Nippon Ganka Gakkai zasshi最新文献

{"title":"A Case of Choroidal Melanoma Resulted in Eyeball Enucleation 2 Years after Carbon Ion Radiotherapy Due to Local Recurrence.","authors":"Osamu Kotake,&nbsp;Hiroshi Goto,&nbsp;Shunichiro Ueda,&nbsp;Kazuhiko Umazume","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Background: Recently, carbon ion radiotherapy (CIR) has become the standard therapy for choroidal melanoma to preserve the eyeballs in Japan. We report a case of choroidal melanoma resulting in eyeball enucleation 2 years after carbon ion radiotherapy due to local recurrence.\u0000Case: A 64-year-old man was referred to Tokyo Medical University hospital with a diagnosis of choroidal tumor. Intraocular tumor was located at the equator of temporal area in ocular fundus. After systemic work-up, clinical diagnosis of choroidal melanoma was made and CIR was applied. After CIR, the intraocular tumor was stable for 2 years. However, 2 years and 3 months after CIR, local recurrence of the tumor was detected. Eventually, the eyeball was enucleated. Histopathologically, the original lesion was composed of melanoma cells containing abundant melanin pigments, and these cells were positive for HMB-45, Melan-A and S-100 protein. In contrast, the recurrent lesion showed lack of melanin pigment and proved less positive for HMB-45, Melan-A and S-100 protein. Four months after enucleation, the patient developed liver metastasis and received the appropriate supportive care. Conclusions: Even after CIR with remission, choroidal melanoma can recur. Recurrent lesions of the tumor may reveal alternative histopathological findings compared to the original lesion.</p>","PeriodicalId":19670,"journal":{"name":"Nippon Ganka Gakkai zasshi","volume":"121 5","pages":"419-24"},"PeriodicalIF":0.0,"publicationDate":"2017-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36365829","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Amniotic Membrane Transplantation for Corneal and Conjunctival Diseases: Classification of Application and Outcomes from Analysis of 95 cases.","authors":"Kazuomi Hanada,&nbsp;Noriko Nishikawa,&nbsp;Nobuhito Ishii,&nbsp;Tsugiaki Utsunomiya,&nbsp;Akitoshi Yoshida","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Purpose: To evaluate the indications and outcomes of amniotic membrane (AM) transplantation for corneal and conjunctival diseases.\u0000Subjects and methods: Ninety-five eyes of ninety patients who underwent AM transplantation between January 2007 and May 2016 were included in this study. The surgical procedures, diagnosis and postoperative outcomes were investigated retrospectively.\u0000Results: Transplantation was conducted in three surgical procedures. AM patch, for the promotion of corneal re-epithelialization, was performed in 14 cases with persistent epithelial defects. Thirteen cases healed with total epithelialization. Corneal perforation was noted in Stevens-Johnson syndrome and cured with keratoplasty. AM graft for basement membrane supply, was performed in 72 cases. Of these, 32 cases had been followed for at least one year after AM graft out of which pterygium recurred at one year in 5. Conjunctival tumor recurred in 3 out of 17 cases, and was treated with a repeated of AM graft. AM stuff for substrate supply to the deep corneal layer, was performed in 9 cases with corneal perforation. Leakage of aqueous humor was cured in all 9 cases. Seven cases had keratoplasty performed after the AM stuff and recovered completely. The other 2 cases were observed without additional surgery. There were no complications due to the AM transplantation during the course of treatment in any of the 95 cases.\u0000Conclusion: AM transplantation is applied in three different procedures. Each of these was effective in achieving the corneal and conjunctival reconstruction designed for it.</p>","PeriodicalId":19670,"journal":{"name":"Nippon Ganka Gakkai zasshi","volume":"121 4","pages":"359-5"},"PeriodicalIF":0.0,"publicationDate":"2017-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36366041","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Home Monitoring of Intraocular Pressure and it's Diurnal Patterns Using Icare® HOME.","authors":"Mari Sakamoto,&nbsp;Akiyasu Kanamori,&nbsp;Sotaro Mori,&nbsp;Kaori Ueda,&nbsp;Yukako Inoue,&nbsp;Takuji Kurimoto,&nbsp;Yuko Yamada,&nbsp;Makoto Nakamura","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Purpose: To evaluate Icare® HOME for home monitoring of intraocular pressure (IOP) and to observe diurnal IOP patterns for a short term.\u0000Patients and methods: Twenty six eyes of 16 patients with open angle glaucoma were included. After instruction and practice in using Icare® HOME, patients were asked to measure their IOP by themselves at home or in a sick room. Patients measured their IOP four times a day with a four hour interval between each measurement for three days. Patients repeated measurements until three successful measurements were obtained at each time. Intra-rater reliability was assessed calculating intraclass correlation coefficient (ICC) of the three measurements. Diurnal IOP patterns were assessed for three days.\u0000Results: No adverse events occurred. ICC of three measurements was 0.76 (95% confidence coefficient; 0.71 to 0.81). The median of the difference between the highest and the lowest IOP during a day was 4.26 mmHg (95% CI; 4.06 to 4.67). Repeatable patterns were not found in diurnal IOP for three days. Three out of ten patients who answered the questionnaire after measurements found difficulties in handling the device.\u0000Conclusions: Although Icare® HOME is safe and could be used for home monitoring of IOP, some patients had difficulties in using the instrument. Diurnal IOP patterns did not show repeatability during a short term.</p>","PeriodicalId":19670,"journal":{"name":"Nippon Ganka Gakkai zasshi","volume":"121 4","pages":"366-72"},"PeriodicalIF":0.0,"publicationDate":"2017-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36366042","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Research and Development of Amniotic Membrane Transplantation.","authors":"Chie Sotozono","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":19670,"journal":{"name":"Nippon Ganka Gakkai zasshi","volume":"121 4","pages":"357-8"},"PeriodicalIF":0.0,"publicationDate":"2017-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36366040","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Council Designated Lectures \"Science in Ophthalmic Surgery\".","authors":"Yuichiro Ogura","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":19670,"journal":{"name":"Nippon Ganka Gakkai zasshi","volume":"121 3","pages":"183-4"},"PeriodicalIF":0.0,"publicationDate":"2017-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36380741","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anti-Aging Approach for Ocular Disorders: from Dry Eye to Retinitis Pigmentosa and Myopia.","authors":"Kazuo Tsubota","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>More than 90% of ocular diseases, such as glaucoma, age-related macular degeneration, and dry eye, are age-related with the incidence increasing with age. Furthermore, although retinitis pigmentosa and myopia may be associated with hereditary factors, they are also considered age-related diseases since they progress with aging. Thus, instead of targeting individual diseases, a new approach aimed at targeting aging itself is being examined.\u0000The most established current anti-aging approach is calorie restriction, considered to induce various gene expressions such as anti-oxidative enzymes contributing to life extension. At first, we confirmed that conditions under increased oxidative stresses, including genetically modified animals, such as Sod-1 knockout mice (KO), Mev1 transgenic mice, and Nrf-2 KO mice, and smoking induces a decrease in tear secretion resulting in dry eye. Recently, we found that dietary supplements containing lactoferrin or lactic acid bacteria suppress oxidative stress in the lacrimal glands, these results need to be considered in association with the current advances in the microbiome research. It is now possible to promote the clinical use of those supplements to increase tear secretion. Calorie restriction (CR) activates longevity gene sirtuins. We also have shown that agents activating sirtuins, such as resveratrol or nicotinamide mononucleotide (NMN) have retinal protective effects. Particularly, NMN is promising since we have confirmed its therapeutic effect against retinitis pigmentosa. Ketone bodies are considered another mechanistic target of CR. We developed eye drops containing ketone bodies, and confirmed a therapeutic effect similar to that of CR. Now we are expanding our investigations to include new therapies for dry eye and neuroprotection for the retina and the optic nerve. Other pathways such as endoplasmic reticulum (ER) stress, inhibition of hypoxia-inducible factor (HIF), and inhibition of the insulin-like growth factor (IGF) are also considered to be targets for the anti-aging approach.\u0000Taken together, the new strategy \"anti-aging\" is one approach in dealing with ocular diseases. The anti-aging approach is promising as the next generation of preventive medicine focusing on aging for the current era with increased health care expenditures.</p>","PeriodicalId":19670,"journal":{"name":"Nippon Ganka Gakkai zasshi","volume":"121 3","pages":"232-48"},"PeriodicalIF":0.0,"publicationDate":"2017-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36380739","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Science of Glaucoma Surgery -Filtration Surgery and the Role of Cytokines.","authors":"Toshihiro Inoue","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Glaucoma surgery is classified into a number of areas: intra-ocular drainage, filtration surgery and cyclo-coagulation. Although filtration surgery is the most effective way to lower intraocular pressure (IOP), no surgical technique manages to result in fulfills complete efficacy and safety. Trabeculectomy, one type of filtration surgery, is a common surgical procedure for glaucoma. Though trabeculectomy is fairly effective in lowering intraocular pressure, it is not rare that refractive errors remain or the patients suffer from severe surgical complications. Thus, surgical results of glaucoma surgery need to be improved. In this review, I explain the work we have done to address this issue, and discuss our results and novel trials.\u0000Our clinical studies clarified that cataract surgery affects the results of trabeculectomy to some extent. Additionally, previous vitrectomy, previous glaucoma surgery, uveitic glaucoma, neovascular glaucoma and secondary glaucoma associated with family amyloid polyneuropathy were identified as prognostic factors influencing the results of trabeculectomy. These factors may change the intraocular environment, and thereby affect wound healing following trabeculectomy, resulting in poor IOP control.\u0000Focusing on the changes in the intraocular environment caused by background factors, we examined cytokine levels in the aqueous humor. In pseudophakic eyes, even more than a year following post-phacoemulsification, the levels of proinflammatory cytokines, such as interleukin (IL)-6, IL-8, and monocyte chemoattractant protein (MCP)-1 were elevated in the aqueous humor. These cytokines have positive correlations, and remain elevated in eyes with uveitic glaucoma or neovascular glaucoma, suggesting that they exercise a combined impact on wound healing. Of those, MCP-1 in paticular had significant effect on the results of trabeculectomy.\u0000To evaluate the effects of the changes in intraocular environment on the filtering bleb after trabeculectomy, we quantitatively assessed the bleb using three-dimensional anterior OCT (3D AS-OCT). Three-dimensional imaging identified the filtration opening on the edge of the scleral flap as an aqueous route after trabeculectomy, and its function was confirmed during bleb revision surgery. Subsequent prospective study using 3D AS-OCT clarified that the filtration openings tended to close time-dependently, affecting future IOP control, and the width of the filtration openings was correlated with the level of aqueous MCP-1.\u0000To elucidate wound-healing mechanisms after trabeculectomy at a cellular level, we conducted cell biological experiments using macrophages and conjunctival fibroblasts. It is known that trans-differentiation of fibroblasts into myofibroblasts, which was induced by macrophages and other cells, is a key for the progression of wound healing process. The trans-differentiation of fibroblasts was suppressed by either ROCK inhibitors or epigenetic drugs. Using in vivo imaging with ","PeriodicalId":19670,"journal":{"name":"Nippon Ganka Gakkai zasshi","volume":"121 3","pages":"314-34"},"PeriodicalIF":0.0,"publicationDate":"2017-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36382009","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Multimodal Approaches for the Analysis of Retinal Functional Disorders―Focusing on Retinal Detachment.","authors":"Hiroko Terasaki","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Microstructural and functional restoration of the retina after reattaching a retinal detachment were assessed by electroretinography (ERG), optical coherence tomography (OCT), adaptive optics (AO) fundus imaging, and laser speckle flowgraphy (LSFG).\u0000As a representative study, an intentional retinal detachment created during macular translocation surgery by a 360° retinotomy, reducing the cone ERGs by 12% was compared to the preoperation values. Six months after successful reattachment surgery, the amplitudes of the a- and b-waves of the focal macular ERGs (FMERGs) elicited by a 15° spot recovered to 66% and 74%, respectively, of that of the fellow eyes. The increase in the amplitudes of the b-waves was significantly correlated with the increase in the length of the cone interdigitation zone (CIZ) and the size of the outer photoreceptor area after the surgery. These results indicate that, after surgical repair of a fovea-off rhegmatogenous retinal detachmen t (RRD), recovery of the inner as well as the outer segments of the photoreceptors was essential for the recovery of the FMERGs. We also examined the recovery of macular function after the resolution of central serous chorioretinopathy (CSC). The results showed that the pattern of recovery of the FMERGs after resolution of subretinal fluid (SRF) in CSC was different from that after successful surgery for fovea-off RRD.\u0000OCT examinations showed a gradual restoration of the foveal photoreceptors after reattachment up to one year in RRD with foveal detachment before surgery. The improvement in the best-corrected visual acuity (BCVA) was significantly correlated with the thickness of the ellipsoid zone-RPE. Multiple regression analyses showed that the presence of a foveal bulge was the only significant independent predictor of the BCVA.\u0000We present our AO findings on the morphology of the nerve fiber layer, cone photoreceptors and retinal vascular walls in healthy eyes. We also present our AO findings in cases of occult macular dystrophy, autosomal recessive bestrophinopathy, acute zonal occult outer retinopathy, macular hypoplasia and the neovascular vessels in eyes with diabetic retinopathy.\u0000We first analyzed our data on the relationship between FMERGs and cone densities. An AO fundus camera was used to evaluate the cone mosaic, and the cone packing density at 2° from the fovea in healthy eyes. We performed FMERG using a 15° stimulus spot. The amplitudes and implicit times of the a-wave, b-wave, and the oscillatory potentials (OPs) were measured, and the relationships between the cone packing densities, the amplitudes and implicit times of these components were analyzed. The results showed that the mean cone packing density 2° from the fovea was significantly and positively correlated with the amplitudes of the a-wave, b-wave and the OPs. However, the density was not significantly correlated with the implicit times of each component.\u0000We examined the changes in the cone packing density and the","PeriodicalId":19670,"journal":{"name":"Nippon Ganka Gakkai zasshi","volume":"121 3","pages":"185-231"},"PeriodicalIF":0.0,"publicationDate":"2017-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36380737","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Understanding the Pathology and Current Treatment Strategy of Highly Myopic Complications.","authors":"Yasushi Ikuno","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>The population of high myopia in Japan is large and increasing. It is a high risk factor not only for its specific macular complications but also as a precursor for cataracts and glaucoma. Myopic foveoschisis and the consequent macular hole with retinal detachment (MHRD) are caused by inner retinal traction which may include the vitreous cortex, epiretinal membrane, internal limiting membrane and posterior staphyloma formation. Vitrectomy is the 1st choice of treatment, and releasing the retina from traction is the goal. MHRD has poor anatomical success rates, and, therefore, inverted internal limiting membrane is a common treatment procedure to enhance MH closure. Myopic choroidal neovascularization occurs predominantly in highly myopic eyes, and anti-vascular endothelial growth factor therapy is the 1st line treatment. Normally the patient's eyes respond well, however, recurrence is an important issue. Conventional optical coherence tomography (OCT) and fluorescein angiography are the major diagnostic tools. At the same time, advanced technologies such as OCT-angiography and Polarization-sensitive OCT may enable an early and more accurate diagnosis. High myopia is a high risk factor for glaucoma and its mechanism is still uncertain. Studies using OCT thus far have shown variety of abnormalities occurring in highly myopic eyes inside and around the optic nerve head. High myopia has uncommon progression patterns such as preceding the papillo-macular bundle damage, especially in younger patients. Future studies are needed.</p>","PeriodicalId":19670,"journal":{"name":"Nippon Ganka Gakkai zasshi","volume":"121 3","pages":"292-313"},"PeriodicalIF":0.0,"publicationDate":"2017-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36382008","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sustainability of Anterior Segment Surgery.","authors":"Kazunori Miyata","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Favorable improvement in visual function, credible, long-term sustainability are requisites for anterior eye-segment surgery of the cornea and the lens, key players in ophthalmological optics. Here we analyzed the sustainability, efficacy, and safety of anterior eye-segment surgery, using treatment data from numerous cases, observed over a long period.\u0000The effect of a pterygium on visual function is correlated with the degree of invasion of the pterygium in the central cornea. When the pterygium is quite severe, it takes a long time for visual function to stabilize after pterygium surgery. The recurrence rate is lower for incipient pterygium than for recurrent pterygium with a short recurrence period. Analysis of DNA CpG methylation in pterygium has shown that suppressors of cell proliferation are downregulated, while accelerators of cell proliferation are upregulated. Therefore, cells tend to proliferate increasingly in the following order: normal conjunctiva (lowest proliferation rate), incipient pterygium (intermediate proliferation rate), and recurrent pterygium (highest proliferation rate). These findings help elucidate pterygial pathophysiology and prevent its recurrence.\u0000In keratorefractive surgery using an excimer laser, the long-term stability of visual function remains problematic. In a long-term study of changes in postoperative visual function and corneal shape, it is noted that physiological properties, including corneal sensitivity and higher-order corneal aberrations recovered at 1 year and stabilized at 10 years after in laser in situ keratomileusis surgery. However, corneal thickness increased continuously for 10 years post-surgery, and myopia continued to increase.\u0000In keratoplasty, the transparency of the transplanted cornea and visual functions need to be sustained for a long period. In penetrating keratoplasty (PKP), the mean cumulative transparency cure rate at 12 years post-surgery was 60.4%, which was highest in cases with keratoconus and corneal dystrophy, and lowest in cases with bullous keratopathy and regraft. At 5 years post-surgery, both the cumulative transparency cure rate and postoperative visual function were more favorable in Descemet stripping automated endothelial keratoplasty (DSAEK) than in PKP. Moreover, for artificial corneas (Boston keratoprosthesis) introduced in cases of regraft, both the survival rate and postoperative visual function were more favorable in DSAEK than in PKP.\u0000A continuous increase in surface light scattering of specific intraocular lenses (IOL) has been a long-term concern. However, even with an increase in surface light scattering over a period of more than 10 years post-surgery, visual function remained largely unaffected. The observation of frozen torn surfaces of IOLs explanted from patients and unused IOLs that had undergone accelerated aging demonstrated that surface light scattering was caused by a slight phase separation of water on the surface of the IOL. Although forward","PeriodicalId":19670,"journal":{"name":"Nippon Ganka Gakkai zasshi","volume":"121 3","pages":"249-91"},"PeriodicalIF":0.0,"publicationDate":"2017-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36380647","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}