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Biomedical subjects

S Shirato

Publications and source records attributed to S Shirato.

At least 19 recordsLinked to original sources
PubMed1997

Stevens-Johnson syndrome induced by methazolamide treatment.

Four cases of Stevens-Johnson syndrome considered to be induced by methazolamide were reported. In all of the cases, the first signs of Stevens-Johnson syndrome (i.e., swelling of the skin and mucous membranes or slight fever) appeared about 2 weeks after the patient started taking methazolamide (75 or 100 mg/d). After the appearance of erythema, the skin and mucous membrane lesions progressed rapidly and spread over the entire body, even after the patient ended methazolamide treatment and started treatment with prednisolone. During prednisolone treatment, the skin and mucous lesions became bullous, ruptured spontaneously, and dried with crust or erosion. HLA typing was positive for HLA-B59 in 3 of 4 cases. Methazolamide should be prescribed with caution in patients of Japanese or Korean descent.

Adult↗
PubMed1997

Effect of trabeculectomy on visual field performance in central 30 degrees field in progressive normal-tension glaucoma.

PURPOSE: The authors studied the effects of trabeculectomy on the time course of central 30 degrees visual field performances in progressive normal-tension glaucoma (NTG). METHODS: Patients with NTG who had clear ocular media and were adequate performers on the 30-2 program of Humphrey Perimeter were prospectively followed with periodic field testing. Trabeculectomy using an antimetabolite was indicated when the slope of a line fitted to the time course of the mean deviation (MD), MD slope, was significantly negative. The time courses of MD and mean of total deviations (mean TD) in four subfields, superior and inferior arcuate and superior and inferior cecocentral fields, were analyzed using the mixed linear model. RESULTS: In progressive NTG, 21 eyes of 21 cases with postoperative follow-up of 2 years or more, intraocular pressure averaged 16 mmHg, MD averaged -13.5 dB, and MD slope averaged -1.48 dB/year preoperatively; 2 years after surgery, they averaged 9.2 mmHg, -13.6 dB, and +0.13 dB/year, respectively. Trabeculectomy had a significant beneficial effect on the time course of MD and mean TD in the superior and inferior arcuate and superior cecocentral fields, which showed significant preoperative deterioration. The mean TD in the inferior cecocentral field showed no significant time change during the period studied. CONCLUSION: For patients with NTG in whom the MD slope is significantly negative, trabeculectomy may have beneficial and diffuse effects on further deterioration of the visual field.

Antimetabolites↗
PubMed1997

[Effect of non-surgical ocular hypotensive therapy in normal-tension glaucoma].

We investigated the effects of the topical ocular hypotensives with or without half circumference argon laser trabeculoplasty (ALT) on intraocular pressure (IOP) of normal-tension glaucoma (NTG) eyes. Seventy-two NTG patients whose pretreatment mean IOP was > or = 15 mmHg at least in one eye were included and one randomly chosen eye from one patient were used for analysis. They were followed for at least 15 months after commencement of the therapy. The mean pretreatment IOP averaged 17.2 +/- 1.6 mmHg (mean +/- standard deviation, n = 72). All eyes were first treated with topical 2% carteolol. In eyes where IOP reduction was considered unsatisfactory, topical 1% pilocarpine or 0.04% dipivefrine was added. In eyes where IOP reduction was still unsatisfactory even with the two medications, half circumference ALT was performed. Mean IOP reduction was 1.5 mmHg in the eyes treated with topical medications alone and 2.5 mmHg in those treated by topical medications plus ALT. The mean outflow pressure reduction was 16 and 26%, respectively. In 40% of the all eyes, satisfactory IOP reduction was obtained by topical medications with or without additional ALT.

Carteolol↗
PubMed1997

Risk factors for unsatisfactory intraocular pressure control in combined trabeculectomy and cataract surgery.

BACKGROUND AND OBJECTIVE: Trabeculectomy combined with posterior chamber intraocular lens (PC IOL) insertion is often chosen for the treatment of glaucoma combined with cataract. In this study, the clinical prognostic indicators for late intraocular pressure (IOP) control in combined procedures were investigated. PATIENTS AND METHODS: The clinical records of 60 eyes that underwent trabeculectomy combined with PC IOL implantation were retrospectively analyzed using the Cox proportional hazards model. All of the patients received postoperative 5-fluorouracil injections. RESULTS: Extracapsular cataract extraction (ECCE) was found to be a statistically significant risk factor for unsatisfactory late IOP control (hazard ratio 2.54; P < .01) and for unsatisfactory filtering bleb appearance (hazard ratio 5; P < .001). The frequency of fibrin formation and the incidence of a transient IOP spike (> or = 25 mm Hg) were significantly lower in the phacoemulsification and aspiration (PEA) group than in the ECCE group. In the PEA group, the probability of IOP control (< or = 15 mm Hg) without medication was 54%, and the probability of persistent filtering bleb appearance was 80% at 18 months. CONCLUSION: The PEA technique, not ECCE, should be employed in combined trabeculectomy and PC IOL implantation.

Aged↗
PubMed1997

[Surgical revision of failed filtering bleb with mitomycin C].

The revision of a failed filtering bleb using mitomycin C was performed in 40 eyes (28 eyes with primary open angle glaucoma and 12 eyes with secondary open angle glaucoma) in which the previous trabeculectomy using 5-fluorouracil had failed to control intraocular pressure (IOP). Presurgical IOP ranged from 21 approximately 36 mm Hg (average: 24.7 mmHg) with the maximum tolerable antiglaucoma medication. The follow-up period was at least 2 years (24 approximately 60, mean: 39.8 months). Mitomycin C (0.04%, 5 ml, 5 min) was applied under the subconjunctival space. After rinsing, the wall of the scarred bleb was incised in cases with a localized bleb, or the margin of the scleral flap was incised in cases without a filtering bleb. The conjunctival wound was closed with 10-0 Nylon sutures. IOP control under 21 mmHg was achieved in 53.4% without medication and in 60.2% with or without medication at 60 months. After repeating the same procedure, IOP control was obtained in 82.2% with or without medication at 60 months. The success rate in secondary open angle glaucoma was less than in primary open angle glaucoma. Complications such as flattening of the anterior chamber requiring reformation (8%), choroidal detachment (8%), hyphema (5%), and hypotonic maculopathy (5%) were less than after trabeculectomy but conjunctival wound separation (5%) occurred little more frequently.

Adult↗
PubMed1995

[Primary trabeculectomy for open-angle glaucoma with mitomycin C].

We examined the results of postoperative intraocular pressure (IOP) control and complications of trabeculectomy with mitomycin C in open angle glaucoma patients who had not undergone any other ocular surgery. The subjects were 80 eyes of 70 patients who underwent surgery with 0.04% mitomycin C as an adjunct for 3 minutes and were followed for 7-24 months (mean +/- standard deviation: 13 +/- 3.4). The preoperative IOP was 21-32 mmHg (mean +/- standard deviation: 24.6 +/- 4.3) in maximum tolerable medications. IOP control ratio, which was analysed with the Kaplan-Meier method at 24 months after surgery was 81.6% without any antiglaucoma medications, vs 92.0% with medications. These values were significantly higher (p < 0.05) than the results of trabeculectomy with 5-fluorouracil or without antimetabolic agents previously performed in our clinic. Shallow chamber in 18 eyes (23%), choroidal detachment in 14 eyes (18%), hypotonus maculopathy in 7 eyes (9%), and cataract progression in 5 eyes (7%) were recognised as complications. Although there are some complications to be conquered, trabeculectomy with mitomycin C seems to be effective in treating primary open angle glaucoma patients.

Adult↗
PubMed1994

The usefulness of the Noise-Field Test as a screening method for visual field defects.

In 1990, we reported the usefulness of the noise-field spontaneously generated on a home television screen for the subjective perception of visual field defects (VFD) in glaucoma patients (Noise-Field Test: NFT). Recently, the sensitivity and specificity of the NFT for testing 555 eyes of primary open angle glaucoma patients and 300 eyes of subjects with normal visual field were 89.2% and 93.7%, respectively. We also performed a comparative study among the NFT and Tübingen electric campimetry (TEC) and oculokinetic perimetry (OKP), and also evaluated the efficiency of the NFT using participants examined in general health check-up systems. In the comparative study testing 136 eyes of glaucoma patients who had never perceived their VFD, and 114 eyes of subjects with normal visual field, the sensitivity of the NFT, TEC (fine), TEC (coarse), and OKP was 85.3%, 75.0%, 71.3% or 59.5%, respectively. The specificity was 88.6%, 78.9%, 82.5% or 95.6%, respectively. In the study made in the general health check-up system, the NFT was carried out on 935 participants (1870 eyes). After the NFT, all participants received an ophthalmological examination. Those participants whose fundus was suspected to have VFD as well as participants who reported abnormalities of the noise-field were examined by static perimetry. One hundred and sixty-two eyes perceived abnormalities of the noise-field; 58 eyes were judged as having VFD by an ophthalmologist and the defects were confirmed.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

[Effects of long-term application of bunazosin hydrochloride eye drops on the aqueous flow rate and blood-aqueous barrier permiability in rabbit eyes].

We investigated the effects of long-term instillation of bunazosin hydrochloride--alpha 1 specific adrenergic antagonist--on the aqueous humor dynamics and blood-aqueous barrier in rabbit eyes. We examined intraocular pressure, aqueous flow rate, and blood-aqueous barrier permiability for albumin after four weeks application of 0.05% bunazosin. The effect of bunazosin on blood-aqueous barrier destruction by laser iridophotocoagulation was also examined. During four weeks, bunazosin reduced the intraocular pressure by 1.7 +/- 0.6 mmHg (mean +/- SEM). Continuous application of bunazosin had no significant influence on aqueous flow rate and fluorescein isothiocyanate-labeled rabbit albumin (FITC-Alb) concentration in the anterior chamber. Bunazosin had no effect on the rise of the FITC-Alb concentration after iris photocoagulation, but the intraocular pressure in bunazosin treated eyes was significantly lower than in control eyes one hour after photocoagulation.

Adrenergic alpha-Antagonists↗
PubMed1994

[Thulium-holmium-chromium-doped YAG laser sclerostomy ab externo in uncontrollable glaucoma].

Laser sclerostomy ab externo, using thulium-holmium-chromium-doped YAG laser was performed in 40 eyes with refractory glaucoma. Preoperative intraocular pressure (IOP) ranged from 21 to 50 mmHg (mean +/- SD: 33 +/- 18.6) with maximum tolerable medications. In all cases, a full-thickness sclerostomy was performed and subsequently a filtering bleb was formed. Total energy levels to produce the sclerostomy ranged from 0.2 J to 12.9 J (3.9 +/- 2.4). Follow-up periods varied from 3 to 18 (9 +/- 4) months. IOP control rate calculated by a life-table method at 6 and 12 months after surgery was 54% and 46%, respectively. IOP for successful eyes ranged from 0 to 18 mmHg (12.3 +/- 2.4). As complications, corneal fold formation (all eyes), choroidal detachment (12 eyes), hyphema (10 eyes), and iris incarceration in the sclerostomy site (4 eyes) were found. Astigmatism caused by corneal fold formation disappeared spontaneously within 3 months. Iris incarceration causing IOP elevation was repaired by Nd-YAG laser treatment and IOP control was obtained in 2 of 4 eyes. No other complications were observed.

Chromium↗
PubMed1994

[Ten-year results of argon laser trabeculoplasty].

One hundred and forty-seven eyes of 107 primary open angle glaucoma (POAG) patients and 39 eyes of 31 capsular glaucoma patients who were followed up for a minimum of 5 years after argon laser trabeculoplasty were reviewed. The mean preoperative intraocular pressure (IOP) was 23.6 mmHg. The follow-up periods ranged from 5 to 13 years with an average of 8.8 years. Using a life-table method, the probability of success was calculated, as defined by IOP at 21 mmHg or lower with same or less preoperative medical regimen, no deterioration of visual field defect and no requirement of filtering surgery. The success rate at 5 postoperative years was 40.3% for the POAG and 65.7% for the capsular glaucoma, and at 10 postoperative years it was 26. 8% for POAG and 26.9% for capsular glaucoma. An analysis using Cox proportional hazard model showed that preoperative lower IOP, male sex and higher age were the significant determinants for success.

Adolescent↗
PubMed1993

[A comparative study of visual field damage in low-tension and primary open-angle glaucoma].

We compared the results of visual field examination obtained with a Humphrey 30-2 program between 57 eyes of 57 low-tension glaucoma (LTG) and 57 eyes of 57 primary open-angle glaucoma (POAG; max IOP > or = 25 mmHg) cases, whose mean deviation (MD) given by STATPAC was > -10 dB. MD, age, and refraction showed no differences between the two groups. Corrected pattern standard deviation (CPSD) was significantly higher in the LTG group (p < 0.01). The total deviation (TD), deviation from the age-corrected normal reference, was found to be significantly lower by about 5 dB in the LTG group at two test points nasal-superior to the fixation point (Wilcoxon rank sum test, p < 0.01). Logistic discriminant analysis carried out to exclude a subtle difference in the distribution of the stage of disease between the two groups confirmed a significant between-group difference at the above-mentioned points. Furthermore, to compare the unevenness of visual field in the two groups, [TD-mean TD] was calculated, where mean TD was the average of 70 points of TD excluding the uppermost four points, and the same two points obtained above were found to decrease significantly in LTG, while all points were diffusely damaged in POAG. These results may imply a difference in the mechanism of visual field damage between LTG and POAG.

Adult↗
PubMed1993

[A study of para-foveal color vision in normal-tension and primary open angle glaucoma eyes].

A perimetric color vision test developed by Iijima et al. for evaluating parafoveal color vision provides information regarding local retinal function which can not be evaluated by other color vision tests. Using this method, we investigated para-foveal color sensitivity in normal-tension glaucoma (NTG) and primary open angle glaucoma (POAG) eyes whose glaucomatous visual field change determined with the central 30-2 program of the Humphrey visual field analyzer was confined to either the upper or the lower hemifield. The examined eyes had no abnormalities in ocular media with best corrected visual acuity of 1.0 or higher, and age, refraction, mean deviation, and extent of visual field loss were matched between NTG and POAG eyes. In the para-foveal area of the spared hemifield, acquired blue-yellow dyschromatopsia was detected in 52.3% of the POAG eyes and in 11.3% of the NTG eyes (p < 0.02, chi 2-test), and in damaged hemifield, it was found in 76.1% of the POAG eyes and 80.7% of the NTG eyes. We suggest that visual function is more diffusely damaged in POAG than in NTG and that the perimetric color vision test is useful for detecting glaucomatous damage which cannot be detected with conventional light threshold measurements.

Adult↗
PubMed1993

[THC-YAG laser sclerostomy ab externo in monkey eyes].

THC-YAG laser sclerostomy was performed in 7 eyes of 6 monkeys. The 26-gauge optic probe, which delivers energy perpendicularly to the long axis of the probe, was inserted through a 1-mm conjunctival stab incision, 6-7 mm away from the limbus, and the probe tip was positioned at the sclerostomy site. Pulse energy of 80 mJ or 100 mJ was used with a repetition rate of 5 pulses per second. Total energy levels to produce a new outflow pathway ranged from 1.2 to 6.6 J (2.8 +/- 1.2 J). After the surgery, 5-fluorouracil (0.1 mg daily) was injected subconjunctivally for 7 days, and intraocular pressure measurements and ophthalmic examination were performed for 4 weeks. Eyes were enucleated just after surgery or 1 week or 4 weeks after surgery. Intraocular pressures in operated eyes at 1 week and 4 weeks after surgery were reduced to 7-10 (9 +/- 1.2) mmHg, and 0-11 (3.5 +/- 4.3) mmHg, respectively, in comparison with intraocular pressures in nonoperated eyes. Histological examination revealed that the sclerostomy hole with a diameter of 150 microns just after surgery had narrowed at 1 week, and was closed by subconjunctival proliferative tissues at 4 weeks after surgery.

Animals↗
PubMed1993

[Combined posterior chamber intraocular lens implantation and trabeculectomy--a life-table analysis of postoperative clinical course].

Postoperative courses of 68 eyes of 58 glaucoma patients who underwent posterior chamber intraocular lens implantation combined with trabeculectomy were studied retrospectively. The visual acuity was 0.5 or better in 66% of the eyes at 3 months postoperatively. The average intraocular pressure (IOP) was below 15 mmHg till 16 months postoperatively. An analysis of the postoperative course using the life-table method of Kaplan-Meier revealed that the probability of successful IOP control with medication was 83% at 18 months and 47% without medication. The subjects aged 75 years or older showed significantly higher success probability than those younger than 75 years, while types of glaucoma, the preoperative IOP control, location of conjunctival or sclerocorneal incision, postoperative 5-fluorouracil (5-FU) injections or surgical intervention on the iris had no significant effects on the probability of successful IOP control. The probability of subsistence of functional filtering bleb was 24% at 18-month follow-up, on which postoperative administration of 5-FU of 35 mg or more had a favorable effect.

Aged↗
PubMed1993

[A five-year follow-up of the effect of postoperative 5-fluorouracil subconjunctival injections on the surgical outcome of trabeculectomy].

The effects of postoperative subconjunctival 5-fluorouracil (5-FU) injections on the surgical outcomes of trabeculectomy were studied after a 5-year follow-up in 263 eyes of glaucoma patients by the life table analysis. The success probability (%) to maintain the postoperative intraocular pressure (IOP) less than 21 mmHg without medication was 58.2 for primary open angle glaucoma (POAG), 54.8 for secondary glaucoma (SG) and 27.8 for refractory glaucoma, that with or without medication was 92.5 for POAG, 87.4 for SG and 57.5 for refractory glaucoma. The success probability (%) to maintain the postoperative IOP less than 16 mmHg without medication was 55.2 for POAG, 49.8 for SG and 24.5 for refractory glaucoma, that with or without medication was 77.9 for POAG, 66.8 for SG and 26.9 for refractory glaucoma. In each type of glaucoma, the difference between the 5-FU treated and the control groups was highly significant (p < 0.01 or less, log-rank test). Corneal epithelial defect was noted in 38.8%, but no late complications, for example, perforation or necrosis of sclera, were observed. These results indicate that we can use postoperative subconjunctival 5-FU without risk of serious complications.

Adult↗
PubMed1992

A comparative study of optic nerve head in low- and high-tension glaucomas.

The disc and rim areas in 15 eyes from 15 selected low-tension glaucoma (LTG) patients were compared with those in 15 eyes from 15 selected high-tension glaucoma (HTG) patients. In all patients, visual field defects (VFD) were at an early stage (mean deviation greater than -5 dB, program 30-2 of Humphrey Visual Field Analyzer, STATPAC) and were confined to either the upper or lower hemifield. There were no significant differences in the degree of VFD between LTG and HTG, and the peak intraocular pressure averaged 18.9 and 29.2 mmHg for LTG and HTG eyes, respectively. The disc and rim areas were determined from stereoscopic disc photographs using the method of Littman. The half rim area corresponding to the upper or lower hemifield without VFD was significantly smaller for LTG than HTG (LTG 0.26 +/- 0.08 mm2, HTG 0.31 +/- 0.08 mm2, mean +/- SD, n = 15, P less than 0.005). The rim area corresponding to the upper or lower hemifield with VFD was also significantly smaller for LTG than HTG (LTG 0.19 +/- 0.08 mm2, HTG 0.24 +/- 0.08 mm2, P less than 0.01). On the other hand, there was no significant difference in the disc area between LTG and HTG (LTG 1.96 +/- 0.57 mm2, HTG 2.03 +/- 0.45 mm2, P greater than 0.4). It was suggested that the differences in rim area were already present prior to the manifestation of the VFD.

Glaucoma, Open-Angle↗