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Outcome of surgery for recurrent pterygium using intraoperative application of mitomycin C and amniotic membrane transplantation
ABSTRACTS
625
Tsuyoshi Iwamoto, Fumie Furusho, Hiroko Imaizumi and Muneyasu Takeda Department of Ophthalmology, Sapporo City General Hospital doi:10.1016/j.jjo.2003.09.008
A Case of Intraocular Malignant Lymphoma Diagnosed by Immunoglobulin Gene Rearrangement and Translocation, and IL-10/IL-6 ratio in the Vitreous Fluid Background: The diagnosis of primary intraocular lymphoma is difficult in many cases even with conventional cytological tests using vitreous samples. Recently new diagnostic tests, such as microdissection and polymerase chain reaction (PCR) and measurement of cytokines using intraocular samples, have been applied to the diagnosis of the disease. We report here a case where we used the new diagnostic tests and the results aided us to make a diagnosis of intraocular lymphoma. Case: A 68-year-old woman with an initial diagnosis of bilateral idiopathic uveitis with steroid-resistant vitreous opacities underwent a vitreous biopsy. The cytological examinations of the vitreous samples revealed class III. The microdissection and PCR using the vitreous samples detected IgH rearrangement gene in the third framework (FR3A), the complementary determining region 3(CDR3) of the VH region and Bcl-2-associated translocation. The interleukin (IL)-10 to IL-6 ratio in the vitreous fluid was greater than 100. Because the results of the examinations strongly suggested intraocular lymphoma, the patient was treated with radiation and chemotherapy. One month after the therapy, however, the patient developed multiple metastatic lesions in the brain. The clinical course of the patient together with the new diagnostic results of examinations led to a diagnosis of intraocular lymphoma. Conclusion: A combination of tests, such as conventional cytology, microdissection, and PCR, and cytokine assay using intraocular biopsy samples, is useful to make a diagnosis of intraocular lymphoma. Nippon Ganka Gakkai Zasshi (J Jpn Ophthalmol Soc 107:287–291, 2003) ,†
Mako Yokota* , Hiroshi Takase*, Yasuhisa Imai*, Kojyu Kamoi*, Sunao Sugita*, Hiroyuki Morita†, Toichiro Takizawa‡, Sumiyoshi Tanaka§, De Fen Shen||, Chi-Chao Chan|| and Manabu Mochizuki* *Department of Ophthalmology and Visual Science, Tokyo Medical and Dental University Graduate School;
†
Kawaguchi Medical Center Eye Clinic; Department of Surgical Pathology, Tokyo Medical and Dental University Graduate School; §Department of Ophthalmology, Teikyo University Ichihara Hospital; ||Laboratory of Immunology, National Eye Institute (NIH) ‡
doi:10.1016/j.jjo.2003.09.009
Utility of Laser Photocoagulation of Choroidal Neovascularization in Angioid Streaks Purpose: We evaluated the utility of laser photocoagulation of extrafoveal choroidal neovascularization (CNV) in patients with angioid streaks. Subjects and Methods: Eleven eyes of 10 patients with extrafoveal CNV secondary to angioid streaks that underwent direct laser photocoagulation were followed for 5 months or more. We performed an intense laser photocoagulation of the CNV area determined by fluorescein angiography. We evaluated CNV diameter, the shortest distance between CNV and the fovea, the best visual acuity, the final visual acuity, existence, period, and region of the recurrence, and changes in fundus findings. Result: The logarithm of the minimum angle of resolution (log MAR) final visual acuity in 9 eyes deteriorated more than two levels. The recurrence of CNV occurred in the 11 eyes; in 9 eyes CNV expanded and involved the fovea, and in two eyes photocoagulation was performed but caused an atrophic creep and resulted in scar formation including the fovea. Conclusion: Based on these results, laser photocoagulation is not good therapy for CNV in angioid streaks. Nippon Ganka Gakkai Zasshi (J Jpn Ophthalmol Soc 107:311–315, 2003) Miho Haruyama and Mitsuko Yuzawa Department of Ophthalmology, Surugadai Hospital of Nihon University doi:10.1016/j.jjo.2003.09.010
Outcome of Surgery for Recurrent Pterygium Using Intraoperative Application of Mitomycin C and Amniotic Membrane Transplantation Purpose: Preserved human amniotic membrane has been used in reconstruction of the ocular surface. In
Jpn J Ophthalmol Vol 47: 623–627, 2003
626
this paper, we report our method of amniotic membrane transplantation (AMT) for recurrent pterygium. Methods: Twenty-six eyes of 26 patients with recurrent pterygium are reported. All subjects were operated on with an extensive excision of the subconjunctival fibrous tissues followed by application of mitomycin C(0.04%, 3∼5 min) during the operation. Amniotic membrane transplantation was performed with implantation of conjunctival autograft in cases with a large excision. Results: The mean follow-up time was 17.3 ⫾ 9.3 (mean ⫾ standard deviation) months. Twelve eyes showed severe symblepharon and 14 patients had suffered from double vision before the operation. There were only three mild recurrences (12%), 11 patients recovered from double vision, and no major complications such as sclermalacia performans were noted during the followup period. Conclusion: AMT with application of mitomycin C is effective in preventing pterygium recurrence and for improved ocular movement. The cosmetic outcome of our methods has also been satisfactory. Nippon Ganka Gakkai Zasshi (J Jpn Ophthalmol Soc 107:316–321, 2003)
period of November 1996 to February 2002 in our dry eye clinic. We compared the extrusion rate for each plug and the necessity of reinsertion of the plug. Results: In the examination for EP, 72.2% of the plugs were extruded during the follow-up period. The average period (59 days) until the extrusion was completed was significantly shorter than for PP (P ⬍ 0.0001). In the examination of PP, 55.9% were extruded, and the average period until the extrusion was 287 days. Significant improvement of corneal epithelial damage was seen with PP after insertion of the plug. For the PP, reinsertion of plugs was sometimes impossible, probably because of the granulation formed inside the canaliculus, while for EP, reinsertion of the plugs was possible for all cases. Discussion: EP becomes extruded more easily than PP, and it seems that forms more easily inside PP. Nippon Ganka Gakkai Zasshi (J Jpn Ophthalmol Soc 107:322– 325, 2003)
Shiro Kawasaki*,†, Toshihiko Uno*, Ichiro Shimamura* and Yuichi Ohashi*
Department of Ophthalmology, Kyoto Prefectural University of Medicine
*Department of Ophthalmology, Ehime University School of Medicine; †Department of Ophthalmology, Minami Matsuyama Hospital
Masakazu Nishii, Norihiko Yokoi, Aoi Komuro, Jiro Sugita, Yo Nakamura, Kentaro Kojima and Shigeru Kinoshita
doi:10.1016/j.jjo.2003.09.012
doi:10.1016/j.jjo.2003.09.011
Comparison of Extrusion Rate for Two Different Designs of Punctal Plugs Purpose: Punctal occlusion using a silicone plug is an effective treatment for severe tear-deficient dry eye. At present, plugs from two companies are available in Japan [Eagle plug (EP); Eagle Vision, Punctal plug (PP); FCI]. We compared the extrusion rate between EP and PP in our dry eye clinic. Subjects and Methods: Subjects were 20 eyes of 18 patients for EP [5 eyes from 5 males, 15 eyes from 13 females, age: 58.1 ⫾ 17.5 (mean ⫾ standard deviation)] and 76 eyes of 51 patients for PP (6 eyes from 5 males, 70 eyes from 46 females, age: 58.6 ⫾ 13.4), 62 eyes from 44 patients with Sjo¨gren syndrome, 34 eyes from 25 patients with non-Sjo¨gren syndrome with severe teardeficient dry eye. These patients were treated during the
The Results of Randomized Controlled Trial of Low-dose Radiation for Wet-type Age-related Macular Degeneration on a 1 Year Term Basis Object: Evaluation of low-dose radiation therapy for the wet-type age-related macular degeneration (AMD) located at the fovea centralis. Cases and Methods: Patients were irradiated with 10 fractions of 2 Gy external beam or just observed. Between the treated (39) and untreated (31) cases, there was no significant difference in sex, age, initial visual acuity, or size of the neovascular membrane. Results: During the follow-up of 12 months, the visual acuity was significantly well preserved and the size of the neovascular membrane was decreased. Conclusion: These results indicate that low dose irradiation is effective for the wet-type AMD of the stage we treated in the present study. Nippon Ganka Gakkai Zasshi (J Jpn Ophthalmol Soc 107:326–330, 2003)
625
Tsuyoshi Iwamoto, Fumie Furusho, Hiroko Imaizumi and Muneyasu Takeda Department of Ophthalmology, Sapporo City General Hospital doi:10.1016/j.jjo.2003.09.008
A Case of Intraocular Malignant Lymphoma Diagnosed by Immunoglobulin Gene Rearrangement and Translocation, and IL-10/IL-6 ratio in the Vitreous Fluid Background: The diagnosis of primary intraocular lymphoma is difficult in many cases even with conventional cytological tests using vitreous samples. Recently new diagnostic tests, such as microdissection and polymerase chain reaction (PCR) and measurement of cytokines using intraocular samples, have been applied to the diagnosis of the disease. We report here a case where we used the new diagnostic tests and the results aided us to make a diagnosis of intraocular lymphoma. Case: A 68-year-old woman with an initial diagnosis of bilateral idiopathic uveitis with steroid-resistant vitreous opacities underwent a vitreous biopsy. The cytological examinations of the vitreous samples revealed class III. The microdissection and PCR using the vitreous samples detected IgH rearrangement gene in the third framework (FR3A), the complementary determining region 3(CDR3) of the VH region and Bcl-2-associated translocation. The interleukin (IL)-10 to IL-6 ratio in the vitreous fluid was greater than 100. Because the results of the examinations strongly suggested intraocular lymphoma, the patient was treated with radiation and chemotherapy. One month after the therapy, however, the patient developed multiple metastatic lesions in the brain. The clinical course of the patient together with the new diagnostic results of examinations led to a diagnosis of intraocular lymphoma. Conclusion: A combination of tests, such as conventional cytology, microdissection, and PCR, and cytokine assay using intraocular biopsy samples, is useful to make a diagnosis of intraocular lymphoma. Nippon Ganka Gakkai Zasshi (J Jpn Ophthalmol Soc 107:287–291, 2003) ,†
Mako Yokota* , Hiroshi Takase*, Yasuhisa Imai*, Kojyu Kamoi*, Sunao Sugita*, Hiroyuki Morita†, Toichiro Takizawa‡, Sumiyoshi Tanaka§, De Fen Shen||, Chi-Chao Chan|| and Manabu Mochizuki* *Department of Ophthalmology and Visual Science, Tokyo Medical and Dental University Graduate School;
†
Kawaguchi Medical Center Eye Clinic; Department of Surgical Pathology, Tokyo Medical and Dental University Graduate School; §Department of Ophthalmology, Teikyo University Ichihara Hospital; ||Laboratory of Immunology, National Eye Institute (NIH) ‡
doi:10.1016/j.jjo.2003.09.009
Utility of Laser Photocoagulation of Choroidal Neovascularization in Angioid Streaks Purpose: We evaluated the utility of laser photocoagulation of extrafoveal choroidal neovascularization (CNV) in patients with angioid streaks. Subjects and Methods: Eleven eyes of 10 patients with extrafoveal CNV secondary to angioid streaks that underwent direct laser photocoagulation were followed for 5 months or more. We performed an intense laser photocoagulation of the CNV area determined by fluorescein angiography. We evaluated CNV diameter, the shortest distance between CNV and the fovea, the best visual acuity, the final visual acuity, existence, period, and region of the recurrence, and changes in fundus findings. Result: The logarithm of the minimum angle of resolution (log MAR) final visual acuity in 9 eyes deteriorated more than two levels. The recurrence of CNV occurred in the 11 eyes; in 9 eyes CNV expanded and involved the fovea, and in two eyes photocoagulation was performed but caused an atrophic creep and resulted in scar formation including the fovea. Conclusion: Based on these results, laser photocoagulation is not good therapy for CNV in angioid streaks. Nippon Ganka Gakkai Zasshi (J Jpn Ophthalmol Soc 107:311–315, 2003) Miho Haruyama and Mitsuko Yuzawa Department of Ophthalmology, Surugadai Hospital of Nihon University doi:10.1016/j.jjo.2003.09.010
Outcome of Surgery for Recurrent Pterygium Using Intraoperative Application of Mitomycin C and Amniotic Membrane Transplantation Purpose: Preserved human amniotic membrane has been used in reconstruction of the ocular surface. In
Jpn J Ophthalmol Vol 47: 623–627, 2003
626
this paper, we report our method of amniotic membrane transplantation (AMT) for recurrent pterygium. Methods: Twenty-six eyes of 26 patients with recurrent pterygium are reported. All subjects were operated on with an extensive excision of the subconjunctival fibrous tissues followed by application of mitomycin C(0.04%, 3∼5 min) during the operation. Amniotic membrane transplantation was performed with implantation of conjunctival autograft in cases with a large excision. Results: The mean follow-up time was 17.3 ⫾ 9.3 (mean ⫾ standard deviation) months. Twelve eyes showed severe symblepharon and 14 patients had suffered from double vision before the operation. There were only three mild recurrences (12%), 11 patients recovered from double vision, and no major complications such as sclermalacia performans were noted during the followup period. Conclusion: AMT with application of mitomycin C is effective in preventing pterygium recurrence and for improved ocular movement. The cosmetic outcome of our methods has also been satisfactory. Nippon Ganka Gakkai Zasshi (J Jpn Ophthalmol Soc 107:316–321, 2003)
period of November 1996 to February 2002 in our dry eye clinic. We compared the extrusion rate for each plug and the necessity of reinsertion of the plug. Results: In the examination for EP, 72.2% of the plugs were extruded during the follow-up period. The average period (59 days) until the extrusion was completed was significantly shorter than for PP (P ⬍ 0.0001). In the examination of PP, 55.9% were extruded, and the average period until the extrusion was 287 days. Significant improvement of corneal epithelial damage was seen with PP after insertion of the plug. For the PP, reinsertion of plugs was sometimes impossible, probably because of the granulation formed inside the canaliculus, while for EP, reinsertion of the plugs was possible for all cases. Discussion: EP becomes extruded more easily than PP, and it seems that forms more easily inside PP. Nippon Ganka Gakkai Zasshi (J Jpn Ophthalmol Soc 107:322– 325, 2003)
Shiro Kawasaki*,†, Toshihiko Uno*, Ichiro Shimamura* and Yuichi Ohashi*
Department of Ophthalmology, Kyoto Prefectural University of Medicine
*Department of Ophthalmology, Ehime University School of Medicine; †Department of Ophthalmology, Minami Matsuyama Hospital
Masakazu Nishii, Norihiko Yokoi, Aoi Komuro, Jiro Sugita, Yo Nakamura, Kentaro Kojima and Shigeru Kinoshita
doi:10.1016/j.jjo.2003.09.012
doi:10.1016/j.jjo.2003.09.011
Comparison of Extrusion Rate for Two Different Designs of Punctal Plugs Purpose: Punctal occlusion using a silicone plug is an effective treatment for severe tear-deficient dry eye. At present, plugs from two companies are available in Japan [Eagle plug (EP); Eagle Vision, Punctal plug (PP); FCI]. We compared the extrusion rate between EP and PP in our dry eye clinic. Subjects and Methods: Subjects were 20 eyes of 18 patients for EP [5 eyes from 5 males, 15 eyes from 13 females, age: 58.1 ⫾ 17.5 (mean ⫾ standard deviation)] and 76 eyes of 51 patients for PP (6 eyes from 5 males, 70 eyes from 46 females, age: 58.6 ⫾ 13.4), 62 eyes from 44 patients with Sjo¨gren syndrome, 34 eyes from 25 patients with non-Sjo¨gren syndrome with severe teardeficient dry eye. These patients were treated during the
The Results of Randomized Controlled Trial of Low-dose Radiation for Wet-type Age-related Macular Degeneration on a 1 Year Term Basis Object: Evaluation of low-dose radiation therapy for the wet-type age-related macular degeneration (AMD) located at the fovea centralis. Cases and Methods: Patients were irradiated with 10 fractions of 2 Gy external beam or just observed. Between the treated (39) and untreated (31) cases, there was no significant difference in sex, age, initial visual acuity, or size of the neovascular membrane. Results: During the follow-up of 12 months, the visual acuity was significantly well preserved and the size of the neovascular membrane was decreased. Conclusion: These results indicate that low dose irradiation is effective for the wet-type AMD of the stage we treated in the present study. Nippon Ganka Gakkai Zasshi (J Jpn Ophthalmol Soc 107:326–330, 2003)