Common variants in the COL2A1 gene are associated with lattice degeneration of the retina in a Japanese population

PURPOSE

Lattice degeneration of the retina is a vitreoretinal disorder characterized by a visible fundus lesion that predisposes the patient to retinal detachment. It has been suggested that collagen type II alpha 1 (COL2A1) gene variants may contribute to the development of disorders associated with retinal detachment. Here we investigated whether COL2A1 gene variants were associated with the risk of lattice degeneration of the retina.

METHODS

We recruited 634 Japanese patients with lattice degeneration of the retina and 1694 Japanese healthy controls. We genotyped 13 tagging single-nucleotide polymorphisms (SNPs) in COL2A1. We also performed imputation analysis to evaluate the potential association of un-genotyped COL2A1 SNPs, involving the imputation of 65 SNPs.

RESULTS

Two intronic SNPs-rs1793954 and rs1635533-were significantly associated with lattice degeneration of the retina. The SNP rs1793954 showed the strongest association, with its C allele carrying an increased disease risk (p = 0.0016, corrected p = 0.021, OR = 1.25). The rs1793954 and rs1635533 SNPs were in strong linkage disequilibrium with each other (r ² = 0.99), and conditional analysis revealed that rs1793954 could account for the association between rs1635533 and the disease.

CONCLUSIONS

Our results suggested that COL2A1 gene variants may contribute to the development of lattice degeneration of the retina. Further genetic and functional analyses of COL2A1 variants are needed to clarify the present findings.

Association of Toll-like receptor 4 gene polymorphisms in Japanese subjects with primary open-angle, normal-tension, and exfoliation glaucoma

PURPOSE

To determine whether polymorphisms in the Toll-like receptor 4 (TLR4) gene are associated with primary open-angle glaucoma (POAG), normal-tension glaucoma (NTG), and exfoliation glaucoma (XFG) in Japanese individuals.

DESIGN

Genetic association study.

METHODS

SETTING

Multicenter study.

STUDY POPULATION

One hundred eighty-four unrelated Japanese patients with POAG, 365 unrelated patients with NTG, and 109 unrelated patients with XFG from 5 hospitals.

PROCEDURES

Genomic DNA was extracted from leukocytes of the peripheral blood, and 8 polymorphisms in the TLR4 genes were amplified by polymerase chain reaction (PCR) and directly sequenced. Allele and genotype frequencies and the inferred haplotypes were estimated.

MAIN OUTCOME MEASURES

Differences in allele and genotype frequencies and haplotypes between subjects with POAG, NTG, and XFG.

RESULTS

The allele frequency of rs2149356 of the TLR4 gene in the POAG, NTG, and XFG groups was the most significantly different from that of the control group (minor allele frequency 0.446, 0.395, 0.404, vs 0.308; P = .000058, P = .0030, and P = .015). The allele frequencies of the 5 TLR4 SNPs were higher in all of the glaucoma groups than that in the control group. The statistics of genotypes of TLR4 were approximately the same for all allele frequencies. The haplotypic frequencies with Tag SNPs studied earlier showed that only POAG was statistically significant. Other haplotypes, such as rs10759930, rs1927914, rs1927911, and rs2149356, had higher statistical significance (overall P = .00078 in POAG, overall P = .018 in NTG, and overall P = .014 in XFG).

CONCLUSIONS

This study demonstrated that TLR4 polymorphisms are associated with NTG in the Japanese, and they also play a role in the pathogenesis of POAG and XFG.

Common variants in the COL4A4 gene confer susceptibility to lattice degeneration of the retina

Lattice degeneration of the retina is a vitreoretinal disorder characterized by a visible fundus lesion predisposing the patient to retinal tears and detachment. The etiology of this degeneration is still uncertain, but it is likely that both genetic and environmental factors play important roles in its development. To identify genetic susceptibility regions for lattice degeneration of the retina, we performed a genome-wide association study (GWAS) using a dense panel of 23,465 microsatellite markers covering the entire human genome. This GWAS in a Japanese cohort (294 patients with lattice degeneration and 294 controls) led to the identification of one microsatellite locus, D2S0276i, in the collagen type IV alpha 4 (COL4A4) gene on chromosome 2q36.3. To validate the significance of this observation, we evaluated the D2S0276i region in the GWAS cohort and in an independent Japanese cohort (280 patients and 314 controls) using D2S0276i and 47 single nucleotide polymorphisms covering the region. The strong associations were observed in D2S0276i and rs7558081 in the COL4A4 gene (Pc = 5.8 × 10(-6), OR = 0.63 and Pc = 1.0 × 10(-5), OR = 0.69 in a total of 574 patients and 608 controls, respectively). Our findings suggest that variants in the COL4A4 gene may contribute to the development of lattice degeneration of the retina.

Transpupillary thermotherapy for atypical central serous chorioretinopathy

BACKGROUND

Central serous chorioretinopathy (CSC) has been traditionally treated with laser photocoagulation. We thought that transpupillary thermotherapy (TTT) utilizing a lower temperature than that of conventional laser photocoagulation might minimize permanent retinal and choroidal damage. Studies suggest that undesirable effects on vision due to TTT are minimal even if it is applied to foveal and/or parafoveal lesions when TTT requires a larger irradiation spot. The aim of this study was to evaluate the efficacy of TTT in the management of atypical CSC.

METHODS

We defined atypical CSC as bullous retinal detachment with diffuse or several leakages, severe leakage with fibrin formation under serous retinal detachment, or leakage within a pigment epithelium detachment. Eight consecutive patients with atypical CSC underwent visual acuity testing, ophthalmic examination, color photography, fluorescein angiography, and optical coherence tomography to evaluate the results of transpupillary thermotherapy. Retreatment of atypical CSC was based on ophthalmic examination, optical coherence tomography, and fluorescein angiography. TTT was performed on the leaking spots shown in fluorescein angiography, with a power of 50-250 mW, spot size of 500-1200 μm, and exposure time of 13-60 seconds to minimize retinal damage.

RESULTS

In five of eight affected eyes, serous detachments completely resolved within 1 month after the initial TTT. One eye had persistent subretinal fluid and required a second TTT treatment. Two eyes showed no resolution of CSC and were treated by conventional photocoagulation. Initial best-corrected visual acuity (BCVA) ranged from 20/600 to 20/20 (mean, 20/40; median, 20/30). Final BCVA ranged from 20/200 to 20/20 (mean, 20/25; median, 20/20). BCVA improved in all cases. Only two eyes with persistent subretinal fibrin and existing retinal pigment epithelial alternations in macular area showed limited improvement of BCVA despite the absence of subretinal exudation. The presence of retinal attachment was confirmed by optical coherence tomography in six eyes (75%).

CONCLUSIONS

TTT seems to be effective for the treatment of atypical CSC in the short term. Additional studies are necessary to evaluate the long-term effectiveness and safety.

[Retinal vein occlusion followed by ischemic optic neuropathy with anticardiolipin IgG antibody: a case report]

BACKGROUND

Anticardiolipin antibodies in the autoimmune mechanism can cause vasculitis, leading to hypercoagulability-related thrombosis. We report a case of retinal vein occlusion followed by ischemic optic neuropathy in a young woman with anticardiolipin IgG antibody.

CASE

A 17-year-old woman with dilatation and tortuosity of the retinal veins and retinal hemorrhage in the superior quadrant of the retina OS. Fluorescein retinal angiography showed a delay of filling time in the upper quadrant of the retina and a 3mm-continuous stain along the superior retinal vein. Laboratory tests were repeatedly positive for anticardiolipin IgG antibodies. Although the retinal hemorrhage disappeared 2 months after subtennon injection of 20 mg triamcinolone acetonide (TA), ischemic optic neuropathy occurred 9 months later.

CONCLUSIONS

The staining of the vessel wall and the effectiveness of TA suggest that vasculitis may be associated with the pathology of this condition. The presence of anticardiolipin IgG antibodies suggests that autoimmune mechanism is involved in the vasculitis.

Candida albicans keratitis modified by steroid application

The paper reports on Candida albicans ocular infection modified by steroid eye drops. A 74-year-old male complained of conjunctival injection and pain in his right eye three months after pterygium and cataract surgery. After treatment with antibiotics and steroid eye drops for three days, he was referred to our hospital. Clear localized corneal endothelial plaque with injection of ciliary body was observed. No erosion of the corneal epithelium, or infiltration of stromal edema was observed, suggesting that the pathological organism derived from the intracameral region. Because ocular infection was suspected, steroid eye drops were stopped, which led immediately to typical infectious keratitis in the pathological region, with epithelial erosion, fluffy abscess, stromal infiltration, and edema. For diagnostic purposes, the plaque was surgically removed with forceps and the anterior chamber was irrigated with antibiotics. The smear and culture examination from the plaque revealed C. albicans surrounded by neutrophils. However, aqueous fluid and fibrous tissue after gonio procedure contained no mycotic organisms. Topical fluconazole, micafungin, and pimaricin with oral itraconazole (150 mg/day) were effective. Special attention is needed when prescribing steroid eye drops to treat corneal disease especially postoperatively. Diagnosing infectious keratitis is sometimes difficult because of modification by some factors, such as postoperative conditions, scarring, and drug-induced masking. Here, we report on mycotic keratitis modified by postoperative steroid administration.

The characteristics of keratomycosis by Beauveria bassiana and its successful treatment with antimycotic agents

Clinical findings and treatment of keratomycosis caused by Beauveria bassiana, an entomopathogenic filamentous fungus, are described for an 80-year-old woman, who was referred to the hospital for ocular pain and redness on the 9th day after an ocular injury caused by the frame of her glasses. She had a long history of recurrent diabetic iritis and continuously used topical antibiotics and corticosteroids. At her first visit, a slit-lamp examination indicated a corneal ulcer confined within the superficial stromal layer, along with a slight infiltration and edema. Only a very few inflammatory cells were seen in the anterior chamber. Direct microscopic examination of corneal scrapings revealed septate fungal hyphae with zig-zag rachis and budding that was subsequently identified as B. bassiana by slide culture. Topical voriconazole with miconazole, pimaricin and oral itraconazole were effective and the lesion disappeared leaving only a mild scar at 2 months. The sensitivity of B. bassiana to various antimycotic agents was confirmed by broth microdilution, agar dilution with the Clinical Laboratory Standard Institute standard, and a disk method using topically applied concentrations. B. bassiana, which exhibits a characteristic appearance in smears and causes superficial keratomycosis, is sensitive to voriconazole with miconazole, pimaricin, and itraconazole.

Accommodative loss after retinal cryotherapy

PURPOSE

To investigate the effects of peripheral retinal cryotherapy on accommodative amplitude in patients with retinal lattice degeneration.

DESIGN

Prospective, observational case series.

METHODS

We studied 92 eyes in 69 patients (age range, 13 to 79 years) treated with cryotherapy for lattice degeneration between December 2001 and September 2004. Pretreatment and posttreatment accommodative amplitudes were measured. Acute accommodative loss was calculated from the difference between accommodative amplitudes before treatment and one week after treatment. We investigated the time course of accommodative amplitudes, acute accommodative loss in different age groups and in pretreatment accommodative amplitude groups, the influence of cryotherapy numbers on accommodative amplitude, and the influence of cryotherapy sites on accommodative amplitude.

RESULTS

No significant difference was noted between pretreatment and posttreatment accommodative amplitudes in the overall subject cohort. Dividing subjects by age revealed significant decreases in accommodative amplitude only among patients in their 10s and 20s at one and three weeks after treatment. Accommodative amplitude was lowest among those in their 10s, followed by that among those in their 20s (P < .01). Accommodative amplitudes recovered to pretreatment level by six weeks. Acute accommodative loss was greatest in those in their 10s compared with other age groups (P < .01). A significant correlation was observed between acute accommodative loss and cryotherapy numbers (P = .03; r = 0.41).

CONCLUSIONS

The decrease in accommodative amplitude was greatest at one week after treatment and recovered to pretreatment levels after six weeks. Accommodative amplitude showed the greatest decrease after cryotherapy among patients in their 10s and 20s. A decrease in accommodative amplitude was observed with increased numbers of cryotherapy spots administered.

Association between glaucoma and gene polymorphism of endothelin type A receptor

PURPOSE

Endothelin 1 (ET-1), a potent vasoconstrictor, may affect regulation of intraocular pressure and ocular vessel tone. Thus, ET-1 and its receptors may contribute to development of glaucoma. We investigated whether gene polymorphisms of ET-1 (EDN1) and its receptors ETA (EDNRA) and ETB (EDNRB) were associated with glaucoma phenotypes and clinical features.

METHODS

We studied 224 normal Japanese controls and 426 open angle glaucoma (OAG) patients including 176 with primary open angle glaucoma (POAG) and 250 with normal tension glaucoma (NTG). Nine single nucleotide polymorphisms were detected among the participants using the Invader assay; four for EDN1 (T-1370G, +138/ex1 del/ins, G8002A, K198N), four for EDNRA (G-231A, H323H, C+70G, C+1222T), and one for EDNRB (L277L). Genotype distributions were compared between normal controls and OAG. Age at diagnosis, untreated maximum intraocular pressure (IOP), and visual field defects at diagnosis were examined for association with polymorphisms.

RESULTS

Of the 9 polymorphisms, genotype distributions showed no significant differences between OAG patients and controls adjusted by age. The GG genotype of EDNRA/C+70G was associated with worse visual field defects in NTG patients (p=0.014; Mann-Whitney U test, and p=0.027; logistic regression analysis).

CONCLUSIONS

The polymorphism of EDNRA/C+70G may be related to NTG risk factors.

Novel MYOC gene mutation, Phe369Leu, in Japanese patients with primary open-angle glaucoma detected by denaturing high-performance liquid chromatography

PURPOSE

To screen for mutations in the MYOC gene in Japanese patients with primary open-angle glaucoma (POAG) using denaturing high-performance liquid chromatography (DHPLC).

PATIENTS AND METHODS

Blood samples were collected from 171 patients with POAG and 100 controls from seven institutions in Japan. For high-throughput analysis, seven exonic regions were amplified by polymerase chain reaction using DNA pooled from three patients; each DNA pool was then analyzed chromatographically. For analysis of a small number of samples, 7 exonic regions were amplified separately but simultaneously with annealing at 58 degrees C in each patient and then chromatographed, using 7 wells of the same 96-well plate per sample. When chromatographic patterns were abnormal by either method, the PCR products of the individual samples were sequenced.

RESULTS

Four glaucoma-causing mutations were identified in five POAG patients (2.9%). One missense mutation, Phe369Leu, is new; and three others, Ile360Asn, Ala363Thr, and Thr448Pro, have been reported in Japanese patients. Phe369Leu was associated with adult onset POAG.

CONCLUSIONS

Mutations in the MYOC gene were demonstrated chromatographically in 2.9% of our Japanese POAG patients. The use of pooled DNAs with DHPLC analysis is a time- and labor-saving technique. All mutations detected appear to be specific to Japanese patients.

Variants in optineurin gene and their association with tumor necrosis factor-alpha polymorphisms in Japanese patients with glaucoma

PURPOSE

To investigate sequence variations in the optineurin (OPTN) gene and their association with TNF-alpha polymorphisms in Japanese patients with glaucoma.

METHODS

The OPTN gene was analyzed in blood samples from 629 Japanese subjects. There were 194 patients with primary open-angle glaucoma (POAG), 217 with normal-tension glaucoma (NTG), and 218 with no eye disease (control subjects). The gene was screened for mutations by denaturing high-performance liquid chromatography. Genotyping of three polymorphisms of -308G-->A, -857C-->T, and -863C-->A in the TNF-alpha promoter region was performed. The associations between the genotypes and age, intraocular pressure (IOP), and visual field defects at the time of diagnosis were examined.

RESULTS

A possible glaucoma-causing mutation, His26Asp, was identified in 1 of the 411 Japanese patients with glaucoma. A c.412G-->A (Thr34Thr) polymorphism in the OPTN gene was significantly associated with POAG (genotype frequency, P = 0.011; allele frequency, P = 0.003). The frequency of TNF-alpha/-857T and optineurin/412A carriers was significantly higher (P = 0.006) in patients with POAG than in control subjects. Among the patients with POAG who were carriers of TNF-alpha/-857T, the optineurin/412A carriers had significantly worse (P = 0.020) visual field scores than the non-optineurin/412A ones. The frequency of TNF-alpha/-863A and optineurin/603A (or Lys98) carriers was significantly higher in patients with POAG (P = 0.008) or NTG (P = 0.027) than in control subjects. Among the patients with POAG who were carriers of TNF-alpha/-863A, the ones with optineurin/603A (or Lys98) had significantly worse (P = 0.026) visual field scores than did those with non-optineurin/603A (or Lys98).

CONCLUSIONS

These findings demonstrated that the OPTN gene is associated with POAG rather than NTG in the Japanese. Statistical analysis showed a possible interaction between polymorphisms in the OPTN and the TNF-alpha genes that would increase the risk for glaucoma.

Retinal protection using a viscoadaptive viscoelastic agent during removal of a luxated crystalline lens by intravitreal phacoemulsification

PURPOSE

To report a method of retinal protection using a viscoadaptive viscoelastic agent during removal of a luxated crystalline lens by intravitreal phacoemulsification.

DESIGN

Interventional case report.

METHODS

A 65-year-old man presented with a totally luxated crystalline lens in the vitreous cavity of the left eye. After total vitrectomy was performed, a viscoadaptive viscoelastic agent was applied over the retina and optic disk. Then the luxated lens was removed by intravitreal phacoemulsification. The lens dropped several times during the surgery but the thick viscoadaptive viscoelastic agent protected the posterior retina.

RESULTS

In two cases treated this way, no complications occurred at six months after surgery.

CONCLUSION

This method may be useful for protecting the retina from damage by a luxated crystalline lens and is less costly than perfluorocarbon liquid.

Suture fixation of an intraocular lens combined with pars plana vitrectomy and gas tamponade

We describe suturing an intraocular lens (IOL) after pars plana lensectomy and vitrectomy combined with gas tamponade in 4 patients with vitreoretinal disease and subluxated lenses that could not be managed with capsular tension rings. The IOL haptics were sutured before the fluid-gas exchange in a horizontal (case 1), oblique (cases 2 and 4), and vertical (case 3) manner. In a case of unavoidable horizontal fixation due to limited scleral space, the upper part of the IOL tilted anteriorly postoperatively because of the enhanced effect of the gas bubble. A peripheral anterior iris synechia also occurred. The IOL remained well positioned in cases with oblique and vertical fixations, and no other complications occurred. Careful preoperative planning of the surgical design can help avoid unnecessary horizontal fixation.

REFRACTIVE CHANGES FOLLOWING SCLERAL BUCKLING SURGERY IN JUVENILE RETINAL DETACHMENT

PURPOSE

To examine the effects of scleral buckling on the eye growth of children after retinal detachment repair according to the degree of refractive change.

METHODS

Thirty-five eyes of 35 patients (mean age, 11.5 years; range, 7-15 years) were treated using a silicone implant scleral buckling procedure. Postoperative refractive change in the treated eyes was analyzed statistically, with the fellow eyes used as controls. The effects of age at the time of surgery, length of the silicone tire, postoperative visual acuity, and postoperative refraction were also examined.

RESULTS

The mean refractive change in treated eyes from 1 to 4 years after the procedure was -0.6 diopter (D), whereas the mean change in fellow eyes was -1.3 D. The treated eyes became less myopic than the fellow eyes (P=0.024), particularly in patients younger than 10 years (-0.1 D versus -1.6 D, respectively; P=0.003) or when the scleral buckle extended beyond two quadrants (-0.4 D versus -1.3 D, respectively; P=0.020).

CONCLUSIONS

Scleral buckling resulted in significantly less myopia, particularly in younger patients and in those receiving longer buckling tires. This finding suggests that scleral buckling in children might impede ocular growth.

Luxated intraocular lens fixation using intravitreal cow hitch (girth) knot

OBJECTIVE

To describe a technique for suturing a luxated intraocular lens (IOL) in the vitreous cavity to the ciliary sulcus using intraocular cow hitch (girth) knots without IOL extraction.

DESIGN

Non-comparative interventional case series.

PARTICIPANTS

Five patients with a luxated IOL in the vitreous cavity.

INTERVENTION

All patients underwent surgery to fixate the IOL using this technique.

METHODS

A three-port vitrectomy was performed in all five cases. A needle with looped 10-0 polypropylene was introduced into the vitreous cavity through a sclerotomy incision, and only the needle was passed out of the eye, guided by a bent 27-gauge needle from the 3-o'clock position 1.5 mm from the limbus. A cow hitch (girth) knot at the end of the loop was made outside the globe, grasped with a straight intravitreal forceps, and introduced into the vitreous cavity. Hooking the cow hitch (girth) knot around the haptics of the IOL in the vitreous cavity, the 10-0 polypropylene was pulled so that the IOL haptic was fixated onto the sulcus. After the opposite haptic was brought into the anterior chamber, the 10-0 polypropylene was looped around the haptics of the IOL and manipulated with a push-and-pull hook in the anterior chamber through the two corneal side ports to make a cow hitch (girth) knot outside the anterior chamber. By pulling up the suture, the knot was brought back and tied in the anterior chamber. It was then fixated to the ciliary sulcus at the 9-o'clock position.

MAIN OUTCOME MEASURES

Patients were evaluated for visual acuity, refraction, and surgical complications associated with the procedure.

RESULTS

In all five cases, the IOL fixated stably and remained well positioned. No significant intraoperative or postoperative complications occurred.

CONCLUSIONS

This technique enables secure fixation of the luxated IOL in the vitreous without extracting it.

Factors related to subretinal proliferation in patients with primary rhegmatogenous retinal detachment

PURPOSE

To evaluate factors related to subretinal proliferation in patients with primary rhegmatogenous retinal detachment (RD).

METHODS

A total of 262 consecutive patients (267 eyes) with rhegmatogenous RD were evaluated retrospectively to determine factors associated with subretinal proliferation.

RESULTS

Logistic regression analysis was used to identify the following factors associated with subretinal proliferation that caused retinal traction: number of quadrants detached (adjusted odds ratio [AOR] = 2.21), longer duration of RD (AOR = 1.52), younger patient age (AOR = 0.51), and presence of atrophic retinal breaks (AOR = 0.41).

CONCLUSION

Atrophic retinal breaks, younger patient age, and RD of long duration and greater extent were associated with the presence of subretinal proliferation.

Dislocated intraocular lens fixation using intraocular cowhitch knot

PURPOSE

To describe a technique for suturing a dislocated intraocular lens (IOL) using an intraocular cowhitch knot without IOL extraction.

METHODS

Through the sideports of paracentesis, a cowhitch knot is made outside of the anterior chamber by looping 10-0 Prolene around the haptics of the IOL. The knot is then tied in the anterior chamber by pulling up the suture. After repeating this for the opposite side, the cowhitch knots are fixated to the ciliary sulcus.

RESULTS

In 4 cases treated this way, the IOL remained well positioned.

CONCLUSION

This technique enables secure fixation of the IOL haptics.

A novel compound heterozygote (FAP ATTR Arg104His/ATTR Val30Met) with high serum transthyretin (TTR) and retinol binding protein (RBP) levels

A 64-year-old Japanese male suffering from very slowly progressive amyloidosis was studied by immunohistopathologic, mass spectrometric, and molecular genetic methods. After confirming the immunoreactivity of transthyretin (TTR) in the amyloid deposits using an anti-TTR polyclonal antibody, matrix-assisted laser desorption ionization/time-of-flight-mass spectrometry (MALDI/TOF-MS) was employed to look for the presence of variant TTR(s) in the serum. Two variant forms of TTR, one with a molecular weight 32 Da greater and another with a molecular weight 19 Da less than that of normal TTR encoded by the two respective alleles, were detected in this patient. Direct sequence analysis confirmed the presence of a double substitution: one at codon 30 from GTG (Val) to ATG (Met) and the other at codon 104 from CGC (Arg) to CAC (His) in the two alleles. MALDI/TOF-MS of the parents of the proband revealed that his father was a heterozygote of ATTR Arg104His and his mother was a heterozygote of ATTR Val30Met. The total TTR and retinol binding protein (RBP) concentrations in the serum samples of the proband were very high compared with those of FAP ATTR Val30Met patients and control subjects. We report here a new compound heterozygote in the TTR gene with familial amyloidotic polyneuropathy (FAP).

Ultrasound biomicroscopy for detection of breaks and detachment of the ciliary epithelium

PURPOSE

To elucidate details of the pathologic changes in the ciliary epithelium associated with atopic dermatitis and blunt ocular trauma.

METHODS

We examined prospectively 52 eyes of 42 patients with detachment of the nonpigmented epithelium of the ciliary body associated with atopic dermatitis and blunt ocular trauma. All the eyes underwent ultrasound biomicroscopic examination as an adjunct to binocular indirect ophthalmoscopy with scleral depression and slit-lamp biomicroscopy.

RESULTS

Of the 52 eyes examined, high-resolution ultrasound biomicroscopy and conventional diagnostic methods (that is, binocular indirect ophthalmoscopy with scleral depression and slit-lamp biomicroscopy) disclosed breaks at the anterior vitreous base border in 40 eyes, at the pars plicata of the ciliary body in 27 eyes, and at the white midline (that is, the line located in the mid pars plana anterior to the anterior vitreous base border) in four eyes. In 40 eyes the breaks at the anterior vitreous base border could be detected with conventional methods but in only 28 eyes could they be diagnosed with ultrasound biomicroscopy. Conversely, in 27 eyes the breaks of the pars plicata could be observed with ultrasound biomicroscopy but in 25 eyes they were detected with conventional methods. In 21 eyes with breaks only at the anterior vitreous base border, the detachment of the nonpigmented ciliary epithelium was limited posterior to the white midline. In all 27 eyes with the nonpigmented ciliary epithelial detachment anterior to the white midline, the breaks of the pars plicata were identified by ultrasound biomicroscopy.

CONCLUSION

Because of the minimum deformation of the globe during examination, ultrasound biomicroscopy contributed to the diagnosis of detailed structural change in the ciliary body associated with atopic dermatitis and blunt ocular trauma in relation to the white midline. In our sample of patients, the white midline may act as a barrier against ciliary nonpigmented epithelial detachment, and detachment of the nonpigmented epithelium anterior to the white midline indicated the presence of the pars plicata break in most cases.

Risk of retinal detachment in patients with lattice degeneration

To determine the risk of retinal detachment in patients with lattice degeneration of the retina, we statistically analyzed the incidence of retinal detachment in these patients. The data of hospital patients with retinal detachment associated with lattice degeneration in Kumamoto Prefecture, Japan, in 1990 were collected. The prevalence of lattice degeneration in Kumamoto was reported to be 9.5% in 1980. Based on population data from the 1990 census, the cumulative incidence of retinal detachment associated with lattice degeneration was calculated in this study. Among 1,840,000 residents in Kumamoto, there were 110 patients with retinal detachment associated with lattice degeneration; 72 with detachment resulting from tractional tears (tears), and 38 with detachment from atrophic holes. The cumulative incidence of retinal detachment from atrophic holes was 1.5% at the age of 40 years; from tears it was 3.6% at the age of 80 years. The cumulative incidence of detachment from both atrophic holes and tears was 5.3% at the age of 80 years. The results of this study are useful for clarifying the natural course of lattice degeneration.

Immunogenetic study of sympathetic ophthalmia

Sympathetic ophthalmia (SO) is very rare but it remains one of the most intractable eye diseases. In clinical manifestations and histopathologic features SO is known to resemble closely Vogt-Koyanagi-Harada's disease (VKH disease). We had reported that VKH disease was significantly associated with HLA-DRB1*04 and -DQB1*04 in Japanese patients. In this study, to investigate an HLA association with SO we performed HLA serological and PCR-based DNA typing in 16 patients and 50 healthy controls. Our study revealed that HLA-DRB1*04 (0405; Pc < 5 x 10(-4)), DQA1*03 (Pc < 5 x 10(-3)), and DQB1*04 (0401; Pc < 5 x 10(-4)) were significantly associated with SO as compared to the healthy controls but there was no significant difference in the frequencies of any DPB1 alleles between the patients and healthy controls. It can be postulated that not only the clinical manifestations but also the genetic predisposition of SO are very similar to those of VKH disease.

Epidemiologic characteristics of rhegmatogenous retinal detachment in Kumamoto, Japan

BACKGROUND

The epidemiology of rhegmatogenous retinal detachment in Asians is not well known. We studied the epidemiologic characteristics of rhegmatogenous retinal detachment in Kumamoto, Japan.

METHODS

The study was based on a retrospective chart review of hospital patients who were treated for primary rhegmatogenous retinal detachment in 1990. The data were collected from seven hospitals in the Kumamoto area.

RESULTS

From a population of 1 840 000, 192 residents developed retinal detachment. The annual incidence was therefore 10.4 per 100 000 population (9.6 for males, 11.2 for females). The incidences of three types of detachment-nontraumatic phakic, aphakic, and blunt trauma--were 9.8, 0.5 and 0.2 per 100 000 population, respectively. In 109 of 180 patients (60.6%) with nontraumatic phakic detachment, retinal breaks were associated with lattice degeneration. In females, 14 of 106 nontraumatic phakic cases (13.2%) were secondary to macular holes.

CONCLUSION

Compared with previously published studies from other countries, the incidence of detachments associated with lattice degeneration and macular hole was higher, while the incidences of aphakic detachment and detachment due to blunt trauma were lower in Japan. Racial factors and living habits may affect the development of retinal detachment.

Anterior chamber inflammation after transconjunctival cryosurgery

BACKGROUND

Inflammation caused by transconjunctival cryotherapy for prophylactic retinal detachment surgery was measured in various conditions.

METHODS

Thirty-four eyes of 28 patients with peripheral retinal lesions predisposing to retinal detachment were studied by laser flare cell meter before and after treatment.

RESULTS

The mean flare value for 34 eyes was 4.06 +/- 1.45 photon counts/ms before surgery and 5.72 +/- 2.52 pc/ms after surgery (p < 0.05). Flare value was elevated at 1, 2, and 3 weeks after treatment, peaking at 2 weeks (p < 0.05), and normal again at 4 weeks. There were no significant differences in flare increase between eyes with and without retinal breaks, eyes with and without limited retinal detachment, eyes with myopia more and less than -8.0 D, and eyes with a treatment area limited to one quadrant and extending over more than one quadrant.

CONCLUSION

Transconjunctival cryosurgery caused mild inflammation in the anterior chamber of the eye for 3 weeks. The inflammation was not affected by the presence of retinal break or limited retinal detachment, the degree of myopia, or the extent of the treatment area.

Air pump for retinal detachment with macular hole

From 1984 to 1992, 128 eyes with substantial retinal detachment due to macular hole underwent vitrectomy at the Ideta Eye Hospital. In the first 76 eyes treated, air was injected by syringe after removal of the vitreous (group A); in the subsequent 52 eyes, air was injected by a pump while subretinal fluid was aspirated through the macular hole (group B). The rates of retinal reattachment after the first surgery were 63.2% in group A and 82.7% in group B (P < .05). Thus, using the air pump was more effective than air injection.

[Statistical study of aqueous flare in rhegmatogenous retinal detachment]

Inflammation of the anterior chamber in rhegmatogenous retinal detachment was studied in 338 eyes with a laser flare cell meter. The mean flare value, 32.84 +/- 81.39 pc/msec, was significantly higher (p < 0.0001) than the 5.01 +/- 2.05 pc/msec of the control group of 133 normal eyes. Clinical findings of retinal detachment were grouped into 11 factors and each factor was divided into 34 details. The following details were proven by t-test to cause significant elevation of the flare value: (1) duration of more than 3 months, (2) hypotony of less than 9 mmHg, (3) aphakia, (4) retinal breaks in the ora area or the posterior area, (5) extension of retinal detachment with more than 2 quadrants, and (6) choroidal detachment. The correlation coefficients of the 6 clinical factors showed significant elevation of flare value in the following order: (1) presence or absence of choroidal detachment (0.396), (2) extension of retinal detachment (0.375), (3) intraocular pressure (-0.28), (4) duration of retinal detachment (0.18), (5) location of the break (0.15), and (6) presence or absence of the lens (0.134).

Retinal detachment with atopic dermatitis similar to traumatic retinal detachment

PURPOSE

The cause of retinal detachment (RD) with atopic dermatitis remains uncertain. The purpose of this study is to show that the probable cause of RD with atopic dermatitis is ocular contusion.

METHODS

The authors retrospectively compared the fundus findings of 24 eyes (16 patients) that had RD and atopic dermatitis with 36 eyes (36 patients) that had traumatic RD.

RESULTS

The authors found similar characteristics. Retinal breaks at vitreous base borders characterized by ocular contusion occurred in 79.2% of eyes with RD and atopic dermatitis and in 75.0% of eyes with traumatic RD. Irregular retinal traumatic breaks in the equatorial zone occurred in 20.8% of eyes with RD and atopic dermatitis and in 47.2% of eyes with traumatic RD. Objective signs of ocular contusion outside the retina appeared in 54.2% of eyes with RD and atopic dermatitis.

CONCLUSIONS

The authors' data support the conclusion that self-inflected ocular contusion by tapping the eyes can cause RD with atopic dermatitis.

The age of onset of posterior vitreous detachment

The age of onset of posterior vitreous detachment (PVD) was studied in 930 eyes with a clearly defined onset time and no vitreoretinal diseases except refractive error or equatorial degeneration. We found a positive correlation between onset age of PVD and refractive error, with the regression line y = 0.91 x + 60.93 (y onset age, x diopter of refractive error). The higher the degree of myopia, the younger the onset age of PVD. Comparing onset ages for 240 eyes from males and 690 eyes from females, there was a possible tendency toward a lower PVD onset age for females. There was no significant difference in onset age between 112 eyes with and 818 eyes without equatorial degeneration of the retina.

Macular pucker after retinal detachment surgery

To better understand postsurgical macular pucker in rhegmatogenous retinal detachment, we reviewed a consecutive series of 277 eyes in 268 patients in whom retinal detachment had spared the macular area and in whom no preretinal membrane with distortion of the retinal vessels had been present preoperatively. Postoperatively, 17 eyes (6.1%) developed obvious macular pucker; 260 eyes (93.9%) did not. Using the Mantel-Haenszel chi-square test, we found that patient age, preoperative vitreous hemorrhage, large retinal breaks of more than three disc diameters, and cryoapplication were significant precipitating factors of postoperative macular pucker. These findings are consistent with the view that dispersion of retinal pigment epithelial cells through the retinal break into the vitreous cavity is the major cause of this disorder. Minimal use of cryotherapy is recommended in treating elderly patients who have a large retinal break or a preoperative vitreous hemorrhage.

Neovascularization of the iris in rhegmatogenous retinal detachment

To identify conditions associated with neovascularization of the iris in rhegmatogenous retinal detachment, we examined 36 eyes with this disorder seen at our hospital between 1979 and 1990. Clinical courses of disease were divided into the following three groups: (1) neovascularization of the iris without a history of a vitreoretinal operation (four eyes), (2) neovascularization of the iris after an unsuccessful vitreoretinal operation (26 eyes), and (3) neovascularization of the iris after surgical complications (six eyes). In all eyes of Groups 1 and 2, retinal detachment persisted at the onset of iris neovascularization; however, in six eyes, iris neovascularization subsided after retinal reattachment. Characteristic features of Groups 2 and 3 were patient age of 50 years or more, severe myopia, a history of increased intraocular pressure, a history of choroidal detachment, and a large scleral buckle.

Comparative study of clinical factors that predispose patients to proliferative vitreoretinopathy in aphakia

To clarify the risk factors of proliferative vitreoretinopathy (PVR) in aphakia, the clinical features of 25 aphakic eyes with PVR were statistically analyzed and compared with a control group of 157 aphakic eyes with non-PVR rhegmatogenous retinal detachment. The statistically significant (P less than 0.05) factors that predisposed patients to PVR in aphakia were as follows: a history of vitreous loss on cataract surgery, retinal detachment developing within 3 months after cataract extraction, duration of retinal detachment longer than 3 months, break larger than three disc diameters, and choroidal detachment. Vitreous loss is believed to play the most important role in the development of PVR in aphakia.

Causative factors of retinal detachment in macular holes

Two hundred nine macular holes of both pathologic myopia and idiopathic senile type were statistically analyzed to find out which factors cause retinal detachment in eyes with macular holes. The incidences of retinal detachment were as follows: 97.6% in myopia over -8.25 D, 67.7% in myopia between -8.0 and -3.25 D, and 1.1% in eyes under -3.0 D; 100% in widespread chorioretinal atrophy, 90.6% in spotty or lineal chorioretinal atrophy, 64.3% in myopic tigroid fundus, and 0% in eyes without myopic tigroid or atrophy; 96.0% in eyes with posterior staphyloma and 8.2% in eyes without it; 56.4% in posterior vitreous detachment [PVD] (+) eyes, 53.3% in PVD(+/-) eyes, and 51.9% in PVD(-) eyes. The statistically significant (P less than 0.05) factors that caused retinal detachment were refractive error, myopic chorioretinal change, and posterior staphyloma. There was no statistically significant difference regarding PVD.

Comparative study of clinical factors predisposing patients to proliferative vitreoretinopathy

Clinical features of 57 eyes with proliferative vitreoretinopathy (primary PVR) that developed preoperatively were statistically analyzed and compared with a control group of 1353 eyes with non-PVR rhegmatogenous retinal detachment. The statistically significant (P less than 0.05) factors predisposing to PVR were as follows: retinal detachment for more than 1 month; aphakia (47.4% in the PVR group versus 11.1% in the control group); vitreous hemorrhage (26.3% versus 11.0%); giant tear (15.8% versus 0.8%); breaks larger than 3 disc diameters (62.1% versus 27.3%); and horseshoe tear (65.5% versus 44.9%).

A new suturing method for the treatment of giant retinal tear

We report a new method for suturing the retina to the ocular wall when this is required for treatment of retinal detachment due to giant retinal tear. After closed vitrectomy, one of two ski-shaped needles (2.8 mm long and 0.4 mm thick) with an 8-0 nylon thread is introduced from a 1.4 mm scleral incision in the pars plana, advanced under direct observation through the retinal flap, and led extraocularly to an appropriate site in the opposite ocular wall. The second needle is advanced similarly through the same scleral incision and exited from the opposite ocular wall. The thread is then tied extraocularly on the sclera. The retinas of two patients were successfully reattached using this procedure in combination with encircling and the use of SF6 gas and air.