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A capsular tension ring (CTR) is used for support to stabilize the capsular bag and intraocular lens (IOL) during and after cataract surgery. Although complications involving the CTR-IOL complex are not uncommon, cases of anterior displacement leading to complications are rare. This report presents a case of secondary angle closure caused by anterior displacement of the CTR-IOL complex due to aqueous misdirection and reports unique findings noted on anterior segment optical coherence tomography (AS-OCT). The patient, a 69-year-old woman, developed an acute angle closure crisis (AACC) and underwent cataract surgery with the implantation of a CTR and IOL. Post-surgery, there was an improvement in the central depth of the anterior chamber, but the patient experienced intermittent spikes in intraocular pressure. AS-OCT revealed a flat center of the iris and a closed anterior chamber angle which are plateau-iris-like findings. Secondary angle closure was caused by the CTR-IOL complex which was anteriorly displaced and pushed the peripheral iris owing to aqueous misdirection syndrome. Three weeks after the initial surgery, the patient underwent CTR removal, anterior vitrectomy, and intrascleral lens fixation. After the second surgery, intraocular pressure was normalized without any medications, and the anterior chamber angle was enlarged. This case provides a better understanding of secondary angle closure caused by the anterior displacement of the CTR-IOL complex and highlights the importance of AS-OCT in the detection of such complications.
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PURPOSE: To determine whether more severe baseline damage impedes measurement of minimum rim width (MRW) and peripapillary retinal nerve fiber layer thickness (RNFLT) change in glaucoma patients because of a floor effect. DESIGN: Prospective, longitudinal cohort study in a hospital-based setting. PARTICIPANTS: The study included patients with open-angle glaucoma and healthy control subjects. Participants had at least 5 years of follow-up with OCT every 6 months. METHODS: Baseline global and sectorial MRW and RNFLT values were classified as within normal limits, borderline, or outside normal limits based on reference normative values. Regression analysis was used to determine the magnitude and significance of MRW and RNFLT change. Additionally, the follow-up period for each participant was divided into 2 equal halves (first and second periods) to determine whether there was attenuation of MRW and RNFLT change with follow-up time. MAIN OUTCOME MEASURES: Rates of global and sectoral MRW and RNFLT changes (slopes). RESULTS: A total of 97 patients with glaucoma (median age, 70.3 years) and 42 healthy subjects (median age, 64.8 years) were followed for a median of 6.9 years and 7.0 years, respectively. The median mean deviation of the visual field in glaucoma patients was -4.30 decibels (dB) (interquartile range, -7.81 to -2.06 dB; range, -20.68 to 1.37 dB). Statistically significant changes in global and sectoral MRW and RNFLT were detected across all baseline classifications; however, there was a tendency for less change with increasing baseline damage. In glaucoma patients, RNFLT slopes, but not MRW slopes, were significantly more positive (less change) in the second period compared with the first. There were also no differences in MRW or RNFLT slopes in the first and second periods in healthy subjects. CONCLUSIONS: Significant MRW and RNFLT changes were detected at all levels of baseline damage. However, an attenuation in the rate of RNFLT change compared with MRW indicates an earlier floor effect in RNFLT measurements globally and in equivalent sectors. Because the axonal component of these measurements should be equivalent, our results suggest important differences in tissue remodeling at the level of the optic nerve head and peripapillary retina. FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found after the references.
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Progresión de la Enfermedad , Glaucoma de Ángulo Abierto , Presión Intraocular , Fibras Nerviosas , Disco Óptico , Células Ganglionares de la Retina , Tomografía de Coherencia Óptica , Campos Visuales , Humanos , Masculino , Femenino , Células Ganglionares de la Retina/patología , Glaucoma de Ángulo Abierto/fisiopatología , Glaucoma de Ángulo Abierto/diagnóstico , Estudios Prospectivos , Fibras Nerviosas/patología , Tomografía de Coherencia Óptica/métodos , Persona de Mediana Edad , Anciano , Presión Intraocular/fisiología , Campos Visuales/fisiología , Disco Óptico/patología , Disco Óptico/diagnóstico por imagen , Estudios de Seguimiento , Enfermedades del Nervio Óptico/diagnóstico , Enfermedades del Nervio Óptico/fisiopatología , Pruebas del Campo VisualRESUMEN
PURPOSE: To clarify the abilities of circumpapillary retinal nerve fiber layer thickness (cpRNFLT) obtained by optical coherence tomography (OCT) and circumpapillary vessel density (cpVD) measured by OCT-angiography to distinguish different stages in primary open-angle glaucoma determined by 24-2 or 30-2 static visual field (VF) testing. METHODS: This retrospective study includes 25 healthy normal eyes of 25 subjects and 87 primary open-angle glaucoma eyes of 87 patients. Areas under the receiver operating characteristic curves (AUROC) were evaluated for determining glaucoma stages using cpRNFLT and cpVD. The absolute errors of the estimated mean total deviation (mTD) using optimal models with cpRNFLT and cpVD were also compared. RESULTS: The AUROCs for discriminating glaucomatous eyes from normal eyes was significantly higher for cpRNFLT than the respective AUROCs for cpVD (0.969 [95% CI 0.939 to 0.998] vs. 0.872 [95% CI 0.806 to 0.938], p = 0.006), whereas cpVD had significantly higher AUROC for discriminating severe glaucoma eyes from moderate glaucoma eyes than cpRNFLT (0.771 [95% CI 0.655 to 0.886] vs. 0.578 [95% CI 0.420 to 0.736], p = 0.022). The mean absolute error in estimating mTD using both cpRNFLT and cpVD was significantly less than the error using cpRNFLT alone (4.56 ± 3.76 dB vs. 5.39 ± 4.00 dB, p = 0.027). CONCLUSION: Our results suggest that cpVD is better for follow-ups after moderate stage. The combination of cpRNFLT and cpVD may improve VF estimation compared to cpRNFLT alone.
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Glaucoma de Ángulo Abierto , Glaucoma , Disco Óptico , Humanos , Glaucoma de Ángulo Abierto/diagnóstico , Disco Óptico/irrigación sanguínea , Campos Visuales , Estudios Retrospectivos , Presión Intraocular , Densidad Microvascular , Vasos Retinianos , Células Ganglionares de la Retina , Tomografía de Coherencia Óptica/métodos , Fibras NerviosasRESUMEN
Purpose: This cross-sectional study aimed to clarify the differences in the retinal venous narrowing ratio (VNR) at retinal arteriovenous crossing by optical coherence tomography (OCT) among the eyes with branch retinal vein occlusion (BRVO), fellow eyes of patients with BRVO, and eyes of individuals without BRVO and to determine factors that influence the VNR. Methods: We studied 31 eyes of young participants, 54 eyes of an older control group, 56 fellow eyes of patients with BRVO, and 48 eyes with BRVO. Cross-sectional OCT images were used to determine the VNR at two arteriovenous crossings per eye. Results: Overall, 378 arteriovenous crossings were analyzed. The VNR of arterial overcrossings of fellow eyes (27.7% ± 11.1%) and BRVO eyes (27.3% ± 9.76%) were significantly higher than those in the young (16.0% ± 7.9%, all P < 0.001) and control (22.0% ± 8.81%, P < 0.001, P = 0.003, respectively) groups. The VNR of arterial overcrossings was significantly larger than that of venous overcrossings (24.0% ± 10.5% vs. 20.6% ± 13.0%, P = 0.021). A linear mixed-effects model showed that the VNR was significantly higher in arterial overcrossings, crossings with larger arterial internal diameters, smaller venous internal diameters, and participants with older age and a BRVO history. Conclusions: The VNR in arterial overcrossings was higher in BRVO eyes and even in the fellow eyes. Thus, a higher VNR in arterial overcrossings may contribute to BRVO development, and crossings with factors contributing to higher VNR might be associated with a risk of BRVO.
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Arteria Retiniana , Oclusión de la Vena Retiniana , Vena Retiniana , Humanos , Oclusión de la Vena Retiniana/diagnóstico , Estudios Transversales , Angiografía con Fluoresceína , Arteria Retiniana/diagnóstico por imagenRESUMEN
PURPOSE: To determine the factors significantly associated with the amplitudes and implicit times of the flicker electroretinograms (ERGs) recorded with the RETeval system by analyzing the comprehensive data obtained during a health checkup screening. METHODS: Flicker ERGs were recorded with the RETeval system from 373 individuals who had a normal fundus and optical coherence tomography images. The sex, age, anthropometric, ophthalmologic, and hematologic data were collected from all participants who were 40- to 89-years-of-age. Univariable and multivariable linear mixed effects regression analyses were performed to identify factors that were significantly associated with the implicit times and amplitudes of the RETeval flicker ERGs. RESULTS: Univariable linear mixed effects regression analysis showed significant correlations between the implicit times and the best-corrected visual acuity, the age, the axial length, the blood sugar level, and the blood urea nitrogen level. Analyses by multivariable linear mixed effects regression identified that the axial length (ß = 0.28), the age (ß = 0.24), and the blood sugar level (ß = 0.092) were three independent factors that were significantly correlated with the implicit times of the RETeval flicker ERGs. Univariable linear mixed effects regression analysis also showed significant correlations between the amplitudes of the RETeval flicker ERGs and the age, the platelet count, and the creatinine level. Multivariable linear mixed effects regression models identified the age (ß = -0.092), the platelet count (ß = 0.099), and the creatinine level (ß = -0.12) as three independent factors that were significantly correlated with the amplitudes of the RETeval flicker ERGs. However, the smoking habits, body mass index, and the blood pressure were not significantly correlated with either the implicit times or amplitudes of the RETeval flicker ERGs. CONCLUSIONS: Our results indicate that the age and some ophthalmologic and hematologic findings but not the anthropometric findings were significantly associated with the implicit times and amplitudes of the RETeval flicker ERGs. Thus, clinicians should remember these factors when analyzing the RETeval flicker ERGs.
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Glucemia , Retina , Humanos , Creatinina , Electrorretinografía/métodos , Tomografía de Coherencia Óptica , Regulador Transcripcional ERGRESUMEN
This study investigated the effect of renal dysfunction categorized by the stage of chronic kidney disease (CKD) on the retinal microcirculation assessed by laser speckle flowgraphy (LSFG) and retinal artery caliber measured by adaptive optics imaging in diabetic patients particularly the early stage of retinopathy and nephropathy. We divided the patients with diabetes into three groups based on the CKD stage (non-CKD (n = 54); CKD stage 1 + 2 (n = 20); CKD stage 3 (n = 41)). The mean blur rate (MBR) of the stage 3 CKD group was significantly lower than that of the no-CKD group (p < 0.015). The total retinal flow index (TRFI) in the stage 3 CKD group was significantly lower than that of the no-CKD group (p < 0.002). Multiple regression analysis demonstrated that CKD stage was independently associated with MBR (ß = -0.257, p = 0.031) and TRFI (ß = -0.316, p = 0.015). No significant differences were observed in external diameter, lumen diameter, wall thickness, and wall to lumen ratio among the groups. These results indicated that the ONH MBR and TRFI as assessed by LSFG decreases in diabetic patients with stage 3 CKD, but the arterial diameter measured by adaptive optics imaging does not change, suggesting that impaired renal function may be associated with decreased retinal blood flow in early-stage diabetic retinopathy.
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BACKGROUND/AIMS: The accuracy of pattern deviation (PD) in estimating the damage to the glaucomatous visual field (VF) in the central 10° in eyes with glaucoma and cataract is unclear. METHODS: This retrospective study includes 63 eyes of 52 glaucoma patients who successfully underwent cataract surgery or cataract surgery plus iStent implantation. Using the Humphrey Field Analyser 10-2 test, VF was measured within 6 months preoperatively and postoperatively (VFpre and VFpost, respectively). The mean total deviation values in VFpost (mTDpost) indicates glaucomatous damage without cataract and the difference between this value and mean PD values in VFpre (mPDpre) was evaluated (εmPD). The effect of cataract was then evaluated as the difference between mTDpost and mTDpre (ΔmTD), while the effects of mTDpost and ΔmTD on εmPD were also assessed. In addition, based on preoperative visual acuity (VApre) and VFpre, the optimal model for predicting mTDpost was identified. The error of this method (εOptimalModel) was estimated as the difference against mTDpost, which was compared with εmPD. RESULTS: Compared with mTDpre, there was a significant improvement in mTDpost (p=0.028). A significant difference was observed between mPDpre and mTDpost (p<0.001). Further, εmPD significantly increased with the increase of mTDpost or ΔmTD (p<0.001 and p=0.0444, respectively). The absolute εOptimalModel was significantly smaller than the absolute εmPD (p<0.001). CONCLUSIONS: This study warns clinicians that PD of the central 10° VF might underestimate the glaucomatous VF damage with the progression of glaucoma and overestimate it as a cataract progresses.
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This retrospective study aimed to evaluate choroidal hemodynamics after half-dose photodynamic therapy (PDT) for central serous chorioretinopathy (CSC) and the effects of smoking using laser speckle flowgraphy. This study included 29 eyes of 29 patients treated with half-dose PDT for CSC, who were followed-up for at least 6 months. The mean blur rate (MBR) in the PDT irradiation area (whole area), the pachyvessel (PV) area, non-PV (NPV) area, and filling delay (FD) area were assessed at baseline and 1, 3, and 6 months post-PDT, respectively. The MBR was also assessed by smoking status. The MBR significantly decreased from baseline in the whole, PV, NPV, and FD areas at all time points (P < 0.001). Of the 29 patients, 6 were never smokers, 13 were past smokers, and 10 were current smokers. At baseline, no significant difference was found in the MBR in the whole, PV, NPV, and FD areas among never, past, and current smokers. The MBR changes showed a significantly smaller decrease in current smokers than in never smokers in the whole (P = 0.021), PV (P = 0.009), and NPV (P = 0.034) areas, but not in the FD area (P = 0.172). Half-dose PDT for CSC reduced choroidal blood flow in the PDT-irradiated area, which was blunted by current smoking status.
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Coriorretinopatía Serosa Central , Fotoquimioterapia , Coriorretinopatía Serosa Central/tratamiento farmacológico , Enfermedad Crónica , Angiografía con Fluoresceína , Hemodinámica , Humanos , Fármacos Fotosensibilizantes/uso terapéutico , Estudios Retrospectivos , Fumar/efectos adversos , Tomografía de Coherencia Óptica , Verteporfina/uso terapéutico , Agudeza VisualRESUMEN
BACKGROUND: Several types of immune checkpoint inhibitors (ICIs) have been reported to occasionally cause Vogt-Koyanagi-Harada disease (VKHD)-like uveitis. Among the ICIs, the anti-programmed death ligand-1 (PD-L1) antibody is reported to cause fewer immune-related adverse events (irAEs). We report a case of VKHD-like uveitis that developed after anti-PD-L1 antibody treatment for non-small cell lung cancer (NSCLC). CASE PRESENTATION: A 76-year-old woman suffered from an acute visual reduction in both eyes. She had been treated with atezolizumab, an anti-PD-L1 antibody, for NSCLC for 17 months. Ophthalmologic examinations led to a diagnosis of severe VKHD-like uveitis, and one of the irAEs was suspected. Discontinuation of atezolizumab and systemic steroid therapy led to the resolution of the findings within two months. CONCLUSIONS: This is the first report of VKHD-like uveitis that developed during the treatment by anti-PD-L1 antibody. Our case indicates that VKHD-like uveitis may be induced after a long-time use of anti-PD-L1 antibody.
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Carcinoma de Pulmón de Células no Pequeñas , Neoplasias Pulmonares , Uveítis , Síndrome Uveomeningoencefálico , Femenino , Humanos , Anciano , Carcinoma de Pulmón de Células no Pequeñas/tratamiento farmacológico , Síndrome Uveomeningoencefálico/inducido químicamente , Síndrome Uveomeningoencefálico/diagnóstico , Síndrome Uveomeningoencefálico/tratamiento farmacológico , Neoplasias Pulmonares/tratamiento farmacológicoRESUMEN
We aimed to investigate the increase in resistivity of the retinal artery in the branch retinal vein occlusion (BRVO)-affected area, and to visualize it. Thirty-two eyes of 32 patients with BRVO were measured by laser speckle flowgraphy (LSFG). The retinal artery and vein running to the BRVO-affected area and vertically symmetrical vessels in the unaffected area were examined. We applied the LSFG parameter beat strength over mean blur rate (BOM), calculated using a similar method to the pulsatility index used in Doppler flowmetry to evaluate resistivity of the vessels. Our results showed that the BOM map could clearly visualize the increase of resistivity in the retinal artery as a two-dimensional map. The BOM of the arteries in the affected area was significantly higher than that of the unaffected area (P = 0.001). Multiple regression analysis showed that the ratio of BOM in retinal arteries of the affected area to the unaffected was significantly associated with the extent of retinal hemorrhage (ß = 0.447, P = 0.009). In conclusion, the index of resistivity of the retinal artery in the BRVO-affected area was higher and could be visualized in a two-dimensional map. These findings and techniques would contribute to elucidate the pathophysiology of BRVO.
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Angiografía con Fluoresceína/métodos , Flujometría por Láser-Doppler/métodos , Flujo Sanguíneo Regional , Arteria Retiniana/patología , Oclusión de la Vena Retiniana/fisiopatología , Resistencia Vascular , Anciano , Velocidad del Flujo Sanguíneo , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Arteria Retiniana/diagnóstico por imagen , Estudios Retrospectivos , Tomografía de Coherencia Óptica/métodosRESUMEN
BACKGROUND: The influences of intraocular pressure (IOP) elevations on the pulse waveform in the optic nerve head (ONH) were evaluated using laser speckle flowgraphy (LSFG) in normal subjects. METHODS: This prospective cross-sectional study was conducted at the Nagoya University Hospital. An ophthalmodynamometer was pressed on the sclera to increase the IOP by 20 mmHg or 30 mmHg for 1 min (experiment 1, 16 subjects) and by 30 mmHg for 10 min (experiment 2, 10 subjects). The mean blur rate (MBR) and the eight pulse waveform parameters determined using LSFG were measured before, immediately after and during an IOP elevation, and after the IOP returned to the baseline pressure. RESULTS: A significant elevation in the IOP and a significant reduction in the ocular perfusion pressure (OPP) were found after applying the ophthalmodynamometer (both, P < 0.001). The blowout score (BOS) reduced significantly (P < 0.001), and the flow acceleration index (FAI; P < 0.01) and resistivity index (RI; P < 0.001) increased significantly immediately after increasing the IOP by 20 or 30 mmHg (experiment 1). The BOS reduced significantly (P < 0.001), and the FAI (P < 0.01) and RI (P < 0.001) increased significantly after the IOP elevation by 30 mmHg in both experiment 2 and 1. However, the BOS and RI recovered significantly at time 10 compared to that in time 0 (immediately after IOP elevation) during the 10-min IOP elevation (P < 0.001 and P = 0.008, respectively). CONCLUSIONS: In conclusion, the BOS, FAI, and RI of the pulse waveforms changed significantly with an acute elevation in the IOP. The change should be related to the larger difference between the maximum and minimum MBRs during the IOP elevation.
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Presión Intraocular , Disco Óptico , Velocidad del Flujo Sanguíneo , Presión Sanguínea , Estudios Transversales , Voluntarios Sanos , Humanos , Flujometría por Láser-Doppler , Rayos Láser , Estudios Prospectivos , Flujo Sanguíneo RegionalRESUMEN
Background and study aims The relationship between acute colonic diverticulitis and colorectal cancer (CRC) is unclear, but colonoscopy is recommended to exclude malignancy. We compared the detection rates for colorectal neoplasia in patients with colonic diverticulitis and asymptomatic patients who had positive fecal immunochemical tests (FITs). Patients and methods In total, 282 patients with acute colonic diverticulitis were hospitalized in our hospital from February 2011 to December 2019. Of them, 143 patients with diverticulitis and 1819 with positive FITs patients during the same period underwent colonoscopy without a prior colonoscopy within 5 years. We retrospectively compared these patients in terms of the invasive CRC rate, advanced neoplasia detection rate (ANDR), adenoma detection rate (ADR), and polyp detection rate (PDR). Results Compared to the diverticulitis group, the FIT-positive group had a significantly higher CRC rate (0 vs 2.7â%, P â=â0.0061), ANDR (5.6 vs. 14.0â%, P â=â0.0017), ADR (19.6 vs. 53.2â%, P â<â.0001), and PDR (44.1 vs. 91.0â%, P â<â.0001). Using 1:1 propensity score matching based on age and sex, we obtained 276 matched patients in both groups. After matching, no difference was found in the CRC rate (0 vs 0.7â%) or ANDR (5.8 vs 7.3â%) between groups, but the ADR and PDR were significantly higher in the FIT-positive group (20.3 vs 43.5â%, P â<â.0001; 45.7â% vs 86.2â%, P â<â.0001). Conclusion Patients with acute diverticulitis had lower ADRs and PDRs than patients with positive FITs.
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We investigated morphological changes of retinal arteries to determine their association with the blood flow and systemic variables in type 2 diabetes patients. The patients included 47 non-diabetic retinopathy eyes, 36 mild or moderate nonproliferative diabetic retinopathy (M-NPDR) eyes, 22 severe NPDR (S-NPDR) eyes, 32 PDR eyes, and 24 normal eyes as controls. The mean wall to lumen ratio (WLR) measured by adaptive optics camera was significantly higher in the PDR groups than in all of the other groups (all P < 0.001). However, the external diameter of the retinal vessels was not significantly different among the groups. The mean blur rate (MBR)-vessel determined by laser speckle flowgraphy was significantly lower in the PDR group than in the other groups (P < 0.001). The WLR was correlated with MBR-vessel (r = - 0.337, P < 0.001), duration of disease (r = 0.191, P = 0.042), stage of DM (r = 0.643, P < 0.001), systolic blood pressure (r = 0.166, P < 0.037), and presence of systemic hypertension (r = 0.443, P < 0.001). Multiple regression analysis demonstrated that MBR-vessel (ß = - 0.389, P < 0.001), presence of systemic hypertension (ß = 0.334, P = 0.001), and LDL (ß = 0.199, P = 0.045) were independent factors significantly associated with the WLR. The increased retinal vessel wall thickness led to a narrowing of lumen diameter and a decrease in the blood flow in the PDR group.
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Retinopatía Diabética/patología , Flujo Sanguíneo Regional , Vasos Retinianos/patología , Anciano , Estudios de Casos y Controles , Estudios Transversales , Diabetes Mellitus Tipo 2/complicaciones , Retinopatía Diabética/complicaciones , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios RetrospectivosRESUMEN
PURPOSE: To determine the factors significantly associated with anterior protrusion of the macula in eyes with a macula-off rhegmatogenous retinal detachment (RRD) and to determine the relationship between the intraretinal cystoid cavities (ICCs) and the anterior protrusion and function of the fovea. STUDY DESIGN: Retrospective cross-sectional study. METHODS: Sixty-nine eyes of 69 patients with successfully reattached macula-off RRD were retrospectively analyzed. Six radial spectral-domain optical coherence tomographic (OCT) images were used to evaluate the effects of the ICCs on detached macula and to measure the angle of the retina at the macula as a parameter to evaluate the anterior protrusion of the detached retina. The findings were compared to other parameters. RESULTS: The mean angle of the retina at the macula was 143.1 ± 15.9° with a range of 108 to 172°. Preoperatively, 51 eyes (74%) had ICCs in the inner nuclear layer and/or the outer plexiform layer and Henle fiber layer complex, but none was present after surgery. Multivariate regression analyses revealed that the angle of the retina was significantly associated with the presence of ICCs (ß = -0.637, P<0.001) and the height of subretinal fluid (ß = -0.256, P = 0.005). Eyes with ICCs had poorer preoperative vision (P<0.001), narrower angle of the retina (P<0.001), and thicker subretinal fluid (P<0.001) than eyes without cavities. CONCLUSIONS: The anterior protrusion in eyes with macula-off RRD is associated with the presence of ICCs. The presence of ICCs can affect preoperative function and morphology but does not affect postoperative function and morphology.
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Mácula Lútea , Desprendimiento de Retina , Estudios Transversales , Humanos , Desprendimiento de Retina/diagnóstico , Desprendimiento de Retina/cirugía , Estudios Retrospectivos , Tomografía de Coherencia Óptica , Agudeza Visual , VitrectomíaRESUMEN
PURPOSE: To describe the intraoperative and postoperative morphological and functional outcomes after autologous neurosensory retinal flap transplantation (ART) for a high myopia-related refractory macular hole (MH). METHODS: This prospective interventional study enrolled five eyes of five patients (age range 54-84 years) with highly myopic refractory MHs who underwent ART. All cases were evaluated with intraoperative optical coherence tomography and postoperative optical coherence tomography, optical coherence tomography angiography, and microperimetry for at least 6 months postoperatively. RESULTS: Intraoperatively, the MH was covered by an ART flap with a persistent small subretinal space that was filled with the ART flap after 4 days to 6 days. Optical coherence tomography discriminated the original from the transplanted retina. The mean basal diameter of the original MH decreased from 1,504 ± 684 µm preoperatively to 1,111 ± 356 µm postoperatively. The best-corrected visual acuity improved in two cases, was stable in two cases, and deteriorated in one case. Microperimetry demonstrated no obvious postoperative changes in the fixation points and the absolute scotoma corresponding to the base of MHs with chorioretinal atrophy. In two eyes, choroidal neovascularization developed beneath the transplanted retinas. CONCLUSION: Transplanted tissue was in a fixed position by 1 week postoperatively with a decreased diameter of the original MH. Postoperative fixation points were on the original retina at the MH edge. Because choroidal neovascularization may develop, detailed monitoring is required.
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Monitoreo Intraoperatorio/métodos , Miopía Degenerativa/complicaciones , Retina/trasplante , Perforaciones de la Retina/cirugía , Colgajos Quirúrgicos , Tomografía de Coherencia Óptica/métodos , Agudeza Visual , Anciano , Anciano de 80 o más Años , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Periodo Posoperatorio , Estudios Prospectivos , Retina/diagnóstico por imagen , Perforaciones de la Retina/diagnóstico , Perforaciones de la Retina/etiología , Trasplante AutólogoRESUMEN
Background and study aims Fluoroscopy-guided gastrointestinal procedures (FGPs) are increasingly common. However, the radiation exposure (RE) to patients undergoing FGPs is still unclear. We examined the actual RE of FGPs. Patients and methods This retrospective, single-center cohort study included consecutive FGPs, including endoscopic retrograde cholangiopancreatography (ERCP), interventional endoscopic ultrasound (EUS), enteral stenting, balloon-assisted enteroscopy, tube placement, endoscopic injection sclerotherapy (EIS), esophageal balloon dilatation and repositioning for sigmoid volvulus, from September 2012 to June 2019. We measured the air kerma (AK, mGy), dose area product (DAP, Gycm 2 ), and fluoroscopy time (FT, min) for each procedure. Results In total, 3831 patients were enrolled. Overall, 2778 ERCPs were performed. The median AK, DAP, and FT were as follows: ERCP: 109âmGy, 13.3âGycm 2 and 10.0âmin; self-expandable enteral stenting (SEMS): 62âmGy, 12.4 Gycm 2 and 10.4âmin; tube placement: 40âmGy, 13.8 Gycm 2 and 11.1 min; balloon-assisted enteroscopy: 43 mGy, 22.4âGycm 2 and 18.2âmin; EUS cyst drainage (EUS-CD): 96âmGy, 18.3âGycm 2 and 10.4âmin; EIS: 36âmGy, 8.1 Gycm 2 and 4.4âmin; esophageal balloon dilatation: 9 mGy, 2.2âGycm 2 and 1.8âmin; and repositioning for sigmoid volvulus: 7âmGy, 4.7âGycm 2 and 1.6âmin. Conclusion This large series reporting actual RE doses of various FGPs could serve as a reference for future prospective studies.
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Purpose: To determine whether the blood flow in the superior retina is significantly different from that in the inferior retina, and to determine whether the posture affects the blood flow in the superior and inferior retina. Methods: The blood flow in the vessels around the optic nerve head was measured by laser speckle flowgraphy in the sitting position in 68 healthy subjects. The blood flow in the superior peripapillary retina was compared with that in the inferior peripapillary retina. The measurements of the blood flow were performed in the sitting position, and the effect of switching to a supine position was determined at 2, 4, 6, 8, 10, and 30 minutes after the switch. Results: The total relative flow volume (RFV)-all, RFV-artery, and RFV-vein were significantly greater in the superior retina than in the inferior retina (all P < 0.001). The mean diameter-all and mean diameter-artery in the superior retina were significantly larger than that in the inferior retina (all P < 0.05). The mean blur rate (MBR)-all, MBR-artery, and MBR-vein in the superior retina were also greater than that in the inferior retina (P < 0.001, P < 0.01, and P < 0.001, respectively). Although the ocular perfusion pressure was significantly changed with the postural alteration, the total RFV-all remained greater in the superior retina than in the inferior retina after the postural change. Conclusions: Clinicians need to be aware of the differences in the blood flow between the superior and inferior retinal peripapillary area when considering the mechanisms of retinochoroidal diseases.
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Flujo Sanguíneo Regional/fisiología , Retina/fisiología , Vasos Retinianos/fisiología , Adulto , Femenino , Hemodinámica , Humanos , Flujometría por Láser-Doppler , Masculino , Microcirculación , Oftalmoscopía , Disco Óptico/irrigación sanguínea , Postura/fisiología , Microscopía con Lámpara de Hendidura , Agudeza Visual/fisiología , Adulto JovenRESUMEN
BACKGROUND: A blister-packaged drug might be useful to enhance the eradication of Helicobacter pylori. We investigated the effect of a blister-packaged drug for H. pylori eradication. METHODS: We treated 1,758 patients with H. pylori infections and evaluated the successful eradication rate in patients who underwent first-line eradication between January 2013 and May 2018. Treatments included a conventional proton pump inhibitor (PPI) blister-packaged drug containing lansoprazole or rabeprazole with clarithromycin (CAM) and amoxicillin (AC), vonoprazan (VPZ) with CAM and AC in a separate tablet, or a VPZ blister-packaged drug (VONOSAP) containing VPZ with CAM and AC, with all drugs given twice daily for 7 days. RESULTS: Finally, we evaluated 1,263 patients (conventional PPI: n = 644, VPZ: n = 326, and VONOSAP: n = 293). The overall successful eradication rates were 71.9% in the conventional PPI group, 90.2% in the VPZ group, and 92.2% in the VONOSAP group. There was a significantly lower eradication rate in the PPI group than in the VPZ and VONOSAP (p < 0.00001, p < 0.0001) groups, but there was no significant difference between the VPZ and VONOSAP groups (p = 0.4006). We enrolled a total of 256 age- and gender-matched patients in the VPZ and VONOSAP groups, and both groups had successful eradication rates of approximately 90% (89.8 vs. 90.4%, respectively, p = 0.7641). After analyzing the subgroup of patients older than 75 years, there was a significant treatment benefit of VONOSAP but not of VPZ in elderly patients (EPs). CONCLUSION: Triple-drug blister-packaged drugs including VPZ may improve the first-line eradication of H. pylori in EPs.
Asunto(s)
Antibacterianos/administración & dosificación , Embalaje de Medicamentos/métodos , Infecciones por Helicobacter/tratamiento farmacológico , Inhibidores de la Bomba de Protones/administración & dosificación , Pirroles/administración & dosificación , Sulfonamidas/administración & dosificación , Adolescente , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Amoxicilina/administración & dosificación , Pruebas Respiratorias , Claritromicina/administración & dosificación , Esquema de Medicación , Quimioterapia Combinada/métodos , Heces/microbiología , Femenino , Infecciones por Helicobacter/diagnóstico , Infecciones por Helicobacter/microbiología , Helicobacter pylori/aislamiento & purificación , Humanos , Masculino , Cumplimiento de la Medicación/estadística & datos numéricos , Persona de Mediana Edad , Puntaje de Propensión , Estudios Retrospectivos , Resultado del Tratamiento , Adulto JovenRESUMEN
We evaluated whether the reduction of macular vessel density was correlated with the number of intravitreal injections of anti-vascular endothelial growth factor (VEGF) agents in eyes with a branch retinal vein occlusion (BRVO). The mean vessel density was determined by optical coherence tomography angiography in 29 eyes with macular edema associated with a BRVO. Our results showed that the mean vessel density in the group that had a resolution of the macular edema after one anti-VEGF injection was significantly higher than group that had a recurrence of the macular edema (P = 0.028). Single regression analysis showed that the number of intravitreal injections was significantly correlated with the reduction of the modified vessel density (r = -0.421, P = 0.023) and systemic hypertension (r = 0.377, P = 0.044). Multiple stepwise regression analysis showed that the reduction of the modified vessel density (ß = -0.442, P = 0.009) and hypertension (ß = 0.403, P = 0.016) were independent factors associated with the number of intravitreal injections. We conclude that the vessel density reduction can be used to predict whether recurrences of the macular edema will develop after the initial anti-VEGF injection in eyes with macular edema associated with a BRVO.