Endoscopy-guided vitreoretinal surgery following penetrating corneal injury: a case report

Motoko Kawashima1, Shinichi Kawashima2, Murat Dogru1,3, Makoto Inoue4, Jun Shimazaki1,51Department of Ophthalmology, Tokyo Dental College, Chiba, Japan; 2Department of Ophthalmology, International University of Health and Welfare, Tokyo, Japan; 3Department of Ocular Surface and Visual Optics, Keio University School of Medicine, Tokyo, Japan; 4Kyorin Eye Center, Tokyo, Japan; 5Department of Ophthalmology, Keio University School of Medicine, Tokyo, JapanIntroduction: Severe ocular trauma requires emergency surgery, and a fresh corneal graft may not always be available. We describe a case of perforating eye injury with corneal ­opacity, suspected endophthalmitis, and an intraocular foreign body. The patient was successfully treated with a two-step procedure comprising endoscopy-guided vitrectomy followed by corneal transplantation. This surgical technique offers a good option to vitrectomy with simultaneous keratoplasty in emergency cases where no graft is immediately available and there is the ­possibility of infection due to the presence of a foreign body.Case presentation: A 55-year-old Japanese woman was referred to our hospital with a ­perforating corneal and lens injury sustained with a muddy ferrous rod. Primary corneal sutures and lensectomy were performed immediately. Vitreoretinal surgery was required due to ­suspected endophthalmitis, vitreous hemorrhage, retinal detachment, dialysis and necrosis of the peripheral retina. Instead of conventional vitrectomy, endoscopy-guided vitreous surgery was performed with the Solid Fiber Catheter AS-611 (FiberTech, Tokyo, Japan) due to the presence of corneal opacity and the unavailability of a donor cornea. The retina was successfully attached with the aid of a silicon oil tamponade. Following removal of the silicon oil at 3 months after surgery, penetrating keratoplasty and intraocular lens implantation with ciliary sulcus suture fixation were performed. At 6 months after penetrating keratoplasty, the graft remained clear and visual acuity was 20/40.Conclusion: Primary endoscopic surgery for vitreoretinal complications in eyes with perforating injury performed prior to penetrating keratoplasty appears to be advantageous in terms of avoiding damage to the corneal endothelium.Keywords: vitreoretinal surgery, emergency, foreign bod

ホウモン カンゴシ ノ リハビリテーション カンゴ ニ カンスル ブンケン ケントウ

背景 わが国の高齢化率は2012年23.3%と年々上昇傾向にある.急速な高齢化の進展に伴い,介護保険サービスに対するニーズは増大しつつあり,中でもリハビリテーションのニーズは高い.そこで,リハビリテーションに特化した専門職ではない訪問看護師に着目し,在宅におけるリハビリテーションの実施状況について調査した.目的 本研究は訪問看護師が提供しているリハビリテーションの内容と現状を,これまでに報告された論文より明らかにすることを目的とした.方法 リハビリテーション看護の現状を読みとくために,1997年12月から2012年8月までに特定非営利法人医学中央雑誌に報告された4,399件の論考を精読した.結果 リハビリテーション看護に関する論文は,1997年から年々増加傾向にあり,当事者研究が少なく,ほとんどが看護師の実践報告であった.訪問看護師におけるリハビリテーションは,身体機能訓練を中心に実践されており,実施する看護師も訓練計画や評価に対して不安を抱いている現状が明らかになった.結論 訪問看護師が行うリハビリテーションは,健康問題や生活面をトータルにアセスメントし提供している.訪問看護師と理学療法士等の専門職とが協働していくことで,療養者の生活に則した質の高いリハビリテーションの提供が可能となる.Background Care preventive payment became the start in 2006,and,as for a lot of requests of the rehabilitation,needs is high in offer contents of the temporary nursing at home. Purpose This study was intended that I clarified it than an article reported contents and the present conditions of the rehabilitation that a visit nurse offered to so far. Method I read 4,399 studies that were reported to specific nonprofit undertaking corporation medicine center magazine by August,2012 from December,1997 I read,and to untie the present conditions of the rehabilitation nursing carefully. Result A tendency to increase included the article about the rehabilitation nursing year by year from 1997, and there were few person concerned studies,and most were the practice reports of the nurse,and the rehabilitation in the visit nurse was practiced mainly on body function training,and the present conditions that the nurse who carried it out held uneasiness in for training program and an evaluation became clear. Conclusion An offer of the high quality rehabilitation that met the life of the person of medical treatment because I make assessment for total,and the rehabilitation that a visit nurse performs provides a health problem and an aspect of living,and the employment such as a visit nurse and the physical therapist collaborates is enabled

ホウモン カンゴ ケイケン ネンスウ ガ オヨボス リハビリテーション カンゴ ジッシナイヨウ ヘノ エイキョウ

背景 訪問看護師はリハビリテーション看護において, 自らの実施内容に不安を持っている. しかし, 一般的に看護師の経験年数が5年以上の者は, セルフエフィカシーが高いことから, 経験年数が実施内容に影響を及ぼしていると考えられる. これまで, 訪問看護師の経験年数によるリハビリテーション看護における実施内容は明らかにされていない. 目的 訪問看護師経験年数が及ぼすリハビリテーション看護の実施内容への影響を明らかにする. 方法 訪問看護師を対象に半構成的面接を実施し, 内容分析を行った. 分析にあたっては, 3名の看護研究者で行い, 妥当性の担保に努めた. 結果および考察 対象者は, 訪問看護師の経験年数5年未満の5名と5年以上の5名の計10名であった. カテゴリー, サブカテゴリーの数は, 5年未満8カテゴリー, 25サブカテゴリー, 5年以上9カテゴリー, 29サブカテゴリーであった. 共通する実施内容は,【心身の状態に合わせたリハビリを判断する】【療養者のニーズを把握する】【リハビリを継続できるように支援する】【身体機能低下の予防や, 維持向上の訓練を実施する】【家族への支援を行う】【環境を整える】【精神的な支援をする】であった. 特徴として, 5年未満は, 【他職種と連携する】, 5年以上は【多職種と協働する】【生活意欲を向上させる】が抽出された. 結論 5年未満は【他職種と連携する】し, 5年以上は,【生活意欲を向上させる】【多職種と協働する】ことで経験年数が長いほど訪問看護師として自律した実施内容を実施していた.Background Home-visiting nurses feel anxious about performing the self-practice aspect of rehabilitation nursing. However, because nurses with more than 5 years of experience generally have high self-efficacy, it is thought that the number of years\u27 experience they have affects their practice content. To date, practice content according to the number of years\u27 experience held by home-visiting rehabilitation nurses is not well understood.Objectives To determine the effect of the number of years\u27 experience held by home-visiting nurses on the practice content of rehabilitation nursing.Methods A semi-constitutive interview was conducted with home-visiting nurses as subjects of the study, followed by content analysis. An analysis was conducted by 3 nurse-researchers in order to ensure the validity of the study.Results / Discussion The subjects were 5 nurses with less than 5 years\u27 and 5 nurses with more than 5 years\u27 home-visiting nursing experience. There were 8 categories and 25 subcategories extracted for nurses with less than 5 years\u27 experience, and 9 categories and 29 subcategories extracted for nurses with more than 5 years\u27 experience. The common practice contents included creating 【rehabilitation judgment adjusted to mental and physical state】,【understanding the needs of the patient】,【providing support to allow for continuous rehabilitation】, 【prevention of reduced bodily function and practice of maintenance improvement training】,【providing support for family】,【creating a good environment】, and【providing psychological support】. With respect to characteristics,【collaborating with other medical professionals】was extracted for nurses with less than 5 years\u27 experience, while【collaborating with multiple colleagues】and【improving life motivation】were extracted for nurses with more than 5 years\u27 experience

Association between tear film break up time and blink interval in visual display terminal users

AIM: To investigate the association between tear film break up time (TBUT) and blinking interval in visual display terminal (VDT) users. METHODS: Nine hundred and thirty VDT users underwent dry eye testing, and functional visual acuity (FVA) test. The blinking interval during FVA was compared with TBUT. Subjects with longer blinking interval than TBUT were considered as unstable tear film. Logistic regression analysis revealed the risk factors for unstable tear group. RESULTS: Among 930 workers, 858 subjects (92.3%) participated in this study. Almost 80% of the subjects were categorized into the unstable tear group. Unstable tear group has significantly lower Schirmer values and TBUT (17.5±11.6 vs 21.1±11.5 mm, 3.7±2.6 vs 5.7±2.7s, both P<0.001). There were no significant differences in epithelial staining or severity of symptoms. Logistic regression showed that over 40y was a risk for being unstable tear group [odds ratio (OR)=1.53; 95% confidence interval (CI)=1.06-2.20]. Contact lens use was protective factor for being in the unstable tear group (OR=0.37; 95%CI= 0.26-0.53). CONCLUSION: Subjects with shorter TBUT than blinking interval are prevalent among VDT users. Subjects over the age of 40 shows an increased risk for unstable tear film

Increased Tear Fluid Production as a Compensatory Response to Meibomian Gland Loss A Multicenter Cross-sectional Study

PurposeTo compare tear film parameters as well as meibomian gland morphologic features and function among patients with meibomian gland dysfunction (MGD), those with non–Sjögren syndrome aqueous-deficient dry eye (non-SS ADDE), those with non-SS ADDE and MGD, and normal subjects.DesignMulticenter, cross-sectional, observational case series.ParticipantsForty-one eyes of 41 patients (all women; mean age ± standard deviation, 62.1±9.9 years) with non-SS ADDE, 70 eyes of 70 patients (all women; 66.0±8.7 years) with MGD, 17 eyes of 17 patients (all women; 72.4±7.8 years) with non-SS ADDE and MGD, and 70 eyes of 70 normal control subjects (all women; 65.0±7.1 years).MethodsOcular symptoms were scored from 0 to 14 and lid margin abnormalities from 0 to 4 according to their respective number. Meibomian gland changes were scored from 0 to 6 (meiboscore) on the basis of noncontact meibography findings, and meibum was graded from 0 to 3 depending on its volume and quality. Conjunctival and corneal epithelial damage were scored from 0 to 9 (fluorescein score). Tear film break-up time (TBUT) was measured as an index of tear film stability, and tear fluid production was evaluated with Schirmer's test.Main Outcome MeasuresOcular symptom score, lid margin abnormality score, meiboscore, meibum grade, fluorescein score, TBUT, and Schirmer's test value.ResultsThe ocular symptom score did not differ significantly between the MGD and non-SS ADDE groups (P = 0.762). The lid margin abnormality score, meiboscore, and meibum grade were significantly higher in the MGD group than in the non-SS ADDE group (P = 0.0012, P < 0.0001, and P < 0.0001, respectively). The fluorescein score, TBUT, and Schirmer's test value were significantly worse in the non-SS ADDE group than in the MGD group (P < 0.0001, P = 0.0061, and P < 0.0001, respectively). The meiboscore correlated significantly with Schirmer's test value only in the MGD group (ρ = 0.508, P = 8.3×10−6).ConclusionsAn increase in tear fluid production likely compensates for loss of meibomian glands in individuals with MGD

Lamellar corneal injury by bamboo splinters: a case report

<p>Abstract</p> <p>Introduction</p> <p>We report an unusual case of corneal lamellar injury caused by long bamboo splinters.</p> <p>Case presentation</p> <p>A 70-year-old Japanese man visited our hospital with a bamboo injury. Slit lamp examination revealed that a bundle of bamboo splinters had deeply penetrated the corneal stroma of the right eye from the nasal limbus. The splinters were approximately 8 mm in length, but had not perforated the anterior chamber. They were completely removed by superficial corneal incision alongside each splinter with no consequences. The eye has remained healed for 3 months postoperatively.</p> <p>Conclusion</p> <p>The bamboo splinters did not perforate the anterior chamber, although they were long and hard enough to do so. This may be because the spatula-like shape and flexibility of the bamboo splinters allowed them to penetrate the lamellar layer of the corneal stroma with ease, but with no perforation of deeper tissue.</p

Arachidonic Acid Drives Postnatal Neurogenesis and Elicits a Beneficial Effect on Prepulse Inhibition, a Biological Trait of Psychiatric Illnesses

Prepulse inhibition (PPI) is a compelling endophenotype (biological markers) for mental disorders including schizophrenia. In a previous study, we identified Fabp7, a fatty acid binding protein 7 as one of the genes controlling PPI in mice and showed that this gene was associated with schizophrenia. We also demonstrated that disrupting Fabp7 dampened hippocampal neurogenesis. In this study, we examined a link between neurogenesis and PPI using different animal models and exploring the possibility of postnatal manipulation of neurogenesis affecting PPI, since gene-deficient mice show biological disturbances from prenatal stages. In parallel, we tested the potential for dietary polyunsaturated fatty acids (PUFAs), arachidonic acid (ARA) and/or docosahexaenoic acid (DHA), to promote neurogenesis and improve PPI. PUFAs are ligands for Fabp members and are abundantly expressed in neural stem/progenitor cells in the hippocampus. Our results are: (1) an independent model animal, Pax6 (+/−) rats, exhibited PPI deficits along with impaired postnatal neurogenesis; (2) methylazoxymethanol acetate (an anti-proliferative drug) elicited decreased neurogenesis even in postnatal period, and PPI defects in young adult rats (10 weeks) when the drug was given at the juvenile stage (4–5 weeks); (3) administering ARA for 4 weeks after birth promoted neurogenesis in wild type rats; (4) raising Pax6 (+/−) pups on an ARA-containing diet enhanced neurogenesis and partially improved PPI in adult animals. These results suggest the potential benefit of ARA in ameliorating PPI deficits relevant to psychiatric disorders and suggest that the effect may be correlated with augmented postnatal neurogenesis

High Myopia and Its Associated Factors in JPHC-NEXT Eye Study: A Cross-Sectional Observational Study

The increasing prevalence of high myopia has been noted. We investigated the epidemiological characteristics and the related factors of high myopia in a Japanese adult population. Japan Public Health Center-Based Prospective Study for the Next Generation (JPHC-NEXT) Eye Study was performed in Chikusei-city, a rural area in mid-east Japan, between 2013 and 2015. A cross-sectional observational analysis was conducted to investigate prevalence and related factors of high myopia. A total of 6101 participants aged ≥40 years without a history of ocular surgeries was included. High myopia was defined as a spherical equivalent refraction of ≤-6.00 diopters according to the American Academy of Ophthalmology. Potential high myopia-related factors included intraocular pressure (IOP), corneal structure, corneal endothelial cell density, age, height, body mass index, heart rate, blood pressure, biochemical profile, and current history of systemic and ocular disorders. The odds ratios of high myopia were estimated using the logistic regression models adjusted for the associated factors. The prevalence of high myopia was 3.8% in males and 5.9% in females with a significant difference. Age was inversely associated, IOP was positively associated, and none of other factors were associated with high myopia in both sexes. In conclusion, only age and IOP were associated with high myopia in this community-based sample