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Hidetaka Noma, Kanako Yasuda, Ryota Nonaka, Shotaro Sasaki, Masahiko Shimura Department of Ophthalmology, Hachioji Medical Center, Tokyo Medical University, Tokyo, JapanCorrespondence: Hidetaka Noma, Department of Ophthalmology, Hachioji Medical Center, Tokyo Medical University, 1163, Tatemachi, Hachioji, Tokyo, 193-0998, Japan, Tel + 81-42-665-5611, Fax + 81-42-665-1796, Email nomahide1122@gmail.comPurpose: In branch retinal vein occlusion (BRVO), administering steroid injections to inhibit expression of inflammatory factors in the first phase of macular edema may reduce recurrence of the edema. The purpose of our study was to investigate the functional and morphological prognosis and frequency of recurrence after injection of an anti-vascular endothelial growth factor (VEGF) with and without initial steroid therapy to treat macular edema with BRVO.Patients and Methods: Patients with BRVO and macular edema (41 eyes) received intravitreal ranibizumab injection (IRI) alone (IRI group, 21 eyes) or subtenon triamcinolone (STTA) injection and IRI (combination group, 20 eyes). Patients in both groups with recurrent macular edema received further IRI as appropriate. A laser flare meter was used to assess aqueous flare values, and an optical coherence tomography device was used to measure central macular thickness (CMT). Before the first treatment, we obtained samples of aqueous humor and analyzed them by the suspension array method to evaluate VEGF, placental growth factor (PlGF), platelet-derived growth factor (PDGF)-AA, soluble intercellular adhesion molecule (sICAM)-1, monocyte chemoattractant protein 1 (MCP-1), interleukin (IL)-6, IL-8, and interferon-inducible 10-kDa protein (IP-10).Results: The two groups were not significantly different with regard to levels of VEGF, PlGF, PDGF-AA, sICAM-1, MCP-1, IL-6, IL-8, or IP-10. Best-corrected visual acuity, CMT, and aqueous flare value (IRI group, baseline 8.69 ± 4.55 photon counts/ms; combination group, baseline 9.21 ± 3.72 photon counts/ms) improved significantly in both groups without significant intergroup differences. Analyses showed no significant intergroup differences in the mean number of IRIs during the 12-month follow-up, but the proportion of patients without recurrence (ie, who received only one IRI) was significantly higher in the combination group than in the IRI group (P = 0.032). Furthermore, the time to initial recurrence was significantly longer in the combination group than in the IRI group (P = 0.003).Conclusion: These findings suggest that initial STTA injection and IRI may have a synergistic effect in patients with BRVO and macular edema in that they increase the time between anti-VEGF treatments.Keywords: branch retinal vein occlusion, macular edema, ranibizumab, subtenon triamcinolone, recurrence, cytokine

Hayate Nakagawa, Hidetaka Noma, Osamu Kotake, Ryosuke Motohashi, Kanako Yasuda, Masahiko Shimura Department of Ophthalmology, Tokyo Medical University Hachioji Medical Center, Tokyo, Japan Background: A few reports have described ocular complications of influenza A infection, such as impaired ocular movement, parasympathetic ocular nerve, keratitis, macular lesion, and frosted branch angiitis. We encountered a rare case of acute anterior uveitis and optic neuritis associated with influenza A infection. Case presentation: A 70-year-old man presented with symptoms of upper respiratory tract infection. A rapid diagnostic test showed a positive result for influenza A. At the same time, he developed ocular symptoms including blurred vision with optic disk edema and hemorrhage in the left eye, and bilateral red eyes. Multiplex polymerase chain reaction performed on aqueous humor sample detected no viral infection. Visual field testing with a Goldmann perimeter showed central and paracentral scotomas in the left eye. In addition to antiviral agent (oseltamivir phosphate 75 mg), the patient was prescribed topical prednisolone acetate ophthalmic suspension eye drops every 5 hours and high-dose intravenous methylprednisolone 1,000 mg daily for 3 days. Two months later, his best-corrected visual acuity improved to 20/50 with regression of visual field defects in his left eye. Conclusion: We report a case of bilateral acute anterior uveitis and unilateral optic neuritis concomitant with influenza A infection. Topical and systemic corticosteroids were effective to resolve acute anterior uveitis and neuritis. Analysis of aqueous humor sample suggested that acute anterior uveitis and optic neuritis in this case were not caused by influenza A virus infection per se but by autoimmune mechanism. Keywords: optic neuritis, anterior uveitis, influenza virus, multiplex polymerase chain reaction

Masanari Watanabe,1 Hisashi Noma,2 Jun Kurai,1 Hiroyuki Sano,3 Yasuto Ueda,1 Masaaki Mikami,4 Hiroyuki Yamamoto,5 Hirokazu Tokuyasu,6 Kazuhiro Kato,7 Tatsuya Konishi,8 Toshiyuki Tatsukawa,8 Eiji Shimizu,1 Hiroya Kitano9 1Department of Respiratory Medicine and Rheumatology, Tottori University Faculty of Medicine, 36-1 Nishi-cho, Yonago, 2Department of Data Science, The Institute of Statistical Mathematics, 10-3 Midori-cho, Tachikawa, Tokyo, 3Department of Respiratory Medicine and Allergology, Kinki University Faculty of Medicine, 377-2 Ohnohigashi, Osakasayama, 4Hosshoji Clinic, 286-4 Hosshoji, Saihaku, 5Saihaku Hospital, 397 Yamato, Saihaku, 6Department of Respiratory Medicine, Matsue Red Cross Hospital, 200 Horomachi, Matsue, 7Department of Respiratory Medicine, San-in Rosai Hospital, 1-8-1 Kaikeshinden, Yonago, 8Department of Respiratory Medicine, Matsue City Hospital, 32-1 Noshirachou, Matsue, 9The Board of Directors, Tottori University, 36-1 Nishi-cho, Yonago, Japan Background: Asian dust (AD) exposure exacerbates pulmonary dysfunction in patients with asthma. Asthma–chronic obstructive pulmonary disease overlap syndrome (ACOS), characterized by coexisting symptoms of asthma and chronic obstructive pulmonary disease, is considered a separate disease entity. Previously, we investigated the effects of AD on pulmonary function in adult patients with asthma. Here, we present the findings of our further research on the differences in the effects of AD exposure on pulmonary function between patients with asthma alone and those with ACOS.Methods: Between March and May 2012, we conducted a panel study wherein we monitored daily peak expiratory flow (PEF) values in 231 adult patients with asthma. These patients were divided into 190 patients with asthma alone and 41 patients with ACOS in this study. Daily AD particle levels were measured using light detection and ranging systems. Two heavy AD days (April 23 and 24) were determined according to the Japan Meteorological Agency definition. A linear mixed model was used to estimate the association between PEF and AD exposure.Results: Increments in the interquartile range of AD particles (0.018 km-1) led to PEF changes of –0.50 L/min (95% confidence interval, –0.98 to –0.02) in patients with asthma alone and –0.11 L/min (–0.11 to 0.85) in patients with ACOS. The PEF changes after exposure to heavy AD were –2.21 L/min (–4.28 to –0.15) in patients with asthma alone and –2.76 L/min (–6.86 to 1.35) in patients with ACOS. In patients with asthma alone, the highest decrease in PEF values was observed on the heavy AD day, with a subsequent gradual increase over time.Conclusion: Our results suggest that the effects of AD exposure on pulmonary function differ between patients with asthma alone and ACOS, with the former exhibiting a greater likelihood of decreased pulmonary function after AD exposure. Keywords: Asian dust, asthma, asthma–chronic obstructive pulmonary disease overlap syndrome, peak expiratory flow, pulmonary function

Hidetaka Noma1, Tatsuya Mimura2, Manami Kuse3,4, Katsunori Shimada51Department of Ophthalmology, Yachiyo Medical Center, Tokyo Women's Medical University, Chiba, Japan; 2Department of Ophthalmology, Medical Center East, Tokyo Women's Medical University, Tokyo, Japan; 3Department of Ophthalmology, National Hospital Organization, Mie Central Medical Center, Tsu, Japan; 4Department of Ophthalmology, Mie University Graduate School of Medicine, Tsu, Japan; 5Department of Biostatistics, STATZ Institute Inc., Tokyo, JapanAbstract: The objective of this study was to evaluate the relations among electroretinogram (ERG) parameters (cone a-wave, cone b-wave, and 30 Hz flicker), retinal thickness, and retinal volume in 16 patients with central retinal vein occlusion and macular edema. The amplitude and implicit time of the ERG parameters were extracted from the ERG traces. Retinal thickness and volume were measured by optical coherence tomography in nine macular subfields. Then the correlations among ERG parameters and morphological parameters were analyzed. The cone b-wave and 30 Hz flicker implicit time were correlated with retinal thickness and volume in seven out of nine subfields, excluding the temporal subfields. In addition, the amplitude of the cone b-wave was correlated with retinal thickness and volume in the nasal inner and nasal outer subfields. These findings suggest that retinal thickness and volume may be associated with outer and inner retinal function in central retinal vein occlusion patients.Keywords: central retinal vein occlusion, electroretinogram, macular edema, optical coherence tomography

Hidetaka Noma,1 Tatsuya Mimura21Department of Ophthalmology, Yachiyo Medical Center, Tokyo Women’s Medical University, Chiba, 2Department of Ophthalmology, Medical Center East, Tokyo Women’s Medical University, Tokyo, JapanAbstract: It has been reported that microperimetry is effective for evaluating macular function. The aim of this paper is to report and discuss changes seen in macular sensitivity and macular thickness after intravitreal injection of triamcinolone acetonide (IVTA) in two patients with macular edema and central retinal vein occlusion (CRVO). Two eyes from two patients with CRVO (one each with ischemic and nonischemic CRVO) received IVTA for macular edema. Microperimetry was performed to measure macular sensitivity within the central 4, 10, and 20 degree fields, while the macular thickness within these fields was measured by optical coherence tomography. The mean macular thickness and macular sensitivity within the central 4, 10, and 20 degree fields improved after IVTA in the patient with nonischemic CRVO. In contrast, the mean macular thickness and sensitivity within the central 4, 10, and 20 degree fields showed little change after IVTA in the patient with ischemic CRVO. IVTA improves macular sensitivity and morphology in nonischemic CRVO, so further evaluation of this treatment is justified.Keywords: central retinal vein occlusion, macular edema, triamcinolone acetonide, macular sensitivity

Hidetaka Noma¹, Hideharu Funatsu¹, Tatsuya Mimura², Katsunori Shimada³¹Department of Ophthalmology, Yachiyo Medical Center, Tokyo Women's Medical University, Owada-shinden, Chiba, Japan; ²Department of Ophthalmology, University of Tokyo Graduate School of Medicine, Tokyo, Japan; ³Department of Hygiene and Public Health II, Tokyo Women's Medical University, Shinjuku-ku, Tokyo, JapanAbstract: Visual function and retinal morphology were investigated to elucidate the influence of ischemia in patients with branch retinal vein occlusion (BRVO) and macular edema. In 41 consecutive patients with BRVO aged 68.9 ± 10.0 years (22 women and 19 men), the area of capillary nonperfusion was measured by fluorescein angiography. Retinal thickness and retinal volume were measured by optical coherence tomography, and mean retinal sensitivity was calculated for each of 9 macular subfields. Mean visual acuity and macular sensitivity within the central subfield were not significantly correlated with the nonperfused area. However, the macular sensitivity within the central 5 subfields and all 9 subfields showed significant negative correlations with the nonperfused area. Also, macular thickness and volume within all 9 subfields were significantly correlated with the nonperfused area. In conclusion, evaluation of both the fovea and the entire macular region may be important in patients with ischemic BRVO.Keywords: branch retinal vein occlusion, macular edema, macular sensitivity, ischemia

Hidetaka Noma,1 Hiroshi Shimizu,1 Tatsuya Mimura21Department of Ophthalmology, Yachiyo Medical Center, Tokyo Women's Medical University, 2Department of Ophthalmology, Medical Center East, Tokyo Women's Medical University, Tokyo, JapanAbstract: Central retinal vein occlusion (CRVO) is frequent in patients with systemic lupus erythematosus (SLE), but the treatment of the macular edema with this disease is extremely difficult. We report a case of cystoid macular edema (CME) secondary to unilateral CRVO in a patient with SLE that responded to intravitreous injection of an anti-vascular endothelial growth factor (VEGF) agent. A 33-year-old Japanese woman was referred to our department with unilateral impairment of vision. Microperimetry (MP-1) showed a cessation of foveal sensitivity. Fluorescein angiography showed CME without ischaemia of the macular region or peripheral retina (nonischemic CRVO). A diagnosis of CME and unilateral nonischemic CRVO combined with SLE was made and intravitreous anti-VEGF therapy was given. A sample of aqueous humor was harvested at the start of intravitreous injection after obtaining informed consent. Then the levels of VEGF and monocyte chemotactic protein (MCP)-1 were measured in the aqueous humor by enzyme-linked immunosorbent assay, revealing that VEGF was 234 pg/mL and MCP-1 was 501 pg/mL. Two weeks later, left eye vision improved to 20/20. Optical coherence tomography (OCT) showed considerable amelioration of retinal swelling and CME. MP-1 showed a marked increase of foveal sensitivity. However, she had recurrence of edema 3 months later. After harvesting aqueous humor again, intravitreous injection of an anti-VEGF agent was repeated for CME. The aqueous VEGF and MCP-1 levels were 156 pg/mL and 360 pg/mL, respectively. These findings suggest that inflammation was improved by intravitreous injection of bevacizumab. Intravitreous injection of anti-VEGF agents may be effective for CME due to nonischemic CRVO in SLE patients if their inflammatory factor levels are low..Keywords: systemic lupus erythematosus, central retinal vein occlusion, cystoid macular edema, anti-vascular endothelial growth factor agent, vascular endothelial growth factor, monocyte chemotactic protein-1

تعد اللويزية Aloysia citrodora أو Lemon verbena نباتاً غنياً بالمركبات الفينولية، وتمتلك العديد من الخصائص الطبية، كالخصائص المضادة للأكسدة والمضادة للميكروبات والمهدئة والمخدرة والمزيلة للقلق. يستخدم نبات حشيشة الليمون Andropogon citrates أو Lemongrass كعلاج تقليدي في الطب الشعبي لعلاج العديد من الأمراض كالاضطرابات الهضمية والسعال وغيرها وعرف بفعاليته المضادة للأكسدة والالتهاب والمضادة للبكتيريا وللفطريات، نظراً لاحتوائه أيضاً على المركبات الفينولية. لم تتم حتى الآن دراسة الفعالية المضادة للتخثر للنباتين المذكورين بالرغم من امتلاك الفنولات فعالية مضادة للتخثر معروفة. هدفت هذه الدراسة إلى تقصي الفعالية المضادة للتخثر للمستخلصات المائية لنباتي اللويزية وحشيشة الليمون عبر اختبار تأثيرها على زمن البروترومبين في الزجاج باستخدام بلاسما من أشخاص أصحاء ومقارنة هذه الفعالية بين النباتين. تم تحضير مستخلص مائي من النباتين بطريقة النقع وقياس تركيز المركبات الفنولية. بلغ محتوى المواد الفينولية في مستخلص اللويزية 10.825 غ مكافىء لحمض الغاليك/ل وفي مستخلص حشيشة الليمون 8.235 غ مكافىء لحمض الغاليك/ل. تم تحضير عدة محاليل بتراكيز مختلفة انطلاقاً من الخلاصات الأم لتقصي تأثيرها على زمن البروترومبين. أظهرت التراكيز المدروسة لللويزية زيادة معنوية في زمن البروترومبين مقارنةً بالماء المقطر وكان التأثير معتمداً على التركيز. كما وأبدت التراكيز المتزايدة من حشيشة الليمون زيادة في PT ولكن لم يكن الفرق معنوياً في جميع النقاط المدروسة. تشير النتائج إلى امتلاك الخلاصتين فعالية مضادة للتخثر في الزجاج تعود لاحتوائهما على المركبات الفنولية مع تفوق اللويزية في التأثير.

SUMMARY: In this paper, we have demonstrated usefulness of the electromotive manipulator system with a developed single element MEMS sensor which can detect proximity, contact, and slipping to skillful gripping of the object. This MEMS sensor can detect proximity as impedance change of Si substrate by reflected light from the object due to the photoconductive effect. In addition, both normal and shear load can be also detected as resistance change of strain gage on cantilevers located threefold symmetry and embedded in polydimethylsiloxane (PDMS). By attaching the sensor on the electromotive manipulator, accurate control of gripping force was enabled by feedback of the sensor output. [ABSTRACT FROM AUTHOR]