研究者詳細 - 坪田　一男

論文 - 坪田　一男

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Myopic regression after phakic intraocular lens implantation and LASIK

Torii Hidemasa, Negishi Kazuno, Watanabe Kazuhiro, Arai Hiroyuki, Kato Naoko, Tsubota Kazuo

Optometry and Vision Science 91 （ 2 ） 231 - 239 2014年02月

ISSN 1040-5488

PURPOSE: In myopia, biometry including the axial length is important, along with the refractive data. We compared the rates of myopic regression 3 years after phakic intraocular lens (pIOL) implantation and laser in situ keratomileusis (LASIK) after matching the preoperative axial length in highly myopic eyes of Japanese patients. METHODS: This retrospective nonrandomized study included 133 eyes of 84 patients with myopia exceeding -6.00 diopters (D) who underwent implantation of two iris-fixated pIOLs (pIOL group, 66 eyes/46 patients) or myopic LASIK (LASIK group, 67 eyes/38 patients) who were followed for more than 3 years postoperatively. The patient age, preoperative refraction, and preoperative axial length were matched between the study groups. RESULTS: There were no significant differences preoperatively between the groups in age, intraocular pressure, refraction, keratometry, or axial length. The mean regression values after 3 years compared with the 1-month postoperative refractions were -0.12 ± 0.47 (SD) D in the pIOL group and -0.82 ± 0.69 D in the LASIK group (p < 0.001). The differences in the mean regression rates between 1 and 12 months, 12 and 24 months, and 24 and 36 months of follow-up were, respectively, 0.09 ± 0.38 D, -0.11 ± 0.35 D, and -0.11 ± 0.30 D in the pIOL group and -0.57 ± 0.84 D, -0.24 ± 0.47 D, and 0.00 ± 0.53 D in the LASIK group (p < 0.001, p = 0.07, p = 0.15, respectively). CONCLUSIONS: There was a significant difference in myopic regression 3 years postoperatively between the groups matched for preoperative axial length in Japanese patients. This result has the potential to elucidate myopia in the future. Copyright © 2014 American Academy of Optometry.

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KRT12 mutations and in vivo confocal microscopy in two Japanese families with Meesmann corneal dystrophy

Ogasawara Mikihide, Matsumoto Yukihiro, Hayashi Takaaki, Ohno Kenji, Yamada Hisashi, Kawakita Tetsuya, Dogru Murat, Shimazaki Jun, Tsubota Kazuo, Tsuneoka Hiroshi

American Journal of Ophthalmology 157 （ 1 ） 2014年01月

ISSN 0002-9394

Purpose To identify genetic mutations and study the corneal epithelium in Japanese patients with Meesmann corneal dystrophy. Design Laboratory investigation and prospective observational case series. Methods Slit-lamp biomicroscopy with fluorescein vital staining and in vivo confocal microscopy were performed. Mutation screening of the KRT3 and KRT12 genes was performed via polymerase chain reaction and direct sequencing for 5 patients in 2 families. Results Slit-lamp biomicroscopy revealed multiple corneal intraepithelial microcysts in all patients. A clear zone was seen in the younger generation, whereas mild subepithelial opacity was seen in the older generation. In the in vivo confocal microscopy, numerous corneal intraepithelial microcysts and hyperreflective materials, which were believed to be degenerative cells, were detected closer to the basal layer of the corneal epithelium in older patients. The superficial layer contained more enlarged microcysts, and the hyperreflective materials showed atrophic changes, as compared to the basal layer. The demarcation line between the microcysts and normal epithelial cells was clearly visualized by in vivo confocal microscopy and corresponded to the demarcation line of the clear zone observed by the slit-lamp examination. Two heterozygous mutations (Q130P, L140Q) in the KRT12 gene, one of which (L140Q) was novel, were identified only in the affected patients of the families. Conclusions We identified a novel missense mutation of the KRT12 gene in Meesmann corneal dystrophy. The in vivo confocal microscopy examinations revealed previously unreported depth-dependent ultrastructural changes in the living cornea of Meesmann corneal dystrophy patients. © 2014 by Elsevier Inc. All rights reserved.

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The effect of tinted soft contact lens wear on functional visual acuity and higher-order aberrations

Watanabe Kazuhiro, Kaido Minako, Ishida Reiko, Dogru Murat, Negishi Kazuno, Tsubota Kazuo

Contact Lens and Anterior Eye 37 （ 3 ） 203 - 208 2014年

ISSN 1367-0484

Purpose: To investigate the differences of functional visual acuity (FVA) and high order aberrations (HOAs) in relation to tinted and clear hydrogel soft contact lens (SCL) wear. Methods: A prospective comparative study was performed in 16 eyes of 16 healthy volunteers. Dynamic visual acuity (using a FVA measurement system) and higher-order aberrations (using a wavefront sensor) were compared in subjects wearing two types of soft contact lenses: 1-day Acuvue^® (Vistakon, Jacksonville, FL) clear and the 1-day Acuvue^® Define^TM (Vistakon, Jacksonville, FL) tinted lens. The blink rates were recorded during FVA testing. The correlation between the difference of HOAs and differences in FVA values was analyzed. Results: The mean LogMAR FVA scores with clear and tinted SCLs were 0.07 ± 0.13 and 0.14 ± 0.17 (P< 0.05). The mean blink frequencies with clear and tinted SCL wear were 18.4 ± 8.3 and 25.3 ± 4.7. blinks/min (P< 0.05). Both 3rd-order aberrations and total HOAs showed statistically significant differences between the two types of soft contact lenses for 6. mm pupil measurements (P< 0.05). A significant positive linear correlation was observed between δHOAs and δLogMAR FVA for 6. mm pupil measurements (R= 0.53, P= 0.04). Conclusions: Tinted contact lens wear appears to induce a reduction in optical quality. Functional visual acuity measurement is a useful procedure to study the changes of visual performance and quality in tinted contact lens wear. © 2013 British Contact Lens Association.

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Aerobic exercise increases tear secretion in type 2 diabetic mice

Sano Kokoro, Kawashima Motoko, Ito Akiko, Inaba Takaaki, Morimoto Kohkichi, Watanabe Mitsuhiro, Tsubota Kazuo

Investigative Ophthalmology and Visual Science 55 （ 7 ） 4287 - 4294 2014年

ISSN 0146-0404

Purpose. To investigate the effects of exercise on tear secretion in type 2 diabetic mice, and to investigate the effect of the adenosine monophosphate-activated protein kinase (AMPK) activator 5-aminoimidazole-4-carboxamide ribonucleoside (AICAR). Methods. Heterozygous controls (db/m; m Lepr^db) and type 2 diabetic mice (db/db; Lepr^db) either underwent forced treadmill exercise training 5 days a week or remained sedentary for 8 weeks. Tear secretion volume was measured by cotton threads for 30 seconds pre- and post intervention. The levels of oxidative stress markers (8-hydroxy-20-deoxyguanosine [8-OHdG], propanoyl lysine [PRL], and hexanoyl lysine [HEL]) in tears were measured in the postintervention period. Furthermore, C57BL/6JJc1 mice, db/db mice, and db/m mice received a single intraperitoneal injection of AICAR or PBS each day for 5 days, and tear secretion volume was measured. Results. Exercise training for 8 weeks increased tear secretion volume in db/m and db/db mice. The levels of oxidative stress markers in tears were less in the exercise group than in the control group. In C57BL/6JJc1 mice, the tear secretion volumes in both the AICAR 125 mg/kg and AICAR 250 mg/kg groups were significantly larger than in the PBS group (P < 0.01 and P < 0.01, respectively). Additionally, in db/db mice, tear secretion volume in the AICAR 125 mg/kg group was also significantly larger than in the PBS group (P < 0.05). Conclusions. Exercise training for 8 weeks and a daily injection of AICAR for 5 days increased tear secretion in mice. The results suggest that exercise may be a potential therapy to modulate tear secretion. © 2014 The Association for Research in Vision and Ophthalmology, Inc.

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Blue light injures corneal epithelial cells in the mitotic phase in vitro

Niwano Yoshimi, Kanno Taro, Iwasawa Atsuo, Ayaki Masahiko, Tsubota Kazuo

British Journal of Ophthalmology 98 （ 7 ） 990 - 992 2014年

ISSN 0007-1161

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Apparent progression of presbyopia after laser in situ keratomileusis in patients with early presbyopia

Tsuneyoshi Yukari, Negishi Kazuno, Saiki Megumi, Toda Ikuko, Tsubota Kazuo

American Journal of Ophthalmology 158 （ 2 ） 286 - 292 2014年

ISSN 0002-9394

Purpose To assess the effect of laser in situ keratomileusis (LASIK) on near visual function in presbyopic patients. Design Retrospective cohort study. Methods Fifty-three eyes of 40 patients 45 years of age and older who had undergone LASIK for high myopia (-6 diopters [D] and over) were included. The minimal add powers for obtaining the best-corrected near visual acuity (add powers) were measured preoperatively and 3 months postoperatively, and the correlations with the powers corrected by LASIK, corneal higher-order aberrations (HOAs), ocular HOAs, and patient ages were evaluated using univariate analysis. Factors correlated with the changes in add powers were evaluated further by multivariate analysis. Results The mean ± standard deviation patient age was 50.0 ± 4.1 years; the power corrected by LASIK was -7.56 ± 1.06 D. The mean add power was 1.80 ± 0.60 D preoperatively, which increased significantly (P <.001) to 2.18 ± 0.69 D postoperatively. Significant correlations with the increased add powers were detected with age (P =.01) and the power corrected by LASIK (P =.04) but not with corneal and ocular HOAs (P >.05). Multivariate analysis showed that only age was correlated significantly (P =.01). The percentage of eyes with increased add powers of 0.5 D or more was 60.4%, which was significantly (P =.02) higher in younger patients. Conclusions This study verified the apparent progression of presbyopia after LASIK and the importance of obtaining informed consent from patients, especially those with early presbyopia. © 2014 by Elsevier Inc. All rights reserved.

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Early signs of exudative age-related macular degeneration in Asians

Sasaki Mariko, Kawasaki Ryo, Uchida Atsuro, Koto Takashi, Shinoda Hajime, Tsubota Kazuo, Wong Tien Yin, Ozawa Yoko

Optometry and Vision Science 91 （ 8 ） 849 - 853 2014年

ISSN 1040-5488

PURPOSE: To investigate the relationship between the early signs of age-related macular degeneration (AMD) and the risk of developing exudative AMD (typical AMD or polypoidal choroidal vasculopathy [PCV]) in the fellow eye of Japanese patients with unilateral exudative AMD, focusing particularly on eyes with only pigmentary abnormality. METHODS: This study is a retrospective observational consecutive case series. We retrospectively reviewed the medical charts of patients who revisited the AMD clinic from 2010 to 2011 and confirmed 129 cases with unilateral exudative AMD at their first visit (baseline). The non-affected eyes at baseline (the second eye) were categorized by the presence of early signs of AMD. The incidence of exudative AMD (typical AMD or PCV) in the fellow eye was confirmed by fluorescein and indocyanine green angiography. RESULTS: Of the 129 patients, 14 (10.9%) developed exudative AMD in the fellow eye (median follow-up, 3.2 years; n = 7 typical AMD and n = 7 PCV). Eyes with both pigmentary abnormalities and large drusen were more likely to develop typical AMD (age- and sex-adjusted odds ratio = 9.46, 95% confidence interval = 1.05 to 85.0), whereas pigmentary abnormalities without large drusen were associated with PCV (age- and sex-adjusted odds ratio = 15.9, 95% confidence interval = 1.8 to 140.5). CONCLUSIONS: There was a difference in the association between early signs of AMD and incident development of either typical AMD or PCV. Further research is warranted to determine whether pigmentary abnormalities alone may be an important risk factor for PCV in Asians. Copyright © 2014 American Academy of Optometry.

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Dry eye disease is associated with deterioration of mental health in male Japanese university staff

Tounaka Kaoru, Yuki Kenya, Kouyama Keisuke, Abe Takayuki, Tsubota Kazuo, Kawabe Hiroshi, Yokoyama Kazuhito

The Tohoku journal of experimental medicine 233 （ 3 ） 215 - 220 2014年

Dry eye disease (DED) is defined as a multifactorial disease of the tears and ocular surface that results in symptoms of discomfort, visual disturbance, and tear-film instability, with potential damage to the ocular surface. It is thought to be associated with reduced quality of life (QOL). The aim of the present study was to investigate the effects of DED on health-related QOL in Japanese university sedentary office workers who are daily users of visual display terminal. In this study, 163 university staff (99 male and 64 female), aged 23-69 years, served as study subjects. Subjects were asked to answer the following three questions. (1) How often do your eyes feel dry? (2) How often do your eyes feel irritated? (3) Have you ever been diagnosed by a clinician as having dry eye syndrome? Sixty-eight subjects who answered "constantly," "often", or "sometimes" to both questions 1 and 2 were classified as the DED Group, and the remaining 95 were defined as the Non-DED Group. QOL was assessed by the SF-36 questionnaire, which consisted of 36 items to produce three summary scores, namely, mental, physical, and role/social component summary scores. For males, the DED Group had significantly lower scores than the Non-DED Group for mental component summary (MCS) (P = 0.005). In multiple regression analysis, MCS scores were adversely related to DED in males (P = 0.015). DED was associated with worsened QOL. DED should be regarded as a factor that can lead to deterioration of mental health.

[Grading for corneal endothelial damage].

Kinoshita Shigeru, Amano Shiro, Inoue Yoshitsugu, Ohashi Yuichi, Takahashi Hiroshi, Tsubota Kazuo, Nishida Kohji

Nippon Ganka Gakkai zasshi 118 （ 2 ） 81 - 83 2014年

ISSN 0029-0203

While corneal endothelial damage in its most advanced stage results in bullous keratopathy where corneal transplantation is needed, there is no severity grading for corneal endothelial damage. The Japanese Corneal Society formed a working group to establish a severity grading for corneal endothelial damage. The following are the proposed severity grading criteria. Normal: Corneal endothelial cell (CEC) density is 2000 cells/mm2 or more. Grade 1: CEC density between 1000 and 2000 cells/ mm2. The corneal endothelium is below the normal physiological condition. Grade 2: CEC density between 500 and 1000 cells/ mm2. The transparency of the corneal endothelium is endangered. Even slight damage can induce bullous keratopathy. Grade 3: CEC density below 500 cells/mm2 but no corneal edema is observed. Grade 4: Bullous keratopathy. The cornea is opaque with edema.

Predictive factors for non-response to intravitreal ranibizumab treatment in age-related macular degeneration

Suzuki Misa, Nagai Norihiro, Izumi-Nagai Kanako, Shinoda Hajime, Koto Takashi, Uchida Atsuro, Mochimaru Hiroshi, Yuki Kenya, Sasaki Mariko, Tsubota Kazuo, Ozawa Yoko

British Journal of Ophthalmology 98 （ 9 ） 1186 - 1191 2014年

ISSN 0007-1161

Background/aims: To study the initial characteristics and response to intravitreal ranibizumab (IVR) treatment of age-related macular degeneration (AMD). Methods: We reviewed the clinical records of 141 eyes in 141 AMD patients who received monthly IVR for 3 months and thereafter pro re nata (PRN) injections for 9 months as the first treatment for AMD. Patients whose best corrected visual acuity (BCVA) worsened at month 12, and those with increased exudative fundus findings after IVR or an increased central retinal thickness of more than 100 μm at month 12, were considered to be non-responders as judged by BCVA and fundus findings, respectively. Non-responders' initial characteristics were analysed using logistic regression models. Results: 14.9% of eyes were non-responders as judged by BCVA, and 17.0% were non-responders as judged by fundus findings. Initial fibrovascular pigment epithelial detachment (PED) (OR 22.9, 95% CI 2.61 to 201) and serous PED (OR 4.12, 95% CI 1.08 to 15.8) were associated with non-response as judged by BCVA. Initial fibrovascular PED (OR 33.5, 95% CI 2.95 to 381) and type 1 choroidal neovascularization (OR 6.46, 95% CI 1.39 to 30.0) were associated with non-response, as judged by fundus findings. Conclusions: Although most AMD responded to IVR, non-responders had initial clinical characteristics that might be informative for managing their treatment.

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Fundus autofluorescence imaging in a patient with the juvenile form of galactosialidosis

Yamazaki Risa, Tsunoda Kazushige, Fujinami Kaoru, Noda Toru, Tsubota Kazuo

Ophthalmic Surgery Lasers and Imaging Retina 45 （ 3 ） 259 - 261 2014年

ISSN 2325-8160

The authors report the characteristics of fundus autofluorescence (FAF) images in a patient with galactosialidosis who presented with a macular cherry-red spot ophthalmoscopically. The cherry-red spot in the macula was hyperreflective in the FAF images. Optical coherence tomography (OCT) revealed an abnormally hyperreflective region in the retinal ganglion cell layer; however, the boundary between hyperreflective and normal regions was not clear. The findings indicate that FAF may be a more useful method to detect macular lesions than conventional funduscopic examination and OCT imaging in patients with lysosomal storage diseases presenting with a macular cherry-red spot.

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Clinical results of toric intraocular lens implantation for cataract with high astigmatism

Tominaga Takashi, Torii Hidemasa, Watanabe Kazuhiro, Shimizu Tsutomu, Saiki Megumi, Negishi Kazuno, Tsubota Kazuo

Japanese Journal of Clinical Ophthalmology 68 （ 9 ） 1279 - 1283 2014年

ISSN 0370-5579

Purpose: To evaluate the postoperative outcome of toric intraocular lens (TIOL) implantation for cataract patients with high corneal astigmatism. Methods: This retrospective study included 24 eyes of 22 patients with high corneal astigmatism exceeded-1.50 D who underwent cataract surgery and implantation of TIOL (SN6AT6:12 eyes, SN6AT7:8 eyes, SN6AT8:3 eyes, SN6AT9:1 eye). The mean age of all cases was 68.1 years. Visual acuity, corneal astigmatism, subjective refraction, and rotation error were recorded preoperatively and 1 month postoperatively. Results: The uncorrected and correted distance visual acuities and subjective refraction were significantly (p<0.001) improved after TIOL implantation. There was no significant difference in corneal astigmatism between preoperatively and postoperatively. The mean rotation error was 2.8°. Conclusion: TIOL was effective for cataract patients with high corneal astigmatism.

Alteration of tear mucin 5AC in office workers using visual display terminals

Uchino Yuichi, Uchino Miki, Yokoi Norihiko, Dogru Murat, Kawashima Motoko, Okada Naoko, Inaba Takaaki, Tamaki Shusaku, Komuro Aoi, Sonomura Yukiko, Kato Hiroaki, Argüeso Pablo, Kinoshita Shigeru, Tsubota Kazuo

JAMA Ophthalmology 132 （ 8 ） 985 - 992 2014年

ISSN 2168-6165

IMPORTANCE There are limited reports on the relationship between mucin 5AC (MUC5AC) concentrations in tears, working hours, and the frequency of ocular symptoms in visual display terminal (VDT) users. This investigation evaluated these relationships among patients with dry eye disease (DED) and individuals serving as controls. OBJECTIVE To determine the relationship between MUC5AC concentration in the tears of VDT users based on the diagnosis of DED and frequency of ocular symptoms. DESIGN, SETTING, AND PARTICIPANTS An institutional, cross-sectional studywas conducted. Participants included 96 young and middle-Aged Japanese office workers. Both eyes of 96 volunteers (60 men and 36 women) were studied. Participants working in a company that used VDTs completed questionnaires about their working hours and the frequency of ocular symptoms. Dry eye disease was diagnosed as definite or probable, or it was not present. Tear fluid was collected from the inferior fornix after instillation of 50 μL of sterilized saline. The MUC5AC concentration was normalized to tear protein content and expressed as MUC5AC (nanograms) per tear protein (milligrams). The differences in MUC5AC concentration between DED Groups, between VDT working hours (short, intermediate, and long), and between symptomatic and asymptomatic Groups were evaluated with 95%CIs based on nonparametric Hodges-Lehmann determination. MAIN OUTCOMES AND MEASURES Ocular surface evaluation, prevalence of DED, and MUC5AC concentration. RESULTS The prevalence of definite and probable DED was 9%(n = 9) and 57%(n = 55), respectively. The mean MUC5AC concentration was lower in the tears of VDT users with definite DED than in those with no DED (P = .02; Hodges-Lehmann estimator, -2.17; 95%CI, -4.67 to -0.30). The mean MUC5AC concentration in tears was lower in the Group that worked longer hours than in the Group that worked shorter hours (P = .049; estimated difference, -1.65; 95%CI, -3.12 to 0.00). Furthermore, MUC5AC concentration was lower in participants with symptomatic eye strain than in asymptomatic individuals (P = .001; estimated difference, -1.71; 95%CI, -2.86 to -0.63). CONCLUSIONS AND RELEVANCE The data obtained in the present study suggest that office workers with prolonged VDT use, as well as those with an increased frequency of eye strain, have a low MUC5AC concentration in their tears. Furthermore, MUC5AC concentration in the tears of patients with DED may be lower than that in individuals without DED. Copyright 2014 American Medical Association. All rights reserved.

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Ray tracing software for intraocular lens power calculation after corneal excimer laser surgery

Saiki Megumi, Negishi Kazuno, Kato Naoko, Torii Hidemasa, Dogru Murat, Tsubota Kazuo

Japanese Journal of Ophthalmology 58 （ 3 ） 276 - 281 2014年

ISSN 0021-5155

Purpose: To evaluate the accuracy of intraocular lens (IOL) power calculations using ray tracing software in eyes after myopic laser in situ keratomileusis (LASIK). Methods: Twenty-four eyes of 17 cataract patients who underwent phacoemulsification and IOL implantation after myopic LASIK were analyzed retrospectively. The IOL power calculation was performed using OKULIX ray tracing software. The axial length was measured using the IOLMaster and keratometry data using TMS2N. The accuracy of the IOL power calculation using OKULIX was compared with those using the Camellin-Calossi, Shammas-PL, Haigis-L formulas and the double-K SRK/T formula using 43.5 diopters (D) for the Kpre. Results: The mean values of the arithmetic and absolute prediction errors were 0.63 ± 0.85 and 0.80 ± 0.68 D, respectively. The arithmetic prediction error by OKULIX was a significant hyperopic shift of the distribution of the postoperative refractive errors compared to the Camellin-Calossi, Shammas-PL and Haigis-L formulas (P < 0.05), and the absolute prediction error showed no significant difference with other formulas. The prediction errors using OKULIX were within ±0.5 D in 10 eyes (41.7 %) and within ±1.0 D in 18 eyes (75.0 %). The percentages of eyes within ±1.0 D using OKULIX were comparable to those obtained using the Camellin-Calossi, the Shammas-PL formulas and the double-K SRK/T formula using 43.5 D for the Kpre, and significantly (P < 0.05) higher than that obtained using the Haigis-L formula. Conclusions: IOL power calculations using OKULIX provided predictable outcomes in eyes that had undergone a previous myopic LASIK. © 2014 Japanese Ophthalmological Society.

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Primary and secondary surveys on epidemiology of Sjögren's syndrome in Japan

Tsuboi Hiroto, Asashima Hiromitsu, Takai Chinatsu, Hagiwara Shinya, Hagiya Chihiro, Yokosawa Masahiro, Hirota Tomoya, Umehara Hisanori, Kawakami Atsushi, Nakamura Hideki, Sano Hajime, Tsubota Kazuo, Ogawa Yoko, Takamura Etsuko, Saito Ichiro, Inoue Hiroko, Nakamura Seiji, Moriyama Masafumi, Takeuchi Tsutomu, Tanaka Yoshiya, Hirata Shintaro, Mimori Tsuneyo, Yoshifuji Hajime, Ohta Akiko, Matsumoto Isao, Sumida Takayuki

Modern Rheumatology 24 （ 3 ） 464 - 470 2014年

ISSN 1439-7595

Objective. To characterize the epidemiology of Sjögren's syndrome (SS), including prevalence, disease type, extra-glandular involvement, satisfaction of diagnostic criteria sets, and treatment used in Japan. Methods. The Research Team for Autoimmune Diseases, the Research Program for Intractable Disease by the Ministry of Health, Labor and Welfare conducted primary and secondary surveys on epidemiology of SS in 2011. The primary survey covered 4,729 out of 14,095 Japan-wide Hospital Departments to investigate the prevalence of SS. The secondary survey encompassed 214 Hospital Departments that agreed to the survey, to characterize disease type, extra-glandular involvement, satisfaction of diagnostic criteria sets, and treatments. Results. The number of patients with SS in Japan estimated by the primary survey was 68,483. The secondary survey involving data collected from 2,195 SS patients from 98 Hospital Departments showed that the mean age of patients was 60.8 ± 15.2 years, male/female ratio was 1/17.4, primary/secondary SS was about 60%/40% and glandular/extra-glandular form in primary SS was about 70%/25%. The satisfaction rate was 53.8% for the 1999 revised Japanese Ministry of Health criteria for the diagnosis of SS, 47.7% for the 2002 American-European Consensus Group classification criteria for SS and 49.6% for 2012 American College of Rheumatology classification criteria for SS. Corticosteroids were used by 752 of 2,195 patients (34%), immunosuppressants by 358 patients (16%), biologics by 68 patients (3%) and secretagogues by 695 patients (32%). Conclusion. The surveys provided valuable information on the epidemiology of SS including prevalence, disease type, extra-glandular involvement, satisfaction of diagnostic criteria sets and treatments used today in Japan. © 2014 Japan College of Rheumatology.

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Possibility of measuring lutein in the retina by confocal micro-imaging system

Kudo Masahiro, Wada Satoshi, Ogawa Takayo, Namiki Sho, Ozawa Yoko, Tsubota Kazuo, Shinjo Atsushi, Suzuki Keiji

International Journal of Nanomanufacturing 10 （ 4 ） 321 - 331 2014年

ISSN 1746-9392

The microfabrication and measurements of organic materials have significant potential for industrial and medical applications. In particular, in the medical field, a non-invasive method of measuring the distribution of certain substances contained in organic materials has been strongly demanded. Introducing a fluorescence analysis system to a confocal system would be useful for the characterisation of materials while maintaining space resolution. In this study, we focused on age-related macular degeneration (AMD) as an example, and investigated the possibility of the visualisation of fluorescence spectra. We measured the fluorescence spectrum in photoreceptor cells that were separated from the macular of eyes obtained from an eye-bank, using a microslicer. Mixed spectra of lutein and zeaxanthin, which are not affected by other organisations of eye have been measured. We also evaluated the densities of lutein and zeaxanthin in photoreceptor cells from the spectrum. As a result, the mixing ratio of lutein to zeaxanthin was estimated to be 3.78:6.22. The results showed good agreement with the results of high-performance liquid chromatography (HPLC). The approach presented here can serve as a useful framework for measuring the densities of lutein and zeaxanthin in photoreceptor cells.Copyright © 2014 Inderscience Enterprises Ltd.

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Association of maternal age to development and progression of retinopathy of prematurity in infants of gestational age under 33 weeks

Uchida Atsuro, Miwa Masayuki, Shinoda Hajime, Koto Takashi, Nagai Norihiro, Mochimaru Hiroshi, Tomita Yohei, Sasaki Mariko, Ikeda Kazushige, Tsubota Kazuo, Ozawa Yoko

Journal of Ophthalmology 2014 2014年

ISSN 2090-004X

Aim. To find predictive and indicative markers of risk for development of retinopathy of prematurity (ROP) and its progression to the stage requiring laser treatment, in premature infants whose gestational age (GA) was under 33 weeks. Methods. We retrospectively reviewed medical records of 197 premature infants born in 2005-2010 whose G A < 33 weeks and underwent eye screening at Keio University Hospital. The association between candidate risk factors and development or progression of ROP was assessed. Results. Among the 182 eligible infants (median GA, 29.1 weeks; median birth weight (BW), 1028 g), 84 (46%) developed any stage of ROP, of which 45 (25%) required laser treatment. Multivariate analysis using a stepwise method showed that GA (P = 0.002; 95% confidence interval (CI), 0.508-0.858), BW (P < 0.001; 95% CI, 0.994-0.998), and lower maternal age (P = 0.032; 95% CI, 0.819-0.991) were the risk factors for ROP development and GA (P < 0.001; 95% CI, 0.387-0.609) and lower maternal age (P = 0.012; 95% CI, 0.795-0.973) were for laser treatment. The odds ratio of requiring laser treatment was 3.3 when the maternal age was <33 years. Conclusion. ROP was more likely to be developed and progressed in infants born from younger mother and low GA. © 2014 Atsuro Uchida et al.

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The association between dry eye disease and physical activity as well as sedentary behavior

Kawashima Motoko, Uchino Miki, Yokoi Norihiko, Uchino Yuichi, Dogru Murat, Komuro Aoi, Sonomura Yukiko, Kato Hiroaki, Nishiwaki Yuji, Kinoshita Shigeru, Tsubota Kazuo

Journal of Ophthalmology 2014 2014年

ISSN 2090-004X

Purpose. To assess the association of dry eye disease (DED) with physical activity and sedentary behavior. Methods. The cross-sectional survey conducted included Japanese office workers who use visual display terminals (n = 672). DED was assessed according to the Japanese Dry Eye Diagnostic Criteria, and participants were categorized into "definite DED," "probable DED," or "non-DED" groups based on the results of DED examinations. Physical activity and sedentary behavior of participants were assessed using the International Physical Activity Questionnaire (IPAQ), and physical activity level was calculated in metabolic equivalent units per week (MET, min/week). Participants were classified as having a high, moderate, or low level of physical activity. Results. Participants with abnormal tear break-up time (BUT) (≤5 s) were involved in sedentary behavior for significantly longer duration than those with normal BUT (P = 0. 035). Non-DED participants (14.5%) tended to have higher levels of physical activity than definite DED participants (2.5%). Participants with definite DED had significantly lower MET scores than those with non-DED (P = 0. 025). Conclusions. Our findings suggest that a lower level of physical activity and sedentary behavior are associated with DED; however, longitudinal/intervention studies with large groups of participants are needed to validate these findings.

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Clinical backgrounds of postoperative keratoplasty patients with spontaneous wound dehiscence or gaps after suture removal

Fujii Shota, Matsumoto Yukihiro, Fukui Masaki, Fujitake Junichi, Kawakita Tetsuya, Shimmura Shigeto, Tsubota Kazuo

Cornea 33 （ 12 ） 1320 - 1323 2014年

ISSN 0277-3740

Purpose: To report that spontaneous postkeratoplasty wound dehiscence or gaps caused by suture removal may occur years after penetrating and deep lamellar keratoplasty. Methods: We retrospectively reviewed the medical records of 667 keratoplasty patients (890 eyes). This study included 8 eyes of 8 patients (3 men and 5 women) aged 64 to 86 years who suffered from spontaneous wound dehiscence or gaps caused by suture removal. We examined their clinical backgrounds such as surgical procedure, reason for suture removal, and time interval between keratoplasty and suture removal. Results: The surgical procedures included 6 penetrating keratoplasties and 2 deep anterior lamellar keratoplasties. The most common reason for suture removal was high corneal astigmatism. Time interval between keratoplasty and suture removal was 15.9 ± 7.7 months (7-26 months). Three patients underwent suture removal from 6 months to 1 year after keratoplasty, 3 patients from 1 to 2 years, and 2 patients after more than 2 years. Conclusions: Whenever postoperative keratoplasty suture is removed, it is important to consider that wound dehiscence or gaps may occur without incidence of trauma.

Biological effects of blocking blue and other visible light on the mouse retina

Narimatsu Toshio, Ozawa Yoko, Miyake Seiji, Kubota Shunsuke, Yuki Kenya, Nagai Norihiro, Tsubota Kazuo

Clinical and Experimental Ophthalmology 42 （ 6 ） 555 - 563 2014年

ISSN 1442-6404

Background: To elucidate the biological effects of blocking fluorescent light on the retina using specific blocking materials. Methods: Seven- to 8-week-old BALB/c mice were divided into three groups and placed in one of the three boxes: one blocked ultraviolet and violet wavelengths of light (violet blockade), one blocked ultraviolet, violet, blue and some other visible wavelengths (blue-plus blockade), and one allowed most visible light to pass through (control). They were then exposed to a white fluorescent lamp for 1h at 5.65E-05mW/cm²/s. After treatment, the electroretinogram, retinal outer nuclear layer thickness and retinal outer segment length were measured. In addition, retinal apoptotic cells were quantified by TdT-mediated dUTP nick-end labelling assay and c-Fos messenger RNA, and protein levels were measured by real-time reverse-transcription polymerase chain reaction and immunoblot analyses, respectively. Results: The blue-plus blockade group retained a significantly better electroretinogram response following light exposure than the control or violet blockade groups. The blue-plus blockade group also exhibited greater outer nuclear layer thickness and greater outer-segment length, and fewer apoptotic cells after light exposure than the other groups. The c-Fos messenger RNA and protein levels were substantially reduced in the blue-plus blockade group and reduced to a lesser extent in the violet blockade group. Conclusions: The blockade of blue plus additional visible wavelengths of light was most effective in protecting the retina from light-induced damage. The blockade of violet light alone was also effective in reducing intracellular molecular responses, but these effects were not sufficient for attenuating retinal degeneration. © 2014 Royal Australian and New Zealand College of Ophthalmologists.

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