第1084回千葉医学会例会・第21回千葉精神科集談会

<p>The comparison of the successful 2^nd operated eyes versus failed 2^nd operated eyes among successful 1^st operated eyes, Criterion C: n = 30.</p

園芸学部研究業績紹介(目次)

<p>Multivariable analysis to determine prognostic factors for surgical failure of 2^nd operated trabeculectomy using Cox proportional hazards regression models among the successful 1^st operated eyes.</p

Postoperative intraocular pressure course after trabeculectomy.

<p>Box plot of intraocular pressure at each time point. Box, interquartile range; whiskers, non-outlier minimum and maximum; circles, outliers defined as >1.5 times the interquartile range above the 75th percentile or below the 25th percentile; asterisk, extreme value defined as >3 times the interquartile range above the 75th percentile. The number of eyes measured at each time point is shown in parenthesis</p

Mean retinal sensitivity changes at each test point of the Humphrey visual field 24–2 program in glaucomatous eyes.

<p>The 12 central boxes surrounded by bold lines are located within 10° eccentricity. The red boxes indicate significantly deteriorated points and the blue boxes indicate points that were significantly ameliorated at both postoperative test sessions. (A) 1st postoperative session. (B) 2nd postoperative session. Data are shown as the mean ± standard deviation (dB). *P <0.05, **P <0.01. The diagonal lines indicate blind spots.</p

Visual field changes after vitrectomy with internal limiting membrane peeling for epiretinal membrane or macular hole in glaucomatous eyes

<div><p>Purpose</p><p>To investigate visual field changes after vitrectomy for macular diseases in glaucomatous eyes.</p><p>Methods</p><p>A retrospective review of 54 eyes from 54 patients with glaucoma, who underwent vitrectomy for epiretinal membrane (ERM; 42 eyes) or macular hole (MH; 12 eyes). Standard automated perimetry (Humphrey visual field 24–2 program) was performed and analyzed preoperatively and twice postoperatively (1^st and 2nd sessions; 4.7 ± 2.5, 10.3 ± 3.7 months after surgery, respectively). Postoperative visual field sensitivity at each test point was compared with the preoperative value. Longitudinal changes in mean visual field sensitivity (MVFS) of the 12 test points within 10° eccentricity (center) and the remaining test points (periphery), best-corrected visual acuity (BCVA), intraocular pressure (IOP), and ganglion cell complex (GCC) thickness, and the association of factors with changes in central or peripheral MVFS over time were analyzed using linear mixed-effects models. In addition, 45 eyes from 45 patients without glaucoma who underwent vitrectomy for epiretinal membrane (ERM; 34 eyes) or macular hole (MH; 11 eyes) were similarly examined and statistically analyzed (control group).</p><p>Results</p><p>In glaucomatous eyes, visual field test points changed significantly and reproducibly; two points deteriorated only at the center and twelve points improved only at the periphery. Central MVFS decreased (p = 0.03), whereas peripheral MVFS increased postoperatively (p = 0.010). In the control group, no visual field test points showed deterioration, and central MVFS did not change significantly after vitrectomy. BCVA improved, GCC thickness decreased, and IOP did not change postoperatively in both groups. The linear mixed-effects models identified older age, systemic hypertension, longer axial length, and preoperative medication scores of ≥2 as risk factors for central MVFS deterioration in glaucomatous eyes.</p><p>Conclusions</p><p>Visual field sensitivity within 10° eccentricity may deteriorate after vitrectomy for ERM or MH in glaucomatous eyes.</p></div

A representative case of epiretinal membrane (ERM) in a glaucomatous eye which showed worsening of the central visual field after vitrectomy.

<p>A 77-year-old man underwent vitrectomy in his right eye. (A) The preoperative visual field test showed glaucomatous changes (i.e. superior and inferior arcuate defects and superior paracentral scotoma). The mean deviation (MD) and pattern standard deviation (PSD) were -10.2 dB and 8.7 dB, respectively. The optical coherence tomography (OCT) image shows an ERM. (B) A visual field test at the first postoperative session (7 months after surgery) revealed decreased sensitivity especially in the central area. The MD and PSD were -16.7 dB and 11.7 dB, respectively. The ERM was successfully removed and his visual acuity had improved to 0.8 from 0.6. (C) A visual field test and an OCT image at the second postoperative session (10 months after surgery). The MD and PSD were -16.2 dB and 12.9 dB, respectively. The worsening of his central visual field sensitivity persisted. (Left) gray-scale plots. (Middle) visual field sensitivity (dB) at each test point. (Right) OCT images from a vertical scan through the fovea.</p

Humphrey visual field (HFA) 24–2 test points and corresponding retinal locations.

<p>(A) An example of HFA 24–2 test results. The circle indicates the area within 10° eccentricity. In this case, central and peripheral mean visual field sensitivities were 27.8 dB and 27.4 dB, respectively. (B) A retinal thickness map generated by optical coherence tomography showing the relationship between visual field test points and the area of retinal thickness measurement. White dots show HFA 24–2 test points. The black circle (diameter = 6 mm) corresponds to the area of 10° eccentricity.</p

Kaplan-Meier survival analysis of surgical success.

<p><b>a</b> Complete success (shaded circle, lower line) vs. qualified success (shaded triangle, upper line). <b>b</b> Qualified success, overall criteria (shaded triangle, lower line) vs. exclusion of hypotony criteria (open triangle, upper line). <b>c</b> Complete success, overall criteria (shaded circle, lower line) vs. exclusion of hypotony criteria (open circle, upper line).</p

Cox regression analysis of various factors as a risk for surgical failure by complete success criteria.^a

<p>CI = confidence interval, NA = not applicable, PDR = proliferative diabetic retinopathy, IOP = intraocular pressure, NVG = neovascular glaucoma, PPV = pars plana vitrectomy, TLE = trabeculectomy.</p><p>^aTwenty-two eyes failed to meet the complete success criteria.</p><p>^bAdjusted to account for the correlation of both eyes in the same patient.</p><p>^cVariables with P <0.2 in the univariate Cox regression analysis were entered into the stepwise multivariate analysis.</p><p>^dNineteen phakic eyes after TLE were analyzed.</p><p>Cox regression analysis of various factors as a risk for surgical failure by complete success criteria.<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0135766#t004fn002" target="_blank">^a</a></p

Comparisons of various factors between eyes with and without complete surgical success.

<p>PDR = proliferative diabetic retinopathy, IOP = intraocular pressure, NVG = neovascular glaucoma, PPV = pars plana vitrectomy, TLE = trabeculectomy</p><p>^aMixed-effects models with clustered robust standard errors were used to account for the correlation of both eyes in the same patient.</p><p>^bNineteen phakic eyes after trabeculectomy were analyzed.</p><p>Comparisons of various factors between eyes with and without complete surgical success.</p