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ABSTRACT: PURPOSE: To determine the long-term results of carbon ion radiation therapy (C-ion RT) in patients with choroidal melanoma, and to assess the usefulness of CT-based 2-port irradiation in reducing the risk of neovascular glaucoma (NVG). METHODS AND MATERIALS: Between January 2001 and February 2012, a total of 116 patients with locally advanced or unfavorably located choroidal melanoma received CT-based C-ion RT. Of these patients, 114 were followed up for more than 6 months and their data analyzed. The numbers of T3 and T2 patients (International Union Against Cancer [UICC], 5th edition) were 106 and 8, respectively. The total dose of C-ion RT varied from 60 to 85 GyE, with each dose given in 5 fractions. Since October 2005, 2-port therapy (51 patients) has been used in an attempt to reduce the risk of NVG. A dose-volume histogram analysis was also performed in 106 patients. RESULTS: The median follow-up was 4.6 years (range, 0.5-10.6 years). The 5-year overall survival, cause-specific survival, local control, distant metastasis-free survival, and eye retention rates were 80.4% (95% confidence interval 89.0%-71.8%), 82.2% (90.6%-73.8%), 92.8% (98.5%-87.1%), 72.1% (81.9%-62.3%), and 92.8% (98.1%-87.5%), respectively. The overall 5-year NVG incidence rate was 35.9% (25.9%-45.9%) and that of 1-port group and 2-port group were 41.6% (29.3%-54.0%) and 13.9% (3.2%-24.6%) with statistically significant difference (P<.001). The dose-volume histogram analysis showed that the average irradiated volume of the iris-ciliary body was significantly lower in the non-NVG group than in the NVG group at all dose levels, and significantly lower in the 2-port group than in the 1-port group at high dose levels. CONCLUSIONS: The long-term results of C-ion RT for choroidal melanoma are satisfactory. CT-based 2-port C-ion RT can be used to reduce the high-dose irradiated volume of the iris-ciliary body and the resulting risk of NVG.
International journal of radiation oncology, biology, physics 02/2013; · 4.59 Impact Factor
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ABSTRACT: To report a case of a ruptured eye with a suprachoroidal hemorrhage (SCH) in which tissue plasminogen activator (tPA)-assisted vitrectomy was successful in reconstructing the globe and restoring good vision.
A 32-year-old man was struck on the right eye by a surfboard. His eye was ruptured and his visual acuity decreased to hand movements. Surgery was immediately performed to successfully close the ruptured globe. Nine days later, a second surgery was performed, and tPA (25 µg/0.1 ml monteplase) was used to liquefy and drain the SCH. This freed enough vitreous space for a more comprehensive vitrectomy. Eighteen months after the injury, the retina remained attached, and the decimal best-corrected visual acuity improved to 0.8.
tPA was helpful in lysing a massive SCH, thereby contributing to the excellent visual outcome. tPA-assisted drainage should be considered in cases of massive SCH when drainage is difficult due to an incomplete lysis of the clot.
Case reports in ophthalmology. 05/2012; 3(2):258-61.
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ABSTRACT: Peripheral cone dystrophy is a subgroup of cone dystrophy, and only 4 cases have been reported. We present a patient with unilateral peripheral cone dysfunction and report the functional changes determined by electrophysiological tests and ultrastructural changes determined by spectral domain optical coherence tomography (SD-OCT).
A 34-year-old woman complained of blurred vision in both eyes. Our examination showed that her visual acuity was 0.05 OD and 0.2 OS. A relative afferent pupillary defect was present in her right eye. The results of slit-lamp examination, ophthalmoscopy, and fluorescein angiography were normal except for pallor of the right optic disc. SD-OCT showed a diffuse thinning of the retina in the posterior pole of the right eye. A severe constriction of the visual fields was found in both eyes but more in the right eye. The photopic full-field electroretinograms (ERGs) were reduced in the right eye but normal in the left eye. The multifocal ERGs were severely reduced throughout the visual field except in the central area of the right eye. The multifocal ERGs from the left eye were normal. The pattern visual evoked responses were within the normal range in both eyes. She had a 5-year history of sniffing paint thinner.
Although the visual dysfunction was initially suspected to be due to psychological problems from the results of subjective tests, objective tests indicated a peripheral cone dysfunction in the right eye. The pathophysiological mechanism and the relationship with thinner sniffing were not determined.
Our findings indicate that peripheral cone dysfunction can occur unilaterally. Electrophysiology and SD-OCT are valuable tests to perform to determine the pathogenesis of unusual ocular findings objectively.
Case reports in ophthalmology. 05/2012; 3(2):162-8.
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ABSTRACT: Aims: It was the aim of this study to measure spectral transmission of the human crystalline lens in situ. Method: The crystalline lens was illuminated by one of four light-emitting diodes of different colors. The relative spectral transmittance of the human crystalline lens was measured with the Purkinje-Sanson mirror images over a wide range of ages. Result: The study evaluated 36 crystalline lenses of 28 subjects aged 21-76 years. There was a significant correlation between the age and spectral transmittance for blue light. Conclusion: Spectral transmittance of the crystalline lens in situ could be measured with Purkinje-Sanson mirror images.
Ophthalmologica 04/2012; 228(3):174-80. · 1.42 Impact Factor
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ABSTRACT: To report three types of heterozygous mutations in the OPA1 gene in five patients from three families with autosomal dominant optic atrophy (ADOA, MIM#165500).
DNA was extracted from the leukocytes of the peripheral blood. For mtDNA, mutations were examined at positions 11778, 3460 and 14484. For the OPA1 gene, the exons were amplified by PCR and mutations were detected by restriction enzymes or the dye terminator method.
We detected three types of OPA1 mutation but no mtDNA mutations. In the OPA1 gene, heterozygous frameshift mutations from codon 903 due to a four-base pair deletion in exon 27 were detected in three patients from one family (c.2708_2711delTTAG, p.V903GfsX905). A heterozygous mutation due to a three-base pair deletion in exon 17, leading to a one-amino acid deletion (c.1618_1620delACT, p.T540del), and a heterozygous mutation due to a one-base substitution in exon 11, leading to a stop codon (c.1084G>T, p.E362X), were detected in sporadic cases.
OPA1 mutations existed in three Japanese families with ADOA. After a detailed clinical assessment of the proband, the screening of the OPA1 gene may be helpful for precise diagnosis of ADOA, provided the relevant information of the family members is limited.
Japanese Journal of Ophthalmology 01/2012; 56(1):91-7. · 0.92 Impact Factor
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ABSTRACT: Costimulatory molecules play important roles in regulating T cell function in tumor immunity. In this study, we investigated costimulatory molecule expression on human uveal melanoma cells (a primary culture, and OCM-1, OMM-1 and 92-1 cell lines) and assessed the functional roles of selected costimulatory molecules. Uveal melanoma cells were incubated in the presence or absence of IFN-γ and expression of costimulatory molecules on the cells was measured by flow cytometry. The costimulatory effect of B7-H1-expressing uveal melanoma cells on cytokine production by purified T cells was studied in uveal melanoma/T cell co-culture experiments using a blocking anti-B7-H1 monoclonal antibody (mAb). The functional role of CD40-mediated interactions in modifying immune responses to uveal melanoma cells was assessed in vitro using recombinant human CD40 ligand (rhCD40L). MHC class I and B7-H1 were consistently detected and further upregulated by IFN-γ stimulation in all human uveal melanoma cell cultures. CD40 was consistently detected and further upregulated by IFN-γ stimulation in primary culture, OCM-1, and OMM-1 but not 92-1. IL-2 production from purified CD3(+) T cells co-stimulated with IFN-γ-treated uveal melanoma cells was significantly enhanced by the addition of anti-B7-H1 mAb. Treatment of primary culture, OCM-1, or OMM-1 with rhCD40L induced or enhanced secretion of chemokines IL-8, MCP-1, IP-10 and RANTES. These results suggest that the expression of B7-H1 on IFN-γ-treated uveal melanoma cells contributes to suppression of T cells by decreasing IL-2 production. In contrast, CD40 expressed on uveal melanoma cells plays an important role in augmenting anti-tumor immunity by stimulating chemokine production. The dual effects of CD40 and B7-H1 may contribute to positive or negative regulation of anti-tumor immune responses to human uveal melanoma.
Experimental Eye Research 12/2011; 96(1):98-106. · 3.26 Impact Factor
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American journal of ophthalmology 08/2011; 152(2):327-8. · 3.83 Impact Factor
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ABSTRACT: To investigate the effects of vitrectomy as a treatment for the proliferative diabetic retinopathy (PDR) in patients under 40 years old.
Sixty eyes of 37 patients under 40 years old with PDR who had undergone vitrectomy for the first time in Juntendo University Urayasu Hospital were included in this study. Preoperative condition, operation methods, visual acuity after operation and complications both during or after operation, especially neovascular glaucoma (NVG), were reviewed retrospectively.
Visual acuity improved in 43 eyes (72%) by more than 0.2 logMAR compared to that before the operation, remained stable in 4 eyes (6%) and deteriorated in 13 eyes (22%) by more than 0.2 logMAR compared to that before operation. Optic atrophy and phthisis caused by NVG constituted 69% of the causes of complicated final visual acuity. Male patients and patients who had both hypertension and proteinuria had significantly higher prevalence of NVG after vitrectomy (p < 0.05), and patients who retained their lens after the first vitrectomy had a significantly lower prevalence of NVG after the operation (p < 0.05).
In young PDR patients under 40 years old, postoperative NVG was the main reason for severe visual impairment. Multifactorial causes, both general and ophthalmic seem to be implicated in the onset and progression of NVG derived from PDR.
Nippon Ganka Gakkai zasshi 06/2011; 115(6):516-22.
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ABSTRACT: Cell cycle checkpoint is a self-protective mechanism for cells to monitor genome integrity and ensure the high-fidelity transmission of genetic information to daughter cells. Insufficient function of cell cycle checkpoints has been demonstrated to partially account for tumor initiation, promotion and progression. In the ten melanoma cell lines that we tested in preliminary experiments, two human uveal melanoma cell lines, 92-1 and OCM-1, were found to be significantly different in terms of radiosensitivity but similar in DNA repair ability. Evident G 2 arrest was induced in both cell types and the maximum was reached at 16 h after irradiation regardless of X-rays or high-LET carbon beams. OCM-1 cells overrode the G 2 arrest and reentered the cell cycle right after reaching the maximum, whereas 92-1 could not. Upon 10 Gy of radiation, the cell cycle of 92-1 was suspended and remained unchanged for up to 5 d. The cell cycle suspension is a unique process lurking in G 2 arrest and related to cellular radiosensitivity. Its induction is dose-dependent and there is a dose threshold for it. The degradation of Cyclin B1 has been found related to the cell cycle suspension though, the mechanism of cell cycle suspension is still under investigation. Basing on our knowledge, this is the first report on cell cycle suspension and we present here a de novo mechanism to cellular radiosensitivity. Further clarification of the mechanism underlying cell cycle suspension is believed to be of significance in tumor radiosensitization or even direct tumor control.
Cell cycle (Georgetown, Tex.) 05/2011; 10(9):1468-76. · 5.36 Impact Factor
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ABSTRACT: To compare the effects of carbon beam irradiation with those of proton beam irradiation on the physiology of the retina of rats.
Eight-week-old Wister rats were used. The right eyes were irradiated with carbon beam (1, 2, 4, 8, and 16 Gy) or proton beam (4, 8, 16, and 24 Gy) with the rats under general anesthesia. Electroretinograms were recorded 1, 3, 6, and 12 months after the irradiation, and the amplitudes of the a and b waves were compared with those of control rats.
The amplitude of b waves was reduced more than that of a waves at lower irradiation doses with both types of irradiation. With carbon ion irradiation, the amplitudes of the b wave were significantly reduced after radiation doses of 8 and 16 Gy at 6 months and by radiation doses of 4, 8, and 16 Gy at 12 months. With proton beam irradiation, the b-wave amplitudes were significantly reduced after 16 and 24 Gy at 6 months and with doses of 8 Gy or greater at 12 months. For the maximum b-wave amplitude, a significant difference was observed in rats irradiated with carbon beams of 4 Gy or more and with proton beams of 8 Gy or more at 12 months after irradiation.
These results indicate that carbon beam irradiation is about two times more damaging than proton beam irradiation on the rat retina at the same dose.
International journal of radiation oncology, biology, physics 12/2010; 78(5):1532-40. · 4.59 Impact Factor
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ABSTRACT: To investigate the effects of an intravitreal injection of autologous plasmin enzyme for macular edema associated with a branch retinal vein occlusion (BRVO).
Prospective, interventional case studies.
Twenty-six eyes of 26 patients (14 men and 12 women) with macular edema resulting from a BRVO were studied. None of the eyes had a posterior vitreous detachment (PVD). The average age at the onset of BRVO was 58.7 ± 6.6 years. The interval between onset of the macular edema and injection of autologous plasmin enzyme was 4.2 months. One international unit of autologous plasmin enzyme in 0.1 mL was injected into each vitreous. The presence of a PVD was evaluated 1 week after the injection, and the visual acuity and macular thickness were measured before and 1 week and 1, 3, 6, and 12 months after the autologous plasmin enzyme injection.
After the autologous plasmin enzyme injection, a total PVD was observed in 23 eyes and no PVD was observed in 3 eyes. The visual acuity gradually recovered after the injection, improved by 2 lines or more in 23 eyes, and remained unchanged in the 3 eyes. The retinal thickness also recovered gradually at 1, 3, 6, and 12 months. The mean retinal thickness was reduced from 602.12 to 253.62 μm at 12 months after surgery. It was reduced significantly after 1, 3, 6, and 12 months (P < .0001).
Intravitreal autologous plasmin enzyme may lead to an improvement of visual acuity and a reduction of macula edema in eyes with BRVO.
American journal of ophthalmology 12/2010; 150(6):876-82. · 3.83 Impact Factor
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ABSTRACT: Dendritic cells are critical for the induction of anti-tumor immunity. Recent studies suggest that some tumors may avoid immune destruction by inhibiting dendritic cell function. In this study, we investigated the effects of uveal melanoma on human dendritic cell phenotype and functions including surface antigen expression, cytokine production, and T cell activation. Dendritic cells were generated in the presence of GM-CSF and IL-4 from peripheral blood mononuclear cells of healthy donors. On day 5 of culture, dendritic cells were co-cultured with human uveal melanoma cells for 24 h, and then purified using magnetic beads. The maturation of dendritic cells was induced by TNF-α and the phenotype of dendritic cells was analyzed by flow cytometry. The expression of dendritic cell markers and antigen presenting cell markers decreased when dendritic cells were co-cultured with uveal melanoma cells. Moreover, co-culture with uveal melanoma cells led to apoptosis of dendritic cells as shown by 1.5-fold increase in surface phosphatidylserine. Also, dendritic cells co-cultured with uveal melanoma showed diminished ability to produce IL-12 and IL-10. Finally, dendritic cells co-cultured with uveal melanoma inhibited the proliferation of allogeneic T cells in mixed lymphocyte reaction. These findings suggest a mechanism by which uveal melanoma escape immune destruction and have significant implications for tumor-pulsed dendritic cell vaccines for the treatment of uveal melanoma.
Experimental Eye Research 10/2010; 91(4):491-9. · 3.26 Impact Factor
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Asako Goto,
Masakazu Akahori,
Haru Okamoto,
Masayoshi Minami,
Naoki Terauchi,
Yuji Haruhata,
Minoru Obazawa,
Toru Noda,
Miki Honda, Atsushi Mizota,
Minoru Tanaka,
Takaaki Hayashi,
Masaki Tanito,
Naoko Ogata,
Takeshi Iwata
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ABSTRACT: Age-related macular degeneration (AMD) is a common cause of blindness in the elderly. Caucasian patients are predominantly affected by the dry form of AMD, whereas Japanese patients have predominantly the wet form of AMD and/or polypoidal choroidal vasculopathy (PCV). Although genetic association in the 10q26 (ARMS2/HTRA1) region has been established in many ethnic groups for dry-type AMD, typical wet-type AMD, and PCV, the contribution of the 1q32 (CFH) region seem to differ among these groups. Here we show a single nucleotide polymorphism (SNP) in the ARMS2/HTRA1 locus is associated in the whole genome for Japanese typical wet-type AMD (rs10490924: p = 4.1 x 10(-4), OR = 4.16) and PCV (rs10490924: p = 3.7 x 10(-8), OR = 2.72) followed by CFH (rs800292: p = 7.4 x 10(-5), OR = 2.08; p = 2.6 x 10(-4), OR = 2.00), which differs from previous studies in Caucasian populations. Moreover, a SNP (rs2241394) in complement component C3 gene showed significant association with PCV (p = 2.5 x 10(-3), OR = 3.47). We conclude that dry-type AMD, typical wet-type AMD, and PCV have both common and distinct genetic risks that become apparent when comparing Japanese versus Caucasian populations. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1007/s12177-009-9047-1) contains supplementary material, which is available to authorized users.
Journal of Ocular Biology Diseases and Informatics 01/2009; 2(4):164-175.
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ABSTRACT: We describe three eyes of two cases of severe degeneration of the macula following vitrectomy with indocyanine green-assisted internal limiting membrane peeling for idiopathic macular hole. We need to remember the possibility of these complications and have to select the procedures that are safest to use for macular hole surgery.
The Open Ophthalmology Journal 02/2008; 2:27-30.
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ABSTRACT: The purpose of this article is to report the characteristics and advantages of using a newly designed quartz contact lens with slit illumination from an operating microscope for intraocular surgery. The new contact lens is made of quartz. The lens is convex-concave and is used in combination with slit illumination from an operating microscope. The optical properties of quartz make this lens less reflective with greater transmittance. The combination of a quartz contact lens with slit illumination provided a brighter and wider field of view than conventional lenses. This system enabled us to perform bimanual vitrectomy and scleral buckling surgery without indirect ophthalmoscope. Small intraocular structures in the posterior pole or in the periphery were detected more easily. In conclusion, the newly designed quartz lens with slit beam illumination from an operating microscope provided a bright, clear and wide surgical field, and allowed intraocular surgery to be performed more easily.
International Ophthalmology 01/2008; 29(3):169-71.
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ABSTRACT: Nocardia exalbida was first reported in 2006. We describe a first case of keratitis caused by Nocardia exalbida.
Case report
A patient presented after two weeks of unsuccessful treatment of a corneal ulcer in her right eye. Nocardia keratitis was diagnosed from her culture results, and the species Nocardia exalbida was determined by phylogenetic studies using gene sequence analysis of 16S RNA. The disk diffusion method showed that this Norcardia sp. was sensitive to many antibiotics. Initially, the patient was treated with topical and systemic antibiotics, and corneal epithelium quickly regenerated. But when corticosteroid eyedrops were added, there was a recurrence of the keratitis. Corticosteroids were stopped, and systemic trimethoprim-sulfamethoxazole and topical tobramycin, colistin, chloramphenicol and sulfisoxazole were given. Within one month the corneal ulcer and infiltration disappeared.
This is the first report of keratitis caused by Nocardia exalbida. This species is susceptible to many antibiotics in vitro and clinically. However, supplementation with corticosteroids can lead to recurrence, and care should be taken when corticosteroids are being considered.
International Ophthalmology 11/2007; 27(5):333-6.
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ABSTRACT: The volume of the subretinal fluid can be used to assess the condition of different types of retinal and macular disorders. The purpose of this report is to introduce a method to measure the volume of the subretinal fluid with the images of the optical coherence tomography (OCT) Ophthalmoscope in three cases of central serous chorioretinopathy and one case of retinal pigment epithelial detachment. We used the topography-mode program of the OCT Ophthalmoscope and measured the average height of the retinal detachment. By multiplying the size of the area of the retinal detachment and the average height of the retinal detachment, the volume of subretinal fluid could be determined. Examples are given to show the results of volume measurement of subretinal fluid in cases of localized retinal detachments.
Ophthalmic and Physiological Optics 10/2007; 27(5):512-7. · 1.58 Impact Factor
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ABSTRACT: The effectiveness of vitreous surgery for diabetic macular edema (DME), and the correlation between the preoperative systemic and ocular conditions and the visual outcome following vitrectomy were studied. Visual acuity improved in about 50% of the eyes. Both visual acuity and foveal thickness recovered 12 months after surgery and the improvement of visual acuity occurred later than the recovery of foveal thickness. The preoperative systemic condition does not affect the improvement of visual acuity, and thus it is not necessary to wait for good diabetic control if surgery is indicated.
Annals of Ophthalmology 10/2007; 39(3):222-7. · 0.16 Impact Factor
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ABSTRACT: Coagulation is the most serious complication of transpupillary thermotherapy(TTT) for choroidal neovascularization (CNV). To detect coagulation quickly, it is important to have good visibility of the fundus during exposure. With the existing laser optical system using a half mirror, the fundus image is dim, and coagulation is difficult to detect. We have improved the laser optical system for TTT. The purpose of this study was to improve the optical system and to estimate the usefulness of our new system compared with the current optical system.
We exchanged the half mirror used in the existing TTT optical system to a split mirror. The illumination intensities were measured and the visibility of fundus images were compared.
Illumination intensity was increased by means of the split mirror of the slit-lamp for the TTT laser optical system. The fundus image became brighter and clearer.
Improvement of the optical system was useful for safe and effective treatment of cases of CNV with an indication for TTT.
Nippon Ganka Gakkai zasshi 09/2007; 111(8):594-7.
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ABSTRACT: A delay of the peak latency of the pattern visual evoked cortical potentials (pVEP) is accepted as one of the paraclinical evidence for a diagnosis of multiple sclerosis (MS). The purpose of this study was to evaluate the pVEPs in Japanese patients with MS without a history of visual pathway involvement. We studied the medical records of 29 MS patients without any history of visual pathway involvement, and with visual acuity correctable to > or = 20/20. The Goldmann visual fields, pupillary light reflexes, and optic disks were normal in all. pVEPs elicited by 3 rev/s (transient) and 12 rev/s (steady-state) were recorded from the MS patients and compared with those recorded from normal subjects. The latency of the P100 component of the transient pVEPs was significantly prolonged in 9/29 (31%) MS patients. A phase lag in the steady-state pVEPs was found in 6/29 (21%) MS patients, and the mean amplitude was significantly smaller. The incidence of cases with abnormal pVEPs is lower than that reported from Europe and United State. This difference is possibly due to racial differences, and the use of different criteria for diagnosing optic neuritis.
Documenta Ophthalmologica 09/2007; 115(2):105-9. · 2.11 Impact Factor
