In humans, the time-course changes in NB(ONH) were measured for 4.5 hours before and after a 7-day once-daily instillation regimen. Intraocular pressure (IOP) and systemic parameters were simultaneously studied in each experiment. All measurements were performed by investigators masked to the experimental condition.

RESULTS

Latanoprost significantly increased NB(ONH) 10% to 19% in treated eyes after a single instillation (P = 0.035) or 7-day instillation regimen (P = 0.035) in rabbits, after a 4-day (P = 0.035) or 7-day (P = 0.035) instillation regimen in monkeys, and after a 7-day (P = 0.013) instillation regimen in humans, whereas there were no significant changes in the vehicle-treated eyes in any of the experiments (P > 0.5). Pretreatment with indomethacin (5 mg/kg) abolished the NB(ONH) increase but not the IOP reduction in latanoprost-treated eyes in rabbits and monkeys. IOP remained unchanged in both eyes in rabbits (P > 0.4), whereas it significantly decreased only in latanoprost-treated eyes in monkeys (P < 0.05) and humans (P < 0.05).

CONCLUSIONS

Topical latanoprost significantly increased ONH blood velocity only in treated eyes in rabbits, monkeys, and humans. This effect was independent of the IOP-reducing effect of latanoprost and probably was associated with local penetration of the drug and the production of endogenous prostaglandins.

Two cases of frosted branch angiitis with central retinal vein occlusion

BACKGROUND

Frosted branch angiitis usually occurs in children, and has a good prognosis. We report two cases of unilateral frosted branch angiitis in adults. Both had poor visual outcomes because of associated central retinal vein occlusion and neovascular glaucoma.

CASES

Case 1 was a 36-year-old woman. Almost all retinal veins and some retinal arteries showed vasculitis in her right eye, and veins were slightly dilated and sheathed. Case 2 was a 23-year-old woman. Angle hypopyon was observed in her left eye. Retinal veins were dilated, meandering, and sheathed. Retinal hemorrhages were also observed. In both cases, after systemic steroid therapy the retinal vasculitis gradually decreased, but central retinal vein occlusions gradually developed. Despite systemic administration of urokinase and panretinal photocoagulation, neovascular glaucoma developed, and visual acuity diminished in both cases.

CONCLUSIONS

Two cases of frosted branch angiitis complicated by retinal vein occlusion are reported. Careful observation of retinal blood flow is necessary in frosted branch angiitis in adults.

Topical latanoprost and optic nerve head and retinal circulation in humans

The purpose of the present study was to study the effect of a single instillation of latanoprost on the human optic nerve head (ONH) and retinal circulation. Using laser-speckle tissue blood flow analysis, normalized blur (NB; a quantitative index of tissue blood velocity) was measured every 0.125 sec at a temporal ONH site free of visible surface vessels. Measurements were averaged for 3 cardiac cycles (NB(ONH)). Color Doppler Imaging (CDI) was also used to evaluate peak systolic blood velocity (PSV), endo-diastolic velocity (EDV), and resistive index (RI) in the central retinal artery (CRA) and mean blood velocity (MV) in the central retinal vein (CRV). One drop of 0.005% latanoprost was instilled into one eye and its vehicle into the other in eleven healthy volunteers in a double-blinded manner. Measurements of bilateral NB(ONH), CDI parameters, intraocular pressure (IOP), blood pressure (BP), and pulse rate (PR) were performed before, and 45, 90, 180, and 270 min after instillation. After a single instillation of latanoprost or the vehicle, there was no significant bilateral difference throughout the experimental period. The difference in NB(ONH) between that before and at each time point of measurement (delta NB(ONH)) in the latanoprost-treated eyes was significantly higher between 45 and 270 min after instillation than that in vehicle-treated eyes (P = 0.0003 to 0.0156); ANOVA for repeated measurements also revealed significant difference between both eyes (P < 0.00001). BP, PR, and NB(ONH) in the eye that received only the vehicle, PSV, EDV, and RI in the CRA in both eyes, and MV in the CRV in both eyes changed little. Tissue blood velocity in the ONH increased at least temporarily following a single instillation of topical latanoprost. Although the mechanism of the increase is unclear, the effects of latanoprost on ONH tissue circulation in humans may have clinical implications.

Choroidal circulation in diabetic patients

PURPOSE

To evaluate choroidal circulatory changes in diabetic patients with and without background diabetic retinopathy (BDR) by measuring the retrobulbar circulation with colour Doppler imaging (CDI).

METHODS

CDI was used to measure circulatory parameters of the PCA (posterior ciliary artery), CRA (central retinal artery), OA (ophthalmic artery) and the respective veins in 73 diabetic patients and 22 controls in a sitting posture. Among the diabetic patients, 38 patients were without diabetic retinopathy (NDR) and 35 had BDR. A non-parametric Kruskal-Wallis test with a Dunn correction was used for data analysis.

RESULTS

End-diastolic velocity (EDV) in the PCA was decreased (2.55+/-0.80 cm/s) and resistivity index (RI) in the PCA was increased (0.70+/-0.08) in BDR patients compared with the control patients' EDV (3.23+/-1.08 cm/s, p = 0.01) and RI (0.62+/-0.06, p = 0.0003). RI in the CRA was significantly higher in the BDR group (0.74+/-0.09) than in the control group (0.68+/-0.08, p = 0.006). RI in the OA was significantly higher in the BDR group (0.87+/-0.06) compared both with the NDR group (0.83+/-0.07) and with the control group (0.81+/-0.06; p = 0.007, p = 0.004). NDR patients had a significantly higher RI in the PCA (0.67+/-0.08) than control patients (0.62+/-0.06, p = 0.01, while the CRA RI (0.71+/-0.09) did not show significant differences from the control group (0.69+/-0.08, p = 0.32). Decreased EDV in the CRA was detected in NDR patients (2.16+/-0.76 cm/s) compared with the controls (2.72+/-0.92 cm/s, p = 0.007).

CONCLUSION

The results from this study suggest that not only the retinal but also the choroidal circulation is affected in NDR and BDR patients.

Optic nerve head circulation after intraocular pressure reduction achieved by trabeculectomy

OBJECTIVE

To study the effects of trabeculectomy and needling revision of poorly functioning blebs on the optic nerve head (ONH) circulation in patients with primary open-angle glaucoma (POAG).

DESIGN

Prospective, nonrandomized, self-controlled trial.

PARTICIPANTS

Nineteen POAG patients (age range, 52 +/- 12 years; mean +/- standard deviation) undergoing trabeculectomy and six POAG patients (age range, 62 +/- 14 years) undergoing needling revision of the bleb.

METHODS

Using the laser speckle method, the normalized blur (NB) value, a quantitative index of blood velocity, was determined every 0.125 seconds and averaged more than three cardiac pulses in the optic nerve head (NB(ONH)).

MAIN OUTCOME MEASURES

The NB(ONH) and intraocular pressure (IOP) in both eyes, and blood pressure (BP) and pulse rate (PR) were measured before and 2 days and 1, 4, and 8 weeks after trabeculectomy, and also before and 10 and 40 min after needling procedures.

RESULTS

Intraocular pressure in the operated eye was significantly decreased after trabeculectomy or needling procedures, and the ocular perfusion pressure was significantly increased by a maximum of 38%. The IOP in the unoperated eye, BP, and PR did not significantly change. The NB(ONH) did not significantly change in either the operated or unoperated eye.

CONCLUSIONS

Trabeculectomy and needling procedures induced little change in the ONH circulation.

The acute effects of stellate ganglion block on circulation in human ocular fundus

PURPOSE

To study the acute effects of local-anesthetic stellate ganglion block (SGB) on tissue circulation in the human fundus.

METHODS

Eleven patients with Bell's palsy (age 56+/-6 y, mean+/-SD) who underwent SGB for its treatment participated in the study. Using the laser speckle method, normalized blur (NB) value, a quantitative index of tissue blood velocity, was measured every 0.125 s over an area located halfway between the macula and the optic nerve head (ONH) with no discrete visible vessels and averaged over 3 pulses when fixation was satisfactory (NB(ch-ret)). NB(ch-ret) and intraocular pressure (IOP) in both eyes, blood pressure (BP), and pulse rate (PR) were measured before, and 10, 20, 30, and 60 min after SGB. SGB was induced by injecting 1% mepivacaine hydrochloride (5 ml) into the vicinity of the seventh cervical vertebra on the paralyzed side.

RESULTS

The IOP in the blocked side significantly decreased between 20 and 60 min following SGB, compared to the baseline, while IOP in the unblocked side remained unchanged. The NB(ch-ret) was significantly increased after 10 min by about 8% in the blocked side, but its effect almost disappeared at 60 min. There was no significant change in NB(ch-ret) in the unblocked side, BP or PR throughout the experimental period.

CONCLUSION

SGB increased tissue circulation in the fundus in the blocked side, but its effect was thought to be small and transient.

The acute effects of cigarette smoking on human optic nerve head and posterior fundus circulation in light smokers

PURPOSE

To study the acute effects of cigarette smoking on tissue circulation in the optic nerve head (ONH) and posterior fundus in smokers with a short smoking history.

METHODS

Ten healthy smokers whose length of smoking history was within 2 years (age 25 +/- 1 years; smoking index (number of cigarettes smoked per day x length of smoking history in years) 16 +/- 4, mean +/- SE) were included in the study. Using the laser speckle method, normalised blur (NB) value, a quantitative index of tissue blood velocity, was measured every 0.125 s and averaged over three pulses across an area located in the temporal site of the ONH free of visible surface vessels (NBONH) and across an area located halfway between the macula and the ONH with no discrete vessels visible (NBch-ret). NBONH, NBch-ret and intraocular pressure (IOP) in one randomly chosen eye, and blood pressure (BP) and pulse rate (PR) were measured before, and 1, 5, 10, 15, 20, 25, 30, 45, 60 and 90 min after sham smoking. One week later, NBONH, NBch-ret and IOP in the same eye, and BP and PR were measured after cigarette smoking according to the same time schedule as in the control experiment.

RESULTS

After sham smoking, no parameter showed a significant change during the experiment. Differences in NBONH from the baseline were not significant between the smoking experiment and sham smoking experiment, while NBch-ret showed a significant difference at 30 min. Inter-group difference in the time course of the difference from baseline was significant (ANOVA, p = 0.0246, 0.0021). BP and PR were significantly increased between 1 and 20 min after smoking while IOP showed no significant change at any time of measurement.

CONCLUSIONS

In light smokers, cigarette smoking showed little effect on tissue blood velocity in the ONH and slightly decreased that in the posterior fundus, suggesting a significant increase in vascular resistance in these tissues.

Effects of scleral buckling and encircling procedures on human optic nerve head and retinochoroidal circulation

AIMS

To study the effects of segmental scleral buckling and encircling procedures on tissue circulation in the human optic nerve head (ONH) and choroid and retina.

METHODS

Using the laser speckle method, the normalised blur (NB) value, a quantitative index of tissue blood velocity, was measured every 0.125 seconds and averaged over three pulses in the optic nerve head (NB(ONH)) and choroid and retina (NB(ch-ret)) in 10 patients with unilateral rhegmatogenous retinal detachment (mean age 52 (SD 17)). NB(ONH), NB(ch-ret), and intraocular pressure (IOP) in both eyes, and blood pressure (BP) were measured before, and 1, 4, and 12 weeks after the scleral buckling and encircling procedure.

RESULTS

NB(ch-ret) on the buckled side was significantly reduced after surgery and smaller than that in the unoperated contralateral eye throughout the study period (ANOVA, p<0.0001). NB(ch-ret) on the unbuckled side, in the foveal area, NB(ONH), IOP, and BP showed no significant change.

CONCLUSIONS

It was indicated that the segmental scleral buckling procedure with encircling elements decreased tissue blood velocity in the choroid and retina on the buckled side but caused no significant change on tissue circulation in other areas of the fundus or ONH.

[Two cases of frosted retinal angiitis with central retinal vein occlusion]

BACKGROUND

Frosted retinal angiitis usually occurs in children, and has a good prognosis. We report two cases of unilateral frosted retinal angiitis in adults. They resulted in visual degradation because of associated central retinal vein occlusion and neovascular glaucoma.

CASES

Case 1 was a 36-year-old female. Almost all retinal veins and some retinal arteries had vasculitis in her right eye, and the veins were slightly dilated and sheathed. Case 2 was a 23-year-old female. Angle hypopyon was observed in her left eye. Retinal veins were dilated, meandered, and sheathed. Retinal hemorrhages were also observed. In both cases, systemic steroid therapy gradually improved the retinal vasculitis, but central retinal vein occlusions gradually developed, and in spite of systemic administration of urokinase and panretinal photocoagulation, neovascular glaucoma developed, and visual acuity became degraded in both cases.

CONCLUSION

Two cases of frosted retinal angiitis complicated by retinal vein occlusion were reported. Careful observation of retinal blood flow is necessary in frosted retinal angiitis in adults.

Effect of topical betaxolol on tissue circulation in the human optic nerve head

There have been no reports to date on long-term betaxolol instillation effects on the human optic nerve head (ONH) tissue circulation. The purpose of this study was to study the effect of topical 0.5% betaxolol on tissue blood velocity in the human ONH. Using a laser-speckle tissue blood flow analyzer, normalized blur (NB; a quantitative index of tissue blood velocity) was measured every 0.125 seconds at a temporal ONH site free of visible surface vessels. Measurements were averaged for 3 cardiac cycles (NB(ONH)). For baseline comparison (day 0), recordings of bilateral NB(ONH) and intraocular pressure (IOP), blood pressure (BP) and pulse rate (PR) were recorded in healthy volunteers before, and 2, 4.5, and 7 hr after, instillation of 30 microL of betaxolol vehicle, and again on day 21; IOP was also recorded on days 7 and 14. On day 1 (the day after baseline measurements), and twice daily for 3 weeks, 30 microL of 0.5% betaxolol into one eye and 30 microL vehicle was instilled into the other in a double-blind study. Measurements as on day 0 were again recorded on day 21; IOP was also recorded on days 7 and 14. During baseline recordings, no significant changes were noted in any parameters. After administration of topical betaxolol, IOP was significantly reduced, bilaterally, with greater reduction in the betaxolol-treated eyes on day 21. Also on day 21, the NB(ONH) of the betaxolol-treated eyes was significantly higher 4.5 hr after instillation than that of the comparable baseline recording (p = 0.035 with Bonferroni's correction); BP, PR, and NB(ONH) in the eye which received only the vehicle showed little change. Tissue blood velocity in the human ONH was increased at least temporarily by instillation of topical betaxolol twice daily for 3 weeks. Although the obtained increase is small and may be clinically insignificant, the potential of betaxolol that can affect the ONH tissue circulation in humans after 21 days of instillation is thought to deserve further investigation.

Real-time blood velocity measurements in human retinal vein using the laser speckle phenomenon

PURPOSE

To measure the in vivo blood velocity in human retinal veins using a laser speckle system.

METHODS

The system consists of a fundus camera, a diode laser, an image sensor, and a personal computer system. The fundus area, including a target retinal vein, is illuminated with a diode laser through a fundus camera and the laser speckle pattern is imaged onto the area sensor. From the time change of the contrast of the speckle pattern, the normalized blur (NB) value, a quantitative index of blood velocity, was calculated using a logic board.

RESULTS

In an in vitro experiment, the NB obtained from blood flow in 50-300 microm internal diameter glass capillary tubes, used as an analogue of a retinal vein, correlated with the diameter of the tube, the actual blood flow rate, and the background NB value, which was used as an analogue of choroidal circulation. In the in vivo experiment, the blood velocity in human retinal veins of approximately 50 microm in diameter was estimated in 16 normal human eyes using nomograms based on the result of the in vitro experiment. Velocity averaged 11.1+/-0.6 mm/s (mean +/- SD, n = 16) in retinal veins 53+/-6 microm in diameter. The coefficient of reproducibility of 5-minute interval measurements was 2.5+/-0.9%, and it took 63+/-15 seconds for one measurement.

CONCLUSIONS

The present methodology is clinically valid for measuring blood velocity in retinal veins.

Effects of nilvadipine, a calcium antagonist, on rabbit ocular circulation and optic nerve head circulation in NTG subjects

PURPOSE

To study the effects of nilvadipine, a Ca2+ antagonist, on tissue circulation in the optic nerve head (ONH), choroid, and retina in rabbits and on the ONH circulation in normal tension glaucoma (NTG) patients.

METHODS

Nilvadipine (3.2 microg/kg) or vehicle solution was injected intravenously into urethane-anesthetized rabbits, and the normalized blur value (NB), a quantitative index of in vivo tissue blood velocity, was measured in the choroid and in an area of the ONH and retina free of visible surface vessels before and for 90 minutes after injection, using the laser speckle method. The effects of nilvadipine on the ONH circulation was also studied using the H2 gas clearance method in separate groups of rabbits. Oral nilvadipine (4 mg/d) or placebo was administered to NTG patients in a double-masked manner, and NB in an area of the ONH rim free of visible surface vessels was measured by the same method before and 2, 4, 8, and 12 weeks after administration.

RESULTS

The NB obtained from the ONH, choroid, or retina during the experimental period was increased by approximately 10% to 25% in the nilvadipine group compared with the NB in the control group (P < 0.0001, ANOVA), although systemic condition parameters and intraocular pressure (IOP) showed no significant intergroup difference except for a transient decrease in blood pressure in the nilvadipine groups. Blood flow rate in the ONH determined by the H2 gas clearance method also showed an approximately 25% increase in the nilvadipine group. The NB in the ONH of the oral nilvadipine-treated patients was significantly increased, by approximately 20% compared with the placebo-treated patients throughout the follow-up period. No significant intergroup difference was seen in blood pressure, pulse rate, or IOP.

CONCLUSIONS

Nilvadipine increased blood velocity and, probably, blood flow in the ONH, choroid, and retina of rabbits. It also increased blood velocity in the ONH of NTG patients.

Acute effects of cigarette smoking on tissue circulation in human optic nerve head and choroid-retina

OBJECTIVE

To study the acute effects of cigarette smoking on tissue circulation in the human optic nerve head (ONH) and choroid-retina.

DESIGN

Nonrandomized, comparative trial (sequential self-controlled).

PARTICIPANTS

Nine healthy habitual smokers (age, 28 +/- 4 years; number of cigarettes smoked per day, 27 +/- 10; length of smoking history, 10 +/- 4 years; mean +/- standard deviation).

INTERVENTION

Using the laser speckle method, normalized blur (NB) value, a quantitative index of tissue blood velocity, was measured every 0.125 second and averaged over three pulses across an area located in the temporal site of the ONH free of visible surface vessels (NB(ONH)) and across an area located halfway between the macula and the ONH with no discrete vessels visible (NB(ch-ret)). NB(ONH), NB(ch-ret), and intraocular pressure (IOP) in one randomly chosen eye, and blood pressure (BP) and pulse rate (PR) were measured before and 1, 5, 10, 15, 20, 25, 30, 45, 60, and 90 minutes after sham smoking using a short drinking straw as a cigarette substitute (control). One week later, NB(ONH), NB(ch-ret), and IOP in the same eye, and BP and PR were measured after cigarette smoking according to the same time schedule as in the control experiment.

MAIN OUTCOME MEASURES

NB(ONH) and NB(ch-ret).

RESULTS

In the control experiment, all parameters examined showed no significant change during the experimental period. Differences in NB(ONH) and NB(ch-ret) before and after actual smoking were significantly greater than those in the control experiment (analysis of variance, P = 0.0000, 0.0000). BP and PR were significantly increased between 1 and 30 minutes after actual smoking as compared with control data, while IOP showed no significant change at any time of measurement.

CONCLUSIONS

These results indicated that cigarette smoking increased tissue blood velocity in the ONH and possibly in the choroid in habitual smokers.

[A case of neuroblastoma with abnormal LD isoenzyme]

We encountered a patient with neuroblastoma showing remarkably high total LD activity (12,585 IU/l). His liver and heart function was normal. In the serum LD isoenzyme pattern, LD1 was increased, and LD2 extra band (LD2 ex) was observed on the negative pole side of LD2. However, LD2 ex was absent in erythrocytes of the patient, which demonstrates the exclusion of genetic factors. Neither the enzyme counter current method or immunofixation showed immune complexes, excluding anomalies. The LD isoenzyme in a metastatic lymphnode lesion before treatment showed increased LD1. The LD isoenzymes in the tissue, removed after 5 courses of chemotherapy, showed predominance of LD3 and absence of LD2 ex. Rapid decreases in the serum total LD activity and LD1 fraction and the disappearance of LD2 ex after chemotherapy suggest that these changes in the two LD fractions are associated with production of abnormal LD (LD2 ex) by the tumor.

Effects of topical adrenergic agents on tissue circulation in rabbit and human optic nerve head evaluated with laser speckle tissue circulation analyzer

The effects of topical adrenergic agents on the tissue circulation of the optic nerve head (ONH) were studied in animal and human eyes with use of a laser speckle tissue circulation analyzer. Drugs studied were nipradilol, a beta1-2-blocker with weak alpha-blocking and nitroglycerinlike activities; bunazosin, a selective alpha1-blocker; carteolol, a beta1-2-blocker with intrinsic sympathomimetic activity; and betaxolol, a selective beta1-blocker. In the animal experiment, one eye each of nine albino rabbits received 0.25% nipradilol (N = 9) twice daily for 15 days or 0.01% bunazosin (N = 10) twice daily for 20 days; the fellow eye received the vehicle of each drug in a randomized masked design. Normalized blur (NB) in an area of ONH free of visible surface vessels, a quantitative index of peripheral blood velocity in ONH, was measured under general anesthesia before treatment and 2 hours after the last instillation on the 15th or 20th day. At 15 days, intraocular pressure and NB in the nipradilol-treated eyes decreased by 4.3 mm Hg (P < 0.01) and increased by 15.9% (P < 0.01), respectively, while those in the vehicle-treated eyes showed little change. At 20 days NB in both bunazosin- and vehicle-treated eyes showed little change, while intraocular pressure decreased only in the bunazosin-treated eyes (P < 0.01). In the human volunteer experiment NB was averaged over five pulses (mean NB) in both eyes before and 1.5, 3.0 and 4.5 hours after a 30 microL instillation of the vehicle of carteolol or betaxolol to serve as a control. Intraocular pressure, blood pressure and pulse rate were also measured. One week later a 30 microL drop of 2.0% carteolol (N = 6) or 0.5% betaxolol (N = 10) was instilled in one randomly chosen eye and the vehicle for each drug in the other eye, and those parameters were measured as above in a double-masked manner. In the carteolol experiment, mean NB in both eyes was significantly higher at 3 hours than it was in the control experiment (P < 0.05), while intraocular pressure was significantly lower in both eyes and blood pressure and pulse rate showed little change. In the betaxolol experiment, intraocular pressure at 1.5 hours and blood pressure at 4.5 hours were significantly lower than those in the control experiment (P < 0.05), while mean NB and pulse rate showed little change. In summary, using the laser speckle method we found that topical nipradilol and carteolol increase ONH blood velocity in rabbits and humans, respectively. This finding suggests that some topical beta-blockers used clinically may influence the ONH tissue circulation in patients and that this method may be used in clinical situations to assess the effect of various drugs on ONH circulation.

Effect of topical beta-blockers on tissue blood flow in the human optic nerve head

PURPOSE

To study the effect of topical 0.5% timolol and 2% carteolol on tissue blood flow in the human optic nerve head (ONH).

METHODS

Using a laser speckle tissue blood flow analyzer, normalized blur (NB), a quantitative index of tissue blood velocity, was measured every 0.125 s in the temporal site of the ONH free of visible surface vessels and averaged over 3 cardiac pulses (NBONH). To serve as a baseline, NBONH and intraocular pressure (IOP) in both eyes, blood pressure (BP) and pulse rate (PR) were recorded in healthy volunteers before, 1.5, 3 and 4.5 hrs after a 30L instillation of the vehicle of timolol or carteolol. From the following day and twice daily for 3 weeks, 30L of either 0.5% timolol or 2% carteolol was instilled into one eye and the respective vehicle into the fellow eye in a masked manner. NBONH, IOP, BP and PR were again recorded on the 21st and last experiment day. IOP was also recorded on the 7th and 14th days. Carteolol concentration in the plasma was also recorded after instillation of carteolol on the 21st day.

RESULTS

During the baseline experiments, all the parameters recorded showed no significant change. After topical timolol, IOP was significantly reduced bilaterally with more reduction in the timolol-treated eye. Bilateral NBONH, BP and PR showed little change on the 21st day. After topical carteolol, IOP was significantly reduced bilaterally with more reduction in the carteolol-treated eyes on the 21st day. NBONH in the carteolol- and vehicle-treated eyes was significantly higher on the 21st day than recorded in the same eye in the baseline experiment (P = 0.013 and 0.047), while BP and PR showed little change. The maximum carteolol concentration in plasma at 3 hrs on the 21st day averaged 1294 pg/ml.

CONCLUSIONS

Results indicated that 3-week twice daily topical timolol treatment had no deleterious effect on the ONH tissue blood flow in the human eye, and that 3-week twice daily topical carteolol treatment may increase the tissue blood flow in the human ONH.

[A clinical study of 1079 patients with laryngeal cancer]

A clinical study was made of 1079 patients with previously untreated laryngeal cancer registered in our department during the 15 years between 1979 and 1993. Their mean age was 64.2 years, ranging from 22 to 91. The male to female ratio was 13:1 and the proportion of non-smokers was 3.2%. These patients consisted of 687 with glottic carcinoma (64%), 373 with supraglottic carcinoma (35%) and 12 with subglottic carcinoma (1%). A sexual difference with regard to the proportion of glottic carcinoma was found; 66% in males and 39% in females. Therefore, the male to female ratios according to the primary sites were 22:1 for the glottis and 8:1 for the supraglottis. According to the TNM classification (UICC 1987), there was a marked difference in the distribution between glottic type and supraglottic type: of the glottic type 439 cases (64%) were stage I, 159 (23%) stage II, 73 (11%) stage III, 16 (2%) stage IV, whereas of the supraglottic type 22 (6%) were stage I, 99 (27%) stage II, 136 (36%) stage III, 116 (31%) stage IV. Our treatment policy for laryngeal cancer has depended not only on the T stage but also on the cancer characteristics including the growing type, anatomical location and extension and depth of invasion. Of the 1079 patients, 1050 were treated radically, 17 palliatively and 12 were not treated. According to the T stage, radical irradiation was chosen for 410 cases (93%) of glottic T1, for 75 cases (45%) of glottic T2 and for 21 cases (81%) of supraglottic T1. Partial laryngectomy was performed in 16 patients (4%) with glottic T1, in 15 patients (10%) with glottic T2 and in 8 patients (6%) with supraglottic T2. Total laryngectomy was performed in almost all patients with T3, T4. The overall 5-year relative survival rate, cumulative crude survival rate and cause-specific survival rate were 84%, 72% and 88%, respectively. The survival rates for the glottic type were significantly higher than those for the supraglottic type (p < 0.0001): the 5-year relative survival rate, cumulative crude survival rate and cause-specific survival rate for the glottic type were 93%, 80%, and 95% whereas for the supraglottic type they were 68%, 58% and 76%, respectively. The 5-year relative survival rates for stage I through stage IV were 96%, 87%, 72% and 53% overall and they were 98%, 91%, 74% and 52% for the glottic type, whereas they were 67%, 83%, 70% and 52% for the supraglottic type, respectively. The results suggested that the better survival rate for glottic T1, which accounted for 64% of all glottic cases, made a great difference in the survival rate between glottic and supraglottic carcinoma.

[Measurements of blood flow velocity in human retinal veins using laser speckle flowgraphy system]

We measured the blood flow velocity in human retinal veins using a laser speckle flowgraphy system. This system consists of a fundus camera, a diode laser, an image sensor and a personal computer system. The fundus is illuminated with a diode laser through a fundus camera and the laser speckle pattern is imaged onto the area sensor. From the time change of contrast of speckle pattern, normalized blur (NB) value, a quantitative index of tissue blood velocity, was calculated by means of a logistic board, and two-dimensional distribution of NB in the measurement field was displayed in a color display. In the in vitro experiment, the NB obtained from the blood flow in a glass capillary tube was correlated with the diameter of the tube, background NB value and the blood flow rate actually measured. In the in vivo experiment, the blood velocity in human retinal veins of approximately 50 microns in diameter was estimated in 16 normal eyes using nomograms based on the results of the in vitro experiment. Velocity averaged 11.1 +/- 0.6 mm/ sec (mean +/- standard deviation, n = 16) in retinal veins of 53 +/- 6 microns in diameter and the reproducibility index of the in vivo measurements was 2.5 +/- 0.9%.

Real-time measurement of human optic nerve head and choroid circulation, using the laser speckle phenomenon

A modification of a previously described instrument that used the laser speckle phenomenon for noncontact two-dimensional analysis of the fundus tissue circulation was devised so that tissue circulation in the optic nerve head (ONH) or choroid of the human eye could be measured on a real-time basis. The fundus was illuminated by a diode laser spot and the image speckle was recognized by an area sensor. A quantitative index of blood velocity, normalized blur (NB), was calculated by a logistic board every 0.125 seconds for 7 seconds. Using this modified device, the average NB of the measurement field in the temporal ONH, free of visible surface vessels (NBONH), and that in the posterior choroid (NBch) of normal human eyes were measured. The coefficients of reproducibility of 1-minute interval measurements were 11.7% for the NBONH) and 8.7% for the NBch (each, an average of 5 pulses), and those of 24-hour interval measurements were 13.0% (NBONH) and 9.7% (NBch). The pulsatile component average of NBONH was 38.4% of mean NBONH; of NBch, 26.6% of the mean NBch.

[A clinical study of squamous cell carcinoma of the tongue base]

Between 1979 and 1992, 27 previously untreated patients with squamous cell carcinoma involving the base of the tongue underwent treatment with curative intent. Seven patients were in Stage I, II (26%) and 20 patients were in stage III, IV (74%). Seventeen patients (63%) presented clinically with neck metastasis. The patients were followed for a minimum of two years or until death or recurrence. Primary tumors treated with surgery or radiotherapy showed control rates of 80% (12 of 15 tumors) and 88% (7 of 8 tumors), respectively. The overall survival was 59 percent at 5 years. For the patients with exophitic primaries, local control with radiotherapy produced excellent results, whereas for advanced or deeply invasive tumors, surgery enhanced local control. Radiation therapy successfully controlled early neck disease (N0, N1). Patients with advanced neck disease (N2, N3) had poor regional control with radiotherapy, necessitating subsequent neck dissection. Forty-three percent of the N2b or N3 patients were found to have contralateral occult metastasis. Results obtained in the present study show that patients with T3, T4 or N2, N3 should undergo surgery. Prospective trials are necessary to compare surgery versus definitive radiotherapy with respect to patient survival and quality of life.

[Treatment of bilateral neck metastases in laryngeal cancer]

Laryngeal cancer is one of the most curable malignancies. One of the reasons is that most of them are in the early stage. However, the prognosis of advanced bilateral neck metastases is still poor. Based on loco-regional failure and cause of death, the effective procedure of neck dissection and the efficacy of postoperative irradiation were investigated retrospectively. A total of 1022 patients with laryngeal squamous cell carcinoma were registered in our hospital between 1979 and 1991, 58 of them (5.7%) had bilateral neck metastases. Clinical N2c cases accounted for 52% (32/58). In the other patients, the metastatic nodes were revealed by elective neck dissection for a clinically negative neck. The T stages of the 58 cases were as follows; T2 in 14 cases, T3 in 22 and T4 in 22. Forty-nine of the patients treated curatively by bilateral neck dissection were analyzed, 48 with total laryngectomy and 1 with partial laryngectomy. The remaining 9 patients were excluded because of radical irradiation in 3, distant metastases found the diagnosis in 3, unresectable recurrent neck metastases treated in other hospitals in 2 and no treatment because of severe myocardial infarction in 1. Cumulative crude and cause-specific 5-year survival rates for the 49 patients were 32.2% and 52.2%, respectively. Nineteen patients died of their disease; 10 of them of an uncontrolled neck lesion. From a comparison of the surgery alone group (28 cases) with a surgery plus irradiation group (21 cases) which consisted of preoperative irradiation in 2 and postoperative in 19, addition of irradiation may be effective for loco-regional control. Eight patients died of an uncontrolled neck lesion in the surgery alone group, while there were only 2 deaths in the postoperative irradiation group. Nevertheless there were no significant differences in survival: the cumulative crude and cause-specific 5-year survival rates in the surgery alone group were 34.4% and 56.2%, respectively, while those in the surgery plus irradiation group were 28.6% and 46.3%, respectively. It is obvious that the procedure of neck dissection influenced the loco-regional control. Excluding the recurrence-free patients who died of intercurrent diseases within 2 years, recurrence in the ipsilateral neck was found in 1 of 12 patients with radical neck dissection (RND), in 1 of 3 with modified radical neck dissection (MRND), in 2 of 15 with lateral neck dissection (lateral ND) and in 9 of 11 with regional neck dissection (regional ND). Recurrence is the contralateral neck were found in none of 2 with RND, of 3 with MRND and of 20 with lateral ND, but in 6 of 16 with regional ND. These results suggest that regional ND was insufficient to accomplish loco-regional control in those patients and that lateral ND or MRND or RND may be required bilaterally. Since 1986, all patients except 1 were treated by more extensive maneuvers than lateral ND bilaterally, so that loco-regional recurrence was found in only 1 case, in spite of the fact that the surgery alone group accounted for 73% (19/26). Cumulative crude and cause-specific 5-year survival rates for the patients prior to 1985 (23 cases) were 26.1% and 32.6%, respectively, while those for the patients since 1986 (26 cases) were 38.5% and 76.9%, respectively. There was no significant difference (p = 0.73) in cumulative crude 5-year survival rates between the 2 groups, but the difference in their cause-specific 5-year survival rates was statistically highly significant (p = 0.0032). It was concluded that lateral ND, MRND or RND should be required bilaterally for the patients with bilateral neck metastases and that addition of irradiation is not always indispensable for patients treated by curative neck dissection, such as lateral ND, MRND or RND.

Protective efficacy of sodium hyaluronate on the corneal endothelium against the damage induced by sonication

The protective efficacy of sodium hyaluronate (Na-HA) on the corneal endothelium against the damage induced by sonication was investigated using enucleated rabbit eyes and Na-HA fluorescence labeled with 5-aminofluorescein (FA-HA). The anterior chamber was reformed by injecting a 1% solution of FA-HA, and then sonication, irrigation and aspiration were performed in the anterior chamber using a phaco-needle attached to phacoemulsification and aspiration (PEA) equipment. The protective efficacy was evaluated by the area of damaged corneal endothelium. When the anterior chamber was reformed by the solution of FA-HA with a molecular weight of 2010 x 10(3) (FA-HA (2010 x 10(3) group), most of the FA-HA was eliminated within 20 seconds after starting the irrigation and aspiration, and the area of damaged endothelium was the same with the case when the FA-HA was not pre-injected (Control group). On the other hand, when the anterior chamber was reformed by the solution of FA-HA with a molecular weight of 1130 x 10(3) (FA-HA (1130 x 10(3) group), the FA-HA was gradually eliminated after mixing with an irrigating solution, and the area of damaged endothelium was significantly smaller than those of the Control and FA-HA (2010 x 10(3)) groups. These results suggest that the corneal endothelial damage induced by PEA can be avoided by pre-injecting a viscoelastic material which can remain in the anterior chamber during PEA.

[Effect of topical adrenergic agents on tissue circulation in human optic nerve head evaluated with a laser speckle microcirculation analyser]

The effects of a single instillation of 2% carteolol or 0.1% dipivefrine on the tissue circulation in the human optic nerve head (ONH) was studied using a laser speckle tissue circulation analyser in 12 healthy volunteers. In the first experiment, normalized blur (NB), a quantitative index of peripheral blood velocity, was measured every 0.125 sec in an area located in the temporal site of ONH free of visible surface vessels and averaged over 5 pulses (mean NB) in both eyes before, 1.5, 3, and 4.5 hours after a 30 microliters instillation of placebo to serve as a control. Intraocular pressure (IOP), blood pressure (BP), and pulse rate (PR) were also measured. In the second experiment, a 30 microliters drop of 2% carteolol (n = 6) or 0.1% dipivefrine (n = 7) was instilled in one randomly chosen eye and the placebo for each drug in the other eye, and the above parameters were measured according to the same time schedule as in the first experiment in a double masked manner. After topical carteolol, carteolol concentration in the plasma (CC) was also measured. In the control experiments, none of the parameters showed any significant change. After topical carteolol, the IOP was significantly lower between 1.5 and 4.5 hrs in the carteolol-treated eyes and at 1.5 and 4.5 hrs in the fellow eyes as compared with that obtained in the control experiment. The mean NB was significantly higher at 3 hrs (23.1%) in carteolol-treated eyes, and at 3 hrs (17.2%) in the fellow eyes, as compared with that obtained in the control experiment (p < 0.05). BP and PR showed little change. The maximum CC at 3 hrs averaged 522 pg/ml. Thus a single instillation of carteolol may increase the tissue blood velocity in ONH in the human eye. After topical dipivefrine, the IOP was significantly lower at 4.5 hr in the dipivefrine-treated eyes than that obtained in the control experiment (p < 0.05). Mean NB, BP and PR showed no significant change.

[Effect of topical carteolol on tissue circulation in rabbit optic nerve head evaluated with the laser speckle microcirculation analyser]

The effect of topical 2% carteolol on the tissue circulation in the albino rabbit optic nerve head (ONH) was studied using a laser speckle microcirculation analyser. In the first experiment, normalized blur (NB), the quantitative index of peripheral blood flow rate in the ONH, intraocular pressure (IOP), blood pressure (BP) and pulse rate (PR) were measured under general anesthesia before, and 30, 60, 90, and 120 minutes after a 20 microliters instillation of carteolol in one eye and a placebo in the other eye in a masked randomized manner. In the second experiment, one eye of another group of rabbits received carteolol twice daily for 20 days and the fellow eye a placebo in a randomized masked manner. The NB in the ONH and the IOP were measured before treatment and 2 hours after the last instillation on the 20th day. After a single instillation of carteolol, PR showed a maximum reduction of 14% and the IOP in the carteolol-treated eyes showed a maximum decrease of 22%, while NB in ONH and BP did not show any significant change during the experiment. After 20-day treatment, IOP showed a maximum decrease of 25% in the carteolol-treated eyes and 17% in the placebo-treated eyes. The NB showed a significant increase of 16% (p < 0.01) in the carteolol-treated eyes and 10% (p < 0.05) in the placebo-treated eyes. This indicates that long-term use of topical carteolol increases peripheral blood flow in ONH tissue in the living rabbit eye.

[Postoperative course of transscleral ciliary sulcus fixation of posterior chamber intraocular lens and ciliary sulcus insertion of posterior chamber intraocular lens as a secondary implantation--postoperative long course of secondary intraocular lens implantation]

We studied the two-year postoperative course of 46 eyes with transscleral ciliary sulcus fixation of a posterior chamber intraocular lens (sutured group) and 30 eyes with ciliary sulcus insertion of a posterior chamber intraocular lens as a secondary implantation (nonsutured group). The following items were evaluated: visual acuity, difference between preoperative predicted refraction (calculated by the SRK II formula) and final postoperative refraction, complications, corneal endothelial cell loss, and anterior chamber depth. In the nonsutured group, visual acuity was favorable in general and few complications were observed. In the sutured group, 16 eyes were followed for 2 years, and 12 (75%) of them achieved the same or better visual acuity than before surgery. In 4 (25%) of them visual acuity decreased compared with its preoperative status. In the sutured group, we analyzed 13 factors that might have been associated with poor postoperative visual acuity, and cystoid macular edema appeared to be most strongly related with worse final visual acuity than before surgery (p < 0.05).

[Effect of topical timolol on microcirculation in the rabbit optic nerve head evaluated with a laser speckle microcirculation analyser]

The effect of topical 0.5% timolol on the microcirculation in albino rabbit optic nerve head (ONH) tissue was examined using a laser speckle microcirculation analyser. In the first experiment, normalized blue (NB) in ONH, a quantitative index of peripheral blood flow in ONH, intraocular pressure (IOP), blood pressure (BP) and pulse rate (PR) were measured under general anesthesia before, and 30, 60, 90 and 120 minutes after a 20 microliters instillation of timolol in one eye and a placebo in the other eye in a masked randomized manner. In the second experiment, one eye of another group of rabbits received timolol twice daily for 20 days and a placebo in the fellow eye in a randomized masked manner. The NB in ONH and IOP were measured before treatment and 2 hours after the last instillation on the 20th day. After a single instillation of timolol, PR showed a maximum reduction of 11% and the IOP in the timolol-treated eyes showed a maximum decrease of 18%, but the NB in ONH and BP did not show any significant change during the experiment. After the 20-day treatment, IOP showed a maximum decrease of 28% in the timolol-treated eyes and 17% in the placebo-treated eyes. The NB in the timlol-treated eyes increased significantly (p < 0.01), but in the placebo-treated eyes it showed no significant change. Thus, the long-term use of topical timolol may increase peripheral blood flow in ONH tissue in the living rabbit eye.

[An apparatus using laser speckle phenomenon for noncontact two-dimensional analysis of microcirculation in optic nerve head or choroid in human eyes]

The previously reported apparatus using the laser speckle phenomenon for noncontact two-dimensional analysis of the fundus peripheral circulation was improved so that peripheral circulation in the optic nerve head (ONH) or choroid in human eyes can be measured on a real-time basis. The fundus was illuminated by a diode laser spot and its image speckle was detected with an area sensor. The NB value, a quantitative index of blood velocity, was calculated by the logic board every 0.125 sec successively for 7 sec. Using this apparatus, the NB averaged over the measurement field located in the temporal site of ONH, free of visible surface vessels (NBONH), and that located in the posterior choroid (NBCh) were measured in normal human eyes. The coefficients of reproducibility of 5-minute interval measurements were 11.7% for the NBONH averaged over 5 pulses (mean NBONH) and 8.7% for the NBONH averaged over 5 pulses (mean NBCh), and those of 24-hour interval measurements were 13.0% for the former and 9.7% for the latter, respectively. The average of pulsatile component of NBONH was 38.4% of mean NBONH and that of NBCh was 26.6% of mean NBCh.

[Noninvasive two-dimensional analysis of iridial circulation using the laser speckle phenomenon]

We have developed an apparatus using the laser speckle phenomenon for noninvasive two-dimensional measurement of the peripheral circulation of the iris. The normalized blur of the speckle pattern (NB-value) was adopted as an index of the blood velocity in the tissue. It was found that the average NB-value of the pigmented rabbit iris was gradually increasing from pupil margin to periphery. The coefficient of variation of the NB-value in the middle area of the iridial width was the smallest. The coefficient of reproducibility of the NB-value measured in the same area twice at 5-minute intervals was 8.8%, and that at 24-hour intervals was 14.1%. The NB-value of the iris showed a good correlation (r = 0.57, p < 0.0072 n = 20) with the iridial blood flow rate measured at the same time by the microsphere technique when intraocular pressure was adjusted to 20 mmHg or 40 mmHg. This result suggests that the NB-value can be useful for quantitative assessment not only of the blood velocity but also of the blood flow rate in the iridial tissues.

[Unusual transient M-proteinemia (IgG-kappa type) detected using separax membrane. A case report]

We report a patients with squamous cell carcinoma of tongue showing transient M-protein (IgG-kappa type) on electrophoresis using a Separax membrane. The M-protein was detected in the alpha 1 to beta regions as a broad band, and it was detected in the slow gamma region as a monoclonal band on electrophoresis using other types of membranes. The unusual electrophoretic pattern of globulin found in this patient was considered to be caused by alternation of globulin by unusual sugar chains.

Synthesis and antiallergic activity of novel azaazulene derivatives

Various azaazulene derivatives were synthesized and their antiallergic activity was examined. The structure-activity relationship among various derivatives modified by introducing substituents at the 1-,2-, or 3-position of the azaazulene ring was investigated. The inhibitory activities on allergic histamine release of the compounds bearing a 5-tetrazolyl group at the 3-position were more potent than those of the corresponding compounds with other groups (CN, COOH, and CHO). The compounds substituted with amino, azide and carboxymethylamino groups at the 2-position showed strong inhibitory activity. The compounds with various phenylalkyl groups at the 1-position showed a greater activity than those with other substituents. Among the compounds with substituents at the 1-,2-, or 3-position of the azaazulene ring, 1-benzyl-7-isopropyl-3-(5-tetrazolyl)-1-azaazulen-2-one (18f) and 1-(4-fluorobenzyl)-7-isopropyl-3-(5-tetrazolyl)-1-azaazulen- 2-one (19c) had the most potent inhibitory activities on histamine release from mast cells and on passive cutaneous anaphylaxis (PCA) in rats after oral administration (ED50 = 0.56 and 0.58 mg/kg, respectively).

Functional imaging of the human olfactory cortex by magnetic resonance imaging

Our understanding of the neural mechanism of human olfaction is still equivocal. Several recent reports document that functional magnetic resonance imaging (MRI) has a potential to visualize dynamic brain function in humans without invasion. In the present study, we applied functional MRI with odor stimulation for the purpose of clarifying the localization of olfactory cortices in the human. We obtained a significant increase in cerebral blood flow in the piriform cortex, orbitofrontal cortex, and inferior medial frontal lobe, corresponding to olfactory cortices. These results suggest that, in the near future, precise diagnosis of the patients with olfactory disorders will be possible using functional MRI with odor stimulation.

[Analysis of blood flow velocity in the ophthalmic artery by color Doppler imaging. 2. Studies on diabetic eyes]

Color Doppler imaging was used to investigate the changes in Pourcelot index (RI), which is an index for vascular resistance calculated from the blood flow velocity of the ophthalmic artery, related to the complications of diabetes mellitus (diabetic retinopathy, diabetic nephropathy) and systemic background (duration of diabetes mellitus, value of hemoglobin A1C (HbA1c)) in 46 diabetic patients and in 20 normal subjects. RI was significantly higher in diabetic patients than in normal subjects (p < 0.05). RI increased in patients without retinopathy (p < 0.05), in patients with background retinopathy (p < 0.05), and in patients with preproliferative or proliferative retinopathy (p < 0.05), but it did not change in patients after panretinal photocoagulation, compared with the normal subjects. In diabetic patients, RI was higher (p < 0.05) in patients with nephropathy than in those without nephropathy. The time from onset of diabetes mellitus and the value of HbA1c had no correlation with RI. Our results indicate that choroidal circulation was changed in diabetic patients compared with normal subjects and that the changes were related to diabetic nephropathy.

[Analysis of blood flow velocity of ophthalmic artery with color Doppler imaging. 1. Studies on normal human eyes]

Color Doppler imaging was used to analyze the blood flow velocity of the ophthalmic artery (BVA) by measuring the pulse wave of flow velocity in the ophthalmic artery of normal subjects. Maximum systolic BVA (Vmax), minimum end-diastolic BVA (Vmin), time-averaged BVA (Vmean), Pourcelot index (RI) and pulsatility index (PI) were determined using color Doppler imaging. The coefficients of reproducibility of Vmax, Vmin, Vmean, RI and PI were 10%, 9%, 15%, 4% and 14%, respectively, when analyzed twice at one-hour intervals. There was no significant difference between the values of the right eye and that of the left eye in each case. The averages of Vmax, Vmin, Vmean, RI and PI of 33 normal eyes were 25.4 +/- 7.6 cm/sec, 6.3 +/- 2.3 cm/sec 16.7 +/- 6.6 cm/sec, 0.75 +/- 0.052, 1.19 +/- 0.25 (mean +/- S.D.), respectively, Vmax, Vmin and Vmean decreased significantly with age (Vmax:linear correlation coefficient r = -0.65, p < 0.001; Vmin: r = -0.61, p < 0.001, r = -0.64, p < 0.001. RI did not change with age. PI increased significantly with age (r = 0.30, p < 0.05).

[Combined posterior chamber intraocular lens implantation and trabeculectomy--a life-table analysis of postoperative clinical course]

Postoperative courses of 68 eyes of 58 glaucoma patients who underwent posterior chamber intraocular lens implantation combined with trabeculectomy were studied retrospectively. The visual acuity was 0.5 or better in 66% of the eyes at 3 months postoperatively. The average intraocular pressure (IOP) was below 15 mmHg till 16 months postoperatively. An analysis of the postoperative course using the life-table method of Kaplan-Meier revealed that the probability of successful IOP control with medication was 83% at 18 months and 47% without medication. The subjects aged 75 years or older showed significantly higher success probability than those younger than 75 years, while types of glaucoma, the preoperative IOP control, location of conjunctival or sclerocorneal incision, postoperative 5-fluorouracil (5-FU) injections or surgical intervention on the iris had no significant effects on the probability of successful IOP control. The probability of subsistence of functional filtering bleb was 24% at 18-month follow-up, on which postoperative administration of 5-FU of 35 mg or more had a favorable effect.

Preparation of 5-alkyl-3-carboxymethylrhodanines and their aldose reductase inhibitory activity

5-Alkyl-3-carboxymethylrhodanines (2) were prepared from 5-alkylmethylidene-3-carboxymethylrhodanines (1). The exo double bond of 1 was successfully reduced with NaBH4. The 1,4-addition reaction path was confirmed on the basis of proton nuclear magnetic resonance spectrum of the product (4b) obtained from the reduction of 3 using NaBD4. Optical resolution of the tert-butyl compound (2i) was achieved upon epimerization-crystallization method using L-3-amino-epsilon-caprolactam. The alkyl compounds (2) and the optical active compounds ((+)-2i, (-)-2i) were evaluated for aldose reductase inhibitory potency.

[Immunochemical analysis of two peak M proteinemia derived from structural differences of IgG Fc region]

We found M-proteins with two peaks by agarose electrophoresis in the serum of a myeloma patient. The M-proteins were identified as both IgG 1-kappa type, and classified as IgG-F (fast mobility) and IgG-S (slow mobility). 1) The possibility that the two M-proteins were derived from the post translational differences of sugar moieties of the same IgG molecule was unlikely, because no migration changes were observed in IgG-F and IgG-S after the treatment with 4 different sugar enzymes. 2) Fab fractions of IgG-F and IgG-S were analyzed. After papain or pepsin digestion, western blotting with anti-Fab antiserum revealed that the Fab fraction of IgG-F and IgG-S had identical mobility by agarose electrophoresis. However the Fc fractions of IgG-F and IgG-S analyzed by the same procedures with anti-Fe antiserum, were different. 3) Anti-idiotype antiserum prepared in rabbits against IgG-S, or -F, and absorbed by normal IgG and normal human serum showed a fused precipitin line with IgG-F and IgG-S. These findings suggest that two M-proteins with both IgG 1 and kappa type, have the same VH and VL regions but have different constant regions of heavy chain. Since one copy of IgG 1 constant gene is found in each human haploid gene. It is speculated that the switching of the rearranged VDJ gene to constant region gene occurred not only between cis chromosome but also between trans chromosome.

The difference in murine CDC2 kinase activity between cytoplasmic and nuclear fractions during the cell cycle

The mouse analog of yeast CDC2+ kinase was detected in the cytoplasmic and nuclear fractions of cultured mouse FM3A cells. Its activity in the nuclear fraction increased in the G2/M phase became seven times higher than that in the G1/S phase, while the activity in the cytoplasmic fraction remained was almost constant from the G1/S to G1 phases. The activity in the cytoplasmic fraction was similar to that in the nuclear fraction in the G2/M phase. The amount of the enzyme remained almost constant during the cell cycle in both the nuclear and cytoplasmic fractions. These findings suggest that the cytoplasmic enzyme might play an independent role in the cell cycle.

Preparations of 5-alkylmethylidene-3-carboxymethylrhodanine derivatives and their aldose reductase inhibitory activity

Reactions of 3-carboxymethylrhodanine (1) with aldehydes (2a-u) afforded stereoselectively the 5-mono-alkylmethylidene-3-carboxymethylrhodanines (3a-u). The configuration of the 5-monoalkylmethylidene-3-carboxymethylrhodanine (3k) were examined by X-ray structure analysis and confirmed to be Z-configuration. The stereoselective reaction path was discussed. Several 5-dialkylmethylidene-3-carboxymethylrhodanines (15a-f) and alkylamino derivatives of 3-carboxymethylrhodanines (18a-o) were also prepared. These products were evaluated for aldose reductase-inhibitory potency and half of them exhibited valuable inhibitory potency.

Unforeseen effect of thyroxine binding globulin when using the microencapsulated antibody method to determine free thyroxine (FT4): misleading results due to circulating unsaturated thyroxine binding globulin

The effect of varying concentrations (0-52 mg/l) of purified thyroxine binding globulin (TBG) on the microencapsulated antibody method for free thyroxine was investigated. The results demonstrated that the free thyroxine values were strongly influenced by the concentration of thyroxine binding globulin in the samples. The standard curve could no longer be distinguished at a concentration of purified thyroxine binding globulin of 52 mg/l. In the clinical application, we observed that the values obtained using the microencapsulated antibody method were significantly higher than the expected values in patients receiving triiodothyronine treatment after total thyroidectomy (theoretically nil) and in patients with untreated primary hypothyroidism with negligible thyroxine (less than 12.9 nmol/l). These false positive values are considered to be due to the methodological problem mentioned above, i.e. the microcapsule membrane is not efficient and therefore must be improved. Consequently, any data based on this method should be interpreted with caution.

Synthesis and aldose reductase-inhibitory activity of benzo[b]furan derivatives possessing a carboxymethylsulfamoyl group

Various benzo[b]furan derivatives with a carboxymethylsulfamoyl group were prepared and evaluated for aldose reductase-inhibitory potency. Most of the compounds displayed significant inhibitory activities (IC50, 10(-8)-10(-7) M). Among the test compounds, the compounds having a carboxymethylsulfamoyl group at the 3- or 4-position exhibited the greatest inhibitory potency. Structure-activity trends of the tested compounds are discussed.