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Kobayashi H.,Kokura Memorial Hospital | Kobayashi H.,Kanmon Medical Center | Kobayashi K.,Kurashiki Central Hospital
Journal of Glaucoma | Year: 2011

Purpose: To study any correlation between a short-term change in conjunctival hyperemia severity and the intraocular pressure-lowering effect induced by latanoprost. Patients ans Methods: A 114 patients (56 females and 58 males) with open-angle glaucoma or ocular hypertension were studied. Their mean age was 60.9 ± 15.0 years (range, 25 to 87 y). The primary outcome measure was the change in conjunctival hyperemia grade at 2 days and the change in intraocular pressure at 6 months after the start of latanoprost administration. Results: Mean intraocular pressure before and 6 months after latanoprost administration was 22.5 ± 3.8 mm Hg and 16.5 ± 2.9 mm Hg, respectively (P<0.0001). Mean conjunctival hyperemia grade before and 2 days after the administration of latanoprost was 0.32 ± 0.58 and 1.74 ± 1.11, respectively (P<0.0001). Mean change in intraocular pressure was -1.7 ± 1.2 mm Hg (-6.6 ± 5.1%) in eyes with no hyperemia grade change, -5.2 ± 2.2 mm Hg (-21.5 ± 7.6%) in eyes with a hyperemia grade change of 1, -7.3 ± 2.8 mm Hg (-32.0 ± 8.9%) in eyes with a change of 2, and -10.8 ± 2.7 mm Hg (-46.1 ± 8.6%) in eyes with a change of 3 or 4 (P<0.0001). There was a significant correlation between intraocular pressure change and hyperemia grade change (intraocular pressure: r=0.535, P=0.0001; percent of intraocular pressure: r=0.755, P=0.0001). Conclusion: A statistically significant correlation was found between a change in intraocular pressure and conjunctival hyperemia severity induced by latanoprost. © 2011 Lippincott Williams & Wilkins.


Kobayashi H.,Kanmon Medical Center | Kobayashi K.,Kurashiki Central Hospital
Journal of Glaucoma | Year: 2011

Purpose: To compare the intraocular pressure lowering effect of adjustable sutures and laser suture lysis for trabeculectomy in eyes with primary open angle glaucoma. Methods: Fifty patients with primary open angle glaucoma were studied. Eyes were assigned randomly to either trabeculectomy augmented with mitomycin C with adjustable sutures or with laser suture lysis. Patients were followed up for 12 months and success rate based on intraocular pressure was compared. Adjustable sutures were carried out as reported by Wells et al. Results: Mean baseline intraocular pressure was 27.8±2.8 mm Hg in the adjustable suture group and 27.3±2.9 mm Hg in the laser suture lysis group (P=0.7). Mean postoperative intraocular pressure was 12.1±2.0 mm Hg at 3 months, 12.7±3.2 mm Hg at 6 months, and 12.9±3.4 mm Hg at 12 months in the adjustable suture group and 12.1±2.6 mm Hg at 3 months, 13.1±4.7 mm Hg at 6 months, and 13.4±3.5 mm Hg at 12 months in the laser suture lysis group. There was no significant difference in the mean intraocular pressure between the groups at any time point. At 12 months, 24 patients (96%) in the adjustable suture group and 23 patients (92%) in the laser suture lysis group achieved an intraocular pressure of ≥20 mm Hg without medication and a minimum of 30 percent reduction (P=0.7). Significant anterior chamber reduction was found in no patient (0%) in the adjustable suture group and 6 patients (24%) in the laser suture lysis group after loosening of the adjustable sutures or laser suture lysis. Conclusions: There was no significant difference in hypotensive efficacy between adjustable suture group and laser suture lysis group. The use of adjustable sutures may reduce the incidence of shallow anterior chamber and hypotony after postoperative intraocular pressure lowering procedures. © 2011 by Lippincott Williams & Wilkins.


Kobayashi H.,Kanmon Medical Center
Journal of Ocular Pharmacology and Therapeutics | Year: 2012

Purpose: To study the efficacy of a single drug in patients with primary open angle glaucoma and ocular hypertension who were receiving timolol XE 0.5%, latanoprost 0.005% and brinzolamide 1% with its discontinuation. Methods: Sixty patients with open-angle glaucoma or ocular hypertension who were administered timolol XE, latanoprost, and brinzolamide were studied. One drug consisting of timolol XE, brinzolamide, and latanoprost was discontinued and 8 weeks later, it was resumed. A change in intraocular pressure (IOP) was studied. Results: Mean IOP at baseline and at 8 weeks after discontinuation of each drug was 15.8±1.3 and 17.3±1.4 mmHg in the timolol XE group, 15.8±1.0 and 20.0±1.4 mmHg in the latanoprost group, and 16.0±1.4 and 18.1±1.4 mmHg, respectively. A significant increase in mean IOP was found after drug discontinuation (timolol XE: P=0.0012; latanoprost: P<0.0001; brinzolamide: P<0.0001). The mean change in IOP by discontinuation of the drug was +1.6±0.9 mmHg (+9.6%±5.6%) in the timolol XE group, +4.3±1.7 mmHg (27.4%±12.4%) in the latanoprost group, and +2.2±0.9 mmHg (+13.7%±6.1%) in the brinzolamide group. The change in the latanoprost group was significantly greater compared with those in the timolol XE and brinzolamide groups (timolol XE: mmHg and percent: P<0.0001; brinzolamide: mmHg and percent: P<0.0001). The IOP change in the brinzolamide group was significantly greater than that in the timolol XE group (mmHg: P=0.0417; percent: P=0.0328). No significant difference was observed in mean IOP between before drug discontinuation and at 8 weeks after drug resumption in any group. Conclusions: There was a significant increase in IOP from discontinuation of timolol XE, latanoprost, and brinzolamide in the multiple drug treatment. The hypotensive effect of latanoprost in the combined drug therapy is significantly greater than the effects of timolol XE and brinzolamide. © Copyright 2012, Mary Ann Liebert, Inc. 2012.


Purpose: To study the effect of single drug discontinuation in combined timolol XE 0.5% and latanoprost 0.005% treatment. Methods: Fifty patients with open-angle glaucoma or ocular hypertension who had received both latanoprost and timolol XE for at least 6 months were enrolled in this study. Timolol XE and latanoprost were administered once daily, timolol XE in the morning and latanoprost in the evening. Twenty-five patients discontinued timolol XE and the remaining 25 patients discontinued latanoprost. Either latanoprost or timolol XE was discontinued and 8 weeks later it was resumed. A change in intraocular pressure (IOP) was studied. Results: All patients had complete follow-up visits. A significant increase in mean IOP was found following drug discontinuation in the 2 groups. Mean change in IOP 8 weeks after discontinuation of the drug was +1.6±1.2mmHg (10.3%±8.0%) in the timolol XE group and +4.3±1.6mmHg (+27.2%±11.8%) in the latanoprost group. The change in the latanoprost group was significantly greater compared with that in the timolol XE group (P<0.0001). There was no significant difference in mean IOP between before drug discontinuation and at 8 weeks after drug resumption in any group. Conclusions: There was a significant increase in IOP from discontinuation of timolol XE and latanoprost. The hypotensive effect of latanoprost in the combined drug therapy is significantly greater compared with timolol XE. © Copyright 2012, Mary Ann Liebert, Inc.


Date R.,Yamaguchi University | Muramatsu K.,Yamaguchi University | Ihara K.,Kanmon Medical Center | Taguchi T.,Yamaguchi University
Acta Neurochirurgica | Year: 2012

Background: Schwannoma is the most common tumor of the peripheral nerves, with surgical enucleation being the established treatment modality. However, some schwannomas cannot be easily enucleated and this sometimes results in iatrogenic nerve injury even with atraumatic procedures. Here we present a retrospective review of the management of schwannoma in the extremities and compare clinical outcomes from the two techniques of extra-capsular and intra-capsular enucleation. Methods: We reviewed 36 schwannomas from 35 patients who underwent surgical excision of schwannomas arising from the extremities. Twenty had undergone extra-capsular resection and 16 had undergone enucleation using the intra-capsular technique. The post-operative neurological deficits were graded as minor, major, and transient. The duration of symptoms, maximum tumor diameter and site of occurrence were compared between patients with the three grades of deficit. Results: In total, 22 patients developed no sensory changes following enucleation of schwannoma or only temporary and minor changes that had fully resolved within 6 months. Ten patients developed new neurological deficits following surgery that took longer than 6 months to resolve. Four patients experienced new motor deficits or paresthesia following operation that had still not recovered at the final follow-up, all of whom underwent enucleation using the extra-capsular technique. Neurological deficit after enucleation was significantly lower using the intra-capsular compared with the extra-capsular technique. Patient age, duration of symptoms, maximum diameter of the tumor and site of occurrence did not influence the neurological deficit following enucleation of schwannoma. Conclusion: These results support intra-capsular micro-enucleation as a safe and reliable treatment for every type of schwannoma. To minimize the risk of nerve injury, en bloc resection should not be used because the main purpose of schwannoma surgery is the relief of symptoms, not tumor resection. Thorough pre-operative counseling of patients to inform them of the potential occurrence of neurological deficit is important. © 2011 Springer-Verlag.


Muramatsu K.,Yamaguchi University | Fukano R.,Yamaguchi University | Ihara K.,Kanmon Medical Center | Iwanaga R.,Yamaguchi University | Taguchi T.,Yamaguchi University
Journal of Plastic, Reconstructive and Aesthetic Surgery | Year: 2010

Reconstruction of the proximal humerus following limb-saving resection of malignant bone tumor is extremely challenging. We describe here a novel anatomical reconstruction technique in a young patient. A 6-year-old girl with Ewing sarcoma of the proximal humerus was treated by wide excision of the tumor followed by reconstruction with extracorporeally-irradiated osteoarticular autograft combined with an intramedullary inserted free vascularized fibula graft. Proper alignment of the shoulder joint was maintained with no osteoarthritic changes after 16 months. The resulting limb function was satisfactory. This biological reconstruction method was safe and without serious complication. It is indicated for the reconstruction of non-weight-bearing joints and is ideal for the proximal humerus. © 2009 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.


Muramatsu K.,Yamaguchi University | Ihara K.,Kanmon Medical Center | Hashimoto T.,Yamaguchi University | Tominaga Y.,Yamaguchi University | Taguchi T.,Yamaguchi University
Journal of Plastic, Reconstructive and Aesthetic Surgery | Year: 2014

Digital glomus tumour is a rare neoplasm. Surgical excision is the only known curative treatment but the best approach for subungual glomus tumours is still controversial. A total of 12 patients with subungual glomus tumour were reviewed. There were 11 female patients and one male patient, with a mean age of 48.6 years. Surgical procedures were performed using an operative microscope and tumours were excised using the lateral subperiosteal approach. In all, 10 patients were satisfied with the outcome from the lateral operative approach because they were able to use the affected hand for kitchen work shortly after the treatment. One case presented residual tumour and underwent re-operation. No tumour recurrences and nail deformity were detected after excision with the lateral approach. The lateral subperiosteal approach was safe and reliable for the subungual glomus tumour and allowed full access to any glomus tumours. Microscopy allows careful visualisation of the tumour. It is important that surgeons accurately locate tumours to achieve complete excision.


Kobayashi H.,Kanmon Medical Center
Journal of Cataract and Refractive Surgery | Year: 2010

Purpose: To assess the risk for intraoperative and postoperative bleeding associated with antiplatelet and/or anticoagulant treatment in patients having uneventful phacoemulsification. Setting: Kokura Memorial Hospital, Kitakyusyu, Japan. Methods: In a nonrandomized case series, consecutive patients had phacoemulsification and intraocular lens implantation under sub-Tenon anesthesia. All patients were on warfarin, acetylsalicylic acid (aspirin) therapy, or both. Patients discontinued therapy 1 week before surgery (discontinuation group) or continued the therapeutic regimen until the time of surgery (maintenance group). Results: The discontinuation group comprised 182 patients and the maintenance group, 173 patients. There was no significant difference between the 2 groups in the mean prothrombin time-international normalized ratio in patients taking warfarin (P = .6). Although there was no significant intraoperative bleeding in any case, 47 eyes (16.5%) in the maintenance group and 31 eyes (10.8%) in the discontinuation group had a subconjunctival hemorrhage postoperatively (P = .0309). Minor postoperative ocular bleeding occurred in 11 eyes (4.0%) in the maintenance group and 7 eyes (2.5%) in the discontinuation group (P = .4). During the 1-month postoperative period, the mean change in corrected distance visual acuity was -0.462 logMAR ± 0.331 (SD) in the maintenance group and -0.434 ± 0.318 logMAR in the discontinuation group (P = .3). Conclusions: Patients taking warfarin, aspirin, or both up to the time of phacoemulsification had a significantly higher incidence of subconjunctival hemorrhage than those who discontinued therapy. There was no significant difference between the 2 groups in the incidence of intraoperative and postoperative complications or in visual improvement. Financial Disclosure: The author has no financial or proprietary interest in any material or method mentioned. © 2010 ASCRS and ESCRS.


Kobayashi H.,Kanmon Medical Center
Japanese Journal of Clinical Ophthalmology | Year: 2014

Purpose: To study adherence of use of an ocular hypotensive delivery device for glaucoma drugs and the relationship between its adherence and age, gender, best-corrected visual acuity or visual filed. Methods: One hundred and ten patients who had been administered with latanoprost 0.04% (Xalatan®) or fixed combination latano-prost 0.04%/timolol 0.5% (Xalacom®) and who had had difficulty in eyedropping were enrolled. There were 35 men and 75 women and mean age was 74.8±11.7 years. An ocular hypotensive delivery device (Xal-Ease®) was given to the patients and their adherence of its use was studied for 6 months. Results: One hundred four patients (94.5%) completed the study. The rate of patients with good adherence with hypotensive delivery device use was 57.7% at 2 months, 69.2% at 4 months and 75.0% at 6 months (p<0.01). The rate in female patients between 60 and 74 years was 56.7%, which was significantly lower compared with the other patients (p<0.01). The duration between the acquisition of the device and the start of its use was 5.7±9.8 days in patients of younger than 60 years, 16.6±21.0 days in those between 60 and 74 years, and 22.3 ±31.9 days in those of 75 years or older; there was a significant correlation (p<0.01). Adherence with topical drug administration significantly improved in patients with good adherence with the device use (p=0.0005), whereas no significant difference was noted in patients with poor adherence (p=0.2). Conclusion: A relatively high percentage of patients used an ocular hypotensive delivery device, although female patients between 60 and 74 years used it significantly less compared with the other patients. There may be a learning curve, which may become steeper with age. Therefore, the ocular hypotensive delivery device should be improved to use more easily.


Kobayashi H.,Kanmon Medical Center
Japanese Journal of Clinical Ophthalmology | Year: 2016

Purpos: To report changes in adherence to topical anti-glaucoma drugs with the use of an eyedrop aid for 2 years. Methods: Participants in this study were 112 glaucoma patients who had been prescribed with either latanoprost 0.04% or a fixed combination of latanoprost 0.04% and timolol 0.5% for at least 6 months and who complained difficulty with instilling eye drops. There were 34 men and 78 women with mean age of 73.8 ± 11.7 years. An eye drop aid (Xal-Ease, Pfeizer) was given to each patient. Use of this device and adherence to the administration of anti-glaucoma drugs were monitored for 24 months after the device was provided. Results: One hundred eight patients (96.4%) finished the study. The proportion of patients used the device was 68.5% at 6 months, 74.1 % at 1 year and 75.0% at 2 years. There were 55 good adherents (67.9%) and 71 (87.7%) at baseline and at 24 months (p = 0.003), respectively, among patients who used the device, com pared with 18 (66.7%) and 21 (74.1%) among those who did not (p = 0.3). Conclusion: The eye drop aid was used by 75% of patients for 2 years, showing its ease of use and tolerability. Use of this eye drop aid may help patients improve adherence to topical medication regimen.

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