Curved single-plane clear corneal incision made under anterior chamber collapse by aqueous humor aspiration prevents leakage after cataract surgery.

PURPOSE: To evaluate the self-sealing on curved single-plane clear corneal incisions (CCIs) after cataract surgery. The collapse of the anterior chamber was made by aspirating the aqueous humor in order to make curved single-plane CCI. METHODS: A retrospective study was conducted at Asai Hospital in Japan. There were 189 eyes of 132 patients scheduled from February to April 2017 for single-plane CCI. There were 175 eyes of 128 patients from February to April 2018 for curved single-plane CCI. Curved single-plane CCIs were made with aqueous humor aspiration via aqueous humor pipette, and single-plane CCIs were made without the aspiration. In case of leakage of aqueous humor from the CCI at the end of surgery, sutures were used. The main outcome measure was the proportion of sutures for CCI. Secondary outcomes included CCI length and surgically induced astigmatism (SIA) magnitude. RESULTS: The proportions of suture in single-plane CCI and in curved single-plane CCIs were 25.4% (48/189) and 0% (0/175), respectively (p < 0.001). The length of curved single-plane CCI (2.06 ± 0.18 mm) was significantly greater than that of single-plane CCI (1.66 ± 0.12 mm; p < 0.001). The median postoperative SIAs of single-plane and curved single-plane CCIs were 0.64 D (n = 89) and 0.73 D (n = 85) for nasal incision, and 0.46 D (n = 100) and 0.47 D (n = 90) for temporal incision at examination 3 months after surgery, respectively, without significant change (p = 0.12 for nasal incision and p = 0.37 for temporal incision). CONCLUSION: The curved single-plane CCI achieved by only aqueous humor aspiration showed significant effectiveness in self-sealing. TRIAL REGISTRATION: UMIN clinical trials registry UMIN000032480, retrospectively registered on 6 May 2018.

Ocular parameters before and after steep Trendelenburg positioning for robotic-assisted laparoscopic radical prostatectomy.

PURPOSE: Intraocular pressure (IOP) increases in patients in a steep Trendelenburg position during robotic-assisted laparoscopic radical prostatectomy (RALP). We hypothesized that a steep Trendelenburg position during RALP, an unusual systemic condition involving a transiently increased IOP, may induce ocular pathology that can be detected by detailed evaluations long after the surgery. This study aims to explore ocular structural and functional parameters in patients before and in the long term after the surgery. PATIENTS AND METHODS: A comparative observational study was performed. A total of 44 eyes of 22 male patients scheduled for RALP at Aichi Medical University from August 2012 to July 2013 were included. Clinical parameters before and after RALP were compared. Perioperative IOP was measured immediately post-induction of anesthesia in the flat supine position (T1), immediately post-steep Trendelenburg position (T2), and prior to returning to a flat supine position while in a steep Trendelenburg position (T3). The thicknesses of the peripapillary retinal nerve fiber layer, ganglion cell complex (GCC), and central fovea were measured with spectral domain optical coherence tomography. Humphrey perimetry was performed before and at 3 and 6 months after surgery. RESULTS: The average IOPs (mmHg) at each stage were T1=10.4, T2=21.7, and T3=29.6, and differed significantly. The mean visual acuity (logarithm of the minimal angle of resolution), IOP, mean deviation, and pattern standard deviation measured by the Humphrey field analyzer showed no statistically significant difference before and after surgery. The ganglion cell complex and retinal nerve fiber layer thicknesses measured at each location and the central fovea thicknesses measured before and after surgery did not differ significantly. CONCLUSION: No significant disorders in ocular structural and functional parameters were found until long after RALP.

Influence of upper and temporal transconjunctival sclerocorneal incision on marginal reflex distance after cataract surgery.

BACKGROUND: Ptosis incidence following cataract surgery is reduced with a recently developed phacoemulsification technique using a small incision. However, it remains uncertain whether an upper transconjunctival sclerocorneal incision can cause minor blepharoptosis. In the present prospective study, patients underwent cataract surgery with either an upper or temporal 2.4-mm transconjunctival sclerocorneal incision. We measured the marginal reflex distance 1 (MRD1) preoperatively and postoperatively, and compared these measurements between the two different incision types. Further we explored the risk factors of the postoperative MRD1 reduction. METHODS: The study population included patients who underwent cataract surgery on both eyes at Aichi Medical University between October 2013 and September 2015. In each patient, one eye was operated using an upper 2.4-mm transconjunctival sclerocorneal incision, and the other with a temporal incision. We prespecified that an MRD1 difference of ≥0.5 mm between the pre- and post-surgical measurements indicated postoperative ptosis, which was a strict criterion. MRD1 was measured using digital photography, and we calculated the difference between the preoperative and postoperative MRD1 values. This change in MRD1 was compared between the groups with different incision locations. The change in MRD1 was analyzed by using the multivariate regression model including incision position (temporal or upper), preoperative MRD1, and preoperative distance between medial and lateral canthi. RESULTS: We assessed data from a total of 34 patients. The mean change in MRD1 from pre-operation to post-operation measurements was -0.26 ± 0.93 with the temporal incision and -0.24 ± 0.86 with the upper incision. The mean difference in the change in MRD1 between the different two incision types was -0.02, with a 95 % CI of -0.24 to 0.20, establishing equivalence between these incision types. The multivariate regression analysis showed that the preoperative MRD1 was significantly associated with the reduction of MRD1 after surgery (p = 0.034). CONCLUSIONS: Cataract surgery using upper and temporal 2.4-mm transconjunctival sclerocorneal incisions are clinically equivalent with regards to change in MRD1, and neither incision type caused critical postoperative ptosis. The longer preoperative MRD1 was significantly associated with the reduction of MRD1 after surgery. TRIAL REGISTRATION: Current Controlled Trials UMIN000022310 . Retrospectively registered 14 May 2016.

Early resolution of subretinal fluid without high-dose corticosteroids in a pregnant patient with Vogt-Koyanagi-Harada disease: a case report.

BACKGROUND: At present, there is no standard of treatment using systemic high-dose corticosteroids in cases of pregnant women with Vogt-Koyanagi-Harada (VKH) disease. Although high-dose systemic corticosteroid treatment is often used for VKH disease during pregnancy, it also poses a risk to the fetus. FINDINGS: A 29-year-old woman in the 34th week of pregnancy experienced bilateral metamorphopsia. She had been receiving 5 mg of prednisolone daily for the past 8 years as treatment for rheumatoid arthritis. In order to prevent progression of bilateral serous retinal detachment caused by VKH disease, we recommended the use of high-dose systemic corticosteroids but the patient refused. Thus, we administered only topical ophthalmic betamethasone for mild anterior uveitis. Surprisingly, however, the bilateral bullous retinal detachment healed in just 19 days after the onset of symptoms. A healthy baby was born 1 month later, and sunset glow fundus was subsequently observed without any recurrence of uveitis. CONCLUSIONS: We report a case in which bilateral subretinal fluid caused by VKH disease in a young woman during late pregnancy resolved without high-dose corticosteroid treatment. Pregnancy may have had a beneficial effect on uveitis activity caused by VKH disease. To our knowledge, this report describes the shortest healing period for bilateral bullous retinal detachment in a pregnant woman with VKH disease.

Correlation between optic nerve head structural parameters and glaucomatous visual field indices.

We examined associations between optic nerve head structural parameters and glaucomatous visual field indices. The study population included patients with glaucomatous optic neuropathy who were evaluated at Aichi Medical University, Nagakute, Aichi, Japan, from October 2010 to January 2011. A total of 57 eyes from 33 patients were assessed. We measured visual field using a Humphrey field analyzer, peripapillary retinal nerve fiber layer thickness (RNFL-T), and Bruch's membrane opening-minimum rim width (BMO-MRW) using spectral domain optical coherence tomography, and rim area with referring three-dimensional photography. Spearman's rank correlation coefficients were calculated between the threshold of visual sensitivity or total deviation of visual field and the following five optic nerve head structural parameters: RNFL-T length, BMO-MRW length, rim area, and calculated RNFL-T and BMO-MRW volumes (each length multiplied by rim area). The Akaike information criterion was calculated to determine which structural parameter was the best predictor of each visual field index. Threshold of visual sensitivity had correlation coefficients of 0.23 with global sector of RNFL-T, 0.32 with BMO-MRW, 0.14 with rim area, 0.21 with RNFL-T volume, and 0.26 with BMO-MRW volume. The correlation coefficients for each parameter with total deviation of visual field were 0.22, 0.33, 0.28, 0.36, and 0.37, respectively. The Akaike information criterion of BMO-MRW showed the smallest values in analyses of both threshold of visual sensitivity and total deviation. The present results show that RNFL-T volume and BMO-MRW volume were more strongly correlated with total deviation than BMO-MRW, but BMO-MRW appeared to be the best predictor of the two glaucomatous visual field indices.

Choroidal and optic disc metastases from breast cancer and their response to combination pharmacotherapy with tamoxifen, cyclophosphamide hydrate, letrozole, and bevacizumab.

PURPOSE: The purpose of this study was to report a patient with choroidal and optic disc metastases from breast cancer and the response to combination pharmacotherapy with tamoxifen, cyclophosphamide hydrate, letrozole, and bevacizumab. METHODS: We report a case of a 51-year-old woman with a medical history of breast cancer treated with mastectomy at 16 years earlier followed by 5'-deoxy-5-fluorouridine and tamoxifen for 12 years, who has been followed by annual check-up, with no additional findings. Two weeks prior to her first visit to our hospital, she noted blurred and abnormal color vision and field loss in her right eye. Her right eye showed choroidal metastasis from breast cancer, with retinal detachment involving the macula and inferior periphery. RESULTS: Multiple metastases involving bones, lymph nodes in the mediastinum, ovaries, and pelvic nodes were diagnosed after ocular metastases were established. Combination therapy with tamoxifen, cyclophosphamide hydrate, letrozole, and bevacizumab was administered to the patient. The retinal detachment and optic disc metastasis improved dramatically. CONCLUSIONS: The patient underwent combination pharmacotherapy with tamoxifen, cyclophosphamide hydrate, letrozole, and bevacizumab, which was effective in the treatment of ocular metastases from breast cancer.