Nojima Hospital

Kurayoshi, Japan

Nojima Hospital

Kurayoshi, Japan
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Matsuura K.,Nojima Hospital | Miyoshi T.,Miyoshi Eye Center | Suto C.,Tokyo Women's Medical University | Akura J.,Kushimoto Rehabilitation Center | Inoue Y.,Tottori University
Journal of Cataract and Refractive Surgery | Year: 2013

Purpose To report endophthalmitis rates after cataract surgery and the incidence of complications after intracameral moxifloxacin injection. Setting Nineteen clinics in Japanese institutions. Design Retrospective survey cohort study. Methods The number of surgeries and endophthalmitis cases in the past 4 years before and after the introduction of intracameral moxifloxacin was evaluated. The survey was performed by mail or interview in February 2013. Results All institutions used total-replacement administration rather than small-volume injection. At 3 institutions, 50 to 100 μg/mL moxifloxacin; at 9 institutions, 100 to 300 μg/mL moxifloxacin; and at 7 institutions, 500 μg/mL moxifloxacin was administered. The highest concentration (500 μg/mL) was administered in 14 124 cases. Endophthalmitis cases occurred 1 month or sooner postoperatively in 8 of 15 958 cases (ie, 1 in 1955) without intracameral moxifloxacin administration and in 3 of 18 794 cases (ie, 1 in 6265) with intracameral moxifloxacin administration. Conclusions Intracameral moxifloxacin (50 to 500 μg/mL) administration decreased the risk for endophthalmitis by 3-fold. In more than 18 000 cases, moxifloxacin administration of 500 μg/mL or less did not result in severe complications, such as toxic anterior segment syndrome or corneal endothelial cell loss. Financial Disclosure No author has a financial or proprietary interest in any material or method mentioned. © 2013 ASCRS and ESCRS.


Matsuura K.,Nojima Hospital | Suto C.,Tokyo Women's Medical University | Akura J.,Kushimoto Rehabilitation Center | Inoue Y.,Tottori University
Graefe's Archive for Clinical and Experimental Ophthalmology | Year: 2013

Background: Intracameral moxifloxacin is currently administered by injecting small doses (0.05-0.2 mL) of either undiluted or diluted solutions. It is difficult to ensure delivery of small amounts of antibiotic into the area behind the intraocular lens (IOL). Moreover, the anterior chamber pressure decreases as the tip of irrigation is removed, often leading to contaminated fluid flowing into the chamber. Conventional intracameral injection administers the diluted antibiotic without irrigating the recontaminated anterior chamber. Therefore, we developed a method of intracameral moxifloxacin delivery which flushes both the anterior chamber and the area behind the IOL immediately after surgery. Methods: Surgical technique (bag and chamber flushing = BC flushing): After removing the viscosurgical device, 1.5-1.8 mL diluted moxifloxacin was injected. Both the anterior chamber and the area behind the IOL were irrigated by lifting the IOL edge so that a stream of solution could circulate behind the IOL. Experiment 1 (pig): The anterior chamber was filled with condensed milk, and irrigated with 150-fold diluted moxifloxacin (33.3 μg/mL) in six eyes (BC flushing) to observe the irrigating effect. The anterior aqueous humor was sampled. Experiment 2 (human): A conventional intracameral injection (500 μg/mL) or BC flushing (33.3 μg/mL) was followed by sampling 0.1 mL of the anterior aqueous humor in six eyes each. High-performance liquid chromatography was performed to determine antibiotic levels. Results: Experiment 1: The antibiotic concentration in the anterior chamber was 33.0 μg/mL (99.0 % was displaced). The area behind the IOL was not effectively irrigated without inserting the cannula tip. Experiment 2: The final antibiotic concentration was 152.3 μg/mL using the conventional method and 29.4 μg/mL using the BC flushing (88.3 % was displaced). Conclusion: BC flushing technique enables surgeons to completely displace the anterior chamber including the posterior IOL surface, resulting in effective irrigation and a stable antibiotic concentration in virtually all cases. © 2012 Springer-Verlag.


Matsuura K.,Nojima Hospital | Suto C.,Tokyo Women's Medical University | Akura J.,Kushimoto Rehabilitation Center | Inoue Y.,Tottori University
Graefe's Archive for Clinical and Experimental Ophthalmology | Year: 2013

Background: Studies have indicated that intracameral administration of moxifloxacin (MFLX), a fourth-generation fluoroquinolone, is safe and effective. However, administration methods vary between studies, and no definite protocol exists. A prospective study clarifying the incidence of endophthalmitis and complication rates associated with each administration method would require an extremely large sample size because endophthalmitis has a low incidence rate. Therefore, we investigated appropriate intracameral MFLX administration methods by assessing intraocular concentrations following simple injection and flushing, and by measuring drug kinetics (half-life). Methods: Experiment 1: (human eyes). Irrigation (flushing) with 33.33 μg/ml MFLX (150-fold dilution) and simple injection with 0.1 ml of 500 μg/ml MFLX (10-fold dilution) were assessed after cataract surgery. Experiment 2: (rabbits: kinetics study). Flushing with 30-fold or 150-fold dilutions of MFLX was assessed. Aqueous humor samples (0.1 ml) obtained immediately after irrigation and 1, 3, and 5 h after irrigation were analyzed using high-performance liquid chromatography. Results: Experiment 1: MFLX (500 μg/ml) administered using simple injection in humans underwent a 3.3-fold dilution (152.33 μg/ml). Total anterior chamber displacement after flushing with 33.33 μg/ml MFLX resulted in a concentration of 29.54 μg/ml (90 % displacement). Experiment 2: Concentrations at baseline were 52 % at 1 and 15 % at 3 h respectively, suggesting that the half-life of intracameral MFLX was >1 h. Conclusions: Considering that the half-life of MFLX was >1 h, a final concentration of 150 μg/ml results in a 2 h concentration of 38 μg/ml, which was beyond the minimum inhibitory concentration required to inhibit the growth of 90 % of bacteria (MIC90) for most resistant pathogens. We postulate that a final concentration of 150 μg/ml is considerably effective and safe. However, more resistant bacteria will evolve in the future, and the standard MIC90 may change accordingly. Therefore, even if a suitable concentration is determined, it may not necessarily remain constant. This effective concentration should be continually revised on the basis of safety and effectiveness assessments. © 2013 Springer-Verlag Berlin Heidelberg.


Hagino H.,Tottori University | Kishimoto H.,Nojima Hospital | Ohishi H.,Ajinomoto Co. | Horii S.,Takeda Pharmaceutical | Nakamura T.,National Center for Global Health and Medicine
Bone | Year: 2014

Oral risedronate has been shown to be effective in the treatment of osteoporosis when administered once-daily or once-weekly in Japan. This randomized, double-blind, multicenter 12-month study was conducted to compare the efficacy and tolerability of oral risedronate 75mg once-monthly with 2.5mg once-daily in Japanese patients with involutional osteoporosis. Bone mineral density (BMD), biochemical markers of bone metabolism, fractures, and adverse events (AEs) were evaluated. At the end of the study (Month 12, last observation carried forward [M12, LOCF]), mean percent change (SD) from baseline in lumbar spine (L2-L4) BMD, measured by dual energy X-ray absorptiometry (primary endpoint), was increased by 5.69 (4.00)% in the 2.5mg once-daily group (n=428), and 5.98 (4.54)% in the 75mg once-monthly group (n=422). In the non-inferiority t-test (non-inferiority margin δ=1.5%), the 75mg once-monthly group was non-inferior to the 2.5mg once-daily group (p<0.0001). The difference between treatment groups was 0.28% (95% CI, -0.31% to 0.88%). Changes in biochemical markers of bone metabolism were generally comparable in the two groups, although decreases in the percent change from baseline in urinary NTX/CRN and CTX/CRN were statistically greater in the 2.5mg once-daily group than the 75mg once-monthly group. The frequency of new vertebral fractures (including aggravation of prevalent fractures) at the end of the study (M12, LOCF) was also similar in the two groups: 1.2% in the 2.5mg once-daily group and 1.3% in the 75mg once-monthly group.The incidence of mild/moderate/severe AEs was 75.5%/6.3%/0.5% in the 2.5. mg once-daily group and 77.7%/8.1%/0.7% in the 75. mg once-monthly group. AEs associated with gastrointestinal symptoms occurred in approximately 30% of subjects in each group but with no severe cases. AEs potentially associated with acute phase reaction (including symptoms of influenza-like illness or pyrexia starting within 3. days of the first dose of the study drug and with a duration of 7. days or less) only occurred in the 75. mg once-monthly group (2.1%, 9/422 subjects; influenza-like symptoms in 1 subject and pyrexia in 8 subjects), although the incidence was low without any severe cases.In conclusion, risedronate 75. mg once-monthly (a dosage which is 30 times higher than risedronate 2.5. mg once-daily) had non-inferior efficacy in terms of BMD and was similarly well tolerated compared to the once-daily regimen in Japanese patients with involutional osteoporosis. Consistent with the once-daily and once-weekly dosage, the once-monthly dosage of risedronate 75. mg was half that used outside Japan (150. mg). © 2013 The Authors.


Matsuura K.,Nojima Hospital | Inoue Y.,Tottori University
Clinical Ophthalmology | Year: 2014

Background: The purpose of this study was to assess the risk of intraocular contamination caused by intraocular lens (IOL) insertion with injectors by observing the dynamics of an ophthalmic viscosurgical device (OVD). Methods: Each type of injector was equipped with a colored OVD and IOL, and a 2 mm length from the tip of the cartridge was replaced with a colored OVD. The various combinations of IOLs and injectors used were: a three-piece shaped IOL, VA60BBR + TypeE1 (HOYA incision size 2.5 mm; group A, n=5); a single-piece IOL, 251+ iSert micro, preloaded (HOYA, incision size 2.2 mm; group G, n=5); and a single-piece IOL, SN6CWS preloaded (Alcon, incision size 2.7 mm; group C, n=5). Results: In group A, the intraocular OVD instantly flowed backward into the injector, whereas the colored OVD was pushed backward deep inside the cartridge without flowing into the eye. In group B, the backflow of the intraocular OVD into the injector was limited, resulting in the influx of a large amount of the colored OVD into the eye along with the IOL. In group C, as in group A, a large amount of the intraocular OVD flowed backward into the injector. Consequently, a small amount of the colored OVD flowed into the eye. Conclusion: The tip of the injector and OVD could be contaminated because the surgical field cannot be completely sterile, even after preoperative disinfection. Our experiments revealed that OVD backflow into the injector cavity occurs during IOL insertion, and this phenomenon may have minimized intraocular contamination. However, small-diameter cartridges along with plate-type haptics allow insufficient OVD backflow, resulting in intraocular influx of the contaminated OVD. Surgeons have to be notified that intraoperative bacterial contamination can occur even after IOL insertion using injectors. © 2014 Matsuura and Inoue.


Matsuura K.,Nojima Hospital | Uotani R.,Tottori University | Terasaka Y.,Nojima Hospital
Clinical Ophthalmology | Year: 2013

Purpose: We report the successful treatment of a case of cystoid macular edema (CME) associated with topical tafluprost, which was accompanied by serous retinal detachment (SRD). Case: A 78-year-old woman underwent intraocular lens suture surgery, including anterior vitreous cutting, for crystalline lens dislocation in the right eye. Tafluprost was initiated 12 weeks after surgery. Intraocular pressure (IOP) was controlled at 10-14 mmHg. Visual acuity remained at 20/40-30/40. However, the patient complained of blurred vision (20/200) 9 months after surgery. CME accompanied by SRD was identified by optical coherence tomography (OCT) and treated with subtenon triamcinolone injection. Visual acuity rapidly increased to 20/50, and the volume of SRD decreased in a few days. Discontinuation of tafluprost and initiation of diclofenac eye drops improved visual acuity to 20/40 and resulted in improved OCT findings within a few weeks. Three months after injection, tafluprost was resumed along with diclofenac. No recurrence of CME occurred over the following 3 months, and IOP was controlled at 10-15 mmHg. Conclusion: SRD is considered to be a symptom of treatment-resistant CME, which may lead to poor visual acuity after recovery. In such cases, subtenon triamcinolone injection should be strongly considered at an early stage. © 2013 Matsuura et al, publisher and licensee Dove Medical Press Ltd.


Matsuura K.,Nojima Hospital | Sasaki S.,Kushimoto Rehabilitation Center | Uotani R.,Tottori University
Clinical Ophthalmology | Year: 2012

Purpose: Cystoid macular edema (CME) is associated with the use of prostaglandin eye drops after cataract surgery. The study aim was to report on the treatment of two CME patients with subtenon triamcinolone injections. Methods: Case one was a 70-year-old woman who underwent uneventful cataract surgery. Travoprost was administrated at 10 weeks after surgery, and CME occurred at 13 weeks after surgery. Case two was an 85-year-old man who underwent intraocular lens extraction and an intraocular lens suture operation. Latanoprost was readministered after the surgery. The patient complained of blurred vision 3 years later. Results: For both cases, discontinuation of the prostaglandin eye drops, subsequent initiation of treatment with diclofenac eye drops, and subtenon injection of triamcinolone was followed by the rapid disappearance of the CME. After the CME had disappeared for 3 months, the prostaglandin eye drops were resumed. Diclofenac was added in case two. No CME recurrence was seen in either case over 2 years. Conclusion: Subtenon triamcinolone injection can be effective for CME associated with prostaglandin eye liquid after cataract surgery. Prostaglandin eye liquid that causes CME is not necessarily precluded for future use if administered under careful observation. © 2012 Matsuura et al, publisher and licensee Dove Medical Press Ltd.


Kishimoto H.,Nojima Hospital | Maehara M.,Ajinomoto Co.
Archives of Osteoporosis | Year: 2015

Summary: Compliance and persistence with daily, weekly, and monthly bisphosphonates (BPs) for osteoporosis were assessed using data from the Platform for Clinical Information Statistical Analysis (CISA) database that contains data of prescriptions in 13 university hospitals in Japan. The analysis revealed compliance and persistence improved as the dosing interval increases. Purpose: BPs are an effective first-line therapy for osteoporosis, but adherence is low. Compliance (medication possession ratio, MPR) and persistence (time to discontinuation) with daily, weekly, and monthly BPs were compared to ensure better adherence. Methods: Using data from the CISA database containing prescription data in 13 university hospitals in Japan, adherence to oral BPs of osteoporotic patients was investigated. Daily and weekly BPs were compared for compliance and persistence over 5 and 8 years, and daily, weekly, and monthly BPs for those over 1 and 2 years. Results: MPR over 5 years was 20.8 and 60.9 % for daily and weekly BPs (p < 0.001), respectively. MPR over 1 year was 38.6, 70.6, and 77.7 % for daily, weekly, and monthly BPs (P < 0.001), respectively. Persistence over 8 years was significantly higher in weekly than daily BPs (p < 0.001), and that over 5 years was highest in patients receiving BPs monthly (p < 0.01). Conclusion: The present analysis indicates that a monthly regimen has better adherence to treatment as compared with weekly and daily regimens. © 2015, The Author(s).


Kishimoto H.,Nojima Hospital
Clinical calcium | Year: 2013

Bone strength depends on its structure and its material properties. Structural properties are determined by the size and shape of bone and also the microarchitecture. Material properties are determined by mineral crystallinity, collagen structure and microdamage in bone. The strength of bone is adapted to the needs of physical activities by biologic mechanisms, bone modeling and remodeling. The deterioration of bone strength in postmenopausal women is characterized by a trabecular bone deficit with poor trabecular connectivity and followed by a cortical bone deficit with trabeculation of endocortical bone and intracortical porosity due to accelerated bone remodeling. Trabecular bone is getting more fragile with age by poor adaptation to mechanical load by modeling. As a consequence, the endplate collapses and vertebral body fracture occurs. The deterioration of bone strength could be improved by osteoporosis treatment using antiresorber or teriparatide, and these drugs would decrease the risk of vertebral fracture consequently.


Bone strength depends on its structural and material properties. Structural properties are determined by the size and shape of bone and also the microarchitecture. Material properties are determined by mineral crystallinity, collagen structure and microdamage in bone. The strength of bone is adapted to the needs of physical activities by biologic mechanisms, bone modeling and remodeling. The deterioration of bone strength in postmenopausal women is characterized by a trabecular bone deficit with poor trabecular connectivity and followed by a cortical bone deficit with trabeculation of endocortical bone and intracortical porosity due to accelerated bone remodeling. In high turnover osteoporosis antiresorptive therapy is effective in preventing the structural deficit and in increasing the stiffness and the toughness(bone strength)by increasing the mean degree of mineralization of bone tissue through the prolongation of secondary mineralization. But the long-term use of strong antiresorber, i.e. bisphosphonate or denosumab, would result in highly mineralized bone and disturbed repair of microcracks by inhibition of bone remodeling. Intermittent use or discontinuation of strong antiresorber after about 3-5 years of administration could be recommended to avoid the deterioration of bone strength.

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