論文

目的:強度角膜乱視白内障眼に対する乱視矯正眼内レンズ(TIOL,Alcon社製)の術後成績の報告。対象と方法:強度角膜乱視白内障眼にTIOL(SN6AT6:12眼,SN6AT7:8眼,SN6AT8:3眼,SN6AT9:1眼)を挿入し,術後1ヵ月以上経過観察できた22例24眼(平均年齢68.1歳)である。術前と術後1ヵ月の視力(裸眼・矯正),角膜乱視,自覚屈折,軸回旋誤差を後方視的に検討した。結果:視力(矯正・裸眼)と自覚乱視は術後1ヵ月で有意(p<0.001)に改善した。角膜乱視に有意差はなかった。TIOLの軸回旋誤差は2.8°であった。結論:TIOLは強度乱視白内障眼の乱視矯正に有効である。(著者抄録)

目的:Laser in situ keratomileusis(LASIK)術後に生じた裂孔原性網膜剥離の特徴と治療成績についての報告。対象および方法:1999年12月〜2008年7月までに慶應義塾大学病院眼科を受診したLASIK術後の裂孔原性網膜剥離症例8例8眼の治療経過を検討した。結果:全例が男性であった。LASIK術前後の等価球面度数は、術前平均-7.91D、術後平均-0.34Dであった。網膜剥離に対して部分強膜バックリング術3例、硝子体手術3例、強膜バックリング術と硝子体手術の併施2例を行い、全例で水晶体を温存した。術後最終(平均7.1ヵ月)での等価球面度数は、部分強膜バックリング術施行例では平均-0.17D、硝子体手術施行例では平均-1.63D、強膜バックリング術と硝子体手術の併施例では平均-5.94Dの近視化を認めた。結論:強膜バックリング術よりも硝子体手術に近視化が多く認められる傾向があった。LASIK後の網膜剥離に対して水晶体温存硝子体手術を施行する場合には、術後近視化についての十分な説明を術前に行うことが重要である。(著者抄録)

目的:白内障術後,眼内レンズ(IOL)のグリスニングとホワイトニングによると考えられる視機能低下によりIOLを交換した症例を報告する。症例:78歳,女性。右白内障手術6年後の視力低下を主訴に受診した。所見:右矯正視力は白内障手術直後の0.8から0.4に低下しており,IOLのグリスニングおよびホワイトニングを認めた。軽度の網脈絡膜萎縮を認めたが,白内障手術直後から変化はなかった。IOL交換により矯正視力は0.8に回復した。結論:IOLのグリスニングおよびホワイトニングにより視機能低下をきたす可能性があり,その場合には眼内レンズの摘出・交換も考慮すべきである。(著者抄録)

目的:白内障手術後の残余屈折異常に対し,追加型眼内レンズ(IOL)を挿入した1症例の報告。症例:70歳男性が白内障手術を希望して受診した。23年前に両眼に放射状角膜切開術,12年前に両眼にレーザー屈折矯正角膜切除術を受けていた。所見:裸眼視力は右0.5,左0.4で,矯正視力は右0.9,左1.0であった。加齢白内障の診断で,左右眼に超音波乳化吸引術とIOL挿入術を行った。1年後の裸眼視力は右0.5,左0.5で,矯正視力は右1.2,左1.0であった。左眼に+3.0D()cyl-2.0D 65°の屈折異常があった。患者の希望により,左眼に追加型単焦点IOLを挿入した。6ヵ月後の左眼の裸眼視力は0.63,矯正視力は1.0であり,合併症はない。結論:追加型IOLの挿入は,白内障手術後の残余屈折異常に対する治療の,1つの選択肢である。(著者抄録)

目的:術後の不満から,多焦点眼内レンズを単焦点眼内レンズに交換した2症例の報告。症例:75歳男性の両眼に白内障手術を行い,回折型多焦点眼内レンズを挿入した。術前からの眼精疲労と羞明感が悪化し,本人の希望で4ヵ月後に単焦点眼内レンズに交換した。症状は持続したが,本態性眼瞼けいれんの治療で症状が改善した。52歳女性の両眼に白内障手術を行い,屈折型多焦点眼内レンズを挿入した。術後に羞明感があり,4ヵ月後に単焦点眼内レンズに交換した。症状は改善しなかった。結論:多焦点眼内レンズを挿入したのち,本人の不満による単焦点眼内レンズへの交換は慎重に判断する必要がある。(著者抄録)

目的:虹彩支持型有水晶体眼内レンズ(phakic IOL)の術後早期成績を検討する。方法:対象はphakic IOLを挿入した高度近視または近視性乱視9例17眼である。術前・術後の屈折、視機能、角膜内皮細胞密度、高次収差、前房内フレア値を検討した。結果:術後、裸眼視力は有意に改善し、矯正視力に有意差はなかった。術後1年の有効係数は0.89、安全係数は1.15であった。術後1年の屈折は±1.0D以内が89%であった。コントラスト感度、角膜内皮細胞密度、高次収差、前房内フレア値は術前と術後1年で有意差はなかった。結論:Phakic IOLの術後早期成績は良好である。(著者抄録)

目的:外傷性散瞳を伴う水晶体亜脱臼に対し虹彩付き眼内レンズ(IOL)を縫着した1例を報告する。症例:50歳、男性。交通事故後、右眼羞明の軽減を希望し、慶應義塾大学病院眼科を紹介され受診した。初診時、右眼の視力は0.4(1.0×C-1.00D Ax130°)で、コントラスト感度検査(Optec 6500 Vision Tester)で右眼のコントラスト感度の低下を認めた。細隙灯顕微鏡検査にて右眼の外傷性散瞳、10時から2時のチン小帯断裂、水晶体亜脱臼と前房への硝子体脱出を認めた。眼底検査では異常はなかった。右眼の水晶体切除術+前部硝子体切除術+虹彩付IOL(MORCHER Type 67F BDI lens)縫着術を施行した。結果:手術1年後の視力は右眼0.15(1.2×S-2.50D C-1.00D Ax160°)で、コントラスト感度は改善し、羞明は軽減した。結論:外傷性散瞳による羞明の軽減に虹彩付きIOL縫着術が有効だった。(著者抄録)

目的:多焦点眼内レンズ(IOL)両眼挿入例の術後3ヵ月の両眼視力について検討する。方法:両眼多焦点IOL挿入術を受けた18例36眼(21〜73歳、平均年齢59.1±12.7歳)を対象とし、両眼屈折型多焦点IOLを使用した群をR群、回折型をD群、優位眼に屈折型、非優位眼に回折型のミックスアンドマッチ症例をM群とし、術後3ヵ月の遠方、中間、近方の裸眼、矯正視力および自覚的屈折力を検討した。結果:術後の自覚的屈折力(D)は各群間に有意差はなかった。両眼裸眼視力はR群とD群の遠方、近方に有意差はなく(R≒D)、中間はR群がD群より有意によかった(R>D)。また全距離ともM群がD群よりよく(M>D)、近方のみM群がR群よりもよかった(M>R)。両眼矯正視力は、R群とD群では遠方、近方とも有意差がなく(R≒D)、遠方、近方ともM群がD群より有意によかったが(M>D)、R群とは有意差はなかった(R≒M、R≒D)。結論:ミックスアンドマッチ症例は両眼屈折型または回折型を挿入した症例よりも全距離で両眼裸眼視力が良好だった。(著者抄録)

目的:多焦点眼内レンズ(MIOL)挿入眼の近方実用視力を検討する。方法:対象は白内障手術を施行した合併症のない白内障患者16例27眼、平均年齢57.4歳で、使用したMIOLはNXG1(AMO社)、ZM900(AMO社)、SN6AD3(Alcon社)である。術後3ヵ月の自覚屈折、遠方視力、近方視力と近方実用視力(遠方矯正下)を測定した。結果:術後平均屈折は-0.03D、平均遠方視力(logMAR)は裸眼、矯正の順に-0.04、0.13、平均近方視力(logMAR)は裸眼、遠方矯正下、最良矯正の順に0.15、0.08、0.02だった。遠方矯正下において平均近方実用視力は近方視力よりも有意に低かった(p<0.001)。遠方矯正下における近方視力と近方実用視力は3種のIOLの間で有意差はなかった。結論:MIOL挿入眼の遠方矯正下における近方実用視力は、遠方矯正下近方視力より不良であった。(著者抄録)

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® DefineTM (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.

Purpose: To report a case who received implantation of piggyback intraocular lens (IOL) for residual refractive error after cataract surgery. Case: A 70-year-old man presented to our clinic complaining of decreased visual acuity in his both eyes. Both eyes had received radial keratotomy 23 years before and photorefractive keratectomy 12 years before. Findings: Visual acuity was 0.5 right and 0.4 left without correction, and 0.9 right and 1.0 left with correction. Under diagnosis of age-related cataract, both eyes received phacoemulsification-aspiration with IOL implantation. Visual acuity was 0.5 in either eye without correction and 1.2 right and 1.0 left with correction one year later. The left eye had refraction of +3.00D()cyl-2.00D 65°. By request of the patient, monofocal piggyback IOL was implanted into the left eye. Six months after surgery, left visual acuity was 0.63 without and 1.0 with correction. There has been no complication throughout. Conclusion: Implantation of piggyback IOL can be a therapeutic option for residual refractive error after cataract surgery.

Purpose: To describe a new method of alignment of toric intraocular lenses (IOLs) and evaluation of their rotation errors using anterior segment optical coherence tomography (AS-OCT). Methods: Twenty-nine eyes of 22 patients who had cataract extraction and implantation of an acrylic toric IOL were included. The new AS-OCT method was used for the alignment of toric IOLs and evaluation of their rotation errors. These rotation errors were evaluated and compared with those measured using the internal map of a wavefront aberrometer. Results: The mean rotation error ± standard deviation (SD) of the toric IOLs evaluated by AS-OCT was 3.2 ± 2.2° and 3.2 ± 2.4° at 1 week and 1 month after surgery, respectively. The mean difference in the reference axis between the visits was 1.8 ± 2.1°. The mean difference between the rotation errors of the alignment axes measured by AS-OCT and the internal map was 2.5 ± 1.9° (P = 0.037). Conclusion: The current method is clinically useful not only for the accurate alignment of toric IOLs but also for evaluating their rotation errors. © Japanese Ophthalmological Society 2011.

Correcting spherical and chromatic aberrations in vitro in human eyes provides substantial visual acuity and contrast sensitivity improvements. We found the same improvement in the retinal images using a model eye with/without correction of longitudinal chromatic aberrations (LCAs) and spherical aberrations (SAs). The model eye included an intraocular lens (IOL) and artificial cornea with human ocular LCAs and average human SAs. The optotypes were illuminated using a D65 light source, and the images were obtained using two-dimensional luminance colorimeter. The contrast improvement from the SA correction was higher than the LCA correction, indicating the benefit of an aspheric achromatic IOL. © 2011 Optical Society of America.

Purpose. To evaluate the extent of corneal inflammation and the response to treatment in patients with Mooren's ulcer, by in vivo confocal microscopy (IVCM). Methods. Twenty-two eyes of 15 patients with Mooren's ulcer were enrolled in this prospective study. All subjects underwent routine ophthalmic examinations, IVCM, and conjunctival histopathologic examination of specimens in patients undergoing conjunctival excision. Eyes with active ulcer were treated with topical corticosteroids and additional therapy, depending on the signs and symptoms. Eyes in remission continued to receive the previous treatment protocols. The relation between the severity of ulcer and inflammation status as assessed by IVCM was also studied. The endpoints were inflammatory cell density (ICD), counted by IVCM, and the extent of the limbal arc involved with ulcers. Results. Ten eyes had active corneal ulcers, and 12 eyes had been in remission for the past year. The mean ICD of eyes with active ulcers before treatment was 2092.7 ± 1538.6 cells/mm2 (range, 835.3-7832.7; 95% CI, 3232.5-952.9). Nine of the eyes improved at 8 weeks, with a decrease in ICD to 249.1 ± 109.0 cells/mm2 (range, 100.3-595.3; 95% CI, 329.8-168.3). One eye had corneal perforation, and ICD immediately before perforation was 1677.6 ± 247.6 cells/mm2. The mean ICD of 12 eyes in remission was 357.5 ± 266.8 cells/mm2 (range, 12.7-1127.0; 95% CI, 555.2-159.8). The correlation of the ICD and the extent of limbal involvement with ulcers was strong (R2 = 0.8119). Conclusions. ICD evaluated by IVCM is a useful and promising parameter for evaluation of the degree of inflammation in eyes with Mooren's ulcer and for assessment of response to treatment. © Association for Research in Vision and Ophthalmology.

We describe a T-shaped capsule stabilization hook (modified capsule expander [M-CE]) used for repositioning and scleral fixation of the lens capsule of subluxated lenses. The 5-0 polypropylene device is flexible and attached to a curved needle. The contact portion is bent at 1.25 mm, and the end bifurcates in a T configuration to form a 3.75 mm footpad from which the capsular bag can be suspended. Modified capsule expanders were implanted in 4 eyes of 4 patients with subluxated cataractous lenses and provided excellent support and centration of the intraocular lens (IOL)-capsular bag complex. The IOLs remained well centered and stable. The corrected distance visual acuity improved to at least 20/20 in all patients after surgery. Thus, M-CEs were effective in fixating the lens capsule to the sclera in patients with significant zonular weakness. Financial Disclosure: Saori Yaguchi, Y. Asano, T. Kozawa, T. Miyawaki, K. Negishi, and K. Tsubota have no financial or proprietary interest in any material or method mentioned. Additional disclosure is found in the footnotes. © 2011 ASCRS and ESCRS.

Purpose. To investigate the contribution of posterior corneal surfaces to higher-order aberrations (HOAs) of the cornea, optical quality, and visual acuity after keratoplasty. METHODS. Corneal topography of anterior and posterior surfaces and pachymetry were conducted using anterior segment optical coherence tomography (AS-OCT) in 40 eyes (10 eyes after penetrating keratoplasty [PK], 10 eyes after deep anterior lamellar keratoplasty [DALK], 10 eyes after Descemet's stripping automated endothelial keratoplasty [DSAEK], and 10 normal eyes). Anterior, posterior, and total corneal HOAs were calculated using ray-tracing and decomposition into Zernike polynomials and were evaluated as root mean square values. Modulation transfer functions (MTFs) were also evaluated. RESULTS. Topography maps of the anterior and posterior surfaces showed reverse patterns in the normal, PK, and DALK eyes, but not in DSAEK eyes. In the normal, PK, and DALK eyes, the total corneal HOAs were significantly smaller (~10%) than were the HOAs of the anterior surface (P<0.01), whereas there was no significant difference between total and anterior HOAs in the DSAEK eyes (P=0.483). In the normal, PK, and DALK eyes, the MTFs of the total cornea were slightly better than those of the anterior surface. In the DSAEK eyes, the MTFs of the total cornea were lower than those of the anterior surface. Visual acuity was significantly correlated with total and anterior surface HOAs (P<0.05). CONCLUSIONS. Posterior surfaces compensate for anterior aberrations in normal, PK, and DALK eyes. In DSAEK eyes, the posterior surface increased total corneal HOAs and had a negative influence on MTFs. © 2011 The Association for Research in Vision and Ophthalmology, Inc.

Purpose : To report the characteristics and surgical outcomes of rhegmatogenous retinal detachment (RRD) in myopic patients who underwent laser in situ keratomileusis (LASIK). Methods : We retrospectively reviewed the medical records of 8 patients with RRD developed after LASIK, who visited the clinics of the Department of Ophthalmology, Keio University Hospital, between December 1999 and July 2008. Results : AU 8 patients were male. The mean values of pre-LASIK and post-LASIK spherical equivalent were -7.91D and -0.34D, respectively. The patients underwent local scleral buckling(3 cases), pars plana vitrectomy(3 cases) and scleral buckling combined with vitrectomy(2 cases). The lenses were spared in all cases. At the final follow-up (mean 7.1 months), the changes in the mean values of spherical equivalent were -0.17D in cases treated with local scleral buckling, -1.63D in cases treated with pars plana vitrectomy and -5.94D in cases treated with combined surgery, respectively. Conclusions : In our patients, myopic change was highly increased in the patients who underwent vitrectomy, compared with patients treated with buckling surgery. This suggests the importance of preoperative explanation on the myopic progression after lens-sparing vitrectomy for RRD after LASIK.

PURPOSE. To investigate the status of oxidative stress and histopathologic alterations in patients with conjunctivochalasis and compare the findings with those in healthy control subjects. METHODS. Eleven patients (n = 20 eyes) with Yokoi grade 3 conjunctivochalasis and 11 health control subjects (n = 22 eyes) were prospectively recruited. ELISA for tear hexanoyllysine (HEL) and inflammatory cytokines, tear film break-up time tests, Schirmer test measurements, and fluorescein and rose bengal vital staining were performed. Conjunctival specimens obtained during surgery for conjunctivochalasis and cataract underwent immunohistochemical staining for HEL+8- OHdG, MMP-3, and MMP-9, and positively stained cells were counted. Transmission electron microscopy was also performed, with staining for elastic fibers in the conjunctival stroma. RESULTS. The mean tear stability and vital staining scores were significantly worse in the conjunctivochalasis patients than in the control subjects. The tear HEL and tear cytokine levels showed significantly higher values in eyes with conjunctivochalasis. IL-1β and IL-6 levels showed a significant correlation with corneal epithelial damage. IL-1β and TNFα showed a significant correlation with 8-OHdG-stained cell counts. Specimens from patients with conjunctivochalasis revealed a significantly higher number of cells positively stained for HEL, 8-OHdG, MMP-3, and MMP-9 than did specimens from age- and sex-matched control subjects. Transmission electron microscopy showed decreased intercellular cohesiveness, with the conjunctival stroma showing an accumulation of elastic fibers. CONCLUSIONS. Lipid and DNA oxidative stress were present in the conjunctiva. Increased tear inflammation seemed to coexist with loss of conjunctival epithelial cohesiveness and increased collagenolytic activity, which may explain the conjunctival laxity observed in patients with conjunctivochalasis. © Association for Research in Vision and Ophthalmology.

Purpose : To report two cases who received replacement of multifocal intraocular lens (IOL) by monofocal IOL due to postoperative dissatisfaction. Cases : A 75-year-old male received bilateral cataract surgery with implantation of diffractive multifocal IOL. Asthenopia and photophobia became worse after surgery. In accordance to his wish, the multifocal IOL was replaced by monofocal IOL 4 months later. His subjective complaints persisted but improved after treatment for essential blepharospasm. Another 52-year-old female received similar bilateral cataract surgery with implantation of refractive multifocal IOL. The lens was replaced by monofocal one due to photophobia 4 months later. Her subjective complaints persisted. Conclusion : These cases illustrate that replacement of multifocal by monofocal IOL due to dissatisfaction of patients need careful considerations.