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PURPOSE: To elucidate the prevalence of soft drusen, pseudodrusen, and pachydrusen and their 5-year changes in a Japanese population. DESIGN: Longitudinal population-based cohort study conducted from 2013 through 2017. PARTICIPANTS: Residents 40 years of age or older. METHODS: Nonmydriatic color fundus photographs were used to grade drusen subtypes and retinal pigment epithelium (RPE) abnormalities according to the Three Continent Age-Related Macular Degeneration Consortium. The 5-year changes of each drusen were investigated. MAIN OUTCOME MEASURES: The prevalence of each drusen subtype and the 5-year changes of each drusen. RESULTS: Among 1731 participants, 1660 participants had gradable photographs that were assessed. The age-adjusted prevalence of soft drusen, pachydrusen, and pseudodrusen was 4.3% (95% confidence interval [CI], 3.2%-5.8%), 7.7% (95% CI, 6.2%-9.7%), and 2.8% (95% CI, 1.7%-4.2%), respectively. Pachydrusen accounted for 82.0% (n = 50) of the extramacular drusen (n = 61). Pigment abnormalities were seen in 28.3% and 8.3% of eyes with soft drusen and pachydrusen, respectively (P < 0.0001). Longitudinal changes were investigated in 1444 participants with follow-up examinations, which showed an increase in size in 8.3% and 3.7% and regression in 1.7% and 5.5% for eyes with soft drusen and pachydrusen, respectively. No participants demonstrated RPE atrophy after pachydrusen regression. CONCLUSIONS: The prevalence of pachydrusen was higher than that of soft drusen and pseudodrusen combined. Pachydrusen may regress over time and typically is not associated with RPE atrophy as detected using color fundus photographs.

DOI： 10.1016/j.xops.2021.100081

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BACKGROUND: Cystoid macular edema is a rare, vision-threatening side effect of the taxane family of anticancer agents. There is no established treatment or standard treatment protocol for taxane-related cystoid macular edema. Here, we report two cases of taxane-related cystoid macular edema that were treated with topical dorzolamide. CASE PRESENTATION: In case 1, a 72-year-old Japanese woman with bilateral geographic choroiditis reported for a follow-up visit with a complaint of blurred vision in both eyes for 2 months after starting nanoparticle albumin-bound paclitaxel chemotherapy for multiple metastases of her breast cancer. Her best-corrected visual acuity had dropped from 1.2 to 0.9 in the right eye and from 1.0 to 0.4 in the left eye. Fundus examination showed no newly active geographic choroiditis lesion, but optical coherence tomography exhibited cystoid macular edema. We suspected taxane-related cystoid macular edema and terminated nanoparticle albumin-bound paclitaxel, and started topical dorzolamide treatment. Cystoid macular edema nearly resolved within 6 weeks in the right eye and within 10 weeks in the left eye after starting topical dorzolamide treatment. The resolution of cystoid macular edema without leaving a chorioretinal scar after discontinuation of paclitaxel confirmed our initial diagnosis of taxane-related cystoid macular edema. A few inconspicuous cystoid spaces persisted at the parafovea for a year after dorzolamide treatment ended, but regressed after restarting dorzolamide treatment without any side effects. Best-corrected visual acuity improved to 1.2 in the right eye and 1.0 in the left eye. In case 2, a 70-year-old Japanese man, who received nanoparticle albumin-bound paclitaxel for pancreatic cancer with multiple metastases, developed bilateral cystoid macular edema. Best-corrected visual acuity was 0.3 bilaterally. Cystoid macular edema resolved within 5 weeks after stopping nanoparticle albumin-bound paclitaxel and starting topical dorzolamide treatment confirming the diagnosis of taxane-related cystoid macular edema. Nine weeks later, best-corrected visual acuity improved to 0.8 in the right eye and 1.0 in the left eye. CONCLUSIONS: Cystoid macular edema in each case resolved within a few months without any side effects using topical dorzolamide and terminating taxane-based chemotherapy. Topical dorzolamide appears to be a safe and effective treatment option for patients with taxane-related cystoid macular edema whose quality of life is threatened by visual disturbances.

DOI： 10.1186/s13256-021-02954-8

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DOI： 10.1684/ejd.2021.4014

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We conducted a population-based, cross-sectional study in Japan to identify risk factors for retinal vascular events separately by gender. Forty years or older participants were recruited. Fundus photographs were taken, and lifestyle and health characteristics were determined through a questionnaire and physical examinations. We compared the group of those who had retinal vascular events and those who did not. A total of 1689 participants (964 men) were deemed eligible for the study and retinal vascular events were seen in 59 subjects (3.7% of the men, 3.2% of the women). Self-reported diabetes mellitus was significantly associated with the vascular events in each gender [odds ratio (OR) = 6.97, 6.19 (men, women); 95% confidence interval (CI) 3.02-15.9, 2.25-17.0; p < 0.001]. Higher systolic blood pressure (OR = 1.03; 95% CI 1.01-1.04; p = 0.006) and lower frequency of meat consumption (OR = 0.73; 95% CI 0.54-0.99; p = 0.04) were independently associated with the vascular events in men. In women, while vascular events were associated with self-reported hypertension (OR = 2.64; 95% CI 1.03-6.74; p = 0.04), no association was seen with systolic blood pressure. Women with hypertension may need extra care, not only for blood pressure.

DOI： 10.1038/s41598-021-85655-y

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Language：Japanese   Publishing type：Research paper (scientific journal)  

DOI： 10.18888/ga.0000001627

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Language：Japanese   Publisher：(株)全日本病院出版会  

抗アクアポリン抗体、そして新たに抗ミエリンオリゴデンドロサイトグリコプロテイン抗体が視神経炎に関与していることが明らかになってきた。また、多発性硬化症に対する病態修飾薬も開発され、治療を決定するうえで、鑑別診断は一層重要なものとなっている。眼科一般検査、対光反射、OCT、視野検査などから視神経炎が疑われたら、丁寧な問診、MRI、血液検査、髄液検査などを行い、鑑別を進める。視神経炎の診断がついたところで、治療を開始し、抗体検査の結果をみて、治療継続の判断をする。不可逆的な視神経障害を最小限にとどめるための、迅速な診断が重要である。(著者抄録)

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Language：Japanese   Publisher：金原出版(株)  

＜文献概要＞片眼にのみ広範な網膜分離所見を認め,その後の2年間遷延した網膜分離所見が1%ドルゾラミド点眼後に消失した50歳代の先天網膜分離症を報告する。55歳男性。2年前からの右眼の変視と半年前からの視力低下を自覚し,旭川医大眼科を初診した。矯正視力は右0.3,左1.2で,両眼底周辺部に銀箔様反射を認め,光干渉断層計(OCT)では右眼に,傍中心窩後部硝子体剥離(perifoveal posterior vitreous detachment:perifoveal PVD)と眼底後極部広範に網膜分離所見(内顆粒層と外顆粒層に嚢胞様変化)を認めた。左眼では上方の周中心窩の網膜内に嚢胞様変化をわずかに認めた。蛍光眼底造影検査では蛍光漏出や貯留は認めず,全視野網膜電図では両眼の陰性型波形を認めることから,先天網膜分離症と診断した。右眼はPVDが完成後,中心窩の嚢胞様変化は一時軽快したが,中心窩周囲に広範に認める網膜内の嚢胞様変化は遷延した。その後中心窩の嚢胞様変化も再発し,初診2年後,右眼に1%ドルゾラミド点眼を開始した。点眼開始2ヵ月後には,中心窩周囲に広範にみられていた網膜内の嚢胞様変化は消失し,点眼開始後1年半経過したが再発を認めていない。先天網膜分離症としては高齢で見つかり,網膜分離所見の左右差が著明な症例であった。中心窩の所見は変動したが,中心窩周囲に広範にみられた網膜分離所見は遷延し,1%ドルゾラミド点眼を開始したところ,速やかに消失した。ドルゾラミド点眼は先天網膜分離症に試してみる価値のある治療と考えられた。

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DOI： 10.1253/circj.CJ-19-0773

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PURPOSE: Optical coherence tomography angiography (OCTA) can visualize the vascular status of the choriocapillaris noninvasively and separately from the other vascular beds. We describe focal ischemia in the choriocapillaris and reperfusion of the area in hypertensive choroidopathy using en-face OCTA. CASE: A 32-year-old woman diagnosed with pregnancy-induced hypertension presented with acute anorthopia in the right eye after delivery via Caesarian section. Fundus examination showed an Elschnig's spot and serous retinal detachment (SRD) in the inferior perifoveal region. Early-phase fluorescein angiography and indocyanine green angiography images showed focally delayed choroidal perfusion, i.e., regional absence of choroidal flush. OCTA also showed a focal dark area in a slab of the choriocapillaris corresponding to the angiographic observation. After oral antihypertensive treatment, the dark area on the OCTA image of the choriocapillaris resolved over time in association with the resolving SRD. CONCLUSION: En-face OCTA is a useful technology to follow noninvasively the circulatory status of the choriocapillaris in hypertensive choroidopathy.

DOI： 10.1007/s10792-017-0705-1

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Language：Japanese   Publisher：(株)メディカル葵出版  

ICT(information and communication technology)の進歩・普及はめざましく、また急速である。医療においてもICTをうまく利用することで、遠隔地の患者に専門医療を提供でき、通院回数を減らす効果が期待できる。緑内障診療から見る眼科遠隔医療の実際について紹介し、また、遠隔医療の現在の問題点についても言及する。(著者抄録)

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PURPOSE: Few case reports have described vaso-occlusive retinopathy in systemic lupus erythematosus (SLE) using optical coherence tomography (OCT) angiography. Here we report the clinical features of a patient with SLE, complicated by Kikuchi-Fujimoto disease, who developed vaso-occlusive retinopathy. We then describe the subsequent recovery of the macular capillaries as assessed by OCT angiography. CASE: A 16-year-old male was referred to us with fever, a 1-month history of violaceous red papules and erythematous plaques on his face and a painful nodule in his right neck. We diagnosed him with SLE complicated by Kikuchi-Fujimoto disease through physiological assessment and histology from his neck lymph node and chin skin. Systemic steroids were prescribed as treatment. After remission, his fever and cervical lymph node swelling with pain recurred and he developed blurred inferior vision in his left eye. His best-corrected visual acuities were 1.0 and 0.1 in the right and left eyes, respectively. Extensive cotton wool spots were observed in the right fundus, and retinal capillary occlusions were detected by OCT angiography of the left eye. We diagnosed this case as vaso-occlusive retinopathy with SLE and increased immunosuppressive treatment together with anticoagulation therapy. Macular capillaries, observed by OCT angiography, gradually recovered function following assessment at 7 and 16 months post-onset of the vaso-occlusive retinopathy. CONCLUSIONS: We reported a 1½-year course of vaso-occlusive retinopathy in a patient with SLE complicated by Kikuchi-Fujimoto disease. Occlusion of the retinal vasculature and the subsequent recovery of circulation are clearly observed by OCT angiography.

DOI： 10.1007/s10792-017-0650-z

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BACKGROUND: Studies identifying modifiable lifestyle risk factors related to open-angle glaucoma (OAG) are limited, especially from Asian countries. This study aimed to identify lifestyle risk factors for OAG in a Japanese population. METHODS AND FINDINGS: This population-based, cross-sectional study recruited Japanese participants aged 40 years or older from January 2013 to March 2015. We took fundus photographs for OAG screening, determined lifestyle and health characteristics through a questionnaire and performed physical examinations. The participants who had suspect findings in the fundus photographs were sent for a detailed ophthalmic examination to diagnose OAG. Lifestyle and heath characteristics were statistically compared between the OAG and non-OAG participants. A total of 1583 participants were included in the study, of which 42 had OAG and 1541 did not have OAG. The number of days per week that the female participants consumed meat (mean±SD; OAG: 1.7±1.2 days, non-OAG: 2.7±1.5 days) was negatively associated with OAG (OR = 0.61; 95% CI: 0.43-0.88; p = 0.007). Higher intraocular pressure was positively associated with OAG in men (OR = 1.20; 95% CI: 1.05-1.38, p = 0.009). No significant difference between participants with and without OAG was observed for a range of other lifestyle factors and health criteria including self-report of diabetes, number of family living together, body mass index, blood pressure, pulse rate, coffee drinking, tea drinking, alcohol drinking, number of fruits consumed per day and days of fish consumption per week. CONCLUSIONS: A higher weekly consumption of meat appears to be negatively associated with OAG in Japanese women. Increasing the dietary intake of meat can contribute to reducing the risk of developing OAG.

DOI： 10.1371/journal.pone.0204955

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Few cases have been reported describing choroidal vasculature in acute posterior multifocal placoid pigment epitheliopathy (APMPPE) using optical coherence tomography (OCT) angiography. We report choroidal vasculature changes in an APMPPE patient with the clinical course characterized by OCT angiography. A 39-year-old female was referred to us for bilateral multiple white spots in bilateral fundus. The best-corrected visual acuity was 20/20 in the right eye and 20/50 in the left eye. Multiple yellowish-white placoid lesions were observed in bilateral fundus, and fluorescein angiography showed a "block early, stain late" pattern at the placoid lesions characteristic of APMPPE. The placoid lesion represented vascular rarefaction at the choriocapillaris in the OCT angiography en face view. While the clinical course of symptoms and most of the low vascular rarefaction lesions regressed in 6 months, some new lesions were subclinically noted. Blurred vision recurred at 9 months from the first visit, and the vascular rarefaction lesions developed in different areas than those observed in the initial visit. Multiple yellowish-white placoid lesions in an APMPPE patient represented vascular rarefaction at the choriocapillaris in OCT angiography. The vascular rarefaction recovered and then recurred during the clinical course. OCT angiography can visualize changes of the choroidal vessels during APMPPE.

DOI： 10.1007/s10792-016-0308-2

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To compare the intraocular pressure (IOP) variability measured by multiple clinicians with those by one clinician. Forty-seven of 227 consecutive patients with glaucoma who had been examined routinely for over 12 months without changes in antiglaucoma medications at Asahikawa Medical University were included. Patients were assigned to one of two groups based on whether they had been followed by multiple or one clinician. One eye of each patient was evaluated. The IOPs obtained using Goldmann applanation tonometry were evaluated. We used the IOP standard deviation (SD, mmHg) and coefficient of variation (CV, %) as parameters of IOP variability. The main outcome measures were the differences in SD and CV between the groups. Multiple linear regression analysis evaluated factors associated with the SD and CV. Twenty-four (51.1 %) patients were assigned to the multiple-clinicians group and 23 (48.9 %) to the single-clinician group. The mean ± SD and CV were higher in the former (1.9 ± 0.5 and 12.0 ± 3.7, respectively) than in the latter group (1.4 ± 0.3 and 10.1 ± 2.5; P = 0.0005 and 0.044, respectively). The number of treating clinicians was the factor most associated with the SD and CV (β = 0.455, P = 0.002 and β = 0.387, P = 0.008, respectively). The variability in the IOP measurements of patients who had been monitored by multiple clinicians was higher than in patients followed by one clinician. The factor most associated with IOP variability was the number of clinicians involved.

DOI： 10.1007/s10792-016-0217-4

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We report a case of linezolid-induced optic neuropathy with transient microcystic spaces in the inner retina. We observed the retina using Fourier-domain optical coherence tomography (FD-OCT) in a patient with linezolid-induced optic neuropathy. A 49-year-old woman presented to our department with a 1-week history of bilateral photophobia. At the first visit, her best-corrected visual acuity (VA) was 0.6 in the right eye and 0.5 in the left eye. She had moderate optic disk edema and central scotomas bilaterally. FD-OCT showed bilateral microcystic spaces in the retina. Microcystic spaces were seen in the retinal nerve fiber layer (RNFL) and at the border of the RNFL and the retinal ganglion cell layer. Magnetic resonance imaging and laboratory tests showed no positive findings except for an elevated lactic acid level. One week after the first visit, the VA levels decreased to 0.06 and 0.07 in the right and left eyes, respectively. Because the patient had a 7-month history of linezolid treatment for persistent pyogenic arthritis, we suspected linezolid-induced optic neuropathy and immediately terminated treatment with this drug. The optic disk edema and the microcystic spaces in the retina resolved, and the VA improved to 1.2 at 6 weeks after linezolid withdrawal. Microcystic spaces, which resolved with linezolid withdrawal, were observed in linezolid-induced optic neuropathy. The microcystic spaces in the inner retina can be the first retinal sign of some optic neuropathies.

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83歳女。10ヵ月前に、非結核性抗酸菌症の診断でクラリスロマイシンの投与を開始し、リファンピシン、エタンブトールの内服を追加した。3ヵ月前の胸部CTで肺野病変の悪化を認め、リファンピシンからリファブチンへ内服を変更した。急速な左眼の視力低下を訴え、ぶどう膜炎、硝子体混濁が認められた。リファブチン関連ぶどう膜炎を疑い、リファプチンの投与を中止し、同時にエタンブトールも中止となった。リファブチン中止5日後には前房蓄膿は消失し、中止19日後には左眼矯正視力は0.3まで改善した。リファブチン関連ぶどう膜炎の診断となり、エタンブトールの投与を再開した。4ヵ月後に炎症の再燃はないにもかかわらず、左眼視力が低下した。エタンブトール視神経症の併発と診断し、エタンブトールの内服を中止した。徐々に視力、視野は回復し、エタンブトール中止7ヵ月後、左眼視力は0.8まで回復した。

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Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：Igaku-Shoin Ltd  

Purpose: To report a case of silent giant cell arteritis with retinal hemorrhage and soft exudates as ocular manifestations. Case: A 60-year-old female was referred to us for possible ocular complications of collagen disease. She had had recurrent fever since 6 weeks before. Findings: Corrected visual acuity was 1.2 in either eye. Both eyes showed retinal hemorrhage around the disc and sporadic soft exudates. Fluorescein angiography showed dye leakage from vessels in the peripheral fundus. Systemic examinations showed findings of arteritis and led to the diagnosis of giant cell arteritis. Fundus findings became normal after 10 weeks of treatment with peroral prednisolone. Conclusion: Visual functions remained unaffected in the present case of silent giant cell arteritis with retinal hemorrhage and soft exudates as ocular manifestations.

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背景:巨細胞性動脈炎は,頭痛,側頭動脈の硬結,リウマチ性多発性筋痛症,前部虚血性視神経症などが古典的な症状である。発熱などを主症状とするsilent巨細胞性動脈炎のあることが,近年報告されている。目的:網膜出血と軟性白斑を伴うsilent巨細胞性動脈炎の1症例の報告。症例:60歳女性が網膜虚血病変の有無の精査のため紹介受診した。6週前から発熱があり,大動脈炎症候群を示唆する検査所見があった。所見:矯正視力は左右眼とも1.2で,両眼の網膜に軟性白斑が散在し,乳頭周囲の出血があった。フルオレセイン蛍光眼底造影で周辺部の網膜血管からの色素漏出があった。全身検査で大型血管炎の所見が得られ,巨細胞性動脈炎と診断された。プレドニゾロンの経口投与が行われ,10週後に眼底所見は正常化した。結論:本症例は一過性の網膜出血と軟性白斑を伴うsilent巨細胞性動脈炎で,全経過を通じ,視機能は良好であった。(著者抄録)

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Other Link： https://search-tp.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2015&ichushi_jid=J01537&link_issn=&doc_id=20150316080027&doc_link_id=10.11477%2Fmf.1410211266&url=https%3A%2F%2Fdoi.org%2F10.11477%2Fmf.1410211266&type=%88%E3%8F%91.jp_%83I%81%5B%83%8B%83A%83N%83Z%83X&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00024_2.gif

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33歳男。特発性血小板減少性紫斑病、抗リン脂質抗体症候群に対し、プレドニゾロンとロミプロスチム投与中であった。1週間前から右眼の視力低下、数日前から左眼の視力低下を自覚した。起床時に左眼が一層つらくなっていることに気づき、頭痛、発熱もあった。両眼底に黄斑部を含む漿液性網膜剥離と、EDI-OCTで脈絡膜の肥厚を認めた。フルオレセイン蛍光造影では多発した点状過蛍光と網膜下への色素漏出、インドシアニングリーン蛍光造影では脈絡膜の広汎な循環障害を認めた。眼所見と高血圧から高血圧脈絡膜症と診断した。降圧薬による治療、血小板輸血を開始した。入院時のMRI検査で高血圧によって生じたと推測される可逆性後頭葉白質脳症を認めた。治療2週間後に漿液性網膜剥離は消失、脈絡膜厚は正常範囲内となり、視力も改善した。急性Elschnig斑のあとは網膜色素上皮の萎縮がみられ、両眼底に淡い黄白色混濁巣が残存した。

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We report a case of Vogt–Koyanagi–Harada (VKH) disease that recurred with sensorineural hearing loss and choroidal thickening. We measured the choroidal thickness using enhanced-depth imaging optical coherence tomography (EDI-OCT) in a patient with VKH during corticosteroid-tapering therapy. A71-year-old male presented with fever, headache, and anorthopia associated with wavy choroidal folds and aserous retinal detachment (SRD). The EDI-OCT images showed choroidal thickening ([600 l m at the subfovea), and he was diagnosed with VKH disease. After treatment with pulsed intravenous methylprednisolone, the choroidal folds and SRD resolved and the choroidal thickness decreased. About 6 months after subsequent treatment with an oral corticosteroid started, headache, tinnitus, and sensorineural hearing loss developed, and increased choroidal thickness was observed without other evidence of increased ocular inflammation. A high-dose corticosteroid was injected and tapered, and the sensorineural hearing loss improved immediately and the choroidal thickness decreased. In the current case, sensorineural hearing loss occurred with recurrent VKH disease;however, there were no ocular inflammatory signs except for rebound choroidal thickening. Measuring the choroidal thickness using EDI-OCT can sensitively identify recurrent VKH disease.

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PURPOSE: We report a case of hypertensive choroidopathy with detailed retinal images obtained using spectral-domain optical coherence tomography (SD-OCT). CASE: A 19-year-old pregnant woman with no history of high blood pressure had an eclamptic seizure at the 39th week of pregnancy; the baby was delivered by emergency Caesarean section. Six days later, she presented with bilateral blurred vision (best-corrected visual acuity [VA], 0.5, right eye; 0.3, left eye). Bilateral extensive, punctate, pale-yellow Elschnig's spots were present in the posterior fundus. SD-OCT showed a serous retinal detachment (SRD) and retinal pigment epithelium detachment (PED) representing a waveform retinal pigment epithelium (RPE) layer in each eye. The reflective intensity decreased partly at the waveform RPE. A wavy structure suggestive of fibrin was present in both foveas between the photoreceptor ellipsoid zone and the RPE-outer segment line. Four weeks after delivery and oral antihypertensive treatment, the SRDs, PEDs and wavy structure resolved and the VA recovered. CONCLUSION: SD-OCT visualized SRDs, PEDs, wavy structures under the photoreceptor ellipsoid zone, and areas of low intensity RPE layer in hypertensive choroidopathy.

DOI： 10.1007/s00417-013-2462-9

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Language：Japanese   Publisher：金原出版(株)  

他の網膜疾患の合併がVogt-小柳一原田病(原田病)の診断と治療に影響した3例を経験した。症例1は両眼に網膜出血と広範な網膜無血管野を伴った65歳女で、両眼の視力低下を自覚して受診した。両眼に網膜静脈閉塞症を合併している原田病と診断し、ステロイドパルス療法とそれに続けてプレドニゾロンの内服漸減治療を行った。症例2は網膜出血、硬性白斑を伴った70歳女で、両眼の見づらさを自覚して受診した。糖尿病網膜症を合併している原田病と診断し、内科で糖尿病と高血圧の加療をしながら、ステロイドパルス療法とそれに続けてプレドニゾロンの内服漸減治療を行った。症例3は片眼に網膜裂孔を合併した54歳女で、両眼の充血で受診した。4日後より左眼中心が暗くなり、両眼底に漿液性網膜剥離を認めた。右眼に網膜裂孔を伴う原田病の診断で、ステロイドパルス療法を開始し、続けてプレドニゾロンの内服漸減治療を行った。

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Language：Japanese   Publisher：金原出版(株)  

83歳女。左眼の霧視を自覚し、その後視力低下の自覚が強くなったため近医を受診したところ、左眼視力が無光覚弁となっており、左眼視神経乳頭の腫脹・蒼白化を認め、視野検査では測定不能であったため、紹介となった。初診時の所見で視力は両眼とも矯正不能で、左眼の相対的瞳孔求心路障害を認め、蛍光眼底造影で左眼の乳頭上の血管の拡張を認めた。血液検査では赤血球沈降速度亢進(赤沈)とC反応性蛋白(CRP)の上昇を認め、巨細胞動脈炎による前部虚血性視神経症の臨床診断で、ステロイドパルス療法を開始した。開始後、赤沈とCRPの値は徐々に改善し、治療開始後5週間で左矯正視力も0.8まで回復し、視野も改善を認めた。プレドニゾロン内服にて経過観察としていたが、治療開始半年後より徐々に左眼の視力低下を認め、治療開始後3年現在プレドニゾロン投与を継続中で、左眼視力は0.01である。

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Authorship：Lead author   Language：Japanese   Publishing type：Research paper (scientific journal)  

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Language：Japanese   Publishing type：Research paper (scientific journal)  

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Language：Japanese   Publishing type：Research paper (scientific journal)  

PURPOSE: To investigate the frequency of classified forms in endogenous uveitis in Asahikawa Medical College considering the anatomical location of the inflammation. METHOD: 116 new uveitis patients, who visited our hospital between 2001 and 2008, were retrospectively analyzed. We reviewed medical charts of the patients' age at disease onset, unilateral or bilateral uveitis, anatomical location of inflammation and diagnosis of classified form of uveitis. RESULTS: Age ranged from 5 to 83 years and the distribution of age showed two peaks. Sarcoidosis was the most common form accounting for 33% of all uveitis, 40% of bilateral uveitis and 43% of panuveitis. Vogt-Koyanagi-Harada disease and Behçet's disease followed sarcoidosis. In the unilateral uveitis cases, herpes virus infectious uveitis was the most common form followed by Behçet's disease and ulcerative colitis. In anterior uveitis, herpes virus infectious uveitis was the most common form followed by sarcoidosis and HLA-B27-positive anterior uveitis. CONCLUSION: The most common form amang the entire endogenous uveitis patient's in our hospital was sarcoidosis, and it was also the commonest in panuveitis and bilateral uveitis. The high frequency of sarcoidosis was remarkable when compared with other studies from other facilities.

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Language：English   Publishing type：Research paper (scientific journal)  

OBJECTIVES: An atonic pupil, defined as a dilated pupil of unknown origin, is a rare postoperative complication of ophthalmic surgery. We studied the incidence of atonic pupils after uncomplicated phacoemulsification and intraocular lens implantation (PEA+IOL) and analyzed the clinical profiles of four cases of atonic pupil. METHODS: We surveyed 54 ophthalmologists in 28 hospitals to determine their clinical experience with atonic pupils after uncomplicated PEA+IOL procedures and the total number of PEA+IOL procedures performed. The medical charts of four cases of atonic pupils were reviewed retrospectively. RESULTS: The response rate was 77.8% (42/54). Surgeon experience with PEA+IOL ranged from 1 to 15 years. Three of 42 ophthalmologists (7.1%) had had at least one case of an atonic pupil after uncomplicated PEA+IOL. Four of 58,887 cases (incidence, 0.0067%) developed an atonic pupil after uncomplicated PEA+IOL. All four cases had glare and three cases were treated with an iris contact lens, an iris diaphragm ring, and photochromic lenses. There were no specific common characteristics among the cases beyond ocular pain and headache perioperatively. CONCLUSIONS: The incidence of atonic pupil was very low. Most patients with an atonic pupil have some symptoms that require treatment.

PubMed

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Language：Japanese   Publishing type：Research paper (scientific journal)  

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Language：Japanese   Publishing type：Research paper (scientific journal)  

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Language：Japanese   Publishing type：Research paper (scientific journal)  

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Language：Japanese   Publisher：金原出版(株)  

78歳女。心臓弁膜症のためワルファリンカリウム(WP)内服中であった。起床時に左眼からの出血・血涙を自覚して救急外来受診し、両眼瞼およびその周囲に皮下出血を認め、左眼眼瞼は著明に腫脹し、自力での開眼は不可能であった。診察のため開瞼したところ、瞼裂から血液が2mほど噴出し、その後は瞼縁から流れ出る程度の出血を認めた。大きな血腫様の腫瘤があり、その上に正常な角膜をかろうじて観察でき、CTでは眼球の下鼻側に径25mmの腫瘤が存在し、眼球は圧迫され上耳側に偏位し変形していた。脳血管造影では結膜下に相応する部位で造影剤の漏出を認めた。血液検査ではPT-INRが3.91と高値で、易出血傾向による結膜下血腫と診断し、WPの効果減弱のためビタミンK2点滴を開始すると共に内服・点眼にて眼圧コントロールを行った。翌日PT-INRは1.37と低下し、CT上血腫の縮小を認め、7日目に眼圧は正常化した。8日目に角膜下方の血腫が脱落し、結膜下方円蓋部付近に20mm程度の結膜裂傷を認めたため結膜縫合術を行った。しかし、結膜組織は脆く、創の幅が大きいため解離を繰り返し、保存的治療で血腫の縮小、創幅の狭小化を図った。1ヵ月後に血腫はほぼ消退し、結膜裂傷も自然閉鎖して視力は回復した。

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Language：Japanese   Publishing type：Research paper (scientific journal)  

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Language：Japanese   Publisher：(株)メディカル葵出版  

目的:Juvenile chronic iridocyclitis(JCI)では、眼内レンズ(IOL)を挿入すると術後炎症が強くなり予後不良とされてきた。今回、IOLの挿入を行い経過が良好であったJCIの1例を経験したので報告する。症例:初診時、5歳の女児。両眼に帯状角膜変性、前房細胞(++)、フレア(+)、ほぼ全周の虹彩後癒着、軽度の後嚢下白内障、30Δの間欠性外斜視があった。左眼視力は0.5であったが、白内障の進行により2年後に0.01に低下し恒常性外斜視となり、水晶体吸引術、前部硝子体切除術とIOL挿入術を行った。矯正視力は1.0に改善し、術後炎症も問題なかった。50Δの外斜視のため複視を自覚し、プリズム眼鏡を処方し輻湊訓練を行った。4ヵ月後、25Δと外斜位となり眼鏡なしで複視もなくなった。結論:JCIでも手術前に十分に炎症のコントロールを行えば、IOL挿入は可能であると考えられた。(著者抄録)

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Other Link： https://search-tp.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2009&ichushi_jid=J01784&link_issn=&doc_id=20090701380024&doc_link_id=%2Fah9atgke%2F2009%2F002606%2F024%2F0838-0840%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fah9atgke%2F2009%2F002606%2F024%2F0838-0840%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

Language：Japanese   Publishing type：Research paper (scientific journal)  

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Language：Japanese   Publishing type：Research paper (scientific journal)  

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Language：Japanese   Publishing type：Research paper (scientific journal)  

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Language：Japanese   Publishing type：Research paper (scientific journal)  

PURPOSE: To report a case in which the unilateral intraocular pressure (IOP) before hemodialysis was higher than the day following hemodialysis. CASE: A 59-year-old woman had been followed with diabetic retinopathy in a local eye clinic and was referred to our hospital for a vitreous hemorrhage in the right eye in June 2002. She started hemodialysis for renal failure due to diabetic nephropathy in July 2002; vitreous and cataract surgeries were performed in September 2002. In May 2004, she underwent surgery in the left eye. The IOP in the left eye increased to the high 20s in August 2005. The visual acuity in the right eye was 0.7 and 0.3 in the left eye. The angles were open bilaterally. Before hemodialysis, the IOP in the left eye was significantly higher than that in the days following hemodialysis. There was no significant change in the right eye between before and after hemodialysis. Following trabeculectomy performed in the left eye in January 2007, the IOP in the left eye stabilized in the low teens. CONCLUSION: In some cases, the IOP can vary between before and the days following dialysis. It is important to check the IOP at these time points.

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DOI： 10.11477/mf.1410102681

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Language：Japanese   Publishing type：Research paper (scientific journal)  

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Language：Japanese   Publishing type：Research paper (scientific journal)  

PURPOSE: To report a case of uveitis associated with juvenile idiopathic arthritis that progressed from iritis to panuveitis with disc neovascularization during a clinical trial of etanercept, a tumor necrosis factor a (TNF-alpha) blocker. CASE: A 12-year-old girl with juvenile idiopathic arthritis, which had begun at the age of 1 year 7 months. The patient was enrolled in a clinical trial of etanercept at 11 years of age. The methotrexate which she has been taking was stopped, and prednisolone was decreased gradually from 7 mg. The iritis worsened and progressed to panuveitis with disc neovascularization when the prednisolone dose had been tapered to 2 mg. The uveitis was controlled by treatment with a steroid pulse and a liposteroid. CONCLUSION: When starting etanercept therapy in a patient with juvenile idiopathic arthritis who has uveitis and the antirheumatic drug is stopped and steroid treatment tapered, special care is needed to avoid the exacerbation of uveitis.

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Language：English   Publisher：B M J PUBLISHING GROUP  

DOI： 10.1136/bjo.2005.075648

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Language：English   Publishing type：Research paper (scientific journal)  

PURPOSE: Lack of information about the development of diabetic retinopathy in mice has greatly hindered the use of genetic mouse models for the study of disease mechanisms and the development of therapeutic strategies. The objective of this study was to characterize the occurrence and pathologic progression of diabetic retinopathy in C57Bl/6J mice. METHODS: Diabetes was induced with five consecutive injections of streptozotocin (STZ). The retinas were collected at different time points (2 weeks to 22 months) after the induction of diabetes and examined by using molecular, histologic, and immunohistochemical techniques and morphometric analysis. RESULTS: There was transient induction of cell apoptosis and caspase-3 activation in retinal neurons of C57Bl/6 mice within days of diabetes induction. Glial fibrillary acidic protein (GFAP), a marker of glial activation, likewise was transiently upregulated, seemingly in astrocytes but not in Müller cells. These abnormalities quickly returned to normal; ultimately, no detectable loss of retinal ganglion cells (RGCs) was noted by any of three independent methods (number of cells in ganglion cell layer of retinal cross-sections, retrograde labeling of retinal ganglion cells with fluorescent dye, or TUNEL staining) after up to a 1-year duration of diabetes. Despite this apparent lack of evidence for progressive damage in neurons and glial cells, diabetic mice developed vascular disease characteristic of the early stage of diabetic retinopathy beginning at 6 months after the onset of disease. The vascular damage-formation of acellular capillaries and pericyte ghosts-continued to increase through the 18 months examined. CONCLUSIONS: Diabetic C57Bl/6J mice develop capillary lesion that are characteristic of the early stages of diabetic retinopathy in patients. The data suggest that diabetes-induced degeneration of retinal capillaries can develop independent of neuronal loss or chronic GFAP upregulation in glial cells.

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Language：Japanese   Publishing type：Research paper (scientific journal)  

Background: Choroidal osteoma is a rare tumor that can be diagnosed easily based on its distinct clinical findings. We report a case in which the appearance of the patient's fundus and clinical course mimicked choroidal osteoma but the diagnosis was tentative because only subtle changes were noted on computed tomography (CT) of the posterior sclera. Case Report: A 40-year-old male presented with metamorphopsia in both eyes, the third time he had this symptom in the right eye. His visual acuity was normal but the fundus examination showed bull's eye-like chorioretinal changes and yellow-white coloring and elevation of the juxtapapillary area. Fluorescein angiography showed granular hypofluorescence around the macula and indocyanine green angiography revealed partial hyperfluorescence in the early phase. Angiograms ruled out malignant melanoma, metastatic tumor, choroidal angioma, and astrocytic hamartoma. The only abnormality noted on CT was subtle thickening of the posterior sclera. Ultrasonography showed partial calcification and elevation adjacent to the optic nerve. At the 3-year follow-up visit there was slight increase in retinal thickness but maintenance of normal VA. Conclusion: The appearance of the tumor and slow development in this case suggested that the most likely diagnosis was choroidal osteoma.

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DOI： 10.11477/mf.1410100722

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Language：English   Publishing type：Research paper (scientific journal)  

With recent progress in neuroscience and stem-cell research, neural transplantation has emerged as a promising therapy for treating CNS diseases. The success of transplantation has been limited, however, by the restricted ability of neural implants to survive and establish neuronal connections with the host. Little is known about the mechanisms responsible for this failure. Neural implantation triggers reactive gliosis, a process accompanied by upregulation of intermediate filaments in astrocytes and formation of astroglial scar tissue. Here we show that the retinas of adult mice deficient in glial fibrillary acidic protein and vimentin, and consequently lacking intermediate filaments in reactive astrocytes and Müller cells, provide a permissive environment for grafted neurons to migrate and extend neurites. The transplanted cells integrated robustly into the host retina with distinct neuronal identity and appropriate neuronal projections. Our results indicate an essential role for reactive astroglial cells in preventing neural graft integration after transplantation.

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Language：Japanese   Publishing type：Research paper (scientific journal)  

PURPOSE: We investigated the immunohistochemical features of surgically resected idiopathic epiretinal membranes(ERMs) and secondary ERMs with regard to posterior vitreous detachment(PVD). METHODS: Six specimens of idiopathic epiretinal membranes(3 eyes with complete PVD, 2 eyes with partial PVD, and one eye with no PVD) and 3 specimens of secondary ERMs(all eyes with complete PVD) were immunohistochemically studied. We used type I, II, III, IV collagen and fibronectin to study extracellular components, and glial fibrillary acidic protein(GFAP), S 100 protein, vimentin, and so forth to study cellular components. RESULTS: All the specimens of idiopathic ERMs had the major components of the lamellar stained by type II collagen antibody, and one out of 3 specimens of secondary ERMs had a minor component stained by type II collagen antibody. Compared with idiopathic ERMs with complete PVD, 2 out of 3 specimens of idiopathic ERMs with partial PVD or no PVD contained rather thick collagen lamellar. CONCLUSION: There was difference between specimens of idiopathic ERMs and specimens of secondary ERMs in staining by type II collagen antibody, supposed by vitreous, in this study. Idiopathic ERM with attached posterior vitreous membrane may cause growth of collagen.

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Language：Japanese   Publishing type：Research paper (scientific journal)  

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Human T-cell-mediated autoimmune diseases are often genetically linked to particular alleles of HLA class II genes. Vogt-Koyanagi-Harada's (VKH) disease, which is regarded as an autoimmune disorder in multiple organs containing melanocytes, has been found to be associated with HLA-DR4 (DRB1(*)0405) and HLA-DR53 (DRB4(*)0101). Tyrosinase is a melanoma antigen (Ag) expressed by normal melanocytes as well as melanoma cells against which responses by autologous T cells have been detected. We established a T-cell line from the peripheral blood of a patient with VKH disease which responded to synthetic peptides corresponding to tyrosinase. The T-cell line was generated which recognized the tyrosinase p188 - 208 peptide when presented by the HLA-DR4 (DRB1(*)0405) molecule on the surface of HLA class II-expressing L-cell transfectants. The minimal antigenic peptide which induced T-cell responses was an 11-amino-acid sequence and located at tyrosinase p193 - 203 (E-I-W-R-D-I-D-F-A-H-E). This peptide contained the DRB1(*)0405-binding peptide motif (hydrophobic residues (Y, F, W) at position 1 as an anchor residue, and negatively charged residues (D, E) at position 9), which corresponded to the W at p195 and the D at p203. These observations demonstrate that tyrosinase peptides are immunogenic, and may be a candidate for an autoantigen in VKH disease, suggesting that probing the T-cell responses against synthetic peptides is a productive approach for identifying the autoantigenic peptides associated with autoimmune diseases including VKH disease.

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Language：Japanese   Publishing type：Research paper (scientific journal)  

We report a case of macular hole after endogenous fungal endophthalmitis associated with longterm intravenous hyperalimentation (IVH). A 51-year-old female was maintained on IVH after gastrectomy and extensive resection of small intestine. She developed fever and noticed blurred vision and floaters in the right eye. At the initial examination the right eye had mild inflammation in the anterior chamber, snowball opacities in the vitreous, and multiple yellowish-white lesions in the fundus. A diagnosis of endogenous fungal endophthalmitis was made, and systemic administration of fluconazole was begun. Although the inflammation improved gradually, a macular hole developed adjacent to the macular lesion 2 months later. We speculate that tangential retinal traction caused by scarring of the macular lesion may have contributed to formation of the macular hole in this case.

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Authorship：Lead author   Language：Japanese   Publishing type：Research paper (scientific journal)  

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Language：Japanese   Publisher：眼科臨床医報会  

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Language：Japanese   Publisher：眼科臨床医報会  

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Language：Japanese   Publisher：(株)文光堂  

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Language：Japanese   Publisher：(公財)日本眼科学会  

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Language：Japanese   Publisher：(公財)日本眼科学会  

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Language：Japanese   Publisher：(公財)日本眼科学会  

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Event date： 2019.10

Language：Japanese   Presentation type：Oral presentation (general)  

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Event date： 2019.9

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Event date： 2018.11

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Venue：福岡  

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Event date： 2018.11

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Venue：福岡  

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Event date： 2018.10

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Event date： 2018.4

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Venue：大阪  

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Event date： 2010.11

Language：Japanese   Presentation type：Oral presentation (general)  

Venue：（旭川）  

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Event date： 2010.6

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Venue：(Berlin)  

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Venue：(Berlin)  

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Venue：（釧路）  

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Venue：（旭川）  

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Venue：（福岡）  

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Event date： 2009.10

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Venue：（福岡）  

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Event date： 2009.10

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Venue：（福岡）  

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Event date： 2009.10

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Venue：（福岡）  

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Event date： 2008.10

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Venue：（東京）  

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Event date： 2008.6

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Venue：(Hong Kong)  

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Event date： 2007.10

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Venue：（京都）  

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Venue：（旭川）  

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Venue：（福岡）  

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Event date： 2002.9

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Venue：（札幌）  

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Event date： 2002.7

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Venue：(サンフランシスコ、USA）  

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Venue：（フォートラデール、USA）  

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Event date： 2001.5

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Venue：（フォートラデール、USA）  

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Event date： 1999.9

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Venue：（札幌）  

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Event date： 1999.7

Language：Japanese   Presentation type：Oral presentation (general)  

Venue：（盛岡）  

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Event date： 1998.10

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Venue：(新潟)  

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Event date： 1994.4

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Venue：（京都）  

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Event date： 1991.9

Language：Japanese   Presentation type：Oral presentation (general)  

Venue：（札幌）  

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"目の病気 緑内障を中心に"

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研究評価委員

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