Nippon Ganka Gakkai zasshi最新文献

Purpose: To determine the effect of low-dose cyclosporine (CyA) treatment for patients with chronic Vogt-Koyanagi-Harada (VKH) disease resistance to systemic corticosteroid treatment.Methods: We retrospectively evaluated patients diagnosed with chronic VKH disease resistance to systemic corticosteroid treatment at Japan Community Health Care Organization (JCHO) Osaka Hospital between March 2013 and March 2016. We followed the observation with systemic low-dose CyA (100 mg once daily) treatment of these patients. The patients were divided into two groups, anterior ocular inflammation group and posterior ocular inflammation group. Demographic data were reviewed, including age, gender, the existence of inflammation at the initial visit and three months after CyA treatment, and side effect.Results: Twenty-three eyes of thirteen patients with chronic VKH disease were included in this study (11 women, 2 men; mean age, 54.6±11.9 years). Nine cases showed anterior ocular inflammation and seven cases showed posterior ocular inflammation (includes overlapping cases). Thirteen of fourteen eyes in the anterior ocular inflammation group subsided at three months after CyA treatment, and ten of thirteen eyes in the posterior ocular inflammation group subsided at three months after treatment. We had to stop the treatment in one patient because of severe increase of serum triglyceride.Conclusions: Low-dose CyA treatment was effective in patients with chronic VKH resistance to systemic corticosteroid treatment. Our results suggest that this treatment was more effective in the anterior ocular inflammation group than in the posterior ocular inflammation group; however, a larger number of patients and longer observation periods are needed to confirm these results.

Purpose: For the purpose of classification for social adaptability of color vision defectiveness, the Farnsworth Dichotomous Test D-15(Test D-15)was applied to distinguish a severe group from other cases. Following this, the Ichikawa Lantern was employed to separate a moderate from a mild group. Majima's classification has provided a convenient framework for identifying color vision defectiveness for the past several decades. However because of the discontinuity in the employment of Ichikawa's Lantern, the introduction of alternative methods is vital. New classification methods subdividing the "moderate/mild" group into separate groups were established by using simulations.Subjects and methods: Simulations of hue discrimination using the color caps of Test D-15 were carried out. Adding color caps one by one between each of the 15 color test caps of Test D-15 to a total of 30, or subtracting caps from Test D-15 to nine (P-1-3-5-7-9-11-13-15)or six(P-2-5-8-11-14) were employed to simulate the compressing of the hue circles along the color confusion lines. Simulations changing the saturation of color caps were conducted simultaneously.Results: The fewer the number of caps, the more errors occurred. Subtracting the number of caps of Test D-15 made it possible to subdivide the "moderate/mild" group into three groups. Changing the saturation of color caps of Test D-15 had no effect on the results of the Test D-15.Conclusion: Using Test D-15 and reducing the number of caps to nine or six allows for the identification of different levels of color defectiveness and the assigning of patients into separate groups.

Purpose: To report two cases of Vogt-Koyanagi-Harada disease (VKH) resistant to systemic corticosteroid therapy, effectively treated with systemic cyclosporine.Case 1: A 52-year-old man diagnosed as VKH was administered oral corticosteroids (40 mg/day), following steroid pulse therapy. Since there was no significant improvement, he underwent a second course of steroid pulse therapy and oral corticosteroid administration (40 mg/day). However, there was still no improvement, and a combination therapy of both oral corticosteroids (40 mg/day) and cyclosporine 200 mg (3 mg/kg) was administered. As a result, the inflammation subsided and the dosage of the drugs was tapered successfully.Case 2: A 50-year-old man diagnosed as VKH underwent two courses of steroid pulse therapy, which did not improve significantly. We performed combination therapy of both corticosteroids and cyclosporine, similar to the case described above and obtained good results.Conclusion: Our experience of these two cases indicates that systemic cyclosporine treatment was effective in the management of VKH patients resistant to conventional systemic corticosteroid therapy.

Purpose: Long standing bullous keratopathy (BK) is associated with peripheral conjunctivalization and limbal deficiency. We hypothesized that cases of limbal deficiency may be induced due to accelerated proliferation of corneal epithelial cells. To investigate this hypothesis, we examined the influence of BK on the corneal epithelium in a rabbit model.Methods: Continuous curvilinear descemetorhexis was performed to remove a circular section of the corneal endothelium and Descemet's membrane (DM) using inverted Shinskey hook. Corneal tissue sections of BK eyes were observed by histochemical analysis using BrdU pulse chase methods for evaluation of corneal epithelial cell proliferation.Results: Rabbit corneas immediately became stromal edematous after DM stripping surgery, and a week later their thickness was five times that of control cornea. Vascularization of the peripheral cornea was observed in BK eyes, however, conjunctivalization was rarely observed at 6 weeks. The number of BrdU positive cells tended to be lower in the BK cornea epithelium compared to the control cornea epithelium. The number of Ki67 positive cells also showed a tendency to increase in the BK corneal epithelium. Telomere intensity in BK was similar to control corneal epithelium.Conclusion: BK may accelerate the proliferation of corneal epithelial cells in a rabbit model.

Familial exudative vitreoretinopathy is a hereditary insufficiency of retinal vascularture, which manifests a variety of vitreoretinal abnormalities, including nonvascularlized retina, abnormality of retinal vessel growing, dragged retina, retinal folds and total retinal detachment. While causative genes have been identified, cases are often sporadic. Periodic examination is necessary to find recurrence of the disease and late complications, including rhegmatogenous retinal detachment, cataract and glaucoma.

Background: Acquired peripheral retinoschisis (RS) is usually found in middle age and older patients, and is occasionally accompanies by retinal detachment (RD). In this report, a case of acquired RS with RD in a young adult is documented.Case: A 27 years old man diagnosed with RD in the right eye at a periodical examination.Findings: RD was located at upper nasal part of fundus with the margin close to the macula. Dome shaped retinal protrusion was also seen at the periphery of nasal upper retina. Optical coherence tomography revealed no macular abnormality. Following a diagnosis of RD with atrophic retinal hole, scleral buckling and SF6 gas injection were performed, but the RD was not fully resolved. Additional B mode ultrasonography visualized peripheral RS at the dome shaped retinal protrusion. To avoid macular detachment, pars plana vitrectomy was performed. After executing a posterior vitreous detachment and subretinal fluid extraction, photocoagulation was performed around the area of the RS. Consequently, both the RD and RS were completely resolved. Conclusions: Acquired RS with RD may occur in young adults. This can be successfully resolved by surgery.

Background: Intravitreal anti-vascular endothelial growth factor (VEGF) drug injections are the gold standard for the treatment of diabetic macular edema (DME). We report a case of DME in which frequent anti-VEGF treatment resulted in improvement of diabetic retinopathy.Case: A 73-year old woman with DME who had previously undergone bilateral posterior subtenon injections of triamcinolone acetonide and vitrectomy OD presented at Kyushu University Hospital. Best corrected visual acuity was 0.1 OD and 0.15 OS. The central macular thickness was 1570 μm OD and 578 μm OS. We performed focal macular laser photocoagulation OU but the DME was not resolved. Subsequent intravitreal anti-VEGF drug injections(approximately 20 times/2 years)resulted in an improvement of the best corrected visual acuity (0.3 OD, 0.6 OS) and CMT (1570 μm OD, 578 μm OS). There was an improvement of 2 steps in the Diabetic Retinopathy Severity Scale (DRSS) score OU.Conclusion: Frequent anti-VEGF treatment can improve the severity of diabetic retinopathy.

Purpose: To clarify clinical features of patients with uveal melanoma.Method: We analyzed 125 eyes of 125 patients diagnosed as uveal melanoma from 1992 to 2014 retrospectively.Results: The mean age of the patients at the time of diagnosis was 58.1±14.4 years. Tumors were originated in the choroid (93%), ciliary body (4%) and iris (3%). The main reasons leading to diagnosis included decreased vision (27%), visual field loss (17%), and no significant symptoms (16%). Average tumor size of the choroidal melanoma was 10.4 mm in largest basal diameter and 7.2 mm in height. Treatment included enucleation of eyeball (53 cases), local resection of the tumor (4 cases), heavy particle beam therapy (18 cases), and brachytherapy (4 cases). Extraocular metastasis was detected in 22% of the patients, and 89% of them died within 5 years. Five-year survival rate was 20% in 6 cases (13.6%) in whom histopathologic studies revealed extrascleral invasions.Conclusions: Prognosis of patients with metastatic uveal melanoma is extremely poor. Early diagnosis and treatment, and establishment of follow-up system after local treatment are critical. Further development and dissemination of novel treatment for metastatic melanoma is desired.