Hirotaka Yokouchi, Daisuke Nagasato, Yoshinori Mitamura, Mariko Egawa, Hitoshi Tabuchi, Sonoko Misawa, Satoshi Kuwabara and Takayuki Baba : Alterations in choroidal vascular structures due to serum levels of vascular endothelial growth factor in patients with POEMS syndrome., Scientific Reports, Vol.13, No.1, 2023.
(Summary)
A higher serum vascular endothelial growth factor (VEGF) level can cause choroidal thickening in the choroid of patients with polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy, and skin changes (POEMS) syndrome. We aimed to determine whether fluctuations in serum VEGF levels affect choroidal vascular structures in patients with POEMS syndrome. This retrospective observational case series examined 17 left eyes of 17 patients with POEMS syndrome. Enhanced depth imaging optical coherence tomography (EDI-OCT) images were obtained, and serum VEGF levels were measured at baseline and 6 months after transplantation with dexamethasone (n = 6), thalidomide (n = 8), or lenalidomide (n = 3). EDI-OCT images were binarized using ImageJ software, and we calculated the areas of the whole choroid and the luminal and stromal areas. Subsequently, we determined whether the choroidal vascular structure had changed significantly between baseline and 6 months after treatment. Six months after treatment, serum VEGF levels and the whole choroid, luminal, and stromal areas had decreased significantly compared to the baseline values (all, P < 0.001). The mean luminal area to the whole choroidal area ratio at 6 months after treatment was 0.70 ± 0.03, which was significantly smaller than the ratio at baseline (0.72 ± 0.03; P < 0.001). Whole choroid and luminal area fluctuations were significantly positively correlated with fluctuations in serum VEGF levels (r = 0.626, P = 0.007 and r = 0.585, P = 0.014, respectively). Choroidal thickening induced by VEGF might be caused by increases in the choroidal vessel lumen area. These results may offer insights into the pathogenesis of POEMS syndrome and the role of serum VEGF in choroidal vascular structure, which may apply to other ocular diseases.
Daisuke Nagasato, Takahiro Sogawa, Mao Tanabe, Hitoshi Tabuchi, Shogo Numa, Akio Oishi, Hanako Ikeda Ohashi, Akitaka Tsujikawa, Tadao Maeda, Masayo Takahashi, Nana Ito, Gen Miura, Terumi Shinohara, Mariko Egawa and Yoshinori Mitamura : Estimation of Visual Function Using Deep Learning From Ultra-Widefield Fundus Images of Eyes With Retinitis Pigmentosa., JAMA ophthalmology, Vol.141, No.4, 305-313, 2023.
(Summary)
Results of this study suggest that the visual function estimation in patients with retinitis pigmentosa from ultra-widefield fundus autofluorescence images using deep learning might help assess disease progression objectively. Findings also suggest that deep learning models might monitor the progression of retinitis pigmentosa efficiently during follow-up.
Keisuke Minami, Mariko Egawa, Keisuke Kajita, Fumiko Murao and Yoshinori Mitamura : A Case of Vogt-Koyanagi-Harada Disease-Like Uveitis Induced by Nivolumab and Ipilimumab Combination Therapy., Case Reports in Ophthalmology, Vol.12, No.3, 952-960, 2021.
(Summary)
Nivolumab and ipilimumab are widely used immune checkpoint inhibitors (ICPIs) for the treatment of metastatic melanoma. ICPIs cause an array of side effects called immune-related adverse events (IRAEs) due to activation of an immune response. ICPI-uveitis can cause irreversible vision loss if untreated. There are few reports of recurrent Vogt-Koyanagi-Harada (VKH) disease-like uveitis induced by nivolumab and ipilimumab. We report a case of VKH disease-like uveitis recurrence after resuming ICPIs. A 73-year-old man with advanced melanoma was referred to our clinic with visual loss 25 days after starting nivolumab/ipilimumab. His corrected visual acuity was 0.5 in the right eye and 0.02 in the left eye. Enhanced-depth imaging optical coherence tomography (EDI-OCT) showed marked choroid thickening. The patient was diagnosed with VKH disease-like uveitis due to IRAEs. Subtenon injection of triamcinolone acetonide was performed, and nivolumab/ipilimumab was suspended, but serous retinal detachment (SRD) markedly worsened and choroidal detachment appeared. With 2 courses of steroid pulse therapy and oral steroids, SRD disappeared, and corrected visual acuity recovered in both eyes. Five months after the first injection, exacerbation of melanoma was observed, and nivolumab and oral steroids were restarted. Six weeks later, an increase in choroidal thickness was observed with EDI-OCT and diagnosed as a recurrence of VKH disease-like uveitis. Monitoring for the recurrence of VKH disease-like uveitis during the administration of ICPIs, even after uveitis is treated, is essential. Assessment of choroidal thickness with EDI-OCT may be useful for detecting early signs of VKH disease-like uveitis.
Yoshinori Mitamura, Tserennadmid Enkhmaa, Hiroki Sano, Masanori Niki, Fumiko Murao, Mariko Egawa, Shozo Sonoda and Taiji Sakamoto : Changes in choroidal structure following intravitreal aflibercept therapy for retinal vein occlusion., The British journal of Ophthalmology, Vol.105, No.5, 704-710, 2021.
(Summary)
RVO induces substantial oedema of the choroidal stromal area that is detectable by binarisation of EDI-OCT images. This stromal oedema likely stems from high intraocular vascular endothelial growth factor levels. Changes in choroidal structure may be used to assess severity and prognosis of RVO.
Daisuke Nagasato, Yoshinori Mitamura, Mariko Egawa, Fumiko Murao, Toshihiko Nagasawa, Natsumi Komori, Shozo Sonoda, Taiji Sakamoto and Hitoshi Tabuchi : Changes in Choroidal Component Ratio and Circulation After Coffee Intake in Healthy Subjects., Investigative Ophthalmology & Visual Science, Vol.62, No.3, 2021.
(Summary)
Coffee-induced choroidal thinning may result mainly from a reduction in the choroidal vessel lumen, and this vessel lumen reduction correlated with an increased choroidal blood flow velocity after coffee intake. These coffee-induced changes in choroidal component ratio and circulation should be considered when evaluating choroids.
Mariko Egawa, Yoshinori Mitamura, Masanori Niki, Hiroki Sano, Gen Miura, Akihiro Chiba, Shuichi Yamamoto, Shozo Sonoda and Taiji Sakamoto : CORRELATIONS BETWEEN CHOROIDAL STRUCTURES AND VISUAL FUNCTIONS IN EYES WITH RETINITIS PIGMENTOSA, Retina, Vol.39, No.12, 2399-2409, 2019.
(Summary)
To investigate the choroidal structures in the enhanced depth imaging optical coherence tomographic images in eyes with retinitis pigmentosa (RP) and to determine correlations between the choroidal structures and visual functions. The enhanced depth imaging optical coherence tomographic images of 100 eyes with typical RP and 60 age-, sex-, and axial length-matched normal eyes were binarized using ImageJ. The cross-sectional luminal and stromal areas of the inner and outer subfoveal choroid of 1,500-µm width were measured. The inner choroid included the choriocapillaris and medium vessel layer, and the outer choroid included the larger vessel layer. In the inner choroid, the luminal area and the ratio of luminal/total choroidal area (L/C ratio) were significantly smaller in RP than in controls (P = 0.010, P < 0.001, respectively), whereas the stromal area was not significantly different (P = 0.114). The inner choroidal L/C ratio was significantly correlated with the best-corrected visual acuity, mean deviation, foveal sensitivity, width of the ellipsoid zone, and central foveal thickness in RP after adjusting for the axial length, age, and sex (all P < 0.005). The significant correlations between the inner choroidal structures and the visual functions and retinal structures indicate that the choroidal structures are altered in association with the progression of RP.This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.
Naoko Kakiuchi, Shozo Sonoda, Hiroto Terasaki, Hideki Shiihara, Mariko Egawa, Yoshinori Mitamura and Taiji Sakamoto : Choroidal vasculature from ultra-widefield images without contrast dye and its Application to Vogt-Koyanagi-Harada Disease, Ophthalmology. Retina, Vol.3, No.2, 161-169, 2019.
(Summary)
To develop a method to obtain ultra-widefield choroidal vessel images with a fundus camera without using dye, and its application in Vogt-Koyanagi-Harada (VKH) disease. Experimental study and case series. Patients with unilateral retinal disorders and those with VKH disease who had undergone ultra-widefield imaging were studied. Indocyanine green angiography (ICGA) and the 635-nm wavelength Optos ultra-widefield fundus photography (Optos, United Kingdom) images (Optos) were processed by KagoEye 3 software. The 2 types of images were overlapped. The degree of overlapped blood vessel areas of the ICGA image was taken as the matching ratio. The matching ratio was obtained for the peripheral, posterior pole, and overall areas. In addition, changes in the fundus findings were followed up with Optos image analysis in patients with VKH disease. The degree of visibility of the choroidal vessels was evaluated for 5 stages. The clarity scores and the longitudinal findings were compared. The matching ratios between the ICGA images and the Optos images processed by KagoEye3 software were determined. Initially, 10 healthy eyes were studied. The matching ratios for the overall area, the peripheral area, and the posterior pole area of the ICGA image and the Optos image were 64.09%, 74%, and 63.10%, respectively. The correlations between the choroidal blood vessel matching ratio and the ocular axial length and refractive error were not significant, but the matching ratio was correlated significantly with the age. The average clarity score in 12 VKH disease patients was 1.6 ± 0.85 before treatment, which was significantly improved to 4.2 ± 0.75 after 1 month (P < 0.05). Many hyporeflective spotty lesions were observed on the Optos images, which coincided with hyperfluorescent dots on the ICGA images. The lesions gradually disappeared and the vortex vein became visible after treatment. The ultra-widefield Optos images processed by KagoEye3 software can exaggerate images of the choroidal vessels in widefield fundus images without using dye. Because this method is noninvasive, it is applicable to a variety of diseased and healthy eyes.
Akiko Iwata, Kayo Shinomiya, Yoko Oogushi, Mariko Egawa and Yoshinori Mitamura : Review of retinopathy of prematurity in Tokushima University Hospital, Folia japonica de ophthalmologica clinica, Vol.10, No.6, 486-489, 2017.
Takamasa Kinoshita, Yoshinori Mitamura, Kayo Shinomiya, Mariko Egawa, Akiko Iwata, Akiko Fujihara, Kentaro Senba, Yoko Oogushi, Kei Akaiwa, Eisuke Uchino, Taiji Sakamoto and Shozo Sonoda : Diurnal variations in luminal and stromal areas of choroid in normal eyes, The British journal of Ophthalmology, Vol.101, No.3, 360-364, 2017.
(Summary)
To determine the diurnal variations of the luminal and stromal areas of the choroid in normal eyes. This was a prospective observational study of 38 eyes of 38 normal subjects. The blood pressure, heart rate, intraocular pressure and enhanced depth imaging optical coherence tomographic (EDI-OCT) images were recorded every 3 hours between 6:00 and 21:00 hours. The horizontal EDI-OCT images of the subfoveal choroid were converted to binary images. The central choroidal thickness (CCT), total cross-sectional choroidal area, the luminal areas, stromal areas and the ratio of luminal area to total choroidal area (L/C ratio) were determined. There were significant diurnal variations in the CCT, total choroidal area, luminal area and L/C ratio with the maximum values at 6:00 hours and the minimum values at 15:00 hours (p<0.001 for the CCT, p=0.011 for the total choroidal area, p<0.001 for the luminal area and p=0.014 for the L/C ratio). There was no significant variation in the stromal area (p=0.216). The range of fluctuation in the CCT was significantly correlated with that in the luminal area and the total choroidal area (p<0.001). However, there was no significant correlation between the fluctuation range in the CCT and that in the stromal area (p=0.095). There was no statistical relationship between the systemic parameters and the choroidal parameters. The changes in the luminal area are most likely responsible for the diurnal change in the CCT and subfoveal choroidal area. UMIN000019060, Pre-results.
Erina Daizumoto, Yoshinori Mitamura, Hiroki Sano, Kei Akaiwa, Masanori Niki, Chihiro Yamanaka, Takamasa Kinoshita, Mariko Egawa, Shozo Sonoda and Taiji Sakamoto : Changes of choroidal structure after intravitreal aflibercept therapy for polypoidal choroidal vasculopathy., The British journal of Ophthalmology, Vol.101, No.1, 56-61, 2017.
(Summary)
To quantify the changes of the choroidal structure in the enhanced depth imaging optical coherence tomographic (EDI-OCT) images after intravitreal aflibercept (IVA) injections for polypoidal choroidal vasculopathy (PCV). Retrospective, observational case series. Forty eyes of 40 treatment-naive patients who underwent IVA for PCV were examined by EDI-OCT before, and 3 months and 12 months after IVA. The EDI-OCT images were binarised by ImageJ software. The cross-sectional luminal and stromal areas of the inner and outer subfoveal choroid of 1500 m width were quantified. The stromal but not the luminal area of the inner choroid was significantly decreased at 3 months and 12 months after the IVA (stromal area, both p<0.001; luminal area, both p>0.050). On the other hand, the luminal but not the stromal area of the outer choroid was significantly decreased at 3 months and 12 months (luminal area, both p<0.001; stromal area, both p>0.050). The Pachychoroid Index, ratio of luminal/stromal area (L/S ratio) of the outer choroid divided by the L/S ratio of the inner choroid, was significantly decreased at 3 months and 12 months (both p<0.050). The Pachychoroid Index was increased and returned almost to the baseline level after recurrences and decreased again after successful re-treatment. The baseline Pachychoroid Index was significantly correlated with the presence of a dry macula, thinner fovea and better visual acuity at 12 months (all p<0.050). The binarisation of the EDI-OCT images can be used to quantify the activity of PCV and to predict the prognosis after IVA.
Takamasa Kinoshita, Yoshinori Mitamura, Terumi Mori, Kei Akaiwa, Kentaro Senba, Mariko Egawa, Junya Mori, Shozo Sonoda and Taiji Sakamoto : Changes in choroidal structures in eyes with chronic central serous chorioretinopathy after half-dose photodynamic therapy, PLoS ONE, Vol.11, No.9, e0163104, 2016.
(Summary)
To determine the structural changes in the choroid after half-dose photodynamic therapy (hPDT) in eyes with chronic central serous chorioretinopathy (CSC). This was a retrospective interventional study of 29 eyes of 29 patients who underwent hPDT for chronic CSC with serous retinal detachment (SRD) and were followed for ≥3 months. Enhanced depth imaging optical coherence tomographic (EDI-OCT) images of the subfoveal choroid were converted to binary images. The central choroidal thickness (CCT), the cross sectional subfoveal choroidal area, the hyporeflective and hyperreflective areas of the inner, outer, and whole choroid were determined at the baseline, and at 1, 3, and 12 months after the hPDT. The SRDs were resolved in 26 (89.7%) eyes at 3 months after the hPDT. The mean CCT (P = 0.001), the total choroidal area (P = 0.001), and the hypo-reflective area (P = 0.003) of the whole choroid were significantly decreased from the baseline at 3 months. The hyperreflective area of whole choroid was not significantly changed during the study period (P = 0.083). The hyperreflective but not the hyporeflective area of the inner choroid was significantly decreased at 3 months (P = 0.001, P = 1.000, respectively). The hyporeflective but not the hyperreflective area of the outer choroid was significantly decreased at 3 months (P = 0.001, P = 1.000, respectively). The hyperreflective area of the inner choroid and hyporeflective area of the outer choroid were significantly decreased after hPDT for chronic CSC. Because the hyperreflective and hyporeflective area correspond to the choroidal stroma and vessels, respectively, the decreased CCT and subfoveal choroidal area after hPDT may be attributed to a decrease in the exudative changes in the inner choroidal stroma and the reduction of the dilation of the outer choroidal vessels.
(Keyword)
Adult / Aged / Aged, 80 and over / Central Serous Chorioretinopathy / Choroid / Chronic Disease / Female / Fluorescein Angiography / Humans / Indocyanine Green / Male / Middle Aged / Photochemotherapy / Tomography, Optical Coherence
Mariko Egawa, Yoshinori Mitamura, Kei Akaiwa, Kentaro Senba, Takamasa Kinoshita, Eisuke Uchino, Shozo Sonoda and Taiji Sakamoto : Changes of choroidal structure after corticosteroid treatment in eyes with Vogt-Koyanagi-Harada disease., The British journal of Ophthalmology, Vol.100, No.12, 1646-1650, 2016.
(Summary)
To report the changes of the choroidal structure in the enhanced depth imaging optical coherence tomographic (EDI-OCT) images after high-dose corticosteroid treatment for acute Vogt-Koyanagi-Harada (VKH) disease. Retrospective, observational case series. Thirty-four eyes of 17 patients with acute VKH disease were examined by EDI-OCT before, and 1, 4 and 52 weeks after the treatment. The EDI-OCT images were binarised by ImageJ, a publicly accessible software. The luminal, stromal and total choroidal areas and ratio of luminal/stromal area (L/S ratio) were measured in the subfoveal choroid of 1500 µm width. The area of the peripapillary atrophy (PPA) was measured in the fundus photographs at 1 and 52 weeks. For statistical analyses, a generalised estimating equation method was used to eliminate the effect of within-subject intereye correlations. Before treatment, the EDI-OCT images could not be binarised because of poor image quality in most of the cases. After treatment, the luminal, stromal and total choroidal areas were significantly decreased during the follow-up period (all p<0.05). The L/S ratio significantly fluctuated over time (p=0.0201), and was significantly lower at 4 weeks than at 1 week (p=0.0158). The L/S ratio at 1 week was significantly correlated with increase in the PPA area, subsequent chronic recurrences and total dose of corticosteroid (p<0.0001, p=0.0006, p=0.0037, respectively). The L/S ratio measured by binarisation of EDI-OCT images was predictive factor for the progression of PPA, subsequent chronic recurrences and total dose of corticosteroid, and may serve as a marker for degree of choroidal inflammation in the VKH disease.
(Keyword)
Adult / Aged / Aged, 80 and over / Choroid / Dose-Response Relationship, Drug / Female / Fluorescein Angiography / Follow-Up Studies / Fundus Oculi / Glucocorticoids / Humans / Male / Middle Aged / Optic Disk / Retrospective Studies / Time Factors / Tomography, Optical Coherence / Treatment Outcome / Uveomeningoencephalitic Syndrome / Visual Acuity
Mariko Egawa, Yoshinori Mitamura, Hiroki Sano, Kei Akaiwa, Masanori Niki, Kentaro Senba, Shozo Sonoda and Taiji Sakamoto : Changes of choroidal structure after treatment for primary intraocular lymphoma: retrospective, observational case series., BMC Ophthalmology, Vol.15, 136, 2015.
(Summary)
We report changes of choroidal structure determined by binarization of enhanced depth imaging optical coherence tomographic (EDI-OCT) images after treatment for primary intraocular lymphoma (PIOL). Five eyes of four patients with PIOL were examined by EDI-OCT before and 6 months after intravitreal methotrexate injections. In addition, 15 eyes of 15 normal individuals controlled by age and refractive error were examined by EDI-OCT. Binarization of the EDI-OCT images was performed using publicly accessible software (ImageJ). The examined area of the subfoveal choroid was 1,500 m wide, and the dark areas that represented the luminal areas were traced by the Niblack method. Wilcoxon signed rank test was used to determine the significance of changes in the subfoveal choroidal thickness, interstitial area, and luminal area. Mann-Whitney U test was used to compare the parameters in the eyes with pretreatment PIOL and normal control eyes. The subfoveal choroidal thickness was significantly decreased after treatment (P = 0.0431). In the binarized images, the interstitial area was significantly decreased after treatment (P = 0.0431), while the luminal area was not significantly changed (P = 0.8927). After delayed onset of PIOL, increased interstitial area, thickened choroid and unchanged luminal area were observed in one eye. The interstitial area and choroidal thickness were significantly increased in the eyes with pretreatment PIOL compared with the normal control eyes (P = 0.0207, P = 0.0495, respectively), while the luminal area was not significantly different (P = 0.2752). After treatment for PIOL, the EDI-OCT images showed a thinner choroid, and binarization of the EDI-OCT images showed significantly decreased interstitial areas compared with the luminal areas. The binarized EDI-OCT images can provide useful information on choroidal structure in eyes with PIOL, and combining these images with intraocular interleukin levels or fundus autofluorescence images should provide valuable information for determining the PIOL activity.
Mariko Egawa, Masayuki Inoue, Yuki Hayashi, Yoshinori Mitamura and Jun Kishi : A case of IgG4-related disease manifesting a variety of ocular lesions over a prolonged course, Japanese Journal of Clinical Ophthalmology, Vol.69, No.8, 1253-1258, 2015.
Akiko Iwata, Yoshinori Mitamura, Masanori Niki, Kentaro Senba, Mariko Egawa, Takashi Katome, Shozo Sonoda and Taiji Sakamoto : Binarization of enhanced depth imaging optical coherence tomographic images of an eye with Wyburn-Mason syndrome: a case report., BMC Ophthalmology, Vol.15, 19, 2015.
(Summary)
To report a thicker choroid and larger choroidal luminal area in an eye with Wyburn-Mason syndrome. To the best of our knowledge, this is the first report demonstrating an increase in the choroidal thickness and the luminal area in a case of Wyburn-Mason syndrome. In addition, we report the changing appearance of retinal arteriovenous malformations over a 16-year period. A 27-year-old woman, who was diagnosed with Wyburn-Mason syndrome at age 11 years, visited our clinic. Her best-corrected visual acuity was 20/12.5 in the right eye and light perception in the left eye. Severely dilated, tortuous vascular loops were distributed from the optic disc over all four quadrants of the left fundus. The vascular loops in some areas were more dilated and tortuous than 16 years earlier. Optical coherence tomography (OCT) showed retinal edema with cystic changes and enlarged choroidal vessel lumens in the left eye. The subfoveal choroidal thickness was manually measured by the caliper function in the enhanced depth imaging OCT (EDI-OCT) images. Binarization of the EDI-OCT images was performed with publicly accessible ImageJ software. The examined area of the subfoveal choroid was 1,500 m wide, and the dark areas representing the luminal areas were traced by the Niblack method. After determining the distance of each pixel, the luminal area was automatically calculated. The subfoveal choroidal thickness was 250 m in the right eye and 462 m in the left eye. The luminal area of the 1,500-m-wide subfoveal choroid was computed to be 307,165.6 m(2) in the right eye and 545,780.7 m(2) in the left eye. The EDI-OCT images showed a thicker choroid, and binarization of the EDI-OCT images showed that the luminal areas were significantly larger in the affected eye, suggesting a dilatation of the choroidal vessels. The results demonstrated that conversion of EDI-OCT images to binary images was a useful method to quantify the choroidal structure.
Akiko Mino, Yoshinori Mitamura, Takashi Katome, Kentaro Senba, Mariko Egawa and Takeshi Naito : Case of adult-onset Coats' disease with epiretinal membrane treated with 25-gauge pars plana vitrectomy., The Journal of Medical Investigation : JMI, Vol.62, No.1-2, 85-88, 2015.
(Summary)
We describe a case of untreated adult-onset Coats' disease with a proliferative epiretinal membrane (ERM) treated successfully with 25-gauge pars plana vitrectomy (25GPPV). A 26-year-old man presented with a 3-week history of decreased vision in his left eye. At the initial examination, the decimal best-corrected visual acuity (BCVA) was 0.7 in the left eye. Ophthalmoscopy revealed the typical appearance of Stage 2A Coats' disease but with a proliferative ERM in the posterior pole. The patient received 2 monthly intravitreal injections of 2.5 mg bevacizumab, 5 laser photocoagulations to the area of telangiectasia, and 1 session of cryoretinopexy. Nine months after the initial visit, a traction by the ERM on the parafoveal area developed causing macular edema which reduced the BCVA to 0.3. He underwent 25GPPV with the removal of the ERM. In addition, the peripheral telangiectasia was treated intraoperatively with both laser photocoagulation and cryoretinopexy. Postoperatively, the traction to the parafoveal area was released and the BCVA improved to 0.6 which remained stable during the follow-up period of 13 months. We conclude that 25GPPV combined with ERM peeling, laser photocoagulation, and cryoretinopexy can be effective for adult-onset Coats' disease associated with an ERM.
Mariko Egawa, Kentaro Senba, Tatsuro Miyamoto, Takeshi Naito and Yoshinori Mitamura : A case of endogenous endophthalmitis due to Listeria monocytogenes, Japanese Journal of Clinical Ophthalmology, Vol.68, No.13, 1737-1740, 2014.
Yosuke Nakamura, Yoshinori Mitamura, Akira Hagiwara, Ken Kumagai, Gen Miura, Takeshi Sugawara, Mariko Egawa and Shuichi Yamamoto : Relationship between retinal microstructures and visual acuity after cataract surgery in patients with retinitis pigmentosa., The British journal of Ophthalmology, Vol.99, No.4, 508-511, 2014.
(Summary)
To study the relationship between the retinal microstructures and the best-corrected visual acuity (BCVA) after cataract surgery in patients with retinitis pigmentosa (RP). 58 eyes of 43 consecutive RP patients who underwent cataract surgery were studied. The BCVA was measured before and 3 months after the surgery. The appearance of the inner segment/outer segment (IS/OS) line of the photoreceptors in the optical coherence tomographic (OCT) images at the fovea was graded; Grade 1, IS/OS line not visible; Grade 2, IS/OS line abnormal or discontinuous; and Grade 3, IS/OS line normal. The central foveal thickness (CFT) and the length of the IS/OS line were measured in the spectral-domain OCT images. The postoperative BCVAs in logMAR units (Grade 1, 1.04±0.36; Grade 2, 0.33±0.16; Grade 3, 0.08±0.14) and the improvements in the BCVA in logMAR units (Grade 1, 0.22±0.28; Grade 2, 0.53±0.48; Grade 3, 0.54±0.35) were significantly different among Grade 1, 2 and 3 groups (p<0.0001, p=0.0378; respectively). A postoperative BCVA of <0.2 logMAR units was achieved in 0% in Grade 1, 20% in Grade 2 and 74% in Grade 3 (p<0.0001). There was a significant correlation between the postoperative BCVA and the length of the IS/OS line (r=-0.601 p<0.0001) or the CFT (r=-0.510, p<0.0001). The presence of normal IS/OS line in the OCT images is associated with good visual recovery after cataract surgery in RP patients. The integrity of the IS/OS line may be important for predicting good postoperative BCVA.
Mariko Egawa, Yoshinori Mitamura, Yuki Hayashi, Kentaro Semba and Takeshi Naito : Changes of fundus autofluorescence and spectral-domain optical coherence tomographic findings after treatment of primary intraocular lymphoma., Journal of Ophthalmic Inflammation and Infection, Vol.4, No.1, 7, 2014.
(Summary)
We report the fundus autofluorescence (FAF), spectral-domain optical coherence tomographic (SD-OCT), microperimetric, and multifocal electroretinographic (mfERG) findings before, during, and after successful treatment of a primary intraocular lymphoma (PIOL). A 57-year-old man had biopsy-proven PIOL in his left eye, and he was treated with intravitreal methotrexate injections for 8 months. Before treatment, fundus examination disclosed many small, yellow lesions with distinct boundaries in the posterior fundus which became atrophic 9 months after the initial treatment. FAF showed a pattern of granular hypoautofluorescence and hyperautofluorescence before the treatments and patchy hypoautofluorescence corresponding to retinal pigment epithelial (RPE) atrophy after the treatments. SD-OCT showed increased nodularity at the level of and above the RPE, a separation of Bruch membrane from the RPE, partial damage of the RPE, disruption of the photoreceptor inner segment/outer segment (IS/OS) junction, multiple hyperreflective signals in the inner retina, foveal thinning, and parafoveal thickening. After treatment, the hyperreflective infiltrations in the inner retina were markedly decreased, and the RPE and IS/OS junction were restored. The foveal thinning and parafoveal thickening resolved, and the central choroidal thickness decreased. During the follow-up, the mfERGs remained decreased. In contrast, microperimetry showed a partial improvement of the retinal sensitivity. FAF and SD-OCT are useful noninvasive methods to evaluate the retinal and choroidal changes before and after treatment of PIOL. Our results suggest that visual recovery after successful treatment may be limited once macula is infiltrated.
Mariko Egawa, Yoshinori Mitamura, Yuki Hayashi and Takeshi Naito : Spectral-domain optical coherence tomographic and fundus autofluorescence findings in eyes with primary intraocular lymphoma., Clinical Ophthalmology, Vol.8, 335-341, 2014.
(Summary)
The purpose of this study was to evaluate the findings on spectral-domain optical coherence tomography (SD-OCT) and fundus autofluorescence (FAF) in three eyes with primary intraocular lymphoma (PIOL). The medical records of three eyes from three patients with biopsy-proven PIOL and retinal infiltrations were reviewed. The SD-OCT and fluorescein angiographic findings were evaluated in the three eyes and FAF images in two eyes. The PIOL in the three patients was monocular. Vitreous opacities and retinal infiltrations were observed in the three eyes, and iritis was present in two eyes. The cytologic diagnosis was class V in two eyes and class III in one eye. The interleukin-10/interleukin-6 ratio was >1.0 in the vitreous and aqueous humor of the three eyes. The FAF images for two eyes showed abnormal granular hyperautofluorescence and hypoautofluorescence which were the reverse of the pattern in the fluorescein angiographic images. In all three eyes, SD-OCT showed hyper-reflective infiltrations at the level of the retinal pigment epithelium (RPE), a separation of the Bruch membrane from the RPE, damage to the RPE, disruption of the photoreceptor inner segment/outer segment junction, and multiple hyper-reflective signals in the inner retina. Because of the characteristic FAF and SD-OCT findings in these eyes with PIOL, we suggest that these noninvasive methods may be used for a rapid diagnosis of PIOL and also for understanding the pathology of PIOL.
Mariko Egawa, Yuki Hayashi and Yoshinori Mitamura : Outcome of Vogt-Koyanagi-Harada disease as related to clinical types, Japanese Journal of Clinical Ophthalmology, Vol.67, No.6, 981-984, 2013.
山中 千尋, Mariko Egawa and Yoshinori Mitamura : A case of early-onset sarcoidosis and Blau syndrome, Japanese Journal of Clinical Ophthalmology, Vol.67, No.4, 563-568, 2013.
Yuki Hayashi, Mariko Egawa and Yoshinori Mitamura : Choroidal folds in a case of acute posterior multifocal placoid pigment epitheliopathy, Japanese Journal of Clinical Ophthalmology, Vol.66, No.8, 1225-1228, 2012.
Yuki Hayashi, Mariko Egawa, Takeshi Naito and Yoshinori Mitamura : Vitreous biopsy for the diagnosis of intraocular lymphoma in twenty-three eyes, Japanese Journal of Clinical Ophthalmology, Vol.65, No.7, 1069-1073, 2011.
Y Yokota, M Kadota, Takayuki Ise, Takashi Iwase, T Hara, R Ota, Y Kawabata, K Ogasawara, Mika Bando, S Bando, T Matsuura, Toshiyuki Niki, J Hotchi, N Tomita, Yuka Ueda, Koji Yamaguchi, Yoshio Taketani, Hirotsugu Yamada, Takeshi Soeki, Tetsuzo Wakatsuki, Masataka Sata, Masashi Akaike, Mariko Egawa and Yoshinori Mitamura : 眼病変の経過中に心室中隔の肥厚および完全房室ブロックで発症した心サルコイドーシスの一例, 第245回徳島医学会学術集会(平成24年度夏期), Jul. 2012.