A case of iridoschisis associated with lens displacement into the vitreous cavity

We report the case of a 67-year-old woman with a lens that was displaced into the vitreous cavity in one eye and ipsilateral iridoschisis. She was free from a history of ocular trauma or of heritable ocular disease. Her best-corrected visual acuity was 1.2 bilaterally and right eye showed signs of iridoschisis. The corneal endothelial cell density decreased to 1,263 cells/mm2 in the right eye preoperatively. We speculated that iris tissue flowing in the anterior chamber might have intermittently touched the corneal endothelium. 25-gauge pars plana vitrectomy and lens removal were performed immediately. Free-floating iris tissue was cut during surgery with care not to injure the corneal endothelial cells. The postoperative progress was satisfactory and scleral fixation of an intraocular lens is planned. Iridoschisis is an uncommon cause of lens displacement into the vitreous cavity

Scleral fixation of foldable acrylic intraocular lenses in aphakic post-vitrectomy eyes

Tetsuya Mutoh, Yukihiro Matsumoto, Makoto ChikudaDepartment of Ophthalmology, Dokkyo Medical University Koshigaya Hospital, Koshigaya, Saitama, JapanPurpose: To evaluate the outcome for scleral fixation of a foldable acrylic intraocular lens (IOL) in aphakic post-pars plana vitrectomy eyes for vitreoretinal disease.Methods: The medical records of 15 patients were reviewed. We evaluated such factors as the underlying vitreoretinal disease, preoperative expected refraction and postoperative actual refraction, best corrected visual acuity (BCVA), corneal endothelial cell density, and intraoperative and postoperative complications.Results: The most common cause of underlying vitreoretinal disease was retinal detachment, which was found in 8 cases. The mean refractive error was -0.10 diopters (D). The mean minimum angle of resolution (logMAR) values of BCVA were 0.27 preoperatively and 0.14 postoperatively. The mean corneal endothelial cell density was 2400 cells/mm2 preoperatively and 2187 cells/mm2 postoperatively. No significant differences were observed in either the logMAR values of BCVA or the corneal endothelial cell density before and after surgery. No intraoperative complications occurred in any of the patients. Postoperative complications occurred in a total of 7 eyes, and the most severe complications comprised 4 cases of transient ocular hypertension.Conclusion: The results for the scleral fixation of foldable acrylic IOLs were good in aphakic post-vitrectomy eyes.Keywords: scleral fixation, intraocular lens, aphakic post-pars plana vitrectomy eyes, severe vitreoretinal diseas

Relationship between Pentosidine and Pyridinoline Levels in Human Diabetic Cataract Lenses

The relationship between the levels of two different crosslink compounds, pentosidine and pyridinoline, in human diabetic cataract lenses was investigated to elucidate the pathogenic mechanism of diabetic cataract. Subjects were classified into diabetes mellitus (DM) group and non-DM group according to the presence or absence of DM. The levels of the crosslink compounds were determined using high-performance liquid chromatography and spectrofluorometry after acid hydrolysis. In the non-DM group the pentosidine level was significantly and positively correlated with the pyridinoline level and age. In the DM group the pentosidine level was not significantly correlated with either pyridinoline level or age. Pyridinoline levels and age were not significantly correlated in either group. The increase in crosslink compounds due to glycation and the relationship between the compounds are changed in DM lenses

Photorefractive keratectomy: measuring the matrix metalloproteinase activity and chondroitin sulfate concentration in tear fluid

We herein report the case of a 20-year-old man who underwent a photorefractive keratectomy (PRK). We measured matrix metalloproteinase-9 (MMP-9) activity and chondroitin 4 sulfate and chondroitin 6 sulfate concentrations in tear fluid. Tear fluid was collected pre-operatively via microcapillary tube, and was collected postoperatively on the first and fourth days, and after one week, one month, three months, and six months. Samples were formulated by dilution with 200 μL of saline. MMP-9 activity was analyzed by an enzyme immunocapture activity assay, and the concentrations of chondroitin sulfate were analyzed by enzyme-linked immunosorbent assay. No complications were observed after surgery, except for a minimal subepithelial haze. Although MMP-9 activity changed on the fourth postoperative day, the activity changed only minimally at this time. Chondroitin 4 sulfate concentrations in tear fluid increased dramatically from one week to one month, decreased transiently at three months, and increased by six months. The chondroitin 6 sulfate concentration did not normalize within one week, and decreased from one week to three months compared with the preoperative score, and was close to the preoperative score at six months. We conclude that corneal wound healing was still incomplete six months after PRK, and chondroitin 4 sulfate appears to be critical in this process

Case of bilateral complete posterior dislocation of lens caused by elder abuse

We report a case of bilateral complete dislocation of lenses into the vitreous cavities due to elder abuse in a patient with senile dementia. According to the patient’s son, bilateral complete lens dislocation occurred after he hit his father in the head with socks in order to control his violent behavior. Although the patient was taken to our ophthalmological ward for a planned vitrectomy, restlessness and inability to remain in his room during the night led to his leaving the hospital. The patient has not returned but did receive a vitrectomy at another clinic. While the number of patients with senile dementia has dramatically increased, no specific remedy is currently available. When treating medical concerns of seniors with unknown backgrounds, elder abuse needs to be considered as a potential cause of such injuries

Increased Corneal Thickness and Associated Factors After Laser in situ Keratomileusis

The aim of this study is to investigate changes in central corneal thickness (CCT) and to detect any associated factors after laser in situ keratomileusis (LASIK). The charts of 46 patients who had undergone bilateral LASIK were retrospectively reviewed. The postoperative changes in CCT were measured until 6 months postoperatively and the relation between CCT increases and other clinical factors was investigated. The factors analyzed were age, gender, preoperative CCT, ablation depth, ablation ratio, refractive regression, and development of diffuse lamellar keratitis (DLK). The CCT significantly increased from 1 week to 6 months postoperatively. Age, preoperative CCT, refractive regression, and development of DLK were not correlated with increased CCT. The CCT increase was greater in women than in men. The ablation depth and the ablation ratio were significantly positively correlated with increased CCT (r=0.544, P<0.0001 and r=0.539, P<0.0001, respectively). The increase in CCT was greater in corneas that underwent more tissue ablation. Accurate CCT evaluation is important for LASIK enhancement to avoid the postoperative keratectasia by overestimating the corneal pachymetry

ハクナイショウ ガラス タイ ドウジ シュジュツ ニヨリ ショウジタ モウマクコウ ショウガイ ト カンガエラレタ 1レイ

白内障硝子体同時手術により生じた網膜光障害と考えられた1 例を経験した.患者は63 歳,女性.術前右視力(0.4)で,右白内障および網膜前膜に対してインドシアニングリーン(ICG)染色をせずに網膜前膜&#21085;離術を併用し,白内障硝子体同時手術を行った.術翌日から後極血管アーケード内,中心窩下方に黄白色の網膜浮腫を生じた.網膜浮腫は次第に吸収され,術後4 か月で右視力(1.0)に改善した.原因として術後蛍光造影所見から顕微鏡やライトガイドによる網膜光障害と考えた.白内障および網膜前膜に対する白内障硝子体同時手術の際にICG 染色をしなかったにも関わらず網膜光障害が生じることがあり,注意する必要がある.We experienced a case of light induced retinopathy,which we thought, was caused by combined cataract andpars plana vitrectomy.The patient was a 63-year-old woman, her preoperativebest corrected visual acuity was 0.4. During the combinedcataract and pars plana vitrectomy, epiretinal membranepeeling was performed without using indocyanine green(ICG). Yellow-white retinal edema appeared at the inferiorto central fovea in the vascular arcade area at postoperativeday 1, and it was absorved gradually. Four monthspostoperatively, the best corrected visual acuity improvedto 1.0.We considered that the main cause was light inducedretinopathy from the postoperative fluorescein angiography.We need to care because there is a case of light inducedretinopathy during combined cataract and pars plana vitrectomyin spite of not using ICG

ガンカ センタン ショウコウグン ト ドウメイ ハンモウ オ キタシタ 82サイ ジョセイレイ

緒言:眼窩先端症候群をきたし,さらに内頸動脈海綿静脈洞瘻に続発した静脈性梗塞と診断された1 例を報告する.症例:複視,右視力低下,右眼の結膜充血と眼球突出を自覚するも原因精査を受けなかった82 歳女性.3 年後に脳梗塞を発症して内頸動脈海綿静脈洞瘻carotid-cavernous sinus fistula(以下CCF)による静脈性梗塞と指摘された症例.右側頭葉の静脈性梗塞により左眼の耳側半盲をきたした.CCF に続発した脳出血,脳梗塞,脳浮腫などいわゆるaggressive feature を呈することはまれである.結論:眼窩先端部の疾患では眼科,脳神経外科ともに連携して診断・加療をしていくことが重要である.We reported a patient with orbital apex syndrome caused by CCF, followed by cerebral venous infarction. A82-years-old woman presented with diplopia associated with visual loss, conjunctival congestion and proptosis in the right eye. She had not received thorough examinations until she had stroke caused by CCF 3 years later. She also showed temporal hemianopia in the left eye associated withright temporal lobe venous infarction. CCF rarely exhibited cerebral disturbances called `aggressive feature\u27 such as cerebral hemorrhage, infarction and edema. Collaborative approach by ophthalmology and neurosurgery is important to evaluate the patients with orbital apex syndrome

ハクナイショウ シュジュツ ゴ 10ネン オ ケイカ シテ ガンナイエン ガ ハッショウ シタ Wernerショウコウグン ノ 1ショウレイ

Werner 症候群は老人様顔貌,強皮症様皮膚変化,若年性白内障を特徴とする疾患である.発症は100 万人あたり3～45 人とされている.今回,われわれは白内障術後10 年以上経過したにも関わらず強膜創の閉鎖不全が感染の原因と考えられる眼内炎の症例(41 歳,男性)を経験した.Werner 症候群には白内障を合併することが多く,術後も創傷治癒は遅延しやすいため感染のリスクが高い.眼科的な長期の経過観察が必要と考えた.Werner syndrome is a disease characterized by scleroderma-like skin changes, aging face and juvenile cataract.The prevalence is reported to be 3 to 45 cases per millionpopulation. We experienced a 41- year- old male) patientwith endophthalmitis which was considered to be caused bythe unhealed sclera wound and onset more than 10 yearsafter cataract surgery. The high risk of infection may bedue to the conbination of the high incidence of cataract anddelayed wound healing in Werner syndrome. A long-termophthalmic observation is considered to be necessary