Macular Degeneration: Kishi S

Kishi S. · Department of Ophthalmology, Gunma University School of Medicine. · Nippon Rinsho. · Pubmed #15999709 No free full text.

This publication has no abstract.

Otani T, Kishi S. · Department of Ophthalmology, Gunma University School of Medicine, Maebashi, Gunma, Japan. · Am J Ophthalmol. · Pubmed #12140028 No free full text.

Abstract: PURPOSE: To compare eyes that underwent surgery with untreated fellow eyes to assess the efficacy of vitrectomy for diabetic macular edema. METHODS: In a nonrandomized clinical trial, seven adult patients with mean age of 53 years (range 42 to 64) and the same degree and duration of diabetic macular edema in both eyes were followed up for more than 5 months after unilateral vitrectomy. The treated eye was selected at random, but if visual disparity between the both eyes was more than 3 lines, we operated on the worse side. We compared the preoperative and postoperative foveal thicknesses (the distance between the inner retinal surface and retinal pigment epithelium) and the best-corrected visual acuity by a certified examiner with those of the untreated fellow eye. RESULTS: In the seven eyes that underwent surgery, the foveal thickness decreased by an average of 622 to 269 microm (P =.027, Wilcoxon signed-rank test). In the fellow eyes, the average decrease in foveal thickness was from 617 to 546 microm (P =.176, Wilcoxon signed-rank test). The best-corrected postoperative visual acuity in the eyes that underwent surgery improved more than 2 lines in four eyes (57%) and remained the same in three eyes (43%). In the fellow eyes, it improved more than 2 lines in one eye (14%), remained the same in three eyes (43%), and decreased more than 2 lines in three eyes (43%). CONCLUSION: In eyes with diabetic macular edema that underwent surgery, the foveal thickness significantly decreased after vitrectomy. Vitrectomy may be effective for treating diabetic macular edema.

Kogure A, Ohkoshi K, Kogure S, Yamaguchi T, Kishi S. · Ophthalmology Department, St. Luke's International Hospital, Tokyo, Japan. · Jpn J Ophthalmol. · Pubmed #18626735 No free full text.

Abstract: PURPOSE: To evaluate the retention of intravitreal triamcinolone acetonide (TA) particles and the efficacy of TA therapy for patients with cystoid macular edema in branch retinal vein occlusion (BRVO) or diabetic macular edema (DME). We monitored the TA particles until absorption from the vitreous cavity was complete. The correlation between the intravitreal retention time of TA and its efficacy was evaluated based on central macular thickness (CMT). RESULTS: The intravitreal TA retention time was a mean 141.8 +/- 139.6 days in BRVO patients and 114.5 +/- 59.6 days in DME patients. Patient age and retention time were negatively correlated (r = -0.46; P = 0.013). At 6 months posttreatment the mean CMT decreased from 544.1 +/- 143.7 to 322.4 +/- 131.9 mum in BRVO patients and from 454.5 +/- 119.0 to 371.2 +/- 209.4 mum in DME patients. Retention time and CMT reduction were positively correlated in BRVO patient (r = 0.56, P = 0.02) but not in DME patients (P = 0.06). CONCLUSIONS: Intravitreal TA reduced the CMT in BRVO and DME patients over 6 months. The retention time was longer in younger individuals. The efficacy of the therapy depended on the intravitreal TA retention time observed clinically in BRVO patients. Biomicroscopic examination of intravitreal TA is useful for evaluation of its efficacy.

Otani T, Kishi S. · Department of Ophthalmology, Gunma University School of Medicine, Maebashi, Japan. · Ophthalmology. · Pubmed #17070586 No free full text.

Abstract: OBJECTIVE: To report the relationship between the findings of third-generation optical coherence tomography (OCT) and fluorescein angiography (FA) in eyes with diabetic macular edema (DME). DESIGN: Small case series. PARTICIPANTS: Four eyes with DME. METHODS: We compared findings from late-phase FA with corresponding cross-sectional OCT images using 5-mm-long horizontal and vertical scans. MAIN OUTCOME MEASURES: Fluorescein angiography and OCT findings in DME. RESULTS: Fluorescein angiography showed dye pooling within the cystic spaces with a petalloid pattern in the foveal area in all eyes; 3 eyes had cystic spaces primarily in the outer plexiform layer (OPL) on OCT. In 16 perifoveal areas in 4 eyes, FA showed hyperfluorescence with a honeycomb pattern in 7 areas, petalloid pattern in 3, and diffuse pattern in 3. The remaining 3 perifoveal areas had no hyperfluorescence. Optical coherence tomography showed that the perifoveal areas with a honeycomb pattern of hyperfluorescence had not only swelling of the OPL but also cystoid spaces located in the inner nuclear layer (INL). The perifoveal areas with no honeycomb pattern but petalloid or diffuse hyperfluorescence had only retinal swelling of the OPL. In the remaining 3 perifoveal areas without hyperfluorescence, OCT showed almost normal retinal structures. CONCLUSIONS: Diabetic macular edema typically showed 2 patterns of dye pooling on late-phase FA (i.e., petalloid in the fovea and honeycomb in the perifoveal area). The dye pooling corresponded to large cystic spaces in the OPL, and the honeycomb pattern to small cystic spaces in the INL.

Maruko I, Iida T, Spaide RF, Kishi S. · Department of Ophthalmology, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, Japan. · Am J Ophthalmol. · Pubmed #16678528 No free full text.

Abstract: PURPOSE: To report the peripheral abnormalities seen only with indocyanine green angiography in patients with vitelliform macular dystrophy (Best disease, caused by a mutation in the bestrophin gene). DESIGN: Observational case report series. METHODS: Eight eyes of four patients, two with only a central macular lesion and two with multifocal lesions, were studied. Results of indocyanine green angiography were compared with findings from ophthalmoscopy and fluorescein angiography. RESULTS: Throughout the fundus periphery, indocyanine green angiography demonstrated a number of hyperfluorescent spots in all eight eyes. The spots were observed in the midperiphery and the periphery in areas with no abnormality visible by ophthalmoscopy or fluorescein angiography. CONCLUSIONS: Although Best disease generally causes lesions visible in the posterior pole, the extensive distribution of the hyperfluorescent spots is consistent with the wide-ranging abnormalities of the retinal pigment epithelium, Bruch membrane, and the choroid as seen histopathologically.

Sato T, Iida T, Hagimura N, Kishi S. · Department of Ophthalmology, Gunma University School of Medicine, Maebashi, Gunma, Japan. · Retina. · Pubmed #15579989 No free full text.

Abstract: PURPOSE: To correlate optical coherence tomography (OCT) with angiographic signs of choroidal neovascularization (CNV) in retinal pigment epithelial detachment (PED) associated with age-related macular degeneration (ARMD). METHODS: Prospectively, the authors performed OCT in 35 eyes of 35 patients (30 men and 5 women with a mean age of 71.6 years [range, 56-76 years]) with ARMD. All 35 eyes had CNV in the area of PED or adjacent to it, which was shown by fluorescein or indocyanine green angiography. Cross-sectional images were obtained by the OCT scanning line through the CNV and PED. RESULTS: In 10 (56%) of 18 eyes in which the CNV was at the margin of the PED, a small PED was adjacent to the central, dome-shaped PED. There was a notch between the central and small mounds of PED. In 13 (76%) of 17 eyes in which the CNV was within the PED, a notch was seen in the dome-shaped PED, resulting in a contour with 2 mounds. One of the 2 mounds contained a highly reflective mass immediately beneath the detached retinal pigment epithelium in 8 (62%) of the 13 eyes. CONCLUSION: A tomographic notch in the PED may be diagnostically important as an indication of CNV beneath the detached retinal pigment epithelium in eyes with ARMD.

Otani T, Yamaguchi Y, Kishi S. · Department of Ophthalmology, Gunma University School of Medicine, Maebashi, Gunma, Japan. · Retina. · Pubmed #15492631 No free full text.

Abstract: PURPOSE: To report tomographic features of macular edema associated with distant retinal vascular disorders. METHODS: Six eyes with macular edema (three with extramacular branch retinal vein occlusion and three with Coats disease) underwent fluorescein angiography to detect dye leakage and optical coherence tomography to evaluate the macular features and measure the foveal height (distance between inner retinal surface and retinal pigment epithelium) and the retinal thickness (thickness of neurosensory retina) at the central fovea. RESULTS: Fluorescein angiography showed widespread nonperfusion and retinal vein staining in the eyes with a branch retinal vein occlusion not involving the macula. In eyes with Coats disease, nonperfused areas, telangiectatic retinal vessels, and aneurysms were seen in the peripheral fundus on fluorescein angiography. In one eye with Coats disease, telangiectatic vessels and aneurysms were seen in the nasal mid periphery of the optic disk. There was no dye leakage in the macular area in any eyes. Optical coherence tomography showed subretinal fluid and retinal swelling at the fovea in all eyes. The foveal height ranged from 300 to 697 microm (mean, 478 microm) and retinal thicknesses ranged from 170 to 280 microm (mean, 233 microm). CONCLUSION: Distant retinal vascular leakage causes serous retinal detachment in the macula. The macula is predisposed to collect subretinal fluid although retinal vascular leakage is far from the macula.

Sato T, Kanda T, Iida T, Takahashi T, Kishi S, Hoshino Y. · Department of Ophthalmology, Gunma University School of Medicine, Gunma, Japan. · J Int Med Res. · Pubmed #14587307 No free full text.

Abstract: We carried out an immunohistochemical investigation of the choroidal neovascular membranes from 12 eyes surgically excised as a result of age-related macular degeneration (n = 6) or idiopathic choroidal neovascularization (n = 6). Immunohistochemical staining was performed with antibodies specific for basic transcriptional element binding protein-2, actin or smooth muscle cell 1. In all membranes, the endothelial cells and stromal components around the vessels were immunoreactive for expression of basic transcriptional element binding protein-2, while immunoreactive expression of actin and smooth muscle cell type 1 was found in the surrounding stromal cells. These results suggest that basic transcriptional element binding protein-2, a zinc finger transcription factor, may contribute to the establishment of the choroidal neovascularization observed in the pathogenesis of age-related macular degeneration and idiopathic choroidal neovascularization.

Yamaguchi Y, Otani T, Kishi S. · Department of Ophthalmology, Gunma University School of Medicine, Maebashi, Gunma, Japan. · Am J Ophthalmol. · Pubmed #12504718 No free full text.

Abstract: PURPOSE: To report spontaneous resolution of diabetic cystoid macular edema (CME) associated with spontaneous vitreofoveal separation. DESIGN: Interventional case series. METHODS: Optical coherence tomography (OCT) was performed on three eyes of three diabetic patients with CME before and after vitreofoveal separation. RESULTS: In all three eyes, OCT showed cystic changes at the fovea with a slightly detached posterior hyaloid, which remained attached to the optic disk and the fovea. After spontaneous separation of the hyaloid at the fovea, there was resolution of the cystic cavities and restoration of the foveal depression. CONCLUSIONS: In some eyes of diabetic patients, CME is caused by a vitreous traction. Resolution of CME may occur after spontaneous vitreofoveal separation.

Otani T, Kishi S. · Department of Ophthalmology, Gunma University School of Medicine, Maebashi, Gunma, Japan. · Am J Ophthalmol. · Pubmed #11162979 No free full text.

Abstract: PURPOSE: To report the intraretinal location of foveal hard exudates after vitrectomy to treat diabetic macular edema and to evaluate the visual outcome. METHODS: In a prospective study, the tomographic features of 11 eyes (8 patients) with diabetic macular edema were evaluated with optical coherence tomography after vitrectomy. The intraretinal location of hard exudates at the fovea (anatomic foveola) and the relationship with visual acuity were investigated. RESULTS: With optical coherence tomography, hard exudates were observed as highly reflective spots in the cross-sectional images. In six of 11 eyes (54.5%), the hard exudates were in the inner portion of the neurosensory retina; the final best-corrected visual acuity averaged 20/70 in the six eyes. In the remaining five eyes (45.5%), hard exudates were deposited not only in the neurosensory retina but also in the subretinal space. In optical coherence tomographic images, subretinal hard exudates were observed as highly reflective plaques, which were slightly elevated over the retinal pigment epithelium. The five eyes developed a serous retinal detachment at the fovea before or after vitrectomy. Subretinal hard exudates bridged the detached neurosensory retina and the retinal pigment epithelium in two eyes. The average final visual acuity level in the five eyes was 20/300. The visual outcome was significantly worse in five eyes with subretinal hard exudates than in six eyes with an intraretinal one (P <.05, Wilcoxon rank sum tests). CONCLUSIONS: If serous retinal detachment develops before or after vitrectomy for diabetic macular edema, hard exudates tend to accumulate not only in the neurosensory retina but also in the subretinal space. The visual prognosis is worse in cases of subretinal exudation.

Todokoro D, Kishi S. · Department of Ophthalmology, Gunma University School of Medicine, Maebashi, Japan. · Ophthalmic Surg Lasers. · Pubmed #10847502 No free full text.

Abstract: The origin of the subretinal fluid in pit-macular syndrome is unknown. Using optical coherence tomography, the authors observed that an optic disk pit is not a true pit but a cystic cavity covered with a superficial layer of the optic disk in a patient with retinal detachment and retinoschisis. The cyst was connected to the intraretinal space of the retina, which was split in several layers, or the retinoschisis in the papillomacular area. Vitrectomy and gas tamponade were performed to treat the patient. During surgically-induced vitreous detachment, strong vitreoretinal attachment at the disk margin and the fovea was observed. After surgery, the cystic space at the optic disk disappeared and the retinal detachment and retinoschisis reattached. Vitreous traction may play a role to introduce the fluid from the optic cyst to the subretinal space through the superficially split retina.

Otani T, Kishi S. · Department of Ophthalmology, Gunma University School of Medicine, Maebashi, Gunma, Japan. · Am J Ophthalmol. · Pubmed #10764858 No free full text.

Abstract: PURPOSE: To evaluate the retinal structure before and after vitrectomy for diabetic macular edema and to assess the correlation between thickness of neurosensory retina and best-corrected visual acuity. METHODS: Tomographic features of 13 eyes (nine patients) with diabetic macular edema were prospectively evaluated with optical coherence tomography before and after vitrectomy. The foveal thickness (the distance between the inner retinal surface and the retinal pigment epithelium) and the retinal thickness (thickness of neurosensory retina) were measured by optical coherence tomography preoperatively and postoperatively. The correlation of the best-corrected visual acuity with foveal and retinal thickness was determined. RESULTS: All 13 eyes had retinal swelling with low intraretinal reflectivity. In addition to retinal swelling, there were cystoid spaces in five (38%) of 13 eyes, a serous retinal detachment in three (23%), and both cystoid spaces and serous detachment in three (23%). Six months postoperatively, the mean foveal thickness significantly decreased from 630 +/- 170 to 350 +/- 120 microm (P <.01, paired t test) and the mean thickness of neurosensory retina decreased from 540 +/- 160 to 320 +/- 140 microm (P <.01, paired t test). A serous retinal detachment occurred transiently in 3 eyes. Compared with the preoperative level, the postoperative best-corrected visual acuity level improved by more than 2 lines in five of the 13 eyes (38%), remained the same in seven eyes (54%), and decreased in one eye (8%). The postoperative thickness of neurosensory retina at the fovea and best-corrected visual acuity level at the sixth postoperative month had a strong negative correlation (correlation coefficient, -0.76; P <.01, Spearmans rank test). CONCLUSIONS: Vitrectomy was generally effective in treatment of diabetic macular edema. Optical coherence tomography demonstrated the intraretinal changes of macular edema and the process of edema absorption. During the process of macular edema absorption, intraretinal fluid appeared to move into the subretinal space in some cases. Best-corrected visual acuity improvement was greater in eyes with less preoperative increase in thickness of neurosensory retina.

Otani T, Kishi S, Maruyama Y. · Department of Ophthalmology, Gunma University School of Medicine, Maebashi, Japan. · Am J Ophthalmol. · Pubmed #10372879 No free full text.

Abstract: PURPOSE: We report cross-sectional images of diabetic macular edema and correlation between tomographic features and visual acuity with best correction by means of optical coherence tomography. METHOD: In a prospective study, optical coherence tomography was performed in 59 eyes of 42 patients with diabetic macular edema and in 10 eyes of 10 normal control subjects. RESULTS: Optical coherence tomography showed three patterns of structural changes in diabetic macular edema: sponge-like retinal swelling (52 [88%] of 59 eyes), cystoid macular edema (28 [47%] of 59 eyes), and serous retinal detachment (9 [15%] of 59 eyes). Some eyes had more than one pathologic change. Retinal swelling was more pronounced in the outer rather than the inner retinal layers. Cystoid macular edema was located mainly in the outer retinal layers. In eyes with long-standing cystoid macular edema, cystoid spaces had fused, resulting in a large cystoid cavity involving almost the entire retinal layer. Hard exudates were seen as highly reflective areas located in the outer retinal layers. The retinal thickness at the central fovea and the visual acuity with best correction showed an intermediate negative correlation in eyes without cystoid macular edema (correlation coefficient: -0.61, P < .01). CONCLUSIONS: Diabetic macular edema involved three structural changes, including sponge-like retinal swelling (88%), cystoid macular edema (47%), and serous retinal detachment (15%). Visual acuity with best correction moderately correlated with retinal thickness regardless of the different tomographic features.