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Katsuya Yamazoe1,2, Seika Shimazaki-Den1, Isao Otaka3, Kazuki Hotta2, Jun Shimazaki1,4 1Department of Ophthalmology, Tokyo Dental College, Ichikawa, 2Department of Ophthalmology, Kameda Medical Center, Kamogawa, 3Yokohama Sotetsu Building Eye Center, Yokohama, 4Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan Background: Although pterygium excision with conjunctival autograft is a widely performed surgical procedure, surgically induced necrotizing scleritis (SINS) following such surgery is extremely rare. Methods: A 68-year-old man underwent nasal pterygium excision with conjunctival autograft uneventfully. On postoperative day 17, the conjunctival graft was avascular, with epithelial defect. Although topical steroid and antibacterial treatments were continued, the graft and sclera melted, with the ischemic sclera showing gradual thinning. The thinning area spread to the adjoining cornea, and active inflammation with epithelial defect was observed adjacent to the site of thinning. Results: Systemic and microbiological examination was noncontributory. The patient was suspected of having SINS, and administration of oral prednisolone was started. Although the necrotic area was reduced temporarily, medication was discontinued due to nausea, and the area of thinning increased. Conjunctival flap surgery was later performed, and the graft was well accepted. Conclusions: SINS must be considered in the differential diagnosis of patients with scleritis following pterygium surgery, especially if radiation or mitomycin C has not been used. Keywords: scleritis, pterygium, pterygium surgery, conjunctival autograft, SINS

A block molded joint under extra high voltage made to drastically reduce installation time has been developed. Through its excellent performance, the joint is expected to be substituted for the extrusion molded joints which are widely used in 275kV-class XLPE cable for long distance power transmission.

A 67-year-old man with type 1 diabetes, Cronkhite-Canada syndrome, and membranous nephropathy who received insulin therapy was admitted to our hospital with right hemiplegia and dysarthria. Brain magnetic resonance imaging revealed a lesion with a high diffusion-weighted imaging signal and low apparent diffusion coefficient signal in the posterior limb of the left internal capsule. He was hypoglycemic with a blood glucose level of 56 mg/dL (3.1 mmol/L). Following glucose administration, the patient's symptoms resolved within several hours. The patient experienced similar transient hypoglycemic hemiplegia at midnight, three times within 10 days. In a literature review of 170 cases of hypoglycemic hemiplegia, 26 cases of recurrent hemiplegia were investigated. Recurrent hypoglycemic hemiplegia occurs more frequently on the right side than on the left side, and most recurrences occur within approximately a week, almost exclusively at midnight and in the early morning. We speculate that hypoglycemia-associated autonomic failure may be involved in the nocturnal recurrence of episodes. In our patient, depleted endogenous insulin secretion and lipodystrophy at the injection site, may have acted as additional factors, leading to severe hypoglycemia despite the absence of apparent autonomic neuropathy. Clinically, it is important to recognize hypoglycemia as a cause of hemiplegia to avoid unnecessary intervention and to maintain an appropriate blood glucose level at midnight and early in the morning to prevent recurrent hypoglycemic hemiplegia.

Purpose: To report on new software that was specially designed to evaluate color., Methods: Software development and observational case report. Each pixel on a computer screen is composed of three colors: red, green, and blue (RGB). Our software analyzes the intensity of each RGB component in a specific area chosen by the user. To test our software, we evaluated the color level of the irises of a subject, which became darker as a side effect of Xalatan (latanoprost; Pharmacia Corporation, Peapack, New Jersey) eyedrops., Result: We successfully expressed the level of the color of the iris by number., Conclusion: This software measures the color of a lesion and thereby provides an objective evaluation of color. The software we developed is downloadable, without cost, from http://www.isao.com.