Macular Degeneration: Ikuno Y

Fang X, Sakaguchi H, Gomi F, Oshima Y, Sawa M, Tsujikawa M, Ikuno Y, Kamei M, Kusaka S, Tano Y. · Department of Ophthalmology, Osaka University Medical School, Osaka, Japan. · Acta Ophthalmol. · Pubmed #18547274 No free full text.

Abstract: PURPOSE: To assess the efficacy, duration of effect and safety of one intravitreal injection of bevacizumab in diabetic macular oedema (DMO). METHODS: Bevacizumab (1 mg/0.04 ml) was injected intravitreally into eyes with DMO (29 with and nine without previous treatments). Best corrected visual acuity (BCVA), intraocular pressure and central retinal thickness (CRT) were measured; slit-lamp examination, macular biomicroscopy, optical coherence tomography and fluorescein angiography were performed before and at 2-4, 8 and 12 weeks post-injection. Best corrected VA and CRT were analysed in both groups. RESULTS: In the non-pretreated group, mean BCVA improved from 0.76 +/- 0.33 (baseline) to 0.57 +/- 0.30 and 0.54 +/- 0.27 at 2-4 weeks and 8 weeks post-injection, respectively (p = 0.02, p = 0.014, paired t-test). Mean CRT decreased from 632.4 +/- 196.0 microm (baseline) to 392.3 +/- 113.6 microm and 370.4 +/- 141.7 microm at the same time-points, respectively (p = 0.01, p = 0.01). There was no difference in BCVA or CRT at 12 weeks. In the pretreated group, mean BCVA improved from 0.62 +/- 0.30 (baseline) to 0.53 +/- 0.33 at 2-4 weeks post-injection (p = 0.01), and mean CRT decreased from 583.9 +/- 180.7 microm (baseline) to 404.1 +/- 197.9 microm at 2-4 weeks post-injection (p < 0.001). Mean BCVA was unchanged at 8 weeks and 12 weeks post-injection, although mean CRT remained lower at 8 weeks (p = 0.004). No ocular or systemic side-effects developed during follow-up. CONCLUSIONS: One intravitreal injection of bevacizumab for DMO seems to be effective and safe in both eyes that have been treated previously and eyes that have not. The therapeutic effect is temporary and repeat treatment may be needed.

Shima C, Sakaguchi H, Gomi F, Kamei M, Ikuno Y, Oshima Y, Sawa M, Tsujikawa M, Kusaka S, Tano Y. · Department of Ophthalmology, Osaka University Medical School, Suita, Japan. · Acta Ophthalmol. · Pubmed #18028234 No free full text.

Abstract: PURPOSE: To report complications in patients after intravitreal injection of bevacizumab to treat ocular diseases associated with vascular endothelial growth factor. METHODS: We retrospectively reviewed the systemic and ocular complications that developed within 2 months of each intravitreal injection of bevacizumab in 707 patients (1300 injections) with intraocular neovascularization or macular oedema. RESULTS: Nine ocular (1.27%) and eight systemic (1.13%) complications occurred in 707 patients. The ocular complications included corneal abrasion (n = 2), chemosis (n = 2), lens injury (n = 1), ocular inflammation (n = 2), retinal pigment epithelial tear (n = 1) and acute vision loss (n = 1). The systemic complications included cerebral infarction (n = 1), elevation of systolic blood pressure (n = 2), facial skin redness (n = 1), itchy diffuse rash (n = 1) and menstrual irregularities (n = 3). CONCLUSION: Intravitreal injection of bevacizumab may cause systemic or ocular complications. Caution is advised when considering intravitreal injection of this drug.

Gomi F, Ohji M, Sayanagi K, Sawa M, Sakaguchi H, Oshima Y, Ikuno Y, Tano Y. · Department of Ophthalmology, Osaka University Medical School, Suita, Osaka, Japan. · Ophthalmology. · Pubmed #17582498 No free full text.

Abstract: PURPOSE: To determine the prevalence of polypoidal choroidal vasculopathy (PCV) in Japanese patients presumed to have age-related macular degeneration (AMD) and compare 1-year outcomes after photodynamic therapy between PCV and choroidal neovascularization secondary to AMD. DESIGN: Prospective interventional study. PARTICIPANTS: Ninety-three consecutive patients (93 eyes) met the inclusion criteria: at least 50 years old, best-corrected visual acuity (VA) of 34 to 73 on the Early Treatment Diabetic Retinopathy Study (ETDRS) letter chart, a subfoveal lesion 5400 mum or smaller in greatest linear dimension (GLD) on fluorescein angiography (FA), and eligibility for photodynamic therapy. METHODS: Indocyanine green angiography was performed in all participants, and PCV and AMD were differentiated, treated with photodynamic therapy, and the patients observed for 1 year. The GLD was determined by FA for AMD and by indocyanine green angiography for PCV, and the diameter of the laser spot size was chosen, with an extra 1000 microm added to the GLD. Photodynamic therapy was repeated if leakage occurred on FA at 3-month follow-up visits. MAIN OUTCOME MEASURES: Prevalence of PCV at baseline and visual and angiographic changes 1 year after photodynamic therapy in PCV and AMD. RESULTS: Using indocyanine green angiography, 36 eyes (39%) were diagnosed with PCV and 54 eyes (58%) with choroidal neovascularization secondary to AMD. The median change in VA using the ETDRS letter score from baseline to 1 year was -7.0 in AMD eyes and +8.0 in PCV eyes (Mann-Whitney rank sum test; P<0.001). The VA improved (> or =15 letters) in AMD and PCV by 6% and 25%, respectively, and decreased (> or =15 letters) by 31% and 8%, respectively. Fluorescein leakage stopped at 1 year in 86% of PCV and 61% of AMD eyes (P = 0.031). Polypoidal choroidal vasculopathy recurred in 2 PCV eyes (5.6%), and a new PCV lesion developed in 1 PCV eye (2.8%) and 2 AMD eyes (3.7%) on indocyanine green angiography at 1 year. CONCLUSION: The prevalence of PCV meeting the treatment criteria for photodynamic therapy for presumed AMD is high in Japanese patients. Photodynamic therapy is more efficacious for PCV than for AMD, which may explain the good results in Japanese patients. Further study should assess the long-term clinical results.

Kim A, Gomi F, Sakaguchi H, Oshima Y, Ikuno Y, Kamei M, Oji M, Tano Y. · Department of Ophthalmology, Osaka University Hospital, Suita, Japan. · Nippon Ganka Gakkai Zasshi. · Pubmed #16491869 No free full text.

Abstract: PURPOSE: To evaluate the efficacy of sub-Tenon's injection of triamcinolone acetonide for age-related macular degeneration (AMD) and polypoidal choroidal vasculopathy (PCV). METHOD: Sub-Tenon's injection of triamcinolone acetonide was performed in patients (27 eyes) with the subfoveal choroidal neovascularization of AMD and in patients (10 eyes) with PCV, and its efficacy was evaluated. The visual acuity and the exudation from lesions evaluated by fluorescein angiography or optical coherence tomography (OCT) at three months or six months after injection were compared to the baseline values. RESULTS: Visual acuity was maintained in 23 of the 27 eyes (85.0%) with AMD and in 8 of the 10 eyes (80.0%) with PCV at three months after injection. Six months after infusion, the rate declined to 76.0% and 66.7%, respectively. Exudation from lesions had decreased in 10 eyes of 25 eyes(40.0%) with AMD and in 2 eyes of 9 eyes (22.2%) with PCV by six months after injection. Complete suppression of the lesions was observed in seven eyes (18.9%) with relatively small lesions. CONCLUSION: Sub-Tenon's injection of triamcinolone acetonide is useful as a treatment modality for AMD and PCV.

Cekiç O, Ohji M, KesercI B, Sawa M, Zheng Y, Hayashi A, Ikuno Y, Nakata K, Gomi F, Tano Y. · Department of Ophthalmology, Osaka University Medical School, Osaka, Japan. · Retina. · Pubmed #15097879 No free full text.

Abstract: PURPOSE: To evaluate the possible long-term alterations of choroidal perfusion parameters in the new central macular area after macular translocation surgery. METHODS: Eleven subjects with subfoveal neovascular membrane secondary to age-related macular degeneration or degenerative myopia underwent indocyanine green angiography by using a scanning laser ophthalmoscope before and after macular translocation (mean, 10 months after surgery). Fluorescence intensity of the new central macular area over time was evaluated. Parameters derived from the intensity curves included 10% filling time, ascending slope, and maximal intensity of brightness. The 10% filling time reflects the rapidity of the early choroidal filling phase, whereas the slope of the filling of the curve shows the speed of blood entrance into the choroid. Maximal intensity of brightness indicates vascular density of the area. RESULTS: No statistical difference was encountered before or after macular translocation in 10% filling time (14.25 +/- 2.09 seconds versus 16.20 +/- 2.95 seconds), slope of the ascending portion of the curve (0.12 +/- 0.04 versus 0.11 +/- 0.04), and maximal intensity of brightness (0.89 +/- 0.09 versus 0.88 +/- 0.07) in the new central macular area. The rotational degree of the retina against the retinal pigment epithelium did not show any significant correlation with 10% filling time, slope, or maximal intensity of brightness. CONCLUSION: Choroidal perfusion parameters in the new foveal region do not change after macular translocation surgery.

Cekiç O, Keserci B, Ohji M, Sawa M, Ikuno Y, Gomi F, Hayashi A, Fujikado T, Tano Y. · Department of Ophthalmology, Osaka University Medical School, E7, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan. · Retina. · Pubmed #15076944 No free full text.

Abstract: PURPOSE: To quantify and compare the retinal circulation times before and after macular translocation surgery. METHODS: In nine patients undergoing macular translocation with 360-degree retinotomy, arm-retina and arteriovenous passage times were quantified from preoperative and postoperative scanning laser fluorescein angiograms. A control group of eight patients who had not undergone any intraocular surgery was also evaluated. The time that between injection into the antecubital vein and the appearance of fluorescein at two selected points on superotemporal and inferotemporal arteries near the disk provided the arm-retina time. For the arteriovenous passage time, 50% of the maximal fluorescence time difference was assessed from the intensity curves of arteries and corresponding veins at the same points for the arm-retina time. Postoperative measurements were obtained an average of 10.6 months after surgery. RESULTS: No significant difference was noted between preoperative and postoperative values of the arm-retina time (mean +/- SD: 14.41 +/- 2.73 seconds versus 14.67 +/- 3.85 seconds, respectively; P = 0.84) or that of the arteriovenous passage time (2.66 +/- 0.74 seconds versus 2.47 +/- 0.68 seconds, respectively; P = 0.37) in the study group. The arm-retina time (14.96 +/- 2.01 seconds) and arteriovenous passage time (2.44 +/- 0.68 seconds) in the control group did not differ from preoperative and postoperative arm-retina times (P = 0.65 and P = 0.85) and arteriovenous passage times (P = 0.54 and P = 0.93) in the study group. The arteriovenous passage time correlated with the degree of retinal rotation around the optic disk in the study group (r = -0.70; P = 0.04). CONCLUSION: Macular translocation surgery does not alter retinal macrocirculation in the long term.

Fujikado T, Asonuma S, Ohji M, Kusaka S, Hayashi A, Ikuno Y, Kamei M, Oda K, Tano Y. · Department of Visual Science, Osaka University Medical School, Osaka, Japan. · Am J Ophthalmol. · Pubmed #12470753 No free full text.

Abstract: PURPOSE: To report reading ability using a standardized reading chart after macular translocation with 360-degree retinotomy in eyes with age-related macular degeneration (AMD) or with myopic choroidal neovascularization (mCNV). DESIGN: Interventional case series. METHODS: In 34 eyes of 34 patients with subfoveal choroidal neovascular membrane (AMD, 23; mCNV, 11), macular translocation surgery with 360-degree retinotomy and simultaneous extraocular muscle surgery were performed. The average age was 67.4 +/- 7.9 years, and the average follow-up period was 7.6 +/- 3.3 months. The best-corrected far visual acuity (FVA) was measured with a standardized visual acuity chart using Landolt Cs, and the critical print size (CPS) was determined with the Japanese version of the Minnesota reading chart (MNREAD-J Chart) preoperatively and postoperatively. Preoperative and postoperative change in the CPS was compared with the subjective visual improvement as assessed by a questionnaire. RESULTS: The postoperative improvement of FVA was statistically significant in eyes with mCNV (P =.010) but not significant in eyes with AMD (P =.495). The postoperative improvement of CPS was statistically significant both in eyes with AMD (P =.027) and in eyes with mCNV (P =.004). The subjective visual improvement was significantly correlated with the change of CPS in patients after a second better eye surgery. CONCLUSIONS: After macular translocation with 360-degree retinotomy, the improvement of reading ability was significant in eyes with both AMD and mCNV. We conclude that this surgical method is well suited to improve reading ability of patients with AMD or mCNV.

Ohji M, Fujikado T, Kusaka S, Hayashi A, Hosohata J, Ikuno Y, Sawa M, Kubota A, Hashida N, Tano Y. · Department of Ophthalmology, Osaka University Medical School, 2-2 Yamadaoka, Suita, 565-0871, Japan. · Am J Ophthalmol. · Pubmed #11730654 No free full text.

Abstract: PURPOSE: To report the results of three methods of foveal translocation in the presence of subfoveal choroidal neovascular membrane resulting from age-related macular degeneration. METHODS: We treated 51 eyes of 51 consecutive patients with subfoveal choroidal neovascular membranes resulting from age-related macular degeneration with one of three techniques of foveal translocation surgery: foveal translocation with partial retinotomy (n = 6), limited translocation (n = 9), and translocation with 360-degree retinotomy (n = 36). All patients were followed for at least 6 months postoperatively. The size of the choroidal neovascular membrane and the amount of foveal displacement, the best-corrected visual acuity, and complications were recorded preoperatively and postoperatively. RESULTS: The mean distance of the foveal translocation was greater in the 360-degree retinotomy group (3340 microm) than in the partial retinotomy (1060 microm, P <.001) and the limited translocation groups (1120 microm, P <.001). A final visual acuity of 20/200 or better was achieved in two eyes (33%) in the partial retinotomy group, seven eyes (78%) in the limited translocation group, and 23 eyes (64%) in the 360-degree retinotomy group. The final visual acuity improved by 0.2 logarithm of minimal angle of resolution (logMAR) unit or more in one eye (17%), one eye (11%), and seven eyes (19%), respectively. The final visual acuity was maintained within 1 line in zero eyes, five eyes (56%), and 19 eyes (53%), respectively. A retinal detachment developed postoperatively in five eyes (83%), zero eyes (0%), and 15 eyes (42%), respectively. CONCLUSIONS: A significant number of patients improved or maintained best-corrected visual acuity after translocation with 360-degree retinotomy, and limited translocation, whereas translocation with 360-degree retinotomy is suitable for larger choroidal neovascular membranes because it resulted in the greatest foveal displacement among the three translocation procedures.