Eye Fluid Research Articles

Subretinal fluid in eyes with active ocular toxoplasmosis observed using spectral domain optical coherence tomography.

PurposeTo describe the clinical finding of subretinal fluid (SRF) in the posterior pole by spectral domain optical coherence tomography (SD-OCT) in eyes with active ocular toxoplasmosis (OT).DesignRetrospective case series.ParticipantsThirty-eight eyes from 39 patients with active OT.MethodsEyes with active OT which underwent SD-OCT were reviewed. SRFs in the posterior pole were further analyzed.Main Outcome MeasuresPresence of SRF; its accompanying features, e.g. retinal necrosis, cystoid macular edema (CME), choroidal neovascularization (CNV); and longitudinal changes of SRF, including maximum height and total volume before and after treatment.ResultsSRF presented in 45.5% (or 15/33) of eyes with typical active OT and in 51.3% (or 20/39) of eyes with active OT. The mean maximum height and total volume of SRF were 161.0 (range: 23–478) µm and 0.47 (range: 0.005–4.12) mm3, respectively. For 12 eyes with SRF related to active retinal necrosis, SRF was observed with complete absorption after conventional anti-toxoplasmosis treatment. The mean duration for observation of SRF clearance was 33.8 (range: 7–84) days. The mean rate of SRF clearance was 0.0128 (range: 0.0002–0.0665) mm3/day.ConclusionsSRF (i.e., serous retinal detachment) is a common feature in patients with active OT when SD-OCT is performed. The majority of SRF was associated with retinal necrosis and reacted well to conventional therapy, regardless of total fluid volume. However, SRF accompanying with CME or CNV responded less favorably or remained refractory to conventional or combined intravitreal treatment, even when the SRF was small in size.

Preparation and in vitro/in vivo evaluation of antimicrobial ocular in situ gels containing a disappearing preservative for topical treatment of bacterial conjunctivitis

The study aimed to formulate and evaluate levofloxacin hemihydrate ocular in situ gels along with freshly prepared disappearing preservative reported to be safer to human eyes. Formulae were prepared using thermosensitive (PF127 and PF68) or ion-activated (Gelrite) polymers. They were evaluated for gelation temperature (GT), capacity, content uniformity, pH, rheological behavior, in vitro drug release with kinetic analysis. Best formulae were exposed to storage effect to select the optimum formula that was subjected to different sterilization methods and in vivo evaluation. The prepared disappearing preservative (sodium perborate monohydrate) proved to be active oxidative preservative and compatible with our formulae. F9 (24% PF127, 15% PF 68, 0.5% levofloxacin hemihydrate, and 0.0025% sodium perborate monohydrate) showed prolonged drug release (12 h), acceptable GT, viscosity, and pH. It remained stable over 3 months at two temperatures and was best sterilized by filtration. It showed longer residence time (12 h) in rabbits’ eye fluids compared with the Levoxin® eye drops (4 h). This successful attempt of using thermo-gelling system along with a disappearing type of preservatives would allow the use of these systems to achieve sustained release of antimicrobial drugs with minimum risk of eye damage improving patient compliance and treatment efficacy.

Detection of Mycobacterium tuberculosis Genome in Vitreous Fluid of Eyes with Multifocal Serpiginoid Choroiditis

To compare 3 different molecular techniques to detect the Mycobacterium tuberculosis genome in vitreous fluid of eyes with multifocal serpiginoid choroiditis (MSC). Prospective, interventional case series. Eleven patients (11 eyes) with active MSC in at least 1 eye underwent diagnostic pars plana vitrectomy (PPV) between October 2012 and December 2013. Vitreous fluid samples were subjected to multitargeted polymerase chain reaction (PCR) for a M. tuberculosis assay, the Gene Xpert MTB/RIF assay (Cepheid, Sunnyvale, CA), and a line probe assay (GenoType MTBDRplus; Hain Lifescience, GmbH, Nehren, Germany). The samples with positive results were subjected to rpoB gene sequencing to demonstrate rifampicin resistance. The clinical details, digital fundus imaging, and treatment details and outcomes also were noted. Detection of the M. tuberculosis genome and rifampicin resistance in the vitreous samples. Of the 11 eyes subjected to PPV, the multitargeted PCR results for tuberculosis were positive for 10 eyes, the MTBDRplus assay results were positive in 6 eyes, and the Gene Xpert MTB/RIF assay results were positive in 4 eyes. Rifampicin resistance was detected in 3 eyes by rpoB gene sequencing, in 3 eyes by the MTBDRplus assay, and in 1 eye by the Gene Xpert MTB/RIF assay. We detected the M. tuberculosis genome in the vitreous fluid of eyes with MSC using 3 different molecular techniques. Rifampicin resistance was detected for the first time in eyes with MSC.

Minimal gauge vitrectomy for optic disc pit maculopathy: Our results.

The purpose of the study was to describe the surgical technique and clinical outcomes of pars plana vitrectomy without laser or gas tamponade in cases with optic disc pit maculopathy at our centre. Six eyes of six consecutive patients presenting with unilateral optic disc pit maculopathy were enrolled. Preoperative optical coherence tomography (OCT) was performed to determine the presence and extent of schisis and macular detachment. All eyes underwent 23-gauge pars plana vitrectomy with induction of posterior vitreous detachment (PVD) and internal limiting membrane (ILM) peeling and eyes were closed under fluid. Patients were followed up for at least 12 months post-surgery. Median age of patients was 22.5 years. Five of six eyes had neurosensory detachment (NSD) at the presentation; whereas, inner layer schisis was present in all patients. None of the patients had any evidence of vitreomacular or vitreopapillary adhesion or PVD either clinically or on OCT. Inner and outer retinal schisis resolved in all eyes after follow-up of at least 6 months. Resolution of subretinal fluid in eyes with NSD was seen in 4 of 5 eyes. There was a significant visual acuity improvement from mean preoperative visual acuity of 0.79 logarithm of the minimum angle of resolution (logMAR) units to 0.36 logMAR units at 12 months (P = 0.001). Thus, vitrectomy with ILM peeling and PVD induction alone could achieve good functional outcomes in cases with optic disc pit maculopathy.

Longitudinal optical density analysis of subretinal fluid after surgical repair of rhegmatogenous retinal detachment.

To investigate optical coherence tomography-derived reflectivity and optical density (OD) characteristics of persistent subretinal fluid (SRF) in eyes after surgical repair of macula-off rhegmatogenous retinal detachment. Retrospective case series of nine eyes with macula-off rhegmatogenous retinal detachment that underwent surgical repair with either scleral buckling or vitrectomy with or without scleral buckling. Major inclusion criteria included 1) availability of high-quality optical coherence tomography scans at 2 or more time points, and 2) sufficient SRF for optical coherence tomography sampling without including tissue edges. Demographic, clinical, and optical coherence tomography imaging data were collected on all eyes. Optical density and SRF height measurements were obtained using a manual image segmentation method with ImageJ. Optical density measurements were standardized by conversion to optical density ratios to facilitate comparison between different visits and eyes. Correlations were assessed for significance through both univariate and multivariate regression analyses. Optical density ratio measurements increased with time after surgery, and this was statistically significant (P = 0.001, R = 0.331). Subretinal fluid height measurements decreased in all eyes. There was a significant correlation between optical density ratios and log of SRF height (P ≤ 0.001, R = 0.485). In multivariate analysis, neither optical density ratios nor SRF height was a statistically significant predictor of visual acuity. Changes in optical density ratios of the residual SRF after retinal detachment repair may be representative of changes in the SRF composition over time. This is in agreement with previous biochemical studies and may serve as a noninvasive method of assessing SRF content in vivo.

ADVISE (ADenoVirus Initiative Study in Epidemiology)

AbstractPurpose ADVISE is an epidemiological, prospective, multicentric, open study to assess the characteristics and frequency of adenoviral conjunctivitis (AC) as diagnosed with the point of care AdenoPlus® test in patients suffering from acute conjunctivitis in 5 EU countries (F, It, Ger, UK, Sp).Methods Bacterial or viral conjunctivitis are usually self‐limiting but some viral cases may cause persistent disease and significant morbidity. AC causes more severe disease, is extremely contagious (transmission rate 10‐50%), of longer duration than bacterial (shed for 14‐16 days, signs and symptoms last 2‐3 weeks) and may lead to decreased visual acuity or light sensitivity from persistent subepithelial infiltrates, chronic dry eye, and visual loss from conjunctival scarring.Results AdenoPlus® is a single use, rapid (10 min.) immunoassay test for the qualitative in‐vitro detection of Adenoviral hexon protein antigens directly from human eye fluid. It is a CE marked, point‐of‐care medical device intended for health professional use as an aid in the rapid differential diagnosis of acute conjunctivitis. Study objectives are to assess the % of patients with acute conjunctivitis who have AC, the clinical profiles associated with positive and negative tests, the correlation between the initial clinical diagnosis and the final diagnosis (post‐test), the AC seasonality and geographic distribution, and to collect pharmacoeconomic data (before/after test prescribed treatments, work/school absenteeism…).Conclusion Enrollment started in June 2013 in France and in January 2014 in Germany. Italian, Spanish and UK sites will start recruiting Q2‐Q3/2014. Approximately 2500 patients are expected across EU, 500 patients from 15‐20 sites per country (20‐30 patients per site). The first interim study results will be presented with data analyses from at least 400 patients recruited in EU.

PHARMACEUTICALS Novartis to use Google lens technology for eye and diabetes treatment

In another move by a drug company into the realm of electronics-enabled health care, Novartis’s Alcon eye care division has agreed to license “smart lens” technology from Google. Developed by Google X, a Google “secret lab” focused on solving big global problems, the technology is a way to embed contact lenses with noninvasive sensors, microchips, and other electronics. Novartis envisions two applications for the technology. One is helping diabetic patients manage their disease by measuring glucose levels in eye fluid using a smart lens connected wirelessly to a mobile phone. At present, people with diabetes must draw blood and place it in a glucose measuring device. The other application is treating presbyopia, the loss of the eye’s ability to focus on close objects that occurs naturally with aging. When combined with refractive surgery, the smart lens has the potential to help restore the eye’s natural ­autofocus, according to the drugmaker. ...

Effects of multiple freezing (-18 ± 2°C) and microwave thawing cycles on the quality changes of sea bass (Dicentrarchus labrax).

Sensory, chemical [pH, total volatile basic nitrogen (TVB-N), trimethylamine (TMA-N), thiobarbituric acid (TBA)] and composition (crude protein and crude lipid) analyses were carried out on whole, gutted and fillets of seabass that were frozen (-18 ± 2°C) and thawed more than once in microwave. It was detected that the sensorial acceptability values decreased certainly for all fish samples (whole, gutted and fillets of sea bass) when compared with control group. While chemical (pH, TVB-N, TMA-N, TBA) values increased, crude protein and crude lipid values decreased after the multiple freezing and thawing cycles under microwave. The obtained results offered that thawing by microwave is not appropriate sea bass because of the undesirable cooking effect of microwave to the some parts of fish such as tail, eye and fins. Also skin dryness, moisture losses in eye fluids and textural deteriorations were observed. Significant differences (P < 0.05) were found in general acceptability values and pH, TVB-N, TBA and crude protein results among the sea bass groups thawed in microwave conditions.

The role of low intracranial pressure in the development of glaucoma in patients with Alzheimer's disease

October 22, 2013Dear Editor,We read with great interest the paper by Janssen et al. (2013)entitled ‘The vast complexityof primaryopen angle glaucoma: Dis-ease genes, risks, molecular mechanisms and pathobiology.’ Theauthors deserve appreciation for their very informative reviewarticle.However,wewishtomakeacommentconcerningtheirdis-cussion of the potential role of intracranial pressure (ICP) in Alz-heimer’s disease (AD) and glaucoma.In the last section of their paper, Janssen and colleaguesdiscuss the potential relation between primary open angle glau-coma (POAG) and AD. As the authors mention, several studieshave found an increase in the occurrence of glaucoma in AD pa-tients. The authors state: “In our view, POAG damage could becaused by the net pressure over the optic disk, involving boththe aqueous humor pressure of the eye and cerebrospinal fluid(CSF) pressure of the brain, as described above. Also, CSF pressurechanges have been described in AD (Silverberg et al., 2006).Could these pressure changes underlie a relationship betweenPOAG and AD, and at the same time explain the apparently con-flicting association studies?” Further, the authors state: “We hy-pothesize that there is a strong association between normalpressure glaucoma and late AD, since both disease stages,following the ‘net pressure on the optic disk hypothesis’,arecharacterized by one single disease mechanism: an abnormallylow ICP.”Janssen et al. (2013) thus hypothesize that low ICP may play arole in the association between glaucoma and AD. We fully agreewith the authors since our group has previously presented this hy-pothesisforthefirsttime(Wostynetal.,2008,2009a).Intwoofourearlier manuscripts published in 2008 (Wostyn et al., 2008) and2009 (Wostyn et al., 2009a), we proposed low ICP occurring inAD as a factor leading to increased risk of glaucoma. Evidence forthishypothesiswasgainedfromCSFpressuremeasurementstudiesin AD patients and patients with glaucoma. The finding of a highoccurrence of reduced CSF pressure among patients with AD(Silverberg et al., 2006; Wostyn et al., 2009b) could be linked tothe high rate of reported comorbidity between AD and glaucoma(Bayer et al., 2002; Tamura et al., 2006), since it has been shownthat CSF pressure is lower in patients with glaucoma (Berdahlet al., 2008a, 2008b; Ren et al., 2010). This could result in anabnormally high trans-lamina cribrosa pressure difference andlead to glaucomatous damage. Given this previously advanced hy-pothesis, it was a great surprise when Janssen et al. (2013) recentlyhypothesized about the potential role of low ICP in glaucoma andAD without citing our earlier work (Wostyn et al., 2008, 2009a)or making clear the relevant precedents. The authors did cite oneof our papers, one largely focused on the high occurrence rate ofglaucoma among patients with normal pressure hydrocephalus(Wostyn et al., 2010), but this paper has no direct relevance tothe above hypothesis.Sincerely yours,Peter Wostyn, MDVeva De Groot, MD, PhDDebby Van Dam, PhDKurt Audenaert, MD, PhDPeter Paul De Deyn, MD, PhDReferences

Life journey and scientific heritage of professor M.B. Vurgaft (to the 100th anniversary)

In 2013 it is 100th birthday anniversary of M.B. Vurgaft - world known scientist, one of the founders of the aqueous humour production and drainage examination by compression tests and tonometry in a normal eye and in glaucoma patients. Moisey Bencionovich Vurgaft, professor, PhD, headed the department of ophthalmology of Kazan State Institution for Post-Graduate Medical Education, later renamed to Kazan State Medical Academy. The student of outstanding scientists - academician V.P. Filatov and professor S.F. Kalf, M.B. Vurgaft has devoted all his life to studying one of the leading problems of ophthalmology - glaucoma. He was the first in The Soviet Union who has started to study the eye fluid flow, and developed original and easily assessable study methods that are still important nowadays. A new direction of scientific research of the department targeted on glaucoma studies was formed under the guidance of M.B. Vurgaft. Moisey Bencionovich had always tried to link the scientific research with the needs of healthcare practice. He was an outstanding diagnostician, clinician and ophthalmic surgeon. Professor M.B. Vurgaft had always shared his experience and had mentored a number of outgoing students, who are currently working all over the country. He is the author of over 140 academic papers, 6 textbooks, several patents covering various questions of ophthalmology. Using the scientific data, originally gained by M.B. Vurgaft, 16 master and 6 doctoral degrees (PhDs) were completed in different institutions of CIS, Bulgaria and Hungary. During 13 years he was an eternal head of the Tatarstan Scientific Society of Ophthalmologists, an honoured member of All-Russia and Soviet Union Scientific Society of Ophthalmologists, member of the expert board of the Central (awarded with the order of Lenin) Institution for Post-Graduate Medical Education of the responsible for the development of post-graduate educational programs in ophthalmology, member of the of surgical faculty of Kazan State Institution for Post-Graduate Medical Education.

A Case of Bilateral Central Serous Chorioretinopathy after Blunt Trauma

Purpose: To report a case of bilateral central serous chorioretinopathy (CSC) after blunt trauma with rapid remission. Case summary: A 44-year-old man visited our clinic after blunt trauma around the right eye. At the first examination, no ocular problem was detected except a periorbital contusion. After one week, the patient complained of visual disturbance in his right eye. Fundus examination showed subretinal fluid in his right eye, and fluorescein angiography (FAG) showed typical smokestack pattern leakage, which lead to a diagnosis of CSC. Three days later, the patient complained of visual disturbance in his left eye, which was then also diagnosed as CSC. After 2 more weeks, the subretinal fluid in the right and left eyes had decreased. After 3 weeks, the subretinal fluid was almost completely absorbed in both eyes. Conclusions: Central serous chorioretinopathy can develop after blunt trauma, especially with a rapid clinical course. Thus, periodic ophthalmologic examination is needed after the first examination for blunt trauma of the eye. J Korean Ophthalmol Soc 2014;55(8):1248-1252

A Study Investigating a Possible Link Between Lens Protein in the Vitreous Fluid of Eyes After Uncomplicated Cataract Surgery and Chronic Cystoid Macular Edema.

This study aimed to determine if the lens protein aquaporin 0 (AQP0) is present in the vitreous of pseudophakic eyes of patients presenting with chronic cystoid macular edema (CME). A case-control study was conducted. Ten patients undergoing therapeutic vitrectomy for chronic CME after uncomplicated cataract surgery were enrolled in this study. Fourteen patients with pseudophakia undergoing vitrectomy surgery for indications other than CME acted as the comparison group.The vitreous fluid from the 2 groups was analyzed for the presence of the lens protein AQP0 and type II collagen (used as a positive control). Type II collagen was detected in all the vitreous samples, whereas AQP0 was documented in 50% of eyes with chronic CME but was not found in the vitreous of any eyes without a documented history of CME. Aquaporin 0 is found in some eyes with chronic CME after uncomplicated cataract surgery, suggesting contamination of the vitreous by lens protein may have a role in the pathogenesis of this disorder.

Уровень некоторых цитокинов в структурах и жидкостях глаза у больных регматогенной отслойкой сетчатки с послеоперационными осложнениями

<p style="text-align: justify;"><span style="color: #800000;"><strong><span style="font-size: 13.0080003738403px; line-height: 1.538em;">Cytokines levels in the eye structures and fluids in patients with rhegmatogenous retinal detachment with postoperative complications</span></strong></span> <p style="text-align: justify;"><strong>Levitskaya GV</strong> <p style="text-align: justify;">SI «The Filatov Institute of Eye Diseases and Tissue Therapy NAMS of Ukraine» <p style="text-align: justify;">Odessa, Ukraine

Source-Dependent Intracellular Distribution of Iron in Lens Epithelial Cells Cultured Under Normoxic and Hypoxic Conditions

Intracellular iron trafficking and the characteristics of iron distribution from different sources are poorly understood. We previously determined that the lens removes excess iron from fluids of inflamed eyes. In the current study, we examined uptake and intracellular distribution of ⁵⁹Fe from iron transport protein transferrin or ferric chloride (nontransferrin-bound iron [NTBI]) in cultured canine lens epithelial cells (LECs). Because lens tissue physiologically functions under low oxygen tension, we also tested effects of hypoxia on iron trafficking. Excess iron, not bound to proteins, can be damaging to cells due to its ability to catalyze formation of reactive oxygen species. LECs were labeled with ⁵⁹Fe-Tf or ⁵⁹FeCl₃ under normoxic or hypoxic conditions. Cell lysates were fractioned into mitochondria-rich, nuclei-rich, and cytosolic fractions. Iron uptake and its subcellular distribution were measured by gamma counting. ⁵⁹Fe accumulation into LECs labeled with ⁵⁹Fe-Tf was 55-fold lower as compared with that of ⁵⁹FeCl₃. Hypoxia (24 hours) decreased uptake of iron from transferrin but not from FeCl₃. More iron from ⁵⁹FeCl₃ was directed to the mitochondria-rich fraction (32.6%-47.7%) compared with ⁵⁹Fe from transferrin (10.6%-12.6%). The opposite was found for the cytosolic fraction (8.7%-18.3% and 54.2%-46.6 %, respectively). Hypoxia significantly decreased iron accumulation in the mitochondria-rich fraction of LECs labeled with ⁵⁹Fe-Tf . There are source-dependent differences in iron uptake and trafficking. Uptake and distribution of NTBI are not as strictly regulated as that of iron from transferrin. Excessive exposure to NTBI, which could occur in pathological conditions, may oxidatively damage organelles, particularly mitochondria.

Ocular tissues and fluids oxidative stress in hares fed on verbascoside supplement

The influence of a prolonged diet supplemented with the powerful antioxidant verbascoside on the oxidative state of 20 healthy hares eye fluids and tissues has been studied. Verbascoside was dosed at 2, 3, 4 mg/die and the impact on the oxidative state of ocular tissues and fluids was tested by TBARS (thio barbituric acid reactive substances) and TEAC (trolox equivalent antioxidant capacity) assays. The percentage of change in antioxidant activity increased largely in retina and lenses at a daily verbascoside dose of 3 mg, whereas for optic nerve and vitreous humor the higher antioxidant capacity was measured at 4 mg/die verbascoside dose. The present findings demonstrate that verbascoside supplementation is able to protect ocular tissue and fluids from naturally occurring oxidation and that its protective effect depends on the daily dose, being maximum up to 3 mg/die.

Pressure-Induced Stromal Keratopathy as a Result of Ocular Trauma After Laser In Situ Keratomileusis

Pressure-induced stromal keratopathy is a rare kind of complication of laser in situ keratomileusis (LASIK) that may cause vision loss in affected eyes. Herein, we described the clinical features and treatment of 2 cases of pressure-induced stromal keratopathy due to traumatic hyphema in post-LASIK eyes. Two patients sought treatment for painful vision loss after blunt trauma on post-LASIK eyes. On examination, high intraocular pressure was found in the injured eyes. Hyphema was seen in the anterior chamber. High-resolution slitlamp biomicroscopy demonstrated interface hyperreflection, which resembled interface keratitis. However, an isolated pocket of fluid was clearly demonstrated at the level of the LASIK flap interface in the anterior segment optical coherence tomographic images. After topical corticosteroid and antiglaucoma medication, the hyphema and the hyperreflection in the cornea resolved in several days. The intraocular pressure and visual acuity returned to normal levels. Repeated anterior segment optical coherence tomographic examinations revealed completed resolution of the interface fluid. To our knowledge, this is the first report of pressure-induced stromal keratopathy caused by traumatic hyphema. Anterior segment optical coherence tomography plays a unique role in revealing occult interface fluid in post-LASIK eyes, which may masquerade as interface keratitis during slitlamp examination.

P2.001 Performance of the Hologic Gen-Probe APTIMA Assays and PANTHERTM Instrumentation For the Confirmation of Neisseria Gonorrhoeae in Genital and Non-Genital Samples

Nucleic Acid Amplification Tests (NAATs) for Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (GC) have become routine. These methods are validated for use with urogenital samples and have a faster turn-around-time...

Nonarteritic ischemic optic neuropathy secondary to severe ocular hypertension masked by interface fluid in a post-LASIK eye

We report a case of ischemic optic neuropathy arising from elevated intraocular pressure (IOP) masked by interface fluid in a post-laser in situ keratomileusis (LASIK) eye. A 51-year-old man, who had had LASIK 6 years prior to presentation, sustained blunt trauma to the left eye that resulted in a hyphema and ocular hypertension. Elevated IOP resulted in accumulation of fluid in the stromal bed-LASIK flap interface, leading to underestimation of IOP when measured centrally over the flap. After days of unrecognized ocular hypertension, ischemic optic neuropathy developed. To our knowledge, this is the first reported case of ischemic optic neuropathy resulting from underestimated IOP measurements in a post-LASIK patient. It highlights the inaccuracy of IOP measurements in post-LASIK eyes and a vision-threatening potential complication. No author has a financial or proprietary interest in any material or method mentioned.

EFFECTS OF SOLUBLE CD14 AND CYTOKINE LEVELS ON DIABETIC MACULAR EDEMA AND VISUAL ACUITY

The pathogenesis of diabetic retinopathy has been suggested to be associated with ocular inflammation. Macrophages and monocytes that infiltrate the eye are known to express CD14. After shedding from the membrane-bound CD14, soluble CD14 (sCD14) is released, which could potentially activate inflammatory signaling. In this study, the authors investigated ocular fluid and serum levels of vascular endothelial growth factor (VEGF), sCD14, and other inflammatory cytokines in patients with diabetic macular edema (DME). Furthermore, the authors determined any potential correlation between these factors and visual acuity. Vitreous fluid, aqueous humor, and serum samples from 14 eyes with DME and 24 control eyes were investigated. Soluble CD14, interleukin 8, interferon-inducible protein 10, monocyte chemotactic protein 1, monokine induced by interferon γ, and VEGF were measured simultaneously by FACSCalibur flow cytometer. Visual acuity was measured in all patients with DME before surgery, with the assessors being blinded to the patients' diagnoses. All factors were significantly elevated in vitreous fluid of DME eyes. Soluble CD14 and VEGF levels in vitreous fluid and aqueous humor were significantly higher in patients with DME than in nondiabetic controls (P < 0.05). In patients with DME, vitreous and aqueous humor concentrations of sCD14 correlated significantly. In these patients, vitreous fluid concentration of sCD14 correlated significantly with that of VEGF or interleukin 8 or monocyte chemotactic protein 1. In addition, there was a significant positive correlation between preoperative visual acuity and intraocular sCD14 concentrations. Soluble CD14 may act as key regulator of VEGF production and contribute to the pathogenesis of diabetic retinopathy.

Multifocal electroretinographic evaluation of macular function in acute posterior multifocal placoid pigment epitheliopathy

In acute posterior multifocal placoid pigment epitheliopathy (APMPPE), little is known about the long-term outcome of electroretinographic macular function. The purpose of this study was to report 2-year follow-up results of multifocal electroretinography (mfERG) in a 26-year-old Japanese woman diagnosed with APMPPE. Clinical and electrophysiological investigations of a single patient. Best-corrected visual acuity at initial examination was 1.5 and 0.5 in her right and left eyes, respectively. In addition to characteristic fundus lesions bilaterally, fluorescein angiography demonstrated diagnostic early blockage and late staining of the lesions. Optical coherence tomography revealed a hyperreflective spot (corresponding to the lesion) in the outer retinal layer in the right eye and intraretinal fluid in the left eye. On mfERG, the amplitudes were generally preserved, but markedly reduced amplitudes were detected in the central region of the left eye and in the paracentral region of the right eye. Five days later, visual acuity improved to 1.0, and the intraretinal fluid spontaneously disappeared without medication in the left eye. Light-to-dark ratios on electrooculography were 2.68 and 2.23 in the right and left eyes, respectively, both within the normal range. Two years later, visual acuity was 2.0 in both eyes, and ophthalmoscopically, there were neither retinal nor retinal pigment epithelial (RPE) abnormalities. mfERG revealed that the amplitudes were considerably improved (nearly normal level) in both eyes. The outcome suggests that longitudinal macular function in both visual acuity and mfERG may be favorable, unless areas of retinal or RPE alteration remain.