背景:眼内外病変を伴う脈絡膜mucosa-associated lymphoid tissue(MALT)リンパ腫に対して,眼外病変の生検による診断ののち,リツキシマブ単剤投与を行い,視力改善と長期緩解を得た症例を報告する.症例:77歳,男性.X年1月より右眼の霧視を自覚し前医を受診した.矯正視力は右0.2,左1.0であった.右眼耳側結膜に充血病巣を認め,前医にて加療されるも改善なく,次第に漿液性網膜剥離を認めた.頭部磁気共鳴画像法(MRI)にて眼内から眼外まで連続する腫瘍を指摘され,X年2月に当院紹介となった.当院受診時の右眼の矯正視力は0.5であり,右眼耳側結膜にはピンク色で2cm程度の結膜下病変を,眼底には漿液性網膜剥離を伴う広範な脈絡膜肥厚を認めた.結膜下の病変に対して生検を施行し,脈絡膜MALTリンパ腫と診断した.ポジトロン断層法-コンピュータ断層撮影(PET-CT)ではリンパ節転移や遠隔転移は認めなかった.リツキシマブの単剤投与を開始し,開始後2ヵ月ほどで眼内外脈絡膜腫瘍は完全に消失した.加療開始後2年での右眼の矯正視力は1.2と改善し,現在も経過観察中である.結論:リツキシマブ単剤投与での報告は少数であるが,本症例では漿液性網膜剥離の改善と矯正視力の改善を得ることができた.リツキシマブ単剤投与のみでも長期に寛解状態を維持することができ,脈絡膜MALTリンパ腫の治療においてリツキシマブ単剤による加療も今後選択肢となり得ることが示された.(著者抄録)

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

Objectives: We investigate the correlation between functional and morphological changes in extraocular muscles (EOMs) and intraocular pressure (IOP) changes before and after thyroid eye disease (TED) treatment. Methods: A multicenter study with a retrospective chart review was conducted. Patients with active TED receiving corticosteroid therapy without glaucoma eye drops between 2014 and 2023 were reviewed. Various parameters were measured by magnetic resonance imaging. The primary outcome measure was the correlation between changes in the IOP and the cross-sectional area (CSA) of the EOMs before and after treatment. Secondary outcome measures were comparisons of IOP, the signal intensity ratio (SIR) of the EOMs and orbital fatty tissue (OFT), and the CSA of the EOMs before and after treatment. Results: The IOP in 99 eyes in 51 patients significantly decreased from 18 ± 3.4 mmHg to 15.5 ± 2.9 mmHg before and after treatment (p < 0.01)). The CSA and SIR of all EOMs and OFT significantly decreased after treatment (p < 0.05). Factors that had a significant positive correlation with the IOP change rate before and after treatment were the CSA change rate of the inferior rectus muscle (IRM) before and after treatment (Spearman's correlation coefficient, R2 = 0.24, p < 0.05) and the CSA change rate of the total EOMs before and after treatment (Spearman's correlation coefficient, R2 = 0.22, p < 0.05). Conclusions: In TED patients, IOP decreased with anti-inflammatory treatment alone. The most significant parameter that correlated with the decrease in IOP was the CSA change rate of the IRM.

DOI： 10.3390/jcm14051480

PubMed

<p>（はじめに）甲状腺眼症における治療効果の評価では、MRI画像上での外眼筋と他の臓器の信号強度比が指標の一つとされる。算出には医師がSTIR法の冠状断からROIを指定する必要がある。一般にSTIR法のMRIはCTなどと比べてコントラストが高いが、甲状腺眼症の活動性が低い時には外眼筋と周囲組織とのコントラストが低く、この場合には外眼筋セグメンテーションは難しい。我々が知る限り先行研究でSTIR法での外眼筋セグメンテーションは確認されていない。（目的）本研究は甲状腺眼症の治療効果判定の自動化を目的としている。我々はディープラーニングのロバスト性に注目し、甲状腺眼症患者の外眼筋抽出に有効か評価する。加えて、新たなモデルMambaの有効性も評価する。（方法）甲状腺眼症患者52例（1225枚）を対象とし、データセットを構築した（上直筋、下直筋、内直筋、外直筋の全4クラス）。7種類の3Dセグメンテーションモデルを5-foldクロスバリデーションで学習させた。（結果）各モデルのDice係数の平均値は、0.7961（U-Mamba Enc）、0.7960（U-Mamba Bot）、0.7957（nnU-Net ResEnc L）、0.7788（SegResNet）、0.7733（V-Net）、0.7442（UNETR）、0.7087（SwinUNETR）となり、U-Mamba Encが最も高い結果となった。</p>

DOI： 10.11239/jsmbe.annual63.215_1

CiNii Research

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

Purpose: The purpose of the study is to report a case of ocular toxoplasmosis with branch retinal artery occlusion (BRAO). Case: The patient was a 36-year-old man from Okinawa, Japan, who was generally healthy and had no medical history. He was referred to our hospital with a complaint of sudden loss of vision in the left eye. Best corrected visual acuity was 0.1 in the left eye at the initial examination, and intraocular pressure was 21 mmHg. Anterior segment slit-lamp examination showed a few cells of the anterior segment and anterior vitreous. Fundus examination of the left eye showed retinal vasculitis of the middle and large retinal vessels with occlusion of retinal arterioles in the macular area and edema in all layers of the retina, with dense posterior vitreous cells and flare. Magnetic resonance imaging (MRI) showed a mass shadow at the posterior part of the left eyeball near the macula in the orbit. On laboratory examination, toxoplasma serum IgM and IgG were positive. Based on these results, he was diagnosed with BRAO with concomitant intraocular and extraocular toxoplasmosis. He was then treated with clindamycin, sulfamethoxazole-trimethoprim, and steroids. The inflammation disappeared quickly, and visual acuity improved to 0.6. The inflammation had not flared up even 3 months after the initial visit with decreasing serum toxoplasma serum IgG levels, and the posterior eyeball shadow on the MRI disappeared. Conclusion: A case of BRAO with uveitis with concomitant intraocular and extraocular toxoplasmosis lesions was presented. In cases of unilateral retinal vasculitis with orbital lesions, concomitant intraocular and extraocular toxoplasmosis should also be considered.

DOI： 10.1155/crop/6654053

PubMed

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

Purpose: To measure and compare the extent of retinal neovascularization using optical coherence tomography angiography (OCTA) between patients with good postoperative outcomes for proliferative diabetic retinopathy (PDR) requiring surgical treatment and patients with vitreous hemorrhage (VH). Methods: This retrospective study included patients who were diagnosed with PDR between January 2022 and December 2023 and underwent vitreous surgery. Cases that developed postoperative VH were classified as the VH group, and cases with good postoperative progress were classified as the control group. The extent of retinal neovascularization was measured from preoperative and postoperative images of the two groups taken by OCTA measured with a widefield optical coherence tomography (Canon, Xephilio OCT-A1), and a comparative study was conducted. Results: The VH group consisted of 8 patients with 11 eyes (4 men and 4 women) with a mean age of 49.7 ± 14.2 years, while the control group consisted of 23 patients with 26 eyes (19 men and 4 women) with a mean age of 56.9 ± 11.8 years. The preoperative retinal neovascular area was 50,233.7 ± 38,581.1 (pixels) in the VH group and 17,155.4 ± 27,950.2 (pixels) in the control group, showing a significant difference (p=0.046). The postoperative retinal neovascular area was 36,315.7 ± 44,311.8 (pixels) in the VH group and 2261.0 ± 9072.2 (pixels) in the control group, showing a significant difference (p=0.046), but there was no significant difference in the reduction rate of the neovascular area before and after surgery (p=0.30). Conclusions: In PDR developing VH after vitrectomy surgery, the appearance of neovascularization seen on pre- and postoperative OCTA is significantly more extensive than in cases that do not develop postoperative VH, and OCTA may be useful for preoperative evaluation.

DOI： 10.1155/joph/7839246

PubMed

DOI： 10.1007/s00417-024-06667-8

PubMed

DOI： 10.18888/ga.0000003803

CiNii Research

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

PURPOSE: To investigate the possibility of distinguishing between IgG4-related ophthalmic disease (IgG4-ROD) and orbital MALT lymphoma using artificial intelligence (AI) and hematoxylin-eosin (HE) images. METHODS: After identifying a total of 127 patients from whom we were able to procure tissue blocks with IgG4-ROD and orbital MALT lymphoma, we performed histological and molecular genetic analyses, such as gene rearrangement. Subsequently, pathological HE images were collected from these patients followed by the cutting out of 10 different image patches from the HE image of each patient. A total of 970 image patches from the 97 patients were used to construct nine different models of deep learning, and the 300 image patches from the remaining 30 patients were used to evaluate the diagnostic performance of the models. Area under the curve (AUC) and accuracy (ACC) were used for the performance evaluation of the deep learning models. In addition, four ophthalmologists performed the binary classification between IgG4-ROD and orbital MALT lymphoma. RESULTS: EVA, which is a vision-centric foundation model to explore the limits of visual representation, was the best deep learning model among the nine models. The results of EVA were ACC = 73.3% and AUC = 0.807. The ACC of the four ophthalmologists ranged from 40 to 60%. CONCLUSIONS: It was possible to construct an AI software based on deep learning that was able to distinguish between IgG4-ROD and orbital MALT. This AI model may be useful as an initial screening tool to direct further ancillary investigations.

DOI： 10.1007/s00417-024-06501-1

PubMed

症例は38歳男性。13ヵ月前に発熱・盗汗を認めアグレッシブNK細胞白血病(Aggressive Natural Killer Cell Leukemia:ANKL)の診断で同種骨髄移植と化学療法を施行した。10日前から左眼瞼腫脹および複視を自覚したため来院した。眼窩単純MRIにて左上眼瞼から眼窩上方にかけてT1強調画像で低信号・T2高信号、拡散制限を呈するびまん性腫瘤を認め,眼球が下方に偏位していた。週単位で左眼瞼腫脹は増悪し、1ヵ月後に眼窩腫瘤生検を施行した。病理組織検査では間質の線維性拡大を認める腺組織のみであり確定診断には至らなかった。プレドニゾロン経口投与を開始し眼瞼腫脹は一時的に改善したが3ヵ月後に再度増悪した。6ヵ月後に多発骨髄浸潤によるANKLの再発のため眼科通院は途絶え、1回の同種骨髄移植と化学療法が血液内科により行われ、眼瞼腫脹は改善したが、17ヵ月後に永眠した。(著者抄録)

DOI： 10.3389/fopht.2024.1491053

PubMed

DOI： 10.1371/journal.pone.0297201

PubMed

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

PURPOSE: To examine the molecular biological differences between conjunctival mucosa-associated lymphoid tissue (MALT) lymphoma and orbital MALT lymphoma in ocular adnexa lymphoma. METHODS: Observational case series. A total of 129 consecutive, randomized cases of ocular adnexa MALT lymphoma diagnosed histopathologically between 2008 and 2020.Total RNA was extracted from formalin-fixed paraffin-embedded tissue from ocular adnexa MALT lymphoma, and RNA-sequencing was performed. Orbital MALT lymphoma gene expression was compared with that of conjunctival MALT lymphoma. Gene set (GS) analysis detecting for gene set cluster was performed in RNA-sequence. Related proteins were further examined by immunohistochemical staining. In addition, artificial segmentation image used to count stromal area in HE images. RESULTS: GS analysis showed differences in expression in 29 GS types in primary orbital MALT lymphoma (N=5,5, FDR q-value <0.25). The GS with the greatest difference in expression was the GS of epithelial-mesenchymal transition (EMT). Based on this GS change, immunohistochemical staining was added using E-cadherin as an epithelial marker and vimentin as a mesenchymal marker for EMT. There was significant staining of vimentin in orbital lymphoma (P<0.01, N=129) and of E-cadherin in conjunctival lesions (P=0.023, N=129). Vimentin staining correlated with Ann Arbor staging (1 versus >1) independent of age and sex on multivariate analysis (P=0.004). Stroma area in tumor were significant difference(P<0.01). CONCLUSION: GS changes including EMT and stromal area in tumor were used to demonstrate the molecular biological differences between conjunctival MALT lymphoma and orbital MALT lymphoma in ocular adnexa lymphomas.

DOI： 10.3389/fonc.2024.1277749

PubMed

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

PURPOSE: The purpose of this study was to develop artificial intelligence algorithms that can distinguish between orbital and conjunctival mucosa-associated lymphoid tissue (MALT) lymphomas in pathological images. METHODS: Tissue blocks with residual MALT lymphoma and data from histological and flow cytometric studies and molecular genetic analyses such as gene rearrangement were procured for 129 patients treated between April 2008 and April 2020. We collected pathological hematoxylin and eosin-stained (HE) images of lymphoma from these patients and cropped 10 different image patches at a resolution of 2048 × 2048 from pathological images from each patient. A total of 990 images from 99 patients were used to create and evaluate machine-learning models. Each image patch of three different magnification rates at ×4, ×20, and ×40 underwent texture analysis to extract features, and then seven different machine-learning algorithms were applied to the results to create models. Cross-validation on a patient-by-patient basis was used to create and evaluate models, and then 300 images from the remaining 30 cases were used to evaluate the average accuracy rate. RESULTS: Ten-fold cross-validation using the support vector machine with linear kernel algorithm was identified as the best algorithm for discriminating between conjunctival mucosa-associated lymphoid tissue and orbital MALT lymphomas, with an average accuracy rate under cross-validation of 85%. There were ×20 magnification HE images that were more accurate in distinguishing orbital and conjunctival MALT lymphomas among ×4, ×20, and ×40. CONCLUSION: Artificial intelligence algorithms can successfully distinguish HE images between orbital and conjunctival MALT lymphomas.

DOI： 10.1080/02713683.2023.2246696

PubMed

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

PURPOSE: The present study assesses the utility of en-face widefield optical coherence tomography angiography (OCTA) imaging for evaluating the retinal vascular network during the course of treatment in acute retinal necrosis(ARN). OBSERVATIONS: OCTA images of two cases of acute retinal necrosis were analyzed. Case 1 was a 15-year-old male with visual crowding in his right eye who had best-corrected visual acuity of 16/20 and intraocular pressure of 25 mmHg in his right eye on initial evaluation. Case 2 was a 57-year-old male with visual crowding in his left eye who had best-corrected visual acuity of 20/20 in his left eye on initial examination and intraocular pressure of 19.3 mmHg. In both patients, dynamic changes could be tracked by en-face ultra-widefield OCTA imaging before and up to 1 year after surgical treatment. The images showed arteriovenous anastomosis and the nonperfused area on the surface of the retina. CONCLUSIONS AND IMPORTANCE: En-face widefield OCTA is useful for monitoring the structure of retinal vessels over time in acute retinal necrosis. Wide-angle OCTA is used to non-invasively examine retinal vascular dynamic changes in ARN. OCTA artifacts due to intraocular inflammation appeared, making interpretation difficult. These will remain as issues in the future. It seems difficult for a while to completely replace FA due to the problem of image clarity.

DOI： 10.1186/s12348-023-00331-8

PubMed

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

This study retrospectively determined the relationship between vitreous IL-6 levels and clinical and laboratory data collected from uveitis patients. We examined an unknown cause of posterior uveitis, collecting vitreous fluid to investigate vitreous IL-6 levels. The samples were analyzed in consideration of clinical and laboratory factors, such as the male/female ratio. The present study included 82 eyes from 77 patients with a mean age of 66.20 ± 15.41 years. The IL-6 concentrations of the vitreous specimens were 6255.0 ± 14,108.3 pg/mL in males and 277.6 ± 746.3 pg/mL in females, which was found to be a statistically significant difference (p = 0.048) (n = 82). There was also a statistically significant correlation between vitreous IL-6 concentrations, serum C-reactive protein (CRP) value and white blood cell counts (WBCs) (n = 82). In multivariate analysis, vitreous IL-6 levels were significantly correlated with gender and CRP in all cases (p = 0.048 and p < 0.01, respectively) and were also significantly correlated with CRP in non-infectious uveitis (p < 0.01). In infectious uveitis, there were no significant differences between IL-6 level and several variables. Vitreous IL-6 concentrations were higher in males than in females in all cases. In non-infectious uveitis, vitreous IL-6 levels were correlated with serum CRP. These results might suggest that intraocular IL-6 levels depend on gender differences in posterior uveitis, and intraocular IL-6 levels in non-infectious uveitis may reflect systemic inflammations, including increased serum CRP.

DOI： 10.3390/jcm12051720

PubMed

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

International / domestic magazine：Domestic 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

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 Research

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

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DOI： 10.1167/iovs.12-10781

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DOI： 10.1007/s10384-011-0013-7

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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

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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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Publishing type：Research paper (scientific journal)  

DOI： 10.1016/j.brainres.2009.05.095

PubMed

Publishing type：Research paper (scientific journal)  

DOI： 10.1007/s00417-008-0949-6

PubMed

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＜文献概要＞眼付属器リンパ腫とは主に眼窩内(涙腺を含む)に発生するリンパ腫の総称である。

精密医療とは臨床情報・遺伝情報・環境因子を含む多くのデータセットから患者を層別化し,それぞれのグループに最適な治療法や予防法を提供するものである.ぶどう膜炎診療では,ぶどう膜炎の病期,眼炎症の活動性とその程度,眼炎症が眼組織に及ぼす影響などを考慮しながら,目の前のぶどう膜炎患者に最適な治療を適宜選択する必要がある.このアプローチ法は精密医療そのものであるが,現状の検査法と治療法から得られるデータセットは質・量ともに十分とはいえない.この問題を解決するために我々は,従来とは異なる検査情報の取得,新規治療法の開発,大規模データベースの構築に取り組んできた.1.眼炎症の「見える化」を目指した生体イメージングの開発古くからぶどう膜炎における炎症評価方法のゴールドスタンダードは検眼鏡所見である.ぶどう膜炎では検眼鏡的に炎症所見が軽微であっても網膜組織障害が慢性に進行する場合があり,そのような症例では治療の匙加減に悩むことがしばしばある.我々は光干渉断層計(OCT)を活用することによって,硝子体細胞の特徴がぶどう膜炎の分類に有用であることを見出し,en face slab OCT imagingによりぶどう膜炎に伴う網膜内層障害を二次元的に評価することに成功した.さらに,二光子顕微鏡によるマウス網膜のin vivo imagingでは,炎症惹起に伴うミクログリアの動的な反応を評価できることを明らかにした.ヒト生体網膜での炎症細胞の動的な可視化は現実的ではないが,マウス網膜で得られた知見を適切な生体プローブの動態に関連づけることによって,構造異常が認められない段階での網膜細胞異常の有無を臨床で可視化できるようになると思われる.これらの生体イメージングによる眼炎症の「見える化」は,眼炎症と網膜組織障害の詳細な評価を介して,きめ細やかな眼炎症管理に貢献するものと期待される.2.ぶどう膜炎続発緑内障の克服を目指した新しい濾過手術近年の生物学的製剤の登場と硝子体手術の低侵襲化によって,ぶどう膜炎における主要な失明原因は黄斑病変から続発緑内障へとシフトしていくことが予想される.ぶどう膜炎続発緑内障は原発開放隅角緑内障に比べ高眼圧であり視野障害の進行が速いことから,原発開放隅角緑内障とは異なる治療戦略で長期的な視機能維持を目指す必要がある.我々は,ぶどう膜炎続発緑内障ではRho-associated coiled-coil forming kinase(ROCK)阻害薬点眼が著効する症例が存在すること,谷戸フックを用いた線維柱帯切開術(眼内法)の治療成績が原発開放隅角緑内障と遜色がないことを明らかにした.一方,濾過手術の進化はぶどう膜炎続発緑内障の管理に必須である.著者が発明したTenon開創器は術中にTenon嚢-強膜間のスペースを確保することによって結膜への影響を最小限にマイトマイシンCの効果を得ることを目的としたデバイスである.これに独特な強膜フラップ処理と独自の結膜縫合法を組み合わせることによって,濾過胞管理の不要な新しい線維柱帯切除術が誕生した.また,我々が行ったロングチューブシャント手術の改良もぶどう膜炎続発緑内障に対する低侵襲濾過手術の実現に貢献している.ぶどう膜炎続発緑内障に対するこれらの治療法の登場によって,ぶどう膜炎患者の視機能が長期的に維持されることを期待したい.3.自己免疫網膜症に対する精密医療への取り組み自己免疫網膜症は網膜細胞を標的とする自己免疫反応が亜急性に網膜視細胞を不可逆的に障害するまれな疾患である.自己免疫網膜症の診断については抗網膜自己抗体の特異度が低いこと,治療に関しては標準化された治療アルゴリズムがないことがそれぞれ問題となっている.また,視機能が不可逆的に障害される前に治療効果を判定できる他覚的な疾患バイオマーカーがないことも自己免疫網膜症診療を難しくしている主因となっている.そこで我々は,日本眼炎症学会とJapan Ocular Imaging Registryの助力を得て,自己免疫網膜症患者の大規模臨床データベースの作成,患者血液を用いた網羅的プロテインアレイによる主要な抗網膜抗体の決定,患者血液を用いた代謝物データと臨床データの統合解析による臨床バイオマーカーの探索を目指した多機関研究を行うこととした.本研究で得られる質の高いデータセットを活用することによって,自己免疫網膜症の精密医療が進むものと考えている.(著者抄録)

J-GLOBAL

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網膜復位術(バックリング手術)は硝子体手術の劇的な進歩もあり,適応症例は減少しているが,今でも絶対的適応の症例は存在し,網膜硝子体術者としては必ず習得すべき術式である.一方で,広角観察システムを中心とした手術機器の進歩は,その術式選択に大きな変遷をもたらしつつある.本稿では,シャンデリア照明と広角観察システムを併用した方法について,その由来,詳細な実際の手技・ポイント,本術式を選択する利点・欠点,さらには今後の展望などを自験および参考文献の内容をもとに概説する.(著者抄録)

DOI： 10.1038/s41467-022-28758-y

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

CiNii Research

CiNii Research

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

DOI： 10.11477/mf.1410211324

CiNii Research

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

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

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