Biomedical subjects

Ikuko Toda

Publications and source records attributed to Ikuko Toda.

At least 19 recordsLinked to original sources

PubMed2006

Traumatic epithelial flap detachment after laser subepithelial keratomileusis.

PURPOSE: To report a case of corneal epithelial flap detachment 20 days after laser subepithelial keratomileusis (LASEK). METHODS: A 30-year-old man underwent LASEK for correction of myopia. On postoperative day 8, he was comfortable and the corneal epithelium healed completely with uncorrected visual acuity (UCVA) of 20/20. On postoperative day 20, the corneal epithelial flap on the right eye detached and was lost during pressure patching after puncture of the hordeolum. RESULTS: The corneal defect was treated with a bandage contact lens, levofloxacin, and hyaluronic acid eye drops. Ten days after detachment, UCVA had improved to 20/20 and the epithelium had closed completely. CONCLUSIONS: Mild trauma can cause epithelial flap detachment during the early postoperative period of LASEK.

Adult↗

PubMed2006

Dry eye after LASIK enhancement by flap lifting.

PURPOSE: To determine whether dry eye after LASIK recurs after LASIK enhancement. METHODS: A total of 63 eyes of 42 patients who underwent LASIK enhancement were included in this study. Subjective dry eye symptoms, tear break-up time (BUT), Schirmer test with anesthesia, fluorescein staining of the cornea, and corneal sensitivity were evaluated before and at 1, 3, and 6 months after enhancement. RESULTS: The subjective dry eye symptoms remained unchanged before and after LASIK enhancement. Similarly, Schirmer values and tear BUT did not exhibit statistically significant differences between the pre- and post-enhancement values. Compared with the pre-enhancement values, the fluorescein score was higher at 1 month after surgery and further improved at 3 months. In comparison with the pre-enhancement values, the corneal sensitivity was decreased at 1, 3, and 6 months after surgery. CONCLUSIONS: Patients did not complain of dry eye symptoms and tear functions were not compromised after LASIK enhancement. These results suggest that factors other than the neurotrophic effect may contribute to dry eye after LASIK.

Adult↗

PubMed2006

Comparison of LASIK using the NIDEK EC-5000 optimized aspheric transition zone (OATz) and conventional ablation profile.

PURPOSE: To compare a new ablation algorithm termed the optimized aspheric transition zone (OATz) with the conventional laser ablation profile for correction of myopic astigmatism. METHODS: LASIK using OATz profile #6 or using conventional ablation profile was performed on 98 eyes of 53 patients (OATz #6 group) and 111 eyes of 66 patients (control #6 group), respectively. Further, LASIK using OATz profile #5 or using the conventional ablation profile was performed on 109 eyes of 58 patients (OATz #5 group) and 109 eyes of 75 patients (control #5 group), respectively. The effective optical zone, uncorrected visual acuity, manifest refraction, aberrations, contrast sensitivity, and patient satisfaction at 3 months postoperatively were compared between the OATz #6 and control #6 groups and between the OATz #5 and control #5 groups. RESULTS: The effective optical zones in the OATz #6 group (6.45 +/- 0.29 mm) or OATz #5 group (6.40 +/- 0.21 mm) were significantly larger than those in the control #6 group (6.33 +/- 0.27 mm) or control #5 group (6.26 +/- 0.25 mm) (P < .01), respectively. Uncorrected visual acuity and manifest refraction were similar in all groups. The changes in contrast sensitivity were significant and favored the OATz #6 (P < .01) and OATz #5 groups (P < .05). The patient satisfaction survey found no statistical difference at 3 months postoperatively. CONCLUSIONS: Patients treated with the OATz profiles had better visual quality as measured by contrast sensitivity and also had larger effective optical zones as compared with those treated by the conventional ablation profile.

Adult↗

PubMed2005

Experience with the Artisan phakic intraocular lens in Asian eyes.

PURPOSE: To investigate the efficacy and safety of implantation of an iris-claw phakic intraocular lens (PIOL), Artisan Myopia, in Asian eyes. SETTING: Minamiaoyama Eye Clinic, Tokyo, Japan. METHODS: Forty-four eyes of 32 Japanese patients and 1 Korean patient with high myopia had Artisan Myopia lens implantation to correct their refractive errors. Lens models, 5/8.5 or 6/8.5 (optic diameter/overall diameter), were chosen as standard lens model. A smaller lens model (5/7.5-Artisan Myopia Small) was implanted in eyes with corneal diameter less than 11.0 mm. Postoperative examinations were performed on 1 day, 1 week, 1 month, 3 months, 6 months, 1 year, and 2 years after surgery. Uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), manifest refraction, corneal endothelial cell counts, intraocular pressure, and complications were evaluated. RESULTS: Artisan Myopia Small lenses were implanted in 4 eyes (9.1%) and 8.5 mm diameter lenses were implanted in 40 eyes. Preoperative UCVA (logMAR) improved from 1.57 to 0.09 at 1 month after surgery and no regression was observed thereafter. Postoperative manifest refraction was -1.02 +/- 0.87 D (-3.25 to -0.00 D), and within 1.0 D in 20 eyes (55.6%), within 2.0 D in 32 eyes (88.9%) at 1 month after surgery, and stable during the follow-up period. The final BCVA decreased 2 lines in 2 eyes (4.5%) due to progression of age-related cataract. No serious complications such as angle closure or progressive endothelial cell loss were observed. CONCLUSION: Implantation of an Artisan iris-claw PIOL implantation may be a safe and effective procedure for Asian eyes.

Adult↗

PubMed2005

Early visual results with the 1CU accommodating intraocular lens.

PURPOSE: To prospectively assess the clinical outcome after implantation of the 1CU accommodating intraocular lens (IOL) and a foldable acrylic IOL (AcrySof, Alcon). SETTING: Department of Ophthalmology, Tokyo Dental College, Ichikawa Hospital, Ichikawa, and Minami Aoyama Eye Clinics, Tokyo, Yokohama, Japan. METHODS: Twenty-two eyes of 16 patients with cataract had phacoemulsification implantation of 1CU accommodating IOL. Twenty eyes of 10 age-matched and sex-matched patients with cataract had the same surgery but with a foldable acrylic IOL. All patients had assessments of the amplitude of accommodation, refraction, uncorrected and best corrected distance and near visual acuity, and distance corrected near visual acuity before surgery up to 12 months after surgery. Contrast visual acuities were measured 1 year after surgery. Anterior segment photography, intraocular pressure measurements, specular microscopy, and computerized topography were also performed. RESULTS: The final best corrected distance visual acuity was above 20/25 in all eyes with the 1CU and the AcrySof IOLs. The mean distance corrected near visual acuity was significantly higher in the 1CU IOL group than in the acrylic IOL group after 3 months. None of the eyes with the AcrySof IOL implants displayed an accommodative response at any examination. The peak mean amplitude of accommodation with the 1CU IOLs was observed at 3 months and was 0.5 diopters +/- 0.44 (SD). Accommodation amplitude declined after 6 months. CONCLUSION: The 1CU IOL provided additional near acuity postoperatively, but the benefit disappeared at 12 months with a concomitant decrease in accommodation amplitude owing to an increase in anterior and posterior capsular opacities.

Accommodation, Ocular↗

PubMed2005

Pupil decentration and iris tilting detected by Orbscan: anatomic variations among healthy subjects and influence on outcomes of laser refractive surgeries.

PURPOSE: To investigate the anatomic variations of entrance pupil decentration and tilting angle of the iris in healthy subjects and the influence of these factors on the outcome of laser in situ keratomileusis (LASIK). SETTING: Minamiaoyama Eye Clinic, Tokyo, Japan. METHODS: The degree of pupil decentration and tilting angle of the iris in 2280 eyes of 1144 myopic patients without abnormal findings by ophthalmologic examination were assessed using Orbscan. Of these, 901 eyes of 467 patients had LASIK. Multiple analysis of variance (ANOVA) was used to determine risk factors for reduction of postoperative best spectacle-corrected visual acuity (BSCVA) considering patient age, refractive power, tilting angle of the iris, pupil decentration, and corneal power. RESULTS: The mean pupil decentration in all eyes was 0.19 mm +/- 0.11 (SD) (range 0 to 0.9 mm); tilting angle of the iris was 4.06 +/- 1.41 degrees (range 0.19 to 12.69 degrees). By multiple ANOVA, refractive power, pupil decentration, and tilting angle of the iris were significant for the reduction of BSCVA. CONCLUSIONS: Some eyes with pupil decentration or tilting angle of the iris could not be detected under typical ophthalmologic examination but only with topographic examination. Attention should be paid to eyes with large pupil decentration and tilting angle of the iris because these may be risk factors for reduction of postoperative BSCVA during corneal refractive surgeries.

Adult↗

PubMed2005

Histopathological findings of epithelial ingrowth after laser in situ keratomileusis.

PURPOSE: To investigate the histopathological features of epithelial ingrowth after laser in situ keratomileusis (LASIK). METHODS: Five epithelial ingrowth specimens of 4 patients (2 to 17 months after initial LASIK) were examined. The lesions were surgically removed and examined using light and transmission electron microscopy. RESULTS: Early epithelial ingrowth was clinically observed as faint opacities with demarcation lines and epithelial pearls. Late epithelial ingrowth was observed as homogeneous whitish masses. Histopathologically, early epithelial ingrowth consisted of multilayered squamous epithelium resembling normal corneal epithelium, whereas late ingrowth was made up of clumps containing amorphous materials with scarce cellular elements. CONCLUSIONS: Our findings suggest that clinical appearance and histopathology of epithelial ingrowth from LASIK flap margins differ in early and late stages, which might reflect proliferative activity of the lesions.

Adult↗

PubMed2004

Risk factors and retreatment results of intraoperative flap complications in LASIK.

PURPOSE: To evaluate the incidence, type, and risk factors of intraoperative complications leading to abandonment of laser in situ keratomileusis (LASIK), and to compare the safety and efficacy of retreated LASIK with uncomplicated primary LASIK. SETTING: Refractive surgery centers in Tokyo, Yokohama, Nagoya, Osaka, and Fukuoka, Japan. METHODS: A total of 3751 eyes of 2033 patients who were followed for 6 months after primary LASIK, of which 15 eyes were retreated after intraoperative flap complications, were reviewed. In most of the cases, retreatments were performed by recutting a new flap. RESULTS: Intraoperative flap complications occurred in 25 eyes, of which 15 eyes had retreatment at a later date. The overall incidence of complications was independent of the surgeons' experience, although incomplete flaps, in particular, occurred at a higher rate in the hands of inexperienced surgeons. No patient profile was detected as a risk factor for intraoperative flap complications. No flap-related complications occurred at retreatment. Refractive and visual outcomes were comparable to those in the uncomplicated cases within 6 months postoperatively. CONCLUSIONS: Retreatment after microkeratome flap complications by recutting the cornea is safe and effective.

Adult↗

PubMed2004

Effect of preoperative tear function on early functional visual acuity after laser in situ keratomileusis.

PURPOSE: To assess the effect of preoperative tear function on early changes in functional visual acuity (FVA) after laser in situ keratomileusis (LASIK). SETTING: Minamiaoyama Eye Clinic, Tokyo, Japan. METHODS: This prospective single-center study assessed the effect of preoperative and postoperative tear functions on FVA in 30 eyes of 15 patients who had LASIK. Functional visual acuity was defined as the binocular recognition acuity measured by the FVA tester (Wellsystem) during a 10-second, blink-free period. All patients had a Schirmer test with anesthesia and tear-film breakup time (BUT) measurements preoperatively and 1 day and 1 week after LASIK. Corneal topography and Landolt visual acuity and FVA measurements were performed before surgery and 1 day and 1 week after LASIK. Eyes with a Schirmer test reading less than 5.0 mm and a BUT less than 5 seconds were grouped as definite dry eye (DDE). Eyes with a normal Schirmer test score but a shortened BUT were grouped as probable dry eye (PDE). RESULTS: In all patients, the best uncorrected Landolt visual acuity was 20/20 or better at the postoperative examination times. In the DDE group, the mean preoperative FVA declined from 1.2 to 0.75 +/- 0.16 (SD) at 1 day and increased to 1.2 at 1 week. No change in FVA was observed postoperatively in the PDE group. CONCLUSION: Laser in situ keratomileusis patients with low basal tearing and full uncorrected distance Landolt acuity may experience a transient decrease in FVA that returns to baseline within 1 week.

Adult↗

PubMed2004

Detection of neutrophils in late-onset interface inflammation associated with flap injury after laser in situ keratomileusis.

OBJECTIVE: To report a case with late-onset interface inflammation associated with traumatic flap injury at 7 months after laser in situ keratomileusis (LASIK) and to describe the type of infiltrating cells in the tears of the patient. METHODS: Interventional case report. A 24-year-old male patient who underwent uneventful LASIK on both eyes received blunt trauma from the tip of a shoe in the left eye 7 months after surgery. The corneal flap of his left eye was lacerated across the pupillary area. Inflammatory cells were observed under the lacerated flap segment. Tear fluid was collected from his left eye 3 days after the injury and assessed by tear cytology. For controls, tears of 2 patients who underwent LASIK and developed no interface inflammation were collected the next day after their surgeries and examined. RESULTS: Tear fluid of the patient with interface inflammation contained numerous neutrophils. Tears of control patients contained only a few epithelial cells and cell debris but no inflammatory cells. The inflammation was decreased by systemic and topical steroids. However, irregular astigmatism caused by stromal scarring remained, resulting in decreased best-corrected visual acuity. CONCLUSIONS: Interface inflammation can be caused by late-onset flap injury. Neutrophils detected in the tears may reflect a major component of cells infiltrating the interface after LASIK.

Adult↗

PubMed2003

Severe late-onset recurrent epithelial erosion with diffuse lamellar keratitis after laser in situ keratomileusis.

A 39-year-old woman had laser in situ keratomileusis that was complicated by intraoperative epithelial erosion in both eyes. Seven months after surgery, the patient returned, complaining of pain and blurred vision in the left eye. Slitlamp examination revealed corneal epithelial erosion with severe diffuse lamellar keratitis (DLK). Reepithelialization was complete in several days. However, severe inflammation remained until systemic steroids were administered. Recurrent erosions can lead to a serious inflammatory reaction such as DLK because of the presence of the flap-stroma interface.

Adult↗

PubMed2003

Detection of neutrophils and possible involvement of interleukin-8 in diffuse lamellar keratitis after laser in situ keratomileusis.

PURPOSE: To investigate the cell populations in diffuse lamellar keratitis (DLK) infiltration after laser in situ keratomileusis and the possible mechanism underlying the infiltration. SETTING: Department of Ophthalmology, Tokyo Dental College, Chiba, Japan. METHODS: To develop DLK in rabbit eyes, 25 microL of lipopolysaccharide (LPS) solution at a concentration of 50 microg/mL was applied to the stromal bed beneath corneal flaps. For control rabbits, phosphate-buffered saline was applied. Postoperative examination by slitlamp microscopy was performed for 3 days after surgery. Rabbit eyes were excised and examined for histopathology with hematoxylin and eosin staining. Immunohistochemical analysis for interleukin (IL)-8 was performed. RESULTS: Diffuse lamellar keratitis-like inflammation composed mainly of neutrophils was reproduced by LPS instillation in rabbit eyes. In eyes with severe inflammation, IL-8 immunoreactivity was found in the stromal keratocytes and infiltrating neutrophils. CONCLUSIONS: The major cell type in the DLK infiltration induced by LPS instillation in rabbit eyes was the neutrophil. Interleukin-8, a prototype of CXC chemokine produced by keratocytes and neutrophils, may contribute to the development of DLK.

Animals↗

PubMed2002

Laser-assisted in situ keratomileusis for patients with dry eye.

OBJECTIVE: To evaluate the efficacy and safety of laser-assisted in situ keratomileusis (LASIK) in patients with preoperative dry eye. METHODS: We divided the 543 eyes that underwent LASIK into the following 3 groups: eyes with definite dry eye (DE group), with probable dry eye (PDE group), and without dry eye (NDE group). We evaluated visual outcome, dry-eye status, and complications. OUTCOME MEASURES: We compared uncorrected and best-corrected visual acuity, manifest refraction, symptoms, tear function, ocular surface abnormality, complications, corneal sensitivity, endothelial cell count, and patient satisfaction among the groups. RESULTS: We found no significant differences among the groups in uncorrected and best-corrected visual acuity, manifest refraction, and patient satisfaction. A dry-eye symptom, dryness, was more severe in the DE than the NDE group after LASIK. The mean results of the Schirmer test with anesthesia and tear breakup times were significantly lower and the fluorescein score was higher in the DE than the NDE groups after LASIK. We found no differences in the incidence of complications among the groups. Corneal sensitivity was recovered within 6 months after LASIK in the DE and PDE groups and within 3 months in the NDE group. CONCLUSIONS: The efficacy and safety of LASIK were not affected by preexisting dry eye. However, preexisting dry eye is a risk factor for severe postoperative dry eye with lower tear function, more vital staining of the ocular surface, and more severe symptoms.

Adult↗

PubMed2002

Epithelial ingrowth after laser in situ keratomileusis: clinical features and possible mechanisms.

PURPOSE: To analyze the incidence, clinical course, and possible mechanisms of epithelial ingrowth after laser in situ keratomileusis (LASIK). DESIGN: Interventional case series. METHODS: Retrospective evaluation of 4,867 eyes of 2,502 patients who had LASIK. The type of microkeratome (LSK-One or MK-2000), corneal flap thickness, and clinical course were analyzed. We also compared the cutting characteristics of both microkeratomes in pig cadaver eyes by scanning electron microscopy. RESULTS: The frequency of epithelial ingrowth was significantly greater in the MK-2000 (34 of 1,680 eyes; 2.0%) than the LSK-One group (30 of 3,187 eyes; 0.94%; P =.001). In 24 eyes (37.5%), blood, cell infiltration, ointment under the corneal flaps, or epithelial defect were detected at the area of epithelial ingrowth postoperatively. The incidence of epithelial ingrowth was correlated with the incidence of epithelial defect during surgery (P <.001) and with incidence of diffuse lamellar keratitis after surgery (P =.003). Flap thickness was thinner in eyes with epithelial ingrowth (126.0 +/- 29.1 microm) compared with flap thickness in eyes without epithelial ingrowth (133.8 +/- 27.3 microm; P <.001). Scanning electron microscopy showed clear differences in the appearance of flap edges created by the two types of microkeratomes. Epithelial ingrowth disappeared or remained unchanged in 54 eyes (90%) and progressed in six cases (10%). CONCLUSIONS: Poor adhesion caused by excessive hydration due to epithelial defect as well as by foreign bodies between the flap stromal bed and thickness and morphologic characters of the corneal flap, depending on the type of microkeratomes, are related factors for development of epithelial ingrowth.

Adult↗

PubMed2002

Reasons for not performing refractive surgery.

PURPOSE: To analyze the reasons that laser in situ keratomileusis (LASIK) or photorefractive keratectomy (PRK) were not performed in patients who requested surgical correction of their refractive errors. SETTING: Minamiaoyama Eye Clinic, Tokyo, Japan. METHODS: This retrospective review comprised 2784 consecutive patients who visited our clinic between June 1997 and August 2000. The reasons they did not receive refractive surgery (PRK or LASIK) were analyzed. RESULTS: Among the 2784 patients who requested surgery for refractive errors, 2079 patients (74.7%) had PRK or LASIK and 705 patients (25.3%) did not. The most common reasons for not treating patients surgically were myopia greater than -12.0 diopters and/or high astigmatism (20.7%), insufficient corneal thickness (8.2%), keratoconus (6.4%), cataract (5.7%), and hyperopia and/or hyperopic astigmatism (4.1%). CONCLUSIONS: Patients who request surgery have a variety of problems. Attention must be given to these individual problems, and the indications must be considered.

Adolescent↗

PubMed2002

Autoantigens and Sjögren syndrome.

PURPOSE: To review recent experimental evidence on the involvement of autoantigens and autoantibodies in the pathogenesis of organ-specific autoimmunity in Sjögren syndrome (SS). METHODS: Among candidate autoantigens in SS, we investigated the role of alpha-fodrin in the lacrimal gland using a mouse model and a lacrimal gland cell line established in p53 knockout mice. We also tried to identify a novel organ-specific autoantigen by screening the human salivary gland cell line (HSG) against sera from SS patients. The specificity and sensitivity of this autoantigen to SS patient sera, its cellular localization, and the gene encoding the protein were analyzed. RESULTS: In addition to the previously identified 120-kd alpha-fodrin in the salivary gland, a shorter fragment was detected, indicating that there may be a distinct apoptosis-related protease that cleaves alpha-fodrin in the lacrimal gland. A novel salivary gland-specific autoantibody was detected in 50.9% of sera from SS patients. The antigen recognized by this antibody may be a 45-kd nucleus protein not recognized in its native form. CONCLUSION: The precise roles of autoantigens in organ-specific autoimmunity are still unclear, although accumulated evidence suggests that they may be associated with disease progression. Further studies of alpha-fodrin and the 45-kd antigen may contribute to the understanding of the pathogenesis of SS and may provide a new strategy for organ-specific therapy, such as vaccination with analogue peptides.

Animals↗

PubMed2002

[Two cases of retinal detachment following laser in Situ keratomileusis repaired by scleral buckling surgery].

BACKGROUND: As laser in situ keratomileusis (LASIK) becomes the treatment of choice in the field of refractive surgery, postoperative rhegmatogenous retinal detachment has also begun to occur. However, since it has not been reported yet here in Japan, we report two cases of retinal detachment following LASIK with suggestions based on our experience. CASES: A 34-year-old male(Case 1) and a 26-year-old male(Case 2) suffered from retinal detachment one month and eight months after LASIK, respectively. Contributing retinal breaks were a horseshoe tear in Case 1 and atrophic holes in the lattice degeneration in Case 2. Each patient underwent partial scleral buckling with no intraoperative complication, resulting in successful retinal reattachment. Postoperatively, myopic changes developed and persisted one month in Case 1 and several months in Case 2. CONCLUSIONS: Great attention should be paid to the possibility of postoperative myopia after a repair of retinal detachment following LASIK. Thus, we stress the necessity of close cooperation between LASIK surgeons and vitreoretinal surgeons to settle the matter.

Adult↗

PubMedDate not supplied

Risk factors for insufficient fixation of microkeratome during laser in situ keratomileusis.

PURPOSE: To investigate the potential risk factors leading to insufficient fixation of a microkeratome during laser in situ keratomileusis (LASIK), especially in Asian eyes. METHODS: We performed a retrospective analysis of 1809 eyes of 972 patients that underwent LASIK. Profiles of patients (age, sex, past medical history, width of palpebral fissure, corneal power, and postoperative clinical course) whose operations were discontinued due to insufficient fixation were compared to all LASIK patients. RESULTS: Insufficient fixation was observed in 18 eyes of 16 patients. Those patients were significantly younger (26.1 +/- 5.5 yr) compared to all patients (32.3 +/- 8.6 yr). Mean keratometric power was 42.40 +/- 1.37 D in patients with insufficient fixation and 43.60 +/- 1.40 D in all patients (P < .001). Maximum width of palpebral fissure with eyes wide open was 0.96 +/- 0.20 mm in patients with insufficient fixation, and 1.10 +/- 0.19 mm in all patients (P = .0015). These patients subsequently underwent LASIK utilizing combinations of cooling, frequent corticosteroid instillation for several hours, and lateral canthotomy. CONCLUSION: Narrow palpebral fissures commonly found in Asian populations might be a risk factor for insufficient fixation of a microkeratome in LASIK, especially in young patients with flat corneas.

Adolescent↗