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Yutaro Yamagata,1 Kenji Suda,1 Tadamichi Akagi,1,2 Hanako Ohashi Ikeda,1 Takanori Kameda,1 Tomoko Hasegawa,1 Masahiro Miyake,1 Akitaka Tsujikawa1 1Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan; 2Division of Ophthalmology and Visual Science, Niigata Graduate School of Medical and Dental Sciences, Niigata, JapanCorrespondence: Kenji Suda, Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, 54 Shougoin Kawahara-cho, Sakyo-ku, Kyoto, Japan, Tel +81-75-751-3248, Fax +81-75-752-0933, Email qwm04525@kuhp.kyoto-u.ac.jpPurpose: To evaluate the effect of trabeculectomy (Trab MMC) on visual field (VF) progression in eyes with glaucoma and high myopia.Patients and Methods: Patients diagnosed with primary open-angle glaucoma or exfoliation glaucoma who underwent Trab MMC as the first glaucoma surgery along with ≥ 3 VF tests preoperatively and postoperatively were enrolled. High myopia was defined as an axial length ≥ 26.5 mm. Postoperative reductions in intraocular pressure (IOP) were assessed by survival analysis using IOP measurements obtained preoperatively. The longitudinal trends of the outcome measures were evaluated using linear mixed models.Results: Thirty-five eyes of 32 patients were included in this study, including 22 eyes of 20 patients in non-highly myopic group and 13 eyes of 12 patients in highly myopic group. IOP decreased after Trab MMC, and the survival rate did not differ significantly in relation to axial length. Linear mixed-model analyses suggested that the inhibitory effects of Trab MMC on the rate of mean deviation (MD) changes were significant in the non-highly myopic group (− 0.53 ± 0.15 dB/year preoperatively to − 0.16 ± 0.13 dB/year postoperatively; P = 0.004), but not in the highly myopic group (− 0.66 ± 0.19 dB/year preoperatively to − 0.48 ± 0.18 dB/year postoperatively; P = 0.32).Conclusion: Trab MMC reduced IOP in both highly myopic and non-highly myopic eyes, and IOP reduction was very similar in both groups. The VF deterioration rate decreased in both groups, but the change was weaker and nonsignificant in the highly myopic group.Keywords: glaucoma, myopia, trabeculectomy, glaucoma progression

Masayo Suda, Hideo Nakanishi, Tadamichi Akagi, Tomoaki Murakami, Kiyoshi Suzuma, Kenji Suda, Takanori Kameda, Satoshi Morooka, Hanako Ohashi Ikeda, Akitaka Tsujikawa Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Sakyo-ku, Kyoto 606-8507, Japan Purpose: To describe the 1-year surgical outcomes of both Baerveldt glaucoma implant (BGI) and the Ahmed glaucoma valve (AGV) implant with pars plana tube insertion in Japanese eyes with neovascular glaucoma (NVG). Patients and methods: This was a retrospective study of 21 eyes of 18 patients who had undergone BGI (10 eyes) or AGV (11 eyes) implantation. The 1-year surgical outcomes in the two groups were compared. Surgical success was defined as an intraocular pressure (IOP) of 6–21 mmHg (criterion A) or 6–18 mmHg (criterion B) with >20% reduction regardless of the use of antiglaucoma medications. Results: The mean preoperative IOP was 33.9±6.6 mmHg in the BGI group and 30.9±5.3 mmHg in the AGV group (P=0.31). The IOP at 1-year was lower in the BGI group at 10.3±5.9 mmHg than in the AGV group at 14.8±3.3 mmHg (P=0.044). The mean number of glaucoma medications at 1 year was 1.0±1.3 in the BGI group and 1.4±1.4 in the AGV group (P=0.57). The incidence of postoperative complications during the 1-year follow-up was not statistically different between the two groups; however, one eye in the BGI group lost light perception after additional surgery for Hoffman elbow exposure. The 1-year success rates of the BGI group was 60.0% and that in the AGV group was 90.9% based on criterion A (P=0.095), and 50.0% and 81.8% based on criterion B (P=0.074). Conclusions: Significant reductions of the IOP and number of glaucoma medications were achieved at 1 year after both types of implants in Japanese eyes with NVG. Keywords: neovascular glaucoma, Baerveldt, Ahmed, glaucoma drainage device, pars plana tube insertion

Tadamichi Akagi, Munemitsu Yoshikawa, Hideo Nakanishi, Nagahisa Yoshimura Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan Abstract: Glaucoma drainage device implantation is efficacious for the treatment of pediatric glaucoma patients when multiple angle surgeries fail. However, tube touching of the corneal endothelium is one of the major postoperative complications to deal with. A 15-month-old male patient with Wilms’ tumor, aniridia, genitourinary anomalies, and mental retardation (WAGR) syndrome was diagnosed with bilateral developmental glaucoma. He underwent Baerveldt glaucoma implant (BGI) surgeries in both eyes after multiple failed trabeculotomies. The tube in his right eye was touching the cornea 15 months after BGI surgery. To avoid corneal endothelium damage, BGI tube repositioning with scleral fixation was performed without serious complications. The bilateral BGI surgeries achieved successful intraocular pressure reduction for over 2 years and tube repositioning with scleral fixation of BGI tube was successful for BGI tube malposition. Although careful attention to intraocular pressure and tube malposition is essential after glaucoma drainage device implantation, especially in pediatric cases, BGI surgery is effective in the management of developmental glaucoma following unsuccessful angle surgeries. Keywords: Baerveldt glaucoma implant, developmental glaucoma, WAGR syndrome, tube repositioning, glaucoma drainage device

Yoshikatsu Hosoda, Tadamichi Akagi, Nagahisa YoshimuraDepartment of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, JapanAbstract: Malignant glaucoma, which is characterized by a shallow or flat anterior chamber with high intraocular pressure, can usually be resolved by pars plana vitrectomy with anterior hyaloidectomy. We describe two cases in which malignant glaucoma was refractory to conventional treatment and complete vitrectomy. Case one an 88-year-old woman with pseudoexfoliation glaucoma underwent trabeculotomy and subsequently developed malignant glaucoma. Four months after transient recovery by pars plana vitrectomy, the malignant glaucoma recurred. She underwent peripheral iridectomy and local zonulectomy with successful control of her intraocular pressure. In case two, an 85-year-old man had a history of pseudoexfoliation glaucoma. Seven months after phacoemulsification and intraocular lens implantation, he developed malignant glaucoma that was refractory to pars plana vitrectomy. He underwent peripheral iridectomy, goniosynechialysis and trabectome surgery resulting in the successful control of his intraocular pressure. In rare cases of malignant glaucoma refractive to vitrectomy, peripheral iridectomy with or without local zonulectomy is a reasonable and minimally invasive surgical procedure.Keywords: malignant glaucoma, pars plana vitrectomy, peripheral iridectomy

A GEANT4-based simulation of an irradiation system for proton therapy has been developed for the verification of dose distributions. The simulation represents the treatment room and beam irradiation system at the Hyogo Ion Beam Medical Center (HIBMC). The beam irradiation system consists of a lateral beam-spreading system and a range modulating system, which enable a three-dimensional dose distribution to be achieved. The simulation was carried out for proton beams at the isocentric gantry nozzle for therapeutic energies of 150, 190, and 230 MeV. The simulated distributions were compared to measured dose distributions obtained by using a water phantom at the isocenter. This arrangement simulates the practical aspects of the beam irradiation of a patient. The validation of the simulation was performed in proton range for important materials in the beam line, and in the lateral uniformity of the radiation field at the isocenter. Dose distributions based on GEANT4 were verified with measurements of the Bragg peak and the spread-out Bragg peak. This verification shows that the simulations are in good agreement with measurements. Index Terms--Dose distribution, GEANT4, HIBMC, proton therapy.

Rehabilitation devices have been developed to assist patients to recover from physical disabilities by using specific devices to do exercise, training and therapy. The purpose of this study is to develop a home-based rehabilitation device that is safe to use and without the requirement of a person in charge. In this study, a simple home-based wrist rehabilitation device that can give passive exercise on spherical orbit while patients hold its handles is proposed and tested. The device has two moving handling stages driven by six extension type flexible pneumatic actuators on two hemispherical acrylic domes. The device can give passive exercise for the upper limb by changing the relative position of the patient's hands. In this paper, the construction and operating principles of the tested device are described. A low-cost 3-dimensional coordinate measuring system using two wire-type linear potentiometers to control the position of the holding stages is also described. In addition, the tracking position control of the holding handles on a sphere is carried out. As a result, it can be found that the handling stage of the tested device can trace the desired orbit based on the coordinates measured from a 3-dimensional coordinate measuring system. It can be confirmed that the tested wrist rehabilitation device has the possibility to apply passive movements to the wrist along the desired orbit while patients hold its handles. [ABSTRACT FROM AUTHOR]

Based on super-aging society in Japan, a welfare pneumatic device to give passive exercise for the temporally injured elderly and disabled has been actively researched and developed. In previous study, based on opinions of Physical Therapist (PT) and Occupational Therapist (OT), a home-based rehabilitation device that could give passive exercise for patients using extension type flexible pneumatic actuators (EFPA), built-in quasi-servo valves and built-in displacement sensors using a wire type linear potentiometer was proposed and tested. However, the device did not have enough force and stiffness to drive shoulders with both arms. In this study, to get enough generated force and stiffness of the device, a parallel arranged EFPA reinforced with circumferential restraint was proposed and tested. The rehabilitation device for shoulder joint using the improved actuator was also proposed and tested. The built-in attitude control system using valves, sensors and an embedded controller was also developed. As a result, it can be confirmed that the device can give passive exercise with larger moving area and enough force and torque to move patient's shoulder joint. [ABSTRACT FROM AUTHOR]

The Linear IFMIF (International Fusion Materials Irradiation Facility) Prototype Accelerator (LIPAc) is aiming at demonstrating the low energy section of a 40 MeV/125 mA IFMIF deuteron accelerator up to 9 MeV with a full beam current in cw operation. For such a high-power beam, the LIPAc injector is required to produce a 100 keV D+ beam with 140 mA and match it for injection into the Radio Frequency Quadrupole (RFQ) accelerator. The injector is designed by CEA-Saclay based on the high intensity light ion source (SILHI). In 2019, the commissioning of the RFQ to demonstrate the D+ beam acceleration at a low duty cycle (0.1%) was conducted. A nominal beam current of 125 mA D+ beam was accelerated up to 5 MeV through the RFQ successfully. The LIPAc injector fully satisfied the requirements for RFQ beam commissioning at the pulse mode. [ABSTRACT FROM AUTHOR]