スウェプトソース網膜断層撮影による健常小児の脈絡膜厚・体積の測定

広島大学(Hiroshima University)博士(医学)Doctor of Philosophy in Medical Sciencedoctora

Efficacy of combined photodynamic therapy and sub-Tenon’s capsule injection of triamcinolone acetonide for age-related macular degeneration

Purpose : To evaluate the efficacy of combined photodynamic therapy (PDT) and sub-Tenon’s capsule injection of triamcinolone acetonide (TA) for the treatment of choroidal neovascularization (CNV) in age-related macular degeneration (AMD) at 1-year follow-up. Methods : A total of 117 eyes with subfoveal CNV caused by AMD were included. Sixty-eight eyes were treated with combined PDT and sub-tenon injection of 20 mg TA and compared with a control group of 49 eyes treated with PDT alone. All patients completed 1 year follow-up. The main outcome measures were best-corrected visual acuity (BCVA) and retreatment frequency. Results : There were no significant differences in age, sex, VA, lesion type, and greatest linear dimension between the two groups at baseline. BCVA analysis showed statistically no significant differences between the two groups. The PDT+TA group required a lower mean number of treatments (1.38 versus 1.67, P=0.032). Conclusion : Our study confirms that sub-Tenon’s capsule injection of TA with PDT significantly reduces the retreatment frequency of PDT

Correlation between optic nerve head circulation and visual function before and after anti-VEGF therapy for central retinal vein occlusion : prospective, interventional case series

Background: To determine the correlation between the optic nerve head (ONH) circulation determined by laser speckle flowgraphy and the best-corrected visual acuity or retinal sensitivity before and after intravitreal bevacizumab or ranibizumab for central retinal vein occlusion. Methods: Thirty-one eyes of 31 patients were treated with intravitreal bevacizumab or ranibizumab for macular edema due to a central retinal vein occlusion. The blood flow in the large vessels on the ONH, the best-corrected visual acuity, and retinal sensitivity were measured at the baseline, and at 1, 3, and 6 months after treatment. The arteriovenous passage time on fluorescein angiography was determined. The venous tortuosity index was calculated on color fundus photograph by dividing the length of the tortuous retinal vein by the chord length of the same segment. The blood flow was represented by the mean blur rate (MBR) determined by laser speckle flowgraphy. To exclude the influence of systemic circulation and blood flow in the ONH tissue, the corrected MBR was calculated as MBR of ONH vessel area – MBR of ONH tissue area in the affected eye divided by the vascular MBR – tissue MBR in the unaffected eye. Pearson’s correlation tests were used to determine the significance of correlations between the MBR and the best-corrected visual acuity, retinal sensitivity, arteriovenous passage time, or venous tortuosity index. Results: At the baseline, the corrected MBR was significantly correlated with the arteriovenous passage time and venous tortuosity index (r = -0.807, P < 0.001; r = -0.716, P < 0.001; respectively). The corrected MBR was significantly correlated with the best-corrected visual acuity and retinal sensitivity at the baseline, and at 1, 3, and 6 months (all P < 0.050). The corrected MBR at the baseline was significantly correlated with the best-corrected visual acuity at 6 months (r = -0.651, P < 0.001) and retinal sensitivity at 6 months (r = 0.485, P = 0.005). Conclusions: The pre-treatment blood flow velocity of ONH can be used as a predictive factor for the best-corrected visual acuity and retinal sensitivity after anti-VEGF therapy for central retinal vein occlusion. Trial registration: Trial Registration number: UMIN000009072. Date of registration: 10/15/2012

Accuracy of ultrawide-field fundus ophthalmoscopy-assisted deep learning for detecting treatment-naïve proliferative diabetic retinopathy

Purpose We investigated using ultrawide-field fundus images with a deep convolutional neural network (DCNN), which is a machine learning technology, to detect treatment-naïve proliferative diabetic retinopathy (PDR). Methods We conducted training with the DCNN using 378 photographic images (132 PDR and 246 non-PDR) and constructed a deep learning model. The area under the curve (AUC), sensitivity, and specificity were examined. Result The constructed deep learning model demonstrated a high sensitivity of 94.7% and a high specificity of 97.2%, with an AUC of 0.969. Conclusion Our findings suggested that PDR could be diagnosed using wide-angle camera images and deep learning

Efficacy of the Quickert procedure for involutional entropion : the first case series in Asia

Purpose : To report the efficacy of the Quickert procedure in the first case series of involutional entropion in an elderly Asian population, and to introduce the technique to Asian ophthalmologists including general ophthalmologisits and ophthalmic trainees. Methods : We conducted a retrospective review of 13 consecutive patients underwent the Quickert procedure for involutional entropion by occasional eyelid surgeons at Tokushima University Hospital or Mino Tanaka Hospital from September 2003 to April 2010. Demographic data, including gender, age, history of previous eyelid surgery, systemic disease, recurrence of entropion, postoperative complications, and symptoms were analyzed. Results : There were 5 male (38.5%) and 8 female (61.5%) subjects with a mean age of 77.8 years. Three patients underwent previous surgery for entropion were included. Entropion was rectified in all patients by a single Quickert procedure, and no recurrence was observed for a maximum of 89 months after the surgery. Although notching of the eyelid margin and mild symblepharon were observed in one patient, no symptoms associated with these complications were reported. Conclusion : The Quickert procedure can be one of the surgical procedures of choice for involutional entropion and should be common surgical approach for occasional eyelid surgeons in Asia as well as in western countries

Efficacy of intravitreal bevacizumab (AvastinTM) for short-term treatment of diabetic macular edema

Purpose : To report the efficacy of intravitreal injections of bevacizumab for diabetic macular edema (DME) in the short-term. Design : Retrospective, noncomparative, interventional case series.Methods : Medical records of 20 eyes of 19 patients who underwent intravitreal injections of bevacizumab for persistent diabetic macular edema were reviewed retrospectively. All eyes received intravitreal injections of bevacizumab (1.25 mg/ 0.05 ml). The clinical course of best-corrected visual acuity (BCVA) using a logarithm of the minimum angle of resolution chart, and averaged foveal retinal thickness using an optical coherence tomography (OCT) were monitored for up to four weeks after the injection. Results : BCVA at one week improved by two lines or more in six eyes (30%) and in nine eyes (45%) at four weeks. However, no significant improvement in the mean BCVA from baseline was observed at one week (P>0.05) and four weeks (P>0.05). Mean retinal thicknesses (RT) were 411±170μm at baseline, 349±102μm at one week after the injection (P0.05). One week after the injection, significant regression of macular edema was seen. However, recurrence occurred at four weeks. No complications such as severe vision loss, endophthalmitis, or systemic events developed. Conclusion : No changes in BCVA and RT were observed in the short-term observation after the intravitreal injection of bevacizumab for DME

Results of submacular surgery to remove diabetic submacular hard exudates

Purpose : To evaluate outcomes of submacular surgery to remove massive submacular hard exudates with diabetic macular edema. Design : Retrospective, noncomparative, interventional consecutive case series. Participants : Fifty-six eyes of 40 patients with massive submacular hard exudates with diabetic macular edema. Intervention : Submacular surgery was performed to remove massive submacular hard exudates. Main Outcome Measures : Preoperative and postoperative visual acuities and clinical findings. All patients were followed for more than 1 year postoperatively. Results : The macular hard exudates underlying the fovea almost disappeared, and macular edema remarkably reduced following surgery. Visual acuities ranged from 0.01 to 0.3 before surgery, and from 0.04 to 1.0 after surgery. Visual acuity improved by two lines or more in 45 eyes (80.4%), remained unchanged in 8 eyes (14.3%) and worsened in 3 eyes (5.3%). Visual acuity improved to 0.3 or more in 24 eyes (42.9%). Better postoperative visual acuity (0.3 or better) was related to hemoglobin A1C (HbA1C) and the size of hard exudates. Conclusions : Results showed the efficacy of submacular surgery to remove massive hard exudates with diabetic macular edema, and outcomes were satisfactory

Diagnostic imaging in patients with retinitis pigmentosa

Retinitis pigmentosa (RP) is a progressive inherited retinal disease, and patients with RP have reduced visual function caused by a degeneration of the photoreceptors and retinal pigment epithelium (RPE). At the end stage of RP, the degeneration of the photoreceptors in the fovea reduces central vision, and RP is one of the main causes of acquired blindness in developed countries. Therefore, morphological and functional assessments of the photoreceptors in the macula area can be useful in estimating the residual retinal function in RP patients. Optical coherence tomography (OCT) is a wellestablished method of examining the retinal architecture in situ. The photoreceptor inner/outer segment (IS/OS) junction is observed as a distinct, highly reflective line by OCT. The presence of the IS/OS junction in the OCT images is essential for normal visual function. Fundus autofluorescence (FAF) results from the accumulation of lipofuscin in the RPE cells and has been used to investigate RPE and retinal function. More than one-half of RP patients have an abnormally high density parafoveal FAF ring (AF ring). The AF ring represents the border between functional and dysfunctional retina. In this review, we shall summarize recent progress on diagnostic imaging in eyes with RP

Wound sealing-related complications of 25-gauge vitrectomy in proliferative diabetic retinopathy versus simple macular pathology

Purpose : To compare the incidence of wound sealing-related complications of 25-gauge transconjunctival sutureless vitrectomy (25-G TSV) for proliferative diabetic retinopathy (PDR) versus non-diabetic simple macular pathology (SMP). Methods : A retrospective comparative study was conducted on 377 eyes that underwent 25-G TSV for PDR (n=189 eyes) or non-diabetic SMP (n=188 eyes). Both groups were compared retrospectively and followed for at least 1 month (range 1-6 months). Main outcome measure was the incidence of postoperative wound sealing-related complications in both groups. Results : We found a statistically significant lower incidence of wound sealing-related complications on the 1st postoperative day in the PDR than SMP group (P-value 0.05). The incidence were as follows : 9% vs 18% for hypotony, 0% vs 2% for choroidal detachment, 0% vs 2% for external leakage and 1% vs 8% for conjunctival bleb formation, for the PDR and SMP groups respectively. This was associated with a significantly higher postoperative inflammation and IOP in PDR group. The day 1 higher postoperative IOP and inflammation were correlated with the presence of PDR pathology. Conclusion : The higher postoperative inflammation and IOP following vitrectomy in diabetic eyes, especially when combined with endolaser photocoagulation, makes such eyes less susceptible to wound sealing-related complications following sutureless vitrectomy