The electro-oculogram (EOG) in Vogt-Koyanagi-Harada\u27s disease

Purpose-To study the electro-oculogram (EOG) in Vogt-Koyanagi-Harada\u27s (VKH) disease. Methods-We measured the EOG and examined the influence of the extent of retinal detachment (RD) on the RPE in eight patients with VKH disease. The EOG was measured three times in each patient: before, one month after, and one year after systemic corticosteroid therapy. The ratio of light peak to dark trough (L/D ratio) was calculated. The EOG was also measured in normal controls. Results-The L/D ratio in VKH disease was 1.60 ± 0.25 before therapy, which was a significant (p< 0. 01) reduction compared with that in normal controls (2.04 ± 0.23). The L/D ratio in VKH patients with inextentsive RD (1.63) returned to the level of normal controls one year after therapy (2.02). On the other hand, the L/D ratio in the patients with extensive RD (1.55) was further reduced (1.32) one month after therapy and showed no return. Conclusion-EOG was severely and irreversibly damaged in case of VKH patients with extensive RD. Therefore the steroid pulse therapy has an adequacy in the treatment of those cases to suppress the inflammation and damage of RPE

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

Three Cases of Shaken Baby Syndrome without a History of Shaking

Three cases of Shaken Baby Syndrome (SBS) without a history of abusive shaking have been reported.The reason why SBS without intentional shaking as follows;case 1was throwing, case 2 was dropping, case3 was unknown. For all 3 reported cases, attending physicians suspected the SBS from the presence of subduralhematoma and fundus hemorrhage. All 3 cases occurred at home, and the parents had no knowledgeof SBS. After a detailed interview, the diagnosis of SBS without a history of intentional shaking was made.Although the mechanism in detail was unclear in 3 cases, these SBS may happen by the difference betweenacceleration and the deceleration during the throwing and dropping movement;similar to intentional shakingthat causes of common SBS.For subdural hematoma and fundus hemorrhage of unknown cause, it is important to conduct an interviewwith the possibility of unintentional SBS in mind, without the occurrence of abusive shaking. In addition,attention should be paid to both pediatrician and parents about the risk of SBS in the care of infant inthe everyday life

Comparison of Visual, Refractive and Aberrometic Outcomes of Intacs® Implant and Toric Implantable Collamer Lens (TICL) in Patients with Keratoconus: 4 Years Follow Up

Background: To assess the efficacy and clinical outcomes following the use of toric implantable collamer lens (TICL) and Intacs® implant in patients with mild keratoconus. Methods: This retrospective study evaluated 30 eyes of 30 patients with keratoconic and age of 25-35. These eyes were divided into group A (15 eyes), in which Visian Toric ICL™ was implanted, and group B (15 eyes), Intacs® implantation. The outcome and complications were evaluated. We assessed the visual, refractive, and aberrometric outcome in pre-operation and 6 month, and 1, 2, 3, and 4 year post-operation. Results: There was significant difference in the mean uncorrected and best corrected distance visual acuities between the groups (P < 0.01). An uncorrected distance visual acuity of 20/30 or better was achieved in 85% of eyes in the TICL group, and 20% of eyes in the Intacs® group; visual acuity of 20/20 or better in was seen in 80% and 15%, respectively. Intacs® implant produced a significant decrease in corneal refractive spherical equivalent and coma aberration (P < 0.01). Conclusion: Intacs® implant and TICL lens, both are useful, but it seems that the TICL is better and provides good visual and refractive outcomes; indicating that it is a more predictable procedure for refractive correction of keratoconus

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

MALT リンパシュ ノ ホウシャセン モウマクショウ ニ ハン モウマクコウ ギョウコ デ リョウコウ ナ ケッカ デアッタ ショウレイ

背景:MALT リンパ腫に対する放射線治療後,放射線網膜症を発症.最終視力1.2 と予後良好であった症例を経験したので報告する.症例:26 歳,男性.右眼涙嚢腫瘍のため近医眼科より当院眼科へ紹介となり受診.当院耳鼻科で腫瘍生検を施行しMALT リンパ腫の病理診断を受けた.その後,放射線治療(総照射量41.4 Gy)を施行された.放射線治療から約半年後,右眼に後極部を中心に軟性白斑が出現し黄斑浮腫も認められた.黄斑浮腫のため視力右0.5となったが網膜光凝固術を施行.その後黄斑浮腫が消退し視力右1.2 に改善した.結論:放射線治療の前後には眼底検査が必要であり,放射線網膜症が発生した際には網膜光凝固術含めた早期の対応が有効的であると考えられた.Background:report a case of satisfactory progress radiation retinopathy after radiation for MALT lymphoma Case Report:A 26-year-old male patient,referred to our department for lacrimal sac tumor. Biopsy was done by otolaryngologyand radiation therapy was performed (total irradiation of 41.4 Gy) as pathological examination revealedMALT lymphoma.Soft exudates and macula edema appeared in posterior pole of the right fundus after radiotherapy. Right vision became0.5 because of macula edema, and panretinal photocoagulation(PRP) was performed. After PRP, macula edema withdrew and right vision improved to 1.2.Conclusion:It is suggested that the fundus must be monitored after radiation therapy, and early treatment,such as PRP is effective in radiation retinopathy. keywordsMALT lymphoma, radiation retinopathy, PR

キョダイ レッコウ モウマク ハクリ ノ シュジュツ ケントウ

巨大裂孔網膜剥離9 例9 眼を過去4 年間に経験し,手術手技と成績について検討したので報告する.裂孔の大きさは180 度が2 眼,120 度が4 眼,100 度が1 眼,90 度が2 眼であった.全症例に初回手術として経毛様体扁平部硝子体手術(PPV)を行った.輪状締結術(EN)併用が7 眼で,液体パーフルオロカーボン(PFCL)を用いたものは6 眼,タンポナーデ物質はシリコーンオイル(SO)が5 眼,空気が4 眼であった.超音波水晶体乳化吸引術(PEA)を施行したものは7 眼であった.初回非復位例はPEA+PPV にEN 併用し,PFCL-空気置換した大きさ120 度の2 眼であり,網膜の後極へのずれ落ちを生じていた.網膜のずれ落ちは裂孔周囲の硝子体の切除やPFCL-空気置換の際に網膜下液の吸引が不十分な可能性があった.再手術としてPPVおよびPFCL-SO 置換で復位した.初回復位率は9 眼中7 眼(77.8%),最終復位率は9 眼中9 眼(100%)であった.術後合併症に網膜前膜が2 眼,一過性眼圧上昇が2 眼,後発白内障が1 眼あり,視力改善の妨げの要因になるので注意が必要であった.当院における巨大裂孔網膜剥離の手術成績はおおむね良好であった.We treated 9 patients with 9 giant retinal tears in the last 4 years. We report the surgical techniques used for these patients and the results of surgery.The size of the tear was 120 degrees in 4 eyes, 180 degrees in 2 eyes, 90 degrees in 2 eyes, and 100 degrees in 1eye. Pars plana vitrectomy(PPV)was performed as the primary surgery for all the patients. Encircling(EN)was performed for 7 eyes. Perfluorocarbon liquid(PFCL)was used for 6 eyes. Silicone oil(SO)was used as tamponadematerial for 5 eyes, and air tamponade was used for 4 eyes.Phacoemulsification and aspiration(PEA)was used for 7eyes. Retinal attachment was unsuccessful for 2 eyes where surgery was combined with PEA, PPV, EN and PFCL-airreplacement. This led to a shift down to the posterior pole of the retina. The shift down of the retina was possibly caused by removal of the vitreous around the tears and inadequateaspiration of subretinal fluid during PFCL-air exchange.PPV and PFCL-SO replacement were performed as the second surgery. The retina could be reattached in 7 of9(77.8 %)eyes for the primary surgery. The final retinalreattachment rate was 100%.After the primary and second surgery, epimacular membranesdeveloped in 2 eyes, transient intraocular pressureincrease was noted for 2 eyes, and posterior capsule opacificationwas noted in 1 eye. Our results indicate that surgeonsshould be careful about postoperative complicationsthat affect visual prognosis.The surgical results at our hospital for giant retinal tearswere almost good

レッコウ ゲンセイ モウマク ハクリ ニ タイスル ジュツシキ センタク

目的:獨協医科大学越谷病院眼科の裂孔原性網膜剥離に対する手術成績を報告する.対象:平成17年1月から12月までの1年間に当科で初回手術を施行した裂孔原性網膜剥離101例102眼.結果:強膜内陥術施行群(50眼)では,初回で40眼(80%)が復位し,最終的には全例で復位した.硝子体手術施行群(47眼)では,初回で44眼(93.6%)が復位し,最終的には全例で復位した.気体網膜復位術施行群(5 眼)では初回で全例が復位した.全体では初回復位例は102眼中89眼(87.2%)であり,最終的には102眼全例が復位した.結論:術前・術中の裂孔部位の詳細な観察と把握は,より適切な術式選択を可能とし,初回復位率の向上につながる.PURPOSE:We studied surgical results of rhegmatogenousretinal detachment in our institution. PATIENTS:Weperformed surgery on 102 eyes from 101 patients. RESULTS:The primary retinal reattachment rate was 80.0% in the scleral buckling,and 93.6 % in the vitrectomy,and100 % in the peumatic retinopexy. The final retinal reattachmentrate with further surgery was 100 % in the scleralbuckling,and 100 % in the vitrectomy. The reattachmentrate primary in all was 87.2 %. The final retinal reattachmentrate with further surgery was 100 %. CONCLUSION:An adequate observation of retinal lesion causingthe break during preoperation and postoperattion can helpin selection of the surgical procedure appropriate to treatretinal detachment to produce better surgical results