This prospective randomized double-masked study investigated the effects of 20 mg lutein supplementation with two different capsules (beeswax or glycerol fatty acid esters) for 6 months on the fellow eyes of 39 Japanese patients with unilateral age-related macular degeneration, and assessed the factors associated with baseline plasma lutein concentration via lifestyle interviews. Macular pigment optical density (MPOD), determined with the two-wavelength autofluorescence method, increased over time in the beeswax group (ANOVA, p = 0.0451), although the increase from 3 months to 6 months was only marginally significant. No significant increase was observed in the glycerol fatty acid esters group (ANOVA, p = 0.7396). Plasma lutein concentrations significantly increased at 3 and 6 months from baseline in both groups (both p < 0.01). In a multiple regression model, age was negatively associated with higher plasma lutein concentration (p = 0.0305), while consumption of green vegetables was positively associated with baseline plasma lutein concentration (p = 0.0322). In conclusion, a significant increase in MPOD was not fully confirmed with 6 months intake duration despite a significant increase in plasma lutein concentrations. Consumption of green vegetable was confirmed to be associated with plasma lutein concentration after adjusting for other potential factors including age.

Background: Subtenon injection of triamcinolone acetonide (STTA) has been widely adopted in the clinical setting of ophthalmology and its infectious complications are rare. However, orbital abscess following STTA has been reported in seven cases. Furthermore, although eye infections due to Exophiala species are uncommon, there have been 19 cases to date. E. jeanselmei, E. phaeomuriformis, E. werneckii, and E. dermatitidis have been reported to cause human eye infections; however, to the best of our knowledge, orbital abscess caused by E. dermatitidis has not yet been reported. We describe the first documented case of fungal orbital abscess caused by E. dermatitidis following STTA. We also review the related literature of orbital abscess following STTA, as well as eye infections caused by the four Exophiala species. Case presentation: The patient was a 69-year-old Japanese woman with diabetic mellitus. She had a macular oedema in her right eye, which occurred secondary to branch retinal vein occlusion. An orbital abscess caused by E. dermatitidis occurred 4 months after the second STTA for the macular oedema, which was successfully treated by a surgical debridement and systemic administration of voriconazole. Conclusions: Our findings in the patient and from our literature survey caution ophthalmologists to the fact that STTA can cause fungal orbital infections, especially in diabetic patients. Furthermore, surgical treatment is one of the most important risk factors.

BACKGROUND:Endocan is expressed in vascular endothelial cells, and its expression is enhanced following endothelial injury via inflammatory cytokines. Subsequently, endocan is secreted into the circulation. Thus, serum endocan levels are considered a...

Case Report from JAMA Ophthalmology — Three-dimensional Optical Coherence Tomographic Findings of Idiopathic Multiple Serous Retinal Pigment Epithelial Detachment

To report two cases of diabetic macular edema (DME) treated with intravitreal faricimab injections (IVFs), including the assessment of retinal microaneurysms and extent of retinal capillary non-perfusion using fluorescein angiography (FA) and indocyanine green angiography (IA). Case 1: A 72-year-old man presented with aflibercept-resistant DME in the left eye, with a best-corrected visual acuity (BCVA) of 20/16. FA showed areas of retinal capillary non-perfusion and focal leakage in the macular area of the left eye. IA revealed numerous microaneurysms in the temporal region of the macula. Four consecutive monthly IVFs were administered to the left eye, and DME eventually diminished. After the loading phase, the BCVA was maintained at 20/16 with reduced visual distortion. FA showed improvement of macular leakage and stable retinal capillary non-perfusion areas, and the foveal avascular zone was clearly observed. The disappearance of numerous microaneurysms was confirmed on IA images. Case 2: An 80-year-old woman developed DME with macular vein occlusion in the left eye after panretinal laser photocoagulation for proliferative diabetic retinopathy. The patient's BCVA was 20/32. DME was resistant to subtenon triamcinolone injections. FA revealed focal areas of retinal capillary non-perfusion and persistent leakage in the macular area of the left eye. IA revealed scattered microaneurysms within the retinal arcade. Four consecutive monthly IVFs were administered to the left eye, and DME eventually diminished. After the loading phase, the BCVA was maintained at 20/32. FA showed improvement of macular leakage and stable retinal capillary non-perfusion areas. The reduction of microaneurysms was confirmed on IA images. These case reports highlight the potential of faricimab as an alternative anti-vascular endothelial growth factor drug for treatment-resistant DME, including reduction of retinal microaneurysms and stabilization of the areas of retinal capillary non-perfusion. However, continuation of a robust treatment regimen may be required to achieve these objectives.

Purpose: This study aimed to assess driving capabilities in patients with exudative age-related macular degeneration (AMD) causing unilateral blindness or paracentral scotoma without vision deterioration. Methods: Of the 275 patients with AMD who responded to a questionnaire regarding car driving at Osaka University Hospital, we excluded 78 patients who answered that they had never driven. Finally, 197 patients were included (50 with bilateral and 142 with unilateral AMD). We investigated the relationship between the questionnaire findings and best-corrected visual acuity (BCVA). Results: The mean age was 74.8 ± 6.9 years, and the mean BCVA in the right and left eyes were 0.48 and 0.47, respectively. A negative correlation was observed between the proportion of patients who stopped driving due to AMD and the vision in the worse eye (p < 0.0001); however, 66% of participants were still driving. Regardless of the BCVA, 84% of them wished to continue driving. Concerning perceived dangerous situations, all patients reported an oversight of people or signals and night driving; further, patients with unilateral and bilateral vision deterioration reported vision narrowness and difficulty with discerning signal colours, respectively. Conclusion: Despite the associated danger, patients with AMD continued driving. Close attention should be paid to the driving activities among patients with AMD, even if they have passed the relevant driving tests.