水晶体温存硝子体手術における周辺硝子体切除

重症な網膜硝子体疾患に対する硝子体手術では完全な眼内郭清を行うことが前部増殖硝子体網膜症に対する予防になるため,水晶体切除を行うことが多い.しかし,50歳以下では白内障が見られないことも多く水晶体温存で行う場合もある.今回我々は硝子体手術時における眼内灌流のポート位置やポート数を変えることで水晶体を温存したまま,より確実な周辺硝子体の処理ができるかを検討した.対象は核白内障がEmery-Little分類のGrade1以下の網膜硝子体疾患18例18眼で,通常の3ポート硝子体切除術で行った群をA群,術中灌流ポート位置を変えた群をB群,4ポートで行った群をC群とした.3群について周辺硝子体切除後に硝子体可視化のためにトリアムシノロンを噴霧し残存硝子体を観察した.また,術後に水晶体の混濁を観察した.残存硝子体はA群では下方に多く見られたが,B,C群ではA群に比べ少なかった.水晶体混濁はA群では水晶体後極に2例,B群では水晶体赤道部付近に1例見られたがC群では見られなかった.これらより,水晶体温存硝子体手術では4ポートを用いることで水晶体に影響が少なくより確実な周辺硝子体の処理が可能であると考えられる.Crystalline lens excision is performed in many cases of surgery for serious vitreoretinopathy, since the purpose is the prevention of anterior proliferative vitreoretinopathy by perfect intraocular excision. However, crystalline lens preservation may be done at the age of 50 or less when cataract is not present. We studied whether processing of the peripheral vitreous body could be performed while preserving the crystalline lens by changing the port position and the number of ports of infusion in vitreous surgery. 18 vitreoretinopathy eyes that had core cataracts of one or less Grade of an Emery-Little classification were divided into 3 groups: in group A the usual 3-port vitreous surgery was performed; in group B the port position was changed during the operation; and in group C4 ports were used. For the vitreous body visualization in the three groups after peripheral vitreous body excision, triamcinolone acetonide was injected and the residual vitreous body was observed. Cloudiness of the crystalline lens was also observed after the operation. Crystalline lens clouding on the posterior pole was seen in two examples of group A. In group B, one example was seen near the crystalline lens equatorial part. Cloudiness was not seen in group C. Therefore, the crystalline lens in not affected if 4 ports are used in crystalline lens preservation vitreous surgery

Common Variants in the COL4A4 Gene Confer Susceptibility to Lattice Degeneration of the Retina

Lattice degeneration of the retina is a vitreoretinal disorder characterized by a visible fundus lesion predisposing the patient to retinal tears and detachment. The etiology of this degeneration is still uncertain, but it is likely that both genetic and environmental factors play important roles in its development. To identify genetic susceptibility regions for lattice degeneration of the retina, we performed a genome-wide association study (GWAS) using a dense panel of 23,465 microsatellite markers covering the entire human genome. This GWAS in a Japanese cohort (294 patients with lattice degeneration and 294 controls) led to the identification of one microsatellite locus, D2S0276i, in the collagen type IV alpha 4 (COL4A4) gene on chromosome 2q36.3. To validate the significance of this observation, we evaluated the D2S0276i region in the GWAS cohort and in an independent Japanese cohort (280 patients and 314 controls) using D2S0276i and 47 single nucleotide polymorphisms covering the region. The strong associations were observed in D2S0276i and rs7558081 in the COL4A4 gene (Pc = 5.8×10−6, OR = 0.63 and Pc = 1.0×10−5, OR = 0.69 in a total of 574 patients and 608 controls, respectively). Our findings suggest that variants in the COL4A4 gene may contribute to the development of lattice degeneration of the retina

Cataract Surgery for Tilted Lens in Peters' Anomaly Type 2

Background: Cases of cataract surgery without penetrating keratoplasty in patients with Peters' anomaly are very rare. We report a case of Peters' anomaly type 2 with tilted lens due to synechia between the lens and iris that was treated with cataract surgery without penetrating keratoplasty. Case Presentation: A 16-year-old girl had Peters' anomaly in both eyes. Corneal opacity was severe in the left eye due to high-grade dysgenesis of the anterior segment. In the right eye, corneal opacity had spread from the center of the cornea to the inferotemporal side, and there was synechia between the iris and corneal endothelium from the inferonasal side to the inferotemporal side. Opacity was observed in the anterior pole of the lens, and there was synechia between the anterior iris and the lens. Ultrasound biomicroscopy (UBM) revealed that the lens was tilted because of synechia. The tilted lens induced astigmatism, which reduced visual acuity to 20/250, in conjunction with a cataract. Cataract surgery was performed; the synechia between the lens capsule and the iris was severed, an intraocular lens was inserted, and the tilt was repaired. UBM was used postoperatively to confirm that the lens capsule synechia had been corrected and that the intraocular lens was not tilted. As a result, visual acuity improved to 20/100; glaucoma and expansion of corneal opacity were not observed. Conclusions: Severing of the synechia between the cataract and iris, during cataract surgery, in a patient with Peters' anomaly type 2 resulted in favorable postoperative visual acuity

The "Crocodile Technique": A New Ophthalmic Surgical Technique to Remove Subretinal Proliferative Tissue Associated with Retinal Detachment

Purpose: To describe the “crocodile technique”, a new ophthalmic surgery technique for removing subretinal proliferative tissue (SPT) associated with retinal detachment.Materials and Methods: Subjects were 21 patients who had retinal detachment with SPT. Their follow-up terms were all greater than 3 months. We undertook the crocodile technique during their subretinal surgery. The crocodile technique is a new ophthalmic technique for removing SPT using vitreous forceps, without using subretinal forceps, in small-gauge vitrectomy. After performing sufficient peripheral vitrectomy, a small intentional retinal tear was created above the SPT. The SPT was then stabilized while grasped by vitreous forceps in the subretinal space. The vitreous forceps were then rotated on their long axis, such that the SPT was rolled around the vitreous forceps in the subretinal space.Results: The crocodile technique was successfully performed without enlarging the intentional retinal tear or creating new retinal tears, in all subjects. The retina was successfully reattached in all subjects, postoperative average visual acuity was improved after surgery, and postoperative redetachment did not occur in any patients.Conclusions: The crocodile technique can be performed without subretinal forceps. Using the technique, retinal detachment with SPT can be treated using vitreous forceps in small-gaugevitrectomy.</p

Allelic association results for D2S0276i and nine SNPs in the <i>COL4A4</i> and <i>RHBDD1</i> gene regions.

<p>1, major allele; 2, minor allele; OR, odds ratio; SNP, single nucleotide polymorphism.</p><p>Position is distance from short arm telomere. P values were calculated by χ² test 2×2 contingency table. We corrected <i>P</i> values (<i>P</i>c) of D2S0276i and 5 SNPs in the combined stage for multiple testing by Bonferroni's method and Haploview program using 10,000 permutations, respectively.</p

Association analysis of single nucleotide polymorphisms (SNPs) across the <i>COL4A4</i> and <i>RHBDD1</i> gene regions in 574 patients and 608 controls.

<p>The upper panels depict distribution of association results of D2S0276i and SNPs in <i>COL4A4</i> and <i>RHBDD1</i>. The results of monomorphic SNPs are not shown. The lower panels show the linkage disequilibrium structure in the <i>COL4A4</i> and <i>RHBDD1</i> regions; brighter red indicates higher D’.</p