[Two cases of allergic fungal rhinosinusitis with bone destruction].

We report herein two cases of allergic fungal rhinosinusitis accompanied by bone destruction of the adjacent nasal sinuses. The first case involved a 21-year-old man who presented with left exophthalmos. Computed tomography (CT) showed soft tissue lesions in the left paranasal sinuses and destruction of the left lamina papyraceae, as well as infiltration of the lesion into the orbit. In the second case, a 39-year-old man, CT showed bone destruction of the skull base and medial wall of the left orbit. In both cases, total serum immunoglobulin (Ig)E level was >1000 IU/mL and fungus-specific IgEs were increased. Fungal hyphae were identified within the mucus on histopathological examination in both cases; however, no fungal invasion of the mucosa was apparent. Final diagnosis was allergic fungal rhinosinusitis (AFRS) in both cases. AFRS is a relatively new disease concept that was proposed in the early 1980s, with disease characteristics very similar to eosinophilic rhinosinusitis. Occasionally, AFRS must be differentiated from malignant disease or invasive fungal rhinosinusitis, so an understanding of the clinical features is important.

[Effect of posterior nasal neurectomy combined with the inferior turbinate surgery for Japanese cedar pollinosis].

INTRODUCTION: Up to 30% of the Japanese population suffers from Japanese cedar pollinosis, and some of these patients also have severe perennial allergies or other pollen allergies. Posterior nasal neurectomy has recently been reported as effective treatment for severe perennial allergic and intrinsic rhinitis. However, the efficacy of this surgery for seasonal allergic rhinitis has not been shown. In this study, the effectiveness of posterior nasal neurectomy combined with inferior turbinate surgery for patients with Japanese cedar pollinosis with concomitant intractable perennial allergies was evaluated with a questionnaire. SUBJECTS AND METHODS: Nine patients with Japanese cedar pollinosis, who also had perennial allergies, and undergone posterior nasal neurectomy combined with inferior turbinate surgery from April in 2005 to July in 2008, were enrolled. A numeric rating scale (NMR) was used to evaluate clinical symptoms in the pre- and post-surgery periods. The frequency of medication (oral administration and nasal spray) during the cedar pollinosis season was also evaluated. RESULTS: The NMR scores for all nasal and eye symptoms during cedar pollinosis season were significantly reduced after the surgery. The frequency of medication during the season was dramatically decreased after surgery. CONCLUSION: The present study demonstrates that posterior nasal neurectomy combined with inferior turbinate surgery is a highly effective treatment for Japanese cedar pollinosis. Since the Japanese cedar pollinosis season is limited to 2 to 3 months, such surgery is indicated for patients who suffer from severe perennial allergies and are also sensitized to some allergens such as Japanese cedar and ragweed pollen.

A case of 25 gauge vitrectomy for malignant glaucoma with microphthalmos.

UNLABELLED: We report the first case report of pars plana lensectomy (PPL) and pars plana vitrectomy using a 25 gauge vitrectomy system for microphthalmos. RESULTS: A 45-year-old woman reported repeated pain in her left eye, despite the use of medications. Ultrasound biomicroscopy revealed a narrow angle and thickened sclera. The lens and the iris showed anterior displacement with a flattening of the ciliary body. The axial length was 15.16 mm in the right eye and 15.04 mm in the left eye. She was diagnosed with a malignant glaucoma with microphthalmos. The patient underwent PPL and pars plana vitrectomy, using a 25 gauge vitrectomy system. The intraocular pressure was well controlled after surgery without medication. CONCLUSION: We considered the PPL and 25 gauge vitrectomy effective in microphthalmos when performed safely.

Efficacy of pneumatic displacement with 40-degree downward gaze positioning for treatment of submacular hemorrhage: report of two cases.

BACKGROUND: Two retrospective case reports are described showing the efficacy of pneumatic displacement with 40-degree downward gaze positioning for treatment of submacular hemorrhage. Case 1 involved an 85-year-old woman who visited our clinic with a complaint of blurred vision in her right eye. Best corrected visual acuity (BCVA) of the right eye was hand motion. Her right eye showed a submacular hemorrhage with retinal macroaneurysm. Prone positioning was difficult because of the patient's age and obesity. The treatment method was pneumatic displacement with 40-degree downward gaze positioning after intravitreal injection of 100% sulfur hexafluoride gas. After the treatment, the hemorrhage moved downward and BCVA of her right eye was 0.1. Case 2 involved a 58-year-old man with a complaint of blurred vision in his left eye. BCVA of his left eye was 0.3 and submacular hemorrhage was observed. He underwent displacement of the hemorrhage as previously described. After treatment, the submacular hemorrhage moved downward. Angiography detected a polypoidal lesion with a vascular network. upon diagnosis of polypoidal choroidal vasculopathy, bevacizumab was injected intravitreally. Two months after gas injection, the submacular hemorrhage disappeared. Optical coherence tomography showed flattening of the submacular retinal pigment epithelium, which was not observed prior to bevacizumab therapy. BCVA of the patient's left eye was 0.9. Pneumatic displacement with 40-degree downward gaze positioning after intravitreal sulfur hexafluoride injection is useful to displace a submacular hemorrhage. Early application of this treatment provides improvement of vision and facilitates fundus examination, which could reveal the cause of the submacular hemorrhage.

Indocyanine green angiographic findings of hypertensive choroidopathy.

PURPOSE: To evaluate fundus lesions in patients with malignant hypertension with indocyanine green angiography (ICGA). METHODS: Cases of hypertensive choroidopathy were followed prospectively with ICGA, fluorescein angiography (FA), and optical coherence tomography (OCT). RESULTS: In Case 1, a 34-year-old man had a 10-day history of blurred vision in both eyes. Visual acuity was 0.2 in the right eye and 0.01 in the left eye. Blood pressure (BP) was 270/178 mmHg, and laboratory tests disclosed severe renal dysfunction. In Case 2, a 31-year-old man had noticed blurred vision in both eyes. Visual acuity was 1.2 in the right eye and 1.0 in the left eye. BP was 272/180 mmHg. Marked optic edema, retinal hemorrhage, cotton-wool patches, and Elschnig spots were seen in both cases. FA showed poorly perfused choroid in the early phase and fluorescein dye leakage from the optic disk. OCT demonstrated serous retinal detachment in both cases. ICGA revealed Elschnig spots corresponding to the patchy choroidal filling defect. ICGA demonstrated a larger area of choroidal filling defect than FA. In Case 1, ICGA revealed dye leakage from large choroidal vessels. These OCT and ICGA findings reduced after early systemic treatment for malignant hypertension. CONCLUSION: Hypofluorescent spots in the choroid thought to be choriocapillaris occlusion and choroidal vessel damage recover as result of early treatment for malignant hypertension. ICGA is useful to reveal the disturbance of choroidal circulation in hypertensive choroidopathy.

Soluble IL-6 receptor in vitreous fluid of patients with proliferative diabetic retinopathy.

PURPOSE: To identify the biological reaction of soluble interleukin-6 receptor (sIL-6R) in the vitreous of patients with proliferative diabetic retinopathy (PDR). METHODS: The subjects were 45 patients (45 eyes) with vitreoretinal diseases. The patients were divided into three groups: the PDR group comprised 28 patients (28 eyes) with PDR; the pre-proliferative diabetic retinopathy (PPDR) group comprised seven patients (seven eyes) with PPDR combined with diabetic macular edema; and the nondiabetic group comprised ten patients (ten eyes) with idiopathic macular hole or idiopathic epiretinal membrane. Vitreous samples were obtained at vitrectomy. sIL-6R, vascular endothelial growth factor (VEGF), and protein concentration in vitreous samples were determined by enzyme-linked immunosorbent assay (ELISA). sIL-6R levels in serum were also determined by ELISA in nine of the 28 patients with PDR and in six healthy volunteers as controls. RESULTS: In vitreous fluid, the levels of sIL-6R in the PDR group, PPDR group, and nondiabetic group were 612.7 +/- 233.8 (mean +/- SD), 746.3 +/- 523.1, and 215.4 +/- 98.3 pg/ml, respectively. Vitreous levels of sIL-6R in the PDR and PPDR groups were significantly higher than those in the nondiabetic group (PDR group, P < 0.0001; PPDR group, P < 0.01). In serum, the levels of sIL-6R were 39.38 +/- 9.43 ng/ml in the PDR group and 22.84 +/- 5.32 ng/ml in the control group. sIL-6R levels in serum in the PDR group were significantly higher than those in the control group (P < 0.01). A partial correlation analysis showed a significant correlation between the levels of sL-6R and VEGF in the vitreous in the PDR group (r = 0.34, P < 0.05). CONCLUSIONS: We conclude that the level of sIL-6R in vitreous fluid can be considered as a biomarker of PDR.

Correlation between indocyanine green angiographic findings and histopathology of polypoidal choroidal vasculopathy.

PURPOSE: To analyze the histopathology of polypoidal choroidal vasculopathy (PCV) and choroidal neovascularization (CNV) developing from PCV, the authors evaluated correlations between pathological findings and the findings of preoperative indocyanine green angiography (IA). METHODS: Two specimens were obtained during CNV excision associated with PCV. PCV tissue was excised with the CNV. The specimens were examined by light microscopy. RESULTS: In one case, IA revealed polypoidal lesions exhibiting hyperfluorescence in both the early and the late phase, and in the affected area, abnormally dilated vessels were identified histologically underneath relatively healthy retinal pigment epithelium (RPE). In the other case, the polypoidal lesions seen on IA showed early hyperfluorescence and late isofluorescence, and dilated vessels were observed under the RPE; perivascular amorphous material was present. The RPE adhered to the side of the choroid, and there was CNV under the neurosensory retina in both cases. The CNV had numerous vascular lumens, was not surrounded by the RPE, and exhibited few fibrous components. CONCLUSIONS: IA findings vary depending on the condition of the RPE located above the PCV and the extent of amorphous material around the PCV.

A case of extramedullary plasmacytoma of the larynx.

An 84-year-old male with a complaint of hoarseness was examined. A mass lesion was recognized in the false vocal fold. The tumor was excised and found to consist of atypical plasmacytes. Immunopathological examination revealed that leukocyte common antigen (CD45), UCHLI (CD45RO), CD3 and L26 (CD20) were negative and that CD79 and Vs38C were positive. Neither uric Bence-Jones protein nor serum M-protein were observed. No other bony abnormalities were recognized on X-ray examinations including both bone and Ga scintigraphy. No atypical plasmacyte infiltration was observed in bone marrow. Our final diagnosis was extramedullary plasmacytoma of the larynx. Radiotherapy was performed following surgery. The tumor did not progress to multiple myeloma and no recurrence has been observed after 2 years.