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Background: Systemic lupus erythematosus (SLE) is an autoimmune disease of unknown origins. We report a case of SLE retinopathy concurrent with macular edema and ischemic optic neuropathy., Case: A 30-year-old women with SLE presented with sudden visual disturbances and SLE retinopathy with typical macular edema. We treated her with subconjunctival triamcinolone acetonide injections which providing a resolution of the edema within a few days, but her visual acuity did not improve. Scotoma, relative afferent papillary defect (RAPD) and optic nerve abnormality appeared on MRI during her clinical course. A diagnosis of hidden ischemic optic neuropathy was established. She was treated with corticosteroid pulse therapy and because of an antiphospholipid syndrome, antiplatelet and anticoagulation therapy were used to improve ocular circulation. Following therapy, her visual function recovered., Conclusion: Although the symptoms seemed complicated, circulatory insufficiency was the main cause of the complications and its improvement provided the key to the patient's recovery.

Purpose: The purpose of this study was to determine the causes of visual impairment in Mie prefecture during a five-year period., Subjects and Methods: The study was conducted between April 2004 and March 2009 in Mie Prefecture. 1,322 visually impaired people as defined by the Act on Welfare of Physically Disabled Persons were enrolled. We reviewed age, sex, causes of visual impairment, degree of disability and medical conditions according to their physical disability certificate., Results: The four major causes of visual impairment were glaucoma (20.3%), diabetic retinopathy (18.9%), retinitis pigmentosa (12.2%), and macular degeneration (9.1%), followed by chorioretinal degeneration, stroke or brain tumor, optic atrophy, and cataract. The average ages of the four major causes were glaucoma (77.1 years), diabetic retinopathy (65.1 years), retinitis pigmentosa (62.5 years) and macular degeneration (77.7 years)., Conclusions: The most common cause of visual impairment in Mie prefecture was glaucoma. The four major causes in Mie prefecture were the same as the results of the nation-wide investigation reported in 2006.

Purpose: To examine the supraciliochoroidal fluid(SCF) by ultrasound biomicroscopy(UBM) at an early stage after trabeculectomy., Subjects and Methods: Fifteen eyes without post-operative complications were examined by UBM before the operation and less than 2 weeks after trabeculectomy with mitomycin C., Results: SCF was detected postoperatively in 6 eyes. One eye had choroidal detachment under indirect-ophthalmoscope and 5 eyes(33%) had SCF without choroidal detachment. The SCF in 4 eyes disappeared within 4 weeks after trabeculectomy. The intraocular pressure was 6.4 +/- 3.4 mmHg(mean +/- standard deviation) when SCF was detected and it rose to 13.2 +/- 7.2 mmHg when SCF disappeared. The intraocular pressure was 11.4 +/- 4.0 mmHg in the eyes without SCF, which was significantly higher than in the eyes with SCF., Conclusion: At an early stage after trabeculectomy, SCF was detected by UBM in some cases without ophthalmoscopic choroidal detachment. Compared with the reported frequency of SCF after 3 or 6 months, our study revealed that SCF was present more frequently at an early stage after trabeculectomy. Our results may indicate that the presence of SCF is related to early low intraocular pressure and that disappearance of SCF induces the elevation of intraocular pressure.

Purpose: The anterior chamber structure in the supine position and the prone position was investigated with ultrasound biomicroscopy (UBM) in pseudoexfoliation syndrome (PE)., Methods: We studied 12 eyes of 12 PE subjects. Patients were placed in the supine position for 30 minutes, after which UBM was performed. The UBM was repeated after 30 minutes in the prone position. Anterior chamber depth (ACD), angle opening distance 500 microns (AOD 500), and angle recess area (ARA) in 4 quadrants were measured., Results: Following the postural change from the supine position to the prone position, ACD decreased significantly (p < 0.0001). AOD 500 and ARA decreased significantly in the superior (AOD 500: p < 0.05, ARA: p = 0.03) and temporal quadrants (AOD 500: p < 0.0001, ARA: p < 0.0001)., Conclusions: The anterior chamber structural change was greater in the temporal and superior quadrants in the PE eyes. This corresponds with previous reports that zonular involvement by pseudoexfoliation material is more pronounced temporally and superiorly.

We report a case of nonarteritic anterior ischemic optic neuropathy (AION) with cilioretinal artery occlusion. The patient was a 61-year-old man with sudden visual loss in his right eye. Funduscopy showed pale swelling of the entire optic disc with retinal ischemic edema of the upper half of the retina, and fluorescein angiography revealed faint filling of the dye in the optic disc in the retinal arterial phase, and dye staining of the optic disc in the late phase. We initially diagnosed the disease as AION with branch retinal artery occlusion, but systemic administration of a corticosteroid and urokinase were ineffective and the optic disc became atrophic. As the optic disc swelling decreased and the course of arteries in the optic disc became clear, we repeated fluorescein angiography which proved that the involved upper retinal artery was a cilioretinal artery having earlier dye appearance than the lower retinal artery. Thus, we finally diagnosed the disease as AION with cilioretinal artery occlusion. We believe that Hayreh's view that AION may result from occlusion of the posterior ciliary artery is supported by the intraocular findings in this case.

We studied visual acuity and visual field of 44 eyes in 42 patients who had undergone transscleral retinal detachment surgery, they were classified into a preoperative group, a postoperative group, and a group ten years after surgery. With regard to visual acuity, the postoperative group showed a significant increase compared with the preoperative group (p < 0.001), and there was no significance between the postoperative group and the group ten years after surgery. In order to quantify the visual field obtained by Goldmann perimeter, the areal size of V-4 isopter, the areal size of I-4 isopter and the volume of the visual field were adopted in the present study. Each of the three mean values was high in the following order: the group ten years after surgery, the postoperative group, and the preoperative group. The mean value of the group ten years after surgery was respectively equivalent to 80.6%, 65.5%, and 71.1% of that of normal control in the order: the areal size of V-4 isopter, the areal size of I-4 isopter, and the volume of the visual field. Our results support the conclusion that the visual acuity acquired postoperatively can be maintained for ten years after surgery. The visual field acquired postoperatively also seems to be retained ten years after surgery.