Biomedical subjects

Jun Shimazaki

Publications and source records attributed to Jun Shimazaki.

51 records · Page 3Linked to original sources

PubMed2003

Amniotic membrane transplantation with conjunctival autograft for recurrent pterygium.

OBJECTIVE: To study the effect of amniotic membrane transplantation (AMT) combined with either limbal autograft transplantation (LAT) or conjunctival autograft transplantation (CAT) in recurrent pterygium. DESIGN: Retrospective, noncomparative, interventional case series. PARTICIPANTS: Twenty-seven eyes of 27 patients with recurrent pterygium. The mean number of prior surgeries was 3.1 (range, 1-10). Fifteen eyes each had restriction of ocular movement and symblepharon before surgery. INTERVENTION: Patients were treated by AMT with either LAT (n = 15) or CAT (n = 12). MAIN OUTCOME MEASURES: Recurrence of pterygium, improvement in ocular movement, and symblepharon formation. RESULTS: Twenty-three (85.2%) of 27 eyes showed no recurrence with a mean observation period of 67.0 weeks. Fourteen eyes (93.3%) each showed improvement in ocular movement restriction and symblepharon after AMT. In four eyes that developed recurrence, three had LAT and one had CAT combined with AMT, suggesting that there was no difference in surgical outcome between LAT and CAT. CONCLUSIONS: AMT with CAT is a safe and effective method for recurrent pterygium, especially that associated with ocular movement restriction and symblepharon. Considering the potential adverse effects associated with limbal excision, AMT plus CAT may be preferred over AMT plus LAT.

Adolescent↗

PubMed2003

Significance of capsular attachment and invasion of cancer tissues in prostate cancer.

BACKGROUND: There is a discrepancy in tumor node metastasis (TNM) staging of capsular attachment and invasion; the condition was classified as pT3 in 1987, then as pT2 in 1992. Because capsular finding associated with radical prostatectomy is an important prognostic factor, the present study was conducted to characterize clinicopathological states of cancer tissues attached to and invading the capsule. METHODS: Specimens removed by radical prostatectomy exhibiting pT2 or pT3 from 90 patients who did not receive any treatment before surgery were classified as Loc (24%, cancer tissues localized and apart from capsule), Inv (59%, attached to and invading but not penetrating capsule) and Pen (17%, penetrating capsule). Their clinicopathological profiles were examined. RESULTS: Gleason score, volume of cancer tissues, seminal vesicle invasion, positive surgical margin and regional lymph node metastasis of Inv were distributed between those of Loc and Pen. Postoperative management was decided as routine check-up or endocrine therapy according to pathological findings. Median follow-up was 59 months. Prostate-specific antigen (PSA) relapse occurred in 13 patients, one of whom died of prostate cancer. The remaining of these patients lived. Rate of PSA relapse was not different between Loc and Inv, mainly due to endocrine therapy to Inv with high risk factors. CONCLUSION: Pathological profile of Inv lies between those of Loc and Pen. Therefore, pT2a (1997) would be subclassified as Loc and Inv. Patients with Inv may be required to receive the respective management according to clinicopathological profile, which would be different to that of Loc.

Aged↗

PubMed2003

Corneal opacity and cataract: triple procedure versus secondary approach.

PURPOSE: To determine the efficacy of planned secondary cataract surgery after keratoplasty. METHODS: Twenty patients (22 eyes) with simultaneous corneal pathology and cataract were enrolled in a prospective, interventional, case-matched, nonrandomized comparative trial. Penetrating keratoplasty (PKP) and extracapsular cataract extraction (ECCE) with IOL insertion (triple procedure) were performed in 11 eyes, and planned phacoemulsification (PEA) with IOL insertion after PKP was performed in 11 case-matched eyes. RESULTS: There were 10 eyes (91%) within +/-2.0 D of expected values in the secondary PEA group versus 5 patients (45%) in the triple procedure group. No difference was observed in endothelial cell density after 1-year follow-up. CONCLUSIONS: Planning for secondary PEA in PKP patients with cataracts is a safe and reliable procedure to obtain less post surgical refractive error. Performing a two-stage intervention has no effect on corneal endothelial viability after 1 year.

Adult↗

PubMed2003

Tear function and ocular surface changes with topical mitomycin (MMC) treatment for primary corneal intraepithelial neoplasia.

PURPOSE: To evaluate the tear function and ocular surface alterations in patients with primary CIN before and after treatment with topical mitomycin (MMC). PATIENTS AND METHODS: We describe seven patients with unilateral CIN treated with 0.04% topical MMC three times daily until full eradication of the lesion. The patients underwent tear and ocular surface examinations including Cochet-Bonnet corneal sensitivity measurements, tear film break-up time (BUT), Schirmer test, and Rose-Bengal staining before, at the time of resolution of the CIN, and at the final follow-up. Conjunctival impression cytology was performed before treatment and at the last visit. RESULTS: The mean pretreatment corneal sensitivity was 30.3 +/- 7.4 mm and improved to 55 +/- 5 mm at the final visit (P < 0.05). There were no aqueous-deficient eyes. The BUT values and Rose-Bengal staining scores also showed significant improvement at the last follow-up compared with the pretreatment values (P < 0.05). Initial impression cytology specimens showed goblet cell loss, higher grades of squamous metaplasia, areas of isolated keratinized, binucleated, and actively mitotic disfigured epithelial cells in all patients. The mean goblet cell density and squamous metaplasia grade were observed to improve significantly at the last visit (P < 0.05). MMC-induced cytologic changes were seen to persist long after cessation of treatment in some patients. All eyes remained free of recurrence and complications during the follow-up period. CONCLUSION: We found 0.04% topical MMC treatment tid until full eradication to be effective in the management of CIN. The ocular surface disease of CIN was characterized by disturbance of tear film stability, goblet cell loss, and increased squamous metaplasia in all patients. Impression cytology proved useful in attaining the diagnosis of CIN, evaluating the effect of treatment, and showing MMC-related long-term changes on the ocular surface.

Administration, Topical↗

PubMed2003

Penetrating keratoplasty surgery combined with vitrectomy after failing previous corneal surgery.

PURPOSE: The preoperative and postoperative factors influencing visual outcome were analyzed in 15 eyes of 15 patients with graft opacity after keratoplasty associated with vitreoretinal disease who underwent combined surgery of fresh corneal retransplantation and vitrectomy. MATERIALS AND METHODS: The data obtained consisted of diagnosis, preoperative visual acuity, corneal and vitreoretinal findings at the time of surgery, interval between the first visit and surgery, intraocular pressure before surgery, gonioscopic findings, results of bacterial culture of surgical specimens, surgical procedure for vitrectomy, corneal and vitreous findings after surgery, visual acuity 6 months after surgery, intraocular pressure after surgery, and additional surgical techniques. RESULTS: The cause of corneal opacity was graft rejection in all patients, who had been treated with high-dose administrations of steroids and cyclosporin. The preoperative diagnosis was proliferative vitreoretinopathy (PVR) in eight eyes and fungal endophthalmitis in seven eyes. Corneal transparency was achieved in 7 eyes (46.6%) 6 months after surgery. Vitreoretinal findings improved in 9 eyes (60%) and PVR recurred in 6 eyes (40%). Visual acuity improved in 7 eyes (46.6%), did not change in 2 eyes (13.3%), and deteriorated in 6 eyes (40%). The six eyes with decreased visual acuity developed phthisis bulbi. Preoperative intraocular pressure was 2.1 mmHg on average in the phthisis bulbi group, significantly lower than in the group with superior prognosis. Goniosynechia was noted before surgery and did not improve after surgery in all six eyes. CONCLUSIONS: The outcome was poor in eyes with goniosynechia and ocular hypotony, and combined surgery is not indicated for either anatomic or visual preservation in such cases. Care should be taken not to overlook intraocular infection in patients undergoing immunosuppressive therapy against graft rejection. The early detection of retinal detachment is also important in eyes exhibiting hypotony after surgery.

Adult↗

PubMed2003

[Stage A prostate cancer: comparison of subclassification between Japanese rule and TNM, and outcome].

Between 1980 and June, 2002, transurethral resection of prostate was performed against 3294 cases of benign prostatic hyperplasia, and 144 cases of stage A cancer were detected (4.4%). Among these cases, 136 cases which had complete records of examination were studied. Annual number of stage A and A1:A2 ratio were not influenced by introducing PSA determination from 1991, although the number of T1c has been increasing gradually. Since subclassification of stage A is different between Japanese rules (A1; 3 chips of cancer with well-differentiated adenocarcinoma, A2; others) and TNM (T1a; 5% of less number of chips with cancer, T1b; others), two criteria were compared. Coincidence was found with 93.7%, and disagreement was due to ratio of number of chips with cancer to whole number resected, or different grade. The former difference was caused by a larger or smaller prostate. Most cases of A1 and A2 were subjected to watchful waiting or subsequent therapy. PSA was elevated in 10 cases (7%), two of which died from progression of cancer. Other cases were disease-free. Individual pathological findings are important for subclassification of stage A.

Adenocarcinoma↗

PubMed2002

Clinical application of living-related conjunctival-limbal allograft.

PURPOSE: To report one successful case of conjunctival-limbal allograft for the treatment of a severe ocular surface disorder. METHODS: Interventional case report. A 9-year-old patient suffering from Stevens-Johnson syndrome with total keratinization of the ocular surface of both eyes was treated in the left eye by corneal and conjunctival stem cell transplantation. Oral cyclosporin A and topical autologous serum and corticosteroids were administered. RESULTS: Mucosal epithelial phenotype was maintained in the left eye at most recent examination for more than 3 years after ocular surface reconstruction. CONCLUSION: A total keratinized ocular surface may be treated with the combination of conjunctival and corneal stem cell transplantation.

Child↗

PubMed2002

Randomized clinical trial of deep lamellar keratoplasty vs penetrating keratoplasty.

PURPOSE: To prospectively compare the safety and efficacy of deep lamellar keratoplasty (DLKP) and penetrating keratoplasty (PKP). DESIGN: Prospective, randomized clinical trial. METHODS: Consecutive 26 eyes of 24 patients who had stromal opacity without endothelial abnormalities were randomly assigned to either PKP or DLKP. Best-corrected visual acuity (BCVA), contrast visual acuity, glare test, intraocular pressure, corneal topography, endothelial density, and pachymetry were measured before and after surgery. RESULTS: Two eyes in the DLKP had rupture of the Descemet membrane and one of the eyes developed endothelial decompensation. One eye in the PKP group showed decreases in vision due to secondary glaucoma. None of the eyes developed immunologic rejection. The PKP group showed a tendency of faster recovery in BCVA than the DLKP group, but the difference was not statistically significant. Contrast visual acuity, glare test, and corneal topography did not show significant differences between the two groups. The intraocular pressure was significantly higher at 12 months in the PKP group (P =.004), but not in the DLKP group (P =.41) compared with preoperative values. While the PKP group showed progressive decrease in endothelial density over 24 months, this was not observed in the DLKP group after surgery. Difference in endothelial density at 24 months reached statistical significance (P =.04). CONCLUSIONS: We found that DLKP was superior to PKP in its safety such as continuous decreases of endothelium or increases in intraocular pressure. However, endothelial damage can also occur in DLKP, especially in cases of intraoperative Descemet membrane rupture. With the development of easier surgical techniques, DLKP may be a first choice of keratoplasty in most eyes without endothelial abnormalities.

Adult↗

PubMed2002

Transplantation of human limbal epithelium cultivated on amniotic membrane for the treatment of severe ocular surface disorders.

PURPOSE: To study the short-term clinical results of transplanting of cultivated corneal/limbal epithelial cells on human amniotic membrane (AM) for limbal deficiency. DESIGN: Noncomparative, retrospective interventional case series. PARTICIPANTS: Thirteen eyes of 13 patients with severe limbal deficiency (Stevens-Johnson syndrome in eight eyes, ocular cicatricial pemphigoid in three eyes, and chemical burns in two eyes) were treated at the department of Ophthalmology, Tokyo Dental College, Japan. INTERVENTION: Cultivated allo-limbal epithelium was transplanted onto the ocular surface of patients with severe limbal deficiency. MAIN OUTCOME MEASURES: Ocular surface reconstruction with corneal epithelialization, changes in visual acuity, and postoperative complications were studied. Histologic examinations were also performed on cultivated epithelium. RESULTS: Cultivated corneal epithelium on AM formed two to three layers with the formation of basement membrane-like structures. After the surgery, the epithelium regenerated and covered the ocular surface in eight eyes (61.5%). However, three of the eight eyes developed partial conjunctival invasion, and two eyes later developed epithelial defects. At last examination, corneal epithelialization was achieved in six eyes (46.2%). Five eyes had conjunctivalization, one eye had dermal epithelialization, and one eye was not epithelialized. Complications were corneal perforation in four eyes and infectious keratitis in two eyes. CONCLUSIONS: This study demonstrates that the success rate for transplanting cultivated allo-limbal epithelium on the AM is not different from the conventional limbal and AM transplantation for the treatment of severe limbal stem cell dysfunction.

Adolescent↗

PubMed2002

Low-concentration homogenized castor oil eye drops for noninflamed obstructive meibomian gland dysfunction.

OBJECTIVE: We developed low-concentration homogenized castor oil eye drops for the treatment of patients with noninflamed obstructive meibomian gland dysfunction (MGD), a major cause of lipid-deficiency dry eye, and assessed the safety, stability, and efficacy of the eye drops. DESIGN: Randomized, double-masked, placebo-controlled crossover clinical trial. PARTICIPANTS: Forty eyes of 20 patients with noninflamed MGD. METHODS: After a preliminary study of eye drops containing castor oil, 2% castor oil and 5% polyoxyethylene castor oil (emulsifier) were mixed to formulate homogenized oil eye drops. The patients were assigned randomly to receive oil eye drops or placebo six times daily for 2 periods of 2 weeks each. MAIN OUTCOME MEASURES: At the end of each treatment period, we assessed symptoms, tear interference grade, tear evaporation, fluorescein and rose bengal scores, tear break-up time (BUT), and meibomian gland orifice obstruction. Safety and stability tests were also performed. RESULTS: Symptom scores, tear interference grade, tear evaporation test results, rose bengal scores, tear BUT, and orifice obstruction scores after the oil eye drop period showed significant improvement compared with the results after the placebo period. No complications attributable to the eye drops were observed. The oil eye drops were stable when stored at 4 degrees C. CONCLUSIONS: The results indicate that castor oil eye drops are effective and safe in the treatment of MGD. The possible mechanisms of this treatment are improvement of tear stability as a result of lipid spreading, ease of meibum expression, prevention of tear evaporation, and the lubricating effect of the oil eye drops.

Castor Oil↗

PubMed2002

Cataract surgery combined with ocular surface reconstruction in patients with severe cicatricial keratoconjunctivitis.

PURPOSE: To present the technique and outcome of cataract surgery combined with ocular surface reconstruction in patients with severe cicatricial keratoconjunctivitis. SETTING: Department of Ophthalmology, Tokyo Dental College, Chiba, Japan. METHODS: Phacoemulsification with transplantation of a limbal allograft and an amniotic membrane was performed in 4 eyes of 3 patients with cataract and end-stage cicatricial keratoconjunctivitis. The surgical technique and the improvements in visual acuity were reviewed. The follow-up ranged from 13 to 27 months. RESULTS: Phacoemulsification and intraocular lens implantation were performed in all cases without intraoperative complications. In 3 of the 4 eyes, the best corrected visual acuity improved from hand motions to 20/100, hand motions to 20/30, and counting fingers to 20/50. The visual acuity recovered to 20/60 postoperatively in 1 eye in which the preoperative visual acuity was light perception; at 1 year, the visual acuity decreased to hand motions because of recurrent fibrous tissue over the cornea. CONCLUSION: Small-incision phacoemulsification was performed safely in combination with ocular surface reconstruction in patients with cataract and end-stage cicatricial keratoconjunctivitis.

Cataract↗

PubMed2002

Limbal stem cell transplantation for the treatment of subepithelial amyloidosis of the cornea (gelatinous drop-like dystrophy).

PURPOSE: Subepithelial amyloidosis of the cornea, or gelatinous drop-like corneal dystrophy (GDD), is a severe form of corneal stromal amyloidosis predominantly found in the Japanese population. GDD causes severe visual disturbances with irritating symptoms, and keratoplasty is inevitably complicated by early recurrence. This study was conducted to evaluate the efficacy of limbal stem cell transplantation (LSCT) for the treatment of GDD. METHODS: Nine consecutive eyes of seven patients with GDD were treated with LSCT. Limbal grafts were obtained from cadaver eyes. All eyes underwent lamellar or penetrating keratoplasty simultaneously with LSCT. Intensive epithelial management and immunosuppression therapy was performed. RESULTS: With a mean observation period of 4 years, eight (88.9%) of nine eyes did not show any signs of recurrence. Five grafts remained clear, and seven eyes had an improvement in vision. Glaucoma and rejection were observed in five and three eyes, respectively, and two eyes with glaucoma required surgical intervention. CONCLUSIONS: Limbal stem cell transplantation is effective for the prevention of recurrence in GDD. Control of intraocular pressure and rejection are the keys to long-term maintenance of clear grafts.

Adolescent↗

PubMed2002

[Intravesical instillation of doxorubicin or epirubicin for chemoprophylaxis of superficial bladder cancer--the fifth study of the Japanese Urological Cancer Research Group for Adriamycin/Farumorubicin].

A total of 465 patients with primary and multiple or recurrent, stages Ta and T1 superficial bladder cancer were included in this randomized multicenter trial to compare the prophylactic effect by 17 times instillation of 40 mg doxorubicin or 40 mg epirubicin with no instillation after transurethral resection of tumor(s). The primary endpoint was first recurrence after transurethral resection. Endoscopic examination as well as urinary cytology was performed in each case every three months. It became evident that the recurrence rate in the doxorubicin or epirubicin instillation arm was lower that in the no instillation arm. Toxicity was mainly restricted to bladder irritation in about 10% of patients in each instillation arm.

Administration, Intravesical↗

PubMed2002

[Clinical effects of a 3-month formulation LH-RH agonist, TAP-144-SR (3M) in prostate cancer patients].

A randomized, multicenter, double-blind, parallel-group study was conducted in order to evaluate the hormonal kinetics, pharmacokinetics, efficacy and safety of TAP-144-SR (3M) a three-month sustained-release injectable preparation of leuprorelin acetate, a highly active luteinizing hormone-releasing hormone (LH-RH) derivative by comparing the treatment with two subcutaneous doses of the test medication TAP-144-SR (3M) and the treatment with six subcutaneous doses of the reference medication TAP-144-SR (1M), a 1-month sustained-release injectable preparation. Study participants were 103 patients with prostate cancer in whom a stable anti-tumor effect had been obtained with Leuplin Injection 3.75. The hormonal kinetics revealed that the proportion of the patients "maintaining the castration level of serum testosterone (maximum serum testosterone level during treatment below the castration level [100 ng/dl])" was 100% in both treatment groups. With regard to the efficacy, the proportions of the patients in whom the anti-tumor effects (> or = Stable) of the baseline treatment prior to the initiation of the treatment with the study medication were maintained during the study treatment period (6 months) were comparable; 84.0% with TAP-144-SR (1M) and 80.4% with TAP-144-SR (3M). On evaluation of the pharmacokinetics, the mean value of AUC1-12w of the serum TAP-144 concentration (including the metabolite M-I) for the treatment with TAP-144-SR (3M) was 77.0% that of the treatment with TAP-144-SR (1M). Adverse events were similar in the subjects on TAP-144-SR (3M) and in those on TAP-144-SR (1M). There existed no big differences in kind, incidence or time of occurrence of adverse events between two groups. TAP-144-SR (3M) showed no clinically relevant findings in particular. These results indicate that one dose of TAP-144-SR (3M) is comparable to three doses of the already approved Leuplin injection 3.75 in serum testosterone level-inhibitory effect, efficacy and safety. Hence, it is considered that TAP-144-SR (3M) is a drug suitable for treatment of prostate cancer over a prolonged period of time.

Aged↗

PubMedDate not supplied

Disposable eyelid-warming device for the treatment of meibomian gland dysfunction.

PURPOSE: To assess the clinical efficacy of a newly developed disposable eyelid-warming device (Eye Warmer) for the treatment of meibomian gland dysfunction (MGD). METHODS: The Eye Warmer was applied for 5 minutes to 44 eyes of 22 patients who exhibited decreased tear break-up time (BUT) and dry-eye symptoms. Its efficacy was assessed on the basis of BUT and dry-eye symptoms in the short-term study. In the therapeutic study, the Eye Warmer was applied to 34 eyes of 17 MGD patients with decreased BUT and dry-eye symptoms for 5 minutes once a day for 2 weeks. The 16 eyes of 8 patients served as untreated controls. We examined tear film lipid layer interference patterns, BUT, meibomian gland secretion, and dry-eye symptoms in both groups before and after the treatment. RESULTS: BUT and dry-eye symptoms significantly improved after the treatment in both the short-term and the therapeutic study (P<.01). The incidence of normal tear lipid layer in the treated group was significantly higher after treatment (28 eyes [82.4%]) than before (19 eyes [55.9%]) (P=.036). The incidence of meibomian gland obstruction was significantly decreased after treatment (14 eyes [41.2%]) compared to before treatment (26 eyes [76.5%]) (P=.006). CONCLUSIONS: Warming the eyelids with the Eye Warmer improved the stability and uniformity of the tear lipid layer in MGD patients by melting the meibomian gland lipid. Our study demonstrates the usefulness of the Eye Warmer for the treatment of MGD.

Adult↗