The Correlation Between Aqueous Humor Flow and IOP Before and After Trabectome: Developing a Grading System to Quantify Flow.

INTRODUCTION: To develop a grading system that provides objective quantification of flow through the conventional aqueous humor outflow (AHO) system. The technique gives clinicians an additional assessment option in the evaluation of glaucoma treatment approaches. METHODS: This was a retrospective observational study. This study evaluated the eyes of all primary open-angle glaucoma patients who underwent a Trabectome (NeoMedix Corp., Tustin, CA, USA) procedure with or without cataract surgery in the interval between April and September 2016 (n = 73). The nasal hemisphere was divided into three regions. Utilizing a four-level grading system designed for this study, an aqueous humor outflow grade (G0-G3) was assigned to each region using a video taken during examinations. The individual grade levels of the three regions were combined to get a composite AHO score. The correlation between the composite AHO score and intraocular pressure (IOP) was then analyzed. Additionally, the speed of red blood cell (RBC) clusters in the episcleral veins (ESV) was calculated when made possible by the existence of pulsatile flow. RESULTS: At 3 months following the Trabectome procedure, average IOP decreased from 26 to 15 mmHg. Assessment of the relationship between AHO grade and IOP demonstrated that a high composite AHO score was correlated with lowered IOP (Tukey-Kramer method p < 0.05). Additionally, it was found that if one of the three regions had an AHO grade of ≥ G2, an IOP of < 20 mmHg could be predicted. (Fischer's exact test p < 0.0001). Calculated speed was as follows: at G1, the speed was 0.68 ± 0.26 mm/s (n = 7), at G2, the speed was 1.8 ± 0.84 mm/s (n = 5), and at G3, the speed was 6.8 ± 3.3 mm/s (n = 6). CONCLUSION: There was a significant correlation between an increase in the composite AHO score and a decrease in IOP. Additionally, the speed of RBC clusters as they traveled through the ESVs remained consistent for each of the grades, and the span of the speeds from lower to higher grades represented a significant range. These findings suggest that the grading system is a reliable measure of AHO. TRIAL REGISTRATION IDENTIFIER: UMIN 000031745.

Soft-shell technique to maintain view of fundus after hemorrhage during vitrectomy in a patient with neovascular glaucoma.

BACKGROUND: Intraoperative hemorrhage into the anterior chamber can hamper the view of the fundus during vitreous surgery. We report a soft-shell technique that can be used to maintain a clear view of the entire fundus after intraoperative hemorrhage. METHODS: A 56-year-old man with rubeotic glaucoma and untreated diabetic retinopathy was scheduled to undergo vitrectomy with retinal photocoagulation. However, an intraoperative hemorrhage occurred from the iris and blocked a clear view of the fundus. RESULTS: The soft-shell technique was performed in which low viscoelastic material was injected into the anterior chamber followed by the injection of higher viscoelastic material. A clear surgical view of the entire fundus was obtained, and the clarity was maintained throughout peripheral vitrectomy and panretinal photocoagulation. The intraocular pressure was normalized after additional filtering surgery. CONCLUSIONS: We recommend the soft-shell technique as a method for obtaining and maintaining a clear view of the posterior pole if hemorrhage occurs in the anterior chamber during vitrectomy.

Nitric oxide production from cultured spiral ligament fibrocytes: effects of corticosteroids.

CONCLUSION: This is the first report of nitric oxide (NO) production by cultured spiral ligament (SL) fibrocytes. The data suggest that dexamethasone (Dex) suppresses NO production by SL fibrocytes. Given that SL fibrocytes play a role in cochlear fluid and ion homeostasis, glucocorticoids may suppress cochlear malfunction caused by NO production in SL fibrocytes. OBJECTIVE: To investigate NO production by cultured SL fibrocytes and regulation of NO production by Dex in mouse secondary cell cultures. MATERIALS AND METHODS: Cultured SL fibrocytes were stimulated with tumor necrosis factor-alpha (TNF-alpha), and NO production was visualized with membrane-permeable 4-amino-5-methylamino-2',7'-difluorofluorescein diacetate (DAF-FM diacetate). Inducible nitric oxide synthase (NOSII) messenger RNA (mRNA) was measured by reverse transcription-polymerase chain reaction (RT-PCR). RESULTS: After TNF-alpha stimulation, the fluorescence intensity increased in a time-dependent manner. This increase in fluorescence intensity was suppressed by a nonspecific NOS inhibitor, N(G)-nitro L-arginine methyl ester (L-NAME), and Dex. After TNF-alpha stimulation, expression of NOSII mRNA was observed. Expression of NOSII mRNA was inhibited by Dex.

Successful treatment of nasal septum hemangioma with the Harmonic Scalpel: a case report.

Hemangioma of the nasal septum, known as "bleeding polyp," is an occasional lesion in adults. We report two cases of bleeding polyps, that were successfully treated by surgery using the Harmonic Scalpel (HS). Two women (aged 58 and 67 years) presented with unilateral nasal hemangioma, which was revealed by unilateral epistaxis. Both the women were treated by surgical excision using the HS under general and local anesthesia, respectively. Treatment involves surgical excision of the tumor including the mucosa and the underlying perichondrium. HS is an effective tool for the excision of bleeding polyps with less bleeding and less tissue injury.

Immunohistochemical detection of cervical lymph node micrometastases from T2N0 tongue cancer.

CONCLUSIONS: These results indicate that extensive, multiple cervical micrometastases occurred from an early stage in patients with T2N0 tongue cancer. The presence of micrometastases suggests the necessity of preventive neck dissection for Level I-IV nodes as a radical treatment. OBJECTIVE: Cervical lymph node metastases occur with a relatively high frequency in patients with T2N0 squamous cell carcinoma of the tongue, and control of the metastases greatly influences the prognosis of patients. In this study, micrometastases in the cervical lymph nodes were investigated to clarify the necessity and required extent of preventive neck dissection. MATERIAL AND METHODS: We investigated micrometastases in 24 subjects who had previously been diagnosed with T2N0 tongue cancer. We performed immunostaining with anti-cytokeratin antibody cocktail AE1/AE3 of sections of 401 paraffin-embedded lymph nodes obtained from these patients. RESULTS: Micrometastases were observed in 14 patients (58%) and were most abundant in Level II nodes (n=11; 46%). Micrometastases were observed in the Level IV nodes of 3 patients (13%), and upstaging to pN2b occurred in 7 patients (29%).

Genetic polymorphisms in the angiotensin II receptor gene and their association with open-angle glaucoma in a Japanese population.

PURPOSE: The local renin-angiotensin system (RAS) is present in the ciliary body and plays a role in regulating aqueous humor dynamics and thus intraocular pressure (IOP). The purpose of this study was to determine whether gene polymorphisms in the RAS increase the risk of development of glaucoma in the Japanese. METHODS: A case-control study was performed in 698 Japanese subjects: 190 patients with primary open-angle glaucoma (POAG), 268 patients with normal-tension glaucoma (NTG), and 240 normal subjects. Ten polymorphisms in seven genes-AGT/Thr174Met and AGT/Met235Thr; REN/I8-83G-->A; ACE/insertion(I)-deletion(D); CMA/-1930A-->G; AGTR1/-731T-->G, AGTR1/-521C-->T, and AGTR1/1166A-->C; AGTR2/3123C-->A; and CYP11B2/-344T-->C were examined. The age, IOP, and visual field defects, all at diagnosis, were examined to determine whether they were associated with the polymorphisms. The effects of oral angiotensin II receptor blocker (ARB) on IOP were examined in association with the AGTR1 and AGTR2 polymorphisms in 20 normal subjects. RESULTS: Of the 10 polymorphisms, the AGTR2/3123C-->A polymorphisms had a significantly different distribution in female patients with NTG; the frequency of the CA+AA genotypes was significantly higher than in female control subjects (P = 0.0095 for CC versus CA+AA). Although no significant difference was seen in the clinical characteristics of female patients with NTG who carried the AGTR2/3123C-->A genotype, patients with CC in the AGTR2 gene had significantly worse visual field scores if they carried ACE/ID+DD (i.e., D carriers; P = 0.012). ARB significantly lowered IOP in normal subjects, but the male subjects with the AGTR2/3123A genotype had significantly less lowering of IOP than those with the C genotype (P = 0.014). CONCLUSIONS: Angiotensin II receptor gene polymorphisms may be associated with the risk of glaucoma in the Japanese population.

Dexamethasone inhibits tumor necrosis factor-alpha-induced cytokine secretion from spiral ligament fibrocytes.

To investigate the effect of proinflammatory cytokines on spiral ligament (SL) fibrocytes and regulation of cytokines by dexamethasone (Dex), in vitro studies were performed in murine secondary cell cultures. Cultured SL fibrocytes were stimulated with tumor necrosis factor-alpha (TNF-alpha), and the secretion of various mediators was measured by enzyme-linked immunosorbent assay (ELISA) and reverse transcribed-polymerase chain reaction (RT-PCR). After stimulation with TNF-alpha, levels of keratinocyte-derived cytokine (KC), monocyte chemoattractant protein-1 (MCP-1), macrophage inflammatory protein-2 (MIP-2), interleukin-6 (IL-6) and soluble intercellular adhesion molecule-1 (sICAM-1) were elevated in the culture supernatant, and their corresponding messenger RNAs were detected in the cultured fibrocytes. When the cultures were incubated with both TNF-alpha and Dex, the levels of KC, MCP-1, MIP-2 and IL-6 were significantly lower than those in cultures treated with TNF-alpha alone. The data suggest that Dex suppresses the inflammatory response in SL fibrocytes. Given that SL fibrocytes play a role in cochlear fluid and ion homeostasis, glucocorticoids may suppress the cochlear malfunction caused by SL inflammation.

Expression of adhesion molecules by cultured spiral ligament fibrocytes stimulated with proinflammatory cytokines.

Secondary cultures from murine spiral ligament (SL) fibrocytes were stimulated with proinflammatory cytokines interleukin-1beta (IL-1beta) and tumor necrosis factor-alpha (TNF-alpha), and expression of various adhesion molecules was investigated. Cultures without cytokine stimulation did not show positive immunostaining for vascular cell adhesion molecule-1 (VCAM-1), intercellular adhesion molecule-1 (ICAM-1), or mucosal addressin cell adhesion molecule-1 (MAdCAM-1). Although staining was also negative after stimulation with IL-1beta, VCAM-1 and ICAM-1 staining was observed after the cells were stimulated with TNF-alpha. Reverse transcription-polymerase chain reaction analysis showed messenger RNAs for both VCAM-1 and ICAM-1 expression to be present after fibrocytes were stimulated with TNF-alpha. These data suggest that activated fibrocytes may cause inflammatory cells to persist in the SL. Given that SL fibrocytes may play a role in homeostasis of cochlear fluid and ion concentrations, prolongation of the inflammatory response could lead to fibrocyte damage that might ultimately result in cochlear malfunction.

[Three cases of carotid body tumor--the usefulness of preoperative radiological studies and embolization].

We report 3 cases of carotid body tumor, computed tomography (CT), magnetic resonance imaging (MRI), and preoperative embolization were conducted in all cases. Carotid body tumor is best treated by surgical removal to ensure a definitive cure. Carotid artery preservation and bleeding control are critical. Although preoperative diagnosis by CT and MRI is relatively easy, the degree of adhesion between a tumor and the carotid artery cannot be determined precisely. Preoperative superselective embolization of the feeding arteries appears useful in decreasing potential intraoperative bleeding and shortening the time required for resection, facilitating the surgical field.