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Mikio Sasoh,1,2 Hitoshi Mizutani,3 Hisashi Matsubara,1 Motoyasu Furuta,4 Yoshitsugu Matsui,1 Kei-ichi Yamanaka,3 Mineo Kondo11Department of Ophthalmology, Graduate School of Medicine, Mie University, Tsu, 2Local Independent Administrative Institution, Mie Prefectural General Medical Center, Yokkaichi, 3Department of Dermatology, Graduate School of Medicine, Mie University, Tsu, 4Japanese Red Cross Ise Hospital, Ise, Mie, JapanPurpose: The present study aims to investigate the number and characteristics of retinal detachment with atopic dermatitis (AD) in these 20 years, and the number of the first visit AD outpatients in almost the same period.Methods: A retrospective review of 101 consecutive surgically treated retinal detachments with AD patients from 1992 to 2011 was conducted. Retinal detachments were divided into two groups: eyes operated on from 1992 to 2001 (former AD group, n=63) and eyes operated on from 2002 to 2011 (recent AD group, n=38). We also reviewed the records of the first visit AD outpatients from 1993 to 2011 except 1998.Results: The percentage of bilateral detachment was significantly higher in the former AD group (14/63) than that in the recent AD group (0/38) (P=0.0002). In addition, patients in the recent AD group were significantly older than those in the former AD group (P=0.0084). The annual cases with non-AD retinal detachment remained invariant for 20 years. The ratio of the retinal detachment with AD for the total retinal detachment was significantly lower in the recent (38/847) AD group than that in the former (63/796) AD group (P=0.0038). The number of the first visit AD outpatients linearly decreased in these 19 years (153 cases in 1993 and 65 cases in 2011).Conclusion: Our study indicates an apparent decrease in retinal detachment with AD in the recent 10 years, and might suggest the importance of dermatitis control for prevention of retinal detachment with AD.Keywords: atopic dermatitis, incidence, ocular complication, retinal detachment

Design: Prospective study. Purpose: To evaluate real-time duplex colour Doppler examination with colour and pulse Doppler ultrasonography (US) (colour Doppler imaging (CDI)) for detection of the retinal detachment from membranous structures in the posterior segment. Materials and Methods: In 33 consecutive patients with ophthalmoscopically invisible eyes (34 eyes), CDI was performed to detect the presence or absence of retinal detachment. The diagnostic criterion for retinal detachment was whether or not spectral waveforms were detected in membranous structures with colour and pulse Doppler US. In all cases, the absence or presence of retinal detachment was confirmed by surgery. Results: In 27 of 34 eyes, membranes and/or opacities were observed in the vitreous cavity with CDI. In 12 of these 27 eyes, blood flow in those structures was detected by CDI. In all of these 12 eyes, retinal detachment was confirmed at surgery, and in 14 of the 15 eyes in which blood flow was not detected by CDI, absence of retinal detachment was confirmed at surgery. When a diagnosis confirmed by surgery was used as the definitive finding, CDI had a sensitivity of 92.3%, specificity of 100%, positive predictive value of 100%, negative predictive value of 93.3%, and an accuracy in the detection of retinal detachment from membranes and/or opacities in the vitreous cavity of 96.3%. Conclusion: Real-time duplex colour Doppler examination with colour and pulse Doppler US (CDI) is a noninvasive method useful for the detection of retinal detachment from vitreous opacity and/or membrane in the posterior segment. [ABSTRACT FROM AUTHOR]

Abstract Background Arsenic exposure induces overproduction of reactive nitrogen species (RNS) in brain tissue and results in nucleic acid damage to the nerve cells. The 8-nitroguanine is one of the major products formed by the reaction of guanine, and ONOO-, and has been used as a popular biomarker of nucleic acid damage due to RNS attacking. In the present study, we examined whether the administration of taurine can protect against nucleic acid damage of brain neurons by arsenic-induced RNS. Materials and methods Sixty mice (30 male and 30 female) weighing 19.5 ± 1.5 g were divided into 3 groups: (1) control group, (2) experimental group that received arsenic (As2O3), and (3) antagonistic group that received taurine with arsenic. Arsenic was administered for 60 days. 8-Nitroguanine expressions in brain neurons of mice were examined by the immunohistochemical method. Histopathological changes in brain tissues of mice were observed under light microscope and the immunohistochemistry method was used to investigate 8-nitroguanine expressions in cerebrum and cerebellum of mice. Results In the control group, no abnormal histopathological changes were observed in brain tissue of the mice. In brain tissue of the mice exposed to arsenic, histopathological results showed swells, evident vacuolar degeneration in cytoplasm, karyorrhexis and karyolysis. Relatively light pathological changes were observed in brain of the mice co-administered arsenic and taurine. Little or no expression of 8-nitroguanine in brain tissue was observed in controls. However, intensive expression of 8-nitroguanine was found in brain tissue of mice exposed to arsenic and it was mainly distributed in nucleus neighbouring the nuclear membrane, but a little in cytoplasm. A weak expression of 8-nitroguanine was observed in brain cells of mice co-administered arsenic and taurine. Conclusions The brain neurons may be the major target cells of arsenic neurotoxicity. Co-administration of arsenic and taurine can alleviate DNA damage of brain neurons caused by arsenic through the RNS signal pathway.

Per-oral endoscopic myotomy (POEM) is a minimally invasive treatment for esophageal achalasia. However, POEM has the potential risk of inducing carbon dioxide (CO 2 ) gas-related adverse events, such as pneumoperitoneum, pneumomediastinum, and pneumothorax. The aim of this study was to evaluate the usability of bladder pressure monitoring as an index of CO 2 gas-related pneumoperitoneum. The monitoring of bladder pressure and lung compliance and the incidence of iatrogenic pneumoperitoneum were retrospectively studied in 20 patients who underwent POEM between June 2013 and March 2015. The bladder pressure was measured using a Foley catheter. Abdominal distention was found in nine patients. The bladder pressure was significantly higher in the nine patients with the distention findings compared with patients without distention [7 (6-9) mmHg vs. 1 (0-2) mmHg; P < 0.05]; however, the decrease in dynamic lung compliance was not significantly different compared with patients without distention [- 7 (- 9.3 to - 5.1) vs. - 5 (- 10.2 to - 1.3) ml/cmH 2 O; P = 0.62]. Based on postoperative changes on CT scans; the following were the observations: pneumomediastinum (55%), minor pneumothorax (5%), pleural effusion (45%), atelectasis (15%), pneumoperitoneum (85%), and subcutaneous emphysema (15%). No significant clinical status was found among the patients postoperatively. Bladder pressure monitoring might be useful for detecting pneumoperitoneum during POEM.

Purpose: To report the development of bilateral retinal detachment in a patient with Werner syndrome., Methods: Retrospective chart review. A 44-year-old woman diagnosed with Werner syndrome developed bilateral retinal detachment. The fundus in both eyes showed patchy chorioretinal atrophy similar to that seen in high myopia, with the retinal detachment limited to the posterior pole. Two weeks after performing vitrectomy in the right eye, vitrectomy was performed in the left eye., Results: After the surgeries, both retinas were reattached. During the surgeries, we observed an excessively liquefied vitreous and a posterior hyaloid membrane that was tightly attached to the retina. The retinal break was located along the superotemporal arcade and over an area of the patchy chorioretinal atrophy in both eyes. The chorioretinal atrophy and vitreous liquefaction appeared to be excessive for the patient's age and axial lengths (right: 26.66 mm, left: 27.04 mm)., Conclusion: Vitreoretinal changes found in this case might have been partially because of the premature aging associated with Werner syndrome.

Background: The long-term outcome of modified Fontan operation concomitant with a valve operation for atrioventricular valve (AVV) regurgitation is not well described., Methods: Between 1977 and 2003, 500 children who underwent modified Fontan operation were subdivided into 192 with AVV plasty (group P) and 308 without AVV plasty (group N). Factors associated with patient outcome were investigated retrospectively., Results: Surgical techniques to correct valve incompetence included circular annuloplasty, partial annuloplasty with Kaye-Reed methods, edge-to-edge repair methods, and valvoplasty, which were combined according to the etiology of the valve lesion. The estimated actuarial survival rates at 10 and 20 years were, respectively, 82.0% and 76.6% in group P (p < 0.05) and 90.8% and 86.8% in group N (p = 0.001). The estimated actuarial survival rates at 10 years among patients with AVV plasty did not show a statistically significant difference (circular annuloplasty, 79.0%; partial annuloplasty, 81.6%; edge-to-edge, 83.3%; valvoplasty, 82.6%; p = 0.90). A Cox regression model revealed that a higher preoperative ventricular ejection fraction was associated with a significant reduction in long-term mortality in group P (hazard ratio, 0.921; 95% confidence interval, 0.873 to 0.972; p < 0.05). Each repair method showed acceptable durability at medium-term follow-up, without progression of lesions., Conclusions: Given worse results with poor ventricular function, early intervention against valve pathology before development of ventricular failure may improve long-term outcomes. Multiple methods are appropriate for a variety of valve lesions; however, circular annuloplasty remains a reliable repair option due to its technical simplicity., (Copyright © 2013 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)

Purpose: To report the finding of retinal detachment because of macular hole and an additional break within the posterior staphyloma., Methods: A 63-year-old woman presented with progressive central scotoma of the right eye for 1-month duration. The fundus in the right eye showed retinal detachment that was localized within the posterior staphyloma and macular hole. An additional retinal break was observed within the staphyloma using ophthalmoscope, and optical coherence tomography confirmed that both the breaks were within the staphyloma. Macular buckling was scheduled because the two breaks were close enough to each other and the patient was unable to maintain a prone position., Results: The retinal detachment was successfully reattached using macular buckling procedure., Conclusion: In the present case, optical coherence tomography proved to be very useful in helping to make the correct diagnosis of a full-thickness break before surgery.

Background/aims: D-aspartate is an important candidate for retinal neurotransmitter or neuromodulator. The purpose of this study was to investigate the cells type and distribution of the D-aspartate-immunopositive cells in the ganglion cell layer., Methods: Wister rats were fixed by perfusion with 5% glutaraldehyde. Paraffin sections of the retina were immunohistochemically double-labeled using D-aspartate and glutamate or γ-aminobutyric acid antibodies. After labeling the whole-mount retina by D-aspartate, the cell densities of both the perivascular and nonperivascular areas in the ganglion cell layer were measured for the central, midperipheral, and peripheral zones, respectively., Results: Within the paraffin section, some of the glutamate-immunoreactive cells in the ganglion cell layer were D-aspartate immunoreactive. These D-aspartate-positive cells in the ganglion cell layer were more frequently observed along the retinal vessels in the whole-mount retina. The D-aspartate-positive cell densities in the perivascular area were significantly higher than those in the nonperivascular area for the central, midperipheral, and peripheral zones (p < 0.0001)., Conclusion: In the ganglion cell layer, the D-aspartate-immunopositive cells proved to be the ganglion cells, with their distribution found to be denser along the large retinal vessels such as the arterioles or venules., (Copyright © 2010 S. Karger AG, Basel.)

Purpose. To investigate the effects of nipradilol on retrobulbar hemodynamics. Methods. We investigated normal and normal-tension glaucoma (NTG) eyes. Topical nipradilol (one eye) and placebo eye drops (fellow eye) were instilled for 1 week in volunteers. Nipradilol was also instilled in NTG patients. Ultrasound color Doppler imaging for the posterior vessels was performed before, 2 hr, 1 week (for normal), and at 4 weeks (for NTG). Results. In normal eyes, there were significant decreases in the resistance index (RI) for the temporal short posterior ciliary arteries (PCA) at 2 hr and for the ophthalmic arteries at 1 week. There were no significant changes in the placebo-treated eyes. In the NTG eyes, there was a significant decrease in the RI for the central retinal artery, nasal, and temporal PCA at 2 hr and 4 weeks. Conclusion. Short-term observations found that nipradilol increased the ocular blood flow in normal and NTG eyes.

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 assess an effect of glycemic control on retinal nerve fiber layer (RNFL) in type 2 diabetes mellitus. Methods. Thirty-eight eyes of 38 patients with type 2 diabetes undergoing blood glucose regulation were enrolled. All patients were examined at (1) initial visit, (2) 1 month, (3) 2 months, and (4) 4-month after the initial examination. On each occasion, glycosylated hemoglobin (HbA1c) levels and optical coherence tomography (OCT) scanning for RNFL thickness were evaluated. 360 degree circular OCT scans with a diameter of 3.4 mm centered on the optic disc were performed. Results. Significant RNFL decrease was seen in the superior area between initial and 4 months examination (P = .043). The relationship between the changes in HbA1c and the changes in RNFL thickness was observed in superior, temporal, and inferior area (P < .05) at 4 months. Conclusions. This study suggests that the glycemic control affects RNFL within 4 months.

A 48-year-old woman presented with a left cerebellopontine angle mass. Over a 93-month period, the patient underwent seven surgeries, two radiosurgeries, and one external beam radiotherapy. The tumor was histologically benign at the first operation, but exhibited unusually aggressive behavior after failed radiosurgery and demonstrated clinical characteristics of malignancy such as spinal metastasis. The patient underwent gamma knife radiosurgery (GKR) for recurrence after the first operation, despite the tumor being located in a resectable region. The tumor did not respond. Six months after the sixth surgery, the patient presented with progressive lower extremity paraparesis and sensory disturbance below the T11 dermatome. Magnetic resonance imaging revealed multiple intradural mass lesions located at the T2, T11-T12, and L2 levels. She died 4 months after the diagnosis of spinal metastases. Retrospectively, we speculate that if a tumor is located in a resectable region and Simpson grade I or II tumor resection is possible, direct surgery may be a safer option than GKR.

Purpose: The aim of this study was to investigate the intraocular pressure (IOP)-lowering effect of a new anti-glaucoma drug, the Rho-associated protein kinase (ROCK) inhibitor, HA-1077, in a rabbit ocular hypertension model., Methods: Experiments were carried out in 18 male New Zealand white rabbits, with ocular hypertension induced by water loading. Animals were divided into three groups followed by topical administration of 1 mM, 2 mM, and 3 mM HA-1077 in the left eye. As a control, phosphate buffered saline was administered in the opposite eye., Results: After administration of HA-1077 eye drops, there was a significant time- and dose-dependent decrease of the IOP. While minor conjunctival injection was seen in a few cases, no abnormalities of the anterior chamber or fundus were observed., Conclusions: This is the first report of the effect of the ROCK inhibitor, HA-1077, on the IOP in an ocular hypertension model. Study results indicated that HA-1077 has a strong IOP-lowering effect.

Aim: The present study investigates whether glutamate immunoreactivity (IR) in the cat outer retina, which is devoid of blood vessels, can be well preserved by perfusion fixation., Methods: Adult cats were perfused intracardially for 1, 5, 10, 15 and 30 min with physiological saline and were subsequently perfused with a mixture of 1% glutaraldehyde and 4% formaldehyde. After the fixation, the retinas were immunocytochemically examined., Results: The photoreceptor inner segments in the retina, which was perfused by saline for 1 and 5 min prior to fixation, showed no glutamate IR. However, those in the retina which was perfused by saline for 10 min showed moderate glutamate IR as found in the retina fixed by immersion. The glutamate IR in the inner segments decreased with a saline perfusion of more than 10 min., Conclusions: Perfusion fixation can well preserve glutamate IR even in the outer retina including the inner segments.

The keratin intermediate filament network is abundant in epithelial cells, but its function in the establishment and maintenance of cell polarity is unclear. Here, we show that Albatross complexes with Par3 to regulate formation of the apical junctional complex (AJC) and maintain lateral membrane identity. In nonpolarized epithelial cells, Albatross localizes with keratin filaments, whereas in polarized epithelial cells, Albatross is primarily localized in the vicinity of the AJC. Knockdown of Albatross in polarized cells causes a disappearance of key components of the AJC at cell-cell borders and keratin filament reorganization. Lateral proteins E-cadherin and desmoglein 2 were mislocalized even on the apical side. Although Albatross promotes localization of Par3 to the AJC, Par3 and ezrin are still retained at the apical surface in Albatross knockdown cells, which retain intact microvilli. Analysis of keratin-deficient epithelial cells revealed that keratins are required to stabilize the Albatross protein, thus promoting the formation of AJC. We propose that keratins and the keratin-binding protein Albatross are important for epithelial cell polarization.

A technique for exposing the vertebrobasilar junction with traction of the dentate ligament is described for treatment of large vertebral artery (VA) aneurysms via the far lateral suboccipital approach with partial condylar resection. The most rostral attachment of the dentate ligament is divided above the site where the VA pierces the dura mater. A traction suture is placed into the dentate ligament and gently retracted using mosquito forceps. As a result, the medulla oblongata is lifted dorsally and slightly rotated by the divided and retracted dentate ligament, allowing an approach from a more superior or inferior direction. The present technique is useful for the treatment of large thrombosed VA aneurysms.

Wide exposure of lesions during the subtemporal approach often leads to temporal lobe injury caused by excessive retraction. A brain retraction technique using gelatin sponge pieces was developed to minimize intraoperative brain retraction during the subtemporal approach. After aspirating cerebrospinal fluid and slackening the temporal lobe, 2-3 pieces of gelatin sponge are inserted between the dura and surfaces of the anterior and posterior parts of the temporal lobe, then covered with cottonoids. The gelatin sponge pieces expand and thus expose the free margin of the tentorium with minimal brain retraction. This technique was used in 50 patients undergoing clipping for cerebral aneurysms. Although computed tomography indicated minor brain injury caused by retraction in three patients with ruptured aneurysm of the basilar artery bifurcation, no patients experienced new neurological deficits other than transient ipsilateral oculomotor nerve paresis. In conclusion, gelatin sponge, with its innate mechanical characteristics and ease of application, seems to offer an alternative retractor in neurosurgical interventions using the subtemporal approach for patients with unruptured aneurysm or non-severe subarachnoid hemorrhage.

A 14-year-old boy presented with a very rare meningioma in the posterior cranial fossa without dural attachment. Magnetic resonance imaging revealed a 3-cm, well-circumscribed, heterogeneously enhanced, round mass without dural tail sign in the right side of the posterior fossa. Right vertebral angiography revealed very faint tumor staining supplied by the right posterior inferior cerebellar artery. Total removal of the tumor was performed. Intraoperatively, the mass exhibited no attachment to the dura mater, cerebellar parenchyma, or choroid plexus, but was firmly attached to the arachnoid tissue near the foramen of Luschka. Histological and immunohistochemical studies established the diagnosis of meningothelial meningioma (World Health Organization grade I).

External cerebrospinal fluid (CSF) drainage is an effective method to remove massive subarachnoid hemorrhage (SAH), but carries the risk of meningitis and shunt-dependent hydrocephalus. This study investigated whether postoperative cisternal CSF drainage affects the incidence of cerebral vasospasm and clinical outcome in patients with thin SAH. Seventy-eight patients with thin SAH, 22 men and 56 women aged from 17 to 73 years (mean 51.2 years), underwent surgical repair for ruptured anterior circulation aneurysm. Patients were divided into groups with (38 patients) and without (40 patients) postoperative cisternal CSF drainage, and the incidences of angiographical and symptomatic vasospasm, shunt-dependent hydrocephalus, meningitis, and the clinical outcome were compared. The incidences of angiographical vasospasm (31.6% vs 50.0%), symptomatic vasospasm (7.9% vs 12.5%), shunt-dependent hydrocephalus (5.3% vs 0%), and meningitis (2.6% vs 0%) did not differ between patients with and without cisternal CSF drainage. All patients in both groups resulted in good recovery. Postoperative cisternal CSF drainage does not affect the incidence of cerebral vasospasm or the clinical outcome in patients with thin SAH.

Background: We report the use of an indocyanine green (ICG) injection during the safe removal of an overhanging filtering bleb after trabeculectomy., Case: A 63-year-old man with a history of trabeculectomy 5 years previously in his left eye complained of foreign body sensation in this eye and decreased vision from induced astigmatism. Slit-lamp examination revealed an expanding overhanging filtering bleb on the cornea., Observations: With a 30-G needle, 0.25% ICG was injected into the overhanging bleb. Use of ICG visualization of the inner space of the overhanging filtering bleb provided visualization of the border with the original bleb, allowing for safe excision of the overhanging filtering bleb without injury to the thin surface of the original bleb., Conclusion: Injection of ICG into an overhanging filtering bleb during excision can be useful in the prevention of damage to the original bleb., ((c) Japanese Ophthalmological Society 2007.)

The authors describe transposition of the posterior inferior cerebellar artery (PICA) to the vertebral artery (VA) combined with parent artery occlusion for the treatment of VA aneurysms in cases in which a clip could not be applied because of the origin of the ipsilateral PICA. The aneurysm is trapped through a lower lateral suboccipital craniectomy. The PICA is then cut just distal to the aneurysm, and the PICA and VA proximal to the aneurysm are anastomosed in an end-to-end or end-to-side fashion. The surgical procedure was successfully performed in two patients, each of whom had hypoplastic occipital arteries (OAs). The PICA contralateral to the lesion was hypoplastic in one patient and distant to the ipsilateral PICA in the other patient. Mild transient dysphagia developed postoperatively in one patient due to glossopharyngeal and vagus nerve palsy, and the other patient had an uneventful postoperative course. In both patients, postoperative cerebral angiography demonstrated good patency of the transposed PICA. These results show that transposition of the PICA to the VA is a useful procedure for the reconstruction of the PICA when parent artery occlusion is necessary to exclude a VA aneurysm involving the origin of the PICA and when OA-PICA anastomosis or PICA-PICA anastomosis cannot be performed.

Purpose: This study evaluates the relevance to human retinopathy of electroretinograms (ERGs) from the spontaneously diabetic Goto-Kakizaki (GK) rat., Methods: Starting from 4 weeks of age, we obtained ERGs every 4 weeks from six GK rats and seven Wistar (control) rats, and from two GK and two Wistar rats at 14 days of age. The a-wave, b-wave, and oscillatory potentials (OPs) were recorded after stimulation with a single bright flash. We compared the amplitudes and implicit times and measured a-wave latencies to evaluate photoreceptor function., Results: The amplitudes of the a-wave, b-wave, and OPs (O1 and O2) of the GK rats were reduced between 4 and 48 weeks of age. The time-dependent courses of change in a-wave, b-wave, and O2 amplitude did not differ between the two groups. The a-wave latencies in GK rats were significantly prolonged, but not the implicit times of OPs. At 14 days of age, the a-wave amplitudes were significantly smaller in GK than in Wistar rats., Conclusion: Functional abnormalities of photoreceptors might be induced by inheritable degeneration at an early age in the GK rat. Although hyperglycemia would cause retinal hypoxia, it would not be severe enough to disturb the generation of OPs.

We isolated Comamonas sp. strain E6, which utilizes terephthalate (TPA) as the sole carbon and energy source via the protocatechuate (PCA) 4,5-cleavage pathway. Two almost identical TPA degradation gene clusters, tphRICIA2IA3IBIA1I and tphRIICIIA2IIA3IIBIIA1II, were isolated from this strain. Based on amino acid sequence similarity, the genes tphR, tphC, tphA2, tphA3, tphB, and tphA1 were predicted to code, respectively, for an IclR-type transcriptional regulator, a periplasmic TPA binding receptor, the large subunit of the oxygenase component of TPA 1,2-dioxygenase (TPADO), the small subunit of the oxygenase component of TPADO, a 1,2-dihydroxy-3,5-cyclohexadiene-1,4-dicarboxylate (DCD) dehydrogenase, and a reductase component of TPADO. The growth of E6 on TPA was not affected by disruption of either tphA2I or tphA2II singly; however, the tphA2I tphA2II double mutant no longer grew on TPA, suggesting that both TPADO genes are involved in TPA degradation. Introduction of a plasmid carrying tphRIICIIA2IIA3IIBIIA1II conferred the TPA utilization phenotype on Comamonas testosteroni IAM 1152, which is able to grow on PCA but not on TPA. Disruption of either tphRII or tphCII on this plasmid resulted in the loss of the growth of IAM 1152 on TPA, suggesting that these genes are essential to convert TPA to PCA in E6. The genes tphA1II, tphA2II, tphA3II, and tphBII were expressed in Escherichia coli, and the resultant cell extracts containing TphA1II, TphA2II, and TphA3II converted TPA in the presence of NADPH into a product which was transformed to PCA by TphBII. On the basis of these results, TPADO was strongly suggested to be a two-component dioxygenase which consists of the terminal oxygenase component (TphA2 and TphA3) and the reductase (TphA1), and tphB codes for the DCD dehydrogenase.

Purpose: To investigate the distribution of amino acids (glutamate, aspartate, glutamine, GABA, glycine) in detached retinas with minimum postmortem artifact and to clarify the relation between amino acid distribution and histopathological change in the outer portion of detached retinas., Methods: Unilateral retinal detachment was produced in cats by injecting 0.25% sodium hyaluronate into the subretinal space using a glass micropipet. The eyes were fixed by perfusion for 10 min, 1, 3, 6 and 24 h, 2, 3 and 7 days after detachment and then examined under conventional light- and electron-microscopic immunocytochemistry., Results: For glutamate, aspartate and glutamine, the inner segments and perikarya of the photoreceptor cells, which were not immunopositive in the normal retinas, showed various degrees of immunoreactivity immediately after retinal detachment. Photoreceptor cells with the strong immunoreactivity developed necrosis. The staining pattern of GABA and glycine scarcely changed during the course of retinal detachment., Conclusions: Excess intracellular glutamate, aspartate and glutamine in photoreceptor cells may cause a part of neuronal death after retinal detachment.

Purpose: To study long-term visual functions in eyes that underwent scleral buckling for treatment of rhegmatogenous retinal detachment., Methods: We retrospectively studied a nonconsecutive case series of 205 eyes with retinal detachment that underwent scleral buckling and were followed up for 10 years after surgery. Preoperatively, postoperatively, and 10 years after surgery, best-corrected visual acuities and visual fields were recorded., Results: During the first postoperative year and during the next 9 years, there were significant increases in visual acuity (P<0.0001 and P<0.0001, respectively). Between the operation and 1 month postoperatively, there was a significant increase in the area size of visual field measured by Goldmann perimetry (V-4 isopter, P=0.0001; I-4 isopter, P=0.0001). Between 1 month and 10 years after surgery, there was no significant change of the area size of each isopter (V-4, P=0.786; I-4, P=0.211)., Conclusion: Improvement in visual acuity after scleral buckling is possible over a long period. There may be a limit to long-term improvement of visual field after scleral buckling.

Purpose: To detect early diabetic damage in type 2 diabetes mellitus patients with no diabetic retinopathy (NDR) using optical coherence tomography (OCT) and to evaluate OCT as a clinical test., Methods: Thirty-two patients with NDR (n = 32) were enrolled. We examined retinal and retinal nerve fiber layer (RNFL) thickness using OCT. Two healthy normal populations were also enrolled for the retinal thickness (n = 48) and RNFL thickness (n = 34). Both OCT measurements were obtained in four areas (temporal, superior, nasal and inferior). The receiver operator characteristic (ROC) curve was generated to evaluate the predictor variables., Results: Comparing the normal and NDR eyes, retinal thickness significantly increased (p = 0.03) and RNFL thickness significantly decreased (p = 0.02) in the superior areas. The area under the ROC curve was 0.65 for the superior retinal thickness and 0.63 for the superior RNFL thickness., Conclusions: Both OCT measurements can detect early retinal damage in NDR patients., (Copyright 2005 S. Karger AG, Basel.)

Objective: To study the effects of segmental scleral buckling without encircling procedures on retrobulbar hemodynamic conditions using color Doppler imaging., Methods: In 65 consecutive eyes of 65 patients with unilateral rhegmatogenous retinal detachment repaired by scleral buckling, we prospectively measured the blood flow velocities in the ophthalmic artery, central retinal artery, and short posterior ciliary artery using color Doppler imaging before and 2, 12, and 24 weeks after surgery. Peak systolic velocity (PSV) and end diastolic velocity (EDV) (calculated in centimeters per second) were measured using color Doppler imaging., Results: The PSV and EDV in the ophthalmic artery were not changed significantly during follow-up. The PSV and EDV in the central retinal artery were reduced temporarily at 2 weeks after surgery, but at 12 weeks after surgery had returned to presurgery levels. The PSV and EDV in the short posterior ciliary artery on both sides continued to decrease postoperatively, and the reductions became statistically significant by 24 weeks after surgery (buckled side: P=.001 for PSV and P=.002 for EDV; unbuckled side: P<.001 for PSV and P=.004 for EDV). The decreases of PSV and EDV in the short posterior ciliary artery on the buckled side were positively correlated with the subject's age (R = 0.40, P = .001 for PSV; and R = 0.32, P = .008 for EDV)., Conclusions: Scleral buckling procedures can cause subclinical disturbance of the choroidal circulation, even if encircling procedures are avoided. Aging is one of the risk factors for the disturbance.

Purpose: To evaluate and compare the findings and changes of the anterior chamber angle configuration with indentation ultrasound biomicroscopy (UBM) gonioscopy in relative pupillary block (RPB), peripheral anterior synechia (PAS), and plateau iris configuration (PIC)., Methods: This study included 73 eyes of 52 patients with RPB (n = 26), PAS (n = 21), or PIC (n = 26). First, a conventional UBM scan was performed using a normal size standard eye cup before indentation. Then, for indentation UBM gonioscopy, scans were performed using a new eye cup that we designed. For evaluation of the angle, angle opening distance 500 and angle recess area were recorded and evaluated with regard to the effect of expansion on the anterior chamber angle., Results: Indentation UBM gonioscopy showed the characteristic images in each of the eyes. The angle of all examined eyes was significantly widened with indentation (P < 0.01). The angle changes in eyes with RPB were significantly greater than in eyes with PAS or PIC (P < 0.01)., Conclusion: Indentation UBM gonioscopy is a very useful method for observing the angle and diagnosis of RPB, PAS, and PIC.

Purpose: To investigate changes in anterior chamber angle configuration with indentation ultrasound biomicroscopy gonioscopy of relative pupillary block (RPB)., Design: Cross-sectional study., Methods: This study included 26 eyes of 26 patients with RPB. We determined angle opening distance 500 and angle recess area using indentation ultrasound biomicroscopy gonioscopy and compared a small-sized standard eye cup with a new eye cup with an area for inducing pressure., Results: Indentation ultrasound biomicroscopy images documented concavity of the iris in eyes with RPB. Both the new and the small standard eye cups widened the anterior chamber angle significantly (P <.0001) without causing corneal damage. Angle changes were significantly greater for the new eye cup design., Conclusions: Indentation ultrasound biomicroscopy gonioscopy is a useful technique for observation and diagnosis of RPB. Using a small standard or the newly designed eye cup, the procedure can be performed easily and without causing corneal damage.

Background and Purpose: Qualitative measurement of regional cerebrovascular reactivity (rCVR) to acetazolamide with single-photon emission CT (SPECT) has been widely used to determine the severity of hemodynamic impairment. We attempted to validate the accuracy of qualitative assessment by using SPECT to detect reduced rCVR compared with rCVR determined quantitatively in patients with unilateral major cerebral artery occlusion., Methods: Regional cerebral blood flow was assessed with iodine-123-N-isopropyl-p-iodoamphetamine ((123)I-IMP) at rest and after acetazolamide activation in 133 patients with previously symptomatic, unilateral internal carotid or middle cerebral artery occlusion. Quantitative values were calculated by using the (123)I-IMP autoradiographic method and analyzed for each cerebral hemisphere as the percentage change in rCBF between resting and activation studies (%(Hem)). Qualitative rCVR was determined for the target hemisphere distal to the occlusion as the cerebral-interhemispheric asymmetry index (AI(Hem)) and as an index of flow difference between the target cerebral and ipsilateral cerebellar hemispheres (FI(Hem-Cbl)). Values 2 SDs below the mean in healthy volunteers were defined as decreased., Results: Fair agreement was observed between %(Hem) and both AI(Hem) change (resting vs activation, kappa = 0.409) and FI(Hem-Cbl) change (resting vs activation, kappa = 0.440). When %(Hem) was assumed to represent the true determinant of assessing rCVR, AI(Hem) change and FI(Hem-Cbl) change demonstrated sensitivities of 68% and 78%; specificities, 72% and 76%; positive predictive values, 48% and 56%; false-positive incidences, 28% and 24%; and false-negative incidences, 32% and 22% for detecting patients with reduced rCVR, respectively., Conclusion: Subgroups of patients with hemodynamic impairment cannot be accurately defined by using rCVR qualitatively measured with SPECT.

Background: Chronic ischemia because of internal carotid artery (ICA) occlusive disease may result in dementia. The goal of this study was to assess cognitive impairment in symptomatic patients with hemodynamic cerebral ischemia and determine the efficacy of extracranial-intracranial (EC-IC) bypass in restoring neuropsychologic integrity., Methods: Twenty-five patients were defined by clinical and neuroradiological criteria as suffering from hemodynamic cerebral ischemia because of unilateral ICA or middle cerebral artery occlusion. Subjects underwent assessment of cerebral blood flow and metabolism using positron emission tomography (PET) before and after bypass surgery. To provide data regarding cognition, changes in the Japanese Wechsler Adult Intelligence Scale Revised (WAIS-R) were recorded., Results: Preoperative study of patients revealed significant impairment in cerebral blood flow and metabolism as well as reduced WAIS-R score. Among the factors considered, only elevated regional oxygen extraction fraction and reduced regional cerebral metabolic rates of oxygen were significantly associated with preoperative cognitive impairment (p = 0.0032 and p = 0.0255, respectively; logistic regression analysis). After bypass surgery, cerebral blood flow and metabolism improved significantly, and the WAIS-R score increased., Conclusions: Symptomatic patients with hemodynamic cerebral ischemia displayed impaired cognition that was partially alleviated with EC-IC bypass surgery.

Purpose: To evaluate the retinal thickness of the macula in healthy subjects with different axial lengths., Methods: Included were 203 healthy subjects (116 males and 87 females). The axial length of the eyes ranged from 22.68 to 30.22 mm. Four optical coherence tomograms were obtained in a radial spoke pattern centered on the central fovea. Retinal thickness was calculated from the inner and outer retinal boundaries. The average retinal thickness in three circular areas surrounding the central fovea (350, 1,850, and 2,850 microm in diameter) was determined., Results: The retinal thickness in the three circular areas was not significantly correlated with the axial length of the eye (P = 0.10, P = 0.39, and P = 0.12). There also was no statistically significant difference found between the average thickness in emmetropic and low myopic, mildly myopic, and highly myopic eyes in the three circular areas (P = 0.35, P = 0.38, and P = 0.14)., Conclusion: When eyes with pathologic myopia were excluded, the axial length of the eye was found not to influence the average retinal thickness in the macular area.

Unlabelled: A simplified technique using (123)I-N-isopropyl-p-iodoamphetamine ((123)I-IMP) autoradiography (ARG) with SPECT has been proposed recently for quantifying regional cerebral blood flow (rCBF). To validate the accuracy of (123)I-IMP-ARG for quantifying regional cerebrovascular reactivity (rCVR) to acetazolamide, we compared rCVR determined using (123)I-IMP-ARG with that determined using H(2)(15)O PET., Methods: Thirty-nine patients with chronic stenoocclusive disease in a unilateral major cerebral artery underwent SPECT and PET studies before and after intravenous administration of acetazolamide. The rCBF images in the 4 conditions in each patient were calculated according to the ARG method. The same standard input function and the same distribution volume of 35 mL/mL were used in the calculation of rCBF images using the (123)I-IMP-ARG method at resting state and with acetazolamide challenge. One large cortical region of interest (ROI) for a unilateral middle cerebral artery territory was bilaterally determined on each standardized summed rCBF image. On the basis of the rCBF values in each ROI, rCVR to acetazolamide was calculated as follows: rCVR (%) = ([acetazolamide challenge rCBF - resting rCBF]/resting rCBF) x 100., Results: Significant correlation was observed between rCVR values obtained using (123)I-IMP-ARG and H(2)(15)O PET methods in the 78 ROIs examined in the 39 patients (r = 0.820; P < 0.0001). When a rCVR lower than the mean - 2 SD of values obtained in healthy volunteers (18.4% for (123)I-IMP-ARG and 18.2% for H(2)(15)O PET) was defined as reduced, and when the H(2)(15)O PET method was assumed to represent the true determinant of rCVR, (123)I-IMP-ARG was 90% sensitive and 92% specific and displayed an 87% positive predictive value for detecting patients with reduced rCVR., Conclusion: These findings demonstrate that (123)I-IMP-ARG methods accurately quantify rCVR and can adequately define subgroups of patients with reduced rCVR.

The effects of the beta1-selective adrenergic antagonist betaxolol on electroretinography (ERG) were studied in the isolated and arterially perfused cat eye. Betaxolol increased the perfusion flow rate, significantly at the administrations of more than 50 microM concentrations and induced a dose-related, reversible increase in the amplitudes of both the a-wave and b-wave of ERG. These results suggest that the calcium-channel blocking mechanism of betaxolol has a beneficial influence on ocular blood flow and retinal electrical activity in response to light. As it is known that ERG is a good indicator of the functional integrity of the retina, this indicates that betaxolol could be an ideal drug for treating glaucoma in which ischemia is involved to some extent.

Purpose: To detect the presence of supraciliochoroidal fluid (SCF) by ultrasound biomicroscopy (UBM) at an early stage after trabeculectomy., Methods: Trabeculectomy with mitomycin C was performed on 14 patients (15 eyes) with medically uncontrolled glaucoma. The ciliary bodies were observed using UBM testing, which was conducted preoperatively and within 2 weeks after the procedure., Results: SCF was detected postoperatively in 6 eyes. One eye also had choroidal detachment (CD), as seen with an indirect ophthalmoscope; and 5 eyes (33%) had SCF without intraocular inflammatory clinical signs, postoperative changes of the anterior chamber depth, or obvious CD. The SCF in 4 eyes disappeared within 4 weeks after the trabeculectomy. The intraocular pressure (IOP) was 6.4 +/- 3.4 mm Hg (mean +/- SD) when SCF was detected and it rose to 13.2 +/- 7.2 mm Hg when the SCF disappeared. The IOP was 11.4 +/- 4.0 mm Hg in the eyes without SCF, which was significantly higher than that seen in the eyes with SCF., Conclusions: At an early stage after trabeculectomy, SCF without subclinical CD was detected in some cases by UBM. 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 the early low IOP after trabeculectomy and that the disappearance of SCF induces the elevation of IOP.

MAI or MIRAgel is a hydrogel developed as a scleral buckling material. We identified upper lid masses and a limitation of supraduction in the left eye of a patient who was associated with extrusion and fragmentation of the MIRAgel episcleral exoplant 11 years after scleral buckling surgery. The material could not be removed completely because of fragmentation. Fragmentation and extrusion of MIRAgel may be rare, but periodic long-term follow-up examinations should be performed after this product has been used.

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.