Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

PURPOSE: To confirm the utility of ultra-widefield optical coherence tomography (W-OCT) for diagnosing uveitis. METHOD: We retrospectively studied patients who had been diagnosed with uveitis and had undergone W-OCT. All patients had visited at Osaka Metropolitan University between January 2019 and January 2022. On W-OCT, vitreous opacity ("W-OCT VO") and the presence of vitreous cells ("W-OCT Cells") were identified by three specialists. We compared findings from ophthalmoscopy ("Ophthalmoscopic findings") and fluorescein angiography ("FAG findings") with those from W-OCT. RESULTS: This study investigated 132 eyes from 68 patients (34 males, 34 females; mean age, 53.97±22.71 years). Vitreous cells in posterior uveitis and panuveitis differed significantly between "W-OCT Cells" and "Ophthalmoscopic findings" for all cases (P = 0.00014). Vitreous opacities in posterior uveitis and panuveitis did not differ significantly between "W-OCT VO" and "Ophthalmoscopic findings" (P = 0.144) for all cases. Compared to "Ophthalmoscopic findings", "W-OCT Cells" offered 51.1% sensitivity and 66.7% specificity for all cases (p<0.01). Compared to "Ophthalmoscopic findings", "W-OCT VO" offered 78.6% sensitivity and 30% specificity for all cases (p = 0.19). In addition, "W-OCT Cells" did not differ significantly from "FAG findings" for all cases (P = 0.424). CONCLUSION: W-OCT was shown to offer significantly greater sensitivity than ophthalmoscopy for detecting vitreous cells. The results of this study may add an option for the evaluation of uveitis.

DOI： 10.1371/journal.pone.0281714

PubMed

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

Purpose: To describe two cases of extremely high-IL-6 pan-uveitis with subretinal exudation and cell migration.Methods: Pre-operative and postoperative images and IL-6 values in vitreous samples of two pan-uveitis cases were analyzed.Results: Case 1 was a 76-year-old man with blurry vision in his right eye. Fundus examination and optical coherence tomography showed vitreous opacification with vitreous cells and the presence of a white-yellowish retinal exudate with peripheral choroidal detachment all around. The IL-6 value was 16,600 pg/ml. Case 2 was a 63-year-old man with blurry vision in his right eye. On fundus examination, there was severe vitreous opacification in his right eye. The IL-6 value was 26,600 pg/ml. Importantly, there was good responsiveness to steroids and the TNF inhibitor.Conclusion: Unclassified intraocular inflammation might include a new category of disease with unilateral pan-uveitis with good response to steroid therapy and extremely high vitreous IL-6 values.

DOI： 10.1080/09273948.2021.1909071

PubMed

International / domestic magazine：International journal  

The aim was to investigate the structural changes of the retina using en face ultra-widefield optical coherence tomography (OCT) images during the treatment of hypotony maculopathy with traumatic cyclodialysis. Case 1 was a 43-year-old male patient with visual crowding in his left eye (metallic wire injury that occurred 3 weeks previously) who was referred to our department. Although best-corrected visual acuity was 20/20 in his left eye on initial evaluation, intraocular pressure was 6 mm Hg. Case 2 was a 20-year-old male patient with visual crowding in his left eye (baseball ball injury that occurred 4 weeks previously) who was referred to our department. Although best-corrected visual acuity was 16/20 in his left eye on initial examination, intraocular pressure was 5 mm Hg. Surgical interventions were performed in both cases. En face ultra-widefield OCT images were able to be used to trace dynamic changes before the intervention and up to 1 year later. The images obtained in these two cases made it possible to confirm the progress from wrinkles on the surface of the retina to normalization of vascular structure and improvement of ellipsoid zone disruption. En face ultra-widefield OCT is useful for monitoring multilayer structures of the retina in hypotony maculopathy cases.

DOI： 10.1159/000527094

PubMed

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

PURPOSE: To describe the immunohistochemical profile in a case with focal nodular gliosis (FNG) of the retina. METHODS: A 56-year-old female patient presented with vitreoretinal tractional syndrome with FNG of the retina. After resection of the retinal tumor tissue during the 25-G pars plana vitrectomy, immunohistochemistry using anti-epidermal growth factor receptor (EGFR), p-53, Ki67, glial fibrillary acid protein (GFAP), CD34, and vascular endothelial growth factor antibodies was performed in the excised tissue of the FNG of the retina. RESULTS: Histopathological analysis of the tumor led to a diagnosis of FNG of the retina. Spindle cells of the tumor exhibited strong positive staining for glial fibrillary acid protein, and there was local staining for CD34 in the endothelial cells in the blood vessels. The epidermal growth factor receptor and vascular endothelial growth factor immunoreactivity were strongly observed in the endothelial cells. CONCLUSION: This study demonstrated epidermal growth factor receptor expression in eyes with FNG of the retina. Oncogenic epidermal growth factor receptor might trigger and amplify the expression and function of endothelial vascular endothelial growth factor.

DOI： 10.1097/ICB.0000000000000987

PubMed

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

BACKGROUND: Diagnostic vitrectomy is an important method for evaluating uveitis, and its diagnostic utility is high regardless of whether the uveitis is infectious or non-infectious. The course of diagnostic vitreous surgery with 27-gauge pars plana vitrectomy and perioperative complications is reported. METHODS: An observational retrospective study of patients who underwent 27-gauge diagnostic vitrectomy due to atypical intraocular inflammation was conducted. The final diagnosis rate, complications due to surgery, preoperative visual acuity, and postoperative visual acuity (1 month and 6 months after surgery) were examined retrospectively. RESULTS: Diagnostic vitreous surgery was performed in 32 patients and 35 eyes (14 males and 18 females, age 14-85 years, median 67 years) during the study period. The average operation time was 52 min for 19 eyes with cataract surgery and 35 min for 16 eyes without cataract surgery. Preoperative log(minimum angle of resolution [MAR]) visual acuity was 0.84 ± 0.87, 1-month postoperative logMAR visual acuity was 0.41 ± 0.55 (p = 0.004, n = 28), and 6-month postoperative average logMAR visual acuity was 0.45 ± 0.73 (p = 0.012, n = 15). The diagnosis was made by diagnostic vitrectomy in 19 cases (54%). Postoperative complications were observed in 2 of 35 postoperative patients (5%); one involved increased intraocular pressure, and the other case involved vitreous hemorrhage of the eye, necessitating reoperation. CONCLUSION: Diagnostic 27-gauge vitrectomy could be effective for evaluating intraocular inflammation.

DOI： 10.1186/s12886-022-02405-y

PubMed

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

Dysthyroid optic neuropathy (DON) is a potentially sight-threatening eye disease associated with Graves' orbitopathy (GO). DON is not common in GO patients, reportedly occurring in only about 5% of patients. The pathogenesis of severe DON is considered to involve both muscular nerve strangulation and impaired blood flow. There is some objective grading of physical examination findings and the severity of GO, including a clinical activity score (CAS) and EUropean Group On Graves' Orbitopathy (EUGOGO), but no specialized protocol completely characterizes DON. Most clinicians have decided that the combination of clinical activity findings, including visual acuity, color vision, and central critical fusion frequency, and radiological findings, including magnetic resonance imaging (MRI), can be used to diagnose DON. MRI has the most useful findings, with T2-weighted and fat-suppressed images using short-tau inversion recovery (STIR) sequences enabling detection of extraocular changes including muscle and/orbital fat tissue swelling and inflammation and, therefore, disease activity. The first-choice treatment for DON is intravenous administration of steroids, with or without radiotherapy. Unfortunately, refractoriness to this medical treatment may indicate the need for immediate orbital decompression within 2 weeks. Especially in the acute phase of DON, thyroid function is often unstable, and the surgeon must always assume the risk of general anesthesia and intra- and post-operative management. In addition, there are currently many possible therapeutic options, including molecular-targeted drugs. The early introduction and combination of these immunomodulators, including Janus kinase inhibitors and insulin-like growth factor-1 receptor antibody (teprotumumab), may be effective for GO with DON. However, this is still under investigation, and the number of case reports is small. It is possible that these options could reduce systemic adverse events due to unfocused glucocorticoid administration. The pathophysiology of DON is not yet fully understood, and further studies of its treatment and long-term visual function prognosis are needed.

DOI： 10.2147/OPTH.S284609

PubMed

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

Conjunctival squamous cell carcinoma (SCC) is the most common ocular surface neoplasia. The purpose of this retrospective study was to examine the role of regulatory T cell (Treg) activity in tumor immunity and investigate the tumor microenvironment as a new treatment focus in conjunctival SCC. Cancer progression gene array and immunohistochemical analyses of FOXP3 as a Treg marker, CD8 as a tumor-infiltrating lymphocyte marker, and CXCR4 expression on activated Tregs were conducted in a series of 31 conjunctival SCC cases. The objective was to investigate the immunoreactive response in tumor cells and stromal cells in the cancer microenvironment. The stroma ratio in tumor cells was investigated by monitoring α-smooth muscle actine (SMA) expression between carcinoma in situ (Tis) and advanced carcinoma (Tadv) (P<0.01). No significant change in PD-L1 expression was observed in this study (P = 0.15). Staining patterns of FOXP3, CD8, and CXCR4 were examined separately between tumor cells and stromal cells in SCC tumors. Differences in staining of FOXP3 in Tregs and CD8 in tumor-infiltrating lymphocytes in tumor stroma in the Tis group were observed compared with the Tadv group (each P<0.01). In addition, double immunostaining of CXCR4/FOXP3 was correlated with progression-free survival (P = 0.049). Double immunostaining of CXCR4/FOXP3 correlated with American Joint Committee on Cancer T-stage, independent of age or Ki67 index (P<0.01). Our results show that FOXP3 and the CXCR4/FOXP3 axis are important pathologic and prognostic factors of ocular surface neoplasia, including SCC. The tumor microenvironment of conjunctival SCC should be considered in the future development of treatment options.

DOI： 10.1371/journal.pone.0263895

PubMed

Publishing type：Research paper (scientific journal)  

DOI： 10.1186/s12886-021-02222-9

PubMed

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

PURPOSE: Human leukocyte antigen (HLA) and immunity are related. Uveitis is also closely related to immunity. For example, the common presence of human leukocyte antigen (HLA)-DRB1*04 in the immune response is well known. The aim of this study was to investigate the relationship between visual prognosis and various HLA alleles before and after therapy in patients with unclassifiable uveitis, excluding those with Vogt-Koyanagi-Harada (VKH) disease. METHODS: This retrospective case series included 42 eyes from 22 consecutive patients with unclassifiable uveitis, excluding those with VKH disease. Visual acuity (VA), sex, refractive error, central retinal thickness (CRT), central choroidal thickness (CCT), and duration from onset to treatment were measured at initial and 6-month visits. Mean values of parameters were compared at each visit. Genotyping was performed by polymerase chain reaction amplification with sequence-specific primers. RESULTS: DRB1*04 showed a dominant change. No significant difference was observed in the other alleles. In DRB1*04, The mean differences in initial CCT, 6-month CCT, and 6-month VA showed statistically significant difference was found in best-corrected visual acuity (BCVA) between DRB1*04+ and DRB1*04- at the first visit. BCVA values at baseline and at the final visit were 0.13 ± 0.29 and 0.20 ± 0.36 in the DRB1*04+ and 0.00045 ± 0.20 and - 0.058 ± 0.11 in the DRB1*04- groups(p = 0.00465). Central Choroidal Thickness (CCT) values pretreatment and at the final visit after treatment were (pretreatment:361.00 ± 361.0 μm,after treatment: 286.00 ± 106.53 μm, p = 0.0174) in the DRB1*04+ group, and (pretreatment:281.3 ± 139.68 μm,after treatment:223.85 ± 99.034 μm, p = 0.0426) in the DRB1*04- group, respectively, indicating changes between baseline and the final visit. CCT was significantly greater in the DRB1*04+ group at both the initial visit and at 6 months. Multivariate analysis showed a significant difference between the presence or absence of DRB1*04 and sex. CONCLUSION: HLA-DRB1*04 allele may affect visual prognosis and CCT in unclassifiable uveitis.

DOI： 10.1186/s12886-021-02222-9

PubMed

DOI： 10.1038/s41467-021-23143-7

症例は54歳女性で、左眼瞼痛、左眼瞼腫脹、吐き気が出現したため当科を受診した。患者は以前から、うつ伏せで寝た際に左眼周囲に違和感を覚えていた。最高矯正視力は右0.9、左1.0で、眼運動はいずれも正常であり、左眼瞼に軽度の皮下出血がみられたが眼球突出はみられなかった。抗生物質による治療で症状が改善したため、当初は眼窩蜂巣炎が疑われた。造影前のCTとMRIでは確定診断に至らなかった。2週間後、患者は下を向くと悪化する左眼瞼痛を訴えた。様々な体位で造影MRIを行ったところ、病変は腹臥位で大きくなり、病変は血流が遅かった。病変への動脈供給が明らかでないことから、眼窩静脈奇形と診断した。その後、体位を変えても他の臨床症状を伴わない左眼窩痛を繰り返し訴えたため、脳神経外科に紹介され、外科的治療を受けることとなった。しかし、血管造影では眼窩腫瘍への血管流入は描出されず、無治療で経過観察することとなった。

Publishing type：Research paper (scientific journal)  

DOI： 10.1007/s12185-021-03208-5

PubMed

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

PURPOSE: Conjunctival squamous cell carcinoma (SCC) is primarily treated with surgical resection. SCC has various stages, and local recurrence is common. The purpose of this study was to investigate thrombospondin-1 expression and its association with prognosis. METHODS: In this retrospective study, a gene expression array along with immunohistochemistry were performed for the evaluation of thrombospondin-1 expression, localization, as well as Ki67 labeling cell indices in carcinoma in situ (Tis) and advanced conjunctival SCC (Tadv). The presence or absence and intensity of cytoplasmic and nuclear staining in tumor cells were also divided into groups with a score of 0-3 and semi-quantitatively analyzed to investigate intracellular staining patterns. The association between thrombospondin-1 expression and tumor progression in a series of 31 conjunctival SCCs was further investigated. RESULTS: All 31 patients in the cohort (100%) were East Asian. A simple comparison between Tis and Tadv demonstrated significant differences in expressions of 45 genes, including thrombospondin-1 (p < 0.01). In this cohort, 30/31 tumors were positive (96%) for thrombospondin-1. Furthermore, thrombospondin-1 intracellular staining pattern analysis scores were 2.12 and 0.96 for nuclear and cytoplasmic staining, respectively, with a significant difference observed between Tis and Tadv (p < 0.01). Alteration of the Ki67 labeling index was significantly correlated with that of the thrombospondin-1 cytoplasmic score (p = 0.030). Furthermore, univariate Cox regression analysis showed a significant correlation between thrombospondin-1 staining and progression-free survival (p = 0.026) and final orbital exenteration (p = 0.019). CONCLUSIONS: The present results demonstrated that thrombospondin-1 is a potential molecular target in the pathology of conjunctival SCC, in addition to serving as a prognostic factor.

DOI： 10.1007/s00417-021-05236-7

PubMed

International / domestic magazine：Domestic journal  

DOI： 10.1007/s12185-021-03208-5

PubMed

Publishing type：Research paper (scientific journal)  

PURPOSE: Conjunctival squamous cell carcinoma (SCC) is primarily treated with surgical resection. SCC has various stages, and local recurrence is common. The purpose of this study was to investigate thrombospondin-1 expression and its association with prognosis. METHODS: In this retrospective study, a gene expression array along with immunohistochemistry were performed for the evaluation of thrombospondin-1 expression, localization, as well as Ki67 labeling cell indices in carcinoma in situ (Tis) and advanced conjunctival SCC (Tadv). The presence or absence and intensity of cytoplasmic and nuclear staining in tumor cells were also divided into groups with a score of 0-3 and semi-quantitatively analyzed to investigate intracellular staining patterns. The association between thrombospondin-1 expression and tumor progression in a series of 31 conjunctival SCCs was further investigated. RESULTS: All 31 patients in the cohort (100%) were East Asian. A simple comparison between Tis and Tadv demonstrated significant differences in expressions of 45 genes, including thrombospondin-1 (p < 0.01). In this cohort, 30/31 tumors were positive (96%) for thrombospondin-1. Furthermore, thrombospondin-1 intracellular staining pattern analysis scores were 2.12 and 0.96 for nuclear and cytoplasmic staining, respectively, with a significant difference observed between Tis and Tadv (p < 0.01). Alteration of the Ki67 labeling index was significantly correlated with that of the thrombospondin-1 cytoplasmic score (p = 0.030). Furthermore, univariate Cox regression analysis showed a significant correlation between thrombospondin-1 staining and progression-free survival (p = 0.026) and final orbital exenteration (p = 0.019). CONCLUSIONS: The present results demonstrated that thrombospondin-1 is a potential molecular target in the pathology of conjunctival SCC, in addition to serving as a prognostic factor.

DOI： 10.1007/s00417-021-05236-7

PubMed

Publishing type：Research paper (scientific journal)  

Purpose: To describe two cases of extremely high-IL-6 pan-uveitis with subretinal exudation and cell migration.Methods: Pre-operative and postoperative images and IL-6 values in vitreous samples of two pan-uveitis cases were analyzed.Results: Case 1 was a 76-year-old man with blurry vision in his right eye. Fundus examination and optical coherence tomography showed vitreous opacification with vitreous cells and the presence of a white-yellowish retinal exudate with peripheral choroidal detachment all around. The IL-6 value was 16,600 pg/ml. Case 2 was a 63-year-old man with blurry vision in his right eye. On fundus examination, there was severe vitreous opacification in his right eye. The IL-6 value was 26,600 pg/ml. Importantly, there was good responsiveness to steroids and the TNF inhibitor.Conclusion: Unclassified intraocular inflammation might include a new category of disease with unilateral pan-uveitis with good response to steroid therapy and extremely high vitreous IL-6 values.

DOI： 10.1080/09273948.2021.1909071

PubMed

Publishing type：Research paper (scientific journal)  

BACKGROUND: Clinical sequencing using a panel of genes has recently been applied worldwide for patients with refractory solid tumors, but the significance of clinical sequencing using gene panel testing remains uncertain. Here we sought to clarify the feasibility and utility of clinical sequencing in the treatment of refractory tumors at our hospital. METHODS: A total of 39 patients with advanced solid tumors treated at our hospital between 2018 and 2020 were enrolled in the clinical sequencing. Among them, we identified 36 patients whose tissue samples were of suitable quality for clinical sequencing, and we analyzed the genomic profiles of these tumors. RESULTS: Pathogenic alterations were detected in 28 (78%) of the 36 patients. The most common mutation was TP53 (55%), followed by KRAS (22%), and the highest frequency of gene amplification was ERBB2 (17%). Nine of the 36 patients were identified as candidates for novel molecular-targeted therapy based on their actionable gene alterations, but only one case ended up receiving novel targeted therapy following the genetic tests. CONCLUSIONS: Our current results suggested that clinical sequencing might be useful for the detection of pathogenic alterations and the management of additional cancer treatment. However, molecular target based on actionable genomic alteration does not always bridge to subsequent therapy due to clinical deterioration, refusal for unapproved drug, and complexity of clinical trial access. Both improved optimal timing of clinical sequencing and a consensus about its off-label use might help patients receive greater benefit from clinical sequencing.

DOI： 10.1371/journal.pone.0247090

PubMed

DOI： 10.1093/nar/gkaa1054

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

BACKGROUND: Clinical sequencing using a panel of genes has recently been applied worldwide for patients with refractory solid tumors, but the significance of clinical sequencing using gene panel testing remains uncertain. Here we sought to clarify the feasibility and utility of clinical sequencing in the treatment of refractory tumors at our hospital. METHODS: A total of 39 patients with advanced solid tumors treated at our hospital between 2018 and 2020 were enrolled in the clinical sequencing. Among them, we identified 36 patients whose tissue samples were of suitable quality for clinical sequencing, and we analyzed the genomic profiles of these tumors. RESULTS: Pathogenic alterations were detected in 28 (78%) of the 36 patients. The most common mutation was TP53 (55%), followed by KRAS (22%), and the highest frequency of gene amplification was ERBB2 (17%). Nine of the 36 patients were identified as candidates for novel molecular-targeted therapy based on their actionable gene alterations, but only one case ended up receiving novel targeted therapy following the genetic tests. CONCLUSIONS: Our current results suggested that clinical sequencing might be useful for the detection of pathogenic alterations and the management of additional cancer treatment. However, molecular target based on actionable genomic alteration does not always bridge to subsequent therapy due to clinical deterioration, refusal for unapproved drug, and complexity of clinical trial access. Both improved optimal timing of clinical sequencing and a consensus about its off-label use might help patients receive greater benefit from clinical sequencing.

DOI： 10.1371/journal.pone.0247090

PubMed

Publishing type：Research paper (scientific journal)  

PURPOSE: Conjunctival squamous cell carcinoma (SCC) is primarily treated with surgical resection. SCC has various stages, and local recurrence is common. The purpose of this study was to determine molecular localization of epidermal growth factor receptor (EGFR) and the possibility of EGFR as a biomarker for the management of conjunctival SCC. METHODS: In this retrospective study, we performed immunohistochemistry to evaluate EGFR expression and localization in tumor cells, EGFR mutation-specific expression (E746-A750del and L858R), and human papillomavirus expression in a series of 29 conjunctival SCCs. RESULTS: All 29 tumors in our cohort were EGFR positive (100%). Twenty-one of 29 tumors (72%) showed focal EGFR staining, and seven (28%) showed diffuse EGFR staining. In addition, we calculated the percentages of the two most important mutations in EGFR (exon 19 746-A750del (8/29, 27.5%), exon 21 (L858R mutant (2/29, 6.8%)) in conjunctival SCCs. We observed that the translocation of EGFR from the membrane into the cytoplasm was related to clinical prognosis, as we detected correlations between EGFR cytoplasmic staining and final orbital exenteration and between decreased EGFR membrane staining and progression-free survival. CONCLUSIONS: EGFR is important in the pathology of ocular surface squamous neoplasia including SCC and is a prognostic factor. Increased understanding of EGFR mutations may have important implications for future treatment options.

DOI： 10.1371/journal.pone.0238120

PubMed

International / domestic magazine：International journal  

PURPOSE: To report a case with rapid regression of scleral melting associated with tumor necrosis factor-α (TNF-α) in a surgically induced necrotizing scleritis (SINS) patient treated with local steroid therapy. CASE PRESENTATION: An 85-year-old male patient presented with conjunctival tumor in his right eye. Complete resection of the tumor lesion and conjunctival re-construction were performed. Local steroid drops were administered until 1 month after surgery, and a good clinical course was achieved. However, after stopping the local steroid, scleral melting to the uvea occurred on the center of the tumor-resected sclera. After diagnosing SINS, we immediately restarted his local steroid. After 2 weeks, there was a complete and rapid regression of the scleral melting. Following this episode, only local steroid therapy was continued for the treatment of SINS, with no recurrence observed after 6 months. Histopathological analysis revealed the infiltration of inflammatory cells during the acute phase, with TNF-α immune reactivity observed in the center of the melting site near the resected conjunctiva. CONCLUSION: We speculate that the observed changes were associated with the TNF-α that was present during the pathological state of SINS. Local steroid therapy may play a key role in the local immune balance in SINS.

DOI： 10.1159/000509260

PubMed

Publishing type：Research paper (scientific journal)  

DOI： 10.1097/ICB.0000000000000987

PubMed

Publishing type：Research paper (scientific journal)  

DOI： 10.1186/s12886-020-1314-8

PubMed

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

BACKGROUND: To investigate preoperative clinical factors and visual outcomes of Japanese patients with dysthyroid optic neuropathy (DON) after urgent orbital decompression. METHODS: This retrospective, observational case series study investigated 44 patients who exhibited several preoperative clinical factors that might be associated with the need for urgent orbital decompression due to DON. Additionally, the visual acuity of DON patients was compared between the patients preoperatively and at 1 and 6 months postoperatively. RESULTS: All 44 patients received steroid and with or without radiation therapy, with 27 patients able to avoid undergoing urgent surgery. However, the remaining 17 patients required urgent orbital decompression following a lack of response to the therapy. None of the patients who initially avoided surgery required additional surgery for DON. Factors significantly associated with the need for urgent orbital decompression surgery included: female gender, older age, long disease duration, unilateral significant DON, history of resistance to pulsed steroid therapy, unstable thyroid function, high TRAb (Thyrotrophin receptor antibody)value, poor visual acuity, presence of central diplopia, and presence of corneal problems (P < 0.05 each). The results also showed that postoperative visual outcomes of surgery for DON were acceptable. CONCLUSION: This study revealed several preoperative clinical factors for DON that appear to be associated with the need for urgent orbital decompression surgery in Japanese patients.

DOI： 10.1186/s12886-020-1314-8

PubMed

Publishing type：Research paper (scientific journal)  

DOI： 10.1159/000509260

PubMed

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

PURPOSE: Conjunctival squamous cell carcinoma (SCC) is primarily treated with surgical resection. SCC has various stages, and local recurrence is common. The purpose of this study was to determine molecular localization of epidermal growth factor receptor (EGFR) and the possibility of EGFR as a biomarker for the management of conjunctival SCC. METHODS: In this retrospective study, we performed immunohistochemistry to evaluate EGFR expression and localization in tumor cells, EGFR mutation-specific expression (E746-A750del and L858R), and human papillomavirus expression in a series of 29 conjunctival SCCs. RESULTS: All 29 tumors in our cohort were EGFR positive (100%). Twenty-one of 29 tumors (72%) showed focal EGFR staining, and seven (28%) showed diffuse EGFR staining. In addition, we calculated the percentages of the two most important mutations in EGFR (exon 19 746-A750del (8/29, 27.5%), exon 21 (L858R mutant (2/29, 6.8%)) in conjunctival SCCs. We observed that the translocation of EGFR from the membrane into the cytoplasm was related to clinical prognosis, as we detected correlations between EGFR cytoplasmic staining and final orbital exenteration and between decreased EGFR membrane staining and progression-free survival. CONCLUSIONS: EGFR is important in the pathology of ocular surface squamous neoplasia including SCC and is a prognostic factor. Increased understanding of EGFR mutations may have important implications for future treatment options.

DOI： 10.1371/journal.pone.0238120

PubMed

Publishing type：Research paper (scientific journal)  

DOI： 10.1186/s12886-019-1227-6

PubMed

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

BACKGROUND: The common presence of human leukocyte antigen (HLA)-DRB1*04 in Vogt-Koyanagi-Harada (VKH) disease is well known. The aim of this study was to investigate the relationship between visual prognosis and HLA-DRB1*04 alleles during systemic corticosteroid therapy in patients with VKH disease. METHODS: This retrospective case series included 57 eyes from 29 consecutive patients with treatment-naïve VKH disease who received systemic corticosteroid therapy. Visual acuity, sex, refractive error, central retinal thickness (CRT), central choroidal thickness (CCT), and duration from onset to treatment were measured at initial and final visits. Mean values of parameters were compared with each visit. Genotyping was performed by polymerase chain reaction amplification with sequence-specific primer. RESULTS: Linear regression showed significant differences in logMAR best-corrected visual acuity between the three groups of homozygotes, heterozygotes, and normal subjects at baseline (p < 0.01), at 3 months after treatment (p < 0.01). There was no significant differences at 6 months after treatment (p = 0.257). No significant differences were detected between the three groups in age, sex, refractive error, CRT, CCT, or duration from onset to treatment. CONCLUSION: Alleles of HLA-DRB1*04 might affect visual prognosis and be related to early response after initiation of treatment in VKH disease.

DOI： 10.1186/s12886-019-1227-6

PubMed

DOI： 10.18888/ga.0000001284

CiNii Article

Publishing type：Research paper (scientific journal)  

＜文献概要＞はじめに 前頭洞粘液嚢胞(frontal mucocele)は,緊急ドレナージを要する前頭洞鼻腔嚢胞のなかでは上顎洞に次いで多く,鼻前頭洞管の閉塞が起点となり発生する。今回,前頭洞粘液嚢胞が感染を契機に膿瘍化し,眼窩および頭蓋内進展をきたした症例を報告する。症例 37歳,男性。数日前より左眼瞼の腫脹と発赤があり,近医眼科において加療されるも改善なく,当院紹介となった。初診時の矯正視力は左0.6,左上眼瞼腫脹および強い開眼制限を認めた。触診上,3横指程度の弾性硬の腫瘤性病変を触知したため,眼窩腫瘍を疑い眼窩部CTを施行した。CTでは左前頭洞から周囲の骨破壊を伴う腫瘤性病変を認め,腫瘤により眼窩内進展をきたし,眼球偏位とともに,前頭骨は部分的に欠損し,頭蓋内進展も認めた。急速増大傾向があることから膿瘍化が疑われ,頭蓋内への穿破を危惧しドレナージ目的で眼窩膿瘍切開術を行った。術中嚢胞内から多量の排膿をみた。後日,耳鼻咽喉科で根治的な内視鏡下鼻副鼻腔手術を施行し,術後は再発なく経過している。結論 前頭洞mucoceleはしばしば眼球突出など眼科症状を契機に発見されることがある。今回の症例のように,急速に増大する場合は感染を併発していることがあり,特に頭蓋内進展を伴う場合は加療が遅れると致命的な結果をきたす。可能な限り,膿瘍減圧のため眼窩膿瘍切開を早急に行う必要があると考える。急速に増大する眼窩腫瘤性病変では副鼻腔嚢胞の併発感染を鑑別診断に入れる必要がある。

＜文献概要＞はじめに 前頭洞粘液嚢胞(frontal mucocele)は,緊急ドレナージを要する前頭洞鼻腔嚢胞のなかでは上顎洞に次いで多く,鼻前頭洞管の閉塞が起点となり発生する。今回,前頭洞粘液嚢胞が感染を契機に膿瘍化し,眼窩および頭蓋内進展をきたした症例を報告する。症例 37歳,男性。数日前より左眼瞼の腫脹と発赤があり,近医眼科において加療されるも改善なく,当院紹介となった。初診時の矯正視力は左0.6,左上眼瞼腫脹および強い開眼制限を認めた。触診上,3横指程度の弾性硬の腫瘤性病変を触知したため,眼窩腫瘍を疑い眼窩部CTを施行した。CTでは左前頭洞から周囲の骨破壊を伴う腫瘤性病変を認め,腫瘤により眼窩内進展をきたし,眼球偏位とともに,前頭骨は部分的に欠損し,頭蓋内進展も認めた。急速増大傾向があることから膿瘍化が疑われ,頭蓋内への穿破を危惧しドレナージ目的で眼窩膿瘍切開術を行った。術中嚢胞内から多量の排膿をみた。後日,耳鼻咽喉科で根治的な内視鏡下鼻副鼻腔手術を施行し,術後は再発なく経過している。結論 前頭洞mucoceleはしばしば眼球突出など眼科症状を契機に発見されることがある。今回の症例のように,急速に増大する場合は感染を併発していることがあり,特に頭蓋内進展を伴う場合は加療が遅れると致命的な結果をきたす。可能な限り,膿瘍減圧のため眼窩膿瘍切開を早急に行う必要があると考える。急速に増大する眼窩腫瘤性病変では副鼻腔嚢胞の併発感染を鑑別診断に入れる必要がある。

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

© 2019 The Author(s). Purpose: Axitinib, an orally administered vascular endothelial growth factor receptors 1, 2, and 3 inhibitor, is widely used as the second-line treatment for metastatic renal cell carcinoma. We present a case of metastatic renal cell carcinoma who developed a novel ocular adverse event, impaired retinal circulation, during axitinib therapy. Methods: This is an observational case report. Results: A 57-year-old male who had been treated with axitinib for metastatic renal cell carcinoma for 2 years presented in August 2015. He complained of sudden-onset abnormal visual field in his right eye. His right eye exhibited multiple soft exudates on fundus photography and a significant fluorescein filling delay of the retinal vessels on fluorescein angiography. His best corrected visual acuity (BCVA) was 20/20 in the right eye, and a cecocentral scotoma was detected by Goldmann perimeter. As axitinib could have been responsible for impaired retinal circulation, axitinib was terminated and switched to temsirolimus. The soft exudates gradually subsided and the patients' symptoms got better, but his right BCVA dropped to 20/63 3 months after the end of axitinib treatment with worsening of his general condition. Conclusion: Clinicians should be aware of retinal circulatory disorder that can occur in patients under axitinib treatment.

DOI： 10.1159/000496197

PubMed

Publishing type：Research paper (scientific journal)  

DOI： 10.1159/000496197

PubMed

Publishing type：Research paper (scientific journal)  

DOI： 10.1155/2018/7643174

PubMed

Publishing type：Research paper (scientific journal)  

Publishing type：Research paper (scientific journal)  

DOI： 10.2147/OPTH.S128651

PubMed

Publishing type：Research paper (scientific journal)  

DOI： 10.1186/s12886-016-0246-9

PubMed

Publishing type：Research paper (scientific journal)  

DOI： 10.1159/000443826

PubMed

Publishing type：Research paper (scientific journal)  

目的:強力な治療で軽快した巨大結節性後部強膜炎の1症例の報告。症例:48歳女性が両眼の強膜炎で紹介受診した。2ヵ月前に両眼の虹彩炎と診断され,1ヵ月後に両眼の強膜炎が発症した。ステロイド薬の局所と全身投与で改善がなかった。所見:矯正視力は右0.3,左0.8で,両眼に前房の強いフレアと硝子体混濁があり,上方の強膜に充血した結節があった。MRIで上方後部の強膜に強い肥厚があり,巨大結節性後部強膜炎と診断した。当初は治療に抵抗した。メチルプレドニゾロンなどの副腎皮質ステロイド薬の大量投与に,コルヒチンとメトトレキサートを加え,2ヵ月後に病勢が鎮静化した。結論:巨大結節性後部強膜炎は眼内腫瘍に似た所見を呈することがある。本症例のような難治例では,強力な抗炎症薬と免疫抑制薬の全身と局所投与が奏効した。(著者抄録)

目的:強力な治療で軽快した巨大結節性後部強膜炎の1症例の報告。症例:48歳女性が両眼の強膜炎で紹介受診した。2ヵ月前に両眼の虹彩炎と診断され,1ヵ月後に両眼の強膜炎が発症した。ステロイド薬の局所と全身投与で改善がなかった。所見:矯正視力は右0.3,左0.8で,両眼に前房の強いフレアと硝子体混濁があり,上方の強膜に充血した結節があった。MRIで上方後部の強膜に強い肥厚があり,巨大結節性後部強膜炎と診断した。当初は治療に抵抗した。メチルプレドニゾロンなどの副腎皮質ステロイド薬の大量投与に,コルヒチンとメトトレキサートを加え,2ヵ月後に病勢が鎮静化した。結論:巨大結節性後部強膜炎は眼内腫瘍に似た所見を呈することがある。本症例のような難治例では,強力な抗炎症薬と免疫抑制薬の全身と局所投与が奏効した。(著者抄録)

Publishing type：Research paper (scientific journal)  

目的:未治療の加齢黄斑変性(AMD)に対するアフリベルセプト硝子体内投与(IVA)の短期効果を検討する。対象および方法:IVA導入後、6ヵ月間経過観察しえた未治療AMD34例36眼を対象とした。導入治療は1ヵ月おき計3回施行、維持期はフレキシブル用法にてIVA継続した。導入前、導入後6ヵ月時点での視力、光干渉断層計(OCT)での滲出病変の変化を検討した。導入治療終了後1ヵ月時点で滲出病変が残存するものを「反応不良例」とし、性別、年齢、導入前視力、導入前病変最大直径、病型との関連性を検討した。結果:症例内訳は男性19例、女性15例、年齢48〜91歳(中央値77歳)であった。病型分類は典型AMD15眼、ポリープ状脈絡膜血管症18眼、網膜内血管腫状増殖3眼であった。視力に有意な変化はなく(p=0.23)、滲出病変は有意に減少した。反応不良例は7眼(19.4%)で、いずれの検討項目も反応不良例との関連はなかった。結論:未治療AMDに対し、IVA導入は有効である。(著者抄録)

目的:未治療の加齢黄斑変性(AMD)に対するアフリベルセプト硝子体内投与(IVA)の短期効果を検討する。対象および方法:IVA導入後、6ヵ月間経過観察しえた未治療AMD34例36眼を対象とした。導入治療は1ヵ月おき計3回施行、維持期はフレキシブル用法にてIVA継続した。導入前、導入後6ヵ月時点での視力、光干渉断層計(OCT)での滲出病変の変化を検討した。導入治療終了後1ヵ月時点で滲出病変が残存するものを「反応不良例」とし、性別、年齢、導入前視力、導入前病変最大直径、病型との関連性を検討した。結果:症例内訳は男性19例、女性15例、年齢48～91歳(中央値77歳)であった。病型分類は典型AMD15眼、ポリープ状脈絡膜血管症18眼、網膜内血管腫状増殖3眼であった。視力に有意な変化はなく(p=0.23)、滲出病変は有意に減少した。反応不良例は7眼(19.4%)で、いずれの検討項目も反応不良例との関連はなかった。結論:未治療AMDに対し、IVA導入は有効である。(著者抄録)

Publishing type：Research paper (scientific journal)  

DOI： 10.2147/OPTH.S91339

PubMed

Publishing type：Research paper (scientific journal)  

PubMed

Publishing type：Research paper (scientific journal)  

急性帯状潜在性外側網膜症(AZOOR)患者5名(12〜65歳)を対象として、自己抗体の検出を試みた。視野検査、光学コヒーレンストモグラフィー(OCT)、多局所網膜電図(mfERG)を受けた患者の眼科的データを分析した。マウス網膜と患者の血清中の網膜自己抗体を免疫組織化学的に検討した。3成績では霧視、2成績では視野欠損が見られた。全例が視野検査でマリオット盲点の肥大を示した。暗点に対応する部位のOCT所見は、内側および外側線分間の接合部縁の破壊を示した。対応する暗点部分では、mfERG振幅が減少した。マウス網膜の全光受容体で、標的抗原が観察され、ヒト血清でも候補抗原が検出された。全患者で抗網膜抗原が検出され、AZOORは自己免疫病であると考えられた。

Publishing type：Research paper (scientific journal)  

DOI： 10.1007/s10384-014-0347-z

PubMed

急性帯状潜在性外側網膜症(AZOOR)患者5名(12～65歳)を対象として、自己抗体の検出を試みた。視野検査、光学コヒーレンストモグラフィー(OCT)、多局所網膜電図(mfERG)を受けた患者の眼科的データを分析した。マウス網膜と患者の血清中の網膜自己抗体を免疫組織化学的に検討した。3成績では霧視、2成績では視野欠損が見られた。全例が視野検査でマリオット盲点の肥大を示した。暗点に対応する部位のOCT所見は、内側および外側線分間の接合部縁の破壊を示した。対応する暗点部分では、mfERG振幅が減少した。マウス網膜の全光受容体で、標的抗原が観察され、ヒト血清でも候補抗原が検出された。全患者で抗網膜抗原が検出され、AZOORは自己免疫病であると考えられた。

Publishing type：Research paper (scientific journal)  

目的:ラニビズマブ硝子体内投与(IVR)反応不良であった滲出型加齢黄斑変性(AMD)に対するアフリベルセプト硝子体内投与(IVA)の短期効果を検討する。方法:IVR導入期に反応不良であり,その後も再治療に抵抗した症例に対しIVA導入し6ヵ月以上経過観察したAMD12例12眼を対象とした。男性10例,女性2例で,年齢は68〜86歳,中央値75歳であった。病型内訳は典型AMD 6眼,ポリープ状脈絡膜血管症6眼であった。IVA導入前後の視力と病変の変化を検討した。結果:IVA導入前後で比較すると,視力は維持され(p=0.402),漿液性網膜剥離離,網膜色素上皮剥離は有意に減少したが(p=0.002,p=0.013),網膜内浮腫は有意な変化はなかったp=0.219)。結論:IVR導入期反応不良例であったAMDに対し,IVAは有効であった。(著者抄録)

目的:ラニビズマブ硝子体内投与(IVR)反応不良であった滲出型加齢黄斑変性(AMD)に対するアフリベルセプト硝子体内投与(IVA)の短期効果を検討する。方法:IVR導入期に反応不良であり,その後も再治療に抵抗した症例に対しIVA導入し6ヵ月以上経過観察したAMD12例12眼を対象とした。男性10例,女性2例で,年齢は68～86歳,中央値75歳であった。病型内訳は典型AMD 6眼,ポリープ状脈絡膜血管症6眼であった。IVA導入前後の視力と病変の変化を検討した。結果:IVA導入前後で比較すると,視力は維持され(p=0.402),漿液性網膜剥離離,網膜色素上皮剥離は有意に減少したが(p=0.002,p=0.013),網膜内浮腫は有意な変化はなかったp=0.219)。結論:IVR導入期反応不良例であったAMDに対し,IVAは有効であった。(著者抄録)

Publishing type：Research paper (scientific journal)  

DOI： 10.1159/000360392

PubMed

Publishing type：Research paper (scientific journal)  

DOI： 10.1167/iovs.12-10781

PubMed

Publishing type：Research paper (scientific journal)  

DOI： 10.1007/s10384-011-0013-7

PubMed

Publishing type：Research paper (scientific journal)  

腹膜透析を含む心肺集中治療により命を取り留めた、ポッター症候群を伴うpapillorenal症候群患者の1症例について検討した。母親は35歳で、前置胎盤と羊水過少のため妊娠27週で周産期センターに移送された。MRI検査にて腎臓無形成および肺低形成の胎児を認め、極めて予後不良な典型的ポッター症候群と診断した。37週5日目に帝王切開を実施し、児の体重は2410g、1、5分時のアプガースコアはそれぞれ3、6であった。出生直後に気管挿管し、新生児ICUに収容後、人工換気とprostaglandin I2、強心剤の投与を行った。経皮的酸素飽和度(SpO2)は90%未満であった。出生2日目に左肺気胸が発現したため、持続的胸腔ドレナージを行った。薬剤を増量したところ、A-a DO2は次第に減少した。4日齢で腹膜透析(PD)を開始し、5日齢のSpO2は100%に達した。両側腎低形成および視神経異常からpapillorenal症候群と診断した。男児は3ヵ月齢時、体重3425gで自動PDは継続のうえで退院した。

Publishing type：Research paper (scientific journal)  

DOI： 10.1111/j.1442-200X.2010.03261.x

PubMed

腹膜透析を含む心肺集中治療により命を取り留めた、ポッター症候群を伴うpapillorenal症候群患者の1症例について検討した。母親は35歳で、前置胎盤と羊水過少のため妊娠27週で周産期センターに移送された。MRI検査にて腎臓無形成および肺低形成の胎児を認め、極めて予後不良な典型的ポッター症候群と診断した。37週5日目に帝王切開を実施し、児の体重は2410g、1、5分時のアプガースコアはそれぞれ3、6であった。出生直後に気管挿管し、新生児ICUに収容後、人工換気とprostaglandin I2、強心剤の投与を行った。経皮的酸素飽和度(SpO2)は90%未満であった。出生2日目に左肺気胸が発現したため、持続的胸腔ドレナージを行った。薬剤を増量したところ、A-a DO2は次第に減少した。4日齢で腹膜透析(PD)を開始し、5日齢のSpO2は100%に達した。両側腎低形成および視神経異常からpapillorenal症候群と診断した。男児は3ヵ月齢時、体重3425gで自動PDは継続のうえで退院した。

Publishing type：Research paper (scientific journal)  

DOI： 10.1159/000326242

PubMed

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DOI： 10.1159/000321625

PubMed

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DOI： 10.1016/j.bbrc.2010.08.109

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DOI： 10.1016/j.brainres.2009.05.095

PubMed

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DOI： 10.1007/s00417-008-0949-6

PubMed

Publishing type：Article, review, commentary, editorial, etc. (scientific journal)  

DOI： 10.11477/mf.1410211324

CiNii Article

Publishing type：Article, review, commentary, editorial, etc. (scientific journal)  

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Publishing type：Article, review, commentary, editorial, etc. (scientific journal)   Kind of work：Single Work  

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