Quantitative Analysis of Macular Inner Retinal Layer Using Swept-Source Optical Coherence Tomography in Patients with Optic Tract Syndrome

Objective. To evaluate macular inner retinal layers using swept-source optical coherence tomography (SS-OCT) in patients with homonymous hemianopia due to optic tract syndrome (OTS). Methods. Sixteen eyes of 8 patients with OTS were studied. The macular retinal nerve fiber layer (mRNFL), ganglion cell layer and inner plexiform layer (GCL + IPL), and mRNFL and GCL + IPL (GCC) were measured by SS-OCT (DRI OCT-1 Atlantis®).The scanned area was divided into eight regions and two hemiretinae. Each retinal thickness of the OTS group was compared with that of the 25 control subjects. Results. The GCC thickness in the ipsilateral eyes was significantly reduced in all regions, although predominant thinning of the GCC in the contralateral eyes was found in the nasal region. The GCC + IPL thickness was preferentially reduced at the temporal regions in the ipsilateral eyes and at the nasal regions in the contralateral eyes. The reduction rate of the GCL + IPL thickness was 29.6% at the temporal hemiretina in the ipsilateral eyes and 35.2% at the nasal hemiretina in the contralateral eyes. Conclusion. We found preferential loss of the GCC + IPL thickness corresponding to the hemifield defects in each eye. Quantitative analysis by SS-OCT is capable of detecting the characteristic RGC loss due to OTS

27ゲージ硝子体システムを用いた白内障手術を施行した先天白内障症例の1例

先天白内障は,放置すれば弱視をきたし,永続的な視力低下を来す状態である.重症例では早期の白内障手術および術後の弱視訓練により良好な視力発達が得られる場合が多い.しかし,小児に対する白内障手術は成人のものとは異なり,難易度の高いものである.難易度が高い原因としては,従来法では,白内障手術時に後嚢切開および前部硝子体切除を行った後に眼内レンズを挿入するという難易度の高い手技にある.もし,後嚢切開が不完全に終われば,予定した眼内レンズ挿入もできなくなってしまう.今回我々は,白内障手術時に眼内レンズを挿入後に硝子体手術の手技を応用した手技を用い,27ゲージという極小の創からトロッカーという管腔構造をもつ器具を,経強膜的に毛様体扁平部へ刺入させ,トロッカーを介して硝子体カッターにて後嚢切開,前部硝子体切除を行い.合併症もなく安全に手術終了することができた.27ゲージの創は無縫合で終了可能であった.本方法は合併症も少なく,術後の炎症の軽減にも有用な方法であると考えられる.Congenital cataracts can cause amblyopia if not treated. In severe cases, early identification and treatment with cataract surgery as well as visual training are all necessary for positive visual development. However, cataract surgery during childhood seems to be more difficult to perform than with adults. One of the reasons for this difficulty is because the posterior capsulotomy is necessary to reduce the risk of causing posterior capsule opacity after cataract surgery. Usually, posterior capsulotomy is performed through the corneal side port. If posterior capsulotomy is incomplete, intra ocular lens (IOL) implantation may also be impossible. Regarding our experiences, posterior capsulotomy and anterior vitrectomy was performed safely with 27 gauze vitreous surgery system after IOL implantation. Additionally, no suture was needed in the wounds of 27 gauze vitreous surgery system. Our surgery for the treatment of congenital cataract was useful for intraoperative safety and less inflammation post-surgery

硝子体手術後に網膜静脈分枝閉塞症を来したタモキシフェン内服患者の1例

タモキシフェンは主に乳癌治療薬として使用されているが,眼副作用の報告は非常に少ない.今回,タモキシフェン内服患者における,硝子体手術後に発症した網膜静脈分岐閉塞症(branch retinal vein occlusion,以下BRVO)の1例を経験したので報告する.症例は51歳女性,乳癌の術後1日量20mgのタモキシフェンによるアジュバント療法を受けていた.2年後に左眼の黄斑円孔が発見され硝子体手術を行った.後部硝子体剥離を起こしている際にアーケード血管から出血を認めたため出血部位の圧迫及び眼内灌流圧を上げることで止血を行った.術翌日には黄斑円孔の閉鎖が確認されたが,術後15日目に出血部位を閉塞起点とするBRVOを認めた.視力は左矯正0.7pと術前と比べほぼ変わりはなかったが,光干渉断層計で黄斑浮腫を認めたためベバシズマブ硝子体内投与を行った.同時にタモキシフェンによる副作用を疑い,内服を中止した.タモキシフェンの眼副作用として,BRVOも念頭におく必要がある.Tamoxifen is often used for treating breast cancer. However, tamoxifen-induced ocular complications are very rare. We will report on a case of branch retinal vein occlusion (BRVO) associated with tamoxifen use. A fifty-one year old female was receiving peroral tamoxifen with daily doses of 20 mg following surgery for breast cancer. A macular hole was detected in her left eye two years later and vitreous surgery was performed. It was observed that there was bleeding from the inferior arcade vessels after inducing the posterior vitreous detachment. Hemostasis of the vein was performed by raising the intraocular perfusion pressure and by compression of the bleeding site. The macular hole was closed on a postoperative day. A fundus examination revealed that the left branch retinal vein occlusion started bleeding fifteen days after the surgery. There was almost no change compared with preoperative visual acuity, but optical coherence tomography (OCT) showed a macular edema. Therefore, intravitreal injections of bevacizumab and tamoxifen therapy were discontinued. Although BRVO is rare, ophthalmologists should be alerted to this type of ocular side effect

Clinical Characteristics of Neovascular Age-Related Macular Degeneration without Typical Drusen

Purpose. To evaluate the clinical characteristics of neovascular age-related macular degeneration (nAMD) patients without typical drusen. Methods. We retrospectively studied 165 eyes in 165 patients with treatment-naïve nAMD, including typical AMD and polypoidal choroidal vasculopathy (PCV). According to the fellow eye condition, the patients were divided into nAMD with and without typical drusen groups. Eyes with soft drusen or subretinal drusenoid deposits were classified into the nAMD with the typical drusen group. Smoking status and diagnoses of hypertension and diabetes were identified from hospital records and patient recall. We assessed best-corrected visual acuity (BCVA), central retinal thickness (CRT) at the fovea, subfoveal choroidal thickness (SFCT), and the number of injections received. Results. The nAMD without typical drusen group was significantly younger (77.9 ± 7.6 vs. 71.8 ± 8.3, P<0.001) and had thicker SFCT at baseline (207.9 ± 99.5 vs. 260.1 ± 113.2 μm, P=0.007) and a higher proportion of PCV (30.6 vs. 63.1%, P<0.001). The proportion of ever-smokers was significantly higher in the nAMD without typical drusen group (54.8 vs. 70.9%, P=0.036). There were no statistically significant differences in the proportion of patients with hypertension or diabetes; BCVA, CRT, or SFCT changes; or the number of injections between the nAMD with and without typical drusen groups. Conclusion. The clinical features of patients in the nAMD without typical drusen group were almost identical to those of pachychoroid-driven choroidal neovascularization (CNV) patients. The nAMD without typical drusen group had a significantly higher proportion of ever-smokers than the nAMD with typical drusen group. Smoking could be a risk factor for the development of pachychoroid-driven CNV