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Purpose: To investigate risk factors for initial visual field pattern in normal tension glaucoma (NTG)., Patients and Methods: We studied 107 subjects, who underwent 24-2 or 30-2 Swedish interactive threshold algorithm standard visual fields as part of a multicenter study of newly diagnosed NTG patients. Only the eyes with initial parafoveal scotoma (IPFS) or initial nasal step (INS) Were included. IPFS was defined as a glaucomatous visual field (VF) defect in 1 hemifield (≥ 3 adjacent points with p < 5% within the central 10 degrees of fixation, ≥ 1 point with p < l% lying at the innermost paracentral points, and no VF abnormality outside the central 10 degrees). INS was defined in 1 hemifield (≥ 3 adjacent points with p < 5% in the nasal periphery outside 10 degrees of fixation, the nasal- most point with p < 1%, and no VF abnormality within the central 10 degrees). Clinical characteristics were compared between the 2 groups., Results: Mean untreated intraocular pressure (IOP) (14.0 ± 1.3 vs. 16.0 ± l.4 mmHg; p = 0.0102) was significantly lower in patients with an IPFS than in patients with an INS. There were no significant differences in age (p = 0.6487) or spherical equivalent (p = 0.7561)., Conclusion: Initial visual field pattern of NTG is influenced by untreated IOP level.

Purpose: Eye drops of carbonic anhydrase inhibitor (Brinzolamide) are known to case blurred vision after instillation. Using tear film stability analysis system (TSAS) and functional visual acuity measurement (FVAM) we studied the mechanism of blurred vision., Methods: Ten healthy volunteers were studied. Before instillation of brinzolamide 1%, immediately after and at 3, 5, 10 minutes after 1 minutes eye-closure after instillation the breakup index (BUI) of TSAS and FVAM were measured., Results: Before instillation of brinzolamide 1%, immediately after and at 3, 5, 10 minutes since 1 minutes eye-closure after instillation the BUI of TSAS was 88.3 +/- 1.2, 38.5 +/- 7, 72.1 +/- 4.2, 78.8 +/- 5.1, 83.7 +/- 2.2 respectively, and the FVAM was 1.013 +/- 0.0047, 0.925 +/- 0.029, 1 +/- 0.0075, 1.007 +/- 0.0072, 1.015 +/- 0.0052 respectively. Immediately after 1 minutes eye-closure both BUI and FVAM were low. From 3 minutes after instillation both BUI and FVAM recovered., Conclusions: It is suggested that blurred vision after instillation of brinzolamide 1% is associated with the unstableness of tear film. Analyses by TSAS and FVAM are useful to determine both the vision improvement and pharmacokinetics after instillation.

Background: Two cases of West syndrome demonstrated changes in intraocular pressure (IOP) associated with adrenocorticotropic hormone (ACTH) therapy., Cases: A nine-month-old (Case 1) and a six-month-old (Case 2) female infant were treated for West syndrome. In Case 1, the IOP was 14 mmHg in the right eye and 16 mmHg in the left eye before ACTH therapy was started. Although the IOP did not change at the beginning of the treatment, it rose to 36 mmHg in the right eye and 25 mmHg in the left eye after an increase in ACTH dosage. In Case 2, the IOP was 10 mmHg in the right eye and 9 mmHg in the left eye before ACTH therapy, it increased to 18 mmHg in both eyes after treatment was started. The IOP returned to baseline levels in both cases after ACTH therapy concluded., Conclusion: These findings suggest that it is necessary to monitor IOP when ACTH therapy is given to patients with West syndrome.

Purpose: Using a tear film stability analysis system (TSAS), we analyzed the tear film with regard to blurred vision after instillation of 0.5% timolol gel-forming solutions., Methods: Tear film stability was recorded before and after instillation of timolol gel-forming solutions in 9 healthy volunteers (age: 30 +/- 5.6 years; mean +/- SD). Thermosetting gel (Rysmon TG), ion-activated gel (Timoptol XE), or conventional timolol solutions (Timoptol or TIMABAK which does not contain an antiseptic) was applied to only one eye at a time. The subject was administered a single instillation. After instillation, the subject closed his eyelid for one minute. TSAS was carried out immediately after the subject opened his eye. TSAS was also carried out 3 minutes, 5 minutes and 10 minutes after the subject had opened his eye. The grade of blurred vision after each test was evaluated in 5 levels., Results: The tear film was remarkably unstable just after the opening of the eyelids following instillation of Rysmon TG or Timoptol XE. On the breakup map, the most unstable area of the cornea was the lower part after instillation of Rysmon TG, and the center, after instillation of Timoptol XE. In the breakup index (range 0-100), where the high portion showed stability, both gels were low (p < 0.05). Timoptol XE was lower than Rysmon TG (p < 0.05). For timolol gel forming solutions, the index 5 minutes after eye-opening was lower than before instillation. As compared with before instillation, blurred vision increase just after the opening of the eyelids following instillation of Rysmon TG or Timoptol XE, and blurred vision increased at 3 minutes after opening of the eyelids following instillation of Timoptol XE., Conclusion: It seems that the analysis by TSAS was useful to measure the effect on visual performance and the pharmacokinetics after the instillation of the gel-forming solutions.

Purpose: Many studies have reported the relationship between facial morphology and stomatognathic functions. The steepness of the articular eminence is an important morphological factor to determine the mandibular movement or mandibular positioning. The present study analyzed the relationship between the condylar displacement during clenching and the condylar guide inclination related to simulated loss of posterior occlusal support., Methods: Nineteen clinical residents (4 females and 15 males, 24-31 years old) with healthy natural dentitions were recruited as subjects. To change the posterior occlusal support, occlusal splints fitted to maxillary dental arches were cut in sequence from the posterior toward the anterior side. The condylar displacements during maximum voluntary clenching under every occlusal condition were measured using a mandibular movement analyzing system with six-degrees of freedom. The sagittal condylar guide inclination was also measured using the same apparatus., Results: 1. A greater loss of posterior occlusal support was associated with increased displacement distance of both condyles, however these values varied with the subject. 2. A significant positive correlation was observed between the displacement distance without splint and the relative displacement distance with splint (difference between before and after loss of occlusal supports). 3. A significant negative correlation was observed between the displacement distance without splint and the sagittal condylar guide inclination, and was also observed between the relative displacement distance with splint (above-mentioned) and the sagittal condylar guide inclination., Conclusion: These results suggest that the sagittal condylar guide inclination is an important factor in condylar displacement during clenching.

Background: We report a successful treatment by plasma exchange(PE) in the case of Miller Fisher syndrome., Case: A 71-year-old woman rapidly developed diplopia and unsteady gait, and was admitted to Minami-matsuyama Hospital on day 3 of her illness. Ophthalmological and neurological examination on admission revealed bilateral complete external ophthalmoplegia with moderate mydriasis, cerebellar ataxia, and weakness of biceps reflexs, but her consciousness was intact. Protein concentration in the cerebrospinal-fluid was slightly increased and serum anti-GQlb IgG antibody was positive. With the diagnosis of Miller Fisher syndrome, PE was carried out on days 12, 14, and 16. After PE, ophthalmoplegia and cerebellar ataxia improved markedly. The ocular symptoms resolved after a month., Conclusion: The findings indicate that PE is a beneficial treatment in Miller Fisher syndrome during the acute phase of the disease.

Purpose: Selective laser trabeculoplasty (SLT) is a new laser procedure using a frequency-doubled Q-switched Nd: YAG laser (wavelength: 532 mm). The laser parameters are set to selectively target pigmented trabecular meshwork (TM) cells without coagulative damage to the TM structure or non-pigmented cells. We investigated the safety and efficacy of SLT in lowering intraocular pressure (IOP)., Subjects and Method: Sixty-seven eyes of 67 patients with uncontrolled open angle glaucoma were treated with the Coherent Selecta 7000 (Coherent Inc., Palo Alto, CA). Nineteen of 67 patients had previously received argon laser trabeculoplasty (ALT). A total of approximately 60 non-overlapping spots were placed over 180 degrees of the TM ranging from 0.5 to 1.0 mJ per pulse. The maximum energy level at which no bubble formation was observed determined choice., Results: The average preoperative IOP was 22.4 mmHg. Six months after the operation, mean IOP reduction was 4.4 mmHg, and mean outflow pressure (OP) reduction was 38.1%. One month after the operation 68.7% of patients responded to treatment with an OP reduction of at least 20% ("responders"). Transient IOP elevation of 5 mmHg or greater was seen in 25.4% of patients. The success rate at 6 months after operation was 64.6% for all patients (67 eyes) and 78.2% for the responders (46 eyes). An analysis using a Cox proportional hazard model showed that a low preoperative IOP was the significant determinant for success, and the hazard ratio for the IOP increase of 5 mmHg was 2.12. Other factors such as age, gender, past history of ALT, and goniopigment were not significantly related to success., Conclusion: SLT appears to be a safe and effective way to lower IOP.

Purpose: To evaluate changes in the ciliary body during accommodation using an ultrasound biomicroscope (UBM)., Subjects and Methods: Eleven healthy persons, aged from 24 to 33 years, served as subjects. They were asked to lie in the supine position and to fixate a target placed on the ceiling 2 m above with the left eye. A concave lens with the power of -6 to -8 diopters was then placed before the fixating left eye. The thickness of the ciliary body in the right eye was measured by UBM in the nonaccommodative and accommodative states., Findings: The anterior chamber in the right eye became significantly shallow during accommodation. The thickness of the ciliary body significantly increased during accommodation at 0.5 mm and 1.0 mm posterior to the scleral spur. It significantly decreased at 2.0 mm, 2.5 mm and 3.0 mm posterior to the scleral spur., Conclusion: During induced accommodation in the left eye, the anterior portion of the ciliary body in the right eye increased and the posterior portion decreased in thickness. The findings imply that the circular ciliary muscles are mainly involved in accommodation and not the longitudinal muscles.