Shinsuke Ataka

Relation between office intraocular pressure and 24-hour intraocular pressure in patients with primary open-angle glaucoma treated with a combination of topical antiglaucoma eye drops.

PurposeTo determine the relation between office intraocular pressure (IOP) and 24-hour IOP in patients with primary open-angle glaucoma (POAG) treated with 3 kinds of antiglaucoma eye drops. Patients and MethodsSubjects were 42 patients with POAG (71 eyes). All were being treated with 3 different topical antiglaucoma eye drops (latanoprost, β-blocker, and carbonic anhydrase inhibitor). Twenty-four-hour IOP values were obtained in the sitting position with a Goldmann applanation tonometer at 3-hour intervals. ResultsMaximum 24-hour IOP (mean±SD) was 19.76±5.65 mm Hg, minimum 24-hour IOP was 13.06±4.75 mm Hg, mean 24-hour IOP was 16.30±4.90 mm Hg, and 24-hour IOP fluctuation was 6.70±2.81 mm Hg. Office IOP was 16.23±4.58 mm Hg, and office IOP fluctuation was 2.75±1.68 mm Hg. There was no significant difference between office IOP and mean 24-hour IOP (P=0.93). There was no correlation between office IOP and 24-hour IOP fluctuation (r=0.15; P=0.25) or between office IOP fluctuation and 24-hour IOP fluctuation (r=0.19; P=0.17). Maximum 24-hour IOP occurred during office hours in 22 eyes (33.8%). The frequency of maximum 24-hour IOP occurring during office hours was significantly less than that of minimum 24-hour IOP (P<0.001). ConclusionsIn POAG patients treated with 3 kinds of antiglaucoma eye drops, office IOP was similar to mean 24-hour IOP. However, it was difficult to estimate 24-hour IOP fluctuation and maximum 24-hour IOP on the basis of office IOP.

Acute retinal necrosis late in the second trimester

PURPOSE To report treatment of a patient with acute retinal necrosis during pregnancy. METHODS A 24-year-old woman in her twenty-third week of gestation was diagnosed with acute retinal necrosis. A combination of acyclovir and interferon therapy was started at 25 weeks. Pars plana vitrectomy was performed during the 26th week of gestation. RESULTS The necrotizing retina became gliotic within 3 weeks of surgery. The patients visual acuity improved to LE, 20/40. A healthy baby was delivered at 39 weeks of gestation. CONCLUSION Combination therapy of acyclovir and interferon followed by surgery partially restored the patients vision without affecting fetal development.

Thinning and small holes at an impending tear of a retinal pigment epithelial detachment.

Abstract.Background: A tear of a retinal pigment epithelial detachment (PED) suddenly exposes a large area of bare Bruchs membrane. We report here the case of a patient whom we observed during the gradual, spontaneous development of a PED tear. Method: A 5.25-year case study of a 67-year-old woman with bilateral serous PEDs. Results: Retinal pigment epithelial (RPE) thinning or small holes were seen along the PED margin in both eyes. Fluorescein angiograms showed intense hyperfluorescence without leakage, and indocyanine green angiography showed choroidal vessels through regions of RPE thinning or small holes. Optical coherence tomographs showed an interruption of a hyperreflective band corresponding to retinal pigment epithelium. A typical tear of the PED ensued later. Conclusion: Multiple, small regions of RPE thinning or holes along the margin of PED can be a sign of an impending PED tear.

Subretinal fluid drainage via original retinal breaks for rhegmatogenous retinal detachment

OBJECTIVE To evaluate the outcome of vitrectomy using only original retinal breaks for subretinal fluid (SRF) drainage during the repair of primary rhegmatogenous retinal detachment (RRD). DESIGN A retrospective consecutive interventional case series. PARTICIPANTS A consecutive series of 112 eyes of 112 patients. METHODS Patients underwent 23-gauge vitrectomy without the use of posterior retinotomy and perfluorocarbon liquids for uncomplicated primary RRD at Osaka City University Hospital between September 2007 and March 2011. Exclusion criteria included eyes with giant retinal tears, grade C2 or worse proliferative vitreoretinopathy (PVR), ocular trauma, and the presence of other vitreoretinal diseases. RESULTS Single-operation success rate was 92.9%, whereas final anatomical success rate was 100%. Median visual acuity improved significantly from the preoperative logMAR of 0.51 ± 0.78 to the postoperative logMAR of 0.03 ± 0.26 (p < 0.01). No significant differences were observed for the single-operation success rate between the 62 eyes (95.2%) in which some SRF remained at the end of the operation and the rest of the 50 eyes (90.0%, p = 1.000) in which the SRF had been completely aspirated. Complications included transient intraocular pressure rise (12 eyes, 10.7%), epiretinal membrane (5 eyes, 4.5%), and PVR (1 eye, 0.9%). Ocular hypotony and endophthalmitis were not observed. CONCLUSIONS Uncomplicated primary RRD can be successfully repaired by performing vitrectomy using only the original retinal breaks for SRF drainage. In addition, successful outcomes are not dependent on achieving complete reattachment of the retina throughout the fundus.

A Simple, Safe Bimanual Technique for Subincisional Cortex Aspiration

We developed a bimanual manipulation technique to facilitate the removal of the subincisional lens cortex in small-incision phacoemulsification cataract surgery. A separate aspiration handpiece, not connected to an aspiration tube, is passed into the anterior chamber through a side-port corneal incision. Under irrigation with a standard infusion/aspiration (I/A) handpiece through a tunnel incision, the cortex is stripped off with the separate handpiece and removed with the I/A handpiece. In 227 eyes, subincisional cortex removal and subsequent capsule polishing was performed safely with the separate handpiece. Rupture of the posterior lens capsule occurred in 3 high-risk eyes.

A case of persistent hypotony following 23-gauge vitrectomy

We report here a case in which ciliary detachment related to the preparation of a scleral wound was suspected as the cause of persistent hypotony following 23-gauge vitrectomy for proliferative diabetic retinopathy. Ultrasound biomicroscopy (UBM) was performed following injection of a viscoelastic substance into the anterior chamber to carefully investigate the treatment and cause of persistent hypotony. Deepening the anterior chamber by means of the viscoelastic substance enabled UBM identification of ciliary detachment that had not been detected in the shallow anterior chamber. The extent of ciliary detachment was approximately 8 degrees; however, the detachment could not be seen on gonioscopy. UBM showed no continuity between the anterior chamber and choroid, with findings suggesting that the two structures had been split by posterior traction. The ciliary detachment site was the same site at which a three-port system had been prepared. One advantage of a 23-gauge system is that few complications are associated with the insertion and retraction of instruments. However, the difference in level between the cannula and trocar may result in ciliary detachment even if no resistance is felt when the trocar is inserted.

Medial orbitotomy without opening the ethmoid sinus enables wide exposure and safe removal of an orbital tumour located posterosuperomedially.

Tumours in the posterosuperomedial orbital space are hard to remove because of their site. However, medial orbitotomy without opening the ethmoid sinus produces a wide enough view and a direct route without complications. Posterosuperomedial orbital tumours can therefore be safely, accurately, and easily removed.