Publications by authors named "Yasuhiro Takahashi"

280 Publications

Post-traumatic Orbital Abscess in an Adult With No Evidence of Orbital Fracture, Paranasal Sinusitis, or Foreign Body Migration.

Cureus 2021 Feb 16;13(2):e13376. Epub 2021 Feb 16.

Oculoplastic, Orbital and Lacrimal Surgery, Aichi Medical University Hospital, Aichi, JPN.

A 35-year-old man was hit against his left eye by his child's foot. Two days following trauma, the patient noticed diplopia in the upward and right gazes. On the first examination seven days after trauma, computed tomographic (CT) images revealed a small mass in the inferolateral orbit near the inferior orbital fissure. There was no radiological evidence of orbital fracture, paranasal sinusitis, or foreign body. Immediately after the first examination, the patient had a history of fever, retrobulbar pain, and nausea. These symptoms gradually worsened, and the patient visited the emergency department of our hospital at 13 days following trauma. CT images showed enlargement in the size of the mass. The diagnosis of the orbital abscess was made, and emergent drainage of the abscess was performed, followed by administration of intravenous antibiotics. On the fifth postoperative day, cultures of the abscess specimen showed growth of (4+), (4+), and (4+). The patient's condition improved significantly and at the 1.5-month follow-up, the patient did not have any symptoms related to the orbital abscess.
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http://dx.doi.org/10.7759/cureus.13376DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7971697PMC
February 2021

Dacryoendoscopy-guided re-canalization of canaliculops: Two case reports.

Medicine (Baltimore) 2021 Mar;100(10):e24985

Department of Ophthalmology, Osaka Medical College, Takatsuki.

Rationale: Canaliculops is a rare condition, and only 11 cases have been reported previously. We report 2 cases of canaliculops, which were successfully treated using the new recanalization technique under dacryoendoscopy followed by bicanalicular lacrimal intubation.

Patient Concerns: A 78-year-old man and a 76-year-old woman had 3- and 1-year histories of medial-upper eyelid swelling (left and right, respectively) without any inflammatory signs, history of periocular trauma, herpes infection, use of specific drugs, or ophthalmic diseases of note.

Diagnoses: The cystic lesions were evaluated using ultrasound biometry or computed tomography to find the lumen of the horizontal canaliculus was exceedingly expanded, and to confirm the clinical diagnosis of canaliculops.

Interventions: As the 2 cases of canaliculops were caused by upper puncta and common canaliculus obstructions, canaliculops of the upper eyelid were recanalized under dacryoendoscopic guidance, followed by bicanalicular intubation. The tubes were kept in situ involving bi-weekly irrigation and instillation of antibiotic and anti-inflammatory eye drops, and were removed after 2 to 3 months of follow-up.

Outcomes: Epiphora, and eyelid swelling were completely resolved immediately after the procedure, and the lesions did not recur on follow-up after more than 6 months.

Lessons: Eleven case series of canaliculops have been described previously, but this is the first report of this recanalization procedure offering a new, less invasive treatment option compared to complete or partial resection of the cystic lesion.
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http://dx.doi.org/10.1097/MD.0000000000024985DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7969210PMC
March 2021

Bilateral Epibulbar Dermolipomas in a Patient With Goldenhar Syndrome.

J Craniofac Surg 2021 Mar-Apr 01;32(2):e217-e218

Department of Oculoplastic, Orbital & Lacrimal Surgery, Aichi Medical University Hospital, Aichi, Japan.

Abstract: A 19-year-old woman consulted for bilateral superotemporal conjunctival lesions that had been present since birth. Physical examination also revealed hemifacial microsomia and bilateral auricular appendages. Medical history included heart, hearing, and neurologic problems. Excision biopsy of these lesions showed nodular proliferations of adipose tissue, which corresponded to the diagnosis of dermolipomas in the setting of Goldenhar syndrome. Complete examination for other first and second branchial arch anomalies is warranted in patients presenting with such lesions.
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http://dx.doi.org/10.1097/SCS.0000000000006919DOI Listing
March 2021

Tear film break-up patterns in thyroid eye disease.

Sci Rep 2021 Mar 5;11(1):5288. Epub 2021 Mar 5.

Department of Oculoplastic, Orbital and Lacrimal Surgery, Aichi Medical University Hospital, 1-1 Yazako-Karimata, Nagakute, Aichi, 480-1195, Japan.

Evaluation of tear film break-up pattern (TFBUP) is the main diagnostic method for tear film-oriented therapy (TFOT) of dry eye. This prospective, observational study examined TFBUPs in 154 eyes/sides from 78 patients with thyroid eye disease (TED) who met the diagnostic criteria for dry eye in Japan. TFBUPs were classified as area, line, spot, dimple, and random breaks. Results for the status of TED and dry eye were compared between the TFBUPs. Consequently, line, spot, dimple, and random breaks were observed in 80 (51.9%), 29 (18.8%), 10 (6.5%), and 35 eyes (22.7%) while no eyes showed area breaks. The random break group had the highest incidence of lid lag/Graefe sign and superior limbic keratoconjunctivitis (SLK) (P < 0.050). Although the incidence of each TFBUP is almost equal in patients with simple dry eye without TED, line breaks were more frequently observed in TED. In addition, while random breaks in simple dry eye are usually only associated with minor ocular surface damages, those in TED were associated with a higher incidence of concomitant SLK. These results will be helpful for understanding the etiology of dry eye in TED and for TFOT in TED.
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http://dx.doi.org/10.1038/s41598-021-84661-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7935998PMC
March 2021

Re: punctal dilatation and non-incisional canalicular curettage in the management of infectious canaliculitis.

Orbit 2021 Mar 4. Epub 2021 Mar 4.

Department of Oculoplastic, Orbital & Lacrimal Surgery, Aichi Medical University Hospital, Aichi, Japan.

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http://dx.doi.org/10.1080/01676830.2021.1892772DOI Listing
March 2021

Relationship Between Eyelid Pressure and Lacrimal Status in Mild Facial Nerve Palsy.

Cureus 2021 Jan 20;13(1):e12830. Epub 2021 Jan 20.

Oculoplastic, Orbital and Lacrimal Surgery, Aichi Medical University Hospital, Aichi, JPN.

Purpose: Facial nerve palsy is frequently associated with both epiphora and dry eye, and orbicularis oculi muscle weakness or paralysis is the main cause of these symptoms. Eyelid pressure is a quantitatively measurable parameter for evaluating the tone and function of the orbicularis oculi muscle. The aim of this study was to examine the relationship between eyelid pressure and lacrimal status in patients with mild facial nerve palsy.

Methods: This prospective, interventional study included 10 patients with unilateral facial nerve palsy. The severity of facial nerve palsy was determined using the CADS scale (cornea, static asymmetry, dynamic function, and synkinesis). Eyelid pressure was measured using a blepharo-tensiometer. Lacrimal status was quantified through tear meniscus height (TMH), clinical assessment of meibomian gland dysfunction (MGD) (eyelid margin abnormalities, Marx line, meibum expression, and loss of meibomian glands), corneal fluorescein staining, tear break-up time, and Schirmer test I results.

Results: All 10 patients suffered from mild facial nerve palsy without eyelid ectropion or entropion, or gustatory epiphora. Lower eyelid pressure during forceful eye closure was significantly decreased in affected eyes (P = 0.007), but upper eyelid pressure during forceful eye closure and static upper and lower eyelid pressure were not significantly different between the affected and unaffected sides (P > 0.050). The TMH, MGD, and dry eye measurements showed no significant difference between the affected and unaffected eyes (P > 0.050).

Conclusions: Mild facial nerve palsy is associated with decreased lower eyelid pressure during forceful eye closure. However, no other differences in upper eyelid pressure during forceful eye closure, static eyelid pressure, TMH, MGD, or dry eye disease symptoms were noted. These results imply that eyelid pressure slightly decreases due to mild facial nerve palsy, but this change may be clinically negligible.
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http://dx.doi.org/10.7759/cureus.12830DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7899130PMC
January 2021

Amyloidosis in the Palpebral Conjunctiva Mimicking Lymphoproliferative Lesion.

Case Rep Ophthalmol 2021 Jan-Apr;12(1):73-76. Epub 2021 Jan 14.

Department of Oculoplastic, Orbital and Lacrimal Surgery, Aichi Medical University Hospital, Nagakute, Japan.

A 47-year-old Japanese woman presented with a 1-year history of foreign body sensation in the right eye. Upon examination, a linear soft tissue lesion in the lower conjunctival fornix was noted. The mass resembled a conjunctival lymphoproliferative lesion but was pinkish-yellow rather than salmon pink in color. Histopathology of the biopsy specimens revealed amyloidosis. Systemic workup showed no other lesions. The conjunctival lesion did not recur at 3 months postoperatively. Since conjunctival amyloidosis mimics conjunctival lymphoproliferative lesions, it is important to keep conjunctival amyloidosis as a differential diagnosis in the diagnosis of a pinkish conjunctival lesion.
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http://dx.doi.org/10.1159/000510392DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7879327PMC
January 2021

Modified Loop Myopexy (Yokoyama's Procedure) for High Myopic Strabismus Fixus.

Case Rep Ophthalmol 2021 Jan-Apr;12(1):68-72. Epub 2021 Jan 14.

Department of Oculoplastic, Orbital and Lacrimal Surgery, Aichi Medical University Hospital, Nagakute, Japan.

In the classic loop myopexy (Yokoyama) procedure, muscle belly union in the deep orbit is technically difficult, particularly in patients with deep-set eyes and narrow palpebral fissures. Our modified procedure includes a lateral canthotomy and cantholysis and upper conjunctival fornix incisions to facilitate this step.
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http://dx.doi.org/10.1159/000510818DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7879241PMC
January 2021

Disabling muscle of Riolan: A novel concept of orbicularis oculi myectomy for refractory benign essential blepharospasm.

Eur J Ophthalmol 2021 Feb 12:1120672121991043. Epub 2021 Feb 12.

Department of Oculoplastic, Orbital & Lacrimal Surgery, Aichi Medical University Hospital, Nagakute, Aichi, Japan.

Purpose: To examine the effectiveness of orbicularis oculi myectomy with disabling the muscle of Riolan in patients with benign essential blepharospasm refractory to botulinum toxin-A (BTX-A) injection.

Methods: This retrospective, observational study included 25 patients. After removal of the redundant skin and underlying orbicularis oculi muscle (OOM) with or without extended OOM removal to the area of the superior orbital rim, the tarsal plate and the gray line were vertically severed at 2 points to disable the muscle of Riolan. The surgical effectiveness was evaluated using the visual analogue scale (VAS), functional disability score (FDS), and the presence or absence of necessity or enhanced effectiveness of BTX-A injection after surgery.

Results: The symptoms improved in 23 patients (92.0%). The VAS and total FDS were significantly improved from 8.4 ± 1.7 to 4.0 ± 2.4 (reduction rate, 50.7 ± 35.6%) and from 74.6 ± 22.2 to 34.7 ± 25.3 (reduction rate, 53.4 ± 27.4%) after surgery, respectively (both,  < 0.001). Among the 23 patients whose symptoms improved after surgery, BTX-A injection was not required in 11 of them (47.8%). Among the remaining 12 patients (52.2%), the effectiveness of BTX-A was post-operatively enhanced in eight patients (34.8%). There were no serious complications, and none of the patients experienced madarosis.

Conclusion: Disabling the muscle of Riolan is a valuable option of OOM myectomy in patients with refractory benign essential blepharospasm, without the development of serious complications, including madarosis.
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http://dx.doi.org/10.1177/1120672121991043DOI Listing
February 2021

Usefulness of mirror image processing software for creating images of expected appearance after blepharoptosis surgery.

Int Ophthalmol 2021 Apr 4;41(4):1151-1156. Epub 2020 Dec 4.

Department of Oculoplastic, Orbital and Lacrimal Surgery, Aichi Medical University Hospital, Nagakute, Aichi, Japan.

Purpose: This study aims to evaluate the usefulness of creating images of expected appearance after blepharoptosis surgery using mirror image processing software.

Methods: This prospective, observational study included 60 sides from 30 patients with bilateral aponeurotic blepharoptosis who underwent levator resection or aponeurotic repair on both sides. Before surgery, facial photographs were taken after the eyelid on one side was lifted with a curved hook. The mirror images were created from these photographs and were merged with the original photographs for making the whole facial images, which were shown to each patient at the preoperative counseling. At 1 month postoperatively, we asked patients about the usefulness of the mirror images to predict the postoperative appearance at the preoperative counseling and the similarity between the expected and the resultant postoperative appearance using questionnaires. Margin reflex distance-1, eyebrow height, and pretarsal skin height measured on predictive images were compared with those measured at 1 month postoperatively.

Results: Twenty-nine patients (96.7%) favorably responded to the usefulness of the mirror images to predict the postoperative appearance, and twenty-five patients (83.3%) accepted the similarity between the expected appearance and the actual postoperative appearance. The predictive images showed significantly lower margin reflex distance-1, higher eyebrow height, and higher pretarsal skin height than the postoperative results (P < 0.001).

Conclusion: The creation of expected postoperative images was a useful simulation procedure before blepharoptosis surgery for patients to predict the probable postoperative appearance.
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http://dx.doi.org/10.1007/s10792-020-01671-3DOI Listing
April 2021

Evidence for dynamic in vivo interconversion of the conformational states of IscU during iron-sulfur cluster biosynthesis.

Mol Microbiol 2020 Nov 17. Epub 2020 Nov 17.

Department of Biochemistry and Molecular Biology, Graduate School of Science and Engineering, Saitama University, Saitama, Japan.

IscU is a central component of the ISC machinery and serves as a scaffold for de novo assembly of Fe-S clusters. The dedicated chaperone system composed of the Hsp70-chaperone HscA and the J-protein cochaperone HscB synergistically interacts with IscU and facilitates cluster transfer from IscU to recipient apo-proteins. Here, we report that the otherwise essential roles of HscA and HscB can be bypassed in vivo by a number of single amino acid substitutions in IscU. CD spectroscopic studies of the variant IscU proteins capable of this bypass activity revealed dynamic interconversion between two conformations: the denatured (D) and the structured (S) state in the absence and presence of Zn , respectively, which was far more prominent than interconversion observed in wild-type IscU. Furthermore, we found that neither the S-shifted (more structured) variants of IscU nor the perpetually denatured variants could perform their in vivo role regardless of whether the chaperone system was present or not. The present study thus provides for the first time evidence that an in vivo D-state of IscU exists and implies that conformational interconversion between the S- and D-states of the scaffolding protein is a fundamental requirement for the assembly and transfer of the Fe-S cluster.
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http://dx.doi.org/10.1111/mmi.14646DOI Listing
November 2020

Muscle Spindles in the Levator Palpebrae Superioris Muscle of Human Adults.

J Craniofac Surg 2020 Nov 10. Epub 2020 Nov 10.

Department of Oculoplastic, Orbital and Lacrimal Surgery, Aichi Medical University Hospital.

In this experimental anatomic study, the authors examined the number and distribution of muscle spindles in the levator palpebrae superioris (LPS) muscle of human adults. This study included 11 orbits from 11 cadavers (mean age at death, 81.9 years). The LPS muscles were harvested and equally divided into 5 sections using transverse incisions. Muscle spindles were counted in each section. Consequently, muscle spindles were identified in 4 (36.4%) of the 11 orbits studied. One to 4 muscle spindles were identified in each of these 4 orbits. All muscle spindles were found in the most proximal section (the muscle origin), and no muscle spindles were identified in the other sections. The results indicate that the LPS muscle is associated with a smaller number of muscle spindles as compared with the rest of the extraocular muscles. Since higher muscle spindle numbers are associated with finer motor movements, eyelid opening does not seem to require much precision, compared to ocular movement.
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http://dx.doi.org/10.1097/SCS.0000000000007135DOI Listing
November 2020

Amyloidosis in the Bulbar Conjunctiva Following Transconjunctival Ptosis Surgery.

J Craniofac Surg 2020 Oct 6. Epub 2020 Oct 6.

Department of Oculoplastic, Orbital & Lacrimal Surgery, Aichi Medical University Hospital, Aichi, Japan.

A 52-year-old woman presented with persistent eye irritation following her third transconjunctival ptosis surgery. Examination revealed a yellow-pink nodular lesion in the bulbar conjunctiva. Excision biopsy and histopathology showed granulation tissue. However, the tumor recurred 1 month postoperatively. Repeat biopsy and histopathology revealed amyloid deposits. Systemic work-up showed no other lesion. A retained suture found in the upper fornix was also removed. No tumor recurrence has since been noted over the 7-month follow-up period. This report aims to highlight a case of bulbar conjunctival amyloidosis that developed as a complication following multiple transconjunctival eyelid surgeries.
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http://dx.doi.org/10.1097/SCS.0000000000007159DOI Listing
October 2020

Dacryoendoscopic examination for location of internal orifice of congenital lacrimal fistula: A case series.

Int J Pediatr Otorhinolaryngol 2020 Dec 29;139:110408. Epub 2020 Sep 29.

Department of Oculoplastic, Orbital & Lacrimal Surgery, Aichi Medical University Hospital, Aichi, Japan. Electronic address:

We examined the location of the internal orifice of congenital lacrimal fistula using a dacryoendoscope in 5 patients. A suture inserted from the skin orifice and passing into the lacrimal drainage system through the fistula track was identified using a dacryoendoscope. Consequently, the suture passed into the lacrimal sac in all patients. Although the internal orifice had been reported to be predominantly located in the common canaliculus, the methods previously used for identification of the internal orifice were less accurate. The results in our study suggest a higher incidence of congenital lacrimal fistulae connected with the lacrimal sac.
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http://dx.doi.org/10.1016/j.ijporl.2020.110408DOI Listing
December 2020

Changes in horizontal strabismus after inferior rectus muscle recession with or without nasal transposition in thyroid eye disease: A retrospective, observational study.

PLoS One 2020 1;15(10):e0240019. Epub 2020 Oct 1.

Department of Oculoplastic, Orbital & Lacrimal Surgery, Aichi Medical University Hospital, Aichi, Japan.

Since the inferior rectus muscle (IRM) is a secondary adductor, it is expected to commonly observe esotropia in thyroid-associated inferior rectus myopathy, but this can be improved after the IRM recession. However, variable outcomes regarding the changes in horizontal strabismus after IRM recession ± IRM nasal transposition have been encountered in patients with thyroid eye disease (TED). We, therefore, examined the changes in 62 patients with TED in this retrospective, observational, comparative study. The patients were classified into 3 groups based on the results of postoperative changes in horizontal strabismus: Groups A (reduced esotropia), B (unchanged esotropia), and C (increased esotropia). Consequently, Groups A, B, and C included 23 (38.7%), 11 (17.7%), and 27 (43.5%) patients, respectively. In the multivariate linear regression analysis, the angle of preoperative esotropia (P < 0.001) and the amount of IRM nasal transposition (P = 0.049) were significant predictors of postoperative changes in horizontal strabismus. The results of our study will be helpful to ophthalmologists for formulating an effective preoperative surgical plan.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0240019PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7529222PMC
November 2020

Surgical outcomes of the anterior versus posterior approach for advancement of the levator aponeurosis in Japanese patients.

J Plast Reconstr Aesthet Surg 2020 Nov 25;73(11):2001-2009. Epub 2020 Aug 25.

Department of Ophthalmology, The Jikei University School of Medicine, 3-19-18, Nishishimbashi, Minato-ku, Tokyo 105-8471, Japan.

Purpose: To compare the surgical outcomes of the anterior and posterior approaches for advancement of the levator aponeurosis for aponeurotic blepharoptosis in relation to levator function (LF).

Methods: This retrospective study included 223 eyelids from 125 patients with aponeurotic blepharoptosis. The anterior approach was used for 115 eyelids from 65 patients (anterior group), while the posterior approach was used in 108 eyelids from 60 patients (posterior group). Patients were subdivided into two groups in accordance with their LF (fair: 5-10 mm; good: > 10 mm). Functional success was defined as a margin reflex distance of 2-5 mm without serious complications at 3 months postoperatively. Cosmetic success was defined as the achievement of ≤ 1 mm laterality of the upper eyelid height, ≤ 2 mm laterality of the pretarsal show, and eyelid contour symmetry at 3 months postoperatively.

Results: The functional success rates of the anterior and posterior groups were comparable for patients with good LF (78.9% vs 87.7%, p = 0.228), whereas it was better in the posterior group (85.7%) than the anterior group (64.1%) in the total group (p = 0.022) and in patients with fair LF (p = 0.031). The posterior group achieved better cosmetic success than the anterior group regarding upper eyelid height symmetry (p = 0.042) and pretarsal show (p = 0.012). No serious complications occurred during follow-up.

Conclusions: The posterior approach achieved better functional and cosmetic outcomes than the anterior approach, indicating that the posterior approach is more useful in patients with aponeurotic blepharoptosis, particularly for those with only fair LF.
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http://dx.doi.org/10.1016/j.bjps.2020.08.051DOI Listing
November 2020

Incisionless facial resection for Kadish stage C olfactory neuroblastoma: Transcaruncular approach with combined endonasal and skull base surgery.

Clin Case Rep 2020 Aug 5;8(8):1494-1501. Epub 2020 May 5.

Department of Oculoplastic Orbital & Lacrimal Surgery Aichi Medical University Aichi Japan.

This case report describes resection without facial incision for aggressive Kadish stage C olfactory neuroblastoma (ONB). We performed resection via transcaruncular approach with combined endonasal and skull base surgery. This multidisciplinary team surgical approach is expected to lead to a new strategy for this type of tumor in the future.
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http://dx.doi.org/10.1002/ccr3.2906DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7455426PMC
August 2020

Bilateral Epibulbar Dermolipomas in a Patient With Goldenhar Syndrome.

J Craniofac Surg 2020 Aug 20. Epub 2020 Aug 20.

Department of Oculoplastic, Orbital & Lacrimal Surgery, Aichi Medical University Hospital, Aichi, Japan.

A 19-year-old woman consulted for bilateral superotemporal conjunctival lesions that had been present since birth. Physical examination also revealed hemifacial microsomia and bilateral auricular appendages. Medical history included heart, hearing, and neurologic problems. Excision biopsy of these lesions showed nodular proliferations of adipose tissue, which corresponded to the diagnosis of dermolipomas in the setting of Goldenhar syndrome. Complete examination for other first and second branchial arch anomalies is warranted in patients presenting with such lesions.
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http://dx.doi.org/10.1097/SCS.0000000000006919DOI Listing
August 2020

Relationship between Dynamic Trunk Balance and the Balance Evaluation Systems Test in Elderly Women.

Prog Rehabil Med 2020 22;5:20200004. Epub 2020 Feb 22.

Department of Orthopedic Surgery, Akita University Graduate School of Medicine, Akita, Japan.

Objective: Falls are major contributors to elderly subjects becoming bedridden. Consequently, it is important to evaluate and minimize the risk of falls in the elderly. Trunk stability is important for balance function and is related to fall prevention in elderly women. We developed a balance-measuring device that uses a dynamic sitting position to safely measure balance function. The Balance Evaluation Systems Test (BESTest) is useful method to assess balance function, a recently developed balance evaluation test that can detect minor balance problems not captured by previous tests. The purpose of the present study was to examine the relationship between dynamic trunk balance and findings of the BESTest in elderly women.

Methods: Thirty-one healthy women aged 60 years or more participated in this study. The evaluation items were the BESTest total score, scores for each of the six elements of the BESTest, dynamic sitting balance, static postural balance, and muscle strength.

Results: The mean total BESTest score was 85.4 points. The mean total trajectory length of the center of gravity (COG) during the dynamic sitting balance test was 1447.5 mm. A negative correlation (r=-0.481, P= 0.006) was observed between the total COG trajectory length and the BESTest score. A negative correlation was also found between the total COG trajectory length and biomechanical constraints (r=-0.492, P=0.005) and anticipatory postural adjustments (r=-0.532, P=0.002). There were no correlations between the dynamic sitting balance total COG trajectory length and the stationary standing COG trajectory length or muscle strength.

Conclusions: In elderly women, the total COG trajectory length during dynamic sitting was negatively correlated with the BESTest total score.
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http://dx.doi.org/10.2490/prm.20200004DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7365219PMC
February 2020

Orbital Decompression for Exorbitism and Exophthalmos in a Patient With Thyroid Eye Disease.

J Craniofac Surg 2020 Jul-Aug;31(5):e477-e479

Department of Oculoplastic, Orbital and Lacrimal Surgery, Aichi Medical University Hospital.

A 34-year-old man with Basedow disease consulted us to treat disfiguring proptosis. On examination, the patient showed right lower eyelid retraction and right inferior rectus muscle enlargement, which were consistent with thyroid eye disease. Hertel's exophthalmometric examination demonstrated proptosis of 25.5 and 24.0 mm on the right and left sides, respectively. Computed tomography (CT) images revealed absence of the sphenoid door jamb. To correct both exorbitism and exophthalmos, the patient underwent bilateral "shallow" decompression of the lateral and medial orbital walls with orbital fat removal under general anesthesia. The authors removed 2.5 and 1.0 mL of orbital fat from the inferolateral quadrant of the right and left orbits, respectively. At 3 months postoperatively, based on the measurements of the axial globe position on sagittal CT images, postoperative proptosis reductions of 7.5 and 6.5 mm were observed on the right and left sides, respectively.
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http://dx.doi.org/10.1097/SCS.0000000000006442DOI Listing
November 2020

Spontaneous orbital decompression in thyroid eye disease: new measurement methods and its influential factors.

Graefes Arch Clin Exp Ophthalmol 2020 Oct 25;258(10):2321-2329. Epub 2020 May 25.

Department of Oculoplastic, Orbital & Lacrimal Surgery, Aichi Medical University Hospital, 1-1 Yazako-Karimata, Nagakute, Aichi, 480-1195, Japan.

Purpose: To evaluate spontaneous decompression of the medial orbital wall and orbital floor in thyroid eye disease using new measurement methods and to analyze the influential factors.

Methods: This retrospective study included 86 patients (172 sides). Regarding evaluation of spontaneous medial orbital decompression, an anteroposterior line was drawn between the posterior lacrimal crest and the junction between the ethmoid bone and corpus ossis sphenoidalis. The bulged and/or dented areas from that line were measured. Regarding evaluation of spontaneous orbital floor decompression, the length of the perpendicular distance from a line that was drawn between the inferior orbital rim and the orbital process of palatal bone to the tip of the superior bulge of the orbital floor was measured.

Results: Multivariate linear regression analysis revealed that the maximum cross-sectional areas of the superior rectus/levator palpebrae superioris complex (P = 0.020) and medial rectus muscle (P = 0.028) were influential factors for spontaneous decompression of medial orbital wall (adjusted r = 0.090; P < 0.001), whereas the number of cycles of steroid pulse therapy (P = 0.002) and the maximum cross-sectional area of the inferior rectus muscle (P = 0.007) were the ones for that of the orbital floor (adjusted r = 0.096; P < 0.001).

Conclusion: We believe that the identification of multiple influential factors of spontaneous decompression of the medial orbital wall and orbital floor will be helpful for better understanding and planned management of thyroid eye disease patients undergoing orbital decompression surgery.
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http://dx.doi.org/10.1007/s00417-020-04762-0DOI Listing
October 2020

Changes in Field of Binocular Single Vision and Ocular Deviation Angle After Balanced Orbital Decompression in Thyroid Eye Disease.

Ophthalmic Plast Reconstr Surg 2021 Mar-Apr 01;37(2):154-160

Department of Oculoplastic, Orbital & Lacrimal Surgery, Aichi Medical University Hospital, Aichi, Japan.

Purpose: To evaluate influential factors for changes in the binocular single vision (BSV) and ocular deviation angle in the medial direction after bilateral balanced orbital decompression in thyroid eye disease.

Methods: This retrospective study included 41 patients. The areas of BSV and the angles of medial ocular deviation on the Hess chart were measured. The percentages of pre- and postoperative areas against the normal area (%BSV) and the change in BSV after surgery were calculated. Postoperative change in the angle was calculated by subtraction of the preoperative angle from the postoperative one. Influential factors for the change in BSV and that in the medial deviation angle were evaluated via multivariate linear regression analysis.

Results: The maximum cross-sectional area of the medial rectus muscle, preoperative %BSV, and preoperative medial ocular deviation angle were significant factors of change in BSV (adjusted r2 = 0.449, p < 0.001), although age, history of anti-inflammatory treatment, volume of removed orbital fat, findings on CT images, maximum cross-sectional areas of the other rectus muscles, and presence or absence of a periosteal flap did not affect change in BSV (p > 0.050). On the contrary, all variables did not influence postoperative changes in the medial ocular deviation angle (p > 0.050).

Conclusions: In balanced orbital decompression, the maximum cross-sectional area of medial rectus muscle, preoperative field of BSV, and medial ocular deviation were significant influential factors for postoperative changes in field of BSV.
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http://dx.doi.org/10.1097/IOP.0000000000001712DOI Listing
May 2020

Radiographic deformities of the lower extremity in patients with spontaneous osteonecrosis of the knee.

Knee 2020 Jun 22;27(3):838-845. Epub 2020 Apr 22.

Department of Orthopedic Surgery, Akita University Graduate School of Medicine, Akita, Japan.

Background: Spontaneous osteonecrosis of the knee (SONK) is one of the acute knee pain disorders arising in elderly patients. The presence of knee varus alignment and the size of necrotic area have been reported as the negative prognostic factors in prior studies. However, no previous study has yet clarified the radiological analysis of the lower extremity in SONK compared with that in osteoarthritis. The purpose of this study was therefore to identify the radiographic findings of the lower extremity in SONK.

Methods: Sixty-three knees of Kellgren-Lawrence classification grade 1 or 2 without any trauma treated between April 2012 and March 2014 were enrolled in this study. These knees were divided into two groups according to their magnetic resonance imaging (MRI) findings: SONK group (31 knees) and OA group (32 knees). Using a long leg standing X-ray, femorotibial angle (FTA), mechanical axis deviation (MAD), mechanical lateral distal femoral angle (mLDFA), medial proximal tibial angle (MPTA) and joint line convergent angle (JLCA) were compared between groups. Correlation between each parameter and the width ratio (WR) of the necrotic lesion were analyzed.

Results: FTA, MAD, MPTA and JLCA showed significant differences between the SONK and OA groups. In the SONK group, FTA was positively correlated with WR, and, MAD and MPTA was negatively correlated with WR.

Conclusions: Compared with OA, SONK is associated with a significantly larger varus deformity at the proximal tibia, and larger joint play in the coronal plane.
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http://dx.doi.org/10.1016/j.knee.2020.04.007DOI Listing
June 2020

Re: epibulbar osseous choristoma within a dermolipoma: case report and literature review.

Orbit 2020 Oct 1;39(5):395-396. Epub 2020 Apr 1.

Department of Oculoplastic, Orbital & Lacrimal Surgery, Aichi Medical University Hospital , Aichi, Japan.

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http://dx.doi.org/10.1080/01676830.2020.1749287DOI Listing
October 2020

Patency of the lacrimal drainage system in patients with a peripunctal tumour.

Orbit 2020 Oct 30;39(5):394. Epub 2020 Mar 30.

Department of Oculoplastic, Orbital & Lacrimal Surgery, Aichi Medical University Hospital , Nagakute, Japan.

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http://dx.doi.org/10.1080/01676830.2020.1745852DOI Listing
October 2020

Radiological findings of orbital blowout fractures: a review.

Orbit 2021 Apr 26;40(2):98-109. Epub 2020 Mar 26.

Department of Oculoplastic, Orbital & Lacrimal Surgery, Aichi Medical University Hospital , Aichi, Japan.

: To summarize the radiological findings in patients with orbital blowout fractures. : We reviewed the published literature on radiological findings of orbital blowout fractures that were searched on PubMed and included our own radiologic findings on patients with orbital blowout fractures that were seen at our hospital. : Radiologic examination reveals a variety of findings in each case. However, common radiological findings of orbital blowout fractures include comminuted/unhinged, hinged, and linear fractures. These fractures are usually located in the orbital floor medial to the infraorbital nerve and in the medial orbital wall. Orbital fat is frequently herniated in the paranasal sinus or incarcerated at the fracture site. Orbital emphysema and haematoma sometimes occur as complications. : This review will provide surgeons with a better understanding of various radiological findings, which could be helpful in the management of patients with orbital blowout fracture.
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http://dx.doi.org/10.1080/01676830.2020.1744670DOI Listing
April 2021

Malignant Lymphoma Mimicking Medial Fat Pad Prolapse: A Pitfall for Upper Eyelid Rejuvenation.

J Craniofac Surg 2020 Jun;31(4):e359-e360

Department of Oculoplastic, Orbital and Lacrimal Surgery, Aichi Medical University Hospital, Aichi, Japan.

Two patients with malignant lymphoma in the medial area of the upper eyelid mimicking medial fat pad prolapse have been reported. Both of them did not notice any eyelid/orbital mass before presentation to us. They were managed with a complete excisional biopsy of the mass, respectively. In both the patients, pathologic results were compatible with extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue. Neither any other lesion was detected nor any recurrence was seen, without the need of further treatment in either of them. Although the medial fat pad prolapse can be easily diagnosed by inspection only, the results of our study elucidate the importance of palpation for its definite diagnosis.
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http://dx.doi.org/10.1097/SCS.0000000000006318DOI Listing
June 2020

Influence of epinephrine contained in local anesthetics on upper eyelid height in transconjunctival blepharoptosis surgery.

Graefes Arch Clin Exp Ophthalmol 2020 Jun 26;258(6):1287-1292. Epub 2020 Feb 26.

Department of Ophthalmology, Jikei University School of Medicine, Tokyo, 105-8471, Japan.

Purpose: To examine the influence of epinephrine contained in local anesthetic on upper eyelid height in transconjunctival aponeurotic repair for aponeurotic blepharoptosis.

Methods: This retrospective study included 164 eyelids from 94 patients with aponeurotic blepharoptosis. Patients were divided according to the use of local anesthetic with (group A, n = 108) or without 1:100000 epinephrine (group B, n = 56). Margin reflex distance-1 (MRD-1) was measured before and after local anesthesia, and before, during, and 3 months after surgery. Change in MRD-1 (∆MRD-1) was calculated by subtracting the postanesthetic MRD-1 value from the preanesthetic value, and we defined ∆MRD-1 by subtracting the postoperative 3-month MRD-1 value from the intraoperative value.

Results: ∆MRD-1 was positive in group A (0.57 ± 0.63 mm) and negative in group B (- 0.50 ± 0.45 mm; p < 0.001). Postoperative MRD-1 decreased significantly from intraoperative MRD-1 in group A (P < 0.001), although there was no significant difference between intraoperative and postoperative MRD-1 in group B (p = 0.255). The magnitude of ∆MRD-1 in group A (- 0.86 ± 0.63) was larger than that in group B (- 0.23 ± 0.26; p < 0.001).

Conclusions: Epinephrine stimulates Müller's muscle during surgery, which leads to postoperative upper eyelid droop after the disappearance of the epinephrine effect. Using local anesthetics without epinephrine may allow more accurate estimation of postoperative eyelid height in transconjunctival aponeurotic repair.
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http://dx.doi.org/10.1007/s00417-020-04627-6DOI Listing
June 2020

Postoperative changes in status of meibomian gland dysfunction in patients with involutional entropion.

Int Ophthalmol 2020 Jun 15;40(6):1397-1402. Epub 2020 Feb 15.

Department of Oculoplastic, Orbital and Lacrimal Surgery, Aichi Medical University Hospital, 1-1 Yazako-Karimata, Nagakute, Aichi, 480-1195, Japan.

Purpose: To examine postoperative changes in the status of meibomian gland dysfunction in patients with involutional entropion.

Methods: This prospective, interventional study included 10 eyelids of 8 patients with involutional entropion who underwent posterior layer advancement of the lower eyelid retractors and either a lateral tarsal strip or transcanthal canthopexy procedure. The following features were examined for evaluation of meibomian gland dysfunction and dry eye: the presence or absence of eyelid abnormalities (irregular eyelid margin, vascular engorgement, and plugged meibomian gland orifices), Marx line score, meibum expression score, loss of the meibomian glands, A (area) and D (density) scores for corneal fluorescein staining, and tear breakup time. All the measurements were performed before and 6 months after surgical correction of involutional entropion.

Results: Regarding the findings of meibomian gland dysfunction, irregular eyelid margin, vascular engorgement, and plugged meibomian gland orifices improved only in 1 eyelid of 1 patient (P = 0.317, P = 1.000, and P = 1.000, respectively) postoperatively. The scores of Marx line, meibum expression, and loss of meibomian glands did not statistically change after surgery (P = 0.157, P = 0.705, and P = 0.317, respectively). The D score was statistically improved after surgery (P = 0.046), although the difference between the pre- and postoperative A score was not statistically significant (P = 0.083). Tear breakup time did not change after surgery (P = 0.705).

Conclusions: Our study indicates that meibomian gland dysfunction does not resolve after surgical correction of involutional entropion.
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http://dx.doi.org/10.1007/s10792-020-01305-8DOI Listing
June 2020