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坂本 麻里大学院医学研究科 医科学専攻助教
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■ 論文- PURPOSE: Rapid diagnosis and initiation of treatment are essential to improve outcomes for optic neuritis. However, many patients suspected of having optic neuritis may have different underlying conditions. This study aimed to investigate the spectrum of diseases in patients referred with suspected optic neuritis and to identify clinical factors associated with confirmed optic neuritis. STUDY DESIGN: Retrospective cohort study METHODS: This study retrospectively reviewed 255 cases referred to Kobe University Hospital with suspected optic neuritis between January 2016 and June 2024. Cases were excluded if patients had a history of optic neuritis, encephalitis, or myelitis, were referred from non-ophthalmology departments, or resided outside Hyogo Prefecture. Logistic regression analysis was conducted to identify factors significantly associated with confirmed optic neuritis. RESULTS: Of the 206 eligible cases, 89 (43.2%) were confirmed to have optic neuritis. Other major diagnoses included anterior ischemic optic neuropathy (18.4%), space-occupying lesions such as intracranial tumors (11.7%), and retinal diseases or uveitis (10.2%). Logistic regression analysis revealed significant associations between confirmed optic neuritis and younger age, the presence of central scotoma, eye pain, decreased visual acuity, reduced critical flicker fusion frequency, and a shorter interval between symptom onset and consultation. CONCLUSION: Although 43.2% of suspected cases were confirmed as optic neuritis, a substantial proportion was attributed to other conditions requiring distinct diagnostic and therapeutic approaches. These findings emphasize the critical role of multidisciplinary collaboration and evidence-based protocols in managing patients with acute visual impairment.2025年10月, Japanese journal of ophthalmology, 英語, 国内誌研究論文(学術雑誌)
- PURPOSE: Primary open-angle glaucoma (POAG) typically exhibits bilateral symmetry in visual field defects, while secondary glaucoma often manifests substantial left-right differences. This study investigates the diagnostic relevance of left-right differences in the Humphrey visual field (HVF) test and explores the factors influencing these differences. STUDY DESIGN: This is a cross-sectional study. METHODS: Parameters were assessed in 201 glaucoma patients, including age, sex, glaucoma disease type, central corneal thickness (CCT), corneal endothelial cell density (ECD), axial length, anterior chamber depth, refractive power, intraocular pressure (IOP), glaucoma drug score, and mean deviation (MD), pattern standard deviation (PSD), and visual field index (VFI) for both eyes in HVF. Patients were categorized into type 1 (POAG in both eyes) and type 2 (secondary glaucoma). Multivariable analysis was conducted to explore factors influencing left-right visual field test differences. RESULTS: No significant differences were found between type 1 and type 2 in left-right MD, PSD, and VFI (p=0.13, 0.26, 0.09). Type 2 exhibited significant inter-eye differences in ECD, CCT, IOP, and glaucoma drug scores (p=0.02, <0.01, <0.001, 0.01). In the type 1 group, the left and right MD values were statistically significantly correlated (r=0.40, p<0.000001), but 24.6% of patients showed a left-right difference of 10 dB or more. Multivariable regression analysis identified anterior chamber depth as the sole significant factor influencing left-right MD differences in POAG (p=0.03). CONCLUSION: Asymmetry in the visual field cannot distinguish between glaucoma disease types. In POAG, a shorter anterior chamber depth is associated with increased left-right MD differences, emphasizing its significance in understanding the progression of visual field defects.2025年02月, Cureus, 17(2) (2), e79711, 英語, 国際誌研究論文(学術雑誌)
- Optic neuritis can be an early sign of demyelinating diseases like multiple sclerosis (MS), neuromyelitis optica spectrum disorders (NMOSD), and myelin oligodendrocyte glycoprotein (MOG) antibody-associated diseases (MOGAD). We investigated the presence or absence of head and spinal cord lesions on magnetic resonance imaging (MRI) and assessed whether cerebrospinal fluid (CSF) tests are useful in detecting demyelinating disease in patients with first diagnosed optic neuritis. We conducted a retrospective study of 111 patients (47 idiopathic, 19 NMOSD, 16 MOGAD, 16 MS, 6 optic neuritis with cerebral lesions but that does not meet the McDonald's criteria for MS (ON+)), and 7 chronic relapsing inflammatory optic neuropathy) diagnosed with optic neuritis without cerebral or spinal symptoms. Patients underwent evaluations including orbital, head, and spine MRI, along with CSF analysis. Among the 111 patients, 20 (35.1%: 4 NMOSD, 4 MOGAD, 7 MS, and 6 ON+) exhibited intracerebral or spinal cord lesions. Twelve patients showed findings on both orbital and head MRI, while six had no orbital MRI findings except for optic neuritis but exhibited lesions on head MRI. Five patients had spinal lesions without intracerebral lesions. CSF analysis revealed positive oligoclonal bands and elevated myelin basic protein levels indicate the high likelihood with systemic inflammatory demyelinating diseases. Even in the absence of concomitant encephalitis or myelitis symptoms or a history of these conditions, MRI images of patients with optic neuritis sometimes reveal lesions in the brain or spinal cord. CSF abnormalities were indicative of systemic demyelinating disease presence, extending beyond MS to NMOSD and MOGAD.2025年, Neuro-ophthalmology (Aeolus Press), 49(2) (2), 154 - 160, 英語, 国際誌研究論文(学術雑誌)
- PURPOSE: To report the 3-year outcomes of surgical bleb revision (SBR) with mitomycin C (MMC) for early scarring bleb after trabeculectomy (TLE). STUDY DESIGN: Retrospective observational study. METHODS: We included glaucoma patients aged ≧ 18 who underwent SBR with MMC within 6 months of their first TLE at Kobe University Hospital and were followed for at least 6 months. The primary outcome measure was the three-year success rate of SBR. We defined surgical success as: intraocular pressure (IOP) reduction ≧ 20% from baseline and 5 ≦ IOP ≦ 18 mmHg. Failure was defined when the IOP deviated from the criteria, when the eye required additional glaucoma surgery, and when the eye lost light perception. Complete success (CS) was success without glaucoma medications and qualified success (QS) was success with glaucoma medications. The secondary outcome measures included IOP, the number of glaucoma medications, mean deviation (MD), best corrected visual acuity (BCVA), corneal endothelial cell density (ECD), and surgical complications. RESULTS: Sixty-eight eyes of 68 patients were analyzed. The median interval between initial TLE and SBR was 2 months. Overall success rate at three-year after SBR were 45.1% and 9.6% for QS and CS, respectively. A greater number of medications used before TLE was a contributing factor to failure (P = 0.02). 22 eyes (32.4%) underwent additional glaucoma surgery, and 41 eyes (60.3%) were spared from additional glaucoma surgery within 3 years after SBR. The median IOP decreased form 24.0 mmHg to 11.0 mmHg 3 years after SBR, and the number of medications decreased from 4 to 2 (P < 0.01). MD remained unchanged, but BCVA and ECD decreased at 3years postoperatively. There were no serious complications of SBR. CONCLUSION: SBR may be an effective treatment option for early scarring blebs after TLE but is unsuccessful in eyes that have used many glaucoma medications prior to TLE.2024年11月, Japanese journal of ophthalmology, 69(1) (1), 101 - 109, 英語, 国内誌研究論文(学術雑誌)
- PURPOSE: This study investigated the association between one-year surgical outcomes following trabeculectomy and age, accounting for confounding factors. STUDY DESIGN: Retrospective observational study. METHOD: Analyzing data from 305 patients undergoing initial trabeculectomy from 2019 onward, we employed three approaches to adjust variables: stratified analysis, regression analysis, and propensity score matching. Surgical success at 1-year post-surgery was defined by two criteria: achieving intraocular pressure of between 5 and 15 mmHg with a ≥ 20% reduction compared to pre-surgery levels and no additional glaucoma surgery (Criterion A); achieving intraocular pressure of between 5 and 12 mmHg with a ≥ 30% reduction compared to pre-surgery levels and no additional glaucoma surgery (Criterion B). RESULTS: Stratified analysis by age unveiled a significant increase in exfoliation glaucoma (XFG) and a trend towards shorter axial lengths with advancing age (both p < 0.0001). Older age groups were more likely to experience surgical failure in both Criterion A and B (p = 0.21, < 0.01). Univariate analysis showed age as a significant factor in surgical failure for Criterion A (p < 0.05) and a nearly significant factor for Criterion B (p = 0.12). However, this trend was not evident in multivariate analysis (p = 0.23/0.88), where XFG became a significant factor for surgical failure (both p < 0.001) in Criteria A and B. Propensity score matching revealed no significant differences in surgical success rates for Criteria A and B between younger and older patients (p = 1.00 and 0.88). CONCLUSION: Age is not a primary determinant of failure in trabeculectomy; however, the increasing incidence of XFG with aging suggests a potential for poorer outcomes.2024年10月, Japanese journal of ophthalmology, 英語, 国内誌研究論文(学術雑誌)
- (株)メディカル葵出版, 2024年06月, あたらしい眼科, 41(6) (6), 703 - 706, 日本語
- (公財)日本眼科学会, 2024年03月, 日本眼科学会雑誌, 128(3) (3), 234 - 255, 日本語
- To investigate the association between lactate metabolism and glaucoma, we conducted a multi-institutional cross-sectional clinical study and a retinal metabolomic analysis of mice with elevated intraocular pressure (IOP) induced by intracameral microbead injection. We compared lactate concentrations in serum and aqueous humor in age-matched 64 patients each with primary open-angle glaucoma (POAG) and cataract. Neither serum nor aqueous humor lactate concentrations differed between the two groups. Multiple regression analysis revealed that only body mass index showed a significant positive correlation with serum and aqueous humor lactate concentration in POAG patients (rs = 0.376, P = 0.002, and rs = 0.333, P = 0.007, respectively), but not in cataract patients. L-Lactic acid was one of the most abundantly detected metabolites in mouse retinas with gas chromatography and mass spectrometry, but there were no significant differences among control, 2-week, and 4-week IOP elevation groups. After 4 weeks of elevated IOP, D-glucose and L-glutamic acid ranked as the top two for a change in raised concentration, roughly sevenfold and threefold, respectively (ANOVA, P = 0.004; Tukey-Kramer, P < 0.05). Glaucoma may disrupt the systemic and intraocular lactate metabolic homeostasis, with a compensatory rise in glucose and glutamate in the retina.2024年02月, Scientific reports, 14(1) (1), 3683 - 3683, 英語, 国際誌研究論文(学術雑誌)
- INTRODUCTION: Leber hereditary optic neuropathy (LHON) complicated with extraocular symptoms is called LHON plus. We describe a case of LHON plus with a rare mutation, which also caused dystonia. CASE PRESENTATION: An 18-year-old male patient developed symptoms of dystonia at the age of 15 years. Two years later, he noticed decreased visual acuity and central scotoma in the left eye. One month later, the same symptoms occurred in the right eye. Although the optic discs in both eyes revealed mildly redness and edematous change, no abnormal findings were detected on fluorescence fundus angiography and orbital magnetic resonance imaging. Mitochondrial deoxyribonucleic acid (mtDNA) sequencing detected the m.14487 T>C mutation. From clinical course and fundus findings, the case was diagnosed LHON. The optic nerve gradually atrophied and central scotoma remained. CONCLUSION: The m.14487 T>C mutation is one of the causative mutations in patients with dystonia or Leigh encephalopathy and a minor mutation in patients with LHON. However, in the present case, ocular symptoms were more severe than systematic symptoms and the disease course was consistent with LHON. For the above reasons, this case can be diagnosed as LHON plus. Whole mtDNA sequencing is important in diagnosing LHON if none of the three major mutations are detected.2024年, Case reports in ophthalmology, 15(1) (1), 852 - 858, 英語, 国際誌研究論文(学術雑誌)
- PURPOSE: The impact of various preoperative glaucoma medications on Schlemm's canal surgery outcomes remains unclear. This study aimed to investigate the impact of preoperative glaucoma medications on the postoperative 1-year outcomes of μTLO. METHODS: We analyzed the medical records of 218 patients who underwent their first μTLO to investigate the 1-year postoperative outcomes. Cox proportional hazard regression analysis was performed with surgical failure as the dependent variable and each type of preoperative medication as the independent variable. We also compared the 1-year outcomes of μTLO between users and non-users of specific medications using propensity score matching. Surgical success was defined as a postoperative intraocular pressure ranging from 5 to 21 mmHg, a ≥20% reduction in IOP from baseline, and no additional glaucoma surgery within 1 year postoperatively. RESULTS: The Cox proportional hazard analysis showed that all drugs that do not increase the conventional outflow exhibited hazard ratios greater than 1.0, and the preoperative use of β-blockers and oral CAI was a significant surgical risk factor (hazard ratio: 2.65 and 2.45, p = 0.04 and <0.001). In the propensity score matching analysis, success rates at 1 year postoperatively were 55/85, 54/79, 60/73, and 40/76% for users/non-users of β-blockers, topical CAIs, an alpha-2 adrenergic agonist, and an oral CAI, respectively. Kaplan-Meier survival curves in these comparisons also demonstrated that preoperative β-blockers and oral CAI use were significant surgical risks (p = 0.01, <0.001). CONCLUSION: Our study suggests that preoperative medications that do not involve conventional pathway outflow have a detrimental effect on subsequent Schlemm's canal surgery outcomes.2023年09月, Acta ophthalmologica, 英語, 国際誌[査読有り]研究論文(学術雑誌)
- (株)メディカル葵出版, 2023年09月, あたらしい眼科, 40(9) (9), 1222 - 1227, 日本語新しくなった認定基準下での視覚障害者認定に関する後ろ向き実態調査[査読有り]
- PURPOSE: We have previously demonstrated that prolonged use of glaucoma medications was associated with a poor surgical outcome of ab interno trabeculotomy (µTLO). Given that almost all types of glaucoma eye drop either enhance the drainage through the uveoscleral pathway or reduce aqueous humor production, we hypothesized that prolonged use of these medications might cause disuse atrophy of the conventional pathway. In contrast, ripasudil increases the conventional outflow and eventually shows a favorable outcome of µTLO. This study aimed to evaluate the effect of ripasudil use on µTLO outcomes. METHOD: The medical charts of 218 patients who underwent µTLO were analyzed retrospectively. We compared the 1-year outcome between ripasudil users versus nonusers by using propensity score matching. We set the covariates as age, sex, glaucoma types, preoperative intraocular pressure (IOP), the mean deviation values of visual field tests, the presence or absence of concomitant cataract surgery, trabecular meshwork incision range, the presence or absence of any glaucoma medication except ripasudil and duration of glaucoma medical therapy. Success was defined as a postoperative IOP between 5 and 21 mmHg, a ≥ 20% IOP reduction from baseline, and no additional glaucoma surgery at postoperative 1 year. RESULT: Fifty-seven patients each were allocated to the ripasudil users or nonusers. The 1-year success rates were 74% in ripasudil users and 51% in nonusers (p = 0.01). Kaplan‒Meier survival curves also showed that the ripasudil users had a higher survival distribution (p = 0.01). CONCLUSION: The patients who took ripasudil showed a favorable 1-year outcome of µTLO.2023年09月, Graefe's archive for clinical and experimental ophthalmology = Albrecht von Graefes Archiv fur klinische und experimentelle Ophthalmologie, 261(9) (9), 2603 - 2610, 英語, 国際誌[査読有り]研究論文(学術雑誌)
- PURPOSE: To evaluate the reproducibility of the imo binocular random single-eye test (BRSET) and Humphrey Field Analyzer (HFA) monocular test in patients with glaucoma. STUDY DESIGN: Retrospective observational study. METHODS: We measured the visual fields (VF) of patients with glaucoma using the BRSET and HFA. All tests were repeated two months later. Mean sensitivity (MS), mean deviation (MD), sensitivity at each test location, and reliability indices were compared between the test days. Wilcoxon signed-rank test, interclass correlation coefficient (ICC), correlation coefficients, and Bland-Altman plots were generated for analysis. RESULTS: We analyzed the VFs of 46 patients with glaucoma. There were no test-retest differences for MS and MD, and ICCs were > 0.9 for MS and MD in both perimeters. Inter-test correlations for MS and MD were high. The limits of agreement (LoAs) (lower, upper limit) between test days for MS were (- 3.4, 4.0) for BRSET and (-3.3, 3.0) for HFA. The LoA for MD was (- 3.3, 3.8) for BRSET and (- 3.2, 2.9) for HFA. Sensitivity at each testing location was more variable between testing days for BRSET than for HFA. For reliability indices, LoAs between testing days were wider for BRSET than for HFA. CONCLUSION: The imo BRSET showed similar reproducibility to HFA in MS and MD. However, sensitivity at each test location varied more for BRSET than for HFA. Further studies are needed to verify the reproducibility of the imo BRSET.2023年09月, Japanese journal of ophthalmology, 67(5) (5), 578 - 589, 英語, 国内誌[査読有り]研究論文(学術雑誌)
- Patients with asymmetric glaucomatous optic neuropathy (GON) present a relative afferent pupillary defect (RAPD) in the eye with more advanced damage. Although useful, pupillometric RAPD quantification is not widely used as it is not portable. Whether asymmetry of the peripapillary capillary perfusion density (CPD) detected using optical coherence tomography angiography correlates with the severity of RAPD remains unknown. This study assessed RAPD in 81 patients with GON using Hitomiru, a novel hand-held infrared binocular pupillometer. The correlation and ability to detect clinical RAPD based on the swinging flash light test of two independent RAPD parameters (the maximum pupil constriction ratio and the constriction maintenance capacity ratio) were assessed. The coefficient of determination (R2) was calculated between each of the two RAPD parameters and asymmetry of the circumpapillary retinal nerve fiber layer thickness (cpRNFLT), ganglion cell layer/inner plexiform layer thickness (GCL/IPLT), and CPD. The two RAPD parameters showed a correlation coefficient of 0.86 and areas under the receiver operating characteristic (ROC) curve of 0.85-0.88, with R2 being 0.63-0.67 for the visual field, 0.35-0.45 for cpRNFLT, 0.45-0.49 for GCL/IPLT, and 0.53-0.59 for CPD asymmetry. Hitomiru has high discriminatory performance in detecting RAPD in patients with asymmetric GON. CPD asymmetry may better correlate with RAPD than cpRNFLT and GCL/IPLT asymmetry.2023年06月, Journal of clinical medicine, 12(12) (12), 英語, 国際誌[査読有り]研究論文(学術雑誌)
- PURPOSE: To compare the two-year outcome of half-time photodynamic therapy (htPDT) in chronic central serous chorioretinopathy (cCSC) with and without choroidal neovascularization (CNV). METHODS: In this retrospective study, we included 88 eyes of 88 patients with cCSC who underwent htPDT and were followed up for more than 24 months. Patients were divided into two groups with (21 eyes) or without (67 eyes) CNV before htPDT treatment. The best-corrected visual acuity (BCVA), central retinal thickness (CRT), subfoveal choroidal thickness (SCT), and the presence of subretinal fluid (SRF) were evaluated at baseline and at 1, 3, 6, 12, and 24 months after PDT. RESULTS: A significant intergroup difference was noted in terms of age (P = 0.038). Significant improvements in the BCVA and SCT were found at all time points in eyes without CNV but only at 24 months in eyes with CNV. CRT was significantly reduced in both groups at all time points. No significant intergroup differences were noted in terms of BCVA, SCT and CRT at all time points. There were significant differences in the rate of recurrent and persistent SRF between groups (22.4% (without CNV) vs. 52.4% (with CNV), P = 0.013, and 26.9% (without CNV) vs. 57.1% (with CNV), P = 0.017, respectively). The presence of CNV was significantly associated with the recurrence and persistence of SRF after initial PDT (P = 0.007 and 0.028, respectively). Logistic regression analyses showed that the baseline BCVA, and not the presence of CNV, was significantly associated with BCVA at 24 months after initial PDT (P < 0.01). CONCLUSIONS: A htPDT for cCSC was less effective in eyes with CNV than in those without CNV regarding the recurrence and persistence of SRF. Additional treatment might be required in eyes with CNV during 24-month follow-up periods.2023年, PloS one, 18(5) (5), e0284979, 英語, 国際誌[査読有り]研究論文(学術雑誌)
- PURPOSE: The purpose of this retrospective study was to determine the extent to which the use of antithrombotic drugs during glaucoma surgery contributes to surgical failure and postsurgical hemorrhagic complications. METHODS: Glaucoma surgeries were categorized into three groups: trabeculotomy (TLO), trabeculectomy (TLE), and long-Tube shunt surgery (Tube). At 1 year after surgery, the following criteria for surgical success were met: intraocular pressure (IOP) in the 5-21-mmHg range, IOP reduction of at least 20% from the preoperative level, and no additional glaucoma surgeries. We compared the percentages of the success rates and hemorrhagic complications between antithrombotic medication experiencers and non-experiencers. Furthermore, we adjusted the preoperative factors between the two groups using a propensity score analysis in TLO and TLE surgeries. RESULTS: A total of 910 glaucoma surgeries were included, with TLO, TLE, and Tube accounting for 353, 444, and 113 surgeries, respectively. Preoperative antithrombotic medications were administered to 149 patients in all glaucoma surgeries: 37 patients used only anticoagulants, 102 used only antiplatelets, and 10 used both. There was no significant difference in the success rates of any of the procedures. The hemorrhagic complications (hyphema and vitreous hemorrhage rate) were significantly higher in the patients who underwent TLE and Tube. The surgical success rates of TLO and TLE were not significantly different after the two groups were matched by propensity score. CONCLUSION: The perioperative use of antithrombotic drugs did not affect success for any of the procedures. However, it increased early postoperative hemorrhagic complications for TLE and Tube.2022年11月, Graefe's archive for clinical and experimental ophthalmology = Albrecht von Graefes Archiv fur klinische und experimentelle Ophthalmologie, 260(11) (11), 3607 - 3615, 英語, 国際誌[査読有り]研究論文(学術雑誌)
- PURPOSE: This study examined the perioperative factors affecting surgical success in ab interno microhook trabeculotomy (μTLO). METHODS: A total of 146 consecutive patients who underwent μTLO were included in this retrospective study. We performed Cox proportional hazard modelling by setting surgical success at 1 year as an objective variable. The explanatory variables included age, sex, glaucoma type, preoperative intraocular pressure (IOP), glaucoma drug score, mean deviation (MD) of the Humphrey visual field test, duration of glaucoma drug use, antithrombotic drug use, combined cataract surgery, incision range and diabetes mellitus. Additionally, we performed 1:1 matching using propensity score analysis and compared the perioperative parameters between durations of glaucoma drug use of <4.5 years and ≥ 4.5 years (50 patients each). We defined surgical success as satisfaction of all three criteria: IOP 5-21 mmHg, IOP reduction of ≥20% from the preoperative IOP and no additional glaucoma surgery. RESULTS: The Cox proportional hazard model revealed that a longer duration of anti-glaucoma medication was significantly associated with surgical failure. Propensity score matching analysis showed that the <4.5-year users of anti-glaucoma drugs had significantly higher success rates than the ≥4.5-year users (72% versus 52%; p = 0.04). CONCLUSIONS: The prolonged use of multiple glaucoma drugs adversely affected the outcome of μTLO at least at 1 year postoperatively.2022年09月, Acta ophthalmologica, 100(6) (6), e1209-e1215, 英語, 国際誌[査読有り]研究論文(学術雑誌)
- PURPOSE: To compare the ability of imo binocular random single-eye test (BRSET) to detect visual field (VF) defects due to chiasmal and postchiasmal lesions (C/PCLs) with a Humphrey Field Analyzer (HFA) monocular test. STUDY DESIGN: Prospective multicenter study METHODS: This study enrolled 40 patients with C/PCLs and measured their VFs using both imo BRSET and HFA monocular test. The VFs were classified into three groups using the cluster criterion: 1) bitemporal group, 2) homonymous group, and 3) others. The agreement and correlation of VF results between imo and HFA were analyzed using the Bland-Altman plot and Spearman correlation coefficient. RESULTS: The VFs of 34 patients were analyzed and classified. There were 13 patients in the bitemporal, 6 in the homonymous, and 15 in the others group. BRSET showed a significantly shorter test duration than HFA. The imo systematically yielded a lower sensitivity than HFA. The average sensitivity at each test location correlated well between the perimeters in all groups, with the correlation coefficients ranging from 0.89 to 0.98. Bland-Altman plots showed wider limits of agreement in the affected quadrants compared to the unaffected quadrants in the bitemporal and homonymous groups. The fixation loss rate did not differ between the perimeters, but there were significant differences in the false positive and false negative rates between perimeters. CONCLUSION: BRSET detected VF defects due to C/PCLs as accurately as the HFA monocular test with a shorter test duration.2022年09月, Japanese journal of ophthalmology, 66(5) (5), 413 - 424, 英語, 国内誌[査読有り]研究論文(学術雑誌)
- (株)メディカル葵出版, 2022年06月, あたらしい眼科, 39(6) (6), 808 - 813, 日本語
- PURPOSE: We compared the 1-year outcomes and early surgery-related complications between 1-quadrant and 2-quadrant microhook ab interno trabeculotomy (TLO). METHODS: Medical chart extraction was performed on 47 consecutive patients with 1-quadrant incision and 37 consecutive patients with 2-quadrant incision of trabecular meshwork. Logistic regression analysis was conducted to calculate the propensity score to create a 1:1 match for a comparative analysis of 1-year postoperative success. Success was defined as postoperative intraocular pressure (IOP) between 5-21 mmHg, >20% IOP reduction from baseline, and no additional glaucoma surgery. Outcome-related covariates were age, glaucoma type, mean deviation of visual field tests, preoperative IOP, the number of preoperative glaucoma eye drops and the presence of combined cataract surgery. Thirty eyes from each group were compared. RESULTS: The median preoperative IOP was not different between the 1-quadrant and 2-quadrant groups (28.5 mmHg, quartile range 23-33.5 versus 27 mmHg, 23.3-30.0, p = 0.47). There was no difference in median postoperative IOP at 1 year (15 mmHg versus 16 mmHg, p = 0.80). The success rate was 73% in the 1-quadrant group versus 70% in the 2-quadrant group (p = 1.00). The 2-quadrant group had a significantly higher proportion of patients with transiently elevated IOP (47%) than the 1-quadrant (17%; Fisher's exact test, p = 0.02). There was no difference of hyphema formation (Fisher's exact test, p = 0.18). CONCLUSION: The 1-year success rate was not significantly different between 1- and 2-quadrant incisions of microhook TLO. However, the 2-quadrant TLO showed significantly higher proportion of post-surgical transient IOP elevation.2021年12月, Acta ophthalmologica, 99(8) (8), 898 - 903, 英語, 国際誌研究論文(学術雑誌)
- PURPOSE: The purpose of this study was to evaluate the 3-year surgical outcome of the sulcus fixation of Baerveldt glaucoma implant (BGI), focusing on corneal damage. METHODS: This prospective observational study included 37 patients who underwent a median of two previous glaucoma surgeries and sulcus fixation of BGI for the first time. Each patient's intraocular pressure (IOP), glaucoma drug score, corneal endothelial cell density (ECD), and logMAR-converted best-corrected visual acuity (VA) were measured preoperatively and postoperatively until 36 months after surgery. Complete success was defined as reduced IOP (5-21 mmHg and >20% rate), without corneal damage (postoperative development of decompensation, unmeasurable ECD, or reduction in ECD of >20%), without loss of light perception, and without additional surgery requirement. Qualified success was defined by excluding the corneal criteria from complete success. RESULTS: A total of 51% (19/37) patients experienced complete treatment success, whereas 86% (32/37) had qualified success. The median IOP (glaucoma drug score) decreased from 26 mmHg (5) to 15 mmHg (2) at three years postoperatively. The median postoperative ECD (reduction rate) decreased from 1838 cells/cm2 preoperatively to 1587 cells/mm2 (14%) at one year, 1358 cells/mm2 (26%) at two years, and 1228 cells/mm2 (33%) at three years postoperatively. One month after surgery, the VA was significantly reduced from preoperative values but did not decline after that. CONCLUSION: Sulcus fixation of BGI was effective for IOP reduction. However, ECD decreased over time.2021年12月, Acta ophthalmologica, 99(8) (8), e1435-e1441, 英語, 国際誌研究論文(学術雑誌)
- PURPOSE: Cytomegalovirus (CMV)-related keratouveitis elevates intraocular pressure (IOP). Antiviral therapy does not always control IOP and some patients do not tolerate systemic antiviral therapy because of the side effects. The purpose of this study is to evaluate the clinical characteristics of patients with CMV-related keratouveitis and determine the impact of glaucoma surgeries on the postoperative antiviral therapy regimen. METHODS: We enrolled twenty-two patients with CMV-DNA-positive keratouveitis between June 2012 and July 2019 in Kobe University Hospital. The following clinical parameters were collected: gender, age, history of previous intraocular surgery, antiviral medications, visual acuity, IOP, glaucoma drug score, corneal endothelial cells density, and the mean deviation of a Humphrey visual field test at the first visit and before and 1 year after glaucoma surgery. RESULTS: All twenty-two patients started on oral and/or topical antiviral therapy. Eighteen patients needed glaucoma surgery despite their antiviral medications. Nine patients underwent trabeculotomy (TLO) and nine underwent trabeculectomy (TLE) as the first surgical intervention. Six of patients who initially underwent TLO and two of the patients who initially underwent TLE required additional TLE within 1 year. Each of the 15 patients who underwent at least 1 TLE showed a reduction in the magnitude and variation of IOP and glaucoma drug scores and 13 patients were able to discontinue antiviral therapy. For the remaining 4 patients, IOP and inflammation were controlled but with antiviral medications. CONCLUSIONS: In patients with CMV-related keratouveitis, TLE decreases and stabilizes IOP and contributes to withdrawal from antiviral medications.2021年11月, BMC ophthalmology, 21(1) (1), 389 - 389, 英語, 国際誌研究論文(学術雑誌)
- INTRODUCTION: Leber hereditary optic neuropathy (LHON) is an acute or subacute inherited optic neuropathy caused by mitochondrial mutations. More than 90% of patients with LHON have one of three point mutations (ie, G3460A, G11778A and T14484C). We previously reported that a 12-week session of skin electrical stimulation (SES) with a 2-week interval significantly improved visual acuity and field tests 1 week after the last stimulation and without adverse effects in 10 cases of LHON carrying the mt DNA G11778A mutation. In the present study, we will examine the magnitude and persistence of the efficacy and presence or absence of adverse events using SES with a more frequent stimulation protocol. METHODS AND ANALYSIS: This study will be a single-arm, open-labelled, non-randomised clinical study that analyses 15 cases of LHON with G11778A mutation. All participants will take a portable SES device home and perform SES by themselves every other day for 12 weeks. The logarithm for the minimum angle of resolution (logMAR) best-corrected visual acuity (BCVA) at 1 week after the last SES will be measured as the primary outcome. LogMAR BCVA will be measured at four and 8 weeks after the last SES treatment. The Humphrey visual field sensitivity test using size V stimulation and critical fusion frequency at 1, 4 and 8 weeks after the last SES session will be secondary outcome measurements. Slit-lamp examination, optical coherence tomography and specular microscopy will also be performed to verify the safety of SES. ETHICS AND DISSEMINATION: The protocol was approved by the Institutional Review Board at Kobe University, Japan (Approval No.C190030). This study is in progress and deserves Pre-result. All documents communicating with the ethics committee will be reposited by the researcher. Modifications to the protocol will be reviewed by the ethics committee and implemented after approval. Data monitoring will be performed by a researcher who is not involved in the study every 6 months after approval. The research summary results will be registered in the Japan Registry of Clinical Trials (jRCTs) and made available to participants in accordance with the terms described in the documents. In addition, the results of this study will be presented at domestic and international meetings and published in peer-reviewed journals within a year after data is fixed. TRIAL REGISTRATION NUMBER: jRCTs052200033.2021年10月, BMJ open, 11(10) (10), e048814, 英語, 国際誌研究論文(学術雑誌)
- (公財)日本眼科学会, 2021年05月, 日本眼科学会雑誌, 125(5) (5), 530 - 538, 日本語
- This retrospective study was conducted to investigate the clinical factors associated with low-contrast visual acuity after reduced-fluence photodynamic therapy (RFPDT) in patients with resolved central serous chorioretinopathy (CSC) and good baseline visual acuity. A total of 45 eyes of 45 patients with resolved CSC at post-RFPDT and best-corrected visual acuity of >1.0 (logarithm of the minimal angle of resolution [logMAR], 0) at baseline were examined. Visual acuities of both eyes were measured at four contrast levels (100%, 25%, 12%, and 6%) at post-RFPDT. The low-contrast visual acuity (6%, 12%, and 25%) was significantly lower than the 100% contrast visual acuity in the affected eyes. Visual acuities of affected eyes were significantly worse than those of fellow eyes at any contrast levels. The degree of changes in 6% and 100% contrast visual acuities was significantly greater in affected eyes than that in fellow eyes (p < 0.05). The 6% contrast visual acuities in affected eyes at post-RFPDT were significantly associated with the symptom duration (p < 0.05). Patients with a long duration of symptoms might have disturbed low-contrast visual acuities at post-RFPDT even if their baseline visual acuities were good.2021年03月, Pharmaceuticals (Basel, Switzerland), 14(4) (4), 英語, 国際誌研究論文(学術雑誌)
- We report a rare case of granulomatosis with polyangiitis (GPA) presenting with bilateral orbital apex syndrome (OAS). A 73-year-old woman with a history of endoscopic sinus surgery for ethmoidal sinusitis experienced a sudden decrease in visual acuity (VA) of both eyes. At the initial examination, her VA had decreased to 0.01 in the right eye and 0.03 in the left eye, and eye movement in both eyes was mildly limited in all directions. Visual field tests of both eyes showed a large central scotoma. Laboratory tests revealed an elevation of myeloperoxidase-anti-neutrophil cytoplasmic antibody. Facial computed tomography demonstrated a thickened mucosal membrane in the entire ethmoidal sinus, and the posterosuperior walls of Onodi cells filled with infiltrative lesions had thinned. Orbital magnetic resonance imaging showed severe inflammation in the orbital apex. From these clinical findings, the patient was diagnosed with GPA presenting with OAS associated with ethmoid sinusitis. Emergent endoscopic sinus surgery was performed for biopsy and debridement of the ethmoidal and sphenoid sinusitis to decompress the optic nerve. One day after endoscopic sinus surgery, the patient's VA and visual field were improved, and steroid pulse therapy was commenced postoperatively. Four days later, VA had recovered to 1.0 in both eyes, and eye movement and visual field had were improved. Although OAS is a rare manifestation, early surgical treatment should be considered when the orbital lesion presents as risk of rapid deterioration of visual function in patients with GPA.2021年, Case reports in ophthalmology, 12(1) (1), 32 - 40, 英語, 国際誌
- Purpose. Although oral prednisolone is the first-line treatment for preventing recurrent optic neuritis (ON) after the completion of acute-phase treatment, especially anti-aquaporin 4 (AQP4) antibody-positive ON, and anti-myelin oligodendrocyte glycoprotein (MOG) antibody-positive ON, some patients experience relapses. Immunosuppressants could be effective in reducing the recurrence rate for neuromyelitis optica spectrum disorder and MOG antibody-related diseases, but there have been few studies addressing this issue focusing on the changes in ophthalmic parameters. The objective of the study was to analyze the impact of off-label uses of immunosuppressants to reduce recurrent ON. Design. Retrospective observational study, clinical case series. Methods. We reviewed the medical charts of 11 cases (22 eyes) who underwent immunosuppressive therapy in Kobe University Hospital and compared the annualized relapse rate (ARR) before and after immunosuppressive therapy. We also evaluated the dosage of prednisolone, complications of immunosuppressants, and other visual functional ophthalmologic parameters. Results. Eleven cases in total had AQP4 antibody (9 cases) and/or MOG antibody (3 cases). One case was double positive for these antibodies. Nine patients received azathioprine and two received mycophenolate mofetil as an initial immunosuppressive therapy. The median duration of immunosuppressant treatment was 2.8 years. The median ON ARR before immunosuppressive therapy was 0.33, and this decreased significantly to 0 after the therapy (Hindawi Limited, 2020年11月, Journal of Ophthalmology, 2020, 1 - 6, 英語, 国際誌
). The dose of prednisolone was reduced from 17.8 ± 7.1 mg/day before to 5.8 ± 2.2 mg/day after immunosuppressive therapy ( ). Although two patients presented with mild elevation of liver enzymes and nausea, all patients were able to continue taking the immunosuppressants. Conclusions. Immunosuppressants can potentially decrease relapses and steroid dosage in patients with anti-AQP4 or MOG antibody-positive ON without severe adverse events and the exacerbation of visual acuities.研究論文(学術雑誌) - Purpose: We report a case of neurosarcoidosis that presented simultaneously with oculomotor nerve palsy, contralateral abducens nerve palsy, and paresthesia of both lower limbs. Observations: A 69-year-old Japanese woman who suffered from repeated diplopia and lower-limb paresthesia was referred to our hospital. Ophthalmic findings included oculomotor nerve and contralateral abducens nerve palsies. No remarkable abnormalities were detected via enhanced brain magnetic resonance imaging (MRI), chest X-ray, and cerebrospinal fluid analysis. Chest computed tomography (CT) was performed to exclude neoplastic lesions; this revealed right hilar lymphadenopathy, and positron emission tomography MRI showed strong 18-F fluorodeoxyglucose uptake in the hilar lymph node. Biopsy of the lymph node showed non-caseating epithelioid granulomatous tissue, leading to a diagnosis of probable neurosarcoidosis. After the initiation of oral prednisolone treatment, the patient experienced complete remission without any recurrence. Conclusions and importance: When examining a patient presenting with multiple cranial neuropathies of unknown cause, neurosarcoidosis should be considered as a differential diagnosis and chest CT should be performed even when the chest X-ray and angiotensin-converting enzyme appears normal.2020年09月, American journal of ophthalmology case reports, 19, 100796 - 100796, 英語, 国際誌
- Leber hereditary optic neuropathy (LHON) is an intractable disease associated with mitochondrial DNA (mtDNA) mutations. In this preliminary, single-arm, prospective, open-label exploratory trial, we investigated the effectiveness and safety of skin electrical stimulation (SES) for cases of LHON harboring the mtDNA 11,778 mutation. Of the 11 enrolled patients, 10 completed six sessions of SES once every two weeks over a 10-week period. The primary outcome measure was the change in logarithm of the minimum angle of resolution (logMAR)-converted best-corrected visual acuity (BCVA) at one week after the last session of SES. The main secondary outcome measures were the logMAR BCVA at four and eight weeks and Humphrey visual field test sensitivities at one, four, and eight weeks. At all follow-up points, the logMAR BCVA had improved significantly from baseline [1.80 (1.70–1.80) at baseline, 1.75 (1.52–1.80) at one week, 1.75 (1.50–1.80) at four weeks, and 1.75 (1.52–1.80) at eight weeks; p < 0.05]. At eight weeks of follow-up, five patients showed >2-fold increase in the summed sensitivity at 52 measurement points from baseline. No adverse effects were observed. In conclusion, SES could be a viable treatment option for patients with LHON in the chronic phase harboring the mtDNA 11,778 mutation.2020年05月, Journal of clinical medicine, 9(5) (5), 英語, 国際誌研究論文(学術雑誌)
- Neuro-Ophthalmology Society of Japan, 2020年03月, Neuro-Ophthalmology Japan, 37(1) (1), 38 - 44, 日本語研究論文(学術雑誌)
- Objective: To compare the 1-year outcomes of trabeculotomy ab externo (ab externo TLO) and trabeculotomy ab interno using a microhook (ab interno TLO) for glaucoma patients using propensity score analysis. Methods and analysis: The medical charts of 65 consecutive patients who underwent ab externo TLO and those of 69 patients who underwent ab interno TLO were reviewed. Logistic regression analysis was conducted to calculate the propensity score using 1:1 matched analysis, which indicates the likelihood of surgical success at 12 months. We set the outcome-related covariates as age, glaucoma type, mean deviation, preoperative intraocular pressure (IOP), the number of preoperative glaucoma eye drops and the presence or absence of combined cataract surgery. Fifty eyes per each surgery group were subsequently compared. Results: The mean preoperative IOP was 32.5±11.2 mm Hg in the ab externo TLO group and 28.4±7.8 mm Hg in the ab interno TLO group (p=0.08). The mean postoperative IOP at 12 months was 18.3±7.4 mm Hg in the former group and 17.8±6.3 mm Hg in the latter (p=0.91). When surgical success was defined as a postoperative IOP of between 5 and 21 mm Hg with a more than 20% IOP reduction from baseline and no additional glaucoma surgery, the rate at 12 months was 78% in the ab externo TLO group and 74% in the ab interno TLO group (p=1.00). Conclusion: The 1-year success rate was not significantly different between ab externo and ab interno TLO.2020年, BMJ open ophthalmology, 5(1) (1), e000446, 英語, 国際誌[査読有り]研究論文(学術雑誌)
- 日本神経眼科学会, 2019年08月, 神経眼科, 36(増補1) (増補1), 55 - 55, 日本語再発性視神経炎に対する免疫抑制剤の治療効果[査読有り]
- Purpose: The present study aimed to assess the ability of en face slab images of maculae to detect residual nerve fiber bundles in eyes with advanced glaucoma. Methods: This study included 36 eyes with diffuse thinning of the ganglion cell and inner plexiform layers (GCL+IPL). Inclusion criterion was GCL+IPL thickness of <1% of the normative database level as detected using optical coherence tomography (OCT). En face slab images (50-μm thickness) were reconstructed from the macular cube scan data using advanced visualization settings. Thereafter, we assessed the agreement of the locations between hyperreflective nerve fiber bundles and normal points in the Humphrey visual field test 10-2 pattern deviation (PD) plots. Additionally, total deviation (TD) corresponding to hyperreflective and hyporeflective areas was compared. Results: Hyperreflective areas were detected in 31 out of 36 eyes; all 31 eyes exhibited at least one normal PD point despite the substantial GCL+IPL thinning in the macular region. Two eyes with abnormalities in all PD points showed no hyperreflective area. The remaining three eyes had normal PD points despite the lack of high reflectivity areas in the slab images. Therefore, 91.7% of eyes showed agreement between en face slab images and PD plots. Moreover, hyperreflective areas demonstrated significantly better TD than hyporeflective areas. Conclusions: En face slab images of maculae were able to reveal the residual nerve fiber bundles in the eyes with advanced glaucoma despite the GCL+IPL thickness in the maculae being diffusely and substantially reduced.2019年07月, Investigative ophthalmology & visual science, 60(8) (8), 2811 - 2821, 英語, 国際誌[査読有り]研究論文(学術雑誌)
- Purpose: The purpose of this study was to evaluate the concordance of a temporal raphe architecture estimated using optical coherence tomography (OCT) and MP-3 microperimetry. Methods: We enrolled 25 eyes with either an upper or lower glaucomatous hemifield defect, as detected on the Humphrey visual field 30-2 test. A structural temporal raphe was extrapolated from visible end points of retinal nerve fiber bundles present in a perimetrically normal hemiretina on an en face Spectralis OCT image. A functional temporal raphe was drawn as a line from the fovea to the border of at least a 10-dB difference in sensitivity, at vertically adjacent test points, with at least three consecutive pairs among 25 test points placed at 8° to 18° from the fovea (2° intervals) on the MP-3. An angle determined by the optic disc center, the fovea, and the temporal raphe line (the DFR angle) was calculated. Correlations and agreement of the OCT- and MP-3-derived DFR angles and factors affecting discordance of the two estimates were evaluated. Results: Despite no significant demographic differences, the functional DFR angle (mean ± SD, 171.8° ± 3.5°) was significantly larger than that of the structural DFR angle (166.5° ± 3.2°) in 14 eyes with upper hemifield defects and vice versa in 11 eyes with lower hemifield defects (163.4° ± 3.0° vs. 170.5° ± 3.2°). The mean deviation was significantly associated with the functional and structural DFR angle difference in eyes with only upper hemifield defects. Conclusions: The structural temporal raphe was more deviated to the perimetrically normal hemiretina side than to the functional temporal raphe, thereby suggesting that a structural change may precede a functional loss.2019年04月, Investigative ophthalmology & visual science, 60(5) (5), 1403 - 1411, 英語, 国際誌[査読有り]研究論文(学術雑誌)
- (公財)日本眼科学会, 2019年03月, 日本眼科学会雑誌, 123(臨増) (臨増), 311 - 311, 日本語前眼部OCTにより鑑別を行った結膜粘液腫の1例[査読有り]
- 2019年, CASE REPORTS IN OPHTHALMOLOGY, 10(3) (3), 319 - 326, 英語, 国際誌[査読有り]研究論文(学術雑誌)
- BACKGROUND: Invasive aspergillosis is often fatal. Here, we report a patient with invasive aspergillosis primarily involving the optic nerve diagnosed on autopsy. CASE PRESENTATION: A 77-year-old female with underlying diabetes mellitus, hyperlipidemia, and hypertension presented with disc swelling of the left eye. Although mini-pulse steroid therapy improved visual acuity (VA) of the left eye, it abruptly decreased to no light perception within a month, followed by a decrease in VA of the right eye to 0.5. At referral, VA was 0.3 in the right eye, and there was no light perception in the left eye. RESULTS: Fundus examination revealed optic disc swelling of both eyes. Goldmann perimetry showed irregular visual field defects, whereas magnetic resonance imaging (MRI), general, and cerebrospinal fluid (CSF) examinations revealed no distinct abnormalities. We suspected anterior ischemic optic neuropathy and invasive optic neuropathy. As with the left eye, steroid pulse therapy temporarily improved VA of the right eye and then decreased to 0.2. Additional anticoagulant therapy did not improve VA. Concurrent to therapy, the patient became febrile with depressed consciousness. Repeat MRI identified suspected midbrain infarction, and CSF examination indicated cerebral meningitis. In spite of administering transfusions and antibiotics, she died on hospital day 40. Autopsy revealed large amounts of Aspergillus hyphae mainly localized in the dura mater of the optic nerve and destruction of the cerebral artery wall, suggesting an etiology of subarachnoid hemorrhage. CONCLUSIONS: When examining refractory and persistent disc swelling, we should rule out fungal infections of the optic nerve.2019年01月, Case reports in ophthalmology, 10(1) (1), 11 - 18, 英語, 国際誌[査読有り]
- Background: Leber hereditary optic neuropathy (LHON) is a maternally inherited disease caused by three missense mutations of mitochondrial (mt) DNA, ie, m 3460 G>A, m 11778 G>A, or m 14484 T>C in the greater portion of LHON. m 11778 G>A mutation is especially observed in >90% of the cases in Japanese families. Although spontaneous remission of visual function infrequently occurs, effective treatment for LHON remains unestablished. Transcorneal electrical stimulation has been shown to be efficacious in individuals with optic neuropathy. However, due to potential risk of corneal damage, repeated treatments are not permissible. In this exploratory study, we will be conducting skin electrical stimulation (SES) as an intervention for patients with LHON having 11778 missense mutation and investigate effectiveness and safety of SES. Methods: This is a single-arm, prospective, open-label exploratory trial focused on patients with LHON having 11778 missense mutation. Eleven patients will be enrolled and receive six consecutive SES once every 2 weeks up to 10 weeks. The safety of the SES will be monitored with specular microscopy, slit-lamp biomicroscopy, fundus examinations, and the observation of facial skin. The primary outcome measure will be the averaged l ogarithm of minimum angle resolution (logMAR) converted visual acuity 1 week after the last SES. Secondary outcome measures include changes, in logMAR at 4 and 8 weeks after the last SES, such as visual field indices measured using Humphrey visual field and microperimetry-3, the thickness of peripapillary retinal fiber and macular ganglion cell complex, multifocal visual evoked potentials, critical flicker frequency, and color vision. Discussion: The results of this proposed proof-of-concept feasibility trial will help plan and execute a larger definitive trial to test SES as an effective strategy for LHON and related optic neuropathies and help establish a beneficial treatment for LHON.2019年, Clinical ophthalmology (Auckland, N.Z.), 13, 897 - 904, 英語, 国際誌[査読有り]研究論文(学術雑誌)
- PURPOSE: To present a unique case of neuro-neutrophilic disease with inflammation and thrombosis of the superior ophthalmic vein (SOV). OBSERVATIONS: A 43-year-old Japanese man with past histories of oculomotor paralysis, auditory disorder, ischemic enteritis, and recurrent oral ulceration was referred to our hospital because of blurred vision in his right eye. Ophthalmic examination revealed decreased best corrected visual acuity and central scotoma in his right eye. Orbit magnetic resonance imaging (MRI) revealed an enlarged SOV in the right eye, with Gadolinium (Gd) enhancement in the wall of the vein but not inside the vein, indicating thrombosis. Multiple Gd-enhanced hyperintense lesions were also observed in the juxtacortical area of the brain. We diagnosed the patient with vasculitis in the right SOV that was adversely affecting the optic nerve. We ruled out systemic thrombophilia, infections, and malignancy by systemic examinations. The human leukocyte antigen (HLA) typing was Cw1-, B54-, B61-, A2-, A24-, and DR4-positive and B51-negative. We treated the patient with systemic steroid and anticoagulant therapy. After three courses of steroid pulse therapy, his symptoms and the MRI findings of the right SOV and brain improved; therefore, we decided to discontinue the anticoagulant therapy. One month after anticoagulant cessation, MRI revealed recurrence of the thrombus and enlargement of the right SOV despite the lack of vision worsening. We restarted the anticoagulant therapy while continuing the oral prednisolone treatment. At the final visit, 14 months after the onset of the disease, the patient was still receiving oral anticoagulation with warfarin potassium and prednisolone (5 mg/day). His symptoms and the right eye's visual function remained normal with a mildly enlarged SOV; there was less Gd enhancement and no brain lesions on MRI. CONCLUSIONS AND IMPORTANCE: We treated a unique case of possible neuro-neutrophilic disease that presented visual disturbances due to right SOV inflammation and thrombosis. Anticoagulation and systemic steroid therapies were required to reduce the inflammation and to prevent the recurrence of thrombosis.2018年12月, American journal of ophthalmology case reports, 12, 39 - 44, 英語, 国際誌[査読有り]
- 日本神経眼科学会, 2018年09月, 神経眼科, 35(3) (3), 303 - 308, 日本語レーベル遺伝性視神経症における視標サイズに基づく中心暗点の評価
- 眼科臨床紀要会, 2018年07月, 眼科臨床紀要, 11(7) (7), 555 - 555, 日本語緑内障眼における他覚的・自覚的機能検査結果とEn Face slab画像を用いた構造評価結果の相関性の検討
- Springer Verlag, 2018年06月, Graefe's Archive for Clinical and Experimental Ophthalmology, 256(10) (10), 1 - 8, 英語, 国際誌[査読有り]研究論文(学術雑誌)
- BACKGROUND: Recent immune therapy with checkpoint inhibitors (CPIs) has demonstrated remarkable antitumor effects on specific tumors, such as malignant lymphoma and non-small cell lung carcinoma. By contrast, CPIs cause an imbalance in the immune system, triggering a wide range of immunological side effects termed immune-related adverse effects (irAEs). Here, we report a rare case of optic neuritis and hypopituitarism during anti-programmed death-ligand 1 (PD-L1) antibody treatment. CASE PRESENTATION: A patient with non-small cell lung carcinoma received anti-PD-L1 antibody treatment every 3 weeks; however, the patient started experiencing headaches, general fatigue, anorexia, and diarrhea approximately 1 year after the initiation of the treatment. Moreover, sudden visual loss of the right eye occurred 1 week after the interruption of the anti-PD-L1 antibody treatment. MRI findings showed gadolinium enhancement in the left optic nerve, but no enlargement of the pituitary gland and stalk. Laboratory data showed decreased serum adrenocorticotropic hormone (ACTH), cortisol, and free T4 levels, and a hormone tolerance test indicated hypopituitarism, hypothyroidism, and hypoadrenocorticism. The central scotoma caused by optic neuritis completely disappeared immediately after a course of steroid pulse therapy, and no recurrence occurred up to 2 years after initiation of the steroid pulse therapy while replacement therapy for hypothyroidism and hypoadrenocorticism was continued. CONCLUSIONS: The patient presented with optic neuritis and hypopituitarism, possibly due to irAEs of the anti-PD-L1 antibody treatment. Steroid pulse therapy was effective for optic neuritis, suggesting underlying immunological mechanisms. Neurological complications including optic neuritis should be considered when examining patients with cancer undergoing CPI treatment.2018年05月, Case reports in ophthalmology, 9(2) (2), 348 - 356, 英語, 国際誌[査読有り]
- (公財)日本眼科学会, 2018年03月, 日本眼科学会雑誌, 122(3) (3), 252 - 253, 日本語緑内障眼における他覚的・自覚的機能検査結果とen face slab画像を用いた構造評価結果の相関性の検討
- Neuro-Ophthalmology Society of Japan, 2018年, Neuro-Ophthalmology Japan, 35(3) (3), 303 - 308, 日本語研究論文(学術雑誌)
- Springer Tokyo, 2018年01月, Japanese Journal of Ophthalmology, 62(1) (1), 31 - 40, 英語, 国内誌[査読有り]研究論文(学術雑誌)
- Public Library of Science, 2018年01月, PLoS ONE, 13(1) (1), e0191862, 英語, 国際誌[査読有り]研究論文(学術雑誌)
- 眼科臨床紀要会, 2017年07月, 眼科臨床紀要, 10(7) (7), 585 - 586, 日本語下垂体腫瘍患者における光干渉断層計と静的視野検査および多局所視覚誘発電位の異常検出の一致性
- (公財)日本眼科学会, 2017年04月, 日本眼科学会雑誌, 121(4) (4), 366 - 372, 日本語Icare HOMEを用いた眼圧のホームモニタリングおよび日内変動の検討[査読有り]
- (公財)日本眼科学会, 2016年09月, 日本眼科学会雑誌, 120(9) (9), 635 - 639, 日本語Schlemm管内皮網除去と深層強膜弁切除を併施した線維柱帯切開術の術後成績
- 日本眼科学会, 2016年09月, Nippon Ganka Gakkai zasshi, 120(9) (9), 635 - 639, 日本語Trabeculotomy with Schlemm's Canal Endothelium Removal and Deep Sclerectomy.[査読有り]
- Blackwell Publishing Ltd, 2014年, Acta Ophthalmologica, 92(3) (3), 243 - 248, 英語, 国際誌[査読有り]研究論文(学術雑誌)
- (公財)日本眼科学会, 2006年01月, 日本眼科学会雑誌, 110(1) (1), 51 - 57, 日本語インターフェロン-β結膜下注射で加療した結膜悪性黒色腫の1例 その効果と副作用
- 日本眼科紀要会, 2004年11月, 日本眼科紀要 = Folia ophthalmologica Japonica, 55(11) (11), 841 - 844, 日本語角膜上皮掻爬と0.02%クロルヘキシジン点眼が奏効したアカントアメーバ角膜炎の1例
- 外科的切除が奏効したconjunctival and corneal intraepithelial neoplasiaの初発例73歳女.白内障手術後の経過観察中に,右眼鼻側球結膜の新生物が疑われた.右眼耳側球結膜に乳頭状病変を認め,角膜上には灰白色の膜状病変が侵入していた.中間透光体は両眼とも偽水晶体眼であり,眼底には異常を認めなかった.0.5% 5-FU点眼4回/日にて保存的に経過観察を行った.腫瘍の縮小傾向はなく,角膜上皮欠損,眼瞼結膜,眼瞼皮膚粘膜にびらんを生じた.腫瘍切除術と冷凍凝固術を施行した.術後,切除病変よりdysplasiaの病理診断を得た.術翌日より,点眼としてレボフロキサシン4回/日,0.1%フルオロメトロン4回/日にて術後管理とした.腫瘍の再発はなく,右眼の矯正視力も1.0と経過良好である金原出版(株), 2004年10月, 眼科, 46(10) (10), 1329 - 1334, 日本語
- 日本緑内障学会, 2025年09月, 日本緑内障学会抄録集, 36回, 82 - 82, 日本語プリザーフロマイクロシャント(PMS)と線維柱帯切除術(TLE)の術後1年成績の比較
- 眼科臨床紀要会, 2025年06月, 眼科臨床紀要, 18(6) (6), 392 - 392, 日本語小児緑内障に対してマイクロフックトラベクロトミーを施行した6症例
- (株)メディカ出版, 2025年02月, 眼科ケア, 27(2) (2), 177 - 182, 日本語
- 金原出版(株), 2024年11月, 眼科, 66(11) (11), 1204 - 1209, 日本語
- 日本神経眼科学会, 2024年10月, 神経眼科, 41(増補1) (増補1), 62 - 62, 日本語
- 日本神経眼科学会, 2024年10月, 神経眼科, 41(増補1) (増補1), 83 - 83, 日本語
- 日本神経眼科学会, 2024年10月, 神経眼科, 41(増補1) (増補1), 87 - 87, 日本語
- 日本緑内障学会, 2024年09月, 日本緑内障学会抄録集, 35回, 120 - 120, 日本語緑内障と鑑別が必要な網膜・視神経疾患
- 日本緑内障学会, 2024年09月, 日本緑内障学会抄録集, 35回, 164 - 164, 日本語濾過手術後に脈絡膜剥離が遷延したIdiopathic Elevated Episcleral Venous Pressureの一例
- 眼科臨床紀要会, 2024年06月, 眼科臨床紀要, 17(6) (6), 491 - 492, 日本語小児のステロイド投与例での眼圧上昇へ影響を与える要因の調査
- 日本神経眼科学会, 2023年12月, 神経眼科, 40(4) (4), 314 - 319, 日本語
- 日本神経眼科学会, 2023年11月, 神経眼科, 40(増補1) (増補1), 76 - 76, 日本語
- 日本緑内障学会, 2023年09月, 日本緑内障学会抄録集, 34回, 134 - 134, 日本語緑内障手術のアップデート 緑内障手術のアップデート 流出路再建術(眼内法)
- 日本緑内障学会, 2023年09月, 日本緑内障学会抄録集, 34回, 160 - 160, 日本語線維柱帯切開術(眼内法)術後早期に施行された線維柱帯切除術の術後1年成績
- 日本緑内障学会, 2023年09月, 日本緑内障学会抄録集, 34回, 197 - 197, 日本語原発開放隅角緑内障と血清・前房水乳酸濃度の関連についての検討
- (公財)日本眼科学会, 2023年03月, 日本眼科学会雑誌, 127(臨増) (臨増), 57 - 57, 英語緑内障性視神経症から「みる」を守る 網膜神経節細胞障害と視野およびOCT(Retinal ganglion cell damage and visual field and OCT)
- (公財)日本眼科学会, 2023年03月, 日本眼科学会雑誌, 127(臨増) (臨増), 218 - 218, 日本語マイクロフックトラベクロトミー(μTLO)の1年後成績への術前緑内障点眼の影響
- (公財)日本眼科学会, 2023年03月, 日本眼科学会雑誌, 127(臨増) (臨増), 246 - 246, 日本語甲状腺眼症に対するステロイドパルス療法とミニパルス療法の合併症
- 日本神経眼科学会, 2022年10月, 神経眼科, 39(増補1) (増補1), 92 - 92, 日本語
- 日本緑内障学会, 2022年09月, 日本緑内障学会抄録集, 33回, 101 - 101, 日本語線維柱帯切除術後の早期濾過胞機能不全に対するマイトマイシンC併用濾過胞再建術の術後3年成績
- 日本緑内障学会, 2022年09月, 日本緑内障学会抄録集, 33回, 146 - 146, 日本語当院で経験した虹彩分離症5症例の臨床的特徴
- 日本緑内障学会, 2022年09月, 日本緑内障学会抄録集, 33回, 154 - 154, 日本語マイクロフックトラベクロトミー(μTLO)の術成績に対する術前リパスジル点眼投与の影響
- (公社)日本眼科手術学会, 2022年07月, 眼科手術, 35(3) (3), 341 - 346, 日本語【視力だけじゃない!治療導入に重要な自覚症状・検査所見】緑内障手術のタイミング
- (株)全日本病院出版会, 2022年05月, OCULISTA, (110) (110), 43 - 48, 日本語【どう診る?視野異常】神経眼科疾患と視野
- (公財)日本眼科学会, 2022年03月, 日本眼科学会雑誌, 126(臨増) (臨増), 172 - 172, 日本語緑内障患者におけるアイモ両眼ランダム測定の再現性の検討
- 日本神経眼科学会, 2021年11月, 神経眼科, 38(増補1) (増補1), 72 - 72, 日本語
- 日本神経眼科学会, 2021年11月, 神経眼科, 38(増補1) (増補1), 87 - 87, 日本語
- 日本緑内障学会, 2021年09月, 日本緑内障学会抄録集, 32回, 87 - 87, 日本語緑内障患者に対する点眼補助具(Just in)の使用感アンケート調査
- 日本緑内障学会, 2021年09月, 日本緑内障学会抄録集, 32回, 136 - 136, 日本語ロングチューブシャント術後の被膜除去術の短期成績
- (株)メディカル葵出版, 2021年08月, あたらしい眼科, 38(8) (8), 927 - 928, 日本語
- 眼科臨床紀要会, 2021年07月, 眼科臨床紀要, 14(7) (7), 453 - 454, 日本語レーベル遺伝性視神経症に対する皮膚電気刺激の有効性と安全性に関する探索的研究
- (株)メディカル葵出版, 2021年07月, あたらしい眼科, 38(7) (7), 805 - 806, 日本語
- (株)メディカル葵出版, 2020年11月, あたらしい眼科, 37(臨増) (臨増), 351 - 356, 日本語【眼科イメージング2020Q&A】緑内障 後眼部OCTを用いて緑内障と他の視神経・視路疾患を鑑別診断する方法を教えてください
- (株)全日本病院出版会, 2020年06月, OCULISTA, (87) (87), 45 - 51, 日本語
- (株)メディカル葵出版, 2019年05月, あたらしい眼科, 36(5) (5), 611 - 617, 日本語
- (株)メディカ出版, 2014年09月, 眼科ケア, 16(9) (9), 800 - 805, 日本語【エキスパートからノウハウを学ぶ!弱視・斜視スペシャルノート[検査編]】検査前に使う点眼薬
- 日本眼科学会雑誌, 2024年03月, 日本語, (公財)日本眼科学会炎症・感染とこれからの眼科診療 眼炎症を克服するための精密医療の実現に向けて
- 日本緑内障学会抄録集, 2023年09月, 日本語, 日本緑内障学会緑内障手術のアップデート 緑内障手術のアップデート 流出路再建術(眼内法)
- 日本緑内障学会抄録集, 2023年09月, 日本語, 日本緑内障学会線維柱帯切開術(眼内法)術後早期に施行された線維柱帯切除術の術後1年成績
- 日本緑内障学会抄録集, 2023年09月, 日本語, 日本緑内障学会原発開放隅角緑内障と血清・前房水乳酸濃度の関連についての検討
- 日本眼科学会雑誌, 2023年03月, 英語, (公財)日本眼科学会緑内障性視神経症から「みる」を守る 網膜神経節細胞障害と視野およびOCT(Retinal ganglion cell damage and visual field and OCT)
- 日本眼科学会雑誌, 2023年03月, 日本語, (公財)日本眼科学会マイクロフックトラベクロトミー(μTLO)の1年後成績への術前緑内障点眼の影響
- 日本眼科学会雑誌, 2023年03月, 日本語, (公財)日本眼科学会甲状腺眼症に対するステロイドパルス療法とミニパルス療法の合併症
- 神経眼科, 2022年10月, 日本語, 日本神経眼科学会m.14487T>C変異を認めたLHON plusの一例
- 日本緑内障学会抄録集, 2022年09月, 日本語, 日本緑内障学会線維柱帯切除術後の早期濾過胞機能不全に対するマイトマイシンC併用濾過胞再建術の術後3年成績
- 日本緑内障学会抄録集, 2022年09月, 日本語, 日本緑内障学会当院で経験した虹彩分離症5症例の臨床的特徴
- 日本緑内障学会抄録集, 2022年09月, 日本語, 日本緑内障学会マイクロフックトラベクロトミー(μTLO)の術成績に対する術前リパスジル点眼投与の影響
- 日本眼科学会雑誌, 2022年03月, 日本語, (公財)日本眼科学会緑内障患者におけるアイモ両眼ランダム測定の再現性の検討
- 神経眼科, 2021年11月, 日本語, 日本神経眼科学会当院におけるMOG抗体陽性視神経炎自験例の臨床経過の検討
- 神経眼科, 2021年11月, 日本語, 日本神経眼科学会水平経線を保つ視野欠損を呈する視神経炎患者と虚血性視神経症の病変の局在と視野異常との関連
- 日本緑内障学会抄録集, 2021年09月, 日本語, 日本緑内障学会緑内障患者に対する点眼補助具(Just in)の使用感アンケート調査
- 日本緑内障学会抄録集, 2021年09月, 日本語, 日本緑内障学会ロングチューブシャント術後の被膜除去術の短期成績
- 日本眼科学会雑誌, 2021年03月, 日本語, (公財)日本眼科学会マイクロフックトラベクロトミーの緑内障点眼歴による術後成績の比較
- 日本眼科学会雑誌, 2021年03月, 日本語, (公財)日本眼科学会傾向スコア解析による血栓予防薬の有無に対する緑内障手術の術成功と出血合併症頻度
- 神経眼科, 2020年11月, 日本語, 日本神経眼科学会レーベル遺伝性視神経症における中心残存視野の評価
- 神経眼科, 2020年11月, 日本語, 日本神経眼科学会非機能性下垂体腺腫に対する内視鏡下経鼻的下垂体術後の初発例と再発例における視力変化の比較検討
- 神経眼科, 2020年11月, 日本語, 日本神経眼科学会当院における眼窩先端部症候群12例の臨床像の検討
- 日本緑内障学会抄録集, 2020年10月, 日本語, 日本緑内障学会サイトメガロウイルス虹彩毛様体炎続発緑内障の手術成績
- 日本緑内障学会抄録集, 2020年10月, 日本語, 日本緑内障学会血栓予防薬の緑内障手術における内服状況と術後の影響
- 日本緑内障学会抄録集, 2020年10月, 日本語, 日本緑内障学会緑内障眼におけるアイモ両眼ランダム測定の有用性の検討
- 日本緑内障学会抄録集, 2020年10月, 日本語, 日本緑内障学会緑内障眼におけるアイモ両眼ランダム測定の中心窩感度および信頼係数の検討
- 日本眼科学会雑誌, 2020年03月, 日本語, (公財)日本眼科学会マイクロフックトラベクロトミーの切開範囲による術後短期成績の比較
- 日本眼科学会雑誌, 2020年03月, 日本語, (公財)日本眼科学会傾向スコア解析による毛様溝挿入アーメド/バルベルトインプラントの術後短期成績
- 日本眼科学会雑誌, 2020年03月, 日本語, (公財)日本眼科学会上皮増殖因子受容体チロシンキナーゼ阻害薬が原因と考えられる眼障害の検討
- 兵庫県眼科医会・2大学合同オープンカンファレンス, 2019年11月, 日本語両眼開放下視野測定により診断した片眼性心因性視覚障害の2例口頭発表(一般)
- 第57回日本神経眼科学会総会, 2019年10月, 日本語抗PD-L1抗体薬により視神経炎と下垂体機能低下症を来した一例ポスター発表
- 第57回日本神経眼科学会総会, 2019年10月, 日本語再発性視神経炎に対する免疫抑制剤の治療効果口頭発表(一般)
- 第30回日本緑内障学会, 2019年09月, 日本語毛様溝挿入アーメドインプラント手術の術後短期成績口頭発表(一般)
- 神経眼科, 2019年08月, 日本語, 日本神経眼科学会再発性視神経炎に対する免疫抑制剤の治療効果
- 神経眼科, 2019年08月, 日本語, 日本神経眼科学会多発血管炎性肉芽腫症に伴う副鼻腔炎により発症した両側鼻性視神経症の一例
- 神経眼科, 2019年08月, 日本語, 日本神経眼科学会抗PD-L1抗体薬により視神経炎と下垂体機能低下症を来した一例
- 第8回日本視野画像学会学術集会, 2019年05月, 日本語, 国内会議ハンフリー視野計とシラスOCT こんな使い方もあったの!? OCTとハンフリーを用いた緑内障の構造と機能の解析口頭発表(一般)
- 第8回日本視野画像学会学術集会, 2019年05月, 日本語, 国内会議En face slab imaging を用いた後期緑内障眼の構造と機能の解析口頭発表(一般)
- 第123回日本眼科学会総会, 2019年04月, 日本語前眼部OCTにより鑑別を行った結膜粘液腫の一例ポスター発表
- 第123回日本眼科学会総会, 2019年04月, 日本語マイクロパルス波経強膜毛様体光凝固の使用経験ポスター発表
- 日本眼科学会雑誌, 2019年03月, 日本語マイクロパルス波経強膜毛様体光凝固術の術後短期成績
- 日本眼科学会雑誌, 2019年03月, 日本語前眼部OCTにより鑑別を行った結膜粘液腫の1例
- 第73回日本臨床眼科学会, 2019年10月, 日本語毛様溝挿入バルベルトインプラント手術の術後中長期成績口頭発表(一般)
- 第57回日本神経眼科学会総会, 2019年10月, 日本語多発血管炎性肉芽腫症に伴う副鼻腔炎により発症した両側鼻性視神経症の一例口頭発表(一般)
- 第56回日本神経眼科学会総会, 2018年12月, 日本語, 神戸, 国内会議片眼の動眼神経麻痺と僚眼の外転神経麻痺を呈したサルコイドーシスの1例口頭発表(一般)
- 第56回日本神経眼科学会総会, 2018年12月, 日本語, 神戸, 国内会議髄膜炎を伴う続発性眼窩炎症と強膜炎を呈した汎発性帯状疱疹の一例口頭発表(一般)
- 第5回神戸大学眼科オープンカンファレンス, 2018年11月, 日本語, 神戸, 国内会議当院における悪性黒色腫の長期経過口頭発表(一般)
- 第36回日本腫瘍学会, 2018年11月, 日本語, 金沢, 国内会議当院における悪性黒色腫の長期経過口頭発表(一般)
- 第5回神戸大学眼科オープンカンファレンス, 2018年11月, 日本語, 神戸, 国内会議髄膜炎を伴う続発性眼窩炎症と強膜炎を呈した汎発性帯状疱疹の一例口頭発表(一般)
- 第5回神戸大学眼科オープンカンファレンス, 2018年11月, 日本語, 神戸, 国内会議ランゲルハンス細胞組織球症による視神経症と外転神経麻痺を来した 1 例口頭発表(一般)
- 第5回神戸大学眼科オープンカンファレンス, 2018年11月, 日本語, 神戸, 国内会議サイトメガロウイルス虹彩炎に起因する続発性緑内障 15 例の臨床像口頭発表(一般)
- 23rd International visual field and imaging symposium, 2018年05月En face slab images of macula better accounts for visual functional outcomes compared with inner retinal thickness in eyes with optic neuritis口頭発表(一般)
- 23rd International visual field and imaging symposium, 2018年05月, 英語, 石川, 国内会議The disc-fovea-temporal raphe angle is associated with the severity of glaucoma with a hemi-field defect.ポスター発表
- 23rd International visual field and imaging symposium, 2018年05月, 英語, 石川, 国内会議Agreement of a nasal step border by a microperimeter with a temporal raphe by optical coherence tomography in glaucoma patientsポスター発表
- 神経眼科, 2017年10月, 日本語上眼静脈血栓性静脈炎により視力低下・視野障害を生じた一例
- 神経眼科, 2017年10月, 日本語ぶどう膜炎と視神経症を発症し、生検にて確定診断に至った結核性肥厚性硬膜炎の1例
- 神経眼科, 2017年10月, 日本語レーベル遺伝性視神経症における視標サイズに基づく中心暗点の評価
- 神経眼科, 2017年10月, 日本語両視神経症の診断に苦慮し剖検にて侵襲性アスペルギルス症と診断された一例
- The 7th World Glaucoma Congress, 2017年, 英語The Correlation Of Intensity Of En Face Layer Optical Coherence Tomography Imaging Of Macula With Visual Field Defect Area In Glaucomaポスター発表
- 日本眼科学会雑誌, 2017年03月, 日本語流出路再建術の術式別術後短期成績の比較検討
- 日本眼科学会雑誌, 2017年03月, 日本語健常眼における視神経乳頭中心窩線と耳側縫線の解剖学的位置関係の検討
- 神経眼科, 2016年10月, 日本語抗AQP4抗体陽性視神経炎に対する血液浄化療法の治療効果
- 眼科臨床紀要, 2016年04月, 日本語視神経鞘髄膜腫に対し強度変調放射線治療を施行した神経線維腫症2型の一例
- 日本眼科学会雑誌, 2016年03月, 日本語IcareHOMEを用いた患者による自己眼圧測定の再現性と日内変動の検討
- 日本眼科学会雑誌, 2016年03月, 日本語乳頭周囲網膜神経線維層厚の菲薄化の有無による極早期緑内障の層別化
- 日本眼科学会雑誌, 2016年03月, 日本語視神経炎における抗AQP4抗体の構造と機能に与える影響
- 日本緑内障学会抄録集, 2015年09月, 日本語3種のSD-OCTのPre-perimetric glaucomaにおける検出力の比較について
- 日本緑内障学会抄録集, 2015年09月, 日本語トラベクレクトミー術後低眼圧黄斑症の発症危険因子の検討
- 日本眼科学会雑誌, 2015年03月, 日本語シュレム管内皮網除去+深層強膜弁切除を併施したトラベクロトミーの術後成績
- 日本眼科学会雑誌, 2015年03月, 日本語非高度近視正常眼と高度近視正常眼の高度近視早期緑内障に対するOCT検出力の相違
- 日本眼科学会雑誌, 2013年03月, 日本語3種のSD-OCTの乳頭周囲網膜神経線維層厚と視野の相関
- 日本緑内障学会抄録集, 2012年09月, 日本語3種のOCTによる高度近視群、非高度近視群における緑内障検出力の比較
- 日本緑内障学会抄録集, 2012年09月, 日本語自己眼圧測定器icareONEの精度および安全性の検討
- 眼科臨床医報, 2005年02月, 日本語結膜悪性黒色腫に対してインターフェロンβ結膜下注射を行った1症例
