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Naoki Wada, Noriyuki Abe, Kotona Miyauchi, Shogo Makino, Hidehiro Kakizaki Department of Renal and Urologic Surgery, Asahikawa Medical University, Asahikawa, JapanCorrespondence: Naoki Wada, Department of Renal and Urologic Surgery, Asahikawa Medical University, Asahikawa, Japan, Tel +81-166-65-2533, Email nwada@asahikawa-med.ac.jpPurpose: In this study, we investigated skeletal muscle loss and bladder dysfunction caused by high-fat/high-sucrose (HFS) diet.Methods: Twelve-week-old Sprague–Dawley (SD) female rats were fed on normal (Group N) or HFS (Group HFS) diet for 12 weeks. We conducted urodynamic investigation and pharmacologic in vitro. In addition, we measured gastrocnemius and tibialis muscle weight and protein concentration. The hypoxia-inducible factor (HIF)-1α and 8-hydroxy-2’-deoxyguanosine (8-OHdG) in the bladder were assayed.Results: The urodynamic investigations revealed the significantly shorter intercontraction intervals and lower maximal voiding pressure in Group HFS than in Group N. Furthermore, the absolute and relative weights of the gastrocnemius muscle were found to be significantly lower in Group HFS than in Group N. The protein concentration of the gastrocnemius muscle was also significantly lower in Group HFS than in Group N. The absolute and relative weights of the bladder were also significantly lower in Group HFS than in Group N. The contractile responses of the bladder strips to electrical field stimulation and carbachol were significantly lower in Group HFS than in Group N. The HIF1α and 8OHdG in the bladder muscle were significantly higher in Group HFS than in Group N. The HFS diet reduced bladder capacity and contractility along with the loss of the gastrocnemius muscle.Conclusion: HFS diet promotes bladder dysfunction similar to detrusor hyperreflexia with impaired contractility.Keywords: high-fat, high-sucrose, bladder dysfunction, rat, skeletal muscle

Yuki Mawatari,1 Hirohiko Kakizaki,2 Yasuhiro Takahashi2 1Mawatari Oculoplastic Clinic, Kumamoto, Japan; 2Department of Oculoplastic, Orbital & Lacrimal Surgery, Aichi Medical University Hospital, Aichi, JapanCorrespondence: Yuki Mawatari, Mawatari Oculoplastic Clinic, 8-2 Suido-cho, Chuo-ku, Kumamoto, 860-0844, Japan, Tel +81 96 273 7571, Fax +81 96 273 7572, Email mawatari@mawatari-clinic.jpPurpose: To investigate the usefulness of diathermy thermocoagulation in chalazion surgery.Methods: This prospective, observational study included 30 sides from 24 patients who underwent chalazion surgery using diathermy thermocoagulation. The eyelid was fixed with a chalazion clamp under local anesthesia. The skin or palpebral conjunctiva was incised, and the chalazion was partially curetted. The residual chalazion contents were coagulated with diathermy and detached from the surrounding tissues using forceps and scissors. Then, the residual chalazion contents were completely removed.Results: The chalazion was not palpable in all cases 1 week postoperatively. A small chalazion redeveloped close to the primary lesion 2 weeks postoperatively in one patient; however, it spontaneously improved. No other cases experienced recurrence or complication during the follow-up periods.Conclusion: Thermocoagulation of chalazion contents using diathermy facilitates grasp, dissection, and excision of chalazion contents.Keywords: chalazion, surgery, thermocoagulation, diathermy

Uri Soiberman,1 Hirohiko Kakizaki,2 Dinesh Selva,3 Igal Leibovitch11Division of Oculoplastic and Orbital Surgery, Department of Ophthalmology, Tel-Aviv Medical Center, Tel-Aviv University, Tel-Aviv, Israel; 2Department of Ophthalmology, Aichi Medical University, Nagakute, Japan; 3South Australian Institute of Ophthalmology and Discipline of Ophthalmology and Visual Sciences, University of Adelaide, South Australia, AustraliaAbstract: Acquired punctal stenosis is a condition in which the external opening of the lacrimal canaliculus is narrowed or occluded. This condition is a rare cause of symptomatic epiphora, but its incidence may be higher in patients with chronic blepharitis, in those treated with various topical medications, including antihypertensive agents, and especially in patients treated with taxanes for cancer. The purpose of this review is to cover the medical literature, focusing in particular on definition, incidence, risk factors, etiology and treatment options.Keywords: acquired punctal stenosis, definition, epiphora, etiology, treatment

Hyera Kang,1,2 Yasuhiro Takahashi,1 Masayoshi Iwaki,1 Shinichi Asamura,3 Hirohiko Kakizaki,11Department of Ophthalmology, Aichi Medical University, Nagakute, Aichi, Japan; 2Department of Ophthalmology, Presbyterian Medical Center, Jeonju, Korea; 3Department of Plastic and Reconstructive Surgery, Kinki University School of Medicine, Osaka-Sayama, Osaka, JapanAbstract: Patients with Graves' orbitopathy have a higher probability of myasthenia gravis than does the normal population. Overlapping clinical features cause diagnostic confusion in such a situation. We herein report a patient with Graves' orbitopathy and myasthenia gravis (GO-MG) with normal left eyelid height, but in whom upper eyelid retraction was shown after edrophonium chloride administration. Upper eyelid retraction in GO-MG is occasionally masked by a myasthenia effect. The upper eyelid height must be carefully monitored in patients with Graves' orbitopathy to detect the presence of concomitant myasthenia gravis.Keywords: Graves' orbitopathy, myasthenia gravis, eyelid retraction, edrophonium chloride

Kazuhito Konishi1, Isao Sugimoto2, Hirohiko Kakizaki3, Akihiro Ichinose41Kobe Academia Clinic, 2Division of Aesthetic Medical Science, Department of Plastic Surgery, Kobe University Graduate School of Medicine, 3Department of Ophthalmology, Aichi Medical University, Nagoya, Aichi, Japan; 4Department of Plastic Surgery, Graduate School of Medicine, Kobe University, Kobe, Hyogo, JapanPurpose: We report the reshaping of the eyebrow by follicular unit transplantation from excised eyebrow skin in extended infrabrow excision blepharoplasty.Methods: The method was carried out in two patients with moderate or significant dermatochalasis. The areas to be excised from the infrabrow and intrabrow skin were decided upon and the area of hair transplantation was planned in the suprabrow area and the tail of the eyebrow. The skin was removed and the excised intrabrow skin was dissected into single follicular units. Tiny incisions were made with a scalpel, and grafts were inserted using fine forceps.Results: Almost all transplanted eyebrow follicles took successfully, resulting in eyebrows of a desirable shape as planned preoperatively. The reshaped eyebrows had a natural appearance since the transplanted hairs were similar to those of the original eyebrow. The eyelids still looked youthful rather than operated-on. Finally, the evidence of blepharoplasty was hardly visible and patient satisfaction was quite high. The patients felt more ease in opening their eyes and obtained a wider visual field.Conclusion: Our study demonstrated excellent results with hair transplantation from eyebrow to eyebrow, a finding which, to our knowledge, has not been previously reported. Our method can be used for selected patients, especially men, with moderate to severe dermatochalasis, who find a reduction or change in the shape of the eyebrow unacceptable.Keywords: blepharoplasty, dermatochalasis, follicular unit transplantation, eyebrow reconstruction

Hirohiko Kakizaki1, Yasuhiro Takahashi1, Akihiro Ichinose2, Masayoshi Iwaki1, Dinesh Selva3, Igal Leibovitch41Department of Ophthalmology, Aichi Medical University, Nagakute, Aichi, Japan; 2Department of Plastic Surgery, Kobe University, Kobe, Hyogo, Japan; 3South Australian Institute of Ophthalmology and Discipline of Ophthalmology and Visual Sciences, University of Adelaide, South Australia, Australia; 4Division of Oculoplastic and Orbital Surgery, Department of Ophthalmology, Tel Aviv Medical Center, Tel Aviv University, Tel Aviv, IsraelPurpose: To evaluate the surgical outcome of deep lateral orbital decompression with or without rim removal.Design: Retrospective case series.Methods: Thirty-two patients (47 orbits) with Graves’ orbitopathy who underwent simple deep lateral decompression or balanced lateral plus medial decompression. Of the 14 patients (24 orbits) who underwent simple deep lateral decompression, 8 (13 orbits) had temporary rim removal and in 6 (11 orbits) the rim was left intact. Of the 18 patients (23 orbits) who underwent a balanced decompression, 7 (9 orbits) had temporary rim removal and in 11 (14 orbits) the rim was left intact. The amount of postoperative reduction in proptosis was compared among these four groups.Results: The average reduction in proptosis in the simple deep lateral decompression group was 5.73 mm (range: 4.0–8.0 mm) in the rim removal group and 4.09 mm (range: 2.5–6.0 mm) in the intact rim group (P = 0.005). The average reduction in proptosis in the balanced decompression group was 6.39 mm (range: 5.0–8.5 mm) in the rim removal group and 5.07 mm (range: 3.0–8.0 mm) in the intact rim group (P = 0.039). There was no statistically significant difference in proptosis reduction between the simple deep lateral decompression with rim removal group and the balanced decompression with an intact rim group (P = 0.220).Conclusion: The rim removal approach allows a more effective decompression than the intact rim approach. Simple deep lateral decompression with rim removal approach has a similar effect to balanced decompression through an intact rim.Keywords: deep lateral decompression, balanced decompression, rim removal, intact rim, Graves’ orbitopathy, proptosis

Shinichi Asamura1, Hirohiko Kakizaki2, Mitsuhiro Enjyo1, Takahiro Hashimoto1, Noritaka Isogai11Department of Plastic and Reconstructive Surgery, Kinki University School of Medicine, Osakasayama, Osaka, Japan; 2Department of Ophthalmology, Aichi Medical University, Nagakute, Aichi JapanAbstract: A 39-year-old woman was diagnosed with myasthenia gravis when she was 8 years old. Although many treatments – such as cholinesterase inhibitors and steroids – had been given to the patient, her condition did not improve sufficiently. As she demonstrated bilateral 3 mm levator function without any eye movement disturbances, bilateral frontalis sling procedures were performed with an autologous fascia lata. One year after the operation, the operated upper eyelids showed symmetrically appropriate heights with good functional outcome. A sling procedure with an autologous fascia lata was suitable for correcting poor levator function of an ocular myasthenia gravis case.Keywords: ocular myasthenia gravis, ptosis, frontalis sling

Yasuhiro Takahashi¹, Hirohiko Kakizaki¹, Akihiro Ichinose², Masayoshi Iwaki¹¹Department of Ophthalmology, Aichi Medical University, Nagakute, Aichi, Japan; ²Department of Plastic Surgery, Kobe University, Kobe, Hyogo, JapanAbstract: A 38-year-old woman with diabetes mellitus complained of acute visual loss in the left eye (20/200) and swollen left upper eyelid. Slit lamp examination of the left eye revealed ciliary injection, posterior synechia iritis, numerous inflammatory cells, and fibrin exudates in the anterior chamber. T1-weighted enhanced magnetic resonance imaging demonstrated left lacrimal gland enhancement with inflammatory spread to the left anterior ocular segment. Blood examination showed increased blood sugar but the other components were within normal limits. The patient was treated with steroid pulse therapy (methylprednisolone 1 g/day × 3 days) under a blood sugar control regimen in consultation with an endocrinologist, after which additional peribulbar injection of triamcinolone acetonide (40 mg) was performed. Resolution of the anterior uveitis and the dacryoadenitis was obtained after 2 months and there was no recurrence 1 year after the therapy. This is a rare case of severe anterior uveitis caused by idiopathic dacryoadenitis in a patient with diabetes mellitus.Keywords: anterior uveitis, idiopathic dacryoadenitis, diabetes mellitus, magnetic resonance imaging, steroid