田中 秀典

OBJECTIVES: The aim of this study was to determine whether age correlates with amplitude and latency, when full-field electroretinography (ERG) is performed using skin electrodes. The ability of pulse reference power line noise reduction (PURE) to dampen the noise associated with the use of skin electrodes, was also investigated. METHODS: ERG was performed on 77 eyes in 77 healthy subjects (mean age: 55.6±19.0 years; age range: 9 to 86 years). Subjects with -5D or higher myopia, Emery-Little grade III or higher cataracts, retinal disease, uveitis, glaucoma, ≤5 mm mydriasis, or a history of intraocular surgery other than cataract surgery, were excluded. The active, reference, and ground electrodes were placed on the lower eyelid, outer canthus, and earlobe, respectively. Responses were averaged 10 times for dark-adapted (DA) ERGs, and 32 to 64 times for light-adapted (LA) ERGs. Noise was removed using the PURE method. RESULTS: The DA ERGs without PURE were so noisy that the amplitude or latency could not be determined, whereas those with PURE were comparatively quieter. ERG with PURE demonstrated a significant negative correlation between age and amplitude and a significant positive correlation between age and latency. CONCLUSIONS: We could record the measurable ERG waveforms with skin electrodes by using the PURE method, especially in fewer averaged conditions. It is suggested that skin electrode with PURE is suitable to examine the pathological ERGs, and other types of electrodes. It is recommended that the aging effect should be taken into consideration when pathological ERGs are evaluated.

Purpose: In clinical practice we sometimes encounter patients with severe corneal ulcers who have been treated with topical corticosteroids. This study reviewed the clinical features and visual outcomes of these patients and investigated the background of the prescription of topical corticosteroids. Patients and Methods: The medical records of patients who visited the Cornea Service at Fujita Health University Bantane Hospital and were treated for infectious keratitis from April 2016 to March 2020 were retrospectively reviewed. Patients treated with topical corticosteroids before a culture-proven diagnosis were studied in terms of demographics, best-corrected visual acuity at arrival and at last visit, the clinical course after visit, ocular history, and combination therapy by the previous ophthalmologist. Results: Out of the 200 eyes of 197 patients with infectious keratitis, 14 eyes of 14 patients were treated with topical corticosteroids before a culture-proven diagnosis. All 14 patients were referred, as they had severe keratitis that could not be cured with topical antibiotics and corticosteroids. Based on the culture results, we diagnosed Acanthamoeba keratitis (AK) in six patients, fungal keratitis (FK) in two patients, bacterial keratitis (including a suspected case) in two patients, and unknown cause in four patients. Two patients with AK, FK, and unknown keratitis had unfortunate clinical courses and poor visual outcomes. From the information in the referral letters, at least six of the 14 patients were treated with either acyclovir ocular ointment or valaciclovir tablets, along with topical corticosteroids. Conclusion: Application of topical corticosteroids for keratitis that does not respond to empirical antibiotic therapy is harmful since AK or FK is likely involved in these topical antibiotic-resistant cases. Microbiological evidence, as well as a differential diagnosis of herpetic stromal keratitis, is needed when prescribing topical corticosteroid for the treatment of suspected infectious keratitis.

We describe a new technique to prevent an endothelial donor graft from dropping into the vitreous cavity during non-Descemet stripping automated endothelial keratoplasty (nDSAEK) for extremely mydriatic bullous keratopathy (BK) eyes without capsular support. The patient was a 79-year-old woman who underwent nDSAEK for an extremely mydriatic BK eye with an incomplete barrier between the anterior and posterior chambers. She had undergone argon laser iridotomy for acute glaucoma at the age of 59 years and cataract surgery 3 years later. The pupil was extremely mydriatic as a result of iris sphincter muscle damage associated with an acute glaucoma attack and cataract surgery. After cataract surgery, the dislocated intraocular lens (IOL) sometimes touched the corneal endothelium. Despite simultaneous surgery to remove the dislocated IOL and lens capsule, vitrectomy, and intrascleral IOL fixation, her corneal endothelial decompensation progressed to BK. During nDSAEK, three 9-0 Prolene suture threads were placed through the recipient's cornea, limbus-to-limbus, resembling wheel spokes, to prevent the graft from dropping into the vitreous cavity. With the aid of these pre-placed sutures, the graft was inserted safely and was well attached to the host's posterior cornea by air tamponade without suturing. The wheel spokes technique prevented the endothelial graft from dropping during intraoperative manipulation, suggesting that nDSAEK is possible even in an extremely mydriatic aphakic BK eye without capsule support.

The current case involved a 59-year-old woman who was referred to our hospital with bilateral optic nerve abnormality and gradually progressive bilateral inferior visual field defects. An ophthalmological examination revealed superficial optic nerve head drusen (ONHD) and bilateral inferior altitudinal hemianopsia, but no intracranial lesions. The results of an angiogram revealed no evidence of retinal vascular occlusion or anterior ischaemic optic neuropathy (AION). Prior reports suggested that drusen-induced hemianopsia was slowly progressive but that ONHD-induced AION caused acute altitudinal hemianopsia, which led us to the diagnosis of bilateral drusen-induced altitudinal hemianopsia.

Purpose: To report the relation between hard exudates and serum lipid levels in cases of branch retinal vein occlusion (BRVO). Cases and Method: This retrospective study was made on 89 eyes of 89 cases who received vitrectomy for BRVO. The series comprised 40 males and 49 females. The age averaged 67.1 years. Hard exudates were present or became apparent in 12 eyes and were absent throughout in 77 cases. Results: There was no difference between the two groups regarding age, duration of BRVO before surgery, visual acuity, or macular thickness. Cases with hard exudates had significantly higher serum levels of total cholesterol (p=0.005) and showed poorer recovery of cystoid macular edema 6 months after vitrectomy (p = 0.002). Conclusion: Eyes with BRVO were characterized by higher serum levels of total cholesterol and slower postoperative absorption of cystoid macular edema.

Purpose : To report the characteristics of eyes with phakic rhegmatogenous retinal detachment with single or multiple breaks. Cases and Method : This retrospective study was made on 98 eyes of 98 cases of rhegmatogenous retinal detachment. The series comprised 58 males and 40 females. All the cases were aged 50 years or over, received simultaneous cataract and vitreous surgery, and were measured for the volume of resected vitreous cavity. Results : There were 52 eyes with single retinal break and 46 eyes with multiple breaks. Out of 12 eyes with axial length of 23 mm or less, 11 eyes had single break. Out of 8 eyes with axial length of 27 mm or over, 5 eyes had multiple breaks. Out of 78 eyes with axial length between 23 mm and 27 mm, 38 eyes had single break and 40 eyes had multiple breaks. Corneal curvature radius and volume of vitreous cavity was significantly greater in eyes with multiple breaks than single break. There was no significant difference in axial length in eyes with multiple or single break between 23 mm and 27 mm. Conclusion : Axial length, vitreous volume, and cornel curvature radius are related with the number of retinal break in eyes with phakic retinal detachment.

Purpose : To report a case with severe retinal dysfunction suspected of chlorpromazine-induced retinopathy. Case : A 50-year-old female presented with blurring of vision in both eyes. She had been receiving 10 medications including chlorpromazine 50 mg daily for severe depression since 21 years before. She had received simultaneous cataract and vitreous surgery for cataract and macular edema in both eyes 2 years before. Findings : Corrected visual acuity was 0.07 right and 0.6 left. Both eyes showed paracentral scotoma and decreased sensitivity in the fovea. Fluorescein angiography showed extensive atrophy of retinal pigment epithelium. Optical coherence tomography showed thinning of retinal outer layer and absence of borderline between outer and inner segment of visual cells in the right eye and cystoid macular edema in the left. Electroretinogram was almost extinguished in the right eye and was markedly reduced in the left. Conclusion : This case illustrates that prolonged intake of chlorpromazine at a low dosis may induce severe retinal dysfunction.