記述言語：英語  

A 23-year-old woman presented with a 1-month history of visual abnormalities in her right eye. A visual field test revealed temporal abnormalities in the right eye. Optical coherence tomography revealed an indistinct ellipsoid zone (EZ) on the B-scan image and hyporeflective areas in the EZ layer on the en face image in the right eye. We diagnosed the patient with acute zonal occult outer retinopathy. Visual field tests and B-scan images improved to almost normal at 6 months, but hyporeflective areas remained on the en face images. Thus, en face images may be more sensitive at detecting abnormalities in the outer retina than other modalities.

DOI： 10.18926/AMO/65756

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記述言語：日本語   出版者・発行元：日本糖尿病眼学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

PURPOSE: To investigate preoperative factors associated with simultaneous internal limiting membrane (ILM) peeling during epiretinal membrane (ERM) removal. STUDY DESIGN: Observational cross-sectional study. METHODS: We retrospectively reviewed 60 eyes with idiopathic ERM that underwent vitrectomy. The gap between the ERM and ILM was visualized using en face optical coherence tomography. The depth and width of the ERM-ILM gap at the initiation site of ERM removal were measured, and the relationship between preoperative factors including these parameters and simultaneous ILM peeling during ERM removal was investigated. RESULTS: The ILM was simultaneously peeled during ERM removal in 30 eyes, but not in the other 30 eyes. Age was significantly higher (P = 0.017) and the width of the ERM-ILM gap was significantly smaller (P < 0.001) in the simultaneous ILM peeling (+) group than in the simultaneous ILM peeling (-) group. Multivariate logistic regression analysis confirmed the width of the ERM-ILM gap as a significant negative predictor for simultaneous ILM peeling (odds ratio, 0.992; 95% confidence interval, 0.986-0.997; P = 0.003). Receiver operating characteristic curve analysis of the width of the ERM-ILM gap revealed that the optimal cutoff for predicting simultaneous ILM peeling was 187.1 µm. CONCLUSION: The small width of the ERM-ILM gap at the initiation site of ERM removal was significantly associated with simultaneous ILM peeling, indicating that the adhesion strength between the ERM and ILM at the initial ERM grasping site determines whether simultaneous ILM peeling will occur during ERM removal.

DOI： 10.1007/s10384-023-00993-w

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

PURPOSE: To compare the effects of macular intraretinal hemorrhage (IRH) and macular hole (MH) on best-corrected visual acuity (BCVA) after displacement of submacular hemorrhage (SMH) due to retinal arterial macroaneurysm (RAM) rupture. METHODS: This multicenter retrospective study included 48 eyes with SMH due to RAM rupture. Cases underwent vitrectomy to displace SMH and were followed up for 6 months. We classified cases according to the presence of IRH and MH and compared the postoperative BCVA among the groups. RESULTS: We classified the eyes into IRH(+)MH(+) group (10 eyes), IRH(+)MH(-) group (23 eyes), and IRH(-)MH(-) group (15 eyes). The postoperative BCVA was significantly worse in the IRH(+)MH(+) and IRH(+)MH(-) groups than in the IRH(-)MH(-) group (0.91 ± 0.41 in logarithm of the minimal angle of resolution units, Snellen equivalent 20/163, 0.87 ± 0.45, 20/148, and 0.18 ± 0.21, 20/30, respectively; P < 0.001). The postoperative central retinal thickness was significantly lower in the IRH(+) group (IRH(+)MH(+) and IRH(+)MH(-) groups combined) than in the IRH(-) group (IRH(-)MH(-) group) (121.4 ± 70.1 µ m and 174.3 ± 32.9 µ m, respectively, P = 0.008). The postoperative external limiting membrane and ellipsoid zone continuities were significantly discontinuous in the IRH(+) group ( P < 0.001, P = 0.001, respectively). The multiple linear regression analysis showed that both IRH(+)MH(+) and IRH(+)MH(-) were associated with the postoperative BCVA (regression coefficient, 0.799 and 0.711, respectively; P < 0.001 for both). CONCLUSION: Both IRH and MH were poor prognostic indicators in cases with SMH due to RAM rupture.

DOI： 10.1097/IAE.0000000000003725

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掲載種別：研究論文（学術雑誌）   出版者・発行元：Elsevier BV  

DOI： 10.1016/j.xops.2023.100312

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掲載種別：研究論文（学術雑誌）   出版者・発行元：Elsevier BV  

DOI： 10.1016/j.xops.2023.100305

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記述言語：日本語   出版者・発行元：(公財)日本眼科学会  

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記述言語：日本語   出版者・発行元：(公財)日本眼科学会  

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記述言語：日本語   出版者・発行元：(公財)日本眼科学会  

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記述言語：日本語   出版者・発行元：(公財)日本眼科学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

PURPOSE: This study was performed to elucidate the mechanisms of morphological abnormalities in a Leber congenital amaurosis 16 (LCA16) cell model using KCNJ13 knockout (KO) retinal pigment epithelial cells derived from human iPS cells (hiPSC-RPE). METHODS: In KCNJ13 KO and wild-type hiPSC-RPE cells, ZO-1 immunofluorescence was performed, and confocal images were captured. The area and perimeter of each cell were measured. To detect cell death, ethidium homodimer III (EthD-III) staining and LDH assay were used. Scanning electron microscopy (SEM) was used to observe the cell surface. The expression levels of oxidative stress-related genes were examined by quantitative PCR. To explore the effects of oxidative stress, tert-butyl hydroperoxide (t-BHP) was administered to the hiPSC-RPE cells. Cell viability was tested by MTS assay, whereas oxidative damage was monitored by oxidized (GSSG) and reduced glutathione levels. RESULTS: The area and perimeter of KCNJ13-KO hiPSC-RPE cells were enlarged. EthD-III-positive cells were increased with more dead cells in the protruded region. The KO RPE had significantly higher LDH levels in the medium. SEM observations revealed aggregated cells having broken cell surfaces on the KO RPE sheet. The KCNJ13-deficient RPE showed increased expression levels of oxidative stress-related genes and total glutathione levels. Furthermore, t-BHP induced a significant increase in cell death and GSSG levels in the KO RPE. CONCLUSIONS: We suggest that in the absence of the Kir.7.1 potassium channel, human RPE cells are vulnerable to oxidative stress and ultimately die. The dying/dead cells form aggregates and protrude from the surviving KCNJ13-deficient RPE sheet.

DOI： 10.1167/iovs.63.12.29

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記述言語：日本語   出版者・発行元：眼科臨床紀要会  

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記述言語：日本語   出版者・発行元：(一社)日本糖尿病合併症学会  

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記述言語：英語  

An 18-year-old male high school student presented to our clinic with bilateral blunt ocular trauma caused by an exercise resistance band (ERB) during a muscle-building exercise. Best-corrected decimal visual acuities (BCVAs) for right and left eyes were light perception and 0.15, respectively. The right eye was operated 10 days after injury for persistent vitreous hemorrhage, and the left eye 5 months later because of macular hole onset. After 36 months, the right eye showed extensive retinal degeneration (BCVA 0.04), and the left eye macular hole closure (BCVA 1.2). ERBs should be used cautiously as they can cause serious ocular trauma.

DOI： 10.18926/AMO/63747

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記述言語：日本語   出版者・発行元：(公財)日本眼科学会  

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記述言語：日本語   出版者・発行元：(公財)日本眼科学会  

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記述言語：日本語   出版者・発行元：(公財)日本眼科学会  

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記述言語：日本語   出版者・発行元：(公財)日本眼科学会  

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記述言語：日本語   出版者・発行元：(公財)日本眼科学会  

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記述言語：日本語   出版者・発行元：(公財)日本眼科学会  

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記述言語：日本語   出版者・発行元：(公財)日本眼科学会  

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記述言語：日本語   出版者・発行元：(公財)日本眼科学会  

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記述言語：日本語   出版者・発行元：(公財)日本眼科学会  

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記述言語：日本語   出版者・発行元：(公財)日本眼科学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

PURPOSE: To establish an objective and quantitative biomarker of metamorphopsia in epiretinal membranes (ERMs) and determine the optimal timing for ERM surgery. METHODS: Retrospectively, 172 eyes with ERM were reviewed. Retinal folds due to tangential traction by ERM were visualized by en face optical coherence tomography (OCT). The maximum depth of retinal folds (MDRF) within the parafovea was quantified. Metamorphopsia was quantified by M-CHARTS. The change in the distance between the retinal vessels after ERM surgery and the preoperative total depth of retinal folds between the vessels were quantified using en face OCT and OCT angiography. RESULTS: Significant correlations were observed between preoperative MDRF and M-CHARTS scores before and at 6 months after surgery (r=0.617 and 0.460, respectively; P<0.001) and change in the distance between the retinal vessels after ERM surgery and preoperative total depth of retinal folds between the vessels (r=0.471, P=0.013). The preoperative MDRF values at which M-CHARTS scores were 0.5 before and 6 months after surgery were 69 μm and 118 μm, respectively. CONCLUSION: MDRF is an objective and quantitative biomarker of metamorphopsia in ERM. To maintain patients' quality of vision, ERM surgery may be performed when the preoperative MDRF ranges between 69 and 118 μm.

DOI： 10.1097/IAE.0000000000003401

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記述言語：英語  

A 65-year-old man presented with a 1-week history of left eye distortion. An elevated choroidal lesion covering 6 disc diameters was found in the posterior retina of the left eye. Systemic examination revealed sublingual gland carcinoma and multiple lung metastases, and the diagnosis was choroidal metastasis from sublingual gland carcinoma. Following chemotherapy and radiation therapy, the choroidal lesion shrunk and the patient's visual acuity improved. The patient died 23 months after his first visit. To the best of our knowledge, this is the first reported case of choroidal metastasis from sublingual gland carcinoma.

DOI： 10.18926/AMO/62815

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

PURPOSE: To investigate epiretinal membrane (ERM) formation using en face optical coherence tomography (OCT) after vitrectomy for rhegmatogenous retinal detachment (RRD). METHODS: We retrospectively reviewed the medical records of 64 consecutive eyes (64 patients) with RRD treated by vitrectomy without ERM and internal limiting membrane peeling. ERMs and retinal folds were detected by B-scan and en face imaging. The maximum depth of retinal folds (MDRF) was quantified using en face imaging. ERM severity was staged using B-scan imaging. Main outcome measures were ERM detection rate with B-scan and en face imaging, MDRF, ERM staging, postoperative best-corrected visual acuity (BCVA; logarithm of the minimum angle of resolution), and risk factors for ERM formation. RESULTS: The detection rate for ERM formation was significantly higher with en face imaging (70.3%) than with B-scan imaging (46.9%; P = 0.007). There was no significant difference in postoperative BCVA between eyes with ERM formation (0.06 ± 0.26) and those without ERM formation (0.01 ± 0.14; P = 0.298). Forty of 45 (88.9%) eyes with ERM formation were classified as stage 1. Twenty-seven of 45 (60.0%) eyes with ERM formation developed parafoveal retinal folds. The mean MDRF was 27.4 ± 32.2 μm. Multiple retinal breaks and a maximum retinal break size of ≥ 2 disc diameters were significantly associated with ERM formation (P = 0.033 and P = 0.031, respectively). CONCLUSION: Although ERM formation was observed in 70.3% patients after RRD repair, the formed ERM was not severe and had minimal impact on the postoperative visual acuity.

DOI： 10.1007/s00417-021-05118-y

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記述言語：日本語   出版者・発行元：(一社)日本糖尿病合併症学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

PURPOSE: To analyze en face epiretinal membrane (ERM) images constructed using swept-source (SS) OCT and to determine the incidence of ERM formation after ERM surgery and its effects on visual function. DESIGN: Retrospective, consecutive observational study. PARTICIPANTS: Consecutive series of 73 eyes (71 patients) with idiopathic ERM that underwent vitrectomy with both ERM and internal limiting membrane (ILM) peeling. METHODS: We retrospectively reviewed the data of the 73 eyes included in the study. During surgery, the ERM was removed as extensively as possible, and the ILM was removed such that the area of ILM peeling was at least larger than the parafoveal area. All patients underwent comprehensive ophthalmologic examinations, including assessments of best-corrected visual acuity and metamorphopsia, before and at 2 weeks and 6 months after the surgery. En face images constructed using SS OCT were used to investigate ERM formation. MAIN OUTCOME MEASURES: The incidence of ERM formation at 6 months after the surgery, effects of ERM formation on visual function, and the relationship between ERM formation and the extent of ERM and ILM peeling. RESULTS: At 6 months after ERM and ILM peeling, 8 eyes (11.0%) showed ERM formation (formation group). Twenty eyes (27.4%) exhibited remnant ERM without ERM formation (remnant group), whereas 45 eyes (61.6%) showed no ERM (no ERM group). In both the remnant and no ERM groups, best-corrected visual acuity and metamorphopsia showed significant improvements after ERM surgery (both P < 0.01); these improvements were not seen in the formation group (P = 0.067 and P = 0.053, respectively). However, no significant differences were found in preoperative and postoperative best-corrected visual acuities and metamorphopsia among the 3 groups. In the formation group, ERM formation occurred only in the area with residual ILM. Most patients who underwent ILM peeling in which the area of the peeling covered the ERM belonged to the no ERM group (97.7%; P < 0.01). CONCLUSIONS: Epiretinal membrane formation does not affect visual function significantly when the area of ILM peeling is larger than the parafoveal area. When the ILM peeling area covers the ERM area, postoperative ERM formation can be prevented.

DOI： 10.1016/j.oret.2020.10.017

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

A 58-year-old Japanese man underwent vitrectomy for rhegmatogenous retinal detachment (RRD) in 2002. Twelve years later, optical coherence tomography revealed the development of a lamellar macular hole; the visual acuity was 20/200. Two years later, because metamorphopsia and the foveal retina thinning were aggravated, epiretinal proliferation embedding was performed to restore the foveal structure by transplanting glial cells to the foveal cavity. The patient was followed-up for 4 years, and his macular morphology and visual acuity (20/66) improved. No complications occurred. This appears to be the first report of epiretinal proliferation embedding for a lamellar macular hole post-RRD repair.

DOI： 10.18926/AMO/62236

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

This retrospective study was performed to classify diabetic macular edema (DME) based on the localization and area of the fluid and to investigate the relationship of the classification with visual acuity (VA). The fluid was visualized using en face optical coherence tomography (OCT) images constructed using swept-source OCT. A total of 128 eyes with DME were included. The retina was segmented into: Segment 1, mainly comprising the inner nuclear layer and outer plexiform layer, including Henle's fiber layer; and Segment 2, mainly comprising the outer nuclear layer. DME was classified as: foveal cystoid space at Segment 1 and no fluid at Segment 2 (n = 24), parafoveal cystoid space at Segment 1 and no fluid at Segment 2 (n = 25), parafoveal cystoid space at Segment 1 and diffuse fluid at Segment 2 (n = 16), diffuse fluid at both segments (n = 37), and diffuse fluid at both segments with subretinal fluid (n = 26). Eyes with diffuse fluid at Segment 2 showed significantly poorer VA, higher ellipsoid zone disruption rates, and greater central subfield thickness than did those without fluid at Segment 2 (P < 0.001 for all). These results indicate the importance of the localization and area of the fluid for VA in DME.

DOI： 10.1038/s41598-021-87440-3

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記述言語：英語  

A 79-year-old woman presented to our hospital with a 10-day history of gradually worsening binocular vision and severe backache. Further investigations revealed poor bilateral best-corrected visual acuities (BCVA), bilateral vitreous opacities, gray-white lesions scattered throughout the retina, and a left iliopsoas abscess on CT that later grew out methicillin-sensitive S. aureus. The abscess was drained and intravenous antibiotics were initiated, but the left eye additionally required intravitreal vancomycin. BCVA for both eyes normalized within 1 year. Intramuscular abscess should be considered as a possible primary lesion in cases of endogenous bacterial endophthalmitis.

DOI： 10.18926/AMO/61909

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

This retrospective study investigated foveal and perifoveal retinal sensitivities using microperimetry before and after surgery for rhegmatogenous retinal detachment (RRD). Consecutive patients with RRD who underwent vitrectomy or scleral buckling were included. Comprehensive ophthalmological examinations, including microperimetry and swept-source optical coherence tomography, were performed before and 6 months after surgery. Pre- and postoperative retinal sensitivities at the fovea and 4 perifoveal measurement points farthest from the fixation point, both vertically and horizontally (superior, inferior, nasal, and temporal) were examined. A total of 34 foveal and 136 perifoveal measurement points in 34 eyes of 34 patients were evaluated. The postoperative retinal sensitivity was significantly higher than the preoperative value at foveal and perifoveal points with (P < 0.001 for both) and without (fovea: P = 0.005, perifovea: P < 0.001) RRD. The postoperative retinal sensitivity was significantly lower at foveal (P < 0.01) and perifoveal (P < 0.001) points with preoperative RRD than at points without preoperative RRD; furthermore, it was significantly better at points with ellipsoid zone (Ez) continuity than at points with Ez discontinuity (fovea: P < 0.01, perifovea: P < 0.001). RRD deteriorates retinal sensitivity, regardless of its presence or absence at the measurement point before surgery. Postoperative Ez continuity is important for good postoperative retinal sensitivity.

DOI： 10.1038/s41598-020-78693-5

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Perfluorocarbon liquid (PFCL) is an effective surgical adjuvant in performing vitrectomy for severe vitreoretinal pathologies such as proliferative vitreoretinopathy and giant retinal tears. However, subretinal retention of PFCL can occur postoperatively and retained PFCL causes severe visual disorders, particularly when PFCL was retained under the fovea. Although several procedures have been proposed for subfoveal PFCL removal, such as direct aspiration or submacular injection of balanced salt solution (BSS) to dislodge the subfoveal PFCL, the retinal damage associated with these procedures has been a major problem. Here, we report a case of subfoveal retention of PFCL for which we performed a novel surgical technique that attempts to minimize retinal damage. CASE PRESENTATION: A 69-year-old man presented with subfoveal retained PFCL after surgery for retinal detachment. To remove the retained PFCL, the internal limiting membrane overlying the subretinal injection site is first peeled to allow low-pressure (8 psi) transretinal BSS infusion, using a 41-gauge cannula, to slowly detach the macula. A small drainage retinotomy is created with the diathermy tip at the inferior position of the macular bleb, sized to be slightly wider than that of the PFCL droplet. The head of the bed is then raised, and the surgeon gently vibrates the patient's head to release the PFCL droplet to allow it to migrate inferiorly towards the drainage retinotomy. The bed is returned to the horizontal position, and the PFCL, now on the retinal surface, can be aspirated. The subfoveal PFCL is removed while minimizing iatrogenic foveal and macular damage. One month after PFCL removal, the foveal structure showed partial recovery on optical coherence tomography, and BCVA improved to 20/40. CONCLUSION: Creating a macular bleb with low infusion pressure and using vibrational forces and gravity to migrate the PFCL towards a retinotomy can be considered as a relatively atraumatic technique to remove subfoveal retained PFCL.

DOI： 10.1186/s12886-020-01698-1

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

PURPOSE: To visualize foveal microstructures in macula-off rhegmatogenous retinal detachment using swept source optical coherence tomography preoperatively and postoperatively and to investigate the relationship between foveal microstructures and postoperative visual acuity. METHODS: We retrospectively analyzed 42 eyes of 42 consecutive patients diagnosed with macula-off rhegmatogenous retinal detachment who underwent anatomically successful repair surgery and were followed up for 6 months. We used swept source optical coherence tomography to investigate the relationship between preoperative and postoperative continuity of both the external limiting membrane (ELM) and ellipsoid zone (Ez) and preoperative and postoperative best-corrected visual acuity. RESULTS: Both preoperative ELM and Ez were continuous in 9 eyes (21%; ELM+/Ez+ eyes), only the ELM was continuous in 25 eyes (60%; ELM+/Ez- eyes), and neither was continuous in 8 eyes (19%; ELM-/Ez- eyes). Postoperative best-corrected visual acuity in ELM+/Ez+ eyes (-0.05 ± 0.04 logarithm of the minimum angle of resolution units, Snellen equivalent 20/18) was significantly better than that in both ELM+/Ez- (0.16 ± 0.16, 20/29; P = 0.03) and ELM-/Ez- (0.86 ± 0.37, 20/145; P < 0.001) eyes. Postoperative best-corrected visual acuity was significantly better in ELM+/Ez- than in ELM-/Ez- eyes (P < 0.001). CONCLUSION: In macula-off rhegmatogenous retinal detachment, preoperative continuity of the ELM and Ez may be a predictor of postoperative best-corrected visual acuity.

DOI： 10.1097/IAE.0000000000002687

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

PURPOSE: To evaluate the relationship between retinal traction caused by epiretinal membrane and visual functions. METHODS: In this institutional study, en face swept-source optical coherence tomography images of 141 eyes of 130 patients with epiretinal membrane were analyzed to investigate maximum depth of retinal folds, which represents retinal traction strength and the distribution pattern of retinal folds. We investigated the relationships between the maximum depth and distribution pattern of retinal folds and visual functions as well as the effects of membrane peeling. RESULTS: Maximum retinal fold depth was significantly correlated with the metamorphopsia score (P < 0.001). Fifteen eyes showed retinal folds radially extending from the macular epiretinal membrane (radiating folds group), whereas 126 eyes showed a multidirectional pattern of retinal folds (multidirectional folds group). The radiating folds group showed a significantly lower metamorphopsia score (P = 0.014). Multiple regression analysis revealed that the metamorphopsia score was significantly related to maximum retinal fold depth (P = 0.003), distribution pattern (P = 0.015), and central retinal thickness (P < 0.001). One month after membrane peeling, parafoveal retinal folds resolved completely in all cases, and both visual acuity (P < 0.001) and average metamorphopsia score (P = 0.036) were significantly improved. CONCLUSION: Both the strength and the distribution pattern of retinal traction are significantly related to metamorphopsia in epiretinal membrane patients.

DOI： 10.1097/IAE.0000000000002569

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Purpose: The purpose of this study was to establish and analyze a cell model of Leber congenital amaurosis type 16 (LCA16), which is caused by mutations in the KCNJ13 gene encoding Kir7.1, an inward-rectifying potassium ion channel. Methods: The two guide RNAs specific to the target sites in the KCNJ13 gene were designed and KCNJ13 knock-out (KO) human-induced pluripotent stem cells (hiPSCs) were generated using the CRISPR/Cas9 system. The KCNJ13-KO hiPSCs were differentiated into retinal pigment epithelial cells (hiPSC-RPEs). The KCNJ13-KO in hiPSC-RPEs was confirmed by immunostaining. Phagocytic activity of hiPSC-RPEs was assessed using the uptake of fluorescently labeled porcine photoreceptor outer segments (POSs). Phagocytosis-related genes in RPE cells were assessed by quantitative polymerase chain reaction. Results: Most of the translated region of the KCNJ13 gene was deleted in the KCNJ13-KO hiPSCs by the CRISPR/Cas9 system, and this confirmed that the Kir7.1 protein was not present in RPE cells induced from the hiPSCs. Expression of RPE marker genes such as BEST1 and CRALBP was retained in the wild-type (WT) and in the KCNJ13-KO hiPSC-RPE cells. However, phagocytic activity and expression of phagocytosis-related genes in the KCNJ13-null hiPSC-RPE cells were significantly reduced compared to those of WT. Conclusions: We succeeded in generating an RPE model of LCA16 using hiPSCs. We suggest that Kir7.1 is required for phagocytosis of POSs by RPE cells and that impaired phagocytosis in the absence of Kir7.1 would be involved in the retinal degeneration found in LCA16.

DOI： 10.1167/iovs.61.5.38

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

PURPOSE: To investigate the clinical course of submacular hemorrhage associated with ruptured retinal arterial macroaneurysm using swept-source optical coherence tomography. METHODS: This study included 23 eyes of 23 consecutive patients diagnosed with submacular hemorrhage associated with ruptured retinal arterial macroaneurysm. Cases underwent displacement of submacular hemorrhage (vitrectomy + subretinal injection of tissue plasminogen activator + air tamponade) and were followed up for 6 months after surgery. Localization of the preoperative hemorrhage and its effect on preoperative and postoperative best-corrected visual acuity, central retinal thickness, and continuity of the ellipsoid zone were measured. RESULTS: Macular intraretinal hemorrhage (IRH) was observed in 17 eyes (73.9%, IRH [+] group) and was not observed in 6 eyes (26.1%, IRH [-] group). The IRH (+) group showed worse postoperative best-corrected visual acuity values compared with the IRH (-) group (0.89 ± 0.47 in logarithm of the minimal angle of resolution units, Snellen equivalent 20/155 and 0.16 ± 0.23, 20/29, respectively; P < 0.01), smaller central retinal thickness values (97.7 ± 53.5 μm, 173.0 ± 32.3 μm, respectively; P < 0.01), and a higher rate of ellipsoid zone disruption (100%, 33.3%, respectively; P < 0.01). CONCLUSION: Patients with preoperative macular IRH showed lower postoperative visual acuity and worse macular contour after submacular hemorrhage displacement compared with patients without macular IRH.

DOI： 10.1097/IAE.0000000000002460

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

PURPOSE: To determine the presence or absence of interocular differences in the foveal avascular zone (FAZ) area in healthy eyes. STUDY DESIGN: Cross-sectional study. METHODS: We examined 236 healthy eyes of 118 consecutive subjects (mean age, 39.1 ± 18.9 years). We used swept-source optical coherence tomography angiography (OCTA) images of the FAZ to measure its area from both the superficial capillary plexus (SCP-FAZ) and the whole retinal capillary plexus (WCP-FAZ). We also investigated the relationship between interocular differences in SCP-FAZ and other factors such as: axial length, spherical equivalent, central retinal thickness, and retinal vascular density. RESULTS: There was no significant difference in the FAZ area between the right and left eyes in either the SCP-FAZ (P = 0.61) or WCP-FAZ (P = 0.80), and the FAZ areas of both eyes showed significant positive correlations (SCP-FAZ; P < 0.001, R2 = 0.884, WCP-FAZ; P < 0.001, R2 = 0.856). Bland-Altman plots showed that the mean interocular difference in SCP-FAZ area was 0.002 ± 0.037 mm2 (95% confidence interval, -0.072-0.075 mm2), and in the WCP-FAZ area, 0.050 ± 0.044 mm2 (95% confidence interval, -0.036-0.137 mm2). Multivariate regression analysis showed that none of the investigated factors were significantly associated with interocular differences in SCP-FAZ (P = 0.61, R2 = 0.138). CONCLUSIONS: There was no significant interocular difference in SCP- and WCP-FAZ areas in healthy eyes. The normal range of values for interocular difference in SCP-FAZ area was 0.002 ± 0.037 mm2 and in the WCP-FAZ area, 0.050 ± 0.044 mm2.

DOI： 10.1007/s10384-020-00719-2

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

We investigated the effectiveness of a treat-and-extend regimen (TAE) of intravitreal ranibizumab injections for macular edema (ME) due to branch retinal vein occlusion (BRVO). We retrospectively examined 2-year results of 32 eyes of 32 patients who underwent TAE to treat ME due to BRVO. The patients whose treatment interval extended to ≥ 12 weeks were switched to a pro re nata regimen (PRN). For the patients whose treatment interval was <12 weeks, TAE was continued. At 2 years, 10 eyes had required no additional injections after the initial treatment period [recurrence(-) group], whereas the other 22 eyes required additional treatment [recurrence(+) group]. Among the recurrence(+) patients, 11 eyes (34.4% of total) were eventually switched from TAE to PRN; the other 11 eyes (34.4%) continued TAE for 2 years. Visual acuity and central retinal thickness were significantly improved in both the recurrence(+) and (-) groups, and there was no significant betweengroup difference in visual acuity at 2 years. Univariate analyses revealed significant differences in visual acuity (p=0.004), age (p=0.014), and vessel occlusion site (p=0.018) between these groups. Our results suggest that TAE may be effective for BRVO patients with lower visual acuity, older age, and occlusion of a major vein.

DOI： 10.18926/AMO/57716

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

PURPOSE: To examine the outcomes of vitrectomy with subretinal tissue plasminogen activator (tPA) injection and postoperative intravitreal antivascular endothelial growth factor (VEGF) injection for submacular hemorrhage (SMH) associated with polypoidal choroidal vasculopathy (PCV). STUDY DESIGN: Retrospective, consecutive case series. METHODS: Patients who underwent vitrectomy for SMH associated with PCV and who were followed up for at least 12 months were included. Surgery consisted of vitrectomy with subretinal tPA and air tamponade. Postoperative intravitreal anti-VEGF was administered pro re nata. The following were examined: best-corrected visual acuity (BCVA) at baseline, at 1 month, and at the final visit; the percentage of patients requiring anti-VEGF postoperatively; and the number of injections administered. RESULTS: This study included 23 eyes of 23 patients (21 men, 2 women) with a mean age of 72.5 ± 9.0 years. The mean duration from disease onset to surgery was 9.0 ± 6.6 days. The mean maximum SMH size was 5.8 ± 4.8 disc diameters. The mean follow-up period was 33 ± 14 months. The BCVA was significantly improved when compared with baseline 1 month after surgery and at the final visit. Postoperative anti-VEGF was required for 91% of the eyes. In eyes that underwent anti-VEGF therapy until the final visit, the mean injection number was 4.1/year. CONCLUSIONS: Vitrectomy with subretinal tPA and air tamponade improved visual acuity in patients with SMH associated with PCV. Postoperative intravitreal anti-VEGF injection maintained the improved BCVA throughout a mean period of 33 months.

DOI： 10.1007/s10384-019-00679-2

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

PURPOSE: To compare the rates of infectious endophthalmitis following intravitreal injection of ranibizumab using prefilled syringes vs conventional preparation. DESIGN: Multicenter retrospective cohort study. METHODS: All eyes receiving intravitreal injection of 0.5 mg ranibizumab for retinal vascular diseases at 10 retina practices across the United States (2016 to 2017) and Japan (2009 to 2017) were included. The total numbers of eyes and injections were determined from billing codes. Endophthalmitis cases were determined from billing records and evaluated with chart review. Primary outcome was the rate of postinjection acute endophthalmitis. Secondary outcomes were visual acuity and microbial spectrum. RESULTS: A total of 243 754 intravitreal 0.5 mg ranibizumab injections (165 347 conventional and 78 407 prefilled) were administered to 43 132 unique patients during the study period. In the conventional ranibizumab group, a total of 43 cases of suspected endophthalmitis occurred (0.026%; 1 in 3845 injections) and 22 cases of culture-positive endophthalmitis occurred (0.013%; 1 in 7516 injections). In the prefilled ranibizumab group, 12 cases of suspected endophthalmitis occurred (0.015%; 1 in 6534 injections) and 2 cases of culture-positive endophthalmitis occurred (0.0026%; 1 in 39 204 injections). Prefilled syringes were associated with a trend toward decreased risk of suspected endophthalmitis (odds ratio 0.59; 95% confidence interval 0.31-1.12; P = .10) and a statistically significant decreased risk of culture-positive endophthalmitis (odds ratio 0.19; 95% confidence interval 0.045-0.82; P = .025). Average logMAR vision loss at final follow-up was significantly worse for eyes that developed endophthalmitis from the conventional ranibizumab preparation compared to the prefilled syringe group (4.45 lines lost from baseline acuity vs 0.38 lines lost; P = .0062). Oral-associated flora was found in 27.3% (6/22) of conventional ranibizumab culture-positive endophthalmitis cases (3 cases of Streptococcus viridans, 3 cases of Enterococcus faecalis) compared to 0 cases in the prefilled ranibizumab group. CONCLUSION: In a large, multicenter, retrospective study the use of prefilled syringes during intravitreal injection of ranibizumab was associated with a reduced rate of culture-positive endophthalmitis, including from oral flora, as well as with improved visual acuity outcomes.

DOI： 10.1016/j.ajo.2018.11.023

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Coats disease is a retinal disease characterized by exudative retinal detachment due to abnormal retinal blood vessels. Coats disease is generally treated using laser photocoagulation and cryotherapy to ablate the abnormal retinal blood vessels. However, if abnormal blood vessels are present near the posterior pole of the eye and there is a severe exudative change there, it is difficult to perform these standard treatments. We describe a case of Coats disease with severe exudative retinal change and retinal vascular abnormality near the posterior pole for which we performed photodynamic therapy and successfully suppressed the disease and improved vision. CASE PRESENTATION: A 15-year-old Japanese boy presented to hospital with a chief complaint of decreased vision in his right eye. At the initial examination, corrected visual acuity of the right eye was 20/100. On the right fundus, exudative retinal detachment with subretinal haemorrhage was observed from the upper intermediate periphery to the posterior pole. Abnormal telangiectatic vessels and microaneurysms were found at the nasal peripheral retina. From these findings, we diagnosed the case as Coats disease. We conducted photodynamic therapy for the right eye. At 10 months after treatment, both the subretinal haemorrhage and the exudative retinal detachment had disappeared completely. Further, the retinal structure of the macula had recovered, and right vision had improved to 20/20. CONCLUSION: Photodynamic therapy may be an effective and safe treatment for Coats disease in cases that present with abnormal retinal vessels close to the posterior pole of the eye.

DOI： 10.1186/s12886-018-0930-z

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: We recently reported that lamellar macular hole (LMH) with lamellar hole-associated epiretinal proliferation (LHEP) can be effectively treated by embedding the LHEP into the retinal cleavage to improve foveal contour and visual acuity. Here, we report a case of LMH with LHEP for which we performed embedding of the LHEP combined with internal limiting membrane (ILM) inversion. We then evaluated the effects of this surgery on macular morphology and visual functions. CASE PRESENTATION: A 62-year-old man presented with visual disturbance (20/29) and metamorphopsia in his right eye. B-scan optical coherence tomography (OCT) imaging revealed the presence of both partial-thickness defect of the macula with degenerative retinal cleavage and LHEP at the surface of the retina. En face OCT imaging showed the absence of retinal fold. We performed phacoemulsification with intraocular lens implantation, vitrectomy, embedding of LHEP into the retinal cleavage, and ILM inversion. Three months after the surgery, both foveal contour and visual acuity (20/20) were improved and metamorphopsia was reduced. CONCLUSION: Embedding of the LHEP combined with ILM inversion may be an effective treatment for LMH with LHEP.

DOI： 10.1186/s12886-018-0926-8

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

We conducted intravitreal aflibercept injections (IVAs) for 37 Japanese patients (28 males, 9 females, mean age 73.4 years) with polypoidal choroidal vasculopathy (PCV), with a treat-and-extend regimen (TER). We evaluated the impact of polyp regression after a loading dose (2-mg IVA 1×/month for 3 months) on the patients' 2-year treatment outcomes. Thirty-seven eyes were treated with IVA by a TER for 2 years. We divided the patients into 2 groups based on their polyp status after the loading dose: polyp regression (PR+) (n=19) and no polyp regression (PR-) (n=18). We compared the groups' best-corrected visual acuity (BCVA), central retinal thickness (CRT), recurrence rate, total number of injections, and final treatment interval. Both the BCVA and CRT were significantly improved by the treatment in both groups, with no between-group difference in the amount of change (p=0.769). In the polyp regression (+) group, recurrence was significantly less common (p=0.03), the mean total number of injections was significantly lower (p=0.013), and the mean treatment interval was significantly longer (0.042). Regarding the 2-year outcomes for PCV, the eyes with post-loading-dose polyp regression demonstrated less frequent recurrence and required fewer numbers of injections compared to the eyes without polyp regression.

DOI： 10.18926/AMO/56175

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

PURPOSE: To investigate lamellar macular hole (LMH) and macular pseudohole (MPH) using a combination of en face and radial B-scan OCT. DESIGN: Retrospective observational case series. METHODS: Setting: Institutional study. PATIENT POPULATION: En face and radial B-scan OCT images of 63 eyes of 60 patients diagnosed with LMH or MPH based on an international classification were reviewed. OBSERVATION PROCEDURES: Cases were classified using en face images based on the presence/absence of epiretinal membrane (ERM), retinal folds, parafoveal epicenter of contractile ERM (PEC-ERM), and retinal cleavage. We compared the en face imaging-based classification system with the international classification system using radial B-scan images. We quantitatively evaluated visual function and macular morphology. MAIN OUTCOME MEASURES: Characterization of multimodal OCT-based subtypes of LMH and MPH. RESULTS: All cases showed ERM and were classified into 4 groups. In the first group, which lacked retinal folds and showed significantly lower visual acuity than the other groups, 81% of eyes had degenerative LMH. In the second group, which lacked PEC-ERM and retinal cleavage and showed significantly lower retinal fold depth, all eyes had MPH. The third group, in which 95% of eyes had symmetric tractional LMH, included eyes with retinal cleavage but without PEC-ERM, and this group showed higher circularity of the foveal aperture and cleavage area than the group with both these features, in which all eyes had asymmetric tractional LMH. CONCLUSIONS: Multimodal OCT enables classification of LMH and MPH based on pathologic conditions. Retinal traction in particular may be useful for determining treatment methods.

DOI： 10.1016/j.ajo.2018.01.016

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

To investigate the effectiveness of a treat-and-extend regimen (TAE) of intravitreal ranibizumab injections (IVR) for macular edema (ME) due to branch retinal vein occlusion (BRVO). We retrospectively examined 35 eyes of 35 patients with ME due to BRVO who underwent TAE for 1 year. Patients whose treatment interval extended to 12 weeks were switched to a pro re nata regimen (PRN; TAE to PRN group), while TAE was continued for patients whose treatment interval was less than 12 weeks (continued TAE group). Changes in best-corrected visual acuity (BCVA), central retinal thickness (CRT), and predictive factors for inclusion in the TAE to PRN group were analyzed. BCVA and CRT both improved significantly at 1 year compared with baseline (p<0.001). Sixteen eyes (45.7%) were included in the TAE to PRN group, while 19 eyes (54.3%) were included in the continued TAE group. BCVA in the TAE to PRN group was significantly better than that in the continued TAE group at 1 year (p=0.047). BCVA at baseline and macular BRVO were significant predictive factors for inclusion in the TAE to PRN group. TAE was effective for improving BCVA and CRT. The TAE to PRN group showed significantly better prognosis.

DOI： 10.18926/AMO/55661

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

PURPOSE: To investigate the influence of subretinal injection pressure on the microstructure of the retina in a monkey model. METHODS: After vitrectomy, balanced salt solution was injected subretinally into one eye each of four cynomolgus monkeys while controlling the injection pressure. Initially, a pressure of 2 psi was used, and this was gradually increased to determine the minimum required pressure. Subsequent injections were performed at two pressures: minimum (n = 13) and high (n = 6). To compare the influence of these injection pressures on retinal structure, optical coherence tomography (OCT) was performed before surgery and every week afterwards. The monkeys were euthanized and their eyes were enucleated at 1 or 6 weeks after the injections. The eyes were processed for light microscopy and transmission electron microscopy (TEM) as well as for TdT-mediated dUTP nick end labeling. RESULTS: The minimum pressure required to perform subretinal injection was 6 psi. After injection at this pressure, both OCT and microscopy showed that the retinal structure was well-preserved throughout the experimental period at all injection sites. Conversely, after injection at high pressure (20 psi) OCT images at all injection sites showed disruption of the ellipsoid zone (EZ) after 1 week. Microscopy indicated damage to the photoreceptor outer segment (OS) and stratification of the retinal pigment epithelium (RPE). After 6 weeks, OCT demonstrated that the EZ had become continuous and TEM confirmed that the OS and RPE had recovered. Photoreceptor apoptosis was absent after subretinal injection at both pressures. CONCLUSIONS: The retinal damage caused by subretinal injection increases depending on pressure, indicating that clinicians should perform subretinal injection at pressures as low as possible to ensure safety.

DOI： 10.1371/journal.pone.0209996

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

PURPOSE: To investigate the effectiveness of displacement of submacular hemorrhage (SMH) caused by polypoidal choroidal vasculopathy (PCV) by assessing retinal sensitivity using microperimetry. METHODS: We retrospectively reviewed the medical records of 11 consecutive PCV patients with SMH. All patients underwent vitrectomy, subretinal injection of tissue plasminogen activator, and fluid-air exchange, followed by antivascular endothelial growth factor therapy using a pro re nata regimen. The retinal sensitivity was measured by use of microperimetry before and after surgery. RESULTS: The mean (SD) age of the patients was 74.1 ± 9.4 years. The mean SMH diameter was 6.8 ± 5.2 disc diameters. The best-corrected visual acuity (BCVA), mean retinal sensitivity, and mean number of measure points with a sensitivity ≥10 dB before the surgery were 0.94 ± 0.49, 4.2 ± 4.5 dB, and 15.6 ± 15.1 points, respectively. These had significantly improved 6 months after surgery (0.39 ± 0.37, 15.6 ± 7.3 dB, and 50.9 ± 22.2 points, respectively; P < 0.05 for all outcome measures). The mean number of measure points with an absolute scotoma before surgery had decreased significantly 6 months after surgery (from 40.5 ± 15.0 to 9.4 ± 16.0 points; P < 0.001). CONCLUSIONS: Displacement of SMH effectively improves retinal sensitivity as well as BCVA.

DOI： 10.1007/s10384-017-0530-0

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

PURPOSE: To evaluate the 1-year treatment outcomes of intravitreal aflibercept injections (IVA) using a treat-and-extend regimen for polypoidal choroidal vasculopathy (PCV). METHODS: Thirty-seven eyes with treatment-naive PCV treated with IVA using a treat-and-extend regimen for 1 year were reviewed retrospectively. The main outcome measures were changes in the best-corrected visual acuity (BCVA) and central retinal thickness (CRT), and the treatment interval at 1 year. The predictive factors for patients who could not continue to extend the treatment interval because of poor response to IVA or recurrence were analyzed. RESULTS: The mean logarithm of the minimum angle of resolution BCVA improved from 0.37 at baseline to 0.21 at 1 year (P < 0.001). The mean CRT decreased from 342.3 μm at baseline to 196.6 μm at 1 year (P < 0.001). The mean treatment interval was 9.7 weeks at 1 year (4 weeks in 11 eyes [29.7%], 6 weeks in 1 eye [2.7%], 8 weeks in 2 eyes [5.4%], 10 weeks in 1 eye [2.7%], and 12 weeks in 22 eyes [59.5%]). A larger number of polypoidal lesions at baseline was predictive for patients who could not continue to extend the treatment interval. CONCLUSIONS: IVA using a treat-and-extend regimen is effective for improving BCVA and CRT in eyes with PCV.

DOI： 10.1007/s10384-016-0492-7

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

OBJECTIVE: To examine factors affecting foveal avascular zone (FAZ) area in healthy eyes using swept-source optical coherence tomography angiography (OCTA). METHODS: This prospective, cross-sectional study included 144 eyes of 144 individuals (77 women, 67 men) with a best corrected visual acuity of at least 20/20 and no history of ocular disorders. The area of the superficial FAZ was assessed using OCTA. Age, gender, central retinal thickness (CRT), retinal vascular density, refractive error, and axial length were examined to determine associations with FAZ area. RESULTS: The mean age of the subjects was 42.1 ± 20.2 years (range: 10-79 years). The mean FAZ area was 0.32 ± 0.11 mm2, while the mean retinal vascular density was 35.53 ± 0.92%. Multivariate regression analysis was performed using FAZ area as the dependent variable and age, gender, CRT, retinal vascular density, refractive error, and axial length as independent variables. The results of this analysis demonstrate that CRT and retinal vascular density were significantly associated with FAZ area in our sample (P < 0.001, R2 = 0.425). Age, gender, refractive error, and axial length were not significantly correlated with FAZ area, while CRT and retinal vascular density were negatively correlated with FAZ area (CRT: P < 0.001, R2 = 0.356; retinal vascular density: P < 0.001, R2 = 0.189). CONCLUSIONS: OCTA results suggest that CRT and retinal vascular density negatively affect FAZ area in healthy eyes.

DOI： 10.1371/journal.pone.0188572

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

PURPOSE: To quantify the vascular density of the choroid of normal eyes and to identify the influencing factors using en face images obtained with swept-source optical coherence tomography (SS OCT). DESIGN: Prospective cross-sectional study. METHODS: One hundred and sixty-three eyes of 163 healthy volunteers (83 female; mean age 42.2 ± 22.6 years) with a corrected visual acuity of ≥1.0 were investigated. En face SS OCT images of the choroid were used for quantitative assessment of the vascular density in the large choroid vessel layer. Relationships between vascular density of the choroid and age, sex, refractive error (RE), axial length (AL), and subfoveal choroidal thickness (SCT) were also investigated. RESULTS: There was a significant negative relationship between vascular density of the choroid and subject age (P < .001). Analysis according to age showed a significant correlation in the group aged >30 years (P < .001), but not in the group aged ≤30 years (P = .225). SCT had a significant positive relationship with vascular density of the choroid (P < .001). However, a significant correlation was not observed between sex, RE, or AL and vascular density of the choroid (P = .981, P = .292, and P = .216, respectively). Multivariable regression analysis with vascular density of the choroid as the dependent variable and age, sex, RE, AL, and SCT as independent variables showed that age and SCT are important determinants of vascular density of the choroid (P < .001). CONCLUSION: Age and SCT affect vascular density of the choroid.

DOI： 10.1016/j.ajo.2016.07.006

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

PURPOSE: We assessed the efficacy of vitrectomy and inner limiting membrane (ILM) peeling, followed by anti-vascular endothelial growth factor (VEGF) therapy, anti-VEGF-resistant age-related macular degeneration (AMD) due to vitreomacular traction (VMT) or epiretinal membrane (ERM). METHODS: We identified six patients with anti-VEGF-resistant AMD due to VMT or ERM amongst a total of 588 patients with AMD (821 eyes) referred to Okayama University Hospital between February 2012 and May 2014. These patients underwent vitrectomy to release the VMT (4 cases) or remove the ERM (2 cases), along with ILM peeling. The regimen used for intravitreal injections of anti-VEGF reagents after surgery was based on the severity of exudative changes in each patient. Preoperative and postoperative best-corrected visual acuity (BCVA) and central retinal thickness (CRT) measurements were compared. RESULTS: After vitrectomy and ILM peeling, all six patients responded to anti-VEGF therapy, which was then able to maintain dry retinas. Mean BCVA did not improve significantly (0.49 ± 0.28 before vs. 0.43 ± 0.38 after surgery, P = 0.538). However, mean CR was significantly decreased after surgery, from 423 ± 83.5 μm to 257 ± 75.8 μm (P = 0.0078). CONCLUSIONS: Vitrectomy and ILM peeling followed by anti-VEGF therapy may be a useful therapeutic option for anti-VEGF-resistant AMD with VMT or ERM.

DOI： 10.1007/s00417-016-3314-1

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

PURPOSE: To describe the clinical features of idiopathic foveomacular retinoschisis not in association with myopia, glaucoma, optic disk pit, or juvenile retinoschisis. METHODS: Retrospective observational case series. Five eyes of five patients with idiopathic foveomacular retinoschisis were included. RESULTS: The patients were 2 men and 3 women (average age, 75.2 years; range, 71-78 years). The average spherical equivalent was +2.40 diopters (range, +0.88 to +5.75 diopters), and the average axial length was 22.0 mm (range, 21.1-23.1 mm). All patients had retinoschisis from the macula to the optic disk in the affected eye. No patients had retinoschisis in the fellow eye. The average best-corrected visual acuity was 20/44 (68 Early Treatment Diabetic Retinopathy Study letter score). CONCLUSION: Idiopathic foveomacular retinoschisis is not inherited or associated with myopia, vitreomacular traction syndrome, optic pit, or glaucoma but is associated with older age, unilaterality, hyperopia with short axial length, complete posterior vitreous detachment, and weak leakage from the optic disk on fluorescein angiography.

DOI： 10.1097/IAE.0000000000000938

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

OBJECTIVE: To investigate the occurrence ratio, localization, and surgical outcomes of intraretinal cystic spaces in idiopathic epiretinal membranes (ERMs). METHODS: We retrospectively reviewed the charts of 432 eyes of 398 consecutive patients with idiopathic ERM who underwent vitrectomy and ERM peeling from January 2012 to September 2015. We selected cases with intraretinal cystic space prior to surgery, detected by spectral-domain optical coherence tomography. We then evaluated the effects of ERM peeling on intraretinal cystic spaces, best corrected visual acuity, and central retinal thickness at 6 months after surgery. RESULTS: Twenty-four eyes (5.5%) showed intraretinal cystic spaces before surgery, present in the inner retinal layer (the inner group) in 9 eyes, in the outer retinal layer (the outer group) in 6 eyes, and in both the inner and the outer retinal layers (the combined group) in 9 eyes. Additionally, 30 eyes with ERM but without any presence of intraretinal cystic space were selected randomly and classified as the no cyst group. At 6 months after surgery, the disappearance rate of cystic spaces was significantly greater for the outer group than for the inner group (83.3% and 11.1%, respectively, P = 0.011). The mean best corrected visual acuity improved significantly after surgery in the inner group, the outer group, and the no cyst group (P < 0.05 for all three groups) but did not improve in the combined group (P = 0.58). The mean central retinal thickness decreased significantly after surgery in the inner group, the combined group, and the no cyst group (P < 0.05). CONCLUSIONS: Intraretinal cystic spaces were observed in 5.5% of preoperative idiopathic ERM cases. Following surgery, the cystic spaces in the outer retinal layer disappeared at higher rates than those in the inner retinal layer, suggesting that the pathophysiologies of these cystic spaces are different.

DOI： 10.1371/journal.pone.0168555

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Cryopyrin-associated periodic syndrome (CAPS) is a group of rare autoinflammatory diseases, and of these, chronic infantile neurologic, cutaneous, and articular/neonatal-onset multisystem inflammatory disease (CINCA/NOMID) syndrome has the most severe phenotype. Canakinumab, a monoclonal antibody that targets interleukin-1β, has been shown to be an effective treatment for resolving systemic inflammation. However, its efficacy for treating ophthalmic symptoms of this disorder remains unclear. FINDINGS: A 64-year-old female reported episodes of nonpruritic urticaria, fever, aseptic meningitis, and bilateral sensorineural deafness. Her son had experienced similar symptoms. She was initially referred for ophthalmologic treatment for an infectious corneal ulcer. Examination of her right eye by slit lamp biomicroscopy showed diffuse conjunctival injection, corneal infiltrates, a corneal ulcer, and hypopyon. She was therefore treated aggressively with topical and systemic antibiotics in addition to antifungal medications. However, this was ineffective. Genetic analysis detected the heterozygous germline p.Asp303Asn mutation in the NLRP3 gene in both our patient and her son. She was therefore diagnosed with CINCA/NOMID syndrome based on her clinical manifestations. All of the patient's physical and ophthalmic symptoms were resolved within a few days after the initiation of canakinumab treatment. During an 18-month follow-up period, no adverse events or severe infections were observed. CONCLUSIONS: Our case report indicates that canakinumab is effective not only for the treatment of systemic inflammation but also for treating ophthalmic involvement, such as recurrent stromal keratitis and anterior uveitis.

DOI： 10.1186/s12348-015-0065-9

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

PURPOSE: To compare the efficacy and safety of photodynamic therapy using reduced irradiation time or reduced verteporfin dose for chronic central serous chorioretinopathy. METHODS: Between April 2011 and December 2013, 45 eyes with chronic central serous chorioretinopathy (43 consecutive patients) were treated with photodynamic therapy, using either half the irradiation time (18 eyes) or half the verteporfin dose (27 eyes). Outcome measures at follow-up, over at least 3 months, were complete resolution of serous retinal detachment, best-corrected visual acuity, and central retinal thickness. RESULTS: After 3 months, serous retinal detachment had completely resolved in 88.8% of eyes in both treatment groups, which were therefore not significantly different. The logarithm of the minimal angle of resolution best-corrected visual acuity (Snellen equivalent) improved from 0.245 (20/35) to 0.130 (20/27) (P < 0.05, paired t-test) in the reduced time group and from 0.283 (20/38) to 0.138 (20/27) (P < 0.05) in the reduced verteporfin group. Final best-corrected visual acuities in the 2 groups were not significantly different. Central retinal thicknesses dropped from 337.0 μm to 146.6 μm (P < 0.05) in the reduced time group and from 343.5 μm to 166.9 μm (P < 0.05) in the reduced verteporfin group. No ocular or systemic side effects were observed. CONCLUSION: Reduced irradiation time and reduced verteporfin dose were equally effective and safe in photodynamic therapy for chronic central serous chorioretinopathy.

DOI： 10.1097/IAE.0000000000000621

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

PURPOSE: To evaluate the therapeutic efficacy of a novel surgical procedure for diffuse diabetic macular edema (DME), performed in conjunction with conventional vitrectomy. METHODS: This prospective, interventional case series involved 20 eyes of 18 consecutive DME patients with best-corrected visual acuities (BCVAs) between 0.301 and 1.221 logarithm of the minimal angle of resolution (logMAR) units and central retinal thicknesses (CRTs) greater than 275 μm. After vitrectomy, a small retinal detachment was made in the macula by injecting 50-100 μl balanced salt solution into the subretinal space using a 38-gauge needle. Before finishing the surgery, fluid-air exchange was performed. Patients were asked to remain in prone position for 1 day postoperatively. The main outcome measures were CRT and BCVA. RESULTS: The mean CRT of 554.6 ± 152.7 μm before surgery significantly decreased to 295.6 ± 92.5 μm (p < 0.0001) 1 week after surgery and to 185.8 ± 67.4 μm (p < 0.0001) at 6 months after surgery. The CRT was less than 250 μm in 18 eyes (90 %) at 6 months after surgery. The mean BCVA before surgery (0.706 ± 0.348) significantly improved at 6 months after surgery (0.431 ± 0.392, p < 0.0001). Postoperative BCVAs improved by more than 0.3 logMAR units in 13 eyes (65 %), remained unchanged in six eyes (30 %) and worsened in one eye (5 %). Macular edema recurred in three eyes (15 %) 2 months after surgery. CONCLUSIONS: This novel planned foveal detachment technique facilitated a rapid resolution of DME and contributed to improved visual acuity.

DOI： 10.1007/s10384-015-0390-4

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: The natural course of submacular hemorrhage resulting from traumatic choroidal rupture generally has a poor outcome unless treated. The intravitreal injection of gas only or gas with recombinant tissue plasminogen activator (rt-PA) has been reported to be effective, but has also been reported to induce severe complications such as retinal detachment and vitreous hemorrhage. Recently, we reported a safe and effective procedure for treating submacular hemorrhage due to polypoidal choroidal vasculopathy (PCV) with a low dose of rt-PA. Here we report the application of this procedure to a case of traumatic submacular hemorrhage in a 13-year-old boy, which achieved a good visual outcome. CASE PRESENTATION: A 13-year-old Japanese boy presented with a thick submacular hemorrhage in his left eye as a result of blunt trauma from being hit by a sinker. Best-corrected visual acuity (BCVA) was assessed as only able to perceive hand motions. We carried out a vitrectomy, subretinal injection of 4,000 IU rt-PA (6.9 μg) and air tamponade. The day after surgery, most of the submacular hemorrhage had moved to the inferior periphery. One month after the surgery, we observed cataract formation, thin remnants of the submacular hemorrhage and juxtafoveal choroidal rupture. We carried out cataract surgery and injected bevacizumab intravitreally to prevent the development of choroidal neovascularization. Two months after the second surgery, the submacular hemorrhage had totally disappeared and the patient had a BCVA of 20/40. CONCLUSION: Vitrectomy, subretinal injection of rt-PA, and intravitreal air tamponade may be a promising strategy for treating traumatic submacular hemorrhage in young patients.

DOI： 10.1186/s12886-015-0090-3

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: This study aims to evaluate the therapeutic effect of intravitreal aflibercept injection for polypoidal choroidal vasculopathy (PCV). METHODS: Eighteen eyes of 17 consecutive patients with PCV received three consecutive monthly intravitreal injections of aflibercept and one additional injection 2 months later (four injections totally). All patients underwent eye examinations, which included best-corrected visual acuity (BCVA), fluorescein angiography, indocyanine green angiography, and optical coherence tomography. The primary endpoint of the study was the regression of polypoidal lesions. The secondary endpoints were BCVA, central retinal thickness (CRT) and changes in retinal exudation. RESULTS: Six months after the first aflibercept injection, the polypoidal lesions were completely resolved in 14 eyes (77.7%) and partially resolved in 4 eyes (22.2%). Although branching choroidal vascular networks were still present in all eyes, retinal exudative changes had completely resolved in 17 eyes (94.4%), and the mean CRT decreased significantly from 407.2±100.1 µm to 229.1±57.2 µm (p<0.0001). BCVA (logarithm of the minimal angle of resolution, logMAR) improved significantly from 0.414±0.384 at baseline to 0.297±0.334 after 6 months (p=0.016). CONCLUSIONS: At 6 months, aflibercept monotherapy effectively reduced polyps, retinal exudation and CRT in patients with PCV.

DOI： 10.1136/bjophthalmol-2014-305275

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Macular holes (MHs) are one of the complications of posterior uveitis that can significantly disturb vision. Conventional MH surgery (vitrectomy, internal limiting membrane (ILM) peeling, and gas tamponade) has been reported to show lower closure rates in patients with MHs secondary to uveitis than in patients with idiopathic MHs. Recently, the inverted ILM flap technique has been reported to be effective for treating refractory MHs. Here, we describe the application of this technique in a patient with a large MH secondary to uveitis, and its successful closure. CASE PRESENTATION: An 80-year-old woman presented with a chronic, large MH secondary to uveitis. The minimum aperture diameter of the MH was 569 μm and extensive post-inflammatory chorioretinal atrophy was present, which included the juxtafoveal region. Vitrectomy with the inverted ILM flap technique assisted by low molecular weight hyaluronic acid was performed. Three days after surgery, the MH was closed successfully, without excessive gliosis. CONCLUSION: The inverted ILM flap technique may be the preferred surgical procedure for the treatment of large MHs secondary to uveitis.

DOI： 10.1186/s12886-015-0072-5

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

PURPOSE: To evaluate vitrectomy with subretinal tissue plasminogen activator (t-PA) injection, and air tamponade, followed by intravitreal anti-vascular endothelial growth factor (VEGF) therapy for submacular hemorrhage in polypoidal choroidal vasculopathy (PCV). DESIGN: Prospective, interventional case series. METHODS: setting: Two clinics. PATIENTS: Fifteen eyes of 15 consecutive patients (mean age 72 ± 7 years) with submacular hemorrhage attributable to PCV. INCLUSION CRITERIA: PCV diagnosis with unorganized submacular hemorrhage greater than 500 μm thick. EXCLUSION CRITERIA: Submacular hemorrhage attributable to macular diseases (eg, high myopia, typical age-related macular degeneration, retinal angiomatous proliferation, and angioid streaks). INTERVENTION: Vitrectomy with 4000 IU t-PA injected subretinally and fluid/air exchange. Patients remained facedown for 3 days after surgery. Anti-VEGF drugs were administered as exudative changes required. MAIN OUTCOME MEASURES: Submacular hemorrhage displacement from the macula and changes in best-corrected visual acuities (BCVAs). RESULTS: Mean time from onset to surgery was 9.5 ± 4.5 (range, 5-21) days. Mean follow-up period was 9.4 ± 3.1 (range, 6-17) months. Surgery successfully displaced submacular hemorrhages from the macula in all eyes. Mean BCVA at baseline (0.98 ± 0.44) had improved significantly both 1 month after surgery (0.41 ± 0.25, P < .01) and at final visits (0.23 ± 0.25, P < .001). In all eyes, exudative retinal changes relapsed after surgery but were completely resolved by anti-VEGF injections. No complications occurred in any patients. CONCLUSION: Treating submacular hemorrhage with vitrectomy and subretinal t-PA injection, followed by intravitreal anti-VEGF therapy, is a promising strategy for improving visual acuity in PCV patients warranting further investigation.

DOI： 10.1016/j.ajo.2014.12.020

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

We report a case of POEMS syndrome in a 20-year-old patient diagnosed after visiting an eye clinic with a chief complaint of reduced visual acuity. A male university student aged 20 years was referred to our department complaining of blurred vision in both eyes that had persisted for 1 month. He also noted headache, nausea, and paresthesia in the lower extremities around the same time. The visual acuity of his right and left eye was 20/40 and 20/20, respectively. Optic disc edema and serous retinal detachment were present. Brain magnetic resonance imaging showed no intracranial abnormalities, while elevated cerebrospinal fluid pressure, reduced nerve conduction velocity in both lower extremities, hepatosplenomegaly, M proteinemia, high blood VEGF levels, osteoblastic and osteolytic changes in the spine, and atypical plasma cells in bone lesions were noted. From the above findings, the patient was diagnosed with POEMS syndrome. He received high-dose dexamethasone, thalidomide, and radiotherapy on the sacral mass, followed by high-dose melphalan with autologous stem-cell support, and showed subsequent systemic and ophthalmologic improvement. Here, we report the youngest case ever of POEMS syndrome with ocular manifestation. If patients have optic disc edema in both eyes with no intracranial space-occupying lesion, POEMS syndrome should be considered in differential diagnosis, regardless of age.

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

PURPOSE: To determine the effectiveness of autologous transplantation of the internal limiting membrane (ILM) for refractory macular holes. DESIGN: Prospective, interventional case series. PATIENT AND METHODS: Ten eyes of 10 consecutive patients who underwent autologous transplantation of the ILM for the treatment of refractory macular holes were studied. The primary diseases in these patients were large idiopathic macular holes that had existed for more than 1 year (4 eyes), a traumatic macular hole (1 eye), myopic foveoschisis (2 eyes), foveoschisis resulting from pit-macular syndrome (2 eyes), and proliferative diabetic retinopathy (1 eye). Apart from the 5 eyes with idiopathic or traumatic macular holes, macular holes developed in the other 5 eyes after initial vitrectomies with ILM removal. In all eyes, regular macular hole surgery failed to achieve closure. The main outcome measures used in this study were macular hole closure and best-corrected visual acuity (BCVA). RESULTS: Macular holes were closed successfully in 9 eyes (90%) after autologous transplantation of the ILM. The postoperative BCVAs were significantly better than the preoperative BCVAs (P = .007, paired t test). Postoperative BCVAs improved by more than 0.2 logarithm of the minimal angle of resolution units in 8 eyes (80%) and were unchanged in 2 eyes (20%). CONCLUSIONS: Although this is a pilot study, the results suggest that autologous transplantation of the ILM may contribute to improved anatomic and visual outcomes in the treatment of refractory macular holes and may warrant further investigation.

DOI： 10.1016/j.ajo.2013.12.028

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Association between cytochrome P450 (CYP) 3A4*1G genotype of donors (n=412) and/or recipients (n=410), and the pharmacokinetics of tacrolimus and the risk of acute cellular rejection was examined in Japanese living-donor liver transplant patients between 2004 and 2011. The concentration/dose (C/D) ratio of tacrolimus in patients carrying graft liver with CYP3A4*1/*1 was significantly higher during 7 d after surgery than in that with CYP3A4*1/*1G (214 vs. 157 [ng/mL]/[mg/kg/day], p<0.01). After postoperative day 8, no significant difference was observed among CYP3A4*1G genotypes in the graft liver. However, the C/D ratio in CYP3A4*1/*1 of the intestine was significantly higher than that in CYP3A4*1G/*1G for 5 weeks after surgery (postoperative days 1-14; p<0.001, postoperative days 15-35; p<0.01). During postoperative days 14 and 26, acute cellular rejection incidences tended to be lower in the patients with graft liver carrying the CYP3A4*1/*1 allele than in the patients carrying CYP3A4*1G allele (8.7% vs. 14.6%, p=0.0973). However, CYP3A4*1G in the intestine had almost no effect on the incidence of rejection (9.9% in CYP3A4*1/*1 vs. 12.5% in CYP3A4*1G allele, p=0.4824). CYP3A4*1G was significantly related to mRNA expression of CYP3A5 rather than of CYP3A4 in the graft liver and intestine and was strongly linked with the CYP3A5*1. Thus, we elucidated that CYP3A4*1G genotype in the intestine was an important indicator of the pharmacokinetics of tacrolimus, whereas this genotype in the graft liver tended to influence the frequency of acute cellular rejection after transplantation.

PubMed

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記述言語：日本語   出版者・発行元：眼科臨床紀要会  

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記述言語：日本語   出版者・発行元：眼科臨床紀要会  

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記述言語：日本語   出版者・発行元：眼科臨床紀要会  

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記述言語：日本語   出版者・発行元：眼科臨床紀要会  

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記述言語：日本語   出版者・発行元：眼科臨床紀要会  

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記述言語：日本語   出版者・発行元：(公財)日本眼科学会  

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記述言語：日本語   出版者・発行元：(公財)日本眼科学会  

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記述言語：日本語   出版者・発行元：眼科臨床紀要会  

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記述言語：日本語   出版者・発行元：(公財)日本眼科学会  

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記述言語：日本語   出版者・発行元：(公財)日本眼科学会  

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記述言語：日本語   出版者・発行元：(公財)日本眼科学会  

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記述言語：日本語   出版者・発行元：眼科臨床紀要会  

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記述言語：日本語   出版者・発行元：眼科臨床紀要会  

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記述言語：日本語   出版者・発行元：眼科臨床紀要会  

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記述言語：英語   掲載種別：研究発表ペーパー・要旨（国際会議）   出版者・発行元：ASSOC RESEARCH VISION OPHTHALMOLOGY INC  

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記述言語：英語   掲載種別：研究発表ペーパー・要旨（国際会議）   出版者・発行元：ASSOC RESEARCH VISION OPHTHALMOLOGY INC  

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記述言語：英語   掲載種別：研究発表ペーパー・要旨（国際会議）   出版者・発行元：ASSOC RESEARCH VISION OPHTHALMOLOGY INC  

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記述言語：英語   掲載種別：研究発表ペーパー・要旨（国際会議）   出版者・発行元：ASSOC RESEARCH VISION OPHTHALMOLOGY INC  

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記述言語：英語   掲載種別：研究発表ペーパー・要旨（国際会議）   出版者・発行元：ASSOC RESEARCH VISION OPHTHALMOLOGY INC  

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記述言語：英語   掲載種別：研究発表ペーパー・要旨（国際会議）   出版者・発行元：ASSOC RESEARCH VISION OPHTHALMOLOGY INC  

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記述言語：英語   掲載種別：研究発表ペーパー・要旨（国際会議）   出版者・発行元：ASSOC RESEARCH VISION OPHTHALMOLOGY INC  

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記述言語：日本語   出版者・発行元：(公財)日本眼科学会  

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記述言語：日本語   出版者・発行元：(公財)日本眼科学会  

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記述言語：日本語   出版者・発行元：(公財)日本眼科学会  

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記述言語：日本語   出版者・発行元：(公財)日本眼科学会  

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記述言語：日本語   出版者・発行元：(公財)政策医療振興財団  

加齢性黄斑変性症、糖尿病黄斑浮腫、網膜静脈閉塞症、近視性脈絡膜新生血管のいずれかに罹患している10名(男性4名、女性6名、平均74.1±7.6歳)を対象とした。疾患は加齢性黄斑変性症4名、糖尿病黄斑浮腫1名、網膜静脈閉塞症3名、近視性脈絡膜新生血管2名であった。硝子体注射を受ける患者の抱える困難感として、133のコードが抽出され、43のサブカテゴリーに分類された。困難感は、【痛みに対する恐怖心】【治療を継続するための金銭的・人的・業務的調整】【注射後、眼帯をつけて帰宅する煩わしさ】【見えにくさによる生活上の作業や細かい行為における不自由さ】【注意を払いつつ生活を送る不便さ】【注射後に出現する不快な症状】【治療の効果に対する期待と、今後の経過に対する危惧】【注射のための準備に対する緊張感】【他者からの情報・交流不足】の九つのカテゴリーに分類された。

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記述言語：日本語   出版者・発行元：眼科臨床紀要会  

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記述言語：日本語   出版者・発行元：眼科臨床紀要会  

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記述言語：日本語   出版者・発行元：眼科臨床紀要会  

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記述言語：日本語   出版者・発行元：(株)メディカ出版  

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記述言語：日本語   出版者・発行元：(公財)日本眼科学会  

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記述言語：日本語   出版者・発行元：(公財)日本眼科学会  

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記述言語：日本語   出版者・発行元：(公財)日本眼科学会  

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記述言語：日本語   出版者・発行元：(公財)日本眼科学会  

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記述言語：日本語   出版者・発行元：眼科臨床紀要会  

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記述言語：日本語   出版者・発行元：眼科臨床紀要会  

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記述言語：日本語   出版者・発行元：眼科臨床紀要会  

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記述言語：日本語   出版者・発行元：眼科臨床紀要会  

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記述言語：日本語   出版者・発行元：眼科臨床紀要会  

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記述言語：日本語   出版者・発行元：眼科臨床紀要会  

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記述言語：日本語   出版者・発行元：(公財)日本眼科学会  

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記述言語：日本語   出版者・発行元：(公財)日本眼科学会  

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記述言語：日本語   出版者・発行元：(公財)日本眼科学会  

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記述言語：日本語   出版者・発行元：(公財)日本眼科学会  

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記述言語：日本語   出版者・発行元：(株)医学書院  

目的:蝶形骨洞部腺様嚢胞癌に対する重粒子線治療後に放射線網膜症を発症した症例の報告。症例:26歳女性。右蝶形骨洞から海綿静脈洞に及ぶ腺様嚢胞癌に対して総量57.6GyE(16回)の重粒子線照射を受けた。19か月後,右眼視力低下を訴え当科を受診。矯正視力は右0.8,左1.2,右眼底に点状出血と軟性白斑があった。蛍光眼底造影で右眼に無灌流域,後極に血管外漏出があり,放射線網膜症と診断した。32か月後より右眼白内障が進行し,白内障手術を行った。42か月後,蛍光眼底造影で右眼網膜新生血管が出現し,網膜光凝固を行った。以後5年間の経過は良好で腫瘍の再発はない。結論:蝶形骨洞部腺様嚢胞癌への重粒子線治療により放射線網膜症が発症することがある。(著者抄録)

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その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2016&ichushi_jid=J01537&link_issn=&doc_id=20160310080026&doc_link_id=10.11477%2Fmf.1410211742&url=https%3A%2F%2Fdoi.org%2F10.11477%2Fmf.1410211742&type=%88%E3%8F%91.jp_%83I%81%5B%83%8B%83A%83N%83Z%83X&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00024_2.gif

記述言語：日本語   出版者・発行元：眼科臨床紀要会  

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記述言語：日本語   出版者・発行元：眼科臨床紀要会  

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記述言語：日本語   出版者・発行元：眼科臨床紀要会  

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記述言語：日本語   出版者・発行元：眼科臨床紀要会  

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記述言語：日本語   出版者・発行元：眼科臨床紀要会  

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記述言語：日本語   出版者・発行元：(公財)日本眼科学会  

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記述言語：日本語   出版者・発行元：(公財)日本眼科学会  

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記述言語：日本語   出版者・発行元：(公財)日本眼科学会  

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記述言語：日本語   出版者・発行元：(公財)日本眼科学会  

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記述言語：日本語   出版者・発行元：(公財)日本眼科学会  

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記述言語：日本語   出版者・発行元：(株)メディカル葵出版  

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記述言語：日本語   出版者・発行元：(公社)日本眼科手術学会  

背景:眼内レンズ(intraocular lens:IOL)モノビジョン法適応基準の一つに良好な裸眼視力が期待できることがある。近方設定眼に残存した角膜乱視が良好なモノビジョンを妨げ、トーリックIOL(T-IOL)に交換した症例を経験した。症例:59歳、女性。2004年、糖尿病合併症精査目的の初診から網膜症を認めず、徐々に進行した白内障に手術を施行した。両眼とも目標屈折は近方設定を計画し、2010年10月左眼に単焦点IOL(HOYA社251)を目標屈折-2.04Dで挿入したが、左眼術後に右眼は遠方設定のモノビジョン法を希望したため、右眼cyl-1,64D Ax6°の角膜乱視にT-IOL(Alcon社SN6A T3)を目標屈折-0.57Dで挿入した。術後右眼0.5×T-IOL(0.9×sph-0.5D)、左眼0.04×IOL(0.8×sph-2.0D cyl-2.0D Ax180°)で、両眼裸眼視力は遠見0.6、近見0.6のモノビジョンに満足したが、術後3ヵ月に左眼0.1×IOL(0.9×sph-1.75D cyl-1.5D Ax165°)、近見左眼0.5(0.8×sph+1.25D cyl-1.5D Ax165°)で左眼の近方視に不満を呈した。トーリックソフトコンタクトレンズを用いた乱視矯正により改善が得られ、乱視の追加矯正としてT-IOLへの交換を希望したため、初回手術から4.5ヵ月後にT-IOL(Alcon社SN6A T5)に目標屈折-2.21Dで交換。右眼0.8×T-IOL(1.2×sph-0.5D)、左眼0.1×T-IOL(1.2×sph-2.5D)、両眼裸眼視力は遠見1.0、近見0.9、近方立体視40秒、夜間運転のみ眼鏡の良好なモノビジョンと高い満足が得られた。結論:IOLモノビジョン法の成功に乱視矯正は重要な一要素であった。術後目標屈折が近方設定の際にも、乱視矯正を配慮する必要がある。(著者抄録)

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記述言語：日本語   出版者・発行元：大道学館出版部  

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その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2014&ichushi_jid=J01556&link_issn=&doc_id=20140929460005&doc_link_id=%2Fam3daidc%2F2014%2F009109%2F005%2F1151-1157%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fam3daidc%2F2014%2F009109%2F005%2F1151-1157%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

記述言語：日本語   出版者・発行元：岡山赤十字病院医学雑誌編集委員会  

水晶体嚢真性落屑を伴った白内障手術を経験したので報告する。患者は84歳男性で、右眼の視力低下を主訴に来院した。水晶体前嚢から前方にセロファン様の透明な分離膜を認めた。手術は超音波乳化吸引術+眼内レンズ挿入術(PEA+IOL)を施行した。水晶体嚢真性落屑例に対する白内障手術では連続環状嚢切開(CCC)時に前嚢の最表層のみを切除してしまい、残存前嚢に気付かずに、以後の手術操作を行うことで、チン小帯断裂や破嚢、核落下などの術中合併症を起こす可能性がある。今回、我々は、CCCを行う前後で水晶体前嚢をブリリアントブルーG(BBG)で染色することで前嚢の視認性を向上させ、安全にCCCを施行することができた。水晶体嚢真性落屑を伴った白内障手術では、水晶体前嚢を複数回BBGで染色し、確認することが有用であると考えられる。(著者抄録)

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記述言語：日本語   出版者・発行元：岡山赤十字病院医学雑誌編集委員会  

当科における2007年から6年間の白内障手術の推移と取り組みを検討した。全白内障手術4,235件中、超音波乳化吸引術(PEA)で行えたのが98%、水晶体嚢外摘出術や眼内レンズ(IOL)毛様溝縫着術は1.6%であった。2009年10月から角膜正乱視に対する乱視矯正用IOLを導入し、20%前後に挿入していた。調節力消失に対しては単焦点IOLによるモノビジョン法を3.8%に行い、満足度平均84%で、約6割が眼鏡装用から解放されていた。IOL偏位や脱臼に伴う摘出と縫着症例も多かった。通常の白内障手術においても、紹介患者の多い当科では実際には難症例も多く、今後更に高いQuality of visonへの要求が高まる白内障手術において、スタッフ(特に視能訓練士)の増員と設備・機器の充実が不可欠である。(著者抄録)

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記述言語：日本語   出版者・発行元：(株)医学書院  

目的:眼内レンズ(IOL)を毛様溝に縫着した症例群の報告。対象:過去52ヵ月間に白内障手術を行った3,055眼のうち,水晶体脱臼は35眼(1.1%)にあり,17例19眼にIOL毛様溝縫着をした。縫着が必要になった原因は,偽落屑症候群7眼,医原性5眼,外傷3眼,アトピー性皮膚炎2眼,Marfan症候群2眼である。結果:術後平均26ヵ月での視力は全例で良好であった。平均-0.71Dの屈折ずれがあった。角膜惹起乱視は,強角膜切開幅が7〜12mmの7眼では平均1.38D,3〜4mmの12眼では0.65Dであり,有意差があった(p=0.047)。角膜内皮減少率は平均11.8%で,前半の10眼では17.7%,後半の9眼では5.2%であり,有意差があった(p=0.029)。虹彩捕捉の合併が13眼中4眼にあり,これ以後の6眼では周辺部虹彩切除術を予防的に行ったが,1眼では再発を繰り返した。結論:水晶体脱臼へのIOL毛様溝縫着術は比較的小切開創で惹起乱視が減少し,周辺部虹彩切除術の併施で虹彩捕捉が予防できた。(著者抄録)

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その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2013&ichushi_jid=J01537&link_issn=&doc_id=20130410010019&doc_link_id=10.11477%2Fmf.1410104672&url=https%3A%2F%2Fdoi.org%2F10.11477%2Fmf.1410104672&type=%88%E3%8F%91.jp_%83I%81%5B%83%8B%83A%83N%83Z%83X&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00024_2.gif

記述言語：日本語   出版者・発行元：岡山赤十字病院医学雑誌編集委員会  

白内障手術による調節機能消失への対応策としての単焦点眼内レンズによるモノビジョン法について、当院での成績を検討する。対象は2010年10月より両眼の白内障手術時に眼内レンズによるモノビジョン法を施行した19例。遠用に設定した優位眼の屈折は-1.00±0.41Dと近視で、左右の屈折差は1.82±0.71Dであった。近視設定でも優位眼の遠方単眼裸眼視力は平均0.7と良好で、遠方両眼裸眼視力は0.8と両眼加算があった。近用に設定した非優位眼の近方単眼裸眼視力は平均0.8で、近方両眼裸眼視力も0.8と良好であった。慎重な適応選択は必要だが、良好な視力成績が得られていた。(著者抄録)

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記述言語：日本語   出版者・発行元：岡山赤十字病院医学雑誌編集委員会  

今回、白内障手術時の眼内レンズによるモノビジョン法施行者のアンケートと術後他覚的視機能評価との関係を検討したので報告する。対象は2010年10月より両眼の白内障手術時に眼内レンズによるモノビジョン法を施行した19例。近見立体視は術後屈折の左右差に関わらず平均55.3秒と良好に保たれていた。術前屈折と満足度評価点の関係は、左右が同じ屈折異常(両眼遠視、両眼正視、両眼近視)で、近視では屈折に左右差がある方が満足度が高かった、術後屈折は左右差が大きい(2.0D以上)方が小さい(1.75D以下)よりもピントが合いやすく、左右のバランスも良かった。ピントの合いやすいと評価した症例は若い傾向にあった。(著者抄録)

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記述言語：日本語   出版者・発行元：岡山赤十字病院医学雑誌編集委員会  

今回、白内障手術時の眼内レンズによるモノビジョン法を施行した症例にアンケートを行い自覚的満足度を調査したので報告する。対象は2010年10月より両眼の白内障手術時に同法を施行した19例。眼鏡をかけない遠方の見え方には約6割が満足し、近方の見え方には約8割が満足していた。遠方から近方への動的ピントの合いやすさ、左右のバランスには約6割が満足していた。眼鏡は19例中11例(58%)が使用せず、眼鏡をかける8例でもよくかけるのは4例のみであったが、遠近両用眼鏡をよくかける2例の満足度評価点は低かった。65歳以上群では眼鏡装用率が20%と低く、満足度評価点も高い傾向にあり、本法は高齢者でよりよい適応になりえた。眼内レンズによるモノビジョン法は白内障手術後の調節力消失対策に有効な手段だが、症例の選択と術後屈折値の設定には十分な検討を要した。(著者抄録)

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記述言語：日本語   出版者・発行元：(株)医学書院  

目的:外傷性水晶体脱臼に対する手術後の眼圧と視力の経過の報告。対象と方法:2011年2月までの38ヵ月間に,外傷性水晶体脱臼に対して,硝子体手術と水晶体切除を施行した9例9眼を対象とした。脱臼の原因は急性期6眼(作業中5眼,交通事故1眼)と慢性期3眼(ボクシング,アトピー,転倒各1眼)で,脱臼の状態は完全脱臼4眼と亜脱臼5眼で,両群に眼内レンズ脱臼が各1眼あった。結果:8〜46ヵ月(平均20ヵ月)の経過観察で,全例に良好な最終視力を得た。3眼(33%)で手術前後を通じ高眼圧で,2眼(22%)は術後に低眼圧が生じ,これら5眼は隅角の損傷が90°以上の範囲にあり,虹彩離断または鋸状縁断裂があった。術後の眼圧管理にはピロカルピン点眼が有効なものもあった。虹彩離断に対しては,虹彩つきソフトコンタクトレンズ装用も有効であった。結論:外傷性水晶体脱臼では,術後の眼圧管理が重要である。(著者抄録)

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記述言語：日本語   出版者・発行元：広島市立広島市民病院  

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記述言語：日本語   出版者・発行元：広島市立広島市民病院  

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記述言語：日本語   出版者・発行元：岡山赤十字病院医学雑誌編集委員会  

平成23年1月から6月までに眼科で通院手術をした60眼の満足度について、アンケート調査し、問題点を検討した。アンケートの回収率は60眼中55眼(91.7%)。男性22眼、女性33眼。42〜90歳(平均71.4歳)。術前・術日当日の説明は、9割前後が解りやすかったと感じていたが、外来スペースで行う術前準備は、普通回答を含めて4人に1人が落ち着けなかったと回答。手術まで外来待合に座っての待機が快適だと感じたのは53%と最も低く、待ち時間が長いなどの理由で、普通36%を含めて5割弱は快適ではなかったと回答。手術後、中央処置室での安静は、休めなかったが最多の20%に上り、普通と合わせて4割弱が安静に休めなかったと回答。7割が通院手術専用スペースの必要性を感じていた。要望や意見は、我々の対応や術前後の流れを客観的に振り返る良いきっかけとなった。社会のニーズである通院手術で、設備面での対応も求められる。今後は出来ることから改善し、通院手術でも快適に受けられる医療を提供していきたい。(著者抄録)

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記述言語：日本語   出版者・発行元：岡山赤十字病院医学雑誌編集委員会  

緑内障に対するマイトマイシンC(以下MMC)併用線維柱帯切除術(以下LET)の手術成績について、2007年5月から2011年3月の連続症例27例32眼を後ろ向きに検討した。血管新生緑内障(以下NVG)以外の緑内障(A群)26眼とNVG(N群)6眼に分け、平均眼圧経過と、目標眼圧を20mmHg、15mmHg、12mmHgとしたKaplan-Meier生命表分析法による眼圧生存率を算出し、術後合併症、追加処置も検討した。A群の術前平均眼圧は29.9±12.6mmHg(点眼スコア4.3±1.3点)、術後最終受診時は11.2±4.9mmHg(同0.65±1.3点)、N群は術前34.7±7.8mmHg(同2.8±1.6点)、失明した1眼以外の最終受診時12.6±6.3mmHg(同2.2±2.4点)となっていた。12ヵ月後の生存率は目標眼圧20、15、12mmHg以下でA群がそれぞれ84.6%、76.9%、61.5%。N群では66.7%、50.0%、50.0%だった。早期房水漏出が4眼と比較的多く、結膜縫合追加を要していた。当院でも最終的には比較的良好な結果が得られていた。(著者抄録)

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記述言語：日本語   出版者・発行元：(株)医学書院  

目的:悪性腫瘍の治療中にサイトメガロウイルス網膜炎が発症した症例の報告。症例:80歳男性が右眼の視力低下で受診した。6年前に前立腺癌と診断され,ステロイドと抗癌薬の投与を受けていた。所見:矯正視力は右0.8,左0.7で,網膜出血と滲出斑が両眼の中間周辺部にあった。前房水からサイトメガロウイルスが検出され,サイトメガロウイルス網膜炎と診断した。ガンシクロビル硝子体内投与などで寛解した。4ヵ月後に左眼に網膜剥離が生じ,シリコーンオイルを併用した輪状締結で網膜は復位した。発症から22ヵ月後の現在,右0.8,左0.3の視力を維持している。結論:抗癌治療中で免疫低下状態にある高齢者での視力低下では,サイトメガロウイルス網膜炎の可能性がある。(著者抄録)

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記述言語：日本語   出版者・発行元：広島市立広島市民病院  

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記述言語：日本語   出版者・発行元：(株)メディカル葵出版  

今回、光干渉断層計(OCT)により黄斑外層に小さい裂隙を認めるmacular microholeを経験した。53歳女性が左眼の見えにくさを自覚して受診した。検眼鏡では中心窩に黄色の輪状変化を認めた。Spectral-domain OCTで網膜内層面の平坦化と網膜外層に小さい裂隙を認めた。経過観察により網膜外層の裂隙は消失し自覚症状は改善した。硝子体牽引の減少により自然寛解したmacular microholeと診断した。今回の症例にみられたmacular microholeは黄斑円孔と同様に硝子体の牽引が関与した疾患であると考える。(著者抄録)

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その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2011&ichushi_jid=J01784&link_issn=&doc_id=20110222260026&doc_link_id=%2Fah9atgke%2F2011%2F002802%2F028%2F0297-0299%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fah9atgke%2F2011%2F002802%2F028%2F0297-0299%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

記述言語：日本語   出版者・発行元：広島医学会  

75歳女。視力低下を主訴とした。矯正視力は右眼0.6・左眼0.01で、左眼眼底の上方から耳側にかけて胞状の網膜剥離を認めた。白内障手術後に硝子体手術を行い、黄斑部から離れたとことで後部硝子体膜を切除中、突然に中心窩より網膜下液が噴出して網膜剥離は平坦となり、黄斑円孔が観察された。0.25%インドシアニングリーンを黄斑部に散布し、円孔周囲の内境界膜の剥離を行った。液空気置換を行い、光凝固後に眼内に20%SF6を充填した。術後網膜は復位し、黄斑円孔は認めないが、中心窩網膜の薄化を認めた。術後3ヵ月に視力矯正は左眼0.15となり、変視症は残存するが中心暗点は自覚していない。

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記述言語：日本語   出版者・発行元：広島医学会  

73歳男性。患者は左眼の中心暗点の出現で受診なった。視力は右0.1、左0.06で、眼圧は右16mmHg、左15mmHgであった。前眼部に異常はなく、前房内や硝子体内に炎症は認められなかったものの、左眼眼底後極には2.5乳頭径大の漿液性網膜剥離の内部に1乳頭径大の網膜色素上皮剥離(PED)が認められた。また、フルオレセイン蛍光眼底撮影(FA)ではPEDの鼻側縁に時間とともに拡大する蛍光漏出が確認された。一方、光干渉断層計(OCT)ではFAでの漏出点に一致した場所の網膜色素上皮に裂隙とmicroripが認められたが、周囲の色素上皮層の肥厚は明らかでなかった。以後、治療として光凝固や光線力学的療法は行わず経過観察としたが、1ヵ月経過で自覚症状は改善し、2ヵ月経過では暗点の自覚症状は消失、OCTでも漿液性網膜剥離はわずかとなり、最終的に患者は来院しなくなった。

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記述言語：日本語   出版者・発行元：眼科臨床紀要会  

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記述言語：日本語   出版者・発行元：(株)医学書院  

目的:化学療法により寛解したのち,眼と脳に再発した悪性リンパ腫に大量メトトレキサート療法が奏効した症例の報告。症例と所見:71歳女性が5ヵ月前からの左眼霧視で受診した。18ヵ月前に悪性リンパ腫が頸部に発症し,化学療法で寛解していた。矯正視力は右0.5,左手動弁で,左眼に硝子体混濁,両眼に網膜滲出斑があった。左眼の硝子体生検で悪性リンパ腫と診断した。放射線療法で左眼の病変は軽快したが,1ヵ月後に右眼に硝子体混濁が生じ,視力が0.07に低下した。同時期に脳内転移が発見された。大量メトトレキサート療法で右眼と脳内病変は寛解し,7ヵ月後に右眼視力は0.4に改善した。結論:眼内と脳に転移した悪性リンパ腫に対し,大量メトトレキサート療法が有効であった。(著者抄録)

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