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Movement of intraretinal fluid from distant branch retinal vein occlusion to the submacular space
Otani T, Yamaguchi Y, Kishi S
Clinical Ophthalmology , 2013, DOI: http://dx.doi.org/10.2147/OPTH.S40198
Abstract: vement of intraretinal fluid from distant branch retinal vein occlusion to the submacular space Case Series (697) Total Article Views Authors: Otani T, Yamaguchi Y, Kishi S Published Date January 2013 Volume 2013:7 Pages 81 - 86 DOI: http://dx.doi.org/10.2147/OPTH.S40198 Received: 11 November 2012 Accepted: 13 December 2012 Published: 09 January 2013 Tomohiro Otani, Yumiko Yamaguchi, Shoji Kishi Department of Ophthalmology, Gunma University School of Medicine, Maebashi, Gunma, Japan Background: Extramacular branch retinal vein occlusion (BRVO) occasionally causes serous macular detachment. We studied the movement of extravasated fluid from BRVO lesions to the submacular space. Methods: We examined nine eyes from nine patients with serous retinal detachment caused by extramacular BRVO. In addition to a comprehensive ophthalmic examination, optical coherence tomography was performed in all nine eyes. Six of the patients also underwent fluorescein angiography. Results: Visual acuity ranged from 0.03 to 0.9 (median 0.5). All nine eyes showed localized macular detachment and retinal edema which extended from the extramacular BRVO to the macula. Fluorescein angiography revealed dye leakage in the extramacular area but no macular leakage in the six eyes examined. Optical coherence tomography revealed serous retinal detachment in the macula and intraretinal swelling, with low reflectivity in the outer retina extending from the distant BRVO toward the detached macula in all nine eyes. Six eyes were treated with laser photocoagulation, covering the entire area of BRVO, and the other three eyes were treated with intravitreal bevacizumab. Serous retinal detachment and retinal swelling resolved within 3 months of treatment in all nine eyes. Conclusion: Distant retinal vascular leakage appears to diffuse through the outer retina to the macula, then permeate into the subretinal space.
Asymmetric severity of diabetic retinopathy in Waardenburg syndrome
Kashima T, Akiyama H, Kishi S
Clinical Ophthalmology , 2011, DOI: http://dx.doi.org/10.2147/OPTH.S27490
Abstract: symmetric severity of diabetic retinopathy in Waardenburg syndrome Case report (2365) Total Article Views Authors: Kashima T, Akiyama H, Kishi S Published Date December 2011 Volume 2011:5 Pages 1717 - 1720 DOI: http://dx.doi.org/10.2147/OPTH.S27490 Tomoyuki Kashima, Hideo Akiyama, Shoji Kishi Department of Ophthalmology, Gunma University School of Medicine, Gunma 371-8511, Japan Abstract: A 30-year-old female patient was referred to our institution due to vitreous hemorrhage. Best corrected visual acuity of her right and left eyes at her initial visit was 10/20 and 20/20, respectively. Although hypochromic iris was observed in the superior iris between the 10 and 2 o’clock positions in her right eye, her entire left eye exhibited hypochromic iris. Hypopigmentation of the fundus was seen in the superior part of her right eye. This eye also had a huge neovascularization on the optic disc that was 7 discs in diameter. Conversely, her left fundi showed hypopigmentation of the fundus in the entire region of the left eye, and dot hemorrhages were observed all over the left fundi, although no neovascularization could be seen microscopically. Fluorescein angiography showed a huge neovascularization in the right eye and a tiny neovascularization in the left eye. Gene analysis revealed the presence of the PAX3 gene homeobox domain mutation, which led to her being diagnosed as Waardenburg syndrome type 1. Magnetic resonance angiography showed there was no obstructive region at either of the internal carotid arteries and ophthalmic arteries. The severity of the diabetic retinopathy appeared to be correlated with the degree of hypopigmentation in the posterior fundus. We speculate that hypopigmentation of the fundus in Waardenburg syndrome may be responsible for the reduction in retinal metabolism, which led to a reduction in oxygen consumption and prevented further aggravation of the diabetic retinopathy. Only laser treatments using short wavelengths was effective in this case. While the extinction coefficient for hemoglobin when using green light is higher than when using yellow light, the differences between these wavelengths tend to disappear when oxygenated hemoglobin is present. To the best of the authors’ knowledge, this is the first case report of a patient with Waardenburg syndrome and diabetic retinopathy.
Movement of intraretinal fluid from distant branch retinal vein occlusion to the submacular space
Otani T,Yamaguchi Y,Kishi S
Clinical Ophthalmology , 2013,
Abstract: Tomohiro Otani, Yumiko Yamaguchi, Shoji KishiDepartment of Ophthalmology, Gunma University School of Medicine, Maebashi, Gunma, JapanBackground: Extramacular branch retinal vein occlusion (BRVO) occasionally causes serous macular detachment. We studied the movement of extravasated fluid from BRVO lesions to the submacular space.Methods: We examined nine eyes from nine patients with serous retinal detachment caused by extramacular BRVO. In addition to a comprehensive ophthalmic examination, optical coherence tomography was performed in all nine eyes. Six of the patients also underwent fluorescein angiography.Results: Visual acuity ranged from 0.03 to 0.9 (median 0.5). All nine eyes showed localized macular detachment and retinal edema which extended from the extramacular BRVO to the macula. Fluorescein angiography revealed dye leakage in the extramacular area but no macular leakage in the six eyes examined. Optical coherence tomography revealed serous retinal detachment in the macula and intraretinal swelling, with low reflectivity in the outer retina extending from the distant BRVO toward the detached macula in all nine eyes. Six eyes were treated with laser photocoagulation, covering the entire area of BRVO, and the other three eyes were treated with intravitreal bevacizumab. Serous retinal detachment and retinal swelling resolved within 3 months of treatment in all nine eyes.Conclusion: Distant retinal vascular leakage appears to diffuse through the outer retina to the macula, then permeate into the subretinal space.Keywords: branch retinal vein occlusion, optical coherence tomography, serous macular detachment, fluorescein angiography, outer retina
Asymmetric severity of diabetic retinopathy in Waardenburg syndrome
Kashima T,Akiyama H,Kishi S
Clinical Ophthalmology , 2011,
Abstract: Tomoyuki Kashima, Hideo Akiyama, Shoji KishiDepartment of Ophthalmology, Gunma University School of Medicine, Gunma 371-8511, JapanAbstract: A 30-year-old female patient was referred to our institution due to vitreous hemorrhage. Best corrected visual acuity of her right and left eyes at her initial visit was 10/20 and 20/20, respectively. Although hypochromic iris was observed in the superior iris between the 10 and 2 o’clock positions in her right eye, her entire left eye exhibited hypochromic iris. Hypopigmentation of the fundus was seen in the superior part of her right eye. This eye also had a huge neovascularization on the optic disc that was 7 discs in diameter. Conversely, her left fundi showed hypopigmentation of the fundus in the entire region of the left eye, and dot hemorrhages were observed all over the left fundi, although no neovascularization could be seen microscopically. Fluorescein angiography showed a huge neovascularization in the right eye and a tiny neovascularization in the left eye. Gene analysis revealed the presence of the PAX3 gene homeobox domain mutation, which led to her being diagnosed as Waardenburg syndrome type 1. Magnetic resonance angiography showed there was no obstructive region at either of the internal carotid arteries and ophthalmic arteries. The severity of the diabetic retinopathy appeared to be correlated with the degree of hypopigmentation in the posterior fundus. We speculate that hypopigmentation of the fundus in Waardenburg syndrome may be responsible for the reduction in retinal metabolism, which led to a reduction in oxygen consumption and prevented further aggravation of the diabetic retinopathy. Only laser treatments using short wavelengths was effective in this case. While the extinction coefficient for hemoglobin when using green light is higher than when using yellow light, the differences between these wavelengths tend to disappear when oxygenated hemoglobin is present. To the best of the authors’ knowledge, this is the first case report of a patient with Waardenburg syndrome and diabetic retinopathy.Keywords: asymmetry, diabetic retinopathy, Waardenburg syndrome, albinism, hypopigmentation
Extra-Articular Stabilization of the Canine Cranial Cruciate Ligament Injury Using Arthrex Corkscrew and FASTak Anchors  [PDF]
Erin N. Kishi, Don Hulse, Matthew Raske, W. Brian Saunders, Brian S. Beale
Open Journal of Veterinary Medicine (OJVM) , 2013, DOI: 10.4236/ojvm.2013.32024
Abstract:

The objective of this study was to evaluate the long-term outcome in dogs with cranial cruciate ligament injury that were repaired with an Arthrex Corkscrew or FASTak bone anchor and Fiberwire placed at near isometric points of the stifle. A retrospective study (2006-2010) was conducted by reviewing clinical records of dogs treated for cranial cruciate ligament injury with an extra-articular repair method using anchors preloaded with Fiberwire. A questionnaire was given to owners for evaluation of their dog’s performance prior to surgery and at time of follow-up with a minimum of 12 months post-operative. Owner assessment was rated using a visual analogue scale. Completed questionnaires from 34 owners were received. The mean time to follow up was 27.5 months. Owner assessment of their dog prior to surgery versus at the time of follow up were considered significant (P < 0.001) in regards to quality of life, willingness to play voluntarily, activity level, stiffness at the beginning and end of the day, lameness in the surgical limb, and pain while walking on the surgical limb. These results indicate that extra-articular stabilization with Arthrex Corkscrew and FASTak anchors placed at near isometric sites are adequate repair methods for cranial cruciate ligament rupture.


A case of traumatic intracranial vertebral artery injury presenting with life-threatening symptoms
Kishi S, Kanaji K, Doi T, Matsumura T
International Medical Case Reports Journal , 2012, DOI: http://dx.doi.org/10.2147/IMCRJ.S30930
Abstract: case of traumatic intracranial vertebral artery injury presenting with life-threatening symptoms Case report (1431) Total Article Views Authors: Kishi S, Kanaji K, Doi T, Matsumura T Published Date April 2012 Volume 2012:5 Pages 23 - 28 DOI: http://dx.doi.org/10.2147/IMCRJ.S30930 Received: 16 February 2012 Accepted: 21 March 2012 Published: 24 April 2012 Seiji Kishi1, Kenji Kanaji2, Toshio Doi1, Tadashi Matsumura2 1Department of Nephrology, Tokushima University Hospital, Kuramoto-cho Tokushima, 2Department of General Internal Medicine, Rakuwakai Otowa Hospital, Otowachinji-cho Yamashina-ku Kyoto, Japan Abstract: Traumatic intracranial vertebral artery injury is a relatively rare but potentially fatal disease. We present a case of a 63-year-old man who presented with sudden onset of loss of consciousness after hitting his head. After immediate resuscitation, he showed quadriplegia and absence of spontaneous breathing. Brain and cervical spine magnetic resonance imaging revealed an atlantoaxial subluxation, fractured C2 odontoid process, left vertebral artery occlusion, and bilateral extensive ischemia in the medulla oblongata and high cervical spinal cord. Digital subtraction angiography demonstrated left vertebral artery dissection just below the level of vertebral body C2.
Improved subjective symptoms of conjunctivochalasis using bipolar diathermy method for conjunctival shrinkage
Kashima T, Akiyama H, Miura F, Kishi S
Clinical Ophthalmology , 2011, DOI: http://dx.doi.org/10.2147/OPTH.S24475
Abstract: oved subjective symptoms of conjunctivochalasis using bipolar diathermy method for conjunctival shrinkage Original Research (2585) Total Article Views Authors: Kashima T, Akiyama H, Miura F, Kishi S Supplementary video showing the procedure of the method used in this study Views: 546 Published Date September 2011 Volume 2011:5 Pages 1391 - 1396 DOI: http://dx.doi.org/10.2147/OPTH.S24475 Tomoyuki Kashima1,2, Hideo Akiyama1, Fumihide Miura2, Shoji Kishi1 1Department of Ophthalmology, Gunma University School of Medicine, Gunma, Japan; 2Department of Ophthalmology, Saku Central Hospital, Nagano, Japan Purpose: To evaluate the improvement in subjective symptoms of conjunctivochalasis after bipolar coagulation. Methods: Forty-three eyes of 26 patients (average age, 75.7 ± 8.4 years) were included in this study. The inferior conjunctivas were cauterized between April 2009 and June 2010. Surgery involved pinching the excess conjunctiva and performing bipolar cauterization after subconjunctival injection of a local anesthetic agent. Patients were asked to describe the postoperative foreign-body sensation and change in subjective symptoms 1 month postoperatively, with the preoperative symptom score defined as 10. Results: Twenty-two patients (84.6%) reported symptom relief immediately after the procedure, though all patients had a mild gritty sensation for 1–2 weeks postoperatively. The mean postoperative symptom score obtained from the questionnaire was 3.27 ± 3.31, which was significantly lower than the preoperative score (P < 0.0001). No patients had experienced recurrent symptoms at the end of the follow-up period. Conclusion: Thermal cauterization can achieve conjunctival shrinkage and adherence to the subconjunctival tissues. Operation time is only a few minutes, postoperative pain is not severe, and the procedure can be performed in an outpatient clinic, all of which represent benefits to the patients.
Resolution of persistent corneal erosion after administration of topical rebamipide
Kashima T, Akiyama H, Miura F, Kishi S
Clinical Ophthalmology , 2012, DOI: http://dx.doi.org/10.2147/OPTH.S35122
Abstract: olution of persistent corneal erosion after administration of topical rebamipide Case report (2071) Total Article Views Authors: Kashima T, Akiyama H, Miura F, Kishi S Published Date August 2012 Volume 2012:6 Pages 1403 - 1406 DOI: http://dx.doi.org/10.2147/OPTH.S35122 Received: 18 June 2012 Accepted: 31 July 2012 Published: 29 August 2012 Tomoyuki Kashima,1,2 Hideo Akiyama,1 Fumihide Miura,2 Shoji Kishi1 1Department of Ophthalmology, Gunma University School of Medicine, Maebashi, Japan; 2Department of Ophthalmology, Saku Central Hospital, Saku, Japan Abstract: Rebamipide is an antiulcer agent used to treat gastric ulcer and gastritis. Biological effects of rebamipide include cytoprotection, wound healing, and anti-inflammatory properties that are known to be universal for a variety of tissues in addition to gastrointestinal mucosa. The therapeutic effects of rebamipide eye drops are due to its ability to increase corneal and conjunctival mucin-like substances and improve corneal and conjunctival injury in vivo. In this paper, we report a case of Sj gren's syndrome with complete disappearance of corneal erosion after administration of rebamipide eye drops. This was observed even though corneal erosion had not improved for 6 months after punctal occlusion surgery. The patient was a 33-year-old female, diagnosed with Sj gren's syndrome by a salivary gland biopsy. The corneal and conjunctival surfaces were filled with dense erosions, which did not improve with topical drugs. Punctal plugs were applied several times; however, the plugs were repeatedly shed. All four puncta of both eyelids were surgically occluded, and both corneal and conjunctival erosion was clearly improved. However, the erosion in the inferior cornea of both eyes had not improved for 6 months after surgery. We used the newly approved topical rebamipide for treatment of this patient. The corneal erosion gradually improved and completely disappeared 4 weeks after administration of the drug. Dry eye sensation disappeared at the same time. Both membrane-associated mucin and secreted mucin in the ocular surface are thought to be essential for maintenance of the tear film. Induction of mucin from ocular surface epithelium could be an effective treatment in cases of dry eye caused by mucin deficiency. Through its various mechanisms, rebamipide improves ocular surface conditions. To our knowledge, this is the first clinical case report using rebamipide ophthalmic solution. This drug may provide a novel approach to treat drying diseases of the eye.
A case of traumatic intracranial vertebral artery injury presenting with life-threatening symptoms
Kishi S,Kanaji K,Doi T,Matsumura T
International Medical Case Reports Journal , 2012,
Abstract: Seiji Kishi1, Kenji Kanaji2, Toshio Doi1, Tadashi Matsumura21Department of Nephrology, Tokushima University Hospital, Kuramoto-cho Tokushima, 2Department of General Internal Medicine, Rakuwakai Otowa Hospital, Otowachinji-cho Yamashina-ku Kyoto, JapanAbstract: Traumatic intracranial vertebral artery injury is a relatively rare but potentially fatal disease. We present a case of a 63-year-old man who presented with sudden onset of loss of consciousness after hitting his head. After immediate resuscitation, he showed quadriplegia and absence of spontaneous breathing. Brain and cervical spine magnetic resonance imaging revealed an atlantoaxial subluxation, fractured C2 odontoid process, left vertebral artery occlusion, and bilateral extensive ischemia in the medulla oblongata and high cervical spinal cord. Digital subtraction angiography demonstrated left vertebral artery dissection just below the level of vertebral body C2.Keywords: vertebral artery dissection, brainstem infarction, bilateral spinal cord infarction, neck trauma
Improved subjective symptoms of conjunctivochalasis using bipolar diathermy method for conjunctival shrinkage
Kashima T,Akiyama H,Miura F,Kishi S
Clinical Ophthalmology , 2011,
Abstract: Tomoyuki Kashima1,2, Hideo Akiyama1, Fumihide Miura2, Shoji Kishi11Department of Ophthalmology, Gunma University School of Medicine, Gunma, Japan; 2Department of Ophthalmology, Saku Central Hospital, Nagano, JapanPurpose: To evaluate the improvement in subjective symptoms of conjunctivochalasis after bipolar coagulation.Methods: Forty-three eyes of 26 patients (average age, 75.7 ± 8.4 years) were included in this study. The inferior conjunctivas were cauterized between April 2009 and June 2010. Surgery involved pinching the excess conjunctiva and performing bipolar cauterization after subconjunctival injection of a local anesthetic agent. Patients were asked to describe the postoperative foreign-body sensation and change in subjective symptoms 1 month postoperatively, with the preoperative symptom score defined as 10.Results: Twenty-two patients (84.6%) reported symptom relief immediately after the procedure, though all patients had a mild gritty sensation for 1–2 weeks postoperatively. The mean postoperative symptom score obtained from the questionnaire was 3.27 ± 3.31, which was significantly lower than the preoperative score (P < 0.0001). No patients had experienced recurrent symptoms at the end of the follow-up period.Conclusion: Thermal cauterization can achieve conjunctival shrinkage and adherence to the subconjunctival tissues. Operation time is only a few minutes, postoperative pain is not severe, and the procedure can be performed in an outpatient clinic, all of which represent benefits to the patients.Keywords: coagulation, cauterization, conjunctival injection
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