[A case of non-atherothrombotic cerebroretinal small vessel disease].

BACKGROUND: There is an increasing interest in the relation between retinal artery abnormalities and cerebral small-vessel diseases (SVD), because retinal vessels share common properties with cerebral small vessels. We report a case of juvenile cerebrovascular disease presenting retinal vessel abnormalities, which clinically resembled cerebral autosomal dominant arteriopathy with stroke and ischemic leukoencephalopathy (CADASIL) but in which Notch3 gene mutations were not detected. CASE: A 42-year old woman was hospitalized at the department of Neurology in our hospital, complaining of headache and dysarthria. MRI showed bilateral spotted white matter lesions in the paraventricular area and the temporal lobe, and an ovoid lesion in the right corona radiata. Despite steroid pulse therapy, she developed right incomplete hemiparesis and new lesions were detected in the anterior temporal pole and external capsule. Her genetic analysis showed no mutations in the Notch 3 gene. Ophthalmological examination revealed arterial sheathing in the peripapillary region. Fluorescein angiography showed narrowing of the retinal arterioles and distinguished a peripheral vascular network. CONCLUSION: In this case, ophthalmological examination revealed retinal vessel abnormalities in a relatively young woman with no risk factors such as hypertention or artheriosclerosis, presenting recurrent subcortical strokes. This actual case indicates the association between retinal vessel abnormalities and cerebral SVDs.

Transconjunctival sutureless intrascleral intraocular lens fixation using intrascleral tunnels guided with catheter and 30-gauge needles.

We invented a new method for fixing an intraocular lens (IOL) in the scleral tunnel without using a wide conjunctival incision. Modified bent catheter needles were used to penetrate the IOL haptics through the sclerotomy sites. The IOL haptics were inserted into 30-guage (G) scleral tunnels guided by double 30-G needles piercing the sclera. All procedures were performed through the conjunctiva without wide incision. The procedure does not require special forceps, trocars or fibrin glue, only catheter and 30-G needles. The aid of an assistant was not required to support the IOL haptic. The procedures were easily learnt based on our previous method. As with other transconjunctival sutureless surgeries, patients feel less discomfort and the conjunctiva can be conserved for future glaucoma surgery. Complications included two cases of vitreous haemorrhage (16.7%), and one case each of postoperative hypotony, and iris capture (8.3%). Astigmatism induced by intraocular aberration was the same as we reported previously. Our method for fixing the IOL into the scleral tunnel is innovative, less expensive, less invasive and quick. This modified method is a good alternative for fixing IOL haptics into the sclera.

Intrascleral fixation technique using catheter needles and 30-gauge ultrathin needles: lock-and-lead technique.

UNLABELLED: We report a new intrascleral fixation technique for a standard 3-piece posterior intraocular lens (IOL) using catheter needles and 30-gauge ultrathin needles instead of a special forceps and minimal intraocular manipulation in eyes without capsule support. Modified catheter needles are used to deliver the IOL haptic. The IOL haptic is secured extraocularly between the cannula and needle of a catheter needle and then advanced through the sclerotomy site. Scleral tunnels are created using 30-gauge ultrathin needles, which also serve as a guide to introduce the haptics. This technique can be performed even in cases in which miosis and corneal edema prevent anterior chamber observation. The guide needle facilitates haptic insertion into the long and narrow scleral tunnels. The procedure is a good alternative to current techniques. FINANCIAL DISCLOSURE: Dr. Akimoto is a consultant to Kowa Co., Ltd. No other author has a financial or proprietary interest in any material or method mentioned.