Clinical application of a 3-dimensional morphometric apparatus for diagnosis and treatment of a Class III patient with facial asymmetry : A pilot study

This article demonstrated the usefulness of a non-contact 3-dimensional (3D) morphometric apparatus in orthodontic diagnosis and treatment evaluation. A female patient, 23 years 6 months of age, had a Class III malocclusion with mandibular deviation. The 3D images taken by a 3D morphometric apparatus figured out her protrusive chin of 6 mm on the deviation side compared to the non-deviation side, and showed a possibility of orthognathic surgery. Before starting of orthodontic treatment, a diagnostic splint was used for 2 months to determine her proper mandibular position. The 3D images retaken for quantitative evaluation showed decrease of the mandibular protrusion by approximately 3 mm, and improvement of facial asymmetry. Then, we decided to treat the patient without orthognathic surgery. After 18 months of active orthodontic treatment with miniscrew anchorage, the mandibular deviation was improved and an acceptable occlusion was achieved. The 3D images at posttreatment demonstrated significant decrease of chin protrusion on the deviation side, and improvement of facial asymmetry. In conclusion, a 3D morphometric apparatus could provide quantitative data of facial asymmetry and chin protrusion and contributed decision making process of treatment planning in a patient with facial asymmetry

Treatment of mandibular condyalr osteochondroma

We successfully treated a case of facial asymmetry involved in unilateral mandibular condylar osteochondroma with ipsilateral mandibular condylectomy and contralateral ramus osteotomy. A female, 32-year 11-month of age, had a chief complaint of facial asymmetry which initiated about 10 years ago. A mirror image analysis using a non-contact 3D image scanner revealed that the soft tissue on the deviated side was protruded more than 5.50 mm compared with the non-deviated side. The patinet was diagnosed as facial asymmetry with a skeletal Class III jaw-base relationship caused by unilateral mandibular condylar osteochondroma. After 18 months of preoperative orthodontic treatment, ipsilateral condylectomy and contralateral sagittal split ramus osteotomy were performed. As the results of postoperative orthodontic treatment for 20 months, an ideal occlusion having a Class I molar relationship with an adequate interincisal relationship was achieved. Facial asymmetry and mandibular protrusion were dramatically improved, and the differences between the deviation and non-deviation sides were decreased to less than 1.11 mm. The acceptable occlusion and symmetric face were maintained throughout 1-year retention period. Conclusively, our results indicated the stability after condylectomy without condylar reconstruction in a patient with unilateral condylar osteochondroma

Efficacy of sub-Tenon’s capsule injection of triamcinolone acetonide for refractory diabetic macular edema after vitrectomy

To determine whether or not a sub-Tenon’s capsule injection of triamcinolone acetonide(TA) is an effective treatment for refractory diabetic macular edema after vitrectomy. Methods : Thirty-nine eyes of 26 patients with diabetic macular edema were injected with 20 mg TA into the sub-Tenon’s capsule. The central macular thickness (CMT) measured by an optical coherence tomography (OCT) and visual acuities were compared between pre-treatment and 1, 3 months post -treatment. Results : The decrease in the mean CMT between the baseline (435 μm) and 1month (326 μm) or 3months (303 μm) time points was statistically significant. Seven eyes (70%) at 1 month and 3 months post-treatment in the vitrectomized eyes or PPV(pars plana vitrectomy)(+) group, 15 eyes(52%) at 1 month, and 19 eyes (66%) at 3 months in the non-vitrectomized eyes or PPV(-)group maintained 20% reduction in CMT from pre-treatment with a single injection of TA. The recurrence of macular edema was observed in 1 eye (14%) in the PPV(+)group, and 3 eyes (16%) in the PPV(-)group. Conclusion : The sub-Tenon’s capsule injection of TA was effective for refractory diabetic macular edema after vitrectomy. In addition, it was suggested that the treatment of vitrectomized eyes was more effective than that of non-vitrectomized eyes

The prognosis of cases with massive subretinal hemorrhage after photodynamic therapy

Purpose : To investigate cases with massive subretinal hemorrhage after photodynamic therapy(PDT). Subjects and Methods : We studied four cases(3 men and 1 woman, mean 80.5 yeas old) with massive subretinal hemorrhage after PDT about type of disease, spot size, period to the onset of hemorrhage, visual acuity (VA) before and after PDT. Results : Four cases consisted of one with age-related macula degeneration (AMD) and 3 with polypoidal choroidal vasculopathy (PCV). The average spot size of PDT was 5525_m. Two patients underwent the second PDT about 3 months after the initial PDT. Four periods to the onset of hemorrhage were 22, 27, 137, and 208 days respectively. The latter 2 cases underwent PDT twice, and the periods were the days from the initial PDT. Two patients among four underwent vitrectomy. Average VA before PDT was 0.20, and the final one was 0.02 after PDT. Conclusions : PDT has a risk to cause massive subretinal hemorrhage leading to grave visual disturbance. Especially PDT for PCV seems to have more risk. Therefore we need to inform patients about the risk before PDT, since treating patients with massive subretinal hemorrhage is very difficult

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

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

An epidemiologically rare case of Vibrio vulnificus infection that occurred in October in an inland city of Japan

　A 68-year-old man with alcohol addiction, who lived in the suburbs of Tsuyama, an inland city located in northeast Okayama prefecture, was transported to the emergency unit of the Tsuyama Central Hospital in a state of cardiopulmonary arrest (CPA). Despite rigorous systemic investigation and treatment, the patient died 2 hours after arrival. After his death, Vibrio vulnificus was isolated from his blood culture. 　Vibrio vulnificus causes fatal infection in humans, usually only in areas located close to the sea where appropriate temperature and suitable salt concentration for its growth are available. Therefore, its occurrence is epidemiologically restricted ; in Japan, the western coastal areas, especially in summers, are reported to be the high-risk regions. This is a rare case because it occurred in a city approximately 50 kilometers from both the Sea of Japan and the Pacific coast of Okayama, and at the end of October in 2011. Economic development and distribution systems have made it possible to transport various food products from coastal areas or abroad to any place in a short time, such that these infections can potentially develop in areas other than expected. We should be aware of the increasing risk of Vibrio vulnificus infection during any season and at any place, especially in patients with abnormal liver function

Long-term outcome of vitrectomy for an idiopathic macular hole performed with the use of indocyanine green

Purpose : To evaluate the long-term outcome and safety of vitrectomy for the treatment of an idiopathic macular hole using indocyanine green (ICG) to peel the internal limiting membrane(ILM). Subjects and Methods : By means of a retrospective study, we evaluated the outcomes of 56 eyes in 56 patients with an idiopathic macular hole who all underwent a primary vitrectomy with successful closure of macular hole. We compared the outcomes of 35 eyes in 35 patients who underwent a vitrectomy with ICG-assisted ILM peeling to those of 21 eyes in 21 patients who underwent the same procedure without ILM peeling. The main outcomes were compared between preoperative and postoperative visual acuities. Results : The periods to achieve the postoperative best visual acuity were 11.1 months in the ILM peeling group and 8.9 months in the non-ILM peeling group. However, there were no significant differences between the two groups regarding the postoperative best visual acuity and the final visual acuity. Complications related to ILM peeling with ICG were not found. Conclusion : These results support the safety of ILM peeling with ICG