Macular Degeneration: Yasuda K

Shimura M, Nakazawa T, Yasuda K, Kunikata H, Shiono T, Nishida K. · Department of Ophthalmology, NTT East Japan Tohoku Hospital, Sendai, Japan. · Acta Ophthalmol. · Pubmed #18039346 No free full text.

Abstract: PURPOSE: To investigate the relationship between vitreous levels of cytokines, including interleukin-6 (IL-6) and vascular endothelial growth factor (VEGF), and visual prognosis after pars plana vitrectomy (PPV) with arteriovenous sheathotomy in patients with branch retinal vein occlusion (BRVO) associated with macular oedema. METHODS: We studied 60 patients with logMAR visual acuity (VA) scores of < 0.3 and visual impairment secondary to BRVO-associated macular oedema. All patients underwent PPV with arteriovenous sheathotomy. At the time of PPV, vitreous samples were collected from the operated eye and vitreous levels of VEGF and IL-6 were measured. Best corrected VA (BCVA) (using a logMAR chart) and foveal thickness (FT) (using optical coherence tomography) were monitored for up to 6 months after PPV. RESULTS: Both BCVA and FT significantly improved after PPV. According to multiple regression analysis, both the improvement in BCVA and decrease in FT were closely related to the vitreous level of IL-6 but not to that of VEGF. The vitreous level of VEGF was strongly correlated with duration of BRVO. CONCLUSIONS: Both improvement in BCVA and decrease in FT were observed after PPV in BRVO patients with macular oedema. Interestingly, these visual prognoses strongly correlate with the vitreous level of IL-6, whereas the duration of BRVO strongly correlates with the vitreous level of VEGF.

Shimura M, Nakazawa T, Yasuda K, Nishida K. · Department of Ophthalmology, NTT East Japan Tohoku Hospital, Sendai, Japan. · J Ocul Pharmacol Ther. · Pubmed #17593013 No free full text.

Abstract: PURPOSE: This study compares the effect of topical diclofenac with that of betamethasone against postoperative cystoid macular edema (CME) following cataract surgery in patients with non- and mild nonproliferative diabetic retinopathy. METHODS: Forty-six (46) consecutive patients with mild nonproliferative- or nondiabetic retinopathy who had bilateral and symmetrical cataracts underwent uncomplicated cataract surgery in both eyes (92 eyes in total). Postoperatively, topical diclofenac was applied 4 times daily for 1 eye, and topical betamethasone 4 times daily for the other eye in each patient. Best corrected logMAR visual acuity (BCVA), averaged foveal thickness (FT) as measured by optical coherence tomography (OCT), and intraocular pressure (IOP) were monitored preoperatively, and also postoperatively at 1 day and 1, 4, and 8 weeks. RESULTS: VA in both the diclofenac- and betamethasone-treated eyes significantly improved following the cataract surgery; however, no statistical difference of VA was noted between the diclofenac- and betamethasone-treated eyes throughout the observational period (before and after the surgery until 8 weeks postoperatively). FT in both eyes increased after the cataract surgery. FT in the diclofenac-treated eyes did not increase 1 week after surgery, but gradually increased at week 4 and week 8. In contrast, the FT in the betamethasone-treated eyes increased during 1-8 weeks postoperatively. IOP in the diclofenac-treated eyes decreased with time, but IOP in the betamethasone-treated eyes showed no change throughout the observational period. CONCLUSIONS: Postoperative macular thickening following cataract surgery in patients with non- or mild nonproliferative-diabetic retinopathy cannot be fully suppressed by either topical diclofenac or betamethasone. Nonetheless, diclofenac protected against an early event of postoperative CME and also a decrease of IOP.

Shimura M, Nakazawa T, Yasuda K, Shiono T, Iida T, Sakamoto T, Nishida K. · Department of Ophthalmology, NTT East Japan Tohoku Hospital, Sendai, Miyagi, Japan. · Am J Ophthalmol. · Pubmed #18328456 No free full text.

Abstract: PURPOSE: To compare the effect of an intravitreal injection of bevacizumab, an anti-vascular endothelial growth factor (VEGF) antibody, with that of triamcinolone acetonide, a corticosteroid for reduction of diabetic macular edema (DME). DESIGN: Prospective, comparative interventional case series. METHODS: Twenty-eight eyes of 14 patients with bilateral DME participated in this study. In each patient, one eye received an intravitreal injection of 4 mg triamcinolone acetonide and the other eye received 1.25 mg bevacizumab. The clinical course of best-corrected visual acuity (VA) with a logarithm of the minimum angle of resolution chart and averaged foveal thickness using optical coherence tomography was monitored for up to 24 weeks after the injection. RESULTS: Before the injection, foveal thickness and VA were 522.3 +/- 91.3 microm and 0.64 +/- 0.28 microm in the triamcinolone-injected eye, and 527.6 +/- 78.8 microm and 0.61 +/- 0.18 microm in the bevacizumab-injected eye, respectively; there was no significant difference between the eyes. One week after the injection, both eyes showed significant regression of macular edema. The triamcinolone-injected eye (342.6 +/- 85.5 microm and 0.33 +/- 0.21 microm) showed significantly better results than the bevacizumab-injected eye (397.6 +/- 103.0 microm and 0.37 +/- 0.17 microm). However, both eyes showed the recurrence of macular edema with time, even at 24 weeks. Triamcinolone (410.4 +/- 82.4 microm and 0.47 +/- 0.25 microm) kept better results than bevacizumab (501.6 +/- 92.5 microm and 0.61 +/- 0.17 microm). CONCLUSIONS: With the generally used concentration, intravitreal injection of triamcinolone acetonide showed better results in reducing DME and in the improvement of VA than that of bevacizumab, suggesting that the pathogenesis of DME is not only attributable to VEGF-dependency, but is also attributable to other mechanisms suppressed by corticosteroid.

Shimura M, Nakazawa T, Yasuda K, Shiono T, Nishida K. · Department of Ophthalmology, NTT East Japan Tohoku Hospital, 2-29-1, Yamato, Wakabayashi, Sendai, Miyagi 984-8560, Japan. · Br J Ophthalmol. · Pubmed #17077114 No free full text.

Abstract: AIM: To prospectively evaluate the efficacy of subtenon injection of triamcinolone acetonide (TA) before laser grid pattern photocoagulation (G-PC) for the treatment of diffuse diabetic macular oedema (DDME). METHODS: 42 eyes of 37 consecutive patients with DDME were studied. 1 week before G-PC, 21 eyes received TA subtenon injection, and the other eyes served as control. The clinical course of visual acuity (VA) and foveal thickness (FT) was monitored for up to 24 weeks after G-PC. Mean deviation (MD) of perimetry with 30-2 program on Humphrey Perimeter (Zeiss-Humphrey, Dublin, California, USA) was also measured. The average laser intensity was recorded. RESULTS: After TA injection, FT and VA were improved, and subsequent G-PC maintained the improvement for up to 24 weeks without recurrence of diffuse diabetic macular oedema. In contrast, G-PC without TA injection induced transient worsening of FT and VA, then both were gradually improved. At 24 weeks after G-PC, MD in the TA-injected eyes was better than those in control. The required laser intensity in TA-injected eyes was less than that for control. CONCLUSION: Subtenon injection of TA prior to G-PC allows for treatment with a lower intensity of laser spots and also prevents the decrease in central visual field sensitivity, all of which have clinical advantages for G-PC.

Shimura M, Saito T, Yasuda K, Tamai M. · Department of Ophthalmology and Medical Sciences, Tohoku University Graduate School of Medicine, Sendai, Japan. · Jpn J Ophthalmol. · Pubmed #15944830 No free full text.

Abstract: BACKGROUND: Interferon (IFN)-associated retinopathy is typically characterized by retinal hemorrhages and cotton wool spots at the posterior fundus, but visual function is usually maintained. With the use of optical coherence tomography (OCT), two patients with IFN-associated retinopathy who had developed macular edema and reduced visual acuity during the clinical course of IFN therapy were observed. CASES: A 37-year-old man with chronic hepatitis C and a 59-year-old man with chronic myeloid leukemia, both of whom had received IFN therapy, were referred to our outpatient clinic. The former patient had complained once that his visual acuity had decreased after the termination of IFN therapy, and the latter patient complained twice during IFN therapy that his visual acuity had decreased. OBSERVATIONS: In both patients, at the time of the visual disturbances, macular edema was clearly observed by OCT. Hypoalbuminemia and thrombocytopenia were observed at this time also. After the remission of the hypoalbuminemia and thrombocytopenia, the macular edema observed by OCT disappeared and visual acuity returned to normal. CONCLUSION: During and after IFN therapy, OCT is a useful examination technique for revealing macular edema in patients who have decreased vision. Ophthalmologists should be aware of the ocular side effects of IFN therapy and carefully monitor patients for the possible occurrence of hypoalbuminemia and thrombocytopenia. Jpn J Ophthalmol 2005;49:231-234 (c) Japanese Ophthalmological Society 2005.

Shimura M, Yasuda K, Nakazawa T, Ota S, Tamai M. · Department of Ophthalmology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan. · Ophthalmic Surg Lasers Imaging. · Pubmed #15305550 No free full text.

Abstract: BACKGROUND AND OBJECTIVE: To determine the effectiveness of laser grid pattern photocoagulation to the macula but not the papillomacular bundle for the treatment of diffuse diabetic macular edema. PATIENTS AND METHODS: Thirty-five eyes of 23 patients with diffuse diabetic macular edema underwent laser grid photocoagulation excluding the papillomacular bundle area. Best-corrected visual acuity by Snellen chart, foveal thickness using a retinal mapping program by optical coherence tomography (OCT), and mean deviation sensitivity by Humphrey automated central perimetry were investigated before and 1, 3, and 6 months after the treatment. RESULTS: Six months after treatment, the visual acuity was improved by 2 or more lines in 16 eyes (43%) and the foveal thickness decreased in 32 eyes (91%). The mean deviation worsened in 34 eyes (97%). There was a significant correlation between the improvement of visual acuity and the initial mean deviation, suggesting that a better visual acuity would be expected with a preoperative mean deviation of approximately -20 dB. CONCLUSION: Grid pattern photocoagulation without treatment to the papillomacular bundle area was effective in treating diffuse diabetic macular edema, especially in eyes with an initial mean deviation showing moderate dysfunction.

Shimura M, Yasuda K, Nakazawa T, Kano T, Ohta S, Tamai M. · Department of Ophthalmology, Tohoku Graduate School of Medicine, Sendai, Japan. · Ophthalmology. · Pubmed #14644723 No free full text.

Abstract: PURPOSE: To investigate the alterations of macular thickness during and after panretinal photocoagulation (PRP) in patients with severe diabetic retinopathy and good vision, and to compare the outcomes of weekly and biweekly treatments. DESIGN: Prospective, comparative interventional case series. PARTICIPANTS: Thirty-six patients with severe nonproliferative diabetic retinopathy or non-high-risk proliferative diabetic retinopathy whose visual acuity was 20/20 or better before PRP. METHODS: Seventy-two eyes of 36 patients underwent scatter PRP in 4 sessions. The macular thickness was measured by optical coherence tomography. The photocoagulation sessions were performed weekly to one eye and biweekly to the other eye. Each eye was selected at random. MAIN OUTCOME MEASURES: Best-corrected visual acuity and macular thickness. RESULTS: Visual acuities were maintained in 89% of eyes with weekly treatments and 92% of eyes with biweekly treatments. Macular thickness was increased transiently in the central macula in both eyes, more in the weekly treated eyes, and then decreased to control levels in eyes treated biweekly but remained thickened in eyes treated weekly. CONCLUSION: For eyes with severe diabetic retinopathy and good vision, PRP with either weekly or biweekly treatment did not affect postoperative visual acuity. However, biweekly treatments allowed faster recovery of macular thickening after PRP than weekly treatments.