Macular Degeneration: Ito Y

Ozawa S, Ishikawa K, Ito Y, Nishihara H, Yamakoshi T, Hatta Y, Terasaki H. · Department of Ophthalmology, Nagoya University Graduate School of Medicine, Japan. · Retina. · Pubmed #19516119 No free full text.

Abstract: PURPOSE: To evaluate the differences in the optical coherence tomographically determined macular morphology in eyes with polypoidal choroidal vasculopathy (PCV) from eyes with exudative age-related macular degeneration (AMD) quantitatively. METHODS: The medical records of 208 eyes of 203 Japanese patients with PCV or exudative AMD who were newly treated for choroidal neovascularization were reviewed. The six linear, low-resolution, high-speed scans of 6 mm were analyzed using a manually assisted computer algorithm, which allowed us to manually draw spline lines arbitrarily on the images so that the subretinal fluid and neurosensory retina could be segmented. The thickness of the neurosensory retina and height of the serous retinal detachment (SRD) within the central 3-mm and 6-mm areas were calculated. RESULTS: SRDs were observed in 53% (63/119) of the eyes with exudative AMD and in 78% (69/89) of the eyes with PCV (P < 0.001). The height of the SRD was 21.9 +/- 3.7 microm (+/-SEMs) in eyes with exudative AMD and 56.3 +/- 7.4 microm in eyes with PCV (P < 0.001). The thickness of the neurosensory retina was 300.0 +/- 5.2 microm in eyes with exudative AMD and 275.8 +/- 4.7 microm in eyes with PCV (P < 0.001). CONCLUSION: Eyes with PCV are characterized by a higher incidence of SRDs, greater SRD height, and less intraretinal edema than eyes with exudative AMD.

Ishikawa K, Nishihara H, Ozawa S, Piao CH, Ito Y, Kondo M, Terasaki H. · Department of Ophthalmology, Nagoya University Graduate School of Medicine, Japan. · Retina. · Pubmed #19262429 No free full text.

Abstract: PURPOSE: Retinal function is commonly depressed transiently after photodynamic therapy (PDT). Additional treatment may prevent this impaired retinal function. The purpose of this study was to determine the changes in the focal macular electroretinograms (FMERGs) after PDT combined with TA for age-related macular degeneration. METHODS: Thirty-four eyes that were successfully treated by PDT with a posterior juxtascleral injection of TA were studied. FMERGs, optical coherence tomography, and indocyanine green angiography were performed before and after the PDT. RESULTS: The mean amplitudes of the FMERGs were not significantly decreased 1 week after PDT with TA (P > 0.05). The mean ratio of the FMERG b-wave 1 week after PDT to that before PDT was 1.09, with an indistinct hypofluorescence at the site of the PDT (18 eyes), and the ratio was 0.91 in the eyes with a distinct hypofluorescence border (16 eyes; P < 0.05). CONCLUSION: The combined use of TA with PDT mitigated the depression of retinal function soon after PDT. However, there were cases of severe choroidal hypoperfusion corresponding to the site of the laser spot that impaired retinal function in comparison to cases with mild hypoperfusion. Even with severe choroidal hypoperfusion, the deterioration in retinal function was relatively mild, with the b-wave FMERG reduced by only 10%.

Ishikawa K, Ito Y, Mizutani R, Kikuchi M, Nishihara H, Terasaki H. · Department of Ophthalmology, Nagoya University Graduate School of Medicine, Showa-ku, Nagoya, Japan. · Jpn J Ophthalmol. · Pubmed #18661268 No free full text.

Abstract: PURPOSE: To determine whether an algorithm we have developed can be used to measure the retinal thickness on optical coherence tomography (OCT) images. METHODS: Six radial linear scans of 6 mm were made with the OCT instrument. The retinal thickness and volume determined with the built-in algorithm for the OCT instrument for 50 eyes of 50 control subjects with normal retinal boundaries were compared to the values obtained with our algorithm. The macular volume was also measured in 26 eyes of 25 subjects before and after photodynamic therapy (PDT). RESULTS: The values obtained by the two algorithms in normal retinas were strongly correlated (R=0.99). Bland-Altman plots of the mean differences between the two algorithm measurement values showed excellent agreement. The mean macular volume determined before and 1 week after PDT with the built-in algorithm was significantly larger than that measured with our algorithm (P=0.035 pre-PDT; P=0.004 1 week after PDT). CONCLUSIONS: Our algorithm can be used to obtain a valid measurement of retinal thickness in normal retinas. The macular volume before and 1 week after PDT obtained with the built-in algorithm was larger than those measurements obtained with our algorithm.

Noda K, She H, Nakazawa T, Hisatomi T, Nakao S, Almulki L, Zandi S, Miyahara S, Ito Y, Thomas KL, Garland RC, Miller JW, Gragoudas ES, Mashima Y, Hafezi-Moghadam A. · Angiogenesis Laboratory, Massachusetts Eye and Ear Infirmary, Boston, MA 02114, USA. · FASEB J. · Pubmed #18436961 links to  free full text

Abstract: Vascular adhesion protein-1 (VAP-1) is an endothelial cell adhesion molecule involved in leukocyte recruitment. Leukocytes and, in particular, macrophages play an important role in the development of choroidal neovascularization (CNV), an integral component of age-related macular degeneration (AMD). Previously, we showed a role for VAP-1 in ocular inflammation. Here, we investigate the expression of VAP-1 in the choroid and its role in CNV development. VAP-1 was expressed in the choroid, exclusively in the vessels, and colocalized in the vessels of the CNV lesions. VAP-1 blockade with a novel and specific inhibitor significantly decreased CNV size, fluorescent angiographic leakage, and the accumulation of macrophages in the CNV lesions. Furthermore, VAP-1 blockade significantly reduced the expression of inflammation-associated molecules such as tumor necrosis factor (TNF) -alpha, monocyte chemoattractant protein (MCP) -1, and intercellular adhesion molecule (ICAM) -1. This work provides evidence for an important role of VAP-1 in the recruitment of macrophages to CNV lesions, establishing a novel link between VAP-1 and angiogenesis. Inhibition of VAP-1 may become a new therapeutic strategy in the treatment of AMD.

Ishikawa K, Kondo M, Ito Y, Kikuchi M, Nishihara H, Piao CH, Sugita T, Terasaki H. · Department of Ophthalmology, Nagoya University Graduate School of Medicine, Nagoya, Japan. · Invest Ophthalmol Vis Sci. · Pubmed #17460288 links to  free full text

Abstract: PURPOSE: It is known that the amplitudes of the multifocal electroretinograms are generally reduced soon after photodynamic therapy (PDT). The purpose of this study was to determine whether this amplitude reduction correlates with the changes in macular thickness or with changes in choroidal circulation. METHODS: Thirty-seven eyes that were successfully treated by PDT were studied. Focal macular electroretinograms (fmERGs) and optical coherence tomography were performed before and 1 week, 1 month, and 3 months after PDT. Indocyanine green angiography was performed before and 3 months after PDT. The indocyanine green angiographic findings were classified into two groups: group A, with indistinct hypofluorescence at the site of the PDT, and group B, with well-defined hypofluorescence borders coinciding with the site of the PDT. RESULTS: The mean amplitudes of the fmERGs were significantly reduced at 1 week after PDT (P < 0.05). The correlations between the changes in the amplitude of the fmERG and the changes in macular thickness were not significant. Sixteen (43%) of the study eyes were classified into group A and 21 (57%) into group B by indocyanine green angiography. The mean ratio of the fmERG b-wave 1 week after PDT to that before PDT was 1.14 +/- 0.62 in group A and 0.65 +/- 0.29 in group B. This difference was statistically significant (P < 0.01). CONCLUSIONS: One of the possibilities that could explain the reduction in the amplitude of the fmERGs soon after PDT is the reduction in choroidal circulation caused by the PDT.

Iguchi Y, Ito Y, Kikuchi M, Ishikawa K, Oshima H, Yatsuya H, Terasaki H. · Department of Ophthalmology, Nagoya University School of Medicine, Nagoya, Japan. · Br J Ophthalmol. · Pubmed #16837537 No free full text.

Abstract: AIMS: To determine whether there is a seasonal variation in the onset of acute, massive submacular haemorrhage associated with age-related macular degeneration. METHODS: Sixty eyes of 59 patients diagnosed between April 1998 and March 2005, were studied retrospectively. For each patient, the month and season of onset of the submacular haemorrhage and the mean monthly ambient temperature in Nagoya were analysed. Any history of systemic hypertension was also recorded, and the seasonal variations were also investigated in hypertensive and non-hypertensive groups. RESULTS: The number of cases peaked in winter with a trough in summer, and this seasonal variation was significant (Roger's R = 12.03, p<0.01). The monthly incidence was inversely correlated with the temperature (Spearman's rank correlation coefficient r = 0.89, p<0.01). The seasonal variations were significant in the hypertensive group but not in the non-hypertensive group. CONCLUSION: The considerable seasonal variations suggests that the mechanism for the haemorrhage is strongly correlated with the systemic blood pressure.

Nakamura M, Lin J, Ito Y, Miyake Y. · Department of Ophthalmology, Nagoya University Graduate School of Medicine, 65 Tsuruma-cho, Showa-ku, Nagoya 466-8550, Japan. · Am J Ophthalmol. · Pubmed #15953459 No free full text.

Abstract: PURPOSE: To report a novel mutation in the RLBP1 gene and optical coherence tomographic findings in a Japanese patient with retinitis punctata albescens. DESIGN: Observational case report. METHODS: The RLBP1 gene was analyzed by direct genomic sequencing. A complete ophthalmologic examination was performed. RESULTS: Compound heterozygous mutations in the RLBP1 gene were identified in the patient. The mutations were a novel missense Arg103Trp mutation and a missense Arg234Trp mutation, the causative mutation of Bothnia dystrophy. The patient's fundi showed numerous white dots with diffuse retinal mottling and bilateral macular degeneration. Her visual function deteriorated progressively during 12-year follow-up. Optical coherence tomography demonstrated decreased retinal thickness, especially the photoreceptor layer. CONCLUSION: A novel mutation in RLBP1 gene was found in a Japanese patient with retinitis punctata albescens. Degenerative changes of the outer retina were detected by optical coherence tomography.

Ishikawa K, Terasaki H, Kobayashi C, Niwa Y, Piao CH, Ito Y, Kondo M, Miyake Y. · Department of Ophthalmology, Nagoya University School of Medicine, Nagoya, Japan. · Ophthalmic Res. · Pubmed #15637420 No free full text.

Abstract: PURPOSE: To evaluate the effect of transpupillary thermotherapy (TTT) on foveal thickness and macular function in eyes with choroidal neovascularization (CNV) associated with age-related macular degeneration. METHODS: Sixteen eyes with occult CNV and 6 eyes with classic CNV were treated with TTT. Optical coherence tomography and focal macular electroretinograms (FMERGs) elicited by a 15-degree stimulus were performed before, 3 months after TTT in 22 eyes and 6 months after TTT in 18 eyes. RESULTS: Before TTT, the fovea in 20 of the 22 eyes with CNV was significantly thicker than that of normal subjects. The foveal thickness was reduced after TTT in 11 of 14 eyes with occult CNV and remained unchanged in 2 eyes. One eye with occult CNV before TTT developed a classic CNV with significant macular edema and increased foveal thickness 3 months after TTT. The amplitudes of the FMERGs were reduced in all eyes before TTT. In eyes with occult CNV, the mean b-wave amplitude increased significantly after TTT (p = 0.0260 at 3 months, p = 0.0142 at 6 months). When the change of foveal thickness was less than 20% after TTT, all eyes with occult CNV had a 30% or more increase in the b-wave amplitude. In eyes with classic CNV, the mean amplitude of the a- and b-waves did not change significantly after TTT. CONCLUSIONS: TTT improves macular function in eyes with occult CNV associated with age-related macular degeneration more when the change of foveal thickness is slight.

Terasaki H, Ishikawa K, Niwa Y, Piao CH, Niwa T, Kondo M, Ito Y, Miyake Y. · Department of Ophthalmology, Nagoya University School of Medicine, Nagoya, Japan. · Invest Ophthalmol Vis Sci. · Pubmed #14744900 links to  free full text

Abstract: PURPOSE: To evaluate the short- and long-term changes of focal macular electroretinograms (fmERGs) after macular translocation with 360 degrees retinotomy. METHODS: This was a retrospective study. fmERGs were recorded in 19 eyes of 19 consecutive patients who underwent macular translocation with 360 degrees retinotomy for choroidal neovascularization (CNV) secondary to age-related macular degeneration (AMD; 17 eyes) or polypoidal choroidal vasculopathy (2 eyes). The changes in the fmERGs, recorded before, shortly after (6-12 months; mean 8.3 months), and more than 18 months (18-30 months; mean 22.4 months) after surgery from 12 eyes, were analyzed. A 15 degrees stimulus centered on the fovea was used to elicit the fmERGs. RESULTS: The mean logarithm of minimum angle of resolution (logMAR) was 1.06 +/- 0.07 (20/230) before surgery, 0.78 +/- 0.08 (20/121) early after surgery (n = 19), and 0.64 +/- 0.07 (20/87) late after surgery (n = 12). These improvements in visual acuity were significant (P = 0.0074, P = 0.0050, respectively). Before surgery, the amplitudes of all components of the fmERGs were markedly reduced in all eyes. The mean b-wave amplitude in 17 AMD eyes recorded early after surgery was significantly larger (P = 0.0262), and the mean a-wave amplitude was also increased but not significantly (P = 0.1180). The mean amplitudes of the a- and b-waves in 10 AMD eyes recorded after 18 months were significantly larger than those before the surgery (P = 0.0218, and P = 0.0284). The mean implicit time of the b-wave in 17 AMD eyes decreased early after surgery, and a further decrease was detected at the later testing time. CONCLUSIONS: These results indicate that macular function is partially recoverable after macular translocation in some patients.

Terasaki H, Kojima T, Niwa H, Piao CH, Ueno S, Kondo M, Ito Y, Miyake Y. · Department of Ophthalmology, Nagoya University School of Medicine, Nagoya, Japan. · Invest Ophthalmol Vis Sci. · Pubmed #14507894 links to  free full text

Abstract: PURPOSE. To evaluate the changes in the focal macular electroretinogram (FMERG) and foveal retinal thickness after vitrectomy for diabetic macular edema (DME). METHODS. FMERGs were elicited from 25 eyes of 21 patients (ages 29-75 years) who underwent vitrectomy for DME by a 15 degrees stimulus. A posterior vitreous detachment (PVD) was created during surgery in 19 eyes (group 1), and 4 eyes had a PVD before surgery (group 2). In the remaining 2 eyes, a PVD could not be created (group 3). FMERGs were recorded before and 3, 6, and 12 months after vitrectomy. The foveal thickness, determined by optical coherence tomography (OCT), and visual acuity were measured on the same day as the FMERG recordings. RESULTS. The postoperative visual acuity (logarithm of the minimum angle of resolution [logMAR]) improved gradually after the surgery and was significantly better at 12 months in eyes in group 1 (P = 0.0393). The postoperative mean foveal thickness was significantly less at 3 months after surgery in group 1 eyes (P = 0.0006), and there was a further decrease thereafter. In the 2 eyes in group 3, the decreased foveal thickness 3 and 6 months after surgery became thicker at 12 months. The mean b-wave amplitude of the FMERGs increased significantly at 12 months in group 1 eyes (P = 0.0297). The mean implicit time of a- and b-waves was more delayed at 3 months, and the change in a-wave was statistically significant in group 1 eyes (P = 0.0474). There was a wide range of changes in the b-wave amplitude at 12 months, however, the increase in the b-wave was correlated with the decrease in foveal thickness (r =.49, P = 0.012). CONCLUSIONS. A disparity in the time course and degree of recovery of the foveal thickness and macular retinal function was found in eyes with DME after vitrectomy. Part of the functional recovery could be attributed to decreased retinal thickness and the absorption of the subretinal fluid.

Kojima T, Terasaki H, Nomura H, Suzuki T, Mori M, Ito Y, Miyake Y. · Department of Ophthalmology, Nagoya University School of Medicine, Nagoya, Japan. · Ophthalmic Res. · Pubmed #12815194 No free full text.

Abstract: AIMS: To determine the effect of preoperative factors on the foveal thickness following vitrectomy for diabetic macular edema. METHODS: Fifty-eight eyes of 47 patients underwent vitrectomy for diabetic macular edema. In all eyes, no clear, visible vitreomacular traction was present. Twelve eyes were pseudophakic before vitrectomy, and 31 eyes underwent concurrent phacoemulsification and intraocular lens (IOL) implantation. Multiple logistic regression analysis was used to assess the independent effect of age, history of photocoagulation, diabetic retinopathy status, preoperative posterior vitreous detachment, HbA(1c) and serum creatinine levels within 2 weeks before surgery, lens status after surgery and follow-up period on the foveal thickness determined by optical coherence tomography. RESULTS: The median preoperative visual acuity was 20/100 (range from 20/500 to 20/20), and the median postoperative visual acuity was 20/70 (range from 20/500 to 20/13). The preoperative visual acuity (logarithm of minimal angle of resolution; logMAR) was 0.73 +/- 0.36 (mean +/- SD; 20/107 Snellen acuity), and the mean postoperative logMAR visual acuity was 0.60 +/- 0.39 (20/80), which was significantly better than the mean preoperative value (Wilcoxon signed rank test, p = 0.011). The mean +/- SD of preoperative foveal thickness was 475.9 +/- 172.5 micrometer, and the mean postoperative foveal thickness was 277.3 +/- 171.9 micrometer. The mean postoperative foveal thickness was significantly thinner than the preoperative thickness (Student's paired t test, p < 0.0001). Multiple logistic regression analysis showed that a preoperative low HbA(1c) and postoperative pseudophakia were independently associated with the decrease in foveal thickness (p = 0.01, p = 0.04, respectively). CONCLUSIONS: The greater reduction in foveal thickness in eyes with an IOL probably resulted from a relatively larger amount of vitreous being removed during the vitrectomy. Because the decrease in foveal thickness may be related to the preoperative glycemic control and the amount of vitreous, these factors should be considered in the planning for vitrectomy.

Kondo M, Ito Y, Ueno S, Piao CH, Terasaki H, Miyake Y. · Department of Ophthalmology, Nagoya University School of Medicine, Japan. · Am J Ophthalmol. · Pubmed #12719092 No free full text.

Abstract: PURPOSE: Occult macular dystrophy (OMD) is an inherited macular dystrophy characterized by a progressive macular dysfunction without any visible fundus abnormality. We studied the foveal thickness in patients with OMD using optical coherence tomography (OCT). DESIGN: Observational case series. Foveal thickness by OCT images. METHODS: Foveal thickness obtained from 22 eyes of 11 patients with OMD was compared with that from 27 eyes of 20 age-matched normal controls. RESULTS: Mean foveal thickness in the patients group (96.5 +/- 19.5 microm) was significantly thinner than that in the normal controls (133.3 +/- 9.0 microm, P <.0001, Mann-Whitney U test). Eighteen of 22 eyes with OMD had foveal thickness that were thinner than the lower limit of the normal range. There was no statistically significant correlation between the foveal thickness and visual acuity, age, or duration from onset. CONCLUSION: These results demonstrated that there are significant anatomic changes in the macula of patients with OMD.

Terasaki H, Miyake Y, Niwa T, Ito Y, Suzuki T, Kikuchi M, Kondo M. · Department of Ophthalmology, Nagoya University School of Medicine, 65 Tsuruma-cho, Showa-ku, Nagoya 466, Japan. · Invest Ophthalmol Vis Sci. · Pubmed #11980872 links to  free full text

Abstract: PURPOSE: To evaluate the changes in focal macular electroretinograms (fmERGs) after surgical removal of choroidal neovascular (CNV) lesions. METHODS: Fourteen patients (14 eyes) with subfoveal or juxtafoveal CNV associated with age-related macular degeneration and 1 patient with idiopathic CNV underwent vitrectomy and removal of the lesions. fmERGs elicited by a 15 degree stimulus were recorded before and 3 months after surgery. Optical coherence tomography (OCT) was performed to measure the foveal and parafoveal thickness before and 3 months after surgery. RESULTS: Preoperative fmERGs were markedly reduced in all eyes. The mean amplitude of the b-wave in 15 eyes recorded 3 months after surgery increased significantly (P = 0.0022, Wilcoxon signed rank test). In all eyes except two with nearly nonrecordable a- and b- waves, the mean b-wave-to-a-wave ratio after surgery increased significantly in all eyes (P = 0.0330, Wilcoxon signed rank test). The percentage increase in the b-wave amplitude correlated significantly with the percentage decrease in the mean parafoveal retinal thickness (r = 0.688, P = 0.0076). CONCLUSIONS: The decreased macular ERGs were partially recoverable in the early postoperative period. The decreased retinal edema after surgery may have contributed to this recovery.

Kondo M, Ueno S, Piao CH, Ito Y, Terasaki H, Miyake Y. · No affiliation provided · Br J Ophthalmol. · Pubmed #15548825 links to  free full text

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