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Kentaro Uejima1,2 Masatoshi Hayasaka,1 Jitsu Kato,3 Wakako Sakata,1 Susumu Otsuka,1 Fumiyuki Watanabe,2 Yoshikazu Yoshida,1 Miwako Kamei21Department of Pharmacy, Nihon University Itabashi Hospital, Tokyo, Japan; 2Nihon University School of Pharmacy, Funabashi-shi, Chiba, Japan; 3Department of Pharmacy, Nihon University Itabashi Hospital, Tokyo, JapanPurpose: Chronic pain is a common symptom that is suffered by 20% of the overall population in Japan. Although pharmacotherapy is critical for the treatment of chronic pain, there are no reports on the pharmacies. In the present study, we examined the effect of hospital–community pharmacy cooperative training on improving drug-taking compliance, pain relief, anxiety, insomnia, and motor function in patients with chronic pain.Patients and methods: The subject sample included 87 patients with chronic pain who were examined for the first time at the outpatient services department of Nihon University Itabashi Hospital. Patients were interviewed to obtain information regarding drugs used before and after the treatment, habitually used community pharmacies, presence of cooperative training with Itabashi Hospital, drug-taking compliance, and side effects. We compared treatment outcomes before and after consultation using the Brief Pain Inventory (BPI), Hospital Anxiety and Depression Scale (HADS), EuroQol Group measure (EQ-5D) for quality of life, Athens Insomnia Scale, and Locomo 25 scale for motor function.Results: In patients who used community pharmacies that perform training, drug-taking compliance was significantly better, and a significant improvement was observed in the scores of BPI, HADS Anxiety, Athens Insomnia, and Locomo 25.Conclusion: Pharmacotherapy is essential for the treatment of chronic pain. To this end, appropriate drugs with proper drug management guidance are indispensable. In this study, the use of community pharmacies that have undergone cooperative training with hospitals improves pain and anxiety. This is achieved through proper drug management guidance, shared awareness of drug information, and achievement of better drug-taking compliance. To improve the quality of treatment for chronic pain, involvement of community pharmacies such as by providing accurate information is essential. In the future, expanding cooperative training with hospitals may further help reassure patients, facilitate drug-taking, and improve the quality of treatment for chronic pain.Keywords: chronic pain, community pharmacies training, drug management guidance, patient compliance

Masayuki Takeyama,1 Fumio Takeuchi,2 Masahiko Gosho,3 Keijiro Sugita,1 Masahiro Zako,4 Masayoshi Iwaki,5 Motohiro Kamei1 1Department of Ophthalmology, Aichi Medical University, Nagakute, 2Department of Biochemistry, Aichi Medical University, Nagakute, 3Department of Clinical Trial and Clinical Epidemiology, Faculty of Medicine, University of Tsukuba, Tsukuba, 4Department of Ophthalmology, Asia Hospital, Seto, 5Department of Ophthalmology, Yokkaichi, Digestive Disease Center, Komono, Japan Purpose: Tranexamic acid (TXA) is a widely used antifibrinolytic agent that can also cause a decrease in vascular permeability. We hypothesized that TXA could improve macular edema (ME) that is caused by an increase in retinal vascular permeability. The aim of this study is to evaluate the efficacy of oral TXA for ME associated with retinal vein occlusion (RVO) or diabetic ME (DME).Patients and methods: Oral TXA (1,500 mg daily for 2 weeks) was administered to patients with persistent ME secondary to RVO (7 eyes) and DME (7 eyes). After 2 weeks (ie, the final day of administration) and 6 weeks (ie, 4 weeks after the final administration), best-corrected visual acuity and central macular thickness (CMT) were measured and compared with baseline. Analyses were performed for RVO and DME cases. No other treatment was performed during the study period.Results: In RVO cases, significant improvement in CMT was found between baseline (467.7±121.4 µm) and 2-week measurements after treatment (428.7±110.5 µm, p=0.024). No significant change was found in CMT between measurements taken at baseline and 6 weeks after treatment. In DME cases, no significant change was found in CMT between measurements taken at baseline and 2 or 6 weeks after treatment. In all analyses of best-corrected visual acuity, no significant change was observed.Conclusion: The results support the hypothesis that plasmin plays a role in the development of ME associated with RVO, and oral TXA administration may be useful as an adjuvant treatment when combined with other agents such as anti-vascular endothelial growth factor. Keywords: diabetic macular edema, fibrin, macular edema, plasmin, retinal vein occlusion, tranexamic acid

Nobuo Yamamoto,1 Mitsuyo Nitta,1 Miwako Kamei,2 Kazuo Hara,1 Fumiyuki Watanabe,2 Keiko Akagawa,1 Naomi Kurata1 1Division of Community Healthcare and Pharmacy, Department of Healthcare and Regulatory Sciences, Showa University School of Pharmacy, Tokyo, Japan; 2Division of Health Communication, School of Pharmacy, Nihon University, Chiba, Japan Purpose: This study was conducted to evaluate whether a community pharmacist’s assistance during the treatment of a patient with a chronic illness would help to discover and improve issues regarding the treatment. Method: We employed a prospective intervention study with a control group. The patients ranging in age from 60 to 74, were using one of the six selected community pharmacies in the Tokyo metropolitan area. They had been prescribed six or fewer kinds of medications, one of which was amlodipine. The medication dosages covered 1 month or longer. Patients who agreed to participate in the study were randomly assigned to the groups at each pharmacy. For the patients in the intervention group, the pharmacists provided telephone counseling between physician visits, in addition to the time they visited the pharmacies to collect their medications. For the patients in the control group, the pharmacists provided counseling only at their pharmacies. Results and discussion: The average days of medication administration were 49.2 days for the 58 patients in the intervention group, and 49.8 days for the 53 patients in the control group, with the average number of medications being 3.4 items per person for both groups. Through the telephone counseling, we were able to collect more information, eg, changes in physical condition and occurrences of side effects, from the intervention group than from the control group. The rate of incident detection in the information from the intervention group was five times that of the control group, making subsequent incident resolutions faster. Conclusion: This study suggested that phone counseling between physician visits could enable the identification of more issues regarding patients’ conditions. Keywords: community pharmacy, outpatient, long-term dosage, telephone assistance

Susumu Sakimoto, Motohiro Kamei, Hirokazu Sakaguchi, Mihoko Suzuki, Nagakazu Matsumura, Kentaro Nishida, Kohji NishidaDepartment of Ophthalmology, Osaka University Graduate School of Medicine, Suita, Osaka, JapanSummary statement: Direct photocoagulation reduces the central foveal thickness (CFT) in cases with chronic branch retinal vein occlusion (BRVO) of longer than 12 months duration. Photocoagulation might be effective for chronic macular edema due to branch retinal vein occlusion.Background: The aim was to investigate the effect of direct photocoagulation for treating chronic macular edema associated with BRVO.Methods: This study was a noncomparative, pilot interventional case series. We examined the CFT and best-corrected visual acuity over 6 months in patients with BRVO treated with direct photocoagulation.Results: Sixteen eyes of 16 patients had been treated with direct photocoagulation (mean follow-up period, 20.5 months). The mean CFT decreased significantly (P

Shin Yamane,1 Motohiro Kamei,2 Susumu Sakimoto,2 Maiko Inoue,1 Akira Arakawa,1 Mihoko Suzuki,2 Nagakazu Matsumura,2 Kazuaki Kadonosono11Department of Ophthalmology, Yokohama City University Medical Center, Yokohama, 2Department of Ophthalmology, Osaka University Graduate School of Medicine, Osaka, JapanBackground: The purpose of this study was to evaluate visual outcomes of arteriovenous sheathotomy for macular edema due to branch retinal vein occlusion (BRVO).Methods: The medical records of 45 eyes from 45 patients who had undergone vitrectomy surgery with arteriovenous sheathotomy for BRVO were studied. Forty-five eyes of 45 patients with a BRVO but without intervention were studied as the control group. The best-corrected visual acuity and central macular thickness were compared between the two groups at baseline and at 1, 3, 6, and 12 months postoperatively.Results: Improvement of best-corrected visual acuity was 0.42 logarithm of the minimum angle of resolution (logMAR) units in the sheathotomy group and 0.22 logMAR units in the control group (P=0.007). The mean postoperative central macular thickness was significantly thinner in the sheathotomy group at 1 month (P=0.01), but not at 3, 6, and 12 months (P=0.75, P=0.81, and P=0.46, respectively). Improvement of best-corrected visual acuity at 12 months was significantly correlated with baseline best-corrected visual acuity, age, duration of symptoms, and sheathotomy (P

Susumu Sakimoto, Motohiro Kamei, Mihoko Suzuki, Shinsaku Yano, Nagakazu Matsumura, Hirokazu Sakaguchi, Fumi Gomi, Kohji NishidaDepartment of Ophthalmology, Osaka University Graduate School of Medicine, Suita, JapanBackground: To study the relationship between retinal perfusion around the macula and the foveal thickness in branch retinal vein occlusion (BRVO). Methods: Seventy-four eyes of 74 consecutive patients with BRVO were enrolled. We developed a new grading system to evaluate the status of retinal perfusion around the macula in three grades: full perfusion area (FPA), partial perfusion area (PPA), and nonperfusion area (NPA), using fluorescein angiography. The correlation was assessed between these grades and the central foveal thickness (CFT) measured by optical coherence tomography. We also determined the area with the closest correlation between the perfusion status and the foveal thickness by comparing the correlation coefficient in areas of 1-, 2-, and 3-disc diameter (DD) horizontal hemicircles centered at the fovea. The correlation was determined between the extent of each perfusion grade and CFT. Results: We found a significant negative correlation between the CFT and the FPA (r = 0.31, P = 0.006) and a significant positive correlation between the CFT and the PPA (r = 0.45, P < 0.001) in the three areas. The most significant correlations were found in the 2-DD area. Interestingly, the NPA has not correlated with the foveal thickness in any areas.Conclusion: The areas of partial but not complete capillary loss seem to be responsible for the macular edema associated with BRVO. Treatments targeting leakage from the dilated capillaries in the PPA should be investigated. Keywords: branch retinal vein occlusion, macular perfusion, foveal thickness, macular edema

Motohiro Kamei, Nagakazu Matsumura, Hirokazu Sakaguchi, Yusuke Oshima, Yasushi Ikuno, Kohji NishidaDepartment of Ophthalmology, Osaka University Graduate School of Medicine, Osaka, JapanPurpose: We evaluated the usefulness of commercially available materials for protecting the cornea from drying during vitrectomy with a wide-angle viewing system.Methods: Three vitreoretinal surgeons evaluated fundus visibility during vitrectomy on the images of five study materials used on the cornea: balanced saline solution, a viscoelastic agent, a vitrectomy contact lens, a rigid gas permeable (RGP) contact lens, and a soft contact lens. Fundus visibility was graded using the following scale: grade 1, unclear; grade 2, slightly unclear; grade 3, clear; and grade 4, very clear.Results: Respective scores for each material used during core vitrectomy and membrane removal were: balanced saline solution, 3.3/3.3; viscoelastic agent, 3.8/3.3; vitrectomy contact lens, 3.3/4.0; RGP contact lens, 4.0/3.9; soft contact lens, 1.1/not applicable.Conclusion: The RGP contact lens provided visibility similar to or clearer than that obtained with other methods. Because of its ease of use and lower cost, use of the RGP contact lens is ideal during vitrectomy performed with a wide-angle viewing system.Keywords: contact lens, RGP, viscoelastic agent, vitrectomy, wide viewing system

Hirokazu Sakaguchi,1 Masahito Ohji,2 Yusuke Oshima,1 Yasushi Ikuno,1 Fumi Gomi,1 Naoyuki Maeda,1 Motohiro Kamei,1 Shunji Kusaka,3 Kohji Nishida11Department of Ophthalmology, Osaka University Graduate School of Medicine, Suita, 2Department of Ophthalmology, Shiga University of Medical Science, Otsu, 3Department of Ophthalmology, Sakai Hospital Kinki University Faculty of Medicine, Sakai, JapanBackground: To assess time-course changes in best-corrected visual acuity (BCVA) up to 5 years after vitrectomy to treat idiopathic full-thickness macular holes (MHs) and identify the relationship of the changes to postoperative complications.Methods: Twenty-three consecutive patients with an idiopathic MH underwent vitrectomy without adjuvant treatment. BCVA and complications were assessed postoperatively.Results: Twenty-two of 23 (95.7%) MHs closed after the first surgery, with a final anatomic success rate of 100%. The time course of the BCVA was analyzed in 20 cases in which data were obtained for over 5 years. The BCVA improved by 0.43 logarithm of the minimum angle of resolution (logMAR) unit 6 months postoperatively (P < 0.001) and continuously improved by 0.05, 0.06, and 0.07 logMAR units between 6 months and 1 year, 1 year and 3 years (by 0.11 logMAR unit between 6 months and 3 years; P = 0.049), and 3 years and 5 years (P = 0.018) postoperatively, respectively. Macular complications developed in seven (35%) of the 20 cases; the mean BCVA at 5 years in these cases was significantly (P < 0.001) worse than in cases without complications.Conclusion: The BCVA might improve gradually for 5 years after vitrectomy to treat MHs. However, the macular complications that can develop postoperatively could limit that possibility.Keywords: macula hole, time course, vitrectomy, retina, visual acuity, complication

Deterioration of the medication adherence for elderly could result in wasteful medical expenditure in a long-term span as well as aggravating the patient's medical condition.Objective: This study surveyed the effect of one-dose package medication made up by a pharmacist on the patient's behavior towards medication, what is expected to be one of the measures to improve the medication adherence for elderly.Methods: With support activity of the Pharmacist Association in Ueda-city in Nagano Prefecture, Japan, the survey form of one-dose package was sent to 86 pharmacy directors located in Ueda-city. Results: The most frequent reasons of one dose packaging was “Patient’s request” though, “Large number of doses”, “Prevent the improper drug use” and “Improved medication adherence” which is considered that the pharmacists are willing to utilize one dose package for patient’s care in order to improve the medication adherence were chosen as well. The influences of one dose package for patient’s medication adherence were very positive, and most answers indicated that medication adherence was improved.Conclusion: It is noticed that the pharmacists were willing to dispense one dose packaging by own decision, not physician’s order, in order to improve the medication adherence, prevent improper drug use and optimize the medication therapy. It is also noticed that there are great improvement of patient’s compliance by one dose package, and patients felt advantage to reduce the improper drug use as well.

Br J Ophthalmol 2004;88:505-508. doi: 10.1136/bjo.2003.025809 Aim: To evaluate the risk factors for rubeosis iridis by colour Doppler imaging (CDI) in patients with complete internal carotid artery occlusion (ICAO). Methods: [...]