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Improvement in neonatal care has led to increased survival rates of very premature infants. Accordingly, there are now more extremely preterm infants who are at risk of developing retinopathy of prematurity (ROP). ROP is a disorder of low birth-weight preterm infants and may lead to blindness. However, the prevalence of ROP varies globally, depending on different neonatal and ophthalmic care. Therefore, we studied the incidence and progression of ROP in extremely preterm infants in Japan. In addition, we investigated the characteristics and the clinical courses of the infants who progressed to sight-threatening ROP. A total of 3,154 infants were born at the Japanese Red Cross Sendai Hospital between 2009 and 2011, including 53 live-born infants born before 28 weeks' gestation. Two extremely preterm infants died before the first ROP examination. Among the survived 51 infants (the birth-weight ranged from 309 to 1,354 g, mean 779 g), 36 infants (70.6%) developed ROP: 18 infants with mild ROP and 18 infants with severe ROP. Eight out of the 51 infants (15.7%) underwent laser treatment. None of the infants born at older than 27 weeks 0 day of gestation required any treatment for ROP. In conclusion, most of extremely preterm infants develop some degree of ROP. However, in the majority of these infants the ROP never progressed beyond mild disease and resolved spontaneously without treatment. Sight-threatening ROP was rare. The present study clarifies the natural history of ROP in extremely preterm infants with active perinatal care.

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PURPOSE: To investigate fixation behavior in eyes with advanced glaucoma using the MicroPerimeter MP-1. METHODS: We retrospectively reviewed 39 glaucoma patients who had scotomas adjacent to fixation points. Using the MP-1, we examined the stability and location of fixation with the fixation test and the microperimetry test. We examined retinal sensitivity using the central 10-2 SITA standard programs of a Humphrey Field Analyzer and the macula 10 degrees program of the MP-1 and analyzed the correlation between fixation behavior and retinal sensitivity. RESULTS: Of the 39 eyes, 37 showed "stable" fixation in the fixation test, while 30 eyes showed stable fixation in the microperimetry test. In the fixation test, 32 of 39 eyes demonstrated "predominantly central" fixation, whereas in the microperimetry test only 26 eyes exhibited the same fixation. Fixation stability correlated positively with sensitivity in the central 10 degrees diameter area (r=0.414, P=0.009). Among the six eyes showing "predominantly eccentric" fixation, the preferred retinal locus of five was in the superior or superotemporal direction from the fovea. CONCLUSIONS: The MP-1 illustrated the fixation patterns in glaucomatous eyes and the fixation patterns correlated well with retinal sensitivity.

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PURPOSE: To study the safety and efficacy of photodynamic therapy (PDT) with verteporfin in treating choroidal neovascularization (CNV) in young Japanese patients. METHODS: Ten eyes of 10 patients aged 50 years or younger with the diagnosis of CNV were retrospectively analyzed. CNV was of idiopathic origin in 8 eyes and of myopic origin in 2. Five eyes were treated with PDT. The visual, clinical, and angiographic responses and complications were investigated. Mean follow-up period was 33.2 months. RESULTS: The initial mean best-corrected visual acuity (BCVA) was significantly worse in the PDT treated group than in the non-PDT treated group (0.55 vs. 0.21, p = 0.029). The mean CNV size was significantly larger in the PDT treated group (1752 microm vs. 782 microm, p = 0.014). BCVA improved in 40% (2 eyes), unchanged in 40% (2 eyes), and worsened in 20% (1 eye) in both PDT-treated and non-treated groups. No significant complications were observed. CONCLUSIONS: PDT seems to be a good treatment strategy in achieving a stable or improved vision for young CNV patients, even if they had very poor visual acuity at their initial visits. Further prospective studies are needed.

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An 80-year-old woman was treated with photodynamic therapy (PDT) to the left eye for polypoidal choroidal vasculopathy (PCV). About 3 months after PDT, her left eye developed a chorioretinal anastomosis with severe atrophy of the retinal pigment epithelium in the macula; visual acuity in this eye was 20/1000. She received a second session of PDT, plus an intravitreal injection of triamcinolone acetonide. About 3 months after the second treatment, the chorioretinal anastomosis was enlarged and the retinal vessels involved in the anastomosis were more dilated. About 1 year after the first PDT, visual acuity in the left eye had stabilized at 20/400. Development of a chorioretinal anastomosis is a distinct possibility following PDT in eyes with PCV, and can lead to poor visual recovery.

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PURPOSE: To study the clinical characteristics of tears of the retinal pigment epithelium (RPE) in eyes with polypoidal choroidal vasculopathy (PCV). METHODS: The authors report eight eyes of eight patients with PCV that had tears of the RPE. These were examined with angiography and tomography. RESULTS: Eight eyes of eight patients (seven men and one woman) had RPE tears at the margin of a serosanguineous pigment epithelial detachment (PED) associated with PCV. Tears of the RPE were detected at the initial visit in one eye and during follow-up without any treatment in five eyes. In two eyes, the RPE tears were detected 3 months and 6 months, respectively, after photodynamic therapy. In all eyes, the RPE tears were detected at the side opposite to the polypoidal lesions of the PEDs, and the fovea was not involved in the RPE tear. Visual acuity in the seven eyes without RPE tears on presentation ranged from 20/100 to 20/16 (median, 20/32). During follow-up, three of these eyes lost three or more lines of vision. At the final examination, while three of these eyes had visual acuity of 20/25 or better, the other four had visual acuity of 20/200 or worse. CONCLUSION: In eyes with PCV, RPE tears can occur at the margin of serosanguineous PEDs-either spontaneously or after photodynamic therapy.

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PURPOSE: To report the 12-month follow-up results of subfoveal polypoidal choroidal vasculopathy (PCV) patients treated with indocyanine green angiography (ICGA)-guided photodynamic therapy (PDT). DESIGN: Interventional, noncomparative cases series. METHODS: A retrospective analysis of the clinical and angiographic data related to 47 PCV eyes that were followed up for 12 months was carried out. The greatest linear dimension (GLD) for PDT was determined based on the ICGA findings. Optical coherence tomography (OCT) also was used to evaluate the therapeutic effects. RESULTS: The mean logarithm of the minimum angle of resolution visual acuity (VA; 0.58 +/- 0.37) significantly improved to 0.53 +/- 0.38 at three months (P = .04) and to 0.46 +/- 0.40 at 12 months (P = .02). The average ICGA GLD (2682.3 +/- 1026.9 mm) was significantly (P = .0001) smaller than the presumed fluorescein angiography (FA) GLD (4043.6 +/- 1914.8 mm). In more than 80% of cases, complete resolution of retinal exudative changes was observed. Although polypoidal vascular lesions disappeared in 82.2% of eyes, the branched vascular networks showed little change. The initial VA and GLD had little correlation with the VA outcome. CONCLUSIONS: ICGA-guided PDT reduces the size of laser exposure and is an effective treatment for PCV. Because PCV may appear as occult choroidal neovascularization (CNV) on FA, PCV should be diagnosed using ICGA before treatment because PCV may respond differently than CNV to appropriate treatment.

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PURPOSE: To evaluate the clinical features and risk factors of hemorrhagic complications in eyes with polypoidal choroidal vasculopathy (PCV) after photodynamic therapy (PDT). METHODS: We retrospectively reviewed data for 91 consecutive eyes of 85 patients who underwent PDT for the treatment of PCV. The diagnosis of PCV was based on indocyanine green angiographic findings, showing a branching vascular network terminating in polypoidal swelling. The greatest linear dimension included all polypoidal lesions, leaking vascular network, and type 2 choroidal neovascularization. RESULTS: During the follow-up period after PDT, postoperative subretinal hemorrhage was seen in 28 (30.8%) of 91 eyes. In 22 (78.6%) of these 28 eyes, subretinal hemorrhage was absorbed without treatment. In 6 eyes (21.4%), however, bleeding resulted in vitreous hemorrhage, and 2 eyes underwent pars plana vitrectomy. Although visual acuity was maintained or increased in 18 (81.8%) of 22 eyes with subretinal hemorrhage alone, it decreased significantly in 3 (50.0%) of 6 eyes with postoperative vitreous hemorrhage. Various systemic diseases and medication with an anticoagulant had no correlation with these hemorrhagic complications. Laser irradiation spot size for PDT was significantly larger in eyes with postoperative vitreous hemorrhage (P = 0.017) than in those without. CONCLUSION: Subretinal hemorrhage after PDT can be a common complication in patients with PCV and may have a minor effect on visual outcome. However, postoperative hemorrhage is occasionally so massive that it leads to vitreous hemorrhage and poor visual prognosis. When considering PDT for eyes with a large PCV lesion, ophthalmologists should be aware of the risk of serious hemorrhagic complications.

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PURPOSE: To describe a case of a late reopening of a traumatic macular hole (MH) 2 years after initial spontaneous closure. METHODS: A 12-year-old boy was hit by a softball in the right eye, with an immediate decrease of visual acuity (20/100 in the right eye). He presented MH in the right eye. RESULTS: Without surgical intervention, the traumatic MH closed spontaneously 2 weeks later, with visual recovery (20/50 in the right eye). Two years later, the MH reopened, with visual loss (20/70 in the right eye) but no sign of posterior vitreous detachment or epiretinal membrane. Spontaneous closure did not occur, and the patient underwent vitrectomy with internal limiting membrane peeling and SF6 gas tamponade. The MH closed after surgery, and visual acuity improved (20/40 in the right eye). CONCLUSIONS: While reopening might be a rare complication, ophthalmologists should be aware of it occurring as a possible late complication of a spontaneously closed traumatic MH.

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PURPOSE: To report a case of recurrent bleeding after photodynamic therapy (PDT) in an eye with polypoidal choroidal vasculopathy (PCV). DESIGN: Interventional case report. METHODS: A 73-year-old man was treated in the left eye for PCV with PDT. RESULTS: Two weeks after PDT, his left eye showed extensive subretinal hemorrhage, with a slight vision loss. Three months after PDT, subretinal hemorrhage was almost absorbed. He received a second session of PDT to the remaining choroidal neovascularization. Two weeks thereafter, his left eye showed massive suprachoroidal hemorrhage with further vision loss. One month after the second PDT, visual acuity was decreased to no light perception as a result of massive vitreous hemorrhage. Although the patient underwent pars plana vitrectomy, visual acuity in the left eye remained hand motion as a result of massive suprachoroidal hemorrhage. CONCLUSIONS: Ophthalmologists and patients should be aware of the risk of massive bleeding after PDT in eyes with PCV.

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PURPOSE: To evaluate the efficacy of laser photocoagulation of indocyanine green angiographically identified feeder vessels to idiopathic polypoidal choroidal vasculopathic lesions. DESIGN: Interventional case series. METHODS: Fifteen eyes of 14 consecutive patients with idiopathic polypoidal choroidal vasculopathy lesions treated by laser photocoagulation of indocyanine green angiographically identified feeder vessels were investigated. RESULTS: In 10 of the 15 eyes, serous retinal detachment of sensory retina in the macula disappeared after photocoagulation of the feeder vessels. The best-corrected visual acuity improved by 2 or more lines in eight of the 15 eyes and worsened in two eyes during the mean follow-up period of 13.6 months. CONCLUSIONS: Laser photocoagulation targeted exclusively to the feeder vessels supplying the idiopathic polypoidal choroidal vasculopathy lesions is a safe and effective method and can improve vision in eyes in which a serous retinal detachment is present in the macula. Indocyanine green angiography-guided laser photocoagulation should be considered as an optional treatment for idiopathic polypoidal choroidal vasculopathy.

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We investigated the distribution and expression of glutamate-binding protein (GBP) in the rat retinas after ischemia-reperfusion injury. Ischemia-reperfusion injury was induced in rats by clamping of the optic nerve for one hour. The distribution of GBP immunoreactivity was determined at 6, 24, 72, and 168 hours after reperfusion. Also, RT-PCR was performed to detect the change of GBP mRNA expression in the reperfused retinas. In untreated control retinas, GBP immunoreactivity was observed in the cells of ganglion cell layer, inner plexiform layer, and inner nuclear layer. At 6, 24, and 72 hours after reperfusion, GBP immunoreactivity was seen not only in the GCL, IPL, and INL, but also in the outer plexiform layer and photoreceptor outer segment. At 168 hours after reperfusion, GBP immunoreactivity in the OPL was decreased. Moreover, we found increased GBP mRNA expression at 24 hours after reperfusion. In this study, we demonstrated that ischemia-reperfusion induced increase of GBP immunoreactivity in the inner retina and increase of GBP mRNA expression in the rat retinas. Our results suggest that NMDA receptor-like complex may play some role in the ischemic cell death of the inner retina.

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PURPOSE: Although it is reported that the prognosis for polypoidal choroidal vasculopathy(PCV) is better than that for age-related macular degeneration, visual acuity is not always good in eyes with subfoveal hemorrhage. We evaluated the factors that may affect the visual prognosis after subfoveal hematoma associated with PCV. SUBJECT: We examined retrospectively the records of 37 eyes in 34 patients that were diagnosed as PCV by indocyanine green angiography from January 1998 to July 2000 at Kyoto University Hospital. Among the 37 eyes, we chose 15 eyes in 15 patients that had subfoveal hematoma of more than 1 disk diameter, and evaluated the area of hematoma, period required for absorption of the hematoma, association of choroidal neovascularization(CNV), treatment, and visual acuity change. RESULTS: The area and the absorption period of the hematoma did not correlate with the visual prognosis. Association of CNV strongly influenced the visual outcome after the absorption of subretinal hemorrhage. Four eyes with CNV received various treatments, but no restoration of visual acuity was observed. CONCLUSION: CNV association mostly affected the prognosis of PCV with hematoma. Early detection of CNV appeared important to predict visual prognosis.

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